A Novel Computerized Flexible Attention Test in Detecting Executive Dysfunction of Patients with Early-Onset Cognitive Impairment and Dementia

Veera Tikkanen; Johanna Krüger; Anna-Leena Heikkinen; Tuomo Hänninen; Christer Hublin; Anne M Koivisto; Jussi Virkkala; Toni T Saari; Anne M Remes; Teemu I Paajanen

doi:10.1093/arclin/acae026

A Novel Computerized Flexible Attention Test in Detecting Executive Dysfunction of Patients with Early-Onset Cognitive Impairment and Dementia

Arch Clin Neuropsychol. 2024 Apr 5:acae026. doi: 10.1093/arclin/acae026. Online ahead of print.

Authors

Veera Tikkanen^{1

2

3}, Johanna Krüger^{1

2

3}, Anna-Leena Heikkinen^{1

2

3

4}, Tuomo Hänninen⁵, Christer Hublin⁴, Anne M Koivisto^{5

6

7

8}, Jussi Virkkala^{4

9}, Toni T Saari^{5

6

10}, Anne M Remes^{1

2

3

8}, Teemu I Paajanen⁴

Affiliations

¹ Research Unit of Clinical Medicine, Neurology, University of Oulu, Oulu, Finland.
² MRC, Oulu University Hospital, Oulu, Finland.
³ Neurocenter, Neurology, Oulu University Hospital, Oulu, Finland.
⁴ Work Ability and Working Careers Unit, Finnish Institute of Occupational Health, Helsinki, Finland.
⁵ Neurocenter, Neurology, Kuopio University Hospital, Kuopio, Finland.
⁶ Unit of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.
⁷ Department of Geriatrics, Helsinki University Hospital, Helsinki, Finland.
⁸ Clinical Neurosciences, University of Helsinki, Helsinki, Finland.
⁹ Clinical Neurophysiology and Clinical Neurosciences, HUS Diagnostic Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
¹⁰ Institute for Molecular Medicine Finland, University of Helsinki, Helsinki, Finland.

PMID: 38581151
DOI: 10.1093/arclin/acae026

Abstract

Objective: The number of computer-based cognitive tests has increased in recent years, but there is a need for tests focusing on the assessment of executive function (EF), as it can be crucial for the identification of early-onset neurodegenerative disorders. This study aims to examine the ability of the Flexible Attention Test (FAT), a new computer-based test battery for detecting executive dysfunction of early-onset cognitive impairment and dementia patients.

Method: We analyzed the FAT subtask results in memory clinic patients with cognitive symptom onset at ≤65 years. The patients were divided into four groups: early onset dementia (EOD, n = 48), mild cognitive impairment due to neurological causes (MCI-n, n = 34), MCI due to other causes (MCI-o, n = 99), and subjective cognitive decline (SCD, n = 14). The test accuracy to distinguish EOD patients from other groups was examined, as well as correlations with pen-and-paper EF tests. We also reported the 12-months follow-up results.

Results: The EOD and MCI-n patients performed significantly poorer (p ≤ .002) than those in the MCI-o and SCD groups in most of the FAT subtasks. The accuracies of the FAT subtasks to detect EOD from other causes were mainly moderate (0.34 ≤ area under the curve < 0.74). The FAT subtasks correlated logically with corresponding pen-and-paper EF tests (.15 ≤ r ≤ .75). No systematic learning effects were detected in the FAT performance at follow-up.

Conclusions: The FAT appears to be a promising method for the precise evaluation of EF and applicable distinguishing early-onset neurodegenerative disorders from patients with other causes of cognitive problems.

Keywords: Early onset dementia; Executive functioning; Mild cognitive impairment; Neurodegenerative diseases; Neuropsychological assessment.

Abstract

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