Brain Health Assessment Research Articles

Detecting Alzheimer\u2019s disease biomarkers with a brief tablet-based cognitive battery: sensitivity to A\u03b2 and tau PET

Backgroundβ-amyloid (Aβ) and tau positron emission tomography (PET) detect the pathological changes that define Alzheimer’s disease (AD) in living people. Cognitive measures sensitive to Aβ and tau burden may help streamline identification of cases for confirmatory AD biomarker testing.MethodsWe examined the association of Brain Health Assessment (BHA) tablet-based cognitive measures with dichotomized Aβ -PET status using logistic regression models in individuals with mild cognitive impairment (MCI) or dementia (N = 140; 43 Aβ-, 97 Aβ+). We also investigated the relationship between the BHA tests and regional patterns of tau-PET signal using voxel-wise regression analyses in a subsample of 60 Aβ+ individuals with MCI or dementia.ResultsFavorites (associative memory), Match (executive functions and speed), and Everyday Cognition Scale scores were significantly associated with Aβ positivity (area under the curve [AUC] = 0.75 [95% CI 0.66–0.85]). We found significant associations with tau-PET signal in mesial temporal regions for Favorites, frontoparietal regions for Match, and occipitoparietal regions for Line Orientation (visuospatial skills) in a subsample of individuals with MCI and dementia.ConclusionThe BHA measures are significantly associated with both Aβ and regional tau in vivo imaging markers and could be used for the identification of patients with suspected AD pathology in clinical practice.

A Brief Digital Cognitive Assessment for Detection of Cognitive Impairment in Cuban Older Adults.

Rapid technological advances offer a possibility to develop cost-effective digital cognitive assessment tools. However, it is unclear whether these measures are suitable for application in populations from Low and middle-income countries (LMIC). To examine the accuracy and validity of the Brain Health Assessment (BHA) in detecting cognitive impairment in a Cuban population. In this cross-sectional study, 146 participants (cognitively healthy = 53, mild cognitive impairment (MCI) = 46, dementia = 47) were recruited at primary care and tertiary clinics. The main outcomes included: accuracy of the BHA and the Montreal Cognitive Assessment (MoCA) in discriminating between controls and cognitively impaired groups (MCI and dementia) and correlations between the BHA subtests of memory, executive functions, and visuospatial skills and criterion-standard paper-and-pencil tests in the same domains. The BHA had an AUC of 0.95 (95% CI: 0.91-0.98) in discriminating between controls and cognitively impaired groups (MCI and dementia, combined) with 0.91 sensitivity at 0.85 specificity. In discriminating between control and MCI groups only, the BHA tests had an AUC of 0.94 (95% CI: 0.90-0.99) with 0.71 sensitivity at 0.85 specificity. Performance was superior to the MoCA across all diagnostic groups. Concurrent and discriminant validity analyses showed moderate to strong correlations between the BHA tests and standard paper-and-pencil measures in the same domain and weak correlations with standard measures in unrelated domains. The BHA has excellent performance characteristics in detecting cognitive impairment including dementia and MCI in a Hispanic population in Cuba and outperformed the MoCA. These results support potential application of digital cognitive assessment for older adults in LMIC.

A-236 Concurrent Validity of the Paper-Match in a Diverse Population

Abstract Introduction Symbol and digit substitution tasks are key instruments in the evaluation of attention, speed of processing, executive functioning, and cognitive dysfunction. The Match is an electronic (app-based) substitution task developed as part of the University of California San Francisco Brain Health Assessment that has been used to demonstrate cognitive impairment. We describe the paper-based oral symbol/number substitution task (Paper-Match), which was developed as part of the 5-Cog battery to assess for cognitive impairment including dementia and demonstrate it’s use in an urban, multi-ethnic, socioeconomically disadvantaged primary care population in Bronx NY. Method 109 participants, mean age 72.61 SD 6.42 and education 11.70 SD 3.82 years, 81% female, 48.6% Hispanic/Latino and 47.7% African American seen as part of 5-Cog. Participants (36.7% tested in Spanish) completed the Paper-Match (scored based on the number of correct matches in 90 seconds) and a comprehensive neuropsychological battery. Descriptive and correlational analysis were conducted. Results Mean Paper-Match score was 38.24 SD 11.83 items correct (range 4–51). Paper-Match performance was highly correlated with performance on the Symbol Digit Modalities Test (r = .819, p < .001) and moderately correlated with performance on the Montreal Cognitive Assessment (MOCA; r = .604, p < .001). Years of education and primary language impacted performances. Conclusion The results of this study provide the initial description and validation of the Paper-Match an oral symbol digit substitution task and its use in a diverse population of older primary care patients. Further research on the psychometric properties and construct validity of the Paper-Match are needed.

Tablet-Administered Screening Tests for the Detection of Major and Mild Cognitive Disorders – Preliminary Findings of a Comparative Study

<p>Preventative screening of at-risk population is a crucial step in the early detection of dementia. Building alternative and ecologically validated screening tests are challenging. This pilot project attempts a) to assess the effectiveness of a culturally oriented computerized screening test for major neurocognitive disorder (eHAST) b) to compare it with the Greek version of the UCSF Brain Health Assessment (BHA) which is culturally neutral. Our study focused in a) evaluation of eHAST’s discriminant ability between groups of older adults with cognitive concerns (OACC) (n=35) vs older adults with Mild Cognitive Impairment (MCI) (n=114) and dementia (n=67), and MCI vs dementia in a sample of 216 cases. b) comparison of eHAST’s discriminant ability vs BHA’s in 116 subjects. The absence of normative data for both of the tests led to balance the sample regarding age and educational level for the comparisons between groups of OACC vs MCI (n = 56) and MCI vs dementia cases (n = 60). All participants were neuropsychologically assessed, clinically diagnosed. Results showed a) Reliability check (Cronbach's alpha) of eHAST was 0.9 and discriminant analyses in separating groups of OACC vs MCI displayed a correct classification rate of 77.3%, for MCI vs dementia 80.6% and OACC vs dementia 89.1% (cross-validated). b) In OACC vs MCI comparison, BHA’s discriminant ability was 67.3% and eHAST’s was 60.7%. In MCI vs dementia comparison, BHA’s discriminant ability was 77.2% and eHAST’s was 76.7% (cross-validated). These preliminary results of the implementation of eHAST are encouraging as the test presents sufficient discriminant ability between groups of OACC-MCI, MCI-Dementia & OACC- Dementia. Also, performs similar scores to BHA, which is a state-of-the-art screening test. The use of a tablet pc in the assessment of cognitive disorders in the elderly can have a catalytic role in the detection of dementia.</p>

White Matter Correlates of Cognitive Performance on the UCSF Brain Health Assessment.

White matter (WM) microstructural changes are increasingly recognized as a mechanism of age-related cognitive differences. This study examined the associations between patterns of WM microstructure and cognitive performance on the University of California, San Francisco (UCSF) Brain Health Assessment (BHA) subtests of memory (Favorites), executive functions and speed (Match), and visuospatial skills (Line Orientation) within a sample of older adults. Fractional anisotropy (FA) in WM tracts and BHA performance were examined in 84 older adults diagnosed as neurologically healthy (47), with mild cognitive impairment (19), or with dementia (18). The relationships between FA and subtest performances were evaluated using regression analyses. We then explored whether regional WM predicted performance after accounting for variance explained by global FA. Memory performance was associated with FA of the fornix and the superior cerebellar peduncle; and executive functions and speed, with the body of the corpus callosum. The fornix-memory association and the corpus callosum-executive association remained significant after accounting for global FA. Neither tract-based nor global FA was associated with visuospatial performance. Memory and executive functions are associated with different patterns of WM diffusivity. Findings add insight into WM alterations underlying age- and disease-related cognitive decline.

The Brain Health Assessment for Detecting and Diagnosing Neurocognitive Disorders.

Brief cognitive screens lack the sensitivity to detect mild cognitive impairment (MCI) or support differential diagnoses. The objective of this study was to validate the 10-minute, tablet-based University of California, San Francisco (UCSF) Brain Health Assessment (BHA) to overcome these limitations. Cross-sectional. UCSF Memory and Aging Center. Older adults (N=347) (neurologically healthy controls (n=185), and individuals diagnosed with MCI (n=99), dementia (n=42), and as normal with concerns (n=21)). The BHA includes subtests of memory, executive function and speed, visuospatial skills, and language and an optional informant survey. Participants completed the Montreal Cognitive Assessment (MoCA) and criterion-standard neuropsychological tests. Standardized structural 3T brain magnetic resonance imaging was performed in 145 participants. At a fixed 85% specificity rate, the BHA had 100% sensitivity to dementia and 84% to MCI; the MoCA had 75% sensitivity to dementia and 25% to MCI. The BHA had 83% sensitivity to MCI likely due to AD and 88% to MCI unlikely due to AD, and the MoCA had 58% sensitivity to MCI likely AD and 24% to MCI unlikely AD. The BHA subtests demonstrated moderate to high correlations with the criterion-standard tests from their respective cognitive domains. Memory test performance correlated with medial temporal lobe volumes; executive and speed with frontal, parietal, and basal ganglia volumes; and visuospatial with right parietal volumes. The BHA had excellent combined sensitivity and specificity to detect dementia and MCI, including MCI due to diverse etiologies. The subtests provide efficient, valid measures of neurocognition that are critical in making a differential diagnosis.

The TabCAT Brain Health Assessment: A Highly Efficient and Sensitive Approach to Detecting Very Mild Cognitive Impairment (P5.197)

The TabCAT Brain Health Assessment: A Highly Efficient and Sensitive Approach to Detecting Very Mild Cognitive Impairment (P5.197)

Understanding and optimizing brain health in HIV now: protocol for a longitudinal cohort study with multiple randomized controlled trials.

BackgroundChronic HIV infection commonly affects both cognition and mental health, even with excellent systemic viral control. The causes of compromised brain health are likely to be a multi-factorial combination of HIV-related biological factors, co-morbidities such as aging and cerebrovascular disease, and the erosion of coping skills, physical health, and social supports resulting from the strains of living with a chronic illness.Methods/designThis study aims to provide a better understanding of the relationship between cognitive complaints, depression, and objectively measured cognitive impairment in HIV, and of the key factors, whether biological or personal, which relate to these presentations and to their evolution over time. Characterization of this heterogeneity will permit more focused pathophysiological studies, and allow more targeted interventions. The project makes extensive use of Web-based research and health care delivery tools, aiming to provide cost-effective, “clinic ready” tools to improve brain health in HIV. This project has two overarching aims, reflecting our dual goals of understanding and improving brain health in HIV, focusing on cognitive impairment, its contributors and consequences.The objectives are to contribute evidence for the validity of a brief brain health assessment, to estimate the extent to which HIV-related cognition-relevant clinical factors and patient-centered outcomes inter-relate and evolve over time, allowing identification of the mechanisms underpinning longitudinal change in brain health and to contribute evidence for the feasibility, effectiveness potential, acceptability, and underlying mechanisms of promising interventions for optimizing brain health. We adopt a cohort multiple randomized control trials design. A total of 900 participants will be characterized prospectively over a 27-month period to answer questions about the evolution of outcomes of interest. All participants will be offered basic brain health self-management information. Sub-groups will participate in pilot studies of specific, more intensive interventions to provide pragmatic evidence for feasibility, effectiveness, and comparative effectiveness.DiscussionThis work will provide needed estimates of the burden, heterogeneity, evolution, and mechanisms underlying compromised brain health in HIV, and test a range of promising non-pharmacological interventions. This is an on-going study; the trials nested within this cohort that are currently recruiting participants were registered on 7 October 2015 (Clinicaltrials.gov NCT02571504 and NCT02571595).

Fighting Dementia with Brain Health Assessment.

Fighting Dementia with Brain Health Assessment.

Efficacité des échelles cognitives chez les patients atteints de la Maladie d’Alzheimer et de Troubles Cognitifs Légers. Une étude préliminaire

The use of digital cognitive tests is getting common nowadays. Older adults or their family members may use online tests for self-screening of dementia. However, the diagnostic performance across different digital tests is still to clarify. The objective of this study was to evaluate the diagnostic performance of digital cognitive tests for MCI and dementia in older adults.Literature searches were systematically performed in the OVID databases. Validation studies that reported the diagnostic performance of a digital cognitive test for MCI or dementia were included. The main outcome was the diagnostic performance of the digital test for the detection of MCI or dementia.A total of 56 studies with 46 digital cognitive tests were included in this study. Most of the digital cognitive tests were shown to have comparable diagnostic performances with the paper-and-pencil tests. Twenty-two digital cognitive tests showed a good diagnostic performance for dementia, with a sensitivity and a specificity over 0.80, such as the Computerized Visuo-Spatial Memory test and Self-Administered Tasks Uncovering Risk of Neurodegeneration. Eleven digital cognitive tests showed a good diagnostic performance for MCI such as the Brain Health Assessment. However, all the digital tests only had a few validation studies to verify their performance.Digital cognitive tests showed good performances for MCI and dementia. The digital test can collect digital data that is far beyond the traditional ways of cognitive tests. Future research is suggested on these new forms of cognitive data for the early detection of MCI and dementia.