Improving Tomorrow’s Health Care With Today’s Technology

Wearable technology, such as smart watches, may help prevent dementia in older adults thanks to a new project from UT Health Austin physician-scientists. The study will evaluate whether these devices can predict the onset of a short-term state of cognitive impairment known as delirium to reduce the risk of permanent cognitive decline in older adults.

“We think that wearables are the future of preventative medicine,” says the project’s leader, David Paydarfar, MD, a board-certified neurologist who serves as Director of UT Health Austin’s Mulva Clinic for the Neurosciences. “Not only are they affordable, but the sensors and battery life of these devices are constantly improving.”

Defining Delirium

“Delirium is a short-term decline in mental functioning set off by some external cause,” says research team member Jared F. Benge, PhD, ABPP, a board-certified clinical neuropsychologist in the Comprehensive Memory Center within the Mulva Clinic for the Neurosciences.

An episode of delirium can be triggered by:

• Exposure to/withdrawal from certain medications
• Exposure to anesthesia
• Illness or infection
• Injury
• Dehydration
• Hospitalization
• Social or emotional distress
• Psychological trauma

“Symptoms of delirium exist on a continuum from agitated delirium associated with restlessness and irritability to a more subdued form of the condition in which a person appears calm and can make small talk but is too disoriented to answer deeper questions,” says Dr. Paydarfar.

During an episode of delirium, a person may experience the following:

• Confusion
• Disrupted sleep patterns
• Restlessness
• Visual or auditory hallucinations

Delirium typically subsides when the stimulus that caused the condition is addressed. For example, a patient in the hospital who enters a state of delirium due to dehydration will recover once their fluids have been optimized. While delirium only lasts anywhere from a few hours to days, the condition is closely associated with more permanent forms of cognitive impairment.

“Clinicians used to think that delirium was just more common in patients who would go on to develop dementia, but we are now realizing that delirium itself is potentially toxic to the brain and may speed up the death of brain cells,” Dr. Paydarfar says. “Delirium is not as reversible as we used to think. This is shocking and upsetting, but at the same time, it presents an opportunity to reduce overall cognitive impairment by addressing delirium before it occurs. We’re excited by the potential to not only avoid the pain and suffering of delirium, but to also prevent dementia.”

Decoding Datasets

The researchers will assess the ability of wearable devices to predict delirium onset in adults ages 65 and older who are predisposed to delirium due to conditions like mild cognitive impairment. The devices will measure the participants’ movement, temperature, heart rate, breathing, and oxygen levels. “There is some evidence of dramatic physiological changes in the early stages of delirium, but nobody has looked at that transition from baseline normal to delirium,” says Dr. Paydarfar.

To determine which physiological changes are most relevant in predicting delirium, the team will leverage machine learning to make sense of their data. “One of the challenges with doing these sorts of data analyses is just how rich a data set can be developed after collecting all these measurements,” explains Dr. Benge. “Machine learning can help us interpret this data to find the best predictors that someone may be at risk for delirium.”

Read more about how Dr. Benge and other UT Health Austin physician-scientists are improving how primary care providers screen for cognitive impairment.

<br>From the Clinic to the Community

The first phase of the study will focus on patients ages 65 and older in a Level 1 trauma facility. Not only are older adults more vulnerable to episodes of delirium in the hospital environment due to factors such as dehydration and sensory deprivation, but this will also allow researchers to compare the measurements collected by the wearable devices to the measurements taken by standard monitoring equipment within the hospital.

“Most consumer wearables are not approved by the U.S. Food and Drug Administration (FDA) to detect health conditions. In the hospital setting, we can test these devices head-to-head with clinically approved monitoring systems,” says Dr. Paydarfar. “We hope that these devices can then facilitate earlier diagnosis and treatment of delirium in hospitals, given the condition’s rapid onset.”

After testing wearables in a clinical setting, the team plans to expand their research to older adults living at home. “Our ultimate goal is to validate wearable devices for delirium prediction outside the hospital, allowing caregivers to intervene before irreversible damage to the brain takes hold,” shares Dr. Paydarfar.

To learn more about the Comprehensive Memory Center, visit here.

To learn more about the Mulva Clinic for the Neurosciences, visit here.