Cognitive tests administered through a smartphone app have reliably detected frontotemporal lobe degeneration (FTLD), also known as frontotemporal dementia (FTD), an observational study has shown.
The smartphone tests had internal consistency and test-retest reliability (range of intraclass correlation coefficients from 0. 77 to 0. 95), according to Adam Staffaroni, PhD, of the University of California, San Francisco (UCSF), and his co-authors.
The validity is underpinned by strong associations between knowledge of smartphone verification with disease severity, brain volume, and neuropsychological measures, the researchers reported in JAMA Network Open. Smartphone measurements were also more delicate in the early stages of familial FTD.
FTD is a heterogeneous dementia with progressive atrophy that affects the frontal or temporal lobes, or both. The average age of onset is between 50 and 60 years. Approximately 15 to 30% of cases have a genetic cause.
The disorder has been in the spotlight after actor Bruce Willis’ family members announced his diagnosis in 2023. New artistic abilities have also been reported in some FTD patients, i. e. , those with variants of the first progressive aphasia.
FTD can be difficult to diagnose, which has made it difficult to recruit for clinical trials, Staffaroni and his colleagues noted.
“Most FTD patients are diagnosed with the disease relatively late because they are young and their symptoms are mistaken for psychiatric disorders,” co-author Adam Boxer, MD, PhD, also of UCSF, said in a statement. of families who suspect their loved one has FTD long before the doctor agrees with the diagnosis. “
The study was conducted from January 2019 to July 2023 with 360 participants, grouped into a discovery cohort (258 people) and a validation cohort (102 people). The mean age was 54. 0 and 58. 1% were women.
Of the 329 participants with data on the level of disease, another 195 people were asymptomatic or had preclinical FTD, 66 had prodromal FTD, and 68 had symptomatic FTD.
Participants were enrolled at 18 centers in a North American FTLD Study Consortium (ALLFTD) and asked to complete the tests remotely from their own phones. They completed executive functioning tasks and an associative memory task three times over two weeks with the mobile app.
Cognitive responsibilities were self-administered without supervision in a predefined order. Study partners of participants with symptomatic FTD stayed nearby to navigate the app, but were asked not to help with testing. The tests included an adaptive associative memory task and gamified versions of older executive functioning paradigms.
Smartphone tests were related to disease severity (r-range, 0. 38-0. 59), neuropsychological tests (r-range, 0. 40-0. 66), and brain volume (β elevated range, 0. 34-0. 50).
The tests also differentiated participants with dementia from controls with a domain under the curve (AUC) of 0. 93 (95% CI 0. 90-0. 96) and were more sensitive to early symptoms (AUC 0. 82) than the Montreal Cognitive Assessment (AUC). 0,68; Comparison Z, −2. 49, p = 0. 01).
In the discovery and validation cohorts, the effects of reliability and validity were similar. People with preclinical FTD and carriers of pathogenic variants performed particularly worse than non-carrier family controls on three application tasks, but not on a combination of classical neuropsychological measures.
This study has limitations, the researchers acknowledged. Validation analyses focused on initial exposure to the task and long-term studies will look at the reliability and sensitivity of repeated measurements. The participants were largely white and college-educated, and the effects would likely not apply to other groups.
The researchers collaborated with a software company that has developed a smartphone platform to study memory and executive functions and compare voice recordings and body movements. They don’t plan to make the mobile app available to the public, but they see its possibilities in clinical trials. .
“Eventually, the app could simply be used to monitor the effects of remedies, replacing the maximum or maximum in-person visits to clinical trial sites,” Staffaroni said.
Judy George covers neurology and neuroscience news for MedPage Today and writes about brain aging, Alzheimer’s disease, dementia, multiple sclerosis, rare diseases, epilepsy, autism, headaches, stroke, Parkinson’s disease, ALS, concussions, CTEs, sleep, and more. Follow
This study is supported by the NIH, the Association for Frontotemporal Degeneration, the Bluefield Project to cure FTD, the Rainwater Charitable Foundation, and the Larry L. Hillblom Foundation.
Staffaroni said he is a co-inventor of 4 responsibilities of the ALLFTD mobile app (not discussed in this study) and receives a license fee from Datacubed Health; receiving studies from the NIH’s National Institute on Aging, the Bluefield Project for Cure FTD, the Alzheimer’s Association, the Larry L. Hillblom Foundation, and the Rainwater Charitable Foundation, and representatives from Alector Inc. , Eli Lilly and Company, Prevail Therapeutics, Passage Bio Inc. , and Takeda Pharmaceuticals. Co-authors reported on relationships with nonprofits and industry.