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98 On Combining In-Person and Remote National Alzheimer’s Coordinating Center (NACC) Uniform Data Set (UDS) data
- Viktorija Smith, Elizabeth C. Mormino, Kathleen L. Poston, Christina B. Young
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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. 500-501
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Objective:
Although remote neuropsychological assessments have become increasingly common, current research on the reliability and validity of scores obtained from remote at-home assessments are sparse. No studies have examined remote at-home administration of the National Alzheimer’s Coordinating Center (NACC) Uniform Data Set (UDS) even though this battery is being used to track over 45,000 participants over time. This study aimed to determine whether remote UDS scores can be combined with in-person data by assessing whether rates of score changes over time (i.e., reliability) differed by modality and whether remote and in-person scores converge (i.e., validity).
Participants and Methods:Data for UDS visits conducted from 09/2005 to 12/2021 from 43 Alzheimer’s Disease Research Centers were examined. We identified 311 participants (254 cognitively unimpaired, 7 impaired - not mild cognitive impairment, 25 mild cognitive impairment, 25 dementia) who completed 2 remote UDS visits 0.868 years apart (SD = 0.200 years). First, initial remote scores were correlated with most recent in-person scores. Second, we examined whether rates of change differed between remote and in-person assessments. Repeated-measure one-way ANOVA were used to compare rates calculated from the same individual from remote versus inperson assessments. We additionally identified a demographically- and visit-number-matched group of 311 participants with in-person UDS visits given that all remote visits occurred after in-person visits; one-way ANOVAs were used to compare remote rates to rates from in-person assessments from the matched in-person group. Finally, accuracy of remote scores were assessed by quantifying the difference between the actual remote scores and predicted scores based on repeated in-person assessments. These residual values were then divided by the maximum score to form error rates.
Results:Remote UDS score on MoCA-blind, Craft story immediate and delayed recall, digits forward, digits backward, phonemic fluency (F, L, F + L), and semantic fluency (animals, vegetables, animals + vegetables) were all highly correlated (all ps < 0.001) with scores obtained from preceding in-person assessments. At the group level, within-subject comparisons between remote and in-person rates of change were not significantly different for 7/11 tests; between-subject comparisons were not significantly different for 10/11 tests. Vegetable fluency had slightly reduced rates of change with remote assessment compared to inperson assessments. Critically, remote scores were consistent with predicted scores based on the trajectory of each subject’s in-person assessments with group mean error rates ranging from 0.7% (Craft Delayed Recall) to 3.9% (Phonemic fluency - F).
Conclusions:Our results demonstrate adequate reliability and convergent validity for remotely administered verbally based tests from the NACC UDS battery. Importantly, our findings provide some support for combining remote and in-person scores for studies that transitioned to remote testing due to COVID-19. However, future research is needed for tests with visual stimuli that assess visual memory, visuospatial function, and aspects of executive function.
2 Computerized Cognitive Practice Effects in Relation to Amyloid and Tau in Preclinical Alzheimer's Disease: Results from a Multi-Site Cohort
- Christina B Young, Elizabeth C Mormino, Kathleen L Poston, Keith A Johnson, Dorene M Rentz, Reisa A Sperling, Kathryn V Papp
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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. 206-207
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Objective:
There is a need to identify scalable cognitive paradigms that are sensitive enough to relate to Alzheimer's disease biomarkers (amyloid and tau) in the preclinical stage. Here, we determine whether initial performance and practice effects on the memory-focused Computerized Cognitive Composite (C3) relate to demographic variables, amyloid status [abnormal (A+), normal (A-)], and regional tau in clinically unimpaired (CU) older adults.
Participants and Methods:We examined pre-randomization data from CU older adults screened for the Anti-Amyloid Treatment in Asymptomatic Alzheimer's Disease (A4) study. We focused on participants who completed the C3 (n=3287), most of whom completed an alternate version of the C3 again approximately 51 days later (n=4141), as well as a subset of preclinical AD participants (i.e., A+ CU) who completed the C3 and tau PET imaging with [18]F-flortaucipir (initial C3: n=354; repeat C3: n=343). C3 initial performance and practice effects were examined in relation to amyloid status (A+, A-) and continuous regional tau burden.
Results:Initial C3 performance was associated with amyloid status [B(SE) = -0.075 (0.021), p < 0.001] across all participants, as well as tau burden in the medial temporal lobe (MTL) [B (SE) = -0.728 (0.220), p = 0.001], inferior temporal (IT) cortex [B (SE) = -0.782 (0.264), p = 0.003], and inferior parietal (IP) cortex [B (SE) = -0.721 (0.281), p = 0.011] amongst preclinical AD individuals. Short-term practice effects were also associated with reduced tau burden in MTL [B (SE) = -0.471 (0.202), p = 0.020], IT [B (SE) = -0.640 (0.240), p = 0.008], and IP [B( SE) = - 0.584 (0.255), p = 0.023] amongst preclinical AD participants, but were not associated with amyloid status [B (SE) = -0.018 (0.020), p = 0.348]. Critically, these effects with tau were only detected when baseline performance was accounted for presumably due to opposing influence from both practice effects and regression to the mean effects.
Conclusions:This is the first study to show that performance on a brief cognitive battery administered in a multisite context is associated with both amyloid and tau among CU older adults. These findings suggest that computerized assessments may be a cost-effective and scalable approach for early detection efforts. Further, diminished practice effects on memory-based measures are associated with elevated tau burden in preclinical AD, suggesting that high-frequency cognitive testing collected over a short follow-up period may provide additional insights regarding early disease processes than single assessments.
4 Episodic Memory Deficits and Fronto-Limbic Correlates in Older Adults Living with HIV: Comparison to Parkinson’s Disease and Normal Aging
- Rosemary Fama, Eva M. Müller-Oehring, Taylor F. Levine, Edith V. Sulivan, Priya Asok, Stephanie A. Sassoon, Helen M. Bronte-Stewart, Kathleen L. Poston, Kilian M. Pohl, Adolf Pfefferbaum, Tilman Schulte
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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, p. 679
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Objective:
The prevalence of mild to moderate cognitive impairment, including episodic memory deficits, in people living with HIV (PLWH) remains high despite the life-extending success of antiretroviral pharmacotherapy. With PLWH now reaching near-normal life expectancy, questions concerning a potential synergy between age- and HIV disease-related effects, including degradation in fronto-limbic circuits, neural systems also compromised in Parkinson’s disease (PD), have emerged.
Participants and Methods:This cross-sectional study examined the similarities and differences in component processes of verbal episodic memory and their neural correlates in 42 PLWH, 41 individuals with PD, and 37 controls (CTRL) (all participants aged 45-79 years). Learning over five trials, short-delay (SD) and long-delay, (LD), free-recall (FR) and cued-recall (CR) indices were assessed using the California Verbal Learning Test-2. Retention scores for FR and CR were derived adjusting for Trial 5 performance. All memory scores were age- and education-corrected based on the control group and reported as Z-scores. Regional brain volumes were calculated using 3T MRI data and the SRI24 atlas to delineate frontal (precentral, superior, orbital, middle, inferior, supplemental motor, and medial) and limbic (hippocampus, thalamus) regions. Brain volumes were age- and head-sized corrected based on 238 controls (19-86 years old).
Results:Compared with the CTRL group, the HIV and PD groups were impaired on learning across trials and on SD and LD free- and cued-recall, with no group difference between the HIV and PD groups on any score. All three groups benefited similarly from cues compared with free-recall. The HIV and PD groups did not differ from CTRL on retention scores. Regarding brain volumes, the HIV group had smaller middle frontal volumes than the PD or CTRL groups and smaller thalamic volumes than the PD group. Correlational analyses (Bonferroni correction for 8 comparisons, p<.01) indicated that fewer total number of words recalled on Trial 5, learning over Trials 1-5, total words recalled on SD-CR, LD-FR, and LD-CR were associated with smaller orbitofrontal volume in the HIV but not the PD group; the correlations between orbitofrontal volume and memory scores were significantly different between the HIV and PD groups. In PD, but not HIV, lower retention scores on SD-FR and LD-CR correlated to smaller hippocampal volume.
Conclusions:Impairment in learning and cued recall performance indicate that both encoding and retrieval processes are affected in PLWH and PD. Neural correlates of verbal memory differed between groups, with orbitofrontal volume associated with learning and recall in PLWH, whereas hippocampal volume was associated with retention scores in PD. Together, these results suggest that different nodes within the fronto-limbic mnemonic circuitry underlie the mutual verbal episodic memory deficits observed in older PLWH and PD. Support: AA023165, AA005965, AA107347, AA010723, NS07097, MH113406, and the Michael J. Fox Foundation for Parkinson’s Research