Glen Doniger - Academia.edu (original) (raw)

Papers by Glen Doniger

European journal of public health, Jan 13, 2017

Evidence for an association of fasting plasma glucose (FPG) with cognitive function in adults fre... more Evidence for an association of fasting plasma glucose (FPG) with cognitive function in adults free of diabetes is scarce and based on middle-aged and older adults. We examined the association of FPG, measured at age 30, and of change in FPG from age 30 to 43, with cognitive function at age 50. 505 nondiabetic participants of the population-based Jerusalem Lipid Research Clinic (LRC) cohort study had baseline FPG, 2-h post-oral challenge plasma glucose (OGTT) and insulin determined at ages 28-32, and FPG and OGTT again at ages 41-46. Subsequently at ages 48-52, global cognitive function and its five specific component domains were assessed with a NeuroTrax computerized test battery, using multiple linear regression and multivariable logistic models. Hyperglycemia (FPG ≥ 5.6 mmol/l vs. <5.6 mmol/l) at baseline was associated with poorer global cognitive function in midlife (predominantly in the visual spatial and attention domains), independent of socio-demographic characteristics,...

PloS one, 2015

Inflammatory markers are elevated in patients with dementia. Evidence for an association between ... more Inflammatory markers are elevated in patients with dementia. Evidence for an association between inflammation and cognitive function in dementia-free individuals is sparse, inconsistent, and predominantly restricted to the elderly. Assessment of inflammatory markers in young adults as predictors of cognitive function in midlife, well before the onset of overt dementia, is lacking. Furthermore, rarely has the relation with longitudinal change in inflammatory markers been examined. To examine the association of the inflammatory markers C-reactive protein (CRP), fibrinogen, white blood cell count (WBC) and GlycA, a novel NMR-determined biomarker of systemic inflammation, measured in young adulthood and of GlycA change over 13 years follow-up with cognitive function in midlife. 507 participants of the Jerusalem Lipid Research Clinic (LRC) study were assessed at 3 time points over 18-22 years. First, the inflammatory variables GlycA, CRP, fibrinogen, and WBC were measured in blood sample...

European Journal of Epidemiology, 2015

Evidence for an association of leukocyte telomere length (LTL) with cognitive function, predomina... more Evidence for an association of leukocyte telomere length (LTL) with cognitive function, predominantly in older adults, is inconsistent. No report has examined the association of LTL dynamics (age-specific LTL and its attrition rate) with cognitive function. We aimed to examine the association of LTL dynamics over 13 years in young adulthood with cognitive function in midlife. 497 individuals who had LTL measured at ages 28-32 and 41-46 years were assessed at ages 48-52 for global cognitive function and its five specific component domains with a NeuroTrax computerized test battery. Multivariable regression and logistic models were applied for cognition treated as a continuous and categorical variable, respectively. We found that LTL attrition (adjusted for sex, baseline LTL and potential confounders including socioeconomic variables) was inversely associated with global cognition (standardized b =-.119, p = .004) and its component domains: information processing speed (b =-.102, p = .024), visual-spatial function (b =-.102, p = .017) and memory (b =-.093, p = .045), but less so for the attention and executive domains. The multivariable-adjusted odds ratio for low global cognition comparing the upper versus lower thirds of LTL attrition was 2.12 (95 % CI 1.11-4.08, p for trend = .023). There was no association of baseline or follow-up LTL with cognition. No effect modification was evident for sex, smoking or inflammatory markers. In conclusion, faster LTL attrition in young adulthood was associated with poorer global and domain-specific cognitive function in midlife, suggesting that more rapid LTL attrition may be predictive of cognitive aging in healthy young adults.

Neurobiology of Aging, 2004

Psychiatry, Psychology and Law, 2012

The most effective tests for detection of negative response bias (NRB) are based on the forced ch... more The most effective tests for detection of negative response bias (NRB) are based on the forced choice paradigm, but patients coached prior to their administration may easily discern their purpose. Algorithms for NRB detection based upon parameters from standard neuropsychological tests may be more difficult for patients to discern and thus more effective in detecting NRB. The current study aimed

Neuromodulation: Technology at the Neural Interface, 2012

The objective of this study is to compare a computerized deep brain stimulation (DBS) screening m... more The objective of this study is to compare a computerized deep brain stimulation (DBS) screening module (Comparing Private Practice vs. Academic Centers in Selection of DBS Candidates [COMPRESS], NeuroTrax Corp., Bellaire, TX, USA) with traditional triage by a movement disorders specialized neurologist as the gold standard. Methods: The COMPRESS consists of a combination of the Florida Surgical Questionnaire for Parkinson disease (FLASQ-PD), a cognitive assessment battery provided by MindStreams® (NeuroTrax Corp.), and the Geriatric Depression Scale and the Zung Anxiety Self-Assessment Scale. COMPRESS resulted in the classification of patients into three categories: "optimal candidate, " "probable candidate, " and "not a good candidate. " Similar categorical ratings made by a referring private practice neurologist and by a trained movement disorders specialist were compared with the ratings generated by COMPRESS. Results: A total of 19 subjects with Parkinson's disease were enrolled from five private neurological practices. The clinical impressions of the private practice neurologist vs. those of the movement disorders specialist were in agreement approximately half the time (10/19 cases). The movement disorders specialist and COMPRESS agreed on 15/19 cases. A further comparison between outcomes from the entire COMPRESS module and the FLASQ-PD questionnaire by itself resulted in high agreement (18/19 cases in agreement). Conclusions: The COMPRESS agreed with an in-person evaluation by a movement disorders neurologist approximately 80% of the time. The computerized COMPRESS did not provide any screening advantage over the short FLASQ-PD paper questionnaire. Larger studies will be needed to assess the utility and cost effectiveness of this computerized triage method for DBS.

Neurobiology of Aging, 2004

Ely S. Simon* t, Glen M. Doniger 1 , David M. Zucker 2, Howard Chertkow 3, Howard Crystal 4, Avra... more Ely S. Simon* t, Glen M. Doniger 1 , David M. Zucker 2, Howard Chertkow 3, Howard Crystal 4, Avraham S chweiger 5 , Tzvi Dwolatzky 6. J NeuroTrax Corporation, New York, NY,, USA," 2Hebrew University, Jerusalem, Israel; 3McGill University, Montreal, PQ, Canada; 4 SUNY Downstate Medical Center, Brooklyn, NY, USA; 5Academic College of Tel Aviv, Tel Aviv, Israel; 6Shaare Zedek Medical Center, Jerusalem, Israel. Contact e-mail: ely@nearotrax.com

Journal of Molecular Neuroscience, 2004

The NeuroTrax Mindstreams™ computerized cognitive assessment system was designed for widespread c... more The NeuroTrax Mindstreams™ computerized cognitive assessment system was designed for widespread clinical and research use in detecting mild cognitive impairment (MCI). However, the capability of Mindstreams tests to discriminate the elderly with MCI from those who are cognitively healthy has yet to be evaluated. Moreover, the comparability between these tests and traditional neuropsychological tests in detecting MCI has not been examined. A two-center study was designed to assess the discriminant validity of tests in the Mindstreams Mild Impairment Battery. Participants were 30 individuals diagnosed with MCI, 29 with mild Alzheimer's disease (AD), and 39 healthy elderly. Testing was with the Mindstreams battery and traditional neuropsychological tests. Receiver operating characteristic (ROC) analysis was used to examine the ability of Mindstreams and traditional measures to discriminate those with MCI from cognitively healthy elderly. Between-group comparisons were made (Mann-Whitney U test) between MCI and healthy elderly and between MCI and mild AD groups. Mindstreams outcome parameters across multiple cognitive domains significantly discriminated between MCI and healthy elders with considerable effect sizes (p < 0.05). Measures of memory, executive function, visual spatial skills, and verbal fluency discriminated best, and discriminability was at least comparable to that of traditional neuropsychological tests in these domains. Mindstreams tests are effective in detecting MCI, providing a comprehensive profile of cognitive function. Further, the enhanced precision and ease of use of these computerized tests make the NeuroTrax system a valuable clinical tool in the identification of elders at high risk for dementia.

Journal of Clinical and Experimental Neuropsychology, 2007

The cognitive profile of adult attention deficit hyperactivity disorder (ADHD) remains understudi... more The cognitive profile of adult attention deficit hyperactivity disorder (ADHD) remains understudied despite difficulty in diagnosis. Further, no battery of neuropsychological tests has been shown valid in adult ADHD. Continuous performance tests are widely used for ADHD but provide limited information on cognitive functioning in general. The present study evaluated the construct and discriminant validity of Mindstreams ® (NeuroTrax Corp., NY), a computerized battery assessing multiple cognitive domains. Twenty-nine young male adults with ADHD diagnosis completed a Mindstreams battery, including a multi-stage continuous performance ('Expanded Go-NoGo') test, and the Conners' CPT-II (Multi-Health Systems Inc., NY). Discriminant validity was assessed by comparisons with cognitively healthy controls of comparable age and education. Expanded Go-NoGo and corresponding CPT-II outcomes were significantly correlated in ADHD participants, and the Expanded Go-NoGo test exhibited excellent discriminant validity, with ADHD participants performing more poorly than controls. ADHD participants also performed more poorly on Stroop and Staged Information Processing Speed tests.

Journal of Child Neurology, 2007

Multidomain assessment may enhance the diagnosis of cognitive impairment in children with attenti... more Multidomain assessment may enhance the diagnosis of cognitive impairment in children with attention-deficit hyperactivity disorder (ADHD). A set of novel Web-enabled computerized tests has recently been shown to be valid for identifying mild cognitive impairment and characterizing the cognitive profile associated with various disorders. It was anticipated that these tests would be well suited for use in children with ADHD. The authors tested this idea in a pilot study of 15 children (12 males, 3 females; mean age, 11 years 10 months; range, 9-15 years) with ADHD and 15 age-, education-, and gender-matched controls. The profile of cognitive impairment in ADHD children off methylphenidate across 6 cognitive domains (memory, executive function, visual-spatial skills, verbal function, attention, and motor skills) was described relative to controls. The effect of treatment with methylphenidate was examined by comparing the ADHD children on methylphenidate and on placebo (administered in ...

International Psychogeriatrics, 2010

ABSTRACTBackground: Computerized cognitive assessment tools have been developed to make precise n... more ABSTRACTBackground: Computerized cognitive assessment tools have been developed to make precise neuropsychological assessment readily available to clinicians. Mindstreams batteries for mild impairment have been validated previously. We examined the validity of a Mindstreams battery designed specifically for evaluating those with moderate cognitive impairment.Methods: 170 participants over the age of 60 years performed the computerized battery in addition to standard clinical evaluation. The battery consists of six technician-administered tests and one patient-administered interactive test sampling the cognitive domains of orientation (to time and place), memory, executive function, visual spatial processing, and verbal function. Staging was according to the Clinical Dementia Rating Scale (CDR) on the basis of clinical data but independent of computerized cognitive testing results, thus serving as the gold standard for evaluating the discriminant validity of the computerized measures...

International Journal of Psychiatry in Clinical Practice, 2006

Previous studies have indicated that estrogen may delay disease progression and minimize the cogn... more Previous studies have indicated that estrogen may delay disease progression and minimize the cognitive decline in patients with Alzheimer's disease (AD). However, the evidence for an estrogen deficiency in women with dementia and cognitive dysfunction is inconsistent. In the present review, a fixed effect meta-analysis revealed that the hormone replacement therapy (HRT) group exhibited significant improvements in Alzheimer Disease Assessment Scale-Cognitive subscale scores relative to those observed in the placebo group, suggesting that HRT is feasible for treating cognitive decline in patients with AD. However, no significant differences in Mini-Mental State Examination and Clinical Dementia Rating scale scores were observed between the 2 groups. The results of our systematic review indicate that HRT can improve cognitive function in female patients with AD. Due to limitations in sample size and the available literature, further multicenter trials with larger sample sizes are required to support these findings.

Genetics in Medicine, 2005

Purpose: Because of concern for drug-induced cognitive dysfunction during clinical trials using s... more Purpose: Because of concern for drug-induced cognitive dysfunction during clinical trials using substrate reduction therapy (miglustat) in type 1 Gaucher disease and because it has been suggested that some patients with type 1 Gaucher disease may develop neurocognitive impairment as part of the natural history, two different batteries of neuropsychological tests were devised to examine these issues. Using these tests, cognitive function was assessed in patients treated with miglustat, in patients receiving enzyme replacement (standard care for symptomatic patients), and in untreated (milder) patients. Methods: For this study, 55/60 patients exposed to miglustat in Israel participated in psychologist-administered testing; 36/55 participated in computerized testing. Of these, 31 enzyme-treated patients and 22 untreated patients participated in the psychologist-administered testing, and 15 enzyme-treated patients and 18 untreated patients participated in computerized testing. The psychologistadministered battery consisted of 18 standard neuropsychological subtests specific to executive and visuospatial functioning. The computerized battery (Mindstreams®, NeuroTrax Corp., New York, NY) consisted of 10 subtests tapping multiple cognitive domains. Between-group analyses for each modality compared cognitive performance. Results: In the psychologist-administered testing, patients exposed to miglustat performed significantly less well than the other groups in 5/18 subtests. On the computerized tests, all patients performed comparably to normal controls. Scores in patients exposed to miglustat were higher than in untreated patients, particularly in visuospatial function, whereas enzyme-treated patients performed less well. However, with the exception of visuospatial function, these results were not statistically significant. Conclusions: It is unclear why different testing methods yielded discordant results. Any dysfunction suggested by the current study is apparently subtle and of doubtful clinical relevance given that cognitive status did not interfere with patients' daily intellectual function. The computerized battery has methodological advantages (e.g., language options, objectivity, brevity, and ease of use) that make it well-suited for longitudinal studies, for long-term surveillance of substrate reduction therapy as well as for comparisons with other lysosomal storage disorders and other chronic diseases. These preliminary findings should allay fears of cognitive dysfunction due to short-term miglustat therapy.

Experimental Aging Research, 2006

The present study examined the cognitive profile of fallers relative to healthy controls and pati... more The present study examined the cognitive profile of fallers relative to healthy controls and patients with Parkinson's disease (PD), a positive control group, using a computerized battery. Fallers performed more poorly than controls on executive function, attention, and motor skills, but performed comparably on memory, information processing and the Mini Mental State Exam. A similar profile was evident for PD patients. However, unlike PD patients, fallers were abnormally inconsistent in their reaction times. These findings indicate that elderly fallers may have a unique cognitive processing deficit (i.e., variability of response timing) and underscore the importance of executive function and attention as potential targets for fall risk screening and interventions.

European Journal of Neurology, 2007

Cognitive impairment is amongst the main symptoms affecting multiple sclerosis (MS) and should be... more Cognitive impairment is amongst the main symptoms affecting multiple sclerosis (MS) and should be comprehensively and accurately assessed. To study the added value of a computerized neuropsychological battery enabling the measurement of response times in the cognitive domains, 58 randomly selected MS patients and 71 age-, gender-and education-matched healthy subjects were evaluated. Construct and discriminant validity were assessed for the standard Neuropsychological Screening Battery for Multiple Sclerosis (NSBMS) and the MindstreamsÒ Computerized Cognitive Battery (MCCB). The MCCB demonstrated good construct validity in comparison with the NSBMS in memory (P < 0.001), executive function (P < 0.001), attention (P < 0.05) and information processing (P < 0.05) domains. In addition, it showed high discriminant validity most prominently for executive function, attention and motor skills (P < 0.001). Response times measured by the computerized battery were longer in all cognitive domains and varied with cognitive load, demonstrating that response time deficits in MS are associated with particular task demands. We conclude that in MS prolonged response times on a range of cognitive tasks signify abnormal conduction within demyelinative tracts.

Current Alzheimer Research, 2005

Behavioral Neuroscience, 2006

Food deprivation has been shown to deleteriously affect human cognition, but findings are equivoc... more Food deprivation has been shown to deleteriously affect human cognition, but findings are equivocal, and few studies have examined several cognitive domains. In this study, the authors used computerized testing to describe the profile of shifts in cognition attributable to short-term religious fasting. Multiple cognitive domains were evaluated at midday and late afternoon following complete abstention from eating and drinking beginning at midnight. Cross-domain, fasting-related deficits were found for tasks requiring perception of spatial relations. Fasting-related information processing deficits were found for response time but not accuracy for test levels of intermediate difficulty. Time-of-day effects often reflected poorer afternoon performance. These findings provide a detailed profile of cognitive consequences of food deprivation, affected by time of day, task demands, and type of outcome.

Applied Neuropsychology, 2008

Neuropsychological assessment is critically dependent upon comparison to a standard normative dat... more Neuropsychological assessment is critically dependent upon comparison to a standard normative database. While generally appropriate for individuals of near-average intelligence, high-intelligence individuals may be erroneously scored as unimpaired and low-intelligence individuals as impaired on cognitive measures. The current paper describes an approach for minimizing such misclassifications that is standardized and practical for clinical use. A computerized test of nonverbal reasoning co-normed with cognitive measures is used for automatic adjustment of normalized cognitive scores. This premorbid estimate showed good construct validity, and adjustment raised cognitive scores for low-intelligence individuals, and lowered cognitive scores for high-intelligence individuals similarly across demographic (age, education, computer experience) and clinical (cognitively healthy, mild cognitive impairment, dementia) subgroups. Adjustment was typically up to three normalized units for scores on the premorbid estimate of AE1 SD and 6 normalized units for scores of AE2 SD. The present approach shows promise as a practical solution for assessment of high-and low-intelligence individuals.

American Journal of Alzheimer's Disease & Other Dementiasr, 2006

Cognitive and depressive symptoms co-occur, complicating detection of mild cognitive impairment (... more Cognitive and depressive symptoms co-occur, complicating detection of mild cognitive impairment (MCI) and early dementia. In this study, discriminant validity of a novel computerized cognitive battery for MCI detection was evaluated after covariation for depressive symptom severity. In addition to the computerized battery, participants at two sites received the 30-item self-administered Geriatric Depression Scale (GDS; n = 72); those at two other centers received the observer-administered Cornell Scale for Depression in Dementia (CSDD; n = 88). In both cohorts, a Global Cognitive Score and memory, executive function, visual spatial, and verbal index scores discriminated among cognitively healthy, MCI, and mild dementia groups after covariation for GDS or CSDD, respectively (p < 0.05). Thus, the computerized battery for detection of mild impairment is robust to comorbid depressive symptoms, supporting its clinical utility in identifying neurodegenerative disease even in elderly wi...

European journal of public health, Jan 13, 2017

Evidence for an association of fasting plasma glucose (FPG) with cognitive function in adults fre... more Evidence for an association of fasting plasma glucose (FPG) with cognitive function in adults free of diabetes is scarce and based on middle-aged and older adults. We examined the association of FPG, measured at age 30, and of change in FPG from age 30 to 43, with cognitive function at age 50. 505 nondiabetic participants of the population-based Jerusalem Lipid Research Clinic (LRC) cohort study had baseline FPG, 2-h post-oral challenge plasma glucose (OGTT) and insulin determined at ages 28-32, and FPG and OGTT again at ages 41-46. Subsequently at ages 48-52, global cognitive function and its five specific component domains were assessed with a NeuroTrax computerized test battery, using multiple linear regression and multivariable logistic models. Hyperglycemia (FPG ≥ 5.6 mmol/l vs. <5.6 mmol/l) at baseline was associated with poorer global cognitive function in midlife (predominantly in the visual spatial and attention domains), independent of socio-demographic characteristics,...

PloS one, 2015

Inflammatory markers are elevated in patients with dementia. Evidence for an association between ... more Inflammatory markers are elevated in patients with dementia. Evidence for an association between inflammation and cognitive function in dementia-free individuals is sparse, inconsistent, and predominantly restricted to the elderly. Assessment of inflammatory markers in young adults as predictors of cognitive function in midlife, well before the onset of overt dementia, is lacking. Furthermore, rarely has the relation with longitudinal change in inflammatory markers been examined. To examine the association of the inflammatory markers C-reactive protein (CRP), fibrinogen, white blood cell count (WBC) and GlycA, a novel NMR-determined biomarker of systemic inflammation, measured in young adulthood and of GlycA change over 13 years follow-up with cognitive function in midlife. 507 participants of the Jerusalem Lipid Research Clinic (LRC) study were assessed at 3 time points over 18-22 years. First, the inflammatory variables GlycA, CRP, fibrinogen, and WBC were measured in blood sample...

European Journal of Epidemiology, 2015

Evidence for an association of leukocyte telomere length (LTL) with cognitive function, predomina... more Evidence for an association of leukocyte telomere length (LTL) with cognitive function, predominantly in older adults, is inconsistent. No report has examined the association of LTL dynamics (age-specific LTL and its attrition rate) with cognitive function. We aimed to examine the association of LTL dynamics over 13 years in young adulthood with cognitive function in midlife. 497 individuals who had LTL measured at ages 28-32 and 41-46 years were assessed at ages 48-52 for global cognitive function and its five specific component domains with a NeuroTrax computerized test battery. Multivariable regression and logistic models were applied for cognition treated as a continuous and categorical variable, respectively. We found that LTL attrition (adjusted for sex, baseline LTL and potential confounders including socioeconomic variables) was inversely associated with global cognition (standardized b =-.119, p = .004) and its component domains: information processing speed (b =-.102, p = .024), visual-spatial function (b =-.102, p = .017) and memory (b =-.093, p = .045), but less so for the attention and executive domains. The multivariable-adjusted odds ratio for low global cognition comparing the upper versus lower thirds of LTL attrition was 2.12 (95 % CI 1.11-4.08, p for trend = .023). There was no association of baseline or follow-up LTL with cognition. No effect modification was evident for sex, smoking or inflammatory markers. In conclusion, faster LTL attrition in young adulthood was associated with poorer global and domain-specific cognitive function in midlife, suggesting that more rapid LTL attrition may be predictive of cognitive aging in healthy young adults.

Neurobiology of Aging, 2004

Psychiatry, Psychology and Law, 2012

The most effective tests for detection of negative response bias (NRB) are based on the forced ch... more The most effective tests for detection of negative response bias (NRB) are based on the forced choice paradigm, but patients coached prior to their administration may easily discern their purpose. Algorithms for NRB detection based upon parameters from standard neuropsychological tests may be more difficult for patients to discern and thus more effective in detecting NRB. The current study aimed

Neuromodulation: Technology at the Neural Interface, 2012

The objective of this study is to compare a computerized deep brain stimulation (DBS) screening m... more The objective of this study is to compare a computerized deep brain stimulation (DBS) screening module (Comparing Private Practice vs. Academic Centers in Selection of DBS Candidates [COMPRESS], NeuroTrax Corp., Bellaire, TX, USA) with traditional triage by a movement disorders specialized neurologist as the gold standard. Methods: The COMPRESS consists of a combination of the Florida Surgical Questionnaire for Parkinson disease (FLASQ-PD), a cognitive assessment battery provided by MindStreams® (NeuroTrax Corp.), and the Geriatric Depression Scale and the Zung Anxiety Self-Assessment Scale. COMPRESS resulted in the classification of patients into three categories: "optimal candidate, " "probable candidate, " and "not a good candidate. " Similar categorical ratings made by a referring private practice neurologist and by a trained movement disorders specialist were compared with the ratings generated by COMPRESS. Results: A total of 19 subjects with Parkinson's disease were enrolled from five private neurological practices. The clinical impressions of the private practice neurologist vs. those of the movement disorders specialist were in agreement approximately half the time (10/19 cases). The movement disorders specialist and COMPRESS agreed on 15/19 cases. A further comparison between outcomes from the entire COMPRESS module and the FLASQ-PD questionnaire by itself resulted in high agreement (18/19 cases in agreement). Conclusions: The COMPRESS agreed with an in-person evaluation by a movement disorders neurologist approximately 80% of the time. The computerized COMPRESS did not provide any screening advantage over the short FLASQ-PD paper questionnaire. Larger studies will be needed to assess the utility and cost effectiveness of this computerized triage method for DBS.

Neurobiology of Aging, 2004

Ely S. Simon* t, Glen M. Doniger 1 , David M. Zucker 2, Howard Chertkow 3, Howard Crystal 4, Avra... more Ely S. Simon* t, Glen M. Doniger 1 , David M. Zucker 2, Howard Chertkow 3, Howard Crystal 4, Avraham S chweiger 5 , Tzvi Dwolatzky 6. J NeuroTrax Corporation, New York, NY,, USA," 2Hebrew University, Jerusalem, Israel; 3McGill University, Montreal, PQ, Canada; 4 SUNY Downstate Medical Center, Brooklyn, NY, USA; 5Academic College of Tel Aviv, Tel Aviv, Israel; 6Shaare Zedek Medical Center, Jerusalem, Israel. Contact e-mail: ely@nearotrax.com

Journal of Molecular Neuroscience, 2004

The NeuroTrax Mindstreams™ computerized cognitive assessment system was designed for widespread c... more The NeuroTrax Mindstreams™ computerized cognitive assessment system was designed for widespread clinical and research use in detecting mild cognitive impairment (MCI). However, the capability of Mindstreams tests to discriminate the elderly with MCI from those who are cognitively healthy has yet to be evaluated. Moreover, the comparability between these tests and traditional neuropsychological tests in detecting MCI has not been examined. A two-center study was designed to assess the discriminant validity of tests in the Mindstreams Mild Impairment Battery. Participants were 30 individuals diagnosed with MCI, 29 with mild Alzheimer's disease (AD), and 39 healthy elderly. Testing was with the Mindstreams battery and traditional neuropsychological tests. Receiver operating characteristic (ROC) analysis was used to examine the ability of Mindstreams and traditional measures to discriminate those with MCI from cognitively healthy elderly. Between-group comparisons were made (Mann-Whitney U test) between MCI and healthy elderly and between MCI and mild AD groups. Mindstreams outcome parameters across multiple cognitive domains significantly discriminated between MCI and healthy elders with considerable effect sizes (p < 0.05). Measures of memory, executive function, visual spatial skills, and verbal fluency discriminated best, and discriminability was at least comparable to that of traditional neuropsychological tests in these domains. Mindstreams tests are effective in detecting MCI, providing a comprehensive profile of cognitive function. Further, the enhanced precision and ease of use of these computerized tests make the NeuroTrax system a valuable clinical tool in the identification of elders at high risk for dementia.

Journal of Clinical and Experimental Neuropsychology, 2007

The cognitive profile of adult attention deficit hyperactivity disorder (ADHD) remains understudi... more The cognitive profile of adult attention deficit hyperactivity disorder (ADHD) remains understudied despite difficulty in diagnosis. Further, no battery of neuropsychological tests has been shown valid in adult ADHD. Continuous performance tests are widely used for ADHD but provide limited information on cognitive functioning in general. The present study evaluated the construct and discriminant validity of Mindstreams ® (NeuroTrax Corp., NY), a computerized battery assessing multiple cognitive domains. Twenty-nine young male adults with ADHD diagnosis completed a Mindstreams battery, including a multi-stage continuous performance ('Expanded Go-NoGo') test, and the Conners' CPT-II (Multi-Health Systems Inc., NY). Discriminant validity was assessed by comparisons with cognitively healthy controls of comparable age and education. Expanded Go-NoGo and corresponding CPT-II outcomes were significantly correlated in ADHD participants, and the Expanded Go-NoGo test exhibited excellent discriminant validity, with ADHD participants performing more poorly than controls. ADHD participants also performed more poorly on Stroop and Staged Information Processing Speed tests.

Journal of Child Neurology, 2007

Multidomain assessment may enhance the diagnosis of cognitive impairment in children with attenti... more Multidomain assessment may enhance the diagnosis of cognitive impairment in children with attention-deficit hyperactivity disorder (ADHD). A set of novel Web-enabled computerized tests has recently been shown to be valid for identifying mild cognitive impairment and characterizing the cognitive profile associated with various disorders. It was anticipated that these tests would be well suited for use in children with ADHD. The authors tested this idea in a pilot study of 15 children (12 males, 3 females; mean age, 11 years 10 months; range, 9-15 years) with ADHD and 15 age-, education-, and gender-matched controls. The profile of cognitive impairment in ADHD children off methylphenidate across 6 cognitive domains (memory, executive function, visual-spatial skills, verbal function, attention, and motor skills) was described relative to controls. The effect of treatment with methylphenidate was examined by comparing the ADHD children on methylphenidate and on placebo (administered in ...

International Psychogeriatrics, 2010

ABSTRACTBackground: Computerized cognitive assessment tools have been developed to make precise n... more ABSTRACTBackground: Computerized cognitive assessment tools have been developed to make precise neuropsychological assessment readily available to clinicians. Mindstreams batteries for mild impairment have been validated previously. We examined the validity of a Mindstreams battery designed specifically for evaluating those with moderate cognitive impairment.Methods: 170 participants over the age of 60 years performed the computerized battery in addition to standard clinical evaluation. The battery consists of six technician-administered tests and one patient-administered interactive test sampling the cognitive domains of orientation (to time and place), memory, executive function, visual spatial processing, and verbal function. Staging was according to the Clinical Dementia Rating Scale (CDR) on the basis of clinical data but independent of computerized cognitive testing results, thus serving as the gold standard for evaluating the discriminant validity of the computerized measures...

International Journal of Psychiatry in Clinical Practice, 2006

Previous studies have indicated that estrogen may delay disease progression and minimize the cogn... more Previous studies have indicated that estrogen may delay disease progression and minimize the cognitive decline in patients with Alzheimer's disease (AD). However, the evidence for an estrogen deficiency in women with dementia and cognitive dysfunction is inconsistent. In the present review, a fixed effect meta-analysis revealed that the hormone replacement therapy (HRT) group exhibited significant improvements in Alzheimer Disease Assessment Scale-Cognitive subscale scores relative to those observed in the placebo group, suggesting that HRT is feasible for treating cognitive decline in patients with AD. However, no significant differences in Mini-Mental State Examination and Clinical Dementia Rating scale scores were observed between the 2 groups. The results of our systematic review indicate that HRT can improve cognitive function in female patients with AD. Due to limitations in sample size and the available literature, further multicenter trials with larger sample sizes are required to support these findings.

Genetics in Medicine, 2005

Purpose: Because of concern for drug-induced cognitive dysfunction during clinical trials using s... more Purpose: Because of concern for drug-induced cognitive dysfunction during clinical trials using substrate reduction therapy (miglustat) in type 1 Gaucher disease and because it has been suggested that some patients with type 1 Gaucher disease may develop neurocognitive impairment as part of the natural history, two different batteries of neuropsychological tests were devised to examine these issues. Using these tests, cognitive function was assessed in patients treated with miglustat, in patients receiving enzyme replacement (standard care for symptomatic patients), and in untreated (milder) patients. Methods: For this study, 55/60 patients exposed to miglustat in Israel participated in psychologist-administered testing; 36/55 participated in computerized testing. Of these, 31 enzyme-treated patients and 22 untreated patients participated in the psychologist-administered testing, and 15 enzyme-treated patients and 18 untreated patients participated in computerized testing. The psychologistadministered battery consisted of 18 standard neuropsychological subtests specific to executive and visuospatial functioning. The computerized battery (Mindstreams®, NeuroTrax Corp., New York, NY) consisted of 10 subtests tapping multiple cognitive domains. Between-group analyses for each modality compared cognitive performance. Results: In the psychologist-administered testing, patients exposed to miglustat performed significantly less well than the other groups in 5/18 subtests. On the computerized tests, all patients performed comparably to normal controls. Scores in patients exposed to miglustat were higher than in untreated patients, particularly in visuospatial function, whereas enzyme-treated patients performed less well. However, with the exception of visuospatial function, these results were not statistically significant. Conclusions: It is unclear why different testing methods yielded discordant results. Any dysfunction suggested by the current study is apparently subtle and of doubtful clinical relevance given that cognitive status did not interfere with patients' daily intellectual function. The computerized battery has methodological advantages (e.g., language options, objectivity, brevity, and ease of use) that make it well-suited for longitudinal studies, for long-term surveillance of substrate reduction therapy as well as for comparisons with other lysosomal storage disorders and other chronic diseases. These preliminary findings should allay fears of cognitive dysfunction due to short-term miglustat therapy.

Experimental Aging Research, 2006

The present study examined the cognitive profile of fallers relative to healthy controls and pati... more The present study examined the cognitive profile of fallers relative to healthy controls and patients with Parkinson's disease (PD), a positive control group, using a computerized battery. Fallers performed more poorly than controls on executive function, attention, and motor skills, but performed comparably on memory, information processing and the Mini Mental State Exam. A similar profile was evident for PD patients. However, unlike PD patients, fallers were abnormally inconsistent in their reaction times. These findings indicate that elderly fallers may have a unique cognitive processing deficit (i.e., variability of response timing) and underscore the importance of executive function and attention as potential targets for fall risk screening and interventions.

European Journal of Neurology, 2007

Cognitive impairment is amongst the main symptoms affecting multiple sclerosis (MS) and should be... more Cognitive impairment is amongst the main symptoms affecting multiple sclerosis (MS) and should be comprehensively and accurately assessed. To study the added value of a computerized neuropsychological battery enabling the measurement of response times in the cognitive domains, 58 randomly selected MS patients and 71 age-, gender-and education-matched healthy subjects were evaluated. Construct and discriminant validity were assessed for the standard Neuropsychological Screening Battery for Multiple Sclerosis (NSBMS) and the MindstreamsÒ Computerized Cognitive Battery (MCCB). The MCCB demonstrated good construct validity in comparison with the NSBMS in memory (P < 0.001), executive function (P < 0.001), attention (P < 0.05) and information processing (P < 0.05) domains. In addition, it showed high discriminant validity most prominently for executive function, attention and motor skills (P < 0.001). Response times measured by the computerized battery were longer in all cognitive domains and varied with cognitive load, demonstrating that response time deficits in MS are associated with particular task demands. We conclude that in MS prolonged response times on a range of cognitive tasks signify abnormal conduction within demyelinative tracts.

Current Alzheimer Research, 2005

Behavioral Neuroscience, 2006

Food deprivation has been shown to deleteriously affect human cognition, but findings are equivoc... more Food deprivation has been shown to deleteriously affect human cognition, but findings are equivocal, and few studies have examined several cognitive domains. In this study, the authors used computerized testing to describe the profile of shifts in cognition attributable to short-term religious fasting. Multiple cognitive domains were evaluated at midday and late afternoon following complete abstention from eating and drinking beginning at midnight. Cross-domain, fasting-related deficits were found for tasks requiring perception of spatial relations. Fasting-related information processing deficits were found for response time but not accuracy for test levels of intermediate difficulty. Time-of-day effects often reflected poorer afternoon performance. These findings provide a detailed profile of cognitive consequences of food deprivation, affected by time of day, task demands, and type of outcome.

Applied Neuropsychology, 2008

Neuropsychological assessment is critically dependent upon comparison to a standard normative dat... more Neuropsychological assessment is critically dependent upon comparison to a standard normative database. While generally appropriate for individuals of near-average intelligence, high-intelligence individuals may be erroneously scored as unimpaired and low-intelligence individuals as impaired on cognitive measures. The current paper describes an approach for minimizing such misclassifications that is standardized and practical for clinical use. A computerized test of nonverbal reasoning co-normed with cognitive measures is used for automatic adjustment of normalized cognitive scores. This premorbid estimate showed good construct validity, and adjustment raised cognitive scores for low-intelligence individuals, and lowered cognitive scores for high-intelligence individuals similarly across demographic (age, education, computer experience) and clinical (cognitively healthy, mild cognitive impairment, dementia) subgroups. Adjustment was typically up to three normalized units for scores on the premorbid estimate of AE1 SD and 6 normalized units for scores of AE2 SD. The present approach shows promise as a practical solution for assessment of high-and low-intelligence individuals.

American Journal of Alzheimer's Disease & Other Dementiasr, 2006

Cognitive and depressive symptoms co-occur, complicating detection of mild cognitive impairment (... more Cognitive and depressive symptoms co-occur, complicating detection of mild cognitive impairment (MCI) and early dementia. In this study, discriminant validity of a novel computerized cognitive battery for MCI detection was evaluated after covariation for depressive symptom severity. In addition to the computerized battery, participants at two sites received the 30-item self-administered Geriatric Depression Scale (GDS; n = 72); those at two other centers received the observer-administered Cornell Scale for Depression in Dementia (CSDD; n = 88). In both cohorts, a Global Cognitive Score and memory, executive function, visual spatial, and verbal index scores discriminated among cognitively healthy, MCI, and mild dementia groups after covariation for GDS or CSDD, respectively (p < 0.05). Thus, the computerized battery for detection of mild impairment is robust to comorbid depressive symptoms, supporting its clinical utility in identifying neurodegenerative disease even in elderly wi...