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Cited by 38Dementia and Cognitive Impairment ResearchCancer-related cognitive impairment studiesPsychological Testing and Assessment

BHA-CS: A novel cognitive composite for Alzheimer's disease and related disorders

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Tsoy, Elena, Erlhoff, Sabrina J., Goode, Collette A., Dorsman, Karen A., Kanjanapong, Suchanan, Lindbergh, Cutter A., La Joie, Renaud, Strom, Amelia +7 more·2020·Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring
DOI 10.1002/dad2.12042PMC PMC7306517
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Abstract

INTRODUCTION: Composite scores based on psychometrically rigorous cognitive assessments are well suited for early diagnosis and disease monitoring. METHODS: We developed and cross-validated the Brain Health Assessment-Cognitive Score (BHA-CS), based on a brief computerized battery, in 451 cognitively normal (CN) and 399 cognitively impaired (mild cognitive impairment [MCI] or dementia) older adults. We investigated its long-term reliability and reliable change indices at longitudinal follow-up (N = 340), and the association with amyloid beta (Aβ) burden in the CN subgroup with Aβ positron emission tomography (N = 119). RESULTS: The BHA-CS was accurate at detecting cognitive impairment and exhibited excellent long-term stability. Reliable decline over one year was detected in 75% of participants with dementia, 44% with MCI, and 3% of CN. Among CN, the Aβ-positive group showed worse longitudinal performance on the BHA-CS compared to the Aβ-negative group. DISCUSSION: The BHA-CS is sensitive to cognitive decline in preclinical and prodromal neurodegenerative disease.

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  • Large language models can act as collaborative partners that help clinicians interpret familiar clinical information by incorporating current evidence and highlighting subtle patterns that might be missed in busy settings.

    “LLMs can serve as collaborative partners that help clinicians interpret familiar clinical information (e.g., neuroimaging, laboratory results, and clinical notes) by incorporating the latest evidence-based information and highlighting subtle patterns that might be overlooked in busy clinical settings.45–47”

    From Review of Artificial Intelligence for Clinical Use in Alzheimer's Disease and Related Dementias (2026) · cites this paper as [47]

    The Introduction and Methods discuss a cognitive composite for detecting and monitoring decline in Alzheimer’s disease and related disorders. Searches for large language models, clinical decision support, and the claimed use of current evidence or subtle clinical patterns found no passage addressing those capabilities. Page numbers are unavailable in our copy. (LLM, conf=0.78)

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  1. [1]Albert MS, DeKosky ST, Dickson D, et al. The diagnosis of mild cognitive impairment due to Alzheimer's disease: recommendations from the National Institute on Aging‐Alzheimer's Association workgroups on diagnostic guidelines for Alzheimer's disease. Alzheimers Dement. 2011; 7(3): 270‐ 279. 21514249 PMC3312027
  2. [2]Snyder PJ, Kahle‐Wrobleski K, Brannan S, et al. Assessing cognition and function in Alzheimer's disease clinical trials: do we have the right tools?. Alzheimers Dement. 2014; 10(6): 853‐ 860. 25458309
  3. [3]Sperling RA, Aisen PS, Beckett LA, et al. Toward defining the preclinical stages of Alzheimer's disease: recommendations from the National Institute on Aging‐Alzheimer's Association workgroups on diagnostic guidelines for Alzheimer's disease. Alzheimers Dement. 2011; 7(3): 280‐ 292. 21514248 PMC3220946
  4. [4]Mortamais M, Ash JA, Harrison J, et al. Detecting cognitive changes in preclinical Alzheimer's disease: a review of its feasibility. Alzheimers Dement. 2017; 13(4): 468‐ 492. 27702618
  5. [5]Baker JE, Lim YY, Pietrzak RH, et al. Cognitive impairment and decline in cognitively normal older adults with high amyloid‐β: a meta‐analysis. Alzheimers Dement. 2017; 6: 108‐ 121. PMC5315443 28239636
  6. [6]Donohue MC, Sperling RA, Petersen R, Sun CK, Weiner MW, Aisen PS. Association between elevated brain amyloid and subsequent cognitive decline among cognitively normal persons. JAMA. 2017; 317(22): 2305‐ 2316. 28609533 PMC5736301
  7. [7]Folstein M, Folstein S, McHugh P. Mini‐mental state”: a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975; 12(3): 189‐ 198. 1202204
  8. [8]Spencer RJ, Wendell CR, Giggey PP, et al. Psychometric limitations of the mini‐mental state examination among nondemented older adults: an evaluation of neurocognitive and magnetic resonance imaging correlates. Exp Aging Res. 2013; 39(4): 382‐ 397. 23875837
  9. [11]Rascovsky K, Salmon D, Lipton A, et al. Rate of progression differs in frontotemporal dementia and Alzheimer disease. Neurology. 2005; 65(3): 397‐ 403. 16087904
  10. [12]Rosen WG, Mohs RC, Davis KL. A new rating scale for Alzheimer's disease. Am J Psychiatry. 1984; 141(11): 1356‐ 1364. 6496779
  11. [13]Ayutyanont N, Langbaum JB, Hendrix SB, et al. The Alzheimer's prevention initiative composite cognitive test score: sample size estimates for the evaluation of preclinical Alzheimer's disease treatments in presenilin 1 E280A mutation carriers. J Clin Psychiatry. 2014; 75(6): 652‐ 660. 24816373 PMC4331113
  12. [14]Donohue MC, Sperling RA, Salmon DP, et al. The preclinical Alzheimer cognitive composite: measuring amyloid‐related decline. JAMA Neurol. 2014; 71(8): 961‐ 970. 24886908 PMC4439182
  13. [15]Weintraub S, Carrillo MC, Farias ST, et al. Measuring cognition and function in the preclinical stage of Alzheimer's disease. Alzheimers Dement. 2018; 4: 64‐ 75. PMC6021264 29955653
  14. [17]Possin KL, Moskowitz T, Erlhoff SJ, et al. The Brain Health Assessment for detecting and diagnosing neurocognitive disorders. J Am Geriatr Soc. 2018; 66(1): 150‐ 156. 29355911 PMC5889617
  15. [18]Nasreddine Z, Phillips N, Bédirian V, et al. The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc. 2005; 53(4): 695‐ 699. 15817019
  16. [19]Gluhm S, Goldstein J, Loc K, Colt A, Liew CV, Corey‐Bloom J. Cognitive performance on the Mini‐Mental State Examination and the Montreal Cognitive Assessment across the healthy adult lifespan. Cogn Behav Neurol. 2013; 26(1): 1‐ 5. 23538566 PMC3638088
  17. [20]Lam B, Middleton LE, Masellis M, et al. Criterion and convergent validity of the Montreal Cognitive Assessment with screening and standardized neuropsychological testing. J Am Geriatr Soc. 2013; 61(12): 2181‐ 2185. 24320735
  18. [21]Morris JC. The Clinical Dementia Rating (CDR): current version and scoring rules. Neurology. 1993; 43(11): 2412‐ 2414. 8232972
  19. [23]Landau SM, Lu M, Joshi AD, et al. Comparing positron emission tomography imaging and cerebrospinal fluid measurements of β‐amyloid. Ann Neurol. 2013; 74(6): 826‐ 836. 23536396 PMC3748164
  20. [24]Landau SM, Breault C, Joshi AD, et al. Amyloid‐imaging with Pittsburgh Compound B and Florbetapir: comparing radiotracers and quantification methods. J Nucl Med. 2013; 54(1): 70‐ 77. 23166389 PMC3747730
  21. [25]Staffaroni AM, Brown JA, Casaletto KB, et al. The longitudinal trajectory of default mode network connectivity in healthy older adults varies as a function of age and is associated with changes in episodic memory and processing speed. J Neurosci. 2018; 38(11): 2809‐ 2817. 29440553 PMC5852659
  22. [26]Burman P. A comparative study of ordinary cross‐validation, v‐fold cross‐validation and the repeated learning‐testing methods. Biometrika. 1989; 76(3): 503‐ 514.
  23. [27]Heaton RK, Taylor MJ, Marcotte TD, et al. Detecting change: a comparison of three neuropsychological methods, using normal and clinical samples. Arch Clin Neuropsychol. 2001; 16(1): 75‐ 91. 14590193
  24. [28]Hinton‐Bayre AD. Deriving reliable change statistics from test‐retest normative data: comparison of models and mathematical expressions. Arch Clin Neuropsychol. 2010; 25(3): 244‐ 256. 20197293
  25. [29]McSweeny AJ, Naugle RI, Chelune GJ, Luders H. “T scores for change”: an illustration of a regression approach to depicting change in clinical neuropsychology. Clin Neuropsychol. 1993; 7(3): 300‐ 312.
  26. [30]Chelune GJ, Naugle RI, Lüders H, Sedlak J, Awad IA. Individual change after epilepsy surgery: practice effects and base‐rate information. Neuropsychology. 1993; 7(1): 41‐ 52.
  27. [31]Cooley SA, Heaps JM, Bolzenius JD, et al. Longitudinal change in performance on the Montreal Cognitive Assessment in older adults. Clin Neuropsychol. 2015; 29(6): 824‐ 835. 26373627 PMC4644436
  28. [32]Kopecek M, Bezdicek O, Sulc Z, Lukavsky J, Stepankova H. Montreal Cognitive Assessment and Mini‐Mental State Examination reliable change indices in healthy older adults. Int J Geriatr Psychiatry. 2017; 32(8): 868‐ 875. 27352935
  29. [33]Kuhn M. Building predictive models in R using the caret package. J Stat Softw. 2008; 28(5): 1‐ 26.27774042
  30. [34]Bates D, Maechler M, Bolker B, Walker S. Fitting linear mixed‐effects models using lme4. J Stat Softw. 2015; 67(1): 1‐ 48.
  31. [35]Wickham H. Ggplot2 ‐ Elegant Graphics for Data Analysis. 2nd ed New York, NY: Springer‐Verlag; 2016 https://www.springer.com/gp/book/9783319242750.
  32. [36]Langbaum JB, Hendrix SB, Ayutyanont N, et al. An empirically derived composite cognitive test score with improved power to track and evaluate treatments for preclinical Alzheimer's disease. Alzheimers Dement. 2014; 10(6): 666‐ 674. 24751827 PMC4201904
  33. [37]Mormino EC, Papp KV, Rentz DM, et al. Early and late change on the preclinical Alzheimer's cognitive composite in clinically normal older individuals with elevated amyloid beta. Alzheimers Dement. 2017; 13(9): 1004‐ 1012. 28253478 PMC5573651
  34. [38]Wilson RS, Leurgans SE, Boyle PA, Bennett DA. Cognitive decline in prodromal Alzheimer disease and mild cognitive impairment. Arch Neurol. 2011; 68(3): 351‐ 356. 21403020 PMC3100533
  35. [39]Alioto AG, Mumford P, Wolf A, et al. White matter correlates of cognitive performance on the UCSF Brain Health Assessment. J Int Neuropsychol Soc. 2019; 25(6): 654‐ 658. 31023399 PMC6620143
  36. [40]Hedden T, Oh H, Younger AP, Patel TA. Meta‐analysis of amyloid‐cognition relations in cognitively normal older adults. Neurology. 2013; 80(14): 1341‐ 1348. 23547267 PMC3656457

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Authors
Tsoy, E., Erlhoff, S. J., Goode, C. A., Dorsman, K. A., Kanjanapong, S., Lindbergh, C. A., La Joie, R., Strom, A., Rabinovici, G. D., Lanata, S. C., Miller, B. L., Tomaszewski Farias, S. E., Kramer, J. H., Rankin, K. P., & Possin, K. L.
Affiliations
  • University of California, San Francisco (US)
  • Department of Neurology, Memory and Aging Center University of California San Francisco San Francisco California USA
  • Department of Neurology University of California Davis Sacramento California USA
Corresponding author
Possin, Katherine L.
ORCID
Venue
Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring
Publisher
Wiley
Published
2020-01
Volume
12
Issue
1
Pages
e12042-e12042
ISSN
2352-8729 (ISSN-L)
DOI
10.1002/dad2.12042
PMC
PMC7306517
OpenAlex
W3036059671
Cited by
38
References
4
Citations by year
2026: 3 · 2025: 13 · 2024: 5 · 2023: 4 · 2022: 5 · 2021: 5 · 2020: 3
FWCI
3.10
Type
journal article
Language
en
Open access
Licence
Locations
  • Alzheimer s & Dementia Diagnosis Assessment & Disease Monitoring (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • eScholarship (California Digital Library) (submittedVersion, cc-by-nc)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • eScholarship (California Digital Library) (submittedVersion)
Funders
  • National Institute of Neurological Disorders and Stroke (UG3 NS105557‐01)
  • National Institute on Aging (P30AG062422, P01AG019724, P30AG010129)
  • Alzheimer's Association (AARF‐16‐443577)
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Cancer-related cognitive impairment studies
  • Social Sciences › Psychology › Applied Psychology › Psychological Testing and Assessment
Keywords
Alzheimer's disease, mild cognitive impairment, dementia, computerized cognitive assessment, amyloid-beta, amyloid PET, cognitive decline, reliable change index, preclinical Alzheimer's disease, prodromal neurodegeneration, older adults

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