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NeuroTrax BrainCare
Please visit this website for more information about the instrument: NeuroTrax BrainCare™
NeuroTrax licenses the product BrainCare™
Exploratory: Parkinson's Disease (PD)
Short Description of Instrument
Purpose: The NeuroTrax BrainCareTM is a cloud-based computerized cognitive assessment application. The original version called MindStreams® was developed in 2003.
Overview: The application includes a series of computerized tests to assess memory, attention, executive function, visuospatial skills, verbal function, information processing, and motor skills; and provides reports for clinicians (physicians, psychologists, occupational therapists, physical therapists, speech therapists, nurses and other healthcare professionals) to monitor brain fitness, and data-driven recommendations for brain training. It has also been used by the pharmaceutical and academic research community. Test results are compared to previous data from the same patient and to performance data from that of a "normative" peer group (i.e., age and education appropriate).
The software resides on the local testing computer and serves as a platform for interactive cognitive tests that produce accuracy and reaction time (millisecond timescale) data. The adaptive nature of the tests (i.e., difficulty level is adjusted according to performance) increases sensitivity and minimizes the prevalence of ceiling effects. Feedback is provided in the practice sessions that precede each test, but not during the actual tests. Web-based administrative features allow for secure entry and storage of patient demographic data. Once tests are run on the local computer, data are automatically uploaded to a central server, where calculation of outcome parameters from raw single-trial data and report generation occur (Dwolatzky et al., 2003).
Time to complete the tests is about 45-60 min.
Comments/Special Instructions
The NeuroTrax system was originally designed to detect individuals with mild cognitive impairment (MCI). Since its development, the NeuroTrax system has been used in many clinical studies examining cognitive function in various neuropsychiatric conditions including PD even though it has not been validated independently for use in PD. The computerized test scores specifically pertaining to the attention and executive function domains have been found to correlate with gait parameters and demonstrated significant change over time and in response to interventions in PD.
Below are examples of studies that used the NeuroTrax system:
-The first study using NeuroTrax in PD showed that executive function measures correlated significantly with gait variability during dual tasking in PD patients (Yogev et al., 2005).
-A subset of executive function scores accounted for variability in gait parameters during dual-tasking in PD patients who experienced motor fluctuations (Plotnik et al., 2011).
-A study assessing the relationship between real-life gait measures (collected with an accelerometer for three days) and cognition in PD patients showed that vertical gait variability and cadence were associated with attention and executive function as well as with global cognition, and dynamic postural control was associated with attention and global cognition (Weiss et al., 2015).
-PD patients with the postural instability-gait difficulty subtype compared with those with the tremor subtype showed significantly worse performance in the visuospatial tests of the Montreal Cognitive Assessment battery and the "catch game" of the NeuroTrax, which requires motor-cognitive control (Herman et al., 2015).
-PD patients with the postural instability-gait difficulty subtype compared with those with the tremor subtype showed significant worsening in global cognition, executive function, and "catch game" scores over the course of 5 years (Arie et al., 2017).  
-A pilot study showed improvement in attention scores and mobility in PD patients 2 hr after administration of a single dose of methylphenidate (Auriel et al., 2006).
-Subthalamic nucleus deep brain stimulation was found to improve motor function, attention and gait speed, but not the negative impact of dual-tasking on gait parameters in PD (Seri-Fainshtat et al., 2013).
-A randomized crossover trial tested the effects of rivastigmine in PD patients with MCI. The Alzheimer's Disease Cooperative Study-Clinical Global Impression of Change was the primary outcome and batteries measuring global cognition including the NeuroTrax were among the secondary outcomes. No significant effect of rivastigmine was found on the primary outcome or on global cognitive measures including those tested with NeuroTrax (Mamikonyan et al., 2015).
Scoring and Psychometric Properties
Scoring: Data are scored on an IQ-like scale 100 representing the estimated population mean normalized for age and education and 15 representing one standard deviation.
Psychometric Properties:
The initial validation study used a receiver operating characteristic- area under the curve (AUC) analysis to discriminate a group of adults with MCI (N=30) from healthy older adults (N=39) (Dwolatzky et al., 2003). The study showed that the computerized tests especially testing memory (AUC range: 0.698-0.859), executive function (AUC range: 0.696-0.810), visuospatial skills (AUC: 0.756), verbal function (AUC range: 0.716-0.824), and attention (AUC range: 0.706-0.771) could discriminate those with MCI from healthy older adults, and the discrimination power was comparable to that of traditional neuropsychological tests used for the same cognitive domains.
-Easy to self-administer
-Automated scoring
-Unsupervised self-administration of the tests may affect data quality and reliability.
-Psychometric properties have not been validated for use in PD.
Key Reference:
Dwolatzky T, Whitehead V, Doniger GM, Simon ES, Schweiger A, Jaffe D, Chertkow H. Validity of a novel computerized cognitive battery for mild cognitive impairment. BMC Geriatr. 2003 Nov 2;3:4.
Additional References:
An updated list of all publications can be found on NeuroTrax's webpage:
Studies in PD that used the NeuroTrax system:
Alcock L, Galna B, Hausdorff JM, Lord S, Rochester L. Enhanced Obstacle Contrast to Promote Visual Scanning in Fallers with Parkinson's Disease: Role of Executive Function. Neuroscience. 2020 Jun 1;436:82-92.
Arie L, Herman T, Shema-Shiratzky S, Giladi N, Hausdorff JM. Do cognition and other non-motor symptoms decline similarly among patients with Parkinson's disease motor subtypes? Findings from a 5-year prospective study. J Neurol. 2017 Oct;264(10):2149-2157.
Auriel E, Hausdorff JM, Herman T, Simon ES, Giladi N. Effects of methylphenidate on cognitive function and gait in patients with Parkinson's disease: a pilot study. Clin Neuropharmacol. 2006 Jan-Feb;29(1):15-7.
Dagan M, Herman T, Bernad-Elazari H, Gazit E, Maidan I, Giladi N, Mirelman A, Manor B, Hausdorff JM. Dopaminergic therapy and prefrontal activation during walking in individuals with Parkinson's disease: does the levodopa overdose hypothesis extend to gait? J Neurol. 2021 Feb;268(2):658-668.
Dagan M, Herman T, Mirelman A, Giladi N, Hausdorff JM. The role of the prefrontal cortex in freezing of gait in Parkinson's disease: insights from a deep repetitive transcranial magnetic stimulation exploratory study. Exp Brain Res. 2017 Aug;235(8):2463-2472.
Hausdorff JM, Doniger GM, Springer S, Yogev G, Simon ES, Giladi N. A common cognitive profile in elderly fallers and in patients with Parkinson's disease: the prominence of impaired executive function and attention. Exp Aging Res. 2006 Oct-Dec;32(4):411-29. Erratum in: Exp Aging Res. 2007 Jan-Mar;33(1):121.
Herman T, Rosenberg-Katz K, Jacob Y, Giladi N, Hausdorff JM. Gray matter atrophy and freezing of gait in Parkinson's disease: Is the evidence black-on-white? Mov Disord. 2014 Jan;29(1):134-9.
Herman T, Weiss A, Brozgol M, Giladi N, Hausdorff JM. Identifying axial and cognitive correlates in patients with Parkinson's disease motor subtype using the instrumented Timed Up and Go. Exp Brain Res. 2014 Feb;232(2):713-21.
Herman T, Weiss A, Brozgol M, Wilf-Yarkoni A, Giladi N, Hausdorff JM. Cognitive function and other non-motor features in non-demented Parkinson's disease motor subtypes. J Neural Transm (Vienna). 2015 Aug;122(8):1115-24.
Jacob Y, Rosenberg-Katz K, Gurevich T, Helmich RC, Bloem BR, Orr-Urtreger A, Giladi N, Mirelman A, Hendler T, Thaler A. Network abnormalities among non-manifesting Parkinson disease related LRRK2 mutation carriers. Hum Brain Mapp. 2019 Jun 1;40(8):2546-2555.
Maidan I, Bernad-Elazari H, Giladi N, Hausdorff JM, Mirelman A. When is Higher Level Cognitive Control Needed for Locomotor Tasks Among Patients with Parkinson's Disease? Brain Topogr. 2017 Jul;30(4):531-538.
Maidan I, Nieuwhof F, Bernad-Elazari H, Bloem BR, Giladi N, Hausdorff JM, Claassen JAHR, Mirelman A. Evidence for Differential Effects of 2 Forms of Exercise on Prefrontal Plasticity During Walking in Parkinson's Disease. Neurorehabil Neural Repair. 2018 Mar;32(3):200-208.
Maidan I, Nieuwhof F, Bernad-Elazari H, Reelick MF, Bloem BR, Giladi N, Deutsch JE, Hausdorff JM, Claassen JA, Mirelman A. The Role of the Frontal Lobe in Complex Walking Among Patients With Parkinson's Disease and Healthy Older Adults: An fNIRS Study. Neurorehabil Neural Repair. 2016 Nov;30(10):963-971.
Maidan I, Rosenberg-Katz K, Jacob Y, Giladi N, Deutsch JE, Hausdorff JM, Mirelman A. Altered brain activation in complex walking conditions in patients with Parkinson's disease. Parkinsonism Relat Disord. 2016 Apr;25:91-6.
Maidan I, Rosenberg-Katz K, Jacob Y, Giladi N, Hausdorff JM, Mirelman A. Disparate effects of training on brain activation in Parkinson disease. Neurology. 2017 Oct 24;89(17):1804-1810.
Mamikonyan E, Xie SX, Melvin E, Weintraub D. Rivastigmine for mild cognitive impairment in Parkinson disease: a placebo-controlled study. Mov Disord. 2015 Jun;30(7):912-8.
Milman U, Atias H, Weiss A, Mirelman A, Hausdorff JM. Can cognitive remediation improve mobility in patients with Parkinson's disease? Findings from a 12 week pilot study. J Parkinsons Dis. 2014;4(1):37-44.
Plotnik M, Dagan Y, Gurevich T, Giladi N, Hausdorff JM. Effects of cognitive function on gait and dual tasking abilities in patients with Parkinson's disease suffering from motor response fluctuations. Exp Brain Res. 2011 Jan;208(2):169-79.
Plotnik M, Giladi N, Dagan Y, Hausdorff JM. Postural instability and fall risk in Parkinson's disease: impaired dual tasking, pacing, and bilateral coordination of gait during the "ON" medication state. Exp Brain Res. 2011 May;210(3-4):529-38.
Plotnik M, Giladi N, Hausdorff JM. Bilateral coordination of gait and Parkinson's disease: the effects of dual tasking. J Neurol Neurosurg Psychiatry. 2009 Mar;80(3):347-50.
Rosenberg-Katz K, Herman T, Jacob Y, Giladi N, Hendler T, Hausdorff JM. Gray matter atrophy distinguishes between Parkinson disease motor subtypes. Neurology. 2013 Apr 16;80(16):1476-84.
Rosenberg-Katz K, Herman T, Jacob Y, Kliper E, Giladi N, Hausdorff JM. Subcortical Volumes Differ in Parkinson's Disease Motor Subtypes: New Insights into the Pathophysiology of Disparate Symptoms. Front Hum Neurosci. 2016 Jul 11;10:356.
Rosenberg-Katz K, Herman T, Jacob Y, Mirelman A, Giladi N, Hendler T, Hausdorff JM. Fall risk is associated with amplified functional connectivity of the central executive network in patients with Parkinson's disease. J Neurol. 2015 Nov;262(11):2448-56.
Seri-Fainshtat E, Israel Z, Weiss A, Hausdorff JM. Impact of sub-thalamic nucleus deep brain stimulation on dual tasking gait in Parkinson's disease. J Neuroeng Rehabil. 2013 Apr 15;10:38.
Thaler A, Gonen T, Mirelman A, Helmich RC, Gurevich T, Orr-Urtreger A, Bloem BR, Giladi N, Hendler T; LRRK2 Ashkenazi Jewish consortium. Altered reward-related neural responses in non-manifesting carriers of the Parkinson disease related LRRK2 mutation. Brain Imaging Behav. 2019 Aug;13(4):1009-1020.
Thaler A, Kliper E, Maidan I, Herman T, Rosenberg-Katz K, Bregman N, Gurevich T, Shiner T, Hausdorff JM, Orr-Urtreger A, Giladi N, Mirelman A. Cerebral Imaging Markers of GBA and LRRK2 Related Parkinson's Disease and Their First-Degree Unaffected Relatives. Brain Topogr. 2018 Nov;31(6):1029-1036.
Weiss A, Herman T, Giladi N, Hausdorff JM. Association between Community Ambulation Walking Patterns and Cognitive Function in Patients with Parkinson's Disease: Further Insights into Motor-Cognitive Links. Parkinsons Dis. 2015;2015:547065.
Weiss A, Herman T, Mirelman A, Shiratzky SS, Giladi N, Barnes LL, Bennett DA, Buchman AS, Hausdorff JM. The transition between turning and sitting in patients with Parkinson's disease: A wearable device detects an unexpected sequence of events. Gait Posture. 2019 Jan;67:224-229.
Yogev G, Giladi N, Peretz C, Springer S, Simon ES, Hausdorff JM. Dual tasking, gait rhythmicity, and Parkinson's disease: which aspects of gait are attention demanding? Eur J Neurosci. 2005 Sep;22(5):1248-56.
Yogev G, Plotnik M, Peretz C, Giladi N, Hausdorff JM. Gait asymmetry in patients with Parkinson's disease and elderly fallers: when does the bilateral coordination of gait require attention? Exp Brain Res. 2007 Mar;177(3):336-46.
Yogev-Seligmann G, Giladi N, Brozgol M, Hausdorff JM. A training program to improve gait while dual tasking in patients with Parkinson's disease: a pilot study. Arch Phys Med Rehabil. 2012 Jan;93(1):176-81.
Document last updated August 2022