The "Little Circles Test" (LCT): a dusted-off tool for assessing fine visuomotor function

BACKGROUND

The fine visuomotor function is commonly impaired in several neurological conditions. However, there is a scarcity of reliable neuropsychological tools to assess such a critical domain.

AIMS

The aim of this study is to explore the psychometric properties and provide normative data for the Visual-Motor Speed and Precision Test (VMSPT).

RESULTS

Our normative sample included 220 participants (130 females) aged 18-86 years (mean education = 15.24 years, SD = 3.98). Results showed that raw VMSPT scores were affected by higher age and lower education. No effect of sex or handedness was shown. Age- and education-based norms were provided. VMSPT exhibited weak-to-strong correlations with well-known neuropsychological tests, encompassing a wide range of cognitive domains of clinical relevance. By gradually intensifying the cognitive demands, the test becomes an indirect, performance-oriented measure of executive functioning. Finally, VMSPT seems proficient in capturing the speed-accuracy trade-off typically observed in the aging population.

CONCLUSIONS

This study proposes the initial standardization of a versatile, time-efficient, and cost-effective neuropsychological tool for assessing fine visuomotor coordination. We propose renaming the VMSPT as the more approachable "Little Circles Test" (LCT).

Serial position effects and mild cognitive impairment: a comparison of measures and scoring approaches

INTRODUCTION

Serial position effects (SPEs) have shown promise as predictors of future cognitive decline and conversion from mild cognitive impairment (MCI) to Alzheimer's disease (AD), even when accounting for total learning and memory scores. However, conflicting results have been found in the literature, which may be at least partially related to the many ways in which SPEs are calculated. The current study aimed to address the discrepancies in the literature by examining whether one method of analyzing SPEs is more sensitive at distinguishing those with and without psychometrically defined MCI.

METHOD

86 older adult participants (57 healthy comparison, 29 MCI) completed the California Verbal Learning Test, Third Edition (CVLT3) and the Rey Auditory Verbal Learning Test (RAVLT), along with measures assessing multiple cognitive domains. Each participant completed two visits, between 3 and 9 days apart, with a different memory measure administered on each day. The standard scoring approach and the regional scoring approach to calculating SPEs were compared.

RESULTS

Results showed that, when significant differences were found, SPEs were always reduced in the MCI group compared to the healthy comparison group when using regional scoring; however, results were not as consistent when using standard scoring. Further, lower primacy than recency scores were only consistently seen in the MCI group when using the RAVLT but not the CVLT3. ROC analyses showed that only regional scoring of SPEs from delayed recall of the RAVLT and the CVLT3 accurately discriminated between those with and without MCI.

CONCLUSION

Regional scoring of SPEs may be more sensitive at identifying subtle cognitive decline compared to standard scoring. However, the specific measure that is used to analyze SPEs can impact the interpretation of findings.

Eye-tracking paradigms for the assessment of mild cognitive impairment: a systematic review

Mild cognitive impairment (MCI), representing the 'transitional zone' between normal cognition and dementia, has become a novel topic in clinical research. Although early detection is crucial, it remains logistically challenging at the same time. While traditional pen-and-paper tests require in-depth training to ensure standardized administration and accurate interpretation of findings, significant technological advancements are leading to the development of procedures for the early detection of Alzheimer's disease (AD) and facilitating the diagnostic process. Some of the diagnostic protocols, however, show significant limitations that hamper their widespread adoption. Concerns about the social and economic implications of the increasing incidence of AD underline the need for reliable, non-invasive, cost-effective, and timely cognitive scoring methodologies. For instance, modern clinical studies report significant oculomotor impairments among patients with MCI, who perform poorly in visual paired-comparison tasks by ascribing less attentional resources to novel stimuli. To accelerate the Global Action Plan on the Public Health Response to Dementia 2017-2025, this work provides an overview of research on saccadic and exploratory eye-movement deficits among older adults with MCI. The review protocol was drafted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Electronic databases were systematically searched to identify peer-reviewed articles published between 2017 and 2022 that examined visual processing in older adults with MCI and reported gaze parameters as potential biomarkers. Moreover, following the contemporary trend for remote healthcare technologies, we reviewed studies that implemented non-commercial eye-tracking instrumentation in order to detect information processing impairments among the MCI population. Based on the gathered literature, eye-tracking-based paradigms may ameliorate the screening limitations of traditional cognitive assessments and contribute to early AD detection. However, in order to translate the findings pertaining to abnormal gaze behavior into clinical applications, it is imperative to conduct longitudinal investigations in both laboratory-based and ecologically valid settings.

Newly self-administered two-step tool for screening cognitive function in an ageing Chinese population: an exploratory cross-sectional study

Background

Early screening of cognitive function is critical to dementia treatment and care. However, traditional tests require face-to-face administration and are often limited by implementation costs and biases.

Aims

This study aimed to assess whether the Thoven Cognitive Self-Assessment (TCSA), a novel, innovative two-step touchscreen-based cognition assessment tool, could identify early cognitive impairment due to dementia in older adults.

Methods

The TCSA was administered to 61 healthy controls (HCs), 46 participants with mild cognitive impairment (MCI) and 44 participants diagnosed with dementia recruited from Shanghai. Two outcome measures were generated from the TCSA test: the TCSA_{primary task} score and the TCSA_{secondary task} score.

Results

The total average scores in the control group for the TCSA_{primary task} and TCSA_{secondary task} were significantly higher than those in the MCI and dementia groups (TCSA_{primary task}: HCs vs MCI group vs dementia group, 8.58±1.76 vs 5.40±2.67 vs 2.74±2.11, F=75.40, p<0.001; TCSA_{secondary task}: HCs vs MCI group vs dementia group, 23.02±3.31 vs 17.95±4.93 vs 11.93±5.50, F=76.46, p<0.001). Moreover, receiver operating characteristic analysis showed that a score below 7.5 for the TCSA_{primary task} and a score below 22.5 for the TCSA_{secondary task} were indicators of MCI.

Conclusions

The TCSA appears to be efficacious for the detection of cognitive impairment in older adults. It demonstrates the potential for large-scale cognition screening in community service settings.

Digital Devices for Assessing Motor Functions in Mobility-Impaired and Healthy Populations: Systematic Literature Review

Background

With the advent of smart sensing technology, mobile and wearable devices can provide continuous and objective monitoring and assessment of motor function outcomes.

Objective

We aimed to describe the existing scientific literature on wearable and mobile technologies that are being used or tested for assessing motor functions in mobility-impaired and healthy adults and to evaluate the degree to which these devices provide clinically valid measures of motor function in these populations.

Methods

A systematic literature review was conducted by searching Embase, MEDLINE, CENTRAL (January 1, 2015, to June 24, 2020), the United States and European Union clinical trial registries, and the United States Food and Drug Administration website using predefined study selection criteria. Study selection, data extraction, and quality assessment were performed by 2 independent reviewers.

Results

A total of 91 publications representing 87 unique studies were included. The most represented clinical conditions were Parkinson disease (n=51 studies), followed by stroke (n=5), Huntington disease (n=5), and multiple sclerosis (n=2). A total of 42 motion-detecting devices were identified, and the majority (n=27, 64%) were created for the purpose of health care–related data collection, although approximately 25% were personal electronic devices (eg, smartphones and watches) and 11% were entertainment consoles (eg, Microsoft Kinect or Xbox and Nintendo Wii). The primary motion outcomes were related to gait (n=30), gross motor movements (n=25), and fine motor movements (n=23). As a group, sensor-derived motion data showed a mean sensitivity of 0.83 (SD 7.27), a mean specificity of 0.84 (SD 15.40), a mean accuracy of 0.90 (SD 5.87) in discriminating between diseased individuals and healthy controls, and a mean Pearson r validity coefficient of 0.52 (SD 0.22) relative to clinical measures. We did not find significant differences in the degree of validity between in-laboratory and at-home sensor-based assessments nor between device class (ie, health care–related device, personal electronic devices, and entertainment consoles).

Conclusions

Sensor-derived motion data can be leveraged to classify and quantify disease status for a variety of neurological conditions. However, most of the recent research on digital clinical measures is derived from proof-of-concept studies with considerable variation in methodological approaches, and much of the reviewed literature has focused on clinical validation, with less than one-quarter of the studies performing analytical validation. Overall, future research is crucially needed to further consolidate that sensor-derived motion data may lead to the development of robust and transformative digital measurements intended to predict, diagnose, and quantify neurological disease state and its longitudinal change.

Digital Cognitive Biomarker for Mild Cognitive Impairments and Dementia: A Systematic Review

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.

Using Self-Administered Game-Based Cognitive Assessment to Screen for Degenerative Dementia: A Pilot Study

BACKGROUND

The earlier detection of dementia is needed as cases increase yearly in the aging populations of Taiwan and the world. In recent years, the global internet usage rate has gradually increased among older people. To expand dementia screening and provide timely medical intervention, a simple self-administrated assessment tool to assist in easily screening for dementia is needed.

OBJECTIVE

The two-part goal of this pilot study was, first, to develop a Game-Based Cognitive Assessment (GBCA) tool, and then, to evaluate its validity at early screening for patients with cognitive impairment.

METHOD

The researchers recruited 67 patients with neurocognitive disorders (NCDs) and 57 healthy controls (HCs). Each participant underwent the GBCA and other clinical cognitive assessments (CDR, CASI, and MMSE), and filled out a questionnaire evaluating their experience of using the GBCA. Statistical analyses were used to measure the validity of the GBCA at screening for degenerative dementia.

RESULTS

The average GBCA scores of the HC and NCD groups were 87 (SD = 7.9) and 52 (SD = 21.7), respectively. The GBCA correlated well with the CASI (r2 = 0.90, p <  0.001) and with the MMSE (r2 = 0.92, p <  0.001), indicating concurrent validity. The GBCA cut-off of 75/76 corresponded to measurements of sensitivity, specificity, and area under curve of 85.1%, 91.5%, and 0.978, respectively. The positive predictive value was 91.9%, and the negative predictive value was 84.4%. The results of the user-experience questionnaire for the HC and NCD groups were good and acceptable, respectively.

CONCLUSION

The GBCA is an effective and acceptable tool for screening for degenerative dementia.

Neuropsychology of posteromedial parietal cortex and conversion factors from Mild Cognitive Impairment to Alzheimer's disease: systematic search and state-of-the-art review

In the present review, we discuss the rationale and the clinical implications of assessing visuospatial working memory (VSWM), awareness of memory deficits, and visuomotor control in patients with mild cognitive impairment (MCI). These three domains are related to neural activity in the posteromedial parietal cortex (PMC) whose hypoactivation seems to be a significant predictor of conversion from MCI to Alzheimer’s disease (AD) as indicated by recent neuroimaging evidence. A systematic literature search was performed up to May 2021. Forty-eight studies were included: 42 studies provided analytical cross-sectional data and 6 studies longitudinal data on conversion rates. Overall, these studies showed that patients with MCI performed worse than healthy controls in tasks assessing VSWM, awareness of memory deficits, and visuomotor control; in some cases, MCI patients’ performance was comparable to that of patients with overt dementia. Deficits in VSWM and metamemory appear to be significant predictors of conversion. No study explored the relationship between visuomotor control and conversion. Nevertheless, it has been speculated that the assessment of visuomotor abilities in subjects at high AD risk might be useful to discriminate patients who are likely to convert from those who are not. Being able to indirectly estimate PMC functioning through quick and easy neuropsychological tasks in outpatient settings may improve diagnostic and prognostic accuracy, and therefore, the quality of the MCI patient’s management.

Touchscreen cognitive testing: Cross-species translation and co-clinical trials in neurodegenerative and neuropsychiatric disease

Translating results from pre-clinical animal studies to successful human clinical trials in neurodegenerative and neuropsychiatric disease presents a significant challenge. While this issue is clearly multifaceted, the lack of reproducibility and poor translational validity of many paradigms used to assess cognition in animal models are central contributors to this challenge. Computer-automated cognitive test batteries have the potential to substantially improve translation between pre-clinical studies and clinical trials by increasing both reproducibility and translational validity. Given the structured nature of data output, computer-automated tests also lend themselves to increased data sharing and other open science good practices. Over the past two decades, computer automated, touchscreen-based cognitive testing methods have been developed for non-human primate and rodent models. These automated methods lend themselves to increased standardization, hence reproducibility, and have become increasingly important for the elucidation of the neurobiological basis of cognition in animal models. More recently, there have been increased efforts to use these methods to enhance translational validity by developing task batteries that are nearly identical across different species via forward (i.e., translating animal tasks to humans) and reverse (i.e., translating human tasks to animals) translation. An additional benefit of the touchscreen approach is that a cross-species cognitive test battery makes it possible to implement co-clinical trials-an approach developed initially in cancer research-for novel treatments for neurodegenerative disorders. Co-clinical trials bring together pre-clinical and early clinical studies, which facilitates testing of novel treatments in mouse models with underlying genetic or other changes, and can help to stratify patients on the basis of genetic, molecular, or cognitive criteria. This approach can help to determine which patients should be enrolled in specific clinical trials and can facilitate repositioning and/or repurposing of previously approved drugs. This has the potential to mitigate the resources required to study treatment responses in large numbers of human patients.

The protective effect of PK11195 on D-galactose-induced amnestic mild cognitive impairment in rats

Background

This study aimed to investigate the preventive effect of translocator protein 18kDa (TSPO) ligand PK11195 on amnestic mild cognitive impairment (aMCI), as well as its influence on astrocytes, in order to identify effective ways to prevent aMCI.

Methods

Male SD rats were randomly divided into control group (n=10), aMCI group (n=10), PK11195 group (n=10), PK11195 + D-gal group (n=10). The preventive effect of PK11195 on aMCI in rats was evaluated. The cognitive function of rats in four different treatment groups was determined using the Morris water maze (MWM), as well as whole-brain pathology and immunofluorescence of rat brain tissue.

Results

The results of the MWM behavioral test showed that rats pre-treated with PK11195 had improved escape latency and a higher number of platform crossings compared with the aMCI model rats. PK11195 was also shown to prevent the D-galactose (D-gal)-induced senescence of pyramidal cells in the hippocampal CA1 region and to inhibit the apoptosis of astrocytes. At the same time, compared with the aMCI model rats, the TSPO in the brain tissue of rats pretreated with PK11195 had a lower distribution density.

Conclusions

Our results prove that PK11195 can effectively prevent D-gal-induced decline of learning and memory function as well as inhibit abnormal changes of related cells.

Mobile-Health Applications for the Efficient Delivery of Health Care Facility to People with Dementia (PwD) and Support to Their Carers: A Survey

Dementia directly influences the quality of life of a person suffering from this chronic illness. The caregivers or carers of dementia people provide critical support to them but are subject to negative health outcomes because of burden and stress. The intervention of mobile health (mHealth) has become a fast-growing assistive technology (AT) in therapeutic treatment of individuals with chronic illness. The purpose of this comprehensive study is to identify, appraise, and synthesize the existing evidence on the use of mHealth applications (apps) as a healthcare resource for people with dementia and their caregivers. A review of both peer-reviewed and full-text literature was undertaken across five (05) electronic databases for checking the articles published during the last five years (between 2014 and 2018). Out of 6195 searches yielded articles, 17 were quantified according to inclusion and exclusion criteria. The included studies distinguish between five categories, viz., (1) cognitive training and daily living, (2) screening, (3) health and safety monitoring, (4) leisure and socialization, and (5) navigation. Furthermore, two most popular commercial app stores, i.e., Google Play Store and Apple App Store, were searched for finding mHealth based dementia apps for PwD and their caregivers. Initial search generated 356 apps with thirty-five (35) meeting the defined inclusion and exclusion criteria. After shortlisting of mobile applications, it is observed that these existing apps generally addressed different dementia specific aspects overlying with the identified categories in research articles. The comprehensive study concluded that mobile health apps appear as feasible AT intervention for PwD and their carers irrespective of limited available research, but these apps have potential to provide different resources and strategies to help this community.