Digital Clock and Recall: a digital, process-driven evolution of the Mini-Cog

IF 2.4 3区医学 Q3 NEUROSCIENCES Frontiers in Human Neuroscience Pub Date : 2024-08-26 DOI:10.3389/fnhum.2024.1337851

Joyce Gomes-Osman, Soo Borson, Claudio Toro-Serey, Russell Banks, Marissa Ciesla, Ali Jannati, W. Isaiah Morrow, Rod Swenson, David Libon, David Bates, John Showalter, Sean Tobyne, Alvaro Pascual-Leone

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Abstract

IntroductionAlzheimer’s disease and related dementias (ADRD) represent a substantial global public health challenge with multifaceted impacts on individuals, families, and healthcare systems. Brief cognitive screening tools such as the Mini-Cog© can help improve recognition of ADRD in clinical practice, but widespread adoption continues to lag. We compared the Digital Clock and Recall (DCR), a next-generation process-driven adaptation of the Mini-Cog, with the original paper-and-pencil version in a well-characterized clinical trial sample.MethodsDCR was administered to 828 participants in the Bio-Hermes-001 clinical trial (age median ± SD = 72 ± 6.7, IQR = 11; 58% female) independently classified as cognitively unimpaired (n = 364) or as having mild cognitive impairment (MCI, n = 274) or dementia likely due to AD (DLAD, n = 190). MCI and DLAD cohorts were combined into a single impaired group for analysis. Two experienced neuropsychologists rated verbal recall accuracy and digitally drawn clocks using the original Mini-Cog scoring rules. Inter-rater reliability of Mini-Cog scores was computed for a subset of the data (n = 508) and concordance between Mini-Cog rule-based and DCR scoring was calculated.ResultsInter-rater reliability of Mini-Cog scoring was good to excellent, but Rater 2’s scores were significantly higher than Rater 1’s due to variation in clock scores (p < 0.0001). Mini-Cog and DCR scores were significantly correlated (τB = 0.71, p < 0.0001). However, using a Mini-Cog cut score of 4, the DCR identified more cases of cognitive impairment (n = 47; χ2 = 13.26, p < 0.0005) and Mini-Cog missed significantly more cases of cognitive impairment (n = 87). In addition, the DCR correctly classified significantly more cognitively impaired cases missed by the Mini-Cog (n = 44) than vice versa (n = 4; χ2 = 21.69, p < 0.0001).DiscussionOur findings demonstrate higher sensitivity of the DCR, an automated, process-driven, and process-based digital adaptation of the Mini-Cog. Digital metrics capture clock drawing dynamics and increase detection of diagnosed cognitive impairment in a clinical trial cohort of older individuals.

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数字时钟和回忆：迷你慢动作的数字、过程驱动进化版

导言阿尔茨海默病及相关痴呆症（ADRD）是全球公共卫生面临的重大挑战，对个人、家庭和医疗保健系统造成多方面的影响。简易认知筛查工具（如 Mini-Cog©）有助于在临床实践中提高对 ADRD 的识别能力，但其广泛应用仍然滞后。我们在一个具有良好特征的临床试验样本中比较了数字时钟和回忆（DCR）--一种下一代过程驱动的迷你Cog改编版--和原始的纸笔版。方法对参加 Bio-Hermes-001 临床试验的 828 名参与者（年龄中位数 ± SD = 72 ± 6.7，IQR = 11；58% 为女性）进行了 DCR 测试，这些参与者被独立归类为认知功能未受损者（364 人）或轻度认知功能受损者（MCI，274 人）或可能因注意力缺失导致的痴呆者（DLAD，190 人）。MCI 组和 DLAD 组合并为一个受损组进行分析。两位经验丰富的神经心理学家采用最初的 Mini-Cog 评分规则对言语回忆的准确性和数字时钟进行评分。对部分数据（n = 508）计算了Mini-Cog评分的评分者间可靠性，并计算了基于Mini-Cog规则的评分与DCR评分之间的一致性。结果Mini-Cog评分的评分者间可靠性为良好至优秀，但由于时钟评分的差异，评分者2的评分明显高于评分者1（p <0.0001）。迷你慢动作和 DCR 分数有明显的相关性（τB = 0.71，pamp &;lt;0.0001）。然而，如果将 Mini-Cog 的切分分值定为 4 分，DCR 能识别出更多的认知障碍病例（n = 47；χ2 = 13.26，p &；lt; 0.0005），而 Mini-Cog 则明显遗漏了更多的认知障碍病例（n = 87）。讨论我们的研究结果表明了 DCR 的灵敏度更高，DCR 是对 Mini-Cog 的自动、过程驱动和基于过程的数字改编。数字指标能捕捉到时钟绘制的动态变化，并能提高对老年人临床试验队列中诊断出的认知障碍的检测率。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Frontiers in Human Neuroscience 医学-神经科学

CiteScore

4.70

自引率

6.90%

发文量

830

审稿时长

2-4 weeks

期刊介绍： Frontiers in Human Neuroscience is a first-tier electronic journal devoted to understanding the brain mechanisms supporting cognitive and social behavior in humans, and how these mechanisms might be altered in disease states. The last 25 years have seen an explosive growth in both the methods and the theoretical constructs available to study the human brain. Advances in electrophysiological, neuroimaging, neuropsychological, psychophysical, neuropharmacological and computational approaches have provided key insights into the mechanisms of a broad range of human behaviors in both health and disease. Work in human neuroscience ranges from the cognitive domain, including areas such as memory, attention, language and perception to the social domain, with this last subject addressing topics, such as interpersonal interactions, social discourse and emotional regulation. How these processes unfold during development, mature in adulthood and often decline in aging, and how they are altered in a host of developmental, neurological and psychiatric disorders, has become increasingly amenable to human neuroscience research approaches. Work in human neuroscience has influenced many areas of inquiry ranging from social and cognitive psychology to economics, law and public policy. Accordingly, our journal will provide a forum for human research spanning all areas of human cognitive, social, developmental and translational neuroscience using any research approach.