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Witzel DD, Cerino ES, Turner SG, Stawski RS, Mejia ST, Hooker K. 'With or without you': associations between noteworthy events and cognitive complaints across 100 days. Aging Ment Health 2024:1-9. [PMID: 38835228 DOI: 10.1080/13607863.2024.2361723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 05/23/2024] [Indexed: 06/06/2024]
Abstract
OBJECTIVES Daily noteworthy events have implications for physical and mental health, but less is known about the role daily events have for self-reported cognition and whether the involvement of close social partners differentiates these associations. The current study examined how daily positive and negative noteworthy events relate to subjective memory and attentional difficulties and whether close social partners moderated associations. METHOD We used data from a 100-day microlongitudinal web-based study of 104 older adults (Nobservations=7,051; Mage=63.13 years, SDage=7.81, 88.46% Female). Participants reported on exposure to and valence of noteworthy events, involvement of close social partners, and subjective cognitive complaints at the end of each day. RESULTS Logistic multilevel models revealed that days with a negative event were associated with increased odds of forgetting something and trouble concentrating whereas days with positive events were associated with decreased odds of trouble concentrating. Close social partner involvement did not moderate within-person associations. CONCLUSION Our results suggest that day-to-day events are correlates of cognitive complaints regardless of close social partner involvement in the events. Research should clarify the role of daily positive and negative events in personalized interventions and determine whether this person-centered approach to self-reported cognitive health helps inform diagnostic practices.
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Affiliation(s)
- Dakota D Witzel
- Center for Healthy Aging, Pennsylvania State University, University Park, PA, USA
| | - Eric S Cerino
- Department of Psychological Sciences, Northern Arizona University, Flagstaff, AZ, USA
| | - Shelbie G Turner
- Division of Geriatrics and Palliative Care, Weill Cornell Medical College, New York, NY, USA
| | - Robert S Stawski
- Institute of Public Health and Wellbeing, and School of Health and Social Care, University of Essex, Essex, UK
| | - Shannon T Mejia
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | - Karen Hooker
- College of Health, Oregon State University, Corvallis, OR, USA
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2
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Welhaf MS, Wilks H, Aschenbrenner AJ, Balota DA, Schindler SE, Benzinger TLS, Gordon BA, Cruchaga C, Xiong C, Morris JC, Hassenstab J. Naturalistic assessment of reaction time variability in older adults at risk for Alzheimer's disease. J Int Neuropsychol Soc 2024; 30:428-438. [PMID: 38282413 PMCID: PMC11078617 DOI: 10.1017/s1355617723011475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2024]
Abstract
OBJECTIVE Maintaining attention underlies many aspects of cognition and becomes compromised early in neurodegenerative diseases like Alzheimer's disease (AD). The consistency of maintaining attention can be measured with reaction time (RT) variability. Previous work has focused on measuring such fluctuations during in-clinic testing, but recent developments in remote, smartphone-based cognitive assessments can allow one to test if these fluctuations in attention are evident in naturalistic settings and if they are sensitive to traditional clinical and cognitive markers of AD. METHOD Three hundred and seventy older adults (aged 75.8 +/- 5.8 years) completed a week of remote daily testing on the Ambulatory Research in Cognition (ARC) smartphone platform and also completed clinical, genetic, and conventional in-clinic cognitive assessments. RT variability was assessed in a brief (20-40 seconds) processing speed task using two different measures of variability, the Coefficient of Variation (CoV) and the Root Mean Squared Successive Difference (RMSSD) of RTs on correct trials. RESULTS Symptomatic participants showed greater variability compared to cognitively normal participants. When restricted to cognitively normal participants, APOE ε4 carriers exhibited greater variability than noncarriers. Both CoV and RMSSD showed significant, and similar, correlations with several in-clinic cognitive composites. Finally, both RT variability measures significantly mediated the relationship between APOE ε4 status and several in-clinic cognition composites. CONCLUSIONS Attentional fluctuations over 20-40 seconds assessed in daily life, are sensitive to clinical status and genetic risk for AD. RT variability appears to be an important predictor of cognitive deficits during the preclinical disease stage.
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Affiliation(s)
- Matthew S Welhaf
- Department of Psychological & Brain Sciences, Washington University in St. Louis. St. Louis, MO, USA
| | - Hannah Wilks
- Department of Psychological & Brain Sciences, Washington University in St. Louis. St. Louis, MO, USA
| | - Andrew J Aschenbrenner
- Department of Neurology. Charles F. and Joanne Knight Alzheimer Disease Research Center, Washington University School of Medicine, St. Louis, MO, USA
| | - David A Balota
- Department of Psychological & Brain Sciences, Washington University in St. Louis. St. Louis, MO, USA
| | - Suzanne E Schindler
- Department of Neurology. Charles F. and Joanne Knight Alzheimer Disease Research Center, Washington University School of Medicine, St. Louis, MO, USA
| | - Tammie L S Benzinger
- Department of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Brian A Gordon
- Department of Psychological & Brain Sciences, Washington University in St. Louis. St. Louis, MO, USA
- Department of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Carlos Cruchaga
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Chengjie Xiong
- Division of Biostatistics, Washington University School of Medicine, St. Louis, MO, USA
| | - John C Morris
- Department of Neurology. Charles F. and Joanne Knight Alzheimer Disease Research Center, Washington University School of Medicine, St. Louis, MO, USA
| | - Jason Hassenstab
- Department of Psychological & Brain Sciences, Washington University in St. Louis. St. Louis, MO, USA
- Department of Neurology. Charles F. and Joanne Knight Alzheimer Disease Research Center, Washington University School of Medicine, St. Louis, MO, USA
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Muñoz E, Hyun J, Diaz JA, Scott SB, Sliwinski MJ. Exposure to neighborhood violence, and laboratory-based and ambulatory cognitive task performance in adulthood. Soc Sci Med 2024; 348:116807. [PMID: 38569283 DOI: 10.1016/j.socscimed.2024.116807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 03/03/2024] [Accepted: 03/19/2024] [Indexed: 04/05/2024]
Abstract
OBJECTIVE Exposure to neighborhood violence may have negative implications for adults' cognitive functioning, but the ecological sensitivity of these effects has yet to be determined. We first evaluated the link between exposure to neighborhood violence and two latent constructs of cognitive function that incorporated laboratory-based and ambulatory, smartphone-based, cognitive assessments. Second, we examined whether the effect of exposure to violence was stronger for ambulatory assessments compared to in-lab assessments. METHODS We used data from 256 urban-dwelling adults between 25 and 65 years old (M = 46.26, SD = 11.07); 63.18% non-Hispanic Black, 9.21% non-Hispanic White, 18.41% Hispanic White, 5.02% Hispanic Black, and 4.18% other. Participants completed baseline surveys on neighborhood exposures, cognitive assessments in a laboratory/research office, and ambulatory smartphone-based cognitive assessments five-times a day for 14 days. RESULTS Exposure to neighborhood violence was associated with poorer performance in a latent working memory construct that incorporated in-lab and ambulatory assessments, but was not associated with the perceptual speed construct. The effect of exposure to neighborhood violence on the working memory construct was explained by its effect on the ambulatory working memory task and not by the in-lab cognitive assessments. CONCLUSION This study shows the negative effect that exposure to neighborhood violence may have on everyday working memory performance in urban-dwelling adults in midlife. Results highlight the need for more research to determine the sensitivity of ambulatory assessments to quantify the effects of neighborhood violence on cognitive function.
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Affiliation(s)
- Elizabeth Muñoz
- Department of Human Development and Family Sciences, University of Texas at Austin, Austin, TX, USA.
| | - Jinshil Hyun
- Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Jose A Diaz
- Department of Human Development and Family Studies and Center for Healthy Aging, The Pennsylvania State University, University Park, PA, USA
| | - Stacey B Scott
- Department of Psychology, Stony Brook University, Stony Brook, NY, USA
| | - Martin J Sliwinski
- Department of Human Development and Family Studies and Center for Healthy Aging, The Pennsylvania State University, University Park, PA, USA
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4
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Harris C, Tang Y, Birnbaum E, Cherian C, Mendhe D, Chen MH. Digital Neuropsychology beyond Computerized Cognitive Assessment: Applications of Novel Digital Technologies. Arch Clin Neuropsychol 2024; 39:290-304. [PMID: 38520381 DOI: 10.1093/arclin/acae016] [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: 02/05/2024] [Accepted: 02/16/2024] [Indexed: 03/25/2024] Open
Abstract
Compared with other health disciplines, there is a stagnation in technological innovation in the field of clinical neuropsychology. Traditional paper-and-pencil tests have a number of shortcomings, such as low-frequency data collection and limitations in ecological validity. While computerized cognitive assessment may help overcome some of these issues, current computerized paradigms do not address the majority of these limitations. In this paper, we review recent literature on the applications of novel digital health approaches, including ecological momentary assessment, smartphone-based assessment and sensors, wearable devices, passive driving sensors, smart homes, voice biomarkers, and electronic health record mining, in neurological populations. We describe how each digital tool may be applied to neurologic care and overcome limitations of traditional neuropsychological assessment. Ethical considerations, limitations of current research, as well as our proposed future of neuropsychological practice are also discussed.
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Affiliation(s)
- Che Harris
- Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, NJ, USA
- Department of Neurology, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, USA
| | - Yingfei Tang
- Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, NJ, USA
- Department of Neurology, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, USA
| | - Eliana Birnbaum
- Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, NJ, USA
| | - Christine Cherian
- Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, NJ, USA
| | - Dinesh Mendhe
- Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, NJ, USA
| | - Michelle H Chen
- Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, NJ, USA
- Department of Neurology, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, USA
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Rodrigues EA, Christie GJ, Cosco T, Farzan F, Sixsmith A, Moreno S. A Subtype Perspective on Cognitive Trajectories in Healthy Aging. Brain Sci 2024; 14:351. [PMID: 38672003 PMCID: PMC11048421 DOI: 10.3390/brainsci14040351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Revised: 03/25/2024] [Accepted: 03/30/2024] [Indexed: 04/28/2024] Open
Abstract
Cognitive aging is a complex and dynamic process characterized by changes due to genetics and environmental factors, including lifestyle choices and environmental exposure, which contribute to the heterogeneity observed in cognitive outcomes. This heterogeneity is particularly pronounced among older adults, with some individuals maintaining stable cognitive function while others experience complex, non-linear changes, making it difficult to identify meaningful decline accurately. Current research methods range from population-level modeling to individual-specific assessments. In this work, we review these methodologies and propose that population subtyping should be considered as a viable alternative. This approach relies on early individual-specific detection methods that can lead to an improved understanding of changes in individual cognitive trajectories. The improved understanding of cognitive trajectories through population subtyping can lead to the identification of meaningful changes and the determination of timely, effective interventions. This approach can aid in informing policy decisions and in developing targeted interventions that promote cognitive health, ultimately contributing to a more personalized understanding of the aging process within society and reducing the burden on healthcare systems.
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Affiliation(s)
- Emma A. Rodrigues
- School of Interactive Arts and Technology, Simon Fraser University, Surrey, BC V3T 0A3, Canada
| | | | - Theodore Cosco
- Department of Gerontology, Simon Fraser University, Vancouver, BC V6B 5K3, Canada
| | - Faranak Farzan
- School of Mechatronics and Systems Engineering, Simon Fraser University, Surrey, BC V3T 0A3, Canada
| | - Andrew Sixsmith
- Department of Gerontology, Simon Fraser University, Vancouver, BC V6B 5K3, Canada
| | - Sylvain Moreno
- School of Interactive Arts and Technology, Simon Fraser University, Surrey, BC V3T 0A3, Canada
- Circle Innovation, Simon Fraser University, Surrey, BC V3T 0A3, Canada
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Doucette MM, Kwan H, Premji Z, Duchesne A, Gawryluk JR, Garcia-Barrera MA. Integration of sex/gender and utilization of ecological Momentary assessment of cognition in clinical populations: a scoping review. Clin Neuropsychol 2024:1-32. [PMID: 38533627 DOI: 10.1080/13854046.2024.2333579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 03/15/2024] [Indexed: 03/28/2024]
Abstract
Objectives: We aimed to describe the methods of smartphone-based cognitive ecological momentary assessment designs in clinical populations, with an intention to evaluate how the role of sex and/or gender has been considered in the design and analyses, particularly including female-specific physiology. Methods: This scoping review was conducted based on JBI scoping review methodology. On March 2nd, 2023, we searched for literature across four databases. Screening of the results and data extraction were conducted in duplicate according to the a priori methods in the pre-registered protocol. Results: 31 articles were included in this review. Participants ranged in age from 15-85 years old with various clinical disorders. Prompts were given between 1-7 times per day for 7-84 days. Executive function was the most frequently assessed cognitive domain. Over half the studies (n = 17, 55%) did not investigate the effects of sex and/or gender, and only one study considered the impact of hormonal therapy. Many studies (n = 14, 45%) used sex and gender interchangeably or incorrectly. Conclusions: Studies varied in design, with heterogeneity in the reporting of methodological information. The lack of attention to sex/gender on neuropsychological outcomes can lead to confusion and contradiction regarding its potential impact on cognition in clinical populations. This may hinder the identification of effective interventions for those assigned female at birth who have been overlooked or considered indistinguishable from their male counterparts. Given the well-documented impact of sex/gender on cognition, it is essential that future neuropsychological research, especially EMA-based studies, prioritize investigating sex/gender to ensure better outcomes for all.
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Affiliation(s)
| | - Heather Kwan
- Department of Psychology, University of Victoria, British Columbia, Canada
- Institute on Aging & Lifelong Health, University of Victoria, British Columbia, Canada
| | - Zahra Premji
- Libraries, University of Victoria, British Columbia, Canada
| | - Annie Duchesne
- Department of Psychology, University of Northern British Columbia, British Columbia, Canada
- Department of Psychology, Université du Québec à Trois-Rivières, Quebec, Canada
| | - Jodie R Gawryluk
- Department of Psychology, University of Victoria, British Columbia, Canada
- Institute on Aging & Lifelong Health, University of Victoria, British Columbia, Canada
- Division of Medical Sciences, University of Victoria, British Columbia, Canada
| | - Mauricio A Garcia-Barrera
- Department of Psychology, University of Victoria, British Columbia, Canada
- Institute on Aging & Lifelong Health, University of Victoria, British Columbia, Canada
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7
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Hawks ZW, Beck ED, Jung L, Fonseca LM, Sliwinski MJ, Weinstock RS, Grinspoon E, Xu I, Strong RW, Singh S, Van Dongen HPA, Frumkin MR, Bulger J, Cleveland MJ, Janess K, Kudva YC, Pratley R, Rickels MR, Rizvi SR, Chaytor NS, Germine LT. Dynamic associations between glucose and ecological momentary cognition in Type 1 Diabetes. NPJ Digit Med 2024; 7:59. [PMID: 38499605 PMCID: PMC10948782 DOI: 10.1038/s41746-024-01036-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 02/14/2024] [Indexed: 03/20/2024] Open
Abstract
Type 1 diabetes (T1D) is a chronic condition characterized by glucose fluctuations. Laboratory studies suggest that cognition is reduced when glucose is very low (hypoglycemia) and very high (hyperglycemia). Until recently, technological limitations prevented researchers from understanding how naturally-occurring glucose fluctuations impact cognitive fluctuations. This study leveraged advances in continuous glucose monitoring (CGM) and cognitive ecological momentary assessment (EMA) to characterize dynamic, within-person associations between glucose and cognition in naturalistic environments. Using CGM and EMA, we obtained intensive longitudinal measurements of glucose and cognition (processing speed, sustained attention) in 200 adults with T1D. First, we used hierarchical Bayesian modeling to estimate dynamic, within-person associations between glucose and cognition. Consistent with laboratory studies, we hypothesized that cognitive performance would be reduced at low and high glucose, reflecting cognitive vulnerability to glucose fluctuations. Second, we used data-driven lasso regression to identify clinical characteristics that predicted individual differences in cognitive vulnerability to glucose fluctuations. Large glucose fluctuations were associated with slower and less accurate processing speed, although slight glucose elevations (relative to person-level means) were associated with faster processing speed. Glucose fluctuations were not related to sustained attention. Seven clinical characteristics predicted individual differences in cognitive vulnerability to glucose fluctuations: age, time in hypoglycemia, lifetime severe hypoglycemic events, microvascular complications, glucose variability, fatigue, and neck circumference. Results establish the impact of glucose on processing speed in naturalistic environments, suggest that minimizing glucose fluctuations is important for optimizing processing speed, and identify several clinical characteristics that may exacerbate cognitive vulnerability to glucose fluctuations.
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Affiliation(s)
- Z W Hawks
- Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA, USA.
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
| | - E D Beck
- Department of Psychology, University of California Davis, Davis, CA, USA
| | - L Jung
- Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA, USA
| | - L M Fonseca
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
- Programa Terceira Idade (PROTER, Old Age Research Group), Department and Institute of Psychiatry, University of São Paulo School of Medicine, São Paulo, Brazil
| | - M J Sliwinski
- Department of Human Development and Family Studies, Center for Healthy Aging, Pennsylvania State University, State College, PA, USA
| | | | - E Grinspoon
- Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA, USA
| | - I Xu
- Department of Psychology, University of Notre Dame, Notre Dame, IN, USA
| | - R W Strong
- The Many Brains Project, Belmont, MA, USA
| | - S Singh
- Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - H P A Van Dongen
- Sleep and Performance Research Center & Department of Translational Medicine and Physiology, Washington State University, Spokane, WA, USA
| | - M R Frumkin
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Department of Psychological & Brain Sciences, Washington University in St. Louis, St. Louis, MO, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - J Bulger
- SUNY Upstate Medical University, Syracuse, NY, USA
| | - M J Cleveland
- Department of Human Development, Washington State University, Pullman, WA, USA
| | - K Janess
- Jaeb Center for Health Research, Tampa, FL, USA
| | - Y C Kudva
- Division of Endocrinology, Diabetes and Nutrition, Mayo Clinic, Rochester, MN, USA
| | - R Pratley
- AdventHealth Translational Research Institute, Orlando, FL, USA
| | - M R Rickels
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - S R Rizvi
- Division of Endocrinology, Diabetes and Nutrition, Mayo Clinic, Rochester, MN, USA
| | - N S Chaytor
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | - L T Germine
- Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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Sutin AR, Luchetti M, Gamaldo AA, Mogle J, Lovett HH, Brown J, Sliwinski MJ, Terracciano A. Purpose in Life and Cognitive Function: Evidence for Momentary Associations in Daily Life. Innov Aging 2024; 8:igae018. [PMID: 38511204 PMCID: PMC10953619 DOI: 10.1093/geroni/igae018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Indexed: 03/22/2024] Open
Abstract
Background and Objectives Purpose in life is associated with healthier cognitive outcomes in older adulthood. This research examines within-person dynamics between momentary purpose and cognitive function to provide proof of concept that increases in purpose are associated with better cognitive performance. Research Design and Methods Participants (N = 303; 54% female; Mage = 51.71, SD = 7.32) completed smartphone-based momentary assessments of purpose and short cognitive tasks 3 times a day for 8 days. Results In moments when participants felt more purpose driven than their average, they had faster processing speed (b = -1.240, SE = 0.194; p < .001), independent of person, temporal, and contextual factors and practice effects. Momentary purpose was unrelated to visual working memory performance (b = -0.001, SE = 0.001; p = .475). In contrast to purpose, momentary hedonic affect (e.g., happiness) was unrelated to momentary cognition. Discussion and Implications Feeling more momentary purpose may support faster processing speed in daily life. Such evidence provides stage 0 support for a purpose-based intervention for healthier cognition, which may be particularly useful in middle adulthood and the transition to older adulthood before the onset of cognitive impairment.
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Affiliation(s)
- Angelina R Sutin
- Department of Behavioral Sciences and Social Medicine, Florida State University College of Medicine, Tallahassee, Florida, USA
| | - Martina Luchetti
- Department of Behavioral Sciences and Social Medicine, Florida State University College of Medicine, Tallahassee, Florida, USA
| | - Alyssa A Gamaldo
- Department of Psychology, Clemson University, Clemson, South Carolina, USA
| | - Jacqueline Mogle
- Department of Psychology, Clemson University, Clemson, South Carolina, USA
| | - Hephzibah H Lovett
- Department of Behavioral Sciences and Social Medicine, Florida State University College of Medicine, Tallahassee, Florida, USA
| | - Justin Brown
- Department of Behavioral Sciences and Social Medicine, Florida State University College of Medicine, Tallahassee, Florida, USA
| | - Martin J Sliwinski
- Human Development and Family Studies, The Pennsylvania State University, State College, Pennsylvania, USA
| | - Antonio Terracciano
- Department of Geriatrics, Florida State University College of Medicine, Tallahassee, Florida, USA
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Castilhos RM, Snitz BE. Longitudinal Cognitive Decline in Alzheimer Disease Prevention Trials: A Test of Time. Neurology 2024; 102:e208067. [PMID: 38165353 DOI: 10.1212/wnl.0000000000208067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 10/12/2023] [Indexed: 01/03/2024] Open
Abstract
The landscape of clinical trials for Alzheimer disease (AD) has undergone significant evolution in the past decade, most notably by the inclusion of individuals at progressively earlier stages of the disease. Recent approvals by the Food and Drug Administration have predominantly centered around individuals with prodromal and mild AD,1,2 signaling a shift toward early intervention. Despite the result of some recent trials,3 there is optimism and hope that treating individuals at preclinical stages could have even greater effects. A major challenge for the feasibility and cost-effectiveness of clinical trials on patients with preclinical AD, however, is the fact that cognitive and functional decline over time is mild. Previous studies have already shown the heterogeneity in sensitivity to longitudinal decline across cognitive tests within early disease stages.4,5.
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Affiliation(s)
- Raphael M Castilhos
- From the Neurology Service (R.M.C.), Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil; and School of Medicine (B.E.S.), University of Pittsburgh, PA
| | - Beth E Snitz
- From the Neurology Service (R.M.C.), Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil; and School of Medicine (B.E.S.), University of Pittsburgh, PA
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Sunderaraman P, De Anda‐Duran I, Karjadi C, Peterson J, Ding H, Devine SA, Shih LC, Popp Z, Low S, Hwang PH, Goyal K, Hathaway L, Monteverde J, Lin H, Kolachalama VB, Au R. Design and Feasibility Analysis of a Smartphone-Based Digital Cognitive Assessment Study in the Framingham Heart Study. J Am Heart Assoc 2024; 13:e031348. [PMID: 38226510 PMCID: PMC10926817 DOI: 10.1161/jaha.123.031348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 11/09/2023] [Indexed: 01/17/2024]
Abstract
BACKGROUND Smartphone-based digital technology is increasingly being recognized as a cost-effective, scalable, and noninvasive method of collecting longitudinal cognitive and behavioral data. Accordingly, a state-of-the-art 3-year longitudinal project focused on collecting multimodal digital data for early detection of cognitive impairment was developed. METHODS AND RESULTS A smartphone application collected 2 modalities of cognitive data, digital voice and screen-based behaviors, from the FHS (Framingham Heart Study) multigenerational Generation 2 (Gen 2) and Generation 3 (Gen 3) cohorts. To understand the feasibility of conducting a smartphone-based study, participants completed a series of questions about their smartphone and app use, as well as sensory and environmental factors that they encountered while completing the tasks on the app. Baseline data collected to date were from 537 participants (mean age=66.6 years, SD=7.0; 58.47% female). Across the younger participants from the Gen 3 cohort (n=455; mean age=60.8 years, SD=8.2; 59.12% female) and older participants from the Gen 2 cohort (n=82; mean age=74.2 years, SD=5.8; 54.88% female), an average of 76% participants agreed or strongly agreed that they felt confident about using the app, 77% on average agreed or strongly agreed that they were able to use the app on their own, and 81% on average rated the app as easy to use. CONCLUSIONS Based on participant ratings, the study findings are promising. At baseline, the majority of participants are able to complete the app-related tasks, follow the instructions, and encounter minimal barriers to completing the tasks independently. These data provide evidence that designing and collecting smartphone application data in an unsupervised, remote, and naturalistic setting in a large, community-based population is feasible.
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Affiliation(s)
- Preeti Sunderaraman
- Department of NeurologyBoston University Chobanian & Avedisian School of Medicine School of MedicineBostonMAUSA
- Boston University Alzheimer’s Disease Research CenterBoston University Chobanian & Avedisian School of MedicineBostonMAUSA
- Framingham Heart StudyBoston University Chobanian & Avedisian School of Medicine School of MedicineBostonMAUSA
| | - Ileana De Anda‐Duran
- Department of EpidemiologyTulane University School of Public Health & Tropical MedicineNew OrleansLAUSA
| | - Cody Karjadi
- Framingham Heart StudyBoston University Chobanian & Avedisian School of Medicine School of MedicineBostonMAUSA
| | - Julia Peterson
- Framingham Heart StudyBoston University Chobanian & Avedisian School of Medicine School of MedicineBostonMAUSA
| | - Huitong Ding
- Framingham Heart StudyBoston University Chobanian & Avedisian School of Medicine School of MedicineBostonMAUSA
- Department of Anatomy & NeurobiologyBoston University Chobanian & Avedisian School of Medicine School of MedicineBostonMAUSA
| | - Sherral A. Devine
- Framingham Heart StudyBoston University Chobanian & Avedisian School of Medicine School of MedicineBostonMAUSA
- Department of Anatomy & NeurobiologyBoston University Chobanian & Avedisian School of Medicine School of MedicineBostonMAUSA
| | - Ludy C. Shih
- Department of NeurologyBoston University Chobanian & Avedisian School of Medicine School of MedicineBostonMAUSA
- Framingham Heart StudyBoston University Chobanian & Avedisian School of Medicine School of MedicineBostonMAUSA
| | - Zachary Popp
- Boston University Alzheimer’s Disease Research CenterBoston University Chobanian & Avedisian School of MedicineBostonMAUSA
- Department of Anatomy & NeurobiologyBoston University Chobanian & Avedisian School of Medicine School of MedicineBostonMAUSA
| | - Spencer Low
- Boston University Alzheimer’s Disease Research CenterBoston University Chobanian & Avedisian School of MedicineBostonMAUSA
- Department of Anatomy & NeurobiologyBoston University Chobanian & Avedisian School of Medicine School of MedicineBostonMAUSA
- Department of EpidemiologyBoston University School of Public HealthBostonMAUSA
| | - Phillip H. Hwang
- Department of EpidemiologyBoston University School of Public HealthBostonMAUSA
| | - Kriti Goyal
- Department of NeurologyBoston University Chobanian & Avedisian School of Medicine School of MedicineBostonMAUSA
- Framingham Heart StudyBoston University Chobanian & Avedisian School of Medicine School of MedicineBostonMAUSA
| | - Lindsay Hathaway
- Framingham Heart StudyBoston University Chobanian & Avedisian School of Medicine School of MedicineBostonMAUSA
| | - Jose Monteverde
- Framingham Heart StudyBoston University Chobanian & Avedisian School of Medicine School of MedicineBostonMAUSA
| | - Honghuang Lin
- Department of MedicineUniversity of Massachusetts Chan Medical SchoolWorcesterMAUSA
| | - Vijaya B. Kolachalama
- Boston University Alzheimer’s Disease Research CenterBoston University Chobanian & Avedisian School of MedicineBostonMAUSA
- Department of MedicineBoston University Chobanian & Avedisian School of Medicine School of MedicineBostonMAUSA
- Department of Computer Science and Faculty of Computing & Data SciencesBoston UniversityBostonMAUSA
| | - Rhoda Au
- Department of NeurologyBoston University Chobanian & Avedisian School of Medicine School of MedicineBostonMAUSA
- Boston University Alzheimer’s Disease Research CenterBoston University Chobanian & Avedisian School of MedicineBostonMAUSA
- Framingham Heart StudyBoston University Chobanian & Avedisian School of Medicine School of MedicineBostonMAUSA
- Department of Anatomy & NeurobiologyBoston University Chobanian & Avedisian School of Medicine School of MedicineBostonMAUSA
- Department of EpidemiologyBoston University School of Public HealthBostonMAUSA
- Department of MedicineBoston University Chobanian & Avedisian School of Medicine School of MedicineBostonMAUSA
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11
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Kekäläinen T, Luchetti M, Terracciano A, Gamaldo AA, Mogle J, Lovett HH, Brown J, Rantalainen T, Sliwinski MJ, Sutin AR. Physical activity and cognitive function: moment-to-moment and day-to-day associations. Int J Behav Nutr Phys Act 2023; 20:137. [PMID: 37993862 PMCID: PMC10666351 DOI: 10.1186/s12966-023-01536-9] [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: 05/11/2023] [Accepted: 11/07/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND The beneficial effect of acute physical exercise on cognitive performance has been studied in laboratory settings and in long-term longitudinal studies. Less is known about these associations in everyday environment and on a momentary timeframe. This study investigated momentary and daily associations between physical activity and cognitive functioning in the context of everyday life. METHODS Middle-aged adults (n = 291, aged 40-70) were asked to wear accelerometers and complete ecological momentary assessments for eight consecutive days. Processing speed and visual memory were assessed three times per day and self-rated evaluations of daily cognition (memory, thinking, and sharpness of mind) were collected each night. The number of minutes spent above the active threshold (active time) and the maximum vector magnitude counts (the highest intensity obtained) before each cognitive test and at a daily level were used as predictors of momentary cognitive performance and nightly subjective cognition. Analyses were done with multilevel linear models. The models were adjusted for temporal and contextual factors, age, sex, education, and race/ethnicity. RESULTS When participants had a more active time or higher intensity than their average level within the 20 or 60 minutes prior to the cognitive test, they performed better on the processing speed task. On days when participants had more active time than their average day, they rated their memory in the evening better. Physical activity was not associated with visual memory or self-rated thinking and sharpness of mind. CONCLUSIONS This study provides novel evidence that outside of laboratory settings, even small increases in physical activity boost daily processing speed abilities and self-rated memory. The finding of temporary beneficial effects is consistent with long-term longitudinal research on the cognitive benefits of physical activity.
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Affiliation(s)
- Tiia Kekäläinen
- Gerontology Research Center and Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland.
| | - Martina Luchetti
- Department of Behavioral Sciences and Social Medicine, College of Medicine, Florida State University, Tallahassee, FL, USA
| | - Antonio Terracciano
- Department of Geriatrics, College of Medicine, Florida State University, Tallahassee, FL, USA
| | - Alyssa A Gamaldo
- Human Development and Family Studies, The Pennsylvania State University, Pennsylvania, PA, USA
| | | | - Hephzibah H Lovett
- Department of Behavioral Sciences and Social Medicine, College of Medicine, Florida State University, Tallahassee, FL, USA
| | - Justin Brown
- Department of Behavioral Sciences and Social Medicine, College of Medicine, Florida State University, Tallahassee, FL, USA
| | - Timo Rantalainen
- Gerontology Research Center and Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Martin J Sliwinski
- Human Development and Family Studies, The Pennsylvania State University, Pennsylvania, PA, USA
| | - Angelina R Sutin
- Department of Behavioral Sciences and Social Medicine, College of Medicine, Florida State University, Tallahassee, FL, USA
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12
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Valentine TR, Kratz AL. Feasibility, reliability, and validity of ambulatory cognitive tests in fibromyalgia and matched controls. J Int Neuropsychol Soc 2023; 29:893-901. [PMID: 36762635 PMCID: PMC10412734 DOI: 10.1017/s1355617723000073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
OBJECTIVE This observational study examined the feasibility, reliability, and validity of repeated ambulatory cognitive tests in fibromyalgia (FM). METHOD Adults with FM (n = 50) and matched controls (n = 50) completed lab-based neuropsychological tests (NIH Toolbox) followed by eight days of smartphone-based ambulatory testing of processing speed (symbol search) and working memory (dot memory) five times daily. Feasibility was assessed based on response rates. Reliability was evaluated using overall average between-person reliabilities for the full assessment period and by determining the number of assessment days necessary to attain reliabilities of >.80 and >.90. To assess convergent validity, correlations were calculated between ambulatory test scores and NIH Toolbox scores. Test performance was contrasted between the FM and non-FM groups to examine known-groups validity. RESULTS Average rates of response to the ambulatory cognitive tests were 89.5% in FM and 90.0% in non-FM. Overall average between-person reliabilities were ≥.96. In FM, between-person reliability exceeded .90 after two days for symbol search and three days for dot memory. Symbol search scores correlated with NIH Toolbox processing speed scores in both groups, though there were no significant group differences in symbol search performance. Dot memory scores correlated with NIH Toolbox working memory scores in both groups. FM participants exhibited worse dot memory performance than did non-FM participants. CONCLUSIONS Repeated ambulatory tests of processing speed and working memory demonstrate feasibility and reliability in FM, though evidence for construct validity is mixed. The findings demonstrate promise for future research and clinical applications of this approach to assessing cognition in FM.
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Affiliation(s)
- Thomas R. Valentine
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
| | - Anna L. Kratz
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
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13
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Ji L, Wallace ML, Master L, Schade MM, Shen Y, Derby CA, Buxton OM. Six multidimensional sleep health facets in older adults identified with factor analysis of actigraphy: Results from the Einstein Aging Study. Sleep Health 2023; 9:758-766. [PMID: 37246064 PMCID: PMC10593097 DOI: 10.1016/j.sleh.2023.03.002] [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: 09/13/2022] [Revised: 02/17/2023] [Accepted: 03/19/2023] [Indexed: 05/30/2023]
Abstract
OBJECTIVES The concept of multi-dimensional sleep health, originally based on self-report, was recently extended to actigraphy in older adults, yielding five components, but without a hypothesized rhythmicity factor. The current study extends prior work using a sample of older adults with a longer period of actigraphy follow-up, which may facilitate observation of the rhythmicity factor. METHODS Wrist actigraphy measures of participants (N = 289, Mage = 77.2 years, 67% females; 47% White, 40% Black, 13% Hispanic/Others) over 2 weeks were used in exploratory factor analysis to determine factor structures, followed by confirmatory factor analysis on a different subsample. The utility of this approach was demonstrated by associations with global cognitive performance (Montreal Cognitive Assessment). RESULTS Exploratory factor analysis identified six factors: Regularity: standard deviations of four sleep measures: midpoint, sleep onset time, night total sleep time (TST), and 24-hour TST; Alertness/Sleepiness (daytime): amplitude, napping (mins and #/day); Timing: sleep onset, midpoint, wake-time (of nighttime sleep); up-mesor, acrophase, down-mesor; Efficiency: sleep maintenance efficiency, wake after sleep onset; Duration: night rest interval(s), night TST, 24-hour rest interval(s), 24-hour TST; Rhythmicity (pattern across days): mesor, alpha, and minimum. Greater sleep efficiency was associated with better Montreal Cognitive Assessment performance (β [95% confidence interval] = 0.63 [0.19, 1.08]). CONCLUSIONS Actigraphic records over 2 weeks revealed that Rhythmicity may be an independent factor in sleep health. Facets of sleep health can facilitate dimension reduction, be considered predictors of health outcomes, and be potential targets for sleep interventions.
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Affiliation(s)
- Linying Ji
- Department of Biobehavioral Health, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Meredith L Wallace
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Lindsay Master
- Department of Biobehavioral Health, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Margeaux M Schade
- Department of Biobehavioral Health, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Yuqi Shen
- Department of Biobehavioral Health, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Carol A Derby
- Saul R. Korey Department of Neurology, and Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Orfeu M Buxton
- Department of Biobehavioral Health, The Pennsylvania State University, University Park, Pennsylvania, USA.
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14
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Thompson LI, Kunicki ZJ, Emrani S, Strenger J, De Vito AN, Britton KJ, Dion C, Harrington KD, Roque N, Salloway S, Sliwinski MJ, Correia S, Jones RN. Remote and in-clinic digital cognitive screening tools outperform the MoCA to distinguish cerebral amyloid status among cognitively healthy older adults. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2023; 15:e12500. [PMID: 38026761 PMCID: PMC10680059 DOI: 10.1002/dad2.12500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 09/15/2023] [Accepted: 10/22/2023] [Indexed: 12/01/2023]
Abstract
INTRODUCTION We evaluated the accuracy of remote and in-person digital tests to distinguish between older adults with and without AD pathological change and used the Montreal Cognitive Assessment (MoCA) as a comparison test. METHODS Participants were 69 cognitively normal older adults with known beta-amyloid (Aβ) PET status. Participants completed smartphone-based assessments 3×/day for 8 days, followed by TabCAT tasks, DCTclock™, and MoCA at an in-person study visit. We calculated the area under the curve (AUC) to compare task accuracies to distinguish Aβ status. RESULTS Average performance on the episodic memory (Prices) smartphone task showed the highest accuracy (AUC = 0.77) to distinguish Aβ status. On in-person measures, accuracy to distinguish Aβ status was greatest for the TabCAT Favorites task (AUC = 0.76), relative to the DCTclockTM (AUC = 0.73) and MoCA (AUC = 0.74). DISCUSSION Although further validation is needed, our results suggest that several digital assessments may be suitable for more widespread cognitive screening application.
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Affiliation(s)
- Louisa I. Thompson
- Department of Psychiatry & Human BehaviorAlpert Medical SchoolBrown UniversityProvidenceRhode IslandUSA
| | - Zachary J. Kunicki
- Department of Psychiatry & Human BehaviorAlpert Medical SchoolBrown UniversityProvidenceRhode IslandUSA
| | - Sheina Emrani
- Department of Psychiatry & Human BehaviorAlpert Medical SchoolBrown UniversityProvidenceRhode IslandUSA
| | - Jennifer Strenger
- Department of Psychiatry & Human BehaviorAlpert Medical SchoolBrown UniversityProvidenceRhode IslandUSA
| | - Alyssa N. De Vito
- Department of Psychiatry & Human BehaviorAlpert Medical SchoolBrown UniversityProvidenceRhode IslandUSA
| | | | - Catherine Dion
- Department of Clinical and Health PsychologyUniversity of FloridaGainesvilleFloridaUSA
| | - Karra D. Harrington
- Department of Human Development & Family StudiesThe Pennsylvania State UniversityUniversity ParkPennsylvaniaUSA
| | - Nelson Roque
- Department of PsychologyUniversity of Central FloridaOrlandoFloridaUSA
| | - Stephen Salloway
- Department of Psychiatry & Human BehaviorAlpert Medical SchoolBrown UniversityProvidenceRhode IslandUSA
| | - Martin J. Sliwinski
- Department of Human Development & Family StudiesThe Pennsylvania State UniversityUniversity ParkPennsylvaniaUSA
| | - Stephen Correia
- Department of Health Promotion and BehaviorSchool of Public HealthUniversity of GeorgiaFloridaUSA
| | - Richard N. Jones
- Department of Psychiatry & Human BehaviorAlpert Medical SchoolBrown UniversityProvidenceRhode IslandUSA
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15
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Abstract
PURPOSE OF REVIEW The use of digital tools for remote cognitive measurement of older adults is generating increasing interest due to the numerous advantages offered for accessibility and scalability. However, these tools also pose distinctive challenges, necessitating a thorough analysis of their psychometric properties, feasibility and acceptability. RECENT FINDINGS In this narrative review, we present the recent literature on the use of web-based cognitive assessment to characterize cognition in older adults and to contribute to the diagnosis of age-related neurodegenerative diseases. We present and discuss three types of web-based cognitive assessments: conventional cognitive tests administered through videoconferencing; unsupervised web-based assessments conducted on a computer; and unsupervised web-based assessments performed on smartphones. SUMMARY There have been considerable progress documenting the properties, strengths and limitations of web-based cognitive assessments. For the three types of assessments reported here, the findings support their promising potential for older adults. However, certain aspects, such as the construct validity of these tools and the development of robust norms, remain less well documented. Nonetheless, the beneficial potential of these tools, and their current validation and feasibility data, justify their application [see Supplementary Digital Content (SDC), http://links.lww.com/CONR/A69 ].
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Affiliation(s)
- Sylvie Belleville
- Research Center, Institut universitaire de gériatrie de Montréal
- Psychology Department, Université de Montréal
| | - Annalise Aleta LaPlume
- Research Center, Institut universitaire de gériatrie de Montréal
- Psychology Department, Université de Montréal
- Brain Imaging Centre, Douglas Mental Health University Institute, Montreal, Canada
| | - Rudy Purkart
- Research Center, Institut universitaire de gériatrie de Montréal
- Psychology Department, Université de Montréal
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16
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Christianson K, Prabhu M, Popp ZT, Rahman MS, Drane J, Lee M, Lathan C, Lin H, Au R, Sunderaraman P, Hwang PH. Adherence type impacts completion rates of frequent mobile cognitive assessments among older adults with and without cognitive impairment. RESEARCH SQUARE 2023:rs.3.rs-3350075. [PMID: 37841867 PMCID: PMC10571616 DOI: 10.21203/rs.3.rs-3350075/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2023]
Abstract
Background Prior to a diagnosis of Alzheimer's disease, many individuals experience cognitive and behavioral fluctuations that are not detected during a single session of traditional neuropsychological assessment. Mobile applications now enable high-frequency cognitive data to be collected remotely, introducing new opportunities and challenges. Emerging evidence suggests cognitively impaired older adults are capable of completing mobile assessments frequently, but no study has observed whether completion rates vary by assessment frequency or adherence type. Methods Thirty-three older adults were recruited from the Boston University Alzheimer's Disease Research Center (mean age = 73.5 years; 27.3% cognitively impaired; 57.6% female; 81.8% White, 18.2% Black). Participants remotely downloaded and completed the DANA Brain Vital application on their own mobile devices throughout the study. The study schedule included seventeen assessments to be completed over the course of a year. Specific periods during which assessments were expected to be completed were defined as subsegments, while segments consisted of multiple subsegments. The first segment included three subsegments to be completed within one week, the second segment included weekly subsegments and spanned three weeks, and the third and fourth segments included monthly subsegments spanning five and six months, respectively. Three distinct adherence types - subsegment adherence, segment adherence, and cumulative adherence - were examined to determine how completion rates varied depending on assessment frequency and adherence type. Results Adherence type significantly impacted whether the completion rates declined. When utilizing subsegment adherence, the completion rate significantly declined (p = 0.05) during the fourth segment. However, when considering completion rates from the perspective of segment adherence, a decline in completion rate was not observed. Overall adherence rates increased as adherence parameters were broadened from subsegment adherence (60.6%) to segment adherence (78.8%), to cumulative adherence (90.9%). Conclusions Older adults, including those with cognitive impairment, are able to complete remote cognitive assessments at a high-frequency, but may not necessarily adhere to prescribed schedules.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Rhoda Au
- Boston University School of Medicine
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17
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Kairys AE, Valentine TR, Whibley D, Kratz AL. Mind the Mood: Momentary Depression and Anxiety Moderate the Correspondence Between Subjective and Objective Cognitive Functioning in Fibromyalgia. Arthritis Care Res (Hoboken) 2023; 75:1967-1975. [PMID: 36601904 PMCID: PMC10319918 DOI: 10.1002/acr.25086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 12/21/2022] [Accepted: 01/03/2023] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Subjective cognitive dysfunction (SCD) affects 55-75% of individuals with fibromyalgia (FM), but those reporting cognitive difficulties often lack corresponding objective deficits. Symptoms of depression and anxiety are prevalent in FM and may account for part of this discrepancy. This study was undertaken to investigate whether momentary (within-day, across 7 days) changes in mood moderate the relationship between within-the-moment SCD and mental processing speed performance. METHODS A total of 50 individuals with FM (mean age 44.8 years, mean education 15.7 years, 88% female, 86% White) completed momentary assessments of subjective cognitive functioning, depressive and anxious symptoms, and a test of processing speed. Assessments were completed 5 times per day for 8 consecutive days on a study-specific smartphone application. RESULTS Momentary ratings of SCD were positively associated with mean reaction time (P < 0.001) and variability of processing speed (P = 0.02). Depressive symptoms moderated the relationship between SCD and processing speed, with lower correspondence when depressive symptoms were higher (P = 0.03). A similar moderating effect was demonstrated for both depression (P = 0.02) and anxiety (P = 0.03) on the association between SCD and variability in processing speed performance. CONCLUSION Individuals with FM may have more accurate self-perception of momentary changes in mental processing speed during periods of less pronounced mood symptoms based on their corresponding objective processing speed performance. However, during moments of heightened depression and anxiety, we found increasingly less correspondence between SCD and objective performance, suggesting that psychological symptoms may play an important role in self-perception of cognitive dysfunction in FM as it relates to mental processing speed.
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18
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Hyun J, Katz MJ, Derby CA, Roque N, Muñoz E, Sliwinski MJ, Lovasi GS, Lipton RB. Availability of healthy foods, fruit and vegetable consumption, and cognition among urban older adults. BMC Geriatr 2023; 23:302. [PMID: 37198552 PMCID: PMC10189949 DOI: 10.1186/s12877-023-04003-z] [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: 11/14/2022] [Accepted: 04/26/2023] [Indexed: 05/19/2023] Open
Abstract
BACKGROUND . Although prior studies have examined the associations between neighborhood characteristics and cognitive health, little is known about whether local food environments, which are critical for individuals' daily living, are associated with late-life cognition. Further, little is known about how local environments may shape individuals' health-related behaviors and impact cognitive health. The aim of this study is to examine whether objective and subjective measures of healthy food availability are associated with ambulatory cognitive performance and whether behavioral and cardiovascular factors mediate these associations among urban older adults. METHODS . The sample consisted of systematically recruited, community-dwelling older adults (N = 315, mean age = 77.5, range = 70-91) from the Einstein Aging Study. Objective availability of healthy foods was defined as density of healthy food stores. Subjective availability of healthy foods and fruit/vegetable consumption were assessed using self-reported questionnaires. Cognitive performance was assessed using smartphone-administered cognitive tasks that measured processing speed, short-term memory binding, and spatial working memory performance 6 times a day for 14 days. RESULTS . Results from multilevel models showed that subjective availability of healthy foods, but not objective food environments, was associated with better processing speed (estimate= -0.176, p = .003) and more accurate memory binding performance (estimate = 0.042, p = .012). Further, 14~16% of the effects of subjective availability of healthy foods on cognition were mediated through fruit and vegetable consumption. CONCLUSIONS . Local food environments seem to be important for individuals' dietary behavior and cognitive health. Specifically, subjective measures of food environments may better reflect individuals' experiences regarding their local food environments not captured by objective measures. Future policy and intervention strategies will need to include both objective and subjective food environment measures in identifying impactful target for intervention and evaluating effectiveness of policy changes.
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Affiliation(s)
- Jinshil Hyun
- The Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY, 10461, USA.
| | - Mindy J Katz
- The Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY, 10461, USA
| | - Carol A Derby
- The Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY, 10461, USA
| | - Nelson Roque
- Department of Psychology, University of Central Florida, Orlando, FL, USA
| | - Elizabeth Muñoz
- Department of Human Development and Family Sciences, University of Texas Austin, Austin, TX, USA
| | - Martin J Sliwinski
- Department of Human Development and Family Studies, The Pennsylvania State University, University Park, PA, USA
- Center for Healthy Aging, The Pennsylvania State University, University Park, PA, USA
| | - Gina S Lovasi
- Department of Epidemiology and Biostatistics, Drexel University, Philadelphia, PA, USA
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Richard B Lipton
- The Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY, 10461, USA
- Headache Center, Montefiore Medical Center, Bronx, NY, USA
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19
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Mossavar-Rahmani Y, Shaw PA, Hakun JG, Katz MJ, Wylie-Rosett J, Sliwinski MJ. Multicultural Healthy Diet to Reduce Cognitive Decline & Alzheimer's Disease Risk: Study protocol for a pilot randomized controlled trial. Contemp Clin Trials 2023; 124:107006. [PMID: 36396064 PMCID: PMC9839583 DOI: 10.1016/j.cct.2022.107006] [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: 07/22/2022] [Revised: 10/13/2022] [Accepted: 11/10/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Emerging evidence indicates that healthy dietary patterns are associated with higher cognitive status; however, few clinical trials have explored this association in diverse middle-aged adults before the onset of cognitive decline. We use novel ambulatory methods to assess cognition in natural settings in tandem with diet recording. AIMS We investigate whether the Multicultural Healthy Diet Study to Reduce Cognitive Decline & Alzheimer's Disease Risk, a pilot randomized controlled trial of an anti-inflammatory dietary pattern compared to usual diet, can mitigate cognitive decline and Alzheimer's Disease risk in a diverse population of 40-65 year old adults in Bronx, New York. METHODS Primary cognitive outcomes assessed at nine months are collected in an ecological momentary assessment "measurement burst" design, over the course of participants' daily lives. These ultra-brief, ambulatory cognitive assessments examine processing speed, visuospatial working memory, short-term associative memory binding, long-term associative memory, and working memory capacity. Key secondary outcomes relate to comparing dietary intake between study arms with respect to cognitive outcomes. We assess diet with food records using the National Cancer Institute's Automated Self-Administered 24-h record and serum biomarkers. We further investigate the association of self-reported diet and dietary biomarkers with inflammatory-based biomarkers. CONCLUSION This randomized controlled trial of diet and cognition for the first time combines novel measures of ambulatory cognitive assessment with web-based assessment of dietary intake recording. This new approach enabled the study to continue in the midst of the COVID-19 pandemic in remote format.
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Affiliation(s)
- Yasmin Mossavar-Rahmani
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Belfer Building 1312C, Bronx, NY 10461 USA.
| | - Pamela A Shaw
- Biostatistics Unit, Kaiser Permanente Washington Health Research Institute, 1730 Minor Avenue, Suite 1600, Seattle, WA 98101, USA.
| | - Jonathan G Hakun
- Department of Neurology, The Pennsylvania State University, College of Medicine, 700 HMC Crescent Road, Hershey, PA 17033, USA; Department of Psychology, The Pennsylvania State University, 140 Moore Building, University Park, PA 16802, USA; Center for Healthy Aging, Fourth Floor Biobehavioral Health Building, The Pennsylvania State University, University Park, PA 16802, USA; Translational Brain Research Center, The Pennsylvania State University, College of Medicine, 700 MHC Crescent Road, Hershey, PA 17033, USA.
| | - Mindy J Katz
- Department of Neurology, Albert Einstein College of Medicine, Van Etten Building, Rm 3C5, 1225 Morris Park Avenue, Bronx, NY 10461, USA.
| | - Judith Wylie-Rosett
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Belfer Building 1307, Bronx, NY 10461, USA.
| | - Martin J Sliwinski
- Center for Healthy Aging, The Pennsylvania State University, College of Medicine, University Park, PA, 16802, USA; Department of Human Development & Family Studies, The Pennsylvania State University, College of Medicine, University Park, PA, 16802. USA.
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20
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Singh S, Strong R, Xu I, Fonseca L, Hawks Z, Grinspoon E, Jung L, Li F, Weinstock R, Sliwinski M, Chaytor N, Germine L. Reliability and Validity of Ecological Momentary Assessment of Cognition in Type 1 Diabetes and Community Samples (Preprint). J Med Internet Res 2022. [DOI: 10.2196/45028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023] Open
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21
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Derbie AY, Dejenie MA, Zegeye TG. Visuospatial representation in patients with mild cognitive impairment: Implication for rehabilitation. Medicine (Baltimore) 2022; 101:e31462. [PMID: 36343037 PMCID: PMC9646670 DOI: 10.1097/md.0000000000031462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Behavioral and neurophysiological experiments have demonstrated that distinct and common cognitive processes and associated neural substrates maintain allocentric and egocentric spatial representations. This review aimed to provide evidence from previous behavioral and neurophysiological studies on collating cognitive processes and associated neural substrates and linking them to the state of visuospatial representations in patients with mild cognitive impairment (MCI). Even though MCI patients showed impaired visuospatial attentional processing and working memory, previous neuropsychological experiments in MCI largely emphasized memory impairment and lacked substantiating evidence of whether memory impairment could be associated with how patients with MCI encode objects in space. The present review suggests that impaired memory capacity is linked to impaired allocentric representation in MCI patients. This review indicates that further research is needed to examine how the decline in visuospatial attentional resources during allocentric coding of space could be linked to working memory impairment.
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Affiliation(s)
- Abiot Y. Derbie
- Applied Cognitive Neuroscience Laboratory, Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong
- Department of Psychology, Bahir Dar University, Bahir Dar, Ethiopia
- *Correspondence: Abiot Y. Derbie, Department of Psychology, Bahir Dar University, P.O. Box 79, Bahir Dar, Ethiopia (e-mail: )
| | | | - Tsigie G. Zegeye
- Department of Special Needs, Bahir Dar University, Bahir Dar, Ethiopia
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22
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Ye K, Fleysher R, Lipton RB, Zimmerman ME, Stewart WF, Sliwinski MJ, Kim M, Lipton ML. Repetitive soccer heading adversely impacts short-term learning among adult women. J Sci Med Sport 2022; 25:935-941. [PMID: 36210312 PMCID: PMC10020927 DOI: 10.1016/j.jsams.2022.08.011] [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: 12/03/2021] [Revised: 08/19/2022] [Accepted: 08/24/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To determine the impact of 12-month heading exposure on short-term learning. DESIGN A total of 105 active amateur soccer players, 45 women and 60 men, were administered an EMA-based test of working memory, a version of the two-back, once daily for 14 days. METHODS Heading exposure of the participants was assessed using "HeadCount", a validated structured questionnaire at the baseline visits. The short-term rate of learning of each individual is quantified by first fitting a quadratic model to the daily performance on the two-back test over a two-week period, then taking the instantaneous rate of the quadratic function at the 7th test. A linear regression model was used to test the association of heading exposure with rates of learning, including age, sex, years of education and history of concussion as covariates, as well as variables describing soccer play and heading within the two-week period. Sensitivity analyses were performed using different methods for quantifying the learning effects and different transformations on 12-month heading exposure. RESULTS Greater 12-month heading was associated with lower rates of learning among women (p = 0.008) but not among men (p = 0.74). CONCLUSIONS We have identified evidence for an adverse, albeit subclinical, effect of soccer heading on brain function among young adult players, which selectively affects women in our sample.
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Affiliation(s)
- Kenny Ye
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, USA; Department of Systems & Computational Biology, Albert Einstein College of Medicine, USA.
| | - Roman Fleysher
- Gruss Magnetic Resonance Imaging Center, Albert Einstein College of Medicine and Montefiore Medical Center, USA; Department of Radiology, Albert Einstein College of Medicine and Montefiore Medical Center, USA
| | - Richard B Lipton
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, USA; Saul B. Korey Department of Neurology, Albert Einstein College of Medicine, Department of Neurology, Montefiore Medical Center, USA
| | | | | | - Martin J Sliwinski
- Department of Human Development and Family Studies, Pennsylvania State University, University Park, USA
| | - Mimi Kim
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, USA
| | - Michael L Lipton
- Gruss Magnetic Resonance Imaging Center, Albert Einstein College of Medicine and Montefiore Medical Center, USA; Department of Radiology, Albert Einstein College of Medicine and Montefiore Medical Center, USA; Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine and Montefiore Medical Center, USA; Dominick P. Purpura Department of Neuroscience, Albert Einstein College of Medicine and Montefiore Medical Center, USA.
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23
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Oravecz Z, Harrington KD, Hakun JG, Katz MJ, Wang C, Zhaoyang R, Sliwinski MJ. Accounting for retest effects in cognitive testing with the Bayesian double exponential model via intensive measurement burst designs. Front Aging Neurosci 2022; 14:897343. [PMID: 36225891 PMCID: PMC9549774 DOI: 10.3389/fnagi.2022.897343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 08/23/2022] [Indexed: 11/25/2022] Open
Abstract
Monitoring early changes in cognitive performance is useful for studying cognitive aging as well as for detecting early markers of neurodegenerative diseases. Repeated evaluation of cognition via a measurement burst design can accomplish this goal. In such design participants complete brief evaluations of cognition, multiple times per day for several days, and ideally, repeat the process once or twice a year. However, long-term cognitive change in such repeated assessments can be masked by short-term within-person variability and retest learning (practice) effects. In this paper, we show how a Bayesian double exponential model can account for retest gains across measurement bursts, as well as warm-up effects within a burst, while quantifying change across bursts in peak performance. We also highlight how this approach allows for the inclusion of person-level predictors and draw intuitive inferences on cognitive change with Bayesian posterior probabilities. We use older adults’ performance on cognitive tasks of processing speed and spatial working memory to demonstrate how individual differences in peak performance and change can be related to predictors of aging such as biological age and mild cognitive impairment status.
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Affiliation(s)
- Zita Oravecz
- Department of Human Development and Family Studies, Pennsylvania State University, University Park, PA, United States
- Institute for Computational and Data Sciences, Pennsylvania State University, University Park, PA, United States
- Center for Healthy Aging, Pennsylvania State University, University Park, PA, United States
- *Correspondence: Zita Oravecz,
| | - Karra D. Harrington
- Center for Healthy Aging, Pennsylvania State University, University Park, PA, United States
| | - Jonathan G. Hakun
- Center for Healthy Aging, Pennsylvania State University, University Park, PA, United States
- Department of Neurology, Pennsylvania State University, Hershey, PA, United States
- Department of Psychology, Pennsylvania State University, University Park, PA, United States
| | - Mindy J. Katz
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Cuiling Wang
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Ruixue Zhaoyang
- Center for Healthy Aging, Pennsylvania State University, University Park, PA, United States
| | - Martin J. Sliwinski
- Department of Human Development and Family Studies, Pennsylvania State University, University Park, PA, United States
- Center for Healthy Aging, Pennsylvania State University, University Park, PA, United States
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24
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Moore RC, Ackerman RA, Russell MT, Campbell LM, Depp CA, Harvey PD, Pinkham AE. Feasibility and validity of ecological momentary cognitive testing among older adults with mild cognitive impairment. Front Digit Health 2022; 4:946685. [PMID: 35990012 PMCID: PMC9390883 DOI: 10.3389/fdgth.2022.946685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 07/20/2022] [Indexed: 11/23/2022] Open
Abstract
It is critical to intervene early in the mild cognitive impairment (MCI) stage of the Alzheimer's disease trajectory, but traditional cognitive testing methods are costly, burdensome, and difficult to access. We examined adherence and validity data to a 30-day self-administered ecological momentary cognitive testing protocol among a sample of older adults with MCI and cognitively normal controls to evaluate feasibility, tolerability, and initial validity in comparison to standard neuropsychological tests. Participants included 48 participants with MCI (Mean age = 72 years, SD = 7 years) and 46 demographically-matched cognitively normal (NC) control participants (Mean age = 70 years, SD = 7 years). Participants completed traditional neuropsychological testing to determine MCI status, followed by 30 days of remote ecological momentary cognitive testing. Ecological momentary assessment (EMA) surveys were administered 3 times per day for 30 days (possible total = 90), and mobile cognitive tests were administered every other day (for a total of 15 administrations). Mobile cognitive tests included the Variable Difficulty List Memory Test (VLMT; measure of learning and memory), Memory Matrix (measure of visual working memory), and the Color Trick Test (measure of executive function). EMA and mobile cognitive test adherence, fatigue effects, mobile cognitive test performance and group differences, and psychometrics (reliability, convergent validity, ceiling effects, and practice effects) were examined. Overall mean-level adherence to the mobile cognitive tests was 85% and did not differ by MCI status. The reliability of stable between-person individual differences for the VLMT and Memory Matrix were very high. Moreover, although the reliability of within-person change for Memory Matrix was adequate, the corresponding reliability for VLMT was somewhat low. Averaged performance on the mobile cognitive tests was correlated with lab-based tests measuring the same construct. Participants with MCI performed worse than NCs on the VLMT and Color Trick Test, and there was no evidence of fatigue effects for these two tests. These findings support the feasibility and potential for ecological momentary cognitive testing to support clinical trials and for measuring cognitive changes over time in persons with increased risk for Alzheimer's disease such as those with MCI.
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Affiliation(s)
- Raeanne C. Moore
- Department of Psychiatry, University of California San Diego, La Jolla, CA, United States
- Correspondence: Raeanne C. Moore
| | - Robert A. Ackerman
- Department of Psychology, School of Behavioral and Brain Sciences, The University of Texas at Dallas, Richardson, TX, United States
| | - Madisen T. Russell
- Department of Psychology, School of Behavioral and Brain Sciences, The University of Texas at Dallas, Richardson, TX, United States
| | - Laura M. Campbell
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, United States
| | - Colin A. Depp
- Department of Psychiatry, University of California San Diego, La Jolla, CA, United States
- Veterans Affairs San Diego Healthcare System, San Diego, CA, United States
| | - Philip D. Harvey
- Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL
- Research Service, Bruce W. Carter VA Medical Center, Miami, FL, United States
| | - Amy E. Pinkham
- Department of Psychology, School of Behavioral and Brain Sciences, The University of Texas at Dallas, Richardson, TX, United States
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25
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Ding Z, Lee TL, Chan AS. Digital Cognitive Biomarker for Mild Cognitive Impairments and Dementia: A Systematic Review. J Clin Med 2022; 11:jcm11144191. [PMID: 35887956 PMCID: PMC9320101 DOI: 10.3390/jcm11144191] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 07/10/2022] [Accepted: 07/18/2022] [Indexed: 01/28/2023] Open
Abstract
The dementia population is increasing as the world’s population is growing older. The current systematic review aims to identify digital cognitive biomarkers from computerized tests for detecting dementia and its risk state of mild cognitive impairment (MCI), and to evaluate the diagnostic performance of digital cognitive biomarkers. A literature search was performed in three databases, and supplemented by a Google search for names of previously identified computerized tests. Computerized tests were categorized into five types, including memory tests, test batteries, other single/multiple cognitive tests, handwriting/drawing tests, and daily living tasks and serious games. Results showed that 78 studies were eligible. Around 90% of the included studies were rated as high quality based on the Newcastle–Ottawa Scale (NOS). Most of the digital cognitive biomarkers achieved comparable or even better diagnostic performance than traditional paper-and-pencil tests. Moderate to large group differences were consistently observed in cognitive outcomes related to memory and executive functions, as well as some novel outcomes measured by handwriting/drawing tests, daily living tasks, and serious games. These outcomes have the potential to be sensitive digital cognitive biomarkers for MCI and dementia. Therefore, digital cognitive biomarkers can be a sensitive and promising clinical tool for detecting MCI and dementia.
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Affiliation(s)
- Zihan Ding
- Neuropsychology Laboratory, Department of Psychology, The Chinese University of Hong Kong, Hong Kong, China; (Z.D.); (T.-l.L.)
| | - Tsz-lok Lee
- Neuropsychology Laboratory, Department of Psychology, The Chinese University of Hong Kong, Hong Kong, China; (Z.D.); (T.-l.L.)
| | - Agnes S. Chan
- Neuropsychology Laboratory, Department of Psychology, The Chinese University of Hong Kong, Hong Kong, China; (Z.D.); (T.-l.L.)
- Research Centre for Neuropsychological Well-Being, The Chinese University of Hong Kong, Hong Kong, China
- Correspondence: ; Tel.: +852-3943-6654
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26
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Elbin RJ, Womble MN, Elbich DB, Dollar C, Fedor S, Hakun JG. Ambulatory Assessment in Concussion Clinical Care and Rehabilitation. Front Digit Health 2022; 4:924965. [PMID: 35814821 PMCID: PMC9260167 DOI: 10.3389/fdgth.2022.924965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 05/20/2022] [Indexed: 11/13/2022] Open
Abstract
Concussion is a mild traumatic brain injury that is characterized by a wide range of physical, emotional, and cognitive symptoms as well as neurocognitive, vestibular, and ocular impairments that can negatively affect daily functioning and quality of life. Clinical consensus statements recommend a targeted, clinical profile-based approach for management and treatment. This approach requires that clinicians utilize information obtained via a clinical interview and a multi-domain assessment battery to identify clinical profile(s) (e.g., vestibular, mood/anxiety, ocular, migraine, cognitive fatigue) and prescribe a corresponding treatment/rehabilitation program. Despite this comprehensive approach, the clinical picture can be limited by the accuracy and specificity of patient reports (which often conflate timing and severity of symptomology), as well as frequency and duration of exposure to symptom exacerbating environments (e.g., busy hallways, sitting in the back seat of a car). Given that modern rehabilitation programs leverage the natural environment as a tool to promote recovery (e.g., expose-recover approach), accurate characterization of the patient clinical profile is essential to improving recovery outcomes. Ambulatory assessment methodology could greatly benefit concussion clinical care by providing a window into the symptoms and impairments experienced by patients over the course of their daily lives. Moreover, by evaluating the timing, onset, and severity of symptoms and impairments in response to changes in a patient's natural environment, ambulatory assessments can provide clinicians with a tool to confirm clinical profiles and gauge effectiveness of the rehabilitation program. In this perspective report, we review the motivations for utilizing ambulatory assessment methodology in concussion clinical care and report on data from a pilot project utilizing smart phone-based, ambulatory assessments to capture patient reports of symptom severity, environmental exposures, and performance-based assessments of cognition for 7 days following their initial evaluation.
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Affiliation(s)
- R. J. Elbin
- Department of Health, Human Performance and Recreation/Office for Sport Concussion Research, University of Arkansas, Fayetteville, AR, United States
| | - Melissa N. Womble
- Inova Sports Medicine Concussion Program, Fairfax, VA, United States
| | - Daniel B. Elbich
- Department of Neurology, College of Medicine, The Pennsylvania State University, Hershey, PA, United States
| | - Christina Dollar
- Inova Sports Medicine Concussion Program, Fairfax, VA, United States
| | - Sheri Fedor
- Inova Sports Medicine Concussion Program, Fairfax, VA, United States
| | - Jonathan G. Hakun
- Department of Neurology, College of Medicine, The Pennsylvania State University, Hershey, PA, United States
- Department of Psychology, The Pennsylvania State University, State College, PA, United States
- Center for Healthy Aging, The Pennsylvania State University, State College, PA, United States
- Translational Brain Research Center, College of Medicine, The Pennsylvania State University, Hershey, PA, United States
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