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Tsiakiri A, Koutzmpi V, Megagianni S, Toumaian M, Geronikola N, Despoti A, Kanellopoulou S, Arampatzi X, Margioti E, Davila A, Zoi P, Kalligerou F, Liozidou A, Tsapanou A, Sakka P. Remote neuropsychological evaluation of older adults. APPLIED NEUROPSYCHOLOGY. ADULT 2024; 31:796-803. [PMID: 35595233 DOI: 10.1080/23279095.2022.2074850] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The use of technological means in the process of neuropsychological assessment has been proposed as a technique with promising results in the field of detection of neurocognitive disorders for community-dwelling older adults. Especially during the pandemic period due to COVID-19, telemedicine assumed to be vital in the field of early diagnosis of cognitive disorders and highlighted the clinical utility of remote methods of neuropsychological assessmentby video-conference. This descriptive study presents the development of a remote neuropsychological assessment protocol by selecting appropriate validated tests as part of a more comprehensive evaluation for older adults dwelling in the community. We recruited participants from the Athens Alzheimer's Association center in collaboration with the Hellenic Neuropsychological Society, in Athens, Greece, regarding the period between April 2020 and October 2021. 90 individuals, tested for the first time, were categorized into three groups according to their diagnosis which included: (a) Mild Cognitive Impairment (MCI), (b) Alzheimer's disease, (c) cognitively healthy older adults. The presented protocol outlines the main considerations of a framework about remote neuropsychological assessment, which can maximize the effectiveness of interventions and continuity regarding the care of older adults. The recommendations outlined in the presented protocol highlight strengths and limitations that should be taken into account in remote control procedures. Although the protocol was created in response to pandemic restrictions, tele-neuropsychology shows promise as a way to improve access opportunity to neurodiagnostic services for rural aging and underserved populations, which lack specialized healthcare services. Further application to different populations will add validity to the presented descriptive protocol.
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Affiliation(s)
- A Tsiakiri
- Department of Neurology, Medical School, Democritus University of Thrace, Alexandroupoli, Greece
- Hellenic Neuropsychological Society, Athens, Greece
| | - V Koutzmpi
- Hellenic Neuropsychological Society, Athens, Greece
- Athens Alzheimer's Association, Athens, Greece
| | - S Megagianni
- Hellenic Neuropsychological Society, Athens, Greece
- Athens Alzheimer's Association, Athens, Greece
| | - M Toumaian
- Hellenic Neuropsychological Society, Athens, Greece
- Laboratory of Cognitive Neuroscience and Sensorimotor Control, University Mental Health, Neurosciences and Precision Medicine Research Institute "Costas Stefanis," Athens, Greece
| | - N Geronikola
- Hellenic Neuropsychological Society, Athens, Greece
- Athens Alzheimer's Association, Athens, Greece
- 1st Department of Neurology, Aiginition Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - A Despoti
- Hellenic Neuropsychological Society, Athens, Greece
- Clinical Ergospirometry, Exercise and Rehabilitation Laboratory, 1st Critical Care Department, Evangelismos Hospital, School of Medicine, National & Kapodistrian University of Athens, Athens, Greece
| | | | - X Arampatzi
- Athens Alzheimer's Association, Athens, Greece
| | - E Margioti
- Athens Alzheimer's Association, Athens, Greece
| | - A Davila
- Athens Alzheimer's Association, Athens, Greece
| | - P Zoi
- Athens Alzheimer's Association, Athens, Greece
| | - F Kalligerou
- Athens Alzheimer's Association, Athens, Greece
- 1st Department of Neurology, Aiginition Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - A Liozidou
- Hellenic Neuropsychological Society, Athens, Greece
- Laboratory of Cognitive Neuroscience and Clinical Neuropsychology, The Scientific College of Greece. Department of Medicine, School of Health Sciences, National and Kapodistrian University of Athens
| | - A Tsapanou
- Hellenic Neuropsychological Society, Athens, Greece
- Athens Alzheimer's Association, Athens, Greece
- Cognitive Neuroscience Division, Columbia University Irving Medical Center, New York, NY, USA
| | - P Sakka
- Athens Alzheimer's Association, Athens, Greece
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Despoti A, Megari K, Tsiakiri A, Toumaian M, Koutzmpi V, Liozidou A, Tsapanou A. Effectiveness of remote neuropsychological interventions: A systematic review. APPLIED NEUROPSYCHOLOGY. ADULT 2024:1-9. [PMID: 39067003 DOI: 10.1080/23279095.2024.2382814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/30/2024]
Abstract
OBJECTIVE Remote healthcare services is an upgrowing dynamic field that has been used to reduce potential disease spread and prevent overloading of the healthcare system during COVID-19 pandemic. The need for online interventions during the pandemic required immediate response with sometimes inadequate preparation. The aim of the present study is to investigate the effectiveness of remote healthcare services in the field of neuropsychological interventions. METHODS A systematic literature search was conducted in the electronic databases of PubMed, PsychINFO and Google Scholar. The main search terms were "remote neuropsychological intervention or training." The included articles were RCT studies published in English, examining the effectiveness of remote healthcare services in neuropsychological interventions for adults with neurological disease diagnoses. Studies involving psychiatric disorders were excluded. Two reviewers assessed the quality of the studies and risk of bias using the PEDro Scale. RESULTS A total of 10 studies with 2.221 participants were included. All studies concluded that remote healthcare intervention programs can be feasible, safe and effective in the rehabilitation process of neurological diseases. DISCUSSION The present review demonstrated that the domains of neuropsychology have opportunities to forge ahead beyond traditional settings and have the ability to adapt to constantly changing environmental conditions with a view to providing patient care. Health policy plans should therefore be reformulated to include these needs in accordance with the social and cultural context of implementation.
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Affiliation(s)
- Akyllina Despoti
- Clinical Ergospirometry, Exercise and Rehabilitation Laboratory, 1st Critical Care Department, Evangelismos Hospital, School of Medicine, National & Kapodistrian University of Athens, Athens, Greece
- Hellenic Neuropsychological Society, Athens, Greece
| | - Kalliopi Megari
- Hellenic Neuropsychological Society, Athens, Greece
- CITY College, University of York Europe Campus, Thessaloniki, Greece
| | - Anna Tsiakiri
- Hellenic Neuropsychological Society, Athens, Greece
- Department of Neurology, Medical School, Democritus University of Thrace, Alexandroupoli, Greece
| | - Maida Toumaian
- Hellenic Neuropsychological Society, Athens, Greece
- Laboratory of Cognitive Neuroscience and Sensorimotor Control, University Mental Health, Neurosciences and Precision Medicine Research Institute "Costas Stefanis,"Athens, Greece
| | - Vasiliki Koutzmpi
- Hellenic Neuropsychological Society, Athens, Greece
- Athens Alzheimer's Association, Athens, Greece
| | - Athanasia Liozidou
- Hellenic Neuropsychological Society, Athens, Greece
- Laboratory of Cognitive Neuroscience and Clinical Neuropsychology, Psychology Department, Scientific College of Greece
- Laboratory of Clinical Neuropsychology, Eginiteion Hospital, Neurology Department, Medical School of Athens, National and Kapodistrian University of Athens, Athens, Greece
| | - Angeliki Tsapanou
- Hellenic Neuropsychological Society, Athens, Greece
- Athens Alzheimer's Association, Athens, Greece
- Cognitive Neuroscience Division, Columbia University Irving Medical Center, New York, NY, USA
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Peavy GM, Võ N, Revta C, Lu AT, Lupo JL, Nam P, Nguyễn KH, Wang LS, Feldman HH. Asian Cohort for Alzheimer Disease (ACAD) Pilot Study: Vietnamese Americans. Alzheimer Dis Assoc Disord 2024; 38:277-284. [PMID: 39177172 PMCID: PMC11340683 DOI: 10.1097/wad.0000000000000631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2024] [Accepted: 07/08/2024] [Indexed: 08/24/2024]
Abstract
INTRODUCTION The objective of this pilot study was to establish the feasibility of recruiting older Vietnamese Americans for research addressing genetic and nongenetic risk factors for Alzheimer disease (AD). METHODS Twenty-six Vietnamese Americans were recruited from communities in San Diego. A Community Advisory Board provided cultural and linguistic advice. Bilingual/bicultural staff measured neuropsychological, neuropsychiatric, lifestyle, and medical/neurological functioning remotely. Saliva samples allowed DNA extraction. A consensus team reviewed clinical data to determine a diagnosis of normal control (NC), mild cognitive impairment (MCI), or dementia. Exploratory analyses addressed AD risk by measuring subjective cognitive complaints (SCC), depression, and vascular risk factors (VRFs). RESULTS Twenty-five participants completed the study (mean age=73.8 y). Eighty percent chose to communicate in Vietnamese. Referrals came primarily from word of mouth within Vietnamese communities. Diagnoses included 18 NC, 3 MCI, and 4 dementia. Participants reporting SCC acknowledged more depressive symptoms and had greater objective cognitive difficulty than those without SCC. Eighty-eight percent of participants reported at least 1 VRF. DISCUSSION This pilot study supports the feasibility of conducting community-based research in older Vietnamese Americans. Challenges included developing linguistically and culturally appropriate cognitive and neuropsychiatric assessment tools. Exploratory analyses addressing nongenetic AD risk factors suggest topics for future study.
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Affiliation(s)
- Guerry M. Peavy
- Department of Neurosciences, Alzheimer’s Disease Cooperative Study
- Department of Neurosciences, Alzheimer’s Disease Research Center
| | - Namkhuê Võ
- Department of Neurosciences, Alzheimer’s Disease Cooperative Study
| | - Carolyn Revta
- Department of Neurosciences, Alzheimer’s Disease Cooperative Study
| | - Anna T. Lu
- Department of Neurosciences, Alzheimer’s Disease Cooperative Study
| | - Jody-Lynn Lupo
- Department of Neurosciences, Alzheimer’s Disease Cooperative Study
| | - Percival Nam
- Medical Student Y3, UC San Diego School of Medicine
| | - Khải H. Nguyễn
- Division of Geriatrics, Gerontology, and Palliative Care, UC San Diego School of Medicine, San Diego, CA
| | - Li-San Wang
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Howard H. Feldman
- Department of Neurosciences, Alzheimer’s Disease Cooperative Study
- Department of Neurosciences, Alzheimer’s Disease Research Center
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Boudreau JH, Moo LR, Kennedy MA, Conti J, Anwar C, Pimentel CB, Nearing KA, Hung WW, Dryden EM. Needs for Successful Engagement in Telemedicine Among Rural Older US Veterans and Their Caregivers: Qualitative Study. JMIR Form Res 2024; 8:e50507. [PMID: 38713503 PMCID: PMC11109863 DOI: 10.2196/50507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 02/15/2024] [Accepted: 03/13/2024] [Indexed: 05/08/2024] Open
Abstract
BACKGROUND Telemedicine is an important option for rural older adults who often must travel far distances to clinics or forgo essential care. In 2014, the Geriatric Research, Education, and Clinical Centers (GRECC) of the US Veterans Health Administration (VA) established a national telemedicine network called GRECC Connect. This network increased access to geriatric specialty care for the 1.4 million rural VA-enrolled veterans aged 65 years or older. The use of telemedicine skyrocketed during the COVID-19 pandemic, which disproportionately impacted older adults, exacerbating disparities in specialty care access as overburdened systems shut down in-person services. This surge presented a unique opportunity to study the supports necessary for those who would forgo telemedicine if in-person care were available. OBJECTIVE In spring 2021, we interviewed veterans and their informal caregivers to (1) elicit their experiences attempting to prepare for a video visit with a GRECC Connect geriatric specialist and (2) explore facilitators and barriers to successful engagement in a telemedicine visit. METHODS We conducted a cross-sectional qualitative evaluation with patients and their caregivers who agreed to participate in at least 1 GRECC Connect telemedicine visit in the previous 3 months. A total of 30 participants from 6 geographically diverse GRECC Connect hub sites agreed to participate. Semistructured interviews were conducted through telephone or the VA's videoconference platform for home telemedicine visits (VA Video Connect) per participant preference. We observed challenges and, when needed, provided real-time technical support to facilitate VA Video Connect use for interviews. All interviews were recorded with permission and professionally transcribed. A team of 5 researchers experienced in qualitative research analyzed interview transcripts using rapid qualitative analysis. RESULTS From 30 participant interviews, we identified the following 4 categories of supports participants described regarding successful engagement in telemedicine, as defined by visit completion, satisfaction, and willingness to engage in telemedicine in the future: (1) caregiver presence to facilitate technology setup and communication; (2) flexibility in visit modality (eg, video from home or a clinic or telephone); (3) technology support (eg, determining device compatibility or providing instruction and on-demand assistance); and (4) assurance of comfort with web-based communication, including orientation to features like closed captioning. Supports were needed at multiple points before the visit, and participants stressed the importance of eliciting the varying needs and preferences of each patient-caregiver dyad. Though many initially agreed to a telemedicine visit because of pandemic-related clinic closures, participants were satisfied with telemedicine and willing to use it for other types of health care visits. CONCLUSIONS To close gaps in telemedicine use among rural older adults, supports must be tailored to individuals, accounting for technology availability and comfort, as well as availability of and need for caregiver involvement. Comprehensive scaffolding of support starts well before the first telemedicine visit.
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Affiliation(s)
- Jacqueline Hannah Boudreau
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, US Department of Veterans Affairs, Bedford, MA, United States
| | - Lauren R Moo
- New England Geriatric Research, Education, and Clinical Center, VA Bedford Healthcare System, US Department of Veterans Affairs, Bedford, MA, United States
- Department of Neurology, Harvard Medical School, Boston, MA, United States
| | - Meaghan A Kennedy
- New England Geriatric Research, Education, and Clinical Center, VA Bedford Healthcare System, US Department of Veterans Affairs, Bedford, MA, United States
- Department of Family Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States
| | - Jennifer Conti
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, US Department of Veterans Affairs, Bedford, MA, United States
| | - Chitra Anwar
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, US Department of Veterans Affairs, Bedford, MA, United States
| | - Camilla B Pimentel
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, US Department of Veterans Affairs, Bedford, MA, United States
- New England Geriatric Research, Education, and Clinical Center, VA Bedford Healthcare System, US Department of Veterans Affairs, Bedford, MA, United States
- Department of Public Health, Zuckerberg College of Health Sciences, University of Massachusetts Lowell, Lowell, MA, United States
| | - Kathryn A Nearing
- Eastern Colorado VA Geriatric Research Education and Clinical Center, Aurora, CO, United States
- Division of Geriatric Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - William W Hung
- Bronx Geriatric Research Education and Clinical Center, James J Peters VA Medical Center, Bronx, New York, NY, United States
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine, New York, NY, United States
| | - Eileen M Dryden
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, US Department of Veterans Affairs, Bedford, MA, United States
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Siette J, Campbell C, Adam PJ, Harris CB. Exploring the usability of the virtual reality module LEAF CAFÉ: a qualitative think-aloud study. BMC Geriatr 2024; 24:162. [PMID: 38365613 PMCID: PMC10870684 DOI: 10.1186/s12877-024-04767-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 02/01/2024] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND The global healthcare system faces increasing strain from our ageing population, primarily due to the growing prevalence of age-related health conditions such as dementia. While modern healthcare technology offers potential solutions, it frequently lacks user-friendliness for older adults. Virtual Reality (VR) has emerged as a promising tool for diagnosing cognitive impairment, offering innovative solutions where traditional methods may fall short. This study explores older adults' perspectives on the usability of a newly designed VR module for cognitive assessment. METHODS During a 100-min session, participants were asked to engage and complete recall and recognition tasks within the VR module (think-aloud approach) and provide feedback upon completion (semi-structured interviews). Audio materials were transcribed for analysis and recordings of the users' interactions with the module were annotated to provide additional context. These combined textual data were analysed using content coding and thematic analysis to identify themes that reflect how participants used the module's features and what features are desirable to support that process better. RESULTS Participants (N = 10; Mean age = 73.3, SD = 7.53, range = 65-83 years) perceived the VR module as user-friendly and endorsed its potential as a cognitive screener due to its engaging and immersive nature. Older adults highlighted three key aspects of the module: the usefulness of the platform's ability to offer a comprehensive and reliable evaluation of an individual's cognitive abilities; the need to present concise and relevant content to optimise engagement and use; and the importance of overcoming barriers to support implementation. Suggested game improvements centred on food recognition and adjusting difficulty levels. Barriers to implementation included technology challenges for older adults and concerns about the game's suitability for everyday scenarios. Participants stressed the need for reliable implementation strategies, proposing locations such as libraries and advocating for home-based screening. CONCLUSION Continued improvements in accessibility suggest that VR tools could help with diagnosing cognitive impairment in older adults. Using a simulated environment to assess cognitive status might fill the gap between current diagnostic methods, aiding treatment planning and early intervention. However, these findings should be approached cautiously, as more research is needed to fully grasp the potential impact of VR tools in this context.
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Affiliation(s)
- Joyce Siette
- The MARCS Institute for Brain, Behaviour and Development, Western Sydney University, Westmead, NSW, 2145, Australia.
| | - Christopher Campbell
- The MARCS Institute for Brain, Behaviour and Development, Western Sydney University, Westmead, NSW, 2145, Australia
| | - Patrick J Adam
- The MARCS Institute for Brain, Behaviour and Development, Western Sydney University, Westmead, NSW, 2145, Australia
| | - Celia B Harris
- The MARCS Institute for Brain, Behaviour and Development, Western Sydney University, Westmead, NSW, 2145, Australia
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Amos JG, Zheng L, Eramudugolla R, Parekh D, Huque MH, Delbaere K, Lautenschlager N, Anstey KJ. MyCOACH (COnnected Advice for Cognitive Health): a digitally delivered multidomain intervention for cognitive decline and risk of dementia in adults with mild cognitive impairment or subjective cognitive decline-study protocol for a randomised controlled trial. BMJ Open 2023; 13:e075015. [PMID: 37903606 PMCID: PMC10619101 DOI: 10.1136/bmjopen-2023-075015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 09/26/2023] [Indexed: 11/01/2023] Open
Abstract
INTRODUCTION Digital health interventions are cost-effective and easily accessible, but there is currently a lack of effective online options for dementia prevention especially for people at risk due to mild cognitive impairment (MCI) or subjective cognitive decline (SCD). METHODS AND ANALYSIS MyCOACH (COnnected Advice for Cognitive Health) is a tailored online dementia risk reduction programme for adults aged ≥65 living with MCI or SCD. The MyCOACH trial aims to evaluate the programme's effectiveness in reducing dementia risk compared with an active control over a 64-week period (N=326). Eligible participants are randomly allocated to one of two intervention arms for 12 weeks: (1) the MyCOACH intervention programme or (2) email bulletins with general healthy ageing information (active control). The MyCOACH intervention programme provides participants with information about memory impairments and dementia, memory strategies and different lifestyle factors associated with brain ageing as well as practical support including goal setting, motivational interviewing, brain training, dietary and exercise consultations, and a 26-week post-intervention booster session. Follow-up assessments are conducted for all participants at 13, 39 and 65 weeks from baseline, with the primary outcome being exposure to dementia risk factors measured using the Australian National University-Alzheimer's Disease Risk Index. Secondary measures include cognitive function, quality of life, functional impairment, motivation to change behaviour, self-efficacy, morale and dementia literacy. ETHICS AND DISSEMINATION Ethical approval was obtained from the University of New South Wales Human Research Ethics Committee (HC210012, 19 February 2021). The results of the study will be disseminated in peer-reviewed journals and research conferences. TRIAL REGISTRATION NUMBER ACTRN12621000977875.
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Affiliation(s)
- Jessica G Amos
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
- Neuroscience Research Australia, Randwick, New South Wales, Australia
- UNSW Ageing Futures Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Lidan Zheng
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
- Neuroscience Research Australia, Randwick, New South Wales, Australia
- UNSW Ageing Futures Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Ranmalee Eramudugolla
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
- Neuroscience Research Australia, Randwick, New South Wales, Australia
- UNSW Ageing Futures Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Dinaz Parekh
- Neuroscience Research Australia, Randwick, New South Wales, Australia
| | - Md Hamidul Huque
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
- Neuroscience Research Australia, Randwick, New South Wales, Australia
- UNSW Ageing Futures Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Kim Delbaere
- Neuroscience Research Australia, Randwick, New South Wales, Australia
- UNSW Ageing Futures Institute, University of New South Wales, Sydney, New South Wales, Australia
- School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Nicola Lautenschlager
- UNSW Ageing Futures Institute, University of New South Wales, Sydney, New South Wales, Australia
- Academic Unit of Psychiatry of Old Age, University of Melbourne, Kew, Victoria, Australia
- NorthWestern Mental Health, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Kaarin J Anstey
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
- Neuroscience Research Australia, Randwick, New South Wales, Australia
- UNSW Ageing Futures Institute, University of New South Wales, Sydney, New South Wales, Australia
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Mohamed AA, Marques O. Diagnostic Efficacy and Clinical Relevance of Artificial Intelligence in Detecting Cognitive Decline. Cureus 2023; 15:e47004. [PMID: 37965412 PMCID: PMC10641267 DOI: 10.7759/cureus.47004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2023] [Indexed: 11/16/2023] Open
Abstract
Cognitive impairment is an age-associated disorder of increasing prevalence as the aging population continues to grow. Classified based on the level of cognitive decline, memory, function, and capacity to conduct activities of daily living, cognitive impairment ranges from mild cognitive impairment to dementia. When considering the insidious nature of the etiologies responsible for varying degrees of cognitive impairment, early diagnosis may provide a clinical benefit through the facilitation of early treatment. Typical diagnosis relies heavily on evaluation in a primary care setting. However, there is evidence that other diagnostic tools may aid in an earlier diagnosis of the different underlying pathologies responsible for cognitive impairment. Artificial intelligence represents a new intersecting field with healthcare that may aid in the early detection of neurodegenerative disorders. When assessing the role of AI in detecting cognitive decline, it is important to consider both the diagnostic efficacy of AI algorithms and the clinical relevance and impact of early interventions as a result of early detection. Thus, this review highlights promising investigations and developments in the space of artificial intelligence and healthcare and their potential to impact patient outcomes.
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Affiliation(s)
- Ali A Mohamed
- Neurological Surgery, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, USA
- Electrical Engineering and Computer Science, Florida Atlantic University, Boca Raton, USA
| | - Oge Marques
- Biomedical Sciences, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, USA
- Electrical Engineering and Computer Science, Florida Atlantic University, Boca Raton, USA
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Jordan TL, Foland-Ross LC, Wun VL, Ross JL, Reiss AL. Cognition, Academic Achievement, Adaptive Behavior, and Quality of Life in Child and Adolescent Boys with Klinefelter Syndrome. J Dev Behav Pediatr 2023; 44:e476-e485. [PMID: 37696031 DOI: 10.1097/dbp.0000000000001201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 05/25/2023] [Indexed: 09/13/2023]
Abstract
OBJECTIVE Klinefelter syndrome (KS; 47, XXY), the most common sex chromosome aneuploidy in males, is characterized by testicular failure and testosterone deficiency as well as a variety of cognitive, social, and emotional challenges. In the current study, we aimed to clarify the cognitive-behavioral profile of peripubertal boys with KS using measures of cognition, academic achievement, adaptive behavior, and quality of life. METHOD We compared 47 boys with KS (7-16 years of age) with 55 performance IQ-matched boys without KS on measures of cognition (WISC-V), executive function (BRIEF-2), academic achievement (KTEA-3), adaptive behavior (Vineland-3), and quality of life (PROMIS). In exploratory analyses, we examined associations among these measures and potential associations with pubertal metrics. RESULTS Boys with KS demonstrated a significantly different profile of cognition, behavioral ratings of executive function, academic achievement, adaptive behavior, and quality of life compared with their typically developing peers, with, on average, lower functioning. The groups showed significantly different correlations between cognition and aspects of quality of life. No associations were observed between behavior and pubertal development. CONCLUSION Taken together, these findings indicated that boys with KS are at increased risk for cognitive difficulties, which may affect academic achievement, adaptive behavior, and quality of life. Although initial exploratory analyses indicated that the magnitude of these alterations was not correlated with severity of testicular failure, longitudinal analyses currently being conducted by our group may help clarify the trajectory of these difficulties through the pubertal transition and testosterone replacement.
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Affiliation(s)
- Tracy L Jordan
- Center of Interdisciplinary Brain Sciences Research, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA
| | - Lara C Foland-Ross
- Center of Interdisciplinary Brain Sciences Research, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA
| | - Vanessa L Wun
- Department of Psychology, University of Minnesota, Minneapolis, MN
| | - Judith L Ross
- Department of Pediatrics, Division of Endocrinology, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE
| | - Allan L Reiss
- Center of Interdisciplinary Brain Sciences Research, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA
- Department of Radiology, Stanford University School of Medicine, Palo Alto, CA; and
- Center for Academic Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA
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Sirilertmekasakul C, Rattanawong W, Gongvatana A, Srikiatkhachorn A. The current state of artificial intelligence-augmented digitized neurocognitive screening test. Front Hum Neurosci 2023; 17:1133632. [PMID: 37063100 PMCID: PMC10098088 DOI: 10.3389/fnhum.2023.1133632] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 03/20/2023] [Indexed: 04/18/2023] Open
Abstract
The cognitive screening test is a brief cognitive examination that could be easily performed in a clinical setting. However, one of the main drawbacks of this test was that only a paper-based version was available, which restricts the test to be manually administered and graded by medical personnel at the health centers. The main solution to these problems was to develop a potential remote assessment for screening individuals with cognitive impairment. Currently, multiple studies have been adopting artificial intelligence (AI) technology into these tests, evolving the conventional paper-based neurocognitive test into a digitized AI-assisted neurocognitive test. These studies provided credible evidence of the potential of AI-augmented cognitive screening tests to be better and provided the framework for future studies to further improve the implementation of AI technology in the cognitive screening test. The objective of this review article is to discuss different types of AI used in digitized cognitive screening tests and their advantages and disadvantages.
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Lombardi G, Chipi E, Arenella D, Fiorani A, Frisoni GB, Linarello S, Montanucci C, Muscio C, Pacifico I, Pelizzari S, Perani D, Piras F, Rozzini L, Sorbi S, Spalletta G, Tagliavini F, Tiraboschi P, Parnetti L, Filippini G. Educational interventions to improve detection and management of cognitive decline in primary care-An Italian multicenter pragmatic study. Front Psychiatry 2022; 13:1050583. [PMID: 36506451 PMCID: PMC9731677 DOI: 10.3389/fpsyt.2022.1050583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 11/01/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction Timely detection of cognitive decline in primary care is essential to promote an appropriate care pathway and enhance the benefits of interventions. We present the results of a study aimed to evaluate the effectiveness of an educational intervention addressed to Italian family physicians (FPs) to improve timely detection and management of cognitive decline. Materials and methods We conducted a pre-post study in six Italian health authorities (HAs) involving 254 FPs and 3,736 patients. We measured process and outcome indicators before the intervention (1 January 2014 to 31 December 2016) and after the intervention (1 January 2018 to 31 December 2019). One interactive face-to-face session workshop was delivered by local cognitive disorders and dementia specialists and FP advisors at each HA, in the period September 2017-December 2017. The session focused on key messages of the local Diagnostic and Therapeutic Care Pathway (DTCP) or regional guidelines: (a) the role of the FP for a timely suspicion of cognitive decline is fundamental; (b) when cognitive decline is suspected, the role of the FP is active in the diagnostic work-up; (c) FP's knowledge on pharmacological and non-pharmacological interventions is essential to improve the management of patients with cognitive decline. Results An overall improvement in diagnostic procedures and management of patients with cognitive decline by FPs after the intervention was observed. The number of visits per year performed by FPs increased, and the time interval between the first FP consultation and the diagnosis was optimized. Neuroleptic use significantly decreased, whereas the use of benzodiazepines remained steadily high. Non-pharmacological interventions, or use of support services, were underrepresented even in the post-intervention. Differences among the participating HAs were identified and discussed. Discussion Results from this study suggest the success of the educational intervention addressed to FPs in improving early detection and management of cognitive decline, highlighting the importance to continue medical education in this field. At the same time, further initiatives of care pathway dissemination and implementation should promote strategies to enhance interactions between primary and secondary care optimizing the collaboration between FPs and specialists.
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Affiliation(s)
| | - Elena Chipi
- Centre for Memory Disturbances, Section of Neurology, Lab of Clinical Neurochemistry, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | | | - Ambra Fiorani
- Laboratory of Neurology, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Giovanni Battista Frisoni
- Laboratory of Epidemiology and Neuroimaging, IRCCS San Giovanni di Dio - Fatebenefratelli, Brescia, Italy
- Memory Clinic, Geneva University Hospitals, Geneva, Switzerland
| | | | - Chiara Montanucci
- Centre for Memory Disturbances, Section of Neurology, Lab of Clinical Neurochemistry, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Cristina Muscio
- ASST Bergamo Ovest - Azienda Socio Sanitaria Territoriale di Bergamo Ovest, Bergamo, Italy
| | - Irene Pacifico
- Laboratory of Neuropsychiatry, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Silvia Pelizzari
- Centro per i Disturbi Cognitivi e le Demenze, Spedali Civili di Brescia, Brescia, Italy
| | - Daniela Perani
- Division of Neuroscience, San Raffaele Scientific Institute, San Raffaele University, Milan, Italy
| | - Fabrizio Piras
- Laboratory of Neuropsychiatry, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Luca Rozzini
- Centro per i Disturbi Cognitivi e le Demenze, Spedali Civili di Brescia, Brescia, Italy
| | - Sandro Sorbi
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
- Section of Psychology - Department of Neuroscience, Psychology, Drug Research and Child’s Health (NEUROFARBA), University of Florence, Florence, Italy
| | - Gianfranco Spalletta
- Laboratory of Neuropsychiatry, IRCCS Santa Lucia Foundation, Rome, Italy
- Division of Neuropsychiatry, Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States
| | | | | | - Lucilla Parnetti
- Centre for Memory Disturbances, Section of Neurology, Lab of Clinical Neurochemistry, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
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Battineni G, Chintalapudi N, Hossain MA, Losco G, Ruocco C, Sagaro GG, Traini E, Nittari G, Amenta F. Artificial Intelligence Models in the Diagnosis of Adult-Onset Dementia Disorders: A Review. Bioengineering (Basel) 2022; 9:370. [PMID: 36004895 PMCID: PMC9405227 DOI: 10.3390/bioengineering9080370] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 07/25/2022] [Accepted: 08/02/2022] [Indexed: 11/16/2022] Open
Abstract
Background: The progressive aging of populations, primarily in the industrialized western world, is accompanied by the increased incidence of several non-transmittable diseases, including neurodegenerative diseases and adult-onset dementia disorders. To stimulate adequate interventions, including treatment and preventive measures, an early, accurate diagnosis is necessary. Conventional magnetic resonance imaging (MRI) represents a technique quite common for the diagnosis of neurological disorders. Increasing evidence indicates that the association of artificial intelligence (AI) approaches with MRI is particularly useful for improving the diagnostic accuracy of different dementia types. Objectives: In this work, we have systematically reviewed the characteristics of AI algorithms in the early detection of adult-onset dementia disorders, and also discussed its performance metrics. Methods: A document search was conducted with three databases, namely PubMed (Medline), Web of Science, and Scopus. The search was limited to the articles published after 2006 and in English only. The screening of the articles was performed using quality criteria based on the Newcastle-Ottawa Scale (NOS) rating. Only papers with an NOS score ≥ 7 were considered for further review. Results: The document search produced a count of 1876 articles and, because of duplication, 1195 papers were not considered. Multiple screenings were performed to assess quality criteria, which yielded 29 studies. All the selected articles were further grouped based on different attributes, including study type, type of AI model used in the identification of dementia, performance metrics, and data type. Conclusions: The most common adult-onset dementia disorders occurring were Alzheimer's disease and vascular dementia. AI techniques associated with MRI resulted in increased diagnostic accuracy ranging from 73.3% to 99%. These findings suggest that AI should be associated with conventional MRI techniques to obtain a precise and early diagnosis of dementia disorders occurring in old age.
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Affiliation(s)
- Gopi Battineni
- Clinical Research Centre, School of Medicinal and Health Products Sciences, University of Camerino, 62032 Camerino, Italy
| | - Nalini Chintalapudi
- Clinical Research Centre, School of Medicinal and Health Products Sciences, University of Camerino, 62032 Camerino, Italy
| | - Mohammad Amran Hossain
- Clinical Research Centre, School of Medicinal and Health Products Sciences, University of Camerino, 62032 Camerino, Italy
| | - Giuseppe Losco
- School of Architecture and Design, University of Camerino, 63100 Ascoli Piceno, Italy
| | - Ciro Ruocco
- Clinical Research Centre, School of Medicinal and Health Products Sciences, University of Camerino, 62032 Camerino, Italy
| | - Getu Gamo Sagaro
- Clinical Research Centre, School of Medicinal and Health Products Sciences, University of Camerino, 62032 Camerino, Italy
| | - Enea Traini
- Clinical Research Centre, School of Medicinal and Health Products Sciences, University of Camerino, 62032 Camerino, Italy
| | - Giulio Nittari
- Clinical Research Centre, School of Medicinal and Health Products Sciences, University of Camerino, 62032 Camerino, Italy
| | - Francesco Amenta
- Clinical Research Centre, School of Medicinal and Health Products Sciences, University of Camerino, 62032 Camerino, Italy
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Gallegos M, Morgan ML, Cervigni M, Martino P, Murray J, Calandra M, Razumovskiy A, Caycho-Rodríguez T, Gallegos WLA. 45 Years of the mini-mental state examination (MMSE): A perspective from ibero-america. Dement Neuropsychol 2022; 16:384-387. [DOI: 10.1590/1980-5764-dn-2021-0097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 03/31/2022] [Accepted: 05/03/2022] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT The Mini-Mental State Examination (MMSE) was created by Marshal Folstein et al. in 1975 as an instrument for brief (5–10 min) assessment of mental status in hospitalized patients. It is considered the most widely used test for standardized cognitive assessment in the clinical setting, especially with the elderly population. It has countless translations in different languages, and according to the different international (PubMed) and regional (SciELO, Redalyc, and Dialnet) scientific databases, it has been widely used by the scientific community. This article describes the historical evolution of the MMSE, highlights its evaluative properties, and provides bibliometric data on its impact on scientific publications, with a special focus on Ibero-America.
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Affiliation(s)
- Miguel Gallegos
- Universidad Católica del Maule, Chile; Pontifícia Universidade Católica de Minas Gerais, Brazil; Consejo Nacional de Investigaciones Científicas y Técnicas, Argentina; Universidad Nacional de Rosario, Argentina
| | | | - Mauricio Cervigni
- Consejo Nacional de Investigaciones Científicas y Técnicas, Argentina; Universidad Nacional de Rosario, Argentina
| | - Pablo Martino
- Consejo Nacional de Investigaciones Científicas y Técnicas, Argentina; Universidad Nacional de Rosario, Argentina
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Chepke C, Shaughnessy LW, Brunton S, Farmer JG, Rosenzweig AS, Grossberg GT, Wright WL. Using Telemedicine to Assess and Manage Psychosis Among Outpatients with Neurodegenerative Disease. Int J Gen Med 2021; 14:10271-10280. [PMID: 34992442 PMCID: PMC8711560 DOI: 10.2147/ijgm.s335739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 12/03/2021] [Indexed: 11/23/2022] Open
Abstract
The presence of hallucinations and delusions in patients with neurodegenerative disease correlates negatively with function, cognition, quality of life, and survival. When these patients still have insight, the treatment of mild hallucinations may reduce the risk of progression to more severe symptoms, specifically hallucinations without insight or delusions. On October 22, 2020, a multidisciplinary consensus panel comprising United States-based experts in geriatric psychiatry, geriatric medicine, family medicine, movement disorders, and neuropsychology was convened remotely to discuss best practices for using telemedicine to evaluate, diagnose, and treat psychosis in patients with neurodegenerative diseases. This review reflects the opinions and recommendations discussed at this meeting. Despite drawbacks, telemedicine can offer several advantages over in-person care, particularly for older adults, and may be a unique opportunity for care of patients with neuropsychiatric symptoms. While telemedicine may not be suitable for all patients, it allows the involvement of specialists from multiple geographic locations and the extension of care to homebound individuals. Patients with neurodegenerative diseases who are likely to become homebound as the disease advances may benefit greatly from telemedicine as a standard of care. Healthcare provided via telemedicine should be nothing less than what would be offered to the patient in person. Telemedicine may present some difficulties, including technological issues and inherent constraints of remote care, but with proper planning many problems could be diminished. Technical issues associated with telemedicine are inevitable but may be partially offset by providing clear directions ahead of any tele-visit to ensure connectivity and access to the videoconferencing platform. Alternative procedures to communicate should be established in the eventuality of technological issues. Using these strategies, telemedicine can serve as a valuable complement to traditional in-person practices for the diagnosis and management of hallucinations and delusions associated with Parkinson’s disease psychosis or dementia-related psychosis.
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Affiliation(s)
- Craig Chepke
- Excel Psychiatric Associates, Huntersville, NC, USA
- Atrium Health, Charlotte, NC, USA
- University of North Carolina School of Medicine, Chapel Hill, NC, USA
- Correspondence: Craig Chepke Email
| | - Lynn W Shaughnessy
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Stephen Brunton
- Primary Care Education Consortium, Winnsboro, SC, USA
- Department of Family Medicine, Touro University, Vallejo, CA, USA
| | - Jill G Farmer
- Parkinson’s Disease and Movement Disorder Program, Center for Neurosciences, Robert Wood Johnson University Hospital Hamilton, Lawrenceville, NJ, USA
- Department of Emergency Medicine, Drexel College of Medicine, Philadelphia, PA, USA
| | | | - George T Grossberg
- Department of Psychiatry, St. Louis University School of Medicine, St. Louis, MO, USA
| | - Wendy L Wright
- Wright & Associates Family Health Care, Concord and Amherst, NH, USA
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14
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Tsagkaris C, Desse D, Laskaratou ED. Mental health sequelae of bone cancer: A narrative review. Ment Health (Lond) 2021. [DOI: 10.32437/mhgcj.v4i1.132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Introduction: Bone cancer causes a significant mental health burden. Although the mental health implications of cancer as a whole have been widely discussed, there is limited evidence regarding the psychiatric and psychological sequelae of malignant and benign bone neoplasms in particular.
Purpose: To summarize the scientific literature, present relevant knowledge gaps and discuss a number of recommendations. Methodology: The authors searched Pubmed/Medline and Google Scholar with keywords (mental health, bone cancer, musculoskeletal neoplasms, psychiatric comorbidities). When appropriate, MeSH terms and Boolean operators were used. Relevant peer reviewed studies published in English, French or German until 05 May 2021 were included.
Results and Discussion: Loss of mobility, decrease of physical activity, chronic pain and amputations in combination with patient’s previous psychiatric history, socioeconomic conditions, cancer biology and treatment-related side effects undermine the mental wellbeing of patients and carers. Since March 2020, the COVID-19 pandemic has posed an additional burden, which is yet to be comprehensively evaluated.
Conclusion: More research and solid action towards the integration of mental health care into the management of bone cancer is crucial
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