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Staffaroni AM, Clark AL, Taylor JC, Heuer HW, Sanderson-Cimino M, Wise AB, Dhanam S, Cobigo Y, Wolf A, Manoochehri M, Forsberg L, Mester C, Rankin KP, Appleby BS, Bayram E, Bozoki A, Clark D, Darby RR, Domoto-Reilly K, Fields JA, Galasko D, Geschwind D, Ghoshal N, Graff-Radford N, Grossman M, Hsiung GY, Huey ED, Jones DT, Lapid MI, Litvan I, Masdeu JC, Massimo L, Mendez MF, Miyagawa T, Pascual B, Pressman P, Ramanan VK, Ramos EM, Rascovsky K, Roberson ED, Tartaglia MC, Wong B, Miller BL, Kornak J, Kremers W, Hassenstab J, Kramer JH, Boeve BF, Rosen HJ, Boxer AL. Reliability and Validity of Smartphone Cognitive Testing for Frontotemporal Lobar Degeneration. JAMA Netw Open 2024; 7:e244266. [PMID: 38558141 PMCID: PMC10985553 DOI: 10.1001/jamanetworkopen.2024.4266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 02/02/2024] [Indexed: 04/04/2024] Open
Abstract
Importance Frontotemporal lobar degeneration (FTLD) is relatively rare, behavioral and motor symptoms increase travel burden, and standard neuropsychological tests are not sensitive to early-stage disease. Remote smartphone-based cognitive assessments could mitigate these barriers to trial recruitment and success, but no such tools are validated for FTLD. Objective To evaluate the reliability and validity of smartphone-based cognitive measures for remote FTLD evaluations. Design, Setting, and Participants In this cohort study conducted from January 10, 2019, to July 31, 2023, controls and participants with FTLD performed smartphone application (app)-based executive functioning tasks and an associative memory task 3 times over 2 weeks. Observational research participants were enrolled through 18 centers of a North American FTLD research consortium (ALLFTD) and were asked to complete the tests remotely using their own smartphones. Of 1163 eligible individuals (enrolled in parent studies), 360 were enrolled in the present study; 364 refused and 439 were excluded. Participants were divided into discovery (n = 258) and validation (n = 102) cohorts. Among 329 participants with data available on disease stage, 195 were asymptomatic or had preclinical FTLD (59.3%), 66 had prodromal FTLD (20.1%), and 68 had symptomatic FTLD (20.7%) with a range of clinical syndromes. Exposure Participants completed standard in-clinic measures and remotely administered ALLFTD mobile app (app) smartphone tests. Main Outcomes and Measures Internal consistency, test-retest reliability, association of smartphone tests with criterion standard clinical measures, and diagnostic accuracy. Results In the 360 participants (mean [SD] age, 54.0 [15.4] years; 209 [58.1%] women), smartphone tests showed moderate-to-excellent reliability (intraclass correlation coefficients, 0.77-0.95). Validity was supported by association of smartphones tests with disease severity (r range, 0.38-0.59), criterion-standard neuropsychological tests (r range, 0.40-0.66), and brain volume (standardized β range, 0.34-0.50). Smartphone tests accurately differentiated individuals with dementia from controls (area under the curve [AUC], 0.93 [95% CI, 0.90-0.96]) and were more sensitive to early symptoms (AUC, 0.82 [95% CI, 0.76-0.88]) than the Montreal Cognitive Assessment (AUC, 0.68 [95% CI, 0.59-0.78]) (z of comparison, -2.49 [95% CI, -0.19 to -0.02]; P = .01). Reliability and validity findings were highly similar in the discovery and validation cohorts. Preclinical participants who carried pathogenic variants performed significantly worse than noncarrier family controls on 3 app tasks (eg, 2-back β = -0.49 [95% CI, -0.72 to -0.25]; P < .001) but not a composite of traditional neuropsychological measures (β = -0.14 [95% CI, -0.42 to 0.14]; P = .32). Conclusions and Relevance The findings of this cohort study suggest that smartphones could offer a feasible, reliable, valid, and scalable solution for remote evaluations of FTLD and may improve early detection. Smartphone assessments should be considered as a complementary approach to traditional in-person trial designs. Future research should validate these results in diverse populations and evaluate the utility of these tests for longitudinal monitoring.
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Affiliation(s)
- Adam M. Staffaroni
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco
| | - Annie L. Clark
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco
| | - Jack C. Taylor
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco
| | - Hilary W. Heuer
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco
| | - Mark Sanderson-Cimino
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco
| | - Amy B. Wise
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco
| | - Sreya Dhanam
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco
| | - Yann Cobigo
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco
| | - Amy Wolf
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco
| | | | - Leah Forsberg
- Department of Neurology, Mayo Clinic, Rochester, Minnesota
| | - Carly Mester
- Department of Quantitative Health Sciences, Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
| | - Katherine P. Rankin
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco
| | - Brian S. Appleby
- Department of Neurology, Case Western Reserve University, Cleveland, Ohio
| | - Ece Bayram
- Department of Neurosciences, University of California, San Diego, La Jolla
| | - Andrea Bozoki
- Department of Radiology, University of North Carolina, Chapel Hill
| | - David Clark
- Department of Neurology, Indiana University, Indianapolis
| | - R. Ryan Darby
- Department of Neurology, Vanderbilt University, Nashville, Tennessee
| | | | - Julie A. Fields
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota
| | - Douglas Galasko
- Department of Neurosciences, University of California, San Diego, La Jolla
| | - Daniel Geschwind
- Department of Neurology, Institute for Precision Health, University of California, Los Angeles
| | - Nupur Ghoshal
- Department of Neurology, Knight Alzheimer Disease Research Center, Washington University, Saint Louis, Missouri
- Department of Psychiatry, Knight Alzheimer Disease Research Center, Washington University, Saint Louis, Missouri
| | | | - Murray Grossman
- Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Ging-Yuek Hsiung
- Division of Neurology, University of British Columbia, Musqueam, Squamish & Tsleil-Waututh Traditional Territory, Vancouver, Canada
| | - Edward D. Huey
- Department of Neurology, Columbia University, New York, New York
| | - David T. Jones
- Department of Quantitative Health Sciences, Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
| | - Maria I. Lapid
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota
| | - Irene Litvan
- Department of Neurosciences, University of California, San Diego, La Jolla
| | - Joseph C. Masdeu
- Department of Neurology, Nantz National Alzheimer Center, Houston Methodist and Weill Cornell Medicine, Houston Methodist, Houston, Texas
| | - Lauren Massimo
- Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Mario F. Mendez
- Department of Neurology, UCLA (University of California, Los Angeles)
| | - Toji Miyagawa
- Department of Neurology, Mayo Clinic, Rochester, Minnesota
| | - Belen Pascual
- Department of Neurology, Nantz National Alzheimer Center, Houston Methodist and Weill Cornell Medicine, Houston Methodist, Houston, Texas
| | | | | | | | - Katya Rascovsky
- Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | | | - M. Carmela Tartaglia
- Tanz Centre for Research in Neurodegenerative Diseases, Division of Neurology, University of Toronto, Toronto, Ontario, Canada
| | - Bonnie Wong
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston
| | - Bruce L. Miller
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco
| | - John Kornak
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Walter Kremers
- Department of Quantitative Health Sciences, Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
| | - Jason Hassenstab
- Department of Neurology, Knight Alzheimer Disease Research Center, Washington University, Saint Louis, Missouri
- Department of Psychological & Brain Sciences, Washington University, Saint Louis, Missouri
| | - Joel H. Kramer
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco
| | | | - Howard J. Rosen
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco
| | - Adam L. Boxer
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco
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Diaz MM, Zacarías MG, Sotolongo P, Sanes MF, Franklin DJ, Marquine MJ, Cherner M, Cárcamo C, Ellis RJ, Lanata S, García PJ. Characterization of HIV-Associated Neurocognitive Impairment in Middle-Aged and Older Persons With HIV in Lima, Peru. Front Neurol 2021; 12:629257. [PMID: 34220665 PMCID: PMC8248346 DOI: 10.3389/fneur.2021.629257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 04/21/2021] [Indexed: 12/12/2022] Open
Abstract
Background: With widespread use of antiretroviral medications, people living with HIV (PWH) are living longer worldwide, increasing their risk of developing neurocognitive impairment (NCI). The proportion of Peruvians over age 60 is expected to increase to 25% of the population by 2050, including PWH. Therefore, the problem of aging and NCI, especially in the setting of HIV infection, is uniquely pressing. We sought to study the rates of and risk factors associated with NCI among middle-aged and older PWH in Lima, Peru. Materials and Methods: Sociodemographic, medical (infectious and non-infectious), and psychiatric comorbidity and laboratory data were collected. We administered a brief neuropsychological battery evaluating seven cognitive domains affected in HIV-associated NCI and a depression screening. Cognitive test raw scores were converted to T-scores that were demographically adjusted. Descriptive statistics were performed together with regression (unadjusted and adjusted) analyses to determine potential risk factors for NCI among PWH. Results: This was a cross-sectional study in which 144 PWH aged ≥40 years attending a large HIV clinic in Lima, Peru, were recruited from September 2019 to March 2020. Mean age was 51.6 ± 7.7 years, and mean years of education were 14.0 ± 3.1 with 15% females. Median [interquartile range (IQR)] current CD4 and nadir CD4 were 554 (371, 723) and 179 (83, 291), respectively, and 10% currently had AIDS. The prevalence of NCI was 28.5%, and many demonstrated difficulty with attention and working memory (70%). One-quarter of PWH had mild depression or worse on Patient Health Questionnaire 9 (PHQ-9 ≥ 5). In bivariate analyses, neither a depression history nor a higher PHQ-9 score correlated with NCI. No other non-communicable medical or psychiatric comorbidity nor HIV characteristic was predictive of NCI. Having a positive lifetime history of hepatitis B infection, pulmonary tuberculosis, or syphilis increased risk of NCI (PR 1.72; 95% CI 1.04-2.86) in unadjusted analyses, but not in adjusted analyses. Conclusions: NCI among older Peruvians with HIV was found to be highly prevalent with levels consistent with prior reports of HIV-associated NCI worldwide. Common latent HIV-associated co-infections, including latent syphilis, hepatitis B infection, or pulmonary tuberculosis, may increase the risk of NCI among middle-aged and older PWH in Peru.
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Affiliation(s)
- Monica M. Diaz
- Department of Medicine, University of California, San Diego, San Diego, CA, United States
- University of California Global Health Institute, San Diego, CA, United States
- Facultad de Salud Pública, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Marcela Gil Zacarías
- Facultad de Medicina Alberto Hurtado, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Patricia Sotolongo
- Department of Psychology, Jackson Memorial Hospital, Miami, FL, United States
| | - María F. Sanes
- Facultad de Medicina Alberto Hurtado, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Donald J. Franklin
- Human Immunodeficiency Virus (HIV) Neurobehavioral Research Center, University of California, San Diego, San Diego, CA, United States
- Department of Psychiatry, University of California, San Diego, San Diego, CA, United States
| | - María J. Marquine
- Human Immunodeficiency Virus (HIV) Neurobehavioral Research Center, University of California, San Diego, San Diego, CA, United States
- Department of Psychiatry, University of California, San Diego, San Diego, CA, United States
| | - Mariana Cherner
- Human Immunodeficiency Virus (HIV) Neurobehavioral Research Center, University of California, San Diego, San Diego, CA, United States
- Department of Psychiatry, University of California, San Diego, San Diego, CA, United States
| | - Cesar Cárcamo
- Facultad de Salud Pública, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Ronald J. Ellis
- Human Immunodeficiency Virus (HIV) Neurobehavioral Research Center, University of California, San Diego, San Diego, CA, United States
- Department of Neurosciences, University of California, San Diego, San Diego, CA, United States
| | - Serggio Lanata
- Weill Institute for Neurosciences, Memory and Aging Center, University of California, San Francisco, San Francisco, CA, United States
- Global Brain Health Institute, University of California, San Francisco, San Francisco, CA, United States
| | - Patricia J. García
- Facultad de Salud Pública, Universidad Peruana Cayetano Heredia, Lima, Peru
- School of Public Health, University of Washington, Seattle, WA, United States
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Rodríguez-Salgado AM, Llibre-Guerra JJ, Tsoy E, Peñalver-Guia AI, Bringas G, Erlhoff SJ, Kramer JH, Allen IE, Valcour V, Miller BL, Llibre-Rodríguez JJ, Possin KL. A Brief Digital Cognitive Assessment for Detection of Cognitive Impairment in Cuban Older Adults. J Alzheimers Dis 2021; 79:85-94. [PMID: 33216033 DOI: 10.3233/jad-200985] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Rapid technological advances offer a possibility to develop cost-effective digital cognitive assessment tools. However, it is unclear whether these measures are suitable for application in populations from Low and middle-income countries (LMIC). OBJECTIVE To examine the accuracy and validity of the Brain Health Assessment (BHA) in detecting cognitive impairment in a Cuban population. METHODS In this cross-sectional study, 146 participants (cognitively healthy = 53, mild cognitive impairment (MCI) = 46, dementia = 47) were recruited at primary care and tertiary clinics. The main outcomes included: accuracy of the BHA and the Montreal Cognitive Assessment (MoCA) in discriminating between controls and cognitively impaired groups (MCI and dementia) and correlations between the BHA subtests of memory, executive functions, and visuospatial skills and criterion-standard paper-and-pencil tests in the same domains. RESULTS The BHA had an AUC of 0.95 (95% CI: 0.91-0.98) in discriminating between controls and cognitively impaired groups (MCI and dementia, combined) with 0.91 sensitivity at 0.85 specificity. In discriminating between control and MCI groups only, the BHA tests had an AUC of 0.94 (95% CI: 0.90-0.99) with 0.71 sensitivity at 0.85 specificity. Performance was superior to the MoCA across all diagnostic groups. Concurrent and discriminant validity analyses showed moderate to strong correlations between the BHA tests and standard paper-and-pencil measures in the same domain and weak correlations with standard measures in unrelated domains. CONCLUSION The BHA has excellent performance characteristics in detecting cognitive impairment including dementia and MCI in a Hispanic population in Cuba and outperformed the MoCA. These results support potential application of digital cognitive assessment for older adults in LMIC.
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Affiliation(s)
- Ana M Rodríguez-Salgado
- Department of Neurology, National Institute of Neurology and Neurosurgery, La Havana, Cuba.,Global Brain Health Institute, University of California San Francisco, San Francisco, CA, USA
| | - Jorge J Llibre-Guerra
- Department of Neurology, National Institute of Neurology and Neurosurgery, La Havana, Cuba.,Global Brain Health Institute, University of California San Francisco, San Francisco, CA, USA.,Department of Neurology, Washington University in St Louis, St Louis, MO, USA
| | - Elena Tsoy
- Department of Neurology,Memory and Aging Center, University of California San Francisco, San Francisco, CA, USA
| | - Ana Ibis Peñalver-Guia
- Department of Neurology, National Institute of Neurology and Neurosurgery, La Havana, Cuba
| | - Giosmany Bringas
- Department of Neurology, National Institute of Neurology and Neurosurgery, La Havana, Cuba
| | - Sabrina J Erlhoff
- Department of Neurology,Memory and Aging Center, University of California San Francisco, San Francisco, CA, USA
| | - Joel H Kramer
- Global Brain Health Institute, University of California San Francisco, San Francisco, CA, USA.,Department of Neurology,Memory and Aging Center, University of California San Francisco, San Francisco, CA, USA
| | - Isabel Elaine Allen
- Department of Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Victor Valcour
- Global Brain Health Institute, University of California San Francisco, San Francisco, CA, USA.,Department of Neurology,Memory and Aging Center, University of California San Francisco, San Francisco, CA, USA
| | - Bruce L Miller
- Global Brain Health Institute, University of California San Francisco, San Francisco, CA, USA.,Department of Neurology,Memory and Aging Center, University of California San Francisco, San Francisco, CA, USA
| | | | - Katherine L Possin
- Global Brain Health Institute, University of California San Francisco, San Francisco, CA, USA.,Department of Neurology,Memory and Aging Center, University of California San Francisco, San Francisco, CA, USA
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5
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Staffaroni AM, Tsoy E, Taylor J, Boxer AL, Possin KL. Digital Cognitive Assessments for Dementia: Digital assessments may enhance the efficiency of evaluations in neurology and other clinics. PRACTICAL NEUROLOGY (FORT WASHINGTON, PA.) 2020; 2020:24-45. [PMID: 33927583 PMCID: PMC8078574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- Adam M Staffaroni
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA
| | - Elena Tsoy
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA
| | - Jack Taylor
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA
| | - Adam L Boxer
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA
| | - Katherine L Possin
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, Global Brain Health Institute, University of California, San Francisco, San Francisco, CA
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