Laptop-Administered NIH Toolbox and Cogstate Brief Battery in Community-Dwelling Black Adults: Unexpected Pattern of Cognitive Performance between MCI and Healthy Controls.

Anson Kairys,Judith Heidebrink,Ana Daugherty,Sarah Shair,Carol Persad,Bruno Giordani,Arijit Bhaumik,Voyko Kavcic

doi:10.1017/s135561772100028x

Abstract

Black adults are approximately twice as likely to develop Alzheimer's disease (AD) than non-Hispanic Whites and access diagnostic services later in their illness. This dictates the need to develop assessments that are cost-effective, easily administered, and sensitive to preclinical stages of AD, such as mild cognitive impairment (MCI). Two computerized cognitive batteries, NIH Toolbox-Cognition and Cogstate Brief Battery, have been developed. However, utility of these measures for clinical characterization remains only partially determined. We sought to determine the convergent validity of these computerized measures in relation to consensus diagnosis in a sample of MCI and healthy controls (HC). Participants were community-dwelling Black adults who completed the neuropsychological battery and other Uniform Data Set (UDS) forms from the AD centers program for consensus diagnosis (HC = 61; MCI = 43) and the NIH Toolbox-Cognition and Cogstate batteries. Discriminant function analysis was used to determine which cognitive tests best differentiated the groups. NIH Toolbox crystallized measures, Oral Reading and Picture Vocabulary, were the most sensitive in identifying MCI apart from HC. Secondarily, deficits in memory and executive subtests were also predictive. UDS neuropsychological test analyses showed the expected pattern of memory and executive functioning tests differentiating MCI from HC. Contrary to expectation, NIH Toolbox crystallized abilities appeared preferentially sensitive to diagnostic group differences. This study highlights the importance of further research into the validity and clinical utility of computerized neuropsychological tests within ethnic minority populations.

Highlights

With the significant growth in the population aged 65 years and older, the number of Americans with Alzheimer’s disease (AD) and other dementias is projected to increase from 58 million in 2018 to 88 million by 2050 (Alzheimer’s Association, 2018)
A preliminary analysis applied the discriminant function analysis (DFA) method to confirm the diagnosis made by consensus conference when reviewing performance on the National Alzheimer’s Coordinating Center (NACC)-Uniform Data Set (UDS) neuropsychological battery and ancillary tests (WRAT-IV and Wisconsin Card Sorting Test (WCST))
The NACC-UDS outcomes that were used for clinical diagnosis via case consensus produced the expected pattern of differences between the groups, foremost in memory and executive functioning deficits in individuals with mild cognitive impairment (MCI)

Summary

Introduction

With the significant growth in the population aged 65 years and older, the number of Americans with Alzheimer’s disease (AD) and other dementias is projected to increase from 58 million in 2018 to 88 million by 2050 (Alzheimer’s Association, 2018). There are considerable barriers to treatment; Black adults are diagnosed later in the disease (Chin, Negash, & Hamilton, 2011) and are less likely to receive antidementia medications (Zuckerman et al, 2008) as compared to non-Hispanic Whites. This evident disparity that places Black adults at higher risk for developing AD and barriers to treatment has been attributed to social and behavioral determinants of health: perceived discrimination and environmental stress (Zahodne, Sol, & Kraal, 2019); a higher incidence of comorbid modifiable health risks (i.e., hypertension, cardiovascular disease, diabetes; Brancati et al, 2000; Sundquist, Winkleby, & Pudaric, 2001; Cushman et al, 2008); and insensitive assessment related to years of education, educational quality, and literacy (Manly, Schupf, Tang, & Stern, 2005; Manly, Touradji, Tang, & Stern, 2003)

Methods

Results

Conclusion