Cognitive tools for the transition to anonymous societies

There is no gold standard screening tool available to assess post-stroke cognitive impairment (PSCI). PSCI is a common and under-recognised global problem in stroke patients that may eventually lead to post-stroke dementia (PSD). Two major issues in PSCI research include the lack of a clear-cut definition and a lack of highly specific and sensitive screening tools that accurately predict PSCI. To identify the most appropriate cognitive screening tool to be used in the diagnosis of PSCI. MEDLINE and “The Cochrane Library” were searched for articles published between January 2000 and August 2016 that contained the keywords “post-stroke cognitive impairment”, “post-stroke dementia” or “cognitive tools after stroke” or “cognitive impairment after stroke”. Abstracts were selected using predetermined inclusion and exclusion criteria, and full-text reviews were performed. Publications on cognitive screening tools and PSCI or PSD were pooled separately for the review process. A total of 22 publications discussing cognitive screening tools in PSCI and PSD were identified. Only two publications discussed the use of multidomain cognitive tools. Some publications reported that domain-specific cognitive screening tools had higher sensitivity and specificity when compared to commonly use cognitive screening tools such as the Montreal Cognitive Assessment (MOCA) and Mini-Mental State Examination (MMSE). The superiority of one available tool was not evident in studies that performed a meta-analysis. The Oxford Cognitive Screen (OCS), a multidomain tool, was found to be a better predictor of PSCI/PSD than the MOCA or MMSE. To date, the literature on PSCI has primarily focused on nonspecific cognitive screening tools, although there has been a recent move towards domain-specific screening tools. Multidomain screening tools such as the OCS may be better than existing tools in the diagnosis of PSD and PSCI.

This systematic review identified and critically appraised existing research comparing cognitive screening tools used to assess neurocognitive side effects of electroconvulsive therapy (ECT). A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews (PRISMA) guidelines and the Synthesis Without Meta-analysis (SWiM) reporting guideline. A protocol was registered with the Open Sciences Network (OSF) registry, and critical appraisal was completed using the Joanna Briggs Institute Critical Appraisal tool for Diagnostic Test Accuracy Studies. Pragmatic criteria were applied to assess relative strengths and weaknesses of the identified cognitive screening tools for application to clinical practice. Nine studies met the inclusion criteria; 2 ECT-specific cognitive screening tools, 2 generalised cognitive screening tools, 4 neurocognitive batteries, and 1 brief memory scale. The ECT-specific cognitive screening tools were the Brief ECT Cognitive Screen (BECS) and the ElectroConvulsive Therapy Cognitive Assessment (ECCA). The Montreal Cognitive Assessment (MoCA) was the most common generalised cognitive screening tool used. The BECS and ECCA scored the highest using our specific pragmatic criteria. Key limitations across the included studies were the lack of a suitable gold standard comparator and inadequate blinding of assessors. There is limited evidence to support the superiority of one cognitive tool over another for assessing neurocognitive side effects associated with ECT. The primary limitations across the current literature base are the lack of a gold standard reference tool and heterogeneity of included populations. There is a need for further research to validate the sensitivity and specificity of tools such as the BECS and ECCA.

Cognitive decline is classically attributed to organic causes such as dementia; however, depression can play a role in cognitive decline. To evaluate cognitive screening tools and the 4-item Geriatric Depression Scale (GDS-4) for use in primary care to distinguish cognitive decline secondary to depression. Clinical data collected over 2.5 years for assessed patients in a secondary clinical service for younger adults. Cognitive screening tools (General Practitioner Assessment of Cognition, Addenbrooke's Cognitive Examination-III, Rowland Universal Dementia Assessment Scale, Salzburg Dementia Test Prediction) and GDS-4 were analyzed for their accuracy to differentiate patients with cognitive decline due to depression from those with subjective cognitive complaints. 180 young adults seen in a memory clinic setting (< 65 years) were included. These individuals either had a diagnosis of depression (n = 46) or no cognitive impairment on assessment (n = 134) despite having subjective cognitive complaints. All used cognitive tools had poor accuracy in differentiating cognitive decline secondary to depression from subjective cognitive complaints. The GDS-4 alone, however, was able to differentiate with high accuracy (AUC = 0.818) individuals who had cognitive problems secondary to depression. Cognitive screening tools used alone are ineffective in discriminating cognitive decline secondary to depression. Incorporating the GDS-4 into the screening process by primary practitioners could facilitate early identification and treatment of depression in younger people, avoiding unnecessary referrals memory services.

BackgroundAcross the Arab world, Alzheimer’s disease and related dementias (ADRD) are a growing public health concern with the increase in the proportion of older adults. Yet, our understanding of these conditions remains limited because of a lack of data. Robust assessments of cognitive function are crucial for screening, prevention, and risk factor identification. This systematic review aims to identify available cognitive assessments in Arabic and assess their validity and performance.MethodWe conducted a comprehensive search with a broad inclusion criterion using Medline OVID, EMBASE, and APA PsychInfo up to November 2023. Our search included both studies developing or validating cognitive assessment tools in Arabic for individuals aged 50 and above, and studies applying any such tool in the Arabic language. Study selection and data abstraction were carried out in duplicate and independently and using standardized and pilot‐tested forms. We analyzed and reported the availability, appropriateness, and use of the available cognitive assessment instruments.ResultOur review yielded 154 studies, of which 27 studies involved developing or validating a tool and 127 studies used a cognitive assessment tool. Among the validation studies, measures of validity, reliability, or normative data were available for 22 cognitive assessment tools. 21 studies focused on criterion validity with 18 testing tools compared to clinical assessments and 3 compared to other scales. Cut‐off scores, sensitivity, and specificity were tested in 21 studies for a total of 15 tools. 35% of the validation studies had no reliability measures. Three studies developed a new assessment tool. The Mini Mental State Examination was the most frequently validated and used instrument across diverse settings. Studies validating domain‐specific tools were limited, with memory being the most frequently validated. Among studies using a cognitive tool in Arabic, over half used unvalidated versions.ConclusionPsychometric evaluations of cognitive assessments for older Arabic‐speaking adults remain scarce with limited data regarding domain‐specific assessments, reproducibility, and suitability in different settings (different countries or different samples: clinical, community, nursing home). Findings emphasize this important challenge that can hinder robust data on ADRD burden and risk trajectories in Arab populations.

This systematic review aims to identify available cognitive assessments for Arabic-speaking older adults and to assess their validity and performance. A comprehensive search was conducted using Medline, Embase, and APA PsycInfo up to November 2023, encompassing studies validating or using cognitive tools in Arabic for individuals aged ≥ 50. We identified 29 validation studies for 20 cognitive tools and 125 studies using cognitive tools. Three tools were validated in more than one study/setting. Cut-offs for dementia were validated for 16 tools (including two domain-specific tools) and for cognitive impairment for three tools. The Mini-Mental State Examination and Montreal Cognitive Assessment were the most frequently validated and used tools. The results highlight a large need for improved psychometric data for cognitive assessments for Arabic-speaking older adults and identify important gaps in knowledge regarding domain-specific tools, the detection of cognitive changes, and the suitability of assessments across different settings and subgroups. HIGHLIGHTS: We reviewed the availability and properties of cognitive assessments in Arabic. Psychometric data on cognitive tools for older Arabic-speaking adults are scarce. Only three tools are validated in more than one study/setting. Data are largely lacking for domain-specific tools and early cognitive changes. The review identifies important methodology, reporting, and reproducibility issues.

BackgroundThis study aimed to explore the issues around developing a new automated cognitive assessment. Current cognitive screening or stratification tools were typically developed only using white people so having a normative data set from almost exclusively white populations. In this part of the project we are co‐developing an automated cognitive assessment tool; CognoSpeak (https://cognospeak.github.io/website/) with a Somali ethnic minority group.CognoSpeak is a fully automated cognitive assessment tool based in language an interaction. A virtual clinician asking questions and listening to responses using automatic speech recognition and Machine Learning algorithmsMethodsWe recruited 2 members of the Somali community team (Israac) and undertook workshops to explore the themes of dementia and cognitive impairment. We trained the Research champions to use cognitive assessment tools and have piloted these on 20 healthy controls from the Somali community. Participants were assessed using the Montreal Cognitive Assessment (MoCA), Rowland Universal Dementia Assessment Scale (RUDAS) and the Multicultural Cognitive Examination (MCE).ResultsWe have undertaken a pilot study, recruiting 14 females, and 7 males ranging from 34 years to 80 years old (with mean age of 48.8). Participants were all from a non‐English background and spoke English and identified as either Somalian or British Somalian. 76.19%(16/21 scored below MoCA = 26; MoCA. Zero scored below cut off on RUDAS (RUDAS = 22; RUDAS: all the patients scored more than 22 and zero scored below cut off of 70 on MCE and 14.29% (3/21)We will aim to recruit 50 participants to interact with CognoSpeak and have results from the three cognitive screens described above.ConclusionWe have trained two research champions with no prior research experience to help recruit Healthy controls to start testing CognoSpeak. Validation of novel cognitive tools needs co‐developed methodologies and culturally appropriate cognitive assessment tools. We will have further data on a larger data set, comparing different cognitive screening tools and our automated tool.

The diagnostic process for patients presenting with cognitive decline and suspected dementia is complex. Physicians face challenges distinguishing between normal aging, mild cognitive impairment, Alzheimer's disease, and other dementias. Although there is some evidence for improving attitudes towards the importance of prompt diagnosis, there is limited information describing how physicians approach this diagnostic challenge in practice. This was explored in the present study. Across-sectional survey of primary care and specialist physicians, in 5 European countries, Canada, and the United States, was conducted. Participants were asked about their use of cognitive screening tools and diagnostic technologies, as well as the rationales and barriers for use. In total, 1365 physicians participated in the survey, 63% of whom were specialists. Most physicians stated they use objective cognitive tools to aid the early detection of suspected mild cognitive impairment or Alzheimer's disease in patients. The Mini-Mental State Examination was the most common tool used for initial screening; respondents cited speed and ease of use but noted its lack of specificity. Cerebrospinal fluid biomarker and amyloid positron emission tomography tests, respectively, had been used by only 26% and 32% of physicians in the preceding 6 months, although patterns of use varied across countries. The most commonly cited reasons for not ordering such tests were invasiveness (for cerebrospinal fluid biomarker testing) and cost (for amyloid positron emission tomography imaging). Data reported by physicians reveal differences in the approaches to the diagnostics process in Alzheimer's. A higher proportion of primary care physicians in the United States are routinely incorporating cognitive assessment tools into annual visits, but this is due to country differences in clinical practice. The value of screening tools and regular use could be discussed further with physicians; however, lack of specificity associated with cognitive tools and the investment required from patients and the healthcare system are limiting factors.

Declining cognitive function and physical frailty can independently decrease quality of life and increase dependence and mortality in older adults. While previous works demonstrate relationships between physical and cognitive frailty, studies investigating differences between cognitive function tools and their associations with physical frailty in older adults are lacking. This study aimed to investigate the relationship between various cognitive tools and physical frailty markers in community-dwelling older adults residing in low-income settings. Older adults (≥60 years old) living in the community were recruited (n = 118). Participants completed cognitive functioning assessments, including, Digital Symbol Substitution Test (DSST), Trail Making Test (TMT)-A, TMT-B, Rowland University Dementia Assessment Scale (RUDAS), and Memory Impairment Screen (MIS). Physical frailty was assessed using the Fatigue, Resistance, Ambulatory, Illness, and Loss of weight (FRAIL) questionnaire, short physical performance battery (SPPB), BTracks Balance system, timed-up-and-go (TUG), 30-second sit-to-stand (STS), and handgrip strength (HGS). Spearman correlations were performed (p &amp;lt; 0.05) using GraphPad Prism. FRAIL score was significantly correlated with TMT-A, TMT-B, and DSST. SPPB total was significantly correlated with all cognitive tests. SPPB balance was significantly correlated with RUDAS and MIS, gait speed with TMT-A, TMT-B, and DSST, and chair stand with RUDAS, MIS, TMT-A, and TMT-B. STS was significantly correlated with RUDAS, TMT-A, TMT-B, and DSST. TUG was significantly correlated with TMT-A, TMT-B, and DSST. HGS was significantly correlated with TMT-A and DSST. Findings suggest that tools measuring different aspects of cognitive function have varying relationships with physical frailty. Future work should be done to dissect these relationships better.

BackgroundRising prevalence of Alzheimer's disease and related dementias (ADRD) in Sub‐Saharan Africa (SSA) highlights an urgent need for effective cognitive assessment tools tailored to this region. Existing tools are often culturally and linguistically inappropriate and have inadequate validity and reliability. We report findings from Ethiopia on adapting cognitive tools incorporating local cultural and social contexts. Our work aims to identify challenges in adapting widely used ADRD cognitive assessments in Ethiopia, and explore social, cultural, and linguistic factors influencing cognitive performance.MethodUsing a mixed‐methods approach, we evaluated the cultural applicability of widely used paper‐and‐pencil and digital cognitive tools in urban Ethiopian setting. The study incorporated ethnographic observations, focus group discussions with local communities and normative data development. By July 2024, 100 healthy older adults (age: 62.1±9.1, 60% female, education: 8.0±5.5) who met the inclusion and exclusion criteria harmonized with the National Alzheimer's Coordinating Center protocols were enrolled. Qualitative thematic analysis and multiple linear regression models were used to present the results.ResultThematic analyses indicated challenges related to high rates of screening failures (visual deficits and subjective memory complaints), negative perception of cognitive problems, and limited literacy and technology familiarity. Floor effects were identified on tasks of processing speed (Trails A = 16%, Months Backward = 11%) and motor dexterity (Grooved Pegboard = 10%). Multiple regression analyses indicated strong effects of educational attainment followed by age across most tasks, while female sex effect was present only on task of language functions (Table 1).ConclusionThe study emphasizes the important need for culturally adapted cognitive tools in Ethiopia. Although low literacy, stigma, and limited technology understanding pose challenges, our finding support accessibility and feasibility of neuropsychological tools for ADRD research by incorporating local languages, culturally relevant tasks, and literacy‐independent assessments. Our findings inform development of culturally valid cognitive protocols by highlighting best performing internationally harmonized tasks and identifying predictors of performance. Based on our learnings, we will provide recommendations on the design of aging and ADRD studies in low resource settings in SSA including strengths and weakness of harmonized cognitive assessment protocols.

Objectives: In US nursing homes, cognitive assessment has been an essential component of the federally mandated Minimum Data Set assessment system, inclusive of the Brief Interview for Mental Status (BIMS) for identifying possible cognitive impairment. We compare it with the Brief Cognitive Assessment Tool (BCAT) to determine which instrument is more sensitive in differentiating degrees of cognitive functioning in nursing home residents. We attempt to cross-validate the psychometric properties of both measures.Method: Two hundred twenty-nine individuals residing in a Maryland skilled nursing facility were referred for neurocognitive evaluation over a 10-month period. One hundred eighty-nine of these residents met inclusion criteria by completing the BCAT and BIMS, and were aged 60 or older.Results: The BIMS and the BCAT were confirmed to have strong internal consistency reliability and construct validity. Both cognitive tools were found to predict cognitive diagnoses generally, but only the BCAT was able to identify residents at all specific cognitive levels. The BIMS did not differentiate between residents with normal cognition and those with mild cognitive impairment, or between mild and moderate dementia. Both measures demonstrated high specificity and positive predictive values for identifying severe cognitive impairment or probable dementia. The BIMS had lower sensitivity and negative predictive values for identifying dementia compared to the BCAT. The BCAT accounted for an additional 47% of the variance in dementia diagnoses over and above BIMS scores.Conclusion: Based on these findings, the BCAT appears to be more sensitive than the BIMS in predicting cognitive level for nursing home residents.

In the hospital setting, standardized cognitive screening and assessment tools are critical to determine the presence of cognitive changes for occupational therapy discharge planning and intervention approaches. However, there is limited understanding of trends related to standardized tool availability and use across different trauma center designations. This study aimed to identify commonly used standardized cognitive screens and functional performance assessments, and to explore factors influencing their selection and use. Electronic surveys were employed with a total of 28 questions. Two hundred and eight occupational therapy practitioners completed an electronic survey that measured demographics, availability and use of screens and performance assessments, and attitudes and perceptions regarding cognitive evaluation. Results support 86.5% of participants reported the use of paper-pencil-based standardized cognitive screens and 65.4% reported the use of cognitive performance assessments. Findings showed differences in access and availability of cognitive screening tools as well as performance-based assessments between trauma center designations. Implications of the results are discussed both with past studies and potential future work.

Culturally adapted cognitive assessment tool for Indigenous communities in Brazil: Content, construct, and criterion validity

Background: Under conditions of high demand for primary care services in a setting of low financial resources, there is need for brief, easily administered cognitive screening tools for use in the primary care setting, especially in rural areas. However, interpretation of these cognitive tests’ results requires knowledge on their susceptibility to cultural, educational and demographic patient characteristics.Objectives: To assess the clinical validity of the ‘Test Your Memory’ (TYM) and ‘General Practitioner assessment of Cognition’ (GPCog) which was specifically designed for primary care practice, in a rural primary care setting in Greece, utilizing the ‘Mini Mental State Examination’ (MMSE) as a reference standard.Methods: The MMSE, TYM, and GPCog were administered to a random sample of 319 community dwelling Greek adults aged 60 to 89 years in 11 rural Primary Healthcare Centres of the Prefecture of Heraklion on the island of Crete, Greece. Analyses examined (a) The association of each instrument with demographic factors and MMSE and (b) optimal cut-off scores, sensitivity and specificity against MMSE-based cognitive impairment risk using ROC analyses with the MMSE 23/24 point cut-off as a reference standard.Results: We found a sensitivity of 80% and a specificity of 77% for TYM (35/36 or 38/39 cut-off, depending on education). Corresponding values were 89% and 61% for GPCog (7/8 cut-off), respectively.Conclusion: The TYM and GPCog instruments appear to be suitable for routine use in the primary care setting as tools for cognitive impairment risk detection in elderly rural populations.

1. What are Cognitive Tools?.- 2. Cognitive Tools: A Suitable Case for Learning.- I Semantic Networking as Cognitive Tools.- 3. Constructing Knowledge with Learning Tool.- 4. TextVision and the Visualisation of Knowledge: School-based Evaluation of its Acceptance at two Levels of Schooling.- 5. SemNet: A Tool for Personal Knowledge Construction.- 6. Cognitive Tools: The Experience of CASP, NoteCards, SemNet.- 7. Flexibility of Expressiveness: A Critical Factor in the Design of Concept Mapping Tools for Learning.- II Expert Systems as Cognitive Tools.- 8. Building Knowledge Bases: An Environment for Making Cognitive Connections.- 9. Levels of Processing in Building Expert Systems.- 10. Computers and Exploratory Learning in the Real World.- III Hypertext as Cognitive Tools.- 11. Tailoring Hypertext for the Learner.- 12. Heuristics for Cognitive Tools.- 13. Gloves for the Mind.- IV Collaborative Communication Tools.- 14. Using Timbuktu(TM) and Guide(TM) for Computer Supported Group Learning.- 15. Gossip as a Collaborative Communication Tool.- V Microworlds: Content Dependent Cognitive Tools.- 16. Learning Elementary Mathematics: A Discussion of Microworlds.- 17. How to Put Language in a Child's Mind: The Development of Scriptor as a Computer Tool for Writing.- 18. Structure of Learning Environments and Individual Differences as Predictors of Learning.- 19. Learning Environments for Cognitive Apprenticeship: From Experience to Expertise.- VI Implementing Cognitive Tools.- 20. Consequences of Moving from a Traditional Cybernetic Approach to a Open Exploratory Learning Environment.- Addresses and Biographies of Lecturers.

The purpose of this study was to examine the connection between sixth graders' cognitive tool use and the cognitive processes they engage in as they solve a complex problem in a hypermedia learning environment. The three research questions were: 1) Which cognitive tools are used for which cognitive processes? 2) Is there a relationship between the extent of students' engagement in cognitive processing and their cognitive tool use? and 3) Are there any differences in cognitive tool use and performance scores between students who are engaged in different patterns of cognitive processing? The findings showed that different cognitive tools were used for different cognitive processes, and the degree of engagement in cognitive processing was positively related to the frequency of tool use. These results indicate that there is a connection between cognitive tool use and cognitive processing. In addition, tool use patterns reflected different characteristics of the learners (information processing versus metacognition oriented). Students who were more metacognitively oriented were more consistent in their tool selection, while students who were more information processing oriented were more action oriented in performing the tasks. However, there was no difference in the diversity of tool use or the performance scores between the two groups of students.