Sainsbury Wellcome Centre, University College London, London, United Kingdom.
Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, United Kingdom.
PLoS One. 2023 Apr 26;18(4):e0284220. doi: 10.1371/journal.pone.0284220. eCollection 2023.
Long-term memory tests are commonly used to facilitate the diagnosis of hippocampal-related neurological disorders such as Alzheimer's disease due to their relatively high specificity and sensitivity to damage to the medial temporal lobes compared to standard commonly used clinical tests. Pathological changes in Alzheimer's disease start years before the formal diagnosis is made, partially due to testing too late. This proof-of-concept exploratory study aimed to assess the feasibility of introducing an unsupervised digital platform for continuous testing of long-term memory over long periods outside the laboratory environment. To address this challenge, we developed a novel digital platform, hAge ('healthy Age'), which integrates double spatial alternation, image recognition and visuospatial tasks for frequent remote unsupervised assessment of spatial and non-spatial long-term memory carried out continuously over eight week period. To demonstrate the feasibility of our approach, we tested whether we could achieve sufficient levels of adherence and whether the performance on hAge tasks is comparable to the performance observed in the analogous standard tests measured in the controlled laboratory environments.191 healthy adults (67% females, 18-81 years old) participated in the study. We report an estimated 42.4% adherence level with minimal inclusion criteria. In line with findings using standard laboratory tests, we showed that performance on the spatial alternation task negatively correlated with inter-trial periods and the performance levels on image recognition and visuospatial tasks could be controlled by varying image similarity. Importantly, we demonstrated that frequent engagement with the double spatial alternation task leads to a strong practice effect, previously identified as a potential measure of cognitive decline in MCI patients. Finally, we discuss how lifestyle and motivation confounds may present a serious challenge for cognitive assessment in real-world uncontrolled environments.
长期记忆测试常用于辅助诊断与海马体相关的神经紊乱，如阿尔茨海默病，因为与标准的临床常用测试相比，它们对内侧颞叶损伤具有相对较高的特异性和敏感性。阿尔茨海默病的病理性变化在正式诊断前数年就已开始，部分原因是检测太晚。这项概念验证探索性研究旨在评估在实验室环境之外的长时间内引入一种非监督式数字平台对长期记忆进行连续测试的可行性。为了应对这一挑战，我们开发了一种新的数字平台，hAge（“健康年龄”），它集成了双重空间交替、图像识别和视空间任务，用于在八周的时间内频繁进行远程、非监督的空间和非空间长期记忆的连续评估。为了证明我们方法的可行性，我们测试了是否可以达到足够的依从性水平，以及在 hAge 任务上的表现是否与在控制实验室环境中测量的类似标准测试上的表现相当。191 名健康成年人（女性占 67%，年龄 18-81 岁）参与了这项研究。我们报告的依从性水平估计为 42.4%，采用了最低的纳入标准。与使用标准实验室测试的结果一致，我们表明，空间交替任务的表现与试验间间隔呈负相关，并且图像识别和视空间任务的表现水平可以通过改变图像相似度来控制。重要的是，我们证明了频繁参与双重空间交替任务会导致强烈的练习效应，这以前被认为是 MCI 患者认知能力下降的潜在衡量标准。最后，我们讨论了生活方式和动机混淆如何给现实世界的非控制环境中的认知评估带来严重挑战。
