Brain Health Assessment Research Articles

Stakeholder-informed pragmatic trial protocol of the TabCAT-BHA for the detection of cognitive impairment in primary care

BackgroundCognitive impairment and dementia are frequently under-recognized. Health system strategies anchored in primary care are essential to address gaps in timely, comprehensive diagnosis. The goal of this paper is to describe the adaptation of a tablet-based brain health assessment (TabCAT-BHA) intervention and the study protocol to test its effectiveness in improving the detection of cognitive impairment, including dementia.MethodsThis mixed-methods, pragmatic, cluster randomized, hybrid effectiveness-implementation trial is being conducted in two 18-month waves with 26 Kaiser Permanente Southern California primary care clinics, with 13 serving as intervention clinics and 13 as usual care clinics. Patients 65 years and older with memory concerns (n ~ 180,000) receiving care at the 26 clinics will be included in the analyses. Primary care clinics are provided the following practice supports as part of the TabCAT-BHA intervention: brief education and training on neurocognitive disorders and study workflows; digital tools to assess cognitive function and support clinician decision making and documentation; and registered nurse support during the work-up and post-diagnosis periods for primary care providers, patients, and families. The intervention was adapted based on engagement with multiple levels of clinical and operational leaders in the healthcare system. Effectiveness outcomes include rates of cognitive impairment diagnosis in primary care and rates of completed standardized cognitive assessments and specialist referrals with incident diagnoses. Implementation outcomes include acceptability-appropriateness-feasibility, adoption, and fidelity.ResultsWe identified seven themes organized by system-, provider-, and patient-level domains that were used to adapt the TabCAT-BHA intervention. Accordingly, changes were made to the provider education, diagnostic work-up, and post-diagnostic support. Results will be reported in fall of 2027.ConclusionsOur engagement with multiple primary and specialty care clinical and operational leaders to adapt the TabCAT-BHA intervention to these primary care clinics has informed the protocol to evaluate the intervention’s effectiveness for improving the detection of cognitive impairment, including dementia, in an integrated healthcare system.Trial RegistationClinicaltrials.gov: NCT06090578 (registered 10/24/23).

Cultural adaptation of the brain health assessment for early detection of cognitive impairment in Southeast Nigeria.

The aging population in developing countries demands parallel improvements in brain health assessment services to mitigate stigma, promote healthy aging, and diagnose cognitive impairments including dementia in primary health care (PHC) facilities. The lack of culturally appropriate cognitive assessment tools in PHC facilities delays early detection. This study aims to culturally adapt a brief digital cognitive assessment tool for PHC professionals in Southeast Nigeria. A total of 30 participants (15 healthcare workers HCW and 15 community members) were selected to be culturally representative of the community. We completed focus groups and pilot testing to evaluate and refine the Brain Health Assessment (BHA) a subset of tools from the Tablet-based Cognitive Assessment Tool (TabCAT) known to be sensitive to cognitive impairment in other settings. We examined BHA subtests across local languages (Pidgin and Igbo) spoken at two geriatric clinics in Anambra State Southeast Nigeria. Following structured approaches in focus groups, adaptations were made to the Favorites (memory) and Line Length (visuospatial) subtests based on their input. Participants found the new adaptations to have good construct validity for the region. The BHA subtests showed content validity for future work needed to validate the tool for detecting early cognitive changes associated with dementia and Alzheimer's disease in PHC settings. The use of culturally adapted and concise digital cognitive assessment tools relevant to healthcare professionals in Southeast Nigeria's PHCs is advocated.

Scalable plasma and digital cognitive markers for diagnosis and prognosis of Alzheimer's disease and related dementias.

With emergence of disease-modifying therapies, efficient diagnostic pathways are critically needed to identify treatment candidates, evaluate disease severity, and support prognosis. A combination of plasma biomarkers and brief digital cognitive assessments could provide a scalable alternative to current diagnostic work-up. We examined the accuracy of plasma biomarkers and a 10-minute supervised tablet-based cognitive assessment (Tablet-based Cognitive Assessment Tool Brain Health Assessment [TabCAT-BHA]) in predicting amyloid β positive (Aβ+) status on positron emission tomography (PET), concurrent disease severity, and functional decline in 309 older adults with subjective cognitive impairment (n=49), mild cognitive impairment (n=159), and dementia (n=101). Combination of plasma pTau181, Aβ42/40, neurofilament light (NfL), and TabCAT-BHA was optimal for predicting Aβ-PET positivity (AUC=0.962). Whereas NfL and TabCAT-BHA optimally predicted concurrent disease severity, combining these with pTau181 and glial fibrillary acidic protein was most accurate in predicting functional decline. Combinations of plasma and digital cognitive markers show promise for scalable diagnosis and prognosis of ADRD. The need for cost-efficient diagnostic and prognostic markers of AD is urgent. Plasma and digital cognitive markers provide complementary diagnostic contributions. Combination of these markers holds promise for scalable diagnosis and prognosis. Future validation in community cohorts is needed to inform clinical implementation.

The German version of the tablet-based UCSF Brain Health Assessment is sensitive to early symptoms of neurodegenerative disorders.

Cognition often remains unassessed in primary care. To improve early diagnosis of neurocognitive disorder (NCD) in Switzerland, the tablet-based UCSF brain health assessment (BHA) and brain health survey (BHS) were validated. The German BHA, BHS, and Montreal Cognitive Assessment (MoCA) were administered to 67 patients with mild/major NCD and 50 controls. BHA includes subtests of memory, executive, visuospatial, and language functioning, and informant-based BHS asks about behavior and motor functioning. The complete instrument (BHA + BHS) was most accurate at detecting mild NCD (AUC=0.95) and NCD without amyloid pathology (AUC=0.96), followed by the BHA. All measures were accurate (all AUCs>0.95) at distinguishing major NCD and NCD with amyloid pathology (Alzheimer's disease [AD]) from controls. The German BHA and BHS are more sensitive to mild NCD and non-AD presentations than the MoCA and thus have a high potential to identify patients with NCD in primary care earlier than currently used screens.

Attitudes and Practices towards the use of technology‐screening tools, diagnosis, and management of cognitive impairment in primary care

AbstractBackgroundPrevious studies in the Cuban population suggest that Alzheimer’s Disease and related dementias (ADRD) are under‐diagnosed at primary care relative to population estimates. Recent interventions aimed to introduce the use of technology based cognitive assessments have been validated for primary care (e.g., Brain Health Assessment).However, the implementation of newly develop tools depends on the Primary care providers’ (PCPs) barrier and attitudes toward the diagnosis and management of patients with ADRD at a primary care level. Here we aimed to assess PCPs’ attitudes towards ADRD diagnosis, and the use of technology based cognitive assessments.Method84 PCPs were randomly selected form 10 primary care clinics. Sample size include a wide range of PCPs, including: family medicine (n = 54), neurologist (n = 2), psychiatrists(n = 13), psychologists(n = 10), clinicians (n = 3) and geriatricians (n = 2)). A questionnaire on Dementia assessment and management in primary care settings was administered to the participants. Descriptive statistics were employed for summarizing the data. Kruskal Wallis association test was utilized for determining associations between provider characteristics and outcomes.ResultsMost participants were female (n = 64, 76.2%), over 50 years old (n = 36, 52.9%) and family medicine practitioners (64.3%). The average number of patients consulted per month by PCPs were 250 (CI95% 250‐367) and over 60% of them were 55 years or older. Most of the PCPs (n = 63, 75.0%) will not refer patients with suspected ADRD if they had the training and instruments and technologies for the diagnosis at a primary care level. Lack of time (n = 59, 70.2%) and lack of confidence in their abilities (n = 68, 81.0%) were the most cited barriers for the diagnosis and management of ADRD . Around 80.0% of the interviewed practitioners considered the use of technology based cognitive assessments as important or very important tool for ADRD diagnosis. The positive attitudes of the PCPs for using technologies were correlated with the municipalities where they work (p = 0.01) and the continuous professional development of the PCPs (p = 0.03).ConclusionThere are still barriers for the diagnosis of ADRD at a primary care level. Though PCPs are willing to implement technology based cognitive assessments in their daily practice, addressing existing barriers is key for success

Implementation of a smartphone application for precision brain health assessment in a rural low socioeconomic setting: The Bogalusa Heart Study

AbstractBackgroundSmartphone apps for digital health with decentralized data collection enable more frequent and precise brain‐health monitoring via the abundance of embedded sensors. Such methods may improve the sensitivity of traditional metrics and representation among diverse populations impacted by health disparities, especially in ADRD studies. Here, we describe a framework for implementing a smartphone‐based digital platform for precision brain health assessment in a longitudinal cohort of Black and White men and women.MethodsParticipants are being recruited as part of a multi‐site study from the Bogalusa Heart Study (BHS), a community‐based cohort in rural Louisiana that began in 1973. The digital platform consists of a smartphone application that is used remotely every three months for two weeks. It includes tasks that assess cognition, speech, gait and balance, and questionnaires that ensure instructions are appropriately followed and to monitor usage experiences. The BHS study personnel handle the initial screening, enrollment, and application setup. To overcome internet connection and time/availability issues, remote phone calls from BHS staff and text messages from a local area code using RingCentral software were implemented. Messages included short reminders, a link to step‐by‐step instructions to complete the application setup, and examples of smartphone tasks. (Figure 1.) Participants could schedule a call to receive phone instructions to complete the process.ResultsA total of 94 participants [age 56 ± 4.5, women n = 60 (69%), Black n = 16 (19%)] have been enrolled in the study thus far. Of those, 77 (82%) registered and set up the application (69 at the study site and 8 remotely via text/phone), and 62 (81%) completed at least one set of tasks. There was no significant difference in completion rates between race [White n = 52 (84%) and Black n = 10 (77%); p = 0.54] and sex groups [women n = 45 (82%) and men n = 17 (85%); p = 0.75].ConclusionResults showed that individuals from a rural community‐based cohort are willing to use digital technologies for brain health assessments. These findings highlight the importance of utilizing low‐cost, scalable platforms and adapting research protocols to meet the requirements of specific populations, particularly those from low socioeconomic and underrepresented backgrounds.

Towards the future of ADRD diagnosis: combination of a brief digital cognitive battery and plasma biomarkers for diagnosis and prognosis of disease

AbstractBackgroundScalable and accurate diagnostic markers of Alzheimer’s disease and related dementias (ADRD) are urgently needed. A combination of a sensitive brief digital cognitive assessment and plasma biomarkers could represent a promising scalable alternative to standard diagnostic procedures. We evaluated the performance of the TabCAT Brain Health Assessment Cognitive Score (BHA‐CS) and plasma Aβ42/40, pTau‐181, NfL, and GFAP at predicting concurrent Aβ positivity on CSF or PET, concurrent disease severity, and future functional decline.MethodParticipants were 309 subjectively or objectively impaired older adults enrolled in longitudinal observational studies at UCSF (Table 1), who completed a blood draw and TabCAT‐BHA at baseline. Biomarker concentrations were measured using commercially available Quanterix kits. Receiver operating characteristic analyses were used to determine the accuracy of combined BHA‐CS and plasma biomarkers in discriminating between Aβ+/‐ status on CSF/PET at baseline. Multiple regressions were used to examine baseline associations of BHA‐CS and plasma markers with disease severity measured by Clinical Dementia Rating Sum of Boxes (CDR‐SB). Linear mixed effect models were used to examine the associations of baseline BHA‐CS and biomarker values with longitudinal decline on CDR‐SB. All analyses controlled for age, sex, education, and baseline diagnosis.ResultpTau‐181 was the strongest predictor of Aβ positivity (AUC = .745; 95%CI: .656‐.833), with no significant improvements in the AUC with the addition of any combination of markers (Figure 1). In a combined model with all markers included simultaneously, BHA‐CS (B = ‐0.678, P<.001) and plasma NfL (B = 0.625, P = .01) were the only unique significant predictors of concurrent CDR‐SB. In a combined mixed model with all markers included simultaneously, baseline BHA‐CS, pTau‐181, NfL, and GFAP were unique significant predictors of CDR‐SB decline (Figure 2), and together accounted for 27% of longitudinal variance in CDR‐SB.ConclusionOur findings indicate unique and complementary roles of scalable digital cognitive and plasma biomarkers as diagnostic and prognostic markers of ADRD. At baseline, whereas pTau‐181 was most accurate at predicting Aβ positivity, a combination of BHA‐CS and NfL was most accurate at predicting concurrent disease severity. In longitudinal analyses, a model that combined baseline cognitive testing results and plasma pTau‐181, NfL, and GFAP was most accurate at predicting future decline.

Brain health assessment. An exploratory review of tools related to its cognitive dimension

BackgroundBrain health is an evolving concept and relates to physical and mental health, social well-being, productivity, creativity. Brain health has several dimensions (cognitive, motor, functional, social, and emotional), and should be recognized as one top global priorities of health policies. The purpose of this paper is to provide a summary of tools developed for assessing the cognitive dimension of brain health in the out-patient services. MethodsA literature search on PubMed was performed (from inception to May 31, 2023). We identified cognitive tests, functional and psychological scales, and focused on screening tools specifically proposed to characterize cognition within the construct of brain health, comparing them with common global screening tests. ResultsAmong 1947 records, we identified 17 cognitive screening tools used in the context of brain health assessment, of which four were ad hoc developed: Brain Health Assessment (BHA), Brain Health Test (BHT), Brain Health Test-7 (BHT-7), and The Cogniciti Brain Health Assessment. The four tests have administration time ranging from 4 to 30 min, and different administration methods (paper-and-pencil or tablet-based). All four tools assess memory and other cognitive domains. Specific cut-offs have been identified for BHT and BHT-7, while the other tools have automated scoring systems. All but one test also assess other dimensions. Compared to commonly used cognitive screening tests, the brain health tools are less widely used, translated, and validated. ConclusionsThe concept of brain health is new and requires further validation of tools for its assessment, especially for the cognition dimension.

NeuralGait

Brain health attracts more recent attention as the population ages. Smartphone-based gait sensing and analysis can help identify the risks of brain diseases in daily life for prevention. Existing gait analysis approaches mainly hand-craft temporal gait features or developing CNN-based feature extractors, but they are either prone to lose some inconspicuous pathological information or are only dedicated to a single brain disease screening. We discover that the relationship between gait segments can be used as a principle and generic indicator to quantify multiple pathological patterns. In this paper, we propose NeuralGait, a pervasive smartphone-cloud system that passively captures and analyzes principle gait segments relationship for brain health assessment. On the smartphone end, inertial gait data are collected while putting the smartphone in the pants pocket. We then craft local temporal-frequent gait domain features and develop a self-attention-based gait segment relationship encoder. Afterward, the domain features and relation features are fed to a scalable RiskNet in the cloud for brain health assessment. We also design a pathological hot update protocol to efficiently add new brain diseases in the RiskNet. NeuralGait is practical as it provides brain health assessment with no burden in daily life. In the experiment, we recruit 988 healthy people and 417 patients with a single or combination of PD, TBI, and stroke, and evaluate the brain health assessment using a set of specifically designed metrics including global accuracy, exact accuracy, sensitivity, and false alarm rate. We also demonstrate the generalization (e.g., analysis of feature effectiveness and model efficiency) and inclusiveness of NeuralGait.

DECLINE OF AN ONLINE COGNITIVE COMPOSITE ASSOCIATED WITH MODIFIABLE LIFESTYLE FACTORS

Abstract Voluntary, self-administered online assessment platforms have gained popularity in monitoring cognition and lifestyle behaviors. This study used the AARP Staying Sharp online brain health assessment platform to estimate the progression of a cognitive composite and correlate it with six modifiable lifestyle behaviors (physical activity, diet, sleep, stress, social activity, and brain engagement) in 147,939 participants (68.6 ± 7.0 years old; 70% female). A cognitive composite was created using attention, immediate and delayed recall, and working memory tasks and lifestyle behaviors were collected by self-report. A lower frequency of exercise (p=0.01), a higher frequency of sitting (p=0.03), a lower frequency of getting in touch with family and friends (p=0.04), and the inability to manage stress (p=0.02) were associated with a decline in the online cognitive composite. A self-administered online assessment platform may be useful in informing lifestyle modification interventions for risk reduction of cognitive impairment and dementia.

Neuropsychological correlates of cerebellar volumes in multiple sclerosis: an MRI volumetric analysis study.

The hallmark of Multiple Sclerosis (MS) pathophysiology is the damage to the myelin sheath around axons. The cerebellum is a predilection site for demyelination with a well-recognized role in motor and a rather understudied contribution to cognitive functions. The aim of this study is to investigate patterns of cerebellar grey and white matter pathology, expressed as reduced volume, as well as cortical thickness and their potential contribution to cognitive performance and disability status of patients with MS. 24 patients with MS underwent extensive neuropsychological assessment using paper and pencil tests and the Brain Health Assessment (BHA) tablet-based battery. Cerebellar lobular volumes and thickness were calculated using a volumetric analysis with automated segmentation of the cerebellum and its lobules. The main findings are a reduction of cerebellar grey matter (CGMV) and white matter volumes (CWMV) in lobule X and a widespread cerebellar cortical thinning in patients. Overall disease severity and neurological disability, assessed with the Expanded Disability Status Severity Scale, was correlated with fatigue and information processing speed tasks, but not with CGMV and CWMV. CWMV and CGMV of lobule I-II was negatively correlated with information processing speed, as well as visuospatial memory tests and, finally, inverse cortical thinning associations were noted between the whole cerebellum, lobule I-II, lobule III, lobule VI, Crus I, lobule VIIIA and information processing speed and verbal fluency tasks. The inverse associations observed may represent a compensatory mechanism activated in MS engaging additional high-level cortical areas functionally interconnected with the damaged cerebellum, in order to cope with the cognitive demands of a task.

Ketamine-Associated Intraoperative Electroencephalographic Signatures of Elderly Patients With and Without Preoperative Cognitive Impairment.

Ketamine is typically used by anesthesiologists as an adjunct for general anesthesia and as a nonopioid analgesic. It has been explored for prevention of postoperative delirium, although results have been contradictory. In this study, we investigated the association of ketamine with postoperative delirium and specific encephalographic signatures. Furthermore, we examined these associations in the context of baseline neurocognition as measured by a validated assessment. We conducted a prospective observational study from January 2019 to December 2020. Ninety-eight patients aged ≥65 years and undergoing spine surgery scheduled for ≥3 hours were included in the study. All participants who completed the University of California San Francisco (UCSF) Brain Health Assessment preoperatively and postoperatively were assessed with the confusion assessment method for intensive care unit (CAM-ICU) and/or the Nursing Delirium Screening Scale (NuDESC). Patients had frontal electroencephalogram (EEG) recordings (SedLine Root, Masimo, Corp) quantitatively analyzed. We used 60 seconds of artifact-free EEG (without burst suppression) extracted from the middle of the maintenance period to calculate the normalized power spectral density (PSD). Comparisons were made between those who did or did not receive ketamine and according to results from neurocognitive assessments. Ninety-eight patients (of a total of 155, enrolled and consented) had EEG of sufficient quality for analysis (42 women). Overall, we found a significant increase in the EEG power in the moderate frequency range (10-20 Hz) in patients that received ketamine. When the patients were divided by their preoperative cognitive status, this result in the ketamine group only held true for the cognitively normal patients. Patients that were cognitively impaired at baseline did not demonstrate a significant change in EEG characteristics based on ketamine administration, but impaired patients that received ketamine had a significantly higher rate of postoperative delirium (52% ketamine versus 20% no ketamine) (odds ratio [OR], 4.36; confidence interval [CI], 1.02-18.22; P = .048). In patients determined to be preoperatively cognitively normal, the incidence of postoperative delirium was not significantly associated with ketamine administration (19% ketamine versus 17% no ketamine) (OR, 1.10; CI, 0.30-4.04; P = .5833). Ketamine-related changes in EEG are observed in a heterogeneous group of patients receiving spine surgery. This result was driven primarily by the effect of ketamine on cognitively normal patients and not observed in patients that were cognitively impaired at baseline. Furthermore, patients who were cognitively impaired at baseline and who had received ketamine were more likely to develop postoperative delirium, suggesting that cognitive vulnerability might be predicted by the lack of a neurophysiologic response to ketamine.

Examination of the accuracy of Cogniciti’s self‐administered, online, Brain Health Assessment in detecting amnestic mild cognitive impairment

AbstractBackgroundOur need for easily administered online assessments sensitive to mild cognitive difficulties is increasing as our population ages. Our team has recently presented data indicating the accuracy of an online, publicly available, self‐administered screening measure, Cogniciti’s Brain Health Assessment (BHA), in the detection of amnestic mild cognitive impairment (aMCI) in a sample of community dwelling older adults. This current work extends those findings by further examining diagnostic accuracy of this measure.MethodUsing a cross‐sectional design, community‐dwelling older adults aged 60‐89 completed a gold standard neuropsychological assessment to determine a diagnosis of normal cognition (NC) or aMCI (by consensus of 3 staff neuropsychologists). Each participant also completed the BHA. Penalized logistic regression (PLR) analyses were used to examine which specific BHA tasks and measured demographic variables contributed to this test’s predictive utility in detecting aMCI. Diagnostic accuracy of the PLR model was compared with a logistic regression (LR) model examining BHA total score accuracy.Result91 participants met inclusion criteria (51 aMCI, 40 NC). PLR modelling for the BHA indicated that of the tasks and variables measured by the BHA, the Face‐Name Association and Spatial Working Memory tasks predicted aMCI, with age also accounted for in the model (ROC‐AUC = 0.76; 95%CI: 0.66, 0.86). Based on this model, optimal performance cut‐points were determined, which resulted in 21% of the sample being classified as aMCI (positive), 23% as negative, and 56% as inconclusive. Projected general population classification rates are also presented to provide an estimate of how the BHA may perform in the broader population.ConclusionResults support that validity of the BHA as a screening measure for aMCI, and provide indication of the tasks within this measure that contribute to its utility in screening for this specific type of cognitive decline. Given the BHA is an online, self‐administered task, this measure has the potential to not only decrease unnecessary referrals for comprehensive assessment to determine presence of aMCI, but also to save practitioners time over commonly used paper and pencil screeners.

Using Heartfulness Meditation and Brainwave Entrainment to Improve Teenage Mental Wellbeing.

Teenagers are highly susceptible to mental health issues and this problem has been exacerbated by the quarantine restrictions of COVID-19. This study evaluated the use of Heartfulness Meditation and Audio Brainwave Entrainment to help teenagers cope with mental health issues. It used 30-min Heartfulness meditation and 15-min brainwave entrainment sessions with binaural beats and isochronic tones three times a week for 4 weeks. Using a pretest-posttest methodology, participants were asked to complete a survey battery including the Pittsburgh Quality of Sleep Index, Perceived Stress Scale, Patient Health Question-9, Profile of Mood States, and Cambridge Brain Health assessment. Participants (n = 40) were divided into four experimental groups: the control group (n = 9), Audio Brainwave Entrainment group (n = 9), Heartfulness Meditation group (n = 10), and a combined group (n = 12), for a 4-week intervention. Data were analyzed with paired t-tests. The singular Audio Brainwave Entrainment group did not see statistically significant improvements, nor did any of the intervention groups for brain health (p > 0.05). This study, however, proved the efficacy of a 4-week Heartfulness Meditation program to regulate overall mood (p = 0.00132), stress levels (p = 0.0089), state depression (POMS; p = 0.0037), and anger (p = 0.002). Results also suggest adding Audio Brainwave Entrainment to Heartfulness Meditation may improve sleep quality (p = 0.0377) and stress levels (p = 0.00016).

101 - Alzheimer Disease and Dementia: diagnostic challenges and future directions in Hispanic populations

Alzheimer’s disease (AD) and dementia has emerged as a significant societal issue and a global priority. The prevalence of dementia is rising more rapidly in low and middle income countries (LMIC) than in high income countries. A growing body of evidence shows that prevention through risk factor management is the key to reducing the burden of dementia in the society, especially in LMIC. However, a one-size-fits all approach to health promotion is neither efficient nor effective. Latin American countries (LAC) have unique challenges related to dementia, including rapid aging population, high admixture degree and risk factors profile, which influence the prevalence and presentation of dementia. During this session, we will present findings and tools that will help tailor and personalize risk factor management in Hispanics populations. Participants will be first introduced to genetics of Alzheimer disease in Hispanic populations relative to non-Hispanics and the influence of gene by environment interactions. The second presentation will report on the epidemiology and risk factors of AD using cross countries/society comparisons (Non-Hispanics whites vs Hispanics living in US vs Hispanics living in Latin America.) The third presenter will discuss the development of a tool that visualizes how each risk factor contributes to the risk of dementia and how one may lower their risk by addressing the risk factors. The tool can be used in primary care settings in Cuba, Dominican Republic and Puerto Rico. Finally, the fourth presenter uses state-of-the-art digital assessment tools (brain health assessment), for low-cost monitoring of cognitive functioning, MCI and dementia. Such instruments are important for future evaluation of the impact of preventive strategies. At the end of the presentations, attendees will be able to identify the unique genetic and social determinants that drive AD in LAC. Recommendations will be given for preventive strategies tailored to LMIC. The findings to be shared will be essential for building evidence-based interventions tailored to reducing the burden of dementia in the Hispanic populations.Session Chair:Juan Llibre RodriguezAlzheimer Disease and genetics in Hispanic PopulationsJorge J Llibre-GuerraAlzheimer disease epidemiology and risk factors in Caribbean and non-Caribbean Hispanics populations.Ivonne Z. Jiménez VelázquezDevelopment of a tool to motivate for healthy behaviors to prevent dementia in the Caribbean.Daisy AcostaA brief digital cognitive assessment for detection of cognitive impairment in Hispanics populations.Ana Rodriguez-Salgado

Interindividual and intraindividual variability in amnestic mild cognitive impairment (aMCI) measured with an online cognitive assessment

ABSTRACT Introduction Mean cognitive performance is worse in amnestic mild cognitive impairment (aMCI) compared to control groups. However, studies on variability of cognitive performance in aMCI have yielded inconclusive results, with many differences in variability measures and samples from one study to another. Methods We examined variability in aMCI using an existing older adult sample (n = 91; 51 with aMCI, 40 with normal cognition for age), measured with an online self-administered computerized cognitive assessment (Cogniciti’s Brain Health Assessment). Our methodology extended past findings by using pure measures of variability (controlling for confounding effects of group performance or practice), and a clinically representative aMCI sample (reflecting the continuum of cognitive performance between normal cognition and aMCI). Results Between-group t-tests showed significantly greater between-person variability (interindividual variability or diversity) in overall cognitive performance in aMCI than controls, although the effect size was with a small to moderate effect size, d = 0.44. No significant group differences were found in within-person variability (intraindividual variability) across cognitive tasks (dispersion) or across trials of a response time task (inconsistency), which may be because we used a sample measuring the continuum of cognitive performance. Exploratory correlation analyses showed that a worse overall score was associated with greater inter- and intraindividual variability, and that variability measures were correlated with each other, indicating people with worse cognitive performance were more variable. Discussion The current study demonstrates that self-administered online tests can be used to remotely assess different types of variability in people at risk of Alzheimer`s. Our findings show small but significantly more interindividual differences in people with aMCI. This diversity is considered as “noise” in standard assessments of mean performance, but offers an interesting and cognitively informative “signal” in itself.

Accuracy of a Self-Administered Online Cognitive Assessment in Detecting Amnestic Mild Cognitive Impairment.

ObjectivesOur aim was to validate the online Brain Health Assessment (BHA) for detection of amnestic mild cognitive impairment (aMCI) compared to gold-standard neuropsychological assessment. We compared the diagnostic accuracy of the BHA to the Montreal Cognitive Assessment (MoCA).MethodsUsing a cross-sectional design, community-dwelling older adults completed a neuropsychological assessment, were diagnosed as normal cognition (NC) or aMCI, and completed the BHA and MoCA. Both logistic regression (LR) and penalized logistic regression (PLR) analyses determined BHA and demographic variables predicting aMCI; MoCA variables were similarly modeled. Diagnostic accuracy was compared using area under the receiver operating characteristic curve (ROC AUC) analyses.ResultsNinety-one participants met inclusion criteria (51 aMCI, 40 NC). PLR modeling for the BHA indicated Face–Name Association, Spatial Working Memory, and age-predicted aMCI (ROC AUC = 0.76; 95% confidence interval [CI]: 0.66–0.86). Optimal cut-points resulted in 21% classified as aMCI (positive), 23% negative, and 56% inconclusive. For the MoCA, digits, abstraction, delayed recall, orientation, and age predicted aMCI (ROC AUC = 0.71; 95% CI: 0.61–0.82). Optimal cut-points resulted in 22% classified positive, 8% negative, and 70% inconclusive (LR results presented within). The BHA model classified fewer participants into the inconclusive category and more as negative for aMCI, compared to the MoCA model (Stuart–Maxwell p = .004).DiscussionThe self-administered BHA provides similar detection of aMCI as a clinician-administered screener (MoCA), with fewer participants classified inconclusively. The BHA has the potential to save practitioners time and decrease unnecessary referrals for a comprehensive assessment to determine the presence of aMCI.

BRAIN HEALTH ASSESSMENT IN MACULAR DEGENERATION PATIENTS UNDERGOING INTRAVITREAL ANTI-VASCULAR ENDOTHELIAL GROWTH FACTOR INJECTIONS (THE BHAM STUDY): An Interim Analysis.

After intravitreal injection, anti-vascular endothelial growth factor (VEGF) agents are found in the systemic circulation and can suppress systemic VEGF levels. Neuronal health and cognitive function in the central nervous system have been associated with normal physiological levels of VEGF expression. We wished to determine whether there was an association between cumulative anti-VEGF exposure and cognitive function. One hundred and seventy-five patients aged 65 to 85 with vision of at least 20/50 or better in one eye and a diagnosis of age-related macular degeneration took an iPad-based brain health assessment to determine their risk of mild cognitive impairment. The result for each patient was compared with the total number of anti-VEGF injections per individual patient. Patients were then stratified into groups with 0 injections (control), 1 to 9 injections, 10 to 20 injections, or greater than 20 injections. The group of patients with more than 20 injections had a higher likelihood of mild cognitive impairment compared with the control group, with statistically significant worse mean Z-scores (P = 0.04). Our study is the first to associate worsening cognitive health with higher cumulative anti-VEGF injections. This study was not designed to show a causal link, but does suggest that additional investigation is warranted.

When I'm 64: Age-Related Variability in Over 40,000 Online Cognitive Test Takers.

ObjectivesAge-related differences in cognition are typically assessed by comparing groups of older to younger participants, but little is known about the continuous trajectory of cognitive changes across age, or when a shift to older adulthood occurs. We examined the pattern of mean age differences and variability on episodic memory and executive function measures over the adult life span, in a more fine-grained way than past group or life-span comparisons.MethodWe used a sample of over 40,000 people aged 18–90 who completed psychometrically validated online tests measuring episodic memory and executive functions (the Cogniciti Brain Health Assessment).ResultsCognitive performance declined gradually over adulthood, and rapidly later in life on spatial working memory, processing speed, facilitation (but not interference), associative recognition, and set shifting. Both polynomial and segmented regression fit the data well, indicating a nonlinear pattern. Segmented regression revealed a shift from gradual to rapid decline that occurred in the early 60s. Variability between people (interindividual variability or diversity) and variability within a person across tasks (intraindividual variability or dispersion) also increased gradually until the 60s, and rapidly after. Confirmatory factor analysis revealed a single general factor (of variance shared between tasks) offered a good fit for performance across tasks.DiscussionLife-span cognitive performance shows a nonlinear pattern, with gradual decline over early and mid-adulthood, followed by a transition in the 60s to notably accelerated, but more variable, decline. Some people show less decline than others, and some cognitive abilities show less within-person decline than others.

An evaluation of memory and attention in BRCA mutation carriers using an online cognitive assessment tool.

The objective of this study was to evaluate the impact of various surgical, hormonal, and lifestyle factors on memory and attention in women with a BRCA1 or BRCA2 mutation. BRCA mutation carriers enrolled in a longitudinal study were invited to complete an online brain health assessment tool designed to screen for cognitive deficits. Four measures of memory and executive attention were assessed individually, and an overall score was compiled adjusting for age. Exposures, including preventive surgery, hormone use, and lifestyle factors, were captured by questionnaire. Performance on each of the 5 subtasks was analyzed according to various exposures. Analysis of covariance was used to compare overall scores. In total, 880 women completed the online cognitive assessment. The average age of the participants was 54 years (range, 23-86 years). The mean overall test score was 54.4 (range, 0-93). The individual subtask scores declined with age at test completion (P < .0001) and increased with level of education (P ≤ .01). Women who underwent a preventive oophorectomy had a significantly higher overall score compared with women who did not undergo this surgery (55.5 vs 50.5; P = .01). Reconstructive breast surgery was also associated with a higher overall score (56.5 vs 52.3; P = .005). Chemotherapy and hormone-replacement therapy were not predictive of the overall score. These findings are reassuring to high-risk women who undergo early surgical menopause for their cancer predisposition. Further studies are needed to evaluate cognitive function over time when memory deficits become more prevalent.