Feasibility and Efficacy of Online Neuropsychological Assessment

Large-scale evidence for the validity of remote MoCA administration among people with cerebellar ataxia

Objective: For over half a century, studies of rare diseases using in-person cognitive tools have faced challenges, such as long study periods and small sample sizes (e.g. n = 10). The Montreal Cognitive Assessment (MoCA) was widely employed to assess mild cognitive impairment (MCI). We aimed to validate a modified online version of the MoCA in a large sample of a rare disease (population prevalence < .01%). Method: First, we analyzed 20 previous findings (n = 1,377), comparing the MoCA scores between large groups of neurotypically healthy (NH; n = 837) and cerebellar ataxia (CA; n = 540), where studies were conducted in-person. Second, we administered the MoCA in-person to a group of NH (n = 41) and a large group of CA (n = 103). Third, we administered a video conferencing version of the MoCA to NH (n = 38) and a large group of CA (n = 83). Results: We observed no performance differences between online and in-person MoCA administration in the NH and CA groups (p > .05, η2 = 0.001), supporting reliability. Additionally, our online CA group had lower MoCA scores than the NH group (p < .001, Hedges' g = 0.68). This result is consistent with previous studies, as demonstrated by our forest plot across 20 previous in-person findings, supporting construct validity. Conclusion: The results indicate that an online screening tool is valid in a large sample of individuals with CA. Online testing is not only time and cost-effective, but facilitates disease management and monitoring, ultimately enabling early detection of MCI.

Online cognitive testing in Parkinson's disease: advantages and challenges

Parkinson's disease (PD) is primarily characterized by motor symptoms. Yet, many people with PD experience cognitive decline, which is often unnoticed by clinicians, although it may have a significant impact on quality of life. For over half a century, traditional in-person PD cognitive assessment lacked accessibility, scalability, and specificity due to its inherent limitations. In this review, we propose that novel methods of online cognitive assessment could potentially address these limitations. We first outline the challenges of traditional in-person cognitive testing in PD. We then summarize the existing literature on online cognitive testing in PD. Finally, we explore the advantages, but also the limitations, of three major processes involved in online PD cognitive testing: recruitment and sampling methods, measurement and participation, and disease monitoring and management. Taking the limitations into account, we aim to highlight the potential of online cognitive testing as a more accessible and efficient approach to cognitive testing in PD.

Distinct Contributions of the Cerebellum and Basal Ganglia to Arithmetic Procedures

Humans exhibit complex mathematical skills attributed to the exceptional enlargement of neocortical regions throughout evolution. In the current work, we initiated a novel exploration of the ancient subcortical neural network essential for mathematical cognition. Using a neuropsychological approach, we report that degeneration of two subcortical structures, the cerebellum and basal ganglia, impairs performance in symbolic arithmetic. We identify distinct computational impairments in male and female participants with cerebellar degeneration (CD) or Parkinson's disease (PD). The CD group exhibited a disproportionate cost when the arithmetic sum increased, suggesting that the cerebellum is critical for iterative procedures required for calculations. The PD group showed a disproportionate cost for equations with increasing addends, suggesting that the basal ganglia are critical for chaining multiple operations. In Experiment 2, the two patient groups exhibited intact practice gains for repeated equations at odds with an alternative hypothesis that these impairments were related to memory retrieval. Notably, we discuss how the counting and chaining operations relate to cerebellar and basal ganglia function in other task domains (e.g., motor processes). Overall, we provide a novel perspective on how the cerebellum and basal ganglia contribute to symbolic arithmetic. Our studies demonstrate the constraints on the computational role of two subcortical regions in higher cognition.

Remote assessment of cognition in Parkinson's disease and Cerebellar Ataxia: the MoCA test in English and Hebrew

There is a critical need for accessible neuropsychological testing for basic research and translational studies worldwide. Traditional in-person neuropsychological studies are inherently difficult to conduct because testing requires the recruitment and participation of individuals with neurological conditions. Consequently, studies are often based on small sample sizes, are highly time-consuming, and lack diversity. To address these challenges, in the last decade, the utilization of remote testing platforms has demonstrated promising results regarding the feasibility and efficiency of collecting patient data online. Herein, we tested the validity and generalizability of remote administration of the Montreal Cognitive Assessment (MoCA) test. We administered the MoCA to English and Hebrew speakers from three different populations: Parkinson's disease, Cerebellar Ataxia, and healthy controls via video conferencing. First, we found that the online MoCA scores do not differ from traditional in-person studies, demonstrating convergent validity. Second, the MoCA scores of both our online patient groups were lower than controls, demonstrating construct validity. Third, we did not find differences between the two language versions of the remote MoCA, supporting its generalizability to different languages and the efficiency of collecting binational data (USA and Israel). Given these results, future studies can utilize the remote MoCA, and potentially other remote neuropsychological tests to collect data more efficiently across multiple different patient populations, language versions, and nations.

Contributions of Lower Structures to Higher Cognition: Towards a Dynamic Network Model

Researchers often attribute higher cognition to the enlargement of cortical regions throughout evolution, reflecting the belief that humans sit at the top of the cognitive pyramid. Implicitly, this approach assumes that the subcortex is of secondary importance for higher-order cognition. While it is now recognized that subcortical regions can be involved in various cognitive domains, it remains unclear how they contribute to computations essential for higher-level cognitive processes such as endogenous attention and numerical cognition. Herein, we identify three models of subcortical-cortical relations in these cognitive processes: (i) subcortical regions are not involved in higher cognition; (ii) subcortical computations support elemental forms of higher cognition mainly in species without a developed cortex; and (iii) higher cognition depends on a whole-brain dynamic network, requiring integrated cortical and subcortical computations. Based on evolutionary theories and recent data, we propose the SEED hypothesis: the Subcortex is Essential for the Early Development of higher cognition. According to the five principles of the SEED hypothesis, subcortical computations are essential for the emergence of cognitive abilities that enable organisms to adapt to an ever-changing environment. We examine the implications of the SEED hypothesis from a multidisciplinary perspective to understand how the subcortex contributes to various forms of higher cognition.