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      The California Cognitive Assessment Battery (CCAB)

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          Abstract

          Introduction

          We are developing the California Cognitive Assessment Battery (CCAB) to provide neuropsychological assessments to patients who lack test access due to cost, capacity, mobility, and transportation barriers.

          Methods

          The CCAB consists of 15 non-verbal and 17 verbal subtests normed for telemedical assessment. The CCAB runs on calibrated tablet computers over cellular or Wi-Fi connections either in a laboratory or in participants’ homes. Spoken instructions and verbal stimuli are delivered through headphones using naturalistic text-to-speech voices. Verbal responses are scored in real time and recorded and transcribed offline using consensus automatic speech recognition which combines the transcripts from seven commercial ASR engines to produce timestamped transcripts more accurate than those of any single ASR engine. The CCAB is designed for supervised self-administration using a web-browser application, the Examiner. The Examiner permits examiners to record observations, view subtest performance in real time, initiate video chats, and correct potential error conditions (e.g., training and performance failures, etc.,) for multiple participants concurrently.

          Results

          Here we describe (1) CCAB usability with older (ages 50 to 89) participants; (2) CCAB psychometric properties based on normative data from 415 older participants; (3) Comparisons of the results of at-home vs. in-lab CCAB testing; (4) We also present preliminary analyses of the effects of COVID-19 infection on performance. Mean z-scores averaged over CCAB subtests showed impaired performance of COVID+ compared to COVID- participants after factoring out the contributions of Age, Education, and Gender (AEG). However, inter-cohort differences were no longer significant when performance was analyzed with a comprehensive model that factored out the influences of additional pre-existing demographic factors that distinguished COVID+ and COVID- cohorts (e.g., vocabulary, depression, race, etc.,). In contrast, unlike AEG scores, comprehensive scores correlated significantly with the severity of COVID infection. (5) Finally, we found that scoring models influenced the classification of individual participants with Mild Cognitive Impairment (MCI, z-scores < –1.50) where the comprehensive model accounted for more than twice as much variance as the AEG model and reduced racial bias in MCI classification.

          Discussion

          The CCAB holds the promise of providing scalable laboratory-quality neurodiagnostic assessments to underserved urban, exurban, and rural populations.

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          Most cited references63

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          A brief measure for assessing generalized anxiety disorder: the GAD-7.

          Generalized anxiety disorder (GAD) is one of the most common mental disorders; however, there is no brief clinical measure for assessing GAD. The objective of this study was to develop a brief self-report scale to identify probable cases of GAD and evaluate its reliability and validity. A criterion-standard study was performed in 15 primary care clinics in the United States from November 2004 through June 2005. Of a total of 2740 adult patients completing a study questionnaire, 965 patients had a telephone interview with a mental health professional within 1 week. For criterion and construct validity, GAD self-report scale diagnoses were compared with independent diagnoses made by mental health professionals; functional status measures; disability days; and health care use. A 7-item anxiety scale (GAD-7) had good reliability, as well as criterion, construct, factorial, and procedural validity. A cut point was identified that optimized sensitivity (89%) and specificity (82%). Increasing scores on the scale were strongly associated with multiple domains of functional impairment (all 6 Medical Outcomes Study Short-Form General Health Survey scales and disability days). Although GAD and depression symptoms frequently co-occurred, factor analysis confirmed them as distinct dimensions. Moreover, GAD and depression symptoms had differing but independent effects on functional impairment and disability. There was good agreement between self-report and interviewer-administered versions of the scale. The GAD-7 is a valid and efficient tool for screening for GAD and assessing its severity in clinical practice and research.
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            The Cognitive Failures Questionnaire (CFQ) and its correlates

            This paper describes a questionnaire measure of self-reported failures in perception, memory, and motor function. Responses to all questions tend to be positively correlated, and the whole questionnaire correlates with other recent measures of self-reported deficit in memory, absent-mindedness, or slips of action. The questionnaire is however only weakly correlated with indices of social desirability set or of neuroticism. It is significantly correlated with ratings of the respondent by his or her spouse, and accordingly does have some external significance rather than purely private opinion of the self. The score is reasonably stable over long periods, to about the same extent as traditional measures of trait rather than state. Furthermore, it has not thus far been found to change in persons exposed to life-stresses. However, it does frequently correlate with the number of current psychiatric symptoms reported by the same person on the MHQ; and in one study it has been found that CFQ predicts subsequent MHQ in persons who work at a stressful job in the interval. It does not do so in those who work in a less stressful environment. The most plausible view is that cognitive failure makes a person vulnerable to showing bad effects of stress, rather than itself resulting from stress.
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                Author and article information

                Contributors
                URI : http://loop.frontiersin.org/people/14070/overviewRole: Role: Role: Role: Role: Role: Role: Role: Role: Role: Role: Role: Role: Role:
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                URI : http://loop.frontiersin.org/people/1315505/overviewRole: Role: Role: Role: Role: Role: Role:
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                URI : http://loop.frontiersin.org/people/70402/overviewRole: Role: Role: Role: Role: Role: Role: Role: Role: Role: Role: Role:
                Journal
                Front Hum Neurosci
                Front Hum Neurosci
                Front. Hum. Neurosci.
                Frontiers in Human Neuroscience
                Frontiers Media S.A.
                1662-5161
                11 January 2024
                2023
                : 17
                : 1305529
                Affiliations
                [1] 1NeuroBehavioral Systems Inc. , Berkeley, CA, United States
                [2] 2Department of Neurology, University of California, Davis , Davis, CA, United States
                [3] 3VA Northern California Health Care System , Martinez, CA, United States
                Author notes

                Edited by: John Wesson Ashford, United States Department of Veterans Affairs, United States

                Reviewed by: Xianbo Zhou, Zhongze Therapeutics, China

                Francisco Barceló, University of the Balearic Islands, Spain

                David Nguyen, BrainScanology, Inc, United States

                Maxine Krengel, United States Department of Veterans Affairs, United States

                *Correspondence: Juliana Baldo, jvbaldo@ 123456gmail.com
                Article
                10.3389/fnhum.2023.1305529
                10809797
                38273881
                bf0aa706-a158-4fe4-9f88-ea3e0c4c7dff
                Copyright © 2024 Woods, Pebler, Johnson, Herron, Hall, Blank, Geraci, Williams, Chok, Lwi, Curran, Schendel, Spinelli and Baldo.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 01 October 2023
                : 28 November 2023
                Page count
                Figures: 6, Tables: 5, Equations: 0, References: 64, Pages: 16, Words: 11687
                Funding
                The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This work was supported the by grants R44AG062076 and R44AG080951 from the National Institutes on Aging and this manuscript describes a new computerized test battery developed by a small tech company which has received NIH-SBIR funding, with plans to eventually commercialize.
                Categories
                Neuroscience
                Original Research
                Custom metadata
                Brain Health and Clinical Neuroscience

                Neurosciences
                memory,attention,aging,executive function,automatic speech recognition,remote assessment,processing speed,dementia

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