Computerized tests of cognitive decline in presymptomatic Alzheimer's disease

阿尔茨海默病(AD)患者在情景记忆测试中表现出表现下降， 执行功能和注意力，在症状变得明显之前的十多年 或者是家人。这种性能下降的速度是正在进行的临床试验中的主要结果衡量标准。 评估旨在延缓AD发病的干预措施。然而，目前的临床试验依赖于 “纸和笔”的认知测试，人工管理和评分，昂贵，低效，受制于 考官偏颇，未能全面记录和量化考试成绩。此外，由于 持证考官人数有限，手工考试将越来越无法满足需求 随着人口老龄化进行认知评估。尽管计算机化测试通过以下方式帮助满足这一需求 提高认知测试的敏感度、效率、全面性和客观性 商业测试电池缺乏“黄金标准”人工评估的灵敏度、有效性和可靠性。 现在用于临床试验。在这项“快速通道”计划中，我们建议加强电脑化考试 加州认知评估组合(CCAB)，一套经过经验验证的、计算机化的黄金版本 标准的“手动测试。CCAB测试比手工测试更有效、更可靠、更客观、更准确 提供更详细、更全面、更容易获取的档案记录 纵向测试性能。然后，我们将测试增强的CCAB对纵向认知的敏感性 老年人的认知能力下降，包括那些基于APOE的认知能力下降风险增加的人 基因分型。在第一阶段，我们将重新调整个别CCAB测试，以便在平板电脑和 添加自动语音识别功能，以客观地对言语反应进行评分并测量言语反应 延迟。我们还将整合远程医疗功能，使检查人员能够与患者互动，并 管理远程站点的测试。在第二阶段，我们将开发一个用于托管的安全、加密的数据库 以及分析匿名数据。我们将比较CCAB测试和同等手动测试的性能， 并开发回归函数，将CCAB分数转换为等效的手动测试分数，反之 反过来说。最后，我们将评估CCAB测试对420名老年人认知能力下降的敏感性 志愿者，在两年内每隔六个月进行一次测试。我们将确定基准性能 测量，包括实践效果(重复测试时发生的附带改进)，预测 有和没有AD危险因素的个体随后认知能力下降。此外，我们还将 创建CCAB许可和数据管理工具，为研究人员提供免费访问CCAB测试和 4年SBIR期间的匿名数据。摘要：《加州认知》的增强版 评估电池(CCAB)将降低成本，扩大覆盖范围，并提高年龄测试的灵敏度- 阿尔茨海默病高危患者的相关认知功能下降。

Patients who develop Alzheimer's disease (AD) show performance declines in tests of episodic memory, executive functioning, and attention more than a decade before symptoms become apparent to their physician or family. The rate of this performance decline is the primary outcome measure in ongoing clinical trials evaluating interventions aimed at delaying AD onset. However, current clinical trials rely on measures from “paper and pencil” tests of cognition that are manually-administered and scored, costly, inefficient, subject to examiner bias, and fail to comprehensively record and quantify test performance. Moreover, because of the limited number of licensed examiners, manual tests will be increasingly unable to meet the demand for cognitive assessments as the population ages. Although computerized tests help meet this demand by increasing the sensitivity, efficiency, comprehensiveness, and objectivity of cognitive testing, existing commercial test batteries lack the sensitivity, validity, and reliability of “gold standard” manual assessments now used in clinical trials. In this “fast-track” application, we propose to enhance the computerized tests of the California Cognitive Assessment Battery (CCAB), a set of empirically-validated, computerized versions of “gold standard” manual tests. CCAB tests are more efficient, reliable, objective, and precise than their manual-test counterparts, while providing more detailed, comprehensive, and easily accessible archival records of longitudinal test performance. We will then test the enhanced CCAB’s sensitivity to longitudinal cognitive decline in older individuals, including those at increased risk of cognitive decline based on their APOE genotype. During Phase I, we will restructure the individual CCAB tests for self-administration on tablets and add automatic speech recognition to objectively score verbal responses and measure verbal-response latencies. We will also incorporate telemedical capabilities to enable examiners to interact with patients and administer tests at remote sites. During Phase II, we will develop a secure, encrypted database for hosting and analyzing anonymized data. We will compare performance on CCAB tests and equivalent manual tests, and develop regression functions for translating CCAB scores to equivalent manual test scores, and vice versa. Finally, we will evaluate the sensitivity of the CCAB tests to cognitive decline in 420 older paid volunteers, tested at six-month intervals over a two-year period. We will identify baseline performance measures, including practice effects (incidental improvements that occur when tests are repeated), that predict subsequent cognitive decline in individuals with and without genotype risk factors for AD. In addition, we will create CCAB licensing and data-management tools to provide researchers with free access to CCAB tests and anonymized data during the 4-year SBIR. Summary: Enhanced versions of the California Cognitive Assessment Battery (CCAB) will reduce the cost, expand the reach, and improve the sensitivity of tests of age- related cognitive decline in patients at risk for AD.