Validity of the Web-Based, Self-Directed, NeuroCognitive Performance Test in Mild Cognitive Impairment

BACKGROUND

Digital cognitive tests offer several potential advantages over established paper-pencil tests but have not yet been fully evaluated for the clinical evaluation of mild cognitive impairment.

OBJECTIVE

The NeuroCognitive Performance Test (NCPT) is a web-based, self-directed, modular battery intended for repeated assessments of multiple cognitive domains. Our objective was to examine its relationship with the Alzheimer's Disease Assessment Scale-Cognition Subscale (ADAS-Cog) and Mini-Mental State Examination (MMSE) as well as with established paper-pencil tests of cognition and daily functioning in mild cognitive impairment (MCI).

METHODS

We used Spearman correlations, regressions and principal components analysis followed by a factor analysis (varimax rotated) to examine our objectives.

RESULTS

In MCI subjects, the NCPT composite is significantly correlated with both a composite measure of established tests (r = 0.77, p <  0.0001) as well as with the ADAS-Cog (r = 0.55, p <  0.0001). Both NCPT and paper-pencil test batteries had a similar factor structure that included a large "g" component with a high eigenvalue. The correlation for the analogous tests (e.g., Trails A and B, learning memory tests) were significant (p <  0.0001). Further, both the NCPT and established tests significantly (p <  0.01) predicted the University of California San Diego Performance-Based Skills Assessment and Functional Activities Questionnaire, measures of daily functioning.

CONCLUSION

The NCPT, a web-based, self-directed, computerized test, shows high concurrent validity with established tests and hence offers promise for use as a research or clinical tool in MCI. Despite limitations such as a relatively small sample, absence of control group and cross-sectional nature, these findings are consistent with the growing literature on the promise of self-directed, web-based cognitive assessments for MCI.

Cognitive training and neuroplasticity in mild cognitive impairment (COG-IT): protocol for a two-site, blinded, randomised, controlled treatment trial

INTRODUCTION

Mild cognitive impairment (MCI) is common in older adults and represents a high-risk group for progression to Alzheimer's disease (AD). Medication trials in MCI have generally failed, but new discoveries with brain plasticity in ageing have led to the study of cognitive training as a potential treatment to improve cognitive abilities. Computerised cognitive training (CCT) involves computerised cognitive exercises that target specific cognitive abilities and neural networks to potentially improve cognitive functioning through neuroplasticity.

METHODS AND ANALYSIS

In a two-site study (New York State Psychiatric Institute/Columbia University Medical Center and Duke University Medical Center), we will randomise 100 patients with MCI (Wechsler Memory Scale-III Logical Memory II score 0-11; Folstein Mini Mental State Examination ≥23) to home-based CCT (suite of exercises: memory, matching, spatial recognition, processing speed) or a home-based active control condition (computerised crossword puzzle training (CPT)) with 12 weeks of intensive training followed by regular booster sessions up to 78 weeks. All patients will receive standard neuropsychological and functional assessments in clinic as well as structural/functional brain MRI scans at study entry and endpoint. We will test if CCT, versus CPT, leads to improved cognitive functioning, transfers to functional ability and tasks of everyday life and impacts hippocampal volume changes and changes in the default mode network of the brain measured by resting-state functional MRI.

ETHICS AND DISSEMINATION

The study will be conducted following ethics approval and written informed consent will be obtained from all subjects. Study results will be disseminated via publication, clinicaltrials.gov, media and conference presentations. This will be the first controlled long-term trial to evaluate the effects of home-based CCT versus computerised CPT on cognitive abilities and functional measures and neural outcomes as determined by MRI indices in patients with MCI. Positive results from trial may support further development of home-based CCT.

TRIAL REGISTRATION NUMBER

ClinicalTrials.gov identifier (NCT03205709).

Intravenous chlorpromazine versus intramuscular sumatriptan for acute migraine

OBJECTIVE

To establish whether there is any difference in the efficacy of a chlorpromazine regimen and a sumatriptan regimen for the management of the pain of acute severe migraine.

SETTING

Two urban teaching hospital emergency departments.

METHODS

Prospective, randomised, unblinded, crossover trial. All patients received intravenous metoclopramide 10 mg and 1000 ml of normal saline over 1 h; 20 were then randomised to receive intramuscular sumatriptan 6 mg and 23 to receive intravenous chlorpromazine, 12.5 mg increments to a maximum of 37.5 mg. Response to treatment was measured using visual analogue pain scales.

RESULTS

No difference in efficacy between the sumatriptan regimen and the chlorpromazine regimen was found. Adverse effects were mild and equally distributed between the groups.

CONCLUSIONS

The chlorpromazine and sumatriptan regimens studied are both very effective for the relief of the headache of severe migraine.

Effect of a centralizing device on cement mantle deficiencies and initial prosthetic alignment in total hip arthroplasty

Sixty consecutive patients undergoing a primary hybrid total hip arthroplasty were randomized to receive a femoral component either with or without a distal centralizing device. The group with a centralizer had significantly fewer patients with cement mantle deficiencies (excessively thin areas of cement) than the group without a centralizer (P < .001). Furthermore, the centralizer group was, on average, in a neutral alignment, whereas the group without a centralizer was in a varus alignment (P < .001). It was concluded that the distal centralizing device significantly decreases the incidence of cement mantle deficiences and reproducibly aids in achieving a more neutral prosthetic alignment.

Classification of femoral abnormalities in total hip arthroplasty

Bony abnormalities of the femur can significantly complicate total hip arthroplasty both for the primary and revision operations. No standard nomenclature exists for the description of these femoral abnormalities. A classification system is presented to standardize nomenclature, assist in preoperative planning, and to assist in the reporting of these defects.

Prediction of dosage of lithium carbonate: use of a standard predictive method

The nomogram developed by Cooper and associates used to predict the dose of Lithium Carbonate (Li+) which is needed to attain therapeutic Li+ concentrations has, in general, proven to be accurate and clinically useful. However, there may be some patients in whom the pharmacokinetic disposition of Li+ varies sufficiently so that accurate dosage predictions cannot be made; a report of one such patient is given.