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32 Influence of Prior Experience with Computer-Based Technology on Tablet-Based Neurocognitive Test Performance: Data from a sample of cognitively impaired South African older adults
- Nina S Steenkamp, Hetta-Mari Gouse, Rhiannon Changuion, Christopher M Ferraris, Daphne Tsapalas, Nana Asiedu, Anthony F Santoro, Kevin G. F. Thomas, Reuben N Robbins
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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. 713-714
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Objective:
The global prevalence of persons living with dementia will soon exceed 50 million. Most of these individuals reside in low- and middle-income countries (LMICs). In South Africa, one such LMIC, the physician-to-patient ratio of 9:10 000 severely limits the capacity of clinicians to screen, assess, diagnose, and treat dementias. One way to address this limitation is by using mobile health (mHealth) platforms to scale-up neurocognitive testing. In this paper, we describe one such platform, a brief tablet-based cognitive assessment tool (NeuroScreen) that can be administered by lay health-providers. It may help identify patients with cognitive impairment (related, for instance, to dementia) and thereby improve clinical care and outcomes. However, there is a lack of data regarding (a) the acceptability of this novel technology for delivery of neurocognitive assessments in LMIC-resident older adults, and (b) the influence of technology-use experience on NeuroScreen performance of LMIC-resident older adults. This study aimed to fill that knowledge gap, using a sample of cognitively impaired South African older adults.
Participants and Methods:Participants were 60 older adults (63.33% female; 91.67% right-handed; age M = 68.90 years, SD = 9.42, range = 50-83), all recruited from geriatric and memory clinics in Cape Town, South Africa. In a single 1-hour session, they completed the entire NeuroScreen battery (Trail Making, Number Speed, Finger Tapping, Visual Discrimination, Number Span Forward, Number Span Backward, List Learning, List Recall) as well as a study-specific questionnaire assessing acceptability of NeuroScreen use and overall experience and comfort with computer-based technology. We summed across 11 questionnaire items to derive a single variable capturing technology-use experience, with higher scores indicating more experience.
Results:Almost all participants (93.33%) indicated that NeuroScreen was easy to use. A similar number (90.00%) indicated they would be comfortable completing NeuroScreen at routine doctor's visits. Only 6.67% reported feeling uncomfortable using a tablet, despite about three-quarters (76.67%) reporting never having used a tablet with a touchscreen before. Almost one in five participants (18.33%) reported owning a computer, 10.00% a tablet, and 70.00% a smartphone. Correlations between test performance and technology-use experience were statistically significant (or strongly tended toward significance) for most NeuroScreen subtests that assessed higherorder cognitive functioning and that required the participant to manipulate the tablet themselves: Trail Making 2 (a measure of cognitive switching ability), r = .24, p = .05; Visual Discrimination A (complex processing speed [number-symbol matching]), r = .38, p = .002; Visual Discrimination B (pattern recognition), r = .37, p = .004; Number Speed (simple information processing speed), r = .36, p = .004. For the most part, there were no such significant associations when the NeuroScreen subtest required only verbal input from the participant (i.e., on the list learning and number span tasks).
Conclusions:NeuroScreen, a tablet-based neurocognitive screening tool, appears feasible for use among older South Africans, even if they are cognitively impaired and have limited technological familiarity. However, test performance might be influenced by amount of technology-use experience; clinicians using the battery must consider this in their interpretations.
52 Demographic influences on test performance may not be universal: considerations from a cross-country comparison of South Africa and Zimbabwe
- Shathani Rampa, Desiree Byrd, Primrose Nyamayaro, Hetta Gouse, Reuben N Robbins
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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. 730-731
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Objective:
Appropriate adjustments to normative data for neuropsychological (NP) tests are imperative for their equitable use in brain health practices. Age and education are known to be strong predictors of test performance. In settings where validated tests are not available, common practice has been to adapt and apply them in similar fashion as settings where they were developed. However, demographic adjustments cannot be assumed de facto to be universal in their strength and domain associations. For example, South Africa (SA) and Zimbabwe are neighboring countries with some similarities in their demographic makeup, but with vastly different sociopolitical trajectories- Zimbabwe was colonially occupied until 1980 and SA was oppressed under Apartheid until 1994- which have impacted access to and quality of education by severely limiting educational opportunities for native citizens. The present study explored whether the direction and strength of relationships between age and education on NP test performance were similar or not between SA and Zimbabwe adults living with and without HIV.
Participants and Methods:Data was extracted from two IRB-approved studies in SA and Zimbabwe with similar inclusion and exclusion criteria. The SA sample (n=214) was comprised of 56% females, 48% HIV-positive adults, mean age of 34 years, and a nine-year range in education (3-14 years). The Zimbabwe sample (n=212) was comprised of 68% females, 67% HIV-positive adults, mean age of 36 years, and a thirteen-year range in education (7-20 years). Participants completed NeuroScreen, a tablet-based battery of 12 brief NP tests adapted for indigenous SA and Zimbabwe languages. The two study samples were analyzed separately. Zero order correlations between each of the tests and age and gender were conducted to determine the influence of the demographic variables. Relationships with moderate correlations (r>0.3) in both samples were further analyzed using univariate ANOVA to examine the main effects and interactions of age and education
Results:Overall, there was a similar pattern of results across samples, with nine tests showing no-to-low associative relationships with age and education respectively. Moderate, significant relationships were found between age, education and three tests of processing speed (Visual Discrimination A, Visual discrimination B, and Number Speed) in both samples. Age and education had different effects on Visual discrimination A across samples with a significant main effect for age but not education in SA [F(40,83)=3.060, p<0.01], whilst Zimbabwe had a significant main effect for education but not age [F(10,87)=4.541, p<0.01]. Visual Discrimination B and Number Speed showed significant main effects for both variables in both samples. However, there was a significant interaction for both tests in Zimbabwe only.
Conclusions:The current study is novel in its exploration of country-specific relationships between NP test performance and demographic factors in settings where assessment science is emergent. Results demonstrate the presence of differential relationships between demographic variables on test performance which raises questions about the source of these differences. One important potential source is the socio-cultural context of each country and the intersection of demographic factors in these contexts. Further research is required to explore these considerations.
Assessment of Neurocognitive Functions, Olfaction, Taste, Mental, and Psychosocial Health in COVID-19 in Adults: Recommendations for Harmonization of Research and Implications for Clinical Practice
- Lucette A. Cysique, Emilia Łojek, Theodore Ching-Kong Cheung, Breda Cullen, Anna Rita Egbert, Jonathan Evans, Maite Garolera, Natalia Gawron, Hetta Gouse, Karolina Hansen, Paweł Holas, Sylwia Hyniewska, Ewa Malinowska, Bernice A. Marcopulos, Tricia L. Merkley, Jose A. Muñoz-Moreno, Clare Ramsden, Christian Salas, Sietske A.M. Sikkes, Ana Rita Silva, Imane Zouhar, the NeuroCOVID International Neuropsychology Taskforce
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- Journal:
- Journal of the International Neuropsychological Society / Volume 28 / Issue 6 / July 2022
- Published online by Cambridge University Press:
- 09 August 2021, pp. 642-660
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Objective:
To propose a set of internationally harmonized procedures and methods for assessing neurocognitive functions, smell, taste, mental, and psychosocial health, and other factors in adults formally diagnosed with COVID-19 (confirmed as SARS-CoV-2 + WHO definition).
Methods:We formed an international and cross-disciplinary NeuroCOVID Neuropsychology Taskforce in April 2020. Seven criteria were used to guide the selection of the recommendations’ methods and procedures: (i) Relevance to all COVID-19 illness stages and longitudinal study design; (ii) Standard, cross-culturally valid or widely available instruments; (iii) Coverage of both direct and indirect causes of COVID-19-associated neurological and psychiatric symptoms; (iv) Control of factors specifically pertinent to COVID-19 that may affect neuropsychological performance; (v) Flexibility of administration (telehealth, computerized, remote/online, face to face); (vi) Harmonization for facilitating international research; (vii) Ease of translation to clinical practice.
Results:The three proposed levels of harmonization include a screening strategy with telehealth option, a medium-size computerized assessment with an online/remote option, and a comprehensive evaluation with flexible administration. The context in which each harmonization level might be used is described. Issues of assessment timelines, guidance for home/remote assessment to support data fidelity and telehealth considerations, cross-cultural adequacy, norms, and impairment definitions are also described.
Conclusions:The proposed recommendations provide rationale and methodological guidance for neuropsychological research studies and clinical assessment in adults with COVID-19. We expect that the use of the recommendations will facilitate data harmonization and global research. Research implementing the recommendations will be crucial to determine their acceptability, usability, and validity.