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28 Variability in Remote, Self-Administered Assessment Performance Associated with Self-Reported Memory Perceptions Among Older Adults
- Jennifer R. Strenger, Natalie Riera, Karra Harrington, Nelson Roque, Stephen Salloway, Martin Sliwinski, Louisa I. Thompson
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 340-341
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Objective:
Remote assessment for cognitive screening and monitoring in the elderly has many potential advantages, including improved convenience/access and ease of repeat testing. As remote testing becomes more feasible and common, it is important to examine what factors might influence performance and adherence with these new methods. Personal beliefs about one’s ability to remember effectively have been shown to impact memory performance, especially in older adults (Lineweaver & Hertzog, 1998). The perception of a low level of personal control over memory may impact a person’s use of memory strategies which might otherwise enhance performance, as well as their beliefs about the efficacy of those strategies (Lineweaver et al., 2021). The present study examined the relationship between perceived memory self-efficacy and performance and adherence on self-administered, smartphonebased remote cognitive assessments.
Participants and Methods:Participants were 123 cognitively unimpaired adults (ages 55-80, 68.3% female, 87% White, M= 16.5 years of education) recruited from the Butler Hospital Alzheimer’s Prevention Registry as part of an ongoing study evaluating novel cognitive assessment methods. A cutoff of score of ≥34 on the modified Telephone Interview for Cognitive Status (TICSm) was required for enrollment. Perceived memory self-efficacy was assessed using two subscales of the Personal Beliefs about Memory Instrument (PBMI; Lineweaver et al., 1998): “prospective control”, the perception of control one currently has to influence future memory functioning, and “future control”, the perception of the amount of control over memory function one will have in the future. Participants completed three brief self-administered cognitive testing sessions per day for 8 consecutive days using a mobile app-based platform developed as part of the National Institute of Aging’s Mobile Toolbox initiative. Cognitive tasks assessed visual working memory (WM), processing speed (PS), and episodic memory (EM)(see Thompson et al., 2022).
Results:Statistical analyses were conducted using univariate ANOVA tests to look for main effects of each PBMI subscale score on remote assessment adherence and average performance on each task over 8 days. After adjusting for aging, we found a higher rate of false alarms (proportion of misidentified stimuli) on the WM task was associated with higher levels of both self-reported prospective control (F(2, 86) = 4.188, p = .018) and future control (F(2, 96) = 5.003, p = .009). Increased response time on the PS task was also associated with higher levels of future control when adjusted for aging (F(2, 96) = 6.075, p = .003). There was no main effect of memory self-efficacy ratings on EM. We found no main effects of memory self-efficacy ratings on assessment adherence.
Conclusions:These findings suggest perceptions of high prospective and future control are associated with positive response bias on a forced-choice WM task, and high perceptions of future control are also associated with slower response times on PS tasks. Future research should examine whether this is due to increased deliberation, cautiousness, or other factors. Limitations include the potentially limited generalizability of this largely White, highly educated, and motivated sample self-selected for AD research. Next steps for this research include comparing these results with the effects of perceived self-efficacy on in-person cognitive assessments.
5 Intraindividual Variability in Processing Speed on Digital Cognitive Assessments Differs by Amyloidosis Status in Cognitively Normal Older Adults
- Alyssa De Vito, Zachary Kunicki, Karysa Britton, Priscilla Villa, Jennifer Strenger, Karra Harrington, Nelson Roque, Martin J. Sliwinski, Louisa I. Thompson
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 217-218
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Objective:
Intraindividual variability (IIV) is defined as fluctuations in an individual’s cognitive performance over time1. IIV has been identified as a marker of neurobiological disturbance making it a useful method for detecting changes in cognition among cognitively healthy individuals as well as those with prodromal syndromes2. IIV on laboratory-based computerized tasks has been linked with cognitive decline and conversion to mild cognitive impairment (MCI) and/or dementia (Haynes et al., 2017). Associations between IIV and AD risk factors including apolipoprotein (APOE) ε4 carrier status, neurodegeneration seen on brain imaging, and amyloid (Aß) Positron emission tomography (PET) scan status have also been observed1. Recent studies have demonstrated that evaluating IIV on smartphone-based digital cognitive assessments is feasible, has the capacity to differentiate between cognitively normal (CN) and MCI individuals, and may reduce barriers to cognitive assessment3. This study sought to evaluate whether such differences could be detected in CN participants with and without elevated AD risk.
Participants and Methods:Participants (n=57) were cognitively normal older adults who previously received an Aß PET scan through the Butler Hospital Memory and Aging Program. The sample consisted of primarily non-Hispanic (n=49, 86.0%), White (n=52, 91.2%), college-educated (M=16.65 years), females (n=39, 68.4%). The average age of the sample was 68 years old. Approximately 42% of the sample (n=24) received a positive PET scan result. Participants completed brief cognitive assessments (i.e., 3-4 minutes) three times per day for eight days (i.e., 24 sessions) using the Mobile Monitoring of Cognitive Change (M2C2) application, a mobile app-based cognitive testing platform developed as part of the National Institute of Aging’s Mobile Toolbox initiative (Sliwinski et al., 2018). Participants completed visual working memory, processing speed, and episodic memory tasks on the M2C2 platform. Intraindividual standard deviations (ISDs) across trials were computed for each person at each time point (Hultsch et al., 2000). Higher ISD values indicate more variability in performance. Linear mixed effects models were utilized to examine whether differences in IIV existed based on PET scan status while controlling for age, sex at birth, and years of education.
Results:n interaction between PET status and time was observed on the processing speed task such that Aß- individuals were less variable over the eight assessment days compared to Aß + individuals (B= -5.79, SE=2.67, p=.04). No main or interaction effects were observed on the visual working memory task or episodic memory task.
Conclusions:Our finding that Aß- individuals demonstrate less variability over time on a measure of processing speed is consistent with prior work. No associations were found between IIV in other cognitive domains and PET status. As noted by Allaire and Marsiske (2005), IIV is not a consistent phenomenon across different cognitive domains. Therefore, identifying which tests are the most sensitive to early change is crucial. Additional studies in larger, more diverse samples are needed prior to widespread clinical use for early detection of AD.
91 Remote Smartphone-Based Assessment Predicts Standard Neuropsychological Test Performance and Cerebral Amyloid Status in Cognitively Normal Older Adults
- Louisa I. Thompson, Jennifer R. Strenger, Sheina Emrani, Alyssa De Vito, Karra Harrington, Nelson Roque, Stephen Salloway, Martin Sliwinski, Stephen Correia
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 493-494
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Objective:
Routine cognitive screening in the elderly may facilitate earlier diagnosis of neurodegenerative diseases and access to care and resources for patients and families. However, despite growing rates of Alzheimer's and related disorders (ADRD), the availability and implementation of cognitive screening for older adults in the US remains quite limited. Remote cognitive assessment via smartphone app may reduce several barriers to more widespread screening. We examined the validity of a remote app-based cognitive screening protocol in healthy older adults by examining remote task convergence with standard-person assessments and cerebral amyloid (Aß) status as an AD biomarker.
Participants and Methods:Participants (N =117) were cognitively unimpaired adults aged 60-80 years (67.5% female, 88% White, 75% education > 16 years). A portion had Aß PET imaging results available from prior research participation [(Aß positive (Aß+) n =26, and Aß negative (Aß-) n = 44]. A modified Telephone Interview for Cognitive Status (TICSm) cutoff score of >34 was used to establish unimpaired cognition. Participants completed 8 consecutive assessment days using Mobile Monitoring of Cognitive Change (M2C2), a smartphone app-based testing platform developed as part of the National Institute of Aging's Mobile Toolbox initiative. Brief (i.e., 3-4 minute) M2C2 sessions were assigned daily within morning, afternoon, and evening time windows. Tasks included measures of visual working memory (WM), processing speed (PS), and episodic memory (EM) (see Thompson et al., 2022). Participants then completed a battery of standard neuropsychological assessments in-person at a follow-up visit.
Results:Participants completed 22.6 (SD = 2.6) out of 24 assigned sessions (3 sessions x 8 days) on average. Performance on all M2C2 tasks decreased significantly with age. Women performed significantly better on WM and EM tasks relative to men. There were no detectable significant differences in performance by race or education. Shorter mean reaction time on M2C2 PS trials predicted faster Trails A and B completion (ß = .26, p < .01, 95% CI [3.8, 23.3] and ß = .20, p < .05, 95% CI [.23, 6.8], respectively). Greater mean M2C2 WM accuracy predicted longer maximum backward digital span (ß = .24, p = .01, 95% CI [.02, .16]). Greater mean M2C2 EM accuracy predicted stronger Logical Memory delayed recall (ß = .33, p < .001, 95% CI [.004, .012]) and total immediate recall on the Free and Cued Selective Reminding Test (ß = .19, p < .05, 95% CI [.000, .006]). Moreover, EM significantly distinguished Aß- and Aß+ individuals (t (68) = 3.0, p < .01) with fair accuracy (AUC = .72).
Conclusions:Mean performance across 8-days on each M2C2 task predicted same-domain cognitive task performance on a standard assessment battery, with medium effect sizes. Performance on the EM task was also sensitive to cerebral Aß status, consistent with subtle memory changes implicated in the preclinical stage of AD. These findings support the validity of this remote testing protocol in healthy older adults, with implications for future efforts to facilitate accessible and sensitive cognitive screening for early detection of ADRD. Limitations include the restricted generalizability of this primarily white and college educated sample.
48 Psychometric properties of DCTclock™ with commonly used neuropsychological tests and their combined ability to predict Beta-Amyloid Positron Emission Tomography Status
- Sheina Emrani, Jennifer Strenger, Zachary Kunicki, Alyssa De Vito, Stephen Salloway, Louisa Thompson
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 255-256
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Objective:
Sensitive and non-invasive methods of screening for early-stage Alzheimer’s disease (AD) are urgently needed. The digital clock drawing test (DCTclockTM) is an established and well-researched neuropsychological tool that can aid in early detection of dementia. Other simple, yet sensitive, neuropsychological measures able to detect early stages of AD include Trail Making Tests (TMT). We investigated the psychometric properties of DCTclockTM with TMT-A and TMT-B. We then sought to understand the degree to which neuropsychological tools (i.e., DCTclockTM, TMT-A, and B) versus the Montreal Cognitive Assessment (MoCA) predict beta-amyloid (Aß) positron emission tomography (PET) status (positive or negative) in cognitively normal individuals.
Participants and Methods:Participants included a sample of cognitively normal older adults (n= 59, M age = 69.2, F = 64%) recruited from the Butler Memory and Aging Program. The Linus Health DCTclockTM uses a digital pen to capture traditional clock drawing test performance and advanced analytics to evaluate the drawing process for indicators of cognitive difficulty. DCTclockTM may have overlapping cognitive properties with TMT measures, like efficiency, processing speed, and spatial reasoning. We compared latency measures (i.e., process efficiency, clock face speed, average latency, and processing speed) and spatial reasoning of the DCTclockTM to z-scores of TMT-A and TMT-B to detect any overlapping psychometric properties. Verbal fluency was included for discriminant validity. We then ran logistic regressions on a subset of the sample to compare neuropsychological tests (DCTclockTM total score [score that captures overall performance], TMT-A/B, and verbal fluency) to the MoCA, a commonly used cognitive screening tool, in determining PET status.
Results:Highly correlated (r > .7) DCTclockTM variables were excluded. We found statistically significant correlations between some DCTclockTM measures and TMT-A/B, like DCTclockTM drawing process efficiency and TMT-A and TMT-B (r= .45, p< .001, r=.29, p< .026, respectively), and DCTclockTM average latency and TMT-A and TMT-B (r=.3, p< .024, r= .26, p< .044, respectively). No statistically significant associations were found between any DCTclockTM measures and verbal fluency, or between DCTclockTM spatial reasoning and TMT-A/B. We then investigated the effect of these neuropsychological tests (DCTclockTM total score, TMT-A/B, verbal fluency) and age on the likelihood of PET positivity (subset of sample, total PET, n=31). The model was statistically significant (x2 (5) = 15.35, p< .01). The model explained 53% (Nagelkerke R2) of the variance in PET status and correctly classified 74.2% of cases. DCTclockTM was the only significant predictor (p< .02), after controlling for TMT-A, TMT-B, verbal fluency, and age. Comparatively, there was no effect of MoCA and age (total PET, n= 29) on the likelihood of PET positivity.
Conclusions:Overall, these results suggest psychometric convergence on elements of DCTclockTM and TMT-A/B, while there was no association in spatial operations between DCTclockTM and TMT measures. Further, when compared to the MoCA, DCTclockTM and these commonly used neuropsychological tests (verbal fluency and TMT-A/B) were better predictors of PET status, primarily driven by the DCTclockTM. Digitized neuropsychological tools may provide additional metrics not captured by pen-and-paper tests that can detect AD-associated pathology.