Recent technological advances in digital assessment of auditory and cognitive function may be used to circumvent the costs associated to screening for cognitive decline in the general population. Pre-clinical cognitive screening could have a transformative impact for preventive care in our increasingly old world population. However, advances in digital assessment need to be adapted for Spanish-speaking populations as innovation occurs mainly in English.
Objective
This study explores the potential of a novel screening battery for cognitive decline that utilizes digital tests of cognitive and auditory function adapted to the Spanish language.
Methods
Participants were evaluated on standard clinical scales and questionnaires, and on a digital battery of auditory and cognitive tests with potential clinical value to screen cognitive decline.
Results
We report the ability to detect minimal cognitive impairment (MCI; 3/10 tests) and dementia (10/10 tests) of each digital test and the full battery. We further show concurrent validity for cognitive screening with the Montreal Cognitive Assessment (MoCA) and describe the shared variance across tests in the battery. Lastly, we show multiple regression models predicted with medium sensitivity (57%) and high specificity (97%) the dementia cases, and with high sensitivity (93%) but low specificity (31%) the MCI cases.
Conclusions
Overall, this study demonstrates discriminatory value and concurrent validity to screen for cognitive decline in older adults using open-access digital auditory and cognitive tests in the Spanish language. Follow-up studies with larger and more diverse samples will be instrumental in achieving cognitive screening procedures for the general population.
LivingstonGSommerladAOrgetaV, et al.Dementia prevention, intervention, and care. Lancet2017; 390: 2673–2734.
3.
PrinceMJ. The 10/66 dementia research group - 10 years on. Indian J Psychiatry2009; 51: S8–S15.
4.
LivingstonGHuntleyJLiuKY, et al.Dementia prevention, intervention, and care: 2024 report of the Lancet standing commission. Lancet2024; 390: 2673–2734.
5.
HenrichJHeineSJNorenzayanA. Most people are not WEIRD. Nature2010; 466: 29.
6.
MattapSMMohanDMcGrattanAM, et al.The economic burden of dementia in low- and middle-income countries (LMICs): a systematic review. BMJ Global Health2022; 7: 1–14.
7.
de JagerCASchrijnemaekersACMCHoneyTEM, et al.Detection of MCI in the clinic: evaluation of the sensitivity and specificity of a computerised test battery, the Hopkins Verbal Learning Test and the MMSE. Age Ageing2009; 38: 455–460.
8.
ÖhmanFHassenstabJBerronD, et al.Current advances in digital cognitive assessment for preclinical Alzheimer's disease. Alzheimers Dement2021; 13: e12217.
9.
NasreddineZSPhillipsNABedirianV, et al.The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc2005; 53: 695–699.
10.
De RoeckEEDe DeynPPDierckxE, et al.Brief cognitive screening instruments for early detection of Alzheimer's disease: a systematic review. Alzheimers Res Ther2019; 11: 21.
11.
LibonDJBaligaGSwensonR, et al.Digital neuropsychological assessment: new technology for measuring subtle neuropsychological behavior. J Alzheimers Dis2021; 82: 1–4.
12.
BergJLDurantJLégerGC, et al.Comparing the electronic and standard versions of the Montreal Cognitive Assessment in an outpatient memory disorders clinic: a validation study. J Alzheimers Dis2018; 62: 93–97.
13.
BlonieckiVHagmanGRydenM, et al.Digital screening for cognitive impairment — A proof of concept study. J Prev Alzheimers Dis2021; 8: 127–134.
14.
ChanJYCWongAYiuB, et al.Electronic cognitive screen technology for screening older adults with dementia and mild cognitive impairment in a community setting: development and validation study. J Med Internet Res2020; 22: e17332.
15.
GallunFJSeitzAEddinsDA, et al.Development and validation of Portable Automated Rapid Testing (PART) measures for auditory research. Proc Meet Acoust2018; 33: 050002.
16.
CollinsCLPinaACarrilloA, et al.Video-based remote administration of cognitive assessments and interventions: a comparison with in-lab administration. J Cogn Enhanc2022; 6: 316–326.
17.
Lelo de Larrea-ManceraESStavropoulosTCarrilloAA, et al.Remote auditory assessment using Portable Automated Rapid Testing (PART) and participant-owned devices. J Acoust Soc Am2022; 152: 807–819.
18.
Lelo de Larrea-ManceraESSolís-VivancoRSánchez-JiménezY, et al.Development and validation of a Spanish-language spatial release from masking task in a Mexican population. J Acoust Soc Am2023; 153: 316–327.
19.
Lelo de Larrea-ManceraESSolís-VivancoRSánchez-JiménezY, et al.Testing the informativeness of diverse measures of auditory processing for clinical audiological practice in middle-aged adults in Mexico. Am J Audiol2023; 33: 55–65.
20.
Lelo de Larrea-ManceraESCorrea-MedinaEIPadilla-BustosK, et al.A characterization of central auditory processing in Parkinson’s disease. J Parkinsons Dis2024; 14: 999–1013.
21.
AlbersMWGilmoreGCKayeJ, et al.At the interface of sensory and motor dysfunctions and Alzheimer’s disease. Alzheimers Dement2015; 11: 70–98.
22.
LivingstonGHuntleyJSommerladA, et al.Dementia prevention, intervention, and care: 2020 report of the Lancet Commission. Lancet2020; 396: 413–446.
23.
GatesGAAndersonMLMcCurrySM, et al.Central auditory dysfunction as a harbinger of Alzheimer dementia. Arch Otolaryngol Head Neck Surg2011; 137: 390.
24.
MohammedAGibbonsLEGatesG, et al.Association of performance on dichotic auditory tests with risk for incident dementia and Alzheimer dementia. JAMA Otolaryngol Head Neck Surg2022; 148: 20–27.
25.
GriffithsTDLadMKumarS, et al.How can hearing loss cause dementia?Neuron2020; 108: 401–412.
26.
PowellDSOhESReedNS, et al.Hearing loss and cognition: what we know and where we need to go. Front Aging Neurosci2022; 13: 769405.
27.
SladeKPlackCJNuttallHE. The effects of age-related hearing loss on the brain and cognitive function. Trends Neurosci2020; 43: 810–821.
28.
Aguilar-NavarroSGMimenza-AlvaradoAJPalacios-GarcíaAA, et al.Validity and reliability of the Spanish version of the Montreal Cognitive Assessment (MoCA) for the detection of cognitive impairment in Mexico. Rev Colomb Psiquiatr (Engl Ed)2018; 47: 237–243.
29.
LawtonMPBrodyEM. Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist1969; 9: 179–186.
30.
CharlsonMEPompeiPAlesKL, et al.A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis1987; 40: 373–383.
31.
YesavageJABrinkTLRoseTL, et al.Development and validation of a geriatric depression screening scale: a preliminary report. J Psychiatr Res1982; 17: 37–49.
32.
PahorAMesterRECarrilloAA, et al.UCancellation: a new mobile measure of selective attention. Behav Res Methods2022; 54: 2602–2617.
33.
CorsiPM. Human memory and the medial temporal region of the brain. Doctoral Thesis, McGill University (Canada), 1972.
34.
KaplanEGoodglassHWeintraubS. The Boston Naming Test. 2nd ed. Philadelphia: Lea & Febiger, 1983.
35.
MorrisJCHeymanAMohsRC, et al.The consortium to establish a registry for Alzheimer's Disease (CERAD). Part I. Clinical and neuropsychological assessment of Alzheimer's disease. Neurology1989; 39: 1159–1159.
36.
MackWJFreedDMWilliamsBW, et al.Boston Naming test: shortened versions for use in Alzheimer’s disease. J Gerontol1992; 47: 154–158.
37.
GravesREBezeauSCFogartyJ, et al.Boston Naming test short forms: a comparison of previous forms with new item response theory based forms. J Clin Exp Neuropsychol2004; 26: 891–902.
38.
ReitanRM. The relation of the Trail Making Test to organic brain damage. J Consult Psychol1955; 19: 393–394.
39.
American National Standards Institute. Methods for manual pure-tone threshold audiometry (ANSI S3.21-2004). 2004.
40.
GroseJHMamoSK. Processing of temporal fine structure as a function of age. Ear Hear2010; 31: 755–760.
41.
GroseJHMamoSK. Frequency modulation detection as a measure of temporal processing: age-related monaural and binaural effects. Hear Res2012; 294: 49–54.
42.
DiedeschACBock AdelaideSJ, et al.Clinical importance of binaural information: extending auditory assessment in clinical populations using a portable testing platform. Am J Audiol2021; 30: 655–668.
43.
GallunFJBestV. Age-related changes in segregation of sound sources. Hear Res2020; 264: 143–171.
44.
FüllgrabeCBCJMStoneMA. Age-group differences in speech identification despite matched audiometrically normal hearing: contributions from auditory temporal processing and cognition. Front Aging Neurosci2015; 6: 347.
45.
García-PérezMA. Forced-choice staircases with fixed step sizes: asymptotic and small-sample properties. Vision Res1998; 38: 1861–1881.
46.
MarroneNMasonCRKiddG. The effects of hearing loss and age on the benefit of spatial separation between multiple talkers in reverberant rooms. J Acoust Soc Am2008; 124: 3064–3075.
47.
GallunFJDiedeschACKampelSD, et al.Independent impacts of age and hearing loss on spatial release in a complex auditory environment. Front Neurosci2013; 7: 252.
48.
JakienKMKampelSDStansellMM, et al.Validating a rapid, automated test of spatial release from masking. Am J Audiol2017; 26: 507–518.
49.
Lelo de Larrea-ManceraESStavropoulosTHooverE, et al.Portable Automated Rapid Testing (PART) for auditory research: validation in a normal hearing population. J Acoust Soc Am2020; 148: 1831–1851.
50.
FiferRCJergerJFBerlinCI, et al.Development of a dichotic sentence identification test for hearing-impaired adults. Ear Hear1983; 4: 300–305.
51.
American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed.(DSM-5). Washington, DC: American Psychiatric Publishing, 2013.
52.
World Health Organization. International classification of diseases for mortality and morbidity statistics (11th Revision), https://icd.who.int/ (2019, accessed 22 September 2024).
53.
AlbertMSDeKoskySTDicksonD, et al.The diagnosis of mild cognitive impairment due to Alzheimer’s disease: recommendations from the national institute on aging-Alzheimer’s association workgroups on diagnostic guidelines for Alzheimer’s disease. Alzheimers Dement2011; 7: 270–279.
54.
JackCRAlbertMSKnopmanDS, et al.Introduction to the recommendations from the national institute on aging-Alzheimer’s association workgroups on diagnostic guidelines for Alzheimer’s disease. Alzheimers Dement2011; 7: 257–262.
BenjaminiYHochbergY. Controlling the false discovery rate: a practical powerful approach to multiple testing. J R Stat Soc Series B Methodol1995; 57: 289–300.
