Scientific Publications

Our findings demonstrate the added utility of the DCR, an automated, process-driven, and process-based digital cognitive assessment when compared to the Mini-Cog, a commonly used tool that relies on fixed clock scoring rules. We additionally demonstrated variability in manually scoring the Mini-Cog, even among experts. Digital process-based metrics capture dynamic processes in clock drawing and perform better in detecting cognitive impairment in a diagnosed research cohort of older individuals.

The digital speech hearing screener (dSHS) successfully differentiates between hearing impaired and unimpaired individuals in under 3 minutes. This hearing screener offers a time saving, in clinic hearing screening to streamline the triage of those with likely hearing impairment to the appropriate follow up assessment, thereby improving the quality of services. Additionally, this tool can help to rule out hearing impairment as a cause or confounder of cognitive impairment.

We discuss the current advances and future directions in capturing individualized brain health outcomes and present an approach to integrate person-centered outcome in a scalable manner. Our approach stems from the evidence-based electronic Person-Specific Outcome Measure (ePSOM) program which prompts an individual to define personally meaningful treatment priorities and report level of confidence in managing items that matter to the individual the most.

Digital assessment technology elegantly quantifies occult, nuanced behavior not previously appreciated, operationally defines critical underlying neurocognitive constructs related to functional abilities, and yields selected process-based scores that outperform traditional paper/pencil test scores for participant classification. When brought to scale, the Linus Health dTMT-B test could be a sensitive tool to detect subtle-to-mild functional deficits in emergent neurodegenerative illnesses.

This research demonstrates the DCTclock’s ability to estimate the 5-year risk of developing dementia in an African American population. Early detection of elevated dementia risk using the DCTclock could provide patients, caregivers, and clinicians opportunities to plan and intervene early to improve cognitive health trajectories. Early detection of dementia risk can also enhance participant selection in clinical trials while reducing screening costs.

Multimodal models incorporating graphomotor, memory, and speech and voice features provided the stronger classification performance. Multimodal models were superior to all other single modality and demographics models. The current research contributes to the prevailing multimodal profile of those with cognitive impairment, suggesting that it is associated with slower speech with a particular effect on the duration, frequency, and percentage of pauses compared to normal healthy speech.

The CCE is a powerful neurocognitive assessment tool that is sensitive to patient’s subjective concerns about possible decline in memory, mood symptoms, possible cognitive impairment, and cardiovascular risk. iPad administration ensures total reliability for test administration and scoring. The CCE is easily deployable in outpatient ambulatory primary care settings.

Command digit misplacement is negatively associated with semantics, visuospatial, visuoconstructional, and reasoning and negatively associated with connectivity from the basal nucleus of Meynert (BNM) to the anterior cingulate cortex (ACC). Individuals with MCI had more misplacement and less BNM-ACC connectivity. Total completion time involved posterior and cerebellar associations only. Findings suggest clock drawing digit placement accuracy may be a unique metric of mental planning and provide insight into neurodegenerative disease.

dCDT composite scores were significantly associated with multiple brain MRI measures in a large community-based cohort. The dCDT has the potential to be used as a cognitive assessment tool in the clinical diagnosis of MCI.

These results suggest that DCTclock command/copy parameters can dissociate CN, SbCI, and MCI subtypes. The larger effect sizes for command clock indices suggest these metrics are sensitive in detecting early cognitive decline. Additional research with a larger sample is warranted.

DCTclock discriminates between diagnostic groups and improves upon traditional cognitive tests for detecting biomarkers of amyloid and tau pathology in CN older adults. The validation of such digitized measures has the potential of providing an efficient tool for detecting early cognitive changes along the AD trajectory.

We benchmarked DCTclock against existing clock scoring systems and the Mini-Mental Status Examination, a widely-used but lengthier cognitive test, and showed that DCTclock offered a significant improvement in the detection of early cognitive impairment and the ability to characterize individuals along the Alzheimer's disease trajectory. This offers an example of a robust framework for creating digital biomarkers that can be used clinically and in research for assessing neurological function.

The dCDT can potentially be used as a tool for cognitive assessment in large community-based populations.

The use of quantitative digital cognitive assessment showed greater sensitivity in identifying subtle cognitive decline than the current standardized tests. Differences in cognitive profiles were observed based on genotype. The identification of early cognitive decline may improve the clinical management of PD patients and be useful for cognitive related clinical trials.

The dCDT is able to operationally define graphomotor output that cannot be measured using traditional paper and pencil test administration in older health controls and participants with dementia. These data suggest that kinematic, time-based, and visuospatial behavior obtained using the dCDT may provide additional neurocognitive biomarkers that may be able to identify and tract dementia syndromes.

Digitally-acquired clock drawing profiles differ between PD and non-PD peers, and distinguish PD cognitive phenotypes.

Clock drawing construction slowed for nearly one-quarter of patients after total knee atrthroplasty (TKA) surgery, whereas nonsurgery peers showed the expected practice effect, ie, speed increased from baseline to follow-up time points. Future research should investigate the neurobiological basis for these changes after TKA.

Longer age-related decision making latencies may reflect a greater need for working memory and increased self-monitoring in older subjects. These latency measures have potential to serve as neurocognitive biomarkers of Alzheimer's disease and other insidious neurodegenerative disorders.

An easily observable graphomotor distinction was associated with 1) better performance in specific cognitive domains, 2) higher local efficiency suggesting better regional integration, and 3) more sophisticated modular integration involving the ventral ('what') visuospatial processing stream. Taken together, these results enhance our knowledge of the brain-behavior relationships underlying unprompted graphomotor organization during dCDT.

We worked with clinicians to define guidelines for model interpretability, and constructed sparse linear models and rule lists designed to be as easy to use as scoring systems currently used by clinicians, but more accurate. While our models will require additional testing for validation, they offer the possibility of substantial improvement in detecting cognitive impairment earlier than currently possible, a development with considerable potential impact in practice.

The dCDT differentiated aspects of psychomotor slowing in depression regardless of age, while dCDT/cognitive associates for younger adults with depression mimicked patterns of older euthymics.