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Clifford JO, Anand S, Tarpin-Bernard F, Bergeron MF, Ashford CB, Bayley PJ, Ashford JW. Episodic memory assessment: effects of sex and age on performance and response time during a continuous recognition task. Front Hum Neurosci 2024; 18:1304221. [PMID: 38638807 PMCID: PMC11024362 DOI: 10.3389/fnhum.2024.1304221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 03/08/2024] [Indexed: 04/20/2024] Open
Abstract
Introduction Continuous recognition tasks (CRTs) assess episodic memory (EM), the central functional disturbance in Alzheimer's disease and several related disorders. The online MemTrax computerized CRT provides a platform for screening and assessment that is engaging and can be repeated frequently. MemTrax presents complex visual stimuli, which require complex involvement of the lateral and medial temporal lobes and can be completed in less than 2 min. Results include number of correct recognitions (HITs), recognition failures (MISSes = 1-HITs), correct rejections (CRs), false alarms (FAs = 1-CRs), total correct (TC = HITs + CRs), and response times (RTs) for each HIT and FA. Prior analyses of MemTrax CRT data show no effects of sex but an effect of age on performance. The number of HITs corresponds to faster RT-HITs more closely than TC, and CRs do not relate to RT-HITs. RT-HITs show a typical skewed distribution, and cumulative RT-HITs fit a negative survival curve (RevEx). Thus, this study aimed to define precisely the effects of sex and age on HITS, CRs, RT-HITs, and the dynamics of RTs in an engaged population. Methods MemTrax CRT online data on 18,255 individuals was analyzed for sex, age, and distributions of HITs, CRs, MISSes, FAs, TC, and relationships to both RT-HITs and RT-FAs. Results HITs corresponded more closely to RT-HITs than did TC because CRs did not relate to RT-HITs. RT-FAs had a broader distribution than RT-HITs and were faster than RT-HITs in about half of the sample, slower in the other half. Performance metrics for men and women were the same. HITs declined with age as RT-HITs increased. CRs also decreased with age and RT-FAs increased, but with no correlation. The group over aged 50 years had RT-HITs distributions slower than under 50 years. For both age ranges, the RevEx model explained more than 99% of the variance in RT-HITs. Discussion The dichotomy of HITs and CRs suggests opposing cognitive strategies: (1) less certainty about recognitions, in association with slower RT-HITs and lower HIT percentages suggests recognition difficulty, leading to more MISSes, and (2) decreased CRs (more FAs) but faster RTs to HITs and FAs, suggesting overly quick decisions leading to errors. MemTrax CRT performance provides an indication of EM (HITs and RT-HITs may relate to function of the temporal lobe), executive function (FAs may relate to function of the frontal lobe), processing speed (RTs), cognitive ability, and age-related changes. This CRT provides potential clinical screening utility for early Alzheimer's disease and other conditions affecting EM, other cognitive functions, and more accurate impairment assessment to track changes over time.
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Affiliation(s)
- James O. Clifford
- Department of Psychology, College of San Mateo, San Mateo, CA, United States
| | - Sulekha Anand
- Department of Biological Sciences, San Jose State University, San Jose, CA, United States
| | | | - Michael F. Bergeron
- Department of Health Sciences, University of Hartford, West Hartford, CT, United States
| | - Curtis B. Ashford
- MemTrax, LLC, Redwood City, CA, United States
- CogniFit, LLC, Redwood City, CA, United States
| | - Peter J. Bayley
- VA Palo Alto Health Care System, Palo Alto, CA, United States
- Department of Psychiatry and Behavioral Sciences, Stanford, CA, United States
| | - John Wesson Ashford
- VA Palo Alto Health Care System, Palo Alto, CA, United States
- Department of Psychiatry and Behavioral Sciences, Stanford, CA, United States
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Woods D, Pebler P, Johnson DK, Herron T, Hall K, Blank M, Geraci K, Williams G, Chok J, Lwi S, Curran B, Schendel K, Spinelli M, Baldo J. The California Cognitive Assessment Battery (CCAB). Front Hum Neurosci 2024; 17:1305529. [PMID: 38273881 PMCID: PMC10809797 DOI: 10.3389/fnhum.2023.1305529] [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: 10/01/2023] [Accepted: 11/28/2023] [Indexed: 01/27/2024] Open
Abstract
Introduction We are developing the California Cognitive Assessment Battery (CCAB) to provide neuropsychological assessments to patients who lack test access due to cost, capacity, mobility, and transportation barriers. Methods The CCAB consists of 15 non-verbal and 17 verbal subtests normed for telemedical assessment. The CCAB runs on calibrated tablet computers over cellular or Wi-Fi connections either in a laboratory or in participants' homes. Spoken instructions and verbal stimuli are delivered through headphones using naturalistic text-to-speech voices. Verbal responses are scored in real time and recorded and transcribed offline using consensus automatic speech recognition which combines the transcripts from seven commercial ASR engines to produce timestamped transcripts more accurate than those of any single ASR engine. The CCAB is designed for supervised self-administration using a web-browser application, the Examiner. The Examiner permits examiners to record observations, view subtest performance in real time, initiate video chats, and correct potential error conditions (e.g., training and performance failures, etc.,) for multiple participants concurrently. Results Here we describe (1) CCAB usability with older (ages 50 to 89) participants; (2) CCAB psychometric properties based on normative data from 415 older participants; (3) Comparisons of the results of at-home vs. in-lab CCAB testing; (4) We also present preliminary analyses of the effects of COVID-19 infection on performance. Mean z-scores averaged over CCAB subtests showed impaired performance of COVID+ compared to COVID- participants after factoring out the contributions of Age, Education, and Gender (AEG). However, inter-cohort differences were no longer significant when performance was analyzed with a comprehensive model that factored out the influences of additional pre-existing demographic factors that distinguished COVID+ and COVID- cohorts (e.g., vocabulary, depression, race, etc.,). In contrast, unlike AEG scores, comprehensive scores correlated significantly with the severity of COVID infection. (5) Finally, we found that scoring models influenced the classification of individual participants with Mild Cognitive Impairment (MCI, z-scores < -1.50) where the comprehensive model accounted for more than twice as much variance as the AEG model and reduced racial bias in MCI classification. Discussion The CCAB holds the promise of providing scalable laboratory-quality neurodiagnostic assessments to underserved urban, exurban, and rural populations.
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Affiliation(s)
- David Woods
- NeuroBehavioral Systems Inc., Berkeley, CA, United States
| | - Peter Pebler
- NeuroBehavioral Systems Inc., Berkeley, CA, United States
| | - David K Johnson
- Department of Neurology, University of California, Davis, Davis, CA, United States
| | - Timothy Herron
- NeuroBehavioral Systems Inc., Berkeley, CA, United States
- VA Northern California Health Care System, Martinez, CA, United States
| | - Kat Hall
- NeuroBehavioral Systems Inc., Berkeley, CA, United States
| | - Mike Blank
- NeuroBehavioral Systems Inc., Berkeley, CA, United States
| | - Kristi Geraci
- NeuroBehavioral Systems Inc., Berkeley, CA, United States
| | | | - Jas Chok
- VA Northern California Health Care System, Martinez, CA, United States
| | - Sandy Lwi
- VA Northern California Health Care System, Martinez, CA, United States
| | - Brian Curran
- VA Northern California Health Care System, Martinez, CA, United States
| | - Krista Schendel
- VA Northern California Health Care System, Martinez, CA, United States
| | - Maria Spinelli
- VA Northern California Health Care System, Martinez, CA, United States
| | - Juliana Baldo
- VA Northern California Health Care System, Martinez, CA, United States
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Ashford JW. Neuroplasticity: The Critical Issue for Alzheimer's Disease and Links to Obesity and Depression. Am J Geriatr Psychiatry 2023; 31:867-875. [PMID: 37481402 DOI: 10.1016/j.jagp.2023.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 07/13/2023] [Indexed: 07/24/2023]
Affiliation(s)
- J Wesson Ashford
- Department of Psychiatry & Behavioral Sciences, VA Palo Alto Health Care System, Stanford University, Palo Alto, CA.
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Zhao X, Dai S, Zhang R, Chen X, Zhao M, Bergeron MF, Zhou X, Zhang J, Zhong L, Ashford JW, Liu X. Using MemTrax memory test to screen for post-stroke cognitive impairment after ischemic stroke: a cross-sectional study. Front Hum Neurosci 2023; 17:1195220. [PMID: 37529406 PMCID: PMC10387538 DOI: 10.3389/fnhum.2023.1195220] [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: 03/28/2023] [Accepted: 06/28/2023] [Indexed: 08/03/2023] Open
Abstract
Background Whereas the Montreal Cognitive Assessment (MoCA) and Addenbrooke's cognitive examination-revised (ACE-R) are commonly used tests for the detection of post-stroke cognitive impairment (PSCI), these instruments take 10-30 min to administer and do not assess processing speed, which is a critical impairment in PSCI. MemTrax (MTx) is a continuous recognition test, which evaluates complex information processing, accuracy, speed, and attention, in 2 min. Aim To evaluate whether MTx is an effective and practical tool for PSCI assessment. Methods This study enrolled acute ischemic stroke (AIS) patients who have assessed the cognitive status including MTx, clinical dementia rating (CDR), MoCA, Neuropsychiatric Inventory (NPI), Hamilton depression scale (HAMD), Hamilton anxiety scale (HAMA), the National Institute of Health Stroke Scale (NIHSS), modified Rankin scale (mRS), and Barthel Index of activity of daily living (BI) combined with the physical examinations of the neurologic system at the 90-day (D90) after the AIS. The primary endpoint of this study was establishing MTx cut-offs for distinguishing PSCI from AIS. Results Of the 104 participants, 60 were classified to the PSCI group. The optimized cut-off value of MTx-%C (percent correct) was 78%, with a sensitivity and specificity for detecting PSCI from Non-PSCI of 90.0 and 84.1%, respectively, and an AUC of 0.919. Regarding the MTx-Cp (Composite score = MTx-%C/MTx-RT), using 46.3 as a cut-off value, the sensitivity and specificity for detecting PSCI from Non-PSCI were 80.0 and 93.2%, with an AUC of 0.925. Multivariate linear regression showed that PSCI reduced the MTx-%C (Coef. -14.18, 95% CI -18.41∼-9.95, p < 0.001) and prolonged the MTx-RT (response time) (Coef. 0.29, 95% CI 0.16∼0.43, p < 0.001) and reduced the MTx-CP (Coef. -19.11, 95% CI -24.29∼-13.93, p < 0.001). Conclusion MemTrax (MTx) is valid and effective for screening for PSCI among target patients and is a potentially valuable and practical tool in the clinical follow-up, monitoring, and case management of PSCI.
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Affiliation(s)
- Xiaoxiao Zhao
- Department of Neurology, The First Affiliated Hospital of Kunming Medical University, Kunming, China
- Yunnan Province Clinical Research Center for Neurological Disease, Kunming, China
| | - Shujuan Dai
- Department of Neurology, The First Affiliated Hospital of Kunming Medical University, Kunming, China
- Yunnan Province Clinical Research Center for Neurological Disease, Kunming, China
| | - Rong Zhang
- Department of Neurology, Kunming Second People’s Hospital, Kunming, Yunnan, China
| | - Xinjie Chen
- Department of Neurology, The First Affiliated Hospital of Dali University, Dali, China
| | - Mingjie Zhao
- Department of Neurology, The First Affiliated Hospital of Kunming Medical University, Kunming, China
- Yunnan Province Clinical Research Center for Neurological Disease, Kunming, China
| | - Michael F. Bergeron
- Department of Health Sciences, University of Hartford, West Hartford, CT, United States
| | - Xianbo Zhou
- Zhongze Therapeutics, Shanghai, China
- Center for Alzheimer’s Research, Washington Institute of Clinical Research, Vienna, VA, United States
| | - Junyan Zhang
- Department of Clinical Epidemiology and Evidence-based Medicine, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Taiyuan, China
- Bothwin Clinical Study Consultant, Shanghai, China
| | - Lianmei Zhong
- Department of Neurology, The First Affiliated Hospital of Kunming Medical University, Kunming, China
- Yunnan Province Clinical Research Center for Neurological Disease, Kunming, China
| | - J. Wesson Ashford
- War Related Illness and Injury Study Center, VA Palo Alto Health Care System (HCS), Palo Alto, CA, United States
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, United States
| | - Xiaolei Liu
- Department of Neurology, The First Affiliated Hospital of Kunming Medical University, Kunming, China
- Yunnan Province Clinical Research Center for Neurological Disease, Kunming, China
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Ashford JW, Clifford JO, Bergeron MF. Advancing screening for cognitive impairment: the memtrax continuous recognition test. Aging (Albany NY) 2023; 15:5230-5231. [PMID: 37319322 PMCID: PMC10333071 DOI: 10.18632/aging.204828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 03/29/2023] [Indexed: 06/17/2023]
Affiliation(s)
- J. Wesson Ashford
- Department of Psychiatry and Behavioral Sciences and Alzheimer’s Center, Stanford University, Stanford, CA 94305, USA
- War Related Illness and Injury Study Center and Alzheimer’s Center, VA Palo Alto Health Care System, Palo Alto, CA 94304, USA
| | - James O. Clifford
- Department of Psychology, College of San Mateo, San Mateo, CA 94402, USA
| | - Michael F. Bergeron
- Department of Health Sciences, University of Hartford, West Hartford, CT 06117, USA
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Ellison TS, Cappa SF, Garrett D, Georges J, Iwatsubo T, Kramer JH, Lehmann M, Lyketsos C, Maier AB, Merrilees J, Morris JC, Naismith SL, Nobili F, Pahor M, Pond D, Robinson L, Soysal P, Vandenbulcke M, Weber CJ, Visser PJ, Weiner M, Frisoni GB. Outcome measures for Alzheimer's disease: A global inter-societal Delphi consensus. Alzheimers Dement 2023; 19:2707-2729. [PMID: 36749854 PMCID: PMC11010236 DOI: 10.1002/alz.12945] [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: 11/22/2022] [Accepted: 12/20/2022] [Indexed: 02/09/2023]
Abstract
INTRODUCTION We aim to provide guidance on outcomes and measures for use in patients with Alzheimer's clinical syndrome. METHODS A consensus group of 20 voting members nominated by 10 professional societies, and a non-voting chair, used a Delphi approach and modified GRADE criteria. RESULTS Consensus was reached on priority outcomes (n = 66), measures (n = 49) and statements (n = 37) across nine domains. A number of outcomes and measurement instruments were ranked for: Cognitive abilities; Functional abilities/dependency; Behavioural and neuropsychiatric symptoms; Patient quality of life (QoL); Caregiver QoL; Healthcare and treatment-related outcomes; Medical investigations; Disease-related life events; and Global outcomes. DISCUSSION This work provides indications on the domains and ideal pertinent measurement instruments that clinicians may wish to use to follow patients with cognitive impairment. More work is needed to develop instruments that are more feasible in the context of the constraints of clinical routine.
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Affiliation(s)
| | - Stefano F. Cappa
- Scuola Universitaria Superiore IUSS Pavia, Pavia, Italy
- Dementia Research Center, IRCCS Mondino Foundation, Pavia, Italy
| | | | | | - Takeshi Iwatsubo
- Unit for Early and Exploratory Clinical Development, The University of Tokyo Hospital, Tokyo, Japan
- Department of Neuropathology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Joel H. Kramer
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, California, USA
| | | | - Constantine Lyketsos
- Richman Family Precision Medicine Center of Excellence in Alzheimer’s Disease, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University and Medicine, Baltimore, USA
| | - Andrea B. Maier
- Department of Medicine and Aged Care, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, Victoria, Australia
- Faculty of Behavioural and Movement Sciences, Department of Human Movement Sciences, Vrije Universiteit, Amsterdam Movement Sciences, Amsterdam, Netherlands
- Healthy Longevity Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Centre for Healthy Longevity, National University Health System, Singapore, Singapore
| | - Jennifer Merrilees
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, California, USA
| | - John C. Morris
- Department of Neurology, Washington University, St. Louis, Missouri, USA
| | - Sharon L. Naismith
- School of Psychology, The University of Sydney, Sydney, New South Wales, Australia
| | - Flavio Nobili
- UO Clinica Neurologica, Istituto di Ricovero e Cura a Carattere Scientifico Ospedale Policlinico San Martino, Genova, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, and Child and Mother Health, University of Genoa, Genova, Italy
| | - Marco Pahor
- Department of Aging and Geriatric Research, Institute on Aging, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Dimity Pond
- Faculty of Health and Medicine, School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
| | - Louise Robinson
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Pinar Soysal
- Department of Geriatric Medicine, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
- European Society of Geriatric Medicine, Dementia Special Interest Group
| | - Mathieu Vandenbulcke
- Neuropsychiatry, Department of Neurosciences, Leuven Brain Institute, KU Leuven, Leuven, Belgium
- Geriatric Psychiatry, University Psychiatric Centre KU Leuven, Leuven, Belgium
| | | | - Pieter Jelle Visser
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, Netherlands
- Alzheimer Center, Department of Neurology, Neuroscience Campus Amsterdam, Amsterdam University Medical Center, VU Medical Center, Amsterdam, Netherlands
- Department of Neurobiology, Care Sciences and Society, Division of Neurogeriatrics, Karolinska Institute, Stockholm, Sweden
| | - Michael Weiner
- San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA
| | - Giovanni B. Frisoni
- Laboratory of Neuroimaging of Aging (LANVIE), University of Geneva, Geneva, Switzerland
- Memory Clinic, Department of Readaptation and Geriatrics, Geneva University and University Hospitals, Geneva, Switzerland
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Lin NH, Goh A, Lin SH, Chuang KA, Chang CH, Li MH, Lu CH, Chen WY, Wei PH, Pan IH, Perng MD, Wen SF. Neuroprotective Effects of a Multi-Herbal Extract on Axonal and Synaptic Disruption in Vitro and Cognitive Impairment in Vivo. J Alzheimers Dis Rep 2023; 7:51-76. [PMID: 36777330 PMCID: PMC9912829 DOI: 10.3233/adr-220056] [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] [Received: 08/04/2022] [Accepted: 01/02/2023] [Indexed: 01/19/2023] Open
Abstract
Background Alzheimer's disease (AD) is a multifactorial disorder characterized by cognitive decline. Current available therapeutics for AD have limited clinical benefit. Therefore, preventive therapies for interrupting the development of AD are critically needed. Molecules targeting multifunction to interact with various pathlogical components have been considered to improve the therapeutic efficiency of AD. In particular, herbal medicines with multiplicity of actions produce cognitive benefits on AD. Bugu-M is a multi-herbal extract composed of Ganoderma lucidum (Antler form), Nelumbo nucifera Gaertn., Ziziphus jujuba Mill., and Dimocarpus longan, with the ability of its various components to confer resilience to cognitive deficits. Objective To evaluate the potential of Bugu-M on amyloid-β (Aβ) toxicity and its in vitro mechanisms and on in vivo cognitive function. Methods We illustrated the effect of Bugu-M on Aβ25-35-evoked toxicity as well as its possible mechanisms to diminish the pathogenesis of AD in rat cortical neurons. For cognitive function studies, 2-month-old female 3×Tg-AD mice were administered 400 mg/kg Bugu-M for 30 days. Behavioral tests were performed to assess the efficacy of Bugu-M on cognitive impairment. Results In primary cortical neuronal cultures, Bugu-M mitigated Aβ-evoked toxicity by reducing cytoskeletal aberrations and axonal disruption, restoring presynaptic and postsynaptic protein expression, suppressing mitochondrial damage and apoptotic signaling, and reserving neurogenic and neurotrophic factors. Importantly, 30-day administration of Bugu-M effectively prevented development of cognitive impairment in 3-month-old female 3×Tg-AD mice. Conclusion Bugu-M might be beneficial in delaying the progression of AD, and thus warrants consideration for its preventive potential for AD.
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Affiliation(s)
- Ni-Hsuan Lin
- Institute of Molecular Medicine, College of Life Sciences, National Tsing Hua University, Hsinchu, Taiwan
| | - Angela Goh
- Biomedical Technology and Device Research Laboratories, Industrial Technology Research Institute, Hsinchu, Taiwan
| | - Shyh-Horng Lin
- Biomedical Technology and Device Research Laboratories, Industrial Technology Research Institute, Hsinchu, Taiwan
| | - Kai-An Chuang
- Biomedical Technology and Device Research Laboratories, Industrial Technology Research Institute, Hsinchu, Taiwan
| | - Chih-Hsuan Chang
- Biomedical Technology and Device Research Laboratories, Industrial Technology Research Institute, Hsinchu, Taiwan
| | - Ming-Han Li
- Biomedical Technology and Device Research Laboratories, Industrial Technology Research Institute, Hsinchu, Taiwan
| | - Chu-Hsun Lu
- Biomedical Technology and Device Research Laboratories, Industrial Technology Research Institute, Hsinchu, Taiwan
| | - Wen-Yin Chen
- Biomedical Technology and Device Research Laboratories, Industrial Technology Research Institute, Hsinchu, Taiwan
| | - Pei-Hsuan Wei
- Biomedical Technology and Device Research Laboratories, Industrial Technology Research Institute, Hsinchu, Taiwan
| | - I-Hong Pan
- Biomedical Technology and Device Research Laboratories, Industrial Technology Research Institute, Hsinchu, Taiwan
| | - Ming-Der Perng
- Institute of Molecular Medicine, College of Life Sciences, National Tsing Hua University, Hsinchu, Taiwan,
School of Medicine, College of Life Sciences, National Tsing Hua University, Hsinchu, Taiwan,Correspondence to: Shu-Fang Wen, Biomedical Technology and Device Research Laboratories, Industrial Technology Research Institute, 321, Section 2, Kuang-Fu Road, Hsinchu 300044, Taiwan. Tel.: +886 35743946; E-mail: and Ming-Der Perng, College of Life Sciences, National Tsing Hua University, 101, Section 2, Kuang-Fu Road, Hsinchu 300044, Taiwan. Tel.: +886 35742024; E-mail:
| | - Shu-Fang Wen
- Biomedical Technology and Device Research Laboratories, Industrial Technology Research Institute, Hsinchu, Taiwan,Correspondence to: Shu-Fang Wen, Biomedical Technology and Device Research Laboratories, Industrial Technology Research Institute, 321, Section 2, Kuang-Fu Road, Hsinchu 300044, Taiwan. Tel.: +886 35743946; E-mail: and Ming-Der Perng, College of Life Sciences, National Tsing Hua University, 101, Section 2, Kuang-Fu Road, Hsinchu 300044, Taiwan. Tel.: +886 35742024; E-mail:
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Füllgrabe C. Auditory Biases in Cognitive Assessment: Insights from a Hearing-Loss Simulation for the Screening of Dementia due to Alzheimer's Disease. J Alzheimers Dis 2023; 91:537-541. [PMID: 36463440 DOI: 10.3233/jad-215695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Cognitive-screening tests are used to detect pathological changes in mental abilities. Many use orally presented instructions and test items. Hence, hearing loss (HL), whose prevalence increases with age, may bias cognitive-test performance in the target population for the screening of dementia due to Alzheimer's disease. To study the effect of the auditory test format, an impairment-simulation approach was used in normal-hearing listeners to compare performance on the Hopkins Verbal Learning Test, a memory task employed in dementia screening and research, when test items were unprocessed and processed to simulate age-related HL. Immediate verbal recall declined with simulated HL, suggesting that auditory factors are confounding variables in cognitive assessment and result in the underestimation of cognitive functioning.
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Høilund-Carlsen PF, Revheim ME, Alavi A, Satyamurthy N, Barrio JR. Amyloid PET: A Questionable Single Primary Surrogate Efficacy Measure on Alzheimer Immunotherapy Trials. J Alzheimers Dis 2022; 90:1395-1399. [PMID: 36278356 PMCID: PMC9789473 DOI: 10.3233/jad-220841] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Using amyloid PET imaging as a single primary surrogate efficacy measure in Alzheimer's disease immunotherapy trials, as happened when the FDA granted accelerated approval of aducanumab, is unjustified. In vivo evidence indicates that PET quantification of amyloid deposition is distorted and misrepresents effects of anti-amyloid treatments due to lack of specificity of the PET imaging probe, effects of amyloid-related imaging abnormalities, spill-over from high white matter signals, and questionable quantification models. Before granting approval to other immunotherapy candidates, the FDA should require rigorous evidence of all imaging claims and irrefutable documentation that proposed treatments are clinically effective and harmless to patients.
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Affiliation(s)
- Poul F. Høilund-Carlsen
- Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark,
Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Mona-Elisabeth Revheim
- Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway,
Institute of Clinical Medicine, University of Oslo, Oslo, Norway,Correspondence to: Mona-Elisabeth Revheim, Institute of Clinical Medicine, University of Oslo, Postbox 1078, Blindern, 0316 Oslo, Norway; Division of Radiology and Nuclear Medicine, Oslo University Hospital, Postbox 4950 Nydalen, 0424 Oslo, Norway. Tel.: +47 23 07 08 40; Fax: +47 23 07 38 37; E-mails: ; ; ORCID: 0000-0003-3300-7420
| | - Abass Alavi
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Nagichettiar Satyamurthy
- Department of Molecular and Medical Pharmacology, David Geffen UCLA School of Medicine, Los Angeles, CA, USA
| | - Jorge R. Barrio
- Department of Molecular and Medical Pharmacology, David Geffen UCLA School of Medicine, Los Angeles, CA, USA
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Ashford JW, Clifford JO, Anand S, Bergeron MF, Ashford CB, Bayley PJ. Correctness and response time distributions in the MemTrax continuous recognition task: Analysis of strategies and a reverse-exponential model. Front Aging Neurosci 2022; 14:1005298. [PMID: 36437986 PMCID: PMC9682919 DOI: 10.3389/fnagi.2022.1005298] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 10/17/2022] [Indexed: 07/24/2023] Open
Abstract
A critical issue in addressing medical conditions is measurement. Memory measurement is difficult, especially episodic memory, which is disrupted by many conditions. On-line computer testing can precisely measure and assess several memory functions. This study analyzed memory performances from a large group of anonymous, on-line participants using a continuous recognition task (CRT) implemented at https://memtrax.com. These analyses estimated ranges of acceptable performance and average response time (RT). For 344,165 presumed unique individuals completing the CRT a total of 602,272 times, data were stored on a server, including each correct response (HIT), Correct Rejection, and RT to the thousandth of a second. Responses were analyzed, distributions and relationships of these parameters were ascertained, and mean RTs were determined for each participant across the population. From 322,996 valid first tests, analysis of correctness showed that 63% of these tests achieved at least 45 correct (90%), 92% scored at or above 40 correct (80%), and 3% scored 35 correct (70%) or less. The distribution of RTs was skewed with 1% faster than 0.62 s, a median at 0.890 s, and 1% slower than 1.57 s. The RT distribution was best explained by a novel model, the reverse-exponential (RevEx) function. Increased RT speed was most closely associated with increased HIT accuracy. The MemTrax on-line memory test readily provides valid and reliable metrics for assessing individual episodic memory function that could have practical clinical utility for precise assessment of memory dysfunction in many conditions, including improvement or deterioration over time.
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Affiliation(s)
- J. Wesson Ashford
- War Related Illness and Injury Study Center, VA Palo Alto Health Care System, Palo Alto, CA, United States
- Department of Psychiatry and Behavioral Science, Stanford University, Palo Alto, CA, United States
| | - James O. Clifford
- Department of Psychology, College of San Mateo, San Mateo, CA, United States
| | - Sulekha Anand
- Department of Biological Sciences, San José State University, San Jose, CA, United States
| | - Michael F. Bergeron
- Department of Health Sciences, University of Hartford, West Hartford, CT, United States
| | | | - Peter J. Bayley
- War Related Illness and Injury Study Center, VA Palo Alto Health Care System, Palo Alto, CA, United States
- Department of Psychiatry and Behavioral Science, Stanford University, Palo Alto, CA, United States
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