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The rising prevalence of dementia necessitates a scalable solution to cognitive screening. Paper-based cognitive screening examinations are well-validated but minimally scalable. If a digital cognitive screening examination could replicate paper-based screening, it may improve scalability while potentially maintaining the performance of these well-validated paper-based tests. Here, we evaluate the Rapid Online Cognitive Assessment (RoCA), a remote and self-administered digital cognitive screening examination. The objective of this study was to validate the ability of RoCA to reliably evaluate patient input, identify patients with cognitive impairment relative to the established tests, and evaluate its potential as a screening tool. RoCA uses a convolutional neural network to evaluate a patient's ability to perform common cognitive screening tasks: wireframe diagram copying and clock drawing tests. To evaluate RoCA, we compared its evaluations with those of established paper-based tests. This open-label study consists of 46 patients (age range 33-82 years) who were enrolled from neurology clinics. Patients completed the RoCA screening examination and either Addenbrooke's Cognitive Examination-3 (ACE-3, n=35) or Montreal Cognitive Assessment (MoCA, n=11). We evaluated 3 primary metrics of RoCA's performance: (1) ability to correctly evaluate patient inputs, (2) ability to identify patients with cognitive impairment compared to ACE-3 and MoCA, and (3) performance as a screening tool. RoCA classifies patients similarly to gold standard paper-based tests, with a receiver operating characteristic area under the curve of 0.81 (95% CI 0.67-0.91; P<.001). RoCA achieved sensitivity of 0.94 (95% CI 0.80-1.0; P<.001). This was robust to multiple control analyses. Approximately 83% (16/19) of the patient respondents reported RoCA as highly intuitive, with 95% (18/19) perceiving it as adding value to their care. RoCA may act as a simple and highly scalable digital cognitive screening examination. However, due to the limitations of this study, further work is required to evaluate the ability of RoCA to be generalizable across patient populations, assess its performance in an entirely remote manner, and analyze the effect of digital literacy.

The rising prevalence of dementia necessitates a scalable solution to cognitive assessments. The Autonomous Cognitive Examination (ACoE) is a foundational cognitive test for the phenotyping of cognitive symptoms across the primary cognitive domains. However, while the ACoE has been internally validated, it has not been externally validated in a clinical population, and its ability to render accurate appraisals of cognition is unknown. Further, it is unclear if these phenotypic assessments are useful in clinical tasks such as screening patients with and those without impairments. The objective of this study is to validate the ability of the ACoE to reliably phenotype cognition and to act as a screening examination relative to standard paper-based tests. To compare the evaluations of the ACoE to established paper-based tests, 46 patients with neurological disorders were enrolled in a randomized crossover study and received either the ACoE or a standard paper-based cognitive test. Patients received either the Addenbrooke Cognitive Examination-3 (ACE-3; n=35) or the Montreal Cognitive Examination (MoCA; n=11). We evaluated 3 primary metrics of the ACoE's performance relative to paper-based tests: (1) interrater reliability of overall cognitive scores, (2) interrater reliability of cognitive domain scores, and (3) ability to classify patients similarly to paper-based tests. The ACoE's overall cognitive assessments were significantly reliable (ICC [intraclass correlation coefficient]=0.89; P<.001). Each cognitive domain's assessments were also significantly reliable, including attention (ICC=0.74; PFWE<.001), language (ICC=0.89; PFWE<.001), memory (ICC=0.91; PFWE<.001), fluency (ICC=0.74; PFWE<.001), and visuospatial function (ICC=0.78; PFWE<.001). The ACoE was also able to successfully diagnose patients similarly to both paper-based tests (area under the receiver operating characteristic curve=0.96; PFWE<.001). In this study, we evaluated if the ACoE could reliably phenotype cognitive symptoms relative to the assessments of established standard paper-based cognitive assessments. We found that the ACoE reliably phenotypes patient cognition, which can be used to screen patients. In the future, these cognitive phenotypes may be used to diagnose specific etiologies.

INTRODUCTION Here we contrast cognitive outcomes of deep brain stimulation (DBS) in Parkinson's disease (PD) with Alzheimer's disease (AD) to isolate the shared effect of DBS upon cognition while filtering out disease‐specific effects. Based on prior literature, we evaluate how DBS connectivity to the hippocampus influences cognition. We then evaluate how patient factors moderate this relationship. METHODS We studied electrode locations and cognitive outcomes in patients who received subthalamic nucleus (STN) DBS for PD (2 datasets: n = 33, n = 28) or fornix DBS for AD (1 dataset: n = 46). We then investigate the moderating effect of patient factors and similarities across diseases. RESULTS DBS site connectivity to the hippocampus was cognitively deleterious in PD but beneficial in AD. The opposite findings were driven by patient age. This effect was mediated by age‐related hippocampal atrophy. DISCUSSION The shared cognitive effects of DBS across PD and AD depend on hippocampal connectivity and age. Highlights Cognition can be positively or negatively modulated in the same manner across diseases. Contrary to current clinical practice, older Parkinson's disease (PD) patients may benefit from deep brain stimulation (DBS). Our results support limiting enrollment to patients over 65 for Alzheimer's disease (AD) DBS, an emerging therapy currently in a phase 3 clinical trial. Hippocampal volume mediates the impact of DBS, suggesting patient atrophy must be considered in patient‐specific care.

Schizophrenia likely represents a cluster of diseases presenting with delusions, hallucinations, disorganised behaviour and disorganised thought. Currently, medical therapy struggles to treat a substantial portion of patients, but with improved stratification of component diseases, it may be possible to better understand and treat schizophrenia. The overlap between schizophrenia, schizo-obsessive disorder and obsessive-compulsive disorder is discussed within the context of a clinical case and neuroimaging data. Furthermore, the use of obsessive-compulsive disorder deep brain stimulation protocols for schizo-obsessive disorder is discussed and may yield an advance in neurosurgical treatment of psychiatric conditions.

Background: Many countries rely upon subdural grid electroencephalography in the planning of epilepsy surgeries. However, craniotomy for subdural grid implantation is known to result in a variety of complications and requires diligence from the surgical team. We describe a minimally invasive method of subdural grid insertion, termed the linear oblique craniectomy, designed to mitigate complications and increase ease of subdural grid insertion. Objective: To demonstrate feasibility of minimally invasive subdural grid insertion utilizing skull anatomy. Methods: Three fresh frozen and embalmed human cadavers underwent surface landmarking and craniectomy to introduce a 4 × 5 cm2 subdural grid over the Sylvian fissure. Anteroposterior lens-shaped craniectomy measured 5 cm in length with 1 cm maximal width. The dura mater was longitudinally incised, and subdural grids were introduced over the Sylvian fissure. Results: The total area of the craniectomy created by the linear oblique approach consists of only approximately 20% of the total area removed by the traditional approach to access the Sylvian fissure for mesial temporal epilepsy monitoring/preoperative planning. The locations of the grids were evaluated by MRI and computed tomography scans postoperatively to ensure accurate alignment with the Sylvian fissure. Conclusion: In this cadaveric study, we demonstrate the linear oblique craniectomy procedure that provides an alternative approach to subdural grid implantation with significantly decreased invasiveness. This surgical approach has the potential of reducing complication rates of subdural grid insertion for surface monitoring of the brain activity and/or neuromachine interface analysis and is associated with significant reduction of surgical time.

The presence of red ochre has long been associated with artifacts and burials at prehistoric cultures in North America and elsewhere. Often, however, suggestions on the use of ochre have not considered the natural occurrence of this mineral and natural pedogenic processes that may impact our interpretations of its use. This report reviews some of the characteristics of iron oxides and the factors that may affect its use and distribution in specific settings such as caches and burials.

The Holen et al. article ends with the comment mat they do not think that the artifact was actually associated with the mammodi. Because the point was originally presented as a valid artifact/mammoth association, it is a fraudulent artifact as far as archaeology is concerned.

Modern artifact replicas represent a definite challenge to the integrity of archaeological collections and their value to scientific study. Effective authentication analysis is necessary to preclude these artifacts. Natural artifact post-depositional surface modification is an indicator of antiquity and of vital importance to such analyses. Surface modification of major value is the authigenic precipitation/deposition of pedogenic minerals. Because of their ubiquitous presence in soils, and their stability when oxidized, the iron oxides/hydroxides are of special value with other minerals playing a supportive role. Features of the minerals and deposits most frequently encountered on artifact surfaces are addressed.

Gloss patina is a natural post-depositional surface alteration frequently present on flint artifacts. Features of this patina include reduced surface topography, smoothness, and a pronounced luster. Gloss patina is distinct from stain patina, desilication (white) patina, and the dark glossy patina known as desert varnish. Glossy river patina has similar features but is produced by abrasion accelerated dissolution whereas gloss patina is primarily a result of soil solution related chemical processes. Artifact adsorption of amorphous silica from its depositional environment can produce gloss patina but advanced examples of gloss patina have surface topography reduction, smoothness, luster and thickness strongly indicating dissolution and concomitant re-precipitation of artifact surface silica.