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Ding Z, Lee TL, Chan AS. Digital Cognitive Biomarker for Mild Cognitive Impairments and Dementia: A Systematic Review. J Clin Med 2022; 11:jcm11144191. [PMID: 35887956 PMCID: PMC9320101 DOI: 10.3390/jcm11144191] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 07/10/2022] [Accepted: 07/18/2022] [Indexed: 01/28/2023] Open
Abstract
The dementia population is increasing as the world’s population is growing older. The current systematic review aims to identify digital cognitive biomarkers from computerized tests for detecting dementia and its risk state of mild cognitive impairment (MCI), and to evaluate the diagnostic performance of digital cognitive biomarkers. A literature search was performed in three databases, and supplemented by a Google search for names of previously identified computerized tests. Computerized tests were categorized into five types, including memory tests, test batteries, other single/multiple cognitive tests, handwriting/drawing tests, and daily living tasks and serious games. Results showed that 78 studies were eligible. Around 90% of the included studies were rated as high quality based on the Newcastle–Ottawa Scale (NOS). Most of the digital cognitive biomarkers achieved comparable or even better diagnostic performance than traditional paper-and-pencil tests. Moderate to large group differences were consistently observed in cognitive outcomes related to memory and executive functions, as well as some novel outcomes measured by handwriting/drawing tests, daily living tasks, and serious games. These outcomes have the potential to be sensitive digital cognitive biomarkers for MCI and dementia. Therefore, digital cognitive biomarkers can be a sensitive and promising clinical tool for detecting MCI and dementia.
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Affiliation(s)
- Zihan Ding
- Neuropsychology Laboratory, Department of Psychology, The Chinese University of Hong Kong, Hong Kong, China; (Z.D.); (T.-l.L.)
| | - Tsz-lok Lee
- Neuropsychology Laboratory, Department of Psychology, The Chinese University of Hong Kong, Hong Kong, China; (Z.D.); (T.-l.L.)
| | - Agnes S. Chan
- Neuropsychology Laboratory, Department of Psychology, The Chinese University of Hong Kong, Hong Kong, China; (Z.D.); (T.-l.L.)
- Research Centre for Neuropsychological Well-Being, The Chinese University of Hong Kong, Hong Kong, China
- Correspondence: ; Tel.: +852-3943-6654
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Diagnostic performance of digital cognitive tests for the identification of MCI and dementia: A systematic review. Ageing Res Rev 2021; 72:101506. [PMID: 34744026 DOI: 10.1016/j.arr.2021.101506] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 09/21/2021] [Accepted: 10/26/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND The use of digital cognitive tests is getting common nowadays. Older adults or their family members may use online tests for self-screening of dementia. However, the diagnostic performance across different digital tests is still to clarify. The objective of this study was to evaluate the diagnostic performance of digital cognitive tests for MCI and dementia in older adults. METHODS Literature searches were systematically performed in the OVID databases. Validation studies that reported the diagnostic performance of a digital cognitive test for MCI or dementia were included. The main outcome was the diagnostic performance of the digital test for the detection of MCI or dementia. RESULTS A total of 56 studies with 46 digital cognitive tests were included in this study. Most of the digital cognitive tests were shown to have comparable diagnostic performances with the paper-and-pencil tests. Twenty-two digital cognitive tests showed a good diagnostic performance for dementia, with a sensitivity and a specificity over 0.80, such as the Computerized Visuo-Spatial Memory test and Self-Administered Tasks Uncovering Risk of Neurodegeneration. Eleven digital cognitive tests showed a good diagnostic performance for MCI such as the Brain Health Assessment. However, all the digital tests only had a few validation studies to verify their performance. CONCLUSIONS Digital cognitive tests showed good performances for MCI and dementia. The digital test can collect digital data that is far beyond the traditional ways of cognitive tests. Future research is suggested on these new forms of cognitive data for the early detection of MCI and dementia.
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Binng D, Splonskowski M, Jacova C. Distance Assessment for Detecting Cognitive Impairment in Older Adults: A Systematic Review of Psychometric Evidence. Dement Geriatr Cogn Disord 2021; 49:456-470. [PMID: 33291097 DOI: 10.1159/000511945] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 09/30/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Distance or remote cognitive assessments, administered via phone or computer platforms, have emerged as possible alternatives to traditional assessments performed during office visits. Distance refers to any nontraditional assessment feature, not only or necessarily location. We conducted a systematic review to examine the psychometric soundness of these approaches. METHOD We searched PubMed, PsycINFO, AgeLine, and Academic Search Premier for articles published between January 2008 and June 2020. Studies were included if participants were over the age of 50, a structured assessment of cognitive function in older adults was evaluated, the assessment method was deemed distant, and validity and/or reliability data were reported. Assessment distance was defined as having any of the following features: use of an electronic test interface, nonroutine test location (e.g., home), test self-administered, and test unsupervised. Distance was categorized as low, intermediate, or high. RESULTS/DISCUSSION Twenty-six studies met inclusion criteria. Sample sizes ranged from n = 8 to 8,627, and the mean age ranged from 57 to 83. Assessments included screens, brief or full batteries, and were performed via videoconferencing, phone, smartphone, or tablet/computer. Ten studies reported on low distance, 11 on intermediate distance, and 5 studies for high distance assessments. Invalid performance data were observed with older age and cognitive impairment. Convergent validity data were reported consistently and suggested a decline with increasing distance: r = 0.52-0.80 for low, 0.49-0.75 for intermediate, and 0.41-0.53 for high distance. Diagnostic validity estimates presented a similar pattern. Reliability data were reported too inconsistently to allow evaluation. CONCLUSION The validity of cognitive assessments with older adults appears supported at lower but not higher distance. Less is known about the reliability of such assessments. Future research should delineate the person and procedure boundaries for valid and reliable test results.
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Affiliation(s)
- Davina Binng
- School of Graduate Psychology, Pacific University, Hillsboro, Oregon, USA
| | | | - Claudia Jacova
- School of Graduate Psychology, Pacific University, Hillsboro, Oregon, USA,
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Chan JYC, Kwong JSW, Wong A, Kwok TCY, Tsoi KKF. Comparison of Computerized and Paper-and-Pencil Memory Tests in Detection of Mild Cognitive Impairment and Dementia: A Systematic Review and Meta-analysis of Diagnostic Studies. J Am Med Dir Assoc 2018; 19:748-756.e5. [PMID: 29921507 DOI: 10.1016/j.jamda.2018.05.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 05/08/2018] [Accepted: 05/12/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVES To compare the diagnostic performance of computerized and paper-and-pencil memory tests in detection of mild cognitive impairment (MCI) and dementia. DESIGN Diagnostic studies comparing computerized or paper-and-pencil memory tests with the standard diagnostic criterion for MCI or dementia were identified from OVID databases. The primary outcome was the diagnostic performance of memory tests for detection of MCI, and detection of dementia was the secondary outcome. Risk of bias and reporting quality in included studies was assessed. SETTING AND PARTICIPANTS Participants with MCI and dementia in any kind of setting. MEASURES Bivariate random-effects models were used to combine the diagnostic performance of memory tests and presented with a summary receiver-operating characteristic curve. RESULTS A total of 58 studies with 18,450 participants with mean age ranging from 55 to 84 years were included. For the verbal memory tests on patients with MCI, computerized tests showed diagnostic accuracy of 0.89 sensitivity (95% confidence interval [CI] 0.69-0.97) and 0.82 specificity (95% CI 0.70-0.90), whereas paper-and-pencil tests showed diagnostic accuracy of 0.86 sensitivity (95% CI 0.82-0.90) and 0.82 specificity (95% CI 0.76-0.86). For the visual memory tests on MCI patients, computerized tests showed diagnostic accuracy of 0.79 sensitivity (95% CI 0.71-0.84) and 0.80 specificity (95% CI 0.71-0.86), whereas paper-and-pencil tests showed diagnostic accuracy of 0.80 sensitivity (95% CI 0.67-0.89) and 0.68 specificity (95% CI 0.51-0.81). The findings were also comparable to those with dementia. CONCLUSIONS/IMPLICATIONS Both verbal and visual computerized memory tests showed comparable diagnostic performance to the paper-and-pencil tests. Computerized cognitive tests show a great potential to use as an alternative to paper-and-pencil tests. When the records can be digitalized, long-term monitoring of cognitive function will be feasible for better management of dementia.
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Affiliation(s)
- Joyce Y C Chan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong
| | - Joey S W Kwong
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong
| | - Adrian Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong
| | - Timothy C Y Kwok
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong
| | - Kelvin K F Tsoi
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong; Stanley Ho Big Data Decision Analytics Research Centre, The Chinese University of Hong Kong, Hong Kong.
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Aslam RW, Bates V, Dundar Y, Hounsome J, Richardson M, Krishan A, Dickson R, Boland A, Fisher J, Robinson L, Sikdar S. A systematic review of the diagnostic accuracy of automated tests for cognitive impairment. Int J Geriatr Psychiatry 2018; 33:561-575. [PMID: 29356098 PMCID: PMC5887872 DOI: 10.1002/gps.4852] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 11/21/2017] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The aim of this review is to determine whether automated computerised tests accurately identify patients with progressive cognitive impairment and, if so, to investigate their role in monitoring disease progression and/or response to treatment. METHODS Six electronic databases (Medline, Embase, Cochrane, Institute for Scientific Information, PsycINFO, and ProQuest) were searched from January 2005 to August 2015 to identify papers for inclusion. Studies assessing the diagnostic accuracy of automated computerised tests for mild cognitive impairment (MCI) and early dementia against a reference standard were included. Where possible, sensitivity, specificity, positive predictive value, negative predictive value, and likelihood ratios were calculated. The Quality Assessment of Diagnostic Accuracy Studies tool was used to assess risk of bias. RESULTS Sixteen studies assessing 11 diagnostic tools for MCI and early dementia were included. No studies were eligible for inclusion in the review of tools for monitoring progressive disease and response to treatment. The overall quality of the studies was good. However, the wide range of tests assessed and the non-standardised reporting of diagnostic accuracy outcomes meant that statistical analysis was not possible. CONCLUSION Some tests have shown promising results for identifying MCI and early dementia. However, concerns over small sample sizes, lack of replicability of studies, and lack of evidence available make it difficult to make recommendations on the clinical use of the computerised tests for diagnosing, monitoring progression, and treatment response for MCI and early dementia. Research is required to establish stable cut-off points for automated computerised tests used to diagnose patients with MCI or early dementia.
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Affiliation(s)
| | - Vickie Bates
- Health ServicesUniversity of LiverpoolLiverpoolUK
| | | | | | | | | | | | | | | | - Louise Robinson
- Institute of Health and SocietyNewcastle UniversityNewcastle upon TyneUK
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Zygouris S, Ntovas K, Giakoumis D, Votis K, Doumpoulakis S, Segkouli S, Karagiannidis C, Tzovaras D, Tsolaki M. A Preliminary Study on the Feasibility of Using a Virtual Reality Cognitive Training Application for Remote Detection of Mild Cognitive Impairment. J Alzheimers Dis 2018; 56:619-627. [PMID: 28035922 DOI: 10.3233/jad-160518] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND It has been demonstrated that virtual reality (VR) applications can be used for the detection of mild cognitive impairment (MCI). OBJECTIVE The aim of this study is to provide a preliminary investigation on whether a VR cognitive training application can be used to detect MCI in persons using the application at home without the help of an examiner. METHODS Two groups, one of healthy older adults (n = 6) and one of MCI patients (n = 6) were recruited from Thessaloniki day centers for cognitive disorders and provided with a tablet PC with custom software enabling the self-administration of the Virtual Super Market (VSM) cognitive training exercise. The average performance (from 20 administrations of the exercise) of the two groups was compared and was also correlated with performance in established neuropsychological tests. RESULTS Average performance in terms of duration to complete the given exercise differed significantly between healthy(μ = 247.41 s/ sd = 89.006) and MCI (μ= 454.52 s/ sd = 177.604) groups, yielding a correct classification rate of 91.8% with a sensitivity and specificity of 94% and 89% respectively for MCI detection. Average performance also correlated significantly with performance in Functional Cognitive Assessment Scale (FUCAS), Test of Everyday Attention (TEA), and Rey Osterrieth Complex Figure test (ROCFT). DISCUSSION The VR application exhibited very high accuracy in detecting MCI while all participants were able to operate the tablet and application on their own. Diagnostic accuracy was improved compared to a previous study using data from only one administration of the exercise. The results of the present study suggest that remote MCI detection through VR applications can be feasible.
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Affiliation(s)
- Stelios Zygouris
- 3rd Department of Neurology, Aristotle University of Thessaloniki, Greece.,Network Aging Research, University of Heidelberg, Germany.,Cannot Not Design + (CND+) Design Research Organization, Thessaloniki, Greece
| | - Konstantinos Ntovas
- Greek Association of Alzheimer's Disease and Related Disorders, Thessaloniki, Greece
| | - Dimitrios Giakoumis
- Information Technologies Institute, The Centre for Research and Technology Hellas, Thessaloniki, Greece
| | - Konstantinos Votis
- Information Technologies Institute, The Centre for Research and Technology Hellas, Thessaloniki, Greece
| | - Stefanos Doumpoulakis
- Information Technologies Institute, The Centre for Research and Technology Hellas, Thessaloniki, Greece
| | - Sofia Segkouli
- Information Technologies Institute, The Centre for Research and Technology Hellas, Thessaloniki, Greece.,Department of Special Education, University of Thessaly, Greece
| | | | - Dimitrios Tzovaras
- Information Technologies Institute, The Centre for Research and Technology Hellas, Thessaloniki, Greece
| | - Magda Tsolaki
- 3rd Department of Neurology, Aristotle University of Thessaloniki, Greece.,Network Aging Research, University of Heidelberg, Germany.,Greek Association of Alzheimer's Disease and Related Disorders, Thessaloniki, Greece.,Information Technologies Institute, The Centre for Research and Technology Hellas, Thessaloniki, Greece
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Aslam RW, Bates V, Dundar Y, Hounsome J, Richardson M, Krishan A, Dickson R, Boland A, Kotas E, Fisher J, Sikdar S, Robinson L. Automated tests for diagnosing and monitoring cognitive impairment: a diagnostic accuracy review. Health Technol Assess 2018; 20:1-74. [PMID: 27767932 DOI: 10.3310/hta20770] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Cognitive impairment is a growing public health concern, and is one of the most distinctive characteristics of all dementias. The timely recognition of dementia syndromes can be beneficial, as some causes of dementia are treatable and are fully or partially reversible. Several automated cognitive assessment tools for assessing mild cognitive impairment (MCI) and early dementia are now available. Proponents of these tests cite as benefits the tests' repeatability and robustness and the saving of clinicians' time. However, the use of these tools to diagnose and/or monitor progressive cognitive impairment or response to treatment has not yet been evaluated. OBJECTIVES The aim of this review was to determine whether or not automated computerised tests could accurately identify patients with progressive cognitive impairment in MCI and dementia and, if so, to investigate their role in monitoring disease progression and/or response to treatment. DATA SOURCES Five electronic databases (MEDLINE, EMBASE, The Cochrane Library, ISI Web of Science and PsycINFO), plus ProQuest, were searched from 2005 to August 2015. The bibliographies of retrieved citations were also examined. Trial and research registers were searched for ongoing studies and reviews. A second search was run to identify individual test costs and acquisition costs for the various tools identified in the review. REVIEW METHODS Two reviewers independently screened all titles and abstracts to identify potentially relevant studies for inclusion in the review. Full-text copies were assessed independently by two reviewers. Data were extracted and assessed for risk of bias by one reviewer and independently checked for accuracy by a second. The results of the data extraction and quality assessment for each study are presented in structured tables and as a narrative summary. RESULTS The electronic searching of databases, including ProQuest, resulted in 13,542 unique citations. The titles and abstracts of these were screened and 399 articles were shortlisted for full-text assessment. Sixteen studies were included in the diagnostic accuracy review. No studies were eligible for inclusion in the review of tools for monitoring progressive disease. Eleven automated computerised tests were assessed in the 16 included studies. The overall quality of the studies was good; however, the wide range of tests assessed and the non-standardised reporting of diagnostic accuracy outcomes meant that meaningful synthesis or statistical analysis was not possible. LIMITATIONS The main limitation of this review is the substantial heterogeneity of the tests assessed in the included studies. As a result, no meta-analyses could be undertaken. CONCLUSION The quantity of information available is insufficient to be able to make recommendations on the clinical use of the computerised tests for diagnosing and monitoring MCI and early dementia progression. The value of these tests also depends on the costs of acquisition, training, administration and scoring. FUTURE WORK Research is required to establish stable cut-off points for automated computerised tests that are used to diagnose patients with MCI or early dementia. Additionally, the costs associated with acquiring and using these tests in clinical practice should be estimated. STUDY REGISTRATION The study is registered as PROSPERO CRD42015025410. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Rabeea'h W Aslam
- Liverpool Review and Implementation Group (LRiG), University of Liverpool, Liverpool, UK
| | - Vickie Bates
- Liverpool Review and Implementation Group (LRiG), University of Liverpool, Liverpool, UK
| | - Yenal Dundar
- Liverpool Review and Implementation Group (LRiG), University of Liverpool, Liverpool, UK.,Community Mental Health Team, Mersey Care NHS Foundation Trust, Southport, UK
| | - Juliet Hounsome
- Liverpool Review and Implementation Group (LRiG), University of Liverpool, Liverpool, UK
| | - Marty Richardson
- Liverpool Review and Implementation Group (LRiG), University of Liverpool, Liverpool, UK
| | - Ashma Krishan
- Liverpool Review and Implementation Group (LRiG), University of Liverpool, Liverpool, UK
| | - Rumona Dickson
- Liverpool Review and Implementation Group (LRiG), University of Liverpool, Liverpool, UK
| | - Angela Boland
- Liverpool Review and Implementation Group (LRiG), University of Liverpool, Liverpool, UK
| | - Eleanor Kotas
- Liverpool Review and Implementation Group (LRiG), University of Liverpool, Liverpool, UK
| | - Joanne Fisher
- Liverpool Review and Implementation Group (LRiG), University of Liverpool, Liverpool, UK
| | - Sudip Sikdar
- Older Adults Mental Health Team, Mersey Care NHS Foundation Trust, Waterloo, Liverpool, UK.,Department of Psychological Sciences, University of Liverpool, Liverpool, UK
| | - Louise Robinson
- Newcastle University Institute for Ageing, Newcastle University, Newcastle upon Tyne, UK.,Institute for Health and Society, Newcastle University, Newcastle upon Tyne, UK
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Weissberger GH, Strong JV, Stefanidis KB, Summers MJ, Bondi MW, Stricker NH. Diagnostic Accuracy of Memory Measures in Alzheimer's Dementia and Mild Cognitive Impairment: a Systematic Review and Meta-Analysis. Neuropsychol Rev 2017; 27:354-388. [PMID: 28940127 PMCID: PMC5886311 DOI: 10.1007/s11065-017-9360-6] [Citation(s) in RCA: 89] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 08/16/2017] [Indexed: 11/26/2022]
Abstract
With an increasing focus on biomarkers in dementia research, illustrating the role of neuropsychological assessment in detecting mild cognitive impairment (MCI) and Alzheimer's dementia (AD) is important. This systematic review and meta-analysis, conducted in accordance with PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) standards, summarizes the sensitivity and specificity of memory measures in individuals with MCI and AD. Both meta-analytic and qualitative examination of AD versus healthy control (HC) studies (n = 47) revealed generally high sensitivity and specificity (≥ 80% for AD comparisons) for measures of immediate (sensitivity = 87%, specificity = 88%) and delayed memory (sensitivity = 89%, specificity = 89%), especially those involving word-list recall. Examination of MCI versus HC studies (n = 38) revealed generally lower diagnostic accuracy for both immediate (sensitivity = 72%, specificity = 81%) and delayed memory (sensitivity = 75%, specificity = 81%). Measures that differentiated AD from other conditions (n = 10 studies) yielded mixed results, with generally high sensitivity in the context of low or variable specificity. Results confirm that memory measures have high diagnostic accuracy for identification of AD, are promising but require further refinement for identification of MCI, and provide support for ongoing investigation of neuropsychological assessment as a cognitive biomarker of preclinical AD. Emphasizing diagnostic test accuracy statistics over null hypothesis testing in future studies will promote the ongoing use of neuropsychological tests as Alzheimer's disease research and clinical criteria increasingly rely upon cerebrospinal fluid (CSF) and neuroimaging biomarkers.
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Affiliation(s)
- Gali H Weissberger
- Brain, Behavior, and Aging Research Center, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- Psychology Service, VA Boston Healthcare System, Boston, MA, USA
| | - Jessica V Strong
- Psychology Service, VA Boston Healthcare System, Boston, MA, USA
- New England Geriatric Research, Education and Clinical Center (GRECC), Boston VA Healthcare System, Boston, MA, USA
| | - Kayla B Stefanidis
- Sunshine Coast Mind and Neuroscience - Thompson Institute, University of the Sunshine Coast, Sippy Downs, Queensland, Australia
| | - Mathew J Summers
- Sunshine Coast Mind and Neuroscience - Thompson Institute, University of the Sunshine Coast, Sippy Downs, Queensland, Australia
| | - Mark W Bondi
- VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - Nikki H Stricker
- Psychology Service, VA Boston Healthcare System, Boston, MA, USA.
- Department of Psychiatry and Psychology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
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Külzow N, Witte AV, Kerti L, Grittner U, Schuchardt JP, Hahn A, Flöel A. Impact of Omega-3 Fatty Acid Supplementation on Memory Functions in Healthy Older Adults. J Alzheimers Dis 2016; 51:713-25. [PMID: 26890759 DOI: 10.3233/jad-150886] [Citation(s) in RCA: 89] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
As the process of Alzheimer's disease (AD) begins years before disease onset, searching for prevention strategies is of major medical and economic importance. Nutritional supplementation with long-chain polyunsaturated omega-3 fatty acids (LC-n3-FA) may exert beneficial effects on brain structure and function. However, experimental evidence in older adults without clinical dementia is inconsistent, possibly due to low sensitivity of previously employed test batteries for detecting subtle improvements in cognition in healthy individuals. Here we used LOCATO, recently described as a robust and sensitive tool for assessing object-location memory (OLM) in older adults, to evaluate the impact of LC-n3-FA supplementation on learning and memory formation. In a double-blind placebo-controlled proof-of-concept study, 44 (20 female) cognitively healthy individuals aged 50-75 years received either LC-n3-FA (2,200 mg/day, n = 22) or placebo (n = 22) for 26 weeks. Before and after intervention, memory performance in the OLM-task (primary) was tested. As secondary outcome parameters, performance in Rey Auditory Verbal Learning Test (AVLT), dietary habits, omega-3-index, and other blood-derived parameters were assessed. Omega-3 index increased significantly in the LC-n3-FA group compared with the placebo group. Moreover, recall of object locations was significantly better after LC-n3-FA supplementation compared with placebo. Performance in the AVLT was not significantly affected by LC-n3-FA. This double-blind placebo-controlled proof-of-concept study provides further experimental evidence that LC-n3-FA exert positive effects on memory functions in healthy older adults. Our findings suggest novel strategies to maintain cognitive functions into old age.
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Affiliation(s)
- Nadine Külzow
- Department of Neurology, Charité-Universitätsmedizin, Berlin, Germany.,NeuroCure Cluster of Excellence, Neurocure Clinical Research Center, Charité-Universitätsmedizin, Berlin, Germany
| | - A Veronica Witte
- Department of Neurology, Aging and Obesity Group, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Lucia Kerti
- Center for Stroke Research Berlin, Charité-Universitätsmedizin, Berlin, Germany
| | - Ulrike Grittner
- Department for Biostatistics and Clinical Epidemiology, Charité-Universitätsmedizin, Berlin, Germany
| | | | - Andreas Hahn
- Institute of Food Science and Human Nutrition, Leibniz University Hannover, Germany
| | - Agnes Flöel
- Department of Neurology, Charité-Universitätsmedizin, Berlin, Germany.,NeuroCure Cluster of Excellence, Neurocure Clinical Research Center, Charité-Universitätsmedizin, Berlin, Germany.,Center for Stroke Research Berlin, Charité-Universitätsmedizin, Berlin, Germany
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10
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Computerized and on-line neuropsychological testing for late-life cognition and neurocognitive disorders: are we there yet? Curr Opin Psychiatry 2015; 28:165-72. [PMID: 25602241 DOI: 10.1097/yco.0000000000000141] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Cost-effective, valid, efficient and accessible tests for the detection of late-life neurocognitive disorders are crucial, as early identification facilitates appropriate early intervention. Proponents of computerized neuropsychological assessment devices (CNADs) assert that technology-based assessments improve upon traditional neuropsychological tests. However, there remain fundamental questions of validity, reliability, normative data and administration, raising the question of whether CNADs are appropriate alternatives. RECENT FINDINGS Since publication of the 2012 American Academy of Clinical Neuropsychology and National Academy of Neuropsychology joint position paper outlining appropriate standards for CNAD development, the field has not significantly advanced, with the majority of recommendations inadequately addressed. SUMMARY Whilst there is a pressing need for innovative and readily applicable cognitive tests, these requirements do not outweigh the necessity for valid measures. Overall, the psychometric quality, standardization, normative data and administration advice of CNADs for neurocognitive disorders are lacking. Therefore, the risk of diagnostic errors is potentially high and poor clinical decisions could potentially arise, having significant impact upon individuals in terms of their well being and access to treatment. We recommend clinicians and researchers make informed decisions about CNAD suitability for their clients and their individual requirements based upon published psychometric and other test information.
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Külzow N, Kerti L, Witte VA, Kopp U, Breitenstein C, Flöel A. An object location memory paradigm for older adults with and without mild cognitive impairment. J Neurosci Methods 2014; 237:16-25. [PMID: 25176026 DOI: 10.1016/j.jneumeth.2014.08.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Revised: 08/20/2014] [Accepted: 08/21/2014] [Indexed: 01/15/2023]
Abstract
BACKGROUND Object-location memory is critical in every-day life and known to deteriorate early in the course of neurodegenerative disease. NEW METHOD We adapted the previously established learning paradigm "LOCATO" for use in healthy older adults and patients with mild cognitive impairment (MCI). Pictures of real-life buildings were associated with positions on a two-dimensional street map by repetitions of "correct" object-location pairings over the course of five training blocks, followed by a recall task. Correct/incorrect associations were indicated by button presses. The original two 45-item sets were reduced to 15 item-sets, and tested in healthy older adults and MCI for learning curve, recall, and re-test effects. RESULTS The two 15-item versions showed comparable learning curves and recall scores within each group. While learning curves increased linearly in both groups, MCI patients performed significantly worse on learning and recall compared to healthy controls. Re-testing after 6 month showed small practice effects only. COMPARISON WITH EXISTING METHODS LOCATO is a simple standardized task that overcomes several limitation of previously employed visuospatial task by using real-life stimuli, minimizing verbal encoding, avoiding fine motor responses, combining explicit and implicit statistical learning, and allowing to assess learning curve in addition to recall. CONCLUSIONS Results show that the shortened version of LOCATO meets the requirements for a robust and ecologically meaningful assessment of object-location memory in older adults with and without MCI. It can now be used to systematically assess acquisition of object-location memory and its modulation through adjuvant therapies like pharmacological or non-invasive brain stimulation.
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Affiliation(s)
- Nadine Külzow
- Department of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany; NeuroCure Cluster of Excellence, Neurocure Clinical Research Center, Charité Universitätsmedizin Berlin, Berlin, Germany.
| | - Lucia Kerti
- Department of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Veronica A Witte
- Department of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany; NeuroCure Cluster of Excellence, Neurocure Clinical Research Center, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Ute Kopp
- Department of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | | | - Agnes Flöel
- Department of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany; NeuroCure Cluster of Excellence, Neurocure Clinical Research Center, Charité Universitätsmedizin Berlin, Berlin, Germany; Center for Stroke Research Berlin, Charité Universitätsmedizin Berlin, Berlin, Germany.
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