Validity of a novel computerized cognitive battery for mild cognitive impairment

Tzvi Dwolatzky, Victor Whitehead, Glen M Doniger, Ely S Simon, Avraham Schweiger, Dena Jaffe, Howard Chertkow, Tzvi Dwolatzky, Victor Whitehead, Glen M Doniger, Ely S Simon, Avraham Schweiger, Dena Jaffe, Howard Chertkow

Abstract

Background: The NeuroTrax Mindstreams computerized cognitive assessment system was designed for widespread clinical and research use in detecting mild cognitive impairment (MCI). However, the capability of Mindstreams tests to discriminate elderly with MCI from those who are cognitively healthy has yet to be evaluated. Moreover, the comparability between these tests and traditional neuropsychological tests in detecting MCI has not been examined.

Methods: A 2-center study was designed to assess discriminant validity of tests in the Mindstreams Mild Impairment Battery. Participants were 30 individuals diagnosed with MCI, 29 with mild Alzheimer's disease (AD), and 39 healthy elderly. Testing was with the Mindstreams battery and traditional neuropsychological tests. Receiver operating characteristic (ROC) analysis was used to examine the ability of Mindstreams and traditional measures to discriminate those with MCI from cognitively healthy elderly. Between-group comparisons were made (Mann-Whitney U test) between MCI and healthy elderly and between MCI and mild AD groups.

Results: Mindstreams outcome parameters across multiple cognitive domains significantly discriminated among MCI and healthy elderly with considerable effect sizes (p < 0.05). Measures of memory, executive function, visual spatial skills, and verbal fluency discriminated best, and discriminability was at least comparable to that of traditional neuropsychological tests in these domains.

Conclusions: Mindstreams tests are effective in detecting MCI, providing a comprehensive profile of cognitive function. Further, the enhanced precision and ease of use of these computerized tests make the NeuroTrax system a valuable clinical tool in the identification of elderly at high risk for dementia.

Figures

Figure 1
Figure 1
Discriminant Validity of Executive Function and Visual Spatial Tests. Receiver operating characteristic (ROC) curves demonstrating the ability of Mindstreams tests to discriminate individuals with mild cognitive impairment (MCI) from among cognitively healthy elderly as compared to traditional neuropsychological tests (MCI: N = 20; Healthy Elderly: N = 15). In (A), discriminability of the Mindstreams Go-NoGo performance index is compared with that of the Wechsler Adult Intelligence Scale, 3rd Edition (WAIS-III) Digit Symbol subtest. In (B), discriminability of accuracy on the Mindstreams Visual Spatial Imagery test is compared with that of the WAIS-III Block Design subtest. Discriminant validity of the Mindstreams tests was better than traditional paper-based tests designed to tap similar cognitive domains. AUC=area under the curve.
Figure 2
Figure 2
Discriminant Validity of Non-Verbal Memory Test. During the 'learning phase' of the Mindstreams Non-Verbal Memory test, four consecutive repetitions of a recognition test were administered. In (A), mean accuracy is shown across repetitions for cognitively healthy elderly (diamonds), mild cognitive impairment (MCI; squares), and mild Alzheimer's disease (AD; triangles) participants. (B) depicts mean performance (+ standard error) for each of the diagnostic groups on the final repetition trial. MCI participants are discriminable from healthy elderly and from those with mild AD (see Table 4).

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