Tele-Global Examination of Mental State (Tele-GEMS): an open tool for the remote neuropsychological screening

Improving equivalent scores for clinical neuropsychology: a new method for regression model selection

Equivalent Scores (ES) represent a statistical gold standard to obtain thresholds for clinical inference from normative data. The procedure to obtain ES requires a preliminary mandatory step: to perform a regression model selection to obtain adjusted scores that take into account age, education, and sex. The current article, starting from theoretical considerations, focuses on this step and proposes a new and improved regression model selection method. Results from data simulation show that the newly proposed method outperforms the current one on a wide range of simulation parameters and conditions, leading to better performance in classifying impaired or unimpaired performances, and more precise ES. The article is associated with an online app and R code to allow to easily apply the method to other normative data. This new model selection procedure can be easily incorporated also with other regression-based norm approaches.

Auto-Global Examination of Mental State (Auto-GEMS): a web-based self-administered cognitive screening

Recent methodological developments have contributed to a significant advance in computerised neuropsychological instruments and procedures, including those accessible from remote. In this paper we present Auto-GEMS, a newly developed, web-based, self-administered screening test allowing to quickly estimate an individual's cognitive state also considering their cognitive reserve. Auto-GEMS measures cognitive functioning on eleven items similarly to the in-person paper-and-pencil version (GEMS) and to the remote (phone or video call) version (Tele-GEMS) of the same screening. We collected normative data on a sample of 1308 Italian-speaking participants (age range 18-93) to verify its psychometric properties and computed regression models on demographic variables to establish clinical cut-offs. The psychometric properties of Auto-GEMS have shown good internal consistency, test-retest reliability and convergent validity. This short and user-friendly tool has a number of potential applications. For instance, it can be useful in clinical practice to monitor the cognitive profile of patients or vulnerable individuals, or even administered in a face-to-face, standard clinical setting. It can also be used in research studies to screen participants. The testing materials and the collected data are freely available in a digital archive along with a web App to visualise the test outcome with reference to its normative data.

A digital teleneuropsychology platform for the diagnosis of mild cognitive impairment: from concept to certification as a medical device

BACKGROUND

Innovative digital solutions are shaping a new concept of dementia care, opening additional venues for prevention, diagnosis, monitoring and treatment. Hereby, we report the development of a tablet-based teleneuropsychology platform (Tenèpsia®), from concept to certification as Medical Device (MD) Class IIA, as per new MD regulation 745/2017.

METHODS

The platform was designed for the remote cognitive evaluation and created thanks to the effort of a collaborative working group including experts from three Italian scientific societies and Biogen Italia S.r.l. (hereafter "Biogen"), and developers from Xenia Reply and Inside AI. The development strategy was guided by converting traditional paper-and-pencil tests into digital versions while maintaining comparable neuropsychological features and optimizing patient accessibility and user experience. The experts focused on the choice and adaptation of traditional neuropsychology measures for a 45-min teleneuropsychology assessment.

RESULTS

The developers created a web and a mobile interface, respectively, for the professional (neuropsychologist) and non-professional (patient and caregiver) use. Recording of voice, drawing and typing information was enabled. Instant dashboards provide a quick overview of the patient's condition. Simulation activities were performed to obtain MD certification, valid across Europe.

CONCLUSION

Neuropsychology services will benefit from the implementation in clinics of harmonized digital tools with adequate scientific and technological standards. The use of digital cognitive testing for the diagnosis of mild cognitive impairment is expected to enhance patient and clinician outcomes through simplified, digital objective data collection, sparing of time and resources, with a positive impact on healthcare costs and access to treatments, reducing inequalities and delays in diagnosis and cure.

Cognitive-Cognitive Dual-task in aging: A cross-sectional online study

The prevalence of neurodegenerative disorders, particularly dementia, is on the rise across many countries worldwide. This negative trend calls for improving our understanding of cognitive aging. While motor-cognitive dual-task approaches have already been proven valuable for clinical diagnosis, comparatively less research is available on the application of Cognitive-Cognitive Dual-Tasking (CCDT), across several cognitive domains. Moreover, there is limited understanding about how healthy aging affects performance in such dual-tasks in the general population. CCDT entails engaging individuals in multiple cognitive tasks simultaneously and holds promise for remote e-Health interventions. In this cross-sectional study, our objective was to evaluate the suitability of a newly developed, self-administered, online tool for examining age-related differences in memory performance under dual-tasking. 337 healthy adults aged 50-90 underwent a visual memory test (Memo) under both single and dual-task conditions (attend to auditory letters). Additional measures included questionnaires on subjective memory complaints (MAC-Q), on cognitive reserve (CR), and a cognitive screening (auto-GEMS). As expected, the accuracy of visual memory performance exhibited a negative correlation with age and MAC-Q, and a positive correlation with CR and auto-GEMS scores. Dual-tasking significantly impaired performance, and its detrimental effect decreased with increasing age. Furthermore, the protective effect of cognitive reserve diminished with advancing age. These findings suggest that the commonly observed age-related increase in dual-task costs is not universally applicable across all tasks and cognitive domains. With further refinement, a longitudinal implementation of this approach may assist in identifying individuals with a distinct cognitive trajectory and potentially at a higher risk of developing cognitive decline.

The Telephone Language Screener (TLS): standardization of a novel telephone-based screening test for language impairment

BACKGROUND

This study aimed at developing and standardizing the Telephone Language Screener (TLS), a novel, disease-nonspecific, telephone-based screening test for language disorders.

METHODS

The TLS was developed in strict pursuance to the current psycholinguistic standards. It comprises nine tasks assessing phonological, lexical-semantic and morpho-syntactic components, as well as an extra Backward Digit Span task. The TLS was administered to 480 healthy participants (HPs), along with the Telephone-based Semantic Verbal Fluency (t-SVF) test and a Telephone-based Composite Language Index (TBCLI), as well as to 37 cerebrovascular/neurodegenerative patients-who also underwent the language subscale of the Telephone Interview for Cognitive Status (TICS-L). An HP subsample was also administered an in-person language battery. Construct validity, factorial structure, internal consistency, test-retest and inter-rater reliability were tested. Norms were derived via Equivalent Scores. The capability of the TLS to discriminate patients from HPs and to identify, among the patient cohort, those with a defective TICS-L, was also examined.

RESULTS

The TLS was underpinned by a mono-component structure and converged with the t-SVF (p < .001), the TBCLI (p < .001) and the in-person language battery (p = .002). It was internally consistent (McDonald's ω = 0.67) and reliable between raters (ICC = 0.99) and at retest (ICC = 0.83). Age and education, but not sex, were predictors of TLS scores. The TLS optimally discriminated patients from HPs (AUC = 0.80) and successfully identified patients with an impaired TICS-L (AUC = 0.92). In patients, the TLS converged with TICS-L scores (p = 0.016).

DISCUSSION

The TLS is a valid, reliable, normed and clinically feasible telephone-based screener for language impairment.

Clinical Profiles in Multiple Sclerosis: Cognitive Reserve and Motor Impairment along Disease Duration

(i) Background: Cognitive impairment in people with multiple sclerosis (MS) has been studied in relation to certain clinical variables (e.g., motor disability and disease duration) and lifestyle factors such as cognitive reserve (CR). However, only very few studies have considered the interaction of clinical variables and cognitive reserve in preserving the integrity of the neuropsychological profile. In this paper, we hypothesised that a higher level of CR might predict good cognitive efficiency by modulating the clinical outcome of the disease. (ii) Methods: A sample of 100 participants with MS (age range 30-74), was recruited and assessed remotely with a questionnaire to measure CR and a cognitive screening test. Data were analysed through generalized additive models. (iii) Results: We found that the model analysing the interaction between CR and disease duration, and between CR and motor disability, was able to explain a significant percentage of cognitive performance. In particular, higher levels of CR predicted a better cognitive performance despite a long disease duration, unless the motor disability was severe. (iv) Conclusion: This study highlights the crucial role of CR in modulating cognitive efficiency in people with MS.