A Brief Digital Cognitive Assessment for Detection of Cognitive Impairment in Cuban Older Adults

AI-assisted neurocognitive assessment protocol for older adults with psychiatric disorders

Introduction

Evaluating neurocognitive functions and diagnosing psychiatric disorders in older adults is challenging due to the complexity of symptoms and individual differences. An innovative approach that combines the accuracy of artificial intelligence (AI) with the depth of neuropsychological assessments is needed.

Objectives

This paper presents a novel protocol for AI-assisted neurocognitive assessment aimed at addressing the cognitive, emotional, and functional dimensions of older adults with psychiatric disorders. It also explores potential compensatory mechanisms.

Methodology

The proposed protocol incorporates a comprehensive, personalized approach to neurocognitive evaluation. It integrates a series of standardized and validated psychometric tests with individualized interpretation tailored to the patient's specific conditions. The protocol utilizes AI to enhance diagnostic accuracy by analyzing data from these tests and supplementing observations made by researchers.

Anticipated results

The AI-assisted protocol offers several advantages, including a thorough and customized evaluation of neurocognitive functions. It employs machine learning algorithms to analyze test results, generating an individualized neurocognitive profile that highlights patterns and trends useful for clinical decision-making. The integration of AI allows for a deeper understanding of the patient's cognitive and emotional state, as well as potential compensatory strategies.

Conclusions

By integrating AI with neuro-psychological evaluation, this protocol aims to significantly improve the quality of neurocognitive assessments. It provides a more precise and individualized analysis, which has the potential to enhance clinical decision-making and overall patient care for older adults with psychiatric disorders.

The Potential of Automated Assessment of Cognitive Function Using Non-Neuroimaging Data: A Systematic Review

Background/Objectives: The growing incidence of cognitive impairment among older adults has a significant impact on individuals, family members, caregivers, and society. Current conventional cognitive assessment tools are faced with some limitations. Recent evidence suggests that automating cognitive assessment holds promise, potentially resulting in earlier diagnosis, timely intervention, improved patient outcomes, and higher chances of response to treatment. Despite the advantages of automated assessment and technological advancements, automated cognitive assessment has yet to gain widespread use, especially in low and lower middle-income countries. This review highlights the potential of automated cognitive assessment tools and presents an overview of existing tools. Methods: This review includes 87 studies carried out with non-neuroimaging data alongside their performance metrics. Results: The identified articles automated the cognitive assessment process and were grouped into five categories either based on the tools' design or the data analysis approach. These categories include game-based, digital versions of conventional tools, original computerized tests and batteries, virtual reality/wearable sensors/smart home technologies, and artificial intelligence-based (AI-based) tools. These categories are further explained, and evaluation of their strengths and limitations is discussed to strengthen their adoption in clinical practice. Conclusions: The comparative metrics of both conventional and automated approaches of assessment suggest that the automated approach is a strong alternative to the conventional approach. Additionally, the results of the review show that the use of automated assessment tools is more prominent in countries ranked as high-income and upper middle-income countries. This trend merits further social and economic studies to understand the impact of this global reality.

Stakeholder-informed pragmatic trial protocol of the TabCAT-BHA for the detection of cognitive impairment in primary care

BACKGROUND

Cognitive impairment and dementia are frequently under-recognized. Health system strategies anchored in primary care are essential to address gaps in timely, comprehensive diagnosis. The goal of this paper is to describe the adaptation of a tablet-based brain health assessment (TabCAT-BHA) intervention and the study protocol to test its effectiveness in improving the detection of cognitive impairment, including dementia.

METHODS

This mixed-methods, pragmatic, cluster randomized, hybrid effectiveness-implementation trial is being conducted in two 18-month waves with 26 Kaiser Permanente Southern California primary care clinics, with 13 serving as intervention clinics and 13 as usual care clinics. Patients 65 years and older with memory concerns (n ~ 180,000) receiving care at the 26 clinics will be included in the analyses. Primary care clinics are provided the following practice supports as part of the TabCAT-BHA intervention: brief education and training on neurocognitive disorders and study workflows; digital tools to assess cognitive function and support clinician decision making and documentation; and registered nurse support during the work-up and post-diagnosis periods for primary care providers, patients, and families. The intervention was adapted based on engagement with multiple levels of clinical and operational leaders in the healthcare system. Effectiveness outcomes include rates of cognitive impairment diagnosis in primary care and rates of completed standardized cognitive assessments and specialist referrals with incident diagnoses. Implementation outcomes include acceptability-appropriateness-feasibility, adoption, and fidelity.

RESULTS

We identified seven themes organized by system-, provider-, and patient-level domains that were used to adapt the TabCAT-BHA intervention. Accordingly, changes were made to the provider education, diagnostic work-up, and post-diagnostic support. Results will be reported in fall of 2027.

CONCLUSIONS

Our engagement with multiple primary and specialty care clinical and operational leaders to adapt the TabCAT-BHA intervention to these primary care clinics has informed the protocol to evaluate the intervention's effectiveness for improving the detection of cognitive impairment, including dementia, in an integrated healthcare system.

TRIAL REGISTATION

Clinicaltrials.gov: NCT06090578 (registered 10/24/23).

Cultural adaptation of the brain health assessment for early detection of cognitive impairment in Southeast Nigeria

Objective

The aging population in developing countries demands parallel improvements in brain health assessment services to mitigate stigma, promote healthy aging, and diagnose cognitive impairments including dementia in primary health care (PHC) facilities. The lack of culturally appropriate cognitive assessment tools in PHC facilities delays early detection. This study aims to culturally adapt a brief digital cognitive assessment tool for PHC professionals in Southeast Nigeria.

Method

A total of 30 participants (15 healthcare workers HCW and 15 community members) were selected to be culturally representative of the community. We completed focus groups and pilot testing to evaluate and refine the Brain Health Assessment (BHA) a subset of tools from the Tablet-based Cognitive Assessment Tool (TabCAT) known to be sensitive to cognitive impairment in other settings. We examined BHA subtests across local languages (Pidgin and Igbo) spoken at two geriatric clinics in Anambra State Southeast Nigeria.

Results

Following structured approaches in focus groups, adaptations were made to the Favorites (memory) and Line Length (visuospatial) subtests based on their input. Participants found the new adaptations to have good construct validity for the region.

Conclusions

The BHA subtests showed content validity for future work needed to validate the tool for detecting early cognitive changes associated with dementia and Alzheimer's disease in PHC settings. The use of culturally adapted and concise digital cognitive assessment tools relevant to healthcare professionals in Southeast Nigeria's PHCs is advocated.

Mapping the landscape: A bibliometric analysis of information and communication technology adoption by older adults with cognitive frailty or impairment

The adoption of information and communication technology (ICT) by older adults with cognitive frailty and impairment is beneficial to support aging in place and promote healthy aging. However, data are scarce regarding the use of ICT by this demographic in comparison with other age groups. This bibliometric analysis was aimed at systematically mapping the literature on ICT-related research on older adults with cognitive frailty and cognitive impairment to provide insights into research trends, patterns and knowledge gaps. Data were extracted from the Web of Science database, which identified 324 publications between 1980 and 2023. Performance analysis and science mapping were carried out using Microsoft® Excel, VOSViewer and Harzing's Publish or Perish. The analysis showed an upsurge in the research output trend over time. Notable journals, authors, citations, nations and research areas have been documented. Four key clusters were identified, including: (i) caregiver concern, support and involvement; (ii) technology as a tool for cognitive training and cognitive rehabilitation; (iii) cognitive improvement; and (iv) the use of technology for prevention and self-management. The findings derived from this analysis provide an appropriate reference for future researchers to bridge the gap in ICT-related studies among this population, and distinguish the relevant articles that are required for further investigation. These include the need for further long-term research, the incorporation of ICT-based approaches to counter cognitive frailty and the importance of multidomain telehealth interventions. Geriatr Gerontol Int 2024; 24: 251-262.

Meta-analysis of Montreal cognitive assessment diagnostic accuracy in amnestic mild cognitive impairment

Background

The Montreal Cognitive Assessment (MoCA) is one of the most widely-used cognitive screening instruments and has been translated into several different languages and dialects. Although the original validation study suggested to use a cutoff of ≤26, subsequent studies have shown that lower cutoff values may yield fewer false-positive indications of cognitive impairment. The aim of this study was to summarize the diagnostic accuracy and mean difference of the MoCA when comparing cognitively unimpaired (CU) older adults to those with amnestic mild cognitive impairment (aMCI).

Methods

PubMed and EMBASE databases were searched from inception to 22 February 2022. Meta-analyses for area under the curve (AUC) and standardized mean difference (SMD) values were performed.

Results

Fifty-five observational studies that included 17,343 CU and 8,413 aMCI subjects were selected for inclusion. Thirty-nine studies were used in the AUC analysis while 44 were used in the SMD analysis. The overall AUC value was 0.84 (95% CI: 0.81, 0.87) indicating good diagnostic accuracy and a large effect size was noted for the SMD analysis (Hedge's g = 1.49, 95% CI: 1.33, 1.64). Both analyses had high levels of between-study heterogeneity. The median cutoff score for identifying aMCI was <24.

Discussion and conclusion

The MoCA has good diagnostic accuracy for detecting aMCI across several different languages. The findings of this meta-analysis also support the use of 24 as the optimal cutoff when the MoCA is used to screen for suspected cognitive impairment.

Assessing processing speed and its neural correlates in the three variants of primary progressive aphasia with a non-verbal tablet-based task

Prior research has revealed distinctive patterns of impaired language abilities across the three variants of Primary Progressive Aphasia (PPA): nonfluent/agrammatic (nfvPPA), logopenic (lvPPA) and semantic (svPPA). However, little is known about whether, and to what extent, non-verbal cognitive abilities, such as processing speed, are impacted in PPA patients. This is because neuropsychological tests typically contain linguistic stimuli and require spoken output, being therefore sensitive to verbal deficits in aphasic patients. The aim of this study is to investigate potential differences in processing speed between PPA patients and healthy controls, and among the three PPA variants, using a brief non-verbal tablet-based task (Match) modeled after the WAIS-III digit symbol coding test, and to determine its neural correlates. Here, we compared performance on the Match task between PPA patients (n = 61) and healthy controls (n = 59) and across the three PPA variants. We correlated performance on Match with voxelwise gray and white matter volumes. We found that lvPPA and nfvPPA patients performed significantly worse on Match than healthy controls and svPPA patients. Worse performance on Match across PPA patients was associated with reduced gray matter volume in specific parts of the left middle frontal gyrus, superior parietal lobule, and precuneus, and reduced white matter volume in the left parietal lobe. To conclude, our behavioral findings reveal that processing speed is differentially impacted across the three PPA variants and provide support for the potential clinical utility of a tabled-based task (Match) to assess non-verbal cognition. In addition, our neuroimaging findings confirm the importance of a set of fronto-parietal regions that previous research has associated with processing speed and executive control. Finally, our behavioral and neuroimaging findings combined indicate that differences in processing speed are largely explained by the unequal distribution of atrophy in these fronto-parietal regions across the three PPA variants.

Digital Cognitive Assessment Tests for Older Adults: Systematic Literature Review

BACKGROUND

The global health pandemic has affected the increasing older adult population, especially those with mental illnesses. It is necessary to prevent cases of cognitive impairment in adults early on, and this requires the support of information and communication technologies for evaluating and training cognitive functions. This can be achieved through computer applications designed for cognitive assessment.

OBJECTIVE

In this review, we aimed to assess the state of the art of the current platforms and digital test applications for cognitive evaluation, with a focus on older adults.

METHODS

A systematic literature search was conducted on 3 databases (Web of Science, PubMed, and Scopus) to retrieve recent articles on the applications of digital tests for cognitive assessment and analyze them based on the methodology used. Four research questions were considered. Through the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) methodology, following the application of inclusion and exclusion criteria, a total of 20 articles were finally reviewed.

RESULTS

Some gaps and trends were identified regarding the types of digital applications and technologies used, the evaluated effects on cognitive domains, and the psychometric parameters and personal characteristics considered for validation.

CONCLUSIONS

Computerized tests (similar to paper-and-pencil tests) and test batteries (on computers, tablets, or web platforms) were the predominant types of assessments. Initial studies with simulators, virtual environments, and daily-life activity games were also conducted. Diverse validation methods and psychometric properties were observed; however, there was a lack of evaluations that involved specific populations with diverse education levels, cultures, and degrees of technology acceptance. In addition, these evaluations should consider emotional and usability aspects.

Virtual reality technology in the detection of mild cognitive impairment: A systematic review and meta-analysis

BACKGROUND

In recent years, virtual reality technology has developed the potential to help in the early detection of mild cognitive impairment (MCI). However, integrative evidence of its detection performance for mild cognitive impairment is lacking, and meta-analysis or systematic reviews are required to further determine the effectiveness of virtual reality technology in screening for MCI.

METHODS

Literature searches were performed for MCI screening tests in the Cochrane Library, Web of Science, PsycINFO, PubMed, EMBASE, CINAHL, and Scopus. The primary outcome was the performance of VR tests for MCI detection. A protocol for this systematic review was registered in PROSPERO (Registration number: CRD42022302139).

RESULTS

A total of 14 studies in 13 reports were eventually included. The combined data with the bivariate random-effects model gave a summary point of 0.89 sensitivity (95 % confidence interval [CI]: 0.82-0.94) and 0.91 specificity (95 % CI: 0.82-0.96). The SROC curve was plotted, the DOR was 79.25 (95 % CI: 22.59-277.99), and the AUC was 0.95 (95 % CI: 0.93-0.97).

CONCLUSIONS

Virtual reality-based tests have shown considerable detection performance in detecting MCI, and therefore, virtual reality-based tests can serve as recommended screening methods. Future studies can consider longitudinal assessment and follow-up programs to identify progressive changes.

Age-Related Perioperative Neurocognitive Disorders: Experimental Models and Druggable Targets

With the worldwide increase in life span, surgical patients are becoming older and have a greater propensity for postoperative cognitive impairment, either new onset or through deterioration of an existing condition; in both conditions, knowledge of the patient's preoperative cognitive function and postoperative cognitive trajectory is imperative. We describe the clinical utility of a tablet-based technique for rapid assessment of the memory and attentiveness domains required for executive function. The pathogenic mechanisms for perioperative neurocognitive disorders have been investigated in animal models in which excessive and/or prolonged postoperative neuroinflammation has emerged as a likely contender. The cellular and molecular species involved in postoperative neuroinflammation are the putative targets for future therapeutic interventions that are efficacious and do not interfere with the surgical patient's healing process.

A novel approach for the detection of cognitive impairment and delirium risk in older patients undergoing spine surgery

BACKGROUND

Postoperative delirium is a common postsurgical complication in older patients and is associated with high morbidity and mortality. The objective of this study was to determine whether a digital cognitive assessment and patient characteristics could identify those at-risk.

METHODS

Patients 65 years and older undergoing spine surgeries ≥3 h were evaluated as part of a single-center prospective observational cohort study at an academic medical center, from January 1, 2019, to December 31, 2020. Of 220 eligible patients, 161 were enrolled and 152 completed the study. The primary outcome of postoperative delirium was measured by the Confusion Assessment Method for the Intensive Care Unit or the Nursing Delirium Screening Scale, administered by trained nursing staff independent from the study protocol. Baseline cognitive impairment was identified using the tablet-based TabCAT Brain Health Assessment.

RESULTS

Of the 152 patients included in this study, 46% were women. The mean [SD] age was 72 [5.4] years. Baseline cognitive impairment was identified in 38% of participants, and 26% had postoperative delirium. In multivariable analysis, impaired Brain Health Assessment Cognitive Score (OR 2.45; 95% CI, 1.05-5.67; p = 0.037), depression (OR 4.54; 95% CI, 1.73-11.89; p = 0.002), and higher surgical complexity Tier 4 (OR 5.88; 95% CI, 1.55-22.26; p = 0.009) were associated with postoperative delirium. The multivariate model was 72% accurate for predicting postoperative delirium, compared to 45% for the electronic medical record-based risk stratification model currently in use.

CONCLUSION

In this prospective cohort study of spine surgery patients, age, cognitive impairment, depression, and surgical complexity identified patients at high risk for postoperative delirium. Integration of scalable digital assessments into preoperative workflows could identify high-risk patients, automate decision support for timely interventions that can improve patient outcomes and lower hospital costs, and provide a baseline cognitive assessment to monitor for postoperative cognitive change.

Touchscreen Cognitive Tools for Mild Cognitive Impairment and Dementia Used in Primary Care Across Diverse Cultural and Literacy Populations: A Systematic Review

BACKGROUND

Touchscreen cognitive tools opened new promising opportunities for the early detection of cognitive impairment; however, most research studies are conducted in English-speaking populations and high-income countries, with a gap in knowledge about their use in populations with cultural, linguistic, and educational diversity.

OBJECTIVE

To review the touchscreen tools used in primary care settings for the cognitive assessment of mild cognitive impairment (MCI) and dementia, with a focus on populations of different cultures, languages, and literacy.

METHODS

This systematic review was conducted following the PRISMA guidelines. Studies were identified by searching across MEDLINE, EMBASE, EBSCO, OVID, SCOPUS, SCIELO, LILACS, and by cross-referencing. All studies that provide a first-level cognitive assessment for MCI and dementia with any touchscreen tools suitable to be used in the context of primary care were included.

RESULTS

Forty-two studies reporting on 30 tools and batteries were identified. Substantial differences among the tools emerged, in terms of theoretical framework, clinical validity, and features related to the application in clinical practice. A small proportion of the tools are available in multiple languages. Only 7 out of the 30 tools have a multiple languages validation. Only two tools are validated in low-educated samples, e.g., IDEA and mSTS-MCI.

CONCLUSION

General practitioners can benefit from touchscreen cognitive tools. However, easy requirements of the device, low dependence on the examiner, fast administration, and adaptation to different cultures and languages are some of the main features that we need to take into consideration when implementing touchscreen cognitive tools in the culture and language of underrepresented populations.

Digital Cognitive Biomarker for Mild Cognitive Impairments and Dementia: A Systematic Review

The dementia population is increasing as the world's population is growing older. The current systematic review aims to identify digital cognitive biomarkers from computerized tests for detecting dementia and its risk state of mild cognitive impairment (MCI), and to evaluate the diagnostic performance of digital cognitive biomarkers. A literature search was performed in three databases, and supplemented by a Google search for names of previously identified computerized tests. Computerized tests were categorized into five types, including memory tests, test batteries, other single/multiple cognitive tests, handwriting/drawing tests, and daily living tasks and serious games. Results showed that 78 studies were eligible. Around 90% of the included studies were rated as high quality based on the Newcastle-Ottawa Scale (NOS). Most of the digital cognitive biomarkers achieved comparable or even better diagnostic performance than traditional paper-and-pencil tests. Moderate to large group differences were consistently observed in cognitive outcomes related to memory and executive functions, as well as some novel outcomes measured by handwriting/drawing tests, daily living tasks, and serious games. These outcomes have the potential to be sensitive digital cognitive biomarkers for MCI and dementia. Therefore, digital cognitive biomarkers can be a sensitive and promising clinical tool for detecting MCI and dementia.

A cultural approach to dementia - insights from US Latino and other minoritized groups

Alzheimer disease and related dementias present considerable challenges to health-care and medical systems worldwide. In the USA, older Black and Latino individuals are more likely than older white individuals to have Alzheimer disease and related dementias. In this Perspective, we leverage our experience and expertise with older US Latino groups to review and discuss the need to integrate cultural factors into dementia research and care. We examine the importance of considering the effects of cultural factors on clinical presentation and diagnosis, dementia risk, clinical research and recruitment, and caregiving practices, with a focus on minoritized groups in the USA. We highlight critical gaps in the literature to stimulate future research aimed at improving the prevention and early detection of Alzheimer disease and related dementias and developing novel treatments and interventions across ethnoracially diverse populations. In addition, we briefly discuss some of our own initiatives to promote research and clinical care among Latino populations living in the USA.

Lessons from Detecting Cognitive Impairment Including Dementia (DetectCID) in Primary Care

Background: Cognitive impairment, including dementia, is frequently under-detected in primary care. The Consortium for Detecting Cognitive Impairment, including Dementia (DetectCID) convenes three multidisciplinary teams that are testing novel paradigms to improve the frequency and quality of patient evaluations for detecting cognitive impairment in primary care and appropriate follow-up. Objective: Our objective was to characterize the three paradigms, including similarities and differences, and to identify common key lessons from implementation. Methods: A qualitative evaluation study with dementia specialists who were implementing the detection paradigms. Data was analyzed using content analysis. Results: We identified core components of each paradigm. Key lessons emphasized the importance of engaging primary care teams, enabling primary care providers to diagnose cognitive disorders and provide ongoing care support, integrating with the electronic health record, and ensuring that paradigms address the needs of diverse populations. Conclusion: Approaches are needed that address the arc of care from identifying a concern to post-diagnostic management, are efficient and adaptable to primary care workflows, and address a diverse aging population. Our work highlights approaches to partnering with primary care that could be useful across specialties and paves the way for developing future paradigms that improve differential diagnosis of symptomatic cognitive impairment, identifying not only its presence but also its specific syndrome or etiology.