基于智能手机的帕金森病神经心理学评估：认知的可行性、有效性和情境驱动的可变性。
Smartphone-Based Neuropsychological Assessment in Parkinson's Disease: Feasibility, Validity, and Contextually Driven Variability in Cognition.
机构信息
Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA.
Department of Occupational Therapy and Rehabilitation Sciences, Boston University, Boston, MA, USA.
出版信息
J Int Neuropsychol Soc. 2022 Apr;28(4):401-413. doi: 10.1017/S1355617721000503. Epub 2021 May 17.
OBJECTIVES
The prevalence of neurodegenerative disorders demands methods of accessible assessment that reliably captures cognition in daily life contexts. We investigated the feasibility of smartphone cognitive assessment in people with Parkinson's disease (PD), who may have cognitive impairment in addition to motor-related problems that limit attending in-person clinics. We examined how daily-life factors predicted smartphone cognitive performance and examined the convergent validity of smartphone assessment with traditional neuropsychological tests.
METHODS
Twenty-seven nondemented individuals with mild-moderate PD attended one in-lab session and responded to smartphone notifications over 10 days. The smartphone app queried participants 5x/day about their location, mood, alertness, exercise, and medication state and administered mobile games of working memory and executive function.
RESULTS
Response rate to prompts was high, demonstrating feasibility of the approach. Between-subject reliability was high on both cognitive games. Within-subject variability was higher for working memory than executive function. Strong convergent validity was seen between traditional tests and smartphone working memory but not executive function, reflecting the latter's ceiling effects. Participants performed better on mobile working memory tasks when at home and after recent exercise. Less self-reported daytime sleepiness and lower PD symptom burden predicted a stronger association between later time of day and higher smartphone test performance.
CONCLUSIONS
These findings support feasibility and validity of repeat smartphone assessments of cognition and provide preliminary evidence of the effects of context on cognitive variability in PD. Further development of this accessible assessment method could increase sensitivity and specificity regarding daily cognitive dysfunction for PD and other clinical populations.
目的
神经退行性疾病的患病率要求采用易于获取的评估方法，以便在日常生活环境中可靠地捕捉认知能力。我们研究了智能手机认知评估在帕金森病（PD）患者中的可行性，这些患者除了运动相关问题外，可能还存在认知障碍，这限制了他们前往门诊就诊。我们考察了日常生活因素如何预测智能手机认知表现，并检验了智能手机评估与传统神经心理学测试的聚合效度。
方法
27 名认知正常的轻中度 PD 患者参加了一次实验室检查，并在 10 天内对智能手机通知做出响应。智能手机应用程序每天向参与者询问 5 次他们的位置、情绪、警觉性、运动和用药情况，并进行移动工作记忆和执行功能游戏。
结果
对提示的响应率很高，表明该方法具有可行性。两种认知游戏的组内可靠性都很高。工作记忆的个体内变异性高于执行功能。在传统测试和智能手机工作记忆之间观察到了很强的聚合效度，但在执行功能方面没有，这反映了后者的天花板效应。当参与者在家中且在最近运动后，他们在移动工作记忆任务上的表现更好。白天嗜睡自评得分越低，PD 症状负担越低，与一天中时间较晚和智能手机测试表现较高的相关性越强。
结论
这些发现支持重复使用智能手机评估认知的可行性和有效性，并提供了初步证据表明，日常生活环境对 PD 患者认知变异性的影响。这种易于获取的评估方法的进一步发展可能会提高 PD 和其他临床人群的日常认知功能障碍的敏感性和特异性。
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