A Wearable Sensor Platform for Remote Monitoring of Individuals on the Frontotemporal Dementia Spectrum

Frontotemporal degeneration (FTD) spans the spectrum of rare neurodegenerative disorders affecting movement, behavior, and cognitive function. FTD represents a group of disorders including progressive supranuclear palsy (PSP - a severe and rapidly progressive FTD disorder estimated to affect at least 20,000 Americans), frontotemporal dementia (FTD, the second most common cause of early-onset (<65) dementia), primary progressive aphasia (PPA), semantic dementia (SD), and corticobasal syndrome (CBS). The primary objective of this clinical study is to provide the initial validation for monitoring biomarkers of symptoms and functioning for individuals with FTLD syndromes. Sixty patients with FTLD syndromes will be recruited from Johns Hopkins University School of Medicine and Massachusetts General Hospital to participate in this 24-month study with visits every 6 months. The investigators aim to assess the correlation between outcomes as measured by the PAMSys pendant and PAMSys ULM wrist monitoring sensors, and clinical/functional assessments used for FTLD syndromes (behavioral variant frontotemporal dementia (bvFTD), non-fluent primary progressive aphasia (nfPPA), SD, and CBS), including the FTD Rating Scale (FTDRS), Cortical Basal Ganglia Functional Scale (CBFS), PSP Rating Scale (PSPRS), Frontotemporal lobar degeneration - Clinical Dementia Rating (FTLD-CDR) , modified Interpersonal Reactivity Index (mIRI Perspective Taking and Empathic Concern subscales summed to obtain a total Empathy score), the Pyramids and Palm Trees test (PPT), the Bedside Western Aphasia Battery-Revised (BWAB-R), phonemic fluency, and category fluency, in individuals with different stages of FTLD disease severity. The results will be used to develop and validate monitoring symptoms and function in FTLD syndromes. In an exploratory aim, the caregiver burden (Zarit Burden Inventory) and its relationship to patients' empathy levels (mIRI) will be assessed. The secondary objective of this study is to conduct free-flowing interviews with participants and clinical experts using the Technology Acceptance Model (TAM). This approach will help us examine perceptions of benefit, technology acceptance, technological anxiety, trust, facilitating conditions, perceived risk, and attitudes towards use from the perspectives of both patients and clinicians.

Primary outcomes

• Physical Activity Monitoring [24 months]: Following each clinical visit, participants will be asked to wear a PAMSys pendant sensor and two PAMSys ULM wrist sensors for 14 days at home. The average daily number of steps will be measured using the PAMSys pendant.
• Hand Function Monitoring [24 months]: Following each clinical visit, participants will be asked to wear two PAMSys ULM wrist sensors for 14 days at home. Average daily number of hand goal-directed movements will be measured using the PAMSys ULM wrist sensors.

Secondary outcomes

• Zarit Burden Interview (ZBI-22) [24 months]: The Zarit Burden Interview is completed by a reliable caregiver. The ZBI scores range from 0-88, where 88 represents a worse outcome.
• Montreal Cognitive Assessment (MoCA) [24 months]: This is a brief global cognitive screening assessment. Scores range from 0 to 30 where 0 represents a worse outcome.
• Cortical Basal Ganglia Functional Scale (CBFS) [24 months]: The CBFS is a rating scale that evaluates experiences in daily living (EDLs) and consists of 14 questions on Motor EDLs and 17 questions on Non-Motor EDLs, each of which are rated on a Likert 5-point scale rating function from 0 to 4, where 0 = Normal or no problems and 4 = Severe problems. The questions are for the patient, but should be answered by both the patient and their caregiver together.
• Progressive Supranuclear Palsy Rating Scale (PSPRS) [24 months]: The Progressive Supranuclear Palsy Rating Scale (PSPRS) is a 28-item clinical assessment used to measure the severity and progression of progressive supranuclear palsy (PSP). Out of the 28 items, 6 are scored on a 3-point scale (0-3) and 22 are scored on a 4-point scale (0-4). The PSPRS ranges from a score of 0-100 with a higher score representing greater impairment from the disease.

Other outcomes

• Digital Speech Assessment [24 months]: Using a study tablet, participants will perform a series of digital speech assessments. The collected speech data will be analyzed using BioDigit Speech, an automatic speech analysis software developed by BioSensics.
• Digital Cognitive Assessments [24 months]: Using a study tablet, participants will perform a series of digital cognitive assessments.
• Digital Fine Motor Control Assessment [24 months]: Using a study tablet, participants will perform a series of tapping tests.

Sex: All, ages: 40 Years to any

Inclusion Criteria:

* Male and female participants aged 40 years or older with a clinical diagnosis of possible or probable FTLD syndrome phenotype.
* Participants must be fluent in reading and speaking English and must be capable of providing informed consent based on the principal investigator's judgment.
* Individuals eligible for inclusion must be able to comply with the protocol per the investigator's judgment and must have a caregiver or study partner who is willing and able to assist with all study-related procedures.

Exclusion Criteria:

* Any neurological, medical, or psychiatric condition that would preclude or confound participation in study activities based on the investigator's judgment.
* Individuals who have a history of frequent falls defined as more than 5 falls per month.