Background Early detection of cognitive decline in the elderly has become of heightened importance in parallel with the recent advances in therapeutics. Computerized assessment may be uniquely suited to early detection of changes in cognition in the elderly. We present here a systematic review of the status of computer-based cognitive testing focusing on detection of cognitive decline in the aging population. Methods All studies purporting to assess or detect age-related changes in cognition or early dementia/mild cognitive impairment (MCI) by means of computerized testing were included. Each test battery was rated on availability of normative data, level of evidence for test validity and reliability, comprehensiveness, and usability. All published studies relevant to a particular computerized test were read by a minimum of two reviewers, who completed rating forms containing the above-mentioned criteria. Results Of the 18 test batteries identified from the initial search, eleven were appropriate to cognitive testing in the elderly and were subjected to systematic review. Of those 11, five were either developed specifically for application with the elderly or have been used extensively with that population. Even within the computerized testing genre, great variability existed in manner of administration, ranging from fully examiner administered to fully self-administered. All tests had at least minimal reliability and validity data, commonly reported in peer-reviewed articles. However, level of rigor of validity testing varied widely. Conclusion All test batteries exhibited some of the strengths of computerized cognitive testing: standardization of administration and stimulus presentation, accurate measures of response latencies, automated comparison in real-time with an individual’s prior performance as well as with age-related norms, and efficiencies of staffing and cost. Some, such as the MCIS, adapted complicated scoring algorithms to enhance the information gathered from already existing tests. Others, such as CogState, used unique interfaces and subtests. We found that while basic indices of psychometric properties were typically addressed, sufficient variability exists that currently available computerized test batteries must be judged on a case by case basis.

These results demonstrate for the first time the feasibility of engaging seniors in a large-scale deployment of in-home activity assessment technology and the successful collection of these activity metrics. We plan to use this platform to determine if continuous unobtrusive monitoring may detect incident cognitive decline.

Objective: To determine which vascular pathology measure most strongly correlates with white matter hyperintensity (WMH) accumulation over time, and whether Alzheimer disease (AD) neuropathology correlates with WMH accumulation.Methods: Sixty-six older persons longitudinally followed as part of an aging study were included for having an autopsy and .1 MRI scan, with last MRI scan within 36 months of death. Mixed-effects models were used to examine the associations between longitudinal WMH accumulation and the following neuropathologic measures: myelin pallor, arteriolosclerosis, microvascular disease, microinfarcts, lacunar infarcts, large-vessel infarcts, atherosclerosis, neurofibrillary tangle rating, and neuritic plaque score. Each measure was included one at a time in the model, adjusted for duration of follow-up and age at death. A final model included measures showing an association with p , 0.1.Results: Mean age at death was 94.5 years (5.5 SD). In the final mixed-effects models, arteriolosclerosis, myelin pallor, and Braak score remained significantly associated with increased WMH accumulation over time. In post hoc analysis, we found that those with Braak score 5 or 6 were more likely to also have high atherosclerosis present compared with those with Braak score 1 or 2 (p 5 0.003).Conclusion: Accumulating white matter changes in advanced age are likely driven by small-vessel ischemic disease. Additionally, these results suggest a link between AD pathology and white matter integrity disruption. This may be due to wallerian degeneration secondary to neurodegenerative changes. Alternatively, a shared mechanism, for example ischemia, may lead to both vascular brain injury and neurodegenerative changes of AD. The observed correlation between atherosclerosis and AD pathology supports the latter. Disruption of white matter integrity, frequently observed as white matter hyperintensities (WMH) on T2-weighted MRI sequences, has detrimental effects on cognitive function, motor performance, and functional status in the elderly [1][2][3] and is associated with increased risk of all types of dementia, including Alzheimer disease (AD).4 Furthermore, WMH accumulation over time has been shown to increase risk of cognitive decline. 3,[5][6][7] While the general consensus is that the etiology of white matter accumulation is secondary to small-vessel ischemic changes, [8][9][10][11][12][13] it is not well established whether those with faster WMH accumulation may have contributions from other pathologies. Because accumulation of WMH increases risk of cognitive decline, identifying the pathologic correlates of faster WMH accumulation could potentially guide interventions targeting specific risks for prevention and treatment to preserve cognitive function in the elderly. Furthermore, while there are previous observations supporting a link between cerebrovascular disease (CVD) and AD, 14 it is not clearly established whether WMH progression is associated with neurodegenerative changes of AD. Thus, our aim was to bette...

While the potential benefits of unobtrusive in-home sensing technologies for maintaining health and independence of older adults have been highlighted in recent research, little is known about their views toward such technology. The aims of this project were to identify monitoring needs and expectations of community-residing elderly and their family members. Focus groups were presented with examples of in-home monitoring devices and data output; participants were asked to consider whether the data showed information that was meaningful to them, and how and to whom they would like to have such data disseminated. Content analysis of transcripts revealed four dominant themes: maintaining independence, detecting cognitive decline, sharing of information, and the tradeoff between privacy and usefulness of monitoring. The acceptance by elderly of unobtrusive in-home monitoring was closely tied to perceived utility of data generated by such systems. Privacy concerns appeared to be less of an issue than anticipated in this sample.