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Sperling SA, Acheson SK, Fox-Fuller J, Colvin MK, Harder L, Cullum CM, Randolph JJ, Carter KR, Espe-Pfeifer P, Lacritz LH, Arnett PA, Gillaspy SR. Tele-Neuropsychology: From Science to Policy to Practice. Arch Clin Neuropsychol 2024; 39:227-248. [PMID: 37715508 DOI: 10.1093/arclin/acad066] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2023] [Indexed: 09/17/2023] Open
Abstract
OBJECTIVE The primary aim of this paper is to accelerate the number of randomized experimental studies of the reliability and validity in-home tele-neuropsychological testing (tele-np-t). METHOD We conducted a critical review of the tele-neuropsychology literature. We discuss this research in the context of the United States' public and private healthcare payer systems, including the Centers for Medicare & Medicaid Services (CMS) and Current Procedural Terminology (CPT) coding system's telehealth lists, and existing disparities in healthcare access. RESULTS The number of tele-np publications has been stagnant since the onset of the COVID-19 pandemic. There are less published experimental studies of tele-neuropsychology (tele-np), and particularly in-home tele-np-t, than other tele-np publications. There is strong foundational evidence of the acceptability, feasibility, and reliability of tele-np-t, but relatively few studies of the reliability and validity of in-home tele-np-t using randomization methodology. CONCLUSIONS More studies of the reliability and validity of in-home tele-np-t using randomization methodology are necessary to support inclusion of tele-np-t codes on the CMS and CPT telehealth lists, and subsequently, the integration and delivery of in-home tele-np-t services across providers and institutions. These actions are needed to maintain equitable reimbursement of in-home tele-np-t services and address the widespread disparities in healthcare access.
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Affiliation(s)
- Scott A Sperling
- Department of Neurology, Center for Neurological Restoration, Cleveland Clinic, Cleveland, OH, USA
| | | | - Joshua Fox-Fuller
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | - Mary K Colvin
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Lana Harder
- Children's Health, Children's Medical Center, Dallas, TX, USA
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - C Munro Cullum
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - John J Randolph
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
- Randolph Neuropsychology Associates, PLLC, Lebanon, NH, USA
| | | | - Patricia Espe-Pfeifer
- Department of Psychiatry and Pediatrics, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Laura H Lacritz
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Peter A Arnett
- Department of Psychology, The Pennsylvania State University, State College, PA, USA
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Schäfer S, Mallick E, Schwed L, König A, Zhao J, Linz N, Bodin TH, Skoog J, Possemis N, ter Huurne D, Zettergren A, Kern S, Sacuiu S, Ramakers I, Skoog I, Tröger J. Screening for Mild Cognitive Impairment Using a Machine Learning Classifier and the Remote Speech Biomarker for Cognition: Evidence from Two Clinically Relevant Cohorts. J Alzheimers Dis 2023; 91:1165-1171. [PMID: 36565116 PMCID: PMC9912722 DOI: 10.3233/jad-220762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Modern prodromal Alzheimer's disease (AD) clinical trials might extend outreach to a general population, causing high screen-out rates and thereby increasing study time and costs. Thus, screening tools that cost-effectively detect mild cognitive impairment (MCI) at scale are needed. OBJECTIVE Develop a screening algorithm that can differentiate between healthy and MCI participants in different clinically relevant populations. METHODS Two screening algorithms based on the remote ki:e speech biomarker for cognition (ki:e SB-C) were designed on a Dutch memory clinic cohort (N = 121) and a Swedish birth cohort (N = 404). MCI classification was each evaluated on the training cohort as well as on the unrelated validation cohort. RESULTS The algorithms achieved a performance of AUC 0.73 and AUC 0.77 in the respective training cohorts and AUC 0.81 in the unseen validation cohorts. CONCLUSION The results indicate that a ki:e SB-C based algorithm robustly detects MCI across different cohorts and languages, which has the potential to make current trials more efficient and improve future primary health care.
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Affiliation(s)
- Simona Schäfer
- ki:elements, Saarbrücken, Germany,Correspondence to: Simona Schäfer, ki elements GmbH, Am Holzbrunnen 1a, 66121 Saarbrücken, Germany. Tel.: +49681 372009200; E-mail:
| | | | | | - Alexandra König
- ki:elements, Saarbrücken, Germany,Institut National de Recherche en Informatique et en Automatique (INRIA), Stars Team, Sophia Antipolis, Valbonne, France
| | | | | | - Timothy Hadarsson Bodin
- Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Johan Skoog
- Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Nina Possemis
- Alzheimer Center Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Daphne ter Huurne
- Alzheimer Center Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Anna Zettergren
- Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Silke Kern
- Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Simona Sacuiu
- Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Inez Ramakers
- Alzheimer Center Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Ingmar Skoog
- Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Fristed E, Skirrow C, Meszaros M, Lenain R, Meepegama U, Papp KV, Ropacki M, Weston J. Leveraging speech and artificial intelligence to screen for early Alzheimer's disease and amyloid beta positivity. Brain Commun 2022; 4:fcac231. [PMID: 36381988 PMCID: PMC9639797 DOI: 10.1093/braincomms/fcac231] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 06/30/2022] [Accepted: 09/13/2022] [Indexed: 08/27/2023] Open
Abstract
Early detection of Alzheimer's disease is required to identify patients suitable for disease-modifying medications and to improve access to non-pharmacological preventative interventions. Prior research shows detectable changes in speech in Alzheimer's dementia and its clinical precursors. The current study assesses whether a fully automated speech-based artificial intelligence system can detect cognitive impairment and amyloid beta positivity, which characterize early stages of Alzheimer's disease. Two hundred participants (age 54-85, mean 70.6; 114 female, 86 male) from sister studies in the UK (NCT04828122) and the USA (NCT04928976), completed the same assessments and were combined in the current analyses. Participants were recruited from prior clinical trials where amyloid beta status (97 amyloid positive, 103 amyloid negative, as established via PET or CSF test) and clinical diagnostic status was known (94 cognitively unimpaired, 106 with mild cognitive impairment or mild Alzheimer's disease). The automatic story recall task was administered during supervised in-person or telemedicine assessments, where participants were asked to recall stories immediately and after a brief delay. An artificial intelligence text-pair evaluation model produced vector-based outputs from the original story text and recorded and transcribed participant recalls, quantifying differences between them. Vector-based representations were fed into logistic regression models, trained with tournament leave-pair-out cross-validation analysis to predict amyloid beta status (primary endpoint), mild cognitive impairment and amyloid beta status in diagnostic subgroups (secondary endpoints). Predictions were assessed by the area under the receiver operating characteristic curve for the test result in comparison with reference standards (diagnostic and amyloid status). Simulation analysis evaluated two potential benefits of speech-based screening: (i) mild cognitive impairment screening in primary care compared with the Mini-Mental State Exam, and (ii) pre-screening prior to PET scanning when identifying an amyloid positive sample. Speech-based screening predicted amyloid beta positivity (area under the curve = 0.77) and mild cognitive impairment or mild Alzheimer's disease (area under the curve = 0.83) in the full sample, and predicted amyloid beta in subsamples (mild cognitive impairment or mild Alzheimer's disease: area under the curve = 0.82; cognitively unimpaired: area under the curve = 0.71). Simulation analyses indicated that in primary care, speech-based screening could modestly improve detection of mild cognitive impairment (+8.5%), while reducing false positives (-59.1%). Furthermore, speech-based amyloid pre-screening was estimated to reduce the number of PET scans required by 35.3% and 35.5% in individuals with mild cognitive impairment and cognitively unimpaired individuals, respectively. Speech-based assessment offers accessible and scalable screening for mild cognitive impairment and amyloid beta positivity.
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Affiliation(s)
| | | | | | | | | | - Kathryn V Papp
- Center for Alzheimer Research and Treatment, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, 02115, USA
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, 02114, USA
| | - Michael Ropacki
- Strategic Global Research & Development, Temecula, California, 94019, USA
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Fristed E, Skirrow C, Meszaros M, Lenain R, Meepegama U, Cappa S, Aarsland D, Weston J. A remote speech‐based AI system to screen for early Alzheimer's disease via smartphones. ALZHEIMER'S & DEMENTIA: DIAGNOSIS, ASSESSMENT & DISEASE MONITORING 2022; 14:e12366. [DOI: 10.1002/dad2.12366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 08/16/2022] [Accepted: 09/21/2022] [Indexed: 11/06/2022]
Affiliation(s)
| | | | | | | | | | - Stefano Cappa
- IUSS Cognitive Neuroscience (ICoN) Center University School for Advanced Studies Pavia Italy
- IRCCS Mondino Foundation Pavia Italy
| | - Dag Aarsland
- Department of Old Age Psychiatry Institute of Psychiatry Psychology & Neuroscience King's College London London UK
- Centre for Age‐Related Diseases Stavanger University Hospital Stavanger Norway
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