目的:人类癫痫项目(HEP)是一项针对新诊断和治疗局灶性癫痫患者的大型跨国队列研究。HEP利用Cogstate简短电池(CBB)作为自我指导的在线评估,以检查研究参与者的认知结果。CBB先前已在健康个体和患有各种脑部疾病的人中得到验证,但尚未评估其在参与HEP的成年人中的使用情况。在这项研究中,我们描述了CBB如何用于HEP队列,并评估了研究参与者中与测试完成相关的因素.
方法:HEP的登记数据包括408名具有全面登记记录的参与者,其中249人完成了CBB评估。从2012年6月29日至2017年11月7日,HEP招募了年龄在12至60岁之间的认知正常范围参与者,这些参与者患有新诊断的局灶性癫痫,并且在初始治疗后4个月内。分析了基线参与者特征,包括人口统计,治疗前癫痫发作史,MRI异常,以及在学校时出现的任何学习困难,包括正式的学习障碍诊断,重复的成绩,和补救。将完成CBB测试的人的HEP参与者特征与未使用多元逻辑回归的人进行比较。
结果:对完成CBB测试的HEP参与者的分析表明,在控制了其他因素后,男性参与者更有可能参与测试(OR2.14,95%CI1.29至3.5,p<0.01),黑人受试者的可能性较小(OR0.45,95%CI0.22至0.9,p=0.02),主要说英语的人更有可能(OR3.1,95%CI1.21至7.96,p=0.02),有学习挑战史的患者的可能性较小(OR0.69,95%CI0.49~0.97,p=0.03).完成CBB测试和年龄之间没有显著关联,就业(就业或学生与非就业),教育(高等教育与非高等教育),诊断延迟,诊断前癫痫发作负担,或初始癫痫发作符号学(运动与非运动)。
结论:这项研究的结果强调了在局灶性癫痫成人前瞻性队列中应用远程和无监督认知评估的相关因素。在解释HEP中CBB的性能时,可以考虑这些因素,以及协助设计使用类似方法的未来研究。
OBJECTIVE: The Human Epilepsy Project (HEP) is a large multinational cohort study of people with newly diagnosed and treated focal epilepsy. HEP utilized the Cogstate Brief Battery (CBB) as a self-directed online assessment to examine cognitive outcomes in study participants. The CBB has previously been validated in healthy individuals and people with various brain disorders, but its use in adults participating in HEP has not been assessed. In this study, we describe how the CBB was used in the HEP cohort and assess factors associated with test completion among study participants.
METHODS: Enrollment data for HEP included 408 participants with comprehensive enrollment records, of whom 249 completed CBB assessments. HEP enrolled cognitively normal-range participants between the ages of 12 and 60 from June 29, 2012, to November 7, 2017, with newly diagnosed focal epilepsy and within 4 months of initial treatment. Baseline participant characteristics were analyzed, including demographics, pre-treatment seizure histories, MRI abnormalities, and the presence of any learning difficulties while in school, including formal learning disability diagnoses, repeated grades, and remediation. HEP participant characteristics for those who completed CBB testing were compared to those who did not using multiple logistic regression.
RESULTS: The analysis of HEP participants who completed CBB testing showed that, after controlling for other factors, male participants were more likely to engage in testing (OR 2.14, 95 % CI 1.29 to 3.5, p < 0.01), Black subjects were less likely (OR 0.45, 95 % CI 0.22 to 0.9, p = 0.02), primary English speakers were more likely (OR 3.1, 95 % CI 1.21 to 7.96, p = 0.02), and those with a history of learning challenges were less likely (OR 0.69, 95 % CI 0.49 to 0.97, p = 0.03). There were no significant associations between completing CBB testing and age, employment (employed or student vs not), education (higher education vs not), diagnostic delay, pre-diagnostic seizure burden, or initial seizure semiology (motor vs non-motor).
CONCLUSIONS: The findings from this study highlight factors associated with the application of remote and unsupervised assessments of cognition in a prospective cohort of adults with focal epilepsy. These factors can be considered when interpreting performance on the CBB in HEP, as well as assisting the design of future studies that use similar approaches.