Evaluating High-Frequency Automated Cognitive Tasks Across Immune-Mediated Inflammatory Disease and Neurodegenerative Disease Patients

medRxiv

Abstract

Abstract This analysis evaluates the feasibility and psychometric properties of daily digital cognitive assessments (DCAs) delivered on smartphones using data from the large, international Identifying Digital Endpoints to Assess FAtigue, Sleep and acTivities of daily living in Neurodegenerative disorders and Immune-mediated inflammatory diseases (IDEA-FAST) study. The data we analyse were collected from patients with neurodegenerative diseases (NDDs) and immune-mediated inflammatory diseases (IMIDs), and healthy controls (a subset who participated in all phases of the study, total N=1005) in their own homes. These data were obtained alongside data from other devices that monitored physiology, kinematics, and sleep quality. Following a baseline visit, participants were remotely monitored via three scheduled daily sessions for 6-7 days in each of 4 active assessment phases (APs). APs were separated by 6-week intervals. Daily schedules comprised a morning psychomotor vigilance task (PVT) with eDiary, afternoon session (eDiary only), and an evening digit symbol substitution task (DSST) with eDiary. We evaluated session coverage using logistic mixed effects, test-retest reliability using ICCs, disease impacts on performance using linear mixed effect ANCOVA, and familiarisation using linear mixed effects. Overall coverage was 66.7% for the PVT and 76.2% for the DSST, with no significant differences between the healthy volunteers and disease cohorts. Coverage varied significantly by time-of-day (Evening > Morning > Afternoon), and improved with age, with an interaction revealing session time-of-day affected older participants less, all p < .001. Coverage was highest in AP 1 and reduced in subsequent APs. AP-day effects on coverage interacted significantly with AP, with a modest decline over AP 1, and the pattern reversed in APs 2-4. Baseline reliability was good (> .70) for both PVT mean reaction time and DSST total correct across all cohorts, and the movement-based measure from the DSST ranged [.54, .82], with lower values in the Parkinson’s Disease and Primary Sjögren’s Syndrome cohorts. Both tasks showed significant cohort effects, with performance in IMID cohorts intermediate between healthy controls and NDD. Longitudinal analysis revealed significant familiarisation effects in DSST. This was greatest in healthy controls, with significant attenuation of these effects in disease cohorts. No effect of familiarisation was seen in the PVT. Collectively, these results support the usefulness of at-home cognitive assessment on smartphones. Brief measures of cognition can be captured remotely in disease as well as controls with good adherence and sensitivity to distinguish known patient groups from healthy controls.

Authors 15

1. Alexander J Kaula

   Cambridge Cognition (United Kingdom)

   Affiliation as printed

   Cambridge Cognition, Cambridge, UK

2. Nick Taptiklis

   Cambridge Cognition (United Kingdom)

   Affiliation as printed

   Cambridge Cognition, Cambridge, UK

3. Francesca K Cormack

   Cambridge Cognition (United Kingdom)

   Affiliation as printed

   Cambridge Cognition, Cambridge, UK

4. Laura C M Kuijper Aachen Department of Neurology, Leiden University Medical Center (LUMC)

   Leiden University Medical Center

   Affiliation as printed

   Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands

5. Stefan Avey

   Johnson & Johnson (United States)

   Affiliation as printed

   Johnson & Johnson, Spring House, PA, USA

6. Meenakshi Chatterjee

   Johnson & Johnson (United States)

   Affiliation as printed

   Johnson & Johnson, Spring House, PA, USA

7. Rana Zia Ur Rehman

   Johnson & Johnson (United Kingdom)

   Affiliation as printed

   Johnson & Johnson, Buckinghamshire, UK

8. Susanne Tamara de Bot Aachen Department of Neurology, Leiden University Medical Center (LUMC)

   Leiden University Medical Center

   Affiliation as printed

   Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands

9. Andrea Pilotto

   Karolinska Institutet · Azienda Socio Sanitaria Territoriale degli Spedali Civili di Brescia · University of Brescia

   Affiliation as printed

   Department of Clinical and Experimental Sciences, Neurology Unit and Laboratory of Digital Neurology and biosensors, University of Brescia, Brescia, Italy

   Department of Continuity of Care and Frailty, ASST Spedali Civili Brescia Hospital, Brescia, Italy

   Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society (NVS), Center for Alzheimer Research, Karolinska Institutet, Stockholm, Sweden

10. C. Janneke van der Woude

    Erasmus MC

    Affiliation as printed

    Department of Gastroenterology and Hepatology, Erasmus University Medical Centre, Rotterdam, The Netherlands

11. Christopher Andrew Lamb

    Newcastle upon Tyne Hospitals NHS Foundation Trust · Newcastle University

    Affiliation as printed

    Department of Gastroenterology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK

    Faculty of Medical Sciences, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK

12. Ralf Reilmann

    George Huntington Institute

    Affiliation as printed

    George-Huntington-Institute, Münster, Germany

13. Nikolay V. Manyakov
    Affiliation as printed

    Johnson & Johnson, Beerse, Belgium

14. Walter Maetzler

    Christian-Albrechts-Universität zu Kiel · University Hospital Schleswig-Holstein

    Affiliation as printed

    Department of Neurology, University Hospital Schleswig-Holstein and Kiel University, Kiel, Germany

15. Wan-Fai Ng

    University College Cork · Newcastle upon Tyne Hospitals NHS Foundation Trust

    Affiliation as printed

    Department of Gastroenterology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK

    HRB Clinical Research Facility Cork, University College Cork, Cork, Ireland