Flexible Battery Approach Research Articles

CERAD-NAB and flexible battery based neuropsychological differentiation of Alzheimer’s dementia and depression using machine learning approaches

ABSTRACT Depression (DEP) and dementia of the Alzheimer’s type (DAT) represent the most common neuropsychiatric disorders in elderly patients. Accurate differential diagnosis is indispensable to ensure appropriate treatment. However, DEP can yet mimic cognitive symptoms of DAT and patients with DAT often also present with depressive symptoms, impeding correct diagnosis. Machine learning (ML) approaches could eventually improve this discrimination using neuropsychological test data, but evidence is still missing. We therefore employed Support Vector Machine (SVM), Naïve Bayes (NB), Random Forest (RF) and conventional Logistic Regression (LR) to retrospectively predict the diagnoses of 189 elderly patients (68 DEP and 121 DAT) based on either the well-established Consortium to Establish a Registry for Alzheimer’s Disease neuropsychological assessment battery (CERAD-NAB) or a flexible battery approach (FLEXBAT). The best performing combination consisted of FLEXBAT and NB, correctly classifying 87.0% of patients as either DAT or DEP. However, all accuracies were similar across algorithms and test batteries (83.0% – 87.0%). Accordingly, our study is the first to show that common ML algorithms with their default parameters can accurately differentiate between patients clinically diagnosed with DAT or DEP using neuropsychological test data, but do not necessarily outperform conventional LR.

DEPRESSIVE SYMPTOMATOLOGY PREDICTS WILLINGNESS TO PARTICIPATE IN CLINICAL TRIALS

Despite the recent advances in scientific methodologies, technologies, and knowledge about the neurodegenerative disease process, there haven't been any new treatments approved for AD since 2004. One significant limitation is the lack of available research participants who are willing to participate in clinical trials. Several factors have been cited, such as diagnosis, emotional factors, and lack of knowledge about research. The goal of this study was to assess the willingness of patients to participate in clinical research after a multidisciplinary team evaluation and education about clinical trials. The memory clinic located at PAREXEL Los Angeles Early Phase Clinical Unit is a community-based center that has evaluated approximately 240 patients since its inception in 2016. Patients are referred from a variety of sources to evaluate memory and cognitive function. We offer comprehensive neuropsychological evaluations in multiple languages, using a flexible battery approach depending on the nature of the referral question. For this analysis, we used the Repeatable Battery for Neuropsychological Status Total Scale Score as a measure of global cognitive abilities and the Geriatric Depression Scale as a proxy for mood. At the completion of the evaluation, 126 patients evaluated through the memory clinic were willing to hear about opportunities for research participation versus 19 patients who declined. We found that those who scored higher on the GDS (p<.01) were less willing to learn about opportunities for research participation. Cognitive performance only accounted for 2% of the variance a logistic regression and was not a significant predictor of willingness to participate in research. The results highlight that willingness to participate in research maybe largely mediated by mood factors more so than degree of cognitive impairment. Depressive symptoms in older adults maybe a target of intervention when discussing opportunities about clinical trials in AD.

Following international trends while subject to past traditions: neuropsychological test use in the Nordic countries

Objective: Historically, the neuropsychological test traditions of the four Nordic countries have spanned from the flexible and qualitative tradition of Luria-Christensen to the quantitative large battery approach of Halstead and Kløve–Matthews. This study reports current test use and discusses whether these traditions still influence attitudes toward test use and choice of tests. Method: The study is based on survey data from 702 Nordic neuropsychologists. Results: The average participant used 9 tests in a standard assessment, and 25 tests overall in their practice. Test use was moderated by nationality, competence level, practice profile, and by attitude toward test selection. Participants who chose their tests flexibly used fewer tests than those adhering to the flexible battery approach, but had fewer tests from which to choose. Testing patients with psychiatric disorders was associated with using more tests. IQ, memory, attention, and executive function were the domains with the largest utilization rate, while tests of motor, visual/spatial, and language were used by few. There is a lack of academic achievement tests. Screening tests played a minor role in specialized assessments, and symptom validity tests were seldom applied on a standard basis. Most tests were of Anglo-American origin. Conclusions: New test methods are implemented rapidly in the Nordic countries, but test selection is also characterized by the dominating position of established and much researched tests. The Halstead–Reitan and Luria traditions are currently weak, but national differences in size of test batteries seem to be influenced by these longstanding traditions.

Perspectives on Energy Storage for Flexible Electronic Systems

If truly thin embedded and human worn flexible electronics are to become a commercial reality for wearable electronics, medical devices, and internet of things tags, effective energy storage technologies that safely and robustly match the mechanical flexibility of the overall system form factor are required. At the same time, the energy and transient power needs of functions such as wireless connectivity, information display, and high sample rate sensing must be supported. These capabilities have time-dependent power and current requirements often not captured in simple energy and capacity metrics. In this paper, a progression of energy storage approaches, challenges and learning experiences will be presented from the perspective of an energy storage technology developer. The essential requirements for energy storage for feature-driven applications in flexible electronics are addressed with the goal of finding the most compelling fit between products needs, consumer safety and the technology capabilities of different energy storage approaches. Micropower modules from supercapacitors to microbatteries and their limitations for flexible electronics will be discussed in terms of capacity, power and charge retention as the starting point. Following this discussion, limitations of lithium technologies in this flexible and thin ( $ 1 mm) application space are also outlined. This paper then presents a review of key requirements for energy storage for high functionality flexible electronics prototype systems and some approaches that have been explored to meet those needs. This leads to the conclusion that safe, low cost, flexible electronics energy storage requirements may be most appropriately met using intrinsically stable battery chemistry. Furthermore, such a materials approach allows for simpler lower cost processing and packaging, such as additive printing and roll to roll processing of thin and therefore more mechanically flexible cells. Examples and performance data from such a zinc polymer battery technology are given and compared to other thin and flexible battery approaches.

Using the Halstead–Reitan Battery to Diagnose Brain Damage: A Comparison of the Predictive Power of Traditional Techniques to Rohling’s Interpretive Method

The aim of this project was to validate an alternative global measure of neurocognitive impairment (Rohling Interpretive Method, or RIM) that could be generated from data gathered from a flexible battery approach. A critical step in this process is to establish the utility of the technique against current standards in the field. In this paper, we compared results from the Rohling Interpretive Method to those obtained from the General Neuropsychological Deficit Scale (GNDS; Reitan & Wolfson, 1988) and the Halstead–Russell Average Impairment Rating (AIR; Russell, Neuringer & Goldstein, 1970) on a large previously published sample of patients assessed with the Halstead–Reitan Battery (HRB). Findings support the use of the Rohling Interpretive Method in producing summary statistics similar in diagnostic sensitivity and specificity to the traditional HRB indices.

A statistical interpretive method for neuropsychological test data.

The accurate interpretation of large numbers of neuropsychological tests within a flexible battery approach is a difficult and sometimes controversial process. We present a statistically based method of interpretation (Rohling's Interpretive Method or RIM) and evaluation of neuropsychological data that allows for varying numbers of tests along a varying number of cognitive domains, yet remains psychometrically based. This method requires informed clinical judgment in that the level of confidence for tests, cognitive domains, and global indices are used as the backdrop for interpretive decisions. Specific procedures for use are presented in a systematic, detailed fashion to allow the interested reader to replicate the method. Two case examples are presented: a straightforward case of cerebrovascular insult and a more complicated case of mixed etiology. Examples include a variety of different neuropsychological tests commonly used in a flexible battery approach. A discussion of the practicality, ease of use, and potential limitations of this method are further presented.

Generating a linear function for residual impairment for TBI: a comparison of the HRB and a flexible battery approach

Generating a linear function for residual impairment for TBI: a comparison of the HRB and a flexible battery approach

Five-year follow-up survey of practices and beliefs of clinical neuropsychologists

Abstract Following up on a national survey by Sweet and Moberg (1990), a 21-item questionnaire was mailed to all current ABPP Diplomates in clinical neuropsychology and a comparable number of randomly selected non-ABPP members of Division 40 (Clinical Neuropsychology) of the American Psychological Association. Despite some shifts in training beliefs, the Ph.D. degree in clinical psychology remains prevalent, with a majority now also receiving additional postdoctoral training, whether board-certified or not. Seemingly in response to health-care economic changes, there is now a clear shift of all clinical neuropsychologists toward less involvement in research and teaching activities, and an increased number of clinical hours per week. Across 5 years, the flexible battery approach has gained even more popularity (61%), and the standardized battery approach has declined still further (14%). Use of technicians/psychometricians or some other type of assistant to gather test data, although still common (59%), has declined. Although often viewed as a discipline engaged only in assessment, 64% of clinical neuropsychologists also treat patients with brain dysfunction. Additional findings of the present survey are reported and contrasted with the previous survey.

Standardized and flexible batteries in neuropsychology: An assessment update

This article summarizes current literature relevant to commonly used tests and test batteries in clinical neuropsychology. The first section contains a discussion of the philosophy and relative advantages of standardized and flexible battery approaches in neuropsychology. The second contains historical background and a literature review of the two major standardized test batteries: the Halstead-Reitan and Luria-Nebraska. The third section includes reviews of tests that are frequently used in the flexible battery approach. Various tests of intellectual functioning, attention, memory, language, and spatial analyses are critiqued in this section. Contributions of the process approach are noted. The article ends by underscoring the need for continued research into the nature of neuropsychological measures and the abilities they assess.