Test-retest reliability and minimal detectable change of the Contextual Memory Test in older adults with and without mild cognitive impairment

Reliability of online, remote neuropsychological assessment in people with and without subjective cognitive decline

Online, remote neuropsychological assessment paradigms may offer a cost-effective alternative to in-person assessment for people who experience subjective cognitive decline (SCD). However, it is vital to establish the psychometric properties of such paradigms. The present study (i) evaluates test-retest reliability of remote, online neuropsychological tests from the NeurOn software platform in people with and without SCD (Non-SCD) recruited from the general population; and (ii) investigates potential group differences in baseline performance and longitudinal change. Ninety-nine participants (SCD N = 44, Non-SCD N = 55) completed seven tests from the NeurOn battery, covering visual and verbal memory, working memory, attention and psychomotor speed. Sixty-nine participants (SCD N = 34, Non-SCD N = 35) repeated the assessment six (+/- one) months later. SCD was classified using the Cognitive Change Index questionnaire. Test-retest reliability of the NeurOn test outcome measures ranged from poor to good, with the strongest evidence of reliability shown for the Sustained Attention to Response Test and Picture Recognition. The SCD group was significantly older than the Non-SCD group so group differences were investigated using analysis of covariance whilst controlling for the effect of age. SCD scored significantly better than Non-SCD for Digit Span Backwards (maximum sequence length) and Picture Recognition (recall of object position) at baseline. However, these were not significant when using the Bonferroni-adjusted alpha level. There were no differences between SCD and Non-SCD in longitudinal change. The results suggest online, remote neuropsychological assessment is a promising option for assessing and monitoring SCD, however more research is needed to determine the most suitable tests in terms of reliability and sensitivity to SCD.

Enhancing everyday memory and participation in multiple sclerosis: A pilot study of a metacognitive strategy-based intervention

Background

Cognitive dysfunction in individuals with multiple sclerosis (MS) is associated with limitations in daily activities and restricted participation. Existing interventions for cognitive dysfunction often show inconsistent transfer to everyday activities and typically require frequent clinic visits, which can be challenging for patients with MS due to mobility issues. To address this barrier, we developed a telehealth-based cognitive intervention that is based on metacognitive strategy training.

Objective

Examine the feasibility and impact of a telehealth-based cognitive intervention on activity and participation in persons with MS.

Methods

Ten participants with MS were included in a remote six-week, 12 sessions cognitive treatment program. The treatment emphasized self-generation and metacognitive strategies to enhance cognitive function. Participants' cognitive abilities were evaluated at baseline (Time 1), midtreatment (Time 2), and posttreatment (Time 3).

Results

Participants demonstrated improved memory, self-awareness, strategy use, and functional status. Participants reported enhanced confidence and better focus and found the remote program engaging and applicable to daily life, reporting increased preparedness for learning.

Conclusion

Results provide preliminary proof-of-concept data suggesting that telehealth-based cognitive intervention is well accepted by patients and may improve cognitive functions in persons with MS. These data support the need for a larger trial for this intervention.

Memory benefits of daily-living-related contextual cueing for individuals with subjective cognitive decline and mild cognitive impairment

Objective

We aimed to assess how daily-living-related contextual cueing (DLCC) affects memory performance in three groups: healthy older adults (HA), those with subjective cognitive decline (SCD), and mild cognitive impairment (MCI), while accounting for age and education.

Methods

After gathering demographic information, participants underwent neuropsychological assessments including the Montreal Cognitive Assessment (MoCA), Everyday Cognition Scale (ECog-12), Mini Mental State Examination (MMSE), Geriatric Depression Scale (GDS), and Trail Making Test (TMT) to establish baseline characteristics. Participants were categorized into HA (N = 47), SCD (N = 54), and MCI (N = 43) groups based on MoCA and ECog-12 scores. Memory performance was evaluated through two components of the Contextual Memory Test (CMT): one with non-contextual cues and the other with daily-living-related contextual cues.

Results

Interaction effects between contextual cueing and group for immediate recall (p < .001), delayed recall (p < .001), and total recall (p < .001) were found. All recall scores were lower in the MCI group than in the other two groups in the contextual cueing, not non-contextual. The post-hoc results revealed that scores on immediate recall, delayed recall, and total recall were lower in the MCI group than in the other two groups in the contextual cueing condition but not in the non-contextual cueing one.

Conclusions

Daily-living-related contextual cueing benefited HA, SCD, and younger-adult MCI groups more than older-adult MCI group, particularly enhancing delayed and total memory performance.

Reliability and validity of Foot Posture Index (FPI-6) for evaluating foot posture in participants with low back pain

Previous studies have demonstrated that Foot Posture Index (FPI-6) is a valid and moderately reliable tool to evaluate foot posture. However, data about reliability and validity of FPI-6 in the assessment of foot posture in people with low back pain (LBP) is lacking. To investigate reliability and validity of FPI-6 in the assessment of foot posture in people with LBP. Thirty volunteers with LBP, aged 20-64 years, were recruited for the research and assessed by two raters. The data measured by different raters on the same day were used to calculate the inter-rater reliability. The data measured by the same rater on different dates were used to calculate the test-retest reliability. The reliability of FPI-6 was tested with intraclass correlation coefficient (ICC), and absolute reliability with standard error of measurement (SEM), minimal detectable change (MDC) and Bland-Altman analysis. The validity of FPI-6 was tested with Exploratory Factor Analysis (EFA) and Spearman's correlation coefficients. The FPI-6 indicated excellent inter-rater and test-retest reliability in the evaluation of foot posture in people with LBP (ICC = 0.97 and 0.95). The agreement for inter-rater and test-retest was excellent based on the SEM (SEM = 0.12) and MDC value (MDC = 0.33). Bland-Altman plots showed that there was no significant systematic bias for the agreement on the ground of low mean difference (< 1). The EFA suggested that the fit indices were considered acceptable according to the Kaiser-Meyer-Olkin (KMO) value (KMO = 0.620) and Bartlett's sphericity test (P < 0.01). There was a statistically significant positive correlation between each item and total score of FPI-6 because the Spearman's correlation coefficient of six items were all > 0.3 (P < 0.01). The inter-rater and test-retest reliability and validity of FPI-6 on people with LBP were proved reliable. It might be considered a reliable and valid adjunctive tool to detect possible changes of foot posture after interventions in patients with LBP.

Associations of Word Memory, Verbal Fluency, Processing Speed, and Crystallized Cognitive Ability With One-Legged Balance Performance in Mid- and Later Life

BACKGROUND

Cognitive integration of sensory input and motor output plays an important role in balance. Despite this, it is not clear if specific cognitive processes are associated with balance and how these associations change with age. We examined longitudinal associations of word memory, verbal fluency, search speed, and reading ability with repeated measures of one-legged balance performance.

METHOD

Up to 2 934 participants in the MRC National Survey of Health and Development, a British birth cohort study, were included. At age 53, word memory, verbal fluency, search speed, and reading ability were assessed. One-legged balance times (eyes closed) were measured at ages 53, 60-64, and 69 years. Associations between each cognitive measure and balance time were assessed using random-effects models. Adjustments were made for sex, death, attrition, height, body mass index, health conditions, health behaviors, education, and occupational class.

RESULTS

In sex-adjusted models, 1 SD higher scores in word memory, search speed, and verbal fluency were associated with 14.1% (95% CI: 11.3, 16.8), 7.2% (4.4, 9.9), and 10.3% (7.5, 13.0) better balance times at age 53, respectively. Higher reading scores were associated with better balance, although this association plateaued. Associations were partially attenuated in mutually adjusted models and effect sizes were smaller at ages 60-64 and 69. In fully adjusted models, associations were largely explained by education, although remained for word memory and search speed.

CONCLUSIONS

Higher cognitive performance across all measures was independently associated with better balance performance in midlife. Identification of individual cognitive mechanisms involved in balance could lead to opportunities for targeted interventions in midlife.

Screening recall in older cancer survivors detects differences in balance and mobility

PURPOSE

Cognitive impairments have been reported by up to two-thirds of cancer survivors whose primary cancer did not occur in the central nervous system. Physical impairments as sequelae of cancer-related cognitive impairment (CRCI) have not been well described in previous studies. Furthermore, there is scarcity of literature describing differences among physical performance in those with and without CRCI. The purpose of this study is to examine the differences in physical function of older cancer survivors based on cognitive ability to determine if physical performance differs when different cognitive screening measures are employed.

METHODS

Adults age 65 + with a history of cancer from the 2010 Health and Retirement Study (n = 1,953) were assigned to groups according to their cognitive ability. Between-group demographic, mobility, and cognitive differences were analyzed using chi-squared and t tests. Recall and orientation were used as cognitive variables, and physical performance outcomes included gait speed, balance, and grip strength.

RESULTS

Respondents with Low Recall had more impaired balance (semi-tandem, tandem) (p < .05) and slower gait speeds (p < .05). Respondents that were Not-Oriented had slower gait speed (p < .05). Between-group differences in demographics were found by recall and orientation groups.

CONCLUSIONS

Impairments in balance and gait speed are able to be detected when recall is screened in a population of older cancer survivors. When assessing how physical mobility is related to fall risk, a screen of cognition should go beyond just orientation.

Safety perception and pedestrian dynamics: Experimental results towards affective agents modeling

The modeling of a new generation of agent-based simulation systems supporting pedestrian and crowd management taking into account affective states represents a new research frontier. Pedestrian behaviour involves human perception processes, based on subjective and psychological aspects. Following the concept of pedestrian environmental awareness, each walker adapts his/her crossing behaviour according to environmental conditions and his/her perception of safety. Different pedestrian behaviours can be related to subjective mobility and readiness to respond, and these factors are strongly dependent on the subjective interaction with the environment. Having additional inputs about pedestrian behaviour related to their perception processes could be useful in order to develop a more representative pedestrian dynamic model. In particular, the subjective perception of the safeness of crossing should be taken into consideration. In order to focus on the pedestrians’ perception of safe road crossing and walking, an experiment in an uncontrolled urban scenario has been carried out. Besides more conventional self-assessment questionnaires, physiological responses have been considered to evaluate the affective state of pedestrians during the interaction with the urban environment. Results from the analysis of the collected data show that physiological responses are reliable indicators of safety perception while road crossing and interacting with real urban environment, suggesting the design of agent-based models for pedestrian dynamics simulations taking in account the representation of affective states.