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Tsoy E, La Joie R, VandeVrede L, Rojas JC, Yballa C, Chan B, Lago AL, Rodriguez A, Goode CA, Erlhoff SJ, Tee BL, Windon C, Lanata S, Kramer JH, Miller BL, Dilworth‐Anderson P, Boxer AL, Rabinovici GD, Possin KL. Scalable plasma and digital cognitive markers for diagnosis and prognosis of Alzheimer's disease and related dementias. Alzheimers Dement 2024; 20:2089-2101. [PMID: 38224278 PMCID: PMC10942726 DOI: 10.1002/alz.13686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 12/11/2023] [Accepted: 12/16/2023] [Indexed: 01/16/2024]
Abstract
INTRODUCTION With emergence of disease-modifying therapies, efficient diagnostic pathways are critically needed to identify treatment candidates, evaluate disease severity, and support prognosis. A combination of plasma biomarkers and brief digital cognitive assessments could provide a scalable alternative to current diagnostic work-up. METHODS We examined the accuracy of plasma biomarkers and a 10-minute supervised tablet-based cognitive assessment (Tablet-based Cognitive Assessment Tool Brain Health Assessment [TabCAT-BHA]) in predicting amyloid β positive (Aβ+) status on positron emission tomography (PET), concurrent disease severity, and functional decline in 309 older adults with subjective cognitive impairment (n = 49), mild cognitive impairment (n = 159), and dementia (n = 101). RESULTS Combination of plasma pTau181, Aβ42/40, neurofilament light (NfL), and TabCAT-BHA was optimal for predicting Aβ-PET positivity (AUC = 0.962). Whereas NfL and TabCAT-BHA optimally predicted concurrent disease severity, combining these with pTau181 and glial fibrillary acidic protein was most accurate in predicting functional decline. DISCUSSION Combinations of plasma and digital cognitive markers show promise for scalable diagnosis and prognosis of ADRD. HIGHLIGHTS The need for cost-efficient diagnostic and prognostic markers of AD is urgent. Plasma and digital cognitive markers provide complementary diagnostic contributions. Combination of these markers holds promise for scalable diagnosis and prognosis. Future validation in community cohorts is needed to inform clinical implementation.
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Affiliation(s)
- Elena Tsoy
- Department of NeurologyUniversity of California San FranciscoSan FranciscoCaliforniaUSA
- Global Brain Health InstituteUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Renaud La Joie
- Department of NeurologyUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Lawren VandeVrede
- Department of NeurologyUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Julio C. Rojas
- Department of NeurologyUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Claire Yballa
- Department of NeurologyUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Brandon Chan
- Department of NeurologyUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Argentina Lario Lago
- Department of NeurologyUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Anne‐Marie Rodriguez
- Department of NeurologyUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Collette A. Goode
- Department of NeurologyUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Sabrina J. Erlhoff
- Department of NeurologyUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Boon Lead Tee
- Department of NeurologyUniversity of California San FranciscoSan FranciscoCaliforniaUSA
- Global Brain Health InstituteUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Charles Windon
- Department of NeurologyUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Serggio Lanata
- Department of NeurologyUniversity of California San FranciscoSan FranciscoCaliforniaUSA
- Global Brain Health InstituteUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Joel H. Kramer
- Department of NeurologyUniversity of California San FranciscoSan FranciscoCaliforniaUSA
- Global Brain Health InstituteUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Bruce L. Miller
- Department of NeurologyUniversity of California San FranciscoSan FranciscoCaliforniaUSA
- Global Brain Health InstituteUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Peggye Dilworth‐Anderson
- Department of Health Policy and ManagementGillings School of Global Public HealthUniversity of North Carolina Chapel HillChapel HillCaliforniaUSA
| | - Adam L. Boxer
- Department of NeurologyUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Gil D. Rabinovici
- Department of NeurologyUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Katherine L. Possin
- Department of NeurologyUniversity of California San FranciscoSan FranciscoCaliforniaUSA
- Global Brain Health InstituteUniversity of California San FranciscoSan FranciscoCaliforniaUSA
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Stiver J, Staffaroni AM, Walters SM, You MY, Casaletto KB, Erlhoff SJ, Possin KL, Lukic S, La Joie R, Rabinovici GD, Zimmerman ME, Gorno-Tempini ML, Kramer JH. The Rapid Naming Test: Development and initial validation in typically aging adults. Clin Neuropsychol 2022; 36:1822-1843. [PMID: 33771087 PMCID: PMC8464629 DOI: 10.1080/13854046.2021.1900399] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 03/04/2021] [Indexed: 01/27/2023]
Abstract
ObjectiveProgressive word-finding difficulty is a primary cognitive complaint among healthy older adults and a symptom of pathological aging. Classic measures of visual confrontation naming, however, show ceiling effects among healthy older adults. To address the need for a naming test that is sensitive to subtle, age-related word-finding decline, we developed the Rapid Naming Test (RNT), a computerized, one-minute, speeded visual naming test.MethodFunctionally intact older (n = 145) and younger (n = 69) adults completed the RNT. Subsets of older adults also completed neuropsychological tests, a self-report scale of functional decline, amyloid-β PET imaging, and repeat RNT administration to determine test-retest reliability.ResultsRNT scores were normally distributed and exhibited good test-retest reliability. Younger adults performed better than older adults. Within older adults, lower scores were associated with older age. Higher scores correlated with measures of language, processing speed, and episodic learning and memory. Scores were not correlated with visuospatial or working memory tests. Worse performance was related to subjective language decline, even after controlling for a classic naming test and speed. The RNT was also negatively associated with amyloid-β burden.ConclusionsThe RNT appears to be a reliable test that is sensitive to subtle, age-related word-finding decline. Convergent and divergent validity are supported by its specific associations with measures relying on visual naming processes. Ecological validity is supported by its relationship with subjective real-world language difficulties. Lastly, worse performance was related to amyloid-β deposition, an Alzheimer's disease biomarker. This study represents a key step toward validating a novel, sensitive naming test in typically aging adults.
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Affiliation(s)
- Jordan Stiver
- Memory and Aging Center, Department of Neurology, UCSF
Weill Institute for Neurosciences, University of California, San Francisco, San
Francisco, CA, USA
- Department of Psychology, Fordham University, New York, NY,
USA
| | - Adam M. Staffaroni
- Memory and Aging Center, Department of Neurology, UCSF
Weill Institute for Neurosciences, University of California, San Francisco, San
Francisco, CA, USA
| | - Samantha M. Walters
- Memory and Aging Center, Department of Neurology, UCSF
Weill Institute for Neurosciences, University of California, San Francisco, San
Francisco, CA, USA
- Department of Psychology, University of California, Los
Angeles, Los Angeles, CA, USA
| | - Michelle Y. You
- Memory and Aging Center, Department of Neurology, UCSF
Weill Institute for Neurosciences, University of California, San Francisco, San
Francisco, CA, USA
| | - Kaitlin B. Casaletto
- Memory and Aging Center, Department of Neurology, UCSF
Weill Institute for Neurosciences, University of California, San Francisco, San
Francisco, CA, USA
| | - Sabrina J. Erlhoff
- Memory and Aging Center, Department of Neurology, UCSF
Weill Institute for Neurosciences, University of California, San Francisco, San
Francisco, CA, USA
| | - Katherine L. Possin
- Memory and Aging Center, Department of Neurology, UCSF
Weill Institute for Neurosciences, University of California, San Francisco, San
Francisco, CA, USA
| | - Sladjana Lukic
- Memory and Aging Center, Department of Neurology, UCSF
Weill Institute for Neurosciences, University of California, San Francisco, San
Francisco, CA, USA
| | - Renaud La Joie
- Memory and Aging Center, Department of Neurology, UCSF
Weill Institute for Neurosciences, University of California, San Francisco, San
Francisco, CA, USA
| | - Gil D. Rabinovici
- Memory and Aging Center, Department of Neurology, UCSF
Weill Institute for Neurosciences, University of California, San Francisco, San
Francisco, CA, USA
| | | | - Maria Luisa Gorno-Tempini
- Memory and Aging Center, Department of Neurology, UCSF
Weill Institute for Neurosciences, University of California, San Francisco, San
Francisco, CA, USA
| | - Joel H. Kramer
- Memory and Aging Center, Department of Neurology, UCSF
Weill Institute for Neurosciences, University of California, San Francisco, San
Francisco, CA, USA
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Tsoy E, Brugulat‐Serrat A, Vandevrede L, Erlhoff SJ, Casaletto KB, Rankin KP, Kramer JH, Possin KL. Distinct patters of associations between cognitive performance and Alzheimer’s disease biomarkers in a multinational cohort of clinically normal older adults. Alzheimers Dement 2021. [DOI: 10.1002/alz.055076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Elena Tsoy
- University of California San Francisco San Francisco CA USA
| | - Anna Brugulat‐Serrat
- Global Brain Health Institute San Francisco CA USA
- IMIM (Hospital del Mar Medical Research Institute) Barcelona Spain
- Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES) Madrid Spain
- Barcelonaβeta Brain Research Center (BBRC), Pasqual Maragall Foundation Barcelona Spain
| | | | | | | | | | - Joel H Kramer
- Global Brain Health Institute San Francisco CA USA
- University of California, San Francisco San Francisco CA USA
| | - Kate L Possin
- Global Brain Health Institute San Francisco CA USA
- University of California, San Francisco San Francisco CA USA
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Rodriguez‐Salgado AM, Llibre‐Guerra JJ, Peñalver AI, Tsoy E, Bringas G, Guerra JCL, Erlhoff SJ, Allen IE, Valcour V, Kramer JH, Miller BL, Possin KL, Llibre‐Rodriguez JJ. Brief digital cognitive assessment for detection of cognitive impairment in low‐ and middle‐income countries. Alzheimers Dement 2021. [DOI: 10.1002/alz.050888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
| | | | | | - Elena Tsoy
- University of California, San Francisco San Francisco CA USA
| | | | | | - Sabrina J Erlhoff
- Memory and Aging Center, University of California San Francisco San Francisco CA USA
| | - Isabel Elaine Allen
- Memory and Aging Center, UCSF Weill Institute for Neurosciences, University of California, San Francisco San Francisco CA USA
| | - Victor Valcour
- University of California, San Francisco San Francisco CA USA
- Global Brain Health Institute San Francisco CA USA
| | - Joel H Kramer
- Memory and Aging Center, UCSF Weill Institute for Neurosciences, University of California, San Francisco San Francisco CA USA
| | - Bruce L Miller
- Memory and Aging Center, University of California San Francisco San Francisco CA USA
| | - Kate L Possin
- Memory and Aging Center, University of California San Francisco San Francisco CA USA
- Global Brain Health Institute San Francisco CA USA
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Tsoy E, Strom A, Iaccarino L, Erlhoff SJ, Goode CA, Rodriguez AM, Rabinovici GD, Miller BL, Kramer JH, Rankin KP, La Joie R, Possin KL. Detecting Alzheimer's disease biomarkers with a brief tablet-based cognitive battery: sensitivity to Aβ and tau PET. Alzheimers Res Ther 2021; 13:36. [PMID: 33557905 PMCID: PMC7871372 DOI: 10.1186/s13195-021-00776-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 01/25/2021] [Indexed: 11/29/2022]
Abstract
Background β-amyloid (Aβ) and tau positron emission tomography (PET) detect the pathological changes that define Alzheimer’s disease (AD) in living people. Cognitive measures sensitive to Aβ and tau burden may help streamline identification of cases for confirmatory AD biomarker testing. Methods We examined the association of Brain Health Assessment (BHA) tablet-based cognitive measures with dichotomized Aβ -PET status using logistic regression models in individuals with mild cognitive impairment (MCI) or dementia (N = 140; 43 Aβ-, 97 Aβ+). We also investigated the relationship between the BHA tests and regional patterns of tau-PET signal using voxel-wise regression analyses in a subsample of 60 Aβ+ individuals with MCI or dementia. Results Favorites (associative memory), Match (executive functions and speed), and Everyday Cognition Scale scores were significantly associated with Aβ positivity (area under the curve [AUC] = 0.75 [95% CI 0.66–0.85]). We found significant associations with tau-PET signal in mesial temporal regions for Favorites, frontoparietal regions for Match, and occipitoparietal regions for Line Orientation (visuospatial skills) in a subsample of individuals with MCI and dementia. Conclusion The BHA measures are significantly associated with both Aβ and regional tau in vivo imaging markers and could be used for the identification of patients with suspected AD pathology in clinical practice. Supplementary Information The online version contains supplementary material available at 10.1186/s13195-021-00776-w.
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Affiliation(s)
- Elena Tsoy
- Department of Neurology, Memory and Aging Center, University of California San Francisco, Box 1207, 675 Nelson Rising Lane, Suite 190, San Francisco, CA, 94158, USA
| | - Amelia Strom
- Department of Neurology, Memory and Aging Center, University of California San Francisco, Box 1207, 675 Nelson Rising Lane, Suite 190, San Francisco, CA, 94158, USA
| | - Leonardo Iaccarino
- Department of Neurology, Memory and Aging Center, University of California San Francisco, Box 1207, 675 Nelson Rising Lane, Suite 190, San Francisco, CA, 94158, USA
| | - Sabrina J Erlhoff
- Department of Neurology, Memory and Aging Center, University of California San Francisco, Box 1207, 675 Nelson Rising Lane, Suite 190, San Francisco, CA, 94158, USA
| | - Collette A Goode
- Department of Neurology, Memory and Aging Center, University of California San Francisco, Box 1207, 675 Nelson Rising Lane, Suite 190, San Francisco, CA, 94158, USA
| | - Anne-Marie Rodriguez
- Department of Neurology, Memory and Aging Center, University of California San Francisco, Box 1207, 675 Nelson Rising Lane, Suite 190, San Francisco, CA, 94158, USA
| | - Gil D Rabinovici
- Department of Neurology, Memory and Aging Center, University of California San Francisco, Box 1207, 675 Nelson Rising Lane, Suite 190, San Francisco, CA, 94158, USA.,Department of Radiology and Biomedical Imaging, University of California San Francisco, 1500 Owens Street, 2nd Fl, San Francisco, CA, 94158, USA
| | - Bruce L Miller
- Department of Neurology, Memory and Aging Center, University of California San Francisco, Box 1207, 675 Nelson Rising Lane, Suite 190, San Francisco, CA, 94158, USA.,Global Brain Health Institute, University of California San Francisco, 675 Nelson Rising Lane, San Francisco, CA, 94158, USA
| | - Joel H Kramer
- Department of Neurology, Memory and Aging Center, University of California San Francisco, Box 1207, 675 Nelson Rising Lane, Suite 190, San Francisco, CA, 94158, USA.,Global Brain Health Institute, University of California San Francisco, 675 Nelson Rising Lane, San Francisco, CA, 94158, USA
| | - Katherine P Rankin
- Department of Neurology, Memory and Aging Center, University of California San Francisco, Box 1207, 675 Nelson Rising Lane, Suite 190, San Francisco, CA, 94158, USA
| | - Renaud La Joie
- Department of Neurology, Memory and Aging Center, University of California San Francisco, Box 1207, 675 Nelson Rising Lane, Suite 190, San Francisco, CA, 94158, USA
| | - Katherine L Possin
- Department of Neurology, Memory and Aging Center, University of California San Francisco, Box 1207, 675 Nelson Rising Lane, Suite 190, San Francisco, CA, 94158, USA. .,Global Brain Health Institute, University of California San Francisco, 675 Nelson Rising Lane, San Francisco, CA, 94158, USA.
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Rodríguez-Salgado AM, Llibre-Guerra JJ, Tsoy E, Peñalver-Guia AI, Bringas G, Erlhoff SJ, Kramer JH, Allen IE, Valcour V, Miller BL, Llibre-Rodríguez JJ, Possin KL. A Brief Digital Cognitive Assessment for Detection of Cognitive Impairment in Cuban Older Adults. J Alzheimers Dis 2021; 79:85-94. [PMID: 33216033 DOI: 10.3233/jad-200985] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Rapid technological advances offer a possibility to develop cost-effective digital cognitive assessment tools. However, it is unclear whether these measures are suitable for application in populations from Low and middle-income countries (LMIC). OBJECTIVE To examine the accuracy and validity of the Brain Health Assessment (BHA) in detecting cognitive impairment in a Cuban population. METHODS In this cross-sectional study, 146 participants (cognitively healthy = 53, mild cognitive impairment (MCI) = 46, dementia = 47) were recruited at primary care and tertiary clinics. The main outcomes included: accuracy of the BHA and the Montreal Cognitive Assessment (MoCA) in discriminating between controls and cognitively impaired groups (MCI and dementia) and correlations between the BHA subtests of memory, executive functions, and visuospatial skills and criterion-standard paper-and-pencil tests in the same domains. RESULTS The BHA had an AUC of 0.95 (95% CI: 0.91-0.98) in discriminating between controls and cognitively impaired groups (MCI and dementia, combined) with 0.91 sensitivity at 0.85 specificity. In discriminating between control and MCI groups only, the BHA tests had an AUC of 0.94 (95% CI: 0.90-0.99) with 0.71 sensitivity at 0.85 specificity. Performance was superior to the MoCA across all diagnostic groups. Concurrent and discriminant validity analyses showed moderate to strong correlations between the BHA tests and standard paper-and-pencil measures in the same domain and weak correlations with standard measures in unrelated domains. CONCLUSION The BHA has excellent performance characteristics in detecting cognitive impairment including dementia and MCI in a Hispanic population in Cuba and outperformed the MoCA. These results support potential application of digital cognitive assessment for older adults in LMIC.
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Affiliation(s)
- Ana M Rodríguez-Salgado
- Department of Neurology, National Institute of Neurology and Neurosurgery, La Havana, Cuba.,Global Brain Health Institute, University of California San Francisco, San Francisco, CA, USA
| | - Jorge J Llibre-Guerra
- Department of Neurology, National Institute of Neurology and Neurosurgery, La Havana, Cuba.,Global Brain Health Institute, University of California San Francisco, San Francisco, CA, USA.,Department of Neurology, Washington University in St Louis, St Louis, MO, USA
| | - Elena Tsoy
- Department of Neurology,Memory and Aging Center, University of California San Francisco, San Francisco, CA, USA
| | - Ana Ibis Peñalver-Guia
- Department of Neurology, National Institute of Neurology and Neurosurgery, La Havana, Cuba
| | - Giosmany Bringas
- Department of Neurology, National Institute of Neurology and Neurosurgery, La Havana, Cuba
| | - Sabrina J Erlhoff
- Department of Neurology,Memory and Aging Center, University of California San Francisco, San Francisco, CA, USA
| | - Joel H Kramer
- Global Brain Health Institute, University of California San Francisco, San Francisco, CA, USA.,Department of Neurology,Memory and Aging Center, University of California San Francisco, San Francisco, CA, USA
| | - Isabel Elaine Allen
- Department of Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Victor Valcour
- Global Brain Health Institute, University of California San Francisco, San Francisco, CA, USA.,Department of Neurology,Memory and Aging Center, University of California San Francisco, San Francisco, CA, USA
| | - Bruce L Miller
- Global Brain Health Institute, University of California San Francisco, San Francisco, CA, USA.,Department of Neurology,Memory and Aging Center, University of California San Francisco, San Francisco, CA, USA
| | | | - Katherine L Possin
- Global Brain Health Institute, University of California San Francisco, San Francisco, CA, USA.,Department of Neurology,Memory and Aging Center, University of California San Francisco, San Francisco, CA, USA
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7
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Tsoy E, Erlhoff SJ, Goode CA, Dorsman KA, Kanjanapong S, Lindbergh CA, La Joie R, Strom A, Rabinovici GD, Lanata SC, Miller BL, Tomaszewski Farias SE, Kramer JH, Rankin KP, Possin KL. BHA-CS: A novel cognitive composite for Alzheimer's disease and related disorders. Alzheimers Dement (Amst) 2020; 12:e12042. [PMID: 32582835 PMCID: PMC7306517 DOI: 10.1002/dad2.12042] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 04/20/2020] [Indexed: 12/02/2022]
Abstract
INTRODUCTION Composite scores based on psychometrically rigorous cognitive assessments are well suited for early diagnosis and disease monitoring. METHODS We developed and cross-validated the Brain Health Assessment-Cognitive Score (BHA-CS), based on a brief computerized battery, in 451 cognitively normal (CN) and 399 cognitively impaired (mild cognitive impairment [MCI] or dementia) older adults. We investigated its long-term reliability and reliable change indices at longitudinal follow-up (N = 340), and the association with amyloid beta (Aβ) burden in the CN subgroup with Aβ positron emission tomography (N = 119). RESULTS The BHA-CS was accurate at detecting cognitive impairment and exhibited excellent long-term stability. Reliable decline over one year was detected in 75% of participants with dementia, 44% with MCI, and 3% of CN. Among CN, the Aβ-positive group showed worse longitudinal performance on the BHA-CS compared to the Aβ-negative group. DISCUSSION The BHA-CS is sensitive to cognitive decline in preclinical and prodromal neurodegenerative disease.
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Affiliation(s)
- Elena Tsoy
- Department of Neurology, Memory and Aging CenterUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Sabrina J. Erlhoff
- Department of Neurology, Memory and Aging CenterUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Collette A. Goode
- Department of Neurology, Memory and Aging CenterUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Karen A. Dorsman
- Department of Neurology, Memory and Aging CenterUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Suchanan Kanjanapong
- Department of Neurology, Memory and Aging CenterUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Cutter A. Lindbergh
- Department of Neurology, Memory and Aging CenterUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Renaud La Joie
- Department of Neurology, Memory and Aging CenterUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Amelia Strom
- Department of Neurology, Memory and Aging CenterUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Gil D. Rabinovici
- Department of Neurology, Memory and Aging CenterUniversity of California San FranciscoSan FranciscoCaliforniaUSA
- Department of Radiology and Biomedical ImagingUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Serggio C. Lanata
- Department of Neurology, Memory and Aging CenterUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Bruce L. Miller
- Department of Neurology, Memory and Aging CenterUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | | | - Joel H. Kramer
- Department of Neurology, Memory and Aging CenterUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Katherine P. Rankin
- Department of Neurology, Memory and Aging CenterUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Katherine L. Possin
- Department of Neurology, Memory and Aging CenterUniversity of California San FranciscoSan FranciscoCaliforniaUSA
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Tsoy E, Possin KL, Thompson N, Patel K, Garrigues SK, Maravilla I, Erlhoff SJ, Ritchie CS. Self-Administered Cognitive Testing by Older Adults At-Risk for Cognitive Decline. J Prev Alzheimers Dis 2020; 7:283-287. [PMID: 32920631 DOI: 10.14283/jpad.2020.25] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Self-administered computerized cognitive testing could effectively monitor older individuals at-risk for cognitive decline at home. In this study, we tested the feasibility and reliability of 3 tablet-based executive functioning measures and an executive composite score in a sample of 30 older adults (age 80±6) with high multimorbidity. The tests were examiner-administered at baseline and then self-administered by the participants at home across 2 subsequent days. Eight of the participants reported no prior experience with touchscreen technology. Twenty-seven participants completed both self-administered assessments, and 28 completed at least one. Cronbach's alpha (individual tests: .87-.89, composite: .93) and correlations between examiner-administered and self-administered performances (individual tests: .72-.91, composite: .93) were high. The participants who had never used a smartphone or a tablet computer showed comparable consistency. Remote self-administered tablet-based testing in older adults at-risk for cognitive decline is feasible and reliable, even among participants without prior technology experience.
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Affiliation(s)
- E Tsoy
- Elena Tsoy, PhD, Memory and Aging Center, Department of Neurology, University of California San Francisco, 675 Nelson Rising Lane, Suite 190, San Francisco, California, USA, 94158, Tel: 415-514-7477, E-mail:
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Possin KL, Moskowitz T, Erlhoff SJ, Rogers KM, Johnson ET, Steele NZR, Higgins JJ, Stiver J, Alioto AG, Farias ST, Miller BL, Rankin KP. The Brain Health Assessment for Detecting and Diagnosing Neurocognitive Disorders. J Am Geriatr Soc 2019; 66:150-156. [PMID: 29355911 DOI: 10.1111/jgs.15208] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND/OBJECTIVES Brief cognitive screens lack the sensitivity to detect mild cognitive impairment (MCI) or support differential diagnoses. The objective of this study was to validate the 10-minute, tablet-based University of California, San Francisco (UCSF) Brain Health Assessment (BHA) to overcome these limitations. DESIGN Cross-sectional. SETTING UCSF Memory and Aging Center. PARTICIPANTS Older adults (N = 347) (neurologically healthy controls (n = 185), and individuals diagnosed with MCI (n = 99), dementia (n = 42), and as normal with concerns (n = 21)). MEASUREMENTS The BHA includes subtests of memory, executive function and speed, visuospatial skills, and language and an optional informant survey. Participants completed the Montreal Cognitive Assessment (MoCA) and criterion-standard neuropsychological tests. Standardized structural 3T brain magnetic resonance imaging was performed in 145 participants. RESULTS At a fixed 85% specificity rate, the BHA had 100% sensitivity to dementia and 84% to MCI; the MoCA had 75% sensitivity to dementia and 25% to MCI. The BHA had 83% sensitivity to MCI likely due to AD and 88% to MCI unlikely due to AD, and the MoCA had 58% sensitivity to MCI likely AD and 24% to MCI unlikely AD. The BHA subtests demonstrated moderate to high correlations with the criterion-standard tests from their respective cognitive domains. Memory test performance correlated with medial temporal lobe volumes; executive and speed with frontal, parietal, and basal ganglia volumes; and visuospatial with right parietal volumes. CONCLUSION The BHA had excellent combined sensitivity and specificity to detect dementia and MCI, including MCI due to diverse etiologies. The subtests provide efficient, valid measures of neurocognition that are critical in making a differential diagnosis.
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Affiliation(s)
- Katherine L Possin
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, California
| | - Tacie Moskowitz
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, California
| | - Sabrina J Erlhoff
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, California
| | - Kirsten M Rogers
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, California
| | - Erica T Johnson
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, California
| | - Natasha Z R Steele
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, California
| | | | - Jordan Stiver
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, California
| | - Andrea G Alioto
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, California
| | - Sarah T Farias
- Department of Neurology, University of California Davis, Sacramento, California
| | - Bruce L Miller
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, California
| | - Katherine P Rankin
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, California
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