The value of maintaining cognition in patients with mild cognitive impairment: The innovation headroom and potential cost-effectiveness of roflumilast.

INTRODUCTION: Early health-technology assessment can support discussing scarce resource allocation among stakeholders. We explored the value of maintaining cognition in patients with mild cognitive impairment (MCI) by estimating: (1) the innovation headroom and (2) the potential cost effectiveness of roflumilast treatment in this population. METHODS: The innovation headroom was operationalized by a fictive 100% efficacious treatment effect, and the roflumilast effect on memory word learning test was assumed to be associated with 7% relative risk reduction of dementia onset. Both were compared to Dutch setting usual care using the adapted International Pharmaco-Economic Collaboration on Alzheimer's Disease (IPECAD) open-source model. RESULTS: The total innovation headroom expressed as net health benefit was 4.2 (95% bootstrap interval: 2.9-5.7) quality-adjusted life years (QALYs). The potential cost effectiveness of roflumilast was k€34 per QALY. DISCUSSION: The innovation headroom in MCI is substantial. Although the potential cost effectiveness of roflumilast treatment is uncertain, further research on its effect on dementia onset is likely valuable.

Ambulant cognitive assessment using a smartphone.

The focus of neuropsychology is to understand the relationship between assessment results and everyday cognitive abilities and disabilities. However, the generalizability of traditional neuropsychological tests to real-life behaviors, the ecological validity, is compromised by the test environment, among other things. Neuropsychological tests are often completed in a laboratory setting that is typically quiet with few distractions. This is very unlike most everyday environments. The aim of the present study was to investigate the possibility of using a smartphone in standardized cognitive assessment. A short-term memory task was obtained from young adults in either an everyday-life environment or a controlled test setting at four time points during a day. Results show no significant differences between the task performances in both conditions. There was no indication that fatigue, tension, or environmental noise had an effect on task performance. High correlations between subsequent time points were found in the everyday-life environment, suggesting a high test-retest reliability and commitment of the participants. The present study demonstrates that smartphones can be used to assess cognitive functions outside a laboratory setting.

Assessment of spatial learning abilities of mice in a new circular maze.

In the present study, we tested the spatial learning behavior of four different mouse strains (129/Sv, BALB/c, C57BL and Swiss) in a newly developed circular maze. The maze was based on the circular Barnes maze, which was initially developed for rats. Since mice do not readily enter holes in floor, additional reinforcers (positive and negative) or pretraining procedures have been used to train the animals. Because these methods are not always desirable, we examined whether mice are more willing to enter escape holes (12), which were located in the rim of the apparatus. C57BL mice appeared to improve their performance on three different measures of spatial learning: latency to find escape hole, distance to escape hole and errors (visit to other holes). The other strains also improved their performance although this was only seen for one parameter (i.e. 129/Sv and BALB/c on latency, and Swiss on distance). When the animals were trained to find another location, it was found that only the performance of the C57BL mice was transiently impaired. The C57BL mice were also very efficient in improving their performance in a repeated acquisition paradigm (six trials per day on four successive days). Applying a probe trial procedure, a clear preference for the goal location was found. These findings indicate that these mice used a spatial search strategy. Although this circular maze can be used as an additional tool to assess spatial learning in (genetically modified) mice, it is noted that strain differences in spatial learning seem to be independent of task. Further, our data with different strains indicate that different measures of behavior should be evaluated to assess the spatial learning performance of mice.