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Libon DJ, Swenson R, Price CC, Lamar M, Cosentino S, Bezdicek O, Kling MA, Tobyne S, Jannati A, Banks R, Pascual-Leone A. Digital assessment of cognition in neurodegenerative disease: a data driven approach leveraging artificial intelligence. Front Psychol 2024; 15:1415629. [PMID: 39035083 PMCID: PMC11258860 DOI: 10.3389/fpsyg.2024.1415629] [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: 04/10/2024] [Accepted: 06/12/2024] [Indexed: 07/23/2024] Open
Abstract
Introduction A rapid and reliable neuropsychological protocol is essential for the efficient assessment of neurocognitive constructs related to emergent neurodegenerative diseases. We developed an AI-assisted, digitally administered/scored neuropsychological protocol that can be remotely administered in ~10 min. This protocol assesses the requisite neurocognitive constructs associated with emergent neurodegenerative illnesses. Methods The protocol was administered to 77 ambulatory care/memory clinic patients (56.40% women; 88.50% Caucasian). The protocol includes a 6-word version of the Philadelphia (repeatable) Verbal Learning Test [P(r)VLT], three trials of 5 digits backward from the Backwards Digit Span Test (BDST), and the "animal" fluency test. The protocol provides a comprehensive set of traditional "core" measures that are typically obtained through paper-and-pencil tests (i.e., serial list learning, immediate and delayed free recall, recognition hits, percent correct serial order backward digit span, and "animal" fluency output). Additionally, the protocol includes variables that quantify errors and detail the processes used in administering the tests. It also features two separate, norm-referenced summary scores specifically designed to measure executive control and memory. Results Using four core measures, we used cluster analysis to classify participants into four groups: cognitively unimpaired (CU; n = 23), amnestic mild cognitive impairment (MCI; n = 17), dysexecutive MCI (n = 23), and dementia (n = 14). Subsequent analyses of error and process variables operationally defined key features of amnesia (i.e., rapid forgetting, extra-list intrusions, profligate responding to recognition foils); key features underlying reduced executive abilities (i.e., BDST items and dysexecutive errors); and the strength of the semantic association between successive responses on the "animal" fluency test. Executive and memory index scores effectively distinguished between all four groups. There was over 90% agreement between how cluster analysis of digitally obtained measures classified patients compared to classification using a traditional comprehensive neuropsychological protocol. The correlations between digitally obtained outcome variables and analogous paper/pencil measures were robust. Discussion The digitally administered protocol demonstrated a capacity to identify patterns of impaired performance and classification similar to those observed with standard paper/pencil neuropsychological tests. The inclusion of both core measures and detailed error/process variables suggests that this protocol can detect subtle, nuanced signs of early emergent neurodegenerative illness efficiently and comprehensively.
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Affiliation(s)
- David J. Libon
- Department of Geriatrics and Gerontology, New Jersey Institute for Successful Aging, Rowan-Virtua School of Osteopathic Medicine, Glassboro, NJ, United States
- Department of Psychology, Rowan University, Glassboro, NJ, United States
| | - Rod Swenson
- Department of Psychiatry and Behavioral Health, University of North Dakota School of Medicine and Health Sciences, Grand Forks, ND, United States
| | - Catherine C. Price
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, United States
| | - Melissa Lamar
- Rush Alzheimer's Disease Center and the Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, United States
| | - Stephanie Cosentino
- Columbia University Medical Center, Department of Neurology, Cognitive Neuroscience Division, Taub Institute and Sergievsky Center, New York, NY, United States
| | - Ondrej Bezdicek
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University, Prague, Czechia
| | - Mitchel A. Kling
- Department of Geriatrics and Gerontology, New Jersey Institute for Successful Aging, Rowan-Virtua School of Osteopathic Medicine, Glassboro, NJ, United States
| | | | - Ali Jannati
- Linus Health, Boston, MA, United States
- Department of Neurology, Harvard Medical School, Boston, MA, United States
| | | | - Alvaro Pascual-Leone
- Linus Health, Boston, MA, United States
- Hinda and Arthur Marcus Institute for Aging Research and Deanna, Sidney Wolk Center for Memory Health, Hebrew Senior Life, Boston, MA, United States
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Idowu MI, Szameitat AJ, Parton A. The assessment of executive function abilities in healthy and neurodegenerative aging-A selective literature review. Front Aging Neurosci 2024; 16:1334309. [PMID: 38596597 PMCID: PMC11002121 DOI: 10.3389/fnagi.2024.1334309] [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: 11/08/2023] [Accepted: 02/26/2024] [Indexed: 04/11/2024] Open
Abstract
Numerous studies have examined executive function (EF) abilities in cognitively healthy older adults and those living with mild cognitive impairment (MCI) and Alzheimer's disease (AD). Currently, there are no standard accepted protocols for testing specific EFs; thus, researchers have used their preferred tool, which leads to variability in assessments of decline in a particular ability across studies. Therefore, there is a need for guidance as to the most sensitive tests for assessing EF decline. A search of the most current literature published between 2000 and 2022 on EF studies assessing cognitively healthy older adults and individuals living with MCI and AD was conducted using PubMed/Medline, PsycINFO, Embase, Web of Science, and Google Scholar. Emphasis was placed on the EF's dual-tasking, inhibition, shifting or switching, and working memory updating. Many tasks and their outcomes were reviewed. Of particular importance was the difference in outcomes for tasks applied to the same group of participants. These various EF assessment tools demonstrate differences in effectively identifying decline in EF ability due to the aging process and neurodegenerative conditions, such as MCI and AD. This review identifies various factors to consider in using particular EF tasks in particular populations, including task demand and stimuli factors, and also when comparing differing results across studies.
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Affiliation(s)
- Mojitola I. Idowu
- Centre for Cognitive and Clinical Neuroscience (CCN), College of Health, Medicine and Life Sciences, Division of Psychology, Department of Life Sciences, Brunel University London, Uxbridge, United Kingdom
| | | | - Andrew Parton
- Centre for Cognitive and Clinical Neuroscience (CCN), College of Health, Medicine and Life Sciences, Division of Psychology, Department of Life Sciences, Brunel University London, Uxbridge, United Kingdom
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Zhao X, Ji C, Zhang C, Huang C, Zhou Y, Wang L. Transferability and sustainability of process-based multi-task adaptive cognitive training in community-dwelling older adults with mild cognitive impairment: a randomized controlled trial. BMC Psychiatry 2023; 23:418. [PMID: 37308857 PMCID: PMC10259063 DOI: 10.1186/s12888-023-04917-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 05/31/2023] [Indexed: 06/14/2023] Open
Abstract
BACKGROUND Cognitive training shows promising effects for improving cognitive domains in individuals with mild cognitive impairment (MCI), including the crucial predictive factor of executive function (EF) for dementia prognosis. Few studies have paid sufficient emphasis on the training-induced effects of cognitive training programs, particularly with regards to targeting EF. A process-based multi-task adaptive cognitive training (P-bM-tACT) program targeting EF is required to examine direct, transfer, and sustainability effects in older adults with MCI. OBJECTIVE This study aimed to evaluate the direct effects of a P-bM-tACT program on EF, the transfer effects on untrained cognitive domains, and further explore the sustainability of training gains for older adults with MCI in the community. METHODS In a single-blind, randomized controlled trial, 92 participants with MCI were randomly assigned to either the intervention group, participating in a P-bM-tACT program (3 training sessions/week, 60 min/session for 10 weeks) or the wait-list control group, accepting a health education program on MCI (1 education session/ twice a week, 40-60 min/session for 10 weeks). The direct and transfer effects of the P-bM-tACT program were assessed at baseline, immediately after 10 weeks of training, and the 3-month follow-up. Repeated measures analysis of variance and a simple effect test were used to compare the direct and transfer effects over the 3-time points between the two groups. RESULTS The P-bM-tACT program yielded a greater benefit of direct and transfer effects in the intervention group participants than in the wait-list control group. Combined with the results of simple effect tests, the direct and transfer effects of participants in the intervention group significantly increased immediately after 10 weeks of training compared to the baseline (F = 14.702 ~ 62.905, p < 0.05), and these effects were maintained at the 3-month follow-up (F = 19.595 ~ 122.22, p < 0.05). Besides, the acceptability of the cognitive training program was established with a high adherence rate of 83.4%. CONCLUSIONS The P-bM-tACT program exerted positive direct and transfer effects on the improvement of cognitive function, and these effects were sustained for 3 months. The findings provided a viable and potential approach to improving cognitive function in older adults with MCI in the community. TRIAL REGISTRATION The trial was registered at Chinese Clinical Trials Registry on 09/01/2019 ( www.chictr.org.cn ; Number Registry: ChiCTR1900020585).
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Affiliation(s)
- Xia Zhao
- Department of Geriatric Psychiatry, Suzhou Guangji Hospital, JiangSu, China
- School of Medicine, Huzhou University, Zhejiang, China
| | - Caifang Ji
- Department of Geriatric Psychiatry, Suzhou Guangji Hospital, JiangSu, China
| | - Chen Zhang
- Department of general medicine, Community health service center of Binhu Street, Zhejiang, China
| | - Cheng Huang
- School of Medicine, Huzhou University, Zhejiang, China
| | - Yuanyuan Zhou
- School of Nursing, Jiangsu College of Nursing, JiangSu, China
| | - Lina Wang
- School of Medicine, Huzhou University, Zhejiang, China.
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Matusz EF, Price CC, Lamar M, Swenson R, Au R, Emrani S, Wasserman V, Libon DJ, Thompson LI. Dissociating Statistically Determined Normal Cognitive Abilities and Mild Cognitive Impairment Subtypes with DCTclock. J Int Neuropsychol Soc 2023; 29:148-158. [PMID: 35188095 PMCID: PMC11194727 DOI: 10.1017/s1355617722000091] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To determine whether the DCTclock can detect differences across groups of patients seen in the memory clinic for suspected dementia. METHOD Patients (n = 123) were classified into the following groups: cognitively normal (CN), subtle cognitive impairment (SbCI), amnestic cognitive impairment (aMCI), and mixed/dysexecutive cognitive impairment (mx/dysMCI). Nine outcome variables included a combined command/copy total score and four command and four copy indices measuring drawing efficiency, simple/complex motor operations, information processing speed, and spatial reasoning. RESULTS Total combined command/copy score distinguished between groups in all comparisons with medium to large effects. The mx/dysMCI group had the lowest total combined command/copy scores out of all groups. The mx/dysMCI group scored lower than the CN group on all command indices (p < .050, all analyses); and lower than the SbCI group on drawing efficiency (p = .011). The aMCI group scored lower than the CN group on spatial reasoning (p = .019). Smaller effect sizes were obtained for the four copy indices. CONCLUSIONS These results suggest that DCTclock command/copy parameters can dissociate CN, SbCI, and MCI subtypes. The larger effect sizes for command clock indices suggest these metrics are sensitive in detecting early cognitive decline. Additional research with a larger sample is warranted.
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Affiliation(s)
- Emily F. Matusz
- Department of Geriatrics and Gerontology, New Jersey Institute for Successful Aging, School of Osteopathic Medicine, Rowan University, Stratford, NJ, USA
| | - Catherine C. Price
- Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Melissa Lamar
- Department of Behavioral Sciences and the Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL, USA
| | - Rod Swenson
- University of North Dakota School of Medicine and Health Sciences, Grand Forks, ND, USA
| | - Rhoda Au
- Boston University Schools of Medicine & Public Health, Boston, MA, USA
| | - Sheina Emrani
- Department of Psychology, Rowan University, Stratford, NJ, USA
| | | | - David J. Libon
- Department of Geriatrics and Gerontology, New Jersey Institute for Successful Aging, School of Osteopathic Medicine, Rowan University, Stratford, NJ, USA
- Department of Psychology, Rowan University, Stratford, NJ, USA
| | - Louisa I. Thompson
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
- Butler Hospital Memory & Aging Program, Providence, RI, USA
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Emrani S, Lamar M, Price CC, Swenson R, Libon DJ, Baliga G. Neurocognitive Operations Underlying Working Memory Abilities: An Analysis of Latency and Time-Based Parameters. J Alzheimers Dis 2023; 94:1535-1547. [PMID: 37458036 PMCID: PMC11389823 DOI: 10.3233/jad-230288] [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] [Indexed: 07/18/2023]
Abstract
BACKGROUND The theory of executive attention (Fuster, 2015) suggests considerable plasticity regarding when specific neurocognitive operations are recruited to bring executive tasks to fruition. OBJECTIVE We tested the hypothesis that differing neurocognitive operations are recruited upon the initiation of a response, but that other distinct neurocognitive operations are recruited towards the middle or end of a response. METHODS The Backward Digit Span Test (BDST) was administered to 58 memory clinic patients (MCI, n = 22; no-MCI, n = 36). Latency to generate all correct 5-span responses was obtained. Statistical analyses found that optimal group classification was achieved using the first and third digit backward. First and third response latencies were analyzed in relation to verbal working memory (WM), visual WM, processing speed, visuospatial operations, naming/lexical access, and verbal episodic memory tests. RESULTS For the first response, slower latencies were associated with better performance in relation to verbal WM and visuospatial test performance. For the third response, faster latencies were associated with better processing speed and visuospatial test performance. CONCLUSION Consistent with the theory of executive attention, these data show that the neurocognitive operations underlying successful executive test performance are not monolithic but can be quite nuanced with differing neurocognitive operations associated with specific time epochs. Results support the efficacy of obtaining time-based latency parameters to help disambiguate successful executive neurocognitive operations in memory clinic patients.
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Affiliation(s)
- Sheina Emrani
- Department of Psychiatry and Human Behavior, Brown University, Providence, RI, USA
| | - Melissa Lamar
- Rush Alzheimer's Disease Center and the Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Catherine C Price
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Rod Swenson
- Department of Psychiatry and Behavioral Science at the University of North Dakota, School of Medicine and Health Sciences, Grand Forks, ND, USA
| | - David J Libon
- New Jersey Institute for Successful Aging, School of Osteopathic Medicine and the Department of Psychology, Rowan University, Stratford, NJ, USA
| | - Ganesh Baliga
- Department of Computer Science, Rowan University, Glassboro, NJ, USA
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Fu X, Zhang Z, Zhou Y, Chen Q, Yang LZ, Li H. The Split-Half Reliability and Construct Validity of the Virtual Reality-Based Path Integration Task in the Healthy Population. Brain Sci 2022; 12:brainsci12121635. [PMID: 36552095 PMCID: PMC9775933 DOI: 10.3390/brainsci12121635] [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: 10/18/2022] [Revised: 11/21/2022] [Accepted: 11/26/2022] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE The virtual reality (VR)-based path integration task shows substantial promise in predicting dementia risk. However, the reliability and validity in healthy populations need further exploration. The present study investigates the relationship between task indicators and brain structures in a healthy population using a VR-based navigation task, particularly the entorhinal cortex (EC) and hippocampus. METHODS Sixty healthy adults were randomly recruited to perform a VR-based path integration task, the digit span task (DST), and an MRI scan. The indicators of the VR-based path integration task were calculated, including the absolute distance error (ADE), degree of angle deviation (DAD), degree of path deviation (DPD), and return time (Time). The reliability of the above indicators was then estimated using the split-half method and Cronbach's alpha. Correlation and regression analyses were then performed to examine the associations between these indicators and age, general cognitive ability (DST), and brain structural measures. RESULTS ADE, DAD, and DPD showed reasonable split-half reliability estimates (0.84, 0.81, and 0.72) and nice Cronbach's alpha estimates (0.90, 0.86, and 0.96). All indicators correlated with age and DST. ADE and DAD were sensitive predictors of hippocampal volume, and return time was a predictor of EC thickness. CONCLUSION Our findings demonstrate that the VR-based path integration task exhibits good reliability and validity in the healthy population. The task indicators are age-sensitive, can capture working memory capacity, and are closely related to the integrity of individual EC and hippocampal structures.
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Affiliation(s)
- Xiao Fu
- Hefei Cancer Hospital, Chinese Academy of Sciences, Hefei 230031, China
| | - Zhenglin Zhang
- Anhui Province Key Laboratory of Medical Physics and Technology, Institute of Health and Medical Technology, Hefei Institutes of Physical Science, Chinese Academy of Sciences, Hefei 230031, China
- University of Science and Technology of China, Hefei 230026, China
| | - Yanfei Zhou
- Hefei Cancer Hospital, Chinese Academy of Sciences, Hefei 230031, China
| | - Qi Chen
- Hefei Cancer Hospital, Chinese Academy of Sciences, Hefei 230031, China
| | - Li-Zhuang Yang
- Anhui Province Key Laboratory of Medical Physics and Technology, Institute of Health and Medical Technology, Hefei Institutes of Physical Science, Chinese Academy of Sciences, Hefei 230031, China
- Correspondence: may
| | - Hai Li
- Anhui Province Key Laboratory of Medical Physics and Technology, Institute of Health and Medical Technology, Hefei Institutes of Physical Science, Chinese Academy of Sciences, Hefei 230031, China
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Banerji A, Sleigh JW, Voss LJ, Garcia PS, Gaskell AL. Deconstructing delirium in the post anaesthesia care unit. Front Aging Neurosci 2022; 14:930434. [PMID: 36268194 PMCID: PMC9577324 DOI: 10.3389/fnagi.2022.930434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 09/05/2022] [Indexed: 11/17/2022] Open
Abstract
The course of neuro-cognitive recovery following anaesthesia and surgery is distinctive and poorly understood. Our objective was to identify patterns of neuro-cognitive recovery of the domains routinely assessed for delirium diagnosis in the post anaesthesia care unit (PACU) and to compare them to the cognitive recovery patterns observed in other studies; thereby aiding in the identification of pathological (high risk) patterns of recovery in the PACU. We also compared which of the currently available tests (3D-CAM, CAM-ICU, and NuDESC) is the best to use in PACU. This was a post hoc secondary analysis of data from the Alpha Max study which involved 200 patients aged over 60 years, scheduled for elective surgery under general anaesthesia lasting more than 2 h. These patients were assessed for delirium at 30 min following arrival in the PACU, if they were adequately arousable (Richmond Agitation Sedation Score ≥ −2). All tests for delirium diagnosis (3D-CAM, CAM-ICU, and NuDESC) and the sub-domains assessed were compared to understand temporal recovery of neurocognitive domains. These data were also analysed to determine the best predictor of PACU delirium. We found the incidence of PACU delirium was 35% (3D-CAM). Individual cognitive domains were affected differently. Few individuals had vigilance deficits (6.5%, n = 10 CAM-ICU) or disorganized thinking (19% CAM-ICU, 27.5% 3D-CAM), in contrast attention deficits were common (72%, n = 144) and most of these patients (89.5%, n = 129) were not sedated (RASS ≥ −2). CAM-ICU (27%) and NuDESC (52.8%) detected fewer cases of PACU delirium compared to 3D-CAM. In conclusion, return of neurocognitive function is a stepwise process; Vigilance and Disorganized Thinking are the earliest cognitive functions to return to baseline and lingering deficits in these domains could indicate an abnormal cognitive recovery. Attention deficits are relatively common at 30 min in the PACU even in individuals who appear to be awake. The 3D CAM is a robust test to check for delirium in the PACU.
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Affiliation(s)
- Antara Banerji
- Department of Anaesthesia, Waikato Clinical Campus, University of Auckland, Auckland, New Zealand
- *Correspondence: Antara Banerji,
| | - Jamie W. Sleigh
- Department of Anaesthesia, Waikato Clinical Campus, University of Auckland, Auckland, New Zealand
| | - Logan J. Voss
- Department of Anaesthesia, Waikato Clinical Campus, University of Auckland, Auckland, New Zealand
- Department of Anaesthesia and Pain Medicine, Waikato District Health Board, Hamilton, New Zealand
| | - Paul S. Garcia
- Department of Anesthesiology, Chief Neuroanesthesia Division, Columbia University Medical Center New York Presbyterian Hospital – Irving, Columbia University, New York, NY, United States
| | - Amy L. Gaskell
- Department of Anaesthesia, Waikato Clinical Campus, University of Auckland, Auckland, New Zealand
- Department of Anaesthesia and Pain Medicine, Waikato District Health Board, Hamilton, New Zealand
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Libon DJ, Swenson R, Lamar M, Price CC, Baliga G, Pascual-Leone A, Au R, Cosentino S, Andersen SL. The Boston Process Approach and Digital Neuropsychological Assessment: Past Research and Future Directions. J Alzheimers Dis 2022; 87:1419-1432. [PMID: 35466941 DOI: 10.3233/jad-220096] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Neuropsychological assessment using the Boston Process Approach (BPA) suggests that an analysis of the strategy or the process by which tasks and neuropsychological tests are completed, and the errors made during test completion convey much information regarding underlying brain and cognition and are as important as overall summary scores. Research over the last several decades employing an analysis of process and errors has been able to dissociate between dementia patients diagnosed with Alzheimer's disease, vascular dementia associated with MRI-determined white matter alterations, and Parkinson's disease; and between mild cognitive impairment subtypes. Nonetheless, BPA methods can be labor intensive to deploy. However, the recent availability of digital platforms for neuropsychological test administration and scoring now enables reliable, rapid, and objective data collection. Further, digital technology can quantify highly nuanced data previously unobtainable to define neurocognitive constructs with high accuracy. In this paper, a brief review of the BPA is provided. Studies that demonstrate how digital technology translates BPA into specific neurocognitive constructs using the Clock Drawing Test, Backward Digit Span Test, and a Digital Pointing Span Test are described. Implications for using data driven artificial intelligence-supported analytic approaches enabling the creation of more sensitive and specific detection/diagnostic algorithms for putative neurodegenerative illness are also discussed.
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Affiliation(s)
- David J Libon
- New Jersey Institute for Successful Aging, Rowan University, School of Osteopathic Medicine, NJ, USA
| | - Rod Swenson
- Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Grand Forks, ND, USA
| | - Melissa Lamar
- Rush Alzheimer's Disease Center and the Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Catherine C Price
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Ganesh Baliga
- Department of Computer Science, Rowan University, Glassboro, NJ, USA
| | - Alvaro Pascual-Leone
- Hinda and Arthur Marcus Institute for Aging Research and Deanna and Sidney Wolk Center for Memory Health, Hebrew Senior Life, Boston, MA, USA.,Department of Neurology, Harvard Medical School, Boston, MA, USA.,Guttmann Brain Health Institute, Barcelona, Spain
| | - Rhoda Au
- Departments of Anatomy & Neurobiology and Neurology; Framingham Heart Study, Slone Epidemiology Center and Alzheimer's Disease Research Center, Boston University School of Medicine, Boston, MA, USA.,Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Stephanie Cosentino
- Department of Neurology, Taub Institute and Sergievsky Center, Cognitive Neuroscience Division, Columbia University Medical Center, New York, NY, USA
| | - Stacy L Andersen
- Department of Medicine, Boston University School of Medicine, Boston, MA, USA
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De Tollis M, De Simone MS, Perri R, Fadda L, Caltagirone C, Carlesimo GA. Verbal and spatial memory spans in mild cognitive impairment. Acta Neurol Scand 2021; 144:383-393. [PMID: 33999426 DOI: 10.1111/ane.13470] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 04/21/2021] [Accepted: 04/23/2021] [Indexed: 12/25/2022]
Abstract
OBJECTIVES Working memory (WM) for verbal and visual material may be affected early in individuals with mild cognitive impairment (MCI). Verbal and visuospatial span tasks, that is neuropsychological procedures commonly used for the clinical assessment of WM, have been scarcely investigated in these patients. Therefore, this study was aimed at evaluating whether performance on tests of verbal and visual-spatial span (which rely to different extents on distinct components of the WM system) is differently sensitive to the presence of MCI and, in particular, of a preclinical AD condition in patients with MCI. MATERIALS & METHODS 99 patients with amnesic MCI were given the Digit Span Forward (DSF) and Digit Span Backward (DSB) tests and the Corsi span task (CS) at baseline and were followed up for two years. 32 MCI patients converted to Alzheimer's disease (MCIc), but 67 patients did not deteriorate to meet the criteria for AD (MCIs). RESULTS Results showed that although performance on DSF did not differ between groups, performance on DSB and CS and ratio indexes indicative of a performance decline passing from DSF to DSB and from DSF to CS significantly discriminated between a group of matched healthy controls and the overall group of MCI patients. Moreover, the ratio indexes significantly discriminated between MCIc and MCIs individuals. CONCLUSIONS These data are consistent with the hypothesis that individuals with MCI, particularly those destined to convert to AD, are affected by reduced central executive resources even though the phonological loop is still functioning normally.
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Affiliation(s)
- Massimo De Tollis
- Neuropsychology of Memory Laboratory S. Lucia FoundationIRCCS Rome Italy
| | | | - Roberta Perri
- Neuropsychology of Memory Laboratory S. Lucia FoundationIRCCS Rome Italy
| | - Lucia Fadda
- Neuropsychology of Memory Laboratory S. Lucia FoundationIRCCS Rome Italy
- Systems Medicine Department Tor Vergata University Rome Italy
| | - Carlo Caltagirone
- Neuropsychology of Memory Laboratory S. Lucia FoundationIRCCS Rome Italy
| | - Giovanni Augusto Carlesimo
- Neuropsychology of Memory Laboratory S. Lucia FoundationIRCCS Rome Italy
- Systems Medicine Department Tor Vergata University Rome Italy
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Pereiro AX, Valladares-Rodríguez S, Felpete A, Lojo-Seoane C, Campos-Magdaleno M, Mallo SC, Facal D, Anido-Rifón L, Belleville S, Juncos-Rabadán O. Relevance of Complaint Severity in Predicting the Progression of Subjective Cognitive Decline and Mild Cognitive Impairment: A Machine Learning Approach. J Alzheimers Dis 2021; 82:1229-1242. [PMID: 34151806 DOI: 10.3233/jad-210334] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The presence of subjective cognitive complaints (SCCs) is a core criterion for diagnosis of subjective cognitive decline (SCD); however, no standard procedure for distinguishing normative and non-normative SCCs has yet been established. OBJECTIVE To determine whether differentiation of participants with SCD according to SCC severity improves the validity of the prediction of progression in SCD and MCI and to explore validity metrics for two extreme thresholds of the distribution in scores in a questionnaire on SCCs. METHODS Two hundred and fifty-three older adults with SCCs participating in the Compostela Aging Study (CompAS) were classified as MCI or SCD at baseline. The participants underwent two follow-up assessments and were classified as cognitively stable or worsened. Severity of SCCs (low and high) in SCD was established by using two different percentiles of the questionnaire score distribution as cut-off points. The validity of these cut-off points for predicting progression using socio-demographic, health, and neuropsychological variables was tested by machine learning (ML) analysis. RESULTS Severity of SCCs in SCD established considering the 5th percentile as a cut-off point proved to be the best metric for predicting progression. The variables with the main role in conforming the predictive algorithm were those related to memory, cognitive reserve, general health, and the stability of diagnosis over time. CONCLUSION Moderate to high complainers showed an increased probability of progression in cognitive decline, suggesting the clinical relevance of standard procedures to determine SCC severity. Our findings highlight the important role of the multimodal ML approach in predicting progression.
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Affiliation(s)
- Arturo Xosé Pereiro
- Department of Developmental Psychology, University of Santiago de Compostela, Santiago de Compostela, Spain
| | | | - Alba Felpete
- Department of Developmental Psychology, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Cristina Lojo-Seoane
- Department of Developmental Psychology, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - María Campos-Magdaleno
- Department of Developmental Psychology, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Sabela Carme Mallo
- Department of Developmental Psychology, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - David Facal
- Department of Developmental Psychology, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Luis Anido-Rifón
- School of Telecommunication Engineering>, University of Vigo, Vigo, Spain
| | - Sylvie Belleville
- Research Center of the Institut Universitaire de Gériatrie de Montréal, Montreal, Canada.,Université de Montréal, Montréal, Canada
| | - Onésimo Juncos-Rabadán
- Department of Developmental Psychology, University of Santiago de Compostela, Santiago de Compostela, Spain
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11
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Liu Q, Shkirkova K, Lamorie-Foote K, Connor M, Patel A, Babadjouni R, Huuskonen M, Montagne A, Baertsch H, Zhang H, Chen JC, Mack WJ, Walcott BP, Zlokovic BV, Sioutas C, Morgan TE, Finch CE, Mack WJ. Air Pollution Particulate Matter Exposure and Chronic Cerebral Hypoperfusion and Measures of White Matter Injury in a Murine Model. ENVIRONMENTAL HEALTH PERSPECTIVES 2021; 129:87006. [PMID: 34424052 PMCID: PMC8382048 DOI: 10.1289/ehp8792] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 07/23/2021] [Accepted: 07/26/2021] [Indexed: 05/19/2023]
Abstract
BACKGROUND Exposure to ambient air pollution particulate matter (PM) is associated with increased risk of dementia and accelerated cognitive loss. Vascular contributions to cognitive impairment are well recognized. Chronic cerebral hypoperfusion (CCH) promotes neuroinflammation and blood-brain barrier weakening, which may augment neurotoxic effects of PM. OBJECTIVES This study examined interactions of nanoscale particulate matter (nPM; fine particulate matter with aerodynamic diameter ≤ 200 nm ) and CCH secondary to bilateral carotid artery stenosis (BCAS) in a murine model to produce white matter injury. Based on other air pollution interactions, we predicted synergies of nPM with BCAS. METHODS nPM was collected using a particle sampler near a Los Angeles, California, freeway. Mice were exposed to 10 wk of reaerosolized nPM or filtered air (FA) for 150 h. CCH was induced by BCAS surgery. Mice (C57BL/6J males) were randomized to four exposure paradigms: a) FA, b) nPM, c) FA + BCAS , and d) nPM + BCAS . Behavioral outcomes, white matter injury, glial cell activation, inflammation, and oxidative stress were assessed. RESULTS The joint nPM + BCAS group exhibited synergistic effects on white matter injury (2.3× the additive nPM and FA + BCAS scores) with greater loss of corpus callosum volume on T2 magnetic resonance imaging (MRI) (30% smaller than FA group). Histochemical analyses suggested potential microglial-specific inflammatory responses with synergistic effects on corpus callosum C5 immunofluorescent density and whole brain nitrate concentrations (2.1× and 3.9× the additive nPM and FA + BCAS effects, respectively) in the joint exposure group. Transcriptomic responses (RNA-Seq) showed greater impact of nPM + BCAS than individual additive effects, consistent with changes in proinflammatory pathways. Although nPM exposure alone did not alter working memory, the nPM + BCAS cohort demonstrated impaired working memory when compared to the FA + BCAS group. DISCUSSION Our data suggest that nPM and CCH contribute to white matter injury in a synergistic manner in a mouse model. Adverse neurological effects may be aggravated in a susceptible population exposed to air pollution. https://doi.org/10.1289/EHP8792.
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Affiliation(s)
- Qinghai Liu
- Zilkha Neurogenetic Institute, University of Southern California, Los Angeles, California, USA
| | - Kristina Shkirkova
- Zilkha Neurogenetic Institute, University of Southern California, Los Angeles, California, USA
| | - Krista Lamorie-Foote
- Zilkha Neurogenetic Institute, University of Southern California, Los Angeles, California, USA
| | - Michelle Connor
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Arati Patel
- Department of Neurological Surgery, University of California San Francisco School of Medicine, San Francisco, California, USA
| | - Robin Babadjouni
- Department of Neurological Surgery, Cedars-Sinai, Los Angeles, California, USA
| | - Mikko Huuskonen
- Zilkha Neurogenetic Institute, University of Southern California, Los Angeles, California, USA
- Department of Physiology and Neuroscience, University of Southern California, Los Angeles, California, USA
| | - Axel Montagne
- Zilkha Neurogenetic Institute, University of Southern California, Los Angeles, California, USA
- Department of Physiology and Neuroscience, University of Southern California, Los Angeles, California, USA
| | - Hans Baertsch
- Zilkha Neurogenetic Institute, University of Southern California, Los Angeles, California, USA
| | - Hongqiao Zhang
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, California, USA
| | - Jiu-Chiuan Chen
- Department of Preventative Medicine, University of Southern California, Keck School of Medicine, Los Angeles, California, USA
| | - Wendy J. Mack
- Department of Preventative Medicine, University of Southern California, Keck School of Medicine, Los Angeles, California, USA
| | - Brian P. Walcott
- Department of Neurosurgery, Northshore Neurological Institute, Evanston, Illinois, USA
| | - Berislav V. Zlokovic
- Zilkha Neurogenetic Institute, University of Southern California, Los Angeles, California, USA
- Department of Physiology and Neuroscience, University of Southern California, Los Angeles, California, USA
| | - Constantinos Sioutas
- Department of Civil and Environmental Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, California, USA
| | - Todd E. Morgan
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, California, USA
| | - Caleb E. Finch
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, California, USA
| | - William J. Mack
- Zilkha Neurogenetic Institute, University of Southern California, Los Angeles, California, USA
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
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12
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Emrani S, Lamar M, Price C, Baliga S, Wasserman V, Matusz EF, Saunders J, Gietka V, Strate J, Swenson R, Baliga G, Libon DJ. Neurocognitive Constructs Underlying Executive Control in Statistically-Determined Mild Cognitive Impairment. J Alzheimers Dis 2021; 82:5-16. [PMID: 34219736 DOI: 10.3233/jad-201125] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND The model of executive attention proposes that temporal organization, i.e., the time necessary to bring novel tasks to fruition is an important construct that modulates executive control. Subordinate to temporal organization are the constructs of working memory, preparatory set, and inhibitory control. OBJECTIVE The current research operationally-defined the constructs underlying the theory of executive attention using intra-component latencies (i.e., reaction times) from a 5-span backward digit test from patients with suspected mild cognitive impairment (MCI). METHODS An iPad-version of the Backward Digit Span Test (BDT) was administered to memory clinic patients. Patients with (n = 22) and without (n = 36) MCI were classified. Outcome variables included intra-component latencies for all correct 5-span serial order responses. RESULTS Average total time did not differ. A significant 2-group by 5-serial order latency interaction revealed the existence of distinct time epochs. Non-MCI patients produced slower latencies on initial (position 2-working memory/preparatory set) and latter (position 4-inhibitory control) correct serial order responses. By contrast, patients with MCI produced a slower latency for middle serial order responses (i.e., position 3-preparatory set). No group differences were obtained for incorrect 5-span test trials. CONCLUSION The analysis of 5-span BDT serial order latencies found distinct epochs regarding how time was allocated in the context of successful test performance. Intra-component latencies obtained from tests assessing mental re-ordering may constitute useful neurocognitive biomarkers for emergent neurodegenerative illness.
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Affiliation(s)
- Sheina Emrani
- Department of Psychology, Rowan University, Glassboro, NJ, USA
| | - Melissa Lamar
- Rush Alzheimer's Disease Center and the Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Catherine Price
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Satya Baliga
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA
| | | | - Emily F Matusz
- New Jersey Institute for Successful Aging, School of Osteopathic Medicine, Rowan University, Glassboro, NJ, USA
| | | | - Vaughn Gietka
- New Jersey Institute for Successful Aging, School of Osteopathic Medicine, Rowan University, Glassboro, NJ, USA
| | - James Strate
- Department of Computer Science, Rowan University, Glassboro, NJ, USA
| | - Rod Swenson
- Department of Psychiatry and Behavioral Science at the University of North Dakota, School of Medicine and Health Sciences, Grand Forks, ND, USA
| | - Ganesh Baliga
- Department of Computer Science, Rowan University, Glassboro, NJ, USA
| | - David J Libon
- Department of Psychology, Rowan University, Glassboro, NJ, USA.,New Jersey Institute for Successful Aging, School of Osteopathic Medicine, Rowan University, Glassboro, NJ, USA
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13
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Liao WL, Chang YH. Age trajectories of disability in instrumental activities of daily living and disability-free life expectancy among middle-aged and older adults in Taiwan: an 11-year longitudinal study. BMC Geriatr 2020; 20:530. [PMID: 33297982 PMCID: PMC7727135 DOI: 10.1186/s12877-020-01939-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 11/30/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND This study aims to identify the age trajectories of disability in instrumental activities of daily life (IADLs) over 11 years and their correlates, and to estimate disability-free life expectancy for identified trajectory groups in middle-aged and older adults. METHODS We included 3118 participants aged 50 and over without IADL limitations at baseline from the Taiwan Longitudinal Study in Aging, followed across 1996-2007. We used group-based trajectory models to identify age trajectories of IADL disability, and multiple logistic regressions to examine their correlates. Sullivan method was used to compute IADL disability-free life expectancy for trajectory groups at different ages. RESULTS We identified two trajectories groups: 67.7% of participants classified as the late-onset group and 32.3% as the early-onset group. Female (adjusted odds ratio [aOR]: 1.93, 95% confidence interval [95% CI]: 1.54, 2.41), not being employed (aOR: 1.30, 95% CI: 1,08, 1,56), poor/fair self-rated health (aOR: 1.31, 95% CI:1.09, 1.58), hypertension (aOR: 1.32, 95% CI: 1.07, 1.63), diabetes mellitus (aOR: 2.29, 95% CI: 1.72, 3.07), arthritis (aOR: 1.42, 95% CI: 1.11, 1.81), stroke (aOR: 2.21, 95% CI: 1.04, 4.70), and one-point increase in a 10-item depression scale (aOR: 1.04, 95% CI: 1.02, 1.06) were associated with early-onset of disability, whereas higher education (aOR: 0.59, 95% CI: 0.42, 0.81), regular exercise (aOR: 0.76, 95% CI: 0.62, 0.93), and participating voluntary or club activities (aOR: 0.78, 95% CI: 0.65, 0.93) related to the late-onset. IADL disability-free life expectancies at 65 years old in the late-onset group were 15.6 years for women and 14.4 for men, respectively, comprising 56.6 and 64.2% of their remaining life, whereas those of the early-onset group were 4.8 and 4.6 years for women and men respectively, comprising 22.5 and 27.2% of remaining life. CONCLUSIONS Early-onset of IADLs disability may correlate to chronic conditions, and engagement in employment, exercise, and social participation were associated with a reduced risk of early disability in IADLs.
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Affiliation(s)
- Wen-Ling Liao
- Department of Physical Medicine and Rehabilitation, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No. 66, Sec. 1, Fengxing Rd., Tanzi Dist., Taichung City 427, Taiwan
| | - Yu-Hung Chang
- Department of Public Health, China Medical University, No. 100, Sec. 1, Jingmao Rd., Beitun Dist., Taichung City 406, Taiwan.
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14
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Rutkowski TM, Abe MS, Koculak M, Otake-Matsuura M. Classifying Mild Cognitive Impairment from Behavioral Responses in Emotional Arousal and Valence Evaluation Task - AI Approach for Early Dementia Biomarker in Aging Societies. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2020:5537-5543. [PMID: 33019233 DOI: 10.1109/embc44109.2020.9175805] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The presented paper discusses a practical application of machine learning (ML) in the so-called 'AI for social good' domain and in particular concerning the problem of a potential elderly adult dementia onset prediction. An increase in dementia cases is producing a significant medical and economic weight in many countries. Approximately 47 million older adults live with a dementia spectrum of neurocognitive disorders, according to an up-to-date statement of the World Health Organization (WHO), and this amount will triple within the next thirty years. This growing problem calls for possible application of AI-based technologies to support early diagnostics for cognitive interventions and a subsequent mental wellbeing monitoring as well as maintenance with so-called 'digital-pharma' or 'beyond a pill' therapeutical strategies. The paper explains our attempt and encouraging preliminary study results of behavioral responses analysis in a facial emotion implicit-short-term-memory learning and evaluation experiment. We present results of various shallow and deep learning machine learning models for digital biomarkers of dementia progress detection and monitoring. The discussed machine-learning models result in median accuracies right below a 90% benchmark using classical shallow and deep learning approaches for automatic discrimination of normal cognition versus a mild cognitive impairment (MCI). The classifier input features consist of an older adult emotional valence and arousal recognition responses, together with reaction times, as well as with self-reported university-level degree education and age, as obtained from a group of 35 older adults participating voluntarily in the reported dementia biomarker development project. The presented results showcase the inherent social benefits of artificial intelligence (AI) utilization for the elderly and establish a step forward to advance machine learning (ML) approaches for the subsequent employment of simple behavioral examination for MCI and dementia onset diagnostics.Clinical relevance- This manuscript establishes a behavioral and cognitive biomarker candidate potentially substituting a Montreal Cognitive Assessment (MoCA) evaluation without a paper and pencil test.
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15
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Machine Learning Analysis of Digital Clock Drawing Test Performance for Differential Classification of Mild Cognitive Impairment Subtypes Versus Alzheimer's Disease. J Int Neuropsychol Soc 2020; 26:690-700. [PMID: 32200771 DOI: 10.1017/s1355617720000144] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To determine how well machine learning algorithms can classify mild cognitive impairment (MCI) subtypes and Alzheimer's disease (AD) using features obtained from the digital Clock Drawing Test (dCDT). METHODS dCDT protocols were administered to 163 patients diagnosed with AD(n = 59), amnestic MCI (aMCI; n = 26), combined mixed/dysexecutive MCI (mixed/dys MCI; n = 43), and patients without MCI (non-MCI; n = 35) using standard clock drawing command and copy procedures, that is, draw the face of the clock, put in all of the numbers, and set the hands for "10 after 11." A digital pen and custom software recorded patient's drawings. Three hundred and fifty features were evaluated for maximum information/minimum redundancy. The best subset of features was used to train classification models to determine diagnostic accuracy. RESULTS Neural network employing information theoretic feature selection approaches achieved the best 2-group classification results with 10-fold cross validation accuracies at or above 83%, that is, AD versus non-MCI = 91.42%; AD versus aMCI = 91.49%; AD versus mixed/dys MCI = 84.05%; aMCI versus mixed/dys MCI = 84.11%; aMCI versus non-MCI = 83.44%; and mixed/dys MCI versus non-MCI = 85.42%. A follow-up two-group non-MCI versus all MCI patients analysis yielded comparable results (83.69%). Two-group classification analyses were achieved with 25-125 dCDT features depending on group classification. Three- and four-group analyses yielded lower but still promising levels of classification accuracy. CONCLUSION Early identification of emergent neurodegenerative illness is criterial for better disease management. Applying machine learning to standard neuropsychological tests promises to be an effective first line screening method for classification of non-MCI and MCI subtypes.
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16
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Bezdicek O, Ballarini T, Albrecht F, Libon DJ, Lamar M, Růžička F, Roth J, Hurlstone MJ, Mueller K, Schroeter ML, Jech R. SERIAL-ORDER recall in working memory across the cognitive spectrum of Parkinson's disease and neuroimaging correlates. J Neuropsychol 2020; 15:88-111. [PMID: 32394540 DOI: 10.1111/jnp.12208] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 11/26/2019] [Indexed: 02/06/2023]
Abstract
We sought to determine if Parkinson's disease (PD) with mild cognitive impairment (MCI) is associated with a greater SERIAL-ORDER (mental manipulation) than ANY-ORDER (auditory span, storage) deficit in working memory (WM). We investigated WM combining neuropsychological measures with the study of brain functional connectivity. A cohort of 160 patients with idiopathic PD, classified as PD-MCI (n = 87) or PD with normal cognition (PD-NC; n = 73), and 70 matched healthy controls were studied. Verbal WM was assessed with the Backward Digit Span Task (BDT; Lamar et al., 2007, Neuropsychologia, 45, 245), measuring SERIAL-ORDER and ANY-ORDER recall. Resting-state MRI data were collected for 15 PD-MCI, 15 PD-NC and 30 controls. Hypothesis-driven seed-based functional connectivity of the dorsolateral prefrontal cortex (DLPFC) was compared between the three groups and correlated with BDT performance. We found the main effect of the test (impairment in SERIAL ORDER > ANY ORDER) and group ((NC = PD-NC) > PD-MCI) in BDT performance that was even more pronounced in SERIAL ORDER when controlling for ANY ORDER variability but not vice versa. Furthermore, PD-MCI compared to other groups were characterized by the functional disconnection between the bilateral DLPFC and the cerebellum. In functional correlations, DLPFC connectivity was positively related to both SERIAL- and ANY-ORDER performance. In conclusion, PD-MCI patients evidenced greater SERIAL-ORDER (manipulation and cognitive control) than ANY-ORDER (storage) working memory impairment than PD-NC and controls with a disrupted DLPFC resting-state connectivity that was also related to the verbal WM performance.
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Affiliation(s)
- Ondrej Bezdicek
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, General University Hospital, Charles University, Prague, Czech Republic
| | - Tommaso Ballarini
- Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Franziska Albrecht
- Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - David J Libon
- School of Osteopathic Medicine, New Jersey Institute for Successful Aging, Departments of Geriatric, Gerontology, and Psychology, Rowan University, Stratford, New Jersey, USA
| | - Melissa Lamar
- Rush Alzheimer's Disease Center, Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Filip Růžička
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, General University Hospital, Charles University, Prague, Czech Republic
| | - Jan Roth
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, General University Hospital, Charles University, Prague, Czech Republic
| | - Mark J Hurlstone
- School of Psychology, University of Western Australia, Crawley, Western Australia, Australia
| | - Karsten Mueller
- Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Matthias L Schroeter
- Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany.,Clinic for Cognitive Neurology, University Clinic, Leipzig, Germany.,FTLD Consortium, Ulm, Germany
| | - Robert Jech
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, General University Hospital, Charles University, Prague, Czech Republic
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17
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Wasserman V, Emrani S, Matusz EF, Peven J, Cleary S, Price CC, Ginsberg TB, Swenson R, Heilman KM, Lamar M, Libon DJ. Visuospatial performance in patients with statistically-defined mild cognitive impairment. J Clin Exp Neuropsychol 2020; 42:319-328. [PMID: 31973657 PMCID: PMC7224008 DOI: 10.1080/13803395.2020.1714550] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Accepted: 12/26/2019] [Indexed: 02/08/2023]
Abstract
Introduction: The Oblique Effect denotes superior performance for perceiving horizontal or vertical rather than diagonal or oblique stimuli. The current research investigated responding to oblique test stimuli in patients with mild cognitive impairment (MCI).Method: Four statistically-determined groups (n = 112) were studied; patients with little to no cognitive impairment (non-MCI, n = 39); subtle cognitive impairment (SCI, n = 15); amnestic MCI (aMCI, n = 28); and a combined mixed/dysexecutive MCI (mixed/dys MCI, n = 30). The ability to respond to oblique versus non-oblique test stimuli was assessed using the Judgment of Line Orientation Test (JOLO). Comprehensive neuropsychological assessment was also obtained. Between-group differences for JOLO oblique and non-oblique test stimuli were analyzed. Hierarchical linear regression models were constructed to identify relations between accuracy for oblique and non-oblique test items and neurocognitive domains.Results: The mixed/dys MCI group demonstrated lower accuracy for oblique test items compared to non-MCI patients. Accurate responding to oblique test items was associated with better performance on tests measuring executive control, processing speed, naming/lexical retrieval, and verbal concept formation. No between-group differences were seen for non-oblique items and these items were not associated with cognition.Conclusions:Significant impairment on oblique test items distinguished patients with multi-domain/dysexecutive MCI from non-MCI patients. Accurate responding to oblique test items was associated with a complex array of neuropsychological tests suggesting that multidimensional neuropsychological skills underlie the visuospatial reasoning abilities necessary for successful oblique line identification. Research associating responding to oblique versus non-oblique test stimuli using additional neuropsychological test paradigms, and MRI-defined neuroanatomical regions of interest may provide additional information about the brain-behavior relations that underlie MCI subtypes.
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Affiliation(s)
| | - Sheina Emrani
- Department of Psychology, Rowan University, Stratford, NF
| | - Emily F. Matusz
- New Jersey Institute for Successful Aging, School of Osteopathic Medicine, Rowan University, Stratford, NJ
| | - Jamie Peven
- Department of Psychology and Center for the Neural Basis of Cognition, University of Pittsburgh, Pittsburgh, PA
| | - Seana Cleary
- New Jersey Institute for Successful Aging, School of Osteopathic Medicine, Rowan University, Stratford, NJ
| | - Catherine C. Price
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL
| | - Terrie Beth Ginsberg
- New Jersey Institute for Successful Aging, School of Osteopathic Medicine, Rowan University, Stratford, NJ
| | - Rod Swenson
- University of North Dakota School of Medicine and Health Sciences, Grand Forks, ND
| | - Kenneth M. Heilman
- Department of Neurology, University of Florida College of Medicine, Neurologist-Geriatric Research, Education and Clinical Center, Malcom Randall Veterans Affairs Medical Center, Gainesville, FL
| | - Melissa Lamar
- Department of Behavioral Sciences and the Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL
| | - David J. Libon
- Department of Psychology, Rowan University, Stratford, NF
- New Jersey Institute for Successful Aging, School of Osteopathic Medicine, Rowan University, Stratford, NJ
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18
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Inhibitory Control Deficits in Individuals with Amnestic Mild Cognitive Impairment: a Meta-Analysis. Neuropsychol Rev 2020; 30:97-125. [DOI: 10.1007/s11065-020-09428-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Accepted: 02/05/2020] [Indexed: 01/07/2023]
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19
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Park CH, Kim SH, Jung HY. Characteristics of the Uncinate Fasciculus and Cingulum in Patients with Mild Cognitive Impairment: Diffusion Tensor Tractography Study. Brain Sci 2019; 9:brainsci9120377. [PMID: 31847329 PMCID: PMC6956104 DOI: 10.3390/brainsci9120377] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 12/08/2019] [Accepted: 12/12/2019] [Indexed: 12/22/2022] Open
Abstract
Many studies have examined the relationship between cognition, and the cingulum and uncinate fasciculus (UF). In this study, diffusion tensor tractography (DTT) was used to investigate the correlation between fractional-anisotropy (FA) values and the number of fibers in the cingulum and UF in patients with and without cognitive impairment. The correlation between cognitive function, and the cingulum and UF was also investigated. Thirty patients (14 males, age = 70.68 ± 7.99 years) were divided into a control group (n = 14) and mild-cognitive-impairment (MCI) group (n = 16). The Seoul Neuropsychological Screening Battery (SNSB) and DTT were performed to assess cognition and bilateral tracts of the cingulum and UF. The relationship between SNSB values and the cingulum and UF was analyzed. The number of fibers in the right cingulum and right UF were significantly different between the two groups. The MCI group showed thinner tracts in both the cingulum and UF compared to the control group. A significant relationship was found between the number of fibers in the right UF and delayed memory recall. In conclusion, memory loss in MCI was associated with a decreased number of fibers in the right UF, while language and visuospatial function were related to the number of fibers in the right cingulum.
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Visual versus Verbal Working Memory in Statistically Determined Patients with Mild Cognitive Impairment: On behalf of the Consortium for Clinical and Epidemiological Neuropsychological Data Analysis (CENDA). J Int Neuropsychol Soc 2019; 25:1001-1010. [PMID: 31543085 DOI: 10.1017/s1355617719000808] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE Previous research in mild cognitive impairment (MCI) suggests that visual episodic memory impairment may emerge before analogous verbal episodic memory impairment. The current study examined working memory (WM) test performance in MCI to assess whether patients present with greater visual versus verbal WM impairment. WM performance was also assessed in relation to hippocampal occupancy (HO), a ratio of hippocampal volume to ventricular dilation adjusted for demographic variables and intracranial volume. METHODS Jak et al. (2009) (The American Journal of Geriatric Psychiatry, 17, 368-375) and Edmonds, Delano-Wood, Galasko, Salmon, & Bondi (2015) (Journal of Alzheimer's Disease, 47(1), 231-242) criteria classify patients into four groups: little to no cognitive impairment (non-MCI); subtle cognitive impairment (SCI); amnestic MCI (aMCI); and a combined mixed/dysexecutive MCI (mixed/dys MCI). WM was assessed using co-normed Wechsler Adult Intelligence Scale-IV (WAIS-IV) Digit Span Backwards and Wechsler Memory Scale-IV (WMS-IV) Symbol Span Z-scores. RESULTS Between-group analyses found worse WMS-IV Symbol Span and WAIS-IV Digit Span Backwards performance for mixed/dys MCI compared to non-MCI patients. Within-group analyses found no differences for non-MCI patients; however, all other groups scored lower on WMS-IV Symbol Span than WAIS-IV Digit Span Backwards. Regression analysis with HO as the dependent variable was statistically significant for WMS-IV Symbol Span performance. WAIS-IV Digit Span Backwards performance failed to reach statistical significance. CONCLUSIONS Worse WMS-IV Symbol Span performance was observed in patient groups with measurable neuropsychological impairment and better WMS-IV Symbol Span performance was associated with higher HO ratios. These results suggest that visual WM may be particularly sensitive to emergent illness compared to analogous verbal WM tests.
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21
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Wasserman V, Emrani S, Matusz EF, Miller D, Garrett KD, Gifford KA, Hohman TJ, Jefferson AL, Au R, Swenson R, Libon DJ. Visual and Verbal Serial List Learning in Patients with Statistically-Determined Mild Cognitive Impairment. Innov Aging 2019; 3:igz009. [PMID: 31065596 PMCID: PMC6499409 DOI: 10.1093/geroni/igz009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Indexed: 12/31/2022] Open
Abstract
Background and Objective Prior research with patients with mild cognitive impairment (MCI) suggests that visual versus verbal episodic memory test performance may be more sensitive to emergent illness. However, little research has examined visual versus verbal episodic memory performance as related to MCI subtypes. Research Design and Methods Patients were diagnosed with non-MCI, amnestic MCI (aMCI), and combined mixed/dysexecutive MCI (mixed/dys MCI). Visual and verbal episodic memory were assessed with the Brief Visuospatial Memory Test-Revised (BVMT-R) and the 12-word Philadelphia (repeatable) Verbal Learning Test (P[r]VLT), respectively. Results BVMT-R and P(r)VLT scores yielded similar between-group patterns of performance. Non-MCI patients scored better than other groups on all parameters. aMCI and mixed/dys MCI did not differ on immediate or delayed free recall. Both delayed BVMT-R and P(r)VLT recognition test performance dissociated all three groups. Logistic regression analyses found that BVMT-R delayed free recall and delayed recognition scores correctly classified more patients with MCI (75.40%) than analogous P(r)VLT scores (66.20%). Visual versus verbal memory within-group analyses found no differences among non-MCI patients; P(r)VLT immediate free recall was worse among aMCI patients, but BVMT-R immediate free recall and delayed recognition were worse among mixed/dys MCI patients. Discussion and Implications Between-group analyses found convergent patterns of performance such that both tests identified elements of amnesia. However, logistic and within-group analyses found differing performance patterns suggesting that impaired visual episodic memory performance may be specific to emergent illness in mixed/dys MCI. Complementary but divergent neurocognitive networks may underlie visual versus verbal episodic memory performance in some patients with MCI.
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Affiliation(s)
- Victor Wasserman
- Department of Psychology, Rowan University, Glassboro, New Jersey
| | - Sheina Emrani
- Department of Psychology, Rowan University, Glassboro, New Jersey
| | - Emily F Matusz
- Department of Psychology, Rowan University, Glassboro, New Jersey.,Department of Geriatrics and Gerontology, Rowan University, Glassboro, New Jersey
| | - David Miller
- South Jersey Radiology Associates, Voorhees, New Jersey
| | - Kelly Davis Garrett
- Intermountain Healthcare and Center on Aging, University of Utah, Salt Lake City
| | | | - Timothy J Hohman
- Department of Anatomy & Neurobiology, Department of Neurology, and the Framingham Heart Study, Boston University School of Medicine, Massachusetts
| | | | - Rhoda Au
- Department of Anatomy & Neurobiology, Department of Neurology, and the Framingham Heart Study, Boston University School of Medicine, Massachusetts.,Department of Epidemiology, Boston University School of Public Health, Massachusetts
| | - Rod Swenson
- University of North Dakota School of Medicine and Health Sciences, Grand Forks
| | - David J Libon
- Department of Psychology, Rowan University, Glassboro, New Jersey.,Department of Geriatrics and Gerontology, Rowan University, Glassboro, New Jersey.,New Jersey Institute for Successful Aging, Rowan University School of Osteopathic Medicine, Stratford
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22
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Costa AS, Dogan I, Schulz JB, Reetz K. Going beyond the mean: Intraindividual variability of cognitive performance in prodromal and early neurodegenerative disorders. Clin Neuropsychol 2019; 33:369-389. [PMID: 30663511 DOI: 10.1080/13854046.2018.1533587] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Intraindividual variability (IIV), generally defined as short-term variations in behavior, has been proposed as a sign of subtle early impairment in neurodegenerative disorders, presumably associated with the disintegration of neuronal network connectivity. We aim to provide a review of IIV as a sensitive cognitive marker in prodromal neurodegenerative disorders. METHOD A narrative review focusing not only on theoretical and methodological definitions, including an overview on the neural correlates of IIV, but mainly on results from population-based and clinical-based studies on the role of IIV as a reliable predictor of mild cognitive impairment (MCI) and conversion to dementia in neurodegenerative disorders, mostly Alzheimer's and Parkinson's disease. RESULTS Most studies focus on MCI and Alzheimer's disease and demonstrate that IIV is a reliable cognitive marker. IIV is partly more sensitive than mean performance in the prediction of cognitive impairment or progressive deterioration and is independent of socio-demographic variables and disease mediators (e.g., genetic susceptibility). Neuroimaging data, mostly from healthy subjects, suggest a relationship between IIV and dysfunction of the default mode network, presumably mediated by white matter disintegration in frontal and parietal areas. CONCLUSIONS IIV measures may provide valuable information about diagnosis and progression in prodromal stages of neurodegenerative disorders. Thus, further conceptual and methodological clarifications are needed to justify the inclusion of IIV as a sensible cognitive marker in routine clinical neuropsychological assessment.
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Affiliation(s)
- Ana Sofia Costa
- a Neurocognition Unit, Department of Neurology , Hospital de Braga , Braga , Portugal.,b Department of Neurology , RWTH Aachen University , Aachen , Germany.,c JARA-BRAIN Institute Molecular Neuroscience and Neuroimaging, Forschungszentrum Jülich GmbH and RWTH Aachen University , Aachen , Germany
| | - Imis Dogan
- b Department of Neurology , RWTH Aachen University , Aachen , Germany.,c JARA-BRAIN Institute Molecular Neuroscience and Neuroimaging, Forschungszentrum Jülich GmbH and RWTH Aachen University , Aachen , Germany
| | - Jörg B Schulz
- b Department of Neurology , RWTH Aachen University , Aachen , Germany.,c JARA-BRAIN Institute Molecular Neuroscience and Neuroimaging, Forschungszentrum Jülich GmbH and RWTH Aachen University , Aachen , Germany
| | - Kathrin Reetz
- b Department of Neurology , RWTH Aachen University , Aachen , Germany.,c JARA-BRAIN Institute Molecular Neuroscience and Neuroimaging, Forschungszentrum Jülich GmbH and RWTH Aachen University , Aachen , Germany
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