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Vyshedskiy A, Netson R, Fridberg E, Jagadeesan P, Arnold M, Barnett S, Gondalia A, Maslova V, de Torres L, Ostrovsky S, Durakovic D, Savchenko A, McNett S, Kogan M, Piryatinsky I, Gold D. Boston cognitive assessment (BOCA) - a comprehensive self-administered smartphone- and computer-based at-home test for longitudinal tracking of cognitive performance. BMC Neurol 2022; 22:92. [PMID: 35291958 PMCID: PMC8922721 DOI: 10.1186/s12883-022-02620-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 03/08/2022] [Indexed: 11/13/2022] Open
Abstract
Longitudinal cognitive testing is essential for developing novel preventive interventions for dementia and Alzheimer’s disease; however, the few available tools have significant practice effect and depend on an external evaluator. We developed a self-administered 10-min at-home test intended for longitudinal cognitive monitoring, Boston Cognitive Assessment or BOCA. The goal of this project was to validate BOCA. BOCA uses randomly selected non-repeating tasks to minimize practice effects. BOCA evaluates eight cognitive domains: 1) Memory/Immediate Recall, 2) Combinatorial Language Comprehension/Prefrontal Synthesis, 3) Visuospatial Reasoning/Mental rotation, 4) Executive function/Clock Test, 5) Attention, 6) Mental math, 7) Orientation, and 8) Memory/Delayed Recall. BOCA was administered to patients with cognitive impairment (n = 50) and age- and education-matched controls (n = 50). Test scores were significantly different between patients and controls (p < 0.001) suggesting good discriminative ability. The Cronbach’s alpha was 0.87 implying good internal consistency. BOCA demonstrated strong correlation with Montreal Cognitive Assessment (MoCA) (R = 0.90, p < 0.001). The study revealed strong (R = 0.94, p < 0.001) test-retest reliability of the total BOCA score one week after participants’ initial administration. The practice effect tested by daily BOCA administration over 10 days was insignificant (β = 0.03, p = 0.68). The effect of the screen size tested by BOCA administration on a large computer screen and re-administration of the BOCA to the same participant on a smartphone was insignificant (β = 0.82, p = 0.17; positive β indicates greater score on a smartphone). BOCA has the potential to reduce the cost and improve the quality of longitudinal cognitive tracking essential for testing novel interventions designed to reduce or reverse cognitive aging. BOCA is available online gratis at www.bocatest.org.
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Affiliation(s)
- Andrey Vyshedskiy
- Boston University, 9 Michael Rd., Boston, MA, 02135, USA. .,Alzheimer's Light, Miami, FL, USA.
| | | | | | | | - Matthew Arnold
- Boston University, 9 Michael Rd., Boston, MA, 02135, USA
| | | | | | | | | | | | | | | | - Sienna McNett
- Center for Integrative Medicine, George Washington University, Washington, USA
| | - Mikhail Kogan
- Center for Integrative Medicine, George Washington University, Washington, USA
| | | | - Dov Gold
- Department of Clinical Psychology, William James College, Newton, MA, USA
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Abstract
Evidence-based recommendations for lifestyles to promote healthy cognitive aging (exercise, education, non-smoking, balanced diet, etc.) root in reductionistic studies of mostly physical measurable factors with large effect sizes. In contrast, most people consider factors like autonomy, purpose, social participation and engagement, etc. as central to a high quality of life in old age. Evidence for a direct causal impact of these factors on healthy cognitive aging is still limited, albeit not absent. Ultimately, however, individual lifestyle is a complex composite of variables relating to both body and mind as well as to receiving input and generating output. The physical interventions are tied to the more subjective and mind-related aspects of lifestyle and wellbeing in the idea of the “embodied mind,” which states that the mind is shaped by and requires the body. The causality is reciprocal and the process is dynamic, critically requiring movement: the “embodied mind” is a “embodied mind in motion.” Hiking, playing musical instruments, dancing and yoga are examples of body–mind activities that assign depth, purpose, meaning, social embedding, etc. to long-term beneficial physical “activities” and increase quality of life not only as delayed gratification. The present motivational power of embodied activities allows benefiting from the side-effects of late-life resilience. The concept offers an access point for unraveling the mechanistic complexity of lifestyle-based prevention, including their neurobiological foundations.
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Sevinc G, Rusche J, Wong B, Datta T, Kaufman R, Gutz SE, Schneider M, Todorova N, Gaser C, Thomalla G, Rentz D, Dickerson BD, Lazar SW. Mindfulness Training Improves Cognition and Strengthens Intrinsic Connectivity Between the Hippocampus and Posteromedial Cortex in Healthy Older Adults. Front Aging Neurosci 2021; 13:702796. [PMID: 34512305 PMCID: PMC8430251 DOI: 10.3389/fnagi.2021.702796] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 08/09/2021] [Indexed: 01/02/2023] Open
Abstract
Maintaining optimal cognitive functioning throughout the lifespan is a public health priority. Evaluation of cognitive outcomes following interventions to promote and preserve brain structure and function in older adults, and associated neural mechanisms, are therefore of critical importance. In this randomized controlled trial, we examined the behavioral and neural outcomes following mindfulness training (n = 72), compared to a cognitive fitness program (n = 74) in healthy, cognitively normal, older adults (65-80 years old). To assess cognitive functioning, we used the Preclinical Alzheimer Cognitive Composite (PACC), which combines measures of episodic memory, executive function, and global cognition. We hypothesized that mindfulness training would enhance cognition, increase intrinsic functional connectivity measured with magnetic resonance imaging (MRI) between the hippocampus and posteromedial cortex, as well as promote increased gray matter volume within those regions. Following the 8-week intervention, the mindfulness training group showed improved performance on the PACC, while the control group did not. Furthermore, following mindfulness training, greater improvement on the PACC was associated with a larger increase in intrinsic connectivity within the default mode network, particularly between the right hippocampus and posteromedial cortex and between the left hippocampus and lateral parietal cortex. The cognitive fitness training group did not show such effects. These findings demonstrate that mindfulness training improves cognitive performance in cognitively intact older individuals and strengthens connectivity within the default mode network, which is particularly vulnerable to aging affects. Clinical Trial Registration: [https://clinicaltrials.gov/ct2/show/NCT02628548], identifier [NCT02628548].
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Affiliation(s)
- Gunes Sevinc
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Johann Rusche
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
- Kopf- und Neurozentrum, Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Bonnie Wong
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Tanya Datta
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Robert Kaufman
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Sarah E. Gutz
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
- Program in Speech and Hearing Bioscience and Technology, Harvard Medical School, Boston, MA, United States
| | - Marissa Schneider
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Nevyana Todorova
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
- Department of Behavioral Neuroscience, College of Science, Northeastern University, Boston, MA, United States
| | - Christian Gaser
- Department of Psychiatry and Neurology, Jena University Hospital, Jena, Germany
| | - Götz Thomalla
- Kopf- und Neurozentrum, Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Dorene Rentz
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
- Department of Neurology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Bradford D. Dickerson
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Sara W. Lazar
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
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