A Remote Digital Memory Composite to Detect Cognitive Impairment in Memory Clinic Samples in Unsupervised Settings using Mobile Devices

INTRODUCTION: Mobile app-based unsupervised monitoring of cognition holds the promise to facilitate case-finding in clinical care and the individual detection of cognitive impairment in clinical and research settings. In the context of Alzheimer's disease, this is particularly relevant for patients who seek medical advice due to memory complaints. OBJECTIVE: We developed a Remote Digital Memory Composite score from an unsupervised remote and mobile cognitive assessment battery focused on episodic memory and long-term recall and assessed its construct validity using a neuropsychological composite score for early cognitive impairment in Alzheimer's disease, the Preclinical Alzheimer's Cognitive Composite (PACC5). We also assessed the test-retest reliability of the Remote Digital Memory Composite score across two independent test sessions. Finally, we assessed the diagnostic accuracy of the remote and unsupervised cognitive assessment battery when predicting PACC5-based cognitive impairment in a memory clinic sample and healthy controls. SETTING: This was an add-on study of the DZNE-Longitudinal Cognitive Impairment and Dementia Study (DELCODE) which was also performed in a separate memory clinic-based sample. PARTICIPANTS A total of 102 study participants were included as healthy controls (HC; n=25), cognitively unimpaired first-degree relatives of AD patients (REL; n=7), individuals with subjective cognitive decline (SCD; n= 48) or patients with mild cognitive impairment (MCI; n=22). MEASUREMENTS: We analyzed results from the objects-in-rooms recall (ORR) test, the mnemonic discrimination for objects and scenes (MDT-OS) test and the complex scene recognition (CSR) test implemented on the neotiv digital platform to derive a Remote Digital Memory Composite. Participants used the neotiv mobile app to complete one unsupervised test session every two weeks on their own mobile device in an environment of their choice. We assessed the relationships of the Remote Digital Memory Composite acquired through the mobile app and in-clinic measures of the PACC5 conducted by trained neuropsychologists in the memory clinics participating in the DELCODE study. RESULTS: 102 participants provided technically complete data for at least one single session of each of the three test paradigms, of which 87 participants provided data from at least two test sessions of each task. The derived Remote Digital Memory Composite score was highly correlated with the PACC5 score across all participants (r=.75, p<0.001), and also in those without complaints (HC and REL, r=.51, p=0.003) and those with complaints separately (SCD and MCI, r=.76, p<0.001). Good test-retest reliability for the Remote Digital Memory Composite score was observed in those with at least two assessments of the three tests. (r=.74; p<.0001). Diagnostic accuracy for discriminating PACC5-based memory impairment from no impairment was high (AUC = 0.9) with a sensitivity of 0.83 and a specificity of 0.74. CONCLUSION: Our results indicate that unsupervised mobile cognitive assessments in a memory clinic setting using the implementation in the neotiv digital platform has high construct validity and results in a good discrimination between cognitively impaired and unimpaired individuals based on the PACC5 score. Thus, it is feasible to complement neuropsychological assessment of episodic memory with unsupervised, remote assessments on mobile devices. This contributes to recent efforts for implementing remotely performed episodic memory assessment for case-finding and monitoring in large research trials and clinical care.

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Clinical value of the Montreal Cognitive Assessment (MoCA) in patients suspected of cognitive impairment in old age psychiatry. Using the MoCA for triaging to a memory clinic

Cognitive Neuropsychiatry ◽

10.1080/13546805.2020.1850434 ◽

2020 ◽

pp. 1-17

Author(s):

Géraud Dautzenberg ◽

Jeroen Lijmer ◽

Aartjan Beekman

Keyword(s):

Cognitive Impairment ◽

Old Age ◽

Cognitive Assessment ◽

Montreal Cognitive Assessment ◽

Memory Clinic ◽

Clinical Value ◽

Old Age Psychiatry

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Validity and Reliability of Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS) in Indonesia and the Correlation with Quality of Life

Neurology Research International ◽

10.1155/2019/4290352 ◽

2019 ◽

Vol 2019 ◽

pp. 1-7

Author(s):

Riwanti Estiasari ◽

Yuhyi Fajrina ◽

Diatri Nari Lastri ◽

Syarli Melani ◽

Kartika Maharani ◽

...

Keyword(s):

Quality Of Life ◽

Multiple Sclerosis ◽

Cognitive Impairment ◽

Cognitive Function ◽

Cognitive Assessment ◽

Verbal Learning ◽

Retest Reliability ◽

Cognitive Evaluation ◽

Test Retest Reliability

Introduction. Multiple Sclerosis (MS) can affect cognitive function that might interfere with quality of life. Processing speed and memory are the most common area of cognitive impairment. Cognitive evaluation in daily practice is often difficult to be performed since it needs neuropsychological expert and is time-consuming. Brief International Cognitive Assessment for MS (BICAMS) is valid and practical for cognitive evaluation. This study aims to validate BICAMS in Indonesian MS patients and healthy controls (HC) and to analyse the effect of cognitive impairment on quality of life. Methods. BICAMS, which composes Symbol Digits Modalities Test (SDMT), California Verbal Learning Test-Second Edition (CVLT-II), and Brief Visuospatial Memory Test-Revised (BVMT-R), was translated and cross-culturally adapted to Indonesian from the original BICAMS and then administered to 40 Indonesian MS patients and 66 HC matched by sex, age, and education. Test-retest reliability was performed on 16-MS patients and 42 HC. Quality of life was measured using Multiple Sclerosis Quality of Life (MSQOL-54) instrument. Results. The SDMT, CVLT-II, and BVMT-R score in MS patients were significantly lower than those in HC (effect size, r: 0.61, 0.36, and 0.47, respectively). Test-retest reliability for all tests was satisfactory with correlation coefficient for SDMT, CVLT-II, and BVMT-R in MS subjects 0.86, 0.81, and 0.83, respectively. Using 5th percentile of HC score as cut-off, 15% MS subjects had impairment in one test, 27.5% in two tests, and 40% in three tests. BICAMS was moderately correlated with EDSS but was not correlated with disease duration and relapse rate. SDMT score correlated with physical function and physical and mental role limitation. Conclusion. BICAMS is valid and reliable for assessing cognitive function of Indonesia MS patients.

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Short Montreal Cognitive Assessment

Journal of Geriatric Psychiatry and Neurology ◽

10.1177/0891988716673469 ◽

2016 ◽

Vol 30 (2) ◽

pp. 104-108 ◽

Cited By ~ 14

Author(s):

A. J. Larner

Keyword(s):

Cognitive Impairment ◽

Cognitive Assessment ◽

Computerized Adaptive Testing ◽

Montreal Cognitive Assessment ◽

Test Accuracy ◽

Cognitive Screening ◽

Memory Clinic ◽

Subjective Memory ◽

Index Study ◽

Diagnosis Of Dementia

The diagnostic accuracy of the short Montreal Cognitive Assessment (s-MoCA), a cognitive screening instrument recently derived by item response theory and computerized adaptive testing from the original MoCA, for the diagnosis of dementia and mild cognitive impairment (MCI) was assessed in 2 patient cohorts referred to a dedicated memory clinic in order to examine the validity and reproducibility of s-MoCA. Diagnosis used standard clinical diagnostic criteria for dementia and MCI as reference standard (prevalence of cognitive impairment = 0.43 and 0.46 in each cohort, respectively). There were significant differences in s-MoCA test scores for dementia, MCI, and subjective memory impairment ( P ≤ .01), and s-MoCA effect sizes (Cohen d) were medium to large (range: 0.65-1.42) for the diagnosis of dementia and MCI. Using the cut-off for s-MoCA specified in the index study, it proved highly sensitive (>0.9) for diagnosis of dementia but with poor specificity (≤0.25), with moderate sensitivity (≥0.75) and specificity (≥0.60) for diagnosis of MCI. In conclusion, in these pragmatic diagnostic test accuracy studies, s-MoCA proved acceptable and sensitive for the diagnosis of cognitive impairment in a memory clinic setting, with a performance similar to that of the original MoCA.

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A self-administered, artificial intelligence (AI) platform for cognitive assessment in multiple sclerosis (MS)

10.21203/rs.2.10768/v5 ◽

2020 ◽

Cited By ~ 1

Author(s):

Seyed-Mahdi Khaligh-Razavi ◽

Maryam Sadeghi ◽

Mahdiyeh Khanbagi ◽

Chris Kalafatis ◽

Seyed Massood Nabavi

Keyword(s):

Multiple Sclerosis ◽

Cognitive Impairment ◽

Cognitive Dysfunction ◽

Cognitive Assessment ◽

Cognitive Rehabilitation ◽

Convergent Validity ◽

Strong Association ◽

Therapeutic Interventions ◽

Retest Reliability ◽

Test Retest Reliability

Abstract Background Cognitive impairment is common in patients with multiple sclerosis (MS). Accurate and repeatable measures of cognition have the potential to be used as markers of disease activity. Methods We developed a 5-minute computerized test to measure cognitive dysfunction in patients with MS. The proposed test – named the Integrated Cognitive Assessment (ICA) – is self-administered and language-independent. 91 MS patients and 83 healthy controls (HC) took part in Substudy 1, in which each participant took the ICA test and the Brief International Cognitive Assessment for MS (BICAMS). We assessed ICA’s test-retest reliability, its correlation with BICAMS, its sensitivity to discriminate patients with MS from the HC group, and its accuracy in detecting cognitive dysfunction. In Substudy 2, we recruited 48 MS patients, 38 of which had received an 8-week physical and cognitive rehabilitation programme and 10 MS patients who did not. We examined the association between the level of serum neurofilament light (NfL) in these patients and their ICA scores and Symbol Digit Modalities Test (SDMT) scores pre- and post-rehabilitation. Results The ICA demonstrated excellent test-retest reliability (r=0.94), with no learning bias, and showed a high level of convergent validity with BICAMS. The ICA was sensitive in discriminating the MS patients from the HC group, and demonstrated high accuracy (AUC = 95%) in discriminating cognitively normal from cognitively impaired participants. Additionally, we found a strong association (r=-0.79) between ICA score and the level of NfL in MS patients before and after rehabilitation. Conclusions The ICA has the potential to be used as a digital marker of cognitive impairment and to monitor response to therapeutic interventions. In comparison to standard cognitive tools for MS, the ICA is shorter in duration, does not show a learning bias, and is independent of language.

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Screening utility of the Montreal Cognitive Assessment (MoCA): in place of – or as well as – the MMSE?

International Psychogeriatrics ◽

10.1017/s1041610211001839 ◽

2011 ◽

Vol 24 (3) ◽

pp. 391-396 ◽

Cited By ~ 117

Author(s):

A. J. Larner

Keyword(s):

Cognitive Impairment ◽

Cognitive Assessment ◽

Characteristic Curve ◽

The Elderly ◽

Montreal Cognitive Assessment ◽

Test Accuracy ◽

Diagnostic Utility ◽

Memory Clinic ◽

Index Study ◽

In Series

ABSTRACTBackground: This aim of this study was to assess the clinical utility of the Montreal Cognitive Assessment (MoCA) as a screening instrument for cognitive impairment in patients referred to a memory clinic, alone and in combination with the Mini-Mental State Examination (MMSE).Methods: This was a pragmatic prospective study of consecutive referrals attending a memory clinic (n = 150) over an 18-month period. Patients were diagnosed using standard clinical diagnostic criteria for dementia (DSM-IV) and mild cognitive impairment (MCI; cognitive impairment prevalence = 43%) independent of MoCA test scores.Results: MoCA proved acceptable to patients and was quick and easy to use. Using the cut-offs for MoCA and MMSE specified in the index paper (≥26/30), MoCA was more sensitive than MMSE (0.97 vs 0.65) but less specific (0.60 vs 0.89), with better diagnostic accuracy (area under Receiver Operating Characteristic curve 0.91 vs 0.83). Downward adjustment of the MoCA cut-off to ≥20/30 maximized test accuracy and improved specificity (0.95) for some loss of sensitivity (0.63). Combining MoCA with the MMSE – either in series or in parallel – did not improve diagnostic utility above that with either test alone.Conclusions: In a memory clinic population, MoCA proved sensitive for the diagnosis of cognitive impairment. Use of a cut-off lower than that specified in the index study may be required to improve overall test accuracy and specificity for some loss of sensitivity in populations with a high prior probability of cognitive impairment. Combining the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) with the MMSE did not improve diagnostic utility.

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A self-administered, artificial intelligence (AI) platform for cognitive assessment in multiple sclerosis (MS)

10.21203/rs.2.10768/v4 ◽

2020 ◽

Author(s):

Seyed-Mahdi Khaligh-Razavi ◽

Maryam Sadeghi ◽

Mahdiyeh Khanbagi ◽

Chris Kalafatis ◽

Seyed Massood Nabavi

Keyword(s):

Multiple Sclerosis ◽

Cognitive Impairment ◽

Cognitive Dysfunction ◽

Cognitive Assessment ◽

Cognitive Rehabilitation ◽

Convergent Validity ◽

Strong Association ◽

Therapeutic Interventions ◽

Retest Reliability ◽

Test Retest Reliability

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The Montreal Cognitive Assessment is superior to the Mini–Mental State Examination in detecting patients at higher risk of dementia

International Psychogeriatrics ◽

10.1017/s1041610212001068 ◽

2012 ◽

Vol 24 (11) ◽

pp. 1749-1755 ◽

Cited By ~ 73

Author(s):

YanHong Dong ◽

Wah Yean Lee ◽

Nur Adilah Basri ◽

Simon Lowes Collinson ◽

Reshma A. Merchant ◽

...

Keyword(s):

Cognitive Impairment ◽

Mental State ◽

Cognitive Assessment ◽

Discriminant Validity ◽

Mini Mental State Examination ◽

Montreal Cognitive Assessment ◽

Memory Clinic ◽

Clinic Setting ◽

Incident Dementia ◽

State Examination

ABSTRACTBackground: To examine the discriminant validity of the Montreal Cognitive Assessment (MoCA) and the Mini-Mental State Examination (MMSE) in detecting patients with cognitive impairment at higher risk for dementia at a memory clinic setting.Methods: Memory clinic patients were administered the MoCA, MMSE, and a comprehensive formal neuropsychological battery. Mild cognitive impairment (MCI) subtypes were dichotomized into two groups: single domain–MCI (sd–MCI) and multiple domain-MCI (md–MCI). Area under the receiver operating characteristic curve (ROC) analysis was used to compare the discriminatory ability of the MoCA and the MMSE.Results: Two hundred thirty patients were recruited, of which 136 (59.1%) were diagnosed with dementia, 61 (26.5%) with MCI, and 33 (14.3%) with no cognitive impairment (NCI). The majority of MCI patients had md–MCI (n = 36, 59%). The MoCA had significantly larger AUCs than the MMSE in discriminating md–MCI from the lower risk group for incident dementia (NCI and sd–MCI) [MoCA 0.92 (95% CI, 0.86–0.98) vs. MMSE 0.84 (95% CI, 0.75–0.92), p = 0.02). At their optimal cut-off points, the MoCA (19/20) remained superior to the MMSE (23/24) in detecting md–MCI [sensitivity: 0.83 vs. 0.72; specificity: 0.86 vs. 0.83; PPV: 0.79 vs. 0.72; NPV: 0.89 vs. 0.83; correctly classified: 85.1% vs. 78.7%].Conclusion: The MoCA is superior to the MMSE in the detection of patients with cognitive impairment at higher risk for incident dementia at a memory clinic setting.

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Depressive Symptoms Negatively Impact Montreal Cognitive Assessment Performance: A Memory Clinic Experience

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/cjn.2015.399 ◽

2016 ◽

Vol 43 (4) ◽

pp. 513-517 ◽

Cited By ~ 7

Author(s):

Mervin Blair ◽

Kristy Coleman ◽

Sarah Jesso ◽

Véronique Desbeaumes Jodoin ◽

Kathy Smolewska ◽

...

Keyword(s):

Cognitive Impairment ◽

Depressive Symptoms ◽

Cognitive Assessment ◽

Screening Tool ◽

Depressive Symptomatology ◽

Negative Impact ◽

Montreal Cognitive Assessment ◽

Cognitive Screening ◽

Memory Clinic ◽

The Impact

AbstractObjective:The Montreal Cognitive Assessment (MoCA) is a general cognitive screening tool that has shown sensitivity in detecting mild levels of cognitive impairment in various clinical populations. Although mood dysfunction is common in referrals to memory clinics, the influence of mood on the MoCA has to date been largely unexplored.Method:In this study, we examined the impact of mood dysfunction on the MoCA using a memory clinic sample of individuals with depressive symptoms who did not meet criteria for a neurodegenerative disease.Results:Half of the group with depressive symptoms scored below the MoCA-suggested cutoff for cognitive impairment. As a group, they scored below healthy controls, but above individuals with Alzheimer’s disease and frontotemporal dementia. A MoCA subtask analysis revealed a pattern of executive/attentional dysfunction in those with depressive symptoms.Conclusions:This observed negative impact of depressive symptomatology on the MoCA has interpretative implications for its utility as a cognitive screening tool in a memory clinic setting.

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Development of a computerized tool for the chinese version of the montreal cognitive assessment for screening mild cognitive impairment

International Psychogeriatrics ◽

10.1017/s1041610214002269 ◽

2014 ◽

Vol 27 (2) ◽

pp. 213-219 ◽

Cited By ~ 2

Author(s):

Ke Yu ◽

Shangang Zhang ◽

Qingsong Wang ◽

Xiaofei Wang ◽

Yang Qin ◽

...

Keyword(s):

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Cognitive Assessment ◽

Intraclass Correlation ◽

Montreal Cognitive Assessment ◽

Elderly Chinese ◽

Item Scores ◽

Highly Correlated ◽

Test Retest Reliability ◽

Machine Interaction

ABSTRACTBackground:The Montreal Cognitive Assessment (MoCA) is used for screening mild cognitive impairment (MCI), and the Beijing version (MoCA-BJ) is widely used in China. We aimed to develop a computerized tool for MoCA-BJ (MoCA-CC).Methods:MoCA-CC used person-machine interaction instead of patient-to-physician interaction; other aspects such as the scoring system did not differ from the original test. MoCA-CC, MoCA-BJ and routine neuropsychological tests were administered to 181 elderly participants (MCI = 96, normal controls [NC] = 85).Results:A total of 176 (97.24%) participants were evaluated successfully by MoCA-CC. Cronbach's α for MoCA-CC was 0.72. The test–retest reliability (retesting after six weeks) was good (intraclass correlation coefficient = 0.82; P < 0.001). Significant differences were observed in total scores (t = 9.38, P < 0.001) and individual item scores (t = 2.18–8.62, P < 0.05) between the NC and MCI groups, except for the score for “Naming” (t = 0.24, P = 0.81). The MoCA-CC total scores were highly correlated with the MoCA-BJ total scores (r = 0.93, P < 0.001) in the MCI participants. The area under receiver–operator curve for the prediction of MCI was 0.97 (95% confidence interval = 0.95–1.00). At the optimal cut-off score of 25/26, MoCA-CC demonstrated 95.8% sensitivity and 87.1% specificity.Conclusion:The MoCA-CC tool developed here has several advantages over the paper-pencil method and is reliable for screening MCI in elderly Chinese individuals, especially in the primary clinical setting. It needs to be validated in other diverse and larger populations.

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