Center for Cognitive Neuroscience and Aging, Department of Psychiatry and Behavioral Sciences, Leonard M. Miller School of Medicine, University of Miami.
Department of Neurology, Hospital Clinico San Carlos, San Carlos Health Research Institute (IdISSC), Universidad Complutense de Madrid.
Neuropsychology. 2023 Sep;37(6):661-672. doi: 10.1037/neu0000883. Epub 2022 Dec 8.
There is currently a lack of consensus among neuropsychologists about which cognitive assessment paradigms hold the most promise in identifying subtle cognitive deficits in preclinical Alzheimer's Disease (AD) and which are most useful for monitoring risk of cognitive deterioration. Many widely used instruments are older versions of tests originally developed for the assessment of dementia or traumatic brain injury. Current efforts to digitize these measures provides more uniform and remote assessment, which is an advancement, but does not reflect significant changes in paradigmatic underpinnings or recent advances in cognitive neuroscience.
This work provides an overview of novel Cognitive Challenge Tests (CCTs) that employ semantic interference paradigms that uniquely measure the failure to recover from proactive semantic interference (frPSI). Other salient methods to measure meaningful cognitive change in early stage AD are also presented, as well as how they compare with traditional neuropsychological assessments. Finally, future directions for the development of more effective assessment paradigms are discussed.
frPSI is a cognitive marker which measures the persistent inability to learn new semantically competing stimuli despite multiple opportunities to do so. frPSI and deficits in semantic inhibitory control have repeatedly shown utility for the early detection of AD during its preclinical stages. These novel cognitive markers have been related to various biomarkers of AD and neurodegeneration among culturally diverse older adults.
To meet the critical needs of a rapidly evolving field, cognitive assessment instruments must show sufficient scientific rigor including robust sensitivity, specificity, and predictive utility among culturally and linguistically diverse populations and importantly, be correlated to AD biomarkers. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
神经心理学家目前对于哪些认知评估范式最有希望识别临床前阿尔茨海默病（AD）中的细微认知缺陷，以及哪些范式最有助于监测认知恶化风险存在分歧。许多广泛使用的工具都是最初为评估痴呆或创伤性脑损伤而开发的测试的旧版本。目前将这些措施数字化的努力提供了更统一和远程的评估，这是一种进步，但并没有反映出范式基础或认知神经科学的最新进展的重大变化。
本研究概述了采用语义干扰范式的新型认知挑战测试（CCT），这些范式独特地衡量了从主动语义干扰中恢复的失败（frPSI）。还介绍了其他用于测量早期 AD 中有意义的认知变化的显著方法，以及它们与传统神经心理学评估的比较。最后，讨论了开发更有效的评估范式的未来方向。
frPSI 是一种认知标志物，可衡量在多次机会下仍无法从主动语义干扰中恢复学习新语义竞争刺激的持续能力缺失。frPSI 和语义抑制控制缺陷已被反复证明可用于在临床前阶段早期检测 AD。这些新的认知标志物与各种文化多样性的老年人中的 AD 和神经退行性变的生物标志物有关。
为满足快速发展领域的关键需求，认知评估工具必须具有足够的科学严谨性，包括在文化和语言多样化的人群中具有足够的敏感性、特异性和预测实用性，并且重要的是，与 AD 生物标志物相关。（PsycInfo 数据库记录（c）2023 APA，保留所有权利）。
