ABSTRACT Objective To assess the utility, accessibility, and equivalence to supervised scales of online cognitive assessment in older individuals with cognitive impairment. Methods Patients with Alzheimer's disease (AD, n = 31), idiopathic normal pressure hydrocephalus (iNPH, n = 26), and traumatic brain injury (TBI, n = 23) completed online cognitive tasks (Cognitron). We evaluated cognition relative to a large normative dataset (N ≈ 400,000), adjusting for device and demographics which can affect performance. Principal Component Analysis (PCA) was used to derive domain‐specific and total composite scores. We compared clinical groups and correlated performance with standard assessments. Results Uptake was ~70%. PCA identified components across memory, processing speed, language, and executive functions. AD showed memory and language impairments compared with the norms and other groups. iNPH had greater executive and processing speed deficits, consistent with a subcortical impairment profile. TBI showed milder deficits in memory, working memory, and language. Cognitron total composite was associated with standard supervised tests (ADAS‐Cog: β = −0.76, p < 0.001 and ACE‐III: β = 0.69, p < 0.001). In iNPH, Cognitron composite predicted walking speed (estimate = 1.10, p < 0.001), a core clinical feature of the disease which is difficult to evaluate remotely. We selected five tasks with high completion rates, discriminability between conditions, and broad cognitive coverage. The derived short composite showed very high accuracy in separating AD (AUC = 0.94) and iNPH (AUC = 0.90) from age‐matched norms; performance was weaker for TBI (AUC = 0.66). Interpretation Online assessment in older clinical populations is feasible and sensitive to subtle disease‐specific cognitive deficits. A demographically adjusted, 15‐min battery offers a scalable adjunct to standard testing, with potential to reduce burden on patients and healthcare systems.
M. Del Giovane, V. Giunchiglia, Michael C B David et al.· Annals of Clinical and Trans...· 0 citations
Summary Background Insulin resistance is recognised as a midlife risk factor for cognitive decline, yet the pathways linking metabolic dysfunction to early brain changes remain unclear. Methods We cross-sectionally analysed 355 cognitively normal adults from the PREVENT cohort to test associations between insulin sensitivity (Homoeostatic Model Assessment for Insulin Resistance; HOMA-IR), frontal white matter hyperintensities (WMH), cerebral blood flow (CBF), hippocampal volume, and cognition. Findings Multivariable regression showed higher log-transformed HOMA-IR was associated with greater frontal WMH burden (β = 0.118, p = 0.026) and lower global cognitive performance (β = −0.132, p = 0.012). Decreased insulin sensitivity was not associated with global CBF (β = −0.019, p = 0.74). Adjusting for WMH burden, hippocampal volume, and CBF, lower insulin sensitivity remained associated with lower global cognition (β = −0.123, p = 0.021). Structural equation modelling (n = 328) demonstrated a direct negative association between higher HOMA-IR and cognition (β = −0.055, p = 0.042) and trended toward higher vascular burden (p = 0.06). The indirect pathway through vascular burden was non-significant (p = 0.23), as vascular burden, hippocampal volume, and CBF did not associate with cognition. Interpretation Decreased insulin sensitivity was linked to early small vessel disease and measurable cognitive differences, suggesting the cognitive association was largely direct rather than explained by vascular injury, hippocampal atrophy, or global perfusion. These findings point toward partially parallel metabolic and vascular pathways rather than a sequential process. These cross-sectional associations suggest that insulin sensitivity warrants investigation as a modifiable midlife factor for cognitive health; interventional studies are needed to determine whether targeting it preserves cognition before neurodegenerative markers emerge. Funding MRC Dementias Platform UK, NIHR, Alzheimer's Society, Alzheimer's Association, Race Against Dementia, and HRB.
Rohith Erukulla, Graham Reid, Courtney N. Yotter et al.· EBioMedicine· 0 citations
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