Investigating the relationship between neuropsychiatric symptoms and cognition in mild cognitive impairment and Alzheimer’s disease patients undergoing an exercise‐primed transcranial direct current stimulation clinical trial (The EXPRESS Study)
Bibliographic record
Abstract
Abstract Background Neuropsychiatric symptoms (NPS) are common features of Mild Cognitive Impairment (MCI) and Alzheimer’s disease (AD), and are associated with poorer cognition. Transcranial direct current stimulation (tDCS), a non‐invasive type of brain stimulation, has been investigated for the treatment of some NPS in a few small AD studies, but with negative results for apathy and depression. Priming the brain with an excitatory intervention, such as exercise, may elicit greater changes if applied prior to tDCS. Using data from an ongoing blinded study, we aimed to evaluate the relationship between NPS and cognition in MCI and mild AD. Method MCI or mild AD participants were enrolled in a two‐week, randomized, blinded clinical trial investigating the effects of exercise‐primed tDCS for cognition using the Montreal Cognitive Assessment (MoCA). NPS were measured using the Neuropsychiatric Inventory (NPI) subscales. A Pearson’s correlation determined the relationship between NPI scores and the MoCA at baseline in patients who received exercise‐primed tDCS or tDCS alone. A repeated measures analysis of variance compared changes in NPI scores between the two treatment groups over time. As the study is ongoing, the treatment groups have been randomly coded as Group 1 and Group 2 to avoid unblinding. Result At baseline, participants (N=13) were 76.5±7.2 years of age, MoCA score= 20.9±3.6, 53% female, and 53% MCI. Nine (69.2%) participants reported having at least one NPS (NPI Score ≥ 1). Apathy (46.2%), sleep disturbances (38.5%), agitation (30.8%), and anxiety (30.8%) were the most prevalent NPS. At baseline, only anxiety was negatively correlated with MoCA scores (r=‐0.57, p=0.041; Figure 1). There were no significant differences between treatment groups on anxiety scores over time (F(1,10)= 2.4, p=0.16). However, after controlling for baseline MoCA scores, there was a significantly greater reduction on anxiety scores in Group 1 (‐0.83±1.3) compared to Group 2 over time (0±0; F(1,9)= 5.3, p=0.047). Conclusion Recruitment is ongoing (total N=30). Only anxiety was associated with poorer cognition at baseline. There were differences between treatment groups on anxiety scores over time, after controlling for baseline MoCA scores. It remains to be seen, after unblinding, whether the group with reduction in anxiety was receiving the primed intervention.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.001 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".