Nivedita Bijlani

Background: Sensor-based remote health monitoring is increasingly used to detect adverse health in people living with dementia (PLwD) at home, aiming to prevent hospitalizations and reduce caregiver burden. However, home sensor data is often noisy, overly granular, and suffers from unreliable labeling, data drift and high variability between households. Current anomaly detection methods lack generalizability and personalization, often requiring anomaly-free training data and frequent model updates.Objective: To develop a lightweight, explainable, self-supervised approach with personalized alert thresholds to detect adverse health events in PLwD, using changes in home activity.Methods: We hypothesized that health downturns manifest as detectable shifts in household movement patterns. Our approach leverages a Graph Barlow Twins contrastive model, which uses granular activity data and a macroscopic view to extract noise-robust, high-level and low-level discriminative features that represent daily activity patterns. Household-personalized alert thresholds are calculated based on clinician-set target alert rates, and daily anomaly scores are compared against these thresholds, triggering alerts for the clinical monitoring team. Model attention weights support explainability. Data were collected from a real-world dataset by the UK Dementia Research Institute (August 2019-April 2022).Results: Our model outperformed state-of-the-art temporal graph algorithms in detecting agitation and fall events across three patient cohorts, achieving 81% average recall and 88% generalizability at a target alert rate of 7%.Conclusion: We developed a novel, lightweight, explainable, and personalized Graph Barlow Twins model for real-world remote health monitoring in dementia care, with potential for broader applications in healthcare and sensor-based environments.

Sensor-based remote health monitoring is used in industrial, urban and healthcare settings to monitor ongoing operation of equipment and human health. An important aim is to intervene early if anomalous events or adverse health is detected. In the wild, these anomaly detection approaches are challenged by noise, label scarcity, high dimensionality, explainability and wide variability in operating environments. The Contextual Matrix Profile (CMP) is a configurable 2-dimensional version of the Matrix Profile (MP) that uses the distance matrix of all subsequences of a time series to discover patterns and anomalies. The CMP is shown to enhance the effectiveness of the MP and other SOTA methods at detecting, visualising and interpreting true anomalies in noisy real world data from different domains. It excels at zooming out and identifying temporal patterns at configurable time scales. However, the CMP does not address cross-sensor information, and cannot scale to high dimensional data. We propose a novel, self-supervised graph- based approach for temporal anomaly detection that works on context graphs generated from the CMP distance matrix. The learned graph embeddings encode the anomalous nature of a time context. In addition, we evaluate other graph outlier algorithms for the same task. Given our pipeline is modular, graph construction, generation of graph embeddings, and pattern recognition logic can all be chosen based on the specific pattern detection application.We verified the effectiveness of graph-based anomaly detection and compared it with the CMP and 3 state-of-the art methods on two real-world healthcare datasets with different anomalies. Our proposed method demonstrated better recall, alert rate and generalisability.

Background Sensor‐based remote health monitoring of persons living with dementia (PLwD) can be used to gain insights into their health and monitor the progression of their condition, with minimal intrusion. This helps minimize preventable hospital admissions, while allowing researchers to improve their understanding of dementia. Existing approaches for detecting activity and behavioural anomalies in PLwD are challenged by noise in data, lack of annotated datasets, multivariate data, scalability, data drift and explainability. Method We propose and evaluate a solution based on the Matrix Profile, an exact, ultra‐fast distance‐based anomaly detection algorithm, specifically the Contextual Matrix Profile (CMP), to detect anomalies that may indicate unusual activity and onset of UTI. Daily household movement data collected via passive infrared (PIR) sensors are used to generate CMPs from location‐wise sensor counts, duration and change in hourly movement patterns. We create CMP‐based multivariate anomaly detection models to generate a single daily normalized anomaly score for each patient. We discover digital biomarkers of anomalies and evaluate our method vs. three state‐of‐the‐art algorithms. Result CMP‐based models yield up to 85% recall with only a 5% alert rate, when evaluated on a subset of 9363 days from 15 participant households with 41 clinically validated incidences of urinary tract infections (UTI) and hospitalization, collected by the UK Dementia Research Institute between August 2019 and July 2021. Our multidimensional CMP model offers the best balance of recall vs. anomalies raised, with excellent generalisation. We discover that bathroom early AM activity (midnight to 6 am) is the prime cross‐patient digital biomarker of anomalies. This validates findings in literature that unusual bathroom activity is a clinically significant feature in UTI for dementia. We also demonstrate a cross‐patient view of anomaly patterns. Conclusion We address the need for anomaly detection and scoring using multivariate time series sensor data in remote health monitoring. The CMP allows configurability, ability to denoise and detect patterns, and explainability to clinical practitioners. With higher sensitivity, fewer alerts and better overall performance than state‐of‐the‐art methods, and the ability to discover digital biomarkers of anomalies, the CMP is a clinically meaningful unsupervised anomaly detection technique for dementia and beyond.

BACKGROUNDSensor-based remote health monitoring can be used for the timely detection of health deterioration in people living with dementia with minimal impact on their day-to-day living. Anomaly detection approaches have been widely applied in various domains, including remote health monitoring. However, current approaches are challenged by noisy, multivariate data and low generalizability. OBJECTIVEThis study aims to develop an online, lightweight unsupervised learning-based approach to detect anomalies representing adverse health conditions using activity changes in people living with dementia. We demonstrated its effectiveness over state-of-the-art methods on a real-world data set of 9363 days collected from 15 participant households by the UK Dementia Research Institute between August 2019 and July 2021. Our approach was applied to household movement data to detect urinary tract infections (UTIs) and hospitalizations. METHODSWe propose and evaluate a solution based on Contextual Matrix Profile (CMP), an exact, ultrafast distance-based anomaly detection algorithm. Using daily aggregated household movement data collected via passive infrared sensors, we generated CMPs for location-wise sensor counts, duration, and change in hourly movement patterns for each patient. We computed a normalized anomaly score in 2 ways: by combining univariate CMPs and by developing a multidimensional CMP. The performance of our method was evaluated relative to Angle-Based Outlier Detection, Copula-Based Outlier Detection, and Lightweight Online Detector of Anomalies. We used the multidimensional CMP to discover and present the important features associated with adverse health conditions in people living with dementia. RESULTSThe multidimensional CMP yielded, on average, 84.3% recall with 32.1 alerts, or a 5.1% alert rate, offering the best balance of recall and relative precision compared with Copula-Based and Angle-Based Outlier Detection and Lightweight Online Detector of Anomalies when evaluated for UTI and hospitalization. Midnight to 6 AM bathroom activity was shown to be the most important cross-patient digital biomarker of anomalies indicative of UTI, contributing approximately 30% to the anomaly score. We also demonstrated how CMP-based anomaly scoring can be used for a cross-patient view of anomaly patterns. CONCLUSIONSTo the best of our knowledge, this is the first real-world study to adapt the CMP to continuous anomaly detection in a health care scenario. The CMP inherits the speed, accuracy, and simplicity of the Matrix Profile, providing configurability, the ability to denoise and detect patterns, and explainability to clinical practitioners. We addressed the need for anomaly scoring in multivariate time series health care data by developing the multidimensional CMP. With high sensitivity, a low alert rate, better overall performance than state-of-the-art methods, and the ability to discover digital biomarkers of anomalies, the CMP is a clinically meaningful unsupervised anomaly detection technique extensible to multimodal data for dementia and other health care scenarios.