ABSTRACT
Introduction: Japan has the largest aging population with 33% of the population over the age of 60 years. The number of Japanese adults with dementia is estimated to be approximately 4.6 million, comprising nearly 15% of the older adult population. It is critical to administer cognitive assessments early in the disease state that have high reliability and low user burden to detect negative cognitive changes as early as possible; however, current preclinical AD detection methods are invasive, time-consuming, and expensive. A number of traditional and digital cognitive assessments are also available, but many of these tests are time-consuming, taxing to the user, and not widely scalable. The purpose of this study was to incorporate a digital cognitive assessment battery into a standard clinical assessment performed within a Japanese-based neuropsychology clinic to assess the diagnostic accuracy and the relationship between the digital Neurotrack Cognitive Assessment Battery (N-CAB) to traditional cognitive assessments. Methods: Healthy individuals and probable Alzheimer's patients completed the N-CAB, as well as two traditional cognitive assessments, the Mini Mental Status Exam (MMSE) and the Revised Hasegawa's Dementia Scale (HDS-R). Results: Our results demonstrate the Image Pairs hand-response phase of the N-CAB had the highest diagnostic accuracy with 95% sensitivity and 89% specificity to probable Alzheimer's disease. This was closely followed by the Symbol Match assessment, with a 96% sensitivity and 74% specificity to probable Alzheimer's disease. Additionally, Symbol Match and Path Points used in combination resulted in a sensitivity of 94%, specificity of 90%; a model with all N-CAB assessments resulted in a sensitivity and specificity of 100%. All N-CAB assessments had moderate to strong and significant correlations with the MMSE and HDS-R. Discussion: Together, this suggests that the N-CAB assessment battery may be an appropriate alternative for the clinical screening of cognition for earlier detection of Alzheimer's disease.
ABSTRACT
Geographic, social, political, and economic factors shape access to advanced neurotechnologies, yet little previous research has explored the barriers, enablers, and areas of opportunity for equitable and meaningful access for diverse patient communities across Canada. We applied a mixed-mode approach involving semi-structured interviews and rating scale questions to consult with 24 medical experts who are involved in the care of patients who undergo functional neurosurgery targeting the brain. Seven major themes emerged from the qualitative analysis: Health care system, Neurotechnology features, Patient demographics, Target condition features, Ethics, Upstream barriers and enablers, and Areas of opportunity. Descriptive statistics of the Likert-scale responses suggest that interviewees perceive a disparity between the imperative of access to advanced neurotechnologies for people living in rural and remote areas and the likelihood of achieving such access. The results depict a complex picture of access to functional neurosurgery in Canada with pockets of excellence and a motivation to improve the availability of care for vulnerable populations through the expansion of distributed care models, improved health care system efficiencies, increasing funding and support for patient travel, and increasing awareness about and advocacy for advanced neurotechnologies.
Subject(s)
Brain , Neurosurgery , Humans , Canada , Motivation , Neurosurgical ProceduresABSTRACT
Ethical discourse around machine learning analysis of free speech for the detection of schizophrenia has largely focused on consent and personal privacy. We focus here on additional ethics concerns and principles that must be addressed to move the pendulum of risk over to benefit and propose solutions to achieve that shift.
