Computer-based Cognitive Test Research Articles

Electroencephalography-based classification of Alzheimer’s disease spectrum during computer-based cognitive testing

Alzheimer’s disease (AD) is a progressive disease leading to cognitive decline, and to prevent it, researchers seek to diagnose mild cognitive impairment (MCI) early. Particularly, non-amnestic MCI (naMCI) is often mistaken for normal aging as the representative symptom of AD, memory decline, is absent. Subjective cognitive decline (SCD), an intermediate step between normal aging and MCI, is crucial for prediction or early detection of MCI, which determines the presence of AD spectrum pathology. We developed a computer-based cognitive task to classify the presence or absence of AD pathology and stage within the AD spectrum, and attempted to perform multi-stage classification through electroencephalography (EEG) during resting and memory encoding state. The resting and memory-encoding states of 58 patients (20 with SCD, 10 with naMCI, 18 with aMCI, and 10 with AD) were measured and classified into four groups. We extracted features that could reflect the phase, spectral, and temporal characteristics of the resting and memory-encoding states. For the classification, we compared nine machine learning models and three deep learning models using Leave-one-subject-out strategy. Significant correlations were found between the existing neurophysiological test scores and performance of our computer-based cognitive task for all cognitive domains. In all models used, the memory-encoding states realized a higher classification performance than resting states. The best model for the 4-class classification was cKNN. The highest accuracy using resting state data was 67.24%, while it was 93.10% using memory encoding state data. This study involving participants with SCD, naMCI, aMCI, and AD focused on early Alzheimer’s diagnosis. The research used EEG data during resting and memory encoding states to classify these groups, demonstrating the significance of cognitive process-related brain waves for diagnosis. The computer-based cognitive task introduced in the study offers a time-efficient alternative to traditional neuropsychological tests, showing a strong correlation with their results and serving as a valuable tool to assess cognitive impairment with reduced bias.

BLOOD PRESSURE MEASURES ARE NOT CORRELATED WITH NIH TOOLBOX COGNITIVE BATTERY PERFORMANCE IN BLACK OLDER ADULTS

Abstract Elevated blood pressure has been inconsistently associated with cognitive performance in older adults. Black adults experience higher rates of elevated blood pressure and cognitive impairment than White adults. This study investigated whether blood pressure measurements were associated with cognitive performance on the NIH Toolbox Cognition Battery (NIHTB-CB) in older Black adults. 77 older Black adults 65+ years of age (M=72.6, SD=4.9) with subjective cognitive decline were administered the NIHTB-CB, a battery of computer-based cognitive tests. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured before and after cognitive testing and a cognitive task-based EEG/ERP. Average SBP, DBP, and pulse pressure (PP) were calculated. Difference scores from pre- to post-EEG/ERP served as a reactivity index following cognitive task engagement. A ratio of the difference scores to the baseline measures controlled for resting blood pressure. Bayesian correlations examined the relations between blood pressure measurements and NIHTB-CB performance. Data analysis used fully corrected T scores from the NIHTB-CB subtests. Average SBP, SBP difference scores, and baseline SBP were not associated with NIHTB-CB performance on any measurement (all BF10 < 3.0). Similarly, DBP and PP were unrelated to NIHTB-CB performance. Systolic and diastolic blood pressure were not associated with any NIHTB-CB measure. Additionally, blood pressure reactivity was not related to cognitive performance. Future research may investigate the relationship between SBP reactivity and cognitive performance across multiple measurement periods. Antihypertensive medication and duration of hypertension among hypertensive individuals may also be an important consideration in future studies.

Correlation analysis between subtest scores of CERAD-K and a newly developed tablet computer-based digital cognitive test (Inbrain CST).

The prevalence of Alzheimer's disease (AD) and other dementias is increasing; therefore, identifying individuals at risk for dementia is crucial. Traditional neuropsychological assessments are expensive and time-consuming; however, computerized cognitive testing is becoming popular in clinical and research settings, particularly during the COVID-19 pandemic. This study aimed to investigate the correlation between the computerized cognitive test, Inbrain cognitive screening test (CST), and the traditional neuropsychological battery, the consortium to establish a registry for Alzheimer's disease assessment packet (CERAD-K). We enrolled 166 participants from five districts in Republic of Korea, including cognitively unimpaired individuals and those with mild cognitive impairment (MCI) diagnosed by experienced neurologists. We used the Inbrain CST and CERAD-K to evaluate the cognitive function of the participants, and the scores of each subtest of the Inbrain CST and CERAD-K were compared. A significant correlation was found between the Inbrain CST and CERAD-K subtests. Furthermore, multivariate analysis revealed a significant correlation between the Inbrain CST and the CERAD-K test pairs after adjusting for age, educational level, and sex. In conclusion, this study demonstrates that the Inbrain CST is a reliable tool for detecting cognitive impairment in cognitively unimpaired individuals and patients with MCI, because it has a high correlation and agreement with CERAD-K. Therefore, the Inbrain CST can be a useful, time-efficient, and cost-effective computer-based cognitive test for individuals at risk for cognitive impairment.

Age and sex effects on Super G performance are consistent across internet devices.

There have been recent advances in the application of online games that assess motor skill acquisition/learning and its relationship to age and biological sex, both of which are associated with dementia risk. While this online motor learning assessment (called Super G), along with other computer-based cognitive tests, was originally developed to be completed on a computer, many people (including older adults) have been shown to access the internet through a mobile device. Thus, to improve the generalizability of our online motor skill learning game, it must not only be compatible with mobile devices but also yield replicable effects of various participant characteristics on performance relative to the computer-based version. It is unknown if age and sex differentially affect game performance as a function of device type (keyboard versus touchscreen control). Thus, the purpose of this study was to investigate if device type modifies the established effects of age and sex on performance. Although there was a main effect of device on performance, this effect did not alter the overall relationship between performance vs. age or sex. This establishes that Super G can now effectively be extended to both computer and mobile platforms to further test for dementia risk factors.

Computer-based cognitive tests and cerebral pathology among Japanese older adults

BackgroundThis study aimed to identify the appropriate computer-based cognitive tests and cut-off values for estimating amyloid burden in preclinical Alzheimer’s disease drug trials.MethodsData from 103 older individuals, who underwent 18F-florbetapir positron emission tomography and cognitive testing, were analyzed. Cognitive tests evaluated word list memory (immediate recognition and delayed recall), attention (Trail Making Test-part A), executive function (Trail Making Test-Part B), and processing speed (Digit Symbol Substitution Test [DSST]).ResultsThe Aβ burden was significantly associated with word list memory (odds ratio [OR] = 0.42, 95% confidence interval [CI], 0.19–0.91) and DSST (OR = 0.35; 95% CI, 0.14–0.85). Positive predictive value and number needed to screen at a cut-off of 1.5 SD were better for word list memory and DSST among predictive values.ConclusionsThe computer-based memory and processing speed tests have the potential to reduce failure rates while screening individuals with Aβ accumulation in community settings.

Cognitive Impairment 13 Months After Hospitalization for COVID-19.

This study assessed cognitive function 13 months after hospital discharge for coronavirus disease 2019 (COVID-19), using computer-based cognitive tests. Compared to population norms, 14%–25% of patients were impaired in each dimension, and 53% had cognitive impairment in 1 or more of 4 tests. There was some association with acute COVID-19 disease severity.

Long-Term Effects of Drinking Water and Sweetened Beverages on Cognition of Schoolchildren – CogniDROP-II Study

ObjectivesAdequate fluid intake is essential for cognition. Our previous short-term motivational intervention study (CogniDROP I) showed that a water intake of 0.5–1.5 l in the morning had positive effects on selected parameters of cognition in schoolchildren. The aim of this CogniDROP II study was to determine whether long-term motivation also leads to more water consumption and how this affects cognition.Methods270 children (grades 5 & 6) from a comprehensive school in Germany participated in the randomized intervention trial. Children from 7 intervention classes were motivated by teaching staff to drink water during class breaks for 12 weeks; children from control classes were not. Drinking habits (drinking amount at school, type of drink) were recorded at the beginning and end of the study. At these time points, computer-based cognitive testing was performed for selective attention (switch task), working memory (2-back), visuospatial memory (corsi block), and inhibitory control (flanker). Analysis was performed using a general linear model (GLM) with repeated measures.ResultsThe intervention did not increase water consumption in intervention classes (0.88 ± 0.55 l vs. 1.0 ± 0.67 l) compared to control classes (1.09 ± 0.9 l vs. 1.12 ± 0.77 l). Accordingly, apart from a shorter reaction time for task switching in the intervention group (83.9 ± 23.0 s vs. 88.7 ± 25.4 s; p  =  0.04), no differences in cognition were observed. However, children who did not exclusively drink water at school but also sweetened beverages made more errors in the flanker (p = 0.03) and 2-back (p = 0.004) and showed poorer visuospatial memory.ConclusionsLong-term motivation of children to drink water is a major challenge, as is the assessment of their drinking habits at school. Therefore, no firm conclusions can be drawn from this study as to whether water consumption affects the cognition of schoolchildren in the long term. However, the type of beverage might play a role.Funding SourcesUniscientia Foundation, Vaduz, Liechtenstein

Impact of lunch with carbohydrates differing in glycemic index on children's cognitive functioning in the late postprandial phase: a randomized crossover study

PurposeStudies about effects of lunch dietary Glycemic Index (GI) on cognition of schoolchildren are scarce. Our previous CogniDo GI study found no changes of cognition in the early postprandial phase after consumption of two rice types with medium vs. high dietary GI for lunch (i.e., 45 min after starting lunch). This study investigated whether the dietary GI of lunch has an impact on cognition of schoolchildren in the late postprandial phase, 90 min after lunch.MethodsA randomized, 2 × 2 crossover intervention study was conducted at a comprehensive school with 5th and 6th grade students. Participants (n = 212) were randomly assigned to either sequence 1 or 2. In the first period, participants of sequence 1 received a dish with high GI rice (GI: 79), those of sequence 2 with medium GI rice (GI: 64)—in the second period, 1 week later, vice versa. Computer-based cognitive testing was performed 90 min after lunch examining tonic alertness, visual search and task switching, and working memory. Treatment effects and treatment effects adjusted for estimated lunch glycemic load (GL) were analyzed using a linear mixed model.ResultsThe selected cognitive parameters were not affected by the GI of lunch 90 min after lunch, neither after intention-to-treat nor in the per-protocol analysis. Adjustment for GL also did not change results.ConclusionThe present study revealed no notable differences after the consumption of two rice types with medium vs. high dietary GI for lunch in children’s cognitive function in the late postprandial phase, 90 min after lunch.Clinical trial registrationGerman Clinical Trials Register (DRKS00013597); date of registration: 16/04/2018, retrospectively registered.

76 PREDICTIVE MODEL FOR MOBILITY DECLINE: INDIVIDUAL TRIAL MISTAKE THRESHOLDS IN SUSTAINED ATTENTION TO RESPONSE TASK (SART)

Abstract Background The Sustained Attention to Response Task (SART) is a standard computer-based cognitive test designed to measure the sustained attention, fundamental for completing tasks that require supervision over time (Robertson et al., 1997). However, commonly used average features may result in loss of information and data misinterpretation, leading to inability to detect clinically expected associations (O’Halloran et al., 2014). Methods Here, we present a new method to visualise the full information obtained from the SART test, ordering by age, and categorising in groups based on mobility status in a large population-based study of ageing in Ireland. A new threshold, derived from the visualisation and based on the individual trial number of mistakes, was employed to individuate poorer SART performances, and to predict mobility and cognitive decline after 4 years in binary logistic regression models. Results Raw SART data were available for 4,864 participants aged 50 years and over at baseline. The new variable bad performances, expressing the number of SART trials with at least 4 mistakes, was the most significant predictor of mobility decline, defined as the transition from Timed Up-and-Go (TUG) < 12 to TUG ≥12 seconds (Odds Ratio (OR) = 1.29; 95% Confidence Interval (CI) 1.14–1.46; p < 0.001), and the only significant predictor of new falls (OR = 1.11; 95% CI 1.03–1.21; p = 0.011) compared to traditional SART variables in models adjusted for multiple covariates. No SART-related variables resulted significant predictors of cognitive decline, defined as a decrease of at least 2 points in the Mini-Mental State Examination (MMSE) score. Conclusion This multimodal visualisation and the new threshold approach could help clinicians to easily develop relevant hypotheses, and better identify subjects at higher risk of future mobility decline.

Does Acute Exercise Stress Affect Postural Stability and Cognitive Function in Subjects with Chronic Ankle Instability?

Altered postural control in people with chronic ankle instability (CAI) may be attributed to deficits that are associated with neurocognitive function. Acute training is another factor that may negatively affect postural control and increase the risk of ankle sprain. The purpose of this investigation was to determine the effect of acute exercise on postural stability and cognitive function among patients with CAI. Fifteen patients with CAI (aged 21.5 ± 2.0 years) and 15 healthy controls (aged 20.3 ± 1.7 years) completed a single-limb stance postural control test and a battery of computer-based cognitive tests before and after acute exercise. The overall stability index (OSI) was used as a measure of postural stability. The cognitive domains tested were global cognitive score, executive function, attention, visual-spatial perception, information processing, and fine motor control. Subjects in both groups had similar OSI scores, with a trend for reduced stability in the CAI after the exercise protocol (p = 0.053). There were no differences between the groups in all cognitive domains before or after exercise. Following exercise, the domains of overall cognitive score, visual-spatial perception, and information processing speed improved in both groups (p = 0.003, p = 0.033, p = 0.001; respectively). These findings should be considered with caution due to the heterogeneity of the CAI population.

Adulthood blood levels of hsa-miR-29b-3p associate with preterm birth and adult metabolic and cognitive health

Preterm birth (PTB) is associated with increased risk of type 2 diabetes and neurocognitive impairment later in life. We analyzed for the first time the associations of PTB with blood miRNA levels in adulthood. We also investigated the relationship of PTB associated miRNAs and adulthood phenotypes previously linked with premature birth. Blood MicroRNA profiling, genome-wide gene expression analysis, computer-based cognitive testing battery (CANTAB) and serum NMR metabolomics were performed for Young Finns Study subjects (aged 34–49 years, full-term n = 682, preterm n = 84). Preterm birth (vs. full-term) was associated with adulthood levels of hsa-miR-29b-3p in a fully adjusted regression model (p = 1.90 × 10–4, FDR = 0.046). The levels of hsa-miR-29b-3p were down-regulated in subjects with PTB with appropriate birthweight for gestational age (p = 0.002, fold change [FC] = − 1.20) and specifically in PTB subjects with small birthweight for gestational age (p = 0.095, FC = − 1.39) in comparison to individuals born full term. Hsa-miR-29b-3p levels correlated with the expressions of its target-mRNAs BCL11A and CS and the gene set analysis results indicated a target-mRNA driven association between hsa-miR-29b-3p levels and Alzheimer's disease, Parkinson's disease, Insulin signaling and Regulation of Actin Cytoskeleton pathway expression. The level of hsa-miR-29b-3p was directly associated with visual processing and sustained attention in CANTAB test and inversely associated with serum levels of VLDL subclass component and triglyceride levels. In conlcusion, adult blood levels of hsa-miR-29b-3p were lower in subjects born preterm. Hsa-miR-29b-3p associated with cognitive function and may be linked with adulthood morbidities in subjects born preterm, possibly through regulation of gene sets related to neurodegenerative diseases and insulin signaling as well as VLDL and triglyceride metabolism.

Evidence-Based Physiatry: The Center for Disease Control Guideline on Pediatric Mild Traumatic Brain Injury and the Expanded Role of Physiatry.

A mild traumatic brain injury (mTBI) or concussion is the most commonly occurring type of traumatic brain injury in adults and children. Between 2005 and 2009, the United States Center for Disease Control estimated 2–3 million pediatric mTBI-related emergency department and primary care visits occurred. Although there are subtle variation in definitions of mTBI, a consensus has formed around defining this injury as an acute neurological disturbance manifesting with confusion and/or disorientation after a mechanical force to the head and meeting the following parameters: (1) length of loss of consciousness of less than 30 mins; (2) posttraumatic amnesia less than 24 hrs; and (3) a Glasgow Coma Scale of 13–15, 30 mins after injury or at time of presentation to medical care. Guidelines have emerged to direct treatment of specific groups that commonly sustain mTBI, such as the Consensus Statement on Concussion in Sport directed at student athletes, the Ontario Neurotrauma Foundation guidelines for those with mTBI and persistent symptoms, and Veteran’s Affairs/Department of Defense guidelines for mTBI in military service members and veterans. However, evidence based guidelines for pediatric mTBI in the United States were lacking until the most recently published Center for Disease Control Guideline on the Diagnosis and Management of mTBI among Children (https://www.cdc.gov/media/releases/2018/p0904-tbi-guidelines.html).1 GUIDELINE DEVELOPMENT AND METHODOLOGY The new Center for Disease Control guideline is a set of 19 recommendations based on a systematic review of the literature and expert consensus. Clinical questions were developed by the Pediatric Mild Traumatic Brain Injury Work Group, a panel of experts that included rehabilitation specialists and physiatrists. Guidelines were developed in three clinical areas diagnosis, prognosis, and management/treatment. A systematic review of pediatric mTBI and related topics from 1990 to 2015 was conducted using the American Academy of Neurology Guidelines. Each recommendation was based on evidence obtained in the systematic review as well as other relevant scientific information and expert opinion deemed significant by the work group. This work considered strength of evidence as well as additional factors, such as the risks and benefits of the recommendation, importance of the recommendation, feasibility, patient preference, and financial cost. WHAT ARE THE HIGHLIGHTS IN THE NEW GUIDELINES? These guidelines outline a series of practical and feasible recommendations for emergency department, primary care, and specialty providers focusing on readily available mTBI assessment tools, early identification of poor prognostic factors, and education and active rehabilitation as mainstays of treatment. A complete list of recommendations is located in the guideline supplement and patient and family resources are available online (https://www.cdc.gov/traumaticbraininjury/PediatricmTBIGuideline.html).1 In summary, the guideline recommends against the routine use of neuroimaging or serum based biomarkers for diagnosis of mTBI, except when intracranial injury is suspected. Age-appropriate symptom inventories and computer-based cognitive testing should not be used alone but in conjunction with clinical assessment. In the area of prognosis, the guidelines strongly support education of patients and families about the general course of recovery in pediatric mTBI (1–3 mos) and risk factors that are associated with prolonged recovery (premorbid conditions, injury, and noninjury-related factors). Close monitoring of individuals with multiple risk factors for prolonged symptoms and referral to specialty care within 4–6 weeks of injury if symptoms persist. The guidelines strongly support education of patients and families regarding warning signs in the acute period, the emergence of postconcussive symptoms, prevention of a second, overlapping head injury, and guidance for return to school and activity. Although rest was once the mainstay of concussion treatment, the guideline emphasizes a brief period (2–3 days) of reduced activity in the acute period followed by a gradual return to school and noncontact physical activity that does not exacerbate symptoms. The guideline supports the use of individualized return to school plans based on symptom severity and highlights the importance of a collaborative effort in return to school recommendations. Referral specialists and formal neuropsychological testing is recommended in students struggling with return to school or with persistent cognitive symptoms, respectively. Treatment recommendations focus on multidisciplinary care and dedicated symptom-based treatments for acute and chronic headache, sleep dysfunction, and vestibular and oculomotor symptoms are provided. WHY IS THIS RELEVANT TO PHYSIATRISTS? Physiatrists are uniquely positioned to care for children with mTBI because of their role in leading multidisciplinary rehabilitation teams and their specific clinical expertise in pediatric rehabilitation, sports medicine, and traumatic brain injury. The guideline recommends referral to specialty and rehabilitation care in the early subacute period meaning that the number of children with mTBI referred to specialists, such as physiatry, will likely increase. The guideline supports a paradigm shift in the treatment of mTBI from a rest and recover model to an active rehabilitation, symptom-based approach including physical activity, cognitive activity, and specialized rehabilitation (i.e., vestibular). Such an approach is an ideal forum to leverage physiatric skills.

Relationship between Obesity and Cognitive Function in Young Women: The Food, Mood and Mind Study.

Limited research addresses links between obesity and cognitive function in young adults. Objective. To investigate the relationship between obesity and cognitive function in young women. Methods. This cross-sectional study recruited healthy, young (18–35 y) women of normal (NW: BMI = 18.5–24.9 kg·m−2) or obese (OB: BMI ≥ 30.0 kg·m−2) weight. Participants completed a validated, computer-based cognitive testing battery evaluating impulsivity, attention, information processing, memory, and executive function. Questionnaires on depression and physical activity and a fasting blood sample for C-reactive protein and the Omega-3 Index were also collected. Cognition data are presented as z-scores (mean ± SD), and group comparisons were assessed via ANOVA. Potential confounding from questionnaire and blood variables were evaluated using ANCOVA. Results. 299 women (NW: n = 157; OB: n = 142) aged 25.8 ± 5.1 y were enrolled. Cognition scores were within normal range (±1 z-score), but OB had lower attention (NW: 0.31 ± 1.38; OB: −0.25 ± 1.39; ES: 0.41, CI: 0.17–0.64; p < 0.001) and higher impulsivity (NW: 0.36 ± 1.14; OB: −0.07 ± 1.07; ES: 0.39, CI: 0.15–0.62; p=0.033). Confounder adjustment had minimal impact on results. Conclusion. The OB group had normal but significantly lower performance on attention and were more impulsive compared to NW participants. This may indicate early cognitive decline, but longitudinal research confirming these findings is warranted.

Cognitive performance in young adulthood and midlife: Relations with age, sex, and education-The Cardiovascular Risk in Young Finns Study.

Age, education, and sex associate with cognitive performance. We investigated associations between age, sex, education, and cognitive performance in young or middle-aged adults and evaluated data reduction methods to optimally capture cognitive performance in our population-based data. This study is part of the Cardiovascular Risk in Young Finns Study. The 3,596 randomly selected subjects (aged 3-18 years in 1980) have been followed up for 30 years. In 2011, a computer-based cognitive testing battery (the Cambridge Neuropsychological Test Automated Battery [CANTAB]) was used to assess several cognitive domains. Principal component analysis, categorical and standardized classifications were applied to the cognitive data. Among 34- to 49-year-old participants, cognitive performance declined with age, while education associated with better cognitive functions in several cognitive domains. Men had higher performance on all cognitive domains except visual or episodic memory, in which women outperformed men. The results were similar regardless of the data reduction method used. The associations between sex, age, education, and cognitive performance are already apparent in young adulthood or middle age. Principal component analyses, categorical and standardized classifications are useful tools to analyze CANTAB cognitive data. (PsycINFO Database Record

Validation of the CogState battery for rapid neurocognitive assessment in Ugandan school age children.

BackgroundCogState is a widely used computer-based cognitive test whose validity has not been addressed in resource poor settings. We examined the construct, concurrent and convergent validity of CogState, test–retest reliability and the effect of sociodemographic variables on CogState outcomes in school age children.MethodsTwo hundred and thirty Ugandan children (54% male) with mean age 6.99 years (SD = 1.67, range 5–13 years) were assessed using CogState, the Kaufman Assessment Battery for Children, 2nd edition (KABC-II) and the Test of Variables of Attention (TOVA) at baseline and 8 weeks later. Correlations were run between CogState and the KABC-II and TOVA to evaluate its concurrent and convergent validity. Factor analysis was used to evaluate construct validity of CogState. Correlations between baseline and 8 weeks CogState scores were used to determine the test–retest reliability while general linear models were used to assess associations with sociodemographic factors.ResultsSignificant correlations were observed between CogState’s One Card Learning, One Back Memory and Card Detection with the TOVA and between CogState’s Maze Chase and One Back Memory with KABC-II’s Simultaneous Processing. CogState had a three factor structure with Processing Speed, Processing Accuracy and Maze Chase and Maze Learning. CogState had low to moderate test–retest reliability in Ugandan children with correlations ranging from 0.32 to 0.57. Age, sex and education were associated with CogState outcomes.ConclusionsCogState is a valid and reliable test battery for rapid computer-based neurocognitive assessment in Ugandan children and can thus be used in this cultural context.Electronic supplementary materialThe online version of this article (doi:10.1186/s13034-015-0063-6) contains supplementary material, which is available to authorized users.

The Alzheimer's Prevention Clinic at Weill Cornell Medical College / New York - Presbyterian Hospital: Risk Stratification and Personalized Early Intervention.

In July 2013, Weill Cornell Medical College founded the first Alzheimer's Prevention Clinic (APC) in the United States, providing direct clinical care to family members of patients with Alzheimer's disease (AD) as part of the Weill Cornell Memory Disorders Program. At the APC, patients seeking to lower their AD risk undergo a comprehensive assessment, receive a personalized plan based on rapidly evolving scientific evidence, and are followed over time using validated as well as emerging clinical and research technologies. The APC approach applies the principles of pharmacogenomics, nutrigenomics and clinical precision medicine, to tailor individualized therapies for patients. Longitudinal measures currently assessed in the clinic include anthropometrics, cognition, blood biomarkers (i.e., lipid, inflammatory, metabolic, nutritional) and genetics, as well as validated, self-reported measures that enable patients to track several aspects of health-related quality of life. Patients are educated on the fundamental concepts of AD prevention via an interactive online course hosted on Alzheimer's Universe (www.AlzU.org), which also contains several activities including validated computer-based cognitive testing. The primary goal of the APC is to employ preventative measures that lower modifiable AD risk, possibly leading to a delay in onset of future symptoms. Our secondary goal is to establish a cohort of at-risk individuals who will be primed to participate in future AD prevention trials as disease-modifying agents emerge for testing at earlier stages of the AD process. The clinical services are intended to lower concern for future disease by giving patients a greater sense of control over their brain health.

Administration and Environment Considerations in Computer-Based Sports-Concussion Assessment

Computer-based testing has become a vital tool for the assessment of sport-related concussion (SRC). An increasing number of papers have been published on this topic, focusing on subjects such as the purpose and validity of baseline testing, the performance of special populations on computer-based tests, the psychometric properties of different computerized neurocognitive tools, and considerations for valid and reliable administration of these tools. The current paper describes several considerations regarding computerized test design, input and output devices, and testing environment that should be described explicitly when administering computer-based cognitive testing, regardless of whether the assessment is used for clinical or research purposes. The paper also reviews the conclusions of recent literature (2007-2013) using computer-based testing for the assessment of SRC, with special attention to the methods used in these studies. We also present an appendix checklist for clinicians and researchers that may be helpful in ensuring proper attention to factors that could influence the reliability and validity of computer-based cognitive testing. We believe that explicit attention to these technological factors may lead to the development of standards for the development and implementation of computer-based tests. Such standards have the potential to enhance the accuracy and utility of computer-based tests in SRC.

P85 Cognitive symptoms in chronic hepatitis C infection are associated with impaired cognitive test performance but are unrelated to peripheral markers of cellular immune activation

IntroductionPatients with hepatitis C virus (HCV) infection frequently complain of “brain fog” and impaired cognitive performance is well described in some patients. A direct virological effect of HCV on the...

Age-dependent discrepancies between computerized and paper cognitive testing in patients with schizophrenia

Computer-based cognitive testing is gaining in popularity because of desirable features such as ease of use, standardized administration and online data acquisition. Information technology and computer familiarity are clearly influenced by age in the general population, but the impact of this situation on cognitive testing of patients with schizophrenia has received little attention. In the present paper, participants underwent cognitive testing with computer and paper versions of the same tests. Patients underperformed controls by 1.36 DS (paper tests) and 2.27 DS (computer tests) after controlling for education. Results were highly correlated but patients with schizophrenia were disproportionately impaired on computer tests compared with their paper counterparts. Moreover, for subtests implying active keyboard input from the participant, the difference between paper and computer scores correlated with age in patients, a pattern that was not found in controls. These results have methodological implications because of the implied risk of measuring (lack of) computer proficiency in addition to bona fide cognitive deficits. They confirm, moreover, that patients with schizophrenia are victims of the "digital divide", which adds to the potential benefits of approaches like computer assisted cognitive remediation in this population.

Neurocognition in first‐degree healthy relatives (siblings) of bipolar affective disorder patients

Cognitive deficits have been presupposed to be endophenotypic markers in bipolar disorder, but few studies have ascertained the cognitive deficits in healthy relatives of bipolar disorder patients. The aim of the present study was to assess the cognitive functions of first-degree relatives of patients with bipolar disorder and compare them with healthy controls. Ten first-degree apparently healthy relatives of patients with bipolar disorder were compared with 10 age- and education-matched control subjects on computer-based cognitive tests. As compared to the control group, the relatives group performed significantly poorly on tests for executive function and vigilance, while on the test for working memory the performance was not significantly different on most of the parameters. Executive functioning and vigilance could be potential markers of the endophenotype in bipolar patients.