Audio Recorded Cognitive Screen Research Articles

Multi-modal neuroimaging signatures predict cognitive decline in multiple sclerosis: A 5-year longitudinal study

BackgroundCognitive impairment is a hallmark of multiple sclerosis (MS) but is usually an under-recorded symptom of disease progression. Identifying the predictive signatures of cognitive decline in people with MS (pwMS) over time is important to ensure effective preventative treatment strategies. Structural and functional brain characteristics as measured by various magnetic resonance (MR) methods have been correlated with variation in cognitive function in MS, but typically these studies are limited to a single MR modality and/or are cross-sectional designs. Here we assess the predictive value of multiple different MR modalities in relation to cognitive decline in pwMS over 5 years. MethodsA cohort of 43 pwMS was assessed at baseline and 5 years follow-up. Baseline (input) data consisted of 70 multi-modal MRI measures for different brain regions including magnetic resonance spectroscopy (MRS), diffusion tensor imaging (DTI) and standard volumetrics. Age, sex, disease duration and treatment were included as clinical inputs. Cognitive function was assessed using the Audio Recorded Cognitive Screen (ARCS) and the Symbol Digit Modalities Test (SDMT). Prediction modelling was performed using the machine learning package - GLMnet, where a penalised regression was applied to identify multi-modal signatures with the most predictive value (and the least error) for each outcome. ResultsThe multi-modal approach to neuroimaging was able to accurately predict cognitive decline in pwMS. The best performing model for change in total ARCS (tARCS) included 16 features from across the various MR modalities and explained 54 % of the variation in change over time (R2=0.54, 95 % CI=0.48–0.51). The features included nine MRS, four volumetric and two DTI parameters. The model also selected disease duration, but not treatment, as a predictive feature. By comparison, the best model for SDMT included several of the same above features and explained 39 % of the change over time (R2=0.39, 95 % CI=0.48–0.51). Conventional volumetric measures were about half as good at predicting change in tARCS score compared to the best multi-modal model (R2=0.26 95 % CI:0.22–0.29). The clinical interpretation of the best predictive model for change in tARCS showed that cognitive decline could be predicted with >90 % accuracy in this cohort (AUC=0.92, SE=0.86 - 0.94). ConclusionMulti-modal MRI signatures can predict cognitive decline in a cohort of pwMS over 5 years with high accuracy. Future studies will benefit from the inclusion of even more MR modalities e.g., functional MRI, quantitative susceptibility mapping, magnetisation transfer imaging, as well as other potential predictors e.g., genetic and environmental factors. With further validation, this signature could be used in future trials with high-risk patients to personalise the management of cognitive decline in pwMS, even in the absence of relapses.

Diet Quality and Cognitive Performance in Australian Adults Aged 55-85 Years: A Cross-Sectional Analysis of the Hunter Community Study Cohort.

There is a lack of evidence to determine if diet quality is associated with cognitive performance in older adults. Therefore, the aim of this study was to examine whether diet quality is associated with cognitive performance among older adults. A cross-sectional, secondary analysis of baseline data from the Hunter Community Study (HCS), comparing diet quality, measured using the Australian Recommended Food Score (ARFS), along with validated cognitive performance instruments the Audio Recorded Cognitive Screen (ARCS) and the Mini-Mental State Examination (MMSE) were undertaken in adults aged 55–85 years, living in Newcastle, NSW, Australia. Adjusted linear regression analyses showed that, compared with the lowest ARFS quintile, those in the highest quintile had an ARCS score 5.883 units greater (p < 0.001; R2 = 0.0098). Furthermore, when quintiles of ARFS score were tested against each ARCS sub-scale score, statistically significant associations were observed with the greatest effect for the Memory (β = 4.055; p = 0.001; R2 = 0.0065) and Attention (β = 4.136; p = 0.002; R2 = 0.0047) domains. No statistically significant associations were observed between quintiles of ARFS and MMSE score in the adjusted linear regression analyses. In conclusion, a positive association was observed between diet quality and cognitive performance within this sample of older Australian adults. Further investigation of the above association over time, when follow-up data becomes available, in longitudinal analysis is recommended.

Comparison of BICAMS and ARCS for assessment of cognition in multiple sclerosis and predictive value of employment status

BackgroundCognitive impairment is common in multiple sclerosis (MS) but not adequately monitored by Expanded Disability Status Scale assessment. The Audio Recorded Cognitive Screen (ARCS) and Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS) are easy-to-use tools to assess cognitive function in clinical practice. ObjectiveTo compare the sensitivity of ARCS to BICAMS and their relative predictive value for employment status. MethodsMS patients and healthy controls were assessed using the ARCS and the BICAMS consecutively. Receiver Operating Characteristic (ROC) curve analyses were used to compare the two tests. A step-wise, logistic regression analysis was used to identify the cognitive test(s) that best predicted employment status and quality of life. Results: Total ARCS, memory and attention domain scores were moderately correlated with all BICAMS tests (r = 0.3–0.5; P ≤ 0.05). Total ARCS predicts cognitive impairment with good sensitivity and specificity relative to the BICAMS tests (AUC = 0.8; P = 0.00045). Total ARCS detects higher levels of impairment than BICAMS in MS patients (44% versus 21%). The memory domain of the ARCS and the BVMT-R were the best predictors of employment status (OR = 1.12 and 1.14, P < 0.05). ConclusionBICAMS and ARCS have comparable sensitivity for cognitive impairment in MS. Memory assessment from either tests is the best predictor of employment status; however, the BICAMS is a better predictor of work productivity

Feasibility of the Audio Recorded Cognitive Screen in the Assessment of Individuals Undergoing Electroconvulsive Therapy.

Monitoring for cognitive deficits during a course of electroconvulsive therapy (ECT) is recommended, but cognitive assessment can be time consuming. The Audio Recorded Cognitive Screen (ARCS) is a cognitive test instrument with good psychometric properties that places minimal demands on clinicians' time, but until now, it has not been formally evaluated for monitoring cognition in the context of ECT treatment. This study aimed to assess the feasibility/utility of using the ARCS in the assessment of depressed patients undergoing ECT. Depressed patients undergoing ECT were tested with the ARCS and a comparison instrument, the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), in counterbalance order immediately before any ECT and after the sixth ECT treatment episode. Apathy (Apathy Scale) and depression (Profile of Mood states Short Form) were measured on both occasions. Analyses compared performances on the 2 cognitive instruments and examined for associations with the measures of apathy or depression. Twenty-eight individuals (9 male, 19 female) aged 19 to 84 years underwent testing. Performances on the total ARCS were similar to those on the total RBANS, and both showed decline from baseline to follow-up. The total ARCS and RBANS measures correlated well (r = 0.75, P < 0.001). Neither apathy nor depression scores were significantly associated with scores on either the RBANS or ARCS. The ARCS was acceptable and convenient in the assessment of cognition in patients undergoing treatment with ECT. In light of its practical advantages, further evaluation of the ARCS for detecting cognitive impairment and tracking cognitive changes during ECT seems warranted.

Dietary Long-Chain Fatty Acids and Cognitive Performance in Older Australian Adults.

Convincing evidence exists for the positive effect of an improvement in diet quality on age-related cognitive decline, in part due to dietary fatty acid intake. A cross-sectional analysis of data from the Hunter Community Study (HCS) (n = 2750) was conducted comparing dietary data from a validated Food Frequency Questionnaire (FFQ) with validated cognitive performance measures, Audio Recorded Cognitive Screen (ARCS) and Mini Mental State Examination (MMSE). Adjusted linear regression analysis found statistically significant associations between dietary intake of total n-6 fatty acids (FA), but no other FAs, and better cognitive performance as measured by the ARCS (RC = 0.0043; p = 0.0004; R2 = 0.0084). Multivariate regression analyses of n-6 FA intakes in quartiles showed that, compared with the lowest quartile (179.8–1150.3 mg), those in the highest quartile (2315.0–7449.4 mg) had a total ARCS score 2.1 units greater (RC = 10.60466; p = 0.006; R2 = 0.0081). Furthermore, when n-6 FA intake was tested against each of the ARCS domains, statistically significant associations were observed for the Fluency (RC = 0.0011432; p = 0.007; R2 = 0.0057), Visual (RC = 0.0009889; p = 0.034; R2 = 0.0050), Language (RC = 0.0010651; p = 0.047; R2 = 0.0068) and Attention (RC = 0.0011605; p = 0.017; R2 = 0.0099) domains, yet there was no association with Memory (RC = −0.000064; p = 0.889; R2 = 0.0083). No statistically significant associations were observed between FA intakes and MMSE. A higher intake of total n-6 FA, but not other types of FA, was associated with better cognitive performance among a representative sample of older aged Australian adults.

Differentiation of Cognitive Deficit Profiles in Multiple Sclerosis Patients: Latent Profile Analysis

Objective: The purpose of this study was to ascertain whether the application of the Audio Recorded Cognitive Screen (ARCS) in cognitive functioning screening of persons with multiple sclerosis (MS) differentiates profiles of existing cognitive deficits (CDs) and whether this instrument can discriminate accurately between subjects who are cognitively intact (CI) and those with a cognitive disorder. Subjects and Methods: The research was conducted on a sample of 359 subjects, with two subsets of participants: 108 persons with a relapsing-remitting form of MS and 251 persons from the general population. Results: We labeled the three profiles obtained by applying the ARCS questionnaire: the CI profile, the profile of CI with visuospatial difficulties, and the profile of persons with CD. Conclusion: ARCS has the ability to differentiate persons with a CD from those without, both in a sample of persons suffering from MS and in a sample of persons from the general population. This finding indicates that this instrument is well suited for profiling the cognitive status into specific categories, which puts it among the instruments with a wide range of implementation.

Erythrocyte microRNA sequencing reveals differential expression in relapsing-remitting multiple sclerosis

BackgroundThere is a paucity of knowledge concerning erythrocytes in the aetiology of Multiple Sclerosis (MS) despite their potential to contribute to disease through impaired antioxidant capacity and altered haemorheological features. Several studies have identified an abundance of erythrocyte miRNAs and variable profiles associated with disease states, such as sickle cell disease and malaria. The aim of this study was to compare the erythrocyte miRNA profile of relapsing-remitting MS (RRMS) patients to healthy sex- and age-matched controls.MethodsErythrocytes were purified by density-gradient centrifugation and RNA was extracted. Following library preparation, samples were run on a HiSeq4000 Illumina instrument (paired-end 100 bp sequencing). Sequenced erythrocyte miRNA profiles (9 patients and 9 controls) were analysed by DESeq2. Differentially expressed miRNAs were validated by RT-qPCR using miR-152-3p as an endogenous control and replicated in a larger cohort (20 patients and 18 controls). After logarithmic transformation, differential expression was determined by two-tailed unpaired t-tests. Logistic regression analysis was carried out and receiver operating characteristic (ROC) curves were generated to determine biomarker potential.ResultsA total of 236 erythrocyte miRNAs were identified. Of twelve differentially expressed miRNAs in RRMS two showed increased expression (adj. p < 0.05). Only modest fold-changes were evident across differentially expressed miRNAs. RT-qPCR confirmed differential expression of miR-30b-5p (0.61 fold, p < 0.05) and miR-3200-3p (0.36 fold, p < 0.01) in RRMS compared to healthy controls. Relative expression of miR-3200-5p (0.66 fold, NS p = 0.096) also approached significance. MiR-3200-5p was positively correlated with cognition measured by audio-recorded cognitive screen (r = 0.60; p < 0.01). MiR-3200-3p showed greatest biomarker potential as a single miRNA (accuracy = 75.5%, p < 0.01, sensitivity = 72.7%, specificity = 84.0%). Combining miR-3200-3p, miR-3200-5p, and miR-30b-5p into a composite biomarker increased accuracy to 83.0% (p < 0.05), sensitivity to 77.3%, and specificity to 88.0%.ConclusionsThis is the first study to report differences in erythrocyte miRNAs in RRMS. While the role of miRNAs in erythrocytes remains to be elucidated, differential expression of erythrocyte miRNAs may be exploited as biomarkers and their potential contribution to MS pathology and cognition should be further investigated.

The Association Between Obesity and Cognitive Function in Older Persons: How Much Is Mediated by Inflammation, Fasting Plasma Glucose, and Hypertriglyceridemia?

The aim of the study was to determine how much of the association between obesity, measured by body mass index (BMI), and cognition in older persons is mediated through inflammation, fasting plasma glucose, and hypertriglyceridemia. Anthropometrics, high-sensitivity C-reactive protein (CRP), fasting plasma glucose, and serum triglycerides were measured in 3,256 community-dwelling individuals aged 55-85 years residing in Newcastle, New South Wales, Australia. Audio recorded cognitive screen (ARCS) was used to assess multiple cognitive domains. Mediation analyses showed very modest but significant direct mediation effects, whereby obesity was associated with better cognitive function after adjusting for potential confounders (controlled direct effect ≈ 1/500 point increase in the total ARCS score per 1.0-kg/m2 increase in BMI). There were significant indirect negative mediation effects from BMI to cognition mediated through CRP, that is, increased BMI was associated with increased CRP which was associated with decreased cognition (natural indirect effect -0.20 unit; 95% confidence interval [CI] -0.39, -0.02), and through fasting plasma glucose, that is, increased BMI was associated with increased fasting plasma glucose which was associated with decreased cognition (natural indirect effect -0.12 unit; 95% CI -0.24, -0.01], but not through serum triglycerides. There is a weak positive association between obesity and cognitive performance in older persons, which is partially antagonized by inflammation and elevated fasting plasma glucose, but not hypertriglyceridemia. Further studies are needed to elucidate whether this is due to selection bias, or truly reflects biologically complex and counter balancing pathways involved in obesity.

Application of the Audio Recorded Cognitive Screen and its relation to functioning in schizophrenia

This study investigated the ability of the Audio Recorded Cognitive Screen (ARCS) to detect cognitive deficit in individuals with schizophrenia, relative to the Mini Mental State Examination (MMSE) and the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), and explored the associations between the ARCS and functional outcomes. We hypothesised that the ARCS would be able to better discriminate between individuals with schizophrenia and healthy controls than the MMSE, and that ARCS performance would be correlated with measures of social and vocational functioning. The participants were 19 community-dwelling individuals with schizophrenia or schizoaffective disorder and 19 healthy controls recruited from the Australian Schizophrenia Research Bank (ASRB). Participants completed the ARCS, MMSE, and self-report measures of social and vocational functioning. Clinical and diagnostic data stored by the ASRB were also utilised. The schizophrenia group performed worse than the control group on the ARCS, with memory, t(36)=2.49, p=0.02, 95% CI [-1.84, -18.79] and fluency, t(36)=2.40, p=0.02, 95% CI [-1.87, -22.24] domains being the main discriminating measures. The RBANS also discriminated between the two groups, and ARCS and RBANS total scores were moderately to strongly correlated. There was no difference between the two groups on the MMSE after controlling for demographic variables. ARCS performance was associated with employment status [χ2(1)=7.16, p=0.007]. The ARCS may be sensitive to the cognitive deficits in outpatients with schizophrenia and an indicator of functional outcomes in this population.

Thyroid Antibodies, Autoimmunity and Cognitive Decline: Is There a Population-Based Link

Background: Autoimmunity is considered an uncommon but under-recognised cause of cognitive decline. Methods: Serum samples from 3,253 randomly selected subjects enrolled in the Hunter Community Study, aged 55-85 years, were assayed for thyrotropin stimulatory hormone, anti-thyroid peroxidase antibodies (TPO-Ab), anti-nuclear antibodies (ANA) and extractable nuclear antigens (ENA). Cognitive function was assessed using the Audio Recorded Cognitive Screen (ARCS) tool. Results: TPO-Ab were found in 8.4% and ANA in 27.9% of the study population, of whom 3% had positive ENA findings. No relationship was found between the ARCS score and either TPO-Ab (coefficient = 0.133; 95% CI -0.20, 0.82, p = 0.616), ANA at a low (coefficient = 1.01; 95% CI -2.58, 0.55, p = 0.203) or a high titre (coefficient = -0.65; 95% CI -2.59, 1.28, p = 0.508), or ENA antibodies (coefficient = 5.12; 95% CI -0.53, 10.77; p = 0.076). Conclusions: Autoantibody findings are common in an aging population and are not associated with cognitive decline.

Memory Impairment is Associated with Serum Methylarginines in Older Adults

This study measured serum concentrations of vascular risk factors, asymmetric dimethylarginine (ADMA) and symmetric dimethylarginine (SDMA) in a representative sample of older community-dwelling adults and determined their associations with objective and subjective memory impairment. Data on clinical, lifestyle, and demographic characteristics, serum ADMA, SDMA, and L-arginine (measured using LC-MS/MS) were collected from a population-based sample of older Australian adults from the Hunter Community Study. Objective memory was measured with the Audio Recorded Cognitive Screen (ARCS) neuropsychological battery and subjective memory impairment was measured using the Memory Complaint Questionnaire (MAC-Q). Multivariate analysis revealed that SDMA and diabetes were significantly associated with objective memory impairment (Adjusted Odd ratio (AOR) = 3.90; 95% CI. 1.21 - 12.52 for fourth quartile (Q4) of SDMA. ADMA, SDMA, education, number of general practitioner visits and atrial fibrillation were all significantly associated with subjective memory impairment. (AOR = 1.82; 95% CI. 1.04 - 3.18 for Q4 ADMA. Higher serum SDMA was associated with objective and subjective memory impairment while higher serum ADMA was associated with subjective memory impairment.

Mild hyponatremia is linked to cognitive deficits and increased risk of falls

Objective: To determine if mild hyponatremia (Na+ 130–135mmol/l) is linked to impaired cognition and increased fall risk in asymptomatic community subjects. Materials and methods: Using data from the Hunter Community Study, we investigated the relationship between mild hyponatremia, cognitive function and fall risk in 3532 community participants aged 55–85years. Audio Recorded Cognitive Screen (ARCS) was used to assess multiple cognitive domains. Fall risk was assessed using Functional Reach and Timed Up and Go (TUG) tests as surrogate markers, as well as self-reported falls and admission for falls on health record linkage.

Repeat testing with the Audio Recorded Cognitive Screen (ARCS) in an outpatient clinic

Repeat testing with the Audio Recorded Cognitive Screen (ARCS) in an outpatient clinic

Detection of mild cognitive impairment and early stage dementia with an audio-recorded cognitive scale

Physicians often miss diagnosis of mild cognitive impairment (MCI) or early dementia and screening measures can be insensitive to very mild impairments. Other cognitive assessments may take too much time or be frustrating to seniors. This study examined the ability of an audio-recorded scale, developed in Australia, to detect MCI or mild Alzheimer's disease (AD) and compared cognitive domain-specific performance on the audio-recorded scale to in-person battery and common cognitive screens. Seventy-six patients from the Mount Sinai Alzheimer's Disease Research Center were recruited. Patients were aged 75 years or older, with clinical diagnosis of AD or MCI (n = 51) or normal control (n = 25). Participants underwent in-person neuropsychological testing followed by testing with the audio-recorded cognitive screen (ARCS). ARCS provided better discrimination between normal and impaired elderly individuals than either the Mini-Mental State Examination or the clock drawing test. The in-person battery and ARCS analogous variables were significantly correlated, most in the 0.4 to 0.7 range, including verbal memory, executive function/attention, naming, and verbal fluency. The area under the curve generated from the receiver operating characteristic curves indicated high and equivalent discrimination for ARCS and the in-person battery (0.972 vs. 0.988; p = 0.23). The ARCS demonstrated better discrimination between normal controls and those with mild deficits than typical screening measures. Performance on cognitive domains within the ARCS was well correlated with the in-person battery. Completion of the ARCS was accomplished despite mild difficulty hearing the instructions even in very elderly participants, indicating that it may be a useful measure in primary care settings.

Brief neuropsychological profiles in psychosis: a pilot study using the Audio Recorded Cognitive Screen (ARCS).

Loughland CM, Allen J, Gianacas L, Schofield PW, Lewin TJ, Hunter M, Carr VJ. Brief neuropsychological profiles in psychosis: a pilot study using the Audio Recorded Cognitive Screen (ARCS). This pilot study examines the utility of a novel, standardised brief neuropsychological assessment tool (the ARCS, Audio Recorded Cognitive Screen) in a different clinical setting to that in which it was initially developed. We hypothesised that the ARCS would be feasible to administer to individuals with a psychotic illness and that it would detect cognitive deficits similar to those identified by an established instrument (the RBANS, Repeatable Battery for the Assessment of Neuropsychological Status). Twenty-five people with psychosis (mean age = 43.72, SD = 9.78) and 25 age- and gender-matched controls were recruited from the Newcastle community (NSW, Australia). The ARCS and RBANS were completed about 1 week apart in a counterbalanced order. The ARCS was well received, performed satisfactorily and both the ARCS and RBANS were sensitive to deficits typically associated with psychosis (e.g. memory and attention). After controlling for memory deficits, the largest disparity between the psychosis and control groups was on the ARCS fluency domain [p < 0.001, partial Eta-squared (η p 2) = 0.21]. The ARCS uses audio administration (approximately 34 min) to reduce clinician time (to 3-5 min for scoring) and appears to be a useful brief assessment tool for examining the cognitive deficits associated with psychosis. However, the potential clinical utility of the ARCS needs to be investigated further in larger samples drawn from a wider variety of specialist and non-specialist settings.

The Audio Recorded Cognitive Screen (ARCS): a flexible hybrid cognitive test instrument

ObjectiveTo describe and characterise the Audio Recorded Cognitive Screen (ARCS), a novel instrument that uses an audio device to administer selected neuropsychological tests to unsupervised individuals who write their responses...

23. The Audio Recorded Cognitive Screen (ARCS): a new sensitive and easy to administer tool to assess cognition in patients with multiple sclerosis

Background: Cognitive impairment is common (43-65%) in multiple sclerosis (MS) and often leads to early disability and unemployment. However, cognitive impairment in MS may remain unrecognized if measured only by Expanded Disability Status Scale (EDSS) or Mini Mental State Examination. Detailed neuropsychological testing is time consuming and requires skilled personnel. The ARCS comprises a battery of cognitive tests administered via CD player and headphones. Testing lasts 35 minutes. Unsupervised patients record their responses in a booklet that is later scored. Scoring takes about three minutes and is the only clinician time needed to gain the results of the assessment.

The Audio Recorded Cognitive Screen (ARCS): A New Sensitive and Easy to Administer Tool to Assess Cognition in Patients with Multiple Sclerosis

Background: Cognitive impairment is common (43-65%) in multiple sclerosis (MS) and often leads to early disability and unemployment. However, cognitive impairment in MS may remain unrecognised if measured only by Expanded Disability Status Scale (EDSS) or Mini Mental State Examination. Detailed neuropsychological testing is time consuming and requires skilled personnel. The ARCS comprises a battery of cognitive tests administered via CD player and headphones. Testing lasts 35 minutes. Unsupervised patients record their responses in a booklet that is later scored.

Symptoms of apathy and depression and the validity of the Audio Recorded Cognitive Screen (ARCS)

Symptoms of apathy and depression and the validity of the Audio Recorded Cognitive Screen (ARCS)