Cognitive Assessment Of Older Adults Research Articles

Translation and validation of the audiovisual version of the Montreal cognitive assessment in older adults in Brazil

BackgroundThe use of a reliable remote cognitive screening test for older adults is crucial for the diagnosis of cognitive impairment. This study aimed to translate and validate the audiovisual Montreal Cognitive Assessment (MoCA)for older adults in Brazil.MethodsOne hundred and fourteen older adults were recruited from the community and demographic, functional, mood, and cognitive data were collected. Participants were classified into two groups: cognitively healthy or mild cognitive impairment (MCI). Statistical analyses were performed in order to assess the validity of the test and the cutoff score.ResultsThe psychometric properties of the audiovisual MoCA showed good convergent validity. The audiovisual MoCA was represented as a unifactorial adjusted model, the composite reliability value was acceptable and a cutoff point of ≥23 reached adequate sensitivity and specificity at 0.77 and 0.92, respectively.ConclusionsThe translated audiovisual MoCA is a valid and reliable cognitive screening test that can be administered remotely in older adults in Brazil. The test demonstrated a great ability to discriminate older adults with MCI from cognitively healthy adults. Future studies should focus on validating the audiovisual MoCA using other target population groups in order to expand the use of this remote screening test.

Lower Physical Activity Is Associated With Objective But Not Subjective Cognitive Impairment In Older Adults Without Dementia

AbstractBackgroundPhysical activity has been associated with better performance on cognitive assessments for older adults in both observational and interventional studies. Older adults who exercise the 150 minutes a week recommended by the Physical Activity Guidelines for Americans were also less likely to report subjective cognitive decline on the Behavioral Risk Factor Surveillance System than those with lower levels of physical activity. Potential explanations for a cognitive benefit from exercise include reduction of vascular risk factors, preservation of brain mass and neuronal structural integrity, and promotion of psychological health and self‐efficacy.MethodCross‐sectional data on exercise habits, self‐reported memory problems, and cognition were collected for 137 older adults without dementia as part of a larger observational study. Participants were categorized as meeting (3 or more hours a week of physical activity) or not meeting (< 3 hours) physical activity recommendations. We used multivariable logistic regression to evaluate the association between exercise and self‐reported memory problem, and linear regression for association between exercise and total score on the Montreal Cognitive Assessment (MoCA) after adjusting for potential confounders including age, sex, level of education, cognitive status (CDR global score of 0 vs 0.5), and Geriatric Depression Scale score.ResultData on baseline exercise was available for 103 cognitively normal older adults and 34 with mild cognitive impairment (MCI). Mean participant age was 66.6 years and 58.4% were female. 48 participants (35%) reported exercising at least 3 hours per week. Participants with at least 3 hours a week of physical activity had significantly higher scores on the MoCA compared with those with less than 3 hours a week (B = 1.22, p = 0.040) after adjusting for age, sex, level of education, cognitive status, and depressive symptoms. There was no association between physical activity and participant‐reported memory symptoms using the same covariates (B = ‐0.50, p = 0.223).ConclusionWeekly physical activity levels consistent with current guidelines were associated with better performance on a cognitive assessment in older adults without dementia. Physical activity was not associated with presence or absence of a self‐reported memory problem in this sample.

Metacognition in Community-Dwelling Older Black and African American Adults During the COVID-19 Pandemic.

Cognitive assessment of older adults typically includes symptom reports and objective evaluations. However, there is often poor agreement between these measures. Cultural norms, stress, and anxiety may also influence cognitive self-appraisal and performance. Little research describes how other factors affect the self-report/objective test discrepancies noted in the literature. This study investigated whether the disparity between subjective cognitive concerns and objective cognitive performance is related to measures of anxiety and stress in older Black and African American adults. Telephone screenings were administered to 206 older adults (ages 64-94) during the first year of the pandemic. Demographic data, objective memory (Telephone Interview for Cognitive Status [TICS-m]), an adaptation of the subjective memory measure, the Cognitive Change Questionnaire, emphasizing executive functioning in everyday life [CCQ-e]), Generalized Anxiety Disorder-7 (GAD-7), and Perceived Stress Scale-4 (PSS4) were measured. Metacognition Discrepancy Index (MDI) was calculated from the standardized residual after regressing TICS-m on CCQ-e scores to quantify the discrepancy between cognitive self-appraisal and objective cognitive functioning. Neither GAD-7 nor PSS-4 moderated the relationship between TICS-m and CCQ-e, and TICS-m scores weakly predicted subjective CCQ-e scores (F(1, 197)=4.37, p = 0.038, R2 = 0.022). The MDI correlated with stress and anxiety (rs = 0.294, 0.396, ps < 0.001). Discrepancies exist between objectively measured and self-evaluated cognition. Elevations in stress and anxiety are associated with greater overestimation of cognitive difficulties relative to objective performance. Pandemic-related stressors may have worsened anxiety and diminished self-appraisal of cognitive abilities for some individuals, while others may remain reluctant to acknowledge impairments. Social and emotional factors are meaningful considerations in assessing cognitive difficulties.

Usefulness of the Montreal Cognitive Assessment in Older Adults With Type 1 Diabetes.

Older adults with type 1 diabetes are at high risk for cognitive impairment, yet the usefulness of common cognitive screening instruments has not been evaluated in this population. A total of 201 adults ≥60 years of age with type 1 diabetes completed a battery of neuropsychological measures and the Montreal Cognitive Assessment (MoCA). Receiver operating characteristic (ROC) curves and Youden indices were used to evaluate overall screening test performance and to select an optimal MoCA cutoff score for detecting low cognitive performance, as defined as two or more neuropsychological test performances ≥1.5 SD below demographically corrected normative data. The ROC area under the curve (AUC) was 0.745 (P < 0.001). The publisher-recommended cutoff score of <26 resulted in sensitivity of 60.4% and specificity of 71.4%, whereas a cutoff score of <27 resulted in sensitivity of 75.0% and specificity of 61.0%. The Youden indices for these cutoff scores were 0.318 and 0.360, respectively. Minimally acceptable sensitivity (i.e., >0.80) was obtained when using a cutoff score of <28, whereas >0.80 specificity was obtained with a cutoff score of <25. The MoCA has modest overall performance (AUC 0.745) as a cognitive screening instrument in older adults with type 1 diabetes. The standard cutoff score of <26/30 may not adequately detect individuals with neuropsychological testing-defined abnormal cognition. The optimal MoCA cutoff score (based on the Youden index) was <27/30. A score of <28 resulted in acceptable sensitivity but was accompanied by low specificity (42%). Future studies with a more diverse population are needed to confirm these findings.

Designing Feasible and Effective Cognitive Assessment for Older Adults in Long-Term Care

Cognitive assessment and training are needed to avoid accelerated cognitive decline. We have developed BrainTagger, a suite of serious games that evaluate and potentially train cognitive abilities such as inhibitory control, processing speed, cognitive flexibility, and working memory. Ideally, cognitive assessments can be used as sentinels to detect problems that might damage brain functions (e.g., dehydration, poor nutrition, depression, delirium, inappropriate medication). In this paper, we report on a multi-year effort to develop hardware and software solutions that support effective implementation of cognitive assessment games (CAGs) in long-term care. Issues and constraints addressed include accommodating physical disabilities; making cognitive assessment enjoyable and engaging; providing scientific evidence that each game is measuring the intended construct; and reporting game results in a meaningful way. This article describes how we addressed some of these issues and demonstrates the sustained effort required to make this type of functionality work in practice. We also include some preliminary design guidelines, based on our experience, that may be useful in guiding future work on developing CAGs.

Web-based cognitive assessment in older adults: Where do we stand?

The use of digital tools for remote cognitive measurement of older adults is generating increasing interest due to the numerous advantages offered for accessibility and scalability. However, these tools also pose distinctive challenges, necessitating a thorough analysis of their psychometric properties, feasibility and acceptability. In this narrative review, we present the recent literature on the use of web-based cognitive assessment to characterize cognition in older adults and to contribute to the diagnosis of age-related neurodegenerative diseases. We present and discuss three types of web-based cognitive assessments: conventional cognitive tests administered through videoconferencing; unsupervised web-based assessments conducted on a computer; and unsupervised web-based assessments performed on smartphones. There have been considerable progress documenting the properties, strengths and limitations of web-based cognitive assessments. For the three types of assessments reported here, the findings support their promising potential for older adults. However, certain aspects, such as the construct validity of these tools and the development of robust norms, remain less well documented. Nonetheless, the beneficial potential of these tools, and their current validation and feasibility data, justify their application [see Supplementary Digital Content (SDC), http://links.lww.com/CONR/A69 ].

Evaluation of the usefulness of a paper–pencil group cognitive assessment for older adults in the community

BackgroundAs the older population increases, the need for early detection of cognitive decline is also increasing. In this study, we examined whether our paper–pencil type group examination for cognitive assessment (PAPLICA) could detect the effects of years of education and aging.MethodsPAPLICA was conducted on 829 older people. The inclusion criteria were age 60 years or older and the ability to come to the event site alone. The exclusion criteria were participants with a medical or psychiatric disorder or dementia.One examiner conducted the test on a group of approximately 10–20 people in approximately 25 min. Participants were instructed on tackling the issues projected on the projector, and their answers were recorded in a response booklet.ResultsAn independent sample t-test was performed for years of education, and ANCOVA was performed for aging. Among the test items included in PAPLICA, the Speed I and Letter fluency tests were unable to detect the effects of aging. Furthermore, the age at which the effect of aging manifests varies depending on the test item. For instance, a decline in scores in the Speed I and Picture ECR Free recall tests was observed in the 70–74 age group; for that of Word DRT, Picture ECR cued recall, and Similarity, in the 75–79 age group; for CFT, in the 80–84 age group, and for CLOX, the decline was observed in the 85 ≤ age group.ConclusionsPAPLICA, similar to other neuropsychological tests, was able to detect the effects of years of education and aging. Future testing should be conducted on different demographics to identify the differences in patterns of cognitive decline.

Gait speed according to cognitive status in older adults: a cross-sectional study in a resource-limited country

Objective We aimed to investigate the association between gait speed and cognitive status in outpatient older adults from a resource-limited setting in Peru. Methods We performed a cross-sectional study including older adults aged ≥60 years attending a geriatrics outpatient clinic between July 2017 and February 2020. Gait speed was measured over a 10-meters distance without considering the first and last meter traveled. Cognitive status was assessed through the Short Portable Mental Status Questionnaire (SPMSQ) and the Mini-Mental State Examination (MMSE). We used a multivariate binomial logistic regression to conduct both an epidemiological and fully adjusted models. Results We included 519 older adults (mean age: 75 years; IQR = 10), of whom 95 (18.3%) and 151 (31.5%) were cognitively impaired according to the SPMSQ and MMSE, respectively. Gait speed was slower among patients with poorer cognitive status as assessed by both tools (p < 0.001). Malnutrition (PR: 1.74; CI: 1.45–2.08) and functional dependency (PR: 4.35; CI: 2.68–7.08) were associated with a greater prevalence of cognitive impairment according to the SPMSQ, whereas a faster gait speed (PR: 0.27, CI: 0.14–0.52) and longer years of education (PR: 0.83, CI: 0.77–0.88) were associated with a less prevalence. Conclusions Slower gait speed was associated with poorer cognitive status in outpatient older adults. Gait speed may be a complementary tool in the cognitive assessment of older adults from resource-limited settings.

Design Preferences for a Serious Game-Based Cognitive Assessment of Older Adults in Prison: Thematic Analysis.

Serious games have the potential to transform the field of cognitive assessment. The use of serious game-based cognitive assessments in prison environments is particularly exciting. This is because interventions are urgently needed to address the rapid increase in the number of currently incarcerated older adults globally and because of the heightened risks of dementia and cognitive decline present in this population. Game-based assessments are assumed to be fun, engaging, and suitable alternatives to traditional cognitive testing, but these assumptions remain mostly untested in older adults. This is especially true for older adults in prison, whose preferences and needs are seldom heard and may deviate from those previously captured in studies on cognition and serious games. This study aimed to understand the design preferences of older adults in prison for a game-based cognitive assessment. This study used reflexive thematic analysis, underpinned by critical realism, and applied the technique of abduction. Overall, 4 focus groups with a total of 20 participants were conducted with older adults (aged ≥50 years; aged ≥45 years for Aboriginal and Torres Strait Islander people) across 3 distinct prison environments in Australia. Self-determination theory was used as a theoretical foundation to interpret the results. Overall, 3 themes were generated: Goldilocks-getting gameplay difficulty just right through optimal challenge (the first theme emphasizes the participants' collective desire for an individualized optimal level of difficulty in serious gameplay), Avoiding Childish Graphics-gimmicky gameplay can be condescending (the second theme raises the importance of avoiding immature and childlike gameplay features, as some older end users in prison felt that these can be condescending), and A Balanced Diet-meaningful choice and variety keeps game-based assessments fun (the third theme highlights the strong user preference for meaningful choice and variety in any serious game-based cognitive assessment to maximize in-game autonomy). The collection of these themes provides novel insights into key game design preferences of marginalized older adults.

Capturing Cognitive Aging in Vivo: Application of a Neuropsychological Framework for Emerging Digital Tools.

As the global burden of dementia continues to plague our healthcare systems, efficient, objective, and sensitive tools to detect neurodegenerative disease and capture meaningful changes in everyday cognition are increasingly needed. Emerging digital tools present a promising option to address many drawbacks of current approaches, with contexts of use that include early detection, risk stratification, prognosis, and outcome measurement. However, conceptual models to guide hypotheses and interpretation of results from digital tools are lacking and are needed to sort and organize the large amount of continuous data from a variety of sensors. In this viewpoint, we propose a neuropsychological framework for use alongside a key emerging approach—digital phenotyping. The Variability in Everyday Behavior (VIBE) model is rooted in established trends from the neuropsychology, neurology, rehabilitation psychology, cognitive neuroscience, and computer science literature and links patterns of intraindividual variability, cognitive abilities, and everyday functioning across clinical stages from healthy to dementia. Based on the VIBE model, we present testable hypotheses to guide the design and interpretation of digital phenotyping studies that capture everyday cognition in vivo. We conclude with methodological considerations and future directions regarding the application of the digital phenotyping approach to improve the efficiency, accessibility, accuracy, and ecological validity of cognitive assessment in older adults.

Health practitioner beliefs regarding the impact of age-based stereotype threat on performance in the cognitive assessment of older adults

Objectives Health practitioners’ understanding of the impact of age-based stereotype threat (ABST) on the cognitive test performance of older adults is not well understood. This study aimed to investigate health practitioners’ ability to recognize the influence of ABST in the cognitive assessment of older adults and their perceptions of its impact in practice. Methods One-hundred and twenty-nine health practitioners (86% female; M age = 39.75, SD = 11.50) with experience in conducting cognitive assessments with older adults (mainly psychologists and occupational therapists) completed an online survey assessing demographic and practice characteristics, aging beliefs, a hypothetical cognitive assessment scenario, and perceived impact of ABST on practice. Results Overall, health practitioners rated ABST factors in the assessment scenario as less detrimental to cognitive performance than internal and external factors. In a hierarchical regression model, lower recognition of ABST and negative aging beliefs significantly accounted for lower perceived impact of ABST on older adults’ cognitive test performance in practice (R 2 = .37, p < .001). Conclusion Health practitioners may not recognize the influence of ABST on assessment findings, especially if they hold negative aging beliefs. The findings highlight the need to improve health practitioners’ knowledge of ABST to increase the validity of cognitive testing in older adults.

A proposal for virtual, telephone-based preoperative cognitive assessment in older adults undergoing elective surgery

ObjectiveTo assess the feasibility of administering the MoCA 5-minute test/Telephone (T-MoCA), an abbreviated version of the Montreal Cognitive Assessment to older adults perioperativelyDesignA feasibility study including patients aged ≥ 70 years scheduled for surgery from December 2020 to March 2021SettingPreoperative virtual clinicPatientsPatients ≥70 years undergoing major elective surgeryInterventionA study investigator called eligible patients prior to surgery, obtained consent, and completed the preoperative cognitive assessment. Follow-up assessment was completed 1-month postoperatively, and participating clinicians were surveyed at the completion of the study.MeasurementsAn attention test, T-MoCA, Activities of Daily Living (ADL), Instrumental Activities of Daily Living (IADL), and Generalized Anxiety Disorder 2-item (GAD-2)Main resultsOverall, 37/40 (92.5%) patients completed the pre- and post-operative assessments. The cohort was 50% female, white (97.5%), with a median age of 76 years (interquartile range (IQR) 73-79), and education level was higher than high school in 82.5% of patients. Preoperatively, the median number of medications was 8 (IQR 7-11), 27/40 (67.5%) had medications with anticholinergic effects, and 6/40 (15%) had benzodiazepines. Median completion time of the phone assessment was 10 min (IQR 8.25-12) and 4 min (IQR 3-5) for the T-MoCA with a median T-MoCA score of 13 (IQR 12-14). Most patients (37/40) completed the post-operative assessment, and 6/37 (16.2%) reported they had experienced a change in memory or attention post-operatively. Clinician’s survey reported ease and feasibility in performing T-MoCA as a preoperative cognitive evaluation.ConclusionPreoperative cognitive assessment of older adults using T-MoCA over the phone is easy to perform by clinicians and had a high completion rate by patients. This test is feasible for virtual assessments. Further research is needed to better define validity and correlation with postoperative outcomes.

Comparison of the Greek Version of the Quick Mild Cognitive Impairment Screen and Montreal Cognitive Assessment in Older Adults.

Objective: Cognitive screening instruments (CSIs) are essential for everyday practice. The Quick Mild Cognitive Impairment (Qmci) screen, a short instrument designed to identify mild cognitive impairment, was recently translated into Greek (Qmci-Gr). The present study compared its diagnostic value against the Montreal Cognitive Assessment (MoCA) screen and examined its optimal cutoffs. Method: We recruited consecutive patients aged ≥55 years that presented with cognitive complaints from two outpatient clinics in Greece. The Qmci-Gr and MoCA were completed by all patients. Furthermore, they were assessed independently with a comprehensive flexible neuropsychological battery to establish a diagnostic classification. Results: In the current study, we assessed a total of 145 patients, with a median age of 70 years; 44 were classified as having Subjective Memory Complaints (SMC) but normal cognition, 32 with MCI and 69 with dementia. The Qmci-Gr had a higher accuracy compared to the MoCA in discriminating MCI from dementia, area under the curve (AUC) of 0.81 versus 0.75, respectively; however, this finding was marginally significant (p = 0.08). Its accuracy was marginally higher for distinguishing SMC from dementia, AUC of 0.94 versus 0.89 (p = 0.03). However, Qmci-Gr presented a lower accuracy than MoCa in differentiating SMC from MCI, AUC of 0.76 versus 0.94 (p = 0.006). Conclusions: The Qmci-Gr has comparable diagnostic accuracy to the MoCA regarding MCI and dementia groups. Further research, with larger and more diverse samples, may be necessary to ensure generalizability.

Assessing Social Cognition in Older Adults: A Population-Based Study.

In a population-based study of mild cognitive impairment (MCI), to validate the assessment of social cognition in older adults. Cross-sectional study of 902 adults aged 65+ with mean age 76.6 years (SD 8.06). We created a social cognition composite comprising standardized z scores on the Social Norms Questionnaire and the 10-item Reading the Mind in the Eyes Test. We identified associated factors and compared sensitivity, specificity, and the area under the curve of social cognition, for MCI defined as Clinical Dementia Rating (CDR)=0.5, to those of other cognitive domains. We calculated the impact of including social cognition on the proportion neuropsychologically classified as MCI. Better social cognition was associated with younger age, female sex, higher education, better general cognition (mini-mental state examination), fewer depressive symptoms, and lower CDR. Adjusting for demographics, associations with mini-mental state examination, depressive symptoms, anxiety symptoms, and subjective cognitive complaints remained significant. The sensitivity and specificity of social cognition for CDR=0.5 were comparable to those of the traditional 5 cognitive domains. Including social cognition as a sixth domain of cognition resulted in a 5% increase in the proportion classified as MCI. Brief objective assessment of social cognition may enhance cognitive assessment of older adults.

Remote cognitive assessment of older adults in rural areas by telemedicine and automatic speech and video analysis

AbstractBackgroundEarly detection of cognitive impairments is crucial for successful implementation of preventive strategies. However, in rural isolated areas or so‐called ‘medical deserts’, access to diagnosis and care is very limited. With the current pandemic crisis, now even more than ever, remote solutions such as telemedicine platforms represent great potential and can help to overcome this barrier. Moreover, current advances made in voice and image analysis can help overcoming the barrier of the physical distance by providing additional information of a patients’ emotional and cognitive state. Therefore, the aim of this study is to evaluate the feasibility and reliability of a videoconference system for remote cognitive testing empowered by automatic speech and video analysis.Method60 participants (aged 55 and older) with and without cognitive impairment are recruited. A complete neuropsychological assessment including a short clinical interview are administered in two conditions, once by telemedicine and once by face‐to‐face. The administration procedure is randomized. Acceptability and user experience are assessed among participants and clinicians in qualitative and quantitative manner. Speech and video features will be extracted and analyzed to obtain additional information on mood and engagement levels.ResultSimilar results were obtained on the several cognitive test measures when comparing the remote to the face‐to‐face administration method. Word recall (r=0,928) and picture naming task (r=0,939) showed the strongest correlation. Acceptability of the tool was relatively high with preference even in the remote method for more convenience.ConclusionResults support the feasibility and reliability of remote cognitive testing through administration via a telemedicine tool. These systems can be used for remote disease monitoring, enabling patients to be assessed in their own homes and improve utilization of expert assessors allowing them to conduct neurocognitive testing remotely.

Utility and usability of brief, remote, and self‐administered cognitive assessment for older adults with intact cognition and mild cognitive impairment: A novel approach to increase access during the COVID‐19 pandemic

BackgroundGiven the COVID‐19 pandemic and necessary restrictions on older adults’ in‐person clinical and research exposure, there is an urgent need for validated cognitive measures that can be self‐administered remotely in the home to expand the reach of cognitive assessment. The current presentation describes the implementation, validity, and usability of the Survey for Memory, Attention, and Reaction Time (SMART) assessment protocol that has been deployed in longitudinal cohort studies of older adults for over two years.MethodParticipants were 69 older adults classified as cognitively intact (n=44) or mild cognitive impairment (MCI; n=25). The SMART was sent to participants via email once per month. Participants completed SMART using their computer (n=55), tablet (n=10), or smart phone (n=4). The SMART consists of four face‐valid cognitive tasks available in the public domain assessing visual memory, attention, processing speed, and executive functioning. Participants also completed a neuropsychological battery and self‐ and informant‐rated measures of everyday cognition. Primary SMART outcomes consisted of subtest completion time; secondary meta‐metrics included outcomes indirectly calculated within the SMART (e.g., click count, total completion time). Analyses were based on initial SMART administration.ResultStepwise logistic regression analyses indicated that the SMART executive functioning subtasks (Trails B Completion Time (p=.05) and Stroop Click Count (p=.02)) were the strongest predictors of cognitive status (MCI vs. cognitively intact). Longer Total Completion Time (i.e., worse performance) on the SMART was correlated with reduced global cognition and lower self‐ and informant‐rated perceptions of everyday cognition (p<.05). The SMART was rated as highly usable (M=21.8 out of 25), with no difference in MCI and cognitively intact group scores. Over a three‐month period, 87% of participants completed the SMART within the first three days of receiving it, with 100% completion following a reminder call.ConclusionThis study provides preliminary support for remote, self‐administered cognitive assessment of cognitively intact and MCI older adults using the SMART. Given the prevalence of executive functioning deficits among non‐amnestic MCI presentations, the SMART may prove particularly valuable for increasing access to cognitive assessment for diverse, heterogenous older adults with increased vascular risk factors, medical comorbidities, and health disparities.

Brief digital cognitive assessment for detection of cognitive impairment in low‐ and middle‐income countries

AbstractBackgroundRapid 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).MethodsIn this cross‐sectional study, we examined the accuracy and validity of the Brian Health Assessment (BHA) in detecting cognitive impairment in a Cuban population; 146 participants (cognitively healthy=53, MCI=46, dementia=47) were recruited at primary care and tertiary clinics. The main outcomes included: accuracy of the BHA 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.ResultsThe BHA had an AUC of .95 (95% CI: .91‐ .98) in discriminating between controls and cognitively impaired groups (MCI and dementia, combined) with .91 sensitivity at .85 specificity. In discriminating between control and MCI groups only, the BHA tests had an AUC of .94 (95% CI: .90‐ .99) with .71 sensitivity at .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.ConclusionsThe 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.

Can Virtual Assistants Perform Cognitive Assessment in Older Adults? A Review.

Community-dwelling older adults have raised the scientific community’s interest during the COVID-19 era as their chronic conditions might be aggravated by the consequences of confinement. Digital devices in this field to monitor cognitive impairment are an emerging reality of an innovative nature. However, some groups may not have benefited from these developments as much as, for example, younger people. The aim of this manuscript is to carry out a review on the development of digital devices, and specifically virtual assistants, for the detection of cognitive impairment in older adults. After a screening process, eight studies were found under the given criteria, and this number was even smaller for those using virtual assistants. Given the opportunities offered by virtual assistants through techniques such as natural language processing, it seems imperative to take advantage of this opportunity for groups such as older adults.

Cognitive assessment for older adults with cancer: A Young International Society of Geriatric Oncology and Nursing & Allied Health Interest Group initiative

Cancer is a disease that mostly affects older adults around the world and the incidence is expected to increase further due to the aging of the world population [ [1] Pilleron S. Sarfati D. Janssen-Heijnen M. et al. Global cancer incidence in older adults, 2012 and 2035: a population-based study. Int J Cancer. 2019; 144: 49-58 Crossref PubMed Scopus (162) Google Scholar ]. Cognitive impairment is also common in the older adult population, and can span in severity from Mild Cognitive Impairment (MCI) to dementia. Dementia is a prevalent condition, occurring in 5–7% in older adults aged 60 years and older and this prevalence is also expected to increase due to the aging of the population [ [2] Prince M. Bryce R. Albanese E. Wimo A. Ribeiro W. Ferri C.P. The global prevalence of dementia: a systematic review and metaanalysis. Alzheimers Dement. 2013; 9 (63–75.e62) Abstract Full Text Full Text PDF Scopus (2840) Google Scholar ]. Dementia, also referred to as major neurocognitive disorder in the DSM-5, is diagnosed when an older adult has substantial cognitive impairment in one or more cognitive domains that interferes with independence in daily activities [ [3] Brodaty H. Aerts L. Crawford J.D. et al. Operationalizing the diagnostic criteria for mild cognitive impairment: the salience of objective measures in predicting incident dementia. Am J Geriatr Psychiatry. 2017; 25: 485-497 Abstract Full Text Full Text PDF PubMed Scopus (22) Google Scholar ]. Whereas, MCI is an early stage of memory loss that is defined as: a) a cognitive complaint or concern, ideally corroborated by an informant, b) objective evidence of cognitive impairment that is abnormal for their age on standardized testing (usually defined as 1–2 standard deviations below normal on the test used); and c) no significant impact on function [ [3] Brodaty H. Aerts L. Crawford J.D. et al. Operationalizing the diagnostic criteria for mild cognitive impairment: the salience of objective measures in predicting incident dementia. Am J Geriatr Psychiatry. 2017; 25: 485-497 Abstract Full Text Full Text PDF PubMed Scopus (22) Google Scholar ]. There is no clear data on how many older adults with MCI develop dementia as rates vary between clinical and population samples, but reversal to normal function is also possible [ [3] Brodaty H. Aerts L. Crawford J.D. et al. Operationalizing the diagnostic criteria for mild cognitive impairment: the salience of objective measures in predicting incident dementia. Am J Geriatr Psychiatry. 2017; 25: 485-497 Abstract Full Text Full Text PDF PubMed Scopus (22) Google Scholar ]. MCI incidence varies widely but meta-analyses showed ranges per 1000 person-years from 22.5 (5.1–51.4) for ages 75-79y, 40.9 (7.7–97.5) for ages 80-84y, to 60.1 (6.7–159.0) for ages 85 and older [ [4] Gillis C. Mirzaei F. Potashman M. Ikram M.A. Maserejian N. The incidence of mild cognitive impairment: a systematic review and data synthesis. Alzheimers Dement (Amst). 2019; 11: 248-256 Abstract Full Text Full Text PDF PubMed Scopus (42) Google Scholar ]. In older adults with pre-existing MCI or dementia who are subsequently diagnosed with cancer, cognitive impairment can lead to challenges in cancer care, including later diagnosis, receive less treatment, having more complications during their cancer treatment and have shorter cancer survival [ [5] Hopkinson J.B. Milton R. King A. Edwards D. People with dementia: what is known about their experience of cancer treatment and cancer treatment outcomes? A systematic review. Psychooncology. 2016; 25: 1137-1146 Crossref PubMed Scopus (26) Google Scholar ]. A prior study using the Surveillance, Epidemiology and End Results (SEER) database reported a prevalence of precancer diagnosis of dementia of 7.4% in patients with breast cancer, 10.0% for colon cancer, and 5.1% for prostate cancer [ [6] Raji M.A. Kuo Y.F. Freeman J.L. Goodwin J.S. Effect of a dementia diagnosis on survival of older patients after a diagnosis of breast, colon, or prostate cancer: implications for cancer care. Arch Intern Med. 2008; 168: 2033-2040 Crossref PubMed Scopus (96) Google Scholar ].

A Teleneuropsychology Protocol for the Cognitive Assessment of Older Adults During COVID-19.

The Coronavirus Disease 2019 (COVID-19) pandemic prompted the need for a teleneuropsychology protocol for the cognitive assessment of older adults, who are at increased risk for both COVID-19 and dementia. Prior recommendations for teleneuropsychological assessment did not consider many of the unique challenges posed by COVID-19. The field is still in need of clear guidelines and standards of care for the assessment of older adults under the current circumstances. Advantages of teleneuropsychological assessment during the COVID-19 pandemic include reduced risk of contracting the virus, eliminating travel time and reducing cost, and more rapid access to needed services. Challenges include disparities in technology access among patients, reduced control over the testing environment, impeded ability to make behavioral observations, and limited research on valid and reliable cognitive assessment measures. The aim of this perspective review is to propose a teleneuropsychological protocol to facilitate neuropsychological assessment utilizing a virtual platform. The proposed protocol has been successful with our clinical and research populations and may help neuropsychologists implement teleneuropsychology services without compromising validity or reliability. However, there is increasing need for research on teleneuropsychological assessment options for both clinical and research purposes.