Neurocognitive testing supports a broader concept of mild cognitive impairment

Empowerment-based cognitive behavioural therapy for insomnia in persons with mild cognitive impairment: A sequential explanatory mixed-method pilot study

Insomnia is an emerging risk factor for the onset of mild cognitive impairment (MCI) and its progression to dementia. Impaired cognition and neuropsychiatric symptoms create challenges for persons with MCI to participate actively in non-pharmacological interventions. This study examined the feasibility and preliminary effects of empowerment-based cognitive-behavioural therapy for insomnia (CBT-I) on sleep, cognitive function, and health-related quality of life (HRQoL) in persons with MCI and sleep problems. Sixty participants were randomly allocated to the intervention or control group to receive empowerment-based CBT-I or usual care, respectively. The 12 week intervention comprised all core CBT-I techniques delivered through a group and individualised face-to-face approach. An empowerment approach with interactive teaching methods, goal setting, and action planning was used to deliver the intervention. Outcome measures included subjective and objective sleep quality and pattern, and a battery of neuropsychological tests and the 12-item Short Form Survey were administered 3 months (T1) and 6 months post-randomisation (T2). This intervention is feasible and highly acceptable for persons with MCI. The intervention group showed significant improvements in subjective and objective sleep-related outcomes compared with the control group. Moreover, the intervention group showed greater improvements in global cognition, processing speed, attention, and mental flexibility than the control group at T1 and/or T2. No significant between-group differences were observed in memory or HRQoL scores. The qualitative data converged with the quantitative data. In conclusion, empowerment-based CBT-I was well received by persons with MCI and had potential positive effects on improving sleep and cognition in this cohort.

Distress Symptoms of Old Age and Mild Cognitive Impairment are Two Distinct Dimensions in Older Adults Without Major Depression

Background

Studies in old adults showed bidirectional interconnections between amnestic mild cognitive impairment (aMCI) and affective symptoms and that adverse childhood experiences (ACE) may affect both factors. Nevertheless, these associations may be confined to older adults with clinical depression.

Aim

To delineate the relationship between clinical symptoms of aMCI and affective symptoms in older adults without major depression (MDD) or dysfunctions in activities of daily living (ADL).

Methods

This case-control study recruited 61 participants with aMCI (diagnosed using Petersen's criteria) and 59 older adults without aMCI and excluded subjects with MDD and ADL dysfunctions.

Results

We uncovered 2 distinct dimensions, namely distress symptoms of old age (DSOA), comprising affective symptoms, perceived stress and neuroticism, and mild cognitive dysfunctions, comprising episodic memory test scores, the total Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) scores. A large part of the variance (37.9%) in DSOA scores was explained by ACE, negative life events (health and financial problems), a subjective feeling of cognitive decline, and education (all positively). ACE and NLE have a highly significant impact on the DSOA score and are not associated with aMCI or its severity. Cluster analysis showed that the diagnosis of aMCI is overinclusive because some subjects with DSOA symptoms may be incorrectly classified as aMCI.

Conclusion

The clinical impact is that clinicians should carefully screen older adults for DSOA after excluding MDD. DSOA might be misinterpreted as aMCI.

Examining Relationships between Cognitive Flexibility, Exercise Perceptions, and Cardiovascular Disease Risk Factors

Adults do not engage in enough physical activity. Investigating cognitive and physiological factors related to improving this behavior-and reducing health risks-remains a public health priority. Our objective was to assess whether cognitive flexibility influenced perceptions and choice of exercise programs and whether flexibility was associated with cardiovascular disease (CVD) risk factors. Independent sample groups of college-aged adults (18-24 yrs) participated in two studies. Data were collected on individuals' degree of cognitive flexibility (both self-reported and objectively measured), perceptions and choice of exercise programs, and health status markers known to be associated with CVD (vascular function, muscular strength, and body composition). Vascular function was assessed with a near-infrared spectroscopy device, strength was defined as handgrip, and body composition was estimated via digital circumferences. Self-reported flexibility reliably predicted individuals' choice of exercise program and perceptions of effort required for success on an exercise program. The relationships among CVD risk factors and objectively measured cognitive flexibility were not significant, demonstrating that identifying a healthy individual's degree of performance-based cognitive flexibility does not predict health status. Furthermore, although greater self-reported trait flexibility (rigidity) is known to predict higher (lower) likelihood of physical activity, this finding should not be extrapolated to also assume that flexibility (rigidity), as measured by objective cognitive tests, is associated with reduced CVD risk in healthy adults. We posit a rationale for how understanding cognitive flexibility and rigidity can play an impactful role in improving adherence to exercise prescriptions targeted to reducing risks.

Effect of Continuous Ingestion of Bifidobacteria and Dietary Fiber on Improvement in Cognitive Function: A Randomized, Double-Blind, Placebo-Controlled Trial

Bifidobacterium animalis subsp. lactis GCL2505 has been shown to have some positive effects on health, including improved defecation frequency and reduced visceral fat. These effects are thought to be due to GCL2505's unique ability to reach the intestine in a viable form and proliferate after a single intake. This leads to an increased number of intestinal bifidobacteria. This randomized, double-blind, placebo-controlled, parallel-group study was conducted to confirm that intake of GCL2505 and inulin (a prebiotic) improve cognitive function (n = 80). Participants consumed test drinks containing 1 × 1010 colony-forming units of GCL2505 per 100 g and 2.0 g of inulin per 100 g for 12 weeks. The change in cognitive function assessment scores was set as the primary endpoint. There were significant improvements in scores in the neurocognitive index domain, which is an assessment of overall cognitive function, in addition to overall attention, cognitive flexibility, and executive function domains. The intervention significantly increased the number of fecal bifidobacteria and affected the levels of several inflammatory markers. These results suggest that intake of GCL2505 and inulin improves cognitive function by improving the intestinal environment and alleviating inflammation.

Digital Biomarkers for Well-being Through Exergame Interactions: Exploratory Study

Background

Ecologically valid evaluations of patient states or well-being by means of new technologies is a key issue in contemporary research in health and well-being of the aging population. The in-game metrics generated from the interaction of users with serious games (SG) can potentially be used to predict or characterize a user’s state of health and well-being. There is currently an increasing body of research that investigates the use of measures of interaction with games as digital biomarkers for health and well-being.

Objective

The aim of this paper is to predict well-being digital biomarkers from data collected during interactions with SG, using the values of standard clinical assessment tests as ground truth.

Methods

The data set was gathered during the interaction with patients with Parkinson disease with the webFitForAll exergame platform, an SG engine designed to promote physical activity among older adults, patients, and vulnerable populations. The collected data, referred to as in-game metrics, represent the body movements captured by a 3D sensor camera and translated into game analytics. Standard clinical tests gathered before and after the long-term interaction with exergames (preintervention test vs postintervention test) were used to provide user baselines.

Results

Our results showed that in-game metrics can effectively categorize participants into groups of different cognitive and physical states. Different in-game metrics have higher descriptive values for specific tests and can be used to predict the value range for these tests.

Conclusions

Our results provide encouraging evidence for the value of in-game metrics as digital biomarkers and can boost the analysis of improving in-game metrics to obtain more detailed results.

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.

Digital biomarkers and sex impacts in Alzheimer's disease management - potential utility for innovative 3P medicine approach

Digital biomarkers are defined as objective, quantifiable physiological and behavioral data that are collected and measured by means of digital devices. Their use has revolutionized clinical research by enabling high-frequency, longitudinal, and sensitive measurements. In the field of neurodegenerative diseases, an example of a digital biomarker-based technology is instrumental activities of daily living (iADL) digital medical application, a predictive biomarker of conversion from mild cognitive impairment (MCI) due to Alzheimer's disease (AD) to dementia due to AD in individuals aged 55 + . Digital biomarkers show promise to transform clinical practice. Nevertheless, their use may be affected by variables such as demographics, genetics, and phenotype. Among these factors, sex is particularly important in Alzheimer's, where men and women present with different symptoms and progression patterns that impact diagnosis. In this study, we explore sex differences in Altoida's digital medical application in a sample of 568 subjects consisting of a clinical dataset (MCI and dementia due to AD) and a healthy population. We found that a biological sex-classifier, built on digital biomarker features captured using Altoida's application, achieved a 75% ROC-AUC (receiver operating characteristic - area under curve) performance in predicting biological sex in healthy individuals, indicating significant differences in neurocognitive performance signatures between males and females. The performance dropped when we applied this classifier to more advanced stages on the AD continuum, including MCI and dementia, suggesting that sex differences might be disease-stage dependent. Our results indicate that neurocognitive performance signatures built on data from digital biomarker features are different between men and women. These results stress the need to integrate traditional approaches to dementia research with digital biomarker technologies and personalized medicine perspectives to achieve more precise predictive diagnostics, targeted prevention, and customized treatment of cognitive decline.

Supplementary Information

The online version contains supplementary material available at 10.1007/s13167-022-00284-3.

Development and validity of computerized neuropsychological assessment devices for screening mild cognitive impairment: Ensemble of models with feature space heterogeneity and retrieval practice effect

OBJECTIVE

This study aimed to develop and validate computerized neuropsychological assessment devices for screening patients with mild cognitive impairment (MCI).

METHODS

We conducted this study in three phases. Phase I involved the development of a conceptual framework of Memory Guard (MG) based on the principles of the cognitive design system (CDS). Phase II involved three steps of feature engineering: item development, filter, and wrapper. Based on the initial items, the number of items in each dimension was determined through analytic hierarchy process. We constructed an initial set with a total of 198 items with three levels of difficulty. Next, we performed feature selection through comprehensive reliability and validity tests, which resulted in the best item bank of 38 test items. The features for modeling were obtained from the best item bank (option scores, reading time scores and total time scores), demographic variables and their MoCA groups. Regarding the heterogeneity of the feature space, we combined the AdaBoost with the Naive Bayes classification algorithm as the decision model of MG. For the screening tool to be used repeatedly, the retrieval practice effect was considered in the design. Phase III involved the validation of measuring instruments. The features incorporated into the modeling process were optimized based on the classification accuracy and area under curve. We also verified the classification effect of the other three classification models with MG.

RESULTS

After three steps of feature engineering, a total of 6 dimensions of cognitive areas were included in MG: orientation, memory, attention, calculation, recall, and language & executive function. 38 features were included in the model (17 features of option score, 20 features of time score, and 1 demographic feature). A total of 333 individuals from two communities in Shanghai and Henan province were included in the measuring instrument verification process. Women accounted for 68.2% of the sample. The median age was 63. 15.3% of the participants had bachelor's degrees or above and 111 participants lived in urban areas (33.3%). The results showed that MG had an accuracy of 93.75% and AUC of 0.923, with a sensitivity of 91.67% and a specificity of 95.45%. Compared to the other three classification models, MG that combined the AdaBoost with the Naive Bayes classification algorithm was the most accurate classifier.

CONCLUSIONS

MG was proved to be reliable and valid in early screening for patients with MCI. MG that integrated heterogeneous features such as demography, option scores, and time scores had a better predictive performance for screening MCI.

Diagnostic performance of digital cognitive tests for the identification of MCI and dementia: A systematic review

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.

Effect of Dietary Pyrroloquinoline Quinone Disodium Salt on Cognitive Function in Healthy Volunteers: A Randomized, Double-Blind, Placebo-Controlled, Parallel-Group Study

BACKGROUND

Cognitive dysfunctions are increasing alarmingly around the world, and researchers are exploring preventive measures for improving brain performance. Pyrroloquinoline quinone (PQQ), a naturally occurring coenzyme in foods, exhibits potent antioxidant activity, and improves diverse functions which include mitochondrial activation, growth, repair, protection of nerve cells by increased expression of nerve growth factor (NGF) and NGF receptors; and suppression of fibril formation and aggregation of amyloid β.

OBJECTIVE

This randomized, double-blind, placebo-controlled, parallel-group clinical investigation (RCT) evaluated the efficacy and safety of PQQ disodium salt powder (mnemoPQQ®) for improved cognitive function after 12 weeks of supplementation in healthy Japanese male and female (age 40 to <80 Y).

METHODS

64 healthy subjects were randomly assigned to receive either mnemoPQQ^® (PQQ disodium salt: 21.5 mg/day) or a placebo over a period of 12 weeks. The efficacy of mnemoPQQ^® on cognitive performance (memory, attention, judgment, and cognitive flexibility) was examined using Cognitrax as the primary outcome (primary endpoint), and forgetfulness questionnaire (DECO: Deterioration Cognitive Observee) and Mini-Mental State Examination-Japanese (MMSE-J) as the secondary outcome (secondary endpoint).

RESULTS

A total of 58 subjects (placebo = 31; Age = 70.91 ± 3.06 Y; mnemoPQQ^® group = 27; Age = 72.10 ± 3.77 Y) completed the study over a period of 12 weeks of supplementation. Significant improvements were observed on the Cognitrax's cognitive function domain score on "composite memory", "verbal memory", "reaction time", "complex attention", "cognitive flexibility", "executive function", and "motor speed" in the mnemoPQQ^® group as compared to the placebo group. The DECO and the MMSE-J scores were also significantly improved in the mnemoPQQ^® group. No adverse events were observed.

CONCLUSIONS

Study demonstrates that supplementation of PQQ disodium salt is useful in improving memory, attention, judgment, and cognitive function, in middle-aged to elderly population, who feel they have become more forgetful because of aging.

Therapeutic potential of astaxanthin and superoxide dismutase in Alzheimer's disease

Oxidative stress, the imbalance of the antioxidant system, results in an accumulation of neurotoxic proteins in Alzheimer's disease (AD). The antioxidant system is composed of exogenous and endogenous antioxidants to maintain homeostasis. Superoxide dismutase (SOD) is an endogenous enzymatic antioxidant that converts superoxide ions to hydrogen peroxide in cells. SOD supplementation in mice prevented cognitive decline in stress-induced cells by reducing lipid peroxidation and maintaining neurogenesis in the hippocampus. Furthermore, SOD decreased expression of BACE1 while reducing plaque burden in the brain. Additionally, Astaxanthin (AST), a potent exogenous carotenoid, scavenges superoxide anion radicals. Mice treated with AST showed slower memory decline and decreased depositions of amyloid-beta (Aβ) and tau protein. Currently, the neuroprotective potential of these supplements has only been examined separately in studies. However, a single antioxidant cannot sufficiently resist oxidative damage to the brain, therefore, a combinatory approach is proposed as a relevant therapy for ameliorating pathological changes in AD.

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.

Electronic Cognitive Screen Technology for Screening Older Adults With Dementia and Mild Cognitive Impairment in a Community Setting: Development and Validation Study

BACKGROUND

A digital cognitive test can be a useful and quick tool for the screening of cognitive impairment. Previous studies have shown that the diagnostic performance of digital cognitive tests is comparable with that of conventional paper-and-pencil tests. However, the use of commercially available digital cognitive tests is not common in Hong Kong, which may be due to the high cost of the tests and the language barrier. Thus, we developed a brief and user-friendly digital cognitive test called the Electronic Cognitive Screen (EC-Screen) for the detection of mild cognitive impairment (MCI) and dementia of older adults.

OBJECTIVE

The aim of this study was to evaluate the performance of the EC-Screen for the detection of MCI and dementia in older adults.

METHODS

The EC-Screen is a brief digital cognitive test that has been adapted from the Rapid Cognitive Screen test. The EC-Screen uses a cloud-based platform and runs on a tablet. Participants with MCI, dementia, and cognitively healthy controls were recruited from research clinics and the community. The outcomes were the performance of the EC-Screen in distinguishing participants with MCI and dementia from controls, and in distinguishing participants with dementia from those with MCI and controls. The cohort was randomly split into derivation and validation cohorts based on the participants' disease group. In the derivation cohort, the regression-derived score of the EC-Screen was calculated using binomial logistic regression. Two predictive models were produced. The first model was used to distinguish participants with MCI and dementia from controls, and the second model was used to distinguish participants with dementia from those with MCI and controls. Receiver operating characteristic curves were constructed and the areas under the curves (AUCs) were calculated. The performances of the two predictive models were tested using the validation cohorts. The relationship between the EC-Screen and paper-and-pencil Montreal Cognitive Assessment-Hong Kong version (HK-MoCA) was evaluated by the Pearson correlation coefficient.

RESULTS

A total of 126 controls, 54 participants with MCI, and 63 participants with dementia were included in the study. In differentiating participants with MCI and dementia from controls, the AUC of the EC-Screen in the derivation and validation cohorts was 0.87 and 0.84, respectively. The optimal sensitivity and specificity in the derivation cohorts were 0.81 and 0.80, respectively. In differentiating participants with dementia from those with MCI and controls, the AUC of the derivation and validation cohorts was 0.90 and 0.88, respectively. The optimal sensitivity and specificity in the derivation cohort were 0.83 and 0.83, respectively. There was a significant correlation between the EC-Screen and HK-MoCA (r=-0.67, P<.001).

CONCLUSIONS

The EC-Screen is suggested to be a promising tool for the detection of MCI and dementia. This test can be self-administered or assisted by a nonprofessional staff or family member. Therefore, the EC-Screen can be a useful tool for case finding in primary health care and community settings.

Beta wave enhancement neurofeedback improves cognitive functions in patients with mild cognitive impairment: A preliminary pilot study

BACKGROUND

Mild cognitive impairment (MCI) is a symptom characterizing cognitive decline and a transitional state between normal aging and dementia; however, there is no definitive diagnosis and treatment for MCI. Neurofeedback (NF), which is a training mechanism that employs operant conditioning to regulate brain activity, has been increasingly investigated concerning its beneficial effects for dementia and MCI.

METHODS

This study investigated cognitive improvement and hemodynamic changes in the prefrontal cortex (PFC) following NF training in patients with MCI. Five patients with MCI received NF training for enhanced beta band activity in the dorsolateral PFC-16 sessions for 8 weeks-with each session divided into 9 5-minute trials. The primary outcome measure was a cognitive assessment tool: the Korean version of the Montreal Cognitive Assessment. The secondary outcome measures were the Central Nervous System Vital Signs for neurocognitive testing, hemodynamic changes using functional near-infrared spectroscopy in the PFC during a working-memory task, and Beck Depression Inventory scores.

RESULTS

After completing the training, patients' cognitive function significantly improved in domains such as composite memory, cognitive flexibility, complex attention, reaction time, and executive function. Increased electroencephalogram beta power was observed over NF training sessions (Spearman rank correlation test: r = 0.746, P = .001). The threshold value for gaining positive feedback from pre-NF baseline on beta power significantly increased (Spearman rank correlation test: r = 0.805, P = .001). Hemodynamic response in PFC changed after NF training, and individual differences were identified. Specifically, hypoactivation of the hemodynamic response by emotional distraction recovered following NF training.

CONCLUSION

We suggest that patients' cognitive processing efficiency was improved by the NF training. These beneficial results suggest that NF training may have potential therapeutic applications to prevent the progression from MCI to dementia.

TRIAL REGISTRATION NUMBER

Clinical Research Information Service (KCT0003433).

Effects of Composite Supplement Containing Astaxanthin and Sesamin on Cognitive Functions in People with Mild Cognitive Impairment: A Randomized, Double-Blind, Placebo-Controlled Trial

Background:

Dementia and its first or transitional stage, mild cognitive impairment (MCI), is a major concern for the aging Japanese society. Thus, the use of dietary supplements to improve or maintain cognitive function has become a topic of public interest.

Objective:

In this study, we evaluated the effects of a composite supplement containing food-derived antioxidants, specifically astaxanthin and sesamin (AS), on cognitive function in people with MCI.

Method:

Twenty-one healthy participants with MCI were recruited in our double-blind placebo-controlled pilot study. They were assigned to either an AS group, who received ingestible capsules containing AS, or a placebo group, who received identical placebo capsules. To assess cognitive functions, we performed the Japanese version of the Central Nervous System Vital Signs (CNSVS) test and the Alzheimer’s Disease Assessment Scale-Cog test at baseline, after 6 weeks, and after 12 weeks of dietary supplementation.

Results:

The CNSVS test revealed significant improvements in psychomotor speed and processing speed in the AS group compared with the placebo group, suggesting that the daily supplementation of AS improved cognitive functions related to the ability to comprehend, and perform complex tasks quickly and accurately.

Conclusion:

Our results provide support for the use of AS as a dietary supplementation for improving cognitive functions.

A computerized, self-administered test of verbal episodic memory in elderly patients with mild cognitive impairment and healthy participants: A randomized, crossover, validation study

Introduction

Performance of “Revere”, a novel iPad-administered word-list recall (WLR) test, in quantifying deficits in verbal episodic memory, was evaluated versus examiner-administered Rey Auditory Verbal Learning Test (RAVLT) in patients with mild cognitive impairment and cognitively normal participants.

Methods

Elderly patients with clinically diagnosed mild cognitive impairment (Montreal Cognitive Assessment score 24–27) and cognitively normal (Montreal Cognitive Assessment score ≥28) were administered RAVLT or Revere in a randomized crossover design.

Results

A total of 153/161 participants (Revere/RAVLT n = 75; RAVLT/Revere n = 78) were randomized; 148 (97%) completed study; 121 patients (mean [standard deviation] age: 70.4 [7.84] years) were included for analysis. Word-list recall scores (8 trials) were comparable between Revere and RAVLT (Pearson's correlation coefficients: 0.12–0.70; least square mean difference [Revere-RAVLT]: −0.84 [90% CI, −1.15; −0.54]). Model factor estimates indicated trial (P < .001), period (P < .001) and evaluation sequence (P = .038) as significant factors. Learning over trials index and serial position effects were comparable.

Discussion

Participants' verbal recall performance on Revere and RAVLT were equivalent.

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

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.

A Comparison of Cognitive Function in Former Rugby Union Players Compared with Former Non-Contact-Sport Players and the Impact of Concussion History

AIM

This study investigated differences in cognitive function between former rugby and non-contact-sport players, and assessed the association between concussion history and cognitive function.

METHODS

Overall, 366 former players (mean ± standard deviation [SD] age 43.3 ± 8.2 years) were recruited from October 2012 to April 2014. Engagement in sport, general health, sports injuries and concussion history, and demographic information were obtained from an online self-report questionnaire. Cognitive functioning was assessed using the online CNS Vital Signs neuropsychological test battery. Cohen's d effect size statistics were calculated for comparisons across player groups, concussion groups (one or more self-reported concussions versus no concussions) and between those groups with CNS Vital Signs age-matched norms (US norms). Individual differences within groups were represented as SDs.

RESULTS

The elite-rugby group (n = 103) performed worse on tests of complex attention, processing speed, executive functioning, and cognitive flexibility than the non-contact-sport group (n = 65), and worse than the community-rugby group (n = 193) on complex attention. The community-rugby group performed worse than the non-contact group on executive functioning and cognitive flexibility. Compared with US norms, all three former player groups performed worse on verbal memory and reaction time; rugby groups performed worse on processing speed, cognitive flexibility and executive functioning; and the community-rugby group performed worse on composite memory. The community-rugby group and non-contact-sport group performed slightly better than US norms on complex attention, as did the elite-rugby group for motor speed. All three player groups had greater individual differences than US norms on composite memory, verbal memory and reaction time. The elite-rugby group had greater individual differences on processing speed and complex attention, and the community-rugby group had greater individual differences on psychomotor speed and motor speed. The average number of concussions recalled per player was greater for elite rugby and community rugby than non-contact sport. Former players who recalled one or more concussions (elite rugby, 85 %; community rugby, 77 %; non-contact sport, 23 %) had worse scores on cognitive flexibility, executive functioning, and complex attention than players who did not recall experiencing a concussion.

CONCLUSIONS

Past participation in rugby or a history of concussion were associated with small to moderate neurocognitive deficits (as indicated by worse CNS Vital Signs scores) in athletes post retirement from competitive sport.

Group Changes in Cognitive Performance After Surgery Mask Changes in Individual Patients with Glioblastoma

BACKGROUND

There is a growing interest to include evaluations of cognitive performance in the clinical management of patients with glioblastoma (GBM). However, as changes in cognitive performance of a group may mask changes in individual patients, study results are often difficult to transfer into clinical practice. We focused on the comparison of group versus individual changes in neuropsychological performance of patients with GBM after initial surgical treatment.

METHODS

Patients underwent neuropsychological evaluation using CNS Vital Signs 1 day prior to and 3 months after surgery. Two-tailed paired-samples t tests were conducted to assess changes on the group level. Reliable change indices (RCIs) that correct for practice effects and imperfect test-retest reliabilities were used to examine changes in individual patients.

RESULTS

Cognitive dysfunction was common (>80%) both before and 3 months after surgery in this sample of 82 patients with GBM. Whereas group analyses revealed minimal changes in performance over time, RCIs demonstrated that most patients (89%) showed changes in performance in at least 1 cognitive domain. Half of these individual patients solely showed improvements, a quarter solely showed declines, and another quarter showed both improvements and declines.

CONCLUSIONS

This study clearly demonstrates that important individual changes in performance are masked when looking only at group results. Future studies should more often use an individual patient approach to enhance knowledge transfer into clinical practice.

Computerized Cognitive Screen (CoCoSc): A Self-Administered Computerized Test for Screening for Cognitive Impairment in Community Social Centers

BACKGROUND

Computerized cognitive tests may serve as a preliminary, low-cost method to identify individuals with suspected cognitive impairment in the community.

OBJECTIVE

To develop a self-administered computerized test, namely the "Computerized Cognitive Screen (CoCoSc), Hong Kong version", for screening of individuals with cognitive impairment (CI) in community settings.

METHODS

The CoCoSc is a 15-min computerized cognitive screen covering memory, executive functions, orientation, attention and working memory, and prospective memory administered on a touchscreen computer. Individuals with CI and cognitively normal controls were administered the CoCoSc and the Montreal Cognitive Assessment (MoCA). Validity of the CoCoSc was assessed based on the relationship with the MoCA using Pearson correlation. Receiver operating characteristic curve (ROC) was used to examine the ability of the CoCoSc to differentiate CI from controls.

RESULTS

Fifty-nine individuals with CI and 101 controls were recruited. Seventy-five (46.9%) participants had ≤6 years of education. Performance on the CoCoSc differed between normal and CI groups in both low and high education subgroups. Total scores of the CoCoSc and MoCA were significantly correlated (r = 0.71, p < 0.001). The area under ROC was 0.78, p < 0.001 for the CoCoSc total score in differentiating the CI group from the cognitively normal group. A cut-off of ≤30 on the CoCoSc was associated with a sensitivity of 0.78 and specificity of 0.69. The CoCoSc was well accepted by attendees of community social centers.

CONCLUSION

The CoCoSc is a promising computerized cognitive screen for self-administration in community social centers. It is feasible for testing individuals with high or low education levels.

Feasibility and Neurobehavioral Changes of 10-Day Simulated Microgravity in Acute Ischemic Stroke Patients

OBJECTIVE

The aim of the study was to investigate feasibility and functional changes of simulated microgravity with 6-degree head-down-tilt (HDT) bed rest in acute ischemic stroke.

DESIGN

Patients without lesions in the cingulate cortex and/or cerebellum were enrolled. They underwent HDT for 30 minutes twice per day for 10 weekdays. Systolic blood pressure, diastolic blood pressure, and heart rate were measured before the HDT, immediately after, and also 30 minutes after the stop. Mini-Mental State Examination, Geriatric Depression Scale, Neurobehavioral Tests (i.e., span test, finger-tapping test, continuous performance test, and trail-making test) were conducted before and after the 10-day HDT.

RESULTS

One male and four female patients (median age = 64.6 yrs [SD = 10.5 yrs]) were recruited. Changes in the finger-tapping test (57.80 [SD = 40.96 ] vs. 85.80 [SD = 0.46], P = 0.08) and in the digit span backward test (3.60 [SD = 1.14] vs. 1.42 [SD = 1.75], P = 0.07) were noticed. Few changes were found in other scales. No significant changes in systolic blood pressure, diastolic blood pressure, or heart rate were observed, and no adverse effects occurred.

CONCLUSIONS

The 6-degree HDT revealed no adverse effects on the cardiovascular system, showing nonsignificant increment in the finger-tapping test (representative of motor speed and performance) and nonsignificant reduction in the digit backward span test (representative of spatial memory).

C-TOC (Cognitive Testing on Computer): investigating the usability and validity of a novel self-administered cognitive assessment tool in aging and early dementia

INTRODUCTION

Cognitive Testing on Computer (C-TOC) is a novel computer-based test battery developed to improve both usability and validity in the computerized assessment of cognitive function in older adults.

METHODS

C-TOC's usability was evaluated concurrently with its iterative development to version 4 in subjects with and without cognitive impairment, and health professional advisors representing different ethnocultural groups. C-TOC version 4 was then validated against neuropsychological tests (NPTs), and by comparing performance scores of subjects with normal cognition, Cognitive Impairment Not Dementia (CIND) and Alzheimer disease. C-TOC's language tests were validated in subjects with aphasic disorders.

RESULTS

The most important usability issue that emerged from consultations with 27 older adults and with 8 cultural advisors was the test-takers' understanding of the task, particularly executive function tasks. User interface features did not pose significant problems. C-TOC version 4 tests correlated with comparator NPT (r=0.4 to 0.7). C-TOC test scores were normal (n=16)>CIND (n=16)>Alzheimer disease (n=6). All normal/CIND NPT performance differences were detected on C-TOC. Low computer knowledge adversely affected test performance, particularly in CIND. C-TOC detected impairments in aphasic disorders (n=11).

DISCUSSION

In general, C-TOC had good validity in detecting cognitive impairment. Ensuring test-takers' understanding of the tasks, and considering their computer knowledge appear important steps towards C-TOC's implementation.

A mobile application for cognitive screening of dementia

Neuropsychological assessment tests have an important role in early detection of dementia. Therefore, we designed and implemented a test battery for mobile devices that can be used for mobile cognitive screening (MCS). This battery consists of 33 questions from 14 type of tests for the assessment of 8 different cognitive functions: Arithmetic, orientation, abstraction, attention, memory, language, visual, and executive functions. This test battery is implemented as an application for mobile devices that operates on Android OS. In order to validate the effectiveness of the neuropsychological test battery, it was applied on a group of 23 elderly persons. Within this group, 9 (of age 81.78±4.77) were healthy and 14 (of age 72.55±9.95) were already diagnosed with dementia. The education level of the control group (healthy) and dementia group were comparable as they spent 13.66±5.07 and 13.71±4.14 years at school respectively. For comparison, a validated paper-and-pencil test (Montreal Cognitive Test - MoCA) was applied along with the proposed MCS battery. The proposed test was able to differentiate the individuals in the control and dementia groups for executive, visual, memory, attention, orientation functions with statistical significance (p<0.05). Results of the remaining functions; language, abstraction, and arithmetic were statistically insignificant (p>0.05). The results of MCS and MoCA were compared, and the scores of individuals from these tests were correlated (r(2)=0.57).

Computerized cognitive testing for older adults: a review

OBJECTIVE

This article is a review of computerized tests and batteries used in the cognitive assessment of older adults.

METHOD

A literature search on Medline followed by cross-referencing yielded a total of 76 citations.

RESULTS

Seventeen test batteries were identified and categorized according to their scope. Computerized adaptive testing (CAT) and the Cambridge Cognitive Examination CAT battery as well as 3 experimental batteries and an experimental test are discussed in separate sections. All batteries exhibit strengths associated with computerized testing such as standardization of administration, accurate measurement of many variables, automated record keeping, and savings of time and costs. Discriminant validity and test-retest reliability were well documented for most batteries while documentation of other psychometric properties varied.

CONCLUSION

The large number of available batteries can be beneficial to the clinician or researcher; however, care should be taken in order to choose the correct battery for each application.

Cardiovascular biomarkers and carotid IMT scores as predictors of cognitive function

OBJECTIVE

Multiple cardiovascular risk factors are associated with early cognitive decline. Measures of complex information processing provide one of the earliest signs of cognitive decline and appear related to arterial plaque growth. The purpose of this study was to determine how cardiovascular risk factors and carotid intima-media thickness (IMT) scores are associated with cognitive function and complex information processing scores.

METHODS

This study used a retrospective, cross-sectional analysis of 536 men and women attending an executive evaluation program. Measurements were made of body composition, cardiovascular status, fitness and diet, and laboratory measures, including carotid IMT. Each subject was tested with a computerized neurocognitive test battery.

RESULTS

Complex information processing (CIP), also called executive function, is independently related to carotid IMT scores (p < 0.01), as are other cardiovascular biomarkers, including aerobic capacity fiber, B12, and long-chain n-3 fatty acid intake (p < 0.01 for each). However, after controlling for carotid IMT, only IMT showed a significant relationship with CIP scores.

CONCLUSIONS

Carotid IMT scores are the strongest independent cardiovascular biomarker for cognitive function, especially complex information processing. Greater intake of fiber, long-chain n-3 fatty acids (N3FAs), and vitamin B12, as well as measures of aerobic fitness, is associated with enhanced cognitive function, yet controlling for IMT scores diminished their association. Because decreasing CIP scores are linearly associated with cognitive decline, future randomized clinical trials that yield improvements in carotid IMT scores should also assess for changes in cognitive function.

Computerized Neurocognitive Test (CNT) in mild cognitive impairment and Alzheimer's disease

Currently, computerized batteries are of great value in detecting cognitive impairment. This aim of this review was to compare the computerized neurocognitive batteries used in most studies with cognitive decline over the last 10 years. Using the search words computerized cognitive assessment with: dementia, mild cognitive impairment, and Alzheimer's disease, the CogState, CNS Vital Sings, COGDRAS and Mindstreams batteries were retrieved.

Applications of technology in neuropsychological assessment

Most neuropsychological assessments include at least one measure that is administered, scored, or interpreted by computers or other technologies. Despite supportive findings for these technology-based assessments, there is resistance in the field of neuropsychology to adopt additional measures that incorporate technology components. This literature review addresses the research findings of technology-based neuropsychological assessments, including computer- and virtual reality-based measures of cognitive and functional abilities. We evaluate the strengths and limitations of each approach, and examine the utility of technology-based assessments to obtain supplemental cognitive and behavioral information that may be otherwise undetected by traditional paper-and-pencil measures. We argue that the potential of technology use in neuropsychological assessment has not yet been realized, and continued adoption of new technologies could result in more comprehensive assessment of cognitive dysfunction and in turn, better informed diagnosis and treatments. Recommendations for future research are also provided.

Test-retest reliability of four computerized neurocognitive assessment tools in an active duty military population

Computerized neurocognitive assessment tools (NCATs) are increasingly used for baseline and post-concussion assessments. To date, NCATs have not demonstrated strong test-retest reliabilities. Most studies have used non-military populations and different methodologies, complicating the determination of the utility of NCATs in military populations. The test-retest reliability of four NCATs (Automated Neuropsychological Assessment Metrics 4 [ANAM4], CNS-Vital Signs, CogState, and Immediate Post-Concussion Assessment and Cognitive Test [ImPACT]) was investigated in a healthy active duty military sample. Four hundred and nineteen Service Members were randomly assigned to take one NCAT and 215 returned after approximately 30 days for retest. Participants deemed to have inadequate effort during one or both testing sessions, according to the NCATs scoring algorithms, were removed from analyses. Each NCAT had at least one reliability score (intraclass correlation) in the "adequate" range (.70-.79), only ImPACT had one score considered "high" (.80-.89), and no scores met "very high" criteria (.90-.99). However, overall test-retest reliabilities in four NCATs in a military sample are consistent with reliabilities reported in the literature and are lower than desired for clinical decision-making.

Minimal gender differences on the CNS vital signs computerized neurocognitive battery

Normative test scores often are corrected for demographic variables that can have an impact on neurocognitive abilities (e.g., gender, age, education, and ethnicity). The purpose of this study is to determine whether there are gender differences on the CNS Vital Signs computerized neurocognitive test battery. Participants, selected from a large normative database, were 100 healthy adults aged 18 to 68 years old (M(age) = 35.8 years, SD = 13.6) with 15.5 years of education (SD = 2.2). Men (n = 50) and women (n = 50) were individually and precisely matched on age, education, ethnicity, computer use, occupation, and handedness. This battery of seven tests yields 23 test scores, 5 domain scores (Memory, Psychomotor Speed, Reaction Time, Complex Attention, and Cognitive Flexibility), and a total score. Men had significantly better scores than did women on the Finger-Tapping Test for the right hand (p = .006, Cohen's d = 0.57). No other scores were significantly different, although there were small-medium effect sizes in favor of women on Symbol-Digit Coding (d = .39) and Verbal Memory (d = .37). The trends toward gender differences in word-list recognition memory and processing speed are consistent with the literature, but because they were nonsignificant and the effect sizes were modest, the clinician likely does not need to factor this into test interpretation.

Cognitive approaches to early Alzheimer's disease diagnosis

In this article, cognitive measures in the screening of individuals at risk for Alzheimer disease (AD) are reviewed. Use of cognitive tasks in identifying clinical cases of AD is considered, as well as methods for detecting those in the prodromal stages of the disease, including cognitive screening instruments. Traditional assessments, such as the mini-mental state examination, as well as contemporary computerized screening instruments, are examined. Areas of cognition for investigation in the detection of prodromal AD are recommended. The prospects for general cognitive screening are reviewed, and more engaging technologies to tests individuals at risk for developing AD are recommended.

Computerized neuropsychological testing to rapidly evaluate cognition in pediatric patients with neurologic disorders

Computerized neuropsychological tests represent a viable method for rapidly screening cognition. The purpose of this study was to explore performance on the CNS Vital Signs in a large pediatric neurology sample. Participants included 166 neurology patients (mean age, 13.0 years; standard deviation, 3.2) and 281 controls (mean age, 13.2 years; standard deviation, 3.2) between 7 and 19 years. The neurology sample performed significantly worse on all domain scores and nearly all subtest scores. Cohen d effect sizes were small to medium for verbal memory (d= 0.44), visual memory (d= 0.40), and reaction time (d= 0.48) and very large for psychomotor speed (d= 1.19), complex attention (d = 0.94), cognitive flexibility (d = 0.94), and the overall composite score (d = 1.08). Using the criterion for cognitive impairment of 2 or more scores ≤5th percentile, 36.6% of the neurology sample was identified as having an uncommon cognitive profile. This is the first study to demonstrate the performance of pediatric patients with neurologic disorders on CNS Vital Signs.

Neurological soft signs in persons with amnestic mild cognitive impairment and the relationships to neuropsychological functions

BACKGROUND

Neurological abnormalities have been reported in people with amnestic mild cognitive impairment (aMCI). The current study aimed to examine the prevalence of neurological soft signs (NSS) in this clinical group and to examine the relationship of NSS to other neuropsychological performances.

METHODS

Twenty-nine people with aMCI and 28 cognitively healthy elderly people were recruited for the present study. The NSS subscales (motor coordination, sensory integration, and disinhibition) of the Cambridge Neurological Inventory and a set of neuropsychological tests were administered to all the participants.

RESULTS

People with aMCI exhibited significantly more motor coordination signs, disinhibition signs, and total NSS than normal controls. Correlation analysis showed that the motor coordination subscale score and total score of NSS were significantly inversely correlated with the combined Z-score of neuropsychological tests in aMCI group.

CONCLUSIONS

These preliminary findings suggested that people with aMCI demonstrated a higher prevalence of NSS compared to healthy elderly people. Moreover, NSS was found to be inversely correlated with the neuropsychological performances in persons with aMCI. When taken together, these findings suggested that NSS may play a potential important role and serve as a tool to assist in the early detection of aMCI.

Computerized neuropsychological assessment devices: joint position paper of the American Academy of Clinical Neuropsychology and the National Academy of Neuropsychology

This joint position paper of the American Academy of Clinical Neuropsychology and the National Academy of Neuropsychology sets forth our position on appropriate standards and conventions for computerized neuropsychological assessment devices (CNADs). In this paper, we first define CNADs and distinguish them from examiner-administered neuropsychological instruments. We then set forth position statements on eight key issues relevant to the development and use of CNADs in the healthcare setting. These statements address (a) device marketing and performance claims made by developers of CNADs; (b) issues involved in appropriate end-users for administration and interpretation of CNADs; (c) technical (hardware/software/firmware) issues; (d) privacy, data security, identity verification, and testing environment; (e) psychometric development issues, especially reliability and validity; (f) cultural, experiential, and disability factors affecting examinee interaction with CNADs; (g) use of computerized testing and reporting services; and (h) the need for checks on response validity and effort in the CNAD environment. This paper is intended to provide guidance for test developers and users of CNADs that will promote accurate and appropriate use of computerized tests in a way that maximizes clinical utility and minimizes risks of misuse. The positions taken in this paper are put forth with an eye toward balancing the need to make validated CNADs accessible to otherwise underserved patients with the need to ensure that such tests are developed and utilized competently, appropriately, and with due concern for patient welfare and quality of care.

Computerized neuropsychological assessment devices: joint position paper of the American Academy of Clinical Neuropsychology and the National Academy of Neuropsychology

This joint position paper of the American Academy of Clinical Neuropsychology and the National Academy of Neuropsychology sets forth our position on appropriate standards and conventions for computerized neuropsychological assessment devices (CNADs). In this paper, we first define CNADs and distinguish them from examiner-administered neuropsychological instruments. We then set forth position statements on eight key issues relevant to the development and use of CNADs in the healthcare setting. These statements address (a) device marketing and performance claims made by developers of CNADs; (b) issues involved in appropriate end-users for administration and interpretation of CNADs; (c) technical (hardware/software/firmware) issues; (d) privacy, data security, identity verification, and testing environment; (e) psychometric development issues, especially reliability, and validity; (f) cultural, experiential, and disability factors affecting examinee interaction with CNADs; (g) use of computerized testing and reporting services; and (h) the need for checks on response validity and effort in the CNAD environment. This paper is intended to provide guidance for test developers and users of CNADs that will promote accurate and appropriate use of computerized tests in a way that maximizes clinical utility and minimizes risks of misuse. The positions taken in this paper are put forth with an eye toward balancing the need to make validated CNADs accessible to otherwise underserved patients with the need to ensure that such tests are developed and utilized competently, appropriately, and with due concern for patient welfare and quality of care.

Mild cognitive impairment is associated with impaired visual-motor planning when visual stimuli and actions are incongruent

BACKGROUND/AIMS

This study examined cognitive-motor integration in adults with mild cognitive impairment (MCI). Previously, we showed that the performance of early-stage Alzheimer's disease patients declined significantly as a visually-guided movement went from having a standard mapping (vision and action spatially aligned) to having a non-standard mapping (vision and action incongruent). The present study extends this line of research by examining the performance of individuals affected by MCI.

METHODS

The participants made finger movements over a clear touchscreen placed in two separate spatial planes to either constantly present or remembered visual targets. These spatial plane conditions were repeated with the direction of cursor motion rotated 180° from that of hand motion. We also tested an 'arbitrary' condition where symbols instructed the participants to move their hand in certain directions.

RESULTS

We observe that adults with MCI took significantly longer to plan movements requiring intermediate levels of non-standard mapping, relative to healthy older adults.

CONCLUSIONS

These data suggest that movements requiring rule integration is affected even in individuals at a very early stage of cognitive decline. Cognitive-motor integration may provide a sensitive means to detect functional difficulty in early cognitive impairment.

Apolipoprotein E-e4, processing speed, and white matter volume in a genetically enriched sample of midlife adults

Healthy midlife children of a parent with Alzheimer's disease ([AD] N = 23; 9 male) participated in neuropsychological testing, and magnetic resonance imaging (MRI) of brain volumetrics were obtained. In all, 35% of the sample were apolipoprotein E (ApoE)-e4 positive (n = 8; 5 male). The ApoE-e4 group exhibited significantly slower performances on an executive function and processing speed measure and had less white matter volume than the non-ApoE-e4 group. Lesser white matter volume was significantly correlated with slower processing speed. Processing speed and changes in white matter volume might be indicators of preclinical decline in AD.

Identifying a cognitive impairment subgroup in adults with mood disorders

BACKGROUND

We hypothesized that only a minority of patients with mood disorders have measurable cognitive impairment, and this minority drives the small-to-medium effect sizes detected in group studies. Removal of this minority from group statistical analyses will illustrate that the majority appear to have broadly normal cognitive functioning.

METHODS

Participants were adults between the ages of 20 and 54, including 659 healthy control subjects, 84 unmedicated outpatients diagnosed with depression, 59 outpatients diagnosed with depression who were on medications at the time of the evaluation, and 43 outpatients with bipolar disorder. All completed the CNS Vital Signs computerized cognitive screening battery.

RESULTS

The prevalence rates of low cognitive test scores were calculated for the healthy control subjects and the patients with mood disorders. Having two scores at or below the 5th percentile occurred in 31.2% of the patients and only 8.2% of the control subjects [χ(2)(1)=66.67, p<.0001; Odds Ratio=5.1, 95% CI=3.4-7.7]. For the control subjects, this low false positive rate for cognitive impairment was maintained across age groups, sexes, and education levels. A larger proportion of patients with bipolar disorder (41.9%) than patients with depression (27.1-28.6%) met this criterion for cognitive impairment.

CONCLUSIONS

This study suggests that cognitive impairment associated with mood disorders is limited to a minority of patients with the majority being broadly cognitively normal. Future research should determine if this identified subgroup has neuroanatomical, neurophysiological, or neuroendocrine abnormalities. Cognitive screening tools of this type might be useful in selecting participants for studies.

Assessment of cognition in mild cognitive impairment: a comparative study

The demand for rapidly administered, sensitive, and reliable cognitive assessments that are specifically designed for identifying individuals in the earliest stages of cognitive decline (and to measure subtle change over time) has escalated as the emphasis in Alzheimer's disease clinical research has shifted from clinical diagnosis and treatment toward the goal of developing presymptomatic neuroprotective therapies. To meet these changing clinical requirements, cognitive measures or tailored batteries of tests must be validated and determined to be fit-for-use for the discrimination between cognitively healthy individuals and persons who are experiencing very subtle cognitive changes that likely signal the emergence of early mild cognitive impairment. We sought to collect and review data systematically from a wide variety of (mostly computer-administered) cognitive measures, all of which are currently marketed or distributed with the claims that these instruments are sensitive and reliable for the early identification of disease or, if untested for this purpose, are promising tools based on other variables. The survey responses for 16 measures/batteries are presented in brief in this review; full survey responses and summary tables are archived and publicly available on the Campaign to Prevent Alzheimer's Disease by 2020 Web site (http://pad2020.org). A decision tree diagram highlighting critical decision points for selecting measures to meet varying clinical trials requirements has also been provided. Ultimately, the survey questionnaire, framework, and decision guidelines provided in this review should remain as useful aids for the evaluation of any new or updated sets of instruments in the years to come.

Aging redistributes medial prefrontal neuronal excitability and impedes extinction of trace fear conditioning

Cognitive flexibility is critical for survival and reflects the malleability of the central nervous system (CNS) in response to changing environmental demands. Normal aging results in difficulties modifying established behaviors, which may involve medial prefrontal cortex (mPFC) dysfunction. Using extinction of conditioned fear in rats to assay cognitive flexibility, we demonstrate that extinction deficits reminiscent of mPFC dysfunction first appear during middle age, in the absence of hippocampus-dependent context deficits. Emergence of aging-related extinction deficits paralleled a redistribution of neuronal excitability across two critical mPFC regions via two distinct mechanisms. First, excitability decreased in regular spiking neurons of infralimbic-mPFC (IL), a region whose activity is required for extinction. Second, excitability increased in burst spiking neurons of prelimbic-mPFC (PL), a region whose activity hinders extinction. Experiments using synaptic blockers revealed that these aging-related differences were intrinsic. Thus, changes in IL and PL intrinsic excitability may contribute to cognitive flexibility impairments observed during normal aging.

Identifying cognitive problems in children and adolescents with depression using computerized neuropsychological testing

Depression in children and adolescents can negatively impact cognitive functioning, social development, and academic performance. The purpose of this study was to determine whether a computerized battery of neuropsychological tests could detect neurocognitive difficulties in children and adolescents with depression. Participants included 30 children and adolescents between the ages of 9 and 17 years (M = 14.6, SD = 2.1) with a clinical diagnosis of depression. Healthy control participants were individually matched on age, education, sex, race, primary language, handedness, and self-reported computer familiarity. All participants completed the Central Nervous System Vital Signs computerized battery. This battery of seven tests yields 23 test scores and 5 domain scores (Memory, Psychomotor Speed, Reaction Time, Complex Attention, and Cognitive Flexibility). Children and adolescents with depression performed worse on the Memory (Cohen's d = .43) and Complex Attention domains (d = .58) than matched controls. On the individual test scores, children and adolescents with depression performed worse on delayed verbal memory (d = .63), delayed visual memory (d = .34), measures of reaction time (d = .34-.53), and accuracy/inhibition on complex attention tasks (d = .49-.65). When considering the five domain scores simultaneously, children and adolescents with depression were more likely to have two or more scores at or below the 5th percentile (p = .05). Children and adolescents with depression have problems with reduced processing speed, memory for verbal information, and executive functioning on this computerized battery of tests, which represents a feasible method for neuropsychological screening.

Rapid computerized assessment of neurocognitive deficits in bipolar disorder

The purpose of this study is to illustrate the clinical usefulness of a computerized neuropsychological battery for identifying neurocognitive deficits in adults with bipolar disorder. Participants were 47 outpatients with bipolar disorder who were individually matched on age, education, sex, and ethnicity to 47 control subjects from the Central Nervous System (CNS) Vital Signs normative database. CNS Vital Signs is comprised of seven common neuropsychological measures, and it generates 15 primary scores that are used to calculate five domain scores (Memory, Psychomotor Speed, Reaction Time, Cognitive Flexibility, and Complex Attention). There was a significant multivariate effect and statistically significantly worse scores for those in the bipolar group on all five domain scores (medium to large effect sizes). When using two or more scores below the fifth percentile as a cutoff for neurocognitive impairment, 42.6% of the bipolar sample and only 6.4% of the control sample scored in this range. A subset of outpatients with bipolar disorder has frank neurocognitive impairments identifiable with this 30-40-minute computerized assessment battery.

Identifying neurocognitive impairment in depression using computerized testing

There is considerable interest in the identification of neurocognitive impairment in patients with depression. The purpose of this study is to illustrate a methodology for identifying frank neurocognitive impairment in clinical practice and research using a computerized battery of neuropsychological tests. Participants were 100 adult patients with depression who were not on antidepressants. They were carefully matched on age, education, gender, and ethnicity to 100 healthy adult control subjects. All participants completed the Central Nervous System Vital Signs (CNS-VS) computerized assessment battery, which takes approximately 30-40 minutes to administer. Patients with depression performed more poorly than controls on all five domain scores (Cohen's d ranged from d = .37 to .72). When using two or more scores below the 5th percentile as the cutoff for frank neurocognitive impairment, 31.0% of the depressed sample and only 5.0% of the control sample scored in this range. In this study, patients with depression were 8.5 times more likely to have two or more index scores that were below the 5th percentile. Computerized testing, using the interpretive methodology presented, represents an efficient methodology for identifying cognitive problems in patients who present with untreated depression.

Computerized cognitive assessment of mild cognitive impairment in urban African Americans

Few objective cognitive assessment tools have been validated for mild cognitive impairment (MCI) in African Americans despite higher prevalence of disease. This preliminary study evaluated discriminant validity of a computerized cognitive assessment battery for MCI in an urban African American cohort. Twenty-seven participants with MCI and 22 cognitively healthy individuals completed a multidomain battery (Mindstreams, NeuroTrax Corp, New Jersey). Mild cognitive impairment participants performed more poorly than cognitively healthy participants in all domains, with significant differences in memory (P = .003; d = 0.96), executive function (P = .046; d = 0.64), and overall battery performance (P = .041; d = 0.63). Adjustment for intelligence quotient (IQ) yielded significant differences in memory (P < .001; d = 1.34), executive function (P = .007; d = 0.86), attention (P = .014; d = .80), and overall performance (P = .001; d = 1.09). Such a validated battery may help to address an important clinical need in this population.

Status of computerized cognitive testing in aging: a systematic review

BACKGROUND

Early detection of cognitive decline in the elderly has become of heightened importance in parallel with the recent advances in therapeutics. Computerized assessment might be uniquely suited to early detection of changes in cognition in the elderly. We present here a systematic review of the status of computer-based cognitive testing, focusing on detection of cognitive decline in the aging population.

METHODS

All studies purporting to assess or detect age-related changes in cognition or early dementia/mild cognitive impairment by means of computerized testing were included. Each test battery was rated on availability of normative data, level of evidence for test validity and reliability, comprehensiveness, and usability. All published studies relevant to a particular computerized test were read by a minimum of two reviewers, who completed rating forms containing the above mentioned criteria.

RESULTS

Of the 18 test batteries identified from the initial search, 11 were appropriate to cognitive testing in the elderly and were subjected to systematic review. Of those 11, five were either developed specifically for application with the elderly or have been used extensively with that population. Even within the computerized testing genre, great variability existed in manner of administration, ranging from fully examiner-administered to fully self-administered. All tests had at least minimal reliability and validity data, commonly reported in peer-reviewed articles. However, level of rigor of validity testing varied widely.

CONCLUSION

All test batteries exhibited some of the strengths of computerized cognitive testing: standardization of administration and stimulus presentation, accurate measures of response latencies, automated comparison in real time with an individual's prior performance as well as with age-related norms, and efficiencies of staffing and cost. Some, such as the Mild Cognitive Impairment Screen, adapted complicated scoring algorithms to enhance the information gathered from already existing tests. Others, such as CogState, used unique interfaces and subtests. We found that although basic indices of psychometric properties were typically addressed, sufficient variability exists that currently available computerized test batteries must be judged on a case-by-case basis.

Does familiarity with computers affect computerized neuropsychological test performance?

The purpose of this study was to determine whether self-reported computer familiarity is related to performance on computerized neurocognitive testing. Participants were 130 healthy adults who self-reported whether their computer use was "some" (n = 65) or "frequent" (n = 65). The two groups were individually matched on age, education, sex, and race. All completed the CNS Vital Signs (Gualtieri & Johnson, 2006b) computerized neurocognitive battery. There were significant differences on 6 of the 23 scores, including scores derived from the Symbol-Digit Coding Test, Stroop Test, and the Shifting Attention Test. The two groups were also significantly different on the Psychomotor Speed (Cohen's d = 0.37), Reaction Time (d = 0.68), Complex Attention (d = 0.40), and Cognitive Flexibility (d = 0.64) domain scores. People with "frequent" computer use performed better than people with "some" computer use on some tests requiring rapid visual scanning and keyboard work.