Digital neuropsychological assessment–Part 2: Relations with cardiovascular risk and informant ratings of neurocognitive decline, functional disabilities, and psychiatric symptoms

BackgroundThe Digital Assessment of Cognition (DAC) is a brief, 7-minute iPad administered-scored neuropsychological protocol.ObjectiveThe current research sought to investigate relationships between DAC test results and family ratings for neurocognitive decline; instrumental activities of daily living (IADL) impairment; psychiatric symptoms, and physician-determined cardiovascular risks.Methods179 memory clinic patients were assessed. Family members rated the severity of neurocognitive impairment, IADL decline, and psychiatric symptoms using the Everyday Cognition Scales (ECog); the Functional Assessment Questionnaire (FAQ); the Instrumental Activities of Daily Living-Compensation Scale (IADL-C); and the Neuropsychiatric Inventory (NPI), respectively. An index measuring cardiovascular risk was extracted from medical records.ResultsPartial correlations controlled for age, education, and sex found that greater functional disability and elevated cardiovascular risks were associated with lower DAC memory and executive index scores. Lower DAC memory scores were seen in relation to family ratings suggesting impaired Ecog Episodic Memory difficulty; relatively intact ECog Executive/Attention ability; and impaired IADL-C Memory/Self-Management difficulty. By contrast, lower DAC executive performance was seen in relation to family ratings suggesting impaired Ecog Executive/Planning difficulty and IADL-C Social Skills difficulty. Lower DAC-executive index scores were also associated with greater informant rated apathy.ConclusionsThe relations between DAC index scores and total informant FAQ and IADL-scores; Ecog and IADL-C subscales; and selected NPI-defined psychiatric problems suggest that the DAC is both <i>sensitive</i> to gross IADL decline, and <i>specific</i> to differing ECog and IADL-C and psychiatric problems. Combining digital assessment with family IADL ratings could help with clinical decision-making.