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Novack MA, Young SR, Dworak EM, Kaat AJ, Slotkin J, Nowinski C, Yao L, Adam H, Stoeger J, Hosseinian Z, Amagai S, Pila S, Varela Diaz M, Almonte Correa A, Alperin K, Carlson S, Kellen M, Omberg L, Camacho MR, Landavazo B, Nosheny RL, Weiner MW, Gershon RC. Mobile toolbox (MTB) remote measures of executive function and processing speed: development and validation. J Int Neuropsychol Soc 2024:1-9. [PMID: 38989719 DOI: 10.1017/s1355617724000225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/12/2024]
Abstract
OBJECTIVE The ability to remotely monitor cognitive skills is increasing with the ubiquity of smartphones. The Mobile Toolbox (MTB) is a new measurement system that includes measures assessing Executive Functioning (EF) and Processing Speed (PS): Arrow Matching, Shape-Color Sorting, and Number-Symbol Match. The purpose of this study was to assess their psychometric properties. METHOD MTB measures were developed for smartphone administration based on constructs measured in the NIH Toolbox® (NIHTB). Psychometric properties of the resulting measures were evaluated in three studies with participants ages 18 to 90. In Study 1 (N = 92), participants completed MTB measures in the lab and were administered both equivalent NIH TB measures and other external measures of similar cognitive constructs. In Study 2 (N = 1,021), participants completed the equivalent NIHTB measures in the lab and then took the MTB measures on their own, remotely. In Study 3 (N = 168), participants completed MTB measures twice remotely, two weeks apart. RESULTS All three measures exhibited very high internal consistency and strong test-retest reliability, as well as moderately high correlations with comparable NIHTB tests and moderate correlations with external measures of similar constructs. Phone operating system (iOS vs. Android) had a significant impact on performance for Arrow Matching and Shape-Color Sorting, but no impact on either validity or reliability. CONCLUSIONS Results support the reliability and convergent validity of MTB EF and PS measures for use across the adult lifespan in remote, self-administered designs.
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Affiliation(s)
- Miriam A Novack
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Stephanie Ruth Young
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Elizabeth M Dworak
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Aaron J Kaat
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jerry Slotkin
- Center for Health Assessment Research and Translation, University of Delaware, Newark, DE, USA
| | - Cindy Nowinski
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Lihua Yao
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Hubert Adam
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jordan Stoeger
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Zahra Hosseinian
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Saki Amagai
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Sarah Pila
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Maria Varela Diaz
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Anyelo Almonte Correa
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | | | | | | | - Monica R Camacho
- University of California, San Francisco, NCIRE, San Francisco, CA, USA
- Northern California Institute for Research and Education, San Francisco Veteran's Administration Medical Center, San Francisco, CA, USA
| | - Bernard Landavazo
- University of California, San Francisco, NCIRE, San Francisco, CA, USA
- Northern California Institute for Research and Education, San Francisco Veteran's Administration Medical Center, San Francisco, CA, USA
| | - Rachel L Nosheny
- University of California, San Francisco, NCIRE, San Francisco, CA, USA
- Northern California Institute for Research and Education, San Francisco Veteran's Administration Medical Center, San Francisco, CA, USA
| | - Michael W Weiner
- University of California, San Francisco, NCIRE, San Francisco, CA, USA
- Northern California Institute for Research and Education, San Francisco Veteran's Administration Medical Center, San Francisco, CA, USA
| | - Richard C Gershon
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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2
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Young SR, Dworak EM, Novack MA, Kaat AJ, Adam H, Nowinski CJ, Hosseinian Z, Slotkin J, Stoeger J, Amagai S, Varela Diaz M, Almonte Correa A, Alperin K, Omberg L, Kellen M, Camacho MR, Landavazo B, Nosheny RL, Weiner MW, Gershon R. Development and validation of an episodic memory measure in the Mobile Toolbox (MTB): Arranging Pictures. J Clin Exp Neuropsychol 2024:1-10. [PMID: 38753819 DOI: 10.1080/13803395.2024.2353945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 05/06/2024] [Indexed: 05/18/2024]
Abstract
INTRODUCTION Arranging Pictures is a new episodic memory test based on the NIH Toolbox (NIHTB) Picture Sequence Memory measure and optimized for self-administration on a personal smartphone within the Mobile Toolbox (MTB). We describe evidence from three distinct validation studies. METHOD In Study 1, 92 participants self-administered Arranging Pictures on study-provided smartphones in the lab and were administered external measures of similar and dissimilar constructs by trained examiners to assess validity under controlled circumstances. In Study 2, 1,021 participants completed the external measures in the lab and self-administered Arranging Pictures remotely on their personal smartphones to assess validity in real-world contexts. In Study 3, 141 participants self-administered Arranging Pictures remotely twice with a two-week delay on personal iOS smartphones to assess test-retest reliability and practice effects. RESULTS Internal consistency was good across samples (ρxx = .80 to .85, p < .001). Test-retest reliability was marginal (ICC = .49, p < .001) and there were significant practice effects after a two-week delay (ΔM = 3.21 (95% CI [2.56, 3.88]). As expected, correlations with convergent measures were significant and moderate to large in magnitude (ρ = .44 to .76, p < .001), while correlations with discriminant measures were small (ρ = .23 to .27, p < .05) or nonsignificant. Scores demonstrated significant negative correlations with age (ρ = -.32 to -.21, p < .001). Mean performance was slightly higher in the iOS compared to the Android group (MiOS = 18.80, NiOS = 635; MAndroid = 17.11, NAndroid = 386; t(757.73) = 4.17, p < .001), but device type did not significantly influence the psychometric properties of the measure. Indicators of potential cheating were mixed; average scores were significantly higher in the remote samples (F(2, 850) = 11.415, p < .001), but there were not significantly more perfect scores. CONCLUSION The MTB Arranging Pictures measure demonstrated evidence of reliability and validity when self-administered on personal device. Future research should examine the potential for cheating in remote settings and the properties of the measure in clinical samples.
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Affiliation(s)
- Stephanie Ruth Young
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Elizabeth M Dworak
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Miriam A Novack
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Aaron J Kaat
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Hubert Adam
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Cindy J Nowinski
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Zahra Hosseinian
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jerry Slotkin
- Center for Health Assessment Research and Translation, University of Delaware, Newark, DE, USA
| | | | - Saki Amagai
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Maria Varela Diaz
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Anyelo Almonte Correa
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | | | | | - Monica R Camacho
- University of California San Francisco, San Francisco, CA, USA
- Northern California Institute for Research and Education, San Francisco Veteran's Administration Medical Center, San Francisco, CA, USA
| | - Bernard Landavazo
- University of California San Francisco, San Francisco, CA, USA
- Northern California Institute for Research and Education, San Francisco Veteran's Administration Medical Center, San Francisco, CA, USA
| | - Rachel L Nosheny
- University of California San Francisco, San Francisco, CA, USA
- Northern California Institute for Research and Education, San Francisco Veteran's Administration Medical Center, San Francisco, CA, USA
| | - Michael W Weiner
- University of California San Francisco, San Francisco, CA, USA
- Northern California Institute for Research and Education, San Francisco Veteran's Administration Medical Center, San Francisco, CA, USA
| | - Richard Gershon
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Nutley S, Nguyen BK, Mackin RS, Insel PS, Tosun D, Butters M, Aisen P, Raman R, Saykin AJ, Toga AW, Jack C, Weiner MW, Nelson C, Kassel M, Kryza-Lacombe M, Eichenbaum J, Nosheny RL, Mathews CA. Relationship of Hoarding and Depression Symptoms in Older Adults. Am J Geriatr Psychiatry 2024; 32:497-508. [PMID: 38092621 PMCID: PMC11055473 DOI: 10.1016/j.jagp.2023.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 11/12/2023] [Accepted: 11/17/2023] [Indexed: 03/21/2024]
Abstract
Hoarding disorder (HD) is a debilitating neuropsychiatric condition that affects 2%-6% of the population and increases in incidence with age. Major depressive disorder (MDD) co-occurs with HD in approximately 50% of cases and leads to increased functional impairment and disability. However, only one study to date has examined the rate and trajectory of hoarding symptoms in older individuals with a lifetime history of MDD, including those with current active depression (late-life depression; LLD). We therefore sought to characterize this potentially distinct phenotype. We determined the incidence of HD in two separate cohorts of participants with LLD (n = 73) or lifetime history of MDD (n = 580) and examined the reliability and stability of hoarding symptoms using the Saving Inventory-Revised (SI-R) and Hoarding Rating Scale-Self Report (HRS), as well as the co-variance of hoarding and depression scores over time. HD was present in 12% to 33% of participants with MDD, with higher rates found in those with active depressive symptoms. Hoarding severity was stable across timepoints in both samples (all correlations >0.75), and fewer than 30% of participants in each sample experienced significant changes in severity between any two timepoints. Change in depression symptoms over time did not co-vary with change in hoarding symptoms. These findings indicate that hoarding is a more common comorbidity in LLD than previously suggested, and should be considered in screening and management of LLD. Future studies should further characterize the interaction of these conditions and their impact on outcomes, particularly functional impairment in this vulnerable population.
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Affiliation(s)
- Sara Nutley
- Department of Psychiatry (SN, BN, CAM), University of Florida College of Medicine, Gainesville, FL; Center for OCD, Anxiety, and Related Disorders (COARD) (SN, BN, CAM), University of Florida, Gainesville, FL; Department of Epidemiology (SN), University of Florida, Gainesville, FL
| | - Binh K Nguyen
- Department of Psychiatry (SN, BN, CAM), University of Florida College of Medicine, Gainesville, FL; Center for OCD, Anxiety, and Related Disorders (COARD) (SN, BN, CAM), University of Florida, Gainesville, FL
| | - Robert Scott Mackin
- Department of Psychiatry and Behavioral Sciences (RM, PI, MW, CN, MK, MK-L, RN), University of California, San Francisco, San Francisco, CA; San Francisco Veterans Administration Medical Center (DT, MW, MK, JE), San Francisco, CA
| | - Philip S Insel
- Department of Psychiatry and Behavioral Sciences (RM, PI, MW, CN, MK, MK-L, RN), University of California, San Francisco, San Francisco, CA
| | - Duygu Tosun
- San Francisco Veterans Administration Medical Center (DT, MW, MK, JE), San Francisco, CA; Department of Radiology (DT, MW, JE, RN), University of California, San Francisco, San Francisco, CA
| | - Meryl Butters
- Department of Psychiatry (MB), University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Paul Aisen
- University of Southern California (PA, RR), San Diego, CA; Alzheimer's Therapeutic Research Institute (PA, RR), University of Southern California, San Diego, CA
| | - Rema Raman
- University of Southern California (PA, RR), San Diego, CA; Alzheimer's Therapeutic Research Institute (PA, RR), University of Southern California, San Diego, CA
| | - Andrew J Saykin
- Indiana Alzheimer's Disease Research Center and Department of Radiology and Imaging Sciences (AS), Indiana University School of Medicine, Indianapolis, IN
| | - Arthur W Toga
- Laboratory of Neuro Imaging, Stevens Neuroimaging and Informatics Institute, Keck School of Medicine (AT), University of Southern California, Los Angeles, CA
| | | | - Michael W Weiner
- Department of Psychiatry and Behavioral Sciences (RM, PI, MW, CN, MK, MK-L, RN), University of California, San Francisco, San Francisco, CA; San Francisco Veterans Administration Medical Center (DT, MW, MK, JE), San Francisco, CA; Department of Radiology (DT, MW, JE, RN), University of California, San Francisco, San Francisco, CA; Department of Neurology (MW), University of California, San Francisco, San Francisco, CA
| | - Craig Nelson
- Department of Psychiatry and Behavioral Sciences (RM, PI, MW, CN, MK, MK-L, RN), University of California, San Francisco, San Francisco, CA
| | - Michelle Kassel
- Department of Psychiatry and Behavioral Sciences (RM, PI, MW, CN, MK, MK-L, RN), University of California, San Francisco, San Francisco, CA; San Francisco Veterans Administration Medical Center (DT, MW, MK, JE), San Francisco, CA
| | - Maria Kryza-Lacombe
- Department of Psychiatry and Behavioral Sciences (RM, PI, MW, CN, MK, MK-L, RN), University of California, San Francisco, San Francisco, CA; Mental Illness Research Education and Clinical Centers (MK-L), Veterans Administration Medical Center, San Francisco, CA
| | - Joseph Eichenbaum
- San Francisco Veterans Administration Medical Center (DT, MW, MK, JE), San Francisco, CA; Department of Radiology (DT, MW, JE, RN), University of California, San Francisco, San Francisco, CA
| | - Rachel L Nosheny
- Department of Psychiatry and Behavioral Sciences (RM, PI, MW, CN, MK, MK-L, RN), University of California, San Francisco, San Francisco, CA; Department of Radiology (DT, MW, JE, RN), University of California, San Francisco, San Francisco, CA
| | - Carol A Mathews
- Department of Psychiatry (SN, BN, CAM), University of Florida College of Medicine, Gainesville, FL; Center for OCD, Anxiety, and Related Disorders (COARD) (SN, BN, CAM), University of Florida, Gainesville, FL.
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4
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Young SR, Dworak EM, Kaat AJ, Adam H, Novack MA, Slotkin J, Stoeger J, Nowinski CJ, Hosseinian Z, Amagai S, Pila S, Diaz MV, Correa AA, Alperin K, Omberg L, Kellen M, Camacho MR, Landavazo B, Nosheny RL, Weiner MW, Gershon RM. Development and Validation of a Vocabulary Measure in the Mobile Toolbox. Arch Clin Neuropsychol 2024:acae010. [PMID: 38414411 DOI: 10.1093/arclin/acae010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 01/24/2024] [Accepted: 01/27/2024] [Indexed: 02/29/2024] Open
Abstract
OBJECTIVE We describe the development of a new computer adaptive vocabulary test, Mobile Toolbox (MTB) Word Meaning, and validity evidence from 3 studies. METHOD Word Meaning was designed to be a multiple-choice synonym test optimized for self-administration on a personal smartphone. The items were first calibrated online in a sample of 7,525 participants to create the computer-adaptive test algorithm for the Word Meaning measure within the MTB app. In Study 1, 92 participants self-administered Word Meaning on study-provided smartphones in the lab and were administered external measures by trained examiners. In Study 2, 1,021 participants completed the external measures in the lab and Word Meaning was self-administered remotely on their personal smartphones. In Study 3, 141 participants self-administered Word Meaning remotely twice with a 2-week delay on personal iPhones. RESULTS The final bank included 1363 items. Internal consistency was adequate to good across samples (ρxx = 0.78 to 0.81, p < .001). Test-retest reliability was good (ICC = 0.65, p < .001), and the mean theta score was not significantly different upon the second administration. Correlations were moderate to large with measures of similar constructs (ρ = 0.67-0.75, p < .001) and non-significant with measures of dissimilar constructs. Scores demonstrated small to moderate correlations with age (ρ = 0.35 to 0.45, p < .001) and education (ρ = 0.26, p < .001). CONCLUSION The MTB Word Meaning measure demonstrated evidence of reliability and validity in three samples. Further validation studies in clinical samples are necessary.
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Affiliation(s)
- Stephanie Ruth Young
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Elizabeth M Dworak
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Aaron J Kaat
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Hubert Adam
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Miriam A Novack
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jerry Slotkin
- Center for Health Assessment Research and Translation, University of Delaware, Newark, DE, USA
| | | | - Cindy J Nowinski
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Zahra Hosseinian
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Saki Amagai
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Sarah Pila
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Maria Varela Diaz
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Anyelo Almonte Correa
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | | | | | - Monica R Camacho
- University of California San Francisco, San Francisco CA, USA
- Northern California Institute for Research and Education, San Francisco Veteran's Administration Medical Center, San Francisco, CA, USA
| | - Bernard Landavazo
- University of California San Francisco, San Francisco CA, USA
- Northern California Institute for Research and Education, San Francisco Veteran's Administration Medical Center, San Francisco, CA, USA
| | - Rachel L Nosheny
- University of California San Francisco, San Francisco CA, USA
- Northern California Institute for Research and Education, San Francisco Veteran's Administration Medical Center, San Francisco, CA, USA
| | - Michael W Weiner
- University of California San Francisco, San Francisco CA, USA
- Northern California Institute for Research and Education, San Francisco Veteran's Administration Medical Center, San Francisco, CA, USA
| | - Richard M Gershon
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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5
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Tank R, Diaz A, Ashford MT, Miller MJ, Eichenbaum J, Aaronson A, Landavazo B, Neuhaus J, Weiner MW, Mackin RS, Barnes J, Nosheny RL. Examining Demographic Factors, Psychosocial Wellbeing and Cardiovascular Health in Subjective Cognitive Decline in the Brain Health Registry Cohort. J Prev Alzheimers Dis 2024; 11:787-797. [PMID: 38706295 PMCID: PMC11061024 DOI: 10.14283/jpad.2024.39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 12/19/2023] [Indexed: 05/07/2024]
Abstract
BACKGROUND Subjective cognitive decline (SCD) is defined as an individual's perception of sustained cognitive decline compared to their normal state while still performing within boundaries for normal functioning. Demographic, psychosocial and medical factors have been linked to age-related cognitive decline, and Alzheimer's dementia (AD). However, their relation to risk for SCD remains unclear. This study aims to identify demographic factors, psychosocial and cardiovascular health associated with SCD within the Brain Health Registry (BHR) online cohort. METHODS Participants aged 55+ (N=27,596) in the BHR self-reported SCD measured using the Everyday Cognition Scale (ECog) and medical conditions, depressive symptoms, body mass index, quality of sleep, health, family history of AD, years of education, race, ethnicity and gender. Multivariable linear regression was used to examine whether SCD was associated with demographic, psychosocial, and medical conditions. RESULTS We found that advanced age, depressive symptoms, poorer sleep quality and poorer quality of health were positively associated with more self-reported SCD in all models. No race or ethnicity differences were found in association with SCD. Males who reported alcohol and tobacco use or underweight BMI had higher ECog scores compared with females. CONCLUSION In addition to well-established risk factors for cognitive decline, such as age, our study consistently and robustly identified a strong association between psychosocial factors and self-reported cognitive decline in an online cohort. These findings provide further evidence that psychosocial health plays a pivotal role in comprehending the risk of SCD and early-stage cognitive ageing. Our findings emphasise the significance of psychosocial factors within the broader context of cardiovascular and demographic risk factors.
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Affiliation(s)
- R Tank
- Rachana Tank, Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom,
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6
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Ashford MT, Jin C, Neuhaus J, Diaz A, Aaronson A, Tank R, Eichenbaum J, Camacho MR, Fockler J, Ulbricht A, Flenniken D, Truran D, Mackin RS, Weiner MW, Mindt MR, Nosheny RL. Participant completion of longitudinal assessments in an online cognitive aging registry: The role of medical conditions. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2024; 10:e12438. [PMID: 38188606 PMCID: PMC10767283 DOI: 10.1002/trc2.12438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 11/08/2023] [Accepted: 11/16/2023] [Indexed: 01/09/2024]
Abstract
INTRODUCTION This study aimed to understand whether older adults' longitudinal completion of assessments in an online Alzheimer's disease and related dementias (ADRD)-related registry is influenced by self-reported medical conditions. METHODS Brain Health Registry (BHR) is an online cognitive aging and ADRD-related research registry that includes longitudinal health and cognitive assessments. Using logistic regressions, we examined associations between longitudinal registry completion outcomes and self-reported (1) number of medical conditions and (2) eight defined medical condition groups (cardiovascular, metabolic, immune system, ADRD, current psychiatric, substance use/abuse, acquired, other specified conditions) in adults aged 55+ (N = 23,888). Longitudinal registry completion outcomes were assessed by the completion of the BHR initial questionnaire (first questionnaire participants see at each visit) at least twice and completion of a cognitive assessment (Cogstate Brief Battery) at least twice. Models included ethnocultural identity, education, age, and subjective memory concern as covariates. RESULTS We found that the likelihood of longitudinally completing the initial questionnaire was negatively associated with reporting a diagnosis of ADRD and current psychiatric conditions but was positively associated with reporting substance use/abuse and acquired medical conditions. The likelihood of longitudinally completing the cognitive assessment task was negatively associated with number of reported medical conditions, as well as with reporting cardiovascular conditions, ADRD, and current psychiatric conditions. Previously identified associations between ethnocultural identity and longitudinal assessment completion in BHR remained after accounting for the presence of medical conditions. DISCUSSION This post hoc analysis provides novel, initial evidence that older adults' completion of longitudinal assessments in an online registry is associated with the number and types of participant-reported medical conditions. Our findings can inform future efforts to make online studies with longitudinal health and cognitive assessments more usable for older adults with medical conditions. The results need to be interpreted with caution due to selection biases, and the under-inclusion of minoritized communities.
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Affiliation(s)
- Miriam T. Ashford
- VA Advanced Imaging Research CenterSan Francisco Veteran's Administration Medical CenterSan FranciscoCaliforniaUSA
- Department of Veterans Affairs Medical CenterNorthern California Institute for Research and Education (NCIRE)San FranciscoCaliforniaUSA
| | - Chengshi Jin
- University of California San Francisco Department of Epidemiology and Biostatistics San FranciscoSan FranciscoCaliforniaUSA
| | - John Neuhaus
- University of California San Francisco Department of Epidemiology and Biostatistics San FranciscoSan FranciscoCaliforniaUSA
| | - Adam Diaz
- VA Advanced Imaging Research CenterSan Francisco Veteran's Administration Medical CenterSan FranciscoCaliforniaUSA
- Department of Veterans Affairs Medical CenterNorthern California Institute for Research and Education (NCIRE)San FranciscoCaliforniaUSA
| | - Anna Aaronson
- VA Advanced Imaging Research CenterSan Francisco Veteran's Administration Medical CenterSan FranciscoCaliforniaUSA
- Department of Radiology and Biomedical ImagingUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Rachana Tank
- Department of Radiology and Biomedical ImagingUniversity of CaliforniaSan FranciscoCaliforniaUSA
- Dementia Research CentreUCL Institute of NeurologyUniversity College LondonLondonUK
| | - Joseph Eichenbaum
- VA Advanced Imaging Research CenterSan Francisco Veteran's Administration Medical CenterSan FranciscoCaliforniaUSA
- Department of Radiology and Biomedical ImagingUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Monica R. Camacho
- VA Advanced Imaging Research CenterSan Francisco Veteran's Administration Medical CenterSan FranciscoCaliforniaUSA
- Department of Veterans Affairs Medical CenterNorthern California Institute for Research and Education (NCIRE)San FranciscoCaliforniaUSA
| | - Juliet Fockler
- Department of Veterans Affairs Medical CenterNorthern California Institute for Research and Education (NCIRE)San FranciscoCaliforniaUSA
- Department of Radiology and Biomedical ImagingUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Aaron Ulbricht
- Department of Veterans Affairs Medical CenterNorthern California Institute for Research and Education (NCIRE)San FranciscoCaliforniaUSA
- Department of Radiology and Biomedical ImagingUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Derek Flenniken
- VA Advanced Imaging Research CenterSan Francisco Veteran's Administration Medical CenterSan FranciscoCaliforniaUSA
- Department of Veterans Affairs Medical CenterNorthern California Institute for Research and Education (NCIRE)San FranciscoCaliforniaUSA
| | - Diana Truran
- VA Advanced Imaging Research CenterSan Francisco Veteran's Administration Medical CenterSan FranciscoCaliforniaUSA
- Department of Veterans Affairs Medical CenterNorthern California Institute for Research and Education (NCIRE)San FranciscoCaliforniaUSA
| | - Robert Scott Mackin
- VA Advanced Imaging Research CenterSan Francisco Veteran's Administration Medical CenterSan FranciscoCaliforniaUSA
- Department of Psychiatry and Behavioral SciencesUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Michael W. Weiner
- VA Advanced Imaging Research CenterSan Francisco Veteran's Administration Medical CenterSan FranciscoCaliforniaUSA
- Department of Veterans Affairs Medical CenterNorthern California Institute for Research and Education (NCIRE)San FranciscoCaliforniaUSA
- Department of Radiology and Biomedical ImagingUniversity of CaliforniaSan FranciscoCaliforniaUSA
- Department of MedicineUniversity of California San FranciscoSan FranciscoCaliforniaUSA
- Department of NeurologyUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Monica Rivera Mindt
- Psychology, Latin American Latino Studies Institute& African and African American StudiesFordham UniversityJoint Appointment in NeurologyIcahn School of Medicine at Mount Sinai ‐ New YorkNew YorkNew YorkUSA
| | - Rachel L. Nosheny
- Department of Veterans Affairs Medical CenterNorthern California Institute for Research and Education (NCIRE)San FranciscoCaliforniaUSA
- Department of Psychiatry and Behavioral SciencesUniversity of California San FranciscoSan FranciscoCaliforniaUSA
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7
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Nosheny RL, Yen D, Howell T, Camacho M, Moulder K, Gummadi S, Bui C, Kannan S, Ashford MT, Knight K, Mayo C, McMillan M, Petersen RC, Stricker NH, Roberson ED, Chambless C, Gersteneker A, Martin R, Kennedy R, Zhang Y, Kukull W, Flenniken D, Fockler J, Truran D, Mackin RS, Weiner MW, Morris JC, Li Y. Evaluation of the Electronic Clinical Dementia Rating for Dementia Screening. JAMA Netw Open 2023; 6:e2333786. [PMID: 37707812 PMCID: PMC10502518 DOI: 10.1001/jamanetworkopen.2023.33786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 08/01/2023] [Indexed: 09/15/2023] Open
Abstract
Importance The Clinical Dementia Rating (CDR) is a well-validated instrument widely used to detect and stage dementia due to Alzheimer disease. The digital Electronic Clinical Dementia Rating (eCDR) can be remotely self-administered and automatically scored, with potential to facilitate efficient dementia screening and staging. Objective To evaluate the association of the eCDR with the CDR and other in-clinic assessments for screening older adults for cognitive impairment. Design, Setting, and Participants This multisite, cross-sectional study used baseline data from a longitudinal, observational study from 2020 to 2023, including up to 3 years of follow-up. Participants were enrolled from 3 Alzheimer Disease Research Centers and the Brain Health Registry. Participants (aged ≥55 years, with a study partner, and no acute or unstable major medical conditions) were recruited during in-clinic visits or by automated emails. Exposures Participants completed the Uniform Data Set Version 3 (UDS; including the CDR) in supervised clinical research settings, and then completed the eCDR remotely, online and unsupervised, using their own device. Main Outcomes and Measures The primary outcomes were eCDR scores (item; categorical box and global; continuous box and global), CDR scores (item; categorical box and global), and UDS assessment scores. Associations were evaluated using linear and logistic regressions. Results A total of 3565 participants were contacted, and 288 were enrolled. Among 173 participants with item-level data (mean [SD] age, 70.84 [7.65] years; 76 women [43.9%]), eCDR to CDR concordance was 90% or higher for 33 items (63%) and 70% to 89% for 13 items (25%). Box (domain) level concordance ranged from 80% (memory) to 99% (personal care). The global score concordance rate was 81%. κ statistics were fair to moderate. Among 206 participants with box and global scores (mean [SD] age, 71.34 [7.68] years; 95 women [46.1%]), eCDR continuous global score was associated with CDR global (categorical) score with an area under the receiver operating characteristic curve of 0.79 (95% CI, 0.70-0.87). Correlations between eCDR and in-clinic UDS assessments were similar to those between CDR sum of box scores and the same in-clinic assessments. Conclusions and Relevance These findings suggest that the eCDR is valid and has potential use for screening and assessment of older adults for cognitive and functional decline related to Alzheimer disease. Instrument optimization and validation in diverse cohorts in remote settings are crucial for evaluating scalability and eCDR utility in clinical research, trials, and health care settings.
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Affiliation(s)
- Rachel L. Nosheny
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco
- Department of Radiology and Biomedical Imaging, University of California, San Francisco
- Northern California Institute for Research and Education, Department of Veterans Affairs Medical Center, San Francisco
| | - Daniel Yen
- Knight Alzheimer’s Disease Research Center, Department of Neurology, Washington University School of Medicine, St Louis, Missouri
| | - Taylor Howell
- Department of Radiology and Biomedical Imaging, University of California, San Francisco
| | - Monica Camacho
- Department of Radiology and Biomedical Imaging, University of California, San Francisco
| | - Krista Moulder
- Knight Alzheimer’s Disease Research Center, Department of Neurology, Washington University School of Medicine, St Louis, Missouri
| | - Shilpa Gummadi
- Department of Radiology and Biomedical Imaging, University of California, San Francisco
| | - Chau Bui
- Department of Radiology and Biomedical Imaging, University of California, San Francisco
| | - Sandhya Kannan
- Department of Radiology and Biomedical Imaging, University of California, San Francisco
| | - Miriam T. Ashford
- Northern California Institute for Research and Education, Department of Veterans Affairs Medical Center, San Francisco
| | - Kristen Knight
- Department of Radiology and Biomedical Imaging, University of California, San Francisco
| | - Connie Mayo
- Knight Alzheimer’s Disease Research Center, Department of Neurology, Washington University School of Medicine, St Louis, Missouri
| | - Maureen McMillan
- Knight Alzheimer’s Disease Research Center, Department of Neurology, Washington University School of Medicine, St Louis, Missouri
| | | | - Nikki H. Stricker
- Division of Neurocognitive Disorders, Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota
| | - Erik D. Roberson
- Alzheimer’s Disease Center, Center for Neurodegeneration and Experimental Therapeutics, Department of Neurology, University of Alabama at Birmingham, Birmingham
| | - Carol Chambless
- Alzheimer’s Disease Center, Center for Neurodegeneration and Experimental Therapeutics, Department of Neurology, University of Alabama at Birmingham, Birmingham
| | - Adam Gersteneker
- Division of Neuropsychology, Department of Neurology, The University of Alabama at Birmingham, Birmingham
| | - Roy Martin
- Division of Neuropsychology, Department of Neurology, The University of Alabama at Birmingham, Birmingham
| | - Richard Kennedy
- Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, University of Alabama at Birmingham, Birmingham
| | - Yue Zhang
- Alzheimer’s Disease Center, Center for Neurodegeneration and Experimental Therapeutics, Department of Neurology, University of Alabama at Birmingham, Birmingham
| | - Walter Kukull
- Department of Epidemiology, University of Washington, Seattle
- National Alzheimer’s Coordinating Center, Seattle, Washington
| | - Derek Flenniken
- Northern California Institute for Research and Education, Department of Veterans Affairs Medical Center, San Francisco
| | - Juliet Fockler
- Department of Radiology and Biomedical Imaging, University of California, San Francisco
| | - Diana Truran
- Northern California Institute for Research and Education, Department of Veterans Affairs Medical Center, San Francisco
| | - R. Scott Mackin
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco
- Northern California Institute for Research and Education, Department of Veterans Affairs Medical Center, San Francisco
| | - Michael W. Weiner
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco
- Department of Radiology and Biomedical Imaging, University of California, San Francisco
- Northern California Institute for Research and Education, Department of Veterans Affairs Medical Center, San Francisco
| | - John C. Morris
- Knight Alzheimer’s Disease Research Center, Department of Neurology, Washington University School of Medicine, St Louis, Missouri
| | - Yan Li
- Knight Alzheimer’s Disease Research Center, Department of Neurology, Washington University School of Medicine, St Louis, Missouri
- Department of Biostatistics, Washington University School of Medicine, St Louis, Missouri
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