TY  - JOUR
AU  - Paolillo, Emily W
AU  - Casaletto, Kaitlin B
AU  - Clark, Annie L
AU  - Taylor, Jack C
AU  - Heuer, Hilary W
AU  - Wise, Amy B
AU  - Dhanam, Sreya
AU  - Sanderson-Cimino, Mark
AU  - Saloner, Rowan
AU  - Kramer, Joel H
AU  - Kornak, John
AU  - Kremers, Walter
AU  - Forsberg, Leah
AU  - Appleby, Brian
AU  - Bayram, Ece
AU  - Bozoki, Andrea
AU  - Brushaber, Danielle
AU  - Darby, R Ryan
AU  - Day, Gregory S
AU  - Dickerson, Bradford C
AU  - Domoto-Reilly, Kimiko
AU  - Elahi, Fanny
AU  - Fields, Julie A
AU  - Ghoshal, Nupur
AU  - Graff-Radford, Neill
AU  - G H Hall, Matthew
AU  - Honig, Lawrence S
AU  - Huey, Edward D
AU  - Lapid, Maria I
AU  - Litvan, Irene
AU  - Mackenzie, Ian R
AU  - Masdeu, Joseph C
AU  - Mendez, Mario F
AU  - Mester, Carly
AU  - Miyagawa, Toji
AU  - Naasan, Georges
AU  - Pascual, Belen
AU  - Pressman, Peter
AU  - Ramos, Eliana Marisa
AU  - Rankin, Katherine P
AU  - Rexach, Jessica
AU  - Rojas, Julio C
AU  - VandeVrede, Lawren
AU  - Wong, Bonnie
AU  - Wszolek, Zbigniew K
AU  - Boeve, Bradley F
AU  - Rosen, Howard J
AU  - Boxer, Adam L
AU  - Staffaroni, Adam M
PY  - 2024
DA  - 2024/6/26
TI  - Examining Associations Between Smartphone Use and Clinical Severity in Frontotemporal Dementia: Proof-of-Concept Study
JO  - JMIR Aging
SP  - e52831
VL  - 7
KW  - digital
KW  - technology
KW  - remote
KW  - monitoring
KW  - cognition
KW  - neuropsychology
KW  - cognitive impairment
KW  - neurodegenerative
KW  - screening
KW  - clinical trials
KW  - mobile phone
AB  - Background: Frontotemporal lobar degeneration (FTLD) is a leading cause of dementia in individuals aged <65 years. Several challenges to conducting in-person evaluations in FTLD illustrate an urgent need to develop remote, accessible, and low-burden assessment techniques. Studies of unobtrusive monitoring of at-home computer use in older adults with mild cognitive impairment show that declining function is reflected in reduced computer use; however, associations with smartphone use are unknown. Objective: This study aims to characterize daily trajectories in smartphone battery use, a proxy for smartphone use, and examine relationships with clinical indicators of severity in FTLD. Methods: Participants were 231 adults (mean age 52.5, SD 14.9 years; n=94, 40.7% men; n=223, 96.5% non-Hispanic White) enrolled in the Advancing Research and Treatment of Frontotemporal Lobar Degeneration (ARTFL study) and Longitudinal Evaluation of Familial Frontotemporal Dementia Subjects (LEFFTDS study) Longitudinal Frontotemporal Lobar Degeneration (ALLFTD) Mobile App study, including 49 (21.2%) with mild neurobehavioral changes and no functional impairment (ie, prodromal FTLD), 43 (18.6%) with neurobehavioral changes and functional impairment (ie, symptomatic FTLD), and 139 (60.2%) clinically normal adults, of whom 55 (39.6%) harbored heterozygous pathogenic or likely pathogenic variants in an autosomal dominant FTLD gene. Participants completed the Clinical Dementia Rating plus National Alzheimer’s Coordinating Center Frontotemporal Lobar Degeneration Behavior and Language Domains (CDR+NACC FTLD) scale, a neuropsychological battery; the Neuropsychiatric Inventory; and brain magnetic resonance imaging. The ALLFTD Mobile App was installed on participants’ smartphones for remote, passive, and continuous monitoring of smartphone use. Battery percentage was collected every 15 minutes over an average of 28 (SD 4.2; range 14-30) days. To determine whether temporal patterns of battery percentage varied as a function of disease severity, linear mixed effects models examined linear, quadratic, and cubic effects of the time of day and their interactions with each measure of disease severity on battery percentage. Models covaried for age, sex, smartphone type, and estimated smartphone age. Results: The CDR+NACC FTLD global score interacted with time on battery percentage such that participants with prodromal or symptomatic FTLD demonstrated less change in battery percentage throughout the day (a proxy for less smartphone use) than clinically normal participants (P<.001 in both cases). Additional models showed that worse performance in all cognitive domains assessed (ie, executive functioning, memory, language, and visuospatial skills), more neuropsychiatric symptoms, and smaller brain volumes also associated with less battery use throughout the day (P<.001 in all cases). Conclusions: These findings support a proof of concept that passively collected data about smartphone use behaviors associate with clinical impairment in FTLD. This work underscores the need for future studies to develop and validate passive digital markers sensitive to longitudinal clinical decline across neurodegenerative diseases, with potential to enhance real-world monitoring of neurobehavioral change. 
SN  - 2561-7605
UR  - https://aging.jmir.org/2024/1/e52831
UR  - https://doi.org/10.2196/52831
UR  - http://www.ncbi.nlm.nih.gov/pubmed/38922667
DO  - 10.2196/52831
ID  - info:doi/10.2196/52831
ER  -