Agitation in Dementia Patients




* Enamul Hoque (
* Robert F. Dickerson (
* John A. Stankovic (
* John Lach (
* Karen Rose (


Related Projects:



Our previous work exploring sleep disturbances in community-dwelling persons with dementia has shown that study participants who were more cognitively intact (based upon MMSE scores) were awakened more often for toileting throughout the night (mean of 2.23 times) than those more cognitively impaired (0.93 times) (Rose et al., manuscript under review). Despite the fewer number of awakenings for toileting, persons who were more severely cognitively impaired slept less (mean sleep efficiency of 60.78% vs. 68.6%); had more periodic limb movements of sleep (mean of 123 vs. 70.44); had a longer sleep latency to first 10 minutes of sleep (mean 258.10 minutes vs. 43.10 minutes) and exhibited more nocturnal agitation behaviors than those participants who were less severely cognitively impaired.  In multiple regression models, more severe cognitive impairment, low apnea-hypopnea index, and possible restless legs syndrome significantly predicted agitation (R2=.347, F 3,57 = 9.40, p<.001), but little insight was gained into how agitation might be prevented.

However, a positive relationship between incontinence and nighttime agitation (and general restlessness) may lead to an effective intervention. Based on our previous work above, it is hypothesized that the less frequent toileting of more cognitively impaired persons results in higher rates of bedwetting, which may then lead to nighttime agitation and other sleep disturbances. If confirmed, simple interventions such as regularly waking persons to toilet may be effective in reducing nighttime agitation.

To pursue this hypothesis, agitation, sleep quality, and incontinence data must be collected throughout the night on subjects covering a range of cognitive impairment. Given that collecting such data in a conventional sleep laboratory would be impractical due to cost and the invasiveness on cognitively impaired subjects, inexpensive sensors must be deployed in natural living environments – i.e., the subjects’ bedrooms.

The proposed study will serve as the first step in elucidating the relationship between cognitive impairment, nighttime agitation, and incontinence and will employ the following set of non-invasive wireless sensors: 1) bed sensors that track quality and quantity of sleep, 2) audio sensors that identify verbal agitation, 3) movement sensors that identify physical agitation, and 4) wetness sensors that detect bedwetting. Each sensor has been validated for its specific purpose (e.g., the bed sensor system shows 100% accuracy in detecting discrete sleep movement events and calculates the durations of each movement with high accuracy).   This project represents the first effort in which the suite of sensors will be used together in a large-scale study with at-home deployments. If successful, this project will not only identify a targetable intervention to reduce nighttime agitation in dementia patients but also provide a new infrastructure with which to perform at-home sleep monitoring.

Future Directions:

Our goal is to explore the following research questions:

  1. Do persons with dementia with urinary incontinence at night have more sleep disturbances than persons with dementia who do not have urinary incontinence at night?
  2. What is the relationship between periodic limb movements of sleep and urinary incontinence?
  3. How does type and stage of dementia influence urinary incontinence and sleep?


Physical Agitation Assessment in Dementia Patients



Agitated behavior is one of the most frequent reasons that patients with dementia are placed in long-term care settings. These behaviors are indicators of distress and are associated with increased risk of injury to the patients and their caregivers. This study aims to explore the ability of a custom inertial wireless body sensor network (BSN) to objectively detect and quantify agitation, validating against currently accepted subjective clinical measures – the Cohen-Mansfield Agitation Inventory (CMAI) and the Aggressive Behavior Scale (ABS) – within the nursing home setting. The ultimate goal is to enable continuous, real-time monitoring of physical agitation in any location over an extended period. Continuous, longitudinal assessment facilitates timely response to agitation events in order to minimize patient distress and risk for injury, to more appropriately titrate pharmacotherapy, and to enable staff (or caregivers) to successfully intervene [1].