In one OHSU study, even the smallest actions of older Portlanders may yield critical clues about how we age.
One recent morning, Jean Lindsay woke in her apartment at the Willamette View retirement community, and, as on most mornings, her feet hit the pale blue carpet at around 7. As she passed her queen-size bed, her grandmother’s framed needlework, and several diligently labeled family photographs, four overhead motion detectors recorded how fast she was walking. In the living room, another motion detector took over as Jean, who is 90, headed toward the kitchen to prepare her breakfast of granola, juice, and toast. When she went to dress for her exercise class, the bedroom sensors picked her up again, and when she opened the front door to go out, a monitor recorded that, too.
Whenever Jean is home, the monitors are watching. They observe her as she moves from room to room and as she uses the new Dell computer Oregon Health & Science University (OHSU) recently gave her. When she types in her user name and password, the software observes the pace of her keystrokes. Recently, it watched her work on a sale sign for her job at the Carousel, Willamette View’s basement thrift store, which Jean has managed since she was 81. ALL ITEMS $1, she typed. BELTS 75¢. That night, as on every night, the sensors transmitted the recorded details of Jean’s movements via the cellular modem located behind her living room recliner to file servers four miles downriver at OHSU, where Dr. Jeffrey Kaye is coming a little closer to understanding how our brains change as we grow old.
On the 13th floor of OHSU’s Center for Health and Healing, the glittering new building that opened in late 2006 at the foot of the aerial tram, Kaye stands in an apartment that’s considerably more spartan than Jean’s. An OHSU neurology professor, Kaye was one of the first to publish findings (in 2001) revealing that observable changes in motor function often presage the onset of cognitive disorders like Alzheimer’s.
Now, as director of the university’s Oregon Center for Aging and Technology, an interdisciplinary research program that seeks to identify technologies that can help meet the challenges of aging, Kaye is experimenting with new types of in-home monitoring that may improve the early detection of cognitive decline; for this, the Bioengineering Research Partnership, Jean and 80 of her peers at Willamette View—as well as 142 other seniors across the Portland metropolitan area—have volunteered to have their movements, and their computer keyboards, monitored. Kaye and his team expect the data to provide unprecedented insight into how our bodies—and, more important, our brains—change as we age. If they are correct, the $7 million study, funded by the National Institutes of Health, eventually will show that in-home monitors may catch critical information a doctor might miss during an annual office visit and, in doing so, suggest trouble sooner. “Right now, there’s an average of three years between the onset of memory problems and an actual diagnosis as to what’s causing them,” says Tracy Zitzelberger, an OHSU program administrator working on the study. “We expect, with the kind of data we’re collecting, that we’ll be able to detect changes years before we otherwise could—hopefully before they even occur.”
Hence the existence of the Point of Care Laboratory: a mock apartment with a hospital-style bathroom, a small bedroom, a lumpy blue living room chair. On the linoleum floor, dashed lines made of blue, green, and purple tape lie in intersecting arcs that lead from room to room, roughly marking the daily perambulations of a mildly sedentary apartment dweller. Attached to the walls are motion detectors. It was here, behind the metal door to Room 130, that Kaye figured out how to watch seniors like Jean Lindsay, and it is here that his team is pushing forward with new ideas. On the kitchen counter lies a pillbox that looks like any other, its compartments labeled “SMTWRFS” for the days of the week, only this box corresponds to a wireless reporting device that someday may provide real-time feedback about how seniors take their medications. And suspended from the living room ceiling is a tiny camera that’s helping the scientists devise a way to distinguish between multiple people living in the same space.
Yet of all the projects, none excites Kaye more than the one that plays out daily in the actual apartments of people like Jean. While doctors annually test many seniors for neurological wellness with memory exercises, logic puzzles, and physical tests, such as having them tap a finger against a tabletop as many times as possible within 10 seconds, Kaye’s study goes a bit further. By identifying similar test conditions in the lives of his subjects, he can follow and decode these motions every day. For instance, computer keystrokes mimic tapping, but they improve upon the tap test by providing data that can be recorded daily and that can be combined with information from the motion detectors to form detailed histories of a subject’s motor functions. Kaye believes such histories will show that cognitive changes associated with aging can be predicted not merely by a slowing of activity and motor function but, more specifically, by variations within one’s own routines. A doctor providing an annual checkup won’t necessarily know that a person like Jean Lindsay is spending an increasing amount of time in her bedroom, or that her walking speed has started to vary from day to day, but monitors will.
On the laboratory’s kitchen counter, Zitzelberger spreads out two circular diagrams that show the activities of two volunteers in their homes for one full year. Among the many colored dots that indicate the rooms in which activity occurred, she starts to point out minute details that suggest sudden changes in the subjects’ behavior. “See this activity at night in the second half of the year? This person’s sleeping habits changed notably.” These are the types of variations the motion detectors see unfailingly and they are what may help point out changes early on. Early detection helps seniors plan an appropriate level of care, but it’s also especially important because many causes of cognitive decline are triggered by problems other than Alzheimer’s, and many of those are easy to treat. Depression, for instance, as well as diabetes, thyroid deficiency, high blood pressure caused by improper medicine dosages, or even urinary tract infections can affect cognitive function in seniors. The longer these conditions go untreated, the more dangerous they become.
Yet the benefits of Kaye’s type of assessment go beyond early detection. A particularly promising benefit of passive monitoring is that it transcends a problem endemic to medical studies on aging populations, one that creates a sort of apples-to-oranges comparison. “The people you end up enrolling in medical studies are usually people who are mobile, people who can drive, people who retain a high level of cognitive function,” Kaye says. “Therefore, you have treatments and medicines being developed and tested on people who are about a decade younger than the people who need them, who are generally sicker and frailer.” Kaye’s study, on the other hand, compares test subjects, quite literally, to themselves.
From her apartment window, Jean looks out across the Willamette River toward several sprawling mansions that line its west bank. “I just can’t imagine what they do with all that space,” she says. She’s lived here for nine years, the first year with her husband Bill, who died in 2000. She’s been a volunteer participant in Kaye’s project for a little more than two years.
Though neither of her parents developed dementia, Jean’s sister Mary was diagnosed with Alzheimer’s two years ago. Signs of Mary’s decline had been evident in phone calls years before that. Jean sees this kind of memory loss regularly among the more than 300 people at Willamette View, in Milwaukie.
“We see it happen here all the time,” she says of the community. “All of a sudden residents will get lost in the building. They start forgetting things. You just get the feeling … that you have the responsibility to do anything you can to help.”
More than half of the participants in Kaye’s study, including Jean Lindsay, have even offered to donate their brains to the program for further research after they die. Jean says she felt absolutely no apprehension about the decision and attributes her scientific interest, in part, to her mother, who graduated from Northwestern Medical School in 1900.
As for the monitors, Jean barely notices them anymore. The study requires little of her other than tolerating this slightly voyeuristic presence (though no actual images of the subjects are ever recorded) and responding to a periodic questionnaire. Once a week, after she logs on to her computer, nine questions appear on-screen. Have you been sick? Have you fallen down? The questions are designed to help explain a housebound week, for example, or a spate of restless nights. Kaye admits that it’s difficult to say what will become of these many millions of incoming bits of data. The information will probably keep researchers busy for decades as they look for patterns in subjects’ movements and explore the recesses of subjects’ donated brain tissue.
The tissue studies will focus on the hippocampus, the small, curved section located at the base of each hemisphere; it is here, in the area that is thought to play a role in emotion and the creation of new memory, that evidence of Alzheimer’s and other types of dementia is most prominent, showing up in nerve tissue as abnormal protein accumulations. Matching these studies with the subjects’ medical outcomes, and with the living histories produced by the motion sensors, will require the synthesis of an enormous amount of information. But having unprecedented access to the actions of the very population he’s trying to heal is, Kaye says, a significant step in the right direction. Volunteers such as Jean Lindsay may not live to see their generosity rewarded, but if Kaye succeeds, future generations will.