Digital neuropsychological measures by defense automated neurocognitive assessment: reference values and clinical correlates

Huitong Ding; Minzae Kim; Edward Searls; Preeti Sunderaraman; Ileana De Anda-Duran; Spencer Low; Zachary Popp; Phillip H Hwang; Zexu Li; Kriti Goyal; Lindsay Hathaway; Jose Monteverde; Salman Rahman; Akwaugo Igwe; Vijaya B Kolachalama; Rhoda Au; Honghuang Lin

doi:10.3389/fneur.2024.1340710

Digital neuropsychological measures by defense automated neurocognitive assessment: reference values and clinical correlates

Front Neurol. 2024 Feb 15:15:1340710. doi: 10.3389/fneur.2024.1340710. eCollection 2024.

Authors

Huitong Ding^{1

2}, Minzae Kim¹, Edward Searls¹, Preeti Sunderaraman^{2

3}, Ileana De Anda-Duran⁴, Spencer Low¹, Zachary Popp¹, Phillip H Hwang⁵, Zexu Li¹, Kriti Goyal¹, Lindsay Hathaway¹, Jose Monteverde¹, Salman Rahman¹, Akwaugo Igwe¹, Vijaya B Kolachalama^{6

7}, Rhoda Au^{1

2

3

5

6

8}, Honghuang Lin⁹

Affiliations

¹ Department of Anatomy and Neurobiology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States.
² The Framingham Heart Study, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States.
³ Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States.
⁴ School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, United States.
⁵ Department of Epidemiology, Boston University School of Public Health, Boston, MA, United States.
⁶ Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States.
⁷ Department of Computer Science, Faculty of Computing & Data Sciences, Boston University, Boston, MA, United States.
⁸ Slone Epidemiology Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States.
⁹ Department of Medicine, University of Massachusetts Chan Medical School, Worcester, MA, United States.

Abstract

Introduction: Although the growth of digital tools for cognitive health assessment, there's a lack of known reference values and clinical implications for these digital methods. This study aims to establish reference values for digital neuropsychological measures obtained through the smartphone-based cognitive assessment application, Defense Automated Neurocognitive Assessment (DANA), and to identify clinical risk factors associated with these measures.

Methods: The sample included 932 cognitively intact participants from the Framingham Heart Study, who completed at least one DANA task. Participants were stratified into subgroups based on sex and three age groups. Reference values were established for digital cognitive assessments within each age group, divided by sex, at the 2.5th, 25th, 50th, 75th, and 97.5th percentile thresholds. To validate these values, 57 cognitively intact participants from Boston University Alzheimer's Disease Research Center were included. Associations between 19 clinical risk factors and these digital neuropsychological measures were examined by a backward elimination strategy.

Results: Age- and sex-specific reference values were generated for three DANA tasks. Participants below 60 had median response times for the Go-No-Go task of 796 ms (men) and 823 ms (women), with age-related increases in both sexes. Validation cohort results mostly aligned with these references. Different tasks showed unique clinical correlations. For instance, response time in the Code Substitution task correlated positively with total cholesterol and diabetes, but negatively with high-density lipoprotein and low-density lipoprotein cholesterol levels, and triglycerides.

Discussion: This study established and validated reference values for digital neuropsychological measures of DANA in cognitively intact white participants, potentially improving their use in future clinical studies and practice.

Keywords: clinical correlates; cognitive health; defense automated neurocognitive assessment; digital neuropsychological measures; reference values.

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This work was supported by the National Heart, Lung, and Blood Institute Contract (N01-HC-25195) and by grants from the National Institute on Aging AG-008122, AG-16495, AG-062109, AG-049810, AG-068753, AG054156, P30AG073107, R01AG080670, U01AG068221 and from the National Institute of Neurological Disorders and Stroke, NS017950, and from the Alzheimer’s Association (Grant AARG-NTF-20-643020), and the American Heart Association (20SFRN35360180). It was also supported by Defense Advanced Research Projects Agency contract (FA8750-16-C-0299); Pfizer, Inc. The funding agencies had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.