Diagnostic accuracy of CompCog: reaction time as a screening measure for mild cognitive impairment

Hartle, Larissa; Martorelli, Marina; Balboni, Giulia; Souza, Raquel; Charchat-Fichman, Helenice

doi:10.1590/0004-282X-ANP-2021-0099

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Article • Arq. Neuro-Psiquiatr. 80 (6) • June 2022 • https://doi.org/10.1590/0004-282X-ANP-2021-0099 copy

Diagnostic accuracy of CompCog: reaction time as a screening measure for mild cognitive impairment

Acurácia diagnóstica do CompCog: tempo de reação como uma medida de rastreio para comprometimento cognitivo leve

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Background

Reaction time is affected under different neurological conditions but has not been much investigated considering all types of mild cognitive impairment (MCI).

Objective

This study investigated the diagnostic accuracy of CompCog, a computerized cognitive screening battery focusing on reaction time measurements.

Methods

A sample of 52 older adults underwent neuropsychological assessments, including CompCog, and medical appointments, to be classified as a control group or be diagnosed with MCI. The accuracy of CompCog for distinguishing between the two groups was calculated.

Results

The results from diagnostic accuracy analyses showed that the AUCs of ROC curves were as high as 0.915 (CI 0.837-0.993). The subtest with the highest sensitivity and specificity (choice reaction time subtest) had 91.7% sensitivity and 89.3% specificity. The logistic regression final model correctly classified 92.3% of individuals, with 92.9% specificity and 91.7% sensitivity, and included only four variables from different subtests.

Conclusions

In summary, the study showed that reaction time assessed through CompCog is a good screening measure to differentiate between normal aging and MCI. Reaction time measurements in milliseconds were more accurate than correct answers. This test can form part of routine clinical tests to achieve the objectives of screening for MCI, indicating further procedures for investigation and diagnosis and planning interventions.

Keywords:
Cognitive Dysfunction; Reaction Time; Diagnosis; Dementia; Cognitive Aging

Test	Cognitive functions involved and how they are evaluated	Variables
Simple Reaction Time (SRT)	Processing speed. As soon as a white square appears in the middle of the screen, the person should touch the rectangle at the bottom of the screen.	Median reaction time
Choice Reaction Time (CRT)	Processing speed. As a white or orange square appears in the middle of the screen, the person should touch the rectangle of the same color at the bottom of the screen.	Median reaction time; Correct responses; Revised median reaction time (choice reaction time - simple reaction time).
Implicit Learning Test (ILT)	Implicit learning. As one of ten gray squares distributed in the screen turns white, the person should press it. There is a fixed sequence of 25 squares that is repeated four times and one last random sequence.	Median reaction time in each of five tasks; Implicit learning (median reaction time in sequence 4/median reaction time in sequence 1).
Visual and Spatial Short-Term Memory (STM)	Working memory. There are ten gray squares distributed on the screen. One will become white at a time, making a sequence that should be reproduced.	Correct responses; Direct order SPAN; Median reaction time in direct order; Inverse order SPAN; Median reaction time in inverse order.
Face Recognition and Memory (FRM)	Episodic memory. Ten drawings of unknown faces are presented for 30 seconds. The participant should then choose from among ten pairs of faces, the one that was among those initially shown for memorization, in four attempts.	Correct responses and median reaction time for each of the four tasks and for all tasks together.
Inhibitory Control Test (ICT)	Attention and inhibitory control. Squares of different colors will appear in the middle of the screen for one second each: the white ones should be avoided.	Median reaction time; Correct responses; Median reaction time for correct responses; Median reaction time for errors; Errors.
Stroop Test (StT)	Attention and inhibitory control. All tasks have four colored rectangles located at the bottom of the screen. The person should touch the one matching the stimulus that appears in the middle of the screen considering its color without distracters (task 1) and with distracters (tasks 2 and 3).	Interference; Median reaction time and errors for each of the three tasks.
Survey Test (ST)	Attention. Squares of different colors will appear in the middle of the screen for one second each. Participants should press the white ones in the first task, whites and blues in the second and also yellow ones in the third.	Median reaction time, correct responses, reaction time for correct responses, errors and reaction time for errors, for each of the three tasks.

Variable	CG (n = 28) Mean (SD), min-max	MCI (n = 24) Mean (SD), min-max	p-value
Sex*	23/5	17/7	0.335
Age	71.4 (5.7), 62-83	73.9 (6.9), 61-85	0.164
Number of years of education	14.1 (3.3), 6-17	11.6 (5.3), 3-18	0.052
Health problems	1.5 (1.0), 0-3	1.7 (1.4), 0-4	0.403
Medications in use	2.0 (1.9), 0-6	1.9 (2.0), 0-6	0.840
Depressive symptoms	2.8 (1.9), 0-6	3.6 (2.6), 0-9	0.224
Naming	10.0 (0.0), 10-10	9.8 (4.4), 8-10	0.123
Incidental memory	5.9 (1.2), 4-8	5.2 (1.5), 3-8	0.084
Immediate memory**	8.5 (1.1), 6-10	7.2 (1.4), 5-10	0.001
Learning**	9.3 (0.8), 8-10	8.3 (1.1), 6-10	0.001
Delayed recall**	8.6 (1.5), 4-10	7.2 (1.6), 4-10	0.005
Recognition	9.7 (0.4), 9-10	9.5 (0.9), 7-10	0.930
Clock drawing test	6.2 (2.2), 4-10	5.5 (2.5), 1-10	0.259
Verbal fluency**	20.7 (4.3), 13-30	16.6 (4.6), 8-26	0.002
MMSE30	27.0 (2.1), 22-30	25.7 (2.7), 21-29	0.067
Functionality**	20.9 (0.2), 20-21	19.6 (1.6), 15-21	< 0.001

Test	AUC, 95% confidence interval range	Cutoff point (milliseconds)	Sensitivity/specificity
Simple Reaction Time Test
MRT	0.506, 0.339-0.673		Sensitivity/specificity
Choice Reaction Time Test
MRT†	0.915, 0.837-0.993*	689.813	91.7%/89.3%
Correct responses	0.650, 0.498-0.801
Revised MRT	0.705, 0.559-0.852
Implicit Learning Test
MRT 1	0.839, 0.721-0.957*	688.125	83.3%/75%
MRT 2	0.836, 0.720-0.953*	651.531	75%/75%
MRT 3	0.823, 0.703-0.943*	616.159	79.2%/67.9%
MRT 4	0.829, 0.710-0.948*	618.139	75%/71.4%
MRT 5	0.804, 0.674-0.933*	664.784	75%/75%
Implicit learning	0.521, 0.361-0.681
Visual and Spatial Short-Term Memory Test
Correct responses	0.718, 0.577-0.859
Direct order SPAN	0.725, 0.588-0.861
MRT in direct order	0.774, 0.642-0.906*	643.635	75%/71.4%
Inverse order SPAN	0.868, 0.774-0.962*	3.5	95.8%/64.3%
MRT in inverse order	0.781, 0.648-0.915*	668.615	75%/67.9%
Face Recognition and Memory
MRT†	0.896, 0.799-0.993*	1580.791	83.3%/85.7%
MRT 1	0.823, 0.703-0.943*	1905.385	75%/71.4%
MRT 2	0.881, 0.781-0.981*	1506.316	91.7%/75%
MRT 3	0.872, 0.767-0.977*	1430.946	87.5%/75%
MRT 4	0.813, 0.693-0.932*	1486.333	79.2%/71.4%
Correct responses	0.811, 0.685-0.937*	98.750	79.2%/57.1%
Correct responses 1	0.763, 0.628-0.899
Correct responses 2	0.673, 0.537-0.838
Correct responses 3	0.688, 0.537-0.838
Correct responses 4	0.757, 0.619-0.894
Inhibitory Control Test
MRT	0.884, 0.782-0.976*	664.447	87.5%/78.6%
CAMRT	0.871, 0.774-967*	663.279	83.3%/78.6%
EMRT	0.753, 0.615-0.891
Correct responses	0.794, 0.664-0.924*	96.5	75%/75%
Errors	0.794, 0.664-0.924*	3.5	75%/75%
Stroop Test
MRT 1	0.847, 0.732-0.962*	814.839	87.5%/75%
MRT 2	0.799, 0.672-0.926*	911.100	83.3%/67.9%
MRT 3	0.743, 0.604-0.881
Errors 1	0.587, 0.430-0.744
Errors 2	0.541, 0.378-0.704
Errors 3	0.525, 0.336-0.684
Interference	0.506, 0.343-0.669
Survey Test
MRT 1	0.818, 0.703-0.934*	637.844	79.2%/71.4%
Correct responses 1	0.648, 0.497-0.799
CAMRT 1	0.818, 0.703-0.934*	637.844	79.2%/71.4%
Errors 1	0.648, 0.497-0.799
EMRT 1	0.465, 0.307-0.623
MRT 2	0.829, 0.714-0.944*	663.004	79.2%/75%
Correct responses 2	0.798, 0.676-0.919*	97	79.2%/71.4%
CAMRT 2	0.835, 0.721-0.949*	663.004	79.2%/75%
Errors 2	0.798, 0.676-0.919*	3	79.2%/71.4%
EMRT 2	0.573, 0.415-0.731
MRT 3	0.823, 0.707-0.939*	653.629	83.3%/71.4%
Correct responses 3	0.802, 0.678-0.926*	93	75%/75%
CAMRT 3	0.826, 0.711-0.941*	664.223	83.3%/75%
Errors 3	0.802, 0.678-0.926*	7	75%/75%
EMRT 3	0.507, 0.346-0.669

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[1] Correspondence: Larissa Hartle; Email: larissahartle@gmail.com.