Digital Neuropsychological Assessment May Become Standard After COVID-19

A special collection of articles in JAD explores how digital technology measuring neuropsychological behavior has evolved as a consequence of the COVID-19 pandemic and may become a standard tool

Amsterdam, NL – The COVID-19 pandemic has significantly altered the delivery of health care including neuropsychological evaluations. Telehealth procedures may become a standard feature in healthcare after the crisis has resolved. In a mini-forum published in the Journal of Alzheimer’s Disease experts describe how neuropsychological tests that combine digital technology with standard paper and pencil tests can reveal behavioral information not otherwise obtainable and facilitate earlier identification of individuals with emergent neurodegenerative and other neurological illness.

Technology has transformed the science and practice of medicine. In this special mini-forum, guest-edited by David J. Libon, PhD, Ganesh Baliga, PhD, Rod Swenson, PhD, and Rhoda Au, PhD, experts describe how coupling digital technology with standard neuropsychological tests can benefit patients. Neurocognitive markers obtained using this technology may be able to flag early emergent neurodegenerative illness. The data presented in these five papers collectively show the importance of time-based parameters as related to brain and cognition.

“Necessity is the mother of invention,” explained the guest editors. “Perhaps a serendipitous effect of the COVID-19 crisis is that it has helped us understand that the standard paper and pencil tests used to evaluate patients with neuropsychological disorders can be replaced by a digital medium. This also makes it possible to test more patients who cannot come to the office, perhaps because of medical reasons or location.”  

The articles in this issue cover techniques such as the Backward Digit Span Test; the Digit Symbol Substitution Test; digital speech analysis; and the widely used Digital Clock Drawing Test. 

“Standard paper and pencil neuropsychological tests are powerful tools to assess the integrity of brain and cognition, but they tend to focus on a final test score,” noted David J. Libon, PhD, Department of Geriatrics, Gerontology, and Psychology, New Jersey Institute for Successful Aging, School of Osteopathic Medicine, Rowan University. “The traditional measure we use to calculate a final test score is the total time to completion. However, digital technology calls our attention to the time spent during which output is not produced, i.e., the thinking time or ‘latent content’ versus time spent generating output, i.e., the ‘manifest content.’ 

Both of these time-based parameters provide the basis for a rich, three-dimensional analysis of underlying neuropsychological constructs associated with neurodegenerative illness. These make it easier to appreciate the underlying process patients use to initiate and ultimately bring to fruition complex neuropsychological operations.

“Digitally obtained behavior is able to detect cognitive processes that underlie early brain changes due to Alzheimer’s disease and related neurodegenerative diseases. Moreover, digital neuropsychological parameters may help refine new statistical criteria for subtle or pre-mild cognitive impairment syndromes,” added Dr. Libon.

Before digital assessment technology was available, Edith Kaplan, PhD, a pioneer of neuropsychological testing, championed the analysis of errors and the process by which tests are completed as a means of understanding brain and cognition. She emphasized, “If they want numbers…provide numbers that are meaningful.”

“As digital assessment methods mature, identification of persons with emergent neurodegenerative and other neurological illness at an earlier stage may be possible,” concluded the guest editors.

“I welcome this special collection of papers that demonstrates how digital technology can calculate potentially sensitive clinical neurocognitive biomarkers,” said George Perry, PhD, Editor-in-Chief, Journal of Alzheimer's Disease, and Semmes Foundation Distinguished University Chair in Neurobiology at The University of Texas at San Antonio. “The data presented here open up the possibility of being able to flag emerging illnesses such as mild cognitive impairment or dementia, including Alzheimer’s disease or vascular dementia, before patients actually meet current diagnostic criteria.” 

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NOTES FOR EDITORS
Mini-Forum: Digital Neuropsychological Assessment: New Technology for Measuring Subtle Neuropsychological Behavior
The articles appear in Journal of Alzheimer’s Disease, Volume 82, Issue 1, published by IOS Press 
Content is available at: content.iospress.com/journals/journal-of-alzheimers-disease/82/1

You are invited to view and share the issue mailing that features this mini-forum, which is available here.

Guest Editors

• David J. Libon, PhD, Department Geriatrics, Gerontology, and Psychology, New Jersey Institute for Successful Aging, School of Osteopathic Medicine, Rowan University
• Ganesh Baliga, PhD, Department of Computer Science, Rowan University
• Rod Swenson, PhD, Department Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences
• Rhoda Au, PhD, Department of Anatomy and Neurobiology, Boston University School of Medicine; Framingham Heart Study, Boston University School of Medicine; Department of Neurology, Boston University School of Medicine; and the Department of Epidemiology, Boston University School of Public Health

Mini-Forum Articles

• “Digital Neuropsychological Assessment: New Technology for Measuring Subtle Neuropsychological Behavior” by David J. Libon, Ganesh Baliga, Rod Swenson, and Rhoda Au; openly available online at: content.iospress.com/articles/journal-of-alzheimers-disease/jad210513.
• “Neurocognitive Constructs Underlying Executive Control in Statistically-Determined Mild Cognitive Impairment” by Sheina Emrani, Melissa Lamar, Catherine Price, Satya Baliga, Victor Wasserman, Emily F. Matusz, Johnathan Saunders, Vaughn Gietka, James Strate, Rod Swenson, Ganesh Baliga, and David J. Libon; online at: content.iospress.com/articles/journal-of-alzheimers-disease/jad201125.
• “Digital Technology Differentiates Graphomotor and Information Processing Speed Patterns of Behavior” by Stacy L. Andersen, Benjamin Sweigart, Nancy W. Glynn, Mary K. Wojczynski, Bharat Thyagarajan, Jonas Mengel-From, Stephen Thielke, Thomas T. Perls, David J. Libon, Rhoda Au, Stephanie Cosentino, and Paola Sebastiani on behalf of the Long Life Family Study; online at: content.iospress.com/articles/journal-of-alzheimers-disease/jad201119.
• “Digital Speech Analysis in Progressive Supranuclear Palsy and Corticobasal Syndromes” by Natalia Parjane, Sunghye Cho, Sharon Ash, Katheryn A.Q. Cousins, Sanjana Shellikeri, Mark Liberman, Leslie M. Shaw, David J. Irwin, Murray Grossman, and Naomi Nevler; online at: content.iospress.com/articles/journal-of-alzheimers-disease/jad201132.
• “Classifying Non-Dementia and Alzheimer’s Disease/Vascular Dementia Patients Using Kinematic, Time-Based, and Visuospatial Parameters: The Digital Clock Drawing Test” by Anis Davoudi, Catherine Dion, Shawna Amini, Patrick J. Tighe, Catherine C. Price, David J. Libon, and Parisa Rashidi; online at: content.iospress.com/articles/journal-of-alzheimers-disease/jad201129.
• “Normative References for Graphomotor and Latency Digital Clock Drawing Metrics for Adults Age 55 and Older: Operationalizing the Production of a Normal Appearing Clock” by Anis Davoudi, Catherine Dion, Erin Formanski, Brandon E. Frank, Shawna Amini, Emily F. Matusz, Victor Wasserman, Dana Penney, Randall Davis, Parisa Rashidi, Patrick Tighe, Kenneth M. Heilman, Rhoda Au, David J. Libon, and Catherine C. Price; online at: content.iospress.com/articles/journal-of-alzheimers-disease/jad201249.

Contact
For further information, please contact Diana Murray, IOS Press (+1 718-640-5678 or d.murray@iospress.com). To reach the guest editors or authors of specific papers for comment, please contact David J. Libon, PhD (libon@rowan.edu) or Ganesh Baliga, PhD (baliga@rowan.edu).

About the Journal of Alzheimer’s Disease
The Journal of Alzheimer's Disease (JAD) is an international multidisciplinary journal to facilitate progress in understanding the etiology, pathogenesis, epidemiology, genetics, behavior, treatment, and psychology of Alzheimer's disease. The journal publishes research reports, reviews, short communications, book reviews, and letters-to-the-editor. Groundbreaking research that has appeared in the journal includes novel therapeutic targets, mechanisms of disease, and clinical trial outcomes. JAD has a 2020 Journal Impact Factor of 4.472 according to Journal Citation Reports (Clarivate, 2021). j-alz.com 

About IOS Press
IOS Press is headquartered in Amsterdam with satellite offices in the USA, Germany, India and China and serves the information needs of scientific and medical communities worldwide. IOS Press now publishes more than 90 international peer-reviewed journals and about 70 book titles each year on subjects ranging from computer science, artificial intelligence, and engineering to medicine, neuroscience, and cancer research. iospress.com