Digital Clock and Recall is superior to the Mini-Mental State Examination for the detection of mild cognitive impairment and mild dementia.

BACKGROUND: Disease-modifying treatments for Alzheimer's disease highlight the need for early detection of cognitive decline. However, at present, most primary care providers do not perform routine cognitive testing, in part due to a lack of access to practical cognitive assessments, as well as time and resources to administer and interpret the tests. Brief and sensitive digital cognitive assessments, such as the Digital Clock and Recall (DCR™), have the potential to address this need. Here, we examine the advantages of DCR over the Mini-Mental State Examination (MMSE) in detecting mild cognitive impairment (MCI) and mild dementia. METHODS: We studied 706 participants from the multisite Bio-Hermes study (age mean ± SD = 71.5 ± 6.7; 58.9% female; years of education mean ± SD = 15.4 ± 2.7; primary language English), classified as cognitively unimpaired (CU; n = 360), mild cognitive impairment (MCI; n = 234), or probable mild Alzheimer's dementia (pAD; n = 111) based on a review of medical history with selected cognitive and imaging tests. We evaluated cognitive classifications (MCI and early dementia) based on the DCR and the MMSE against cohorts based on the results of the Rey Auditory Verbal Learning Test (RAVLT), the Trail Making Test-Part B (TMT-B), and the Functional Activities Questionnaire (FAQ). We also compared the influence of demographic variables such as race (White vs. Non-White), ethnicity (Hispanic vs. Non-Hispanic), and level of education (≥ 15 years vs. < 15 years) on the DCR and MMSE scores. RESULTS: The DCR was superior on average to the MMSE in classifying mild cognitive impairment and early dementia, AUC = 0.70 for the DCR vs. 0.63 for the MMSE. DCR administration was also significantly faster (completed in less than 3 min regardless of cognitive status and age). Among 104 individuals who were labeled as "cognitively unimpaired" by the MMSE (score ≥ 28) but actually had verbal memory impairment as confirmed by the RAVLT, the DCR identified 84 (80.7%) as impaired. Moreover, the DCR score was significantly less biased by ethnicity than the MMSE, with no significant difference in the DCR score between Hispanic and non-Hispanic individuals. CONCLUSIONS: DCR outperforms the MMSE in detecting and classifying cognitive impairment-in a fraction of the time-while being not influenced by a patient's ethnicity. The results support the utility of DCR as a sensitive and efficient cognitive assessment in primary care settings. TRIAL REGISTRATION: ClinicalTrials.gov identifier NCT04733989.

Choices favoring cognitive effort in a foraging environment decrease when multiple forms of effort and delay are interleaved.

Cognitive and physical effort are typically regarded as costly, but demands for effort also seemingly boost the appeal of prospects under certain conditions. One contextual factor that might influence choices for or against effort is the mix of different types of demand a decision maker encounters in a given environment. In two foraging experiments, participants encountered prospective rewards that required equally long intervals of cognitive effort, physical effort, or unfilled delay. Monetary offers varied per trial, and the two experiments differed in whether the type of effort or delay cost was the same on every trial, or varied across trials. When each participant faced only one type of cost, cognitive effort persistently produced the highest acceptance rate compared to trials with an equivalent period of either physical effort or unfilled delay. We theorized that if cognitive effort were intrinsically rewarding, we would observe the same pattern of preferences when participants foraged for varying cost types in addition to rewards. Contrary to this prediction, in the second experiment, an initially higher acceptance rate for cognitive effort trials disappeared over time amid an overall decline in acceptance rates as participants gained experience with all three conditions. Our results indicate that cognitive demands may reduce the discounting effect of delays, but not because decision makers assign intrinsic value to cognitive effort. Rather, the results suggest that a cognitive effort requirement might influence contextual factors such as subjective delay duration estimates, which can be recalibrated if multiple forms of demand are interleaved.

Spectral partitioning identifies individual heterogeneity in the functional network topography of ventral and anterior medial prefrontal cortex.

Regions of human medial prefrontal cortex (mPFC) and posterior cingulate cortex (PCC) are part of the default network (DN), and additionally are implicated in diverse cognitive functions ranging from autobiographical memory to subjective valuation. Our ability to interpret the apparent co-localization of task-related effects with DN-regions is constrained by a limited understanding of the individual-level heterogeneity in mPFC/PCC functional organization. Here we used cortical surface-based meta-analysis to identify a parcel in human PCC that was more strongly associated with the DN than with valuation effects. We then used resting-state fMRI data and a data-driven network analysis algorithm, spectral partitioning, to partition mPFC and PCC into "DN" and "non-DN" subdivisions in individual participants (n = 100 from the Human Connectome Project). The spectral partitioning algorithm identified individual-level cortical subdivisions that varied markedly across individuals, especially in mPFC, and were reliable across test/retest datasets. Our results point toward new strategies for assessing whether distinct cognitive functions engage common or distinct mPFC subregions at the individual level.

Characterizing Information Flux Within the Distributed Pediatric Expressive Language Network: A Core Region Mapped Through fMRI-Constrained MEG Effective Connectivity Analyses.

Using noninvasive neuroimaging, researchers have shown that young children have bilateral and diffuse language networks, which become increasingly left lateralized and focal with development. Connectivity within the distributed pediatric language network has been minimally studied, and conventional neuroimaging approaches do not distinguish task-related signal changes from those that are task essential. In this study, we propose a novel multimodal method to map core language sites from patterns of information flux. We retrospectively analyze neuroimaging data collected in two groups of children, ages 5-18 years, performing verb generation in functional magnetic resonance imaging (fMRI) (n = 343) and magnetoencephalography (MEG) (n = 21). The fMRI data were conventionally analyzed and the group activation map parcellated to define node locations. Neuronal activity at each node was estimated from MEG data using a linearly constrained minimum variance beamformer, and effective connectivity within canonical frequency bands was computed using the phase slope index metric. We observed significant (p ≤ 0.05) effective connections in all subjects. The number of suprathreshold connections was significantly and linearly correlated with participant's age (r = 0.50, n = 21, p ≤ 0.05), suggesting that core language sites emerge as part of the normal developmental trajectory. Across frequencies, we observed significant effective connectivity among proximal left frontal nodes. Within the low frequency bands, information flux was rostrally directed within a focal, left frontal region, approximating Broca's area. At higher frequencies, we observed increased connectivity involving bilateral perisylvian nodes. Frequency-specific differences in patterns of information flux were resolved through fast (i.e., MEG) neuroimaging.

Increased Resting-State Functional Connectivity in the Cingulo-Opercular Cognitive-Control Network after Intervention in Children with Reading Difficulties.

Dyslexia, or reading difficulty, is characterized by slow, inaccurate reading accompanied by executive dysfunction. Reading training using the Reading Acceleration Program improves reading and executive functions in both children with dyslexia and typical readers. This improvement is associated with increased activation in and functional connectivity between the anterior cingulate cortex, part of the cingulo-opercular cognitive-control network, and the fusiform gyrus during a reading task after training. The objective of the current study was to determine whether the training also has an effect on functional connectivity of the cingulo-opercular and fronto-parietal cognitive-control networks during rest in children with dyslexia and typical readers. Fifteen children with reading difficulty and 17 typical readers (8-12 years old) were included in the study. Reading and executive functions behavioral measures and resting-state functional magnetic resonance imaging data were collected before and after reading training. Imaging data were analyzed using a graphical network-modeling tool. Both reading groups had increased reading and executive-functions scores after training, with greater gains among the dyslexia group. Training may have less effect on cognitive control in typical readers and a more direct effect on the visual area, as previously reported. Statistical analysis revealed that compared to typical readers, children with reading difficulty had significantly greater functional connectivity in the cingulo-opercular network after training, which may demonstrate the importance of cognitive control during reading in this population. These results support previous findings of increased error-monitoring activation after reading training in children with dyslexia and confirm greater gains with training in this group.