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Victoria LW, Oberlin LE, Ilieva IP, Jaywant A, Kanellopoulos D, Mercaldi C, Stamatis CA, Farlow DN, Kollins SH, Tisor O, Joshi S, Doreste-Mendez R, Perlis RH, Gunning FM. A digital intervention for cognitive deficits following COVID-19: a randomized clinical trial. Neuropsychopharmacology 2024:10.1038/s41386-024-01995-z. [PMID: 39358543 DOI: 10.1038/s41386-024-01995-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 08/26/2024] [Accepted: 09/12/2024] [Indexed: 10/04/2024]
Abstract
Post-COVID-19 cognitive deficits are common, persistent, and disabling. Evidence on effective treatments is limited. The goal of this study was to investigate the efficacy of a digital intervention to reduce cognitive and functional deficits in adults with persistent post-COVID-19 cognitive dysfunction. We used the remotely-delivered intervention in a randomized clinical trial conducted from July 13, 2021 to April 26, 2023. We hypothesized that participants in the intervention group would improve in measures of cognition and daily functioning. Participants were adults with cognitive deficits persisting >4 weeks following acute COVID-19 illness. Of 183 participants screened, 110 were enrolled; 98 participants (78.6% female; mean age = 48.1) completed at least one study visit. Participants were randomized 1:1 to the intervention (AKL-T01) or waitlist control. AKL-T01 is a digital therapeutic using a videogame interface to target attention and executive control. The intervention was delivered remotely for 6 weeks. The primary outcome was change in performance on a sustained attention measure (Digit Symbol Matching Task). The difference in the primary outcome between the intervention (n = 49) and controls (n = 49) was not statistically significant (F [3,261] = 0.12, p = 0.95). Secondary cognitive outcomes of task-switching (F[3,262] = 2.78, p = 0.04) and processing speed (F[3,267] = 4.57, p = 0.004) improved in the intervention relative to control. Secondary measures of functioning also improved in the intervention relative to control, including disability (F[1,82] = 4.02, p = 0.05) and quality of life (F[3,271] = 2.66, p = 0.05). Exploratory analyses showed a greater reduction in total fatigue (F[1,85] = 4.51, p = 0.04), cognitive fatigue (F[1,85] = 7.20, p = 0.009), and anxiety (F[1,87] = 7.42, p = 0.008) in the intervention relative to control. Despite the lack of improvement in sustained attention, select post-COVID-19 cognitive deficits may be ameliorated by targeted cognitive training with AKL-T01, with associated improvements in quality of life and fatigue. If replicated, the scalable nature of this digital intervention may help address substantial need for accessible, effective treatments among individuals with long COVID.
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Affiliation(s)
- Lindsay W Victoria
- Department of Psychiatry, Weill Cornell Medicine, New York, NY, USA
- Weill Cornell Institute of Geriatric Psychiatry, Weill Cornell Medicine, White Plains, NY, USA
| | - Lauren E Oberlin
- Department of Psychiatry, Weill Cornell Medicine, New York, NY, USA
- Weill Cornell Institute of Geriatric Psychiatry, Weill Cornell Medicine, White Plains, NY, USA
- Department of Neuroscience, AdventHealth Research Institute, Orlando, FL, USA
| | - Irena P Ilieva
- Department of Psychiatry, Weill Cornell Medicine, New York, NY, USA
| | - Abhishek Jaywant
- Department of Psychiatry, Weill Cornell Medicine, New York, NY, USA
- Department of Rehabilitation Medicine, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, NY, USA
| | - Dora Kanellopoulos
- Department of Psychiatry, Weill Cornell Medicine, New York, NY, USA
- Weill Cornell Institute of Geriatric Psychiatry, Weill Cornell Medicine, White Plains, NY, USA
| | | | | | | | | | - Ochuwa Tisor
- Department of Psychiatry, Weill Cornell Medicine, New York, NY, USA
- Weill Cornell Institute of Geriatric Psychiatry, Weill Cornell Medicine, White Plains, NY, USA
| | - Sama Joshi
- Department of Psychiatry, Weill Cornell Medicine, New York, NY, USA
- Weill Cornell Institute of Geriatric Psychiatry, Weill Cornell Medicine, White Plains, NY, USA
| | - Raura Doreste-Mendez
- Department of Psychiatry, Weill Cornell Medicine, New York, NY, USA
- Weill Cornell Institute of Geriatric Psychiatry, Weill Cornell Medicine, White Plains, NY, USA
| | - Roy H Perlis
- Center for Quantitative Health and Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Faith M Gunning
- Department of Psychiatry, Weill Cornell Medicine, New York, NY, USA.
- Weill Cornell Institute of Geriatric Psychiatry, Weill Cornell Medicine, White Plains, NY, USA.
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Zhu C, Thomas EHX, Li Q, Arunogiri S, Gurvich C. Cut-off point development for the Everyday Memory Questionnaire - Revised in perimenopausal women. Climacteric 2024:1-10. [PMID: 39324562 DOI: 10.1080/13697137.2024.2401369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Revised: 07/17/2024] [Accepted: 08/26/2024] [Indexed: 09/27/2024]
Abstract
OBJECTIVE Subjective cognitive complaints have been reported in women during perimenopause and the Everyday Memory Questionnaire - Revised (EMQ-R) has been recently evaluated as a standardized instrument to measure subjective cognitive changes. The purpose of this study was to identify potential cut-off points for the EMQ-R retrieval subscale and attentional subscale, and to assess the validity of these cut-off points in detecting objective cognitive changes associated with reported subjective cognitive complaints. METHOD After screening, 232 perimenopausal women were included in the analyses. The supervised classification and regression tree was applied to identify optimal cut-off points. Its performance was evaluated by the value of the receiver operating characteristics curve, sensitivity and specificity. RESULTS Findings revealed that the optimal cut-off point for the attentional subscale was 7, and for the retrieval subscale was 13. Both cut-off points presented acceptable discrimination performance. An independent t-test indicated that both cut-off points were associated with significant differences in scores on neuropsychological measures of retrieval (episodic memory and verbal fluency) as well as neuropsychological measures of higher-level attention (working memory). CONCLUSION The identified cut-off points may be helpful for women to track or quantify their subjective experiences of brain fog or cognitive symptoms during the menopause transition.
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Affiliation(s)
- Chen Zhu
- HER Centre Australia, Department of Psychiatry, School of Translational Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University and The Alfred Hospital, Melbourne, VIC, Australia
| | - Elizabeth H X Thomas
- HER Centre Australia, Department of Psychiatry, School of Translational Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University and The Alfred Hospital, Melbourne, VIC, Australia
| | - Qi Li
- HER Centre Australia, Department of Psychiatry, School of Translational Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University and The Alfred Hospital, Melbourne, VIC, Australia
| | - Shalini Arunogiri
- Eastern Health Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University and Turning Point, Melbourne, VIC, Australia
| | - Caroline Gurvich
- HER Centre Australia, Department of Psychiatry, School of Translational Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University and The Alfred Hospital, Melbourne, VIC, Australia
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Nuechterlein KH, Nasrallah H, Velligan D. Measuring Cognitive Impairments Associated With Schizophrenia in Clinical Practice: Overview of Current Challenges and Future Opportunities. Schizophr Bull 2024:sbae051. [PMID: 39088730 DOI: 10.1093/schbul/sbae051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/03/2024]
Abstract
BACKGROUND Cognitive impairment associated with schizophrenia (CIAS) negatively impacts daily functioning, quality of life, and recovery, yet effective pharmacotherapies and practical assessments for clinical practice are lacking. Despite the pivotal progress made with establishment of the Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) Consensus Cognitive Battery (MCCB) for clinical research, implementation of the full MCCB is too time-consuming and cost-ineffective for most clinicians in clinical practice. STUDY DESIGN Here we discuss current assessments in relation to delivery format (interview-based and performance-based), validity, ease of use for clinicians and patients, reliability/reproducibility, cost-effectiveness, and suitability for clinical implementation. Key challenges and future opportunities for improving cognitive assessments are also presented. STUDY RESULTS Current assessments that require 30 min to complete would have value in clinical settings, but the associated staff training and time required might preclude their application in most clinical settings. Initial profiling of cognitive deficits may require about 30 min to assist in the selection of evidence-based treatments; follow-up monitoring with brief assessments (10-15 min in duration) to detect treatment-related effects on global cognition may complement this approach. Guidance on validated brief cognitive tests for the strategic monitoring of treatment effects on CIAS is necessary. CONCLUSIONS With increased advancements in technology-based and remote assessments, development of validated formats of remote and in-person assessment, and the necessary training models and infrastructure required for implementation, are likely to be of increasing clinical relevance for future clinical practice.
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Affiliation(s)
- Keith H Nuechterlein
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA
| | - Henry Nasrallah
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati School of Medicine, Cincinnati, OH
| | - Dawn Velligan
- Division of Schizophrenia and Related Disorders, Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center, San Antonio, TX
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Gnambs T, Lenhard W. Remote Testing of Reading Comprehension in 8-Year-Old Children: Mode and Setting Effects. Assessment 2024; 31:248-262. [PMID: 36890734 PMCID: PMC10822056 DOI: 10.1177/10731911231159369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2023]
Abstract
Proctored remote testing of cognitive abilities in the private homes of test-takers is becoming an increasingly popular alternative to standard psychological assessments in test centers or classrooms. Because these tests are administered under less standardized conditions, differences in computer devices or situational contexts might contribute to measurement biases that impede fair comparisons between test-takers. Because it is unclear whether cognitive remote testing might be a feasible assessment approach for young children, the present study (N = 1,590) evaluated a test of reading comprehension administered to children at the age of 8 years. To disentangle mode from setting effects, the children finished the test either in the classroom on paper or computer or remotely on tablets or laptops. Analyses of differential response functioning found notable differences between assessment conditions for selected items. However, biases in test scores were largely negligible. Only for children with below-average reading comprehension small setting effects between on-site and remote testing were observed. Moreover, response effort was higher in the three computerized test versions, among which, reading on tablets most strongly resembled the paper condition. Overall, these results suggest that, on average, even for young children remote testing introduces little measurement bias.
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Affiliation(s)
- Timo Gnambs
- Leibniz Institute for Educational Trajectories, Bamberg, Germany
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Sperling SA, Acheson SK, Fox-Fuller J, Colvin MK, Harder L, Cullum CM, Randolph JJ, Carter KR, Espe-Pfeifer P, Lacritz LH, Arnett PA, Gillaspy SR. Tele-Neuropsychology: From Science to Policy to Practice. Arch Clin Neuropsychol 2024; 39:227-248. [PMID: 37715508 DOI: 10.1093/arclin/acad066] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2023] [Indexed: 09/17/2023] Open
Abstract
OBJECTIVE The primary aim of this paper is to accelerate the number of randomized experimental studies of the reliability and validity in-home tele-neuropsychological testing (tele-np-t). METHOD We conducted a critical review of the tele-neuropsychology literature. We discuss this research in the context of the United States' public and private healthcare payer systems, including the Centers for Medicare & Medicaid Services (CMS) and Current Procedural Terminology (CPT) coding system's telehealth lists, and existing disparities in healthcare access. RESULTS The number of tele-np publications has been stagnant since the onset of the COVID-19 pandemic. There are less published experimental studies of tele-neuropsychology (tele-np), and particularly in-home tele-np-t, than other tele-np publications. There is strong foundational evidence of the acceptability, feasibility, and reliability of tele-np-t, but relatively few studies of the reliability and validity of in-home tele-np-t using randomization methodology. CONCLUSIONS More studies of the reliability and validity of in-home tele-np-t using randomization methodology are necessary to support inclusion of tele-np-t codes on the CMS and CPT telehealth lists, and subsequently, the integration and delivery of in-home tele-np-t services across providers and institutions. These actions are needed to maintain equitable reimbursement of in-home tele-np-t services and address the widespread disparities in healthcare access.
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Affiliation(s)
- Scott A Sperling
- Department of Neurology, Center for Neurological Restoration, Cleveland Clinic, Cleveland, OH, USA
| | | | - Joshua Fox-Fuller
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | - Mary K Colvin
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Lana Harder
- Children's Health, Children's Medical Center, Dallas, TX, USA
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - C Munro Cullum
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - John J Randolph
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
- Randolph Neuropsychology Associates, PLLC, Lebanon, NH, USA
| | | | - Patricia Espe-Pfeifer
- Department of Psychiatry and Pediatrics, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Laura H Lacritz
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Peter A Arnett
- Department of Psychology, The Pennsylvania State University, State College, PA, USA
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Liu CL, Cheng X, Choo BL, Hong M, Teo JL, Koo WL, Tan JYJ, Ubrani MB, Suckling J, Gulyás B, Leong V, Kourtzi Z, Sahakian B, Robbins T, Chen ASH. Potential cognitive and neural benefits of a computerised cognitive training programme based on Structure Learning in healthy adults: study protocol for a randomised controlled trial. Trials 2023; 24:517. [PMID: 37568212 PMCID: PMC10422731 DOI: 10.1186/s13063-023-07551-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 07/27/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND Cognitive flexibility refers to the capacity to shift between conceptual representations particularly in response to changes in instruction and feedback. It enables individuals to swiftly adapt to changes in their environment and has significant implications for learning. The present study focuses on investigating changes in cognitive flexibility following an intervention programme-Structure Learning training. METHODS Participants are pseudo-randomised to either the Training or Control group, while matched on age, sex, intelligence and cognitive flexibility performance. In the Training group, participants undergo around 2 weeks of training (at least 13 sessions) on Structure Learning. In the Control group, participants do not have to undergo any training and are never exposed to the Structure Learning task. The effects of Structure Learning training are investigated at both the behavioural and neural level. We measured covariates that can influence an individual's training performance before the training phase and outcome measures that can potentially show training benefits after the training phase. At the behavioural level, we investigated outcomes in both cognitive and social aspects with a primary focus on executive functions. At the neural level, we employed a multimodality approach and investigated potential changes to functional connectivity patterns, neurometabolite concentration in the frontal brain regions, and brain microstructure and myelination. DISCUSSION We reported the development of a novel training programme based on Structure Learning that aims to hone a general learning ability to potentially achieve extensive transfer benefits across various cognitive constructs. Potential transfer benefits can be exhibited through better performance in outcome measures between Training and Control participants, and positive associations between training performance and outcomes after the training in Training participants. Moreover, we attempt to substantiate behavioural findings with evidence of neural changes across different imaging modalities by the Structure Learning training. TRIAL REGISTRATION National Institutes of Health U.S. National Library of Medicine ClinicalTrials.gov NCT05611788. Registered on 7 November 2022. PROTOCOL VERSION 11 May 2023.
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Affiliation(s)
- Chia-Lun Liu
- Centre for Research and Development in Learning (CRADLE), Nanyang Technological University, Singapore, Singapore.
| | - Xiaoqin Cheng
- Centre for Research and Development in Learning (CRADLE), Nanyang Technological University, Singapore, Singapore
- Department of Psychology, University of Innsbruck, Innsbruck, Austria
| | - Boon Linn Choo
- Centre for Research and Development in Learning (CRADLE), Nanyang Technological University, Singapore, Singapore
| | - Min Hong
- Centre for Research and Development in Learning (CRADLE), Nanyang Technological University, Singapore, Singapore
| | - Jia Li Teo
- Centre for Research and Development in Learning (CRADLE), Nanyang Technological University, Singapore, Singapore
- School of Social Sciences, Nanyang Technological University, Singapore, Singapore
| | - Wei Ler Koo
- Centre for Research and Development in Learning (CRADLE), Nanyang Technological University, Singapore, Singapore
| | - Jia Yuan Janet Tan
- Centre for Research and Development in Learning (CRADLE), Nanyang Technological University, Singapore, Singapore
| | - Marisha Barth Ubrani
- Centre for Research and Development in Learning (CRADLE), Nanyang Technological University, Singapore, Singapore
| | - John Suckling
- Department of Psychiatry, University of Cambridge, Cambridge, CB2 0SZ, UK
| | - Balázs Gulyás
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Victoria Leong
- Centre for Research and Development in Learning (CRADLE), Nanyang Technological University, Singapore, Singapore
- School of Social Sciences, Nanyang Technological University, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Zoe Kourtzi
- Department of Psychology, University of Cambridge, Cambridge, CB2 3EB, UK
| | - Barbara Sahakian
- Department of Psychiatry, University of Cambridge, Cambridge, CB2 0SZ, UK
| | - Trevor Robbins
- Department of Psychology, University of Cambridge, Cambridge, CB2 3EB, UK
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, CB2 3EB, UK
| | - Annabel Shen-Hsing Chen
- Centre for Research and Development in Learning (CRADLE), Nanyang Technological University, Singapore, Singapore
- School of Social Sciences, Nanyang Technological University, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- National Institute of Education, Nanyang Technological University, Singapore, Singapore
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Tong K, Chan YN, Cheng X, Cheon B, Ellefson M, Fauziana R, Feng S, Fischer N, Gulyás B, Hoo N, Hung D, Kalaivanan K, Langley C, Lee KM, Lee LL, Lee T, Melani I, Melia N, Pei JY, Raghani L, Sam YL, Seow P, Suckling J, Tan YF, Teo CL, Uchiyama R, Yap HS, Christopoulos G, Hendriks H, Chen A, Robbins T, Sahakian B, Kourtzi Z, Leong V. Study protocol: How does cognitive flexibility relate to other executive functions and learning in healthy young adults? PLoS One 2023; 18:e0286208. [PMID: 37471399 PMCID: PMC10358919 DOI: 10.1371/journal.pone.0286208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 05/10/2023] [Indexed: 07/22/2023] Open
Abstract
BACKGROUND Cognitive flexibility (CF) enables individuals to readily shift from one concept or mode of practice/thoughts to another in response to changes in the environment and feedback, making CF vital to optimise success in obtaining goals. However, how CF relates to other executive functions (e.g., working memory, response inhibition), mental abilities (e.g., creativity, literacy, numeracy, intelligence, structure learning), and social factors (e.g., multilingualism, tolerance of uncertainty, perceived social support, social decision-making) is less well understood. The current study aims to (1) establish the construct validity of CF in relation to other executive function skills and intelligence, and (2) elucidate specific relationships between CF, structure learning, creativity, career decision making and planning, and other life skills. METHODS This study will recruit up to 400 healthy Singaporean young adults (age 18-30) to complete a wide range of cognitive tasks and social questionnaires/tasks. The richness of the task/questionnaire battery and within-participant administration enables us to use computational modelling and structural equation modelling to examine connections between the latent constructs of interest. SIGNIFICANCE AND IMPACT The current study is the first systematic investigation into the construct validity of CF and its interrelationship with other important cognitive skills such as learning and creativity, within an Asian context. The study will further explore the concept of CF as a non-unitary construct, a novel theoretical proposition in the field. The inclusion of a structure learning paradigm is intended to inform future development of a novel intervention paradigm to enhance CF. Finally, the results of the study will be useful for informing classroom pedagogy and the design of lifelong learning policies and curricula, as part of the wider remit of the Cambridge-NTU Centre for Lifelong Learning and Individualised Cognition (CLIC).
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Affiliation(s)
- Ke Tong
- Nanyang Technological University, Singapore, Singapore
| | - Yuan Ni Chan
- Nanyang Technological University, Singapore, Singapore
| | - Xiaoqin Cheng
- Nanyang Technological University, Singapore, Singapore
| | - Bobby Cheon
- National Institutes of Health, Bethesda, Maryland, United States of America
| | | | | | | | | | - Balázs Gulyás
- Nanyang Technological University, Singapore, Singapore
| | - Natalie Hoo
- Nanyang Technological University, Singapore, Singapore
| | - David Hung
- National Institute of Education, Singapore, Singapore
| | | | | | - Kean Mun Lee
- Nanyang Technological University, Singapore, Singapore
| | - Li Ling Lee
- Nanyang Technological University, Singapore, Singapore
| | - Timothy Lee
- National Institute of Education, Singapore, Singapore
| | - Irene Melani
- Nanyang Technological University, Singapore, Singapore
| | | | - Jia Ying Pei
- Nanyang Technological University, Singapore, Singapore
| | - Lisha Raghani
- Nanyang Technological University, Singapore, Singapore
| | - Yoke Loo Sam
- Nanyang Technological University, Singapore, Singapore
| | - Peter Seow
- National Institute of Education, Singapore, Singapore
| | | | - Yan Fen Tan
- Nanyang Technological University, Singapore, Singapore
| | - Chew Lee Teo
- National Institute of Education, Singapore, Singapore
| | | | - Hui Shan Yap
- Nanyang Technological University, Singapore, Singapore
| | | | | | - Annabel Chen
- Nanyang Technological University, Singapore, Singapore
| | | | | | - Zoe Kourtzi
- University of Cambridge, Cambridge, United Kingdom
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Alim-Marvasti A, Kuleindiren N, Harvey K, Ciocca M, Lin A, Selim H, Mahmud M. Validation of a rapid remote digital test for impaired cognition using clinical dementia rating and mini-mental state examination: An observational research study. Front Digit Health 2022; 4:1029810. [PMID: 36620187 PMCID: PMC9811948 DOI: 10.3389/fdgth.2022.1029810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 11/30/2022] [Indexed: 12/24/2022] Open
Abstract
Background The Clinical Dementia Rating (CDR) and Mini-Mental State Examination (MMSE) are useful screening tools for mild cognitive impairment (MCI). However, these tests require qualified in-person supervision and the CDR can take up to 60 min to complete. We developed a digital cognitive screening test (M-CogScore) that can be completed remotely in under 5 min without supervision. We set out to validate M-CogScore in head-to-head comparisons with CDR and MMSE. Methods To ascertain the validity of the M-CogScore, we enrolled participants as healthy controls or impaired cognition, matched for age, sex, and education. Participants completed the 30-item paper MMSE Second Edition Standard Version (MMSE-2), paper CDR, and smartphone-based M-CogScore. The digital M-CogScore test is based on time-normalised scores from smartphone-adapted Stroop (M-Stroop), digit-symbols (M-Symbols), and delayed recall tests (M-Memory). We used Spearman's correlation coefficient to determine the convergent validity between M-CogScore and the 30-item MMSE-2, and non-parametric tests to determine its discriminative validity with a CDR label of normal (CDR 0) or impaired cognition (CDR 0.5 or 1). M-CogScore was further compared to MMSE-2 using area under the receiver operating characteristic curves (AUC) with corresponding optimal cut-offs. Results 72 participants completed all three tests. The M-CogScore correlated with both MMSE-2 (rho = 0.54, p < 0.0001) and impaired cognition on CDR (Mann Whitney U = 187, p < 0.001). M-CogScore achieved an AUC of 0.85 (95% bootstrapped CI [0.80, 0.91]), when differentiating between normal and impaired cognition, compared to an AUC of 0.78 [0.72, 0.84] for MMSE-2 (p = 0.21). Conclusion Digital screening tests such as M-CogScore are desirable to aid in rapid and remote clinical cognitive evaluations. M-CogScore was significantly correlated with established cognitive tests, including CDR and MMSE-2. M-CogScore can be taken remotely without supervision, is automatically scored, has less of a ceiling effect than the MMSE-2, and takes significantly less time to complete.
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Affiliation(s)
- Ali Alim-Marvasti
- Research Division, Mindset Technologies Ltd., London, United Kingdom,Queen Square Institute of Neurology, University College London, London, United Kingdom,Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom,Correspondence: Ali Alim-Marvasti
| | | | - Kirsten Harvey
- Research Division, Mindset Technologies Ltd., London, United Kingdom,Department of Brain Sciences, Imperial College London, London, United Kingdom
| | - Matteo Ciocca
- Research Division, Mindset Technologies Ltd., London, United Kingdom,Department of Brain Sciences, Imperial College London, London, United Kingdom
| | - Aaron Lin
- Research Division, Mindset Technologies Ltd., London, United Kingdom,Medical School, University of Birmingham, Birmingham, United Kingdom
| | - Hamzah Selim
- Research Division, Mindset Technologies Ltd., London, United Kingdom
| | - Mohammad Mahmud
- Research Division, Mindset Technologies Ltd., London, United Kingdom,Department of Brain Sciences, Imperial College London, London, United Kingdom
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Coro DG, Hutchinson AD, Dyer KA, Banks S, Koczwara B, Corsini N, Vitry A, Coates AM. 'Food for Thought'-The Relationship between Diet and Cognition in Breast and Colorectal Cancer Survivors: A Feasibility Study. Nutrients 2021; 14:71. [PMID: 35010946 PMCID: PMC8746644 DOI: 10.3390/nu14010071] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 12/14/2021] [Accepted: 12/20/2021] [Indexed: 01/22/2023] Open
Abstract
Survivors of cancer frequently experience persistent and troublesome cognitive changes. Little is known about the role diet and nutrition plays in survivors' cognition. We explored the feasibility of collecting cross-sectional online data from Australian survivors of breast and colorectal cancer to enable preliminary investigations of the relationships between cognition with fruit and vegetable intake, and the Omega-3 Index (a biomarker of long chain omega 3 fatty acid intake). A total of 76 participants completed online (and postal Omega-3 Index biomarker) data collection (62 breast and 14 colorectal cancer survivors): mean age 57.5 (±10.2) years, mean time since diagnosis 32.6 (±15.6) months. Almost all of the feasibility outcomes were met; however, technical difficulties were reported for online cognitive testing. In hierarchical linear regression models, none of the dietary variables of interest were significant predictors of self-reported or objective cognition. Age, BMI, and length of treatment predicted some of the cognitive outcomes. We demonstrated a viable online/postal data collection method, with participants reporting positive levels of engagement and satisfaction. Fruit, vegetable, and omega-3 intake were not significant predictors of cognition in this sample, however the role of BMI in survivors' cognitive functioning should be further investigated. Future research could adapt this protocol to longitudinally monitor diet and cognition to assess the impact of diet on subsequent cognitive function, and whether cognitive changes impact dietary habits in survivors of cancer.
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Affiliation(s)
- Daniel G. Coro
- Behaviour-Brain-Body (BBB) Research Centre, UniSA Justice & Society, University of South Australia, Adelaide, SA 5000, Australia; (A.D.H.); (S.B.)
| | - Amanda D. Hutchinson
- Behaviour-Brain-Body (BBB) Research Centre, UniSA Justice & Society, University of South Australia, Adelaide, SA 5000, Australia; (A.D.H.); (S.B.)
| | - Kathryn A. Dyer
- UniSA Allied Health & Human Performance, Alliance for Research in Exercise, Nutrition and Activity (ARENA), University of South Australia, Adelaide, SA 5000, Australia; (K.A.D.); (A.M.C.)
| | - Siobhan Banks
- Behaviour-Brain-Body (BBB) Research Centre, UniSA Justice & Society, University of South Australia, Adelaide, SA 5000, Australia; (A.D.H.); (S.B.)
| | - Bogda Koczwara
- Flinders Medical Centre, Department of Medical Oncology, Adelaide, SA 5000, Australia;
- College of Medicine & Public Health, Flinders University, Adelaide, SA 5000, Australia
| | - Nadia Corsini
- Rosemary Bryant AO Research Centre, UniSA Clinical & Health Sciences, University of South Australia, Adelaide, SA 5000, Australia;
| | - Agnes Vitry
- UniSA Clinical & Health Sciences, University of South Australia, Adelaide, SA 5000, Australia;
| | - Alison M. Coates
- UniSA Allied Health & Human Performance, Alliance for Research in Exercise, Nutrition and Activity (ARENA), University of South Australia, Adelaide, SA 5000, Australia; (K.A.D.); (A.M.C.)
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