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Libon DJ, Matusz EF, Cosentino S, Price CC, Swenson R, Vermeulen M, Ginsberg TB, Okoli-Umeweni AO, Powell L, Nagele R, Tobyne S, Gomes-Osman JR, Pascual-Leone A. Using digital assessment technology to detect neuropsychological problems in primary care settings. Front Psychol 2023; 14:1280593. [PMID: 38046126 PMCID: PMC10693332 DOI: 10.3389/fpsyg.2023.1280593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 10/23/2023] [Indexed: 12/05/2023] Open
Abstract
Introduction Screening for neurocognitive impairment and psychological distress in ambulatory primary and specialty care medical settings is an increasing necessity. The Core Cognitive Evaluation™ (CCE) is administered/scored using an iPad, requires approximately 8 min, assesses 3- word free recall and clock drawing to command and copy, asks questions about lifestyle and health, and queries for psychological distress. This information is linked with patients' self- reported concerns about memory and their cardiovascular risks. Methods A total of 199 ambulatory patients were screened with the CCE as part of their routine medical care. The CCE provides several summary indices, and scores on 44 individual digital clock variables across command and copy tests conditions. Results Subjective memory concerns were endorsed by 41% of participants. Approximately 31% of participants reported psychological distress involving loneliness, anxiety, or depression. Patients with self-reported memory concerns scored lower on a combined delay 3- word/ clock drawing index (p < 0.016), the total summary clock drawing command/ copy score (p < 0.050), and clock drawing to command Drawing Efficiency (p < 0.036) and Simple and Complex Motor (p < 0.029) indices. Patients treated for diabetes and atherosclerotic cardiovascular disease (ASCVD) scored lower on selected CCE outcome measures (p < 0.035). Factor analyses suggest that approximately 10 underlying variables can explain digital clock drawing performance. Discussion The CCE is a powerful neurocognitive assessment tool that is sensitive to patient's subjective concerns about possible decline in memory, mood symptoms, possible cognitive impairment, and cardiovascular risk. iPad administration ensures total reliability for test administration and scoring. The CCE is easily deployable in outpatient ambulatory primary care settings.
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Affiliation(s)
- David J. Libon
- School of Osteopathic Medicine, New Jersey Institute for Successful Aging, Rowan University, Stratford, NJ, United States
- Department of Psychology, Rowan University, Glassboro, NJ, United States
| | - Emily Frances Matusz
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, United States
| | - Stephanie Cosentino
- Cognitive Neuroscience Division, Department of Neurology, Taub Institute and Sergievsky Center, Columbia University Medical Center, New York, NY, United States
| | - Catherine C. Price
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, United States
| | - Rod Swenson
- School of Medicine and Health Sciences, University of North Dakota, Grand Forks, ND, United States
| | - Meagan Vermeulen
- Department of Family Practice, School of Osteopathic Medicine, Rowan University, Stratford, NJ, United States
| | - Terrie Beth Ginsberg
- School of Osteopathic Medicine, New Jersey Institute for Successful Aging, Rowan University, Stratford, NJ, United States
| | - Adaora Obiageli Okoli-Umeweni
- School of Osteopathic Medicine, New Jersey Institute for Successful Aging, Rowan University, Stratford, NJ, United States
| | - Leonard Powell
- School of Osteopathic Medicine, New Jersey Institute for Successful Aging, Rowan University, Stratford, NJ, United States
| | - Robert Nagele
- School of Osteopathic Medicine, New Jersey Institute for Successful Aging, Rowan University, Stratford, NJ, United States
| | | | | | - Alvaro Pascual-Leone
- Linus Health, Boston, MA, United States
- Sidney Wolk Center for Memory Health, and Eleanor and Herbert Bearak Memory Wellness for Life Program, Hinda and Arthur Marcus Institute for Aging Research and Deanna, Hebrew SeniorLife, Boston, MA, United States
- Department of Neurology and Harvard Medical School, Boston, MA, United States
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Zhang J, Bandyopadhyay S, Kimmet F, Wittmayer J, Khezeli K, Libon DJ, Price CC, Rashidi P. FaIRClocks: Fair and Interpretable Representation of the Clock Drawing Test for mitigating classifier bias against lower educational groups. RESEARCH SQUARE 2023:rs.3.rs-3398970. [PMID: 37886534 PMCID: PMC10602062 DOI: 10.21203/rs.3.rs-3398970/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
The clock drawing test (CDT) is a neuropsychological assessment tool to evaluate a patient's cognitive ability. In this study, we developed a Fair and Interpretable Representation of Clock drawing tests (FaIRClocks) to evaluate and mitigate bias against people with lower education while predicting their cognitive status. We represented clock drawings with a 10-dimensional latent embedding using Relevance Factor Variational Autoencoder (RF-VAE) network pretrained on publicly available clock drawings from the National Health and Aging Trends Study (NHATS) dataset. These embeddings were later fine-tuned for predicting three cognitive scores: the Mini-Mental State Examination (MMSE) total score, attention composite z-score (ATT-C), and memory composite z-score (MEM-C). The classifiers were initially tested to see their relative performance in patients with low education (<= 8 years) versus patients with higher education (> 8 years). Results indicated that the initial unweighted classifiers confounded lower education with cognitive impairment, resulting in a 100% type I error rate for this group. Thereby, the samples were re-weighted using multiple fairness metrics to achieve balanced performance. In summary, we report the FaIRClocks model, which a) can identify attention and memory deficits using clock drawings and b) exhibits identical performance between people with higher and lower education levels.
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Affiliation(s)
- Jiaqing Zhang
- Department of Electrical and Computer Engineering, University of Florida
- Perioperative Cognitive Anesthesia Network, University of Florida
| | - Sabyasachi Bandyopadhyay
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida
- Perioperative Cognitive Anesthesia Network, University of Florida
| | - Faith Kimmet
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida
- Department of Anesthesiology, College of Medicine, University of Florida
| | - Jack Wittmayer
- Intelligent Critical Care Center (IC3), University of Florida
| | - Kia Khezeli
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida
- Intelligent Critical Care Center (IC3), University of Florida
| | - David J. Libon
- Department of Anesthesiology, College of Medicine, University of Florida
| | - Catherine C. Price
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida
- Department of Anesthesiology, College of Medicine, University of Florida
- Perioperative Cognitive Anesthesia Network, University of Florida
| | - Parisa Rashidi
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida
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Bandyopadhyay S, Wittmayer J, Libon DJ, Tighe P, Price C, Rashidi P. Explainable semi-supervised deep learning shows that dementia is associated with small, avocado-shaped clocks with irregularly placed hands. Sci Rep 2023; 13:7384. [PMID: 37149670 PMCID: PMC10164161 DOI: 10.1038/s41598-023-34518-9] [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: 09/24/2022] [Accepted: 05/03/2023] [Indexed: 05/08/2023] Open
Abstract
The clock drawing test is a simple and inexpensive method to screen for cognitive frailties, including dementia. In this study, we used the relevance factor variational autoencoder (RF-VAE), a deep generative neural network, to represent digitized clock drawings from multiple institutions using an optimal number of disentangled latent factors. The model identified unique constructional features of clock drawings in a completely unsupervised manner. These factors were examined by domain experts to be novel and not extensively examined in prior research. The features were informative, as they distinguished dementia from non-dementia patients with an area under receiver operating characteristic (AUC) of 0.86 singly, and 0.96 when combined with participants' demographics. The correlation network of the features depicted the "typical dementia clock" as having a small size, a non-circular or "avocado-like" shape, and incorrectly placed hands. In summary, we report a RF-VAE network whose latent space encoded novel constructional features of clocks that classify dementia from non-dementia patients with high performance.
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Affiliation(s)
- Sabyasachi Bandyopadhyay
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, USA
| | - Jack Wittmayer
- Department of Computer and Information Science and Engineering, University of Florida, Gainesville, USA
| | - David J Libon
- Department of Geriatrics and Gerontology, Department of Psychology, New Jersey Institute for Successful Aging, School of Osteopathic Medicine, Rowan University, Glassboro, USA
| | - Patrick Tighe
- Department of Anesthesiology, College of Medicine, University of Florida, Gainesville, USA
| | - Catherine Price
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, USA
| | - Parisa Rashidi
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, USA.
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Matusz EF, Price CC, Lamar M, Swenson R, Au R, Emrani S, Wasserman V, Libon DJ, Thompson LI. Dissociating Statistically Determined Normal Cognitive Abilities and Mild Cognitive Impairment Subtypes with DCTclock. J Int Neuropsychol Soc 2023; 29:148-158. [PMID: 35188095 DOI: 10.1017/s1355617722000091] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To determine whether the DCTclock can detect differences across groups of patients seen in the memory clinic for suspected dementia. METHOD Patients (n = 123) were classified into the following groups: cognitively normal (CN), subtle cognitive impairment (SbCI), amnestic cognitive impairment (aMCI), and mixed/dysexecutive cognitive impairment (mx/dysMCI). Nine outcome variables included a combined command/copy total score and four command and four copy indices measuring drawing efficiency, simple/complex motor operations, information processing speed, and spatial reasoning. RESULTS Total combined command/copy score distinguished between groups in all comparisons with medium to large effects. The mx/dysMCI group had the lowest total combined command/copy scores out of all groups. The mx/dysMCI group scored lower than the CN group on all command indices (p < .050, all analyses); and lower than the SbCI group on drawing efficiency (p = .011). The aMCI group scored lower than the CN group on spatial reasoning (p = .019). Smaller effect sizes were obtained for the four copy indices. CONCLUSIONS These results suggest that DCTclock command/copy parameters can dissociate CN, SbCI, and MCI subtypes. The larger effect sizes for command clock indices suggest these metrics are sensitive in detecting early cognitive decline. Additional research with a larger sample is warranted.
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Affiliation(s)
- Emily F Matusz
- Department of Geriatrics and Gerontology, New Jersey Institute for Successful Aging, School of Osteopathic Medicine, Rowan University, Stratford, NJ, USA
| | - Catherine C Price
- Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Melissa Lamar
- Department of Behavioral Sciences and the Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA
| | - Rod Swenson
- University of North Dakota School of Medicine and Health Sciences, Grand Forks, ND, USA
| | - Rhoda Au
- Boston University Schools of Medicine & Public Health, Boston, MA, USA
| | - Sheina Emrani
- Department of Psychology, Rowan University, Stratford, NJ, USA
| | | | - David J Libon
- Department of Geriatrics and Gerontology, New Jersey Institute for Successful Aging, School of Osteopathic Medicine, Rowan University, Stratford, NJ, USA
- Department of Psychology, Rowan University, Stratford, NJ, USA
| | - Louisa I Thompson
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
- Butler Hospital Memory & Aging Program, Providence, RI, USA
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Dion C, Tanner JJ, Libon DJ, Price CC. Contributions of Cardiovascular Burden, Peripheral Inflammation, and Brain Integrity on Digital Clock Drawing Performance in Non-Demented Older Adults. J Alzheimers Dis 2023; 95:453-467. [PMID: 37545230 PMCID: PMC10870342 DOI: 10.3233/jad-221011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Abstract
BACKGROUND Greater cardiovascular burden and peripheral inflammation are associated with dysexecutive neuropsychological profiles and a higher likelihood of conversion to vascular dementia. The digital clock drawing test (dCDT) is useful in identifying neuropsychological dysfunction related to vascular etiology. However, the specific cognitive implications of the combination of cardiovascular risk, peripheral inflammation, and brain integrity remain unknown. OBJECTIVE We aimed to examine the role of cardiovascular burden, inflammation, and MRI-defined brain integrity on dCDT latency and graphomotor metrics in older adults. METHODS 184 non-demented older adults (age 69±6, 16±3 education years, 46% female, 94% white) completed dCDT, vascular assessment, blood draw, and brain MRI. dCDT variables of interest: total completion time (TCT), pre-first hand latency, digit misplacement, hour hand distance from center, and clock face area. Cardiovascular burden was calculated using the Framingham Stroke Risk Profile (FSRP-10). Peripheral inflammation markers included interleukin (IL)-6, IL-8, IL-10, tumor necrosis factor-alpha, and high sensitivity C-reactive protein. Brain integrity included bilateral entorhinal cortex volume, lateral ventricular volume, and whole brain leukoaraiosis. RESULTS FSRP-10, peripheral inflammation, and brain integrity explained an additional 14.6% of the variance in command TCT, where FSRP-10 was the main predictor. FSRP-10, inflammatory markers, and brain integrity explained an additional 17.0% in command digit misplacement variance, with findings largely driven by FSRP-10. CONCLUSION Subtle graphomotor behavior operationalized using dCDT metrics (i.e., TCT and digit misplacement) is partly explained by cardiovascular burden, peripheral inflammation, and brain integrity and may indicate vulnerability to a disease process.
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Affiliation(s)
- Catherine Dion
- Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Jared J. Tanner
- Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - David J. Libon
- Department of Geriatrics and Gerontology, New Jersey Institute for Successful Aging, School of Osteopathic Medicine, Rowan University, Glassboro, NJ, USA
- Department of Psychology, Rowan University, Glassboro, NJ, USA
| | - Catherine C. Price
- Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
- Department of Anesthesiology, University of Florida, Gainesville, FL, USA
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Dion C, Tanner JJ, Formanski EM, Davoudi A, Rodriguez K, Wiggins ME, Amin M, Penney D, Davis R, Heilman KM, Garvan C, Libon DJ, Price CC. The functional connectivity and neuropsychology underlying mental planning operations: data from the digital clock drawing test. Front Aging Neurosci 2022; 14:868500. [PMID: 36204547 PMCID: PMC9530582 DOI: 10.3389/fnagi.2022.868500] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 08/12/2022] [Indexed: 11/13/2022] Open
Abstract
We examined the construct of mental planning by quantifying digital clock drawing digit placement accuracy in command and copy conditions, and by investigating its underlying neuropsychological correlates and functional connectivity. We hypothesized greater digit misplacement would associate with attention, abstract reasoning, and visuospatial function, as well as functional connectivity from a major source of acetylcholine throughout the brain: the basal nucleus of Meynert (BNM). Participants (n = 201) included non-demented older adults who completed all metrics within 24 h of one another. A participant subset met research criteria for mild cognitive impairment (MCI; n = 28) and was compared to non-MCI participants on digit misplacement accuracy and expected functional connectivity differences. Digit misplacement and a comparison dissociate variable of total completion time were acquired for command and copy conditions. a priori fMRI seeds were the bilateral BNM. Command digit misplacement is negatively associated with semantics, visuospatial, visuoconstructional, and reasoning (p's < 0.01) and negatively associated with connectivity from the BNM to the anterior cingulate cortex (ACC; p = 0.001). Individuals with MCI had more misplacement and less BNM-ACC connectivity (p = 0.007). Total completion time involved posterior and cerebellar associations only. Findings suggest clock drawing digit placement accuracy may be a unique metric of mental planning and provide insight into neurodegenerative disease.
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Affiliation(s)
- Catherine Dion
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, United States
| | - Jared J Tanner
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, United States
| | - Erin M Formanski
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, United States
| | - Anis Davoudi
- Department of Biomedical Engineering, University of Florida, Gainesville, FL, United States
| | - Katie Rodriguez
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, United States
| | - Margaret E Wiggins
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, United States
| | - Manish Amin
- Department of Physics, University of Florida, Gainesville, FL, United States
| | - Dana Penney
- Department of Neurology, Lahey Hospital and Medical Center, Burlington, MA, United States
| | - Randall Davis
- Computer Science and Artificial Intelligence Laboratory, MIT, Cambridge, MA, United States
| | - Kenneth M Heilman
- Department of Neurology, University of Florida, & North Florida/South Georgia Veterans Affairs Medical Center, Gainesville, FL, United States
| | - Cynthia Garvan
- Department of Anesthesiology, University of Florida, Gainesville, FL, United States
| | - David J Libon
- Department of Anesthesiology, University of Florida, Gainesville, FL, United States
- Department of Geriatrics and Gerontology, New Jersey Institute for Successful Aging, School of Osteopathic Medicine, Rowan University, Glassboro, NJ, United States
| | - Catherine C Price
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, United States
- Department of Psychology, Rowan University, Glassboro, NJ, United States
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Libon DJ, Swenson R, Lamar M, Price CC, Baliga G, Pascual-Leone A, Au R, Cosentino S, Andersen SL. The Boston Process Approach and Digital Neuropsychological Assessment: Past Research and Future Directions. J Alzheimers Dis 2022; 87:1419-1432. [PMID: 35466941 DOI: 10.3233/jad-220096] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Neuropsychological assessment using the Boston Process Approach (BPA) suggests that an analysis of the strategy or the process by which tasks and neuropsychological tests are completed, and the errors made during test completion convey much information regarding underlying brain and cognition and are as important as overall summary scores. Research over the last several decades employing an analysis of process and errors has been able to dissociate between dementia patients diagnosed with Alzheimer's disease, vascular dementia associated with MRI-determined white matter alterations, and Parkinson's disease; and between mild cognitive impairment subtypes. Nonetheless, BPA methods can be labor intensive to deploy. However, the recent availability of digital platforms for neuropsychological test administration and scoring now enables reliable, rapid, and objective data collection. Further, digital technology can quantify highly nuanced data previously unobtainable to define neurocognitive constructs with high accuracy. In this paper, a brief review of the BPA is provided. Studies that demonstrate how digital technology translates BPA into specific neurocognitive constructs using the Clock Drawing Test, Backward Digit Span Test, and a Digital Pointing Span Test are described. Implications for using data driven artificial intelligence-supported analytic approaches enabling the creation of more sensitive and specific detection/diagnostic algorithms for putative neurodegenerative illness are also discussed.
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Affiliation(s)
- David J Libon
- New Jersey Institute for Successful Aging, Rowan University, School of Osteopathic Medicine, NJ, USA
| | - Rod Swenson
- Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Grand Forks, ND, USA
| | - Melissa Lamar
- Rush Alzheimer's Disease Center and the Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Catherine C Price
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Ganesh Baliga
- Department of Computer Science, Rowan University, Glassboro, NJ, USA
| | - Alvaro Pascual-Leone
- Hinda and Arthur Marcus Institute for Aging Research and Deanna and Sidney Wolk Center for Memory Health, Hebrew Senior Life, Boston, MA, USA.,Department of Neurology, Harvard Medical School, Boston, MA, USA.,Guttmann Brain Health Institute, Barcelona, Spain
| | - Rhoda Au
- Departments of Anatomy & Neurobiology and Neurology; Framingham Heart Study, Slone Epidemiology Center and Alzheimer's Disease Research Center, Boston University School of Medicine, Boston, MA, USA.,Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Stephanie Cosentino
- Department of Neurology, Taub Institute and Sergievsky Center, Cognitive Neuroscience Division, Columbia University Medical Center, New York, NY, USA
| | - Stacy L Andersen
- Department of Medicine, Boston University School of Medicine, Boston, MA, USA
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Bandyopadhyay S, Dion C, Libon DJ, Price C, Tighe P, Rashidi P. Variational autoencoder provides proof of concept that compressing CDT to extremely low-dimensional space retains its ability of distinguishing dementia. Sci Rep 2022; 12:7992. [PMID: 35568709 PMCID: PMC9107463 DOI: 10.1038/s41598-022-12024-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 04/06/2022] [Indexed: 11/08/2022] Open
Abstract
The clock drawing test (CDT) is an inexpensive tool to screen for dementia. In this study, we examined if a variational autoencoder (VAE) with only two latent variables can capture and encode clock drawing anomalies from a large dataset of unannotated CDTs (n = 13,580) using self-supervised pre-training and use them to classify dementia CDTs (n = 18) from non-dementia CDTs (n = 20). The model was independently validated using a larger cohort consisting of 41 dementia and 50 non-dementia clocks. The classification model built with the parsimonious VAE latent space adequately classified dementia from non-dementia (0.78 area under receiver operating characteristics (AUROC) in the original test dataset and 0.77 AUROC in the secondary validation dataset). The VAE-identified atypical clock features were then reviewed by domain experts and compared with existing literature on clock drawing errors. This study shows that a very small number of latent variables are sufficient to encode important clock drawing anomalies that are predictive of dementia.
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Affiliation(s)
- Sabyasachi Bandyopadhyay
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, USA
| | - Catherine Dion
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, USA
| | - David J Libon
- Department of Geriatrics and Gerontology, Department of Psychology, New Jersey Institute for Successful Aging, School of Osteopathic Medicine, Rowan University, Glassboro, USA
| | - Catherine Price
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, USA
| | - Patrick Tighe
- Department of Anesthesiology, College of Medicine, University of Florida, Gainesville, USA
| | - Parisa Rashidi
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, USA.
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Price CC. The New Frontier of Perioperative Cognitive Medicine for Alzheimer's Disease and Related Dementias. Neurotherapeutics 2022; 19:132-142. [PMID: 35084722 PMCID: PMC9130373 DOI: 10.1007/s13311-021-01180-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2021] [Indexed: 01/03/2023] Open
Abstract
This is a review of preoperative cognitive assessment and other healthcare gaps in the care of older adults at risk for Alzheimer's disease and related dementias (ADRD) who have elected surgery with anesthesia. It summarizes concerns regarding ADRD perioperative healthcare, perioperative cognitive, and neuronal domains of vulnerability. It also offers a plan for phased preoperative cognitive screening and perioperative cognitive intervention opportunities. An argument is made for why medical professionals in the perioperative setting need fundamental training in cognitive-behavioral principles, an understanding of neurodegenerative diseases of aging, and an appreciation of the immediate and long-term medical risks for such patients undergoing anesthesia. The author's goal is to encourage readers to consider perioperative cognitive medicine as a new frontier for generating evidence-based care approaches for at-risk older adults with neurodegenerative disorders who require procedures with anesthesia.
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Affiliation(s)
- Catherine C Price
- Clinical and Health Psychology, Anesthesiology, University of Florida, Gainesville, FL, USA.
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Torres-Castro S, Mena-Montes B, González-Ambrosio G, Zubieta-Zavala A, Torres-Carrillo NM, Acosta-Castillo GI, Espinel-Bermúdez MC. Spanish-language screening scales: A critical review. Neurologia 2022; 37:53-60. [PMID: 29753565 DOI: 10.1016/j.nrl.2018.03.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 02/26/2018] [Accepted: 03/01/2018] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Dementia is a chronic, degenerative disease with a strong impact on families and health systems. The instruments currently in use for measuring cognitive impairment have different psychometric characteristics in terms of application time, cut-off point, reliability, and validity. The objective of this review is to describe the characteristics of the validated, Spanish-language versions of the Mini-Cog, Clock-Drawing Test, and Mini-Mental State Examination scales for cognitive impairment screening. DEVELOPMENT We performed a three-stage literature search of articles published on Medline since 1953. We selected articles on validated, Spanish-language versions of the scales that included data on reliability, validity, sensitivity, and specificity. CONCLUSIONS The 3 screening tools assessed in this article provide support for primary care professionals. Timely identification of mild cognitive impairment and dementia is crucial for the prognosis of these patients.
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Affiliation(s)
- S Torres-Castro
- Instituto Nacional de Geriatría, Institutos Nacionales de Salud de México, Secretaría de Salud, Ciudad de México, México.
| | - B Mena-Montes
- Instituto Nacional de Geriatría, Institutos Nacionales de Salud de México, Secretaría de Salud, Ciudad de México, México
| | - G González-Ambrosio
- Instituto Nacional de Geriatría, Institutos Nacionales de Salud de México, Secretaría de Salud, Ciudad de México, México
| | - A Zubieta-Zavala
- Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, México
| | - N M Torres-Carrillo
- Departamento de Microbiología y Patología, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, México
| | - G I Acosta-Castillo
- Instituto Nacional de Neurología y Neurocirugía, Institutos Nacionales de Salud de México, Secretaría de Salud, Ciudad de México, México
| | - M C Espinel-Bermúdez
- Unidad de Investigación Médica en Epidemiología Clínica, Instituto Mexicano del Seguro Social, Guadalajara, México
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Yuan J, Au R, Karjadi C, Ang TF, Devine S, Auerbach S, DeCarli C, Libon DJ, Mez J, Lin H. Associations Between the Digital Clock Drawing Test and Brain Volume: Large Community-Based Prospective Cohort (Framingham Heart Study) (Preprint). J Med Internet Res 2021; 24:e34513. [PMID: 35436225 PMCID: PMC9055470 DOI: 10.2196/34513] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 02/08/2022] [Accepted: 03/13/2022] [Indexed: 11/22/2022] Open
Abstract
Background The digital Clock Drawing Test (dCDT) has been recently used as a more objective tool to assess cognition. However, the association between digitally obtained clock drawing features and structural neuroimaging measures has not been assessed in large population-based studies. Objective We aimed to investigate the association between dCDT features and brain volume. Methods This study included participants from the Framingham Heart Study who had both a dCDT and magnetic resonance imaging (MRI) scan, and were free of dementia or stroke. Linear regression models were used to assess the association between 18 dCDT composite scores (derived from 105 dCDT raw features) and brain MRI measures, including total cerebral brain volume (TCBV), cerebral white matter volume, cerebral gray matter volume, hippocampal volume, and white matter hyperintensity (WMH) volume. Classification models were also built from clinical risk factors, dCDT composite scores, and MRI measures to distinguish people with mild cognitive impairment (MCI) from those whose cognition was intact. Results A total of 1656 participants were included in this study (mean age 61 years, SD 13 years; 50.9% women), with 23 participants diagnosed with MCI. All dCDT composite scores were associated with TCBV after adjusting for multiple testing (P value <.05/18). Eleven dCDT composite scores were associated with cerebral white matter volume, but only 1 dCDT composite score was associated with cerebral gray matter volume. None of the dCDT composite scores was associated with hippocampal volume or WMH volume. The classification model for differentiating MCI and normal cognition participants, which incorporated age, sex, education, MRI measures, and dCDT composite scores, showed an area under the curve of 0.897. Conclusions dCDT composite scores were significantly associated with multiple brain MRI measures in a large community-based cohort. The dCDT has the potential to be used as a cognitive assessment tool in the clinical diagnosis of MCI.
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Affiliation(s)
- Jing Yuan
- Department of Neurology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
- Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston University, Boston, MA, United States
| | - Rhoda Au
- Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston University, Boston, MA, United States
- Framingham Heart Study, Boston University School of Medicine, Boston University, Boston, MA, United States
- Department of Neurology, Boston University School of Medicine, Boston University, Boston, MA, United States
- Department of Epidemiology, Boston University School of Public Health, Boston University, Boston, MA, United States
- Slone Epidemiology Center, Boston University School of Medicine, Boston University, Boston, MA, United States
- Alzheimer's Disease Research Center, Boston University, Boston, MA, United States
| | - Cody Karjadi
- Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston University, Boston, MA, United States
- Framingham Heart Study, Boston University School of Medicine, Boston University, Boston, MA, United States
| | - Ting Fang Ang
- Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston University, Boston, MA, United States
- Framingham Heart Study, Boston University School of Medicine, Boston University, Boston, MA, United States
- Slone Epidemiology Center, Boston University School of Medicine, Boston University, Boston, MA, United States
| | - Sherral Devine
- Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston University, Boston, MA, United States
- Framingham Heart Study, Boston University School of Medicine, Boston University, Boston, MA, United States
| | - Sanford Auerbach
- Framingham Heart Study, Boston University School of Medicine, Boston University, Boston, MA, United States
- Department of Neurology, Boston University School of Medicine, Boston University, Boston, MA, United States
| | - Charles DeCarli
- Department of Neurology and Center for Neuroscience, University of California, Davis, Sacramento, CA, United States
| | - David J Libon
- Department of Geriatrics and Gerontology and Department of Psychology, New Jersey Institute for Successful Aging, Rowan University, School of Osteopathic Medicine, Stratford, NJ, United States
| | - Jesse Mez
- Framingham Heart Study, Boston University School of Medicine, Boston University, Boston, MA, United States
- Department of Neurology, Boston University School of Medicine, Boston University, Boston, MA, United States
- Alzheimer's Disease Research Center, Boston University, Boston, MA, United States
| | - Honghuang Lin
- Division of Clinical Informatics, Department of Medicine, University of Massachusetts Chan Medical School, Worcester, MA, United States
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12
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Hammers DB, Gradwohl BD, Kucera A, Abildskov TJ, Wilde EA, Spencer RJ. Preliminary Validation of the Learning Ratio for the HVLT-R and BVMT-R in Older Adults. Cogn Behav Neurol 2021; 34:170-181. [PMID: 34473668 DOI: 10.1097/wnn.0000000000000277] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 10/13/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND The learning slope is typically represented as the raw difference between the final score and the score of the first learning trial. A new method for calculating the learning slope, the learning ratio (LR), was recently developed; it is typically represented as the number of items that are learned after the first trial divided by the number of items that are yet to be learned. OBJECTIVE To evaluate the convergent and criterion validity of the LR in order to understand its sensitivity to Alzheimer disease (AD) pathology. METHOD Fifty-six patients from a memory clinic underwent standard neuropsychological assessment and quantitative brain imaging. LR scores were calculated from the Hopkins Verbal Learning Test-Revised and the Brief Visuospatial Memory Test-Revised and were compared with both standard memory measures and total hippocampal volumes, as well as between individuals with AD and those with mild cognitive impairment. RESULTS Lower LR scores were consistently associated with poorer performances on standard memory measures and smaller total hippocampal volumes, generally more so than traditional learning slope scores. The LR scores of the AD group were smaller than those of the group with mild cognitive impairment. Furthermore, the aggregation of LR scores into a single metric was partially supported. CONCLUSION The LR is sensitive to AD pathology along the AD continuum. This result supports previous claims that the LR score can reflect learning capacity better than traditional learning calculations can by considering the amount of information that is learned at trial 1.
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Affiliation(s)
- Dustin B Hammers
- Center for Alzheimer's Care, Imaging, and Research, Department of Neurology, University of Utah, Salt Lake City, Utah
| | - Brian D Gradwohl
- Mental Health Service, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
- Department of Psychiatry, Neuropsychology Section, Michigan Medicine, Ann Arbor, Michigan
| | | | - Tracy J Abildskov
- Traumatic Brain Injury and Concussion Center, Department of Neurology, University of Utah, Salt Lake City, Utah
| | - Elisabeth A Wilde
- Traumatic Brain Injury and Concussion Center, Department of Neurology, University of Utah, Salt Lake City, Utah
- George E. Whalen Veterans Affairs Medical Center, Salt Lake City, Utah
| | - Robert J Spencer
- Mental Health Service, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
- Department of Psychiatry, Neuropsychology Section, Michigan Medicine, Ann Arbor, Michigan
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13
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Libon DJ, Baliga G, Swenson R, Au R. Digital Neuropsychological Assessment: New Technology for Measuring Subtle Neuropsychological Behavior. J Alzheimers Dis 2021; 82:1-4. [PMID: 34219670 DOI: 10.3233/jad-210513] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Technology has transformed the science and practice of medicine. In this special mini-forum, data using digital neuropsychological technology are reported. All of these papers demonstrate how coupling digital technology with standard paper and pencil neuropsychological tests are able to extract behavior not otherwise obtainable. As digital assessment methods mature, early identification of persons with emergent neurodegenerative and other neurological illness may be possible.
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Affiliation(s)
- David J Libon
- Department Geriatrics, Gerontology, and Psychology, New Jersey Institute for Successful Aging, School of Osteopathic Medicine, Rowan University, Glassboro, NJ, USA
| | - Ganesh Baliga
- Department of Computer Science, Rowan University, Glassboro, NJ, USA
| | - Rod Swenson
- Department Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Grand Forks, ND, USA
| | - Rhoda Au
- Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, MA, USA.,Framingham Heart Study, Boston University School of Medicine, Boston, MA, USA.,Department of Neurology, Boston University School of Medicine, Boston, MA, USA.,Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
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14
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Wiggins ME, Dion C, Formanski E, Davoudi A, Amini S, Heilman KM, Penney D, Davis R, Garvan CW, Arnaoutakis GJ, Tighe P, Libon DJ, Price CC. Proof of concept: digital clock drawing behaviors prior to transcatheter aortic valve replacement may predict length of hospital stay and cost of care. EXPLORATION OF MEDICINE 2021; 2:110-121. [PMID: 34263257 PMCID: PMC8276939 DOI: 10.37349/emed.2021.00036] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Aims Reduced pre-operative cognitive functioning in older adults is a risk factor for postoperative complications, but it is unknown if preoperative digitally-acquired clock drawing test (CDT) cognitive screening variables, which allow for more nuanced examination of patient performance, may predict lengthier hospital stay and greater cost of hospital care. This issue is particularly relevant for older adults undergoing transcatheter aortic valve replacement (TAVR), as this surgical procedure is chosen for intermediate-risk older adults needing aortic replacement. This proof of concept research explored if specific latency and graphomotor variables indicative of planning from digitally-acquired command and copy clock drawing would predict post-TAVR duration and cost of hospitalization, over and above age, education, American Society of Anesthesiologists (ASA) physical status classification score, and frailty. Methods Form January 2018 to December 2019, 162 out of 190 individuals electing TAVR completed digital clock drawing as part of a hospital wide cognitive screening program. Separate hierarchical regressions were computed for the command and copy conditions of the CDT and assessed how a-priori selected clock drawing metrics (total time to completion, ideal digit placement difference, and hour hand distance from center; included within the same block) incrementally predicted outcome, as measured by R2 change significance values. Results Above and beyond age, education, ASA physical status classification score, and frailty, only digitally-acquired CDT copy performance explained significant variance for length of hospital stay (9.5%) and cost of care (8.9%). Conclusions Digital variables from clock copy condition provided predictive value over common demographic and comorbidity variables. We hypothesize this is due to the sensitivity of the copy condition to executive dysfunction, as has been shown in previous studies for subtypes of cognitive impairment. Individuals undergoing TAVR procedures are often frail and executively compromised due to their cerebrovascular disease. We encourage additional research on the value of digitally-acquired clock drawing within different surgery types. Type of cognitive impairment and the value of digitally-acquired CDT command and copy parameters in other surgeries remain unknown.
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Affiliation(s)
- Margaret Ellenora Wiggins
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL 32610, USA.,Perioperative Cognitive Anesthesia Network (PeCAN), University of Florida, Gainesville, FL 32610, USA
| | - Catherine Dion
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL 32610, USA.,Perioperative Cognitive Anesthesia Network (PeCAN), University of Florida, Gainesville, FL 32610, USA
| | - Erin Formanski
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL 32610, USA.,Perioperative Cognitive Anesthesia Network (PeCAN), University of Florida, Gainesville, FL 32610, USA
| | - Anis Davoudi
- Department of Biomedical Engineering, University of Florida, Gainesville, FL 32611, USA
| | - Shawna Amini
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL 32610, USA.,Perioperative Cognitive Anesthesia Network (PeCAN), University of Florida, Gainesville, FL 32610, USA
| | - Kenneth M Heilman
- Department of Neurology, University of Florida College of Medicine, Gainesville, FL 32610, USA
| | - Dana Penney
- Department of Neurology, Lahey Hospital and Medical Center, Boston, Mass 02421, USA
| | - Randall Davis
- Department of Electronical Engineering and Computer Science, Massachusetts Institute of Technology, Cambridge, Mass 02139, USA
| | - Cynthia W Garvan
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL 32610, USA.,Perioperative Cognitive Anesthesia Network (PeCAN), University of Florida, Gainesville, FL 32610, USA
| | - George J Arnaoutakis
- Department of Surgery, University of Florida College of Medicine, Gainesville, FL 32610, USA
| | - Patrick Tighe
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL 32610, USA.,Perioperative Cognitive Anesthesia Network (PeCAN), University of Florida, Gainesville, FL 32610, USA
| | - David J Libon
- Department of Geriatrics and Gerontology, New Jersey Institute for Successful Aging, Rowan University School of Osteopathic Medicine, Stratford, NJ 08084, USA
| | - Catherine C Price
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL 32610, USA.,Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL 32610, USA.,Perioperative Cognitive Anesthesia Network (PeCAN), University of Florida, Gainesville, FL 32610, USA
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15
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Buckley RA, Atkins KJ, Fortunato E, Silbert B, Scott DA, Evered L. A novel digital clock drawing test as a screening tool for perioperative neurocognitive disorders: A feasibility study. Acta Anaesthesiol Scand 2021; 65:473-480. [PMID: 33296501 DOI: 10.1111/aas.13756] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 10/26/2020] [Accepted: 11/21/2020] [Indexed: 01/15/2023]
Abstract
BACKGROUND We developed a digital clock drawing test (dCDT), an adaptation of the original pen and paper clock test, that may be advantageous over previous dCDTs in the perioperative environment. We trialed our dCDT on a tablet device in the preoperative period to determine the feasibility of administration in this setting. To assess the clinical utility of this test, we examined the relationship between the performance on the test and compared derived digital clock measures with the 4 A's Test (4AT), a delirium and cognition screening tool. METHODS We recruited a sample of 102 adults aged 65 years and over presenting for elective surgery in a single tertiary hospital. Participants completed the 4AT, followed by both command and copy clock conditions of the dCDT. We recorded time-based clock-drawing metrics, alongside clock replications scored using the Montreal Cognitive Assessment (MoCA) clock scoring criteria. RESULTS The dCDT had an acceptance rate of 99%. After controlling for demographic variables and prior tablet use, regression analyses showed higher 4AT scores were associated with greater dCDT time (seconds) for both command (β = 8.2, P = .020) and copy clocks (β = 12, P = .005) and lower MoCA-based clock scores in both command (OR = 0.19, P = .001) and copy conditions (OR = 0.14, P = .012). CONCLUSION The digital clock drawing test is feasible to administer and is highly acceptable to older adults in a preoperative setting. We demonstrated a significant association between both the dCDT time and clock score metrics, with the established 4AT. Our results provide convergent validity of the dCDT in the preoperative setting.
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Affiliation(s)
- Richard A Buckley
- Department of Anaesthesia and Acute Pain Medicine, St Vincent's Hospital, Melbourne, Australia
- Faculty of Medicine, School of Health Sciences, University of Melbourne, Melbourne, Australia
| | - Kelly J Atkins
- Department of Anaesthesia and Acute Pain Medicine, St Vincent's Hospital, Melbourne, Australia
- Faculty of Medicine, School of Health Sciences, University of Melbourne, Melbourne, Australia
| | - Erika Fortunato
- Department of Anaesthesia and Acute Pain Medicine, St Vincent's Hospital, Melbourne, Australia
| | - Brendan Silbert
- Department of Anaesthesia and Acute Pain Medicine, St Vincent's Hospital, Melbourne, Australia
- Faculty of Medicine, School of Health Sciences, University of Melbourne, Melbourne, Australia
| | - David A Scott
- Department of Anaesthesia and Acute Pain Medicine, St Vincent's Hospital, Melbourne, Australia
- Faculty of Medicine, School of Health Sciences, University of Melbourne, Melbourne, Australia
| | - Lisbeth Evered
- Department of Anaesthesia and Acute Pain Medicine, St Vincent's Hospital, Melbourne, Australia
- Faculty of Medicine, School of Health Sciences, University of Melbourne, Melbourne, Australia
- Department of Anesthesiology, Weill Cornell Medicine, NY, USA
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16
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Davoudi A, Dion C, Formanski E, Frank BE, Amini S, Matusz EF, Wasserman V, Penney D, Davis R, Rashidi P, Tighe PJ, Heilman KM, Au R, Libon DJ, Price CC. Normative References for Graphomotor and Latency Digital Clock Drawing Metrics for Adults Age 55 and Older: Operationalizing the Production of a Normal Appearing Clock. J Alzheimers Dis 2021; 82:59-70. [PMID: 34219739 PMCID: PMC8379638 DOI: 10.3233/jad-201249] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Relative to the abundance of publications on dementia and clock drawing, there is limited literature operationalizing 'normal' clock production. OBJECTIVE To operationalize subtle behavioral patterns seen in normal digital clock drawing to command and copy conditions. METHODS From two research cohorts of cognitively-well participants age 55 plus who completed digital clock drawing to command and copy conditions (n = 430), we examined variables operationalizing clock face construction, digit placement, clock hand construction, and a variety of time-based, latency measures. Data are stratified by age, education, handedness, and number anchoring. RESULTS Normative data are provided in supplementary tables. Typical errors reported in clock research with dementia were largely absent. Adults age 55 plus produce symmetric clock faces with one stroke, with minimal overshoot and digit misplacement, and hands with expected hour hand to minute hand ratio. Data suggest digitally acquired graphomotor and latency differences based on handedness, age, education, and anchoring. CONCLUSION Data provide useful benchmarks from which to assess digital clock drawing performance in Alzheimer's disease and related dementias.
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Affiliation(s)
- Anis Davoudi
- Department of Biomedical Engineering, University of Florida, Gainesville, FL, USA
| | - Catherine Dion
- Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Erin Formanski
- Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Brandon E Frank
- Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Shawna Amini
- Department of Anesthesiology, University of Florida, Gainesville, FL, USA
| | - Emily F Matusz
- Department of Geriatrics and Gerontology, New Jersey Institute for Successful Aging, School of Osteopathic Medicine, Rowan University, NJ, USA
| | | | - Dana Penney
- Department of Neurology, Lahey Clinic Medical Center, Burlington, MA, USA
| | - Randall Davis
- Computer Science and Artificial Intelligence Laboratory, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Parisa Rashidi
- Department of Biomedical Engineering, University of Florida, Gainesville, FL, USA
| | - Patrick J Tighe
- Department of Anesthesiology, University of Florida, Gainesville, FL, USA
| | - Kenneth M Heilman
- Department of Neurology, Veterans Affairs Medical Center, University of Florida, Gainesville, FL, USA
| | - Rhoda Au
- Framingham Heart Study, Boston University School of Medicine, Boston, MA, USA
- Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, MA, USA
- Department of Neurology, Boston University School of Medicine, Boston, MA, USA
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - David J Libon
- Department of Geriatrics and Gerontology, New Jersey Institute for Successful Aging, School of Osteopathic Medicine, Rowan University, NJ, USA
- Department of Psychology, Rowan University, NJ, USA
| | - Catherine C Price
- Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
- Department of Anesthesiology, University of Florida, Gainesville, FL, USA
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17
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Dion C, Frank BE, Crowley SJ, Hizel LP, Rodriguez K, Tanner JJ, Libon DJ, Price CC. Parkinson's Disease Cognitive Phenotypes Show Unique Clock Drawing Features when Measured with Digital Technology. JOURNAL OF PARKINSON'S DISEASE 2021; 11:779-791. [PMID: 33682726 PMCID: PMC8108094 DOI: 10.3233/jpd-202399] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND A companion paper (Crowley et al., 2020) reports on the neuroimaging and neuropsychological profiles of statistically determined idiopathic non-dementia Parkinson's disease (PD). OBJECTIVE The current investigation sought to further examine subtle behavioral clock drawing differences within the same PD cohort by comparing 1) PD to non-PD peers on digitally acquired clock drawing latency and graphomotor metrics, and 2) PD memory, executive, and cognitively well phenotypes on the same variables. METHODS 230 matched participants (115 PD, 115 non-PD) completed neuropsychological tests and dCDT. Statistically-derived PD cognitive phenotypes characterized PD participants as PD low executive (PDExe; n = 25), PD low memory (PDMem; n = 34), PD cognitively well (PDWell; n = 56). Using a Bayesian framework and based on apriori hypotheses, we compared groups on: total completion time (TCT), pre-first hand latency (PFHL), post-clock face latency (PCFL), total clock face area (TCFA), and total number of pen strokes. RESULTS Fewer strokes and slower performance to command were associated with higher odds of PD diagnosis, while a larger clock face in the copy condition was associated with lower odds of PD diagnosis. Within PD cognitive phenotypes, slower performance (TCT, PCFL) and smaller clock face to command were associated with higher odds of being PDExe than PDWell, whereas larger clock faces associated with higher odds of being PDMem than PDWell. Longer disease duration, more pen strokes (command) and smaller clocks (command) associated with higher odds of being PDExe than PDWell. CONCLUSION Digitally-acquired clock drawing profiles differ between PD and non-PD peers, and distinguish PD cognitive phenotypes.
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Affiliation(s)
- Catherine Dion
- Department of Clinical and Health Psychology, Gainesville, FL, USA
| | - Brandon E Frank
- Department of Clinical and Health Psychology, Gainesville, FL, USA
| | - Samuel J Crowley
- Department of Clinical and Health Psychology, Gainesville, FL, USA
| | - Loren P Hizel
- Department of Clinical and Health Psychology, Gainesville, FL, USA
| | - Katie Rodriguez
- Department of Clinical and Health Psychology, Gainesville, FL, USA
| | - Jared J Tanner
- Department of Clinical and Health Psychology, Gainesville, FL, USA
| | - David J Libon
- Departments of Geriatrics and Gerontology and Psychology, School of Osteopathic Medicine, Rowan University, Stratford, NJ, USA
| | - Catherine C Price
- Department of Clinical and Health Psychology, Gainesville, FL, USA
- Perioperative Cognitive Anesthesia Network, University of Florida, Gainesville, FL, USA
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18
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Machine Learning Analysis of Digital Clock Drawing Test Performance for Differential Classification of Mild Cognitive Impairment Subtypes Versus Alzheimer's Disease. J Int Neuropsychol Soc 2020; 26:690-700. [PMID: 32200771 DOI: 10.1017/s1355617720000144] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To determine how well machine learning algorithms can classify mild cognitive impairment (MCI) subtypes and Alzheimer's disease (AD) using features obtained from the digital Clock Drawing Test (dCDT). METHODS dCDT protocols were administered to 163 patients diagnosed with AD(n = 59), amnestic MCI (aMCI; n = 26), combined mixed/dysexecutive MCI (mixed/dys MCI; n = 43), and patients without MCI (non-MCI; n = 35) using standard clock drawing command and copy procedures, that is, draw the face of the clock, put in all of the numbers, and set the hands for "10 after 11." A digital pen and custom software recorded patient's drawings. Three hundred and fifty features were evaluated for maximum information/minimum redundancy. The best subset of features was used to train classification models to determine diagnostic accuracy. RESULTS Neural network employing information theoretic feature selection approaches achieved the best 2-group classification results with 10-fold cross validation accuracies at or above 83%, that is, AD versus non-MCI = 91.42%; AD versus aMCI = 91.49%; AD versus mixed/dys MCI = 84.05%; aMCI versus mixed/dys MCI = 84.11%; aMCI versus non-MCI = 83.44%; and mixed/dys MCI versus non-MCI = 85.42%. A follow-up two-group non-MCI versus all MCI patients analysis yielded comparable results (83.69%). Two-group classification analyses were achieved with 25-125 dCDT features depending on group classification. Three- and four-group analyses yielded lower but still promising levels of classification accuracy. CONCLUSION Early identification of emergent neurodegenerative illness is criterial for better disease management. Applying machine learning to standard neuropsychological tests promises to be an effective first line screening method for classification of non-MCI and MCI subtypes.
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Spencer RJ, Gradwohl BD, Williams TF, Kordovski VM, Hammers DB. Developing learning slope scores for the repeatable battery for the assessment of neuropsychological status. APPLIED NEUROPSYCHOLOGY-ADULT 2020; 29:584-590. [PMID: 32654521 DOI: 10.1080/23279095.2020.1791870] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Initial learning and learning slope are often acknowledged as important qualitative aspects of learning, but the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) contains discrete indices for neither. The traditional method of calculating learning slope involves a difference score between the last trial and first trial, which is referred to as raw learning score (RLS). However, this method does not account for initial Trial One performance and produces a ceiling effect that penalizes efficient first learners. We propose an alternative method of calculating learning score that accounts for initial learning performance, called learning ratio (LR), and we compared the psychometric and predictive properties of these methods. Performances from the List Learning and Story Memory subtests were used to create the indices, and composite learning scores were calculated by combining List Learning and Story Memory. The sample included 289 military veterans (mean age = 65.9 [12.6], education = 13.3 [2.4]), most of whom were male, undergoing neuropsychological assessments that included the RBANS. Results indicated that LR demonstrated superior correlations with criterion measures of memory when compared with RLS, and the LR composite score better discriminated between those with and without a neurocognitive diagnosis, AUC = 0.81 (0.76-0.87), than the RLS composite, AUC = 0.70 (0.64-0.76). We concluded that scores from the RBANS can be computed for initial learning and learning slope and that the LR method of calculating learning is superior to RLS in this older veteran sample.
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Affiliation(s)
- Robert J Spencer
- Mental Health, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Brian D Gradwohl
- Mental Health, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
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20
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Thyagarajan B, Nelson HH, Poynter JN, Prizment AE, Roesler MA, Cassidy E, Putnam S, Amos L, Hickle A, Reilly C, Spector LG, Lazovich D. Field Application of Digital Technologies for Health Assessment in the 10,000 Families Study. Cancer Epidemiol Biomarkers Prev 2020; 29:744-751. [PMID: 32132151 DOI: 10.1158/1055-9965.epi-19-0858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 10/24/2019] [Accepted: 01/27/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND We field tested new-to-market portable, digital applications to assess hearing, pulmonary, and cognitive function to determine the feasibility of implementing these applications across a range of age groups in the pilot phase of the 10,000 Families Study (10KFS), a new Minnesota family-based prospective cohort study. METHODS We followed manufacturer recommended protocols for audiometry (SHOEBOX Inc), spirometry (NuvoAir), and the digital clock drawing test (dCDT; Digital Cognition Technologies Inc). RESULTS These digital devices were low cost and readily implemented in a 2.5-hour health fair visit with minimal training (2-3 hours) of study staff. To date, we have performed these measurements on 197 eligible 10KFS participants during an in-person clinic visit. A total of 37 children (age 4-17 years), 107 adults (18-64 years), and 53 seniors (≥65 years) were eligible to undergo hearing and pulmonary assessments. Children were less likely to successfully complete the hearing test (76%) compared with adults (86%) and seniors (89%). However, successful completion of the pulmonary assessment was high across all groups: 100% of children and seniors and 98% of adults. The dCDT was performed among those over the age of 40, and completion rates were 92% for those aged 41-64 and 94% for those ≥65 years. CONCLUSIONS Our field testing indicates these digital applications are easy and cost-effective to implement in epidemiologic studies. IMPACT Digital applications provide exciting opportunities to collect data in population studies. Issues related to data privacy, data access, and reproducibility of measurements need to be addressed before deploying digital applications in epidemiologic studies.See all articles in this CEBP Focus section, "Modernizing Population Science."
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Affiliation(s)
- Bharat Thyagarajan
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota. .,Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota.,Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Heather H Nelson
- Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota.,Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Jenny N Poynter
- Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota.,Division of Epidemiology/Clinical Research, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
| | - Anna E Prizment
- Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota.,Division of Hematology, Oncology and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Michelle A Roesler
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Erin Cassidy
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota
| | - Sara Putnam
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Laura Amos
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Andrea Hickle
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Cavan Reilly
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Logan G Spector
- Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota.,Division of Epidemiology/Clinical Research, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
| | - DeAnn Lazovich
- Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota.,Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota
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21
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Arias F, Wiggins M, Urman RD, Armstrong R, Pfeifer K, Bader AM, Libon DJ, Chopra A, Price CC. Rapid in-person cognitive screening in the preoperative setting: Test considerations and recommendations from the Society for Perioperative Assessment and Quality Improvement (SPAQI). J Clin Anesth 2020; 62:109724. [PMID: 32018131 DOI: 10.1016/j.jclinane.2020.109724] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 12/08/2019] [Accepted: 01/11/2020] [Indexed: 02/01/2023]
Abstract
There are few cognitive screening tools appropriate for fast-paced settings with limited staffing, and particularly in preoperative evaluation clinics. The Society for Perioperative Assessment and Quality Improvement (SPAQI) convened experts in neuropsychology, geriatric medicine, and anesthesiology to conduct a review of the literature and compile a comprehensive list of cognitive screening tools used within primary care and preoperative settings. This Recommendations Statement: 1. summarizes a review of the literature on existing cognitive screening tools used within preoperative settings; 2. discusses factors to consider when selecting cognitive screening tools in a preoperative environment; and 3. includes a work flow diagram to guide use of these screening measures. Methodology involved searching peer-reviewed literature for 29 cognitive screening tools which were identified from the literature that fit inclusion criteria. Of these 29, seven tests have been used in preoperative settings and are discussed. These seven had an average administration time ranging from one to ten minutes. Memory, language, and attention were the most commonly evaluated cognitive domains. Most had adequate sensitivity and specificity to detect cognitive impairment/dementia. While information on the psychometric properties of these tools is limited, the tools discussed are appropriate for lay examiners, are short in duration, and accessible for free or at a low cost. We describe factors that must be considered prior to instrument selection.
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Affiliation(s)
- Franchesca Arias
- Pain Research and Intervention Center of Excellence (PRICE), 101 S. Newell Drive, PO Box 100165, Gainesville, FL 32610, United States of America; Department of Clinical and Health Psychology, The University of Florida, 1225 Center Drive, Gainesville, FL 32603, United States of America; Perioperative Cognitive Anesthesia Network (PeCAN), UF Health Shands Hospital, 1600 SW Archer Road Suite 1111, Gainesville, FL 32608, United States of America; Department of Anesthesiology, The University of Florida, 1600 SW Archer Road, PO Box 100254, Gainesville, FL 32610, United States of America.
| | - Margaret Wiggins
- Department of Clinical and Health Psychology, The University of Florida, 1225 Center Drive, Gainesville, FL 32603, United States of America; Perioperative Cognitive Anesthesia Network (PeCAN), UF Health Shands Hospital, 1600 SW Archer Road Suite 1111, Gainesville, FL 32608, United States of America.
| | - Richard D Urman
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, United States of America.
| | - Rebecca Armstrong
- Department of Clinical and Health Psychology, The University of Florida, 1225 Center Drive, Gainesville, FL 32603, United States of America; Perioperative Cognitive Anesthesia Network (PeCAN), UF Health Shands Hospital, 1600 SW Archer Road Suite 1111, Gainesville, FL 32608, United States of America.
| | - Kurt Pfeifer
- Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, WI 53226, United States of America.
| | - Angela M Bader
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, United States of America.
| | - David J Libon
- Department of Geriatrics and Gerontology, Department of Psychology, New Jersey Institute for Successful Aging, School of Osteopathic Medicine, Rowan University, Stratford, NJ 08084, United States of America.
| | - Anita Chopra
- Department of Geriatrics and Gerontology, Department of Psychology, New Jersey Institute for Successful Aging, School of Osteopathic Medicine, Rowan University, Stratford, NJ 08084, United States of America.
| | - Catherine C Price
- Pain Research and Intervention Center of Excellence (PRICE), 101 S. Newell Drive, PO Box 100165, Gainesville, FL 32610, United States of America; Department of Clinical and Health Psychology, The University of Florida, 1225 Center Drive, Gainesville, FL 32603, United States of America; Perioperative Cognitive Anesthesia Network (PeCAN), UF Health Shands Hospital, 1600 SW Archer Road Suite 1111, Gainesville, FL 32608, United States of America; Department of Anesthesiology, The University of Florida, 1600 SW Archer Road, PO Box 100254, Gainesville, FL 32610, United States of America.
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22
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Torres-Castro S, Mena-Montes B, González-Ambrosio G, Zubieta-Zavala A, Torres-Carrillo N, Acosta-Castillo G, Espinel-Bermúdez M. Spanish-language cognitive screening tests: a critical review. NEUROLOGÍA (ENGLISH EDITION) 2020; 37:53-60. [DOI: 10.1016/j.nrleng.2018.03.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 03/01/2018] [Indexed: 10/25/2022] Open
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23
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Arias F, Wiggins M, Urman RD, Armstrong R, Pfeifer K, Bader AM, Libon DJ, Chopra A, Price CC. Rapid In-Person Cognitive Screening in the Preoperative Setting: Test Considerations and Recommendations from the Society for Perioperative Assessment and Quality Improvement (SPAQI). ACTA ACUST UNITED AC 2020; 19. [PMID: 32342018 DOI: 10.1016/j.pcorm.2020.100089] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
There are few cognitive screening tools appropriate for fast-paced settings with limited staffing, and particularly in preoperative evaluation clinics. The Society for Perioperative Assessment and Quality Improvement (SPAQI) convened experts in neuropsychology, geriatric medicine, and anesthesiology to conduct a review of the literature and compile a comprehensive list of cognitive screening tools used within primary care and preoperative settings. This Recommendations Statement: 1. summarizes a review of the literature on existing cognitive screening tools used within preoperative settings; 2. discusses factors to consider when selecting cognitive screening tools in a preoperative environment; and 3. includes a work flow diagram to guide use of these screening measures. Methodology involved searching peer-reviewed literature for 29 cognitive screening tools which were identified from the literature that fit inclusion criteria. Of these 29, seven tests have been used in preoperative settings and are discussed. These seven had an average administration time ranging from one to ten minutes. Memory, language, and attention were the most commonly evaluated cognitive domains. Most had adequate sensitivity and specificity to detect cognitive impairment/dementia. While information on the psychometric properties of these tools is limited, the tools discussed are appropriate for lay examiners, are short in duration, and accessible for free or at a low cost. We describe factors that must be considered prior to instrument selection.
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Affiliation(s)
- Franchesca Arias
- Pain Research and Intervention Center of Excellence (PRICE), 101 S. Newell Drive PO Box 100165, Gainesville, FL 32610
- Department of Clinical and Health Psychology, The University of Florida, 1225 Center Drive, Gainesville, FL 32603
- Perioperative Cognitive Anesthesia Network (PeCAN), UF Health Shands Hospital, 1600 SW Archer Road Suite 1111, Gainesville, FL 32608
- Department of Anesthesiology, The University of Florida, Department of Anesthesiology, 1600 SW Archer Road PO Box 100254, Gainesville, FL 32610
| | - Margaret Wiggins
- Department of Clinical and Health Psychology, The University of Florida, 1225 Center Drive, Gainesville, FL 32603
- Perioperative Cognitive Anesthesia Network (PeCAN), UF Health Shands Hospital, 1600 SW Archer Road Suite 1111, Gainesville, FL 32608
| | - Richard D Urman
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115
| | - Rebecca Armstrong
- Department of Clinical and Health Psychology, The University of Florida, 1225 Center Drive, Gainesville, FL 32603
- Perioperative Cognitive Anesthesia Network (PeCAN), UF Health Shands Hospital, 1600 SW Archer Road Suite 1111, Gainesville, FL 32608
| | - Kurt Pfeifer
- Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, WI 53226
| | - Angela M Bader
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115
| | - David J Libon
- Department of Geriatrics and Gerontology, Department of Psychology, New Jersey Institute for Successful Aging, School of Osteopathic Medicine, Rowan University, Stratford, NJ 08084
| | - Anita Chopra
- Department of Geriatrics and Gerontology, Department of Psychology, New Jersey Institute for Successful Aging, School of Osteopathic Medicine, Rowan University, Stratford, NJ 08084
| | - Catherine C Price
- Pain Research and Intervention Center of Excellence (PRICE), 101 S. Newell Drive PO Box 100165, Gainesville, FL 32610
- Department of Clinical and Health Psychology, The University of Florida, 1225 Center Drive, Gainesville, FL 32603
- Perioperative Cognitive Anesthesia Network (PeCAN), UF Health Shands Hospital, 1600 SW Archer Road Suite 1111, Gainesville, FL 32608
- Department of Anesthesiology, The University of Florida, Department of Anesthesiology, 1600 SW Archer Road PO Box 100254, Gainesville, FL 32610
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24
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Frei BW, Woodward KT, Zhang MY, Amini S, Tighe P, Garvan CW, Giordano C, Price CC. Considerations for Clock Drawing Scoring Systems in Perioperative Anesthesia Settings. Anesth Analg 2020; 128:e61-e64. [PMID: 30896604 DOI: 10.1213/ane.0000000000004105] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The Clock Drawing Test is a cognitive screening tool gaining popularity in the perioperative setting. We compared 3 common scoring systems: (1) the Montreal Cognitive Assessment; (2) the Mini-Cog; and (3) the Libon scale. Three novice raters acquired interrater and intrarater reliability for each scoring system and then scored 738 preoperative clock drawings with each scoring system. Final scores correlated with each other but with notable discrepancies, indicating the need to attend to interrater and intrarater reliability when implementing any scoring approach in a clinical setting.
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Affiliation(s)
| | | | | | - Shawna Amini
- From the Departments of Anesthesiology.,Clinical and Health Psychology, University of Florida College of Medicine and Public Health and Health Professions, Gainesville, Florida
| | | | | | | | - Catherine C Price
- From the Departments of Anesthesiology.,Clinical and Health Psychology, University of Florida College of Medicine and Public Health and Health Professions, Gainesville, Florida
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25
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Dion C, Arias F, Amini S, Davis R, Penney D, Libon DJ, Price CC. Cognitive Correlates of Digital Clock Drawing Metrics in Older Adults with and without Mild Cognitive Impairment. J Alzheimers Dis 2020; 75:73-83. [PMID: 32250300 PMCID: PMC7217723 DOI: 10.3233/jad-191089] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND A digital version of the clock drawing test (dCDT) provides new latency and graphomotor behavioral measurements. These variables have yet to be validated with external neuropsychological domains in non-demented adults. OBJECTIVE The current investigation reports on cognitive constructs associated with selected dCDT latency and graphomotor variables and compares performances between individuals with mild cognitive impairment (MCI) and non-MCI peers. METHODS 202 non-demented older adults (age 68.79 ± 6.18, 46% female, education years 16.02 ± 2.70) completed the dCDT and a comprehensive neuropsychological protocol. dCDT variables of interest included: total completion time (TCT), pre-first hand latency (PFHL), post-clock face latency (PCFL), and clock face area (CFA). We also explored variables of percent time drawing (i.e., 'ink time') versus percent time not drawing (i.e., 'think time'). Neuropsychological domains of interest included processing speed, working memory, language, and declarative memory. RESULTS Adjusting for age and premorbid cognitive reserve metrics, command TCT positively correlated with multiple cognitive domains; PFHL and PCFL negatively associated with worse performance on working memory and processing speed tests. For Copy, TCT, PCFL, and PFHL negatively correlated with processing speed, and CFA negatively correlated with language. Between-group analyses show MCI participants generated slower command TCT, produced smaller CFA, and required more command 'think' (% Think) than 'ink' (% Ink) time. CONCLUSION Command dCDT variables of interest were primarily processing speed and working memory dependent. MCI participants showed dCDT differences relative to non-MCI peers, suggesting the dCDT may assist with classification. Results document cognitive construct validation to digital metrics of clock drawing.
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Affiliation(s)
- Catherine Dion
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Franchesca Arias
- Aging Brain Center at Hebrew Senior Life, Harvard University, Boston, MA, USA
| | - Shawna Amini
- Department of Anesthesiology, University of Florida, Gainesville, FL, USA
| | - Randall Davis
- Computer Science and Artificial Intelligence Laboratory, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Dana Penney
- Department of Neurology, Lahey Clinic Medical Center, Burlington, MA, USA
| | - David J. Libon
- Department of Geriatrics, Gerontology, and Psychology, Rowan University, Glassboro, NJ, USA
| | - Catherine C. Price
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
- Department of Anesthesiology, University of Florida, Gainesville, FL, USA
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26
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Blanco-Campal A, Diaz-Orueta U, Navarro-Prados AB, Burke T, Libon DJ, Lamar M. Features and psychometric properties of the Montreal Cognitive Assessment: Review and proposal of a process-based approach version (MoCA-PA). APPLIED NEUROPSYCHOLOGY-ADULT 2019; 28:658-672. [PMID: 31718290 DOI: 10.1080/23279095.2019.1681996] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The current study presents a rapid review of the psychometric features of the standard Montreal Cognitive Assessment (MoCA), and the proposal for a modified version of the test, informed by the methodology of the Boston Process Approach to neuropsychological assessment. In order to aid the process of identification of the primary underlying neurocognitive mechanism responsible for defective test performance, the MoCA-Process-Based Approach (MoCA-PA) adds complementary or satellite test conditions in some of its subtests, includes "new" qualitative indices to capture the cognitive processes involved in each cognitive task, and incorporates new qualitative classifications of error subtypes. It provides concurrent assessment of multiple cognitive processes within each task, without significantly increasing administration time or placing significant additional burden upon the respondent. We present preliminary results obtained from an initial sample of 45 community-dwelling older adults attending a University program for seniors. Results suggest the usefulness of additional indices in providing additional information on cognitive deterioration that may be overlooked with the only consideration of quantitative scores. Future research will aim to collect normative data for different clinical populations using the newly developed indices in order to determine the validity and clinical utility of the relatively novel qualitative process-based methods used in the MoCA-PA.
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Affiliation(s)
- Alberto Blanco-Campal
- Department of Psychiatry for the Older Person, Co. Louth (Ardee) and Co. Meath (Navan) Memory Clinic Services, Health Service Executive (HSE), Ireland
| | - Unai Diaz-Orueta
- Department of Psychology, Maynooth University, Maynooth, Co. Kildare, Ireland
| | - Ana Belen Navarro-Prados
- Department of Developmental and Educational Psychology, Faculty of Psychology, University of Salamanca (USAL), Salamanca, Spain
| | - Teresa Burke
- School of Psychology, Dublin City University, Dublin, Ireland
| | - David J Libon
- New Jersey Institute for Successful Aging, School of Osteopathic Medicine - Rowan University, Stratford, New Jersey, USA
| | - Melissa Lamar
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois, USA
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27
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Amini S, Crowley S, Hizel L, Arias F, Libon DJ, Tighe P, Giordano C, Garvan CW, Enneking FK, Price CC. Feasibility and Rationale for Incorporating Frailty and Cognitive Screening Protocols in a Preoperative Anesthesia Clinic. Anesth Analg 2019; 129:830-838. [PMID: 31425227 PMCID: PMC6927245 DOI: 10.1213/ane.0000000000004190] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Advanced age, frailty, low education level, and impaired cognition are generally reported to be associated with postoperative cognitive complications. To translate research findings into hospital-wide preoperative assessment clinical practice, we examined the feasibility of implementing a preoperative frailty and cognitive assessment for all older adults electing surgical procedures in a tertiary medical center. We examined associations among age, education, frailty, and comorbidity with the clock and 3-word memory scores, estimated the prevalence of mild to major cognitive impairment in the presurgical sample, and examined factors related to hospital length of stay. METHODS Medical staff screened adults ≥65 years of age for frailty, general cognition (via the clock-drawing test command and copy, 3-word memory test), and obtained years of education. Feasibility was studied in 2 phases: (1) a pilot phase involving 4 advanced nurse practitioners and (2) a 2-month implementation phase involving all preoperative staff. We tracked sources of missing data, investigated associations of study variables with measures of cognition, and used 2 approaches to estimate the likelihood of dementia in our sample (ie, using extant data and logistic regression modeling and using Mini-Cog cut scores). We explored which protocol variables related to hospital length of stay. RESULTS The final implementation phase sample included 678 patients. Clock and 3-word memory scores were significantly associated with age, frailty, and education. Education, clock scores, and 3-word scores were not significantly different by surgery type. Likelihood of preoperative cognitive impairment was approximately 20%, with no difference by surgery type. Length of stay was significantly associated with preoperative comorbidity and performance on the clock copy condition. CONCLUSIONS Frailty and cognitive screening protocols are feasible and provide information for perioperative care planning. Challenges to clinical adaptation include staff training, missing data, and additional administration time. These challenges appear minimal relative to the benefits of identifying frailty and cognitive impairment in a group at risk for negative postoperative cognitive outcome.
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Affiliation(s)
- Shawna Amini
- Department of Clinical and Health Psychology, University of Florida College of Public Health and Health Professions, Gainesville, Florida
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida
- Perioperative Cognitive Anesthesia Network, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, Florida
| | - Samuel Crowley
- Department of Clinical and Health Psychology, University of Florida College of Public Health and Health Professions, Gainesville, Florida
| | - Loren Hizel
- Department of Clinical and Health Psychology, University of Florida College of Public Health and Health Professions, Gainesville, Florida
| | - Franchesca Arias
- Department of Clinical and Health Psychology, University of Florida College of Public Health and Health Professions, Gainesville, Florida
- Perioperative Cognitive Anesthesia Network, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, Florida
| | - David J. Libon
- Department of Geriatrics, Rowan University, School of Osteopathic Medicine, New Jersey Institute for Successful Aging, Stratford, New Jersey
- Department of Gerontology, Rowan University, School of Osteopathic Medicine, New Jersey Institute for Successful Aging, Stratford, New Jersey
- Department of Psychology, Rowan University, School of Osteopathic Medicine, New Jersey Institute for Successful Aging, Stratford, New Jersey
| | - Patrick Tighe
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida
- Perioperative Cognitive Anesthesia Network, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, Florida
| | - Chris Giordano
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida
| | - Cynthia W. Garvan
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida
| | - F. Kayser Enneking
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida
| | - Catherine C. Price
- Department of Clinical and Health Psychology, University of Florida College of Public Health and Health Professions, Gainesville, Florida
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida
- Perioperative Cognitive Anesthesia Network, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, Florida
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28
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Arias F, Riverso M, Levy SA, Armstrong R, Estores DS, Tighe P, Price CC. Pilot Study: Neurocognitive Disorders and Colonoscopy in Older Adults. Anesth Analg 2019; 129:e89-e93. [PMID: 31425226 PMCID: PMC6774261 DOI: 10.1213/ane.0000000000004212] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
In a preoperative anesthesia setting with integrated neuropsychology for individuals >64 years of age, we completed a pilot study examining the association between neurocognitive disorders with frequency of missed colonoscopies and quality of bowel preparation (prep). Gastroenterologists completed the Boston Bowel Preparation Scale (BBPS) for each patient. Of 47 older adults seen in our service, 68% met criteria for neurocognitive disorders. All individuals failing to attend the colonoscopy procedure had met criteria for major neurocognitive disorder. Poor bowel prep was also identified in 100% of individuals with major neurocognitive disorder and 28% of individuals with mild neurocognitive disorder. Our pilot data suggest that, in high-risk individuals, the presence of neurocognitive disorders is risk factors for missed appointments and inadequate bowel prep. These pilot data provide reference statistics for future intervention protocols.
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Affiliation(s)
- Franchesca Arias
- Pain Research and Intervention Center of Excellence, Gainesville, FL
- Department of Clinical & Health Psychology, University of Florida, Gainesville, FL
| | - Michael Riverso
- Division of Gastroenterology, Hepatology, & Nutrition, Gainesville, FL
| | - Shellie-Anne Levy
- Department of Clinical & Health Psychology, University of Florida, Gainesville, FL
| | - Rebecca Armstrong
- Department of Clinical & Health Psychology, University of Florida, Gainesville, FL
| | - David S. Estores
- Division of Gastroenterology, Hepatology, & Nutrition, Gainesville, FL
| | - Patrick Tighe
- Department of Anesthesiology, University of Florida, Gainesville, FL
| | - Catherine C. Price
- Department of Clinical & Health Psychology, University of Florida, Gainesville, FL
- Department of Anesthesiology, University of Florida, Gainesville, FL
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29
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State of the clinical science of perioperative brain health: report from the American Society of Anesthesiologists Brain Health Initiative Summit 2018. Br J Anaesth 2019; 123:464-478. [PMID: 31439308 DOI: 10.1016/j.bja.2019.07.004] [Citation(s) in RCA: 116] [Impact Index Per Article: 23.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 06/25/2019] [Accepted: 07/02/2019] [Indexed: 12/20/2022] Open
Abstract
Cognitive recovery after anaesthesia and surgery is a concern for older adults, their families, and caregivers. Reports of patients who were 'never the same' prompted a scientific inquiry into the nature of what patients have experienced. In June 2018, the ASA Brain Health Initiative held a summit to discuss the state of the science on perioperative cognition, and to create an implementation plan for patients and providers leveraging the current evidence. This group included representatives from the AARP (formerly the American Association of Retired Persons), American College of Surgeons, American Heart Association, and Alzheimer's Association Perioperative Cognition and Delirium Professional Interest Area. This paper summarises the state of the relevant clinical science, including risk factors, identification and diagnosis, prognosis, disparities, outcomes, and treatment of perioperative neurocognitive disorders. Finally, we discuss gaps in current knowledge with suggestions for future directions and opportunities for clinical and translational projects.
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30
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Hizel LP, Warner ED, Wiggins ME, Tanner JJ, Parvataneni H, Davis R, Penney DL, Libon DJ, Tighe P, Garvan CW, Price CC. Clock Drawing Performance Slows for Older Adults After Total Knee Replacement Surgery. Anesth Analg 2019; 129:212-219. [PMID: 30273231 PMCID: PMC6579692 DOI: 10.1213/ane.0000000000003735] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Clock drawing is a neurocognitive screening tool used in preoperative settings. This study examined hypothesized changes in clock drawing to command and copy test conditions 3 weeks and 3 months after total knee arthroplasty (TKA) with general anesthesia. METHODS Participants included 67 surgery and 66 nonsurgery individuals >60 years who completed the digital clock drawing test before TKA (or a pseudosurgery date), and 3 weeks and 3 months postsurgery. Generalized linear mixed models assessed digital clock drawing test latency (ie, total time to completion, seconds between digit placement) and graphomotor output (ie, total number of strokes, clock size). Reliable change analyses examined the percent of participants showing change beyond differences found in nonsurgery peers. RESULTS After adjusting for age, education, and baseline cognition, both digital clock drawing test latency measures were significantly different for surgery and nonsurgery groups, where the surgery group performed slower on both command and copy test conditions. Reliable change analyses 3 weeks after surgery found that total time to completion was slower among 25% of command and 21% of copy constructions in the surgery group. At 3 months, 18% of surgery participants were slower than nonsurgery peers. Neither graphomotor measure significantly changed over time. CONCLUSIONS Clock drawing construction slowed for nearly one-quarter of patients after TKA surgery, whereas nonsurgery peers showed the expected practice effect, ie, speed increased from baseline to follow-up time points. Future research should investigate the neurobiological basis for these changes after TKA.
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Affiliation(s)
- Loren P Hizel
- Clinical and Health Psychology, University of Florida, Gainesville, Florida
| | - Eric D. Warner
- Clinical and Health Psychology, University of Florida, Gainesville, Florida
| | | | - Jared J. Tanner
- Clinical and Health Psychology, University of Florida, Gainesville, Florida
| | - Hari Parvataneni
- Department of Orthopedic Surgery, University of Florida College of Medicine, Gainesville, Florida
| | - Randall Davis
- Computer Science and Artificial Intelligence Laboratory, Massachusetts Institute of Technology, Boston, Massachusetts
| | - Dana L. Penney
- Department of Neurology, Lahey Clinic, Boston, Massachusetts
| | - David J. Libon
- Department of Geriatric and Gerontology, Rowan University, School of Osteopathic Medicine, Stratford, New Jersey
- Department of Psychology, Rowan University, School of Osteopathic Medicine, Stratford, New Jersey
| | - Patrick Tighe
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida
| | - Cynthia W. Garvan
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida
| | - Catherine C. Price
- Clinical and Health Psychology, University of Florida, Gainesville, Florida
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida
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32
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Duro D, Freitas S, Tábuas-Pereira M, Santiago B, Botelho MA, Santana I. Discriminative capacity and construct validity of the Clock Drawing Test in Mild Cognitive Impairment and Alzheimer's disease. Clin Neuropsychol 2018; 33:1159-1174. [PMID: 30422076 DOI: 10.1080/13854046.2018.1532022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objectives: The aim of this study was to analyze the psychometric and diagnostic properties of the Clock Drawing Test (CDT), scored according to the Babins, Rouleau, and Cahn scoring systems, for Mild Cognitive Impairment (MCI) and Alzheimer's disease (AD) screening, and develop corresponding cutoff scores. Additionally, we assessed the construct validity of the CDT through exploratory and confirmatory factor analysis. Methods: We developed a cross-sectional study of ambulatory MCI and AD patients, divided in two clinical groups (450 MCI and 250 mild AD patients) and a normal control group (N = 400). All participants were assessed with the CDT, Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) for convergent validity. Results: The selected scoring systems presented adequate validity and reliability values. The proposed cutoff scores showed 60 to 65% sensitivity and 58 to 62% specificity to identify MCI patients. The corresponding values for AD were 84 to 90% sensitivity and 76 to 78% specificity. Exploratory and confirmatory factor analysis revealed that the Babins scoring system had good construct validity and allowed us to propose a three-factor model for this system. Conclusions: Our results confirmed the complexity of the CDT and support it as a cognitive screening instrument particularly sensitive to AD. The use of the CDT with MCI patients should be interpreted with more caution due to the lower sensitivity and specificity for milder forms of cognitive impairment.
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Affiliation(s)
- Diana Duro
- Neurology Department, Centro Hospitalar e Universitário de Coimbra , Coimbra , Portugal.,Faculty of Medicine, University of Coimbra , Coimbra , Portugal.,Center for Research in Neuropsychology and Cognitive and Behavioral Intervention, University of Coimbra , Coimbra , Portugal
| | - Sandra Freitas
- Center for Research in Neuropsychology and Cognitive and Behavioral Intervention, University of Coimbra , Coimbra , Portugal.,Center for Neuroscience and Cell Biology, University of Coimbra , Coimbra , Portugal
| | - Miguel Tábuas-Pereira
- Neurology Department, Centro Hospitalar e Universitário de Coimbra , Coimbra , Portugal.,Faculty of Medicine, University of Coimbra , Coimbra , Portugal
| | - Beatriz Santiago
- Neurology Department, Centro Hospitalar e Universitário de Coimbra , Coimbra , Portugal
| | | | - Isabel Santana
- Neurology Department, Centro Hospitalar e Universitário de Coimbra , Coimbra , Portugal.,Faculty of Medicine, University of Coimbra , Coimbra , Portugal
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Liu X, Jiang W, Yuan Y. Aberrant Default Mode Network Underlying the Cognitive Deficits in the Patients With Late-Onset Depression. Front Aging Neurosci 2018; 10:310. [PMID: 30337869 PMCID: PMC6178980 DOI: 10.3389/fnagi.2018.00310] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Accepted: 09/14/2018] [Indexed: 12/15/2022] Open
Abstract
Late-onset depression (LOD) is regarded as a risk factor or a prodrome of Alzheimer’s disease (AD). Moreover, LOD patients with cognitive deficits have the higher risk of subsequent AD. Thus, it is necessary to understand the neural underpinnings of cognitive deficits and its pathological implications in LOD. Consistent findings show that the default mode network (DMN) is an important and potentially useful brain network for the cognitive deficits in LOD patients. In recent years, genetics has been actively researched as a possible risk factor in the pathogenesis of LOD. So, in this review, we discuss the current research progress on the cognitive deficits and DMN in LOD through a combined view of brain network and genetics. We find that different structural and functional impairments of the DMN might be involved in the etiological mechanisms of different cognitive impairments in LOD patients.
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Affiliation(s)
- Xiaoyun Liu
- Department of Psychosomatics and Psychiatry, Zhongda Hospital, Institute of Psychosomatics, Medical School, Southeast University, Nanjing, China
| | - Wenhao Jiang
- Department of Psychosomatics and Psychiatry, Zhongda Hospital, Institute of Psychosomatics, Medical School, Southeast University, Nanjing, China
| | - Yonggui Yuan
- Department of Psychosomatics and Psychiatry, Zhongda Hospital, Institute of Psychosomatics, Medical School, Southeast University, Nanjing, China
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Piers RJ, Devlin KN, Ning B, Liu Y, Wasserman B, Massaro JM, Lamar M, Price CC, Swenson R, Davis R, Penney DL, Au R, Libon DJ. Age and Graphomotor Decision Making Assessed with the Digital Clock Drawing Test: The Framingham Heart Study. J Alzheimers Dis 2018; 60:1611-1620. [PMID: 29036819 DOI: 10.3233/jad-170444] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Digital Clock Drawing Test (dCDT) technology enables the examination of detailed neurocognitive behavior as behavior unfolds in real time; a capability that cannot be obtained using a traditional pen and paper testing format. OBJECTIVE Parameters obtained from the dCDT were used to investigate neurocognitive constructs related to higher-order neurocognitive decision making and information processing speed. The current research sought to determine the effect of age as related to combined motor and non-motor components of drawing, and higher-order decision making latencies. METHODS A large group of stroke- and dementia- free Framingham Heart Study participants were administered the dCDT to command and copy with hands set for "10 after 11". Six age groups (age range 28-98) were constructed. RESULTS Differences between age groups were found for total time to completion, total pen stroke count, and higher-order decision making latencies in both command and copy test conditions. CONCLUSION Longer age-related decision making latencies may reflect a greater need for working memory and increased self-monitoring in older subjects. These latency measures have potential to serve as neurocognitive biomarkers of Alzheimer's disease and other insidious neurodegenerative disorders.
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Affiliation(s)
- Ryan J Piers
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA.,Framingham Heart Study, Boston University School of Medicine, Boston, MA, USA
| | - Kathryn N Devlin
- Department of Psychology, Temple University, Philadelphia, PA, USA
| | - Boting Ning
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Yulin Liu
- Framingham Heart Study, Boston University School of Medicine, Boston, MA, USA
| | - Ben Wasserman
- Framingham Heart Study, Boston University School of Medicine, Boston, MA, USA
| | - Joseph M Massaro
- Framingham Heart Study, Boston University School of Medicine, Boston, MA, USA.,Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | | | - Catherine C Price
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Rod Swenson
- Department of Neuroscience, North Dakota School of Medicine, Grand Forks, ND, USA
| | | | - Dana L Penney
- Department of Neurology, Lahey Hospital and Medical Center, Burlington, MA, USA
| | - Rhoda Au
- Framingham Heart Study, Boston University School of Medicine, Boston, MA, USA.,Department of Anatomy & Neurobiology, Neurology, & Epidemiology, Boston University Schools of Medicine & Public Health, Boston, MA, USA
| | - David J Libon
- Department of Geriatrics and Gerontology and the Department of Psychology, New Jersey Institute for Successful Aging, Rowan University, School of Osteopathic Medicine, Stratford, NJ, USA
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35
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Müller S, Preische O, Heymann P, Elbing U, Laske C. Diagnostic Value of a Tablet-Based Drawing Task for Discrimination of Patients in the Early Course of Alzheimer's Disease from Healthy Individuals. J Alzheimers Dis 2018; 55:1463-1469. [PMID: 27858717 DOI: 10.3233/jad-160921] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
There is a considerable delay in the diagnosis of dementia, which may reduce the effectiveness of available treatments. Thus, it is of great interest to develop fast and easy to perform, non-invasive and non-expensive diagnostic measures for the early detection of cognitive impairment and dementia. Here we investigate movement kinematics between 20 patients with early dementia due to Alzheimer's disease (eDAT), 30 patients with amnestic mild cognitive impairment (aMCI), and 20 cognitively healthy control (HC) individuals while copying a three-dimensional house using a digitizing tablet. Receiver-operating characteristic (ROC) curves and logistic regression analyzes have been conducted to explore whether alterations in movement kinematics could be used to discriminate patients with aMCI and eDAT from healthy individuals. Time-in-air (i.e., transitioning from one stroke to the next without touching the surface) differed significantly between patients with aMCI, eDAT, and HCs demonstrating an excellent sensitivity and a moderate specificity to discriminate aMCI subjects from normal elderly and an excellent sensitivity and specificity to discriminate patients affected by mild Alzheimer's disease from healthy individuals. Time-on-surface (i.e., time while stylus is touching the surface) differed only between HCs and patients with eDAT but not between HCs and patients with aMCI. Furthermore, total-time (i.e., time-in-air plus time-on-surface) did not differ between patients with aMCI and early dementia due to AD. Modern digitizing devices offer the opportunity to measure a broad range of visuoconstructive abilities that may be used as a fast and easy to perform screening instrument for the early detection of cognitive impairment and dementia in primary care.
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Affiliation(s)
- Stephan Müller
- Department of Psychiatry and Psychotherapy, Eberhard Karls University, Tübingen, Germany.,Department of Psychiatry and Psychotherapy, Eberhard Karls University, Tübingen, Germany
| | - Oliver Preische
- German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany.,Section for Dementia Research, Hertie Institute for Clinical Brain Research and Department of Psychiatry and Psychotherapy, Eberhard Karls University, Tübingen, Germany
| | | | | | - Christoph Laske
- German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany.,Section for Dementia Research, Hertie Institute for Clinical Brain Research and Department of Psychiatry and Psychotherapy, Eberhard Karls University, Tübingen, Germany
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Trojano L, Gainotti G. Drawing Disorders in Alzheimer's Disease and Other Forms of Dementia. J Alzheimers Dis 2017; 53:31-52. [PMID: 27104898 DOI: 10.3233/jad-160009] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Drawing is a multicomponential process that can be impaired by many kinds of brain lesions. Drawing disorders are very common in Alzheimer's disease and other forms of dementia, and can provide clinical information for the distinction of the different dementing diseases. In our review we started from an overview of the neural and cognitive bases of drawing, and from a recollection of the drawing tasks more frequently used for assessing individuals with dementia. Then, we analyzed drawing disorders in dementia, paying special attention to those observed in Alzheimer's disease, from the prodromal stages of the amnesic mild cognitive impairment to the stages of full-blown dementia, both in the sporadic forms with late onset in the entorhino-hippocampal structures and in those with early onset in the posterior neocortical structures. We reviewed the drawing features that could differentiate Alzheimer's disease from vascular dementia and from the most frequent forms of degenerative dementia, namely frontotemporal dementia and Lewy body disease. Finally, we examined some peculiar aspects of drawing disorders in dementia, such as perseverations, rotations, and closing-in. We argue that a careful analysis of drawing errors helps to differentiate the different forms of dementia more than overall accuracy in drawing.
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Affiliation(s)
- Luigi Trojano
- Department of Psychology, Second University of Naples, Italy.,S. Maugeri Foundation, Scientific Institute of Telese Terme (BN), Italy
| | - Guido Gainotti
- Center for Neuropsychological Research, Institute of Neurology, Catholic University, Rome, Italy.,IRCCS Fondazione Santa Lucia, Department of Clinical and Behavioral Neurology, Rome, Italy
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Moretti R, Torre P, Antonello RM, Cazzato G, Bava A, Manos PJ. Use of the Ten-Point Clock Test to Compare Executive Functioning across 24 Months in Patients with Subcortical Vascular Dementia. Percept Mot Skills 2016; 100:207-16. [PMID: 15773712 DOI: 10.2466/pms.100.1.207-216] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The Ten-point Clock Test can be used to identify early forms of Alzheimer's disease because it is reliable, well accepted, and easily administered at the bedside. Nevertheless, its clinical role in the detection of early dementia and its correlations with other cognitive processes is still under investigation. Vascular dementia is an uncertain nosological entity, in which unevenly distributed patterns of cognitive deficits comprising slowing of cognitive processing and impairment of executive function occur. The present study assessed how the Clock Test scores correlated with a number of other neuropsychological and functional tests in a sample of 144 patients with vascular dementia, who were followed for a period of 24 mo. At baseline, at 12 mo. and at 24 mo. subjects were administered a battery of tests, including the Mini-Mental State Examination, word fluency, visuospatial skills, an evaluation of hetero- and autotopognosia (knowledge of self), the Proverbs Test, and the Ten-point Clock Test. For these patients scores on the Clock Test correlated significantly with semantic abilities, with abstract reasoning capacities, visuospatial perception, and with right and left recognition.
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Affiliation(s)
- Rita Moretti
- Dipartimento di Fisiologia e Patologia General, U.C.O. di Clinica Neurologica, Università degli Studi di Trieste, Italy.
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Siciliano M, Santangelo G, D’Iorio A, Basile G, Piscopo F, Grossi D, Trojano L. Rouleau version of the Clock Drawing Test: age- and education-adjusted normative data from a wide Italian sample. Clin Neuropsychol 2016; 30:1501-1516. [DOI: 10.1080/13854046.2016.1241893] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Culbertson WC, Moberg PJ, Duda JE, Stern MB, Weintraub D. Assessing the Executive Function Deficits of Patients with Parkinson’s Disease. Assessment 2016; 11:27-39. [PMID: 14994951 DOI: 10.1177/1073191103258590] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aim of the study was to investigate the utility of the Tower of London-Drexel (TOLDX ) in assessing the executive deficits associated with Parkinson’s disease (PD). We sought to determine whether the TOLDX would differentiate between (a) patients with PD and healthy control participants (HCP), (b) demented and nondemented patients, and (c) depressed and nondepressed patients. A new TOLDX score, stimulus bound, was introduced to assess utilization behaviors. Furthermore, the convergent and divergent validity of the TOLDX was examined. The TOLDX total move, rule and time violation, and stimulus-bound scores of patients with PD significantly differed from the HCP. Demented and nondemented patients also differed significantly in their TODX performance, with the stimulus-bound score being the most significantly differentiating score. However, the depressed and nondepressed patients did not differ in their TOLDX performance. Support was found for the convergent and divergent validity of the TOLDX. The clinical and theoretical implications of the findings are discussed.
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40
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Lamar M, Ajilore O, Leow A, Charlton R, Cohen J, GadElkarim J, Yang S, Zhang A, Davis R, Penney D, Libon DJ, Kumar A. Cognitive and connectome properties detectable through individual differences in graphomotor organization. Neuropsychologia 2016; 85:301-9. [PMID: 27037044 DOI: 10.1016/j.neuropsychologia.2016.03.034] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Revised: 03/25/2016] [Accepted: 03/28/2016] [Indexed: 12/31/2022]
Abstract
We investigated whether graphomotor organization during a digitized Clock Drawing Test (dCDT) would be associated with cognitive and/or brain structural differences detected with a tractography-derived structural connectome of the brain. 72 non-demented/non-depressed adults were categorized based on whether or not they used 'anchor' digits (i.e., 12, 3, 6, 9) before any other digits while completing dCDT instructions to "draw the face of a clock with all the numbers and set the hands to 10 after 11". 'Anchorers' were compared to 'non-anchorers' across dCDT, additional cognitive measures and connectome-based metrics. In the context of grossly intact clock drawings, anchorers required fewer strokes to complete the dCDT and outperformed non-anchorers on executive functioning and learning/memory/recognition tasks. Anchorers had higher local efficiency for the left medial orbitofrontal and transverse temporal cortices as well as the right rostral anterior cingulate and superior frontal gyrus versus non-anchorers suggesting better regional integration within local networks involving these regions; select aspects of which correlated with cognition. Results also revealed that anchorers' exhibited a higher degree of modular integration among heteromodal regions of the ventral visual processing stream versus non-anchorers. Thus, an easily observable graphomotor distinction was associated with 1) better performance in specific cognitive domains, 2) higher local efficiency suggesting better regional integration, and 3) more sophisticated modular integration involving the ventral ('what') visuospatial processing stream. Taken together, these results enhance our knowledge of the brain-behavior relationships underlying unprompted graphomotor organization during dCDT.
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Affiliation(s)
- Melissa Lamar
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL 60612, United States; Graduate Program in Neuroscience, University of Illinois at Chicago, Chicago, IL 60612, United States.
| | - Olusola Ajilore
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL 60612, United States; Graduate Program in Neuroscience, University of Illinois at Chicago, Chicago, IL 60612, United States
| | - Alex Leow
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL 60612, United States; Department of Bioengineering, University of Illinois at Chicago, Chicago, IL 60607, United States
| | - Rebecca Charlton
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL 60612, United States; Department of Psychology, Goldsmith's University, London, England SE14 6NW, United Kingdom
| | - Jamie Cohen
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL 60612, United States
| | - Johnson GadElkarim
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL 60612, United States
| | - Shaolin Yang
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL 60612, United States; Department of Bioengineering, University of Illinois at Chicago, Chicago, IL 60607, United States; Department of Radiology, University of Illinois at Chicago, Chicago, IL 60612, United States
| | - Aifeng Zhang
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL 60612, United States
| | - Randall Davis
- MIT Computer Science and Artificial Intelligence Laboratory, Massachusetts Institute of Technology, Cambridge, MA 02139, United States
| | - Dana Penney
- The Lahey Clinic, Burlington, MA 01805, United States
| | - David J Libon
- Department of Geriatrics and Gerontology, New Jersey Institute for Successful Aging, School of Osteopathic Medicine-Rowan University, Stratford, NJ 08084, United States
| | - Anand Kumar
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL 60612, United States
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Abstract
BACKGROUND Studies have shown the clock-drawing test (CDT) to be a useful screening test that differentiates between normal, elderly populations, and those diagnosed with dementia. However, the results of studies which have looked at the utility of the CDT to help differentiate Alzheimer's disease (AD) from other dementias have been conflicting. The purpose of this study was to explore the utility of the CDT in discriminating between patients with AD and other types of dementia. METHODS A review was conducted using MEDLINE, PsycINFO, and Embase. Search terms included clock drawing or CLOX and dementia or Parkinson's Disease or AD or dementia with Lewy bodies (DLB) or vascular dementia (VaD). RESULTS Twenty studies were included. In most of the studies, no significant differences were found in quantitative CDT scores between AD and VaD, DLB, and Parkinson's disease dementia (PDD) patients. However, frontotemporal dementia (FTD) patients consistently scored higher on the CDT than AD patients. Qualitative analyses of errors differentiated AD from other types of dementia. CONCLUSIONS Overall, the CDT score may be useful in distinguishing between AD and FTD patients, but shows limited value in differentiating between AD and VaD, DLB, and PDD. Qualitative analysis of the type of CDT errors may be a useful adjunct in the differential diagnosis of the types of dementias.
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Digital Clock Drawing: differentiating "thinking" versus "doing" in younger and older adults with depression. J Int Neuropsychol Soc 2014; 20:920-8. [PMID: 25222513 PMCID: PMC4310546 DOI: 10.1017/s1355617714000757] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Psychomotor slowing has been documented in depression. The digital Clock Drawing Test (dCDT) provides: (i) a novel technique to assess both cognitive and motor aspects of psychomotor speed within the same task and (ii) the potential to uncover subtleties of behavior not previously detected with non-digitized modes of data collection. Using digitized pen technology in 106 participants grouped by Age (younger/older) and Affect (euthymic/unmedicated depressed), we recorded cognitive and motor output by capturing how the clock is drawn rather than focusing on the final product. We divided time to completion (TTC) for Command and Copy conditions of the dCDT into metrics of percent of drawing (%Ink) versus non-drawing (%Think) time. We also obtained composite Z-scores of cognition, including attention/information processing (AIP), to explore associations of %Ink and %Think times to cognitive and motor performance. Despite equivalent TTC, %Ink and %Think Command times (Copy n.s.) were significant (AgeXAffect interaction: p=.03)-younger depressed spent a smaller proportion of time drawing relative to thinking compared to the older depressed group. Command %Think time negatively correlated with AIP in the older depressed group (r=-.46; p=.02). Copy %Think time negatively correlated with AIP in the younger depressed (r=-.47; p=.03) and older euthymic groups (r=-.51; p=.01). The dCDT differentiated aspects of psychomotor slowing in depression regardless of age, while dCDT/cognitive associates for younger adults with depression mimicked patterns of older euthymics.
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Paula JJD, Miranda DMD, Moraes END, Malloy-Diniz LF. Mapping the clockworks: what does the Clock Drawing Test assess in normal and pathological aging? ARQUIVOS DE NEURO-PSIQUIATRIA 2014; 71:763-8. [PMID: 24212511 DOI: 10.1590/0004-282x20130118] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2012] [Accepted: 05/13/2013] [Indexed: 11/22/2022]
Abstract
The Clock Drawing Test (CDT) is a cognitive screening tool used in clinical and research settings. Despite its role on the assessment of global cognitive functioning, the specific cognitive components required for test performance are still unclear. We aim to assess the role of executive functioning, global cognitive status, visuospatial abilities, and semantic knowledge on Shulman's CDT performance. Fifty-three mild cognitive impairment, 60 Alzheimer's dementia, and 57 normal elderly controls performed the CDT, the Frontal Assessment Battery, the Mini-Mental State Examination, the Stick Design Test, and a naming test (TN-LIN). An ordinal regression assessed specific neuropsychological influences on CDT performance. All the cognitive variables were related to the CDT, accounting for 53% of variance. The strongest association was between the CDT and executive functions, followed by global cognitive status, visuospatial processing, and semantic knowledge. Our result confirms the multidimensional nature of the test and the major role of executive functions on performance.
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Affiliation(s)
- Jonas Jardim de Paula
- Laboratory of Neuropsychological Investigations (LIN), Universidade Federal de Minas Gerais, Belo HorizonteMG, Brazil
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Santana I, Duro D, Freitas S, Alves L, Simões MR. The Clock Drawing Test: Portuguese norms, by age and education, for three different scoring systems. Arch Clin Neuropsychol 2013; 28:375-87. [PMID: 23518874 DOI: 10.1093/arclin/act016] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The Clock Drawing Test has been systematically used to assess visuospatial deficits related to the parietal lobes, but we now acknowledge its much more complex relation with other cognitive abilities. Despite its common use in clinical and investigational practices, no study has developed normative data for the Portuguese population. We present the distribution of clock drawing scores using three scoring systems in a representative community sample of cognitively healthy subjects. We found that the systems were well correlated with each other and with cognitive screening tests widely used and had good psychometric properties. Normative data for the three scoring systems were developed considering age and education. These results allow a more rigorous interpretation of the test performance in clinical context and are especially relevant for epidemiological research.
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Affiliation(s)
- Isabel Santana
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
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Palmqvist S, Hertze J, Minthon L, Wattmo C, Zetterberg H, Blennow K, Londos E, Hansson O. Comparison of brief cognitive tests and CSF biomarkers in predicting Alzheimer's disease in mild cognitive impairment: six-year follow-up study. PLoS One 2012; 7:e38639. [PMID: 22761691 PMCID: PMC3382225 DOI: 10.1371/journal.pone.0038639] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2012] [Accepted: 05/08/2012] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION Early identification of Alzheimer's disease (AD) is needed both for clinical trials and in clinical practice. In this study, we compared brief cognitive tests and cerebrospinal fluid (CSF) biomarkers in predicting conversion from mild cognitive impairment (MCI) to AD. METHODS At a memory clinic, 133 patients with MCI were followed until development of dementia or until they had been stable over a mean period of 5.9 years (range 3.2-8.8 years). The Mini-Mental State Examination (MMSE), the clock drawing test, total tau, tau phosphorylated at Thr(181) (P-tau) and amyloid-β(1-42) (Aβ(42)) were assessed at baseline. RESULTS During clinical follow-up, 47% remained cognitively stable and 53% developed dementia, with an incidence of 13.8%/year. In the group that developed dementia the prevalence of AD was 73.2%, vascular dementia 14.1%, dementia with Lewy bodies (DLB) 5.6%, progressive supranuclear palsy (PSP) 4.2%, semantic dementia 1.4% and dementia due to brain tumour 1.4%. When predicting subsequent development of AD among patients with MCI, the cognitive tests classified 81% of the cases correctly (AUC, 0.85; 95% CI, 0.77-0.90) and CSF biomarkers 83% (AUC, 0.89; 95% CI, 0.82-0.94). The combination of cognitive tests and CSF (AUC, 0.93; 95% CI 0.87 to 0.96) was significantly better than the cognitive tests (p = 0.01) and the CSF biomarkers (p = 0.04) alone when predicting AD. CONCLUSIONS The MMSE and the clock drawing test were as accurate as CSF biomarkers in predicting future development of AD in patients with MCI. Combining both instruments provided significantly greater accuracy than cognitive tests or CSF biomarkers alone in predicting AD.
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Affiliation(s)
- Sebastian Palmqvist
- Clinical Memory Research Unit, Department of Clinical Sciences, Lund University, Malmö, Sweden.
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Seidel GA, Giovannetti T, Libon DJ. Cerebrovascular disease and cognition in older adults. Curr Top Behav Neurosci 2012; 10:213-241. [PMID: 21773915 DOI: 10.1007/7854_2011_140] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The well-established association between advanced age, cerebrovascular pathology, and cognitive decline is receiving greater attention as the population attains new levels of longevity. This chapter will provide an overview of vascular anatomy and age-related cerebrovascular disorders and diseases, including stroke and degenerative dementia. The cognitive and functional sequellae of these cerebrovascular disorders will also be described in detail. Throughout this review, we will emphasize topics that have been relatively underrepresented in the literature, including age-related diseases of the cerebral small vessels, nuanced characterization of cognitive impairment associated with insidious small-vessel vascular dementia, and the real-life functional consequences of cerebrovascular changes in older adults.
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Affiliation(s)
- Gregory A Seidel
- Department of Psychology, Temple University, Philadelphia, PA, USA,
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Magouirk Bettcher B, Giovannetti T, Klobusicky E, Wambach D, Eppig J, Libon DJ. To err is human, to monitor divine: Environmental adaptations reduce everyday errors but do not improve monitoring. J Clin Exp Neuropsychol 2011; 33:1049-58. [DOI: 10.1080/13803395.2011.595395] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Brianne Magouirk Bettcher
- a Department of Neurology , Memory and Aging Center, University of California , San Francisco, CA, USA
| | - Tania Giovannetti
- b Department of Psychology , Temple University , Philadelphia, PA, USA
| | | | - Denene Wambach
- b Department of Psychology , Temple University , Philadelphia, PA, USA
- c Department of Neurology , Drexel University College of Medicine , Philadelphia, PA, USA
| | - Joel Eppig
- b Department of Psychology , Temple University , Philadelphia, PA, USA
- c Department of Neurology , Drexel University College of Medicine , Philadelphia, PA, USA
| | - David J. Libon
- c Department of Neurology , Drexel University College of Medicine , Philadelphia, PA, USA
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Harrington MB, Kraft M, Grande LJ, Rudolph JL. Independent association between preoperative cognitive status and discharge location after cardiac surgery. Am J Crit Care 2011; 20:129-37. [PMID: 21362717 DOI: 10.4037/ajcc2011275] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Among cardiac surgery patients, those with impaired cognitive status before surgery may have longer postoperative stays than do patients with normal status and may require additional care upon discharge. OBJECTIVES To determine if preoperative scores on a screening measure for cognitive status (the Clock-in-the-Box), were associated with postoperative length of stay and discharge to a location other than home in patients who had cardiac surgery. METHODS A total of 181 consecutive patients scheduled for cardiac surgery at a single site were administered the Clock-in-the-Box as part of the preoperative evaluation. Scores on the Clock-in-the-Box tool, demographic and operative information, postoperative length of stay, and discharge location were collected retrospectively from medical records. RESULTS The mean age of the patients was 68.1 years (SD, 0.7), and 99% were men. Mean postoperative length of stay was 10.5 days (SD, 8.2), and 35 patients (19%) were discharged to a facility. Scores on the Clock-in-the-Box assessment were not associated with postoperative length of stay. Increasing age, living alone before surgery, and duration of cardiopulmonary bypass were associated with discharge to a facility and were used as covariates in adjusted analyses. After adjustment, better preoperative cognitive status reduced the risk of being discharged to a facility (adjusted relative risk, 0.93; 95% confidence interval, 0.89-0.98) after cardiac surgery. CONCLUSIONS Cognitive screening before cardiac surgery can identify patients with impaired cognitive status who are less likely than patients with normal cognitive status to return home after cardiac surgery.
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Affiliation(s)
- Mary Beth Harrington
- Mary Beth Harrington is a geriatric nurse practitioner in the Geriatric Research, Education, and Clinical Center and Malissa Kraft and Laura J. Grande are psychologists in the Department of Psychology at the VA Boston Healthcare System, Boston, Massachusetts. James L. Rudolph is a staff physician in the Geriatric Research, Education, and Clinical Center, VA Boston Healthcare System; the Division of Aging, Brigham and Women’s Hospital, and Harvard Medical School, all in Boston, Massachusetts
| | - Malissa Kraft
- Mary Beth Harrington is a geriatric nurse practitioner in the Geriatric Research, Education, and Clinical Center and Malissa Kraft and Laura J. Grande are psychologists in the Department of Psychology at the VA Boston Healthcare System, Boston, Massachusetts. James L. Rudolph is a staff physician in the Geriatric Research, Education, and Clinical Center, VA Boston Healthcare System; the Division of Aging, Brigham and Women’s Hospital, and Harvard Medical School, all in Boston, Massachusetts
| | - Laura J. Grande
- Mary Beth Harrington is a geriatric nurse practitioner in the Geriatric Research, Education, and Clinical Center and Malissa Kraft and Laura J. Grande are psychologists in the Department of Psychology at the VA Boston Healthcare System, Boston, Massachusetts. James L. Rudolph is a staff physician in the Geriatric Research, Education, and Clinical Center, VA Boston Healthcare System; the Division of Aging, Brigham and Women’s Hospital, and Harvard Medical School, all in Boston, Massachusetts
| | - James L. Rudolph
- Mary Beth Harrington is a geriatric nurse practitioner in the Geriatric Research, Education, and Clinical Center and Malissa Kraft and Laura J. Grande are psychologists in the Department of Psychology at the VA Boston Healthcare System, Boston, Massachusetts. James L. Rudolph is a staff physician in the Geriatric Research, Education, and Clinical Center, VA Boston Healthcare System; the Division of Aging, Brigham and Women’s Hospital, and Harvard Medical School, all in Boston, Massachusetts
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Chrysikou EG, Giovannetti T, Wambach DM, Lyon AC, Grossman M, Libon DJ. The importance of multiple assessments of object knowledge in semantic dementia: the case of the familiar objects task. Neurocase 2011; 17:57-75. [PMID: 20812137 PMCID: PMC3303167 DOI: 10.1080/13554794.2010.497156] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Semantic dementia (SD) is characterized by a dramatic loss of conceptual knowledge about the meaning of words and the identity of objects. Previous research has suggested that SD patients' knowledge is differentially influenced by the disease and may decline at different degrees depending on a patient's everyday familiarity with certain items. However, no study has examined (a) semantic knowledge deterioration and (b) the potential significance of autobiographical experience for the maintenance of object concepts in the same cohort of SD patients by using comprehensive assessments of different aspects of object knowledge across an experience-based, distributed semantic memory network. Here, we tested four SD patients and three Alzheimer's disease (AD) control patients using a range of tasks - including naming, gesture generation, and autobiographical knowledge - with personally familiar objects or perceptually similar or different object analogs. Our results showed dissociations between performance on naming relative to other assessments of object knowledge between SD and AD patients, though we did not observe a reliable familiar objects advantage. We discuss different factors that may account for these findings, as well as their implications for research on SD.
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Affiliation(s)
- Evangelia G Chrysikou
- Department of Psychology, University of Pennsylvania, Philadelphia, PA 19104-6241, USA.
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Crowe M, Allman RM, Triebel K, Sawyer P, Martin RC. Normative performance on an executive clock drawing task (CLOX) in a community-dwelling sample of older adults. Arch Clin Neuropsychol 2010; 25:610-7. [PMID: 20601672 PMCID: PMC2957959 DOI: 10.1093/arclin/acq047] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2010] [Indexed: 11/13/2022] Open
Abstract
The CLOX is a clock drawing test used to screen for cognitive impairment in older adults, but there is limited normative data for this measure. This study presents normative data for the CLOX derived from a diverse sample of 585 community-dwelling older adults with complete cognitive data at baseline and 4-year follow-up. Participants with evidence of baseline impairment or substantial 4-year decline on the Mini-Mental State Examination were excluded from the normative sample. Spontaneous clock drawing (CLOX1) and copy (CLOX2) performances were stratified by age group and reading ability from the Wide Range Achievement Test, 3rd edition (WRAT-3). Lowest mean CLOX scores were observed for the oldest age group (75+ years old) with the lowest WRAT-3 reading scores. For all groups, average scores were higher for CLOX2 than CLOX1. These normative data may be helpful to clinicians and researchers for interpreting CLOX performance in older adults with diverse levels of reading ability.
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Affiliation(s)
- Michael Crowe
- Department of Psychology, University of Alabama at Birmingham, USA.
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