Deriving a mental health outcome measure using the pooled index: an application to psychiatric consumer–survivors in different housing types

Mild cognitive impairment identification based on motor and cognitive dual-task pooled indices

OBJECTIVE

This study investigates the possibility of adopting motor and cognitive dual-task (MCDT) approaches to identify subjects with mild cognitive impairment (MCI) and subjective cognitive impairment (SCI).

METHODS

The upper and lower motor performances of 44 older adults were assessed using the SensHand and SensFoot wearable system during three MCDTs: forefinger tapping (FTAP), toe-tapping heel pin (TTHP), and walking 10 m (GAIT). We developed five pooled indices (PIs) based on these MCDTs, and we included them, along with demographic data (age) and clinical scores (Frontal Assessment Battery (FAB) scores), in five logistic regression models.

RESULTS

Models which consider cognitively normal adult (CNA) vs MCI subjects have accuracies that range from 67% to 78%. The addition of clinical scores stabilised the accuracies, which ranged from 85% to 89%. For models which consider CNA vs SCI vs MCI subjects, there are great benefits to considering all three regressors (age, FAB score, and PIs); the overall accuracies of the three-class models range between 50% and 59% when just PIs and age are considered, whereas the overall accuracy increases by 18% when all three regressors are utilised.

CONCLUSION

Logistic regression models that consider MCDT PIs and age have been effective in distinguishing between CNA and MCI subjects. The inclusion of clinical scores increased the models' accuracy. Particularly high performances in distinguishing among CNA, SCI, and MCI subjects were obtained by the TTHP PI. This study suggests that a broader framework for MCDTs, which should encompass a greater selection of motor tasks, could provide clinicians with new appropriate tools.

A New Motor and Cognitive Dual-Task Approach Based on Foot Tapping for The Identification of Mild Cognitive Impairment

This study investigates the adoption of innovative Motor and Cognitive Dual-Task (MCDT) based on the combination of increasing motor and cognitive tasks to discern between subjects with Mild Cognitive Impairment (MCI) and Cognitively Normal Adults (CNA). We aim to adopt new MCDT protocols and to compare their performance against the gold standard (a walking based MCDT, called GAIT). 27 older adults have been assessed through a customized wearable system during 4 MCDTs. We developed as many pooled indices (PIs), based on MCDTs perfomance, demographic data, and clinical scores. We use these parameters as regressors in 4 different logistic regression models. The regression models that encompassed features from innovative MCDT overcame the gold standard classification performance. In particular, models based on the heel tapping and the alternate heel-toe tapping reach the best outputs, namely +8% of accuracy if compared to the gold standard (a walking task). The use of logistic regression models based on MCDT PI have been effective in discerning between CNA vs MCI. Our results suggest that the gold standard MCDT may represents a too demanding exercise to highlight differences between CNA and MCI. It seems that MCDT based on an intermediate level of motor difficulty could represent the sweet spot for the identification of MCI against CNA. Clinical relevance- The combination of innovative digital devices and innovative approach on data analysis (PIs) opened a new scenarios to the early detection and prediction of dementia. Their use would standardize the assessment procedure, lightening the physician from the burden of cumbersome testing sessions. This study suggests that a broader framework for MCDT, which should encompass an ampler selection of motor tasks with different possibilities in terms of difficulties levels, could provide clinicians with a new appropriate set of tools for the early detection of dementia.

Cognition and motor function: The gait and cognition pooled index

BACKGROUND

There is a need for outcome measures with improved responsiveness to changes in pre-dementia populations. Both cognitive and motor function play important roles in neurodegeneration; motor function decline is detectable at early stages of cognitive decline. This proof of principle study used a Pooled Index approach to evaluate improved responsiveness of the predominant outcome measure (ADAS-Cog: Alzheimer's Disease Assessment Scale-Cognitive Subscale) when assessment of motor function is added.

METHODS

Candidate Pooled Index variables were selected based on theoretical importance and pairwise correlation coefficients. Kruskal-Wallis and Mann-Whitney U tests assessed baseline discrimination. Standardized response means assessed responsiveness to longitudinal change.

RESULTS

Final selected variables for the Pooled Index include gait velocity, dual-task cost of gait velocity, and an ADAS-Cog-Proxy (statistical approximation of the ADAS-Cog using similar cognitive tests). The Pooled Index and ADAS-Cog-Proxy scores had similar ability to discriminate between pre-dementia syndromes. The Pooled Index demonstrated trends of similar or greater responsiveness to longitudinal decline than ADAS-Cog-Proxy scores.

CONCLUSION

Adding motor function assessments to the ADAS-Cog may improve responsiveness in pre-dementia populations.

The validity of patient- and clinician-rated measures of needs and the therapeutic relationship in psychosis: a pooled analysis

Measuring outcomes of treatments for psychosis such as needs and the quality of the therapeutic relationship is important in research and routine care. However, evidence on the validity of existing outcome measures is limited. We aimed to test the convergent, discriminant, and predictive validity of two widely used patient- and clinician-rated measures of needs and the therapeutic relationship. Multitrait-multimethod (MTMM) analysis was conducted on the Camberwell Assessment of Need Short Appraisal Schedule (CANSAS) and the Helping Alliance Scale (HAS), both the clinician (CANSAS-C, HAS-C) and patient (CANSAS-P, HAS-P) versions, in a pooled sample of 605 psychotic patients and their clinicians. CANSAS-C and CANSAS-P items loaded substantially into one common unmet needs factor. By comparison, substantial factor loadings were found for HAS-C and HAS-P items on two separate clinician- and patient-rated therapeutic relationship factors. Common unmet needs and clinician-rated therapeutic relationship factors significantly predicted reduced psychiatric in-patient days. Our findings support the convergent validity of the CANSAS, discriminant validity of the HAS, and predictive validity of CANSAS and HAS-C. The findings may inform the use of CANSAS and HAS as psychosis outcome measures in research and routine care.

Measuring patients' views: a bifactor model of distinct patient-reported outcomes in psychosis

BACKGROUND

Patient-reported outcomes (PROs) are widely used for evaluating the care of patients with psychosis. Previous studies have reported a considerable overlap in the information captured by measures designed to assess different outcomes. This may impair the validity of PROs and makes an a priori choice of the most appropriate measure difficult when assessing treatment benefits for patients. We aimed to investigate the extent to which four widely established PROs [subjective quality of life (SQOL), needs for care, treatment satisfaction and the therapeutic relationship] provide distinct information independent from this overlap.

METHOD

Analyses, based on item response modelling, were conducted on measures of SQOL, needs for care, treatment satisfaction and the therapeutic relationship in two large samples of patients with psychosis.

RESULTS

In both samples, a bifactor model matched the data best, suggesting sufficiently strong concept factors to allow for four distinct PRO scales. These were independent from overlap across measures due to a general appraisal tendency of patients for positive or negative ratings and shared domain content. The overlap partially impaired the ability of items to discriminate precisely between patients from lower and higher PRO levels. We found that widely used sum scores were strongly affected by the general appraisal tendency.

CONCLUSIONS

Four widely established PROs can provide distinct information independent from overlap across measures. The findings may inform the use and further development of PROs in the evaluation of treatments for psychosis.