Facilitating the Measurement and Treatment of Behavioral and Psychological Symptoms of Dementia (BPSD) and Understanding Caregiver Burden Using Wearable Devices in Rural Taiwan - Protocol for a Dyadic Feasibility Pilot Study

IntroductionAlzheimers disease (AD) prevalence rises with societal ageing. In clinical care, behavioral and psychological symptoms of dementia (BPSD)--including depression, agitation/aggression, apathy, and sleep disturbance--worsen patients quality of life and substantially increase caregiver burden, more significantly than the cognitive symptoms. Standard BPSD assessments rely on caregiver-rated questionnaires that are cross-sectional and may be biased when caregivers are themselves older adults. Device-based measures (e.g., research-grade wrist actigraphy) can provide objective longitudinal data and novel features. In parallel, therapeutic wearables may improve sleep and mood in adults, and might improve BPSD if accepted by people living with dementia. This study aims to assess the feasibility and acceptability of two wearables (Geneactiv actigraphy and Re-Timer circadian regulator) among AD patients with significant BPSD and their caregivers in Taiwan. MethodsThis dyadic pilot study will recruit 20 participants (n=10 AD patients; n=10 caregivers) from outpatient services and affiliated day-care/dementia hubs in rural Taiwan. Participants will wear Geneactiv continuously for 8 weeks and Re-Timer [≥]30 min/day for 4 weeks. Device-based data will be processed with GGIR, a well validated R-package designed for processing accelerometer data. Questionnaire assessments include Pittsburgh Sleep Quality Index, PSQI (PSQI), Neuropsychiatry Inventory Questionnaire (NPI-Q), Caregiver Burden Inventory (CBI), and a semi-structured interview based on the Taiwanese version of Quebec User Evaluation of Satisfaction with Assistive Technology (T-QUEST) at prespecified timepoints. DiscussionWearable devices may facilitate the measurement and treatment of specific BPSD, as well as reduce caregiver burden. If proven feasible even in rural Taiwan where both digital and health literacy and resources are limited, this model will inform how device-based dementia care model can be considered and applied in the context of global ageing. Ethics & registrationThis protocol has been approved by the China Medical University and Hospital Research Ethics Committee (CMUH114-REC3-072), and pre-registered in ClinicalTrials.gov (NCT07249918).