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      Thirty-Five Years of Computerized Cognitive Assessment of Aging—Where Are We Now?

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          Abstract

          Over the past 35 years, the proliferation of technology and the advent of the internet have resulted in many reliable and easy to administer batteries for assessing cognitive function. These approaches have great potential for affecting how the health care system monitors and screens for cognitive changes in the aging population. Here, we review these new technologies with a specific emphasis on what they offer over and above traditional ‘paper-and-pencil’ approaches to assessing cognitive function. Key advantages include fully automated administration and scoring, the interpretation of individual scores within the context of thousands of normative data points, the inclusion of ‘meaningful change’ and ‘validity’ indices based on these large norms, more efficient testing, increased sensitivity, and the possibility of characterising cognition in samples drawn from the general population that may contain hundreds of thousands of test scores. The relationship between these new computerized platforms and existing (and commonly used) paper-and-pencil tests is explored, with a particular emphasis on why computerized tests are particularly advantageous for assessing the cognitive changes associated with aging.

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          Most cited references28

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          Computerized assessment in neuropsychiatry using CANTAB: discussion paper.

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            Cambridge Neuropsychological Test Automated Battery (CANTAB): A Factor Analytic Study of a Large Sample of Normal Elderly Volunteers

            The CANTAB battery was administered to a large group (n = 787) of elderly volunteers in the age range from 55 to 80 years. This battery, which is based on tests used to identify the neural substrates of learning and memory in non-human primates, has now been extensively used in the assessment of various forms of dementia and also validated on patients with neurosurgical lesions of the frontal and temporal lobes. The tests employed were pattern and spatial recognition, simultaneous and delayed matching to sample, learning of visuo-spatial paired associates, a matching to sample, reaction time task and a test of spatial working memory. The sample was banded into different IQ bands based on performance on 5 standard tests of intelligence. The MMSE was also administered to exclude cases of possible dementia (n = 16) in the normal sample. In general, performance declined with age and IQ, but these factors did not interact. A factor analysis (with varimax rotation) identified 4 factors with eigenvalues greater than 1, which accounted for over 60% of the variance. Factor 1 was equated with general learning and memory ability and loaded significantly with the Intelligence scores; factor 2 was related to speed of responding and loaded most heavily with Age. Comparisons were also made of performance on CANTAB of those subjects with dementing scores on the MMSE and the lowest 5th percentile of the population sample. The results are discussed in terms of the utility of the CANTAB battery for the assessment of dementia and of the implications for theories of changes in cognitive function during normal aging.
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              A comparative study of visuospatial memory and learning in Alzheimer-type dementia and Parkinson's disease.

              Groups of patients with dementia of Alzheimer type (DAT) and idiopathic Parkinson's disease, together with age and IQ-matched normal controls, were compared on several computerized tests of visuospatial memory and learning. Two different groups of parkinsonian patients were studied: (1) a newly diagnosed group, early in the course of the disease, not receiving medication (NMED) PD) and (2) a group later in the course of the disease, receiving medication (MED PD). The DAT and MED PD group were significantly impaired in both spatial and visual pattern recognition memory. The DAT group exhibited a delay-dependent deficit (over 0-16 s) in a delayed matching-to-sample procedure, but were not impaired at simultaneous-matching-to-sample. By contrast, the MED PD group showed delay-independent deficits in the delayed matching-to-sample test and both the MED PD and the NMED PD group were also significantly impaired in simultaneous matching. In a form of delayed response test, the subjects were required first to memorize and then to learn the locations of several abstract visual stimuli which varied progressively in number from 1 to 8. The DAT group were severely impaired in this conditional associative learning task. A significant proportion of patients, but none of the controls, in the NMED and MED PD group also failed the test at the levels of 6 or 8 items. There was a significant correlation between the performance on the first trial, memory score in the delayed response task and indices of clinical disability and disease duration in the patients with Parkinson's disease. The results are discussed in terms of the utility of the comparison between DAT and PD in characterizing the nature of the cognitive deficits in these conditions and their relation to those findings from animal neuropsychology which use comparable paradigms.
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                Author and article information

                Journal
                Diagnostics (Basel)
                Diagnostics (Basel)
                diagnostics
                Diagnostics
                MDPI
                2075-4418
                06 September 2019
                September 2019
                : 9
                : 3
                : 114
                Affiliations
                [1 ]Brain and Mind Institute, Department of Psychology, University of Western Ontario, London, ON N6A 3K7, Canada
                [2 ]Division of Neuroscience & Experimental Psychology, Manchester Institute for Collaborative Research on Ageing, School of Social Sciences, University of Manchester, Manchester M13 9PL, UK
                [3 ]Department of Physiology and Pharmacology, University of Western Ontario, London, ON N6A 3K7, Canada
                Author notes
                [* ]Correspondence: avital.sternin@ 123456uwo.ca
                Author information
                https://orcid.org/0000-0002-9837-0645
                Article
                diagnostics-09-00114
                10.3390/diagnostics9030114
                6787729
                31489940
                b8eff559-2a3e-436b-9990-0224a24ae3ed
                © 2019 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

                History
                : 30 August 2019
                : 03 September 2019
                Categories
                Review

                computerized cognitive assessment,aging,dementia,memory,executive function

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