1
|
Hafiz R, Alajlani L, Ali A, Algarni GA, Aljurfi H, Alammar OAM, Ashqan MY, Alkhashan A. The Latest Advances in the Diagnosis and Treatment of Dementia. Cureus 2023; 15:e50522. [PMID: 38222245 PMCID: PMC10787596 DOI: 10.7759/cureus.50522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2023] [Indexed: 01/16/2024] Open
Abstract
Dementia is a debilitating neurological condition that is characterized by persistent cognitive decline. It is a global health challenge, with a rapidly increasing prevalence due to an increasing aging population. Although definitive diagnosis of various conditions of dementia is only possible by autopsy, clinical diagnosis can be performed by a specialist. The diagnostic process has evolved with recent breakthroughs in diagnostic tools, such as advanced imaging techniques and biomarkers. These tools facilitate early and accurate identification of the condition. Early diagnosis is vital, as it enables timely interventions to improve the quality of life for affected individuals. Treatment strategies for dementia encompass both pharmacological and non-pharmacological approaches. Non-pharmacological treatments include cognitive training and lifestyle modifications. Among pharmacological treatments, acetyl-cholinesterase inhibitors including donepezil, rivastigmine, and galantamine can be used in various doses based on the severity of the disease. Apart from these, N-methyl-D-aspartate receptor antagonists such as memantine can also be used. Furthermore, personalized treatments have also gained significant attention in dementia treatment. Interdisciplinary care, involving healthcare professionals, social workers, and support networks, is crucial for comprehensive and holistic dementia management.
Collapse
Affiliation(s)
- Rehab Hafiz
- Family Medicine, Al Takassusi Primary Healthcare Center, Makkah, SAU
| | - Lama Alajlani
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | - Albatool Ali
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | - Ghadah A Algarni
- College of Medicine, Fakeeh College for Medical Sciences, Jeddah, SAU
| | - Hassan Aljurfi
- Family Medicine, Alfath Care Center, Madinah Health Cluster, Ministry of Health, Madinah, SAU
| | | | - Maria Y Ashqan
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | - Alanoud Alkhashan
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
| |
Collapse
|
2
|
Henneghan AM, Van Dyk KM, Ackerman RA, Paolillo EW, Moore RC. Assessing cancer-related cognitive function in the context of everyday life using ecological mobile cognitive testing: A protocol for a prospective quantitative study. Digit Health 2023; 9:20552076231194944. [PMID: 37588154 PMCID: PMC10426293 DOI: 10.1177/20552076231194944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 07/28/2023] [Indexed: 08/18/2023] Open
Abstract
Objective Millions of cancer survivors are at risk for cancer-related cognitive impairment (CRCI), yet accurate and accessible assessments of cognitive functioning remain limited. Ecological mobile cognitive testing (EMCT) could offer a solution. This paper presents the protocol for a study that aims to (1) establish the reliability and validity of EMCT to assess CRCI in breast cancer survivors, and (2) prospectively evaluate within-person processes (and interactions) among context, mood, and behavior that explain cognitive variability, everyday functioning, and quality of life of cancer survivors. Methods Participants will include breast cancer survivors (>21 years old) who are within 5 years of completing chemotherapy treatment. Participants will complete two virtual visits (baseline, follow-up) 2 months apart to assess self-reported cognitive symptoms and cognitive performance, sociodemographic characteristics, clinical history, everyday functioning, and quality of life. Between virtual visits, EMCT will be used to sample cognitive functioning every other day (28 times total). We will use linear mixed-effect regressions and single-level multiple regression models to analyze the data. Results We anticipate a minimum of 124 breast cancer survivors enrolling and completing data collection. Study results will be published in peer-reviewed scientific journals. Conclusions Our findings will have broad implications for assessing CRCI in an ecologically valid and person-centered way using EMCT. We aim to provide this protocol to aid researchers who would like to apply this approach to their studies.
Collapse
Affiliation(s)
| | - Kathleen M Van Dyk
- Semel Institute of Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, USA
- Jonsson Comprehensive Cancer Center, University of California Los Angeles, Los Angeles, CA, USA
| | | | | | - Raeanne C Moore
- Department of Psychiatry, University of California San Diego, CA, USA
| |
Collapse
|
3
|
Vacas S, Canales C, Deiner SG, Cole DJ. Perioperative Brain Health in the Older Adult: A Patient Safety Imperative. Anesth Analg 2022; 135:316-328. [PMID: 35584550 PMCID: PMC9288500 DOI: 10.1213/ane.0000000000006090] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
While people 65 years of age and older represent 16% of the population in the United States, they account for >40% of surgical procedures performed each year. Maintaining brain health after anesthesia and surgery is not only important to our patients, but it is also an increasingly important patient safety imperative for the specialty of anesthesiology. Aging is a complex process that diminishes the reserve of every organ system and often results in a patient who is vulnerable to the stress of surgery. The brain is no exception, and many older patients present with preoperative cognitive impairment that is undiagnosed. As we age, a number of changes occur in the human brain, resulting in a patient who is less resilient to perioperative stress, making older adults more susceptible to the phenotypic expression of perioperative neurocognitive disorders. This review summarizes the current scientific and clinical understanding of perioperative neurocognitive disorders and recommends patient-centered, age-focused interventions that can better mitigate risk, prevent harm, and improve outcomes for our patients. Finally, it discusses the emerging topic of sleep and cognitive health and other future frontiers of scientific inquiry that might inform clinical best practices.
Collapse
Affiliation(s)
- Susana Vacas
- From the Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Cecilia Canales
- From the Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Stacie G Deiner
- Department of Anesthesiology, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire
| | - Daniel J Cole
- From the Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| |
Collapse
|
4
|
Ganesh A, Barber PA. The Cognitive Sequelae of Transient Ischemic Attacks—Recent Insights and Future Directions. J Clin Med 2022; 11:jcm11092637. [PMID: 35566762 PMCID: PMC9104376 DOI: 10.3390/jcm11092637] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 05/02/2022] [Accepted: 05/05/2022] [Indexed: 02/05/2023] Open
Abstract
There is now considerable evidence that Transient Ischemic Attack (TIA) carries important sequelae beyond the risk of recurrent stroke, particularly with respect to peri-event and post-event cognitive dysfunction and subsequent cognitive decline. The occurrence of a TIA could provide an important window in understanding the relationship of early mixed vascular-neurodegenerative cognitive decline, and by virtue of their clinical relevance as a “warning” event, TIAs could also furnish the opportunity to act preventatively not only for stroke prevention but also for dementia prevention. In this review, we discuss the current state of the literature regarding the cognitive sequelae associated with TIA, reviewing important challenges in the field. In particular, we discuss definitional and methodological challenges in the study of TIA-related cognitive impairment, confounding factors in the cognitive evaluation of these patients, and provide an overview of the evidence on both transient and long-term cognitive impairment after TIA. We compile recent insights from clinical studies regarding the predictors and mediators of cognitive decline in these patients and highlight important future directions for work in this area.
Collapse
Affiliation(s)
- Aravind Ganesh
- Calgary Stroke Program, Departments of Clinical Neurosciences, University of Calgary Cumming School of Medicine, Calgary, AB T2N 4N1, Canada;
- Department of Community Health Sciences, University of Calgary Cumming School of Medicine, Calgary, AB T2N 4N1, Canada
- Hotchkiss Brain Institute, University of Calgary Cumming School of Medicine, Calgary, AB T2N 4N1, Canada
| | - Philip A. Barber
- Calgary Stroke Program, Departments of Clinical Neurosciences, University of Calgary Cumming School of Medicine, Calgary, AB T2N 4N1, Canada;
- Department of Community Health Sciences, University of Calgary Cumming School of Medicine, Calgary, AB T2N 4N1, Canada
- Hotchkiss Brain Institute, University of Calgary Cumming School of Medicine, Calgary, AB T2N 4N1, Canada
- Department of Radiology, University of Calgary Cumming School of Medicine, Calgary, AB T2N 4N1, Canada
- Correspondence:
| |
Collapse
|
5
|
Henneghan A, Lewis KA, Gill E, Franco-Rocha OY, Vela RD, Medick S, Kesler S. Describing cognitive function and psychosocial outcomes of COVID-19 survivors: A cross-sectional analysis. J Am Assoc Nurse Pract 2022; 34:499-508. [PMID: 34469360 PMCID: PMC8882196 DOI: 10.1097/jxx.0000000000000647] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 07/27/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Neurological and psychological symptoms are increasingly realized in the post-acute phase of COVID-19. PURPOSE To examine and characterize cognitive and related psychosocial symptoms in adults (21-75 years) who tested positive for or were treated as positive for COVID-19. METHODS In this cross-sectional study, data collection included a cognitive testing battery (Trails B; Digit Symbol; Stroop; Immediate and Delayed Verbal Learning) and surveys (demographic/clinical history; self-reported cognitive functioning depressive symptoms, fatigue, anxiety, sleep disturbance, social role performance, and stress). Results were compared with published norms, rates of deficits (more than 1 standard deviation (SD) from the norm) were described, and correlations were explored. RESULTS We enrolled 52 participants (mean age 37.33 years; 78.85% female) who were, on average, 4 months post illness. The majority had a history of mild or moderate COVID-19 severity. Forty percent of participants demonstrated scores that were 1 SD or more below the population norm on one or more of the cognitive tests. A subset had greater anxiety (21.15%), depressive symptoms (23.07%), and sleep disturbance (19.23%) than population norms. Age differences were identified in Stroop, Digit Symbol, and Trails B scores by quartile ( p < .01), with worse performance in those 28-33 years old. CONCLUSIONS Cognitive dysfunction and psychological symptoms may be present in the weeks or months after COVID-19 diagnosis, even in those with mild to moderate illness severity. IMPLICATIONS FOR PRACTICE Clinicians need to be aware and educate patients about the potential late/long-term cognitive and psychological effects of COVID-19, even in mild to moderate disease.
Collapse
Affiliation(s)
- Ashley Henneghan
- Assistant Professor, School of Nursing, Department of Oncology, Dell Medical School, The University of Texas at Austin, 1710 Red River St. Austin, TX, U.S., 78712
| | - Kimberly A. Lewis
- Nurse Scientist, Department of Nursing Research, Ascension Texas, Austin, TX
- Postdoctoral Scholar, Department of Physiological Nursing, University of California at San Francisco, CA 94143
| | - Eliana Gill
- Predoctoral Student, School of Nursing, The University of Texas at Austin, 1710 Red River St. Austin, TX, U.S., 78712
- Registered Nurse, Ascension Seton Medical Center Austin, 1201 W. 38 St. Austin, TX 78705
| | - Oscar Y. Franco-Rocha
- School of Nursing, The University of Texas at Austin. 1710 Red River St. Austin, TX, 78712
| | - Ruben D. Vela
- Department of Diagnostic Medicine, Dell Medical School, The University of Texas at Austin, Austin, TX
| | - Sarah Medick
- School of Nursing, The University of Texas at Austin. 1710 Red River St. Austin, TX, 78712
| | - Shelli Kesler
- Associate Professor, School of Nursing, Department of Diagnostic Medicine, Dell Medical School, University of Texas at Austin, Austin, TX
| |
Collapse
|
6
|
Ye S, Sun K, Huynh D, Phi HQ, Ko B, Huang B, Hosseini Ghomi R. Validation of a Computerized Cognitive Test Battery for Detection of Dementia and Mild Cognitive Impairment (Preprint). JMIR Aging 2022; 5:e36825. [PMID: 35436212 PMCID: PMC9055476 DOI: 10.2196/36825] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 03/02/2022] [Accepted: 03/14/2022] [Indexed: 01/19/2023] Open
Abstract
Background Early detection of dementia is critical for intervention and care planning but remains difficult. Computerized cognitive testing provides an accessible and promising solution to address these current challenges. Objective The aim of this study was to evaluate a computerized cognitive testing battery (BrainCheck) for its diagnostic accuracy and ability to distinguish the severity of cognitive impairment. Methods A total of 99 participants diagnosed with dementia, mild cognitive impairment (MCI), or normal cognition (NC) completed the BrainCheck battery. Statistical analyses compared participant performances on BrainCheck based on their diagnostic group. Results BrainCheck battery performance showed significant differences between the NC, MCI, and dementia groups, achieving 88% or higher sensitivity and specificity (ie, true positive and true negative rates) for separating dementia from NC, and 77% or higher sensitivity and specificity in separating the MCI group from the NC and dementia groups. Three-group classification found true positive rates of 80% or higher for the NC and dementia groups and true positive rates of 64% or higher for the MCI group. Conclusions BrainCheck was able to distinguish between diagnoses of dementia, MCI, and NC, providing a potentially reliable tool for early detection of cognitive impairment.
Collapse
Affiliation(s)
- Siao Ye
- Department of Biosciences, Rice University, Houston, TX, United States
| | - Kevin Sun
- BrainCheck, Inc, Houston, TX, United States
| | | | - Huy Q Phi
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, United States
| | - Brian Ko
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, United States
| | - Bin Huang
- BrainCheck, Inc, Houston, TX, United States
| | - Reza Hosseini Ghomi
- BrainCheck, Inc, Houston, TX, United States
- Department of Neurology, University of Washington School of Medicine, Seattle, WA, United States
| |
Collapse
|
7
|
Peacock WF, Kuehl D, Bazarian J, Singer AJ, Cannon C, Rafique Z, d'Etienne JP, Welch R, Clark C, Diaz-Arrastia R. Defining Acute Traumatic Encephalopathy: Methods of the "HEAD Injury Serum Markers and Multi-Modalities for Assessing Response to Trauma" (HeadSMART II) Study. Front Neurol 2021; 12:733712. [PMID: 34956041 PMCID: PMC8693379 DOI: 10.3389/fneur.2021.733712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 10/26/2021] [Indexed: 11/13/2022] Open
Abstract
Despite an estimated 2.8 million annual ED visits, traumatic brain injury (TBI) is a syndromic diagnosis largely based on report of loss of consciousness, post-traumatic amnesia, and/or confusion, without readily available objective diagnostic tests at the time of presentation, nor an ability to identify a patient's prognosis at the time of injury. The recognition that “mild” forms of TBI and even sub-clinical impacts can result in persistent neuropsychiatric consequences, particularly when repetitive, highlights the need for objective assessments that can complement the clinical diagnosis and provide prognostic information about long-term outcomes. Biomarkers and neurocognitive testing can identify brain injured patients and those likely to have post-concussive symptoms, regardless of imaging testing results, thus providing a physiologic basis for a diagnosis of acute traumatic encephalopathy (ATE). The goal of the HeadSMART II (HEAD injury Serum markers and Multi-modalities for Assessing Response to Trauma) clinical study is to develop an in-vitro diagnostic test for ATE. The BRAINBox TBI Test will be developed in the current clinical study to serve as an aid in evaluation of patients with ATE by incorporating blood protein biomarkers, clinical assessments, and tools to measure, identify, and define associated pathologic evidence and neurocognitive impairments. This protocol proposes to collect data on TBI subjects by a multi-modality approach that includes serum biomarkers, clinical assessments, neurocognitive performance, and neuropsychological characteristics, to determine the accuracy of the BRAINBox TBI test as an aid to the diagnosis of ATE, defined herein, and to objectively determine a patient's risk of developing post-concussive symptoms.
Collapse
Affiliation(s)
| | - Damon Kuehl
- Carillion Clinic, Roanoke, VA, United States
| | - Jeff Bazarian
- Department of Emergency Medicine, University of Rochester, Rochester, NY, United States
| | - Adam J Singer
- Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, United States
| | - Chad Cannon
- University of Kansas Medical Center, Kansas City, MO, United States
| | | | - James P d'Etienne
- Integrative Emergency Service/John Peter Smith Health System, Fort Worth, TX, United States
| | - Robert Welch
- Detroit Medical Center, Detroit, MI, United States
| | - Carol Clark
- William Beaumont Hospital, Royal Oak, MI, United States
| | - Ramon Diaz-Arrastia
- Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA, United States
| |
Collapse
|
8
|
Kohli M, Moore DJ, Moore RC. Using health technology to capture digital phenotyping data in HIV-associated neurocognitive disorders. AIDS 2021; 35:15-22. [PMID: 33048886 PMCID: PMC7718372 DOI: 10.1097/qad.0000000000002726] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Maulika Kohli
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology
- HIV Neurobehavioral Research Program, Department of Psychiatry, University of California, San Diego, San Diego, California, USA
| | - David J Moore
- HIV Neurobehavioral Research Program, Department of Psychiatry, University of California, San Diego, San Diego, California, USA
| | - Raeanne C Moore
- HIV Neurobehavioral Research Program, Department of Psychiatry, University of California, San Diego, San Diego, California, USA
| |
Collapse
|
9
|
Ye S, Ko B, Phi HQ, Sun K, Eagleman DM, Flores B, Katz Y, Huang B, Ghomi RH. Detection of mild traumatic brain injury in pediatric populations using BrainCheck, a tablet-based cognitive testing software: a preliminary study. EXPLORATION OF MEDICINE 2020. [DOI: 10.37349/emed.2020.00027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Aim: Despite its high frequency of occurrence, mild traumatic brain injury (mTBI), or concussion, is difficult to recognize and diagnose, particularly in pediatric populations. Conventional methods to diagnose mTBI primarily rely on clinical questionnaires and sometimes include neuroimaging or pencil and paper neuropsychological testing. However, these methods are time consuming, require administration/interpretation from health professionals, and lack adequate test sensitivity and specificity. This study explores the use of BrainCheck Sport, a computerized neurocognitive test that is available on iPad, iPhone, or computer desktop, for mTBI assessment. The BrainCheck Sport Battery consists of 6 gamified traditional neurocognitive tests that assess areas of cognition vulnerable to mTBI such as attention, processing speed, executing functioning, and coordination.
Methods: We administered BrainCheck Sport to 10 participants diagnosed with mTBI at the emergency department of Children’s hospital or local high school within 96 hours of injury, and 115 normal controls at a local high school. Statistical analysis included Mann-Whitney U test, chi-square tests, and Hochberg tests to examine differences between the mTBI group and control group on each assessment in the battery. Significant metrics from these assessments were used to build a logistic regression model that distinguishes mTBI from control participants.
Results: BrainCheck Sport was able to detect significant differences in Coordination, Stroop, Immediate/Delayed Recognition between normal controls and mTBI patients. Receiver operating characteristic (ROC) analysis of our logistic regression model found a sensitivity of 84% and specificity of 81%, with an area under the curve of 0.884.
Conclusions: BrainCheck Sport has potential in distinguishing mTBI from control participants, by providing a shorter, gamified test battery to assess cognitive function after brain injury, while also providing a method for tracking recovery with the opportunity to do so remotely from a patient’s home.
Collapse
Affiliation(s)
- Siao Ye
- Department of Biosciences, Rice University, Houston, TX 77005, USA
| | - Brian Ko
- University of Washington School of Medicine, Seattle, WA 98195, USA
| | - Huy Q. Phi
- College of Arts and Sciences, University of Washington, Seattle, WA 98195, USA
| | - Kevin Sun
- BrainCheck, Inc, Houston, TX 77021, USA
| | - David M. Eagleman
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305, USA
| | | | - Yael Katz
- BrainCheck, Inc, Houston, TX 77021, USA
| | - Bin Huang
- BrainCheck, Inc, Houston, TX 77021, USA
| | | |
Collapse
|
10
|
Sergio LE, Gorbet DJ, Adams MS, Dobney DM. The Effects of Mild Traumatic Brain Injury on Cognitive-Motor Integration for Skilled Performance. Front Neurol 2020; 11:541630. [PMID: 33041992 PMCID: PMC7525090 DOI: 10.3389/fneur.2020.541630] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 08/12/2020] [Indexed: 01/01/2023] Open
Abstract
Adults exposed to blast and blunt impact often experience mild traumatic brain injury, affecting neural functions related to sensory, cognitive, and motor function. In this perspective article, we will review the effects of impact and blast exposure on functional performance that requires the integration of these sensory, cognitive, and motor control systems. We describe cognitive-motor integration and how it relates to successfully navigating skilled activities crucial for work, duty, sport, and even daily life. We review our research on the behavioral effects of traumatic impact and blast exposure on cognitive-motor integration in both younger and older adults, and the neural networks that are involved in these types of skills. Overall, we have observed impairments in rule-based skilled performance as a function of both physical impact and blast exposure. The extent of these impairments depended on the age at injury and the sex of the individual. It appears, however, that cognitive-motor integration deficits can be mitigated by the level of skill expertise of the affected individual, suggesting that such experience imparts resiliency in the brain networks that underly the control of complex visuomotor performance. Finally, we discuss the next steps needed to comprehensively understand the impact of trauma and blast exposure on functional movement control.
Collapse
Affiliation(s)
- Lauren E. Sergio
- School of Kinesiology and Health Science, York University, Toronto, ON, Canada
- Centre for Vision Research, York University, Toronto, ON, Canada
| | - Diana J. Gorbet
- School of Kinesiology and Health Science, York University, Toronto, ON, Canada
- Centre for Vision Research, York University, Toronto, ON, Canada
| | - Meaghan S. Adams
- School of Kinesiology and Health Science, York University, Toronto, ON, Canada
- Vision-Science to Application (VISTA) Program, York University, Toronto, ON, Canada
- Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Danielle M. Dobney
- School of Kinesiology and Health Science, York University, Toronto, ON, Canada
- Vision-Science to Application (VISTA) Program, York University, Toronto, ON, Canada
| |
Collapse
|
11
|
Thabtah F, Peebles D, Retzler J, Hathurusingha C. A review of dementia screening tools based on Mobile application. HEALTH AND TECHNOLOGY 2020. [DOI: 10.1007/s12553-020-00426-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
|
12
|
Charalambous AP, Pye A, Yeung WK, Leroi I, Neil M, Thodi C, Dawes P. Tools for App- and Web-Based Self-Testing of Cognitive Impairment: Systematic Search and Evaluation. J Med Internet Res 2020; 22:e14551. [PMID: 31951218 PMCID: PMC6996724 DOI: 10.2196/14551] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 08/16/2019] [Accepted: 09/24/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Tools for app- and Web-based self-testing for identification of cognitive impairment are widely available but are of uncertain quality. OBJECTIVE The objective of this study was to undertake a scoping review of app- and Web-based self-tests for cognitive impairment and determine the validity of these tests. METHODS We conducted systematic searches in electronic databases, including Google search, Google Play Store, and iPhone Operating System App Store, using the search terms "Online OR Internet-based AND Memory OR Brain OR Dementia OR mild cognitive impairment OR MCI AND Test OR Screen OR Check." RESULTS We identified 3057 tools, of which 25 were included in the review. Most tools meeting the inclusion criteria assessed multiple cognitive domains. The most frequently assessed domains were memory, attention, and executive function. We then conducted an electronic survey with the developers of the tools to identify data relating to development and validation of each tool. If no response to the survey was received, Google (to identify gray literature), Google Scholar, and Medical Literature Analysis and Retrieval System Online were searched using key terms "(name of developer, if available)" AND "(the name of the tool)" to identify any additional data. Only 7 tools had any information concerning psychometric quality, and only 1 tool reported data on performance norms, reliability, validity, sensitivity, and specificity for the detection of cognitive impairment. CONCLUSIONS The number of cognitive self-assessment electronic health tools for cognitive impairment is increasing, but most are of uncertain quality. There is a need for well-validated tools and guidance for users concerning which tools provide reliable information about possible cognitive impairment that could warrant further investigation.
Collapse
Affiliation(s)
| | - Annie Pye
- Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, United Kingdom
| | - Wai Kent Yeung
- Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, United Kingdom
| | - Iracema Leroi
- Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, United Kingdom.,Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland
| | | | | | - Piers Dawes
- Manchester Centre for Audiology and Deafness, University of Manchester and the Manchester Academic Health Sciences Centre, Manchester, United Kingdom
| |
Collapse
|
13
|
Owens AP, Ballard C, Beigi M, Kalafatis C, Brooker H, Lavelle G, Brønnick KK, Sauer J, Boddington S, Velayudhan L, Aarsland D. Implementing Remote Memory Clinics to Enhance Clinical Care During and After COVID-19. Front Psychiatry 2020; 11:579934. [PMID: 33061927 PMCID: PMC7530252 DOI: 10.3389/fpsyt.2020.579934] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 08/31/2020] [Indexed: 12/15/2022] Open
Abstract
Social isolation is likely to be recommended for older adults due to COVID-19, with ongoing reduced clinical contact suggested for this population. This has increased the need for remote memory clinics, we therefore review the literature, current practices and guidelines on organizing such remote memory clinics, focusing on assessment of cognition, function and other relevant measurements, proposing a novel pathway based on three levels of complexity: simple telephone or video-based interviews and testing using available tests (Level 1), digitized and validated methods based on standard pen-and-paper tests and scales (Level 2), and finally fully digitized cognitive batteries and remote measurement technologies (RMTs, Level 3). Pros and cons of these strategies are discussed. Remotely collected data negates the need for frail patients or carers to commute to clinic and offers valuable insights into progression over time, as well as treatment responses to therapeutic interventions, providing a more realistic and contextualized environment for data-collection. Notwithstanding several challenges related to internet access, computer skills, limited evidence base and regulatory and data protection issues, digital biomarkers collected remotely have significant potential for diagnosis and symptom management in older adults and we propose a framework and pathway for how technologies can be implemented to support remote memory clinics. These platforms are also well-placed for administration of digital cognitive training and other interventions. The individual, societal and public/private costs of COVID-19 are high and will continue to rise for some time but the challenges the pandemic has placed on memory services also provides an opportunity to embrace novel approaches. Remote memory clinics' financial, logistical, clinical and practical benefits have been highlighted by COVID-19, supporting their use to not only be maintained when social distancing legislation is lifted but to be devoted extra resources and attention to fully potentiate this valuable arm of clinical assessment and care.
Collapse
Affiliation(s)
- Andrew P Owens
- Department of Old Age Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Clive Ballard
- The University of Exeter Medical School, The University of Exeter, Exeter, United Kingdom
| | - Mazda Beigi
- Psychological Medicine and Older Adults, South London & Maudsley NHS Foundation Trust, London, United Kingdom
| | - Chris Kalafatis
- Department of Old Age Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.,Psychological Medicine and Older Adults, South London & Maudsley NHS Foundation Trust, London, United Kingdom
| | - Helen Brooker
- The University of Exeter Medical School, The University of Exeter, Exeter, United Kingdom.,Ecog Pro Ltd, Bristol, United Kingdom
| | - Grace Lavelle
- Department of Old Age Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Kolbjørn K Brønnick
- SESAM-Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway.,Department of Public Health, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Justin Sauer
- Department of Old Age Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.,Psychological Medicine and Older Adults, South London & Maudsley NHS Foundation Trust, London, United Kingdom
| | - Steve Boddington
- Psychological Medicine and Older Adults, South London & Maudsley NHS Foundation Trust, London, United Kingdom
| | - Latha Velayudhan
- Department of Old Age Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Dag Aarsland
- Department of Old Age Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.,Psychological Medicine and Older Adults, South London & Maudsley NHS Foundation Trust, London, United Kingdom.,SESAM-Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway
| |
Collapse
|
14
|
Groppell S, Soto-Ruiz KM, Flores B, Dawkins W, Smith I, Eagleman DM, Katz Y. A Rapid, Mobile Neurocognitive Screening Test to Aid in Identifying Cognitive Impairment and Dementia (BrainCheck): Cohort Study. JMIR Aging 2019; 2:e12615. [PMID: 31518280 PMCID: PMC6715071 DOI: 10.2196/12615] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 01/11/2019] [Accepted: 02/01/2019] [Indexed: 01/06/2023] Open
Abstract
Background The US population over the age of 65 is expected to double by the year 2050. Concordantly, the incidence of dementia is projected to increase. The subclinical stage of dementia begins years before signs and symptoms appear. Early detection of cognitive impairment and/or cognitive decline may allow for interventions to slow its progression. Furthermore, early detection may allow for implementation of care plans that may affect the quality of life of those affected and their caregivers. Objective We sought to determine the accuracy and validity of BrainCheck Memory as a diagnostic aid for age-related cognitive impairment, as compared against physician diagnosis and other commonly used neurocognitive screening tests, including the Saint Louis University Mental Status (SLUMS) exam, the Mini-Mental State Examination (MMSE), and the Montreal Cognitive Assessment (MoCA). Methods We tested 583 volunteers over the age of 49 from various community centers and living facilities in Houston, Texas. The volunteers were divided into five cohorts: a normative population and four comparison groups for the SLUMS exam, the MMSE, the MoCA, and physician diagnosis. Each comparison group completed their respective assessment and BrainCheck Memory. Results A total of 398 subjects were included in the normative population. A total of 84 participants were in the SLUMS exam cohort, 51 in the MMSE cohort, 35 in the MoCA cohort, and 18 in the physician cohort. BrainCheck Memory assessments were significantly correlated to the SLUMS exam, with coefficients ranging from .5 to .7. Correlation coefficients for the MMSE and BrainCheck and the MoCA and BrainCheck were also significant. Of the 18 subjects evaluated by a physician, 9 (50%) were healthy, 6 (33%) were moderately impaired, and 3 (17%) were severely impaired. A significant difference was found between the severely and moderately impaired subjects and the healthy subjects (P=.02). We derived a BrainCheck Memory composite score that showed stronger correlations with the standard assessments as compared to the individual BrainCheck assessments. Receiver operating characteristic (ROC) curve analysis of this composite score found a sensitivity of 81% and a specificity of 94%. Conclusions BrainCheck Memory provides a sensitive and specific metric for age-related cognitive impairment in older adults, with the advantages of a mobile, digital, and easy-to-use test. Trial Registration ClinicalTrials.gov NCT03608722; https://clinicaltrials.gov/ct2/show/NCT03608722 (Archived by WebCite at http://www.webcitation.org/76JLoYUGf)
Collapse
Affiliation(s)
- Samantha Groppell
- School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | | | | | | | | | - David M Eagleman
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States
| | - Yael Katz
- BrainCheck Inc, Houston, TX, United States
| |
Collapse
|