Sigourney Chiranakorn‐Costa

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Hand Motor Dysfunction Is Associated with Both Subjective and Objective Cognitive Impairment across the Dementia Continuum

Dementia and Geriatric Cognitive Disorders (2024)

Kaylee Rudd Katherine Lawler Michele L. Callisaya Aidan Bindoff Sigourney Chiranakorn‐Costa

Introduction: Motor dysfunction is an important feature of early-stage dementia. Gait provides a non-invasive biomarker across the dementia continuum. Gait speed and rhythm aid risk stratification of incident dementia in subjective cognitive impairment (SCI) and are associated with cognitive domains in mild cognitive impairment (MCI) and dementia. However, hand movement analysis, which may be more accessible, has never been undertaken in SCI and rarely in MCI or dementia. We aimed to address this gap and improve understanding of hand motor-cognitive associations across the dementia continuum. Methods: A total of 208 participants were recruited: 50 with dementia, 58 MCI, 40 SCI, and 60 healthy controls. Consensus diagnoses were made after comprehensive gold-standard assessments. A computer key-tapping test measured frequency, dwell-time, rhythm, errors, and speed. Associations between key-tapping and cognitive domains and diagnoses were analysed using regression. Classification accuracy was measured using area under receiver operating characteristic curves. Results: Hand frequency and speed were associated with memory and executive domains (p ≤ 0.001). Non-dominant hand rhythm was associated with all cognitive domains. Frequency, rhythm, and speed were associated with SCI, MCI, and dementia. Frequency and speed classified ≥94% of dementia and ≥88% of MCI from controls. Rhythm of the non-dominant hand classified ≥86% of dementia and MCI and 69% of SCI. Conclusion: Our findings show hand motor dysfunction occurs across the dementia continuum and, similar to gait, is associated with executive and memory domains and with cognitive diagnoses. Key-tapping performance differentiated dementia and MCI from healthy controls. More research is required before recommending key-tapping as a non-invasive motor biomarker of cognitive impairment.

Motor dysfunction

Motor impairment

10.1159/000540412

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Citations (2)

A new one‐stop interdisciplinary cognitive clinic model tackles rural health inequality and halves the time to diagnosis: Benchmarked against a national dementia registry

International Journal of Geriatric Psychiatry (2023)

Jane Alty Katherine Lawler Katharine Salmon Scott A. McDonald Kimberley E. Stuart

Abstract Objectives Unequal access to cognitive assessments is a major barrier to timely diagnosis, especially for those living in rural or remote areas. ‘One‐stop’ cognitive clinic models are a proposed solution, but few such clinics exist. We evaluate the implementation of a new one‐stop State‐wide clinic model in Tasmania, Australia, where 27% of people live in rural/remote areas. Methods A novel single‐visit protocol has been developed, comprising interdisciplinary medical and cognitive assessments, research participation, consensus diagnosis and management plan. A cross‐sectional evaluation was undertaken using the RE‐AIM (reach, effectiveness, adoption, implementation, maintenance) framework and results benchmarked against the national Australian Dementia Network Registry. Results Over the first 52 consecutive weekly clinics: Reach : 130 adults were assessed (mean age [SD] 70.12 years [10.31]; 59.2% female) with 40 (36.8%) from rural/remote areas. Effectiveness : 98.5% (128/130) received a same‐day diagnosis: 30.1% (n = 40) Subjective Cognitive Decline, 35.4% (46) Mild Cognitive Impairment, 33.1% (43) dementia and one case inconclusive. Adoption : 22.9% (156) of General Practitioners referred patients. Implementation : Nearly all ‘ideal’ diagnostic clinical practices were met and >90% of surveyed patients reported ‘good/very good’ clinic experience. The wait from referral to diagnosis was 2 months shorter than other national Registry clinics (78 vs. 133 days). Conclusions This ‘one‐stop’ model provides an interdisciplinary consensus cognitive diagnosis quickly and is well accepted; this may reduce health inequities especially for people living in rural/remote areas. This cognitive clinic model may be of relevance to other centres worldwide and also provides a rich data source for research studies.

Cognitive Decline

Rural Health

10.1002/gps.5988

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Citations (6)

Diagnostic Accuracy of the Overlapping Infinity Loops, Wire Cube, and Clock Drawing Tests in Subjective Cognitive Decline, Mild Cognitive Impairment and Dementia

Geriatrics (2022)

Sigourney Chiranakorn‐Costa Rebecca J. St George J. S. McDonald Xinyi Wang Jane Alty

Figure drawing tasks are commonly used standalone or as part of broader screening tests to detect cognitive impairment. Only one study has compared the classification accuracy of three common drawing tasks—overlapping infinity loops, wire cube, and the clock drawing task (CDT)—in mild cognitive impairment (MCI) and dementia, but age and education, which impact performance, were not accounted for. We replicated the research, adjusting for age and education and, for the first time, assessed subjective cognitive decline (SCD) too. Participants were recruited from the Tasmanian ISLAND Cognitive Clinic and healthy controls from a community sample. All participants completed the three figure drawing tasks. The clinic patients were categorised according to interdisciplinary consensus diagnosis. Binomial logistic regression and area under ROC curves (AUC) were calculated to determine the discriminatory ability of each drawing task. Overall, 112 adults were recruited; 51 had normal cognition (NC), 21 SCD, 24 MCI, and 16 had dementia. The infinity loops test did not discriminate any of the groups, casting some doubt on its usefulness. The wire cube discriminated NC from dementia (AUC 0.7; p < 0.05). The CDT discriminated NC from dementia (AUC 0.77; p < 0.01), NC from cognitive impairment (dementia + MCI; AUC 0.59; p < 0.05), and MCI from dementia (AUC 0.76; p < 0.01). None of the tests discriminated NC from MCI or NC from SCD. The CDT was the most discriminatory test, followed by the wire cube. This may help guide clinicians who often choose just one figure drawing task due to time constraints or patient fatigue.

Cognitive test

Cognitive Decline

10.3390/geriatrics7040072

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Citations (4)

15 TAS test clinical validation: automated hand movement analysis helps discriminate subjective cognitive decline, mild cognitive impairment and dementia

Jane Alty Xinyi Wang Kaylee Rudd Katherine Lawler Quan Bai

Objectives

New brief cognitive screening tools that are not language-specific are required. Motor function declines across the dementia continuum and may aid screening. We evaluated the accuracy of TAS Test, a new automated online hand movement assessment, to discriminate healthy controls (HC) from adults with Subjective Cognitive Decline (SCD), Mild Cognitive Impairment (MCI) and Dementia.

Methods

Participants attending the Tasmanian ISLAND Cognitive Clinic completed >2 hours of neuropsychological and medical assessments and a consensus diagnosis was formulated. They also completed TAS Test keyboard tapping tests (5 minutes duration). Motor features of frequency, rhythm, accuracy, and dwell time were extracted. Cognitively asymptomatic HCs with normal cognition completed TAS Test. Discriminatory accuracy of TAS Test motor features, adjusted for age, in multiple regression models was assessed using area under ROC curves (AUC) and compared to a null model comprising confounding variables only.

Results

205 participants were recruited (mean [SD] age 69.0 [8.9] years): 16 SCD, 40 MCI, 35 Dementia and 114 HCs. TAS Test discriminated better than null models with AUCs [95% CI]: SCD vs HC: 0.82 [0.73–0.91], MCI vs HC: 0.78 [0.69–0.86], Dementia vs HC: 0.91 [0.86–0.97], MCI vs SCD: 0.7 [0.63- 0.92], Dementia vs MCI: 0.82 [0.82–0.97], all p <0.01. Hand movements were progressively slower, less rhythmic and more inaccurate across the dementia continuum, especially for the dominant hand.

Conclusions

Brief keyboard tapping tests aided stratification of diagnostic groups. This novel hand motor approach is accessible and opens new opportunities for objective motor measure in cognitive clinics and research applications.

Cognitive Decline

Boston Naming Test

Cognitive test

Neuropsychological test

10.1136/bmjno-2023-anzan.16

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