Researchers can use a digital pen to conduct cognitive assessments. This allows them to find patterns in test performance that correlate with various measures of cognitive or physical function.(Boston).--In neuropsychological assessments, participants are asked to complete tasks that study memory and thinking. Participants are given a score based on how they perform in tasks designed to study memory and thinking. This score is used by researchers to assess the functioning of specific domains within their cognition.Two participants may score the same on these neuropsychological paper-and pencil tests. The task took one participant 60 seconds and he was writing all the time. The other took three minutes and alternated between answering questions and staring into space. Researchers might miss something important if they only looked at the combined scores of these two participants.Stacy Andersen (assistant professor of medicine at Boston University School of Medicine) says that if we focus only on the result, which is the score someone receives, we can lose a lot of information about the person's performance, which may help us better understand the underlying issue.The Long Life Family Study (LLFS), which used digital pens to record differences in participants' performance during a cognitive test, found that differences in 'thinking time' and 'writing time on a symbol coding exam might be clinically relevant early biomarkers of cognitive/motor decline.Participants in the LLFS were selected because they had multiple siblings who lived to very old ages. Studies have shown that longevity is associated with a longer life expectancy. This family group has been studied in order to understand the factors contributing to healthy aging. Participants were evaluated on a variety of cognitive and physical measures, including a test that substitutes symbols for the Digit Symbol Substitution Test.Participants must fill in boxes numbered with symbols from a key. This test measures cognitive (attention, processing speed, and motor speed) as well as non-cognitive (motor speed and visual scan). Participants used a digital pen to record their progress during the test. This allowed researchers to gather data on how they did it. A small camera was attached to the pen's tip that allowed researchers to track what and when participants wrote. The LLFS researchers split the output of this pen into 'writing' time (the time that the participant spent writing) as well as 'thinking' time (the time that the participant did not spend writing). They then looked at how they changed over the 90-second test.Researchers then identified groups that shared similar writing and thinking patterns throughout the course of their test. The researchers found that while most participants had the same writing and thinking time, some participants were faster or slower than others. "Using clustering, we were able to examine other similarities between the participants in each group. This allowed us to see if there was any connection in terms of health and function to writing and thinking patterns." Benjamin Sweigart (a biostatistics doctoral candidate at Boston University School of Public Health), coauthor. Researchers found that people who wrote the symbols slower during the test had lower physical function, such as poorer grip strength and slower walking speeds. However, people who thought faster than they wrote scored lower on executive function and memory tests. This suggests that thinking and writing speed are two different factors in overall test performance.These findings, according to researchers, show that it is important to capture more aspects of test performance than just test scores. Andersen adds that it is crucial to determine if poor test performance is due to impaired cognitive function or impaired motor function in order to choose the right treatment for each patient. Digital technologies increase our ability to detect subtle differences between test behavior and functional abilities even when we are only doing brief cognitive function tests. These metrics can also be early indicators of dysfunction.###These findings are published online in The Journal of Alzheimer's Disease.Nancy Glynn of University of Pittsburgh's Department of Epidemiology, Mary Wojczynski of Washington University School of Medicine's Department for Genetics, Bharat Thayagarajan of University of Minnesota School of Medicine's Department of Laboratory Medicine and Pathology, and Thomas Perls of BUSM's Geriatric Research, Education, and Clinical Center. David Libon of Rowan University's School of Osteopathic Medicine and New Jersey Institute for Successful Aging. Rhodaau of BUSM's Department of Neurobiology and Neurology and Neurology and Neurobiology and Neurobiology and Neurology and Neurology and Neurology and Neurology and Neurology and Neurobiology and Neurobiology and Neurobiology and Neurobiology and Neurobiology and Neurobiology and Neurobiology and Neurobiology and Neurobiology and Neurobiology and Neurobiology and Neurobiology and of Tufts Medical Center's Medical Center's Institute for Clinical Research and Paola Sebastiani of Tufts Medical Center's Medical Center's Institute for Clinical Research and Health Policy Studies and of Tufts Medical Center's Institute for Clinical Research and Health Policy Studies and of Tufts Medical Center's Institute for Clinical Research and Health Policy Studies and Paola Sebastiani of Tufts Medical Center's Medical Center's Institute for Clinical Research and Health Policy Studies and Paola Sebastiani of Tufts Medical Center's Medical Center's Medical Center's Institute for Clinical Research and Health Policy Studies and Health Policy Studies and Research and Health Policy Studies and Paola Sebastiani of Tufts Medical Center's Medical Center's Medical Center's Institute for Clinical Research and Health Policy Studies and Health Policy Studies and Research and Health Policy Studies and Research and Health Policy Studies and Research and Health Policy Studies and Research and Health Policy Studies and Research and Research and Health Policy Studies and Research and Research and Health Policy Studies and Research and Research and Research and Research and Research and Research and Research and Research and Research and Research and Research and Research and Research and Research and Research and Research and Health Policy Studies and Research and Research and Paola SebastianiThe National Institute on Aging provided funding for this study (K01AG057798 for S.L.A. and U01AG023749 for S.C.; U01AG023749 for T.T.P., T01AG023755 for T.T.P., T01AG023755 for U01AG023749, T01AG023749, T01AG023749, T01AG023749, T01AG023755, T01AG023746, 003746, U01AG0237463, U01AG0237464, U01AG0237465, U01AG0237466, U01AG0237464, U01AG023746, T01AG023746, T01AG023746, T.L.L.L.L.L.L.L. Andersen and al. / Digital Patterns for Processing Speed 15 (T32GM74905) to B.S. ; The Boston University School of Medicine Department of Medicine Career Investment Award for S.L.A. ; and the Marty and Paulette Samowitz Foundation for T.T.P. The Claude D. Pepper Older Americans Indepen dence Center (NIH AG0248277), Research Registry and Developmental Pilot Grant (NIH 30 AG0248277), and the Intramural Research Programme, National Institute on Aging supported N.W.G. The Pittsburgh Fatigability Scale was developed.Note to editorsStacy L. Andersen* Consultancy FeesIn the last two years, I received $10,000 for research consulting at Washington University. This is not related to this manuscript.Rhoda Au* Consultancy FeesSignant Health, Scientific Advisory Board – 1-2 x annually Biogen, Scientific Advisor and Diversity Advisory Board – sporadicallyGrants* AgencyEvidence HealthDates3-1-18 to 3-2-1-21Stephanie Cosentino* Consultancy FeesSage and the Association for FTD pay me consulting feesNancy W. Glynn* There is nothing to discloseDavid J. Libon* Patents/RoyaltiesOxford University Press grants Dr. Libon royalties
