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Meng W, Inampudi R, Zhang X, Xu J, Huang Y, Xie M, Bian J, Yin R. An Interpretable Population Graph Network to Identify Rapid Progression of Alzheimer's Disease Using UK Biobank. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.03.27.24304966. [PMID: 38585886 PMCID: PMC10996760 DOI: 10.1101/2024.03.27.24304966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
Alzheimer's disease (AD) manifests with varying progression rates across individuals, necessitating the understanding of their intricate patterns of cognition decline that could contribute to effective strategies for risk monitoring. In this study, we propose an innovative interpretable population graph network framework for identifying rapid progressors of AD by utilizing patient information from electronic health-related records in the UK Biobank. To achieve this, we first created a patient similarity graph, in which each AD patient is represented as a node; and an edge is established by patient clinical characteristics distance. We used graph neural networks (GNNs) to predict rapid progressors of AD and created a GNN Explainer with SHAP analysis for interpretability. The proposed model demonstrates superior predictive performance over the existing benchmark approaches. We also revealed several clinical features significantly associated with the prediction, which can be used to aid in effective interventions for the progression of AD patients.
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Affiliation(s)
- Weimin Meng
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, FL, USA
| | - Rohit Inampudi
- Department of Computer Science and Engineering, University of Florida, Gainesville, FL, USA
| | - Xiang Zhang
- Department of Computer Science, University of North Carolina at Charlotte, Charlotte, NC, US
| | - Jie Xu
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, FL, USA
| | - Yu Huang
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, FL, USA
| | - Mingyi Xie
- Department of Biochemistry and Molecular Biology, University of Florida, Gainesville, FL, USA
| | - Jiang Bian
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, FL, USA
| | - Rui Yin
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, FL, USA
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Tuena C, Serino S, Stramba-Badiale C, Pedroli E, Goulene KM, Stramba-Badiale M, Riva G. Usability of an Embodied CAVE System for Spatial Navigation Training in Mild Cognitive Impairment. J Clin Med 2023; 12:jcm12051949. [PMID: 36902733 PMCID: PMC10003531 DOI: 10.3390/jcm12051949] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 02/23/2023] [Accepted: 02/28/2023] [Indexed: 03/06/2023] Open
Abstract
Individuals with mild cognitive impairment (MCI) usually report navigation and spatial memory impairments. Spatial navigation is an embodied process that requires the active involvement of both physical (e.g., motor commands and proprioception) and cognitive (e.g., decision-making and mental rotation) information. Immersive virtual reality (IVR) is a valuable tool that employs this information as real-world navigation does. Given the crucial impact of spatial navigation on daily life, research should focus on ways to enhance it. Though they are still in their development, contemporary IVR methods for spatial navigation training in MCI seem promising. In this usability study, eight patients with MCI syndrome tested an IVR spatial navigation training demo and interacted with the CAVE using active stereo glasses, a foot-motion pad, and a joypad. During the demo, users were asked to report their impressions on the IVR training using the thinking-aloud procedure. Moreover, questionnaires regarding usability, presence and cybersickness were administered at the end of the experience. Our results show that the first version of this system is usable by the patients even if most of them did not have experience with PC/IVR. The system provided a moderate sense of spatial presence and limited negative effects. Issues found during the thinking-aloud procedure concerned the visual aspects, which affected the interaction user-system. Participants reported that they needed more practice with the foot-motion pad even though the overall experience was positively evaluated. Identifying these critical features was essential to develop an improved version of the current system.
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Affiliation(s)
- Cosimo Tuena
- Applied Technology for Neuro-Psychology Lab, IRCCS Istituto Auxologico Italiano, Via Magnasco 2, 20149 Milan, Italy
- Correspondence: ; Tel.: +39-02-61-911-2726
| | - Silvia Serino
- Department of Psychology, Università Cattolica del Sacro Cuore, Largo Gemelli, 1, 20121 Milan, Italy
| | - Chiara Stramba-Badiale
- Applied Technology for Neuro-Psychology Lab, IRCCS Istituto Auxologico Italiano, Via Magnasco 2, 20149 Milan, Italy
| | - Elisa Pedroli
- Applied Technology for Neuro-Psychology Lab, IRCCS Istituto Auxologico Italiano, Via Magnasco 2, 20149 Milan, Italy
- Faculty of Psychology, Università eCampus, Via Isimbardi 10, 22060 Novedrate, Italy
| | - Karine Marie Goulene
- Department of Geriatrics and Cardiovascular Medicine, IRCCS Istituto Auxologico Italiano, Via Mosè Bianchi 90, 20149 Milan, Italy
| | - Marco Stramba-Badiale
- Department of Geriatrics and Cardiovascular Medicine, IRCCS Istituto Auxologico Italiano, Via Mosè Bianchi 90, 20149 Milan, Italy
| | - Giuseppe Riva
- Applied Technology for Neuro-Psychology Lab, IRCCS Istituto Auxologico Italiano, Via Magnasco 2, 20149 Milan, Italy
- Humane Technology Lab, Università Cattolica del Sacro Cuore, Largo Gemelli, 1, 20121 Milan, Italy
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Rivas-Fernández MÁ, Lindín M, Zurrón M, Díaz F, Aldrey-Vázquez JM, Pías-Peleteiro JM, Vázquez-Vázquez L, Pereiro AX, Lojo-Seoane C, Nieto-Vieites A, Galdo-Álvarez S. Brain Atrophy and Clinical Characterization of Adults With Mild Cognitive Impairment and Different Cerebrospinal Fluid Biomarker Profiles According to the AT(N) Research Framework of Alzheimer’s Disease. Front Hum Neurosci 2022; 16:799347. [PMID: 35280203 PMCID: PMC8914376 DOI: 10.3389/fnhum.2022.799347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 01/10/2022] [Indexed: 12/05/2022] Open
Abstract
Introduction This study aimed to evaluate, in adults with mild cognitive impairment (MCI), the brain atrophy that may distinguish between three AT(N) biomarker-based profiles, and to determine its clinical value. Methods Structural MRI (sMRI) was employed to evaluate the volume and cortical thickness differences in MCI patients with different AT(N) profiles, namely, A−T−(N)−: normal AD biomarkers; A+T−(N)−: AD pathologic change; and A+T+(N)+: prodromal AD. Sensitivity and specificity of these changes were also estimated. Results An initial atrophy in medial temporal lobe (MTL) areas was found in the A+T−(N)− and A+T+(N)+ groups, spreading toward the parietal and frontal regions in A+T+(N)+ patients. These structural changes allowed distinguishing AT(N) profiles within the AD continuum; however, the profiles and their pattern of neurodegeneration were unsuccessful to determine the current clinical status. Conclusion sMRI is useful in the determination of the specific brain structural changes of AT(N) profiles along the AD continuum, allowing differentiation between MCI adults with or without pathological AD biomarkers.
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Affiliation(s)
- Miguel Ángel Rivas-Fernández
- Department of Clinical Psychology and Psychobiology, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
- *Correspondence: Miguel Ángel Rivas-Fernández,
| | - Mónica Lindín
- Department of Clinical Psychology and Psychobiology, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
| | - Montserrat Zurrón
- Department of Clinical Psychology and Psychobiology, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
| | - Fernando Díaz
- Department of Clinical Psychology and Psychobiology, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
| | - José Manuel Aldrey-Vázquez
- Neurology Service, Santiago Clinic Hospital (CHUS), Santiago de Compostela, Spain
- NeuroAging Group (NEURAL), Clinical Neurosciences Research Laboratory (LINC), Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Juan Manuel Pías-Peleteiro
- Neurology Service, Santiago Clinic Hospital (CHUS), Santiago de Compostela, Spain
- NeuroAging Group (NEURAL), Clinical Neurosciences Research Laboratory (LINC), Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Laura Vázquez-Vázquez
- NeuroAging Group (NEURAL), Clinical Neurosciences Research Laboratory (LINC), Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Arturo Xosé Pereiro
- Department of Developmental and Educational Psychology, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
| | - Cristina Lojo-Seoane
- Department of Developmental and Educational Psychology, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
| | - Ana Nieto-Vieites
- Department of Developmental and Educational Psychology, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
| | - Santiago Galdo-Álvarez
- Department of Clinical Psychology and Psychobiology, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
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Campos-Magdaleno M, Leiva D, Pereiro AX, Lojo-Seoane C, Mallo SC, Facal D, Juncos-Rabadán O. Changes in visual memory in mild cognitive impairment: a longitudinal study with CANTAB. Psychol Med 2021; 51:2465-2475. [PMID: 32375918 DOI: 10.1017/s0033291720001142] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Mild cognitive impairment (MCI), as a stage in the cognitive continuum between normal ageing and dementia, is mainly characterized by memory impairment. The aims of this study were to examine CANTAB measures of temporal changes of visual memory in MCI and to evaluate the usefulness of the baseline scores for predicting changes in cognitive status. METHODS The study included 201 participants aged over 50 years with subjective cognitive complaints. Visual memory was assessed with four CANTAB tests [paired associates learning (PAL), delayed matching to sample (DMS), pattern recognition memory (PRM) and spatial span (SSP)] administered at baseline and on two further occasions, with a follow-up interval of 18-24 months. Participants were divided into three groups according to the change in their cognitive status: participants with subjective cognitive complaints who remained stable, MCI participants who remained stable (MCI-Stable) and MCI participants whose cognitive deterioration continued (MCI-Worsened). Linear mixed models were used to model longitudinal changes, with evaluation time as a fixed variable, and multinomial regression models were used to predict changes in cognitive status. RESULTS Isolated significant effects were obtained for age and group with all CANTAB tests used. Interactions between evaluation time and group were identified in the PAL and DMS tests, indicating different temporal patterns depending on the changes in cognitive status. Regression models also indicated that CANTAB scores were good predictors of changes in cognitive status. CONCLUSIONS Decline in visual memory measured by PAL and DMS tests can successfully distinguish different types of MCI, and considered together PAL, DMS, PRM and SSP can predict changes in cognitive status.
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Affiliation(s)
- María Campos-Magdaleno
- Department of Developmental Psychology, University of Santiago de Compostela, Galicia, Spain
| | - David Leiva
- Department of Methodology of Behavioural Sciences, University of Barcelona, Catalunya, Spain
| | - Arturo X Pereiro
- Department of Developmental Psychology, University of Santiago de Compostela, Galicia, Spain
| | - Cristina Lojo-Seoane
- Department of Developmental Psychology, University of Santiago de Compostela, Galicia, Spain
| | - Sabela C Mallo
- Department of Developmental Psychology, University of Santiago de Compostela, Galicia, Spain
| | - David Facal
- Department of Developmental Psychology, University of Santiago de Compostela, Galicia, Spain
| | - Onésimo Juncos-Rabadán
- Department of Developmental Psychology, University of Santiago de Compostela, Galicia, Spain
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Zuckermann AM, Gohari MR, de Groh M, Jiang Y, Leatherdale ST. Cannabis cessation among youth: rates, patterns and academic outcomes in a large prospective cohort of Canadian high school students. HEALTH PROMOTION AND CHRONIC DISEASE PREVENTION IN CANADA-RESEARCH POLICY AND PRACTICE 2021; 40:95-103. [PMID: 32270667 DOI: 10.24095/hpcdp.40.4.01] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Following cannabis legalization in Canada, a better understanding of the prevalence of unprompted cannabis use reduction and subsequent effects on youth academic outcomes is needed to inform harm reduction and health promotion approaches. METHODS We analyzed a longitudinally linked sample (n = 91774) from the COMPASS prospective cohort study of Canadian high school students attending Grades 9-12 in Ontario and Alberta between 2013-2014 and 2016-2017. We investigated the prevalence of spontaneous cannabis use reduction and cessation between grade transitions (Grades 9-10, 10-11, 11-12) and the effect of cessation on academic achievement (current or recent math and English course marks) and rigour (usual homework completion and past-month truancy). RESULTS Only 14.8% of cannabis users decreased their use between grades. Of these, two-thirds made only incremental downward changes, a pattern which held true for all three transitions. Cessation rates from daily and weekly use decreased every year. After cessation, students had better odds than continuing users (OR = 1.23, 95% CI: 1.03- 1.48) and worse odds than never-users (OR = 0.55, 95% CI: 0.31-0.97) for some subcategories of math performance. Students who quit cannabis universally improved class attendance (OR = 2.48, 95% CI: 1.93-3.19) and homework completion (OR = 2.32, 95% CI: 1.85-2.92) compared to continuing users. CONCLUSION Increased academic rigour may underlie any improvements seen in academic performance after cannabis cessation. High school students who use cannabis likely need targeted support to facilitate reduction or cessation and subsequent academic recovery. This indicates that a school-based focus on cannabis harm reduction is justified.
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Affiliation(s)
- Alexandra M Zuckermann
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada.,Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Mahmood R Gohari
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | | | - Ying Jiang
- Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Scott T Leatherdale
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
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Cognitive reserve and working memory in cognitive performance of adults with subjective cognitive complaints: longitudinal structural equation modeling. Int Psychogeriatr 2020; 32:515-524. [PMID: 31547899 DOI: 10.1017/s1041610219001248] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To study the influence of cognitive reserve (CR) on cognitive performance of individuals with subjective cognitive complaints (SCCs) within a period of 36 months. DESIGN We used a general linear model repeated measures procedure to analyze the differences in performance between three assessments. We used a longitudinal structural equation modeling to analyze the relationship between CR and cognitive performance at baseline and at two follow-up assessments. SETTING Participants with SCCs were recruited and assessed in primary care health centers. PARTICIPANTS A total of 212 participants older than 50 years with SCCs. MEASUREMENTS Cognitive reserve data were collected with an ad hoc questionnaire administered to the subjects in an interview. General cognitive performance (GCP), episodic memory (EM), and working memory (WM) have been evaluated. The Mini-Mental State Examination and the total score of Spanish version of the Cambridge Cognitive Examination evaluated the GCP. Episodic memory was assessed with the Spanish version of the California Verbal Learning. Working memory was evaluated by the counting span task and the listening span task. RESULTS The satisfactory fit of the proposed model confirmed the direct effects of CR on WM and GCP at baseline, as well as indirect effects on EM and WM at first and second follow-up. Indirect effects of CR on other cognitive constructs via WM were observed over time. CONCLUSION The proposed model is useful for measuring the influence of CR on cognitive performance over time. Cognitive response acquired throughout life may influence cognitive performance in old age and prevent cognitive deterioration, thus increasing processing resources via WM.
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Campos-Magdaleno M, Leiva D, Pereiro AX, Lojo-Seoane C, Mallo SC, Nieto-Vieites A, Juncos-Rabadán O, Facal D. Longitudinal Patterns of the Tip-of-the-Tongue Phenomenon in People With Subjective Cognitive Complaints and Mild Cognitive Impairment. Front Psychol 2020; 11:425. [PMID: 32231626 PMCID: PMC7083146 DOI: 10.3389/fpsyg.2020.00425] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 02/24/2020] [Indexed: 11/24/2022] Open
Abstract
Background The Tip-of-the-Tongue (ToTs) state is considered a universal phenomenon and is a frequent cognitive complaint in old age. Previous cross-sectional studies have found that ToT measures successfully discriminate between cognitively unimpaired adults and adults with Mild Cognitive Impairment (MCI). The aim of this study was to identify longitudinal patterns of ToTs in individuals with subjective complaints and with MCI regarding progress of their cognitive status. Method The study included 193 participants with subjective cognitive complaints (SCC) and 56 participants with MCI who completed a baseline and two follow-up assessments, with an interval of about 18 months between each assessment. Participants were classified into three groups by considering cognitive stability or deterioration from the baseline diagnosis: SCC-stable, MCI-stable and MCI-worsened. Participants performed a ToT task involving recognition and naming of famous people depicted in 50 photographs. Generalized Linear Mixed Models (GLMM) were used to model longitudinal changes in familiarity, feeling of knowing, semantic access, phonological access and verbal fluency. Results Phonological access differentiated MCI patients, stable and worsened, from adults with SCCs at all evaluation times. Phonological access declined over time in the three groups, without significant interactions between groups and time. Discussion This study provides the first longitudinal evidence of differences in ToT measures for adults with MCI. The findings indicate that phonological access measures successfully differentiated between the diagnostic groups. However, slopes remain irrespective of the diagnostic group and progression toward more advance stages of cognitive impairment.
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Affiliation(s)
- María Campos-Magdaleno
- Department of Developmental Psychology, University of Santiago de Compostela, Galicia, Spain
| | - David Leiva
- Department of Social Psychology and Quantitative Psychology, Institute of Neurosciences, University of Barcelona, Barcelona, Spain
| | - Arturo X Pereiro
- Department of Developmental Psychology, University of Santiago de Compostela, Galicia, Spain
| | - Cristina Lojo-Seoane
- Department of Developmental Psychology, University of Santiago de Compostela, Galicia, Spain
| | - Sabela C Mallo
- Department of Developmental Psychology, University of Santiago de Compostela, Galicia, Spain
| | - Ana Nieto-Vieites
- Department of Developmental Psychology, University of Santiago de Compostela, Galicia, Spain
| | - Onésimo Juncos-Rabadán
- Department of Developmental Psychology, University of Santiago de Compostela, Galicia, Spain
| | - David Facal
- Department of Developmental Psychology, University of Santiago de Compostela, Galicia, Spain
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Neuropsychiatric symptoms as predictors of conversion from MCI to dementia: a machine learning approach. Int Psychogeriatr 2020; 32:381-392. [PMID: 31455461 DOI: 10.1017/s1041610219001030] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES To use a Machine Learning (ML) approach to compare Neuropsychiatric Symptoms (NPS) in participants of a longitudinal study who developed dementia and those who did not. DESIGN Mann-Whitney U and ML analysis. Nine ML algorithms were evaluated using a 10-fold stratified validation procedure. Performance metrics (accuracy, recall, F-1 score, and Cohen's kappa) were computed for each algorithm, and graphic metrics (ROC and precision-recall curves) and features analysis were computed for the best-performing algorithm. SETTING Primary care health centers. PARTICIPANTS 128 participants: 78 cognitively unimpaired and 50 with MCI. MEASUREMENTS Diagnosis at baseline, months from the baseline assessment until the 3rd follow-up or development of dementia, gender, age, Charlson Comorbidity Index, Neuropsychiatric Inventory-Questionnaire (NPI-Q) individual items, NPI-Q total severity, and total stress score and Geriatric Depression Scale-15 items (GDS-15) total score. RESULTS 30 participants developed dementia, while 98 did not. Most of the participants who developed dementia were diagnosed at baseline with amnestic multidomain MCI. The Random Forest Plot model provided the metrics that best predicted conversion to dementia (e.g. accuracy=.88, F1=.67, and Cohen's kappa=.63). The algorithm indicated the importance of the metrics, in the following (decreasing) order: months from first assessment, age, the diagnostic group at baseline, total NPI-Q severity score, total NPI-Q stress score, and GDS-15 total score. CONCLUSIONS ML is a valuable technique for detecting the risk of conversion to dementia in MCI patients. Some NPS proxies, including NPI-Q total severity score, NPI-Q total stress score, and GDS-15 total score, were deemed as the most important variables for predicting conversion, adding further support to the hypothesis that some NPS are associated with a higher risk of dementia in MCI.
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Mallo SC, Patten SB, Ismail Z, Pereiro AX, Facal D, Otero C, Juncos-Rabadán O. Does the neuropsychiatric inventory predict progression from mild cognitive impairment to dementia? A systematic review and meta-analysis. Ageing Res Rev 2020; 58:101004. [PMID: 31881368 DOI: 10.1016/j.arr.2019.101004] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 10/22/2019] [Accepted: 12/23/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Neuropsychiatric Symptoms (NPS) are common in Mild Cognitive Impairment (MCI). The Neuropsychiatric Inventory (NPI) and its shorter version, the Neuropsychiatric Inventory Questionnaire (NPI-Q), are the most common measures to assess NPS. Our objective was to determine if NPI/NPI-Q ratings predict conversion from MCI to dementia. METHODS Empirical longitudinal studies published in English or Spanish, concerned with the role of NPS as a risk factor for conversion from MCI to dementia, with a diagnosis of MCI following clinical criteria, that reported NPI/NPI-Q total score in converters versus non-converters, were included. Random effects models were used, and heterogeneity was explored with stratification and a random-effects meta-regression. The overall conversion rate and the standardized mean difference (SMD) for evolution, as a function of NPI/NPI-Q scores, were calculated. RESULTS The overall conversion rate was 35 %. Mean NPI/NPI-Q ratings were higher in converters versus in non-converters, with the overall SMD approaching significance. Heterogeneity was observed in studies of more than two years of follow-up and in a study with a mean age of more than 80 years. This heterogeneity concerned the size, not the direction of the difference. CONCLUSIONS Our results suggest that NPI/NPI-Q ratings are associated with conversion from MCI to dementia.
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Picón E, Juncos-Rabadán O, Lojo-Seoane C, Campos-Magdaleno M, Mallo SC, Nieto-Vietes A, Pereiro AX, Facal D. Does Empirically Derived Classification of Individuals with Subjective Cognitive Complaints Predict Dementia? Brain Sci 2019; 9:brainsci9110314. [PMID: 31703450 PMCID: PMC6895967 DOI: 10.3390/brainsci9110314] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 10/28/2019] [Accepted: 11/05/2019] [Indexed: 11/16/2022] Open
Abstract
(1) Background: Early identification of mild cognitive impairment (MCI) in people reporting subjective cognitive complaints (SCC) and the study of progression of cognitive decline are important issues in dementia research. This paper examines whether empirically derived procedures predict progression from MCI to dementia. (2) Methods: At baseline, 192 participants with SCC were diagnosed according to clinical criteria as cognitively unimpaired (70), single-domain amnestic MCI (65), multiple-domain amnestic MCI (33) and multiple-domain non-amnestic MCI (24). A two-stage hierarchical cluster analysis was performed for empirical classification. Categorical regression analysis was then used to assess the predictive value of the clusters obtained. Participants were re-assessed after 36 months. (3) Results: Participants were grouped into four empirically derived clusters: Cluster 1, similar to multiple-domain amnestic MCI; Cluster 2, characterized by subjective cognitive decline (SCD) but with low scores in language and working memory; Cluster 3, with specific deterioration in episodic memory, similar to single-domain amnestic MCI; and Cluster 4, with SCD but with scores above the mean in all domains. The majority of participants who progressed to dementia were included in Cluster 1. (4) Conclusions: Cluster analysis differentiated between MCI and SCD in a sample of people with SCC and empirical criteria were more closely associated with progression to dementia than standard criteria.
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Affiliation(s)
- Eduardo Picón
- Department of Methodology of Behavioral Sciences, University of Santiago de Compostela, 15782 Santiago de Compostela, Galicia, Spain;
| | - Onésimo Juncos-Rabadán
- Department of Developmental Psychology, University of Santiago de Compostela, 15782 Santiago de Compostela, Galicia, Spain; (O.J.-R.); (C.L.-S.); (M.C.-M.); (S.C.M.); (A.X.P.)
| | - Cristina Lojo-Seoane
- Department of Developmental Psychology, University of Santiago de Compostela, 15782 Santiago de Compostela, Galicia, Spain; (O.J.-R.); (C.L.-S.); (M.C.-M.); (S.C.M.); (A.X.P.)
| | - María Campos-Magdaleno
- Department of Developmental Psychology, University of Santiago de Compostela, 15782 Santiago de Compostela, Galicia, Spain; (O.J.-R.); (C.L.-S.); (M.C.-M.); (S.C.M.); (A.X.P.)
| | - Sabela C. Mallo
- Department of Developmental Psychology, University of Santiago de Compostela, 15782 Santiago de Compostela, Galicia, Spain; (O.J.-R.); (C.L.-S.); (M.C.-M.); (S.C.M.); (A.X.P.)
| | - Ana Nieto-Vietes
- Department of Developmental Psychology, University of Santiago de Compostela, 15782 Santiago de Compostela, Galicia, Spain; (O.J.-R.); (C.L.-S.); (M.C.-M.); (S.C.M.); (A.X.P.)
| | - Arturo X. Pereiro
- Department of Developmental Psychology, University of Santiago de Compostela, 15782 Santiago de Compostela, Galicia, Spain; (O.J.-R.); (C.L.-S.); (M.C.-M.); (S.C.M.); (A.X.P.)
| | - David Facal
- Department of Developmental Psychology, University of Santiago de Compostela, 15782 Santiago de Compostela, Galicia, Spain; (O.J.-R.); (C.L.-S.); (M.C.-M.); (S.C.M.); (A.X.P.)
- Correspondence:
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Facal D, Guàrdia-Olmos J, Pereiro AX, Lojo-Seoane C, Peró M, Juncos-Rabadán O. Using an Overlapping Time Interval Strategy to Study Diagnostic Instability in Mild Cognitive Impairment Subtypes. Brain Sci 2019; 9:brainsci9090242. [PMID: 31546979 PMCID: PMC6770378 DOI: 10.3390/brainsci9090242] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 09/17/2019] [Accepted: 09/18/2019] [Indexed: 12/02/2022] Open
Abstract
(1) Background: Mild cognitive impairment (MCI) is a diagnostic label in which stability is typically low. The aim of this study was to examine temporal changes in the diagnosis of MCI subtypes by using an overlapping-time strategy; (2) Methods: The study included 435 participants aged over 50 years with subjective cognitive complaints and who completed at least one follow-up evaluation. The probability of transition was estimated using Bayesian odds ratios; (3) Results: Within the different time intervals, the controls with subjective cognitive complaints represented the largest proportion of participants, followed by sda-MCI at baseline and in the first five intervals of the follow-up, but not in the last eight intervals. The odds ratios indicated higher odds of conversion to dementia in sda-MCI and mda-MCI groups relative to na-MCI (e.g., interval 9–15 months—sda-MCI OR = 9 and mda-MCI OR = 3.36; interval 27–33—sda-MCI OR = 16 and mda-MCI = 5.06; interval 42–48—sda-MCI OR = 8.16 and mda-MCI = 3.45; interval 45–51—sda-MCI OR = 3.31 and mda-MCI = 1); (4) Conclusions: Notable patterns of instability consistent with the current literature were observed. The limitations of a prospective approach in the study of MCI transitions are discussed.
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Affiliation(s)
- David Facal
- Department of Developmental Psychology, University de Santiago de Compostela, 15782 Santiago de Compostela, Galicia, Spain.
| | - Joan Guàrdia-Olmos
- Department of Methodology of Behavioural Sciences, University of Barcelona, 08035 Barcelona, Catalunya, Spain.
| | - Arturo X Pereiro
- Department of Developmental Psychology, University de Santiago de Compostela, 15782 Santiago de Compostela, Galicia, Spain.
| | - Cristina Lojo-Seoane
- Department of Developmental Psychology, University de Santiago de Compostela, 15782 Santiago de Compostela, Galicia, Spain.
| | - Maribel Peró
- Department of Methodology of Behavioural Sciences, University of Barcelona, 08035 Barcelona, Catalunya, Spain.
| | - Onésimo Juncos-Rabadán
- Department of Developmental Psychology, University de Santiago de Compostela, 15782 Santiago de Compostela, Galicia, Spain.
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12
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Facal D, Valladares-Rodriguez S, Lojo-Seoane C, Pereiro AX, Anido-Rifon L, Juncos-Rabadán O. Machine learning approaches to studying the role of cognitive reserve in conversion from mild cognitive impairment to dementia. Int J Geriatr Psychiatry 2019; 34:941-949. [PMID: 30854737 DOI: 10.1002/gps.5090] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 03/05/2019] [Indexed: 01/01/2023]
Abstract
OBJECTIVES The overall aim of the present study was to explore the role of cognitive reserve (CR) in the conversion from mild cognitive impairment (MCI) to dementia. We used traditional and machine learning (ML) techniques to compare converter and nonconverter participants. We also discuss the predictive value of CR proxies in relation to the ML model performance. METHODS In total, 169 participants completed the longitudinal study. Participants were divided into a control group and three MCI subgroups, according to the Petersen criteria for diagnosis. Information about the participants was compared using nine ML classification techniques. Seven relevant performance metrics were computed in order to evaluate the accuracy of prediction regarding converter and nonconverter participants. RESULTS ML algorithms applied to socio-demographic, basic health, and CR proxy data enabled prediction of conversion to dementia. The best performing models were the gradient boosting classifier (accuracy (ACC) = 0.93; F1 = 0.86, and Cohen κ = 0.82) and random forest classifier (ACC = 0.92; F1 = 0.79, and Cohen κ = 0.71). Use of ML techniques corroborated the protective role of CR as a mediator of conversion to dementia, whereby participants with more years of education and higher vocabulary scores survived longer without developing dementia. CONCLUSIONS We used ML approaches to explore the role of CR in conversion from MCI to dementia. The findings indicate the potential value of ML algorithms for detecting risk of conversion to dementia in cognitive aging and CR studies. Further research is required to develop an ML-based procedure that can be used to make robust predictions.
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Affiliation(s)
- David Facal
- Department of Developmental and Educational Psychology, University of Santiago de Compostela, Santiago de Compostela, Spain
| | | | - Cristina Lojo-Seoane
- Department of Developmental and Educational Psychology, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Arturo X Pereiro
- Department of Developmental and Educational Psychology, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Luis Anido-Rifon
- School of Telecommunication Engineering, University of Vigo, Vigo, Spain
| | - Onésimo Juncos-Rabadán
- Department of Developmental and Educational Psychology, University of Santiago de Compostela, Santiago de Compostela, Spain
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13
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Valladares-Rodriguez S, Fernández-Iglesias MJ, Anido-Rifón L, Facal D, Rivas-Costa C, Pérez-Rodríguez R. Touchscreen games to detect cognitive impairment in senior adults. A user-interaction pilot study. Int J Med Inform 2019; 127:52-62. [PMID: 31128832 DOI: 10.1016/j.ijmedinf.2019.04.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 09/12/2018] [Accepted: 04/15/2019] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Alzheimer's disease is a degenerative brain disease and the most common cause of dementia. Today, 47 million people live with dementia worldwide. This number is projected to increase to more than 131 million by 2050, as populations age. Therefore, the World Health Organization considers serious cognitive deterioration a public health priority. OBJECTIVES Advanced cognitive evaluation mechanisms are needed to help make an early diagnosis. These new mechanisms should overcome the limitations of current neuropsychological tests, including delayed detection; being perceived as intrusive; being non-ecological; being dependent on confounding factors; or their administration being expensive, among others. A promising novel approach consists of the introduction of serious games based on virtual reality and machine learning able to assess cognitive traits relevant to the diagnosis of mild cognitive impairment and Alzheimer's disease. METHODS As a result of a preliminary pilot experiment, promising evidence was obtained about the predictive power of this solution. However, for these new serious games to be effective, evidence has to be gathered on the player experience by senior adults, avoiding the limitations of traditional tests at the same time. This study addresses these aspects with the participation of 74 senior users and 15 test administrators. RESULTS Main findings confirm the usability and playability of Panoramix, a game battery designed according to the principles discussed above, its technological acceptability and its accessibility. For example, in relation to acceptability, the game battery was scored 4.39 in a 5-point scale, while its average usability score was 4.45 regardless of socio-cultural level or previous experience with digital technologies. In addition, health professionals confirm both, usability and playability, levels with an average score of 6.5 in a 7-point scale. Participants' willingness of using this kind of systems for cognitive evaluation was also confirmed. CONCLUSION Promising results obtained pave the way for additional work to confirm the diagnostic validity according to clinical standards of these new cognitive assessment tools.
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Affiliation(s)
| | | | - Luis Anido-Rifón
- Department of Telematics Engineering, University of Vigo, Vigo, Spain
| | - David Facal
- Department of Developmental Psychology, Universidad de Santiago de Compostela, Santiago de Compostela, Spain
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14
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Valladares-Rodriguez S, Fernández-Iglesias MJ, Anido-Rifón L, Facal D, Pérez-Rodríguez R. Episodix: a serious game to detect cognitive impairment in senior adults. A psychometric study. PeerJ 2018; 6:e5478. [PMID: 30202646 PMCID: PMC6129148 DOI: 10.7717/peerj.5478] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 07/30/2018] [Indexed: 12/20/2022] Open
Abstract
Introduction Assessment of episodic memory is traditionally used to evaluate potential cognitive impairments in senior adults. The present article discusses the capabilities of Episodix, a game to assess the aforementioned cognitive area, as a valid tool to discriminate among mild cognitive impairment (MCI), Alzheimer’s disease (AD) and healthy individuals (HC); that is, it studies the game’s psychometric validity study to assess cognitive impairment. Materials and Methods After a preliminary study, a new pilot study, statistically significant for the Galician population, was carried out from a cross-sectional sample of senior adults as target users. A total of 64 individuals (28 HC, 16 MCI, 20 AD) completed the experiment from an initial sample of 74. Participants were administered a collection of classical pen-and-paper tests and interacted with the games developed. A total of six machine learning classification techniques were applied and four relevant performance metrics were computed to assess the classification power of the tool according to participants’ cognitive status. Results According to the classification performance metrics computed, the best classification result is obtained using the Extra Trees Classifier (F1 = 0.97 and Cohen’s kappa coefficient = 0.97). Precision and recall values are also high, above 0.9 for all cognitive groups. Moreover, according to the standard interpretation of Cohen’s kappa index, classification is almost perfect (i.e., 0.81–1.00) for the complete dataset for all algorithms. Limitations Weaknesses (e.g., accessibility, sample size or speed of stimuli) detected during the preliminary study were addressed and solved. Nevertheless, additional research is needed to improve the resolution of the game for the identification of specific cognitive impairments, as well as to achieve a complete validation of the psychometric properties of the digital game. Conclusion Promising results obtained about psychometric validity of Episodix, represent a relevant step ahead towards the introduction of serious games and machine learning in regular clinical practice for detecting MCI or AD. However, more research is needed to explore the introduction of item response theory in this game and to obtain the required normative data for clinical validity.
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Affiliation(s)
| | | | - Luis Anido-Rifón
- Department of Telematics Engineering, Universidad de Vigo, Vigo, Spain
| | - David Facal
- Department of Developmental Psychology, Universidad de Santiago de Compostela, Santiago de Compostela, Spain
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15
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Pavão Martins I, Maruta C, Morgado J, Loureiro C, Tavares J, Freitas V, Lunet N, Viana P, Marques P. Predictors of cognitive stability or decline during aging: A longitudinal study in primary care. APPLIED NEUROPSYCHOLOGY-ADULT 2018; 27:22-34. [PMID: 30183358 DOI: 10.1080/23279095.2018.1476866] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
We aimed to identify the early predictors of cognitive decline, and primary care physicians' (PCP) ability to diagnose cognitively impaired subjects, in a cohort of individuals recruited in primary care centers. Independent adults, aged ≥50 years at inception, with an overall low level of education, undertook a prospective clinical and cognitive evaluation targeting memory, attention and executive functions. At follow-up subjects were classified as cognitively normal (CN) or impaired (CI). Of 275 subjects (70.4 ± 8.3 years old, 176 females, 7.5 ± 4.4 education, 162 with MRI), 31 (11.2%) presented CI 4.9 years later, the majority (64.5%) presenting subjective cognitive complaints. PCP could correctly identify 40% of CI individuals, particularly if they presented current cognitive complaints. Male sex (OR = 3.117; CI95%: 1.007-9.645), age (OR = 1.063; CI95%: 1.004-1.126) and baseline scores on TMT-B (OR = 0.225; CI95%: 0.073-0.688) and Vocabulary (OR = 0.940; 95% CI: 0.894-0.986) predicted CI. This study shows that measures indicating poor cognitive reserve and low executive performance (as shown by low vocabulary and executive test scores, respectively) can be early indicators of the risk of decline, stressing the role of cognitive assessment as part of prevention/early intervention programs. The results also underline the need to help PCP to improve the detection of subjects with cognitive decline.
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Affiliation(s)
- Isabel Pavão Martins
- Language Research Laboratory, Department of Clinical Neurosciences, Institute of Molecular Medicine, Faculty of Medicine, University of Lisbon, Portugal.,Department of Neurology, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon, Portugal
| | - Carolina Maruta
- Language Research Laboratory, Department of Clinical Neurosciences, Institute of Molecular Medicine, Faculty of Medicine, University of Lisbon, Portugal
| | - Joana Morgado
- Department of Neurology, Centro Hospitalar Lisboa Central, Lisboa, Portugal
| | - Clara Loureiro
- Language Research Laboratory, Department of Clinical Neurosciences, Institute of Molecular Medicine, Faculty of Medicine, University of Lisbon, Portugal
| | - Joana Tavares
- Department of Neuro-Imaging, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon, Portugal
| | - Vanda Freitas
- Language Research Laboratory, Department of Clinical Neurosciences, Institute of Molecular Medicine, Faculty of Medicine, University of Lisbon, Portugal
| | - Nuno Lunet
- Faculty of Medicine, University of Oporto, Porto, Portugal
| | - Pedro Viana
- Department of Neurology, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon, Portugal
| | - Paulo Marques
- Instituto de Ciências da Saúde, University of Minho, Braga, Portugal
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Lojo-Seoane C, Facal D, Guàrdia-Olmos J, Pereiro AX, Juncos-Rabadán O. Effects of Cognitive Reserve on Cognitive Performance in a Follow-Up Study in Older Adults With Subjective Cognitive Complaints. The Role of Working Memory. Front Aging Neurosci 2018; 10:189. [PMID: 29997497 PMCID: PMC6028562 DOI: 10.3389/fnagi.2018.00189] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 06/05/2018] [Indexed: 12/12/2022] Open
Abstract
Objective: Analyze the effects of CR on cognitive performance in adults with subjective cognitive complaints at follow-up. Method: We analyzed the factorial structure of the three constructs defined in cognitive performance (Episodic memory, Working memory, and General cognitive performance) separately to search for evidence of the invariance of the measurement model. We then developed four structural nested models to analyze the relationship between CR and cognitive performance, measured at baseline and after approximately 18 months, in 266 participants older than 50 years with subjective cognitive complaints. Results: The nested models revealed the following main results: direct effects of CR on all cognitive constructs at baseline and also indirect effects on the same constructs at follow-up, and indirect effects of CR on other cognitive constructs at follow-up via working memory at follow-up. Conclusion: The findings show that the proposed model is useful for measuring the influence of CR on cognitive performance in follow-up studies and that CR has a positive influence on cognitive performance at follow-up via working memory. CR may enhance mechanisms of information processing, favoring performance of tasks involving other cognitive constructs in older adults with subjective cognitive complaints.
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Affiliation(s)
- Cristina Lojo-Seoane
- Department of Developmental and Educational Psychology, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
| | - David Facal
- Department of Developmental and Educational Psychology, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
| | - Joan Guàrdia-Olmos
- Department of Social Psychology and Quantitative Psychology, University of Barcelona, Barcelona, Spain
| | - Arturo X. Pereiro
- Department of Developmental and Educational Psychology, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
| | - Onésimo Juncos-Rabadán
- Department of Developmental and Educational Psychology, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
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17
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Díaz-Mardomingo MDC, García-Herranz S, Rodríguez-Fernández R, Venero C, Peraita H. Problems in Classifying Mild Cognitive Impairment (MCI): One or Multiple Syndromes? Brain Sci 2017; 7:brainsci7090111. [PMID: 28862676 PMCID: PMC5615252 DOI: 10.3390/brainsci7090111] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 07/31/2017] [Accepted: 08/29/2017] [Indexed: 12/21/2022] Open
Abstract
As the conceptual, methodological, and technological advances applied to dementias have evolved the construct of mild cognitive impairment (MCI), one problem encountered has been its classification into subtypes. Here, we aim to revise the concept of MCI and its subtypes, addressing the problems of classification not only from the psychometric point of view or by using alternative methods, such as latent class analysis, but also considering the absence of normative data. In addition to the well-known influence of certain factors on cognitive function, such as educational level and cultural traits, recent studies highlight the relevance of other factors that may significantly affect the genesis and evolution of MCI: subjective memory complaints, loneliness, social isolation, etc. The present work will contemplate the most relevant attempts to clarify the issue of MCI categorization and classification, combining our own data with that from recent studies which suggest the role of relevant psychosocial factors in MCI.
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Affiliation(s)
| | - Sara García-Herranz
- Department of Basic Psychology I, National University of Distance Education, Juan del Rosal 10, 28040 Madrid, Spain.
| | - Raquel Rodríguez-Fernández
- Department of Behavioural Sciences Methodology, National University of Distance Education, Juan del Rosal 10, 28040 Madrid, Spain.
| | - César Venero
- Department of Psychobiology, National University of Distance Education, Juan del Rosal 10, 28040 Madrid, Spain.
| | - Herminia Peraita
- Department of Basic Psychology I, National University of Distance Education, Juan del Rosal 10, 28040 Madrid, Spain.
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18
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Campos-Magdaleno M, Facal D, Lojo-Seoane C, Pereiro AX, Juncos-Rabadán O. Longitudinal Assessment of Verbal Learning and Memory in Amnestic Mild Cognitive Impairment: Practice Effects and Meaningful Changes. Front Psychol 2017; 8:1231. [PMID: 28775700 PMCID: PMC5518168 DOI: 10.3389/fpsyg.2017.01231] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Accepted: 07/05/2017] [Indexed: 11/18/2022] Open
Abstract
Objectives: To identify learning effects and meaningful changes in amnestic mild cognitive impairment (aMCI) at a follow-up assessment. Method: The Spanish version of the California Verbal Learning Test (CVLT) was administered to a sample of 274 adults of age over 50 years with subjective memory complains (SMC), including single and multiple domain aMCI groups and participants with SMC but without cognitive impairment (SMC group). The Wilcoxon test was used to compare results at baseline and after 18 months in short and long recall, and standardized regression-based (SRB) methods were used to study meaningful changes. Results: Scores were significantly higher at follow-up for short and long-delayed recall in all groups indicating generalized practice effect. SRB scores indicated a significant decline in recall in a higher proportion of participants with aMCI than in SMC group. Discussion: Patients with multiple and single domain aMCI benefit from practice in a verbal learning memory test. The SRB approach revealed a higher incidence of meaningful decline in short and long-delay recall and recognition in the aMCI groups than in the SMC group. Specifically, compared to SMC participants, single-domain aMCI individuals declined in a higher proportion in all measures, and multiple-domain aMCI individuals in long delay free recall.
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Affiliation(s)
- María Campos-Magdaleno
- Department of Developmental and Educational Psychology, University of Santiago de CompostelaSantiago de Compostela, Spain
| | - David Facal
- Department of Developmental and Educational Psychology, University of Santiago de CompostelaSantiago de Compostela, Spain
| | - Cristina Lojo-Seoane
- Department of Developmental and Educational Psychology, University of Santiago de CompostelaSantiago de Compostela, Spain
| | - Arturo X Pereiro
- Department of Developmental and Educational Psychology, University of Santiago de CompostelaSantiago de Compostela, Spain
| | - Onésimo Juncos-Rabadán
- Department of Developmental and Educational Psychology, University of Santiago de CompostelaSantiago de Compostela, Spain
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19
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Valladares-Rodriguez S, Perez-Rodriguez R, Facal D, Fernandez-Iglesias MJ, Anido-Rifon L, Mouriño-Garcia M. Design process and preliminary psychometric study of a video game to detect cognitive impairment in senior adults. PeerJ 2017; 5:e3508. [PMID: 28674661 PMCID: PMC5494179 DOI: 10.7717/peerj.3508] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 06/06/2017] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Assessment of episodic memory has been traditionally used to evaluate potential cognitive impairments in senior adults. Typically, episodic memory evaluation is based on personal interviews and pen-and-paper tests. This article presents the design, development and a preliminary validation of a novel digital game to assess episodic memory intended to overcome the limitations of traditional methods, such as the cost of its administration, its intrusive character, the lack of early detection capabilities, the lack of ecological validity, the learning effect and the existence of confounding factors. MATERIALS AND METHODS Our proposal is based on the gamification of the California Verbal Learning Test (CVLT) and it has been designed to comply with the psychometric characteristics of reliability and validity. Two qualitative focus groups and a first pilot experiment were carried out to validate the proposal. RESULTS A more ecological, non-intrusive and better administrable tool to perform cognitive assessment was developed. Initial evidence from the focus groups and pilot experiment confirmed the developed game's usability and offered promising results insofar its psychometric validity is concerned. Moreover, the potential of this game for the cognitive classification of senior adults was confirmed, and administration time is dramatically reduced with respect to pen-and-paper tests. LIMITATIONS Additional research is needed to improve the resolution of the game for the identification of specific cognitive impairments, as well as to achieve a complete validation of the psychometric properties of the digital game. CONCLUSION Initial evidence show that serious games can be used as an instrument to assess the cognitive status of senior adults, and even to predict the onset of mild cognitive impairments or Alzheimer's disease.
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Affiliation(s)
| | | | - David Facal
- Department of Developmental Psychology, Universidad de Santiago de Compostela, Santiago de Compostela, Spain
| | | | - Luis Anido-Rifon
- School of Telecommunication Engineering, University of Vigo, Vigo, Spain
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20
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Bermejo-Pareja F, Contador I, Trincado R, Lora D, Sánchez-Ferro Á, Mitchell AJ, Boycheva E, Herrero A, Hernández-Gallego J, Llamas S, Villarejo Galende A, Benito-León J. Prognostic Significance of Mild Cognitive Impairment Subtypes for Dementia and Mortality: Data from the NEDICES Cohort. J Alzheimers Dis 2016; 50:719-31. [PMID: 26757038 DOI: 10.3233/jad-150625] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The predictive value of diverse subtypes of mild cognitive impairment (MCI) for dementia and death is highly variable. OBJECTIVE To compare the predictive value of several MCI subtypes in progression to dementia and/or mortality in the NEDICES (Neurological Disorders in Central Spain) elderly cohort. METHODS Retrospect algorithmic MCI subgroups were established in a non-dementia baseline NEDICES cohort using Spanish adaptations of the original Mini-Mental State Examination (MMSE-37) and Pfeffer's Functional Activities Questionnaire (Pfeffer-11). The presence of MCI was defined according two cognitive criteria: using two cut-offs points on the total MMSE-37 score. Five cognitive domains were used to establish the MCI subtypes. Functional capacity (Pfeffer-11) was preserved or minimally impaired in all MCI participants. The incident dementia diagnoses were established by specialists and the mortality data obtained from Spanish official registries. RESULTS 3,411 participants without dementia were assessed in 1994-5. The baseline prevalence of MCI varied according to the MCI definition (4.3%-31.8%). The follow-up was a mean of 3.2 years (1997-8). The dementia incidence varied between 14.9 and 71.8 per 1,000/person-years. The dementia conversion rate was increased in almost all MCI subgroups (p > 0.01), and mortality rate was raised only in four MCI subtypes. The amnestic-multi-domain MCI (aMd-MCI) had the best dementia predictive accuracy (highest positive likelihood ratio and highest clinical utility when negative). CONCLUSIONS Those with aMd-MCI were at greatest risk of progression to dementia, as in other surveys and might be explored with increased attention in MCI research and in dementia preventive trials.
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Affiliation(s)
- Félix Bermejo-Pareja
- Consultant Neurologist of the Clinical Research Unit (Imas12), University Hospital "12 de Octubre", Madrid, Spain.,Ciberned, Carlos III Research Institute, Madrid, Spain
| | - Israel Contador
- Department of Basic Psychology, Psychobiology and Methodology of Behavioral Sciences, University of Salamanca, Spain
| | | | - David Lora
- Clinical Research Unit (Imas12- CIBERESP), University Hospital "12 de Octubre", Madrid, Spain
| | - Álvaro Sánchez-Ferro
- Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, MA, USA.,Centro Integral de Neurociencias A.C., Fundación Hospitales de Madrid, Móstoles, Madrid, Spain
| | - Alex J Mitchell
- Department of Cancer and Molecular Medicine, University of Leicester, UK
| | - Elina Boycheva
- Clinical Research Unit (Imas12- CIBERESP), University Hospital "12 de Octubre", Madrid, Spain
| | - Alejandro Herrero
- Department of Neurology, University Hospital "12 de Octubre", Madrid, Spain
| | - Jesús Hernández-Gallego
- Ciberned, Carlos III Research Institute, Madrid, Spain.,Department of Neurology, University Hospital "12 de Octubre", Madrid, Spain.,Department of Medicine, Complutense University (UCM), Madrid, Spain
| | - Sara Llamas
- Clinical Research Unit (Imas12- CIBERESP), University Hospital "12 de Octubre", Madrid, Spain
| | - Alberto Villarejo Galende
- Ciberned, Carlos III Research Institute, Madrid, Spain.,Department of Neurology, University Hospital "12 de Octubre", Madrid, Spain
| | - Julián Benito-León
- Ciberned, Carlos III Research Institute, Madrid, Spain.,Department of Neurology, University Hospital "12 de Octubre", Madrid, Spain
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21
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Facal D, Juncos-Rabadán O, Guardia-Olmos J, Pereiro AX. Temporal changes in semantic and lexical access related to mild cognitive impairment. Aging Clin Exp Res 2016; 28:497-504. [PMID: 26298686 DOI: 10.1007/s40520-015-0436-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 07/30/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND It has been hypothesized that the deterioration in the ability to name famous people in normal aging and cognitive impairment is a continuum in which meaning-based representations and form-based representations are differentially impaired, with early impairments in lexical access but not in semantic access. AIMS This hypothesis is tested in a follow-up study comparing the performance of fifty-six participants with amnestic mild cognitive impairment and forty-one control participants were assessed. METHOD A lexical task was conducted involving recognition and naming of famous people from photographs. Proportional semantic and phonological access measures were calculated. RESULTS Comparisons revealed significant differences between baseline and follow-up, with improvements in semantic access in the control group and decrements in phonological access in the group with amnestic mild cognitive impairment. Phonological access and reaction time measures were significantly and positively correlated, and semantic access and reaction time were significantly and negatively correlated. CONCLUSIONS These results add evidence to the hypothesis that the decrease of processing resources is related to the increase of difficulties in lexical access throughout aging. Patterns of change must be replicated over longer periods of time.
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Affiliation(s)
- David Facal
- Departamento de Psicoloxía Evolutiva e da Educación, Facultade de Psicoloxía, Universidade de Santiago de Compostela, rúa Xosé María Suárez Núñez, s/n. Campus vida, 15782, Santiago de Compostela, Galicia, Spain.
| | - Onésimo Juncos-Rabadán
- Departamento de Psicoloxía Evolutiva e da Educación, Facultade de Psicoloxía, Universidade de Santiago de Compostela, rúa Xosé María Suárez Núñez, s/n. Campus vida, 15782, Santiago de Compostela, Galicia, Spain
| | - Joan Guardia-Olmos
- Departament de Metodologia de les Ciències del Comportament, University of Barcelona, Santiago de Compostela, Spain
| | - Arturo X Pereiro
- Departamento de Psicoloxía Evolutiva e da Educación, Facultade de Psicoloxía, Universidade de Santiago de Compostela, rúa Xosé María Suárez Núñez, s/n. Campus vida, 15782, Santiago de Compostela, Galicia, Spain
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22
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Facal D, Juncos-Rabadán O, Guardia-Olmos J, Pereiro AX, Lojo-Seoane C. Characterizing Magnitude and Selectivity of Attrition in a Study of Mild Cognitive Impairment. J Nutr Health Aging 2016; 20:722-8. [PMID: 27499305 DOI: 10.1007/s12603-015-0635-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVES Attrition is one of the greatest difficulties in longitudinal studies on cognitive ageing because of the associated risk of underestimating declines. The aims of this paper were to characterize the magnitude and selectivity of attrition in a study of mild cognitive impairment. DESIGN Forty two patients with multiple-domain amnestic MCI, 71 with single-domain amnestic MCI, 35 with non-amnestic MCI and 318 healthy controls were recruited from primary care centers and assessed at baseline. MEASUREMENTS All participants underwent extensive neuropsychological evaluation, including the Mini-Mental State Examination, the Californian Verbal Learning Test, the CAMCOG-R battery, the Counting Span task and Listening Span task, and the Subjective Memory Complaints Questionnaire. RESULTS 21.5% of the participants at baseline did not participate in the follow-up assessment. Comparison between respondents and non-returners did not reveal differences in cognitive performance in the MCI group. Data obtained at the initial assessment regarding comorbidity, social activities and attention given to memory training enabled prediction of the status of the participants in the follow-up assessment. CONCLUSION Identification of potential non- returners is relevant, especially in MCI studies, in order to develop retention strategies to minimize attrition.
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Affiliation(s)
- D Facal
- D. Facal, University of Santiago de Compostela, Department of Developmental Psychology, Spain,
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Facal D, Campos-Magdaleno M, Guàrdia-Olmos J, Juncos-Rabadán O. Confirmatory factor analysis of the Spanish version of the California Verbal Learning Test in a sample of middle-aged and older adults with subjective memory complaints. J Clin Exp Neuropsychol 2015; 38:308-18. [PMID: 26647113 DOI: 10.1080/13803395.2015.1107527] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Assessment of the ability to retain new information is of special interest in the second half of life because of age-related changes, especially in those individuals at risk of cognitive impairment. The California Verbal Learning Test (CVLT) is one of the most common auditory-verbal learning tests used to test episodic memory. The objective of this paper is to study the stability of the factorial structure of the Spanish version of CVLT in a sample of adults aged 50-87 years with subjective memory complaints (SMCs). METHOD Performance at baseline and follow-up assessment (about 18 months later) was analyzed in 301 participants. Models including one, two, three, and four factors were tested, by comparing the results of confirmatory factor analysis and structural equation models of relations between the factors at baseline and follow-up. RESULTS The two-factor models (accurate and inaccurate memory) yielded the best fit. The model establishing a relationship between these two factors at baseline and follow-up provided a good fit. CONCLUSION CVLT performance in a sample of middle-aged and old adults with SMCs was separated into two factors differentiating accurate recollection and errors. A structural equation modeling (SEM) model relating data from both assessments replicated these findings.
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Affiliation(s)
- David Facal
- a Departamento de Psicoloxía Evolutiva e da Educación , University of Santiago de Compostela , Santiago de Compostela , Spain
| | - María Campos-Magdaleno
- a Departamento de Psicoloxía Evolutiva e da Educación , University of Santiago de Compostela , Santiago de Compostela , Spain
| | - Joan Guàrdia-Olmos
- b Departamento de Metodologia de les Ciències del Comportament , University of Barcelona , Barcelona , Spain
| | - Onésimo Juncos-Rabadán
- a Departamento de Psicoloxía Evolutiva e da Educación , University of Santiago de Compostela , Santiago de Compostela , Spain
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