The Boston Process Approach and Digital Neuropsychological Assessment: Past Research and Future Directions

Article type: Review Article

Authors: Libon, David J.^{a; *} | Swenson, Rod^{b; *} | Lamar, Melissa^c | Price, Catherine C.^d | Baliga, Ganesh^e | Pascual-Leone, Alvaro^{f; g; h} | Au, Rhoda^{i; j} | Cosentino, Stephanie^k | Andersen, Stacy L.^l

Affiliations: [a] New Jersey Institute for Successful Aging, Rowan University, School of Osteopathic Medicine, NJ, USA | [b] Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Grand Forks, ND, USA | [c] Rush Alzheimer’s Disease Center and the Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA | [d] Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA | [e] Department of Computer Science, Rowan University, Glassboro, NJ, USA | [f] Hinda and Arthur Marcus Institute for Aging Research and Deanna and Sidney Wolk Center for Memory Health, Hebrew Senior Life, Boston, MA, USA | [g] Department of Neurology, Harvard Medical School, Boston, MA, USA | [h] Guttmann Brain Health Institute, Barcelona, Spain | [i] Departments of Anatomy & Neurobiology and Neurology; Framingham Heart Study, Slone Epidemiology Center and Alzheimer’s Disease Research Center, Boston University School of Medicine, Boston, MA, USA | [j] Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA | [k] Department of Neurology, Taub Institute and Sergievsky Center, Cognitive Neuroscience Division, Columbia University Medical Center, New York, NY, USA | [l] Department of Medicine, Boston University School of Medicine, Boston, MA, USA

Correspondence: [*] Corresponding authors: David J. Libon, PhD, New Jersey Institute for Successful Aging, Rowan University, School of Osteopathic Medicine, NJ, USA. E-mail: [email protected] and Rod Swenson, PhD, Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Grand Forks, ND, USA. E-mail: [email protected].

Abstract: Neuropsychological assessment using the Boston Process Approach (BPA) suggests that an analysis of the strategy or the process by which tasks and neuropsychological tests are completed, and the errors made during test completion convey much information regarding underlying brain and cognition and are as important as overall summary scores. Research over the last several decades employing an analysis of process and errors has been able to dissociate between dementia patients diagnosed with Alzheimer’s disease, vascular dementia associated with MRI-determined white matter alterations, and Parkinson’s disease; and between mild cognitive impairment subtypes. Nonetheless, BPA methods can be labor intensive to deploy. However, the recent availability of digital platforms for neuropsychological test administration and scoring now enables reliable, rapid, and objective data collection. Further, digital technology can quantify highly nuanced data previously unobtainable to define neurocognitive constructs with high accuracy. In this paper, a brief review of the BPA is provided. Studies that demonstrate how digital technology translates BPA into specific neurocognitive constructs using the Clock Drawing Test, Backward Digit Span Test, and a Digital Pointing Span Test are described. Implications for using data driven artificial intelligence-supported analytic approaches enabling the creation of more sensitive and specific detection/diagnostic algorithms for putative neurodegenerative illness are also discussed.

Keywords: Backward digit span test, Boston Process Approach, clock drawing test, cognitive vital signs, digit span test, digital assessment, digital neuropsychological assessment

DOI: 10.3233/JAD-220096

Journal: Journal of Alzheimer's Disease, vol. 87, no. 4, pp. 1419-1432, 2022