Associations between mild behavioral impairment, depression, and remote cognitive performance using the Mobile Toolbox

Elizabeth M. Dworak1, Jiwon Kim1, Y. Catherine Han1, Augusta Zukauskas1, Aaron J. Kaat1, Cindy J. Nowinski1, Stephanie Ruth Young1, Miriam A. Novack1 , Courtney K. Blackwell1, Jerry Slotkin2, Michael Weiner3,5, Joseph Eichenbaum3, Bernard Landavazo4,5, Monica R. Camacho5, Zahinoor Ismail6, Richard C. Gershon1, & Rachel L. Nosheny4,5
1Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL 2Center for Health Assessment Research and Translation, University of Delaware, Newark, DE 3Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA 4Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA 5Northern California Institute for Research and Education, Department of Veterans Affairs Medical Center, San Francisco, CA 6 Hotchkiss Brain Institute, University of Calgary, Calgary, AB

Mild behavioral impairment, depression history, and depression symptoms are associated with diminished performance across multiple remotely assessed cognitive domains in aging populations

INTRODUCTION 

Mild Behavioral Impairment (MBI) is a pre-dementia syndrome marked by the midlife emergence and persistence of neuropsychiatric symptoms1
Both MBI1,2 and emotional symptoms3 (e.g., depression) have been associated with increased risk of progression from normal cognition to mild cognitive impairment and Alzheimer's diseases and related dementias (AD/ADRD)
Although MBI and depression are recognized as risk markers for cognitive decline, their associations with remote cognitive performance remains unexplored
Examining these relationships is important because remote cognitive testing offers scalable and low-burden evaluation across large, diverse populations beyond clinic-based testing

Figure 1. MTB Workflow and Measures

METHODS

Sample
5,346 adult participants were recruited from the Brain Health Registry (BHR)4

Measures
Mobile Toolbox (MTB)5 on personal smartphones at baseline
Brief, sensitive, remote assessments for executive function,6 processing speed,6 verbal ability,7,8 episodic memory,9 associative memory,10 and working memory11
Subset of participants took part in separate BHR ancillary studies examining MBI or depressive symptoms (see Figure 2)

Analysis
Regression models were used to examine the association between MTB scores, MBI, and depression, adjusting for age and education

Figure 2. Sample size and Descriptives

BHR Participants with MTB Scores
N = 5,346
AgeMean(SD) = 63.4(11.3), 77.5% Female

MBI-C1 (proxy-reported checklist) Scores
N = 418
AgeMean(SD)=65.2(9.92) 73.7% Female

Self-reported
depression history
N = 1,086
AgeMean(SD) = 61.9 (11.5) 78.9% Female

Geriatric Depression Scale (GDS)12
N = 992
AgeMean(SD)=62.1 (11.3) 78.0% Female

Patient Health Questionnaire–9 (PHQ-9)13
N = 991
AgeMean(SD) = 62.1 (11.3) 78.0% Female

RESULTS

MBI-C & MTB
Negative associations were found between total MBI symptoms and MTB scores with the effect strongest for processing speed 
Domains of Decreased Motivation and Emotional Dysregulation were not significantly associated with MTB, except for spelling ability
Domains of Impulse Dyscontrol and Social Inappropriateness were negatively associated with verbal ability and working memory performance 
MBI-C psychosis was negatively associated with episodic memory and verbal ability performance 
Depression & MTB
Negative associations were found between measures of depressive symptoms and MTB scores, particularly with processing speed, consistent with current theories of depression and cognitive slowing14
Self-reported depression history indices did not significantly relate with MTB scores except for spelling performance

Figure 3. Associations between MBI-C (domain, total scores) and MTB scores

Figure 4. Associations between depression and MTB scores

REFERENCES

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CONCLUSIONS

MBI and depressive symptoms were associated with diminished cognitive performance, supporting their relevance as early behavioral markers of AD/ADRD risk
Meaningful associations between MBI-C, GDS, PHQ-9, and cognitive performance varied across cognitive domains, suggesting that MBI and depressive symptoms exhibit distinct relationships with cognitive functioning.
Results support the utility and validity of self-administered remote cognitive assessments in aging populations

CONTACT

This work is supported by NIA grant #1U2CAG060426. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

For more information, please contact Dr. Elizabeth Dworak at elizabeth.dworak@northwestern.edu