Practice parameters facilitating adoption of advanced technologies for enhancing neuropsychological assessment paradigms

Multivariable utility of the Memory Integrated Language and Making Change Test

Recent reports indicate that the Memory Integrated Language Test (MIL) and Making Change Test Abbreviated Index (MCT-AI), two web-based performance validity tests (PVTs), have good sensitivity and specificity when used independently. This study investigated whether using these PVTs together could improve the detection of invalid performance in a mixed neuropsychiatric sample. Participants were 129 adult outpatients who underwent a neuropsychological evaluation and were classified into valid (n = 104) or invalid (n = 25) performance groups based on several commonly used PVTs. Using cut scores of ≤41 on the MIL and ≥1.05 on the MCT-AI together enhanced classification accuracy, yielding an area under the curve of .84 (95% CI: .75, .93). As compared to using the MIL and MCT-AI independently, the combined use increased the sensitivity from .10-.31 to.70 while maintaining ≥.90 specificity. Findings also indicated that failing either the MIL or MCT-AI was associated with somewhat lower cognitive test scores, but failing both was associated with markedly lower scores. Overall, using the MIL and MCT-AI together may be an effective way to identify invalid test performance during a neuropsychological evaluation. Furthermore, pairing these tests is consistent with current practice guidelines to include multiple PVTs in a neuropsychological test battery.

Cognitive screening test for rehabilitation using spatiotemporal data extracted from a digital trail making test part-A

We investigated a newly developed digitized Trail Making Test using an iPad (iTMT) as a brief cognitive function screening test. We found that the iTMT part-A (iTMT-A) can estimate generalized cognitive function in rehabilitation inpatients examined using the Mini-Mental State Examination (MMSE). Forty-two hospitalized participants undergoing rehabilitation (rehab participants), 30 of whom had cerebral infarction/hemorrhage (stroke participants), performed the iTMT five times (first three times: iTMT-A; fourth: paper version of TMT-A; fifth: the inverse version of iTMT-A) and the MMSE once. Each iTMT-A trial's completion time was divided into the move and dwell times. A linear mixed model following post-hoc tests revealed that the completion time of the third and fourth iTMT-A was faster compared to that of the first iTMT-A, suggesting the presence of a learning effect. In the partial least squares (PLS) regression analysis, the coefficient of determination for estimating the MMSE score was increased by using the dwell and move times extracted from the repeated iTMT-A and the availability of TMT-B, even for subjects with low MMSE scores. These findings indicate that the dwell time of iTMT-A may be important for estimating cognitive function. The iTMT-A extracts significant factors temporally and spatially, and by incorporating the learning effect of repeated trials, it may be possible to screen cognitive and physical functions for rehabilitation patients.

The future of neuropsychology is digital, theory-driven, and Bayesian: a paradigmatic study of cognitive flexibility

Introduction

This study explores the transformative potential of digital, theory-driven, and Bayesian paradigms in neuropsychology by combining digital technologies, a commitment to evaluating theoretical frameworks, and Bayesian statistics. The study also examines theories of executive function and cognitive flexibility in a large sample of neurotypical individuals (N = 489).

Methods

We developed an internet-based Wisconsin Card-Sorting Task (iWCST) optimized for online assessment of perseveration errors (PE). Predictions of the percentage of PE, PE (%), in non-repetitive versus repetitive situations were derived from the established supervisory attention system (SAS) theory, non-repetitive PE (%) < repetitive PE (%), and the novel goal-directed instrumental control (GIC) theory, non-repetitive PE (%) > repetitive PE (%).

Results

Bayesian t-tests revealed the presence of a robust error suppression effect (ESE) indicating that PE are less likely in repetitive situations than in non-repetitive situations, contradicting SAS theory with posterior model probability p < 0.001 and confirming GIC theory with posterior model probability p > 0.999. We conclude that repetitive situations support cognitive set switching in the iWCST by facilitating the retrieval of goal-directed, instrumental memory that associates stimulus features, actions, and outcomes, thereby generating the ESE in neurotypical individuals. We also report exploratory data analyses, including a Bayesian network analysis of relationships between iWCST measures.

Discussion

Overall, this study serves as a paradigmatic model for combining digital technologies, theory-driven research, and Bayesian statistics in neuropsychology. It also provides insight into how this integrative, innovative approach can advance the understanding of executive function and cognitive flexibility and inform future research and clinical applications.

Design of a video game for assessment of executive functions in deaf and hearing children

This study investigates the effectiveness of a computerized cognitive test battery embedded within a video game to assess executive functions (EF) in deaf and hearing children. We evaluated a diverse cohort of 290 elementary school students aged 5 to 13 years (mean age = 8.86, SD = 1.96), comprising 74 sign language users, 14 Spanish-speaking deaf participants, 23 children with mixed communication methods, and 179 typically hearing individuals. Our statistical analysis focused on item discrimination, reliability, and criterion validation of the game-based assessments. The results indicated high reliability and effective discrimination of EF across the game's three primary stages. External validation was conducted using the Matrices Test, educational attainment, and age as variables. A significant positive correlation (r = 0.377, p < 0.001) was observed between the Matrices Test scores and game-based achievement scores. Furthermore, linear regression analysis revealed education (Standardized Beta = 0.339) and age (Standardized Beta = 0.179) as significant predictors of performance in these scores. This study underscores the value of integrating computerized cognitive assessments within a video game environment for comprehensive neuropsychological evaluations, highlighting its potential in diverse child populations.

Assessing time-based prospective memory online: A comparison study between laboratory-based and web-based testing

Prospective memory (PM, i.e., the ability to remember and perform future intentions) is assessed mainly within laboratory settings; however, in the last two decades, several studies have started testing PM online. Most part of those studies focused on event-based PM (EBPM), and only a few assessed time-based PM (TBPM), possibly because time keeping is difficult to control or standardise without experimental control. Thus, it is still unclear whether time monitoring patterns in online studies replicate typical patterns obtained in laboratory tasks. In this study, we therefore aimed to investigate whether the behavioural outcome measures obtained from the traditional TBPM paradigm in the laboratory-accuracy and time monitoring-are comparable with an online version in a sample of 101 younger adults. Results showed no significant difference in TBPM performance in the laboratory versus online setting, as well as no difference in time monitoring. However, we found that participants were somewhat faster and more accurate at the ongoing task during the laboratory assessment, but those differences were not related to holding an intention in mind. The findings suggest that, although participants seemed generally more distracted when tested remotely, online assessment yielded similar results in key temporal characteristics and behavioural performance as for the laboratory assessment. The results are discussed in terms of possible conceptual and methodological implications for online testing.

"Guttmann Cognitest®," a digital solution for assessing cognitive performance in adult population: A feasibility and usability pilot study

Background

As the world population continues to age, the prevalence of neurological diseases, such as dementia, poses a significant challenge to society. Detecting cognitive impairment at an early stage is vital in preserving and enhancing cognitive function. Digital tools, particularly mHealth, offer a practical solution for large-scale population screening and prompt follow-up assessments of cognitive function, thus overcoming economic and time limitations.

Objective

In this work, two versions of a digital solution called Guttmann Cognitest® were tested.

Methods

Two hundred and one middle-aged adults used the first version (Group A), while 132 used the second one, which included improved tutorials and practice screens (Group B). This second version was also validated in an older age group (Group C).

Results

This digital solution was found to be highly satisfactory in terms of usability and feasibility, with good acceptability among all three groups. Specifically for Group B, the system usability scale score obtained classifies the solution as the best imaginable in terms of usability.

Conclusions

Guttmann Cognitest® has been shown to be effective and well-perceived, with a high potential for sustained engagement in tracking changes in cognitive function.

A virtual reality paradigm with dynamic scene stimuli for use in memory research

Episodic memory may essentially be memory for one's place within a temporally unfolding scene from a first-person perspective. Given this, pervasively used static stimuli may only capture one small part of episodic memory. A promising approach for advancing the study of episodic memory is immersing participants within varying scenes from a first-person perspective. We present a pool of distinct scene stimuli for use in virtual environments and a paradigm that is implementable across varying levels of immersion on multiple virtual reality (VR) platforms and adaptable to studying various aspects of scene and episodic memory. In our task, participants are placed within a series of virtual environments from a first-person perspective and guided through a virtual tour of scenes during a study phase and a test phase. In the test phase, some scenes share a spatial layout with studied scenes; others are completely novel. In three experiments with varying degrees of immersion, we measure scene recall, scene familiarity-detection during recall failure, the subjective experience of déjà vu, the ability to predict the next turn on a tour, the subjective sense of being able to predict the next turn on a tour, and the factors that influence memory search and the inclination to generate candidate recollective information. The level of first-person immersion mattered to multiple facets of episodic memory. The paradigm presents a useful means of advancing mechanistic understanding of how memory operates in realistic dynamic scene environments, including in combination with cognitive neuroscience methods such as functional magnetic resonance imaging and electrophysiology.

Ecologically valid virtual reality-based technologies for assessment and rehabilitation of acquired brain injury: a systematic review

Purpose

A systematic review was conducted to examine the state of the literature regarding using ecologically valid virtual environments and related technologies to assess and rehabilitate people with Acquired Brain Injury (ABI).

Materials and methods

A literature search was performed following the PRISMA guidelines using PubMed, Web of Science, ACM and IEEE databases. The focus was on assessment and intervention studies using ecologically valid virtual environments (VE). All studies were included if they involved individuals with ABI and simulated environments of the real world or Activities of Daily Living (ADL).

Results

Seventy out of 363 studies were included in this review and grouped and analyzed according to the nature of its simulation, prefacing a total of 12 kitchens, 11 supermarkets, 10 shopping malls, 16 streets, 11 cities, and 10 other everyday life scenarios. These VE were mostly presented on computer screens, HMD's and laptops and patients interacted with them primarily via mouse, keyboard, and joystick. Twenty-five out of 70 studies had a non-experimental design.

Conclusion

Evidence about the clinical impact of ecologically valid VE is still modest, and further research with more extensive samples is needed. It is important to standardize neuropsychological and motor outcome measures to strengthen conclusions between studies.

Systematic review registration

identifier CRD42022301560, https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=301560.

Neurocognitive and self-reported psychosocial and behavioral functioning in siblings of individuals with neurodevelopmental conditions: a study using remote self-administered testing

OBJECTIVE

This study compared and explored the neurocognitive profiles of siblings of persons with and without neurodevelopmental conditions (NDCs) and associations between objective test performance and self-reported psychosocial functioning.

METHODS

Siblings of persons with and without NDCs (64 NDC and 64 control siblings; mean age 19.88 years, range 11-27 years, 73.44% female, 75.78% White Caucasian) completed self-report questionnaires and self-administered computerized neurocognitive tests of executive functioning (EF). Using Bayesian analyses, we examined cross-sectional associations between self-reported psychosocial functioning and cognitive test performance, and predictors of EF over 15 months.

RESULTS

NDC siblings had poorer working memory, inhibition, attention, and shifting compared to controls, as measured by experimental paradigms on the backward Corsi span, N-Back 2-back task, Stop Signal Task, Sustained Attention to Response Task, and the Wisconsin Card Sorting Test (effect size δ ranging 0.49 to 0.64). Bayesian cross-sectional networks revealed negative emotion reactivity and working memory difficulties were central to the NDC sibling network. Over 15 months, poorer EF (k low test scores) was predicted by negative emotion reactivity, sleep problems, and anxiety, over and above effects of age and subclinical autistic and ADHD traits. Siblings of autistic individuals and persons with fetal alcohol spectrum disorder had higher rates of neurocognitive and psychiatric difficulties than other NDCs and controls (Bayes factors >20).

CONCLUSIONS

Neurocognitive difficulties were associated with transdiagnostic vulnerability to poorer wellbeing in NDC siblings. These findings demonstrate the feasibility of remote online cognitive testing and highlight the importance of individualized prevention and intervention for NDC siblings.

Computerised cognitive assessment in patients with traumatic brain injury: an observational study of feasibility and sensitivity relative to established clinical scales

Background

Online technology could potentially revolutionise how patients are cognitively assessed and monitored. However, it remains unclear whether assessments conducted remotely can match established pen-and-paper neuropsychological tests in terms of sensitivity and specificity.

Methods

This observational study aimed to optimise an online cognitive assessment for use in traumatic brain injury (TBI) clinics. The tertiary referral clinic in which this tool has been clinically implemented typically sees patients a minimum of 6 months post-injury in the chronic phase. Between March and August 2019, we conducted a cross-group, cross-device and factor analyses at the St. Mary's Hospital TBI clinic and major trauma wards at Imperial College NHS trust and St. George's Hospital in London (UK), to identify a battery of tasks that assess aspects of cognition affected by TBI. Between September 2019 and February 2020, we evaluated the online battery against standard face-to-face neuropsychological tests at the Imperial College London research centre. Canonical Correlation Analysis (CCA) determined the shared variance between the online battery and standard neuropsychological tests. Finally, between October 2020 and December 2021, the tests were integrated into a framework that automatically generates a results report where patients' performance is compared to a large normative dataset. We piloted this as a practical tool to be used under supervised and unsupervised conditions at the St. Mary's Hospital TBI clinic in London (UK).

Findings

The online assessment discriminated processing-speed, visual-attention, working-memory, and executive-function deficits in TBI. CCA identified two significant modes indicating shared variance with standard neuropsychological tests (r = 0.86, p < 0.001 and r = 0.81, p = 0.02). Sensitivity to cognitive deficits after TBI was evident in the TBI clinic setting under supervised and unsupervised conditions (F (15,555) = 3.99; p < 0.001).

Interpretation

Online cognitive assessment of TBI patients is feasible, sensitive, and efficient. When combined with normative sociodemographic models and autogenerated reports, it has the potential to transform cognitive assessment in the healthcare setting.

Funding

This work was funded by a National Institute for Health Research (NIHR) Invention for Innovation (i4i) grant awarded to DJS and AH (II-LB-0715-20006).

Remote Digital Technologies for the Early Detection and Monitoring of Cognitive Decline in Patients With Type 2 Diabetes: Insights From Studies of Neurodegenerative Diseases

Type 2 diabetes (T2D) is a risk factor for cognitive decline. In neurodegenerative disease research, remote digital cognitive assessments and unobtrusive sensors are gaining traction for their potential to improve early detection and monitoring of cognitive impairment. Given the high prevalence of cognitive impairments in T2D, these digital tools are highly relevant. Further research incorporating remote digital biomarkers of cognition, behavior, and motor functioning may enable comprehensive characterizations of patients with T2D and may ultimately improve clinical care and equitable access to research participation. The aim of this commentary article is to review the feasibility, validity, and limitations of using remote digital cognitive tests and unobtrusive detection methods to identify and monitor cognitive decline in neurodegenerative conditions and apply these insights to patients with T2D.

The limitations and challenges in the assessment of executive dysfunction associated with real-world functioning: The opportunity of serious games

Nowadays, there is a broad range of methods for detecting and evaluating executive dysfunction ranging from clinical interview to neuropsychological evaluation. Nevertheless, a critical issue of these assessments is the lack of correspondence of the neuropsychological test's results with real-world functioning. This paper proposes serious games as a new framework to improve the neuropsychological assessment of real-world functioning. We briefly discuss the contribution and limitations of current methods of evaluation of executive dysfunction (paper-and-pencil tests, naturalistic observation methods, and Information and Communications Technologies) to inform on daily life functioning. Then, we analyze what are the limitations of these methods to predict real-world performance: (1) A lack of appropriate instruments to investigate the complexity of real-world functioning, (2) the vast majority of neuropsychological tests assess well-structured tasks, and (3) measurement of behaviors are based on simplistic data collection and statistical analysis. This work shows how serious games offer an opportunity to develop more efficient tools to detect executive dysfunction in everyday life contexts. Serious games provide meaningful narrative stories and virtual or real environments that immerse the user in natural and social environments with social interactions. In those highly interactive game environments, the player needs to adapt his/her behavioral performance to novel and ill-structured tasks which are suited for collecting user interaction evidence. Serious games offer a novel opportunity to develop better tools to improve diagnosis of the executive dysfunction in everyday life contexts. However, more research is still needed to implement serious games in everyday clinical practice.

Integrating Technology in Neuropsychological Assessment

Abstract. Although neuropsychological assessments include some measures that are administered, scored, or interpreted using new technologies, most researchers in this area advocate that more technology should be integrated. The current situation in neuropsychological assessment may be conceptualized as triggering a crisis leading to a paradigm shift, as there is some resistance to adopting more technology. In this paper, the context of the present crisis in neuropsychological assessment, the main obstacles, and new developments will be discussed. An example of a new computerized assessment tool, the NIH Toolbox, is highlighted. Also addressed are potential issues: in the assessment with tablets illustrating it with the older adult population and how to ensure the compatibility of data collected through these devices within the framework of the European General Data Protection Regulation (GDPR). Recommendations for research, test development, and clinical practice are also provided.

The survey for memory, attention, and reaction time (SMART): Preliminary normative online panel data and user attitudes for a brief web-based cognitive performance measure

ObjectiveThe Survey for Memory, Attention, and Reaction Time (SMART) was recently introduced as a brief (<5 min), self-administered, web-based measure of cognitive performance in older adults. The purpose of this study was threefold: (1) to develop preliminary norms on the SMART; (2) to examine the relationship between demographic variables (i.e. age, sex, education), device type used, and SMART performance; and (3) to assess user attitudes of the SMART. Method A sample of 1,050 community-dwelling adults (M age =59.5 (15.2), M education = 16.5 (2.1), 67.1% female, 96% white) was recruited from an ongoing web-based research cohort. Participants completed the SMART, which consists of four face-valid cognitive tasks assessing visual memory, attention/processing speed, and executive functioning. SMART performance outcome metrics were subtest completion time (CT), click count, and total CT. Participants provided demographic information and completed a survey of user attitudes toward the SMART (i.e. usability, acceptability). Results Older age was the only demographic variable associated with slower SMART total CT (r = .60, p <.001). Education was not associated with SMART CT or click counts overall (p > .05). Male sex was generally associated with longer SMART CT (p < .001, partial eta squared = .14) on all sub-tests. Regarding acceptability, 97.3% indicated willingness to take the SMART again, with more than half willing to complete it on a weekly basis. Conclusion The preliminary normative data on the SMART indicates that it is a feasible and well-accepted web-based cognitive assessment tool that can be administered on multiple device platforms.

The Use of Digital Technology to Assess Cognitive Function in Tunisian Adults

Background: There has been increasing evidence and support for the use of digital technology in the cognitive health field. Despite the growing use of innovative digital technology to assess cognitive function, such technology remains scarce in Arabic countries, particularly in Tunisia. Objective: To investigate the effectiveness of a digitally delivered cognitive assessment battery in differentiating varying degrees of cognitive function in older Tunisian adults. Methods: One hundred fifty-five Tunisian older adults (age: 62.24±7.52 years) were assigned to one of four groups: healthy controls (HC), at-risk (AR), mild cognitive impairment (MCI), and Alzheimer’s disease (AD). Participants completed a translated version of the Neurotrack digital cognitive battery. Results: The AD group performed significantly lower on the associative learning (p = 0.01) and associative memory assessments (p = 0.002), than the HC and AR groups. The AD group also performed worse on the inhibition measure (p = 0.008) than the HC, AR, and MCI groups. For recognition memory, the was a significant difference between all four groups (p <  0.0005), with AD having the lowest scores followed by the MCI, AR, and HC groups, respectively. There were no significant differences observed on attention, executive function and processing speed performance between the four groups (p >  0.05). Conclusion: The use of digital technology appears to be a viable solution to current cognitive assessment challenges for assessing cognitive function in a Tunisian population. These findings provide further support for the use of digital technology in cognitive assessment, particularly in understudied populations.

Driving Performance in Older Adults: Current Measures, Findings, and Implications for Roadway Safety

Background and Objectives

Over 10,000 people a day turn 65 in the United States. For many older adults, driving represents an essential component of independence and is one of the most important factors in overall mobility. Recent survey studies in older adults suggest that up to 60% of older adult drivers with mild cognitive impairment, and up to 30% with dementia, continue to drive. The purpose of this review is to provide a comprehensive and detailed resource on the topics of cognition and driving for clinicians, researchers, and policymakers working on efforts related to older adult drivers.

Research Design and Methods

Publications on PubMed and Medline and discussions with experts working in geriatrics, technology, driving policy, psychology, and diverse aspects of driving performance were utilized to inform the current review.

Results

Research indicates that there is a complex and inverse correlation between multiple cognitive measures, driving performance, and risky driving behaviors. The fragmented nature of available peer-reviewed literature, and a reliance on correlative data, do not currently allow for the identification of the temporal and reciprocal nature of the interplay between cognition and driving endpoints.

Discussion and Implications

There are currently no widely accepted definitions, conceptual models, or uniform set of analyses for conducting geriatric research that is focused on driving. Establishing conventions for conducting research that harmonizes the fields of geriatrics, cognition, and driving research is critical for the development of the evidence base that will inform clinical practice and road safety policy.

An ecologically valid examination of event-based and time-based prospective memory using immersive virtual reality: The influence of attention, memory, and executive function processes on real-world prospective memory

Studies on prospective memory (PM) predominantly assess either event- or time-based PM by implementing non-ecological laboratory-based tasks. The results deriving from these paradigms have provided findings that are discrepant with ecologically valid research paradigms that converge on the complexity and cognitive demands of everyday tasks. The Virtual Reality Everyday Assessment Lab (VR-EAL), an immersive virtual reality (VR) neuropsychological battery with enhanced ecological validity, was implemented to assess everyday event- and time-based PM, as well as the influence of other cognitive functions on everyday PM functioning. The results demonstrated the role of delayed recognition, planning, and visuospatial attention on everyday PM. Delayed recognition and planning ability were found to be central in event- and time-based PM respectively. In order of importance, delayed recognition, visuospatial attention speed, and planning ability were found to be involved in event-based PM functioning. Comparably, planning, visuospatial attention accuracy, delayed recognition, and multitasking/task-shifting ability were found to be involved in time-based PM functioning. These findings further suggest the importance of ecological validity in the study of PM, which may be achieved using immersive VR paradigms.

Encouraging Digital Technology in Neuropsychology: The Theory of Visual Attention on Tablet Devices

OBJECTIVE

Visual attention helps us to selectively process relevant information and is crucial in our everyday interactions with the environment. Not surprisingly, it is one of the cognitive domains that is most frequently affected by acquired brain injury. Reliable assessment of attention deficits is pivotal to neuropsychological examination and helps to optimize individual rehabilitation plans. Compared with conventional pen-and-paper tests, computerized tasks borrowed from the field of experimental psychology bring many benefits, but lab-based experimental setups cannot be easily incorporated in clinical practice. Light-weight and portable mobile tablet devices may facilitate the translation of computerized tasks to clinical settings. One such task is based on the Theory of Visual Attention (TVA), a mathematical model of visual attention. TVA-based paradigms have been widely used to investigate several aspects of visual attention in both fundamental and clinical research, and include measures for general processing capacity as well as stimulus-specific attentional parameters.

METHODS

This article discusses the benefits of TVA-based assessments compared with frequently used neuropsychological tests of visual attention, and examines the reliability of a tablet-based TVA-based assessment in 59 neurologically healthy participants.

RESULTS

Pearson's correlations indicate that the tablet-based TVA assessment and the conventional lab-based TVA assessment have a comparable parallel-form (range: .67-.93), test-retest (range: .61-.78), and internal reliability (range: .56-.97).

CONCLUSION

Our results suggest that tablet-based TVA assessment may be a promising tool to acquire clinical measures of visual attention at low cost at the bedside of the patient.

Interindividual and intraindividual variability in amnestic mild cognitive impairment (aMCI) measured with an online cognitive assessment

INTRODUCTION

Mean cognitive performance is worse in amnestic mild cognitive impairment (aMCI) compared to control groups. However, studies on variability of cognitive performance in aMCI have yielded inconclusive results, with many differences in variability measures and samples from one study to another.

METHODS

We examined variability in aMCI using an existing older adult sample (n = 91; 51 with aMCI, 40 with normal cognition for age), measured with an online self-administered computerized cognitive assessment (Cogniciti's Brain Health Assessment). Our methodology extended past findings by using pure measures of variability (controlling for confounding effects of group performance or practice), and a clinically representative aMCI sample (reflecting the continuum of cognitive performance between normal cognition and aMCI).

RESULTS

Between-group t-tests showed significantly greater between-person variability (interindividual variability or diversity) in overall cognitive performance in aMCI than controls, although the effect size was with a small to moderate effect size, d = 0.44. No significant group differences were found in within-person variability (intraindividual variability) across cognitive tasks (dispersion) or across trials of a response time task (inconsistency), which may be because we used a sample measuring the continuum of cognitive performance. Exploratory correlation analyses showed that a worse overall score was associated with greater inter- and intraindividual variability, and that variability measures were correlated with each other, indicating people with worse cognitive performance were more variable.

DISCUSSION

The current study demonstrates that self-administered online tests can be used to remotely assess different types of variability in people at risk of Alzheimer`s. Our findings show small but significantly more interindividual differences in people with aMCI. This diversity is considered as "noise" in standard assessments of mean performance, but offers an interesting and cognitively informative "signal" in itself.

Global Perspectives on Brief Cognitive Assessments for Dementia Diagnosis

BACKGROUND

Timely diagnosis of dementia is a global healthcare priority, particularly in low to middle income countries where rapid increases in older adult populations are expected.

OBJECTIVE

To investigate global perspectives on the role of brief cognitive assessments (BCAs) in dementia diagnosis, strengths and limitations of existing measures, and future directions and needs.

METHODS

This is a qualitative study of 18 dementia experts from different areas of the world. Participants were selected using purposeful sampling based on the following criteria: 1) practicing in countries with projected growth of older adult population of over 100%by 2050; 2) expertise in dementia diagnosis and treatment; 3) involvement in clinical practice and training; and 4) recognition as a national dementia expert based on leadership positions within healthcare system, research, and/or policy work. Participants were individually interviewed in their language of choice over secure videoconference sessions. Interviews were analyzed by a multidisciplinary team using theme identification approach.

RESULTS

Four domains with subthemes emerged illustrating participants' perspectives: 1) strengths of BCAs; 2) limitations of BCAs; 3) needs related to the use of BCAs; and 4) characteristics of an ideal BCA. While most experts agreed that BCAs were important and useful for dementia diagnosis, the themes emphasized the need for development and validation of novel measures that are sensitive, psychometrically sound, and culturally appropriate.

CONCLUSION

BCAs are important for guiding diagnosis and care for dementia patients. Findings provide a roadmap for novel BCA development to assist in diagnostic decision making for clinicians serving a rapidly growing and diverse dementia population.

Developing Digital Tools for Remote Clinical Research: How to Evaluate the Validity and Practicality of Active Assessments in Field Settings

The ability of remote research tools to collect granular, high-frequency data on symptoms and digital biomarkers is an important strength because it circumvents many limitations of traditional clinical trials and improves the ability to capture clinically relevant data. This approach allows researchers to capture more robust baselines and derive novel phenotypes for improved precision in diagnosis and accuracy in outcomes. The process for developing these tools however is complex because data need to be collected at a frequency that is meaningful but not burdensome for the participant or patient. Furthermore, traditional techniques, which rely on fixed conditions to validate assessments, may be inappropriate for validating tools that are designed to capture data under flexible conditions. This paper discusses the process for determining whether a digital assessment is suitable for remote research and offers suggestions on how to validate these novel tools.

A global collaboration to study intimate partner violence-related head trauma: The ENIGMA consortium IPV working group

Intimate partner violence includes psychological aggression, physical violence, sexual violence, and stalking from a current or former intimate partner. Past research suggests that exposure to intimate partner violence can impact cognitive and psychological functioning, as well as neurological outcomes. These seem to be compounded in those who suffer a brain injury as a result of trauma to the head, neck or body due to physical and/or sexual violence. However, our understanding of the neurobehavioral and neurobiological effects of head trauma in this population is limited due to factors including difficulty in accessing/recruiting participants, heterogeneity of samples, and premorbid and comorbid factors that impact outcomes. Thus, the goal of the Enhancing NeuroImaging Genetics through Meta-Analysis (ENIGMA) Consortium Intimate Partner Violence Working Group is to develop a global collaboration that includes researchers, clinicians, and other key community stakeholders. Participation in the working group can include collecting harmonized data, providing data for meta- and mega-analysis across sites, or stakeholder insight on key clinical research questions, promoting safety, participant recruitment and referral to support services. Further, to facilitate the mega-analysis of data across sites within the working group, we provide suggestions for behavioral surveys, cognitive tests, neuroimaging parameters, and genetics that could be used by investigators in the early stages of study design. We anticipate that the harmonization of measures across sites within the working group prior to data collection could increase the statistical power in characterizing how intimate partner violence-related head trauma impacts long-term physical, cognitive, and psychological health.

An ecologically valid examination of event-based and time-based prospective memory using immersive virtual reality: the effects of delay and task type on everyday prospective memory

Recent research has focused on assessing either event- or time-based prospective memory (PM) using laboratory tasks. Yet, the findings pertaining to PM performance on laboratory tasks are often inconsistent with the findings on corresponding naturalistic experiments. Ecologically valid neuropsychological tasks resemble the complexity and cognitive demands of everyday tasks, offer an adequate level of experimental control, and allow a generalisation of the findings to everyday performance. The Virtual Reality Everyday Assessment Lab (VR-EAL), an immersive virtual reality neuropsychological battery with enhanced ecological validity, was implemented to comprehensively assess everyday PM (i.e., focal and non-focal event-based, and time-based). The effects of the length of delay between encoding and initiating the PM intention and the type of PM task on everyday PM performance were examined. The results revealed that everyday PM performance was affected by the length of delay rather than the type of PM task. The effect of the length of delay differentially affected performance on the focal, non-focal, and time-based tasks and was proportional to the PM cue focality (i.e., semantic relationship with the intended action). This study also highlighted methodological considerations such as the differentiation between functioning and ability, distinction of cue attributes, and the necessity of ecological validity.

Validation of the Virtual Reality Everyday Assessment Lab (VR-EAL): An Immersive Virtual Reality Neuropsychological Battery with Enhanced Ecological Validity

OBJECTIVE

The assessment of cognitive functions such as prospective memory, episodic memory, attention, and executive functions benefits from an ecologically valid approach to better understand how performance outcomes generalize to everyday life. Immersive virtual reality (VR) is considered capable of simulating real-life situations to enhance ecological validity. The present study attempted to validate the Virtual Reality Everyday Assessment Lab (VR-EAL), an immersive VR neuropsychological battery, against an extensive paper-and-pencil neuropsychological battery.

METHODS

Forty-one participants (21 females) were recruited: 18 gamers and 23 non-gamers who attended both an immersive VR and a paper-and-pencil testing session. Bayesian Pearson's correlation analyses were conducted to assess construct and convergent validity of the VR-EAL. Bayesian t-tests were performed to compare VR and paper-and-pencil testing in terms of administration time, similarity to real-life tasks (i.e., ecological validity), and pleasantness.

RESULTS

VR-EAL scores were significantly correlated with their equivalent scores on the paper-and-pencil tests. The participants' reports indicated that the VR-EAL tasks were significantly more ecologically valid and pleasant than the paper-and-pencil neuropsychological battery. The VR-EAL battery also had a shorter administration time.

CONCLUSION

The VR-EAL appears as an effective neuropsychological tool for the assessment of everyday cognitive functions, which has enhanced ecological validity, a highly pleasant testing experience, and does not induce cybersickness.

Ethical Challenges of Using Virtual Environments in the Assessment and Treatment of Psychopathological Disorders

Clinicians are increasingly interested in the potential of virtual environments for research and praxes. Virtual environments include both immersive and non-immersive simulations of everyday activities. Moreover, algorithmic devices and adaptive virtual environments allow clinicians a medium for personalizing technologies to their patients. There is also increasing recognition of social virtual environments that connect virtual environments to social networks. Although there has been a great deal of deliberation on these novel technologies for assessment and treatment, less discourse has occurred around the ethical challenges that may ensue when these technologies are applied clinically. In this paper, some of the ethical issues involved in the clinical use of novel technologies are discussed.

Current State of Self-Administered Brief Computerized Cognitive Assessments for Detection of Cognitive Disorders in Older Adults: A Systematic Review

Early diagnosis of cognitive disorders in older adults is a major healthcare priority with benefits to patients, families, and health systems. Rapid advances in digital technology offer potential for developing innovative diagnostic pathways to support early diagnosis. Brief self-administered computerized cognitive tools in particular hold promise for clinical implementation by minimizing demands on staff time. In this study, we conducted a systematic review of self-administered computerized cognitive assessment measures designed for the detection of cognitive impairment in older adults. Studies were identified via a systematic search of published peer-reviewed literature across major scientific databases. All studies reporting on psychometric validation of brief (≤30 minutes) self-administered computerized measures for detection of MCI and all-cause dementia in older adults were included. Seventeen studies reporting on 10 cognitive tools met inclusion criteria and were subjected to systematic review. There was substantial variability in characteristics of validation samples and reliability and validity estimates. Only 2 measures evaluated feasibility and usability in the intended clinical settings. Similar to past reviews, we found variability across measures with regard to psychometric rigor and potential for widescale applicability in clinical settings. Despite the promise that self-administered cognitive tests hold for clinical implementation, important gaps in scientific rigor in development, validation, and feasibility studies of these measures remain. Developments in technology and biomarker studies provide potential avenues for future directions on the use of digital technology in clinical care.

Paradigm Shift Toward Digital Neuropsychology and High-Dimensional Neuropsychological Assessments: Review

Neuropsychologists in the digital age have increasing access to emerging technologies. The National Institutes of Health (NIH) initiatives for behavioral and social sciences have emphasized these developing scientific and technological potentials (eg, novel sensors) for augmented characterization of neurocognitive, behavioral, affective, and social processes. Perhaps these innovative technologies will lead to a paradigm shift from disintegrated and data-poor behavioral science to cohesive and data-rich science that permits improved translation from bench to bedside. The 4 main advances influencing the scientific priorities of a recent NIH Office of Behavioral and Social Sciences Research strategic plan include the following: integration of neuroscience into behavioral and social sciences, transformational advances in measurement science, digital intervention platforms, and large-scale population cohorts and data integration. This paper reviews these opportunities for novel brain-behavior characterizations. Emphasis is placed on the increasing concern of neuropsychology with these topics and the need for development in these areas to maintain relevance as a scientific discipline and advance scientific developments. Furthermore, the effects of such advancements necessitate discussion and modification of training as well as ethical and legal mandates for neuropsychological research and praxes.

Patient and clinician experiences of a computerised cognitive battery for use after concussion: a preliminary qualitative study

Objective:

The Cognition Battery of the National Institute of Health (NIH) Toolbox for Assessment of Neurological and Behavioural Function is a computerised neuropsychological battery recommended for clinical practice, neurological research and clinical trials. We investigated the utility of the NIH Toolbox Cognition Battery (NIHTB-CB) for people with concussion.

Methods:

In this small qualitative study, semi-structured interviews were conducted with five adults with concussion who were participating in a larger study using the NIHTB-CB. Three clinician participants and two cultural advisors familiar with the tool were also interviewed. Interview transcripts were analysed using a general thematic approach and qualitative description.

Results:

Participants described both positive and negative experiences with the NIHTB-CB and using qualitative description, their experiences were organised into three broad themes: (1) using technology for cognitive testing made sense, (2) there were some cultural relevance questions and (3) cognitive testing after concussion could have challenges. They were positive about the computerised format and range of domains assessed for the concussion context but identified the contextual relevance of some content as having potential to impact on performances.

Conclusion:

This was a small study examining the experiences of a select group of participants, but nevertheless does suggest a need for future research validating the NIHTB-CB for use in different cultural and clinical contexts.

An Investigation of the Accuracy of Reaction Time Measurements on ANAM4 TBI-MIL Across Three Computer Platforms

STUDY DESIGN

Using two observational methods and a within-subjects, counterbalanced design, this study aimed to determine if a computer's hardware and software settings significantly affected reaction time (RT) on the Automated Neuropsychological Assessment Metrics (Version 4) Traumatic Brain Injury Military (ANAM4 TBI-MIL).

METHODS

Three computer platforms were investigated: Platform 1-older computers recommended for ANAM4 TBI-MIL administration, Platform 2-newer computers with settings downgraded to run like the older computers, and Platform 3-newer computers with default settings. Two observational methods were used to compare measured RT to observed RT on all three platforms: 1, a high-speed video analysis to compare the timing of stimulus onset and response to the measured RT and 2, comparing a preset RT delivered by a robotic key actuator activated by optic detector to the measured RT. Additionally, healthy active duty service members (n = 169) were administered a brief version of the ANAM4 TBI-MIL battery on each of the three platforms.

RESULTS

RT differences were observed with both the high-speed video and robotic arm analyses across all three computer platforms, with the smallest discrepancies between observed and measured RT on Platform 1, followed by Platform 2, then Platform 3. When simple reaction time (SRT) raw and standardized scores obtained from the participants were compared across platforms, statistically significant and clinically meaningful differences were seen, especially between Platforms 1 and 3.

CONCLUSIONS

A computer's configurations have a meaningful impact on ANAM SRT scores. The difference in an individual's performance across platforms could be misinterpreted as clinically meaningful change.

Comparing Web-Based and Lab-Based Cognitive Assessment Using the Cambridge Neuropsychological Test Automated Battery: A Within-Subjects Counterbalanced Study

Background

Computerized assessments are already used to derive accurate and reliable measures of cognitive function. Web-based cognitive assessment could improve the accessibility and flexibility of research and clinical assessment, widen participation, and promote research recruitment while simultaneously reducing costs. However, differences in context may influence task performance.

Objective

This study aims to determine the comparability of an unsupervised, web-based administration of the Cambridge Neuropsychological Test Automated Battery (CANTAB) against a typical in-person lab-based assessment, using a within-subjects counterbalanced design. The study aims to test (1) reliability, quantifying the relationship between measurements across settings using correlational approaches; (2) equivalence, the extent to which test results in different settings produce similar overall results; and (3) agreement, by quantifying acceptable limits to bias and differences between measurement environments.

Methods

A total of 51 healthy adults (32 women and 19 men; mean age 36.8, SD 15.6 years) completed 2 testing sessions, which were completed on average 1 week apart (SD 4.5 days). Assessments included equivalent tests of emotion recognition (emotion recognition task [ERT]), visual recognition (pattern recognition memory [PRM]), episodic memory (paired associate learning [PAL]), working memory and spatial planning (spatial working memory [SWM] and one touch stockings of Cambridge), and sustained attention (rapid visual information processing [RVP]). Participants were randomly allocated to one of the two groups, either assessed in-person in the laboratory first (n=33) or with unsupervised web-based assessments on their personal computing systems first (n=18). Performance indices (errors, correct trials, and response sensitivity) and median reaction times were extracted. Intraclass and bivariate correlations examined intersetting reliability, linear mixed models and Bayesian paired sample t tests tested for equivalence, and Bland-Altman plots examined agreement.

Results

Intraclass correlation (ICC) coefficients ranged from ρ=0.23-0.67, with high correlations in 3 performance indices (from PAL, SWM, and RVP tasks; ρ≥0.60). High ICC values were also seen for reaction time measures from 2 tasks (PRM and ERT tasks; ρ≥0.60). However, reaction times were slower during web-based assessments, which undermined both equivalence and agreement for reaction time measures. Performance indices did not differ between assessment settings and generally showed satisfactory agreement.

Conclusions

Our findings support the comparability of CANTAB performance indices (errors, correct trials, and response sensitivity) in unsupervised, web-based assessments with in-person and laboratory tests. Reaction times are not as easily translatable from in-person to web-based testing, likely due to variations in computer hardware. The results underline the importance of examining more than one index to ascertain comparability, as high correlations can present in the context of systematic differences, which are a product of differences between measurement environments. Further work is now needed to examine web-based assessments in clinical populations and in larger samples to improve sensitivity for detecting subtler differences between test settings.

Neuropsychological screening with TOWI: Performance in 6- to 12-year-old children

Videogames represent an exciting development in neuropsychological assessment of cognitive function. Here, we used TOWI, a series of games based on standardized tests, to evaluate the cognitive performance of a large sample of school-age children. We compared the metrics produced by TOWI with the performance metrics reported for the standardized tests that inspired each of these tasks. We found ascending values together with age for scores reflecting correct answers and descending values together with age for scores reflecting completion times, mistakes or missed entries. Sensitivity to developmental changes, similarities with standardized tests of task metrics contribute to the validity of TOWI as a screening tool.

Validation of the Virtual Reality Neuroscience Questionnaire: Maximum Duration of Immersive Virtual Reality Sessions Without the Presence of Pertinent Adverse Symptomatology

There are major concerns about the suitability of immersive virtual reality (VR) systems (i.e., head-mounted display; HMD) to be implemented in research and clinical settings, because of the presence of nausea, dizziness, disorientation, fatigue, and instability (i.e., VR induced symptoms and effects; VRISE). Research suggests that the duration of a VR session modulates the presence and intensity of VRISE, but there are no suggestions regarding the appropriate maximum duration of VR sessions. The implementation of high-end VR HMDs in conjunction with ergonomic VR software seems to mitigate the presence of VRISE substantially. However, a brief tool does not currently exist to appraise and report both the quality of software features and VRISE intensity quantitatively. The Virtual Reality Neuroscience Questionnaire (VRNQ) was developed to assess the quality of VR software in terms of user experience, game mechanics, in-game assistance, and VRISE. Forty participants aged between 28 and 43 years were recruited (18 gamers and 22 non-gamers) for the study. They participated in 3 different VR sessions until they felt weary or discomfort and subsequently filled in the VRNQ. Our results demonstrated that VRNQ is a valid tool for assessing VR software as it has good convergent, discriminant, and construct validity. The maximum duration of VR sessions should be between 55 and 70 min when the VR software meets or exceeds the parsimonious cut-offs of the VRNQ and the users are familiarized with the VR system. Also, the gaming experience does not seem to affect how long VR sessions should last. Also, while the quality of VR software substantially modulates the maximum duration of VR sessions, age and education do not. Finally, deeper immersion, better quality of graphics and sound, and more helpful in-game instructions and prompts were found to reduce VRISE intensity. The VRNQ facilitates the brief assessment and reporting of the quality of VR software features and/or the intensity of VRISE, while its minimum and parsimonious cut-offs may appraise the suitability of VR software for implementation in research and clinical settings. The findings of this study contribute to the establishment of rigorous VR methods that are crucial for the viability of immersive VR as a research and clinical tool in cognitive neuroscience and neuropsychology.

Technological Competence Is a Pre-condition for Effective Implementation of Virtual Reality Head Mounted Displays in Human Neuroscience: A Technological Review and Meta-Analysis

Immersive virtual reality (VR) emerges as a promising research and clinical tool. However, several studies suggest that VR induced adverse symptoms and effects (VRISE) may undermine the health and safety standards, and the reliability of the scientific results. In the current literature review, the technical reasons for the adverse symptomatology are investigated to provide suggestions and technological knowledge for the implementation of VR head-mounted display (HMD) systems in cognitive neuroscience. The technological systematic literature indicated features pertinent to display, sound, motion tracking, navigation, ergonomic interactions, user experience, and computer hardware that should be considered by the researchers. Subsequently, a meta-analysis of 44 neuroscientific or neuropsychological studies involving VR HMD systems was performed. The meta-analysis of the VR studies demonstrated that new generation HMDs induced significantly less VRISE and marginally fewer dropouts. Importantly, the commercial versions of the new generation HMDs with ergonomic interactions had zero incidents of adverse symptomatology and dropouts. HMDs equivalent to or greater than the commercial versions of contemporary HMDs accompanied with ergonomic interactions are suitable for implementation in cognitive neuroscience. In conclusion, researchers' technological competency, along with meticulous methods and reports pertinent to software, hardware, and VRISE, are paramount to ensure the health and safety standards and the reliability of neuroscientific results.

Assessment of neurocognitive deficits in people living with HIV in Sub Saharan Africa: A systematic review

Objective: People living with HIV (PLWH) are at risk for HIV-Associated Neurocognitive Disorders (HAND)/Neurocognitive Impairment (NCI). HIV prevalence in Sub-Saharan Africa (SSA) is high, but neuropsychological screening and testing for NCI among HIV-infected individuals is not done frequently. This systematic review aims to establish how NCI among HIV-infected individuals is being assessed in SSA, if and how the tests are adapted, if norms exist and identify personnel who administer them.Method: We searched PubMed, Medline, EBSCO, PsycINFO, and Web of Science. Two reviewers screened the articles for inclusion and risk of bias. We included studies from SSA with a comprehensive neuropsychological assessment battery.Results: We retrieved 212 articles and 23 articles met inclusion criteria. The most commonly used tests were the Color Trails Test 1, Color Trails Test 2, and the WAIS III Digit Symbol Test. Some tests were translated into French (Cameroon), Luganda (Uganda), Chichewa (Malawi), isiXhosa (South Africa), and Afrikaans (South Africa). Some verbal learning tests were adapted to reflect culturally appropriate language. Test administrators were either non-specialized personnel supervised by clinical neuropsychologists or clinical psychologists.Conclusion: Overall, the tests used are similar to the tests being used globally to assess NCI among HIV-infected individuals and there is a general consistency across countries. However, there is generally a lack of norms for the tests and the process of adaptation is not always well described. Future research should establish whether these tests measure neuropsychological constructs as successfully as they do in western populations where the tests were developed.

National Institutes of Health initiatives for advancing scientific developments in clinical neuropsychology

OBJECTIVE

The current review briefly addresses the history of neuropsychology as a context for discussion of developmental milestones that have advanced the profession, as well as areas where the progression has lagged. More recently in the digital/information age, utilization and incorporation of emerging technologies has been minimal, which has stagnated ongoing evolution of the practice of neuropsychology despite technology changing many aspects of daily living. These authors advocate for embracing National Institutes of Health (NIH) initiatives, or interchangeably referred to as transformative opportunities, for the behavioral and social sciences. These initiatives address the need for neuropsychologists to transition from fragmented and data-poor approaches to integrated and data-rich scientific approaches that ultimately improve translational applications. Specific to neuropsychology is the need for the adoption of novel means of brain-behavior characterizations.

METHOD

Narrative review Conclusions: Clinical neuropsychology has reached a developmental plateau where it is ready to embrace the measurement science and technological advances which have been readily adopted by the human neurosciences. While there are ways in which neuropsychology is making inroads into these areas, a great deal of growth is needed to maintain relevance as a scientific discipline (see Figures 1, 2, and 3) consistent with NIH initiatives to advance scientific developments. Moreover, implications of such progress require discussion and modification of training, ethical, and legal mandates of the practice of neuropsychology.

Capturing Expert Knowledge for the Personalization of Cognitive Rehabilitation: Study Combining Computational Modeling and a Participatory Design Strategy

Background

Cognitive impairments after stroke are not always given sufficient attention despite the critical limitations they impose on activities of daily living (ADLs). Although there is substantial evidence on cognitive rehabilitation benefits, its implementation is limited because of time and human resource’s demands. Moreover, many cognitive rehabilitation interventions lack a robust theoretical framework in the selection of paper-and-pencil tasks by the clinicians. In this endeavor, it would be useful to have a tool that could generate standardized paper-and-pencil tasks, parameterized according to patients' needs.

Objective

In this study, we aimed to present a framework for the creation of personalized cognitive rehabilitation tasks based on a participatory design strategy.

Methods

We selected 11 paper-and-pencil tasks from standard clinical practice and parameterized them with multiple configurations. A total of 67 tasks were assessed according to their cognitive demands (attention, memory, language, and executive functions) and overall difficulty by 20 rehabilitation professionals.

Results

After assessing the internal consistency of the data—that is, alpha values from .918 to .997—we identified the parameters that significantly affected cognitive functions and proposed specific models for each task. Through computational modeling, we operationalized the tasks into their intrinsic parameters and developed a Web tool that generates personalized paper-and-pencil tasks—the Task Generator (TG).

Conclusions

Our framework proposes an objective and quantitative personalization strategy tailored to each patient in multiple cognitive domains (attention, memory, language, and executive functions) derived from expert knowledge and materialized in the TG app, a cognitive rehabilitation Web tool.

Comparison of PC and iPad administrations of the Cogstate Brief Battery in the Mayo Clinic Study of Aging: Assessing cross-modality equivalence of computerized neuropsychological tests

Objective: Computerized neuropsychological assessments are increasingly used in clinical practice, population studies of cognitive aging and clinical trial enrichment. Subtle, but significant, performance differences have been demonstrated across different modes of test administration and require further investigation. Method: Participants included cognitively unimpaired adults aged 50 and older from the Mayo Clinic Study of Aging who completed the Cogstate Brief Battery and Cogstate's Groton Maze Learning Test (GMLT) on an iPad or a personal computer (PC) in the clinic. Mode of administration differences and test-retest reliability coefficients were examined across 3 cohorts: a demographically matched test-retest cohort completing PC and iPad administrations the same day (N = 168); a test naïve cohort comparing baseline PC (n = 1820) and iPad (n =605) performance; and a demographically matched longitudinal cohort completing 3 Cogstate visits over 15 months on either the PC (n =63) or iPad (n =63). Results: Results showed a small but statistically significant and consistent finding for faster performance on PC relative to iPad for several Cogstate Brief Battery measures. Measures of accuracy generally did not differ or differences were very small. The GMLT showed faster performance and higher total errors on iPad. Most Cogstate variables showed no difference in the rate of change across PC and iPad administrations. Conclusions: There are small, but significant, differences in performance when giving the same cognitive tests on a PC or an iPad. Future studies are needed to better understand if these small differences impact the clinical interpretation of results and research outcomes.

Executive Function Predicting Longitudinal Change in Type 1 Diabetes Management During the Transition to Emerging Adulthood

OBJECTIVE

The objective of this study was to examine 1) whether teens' glycemic control and adherence to type 1 diabetes treatment regimen worsen during the transition from late adolescence to emerging adulthood, and 2) whether teens' executive function (EF), as measured by performance and self-reported problems with EF, is predictive of these changes (after controlling for general intelligence).

RESEARCH DESIGN AND METHODS

High school seniors with type 1 diabetes (N = 236; mean age 17.74 years) were assessed at three yearly time points. At baseline, during the senior year of high school, participants completed a self-report measure of problems with EF and performance-based measures of EF and general intelligence (IQ). Glycemic control was determined on the basis of results collected from HbA1c assay kits, and teens reported their adherence at all three time points.

RESULTS

HbA1c increased significantly across the three time points and adherence declined. EF performance was not associated with adherence or HbA1c at baseline, nor with changes in adherence over time. However, better EF performance predicted slower increases in HbA1c over time (i.e., slope) while controlling for IQ. Teens' self-reported problems with EF were associated with worse glycemic control and poorer adherence at baseline (i.e., intercept), but they did not predict changes in either HbA1c or adherence over time (i.e., slope).

CONCLUSIONS

Abilities involved in performance on EF tests may be one resource for maintaining better glycemic control during the transition to emerging adulthood. Assessment of such EF abilities may allow for the identification of individuals who are most at risk for deterioration of glycemic control during this transition.