/*
Copyright (C) 2012, University of Cambridge, Department of Psychiatry.
Created by Rudolf Cardinal (rnc1001@cam.ac.uk).
This file is part of CamCOPS.
CamCOPS is free software: you can redistribute it and/or modify
it under the terms of the GNU General Public License as published by
the Free Software Foundation, either version 3 of the License, or
(at your option) any later version.
CamCOPS is distributed in the hope that it will be useful,
but WITHOUT ANY WARRANTY; without even the implied warranty of
MERCHANTABILITY or FITNESS FOR A PARTICULAR PURPOSE. See the
GNU General Public License for more details.
You should have received a copy of the GNU General Public License
along with CamCOPS. If not, see <https://www.gnu.org/licenses/>.
*/
#include "moca.h"
#include "common/textconst.h"
#include "lib/datetime.h"
#include "maths/mathfunc.h"
#include "lib/stringfunc.h"
#include "lib/uifunc.h"
#include "questionnairelib/commonoptions.h"
#include "questionnairelib/qucanvas.h"
#include "questionnairelib/qucountdown.h"
#include "questionnairelib/questionnaire.h"
#include "questionnairelib/quimage.h"
#include "questionnairelib/qumcq.h"
#include "questionnairelib/qumcqgrid.h"
#include "questionnairelib/qutext.h"
#include "questionnairelib/qutextedit.h"
#include "tasklib/taskfactory.h"
#include "tasklib/taskregistrar.h"
using mathfunc::noneNull;
using mathfunc::scorePhrase;
using mathfunc::sumInt;
using mathfunc::totalScorePhrase;
using stringfunc::standardResult;
using stringfunc::strnum;
using stringfunc::strseq;
const int FIRST_Q = 1;
const int N_QUESTIONS = 28;
const int MAX_QUESTION_SCORE = 30;
const QString QPREFIX("q");
const QString Moca::MOCA_TABLENAME("moca");
const QString IMAGE_PATH("moca/path.png");
const QString IMAGE_CUBE("moca/cube.png");
const QString IMAGE_CLOCK("moca/clock.png");
const QString IMAGE_ANIMALS("moca/animals.png");
const QString IMAGE_MISSING("moca/missing.png");
const QString EDUCATION12Y_OR_LESS("education12y_or_less");
const QString TRAILPICTURE_BLOBID("trailpicture_blobid");
const QString CUBEPICTURE_BLOBID("cubepicture_blobid");
const QString CLOCKPICTURE_BLOBID("clockpicture_blobid");
const int N_REG_RECALL = 5;
const QString REGISTER_TRIAL1_PREFIX("register_trial1_");
const QString REGISTER_TRIAL2_PREFIX("register_trial2_");
const QString RECALL_CATEGORY_CUE_PREFIX("recall_category_cue_");
const QString RECALL_MC_CUE_PREFIX("recall_mc_cue_");
const QString COMMENTS("comments");
const int NORMAL_IF_GEQ = 26; // cutoff: normal if score >= this
const QString RECALL_TAG_PREFIX("recall");
const QString SKIP_LABEL("skip");
const QString CATEGORY_RECALL_PAGE_TAG("cr");
const QString MC_RECALL_PAGE_TAG("mc");
void initializeMoca(TaskFactory& factory)
{
static TaskRegistrar<Moca> registered(factory);
}
Moca::Moca(CamcopsApp& app, DatabaseManager& db, const int load_pk) :
Task(app, db, MOCA_TABLENAME, false, true, false) // ... anon, clin, resp
{
addFields(strseq(QPREFIX, FIRST_Q, N_QUESTIONS), QMetaType::fromType<int>());
addField(EDUCATION12Y_OR_LESS, QMetaType::fromType<int>());
addField(TRAILPICTURE_BLOBID, QMetaType::fromType<int>()); // FK to BLOB table
addField(CUBEPICTURE_BLOBID, QMetaType::fromType<int>()); // FK to BLOB table
addField(CLOCKPICTURE_BLOBID, QMetaType::fromType<int>()); // FK to BLOB table
addFields(strseq(REGISTER_TRIAL1_PREFIX, 1, N_REG_RECALL), QMetaType::fromType<int>());
addFields(strseq(REGISTER_TRIAL2_PREFIX, 1, N_REG_RECALL), QMetaType::fromType<int>());
addFields(strseq(RECALL_CATEGORY_CUE_PREFIX, 1, N_REG_RECALL), QMetaType::fromType<int>());
addFields(strseq(RECALL_MC_CUE_PREFIX, 1, N_REG_RECALL), QMetaType::fromType<int>());
addField(COMMENTS, QMetaType::fromType<QString>());
load(load_pk); // MUST ALWAYS CALL from derived Task constructor.
}
// ============================================================================
// Class info
// ============================================================================
QString Moca::shortname() const
{
return "MoCA";
}
QString Moca::longname() const
{
return tr("Montreal Cognitive Assessment");
}
QString Moca::description() const
{
return tr("30-point clinician-administered brief cognitive assessment.");
}
// ============================================================================
// Instance info
// ============================================================================
bool Moca::isComplete() const
{
return noneNull(values(strseq(QPREFIX, FIRST_Q, N_QUESTIONS)));
}
QStringList Moca::summary() const
{
return QStringList{totalScorePhrase(totalScore(), MAX_QUESTION_SCORE)};
}
QStringList Moca::detail() const
{
const int vsp = subScore(1, 5);
const int naming = subScore(6, 8);
const int attention = subScore(9, 12);
const int language = subScore(13, 15);
const int abstraction = subScore(16, 17);
const int memory = subScore(18, 22);
const int orientation = subScore(23, 28);
const int totalscore = totalScore();
const QString category = totalscore >= NORMAL_IF_GEQ ? TextConst::normal()
: TextConst::abnormal();
QStringList reg1;
QStringList reg2;
QStringList recallcat;
QStringList recallmc;
const QString prefix_registered = xstring("registered");
const QString prefix_recalled = xstring("recalled");
const QString suffix_trial = xstring("trial");
const QString suffix_cat_recall = xstring("category_recall_suffix");
const QString suffix_mc_recall = xstring("mc_recall_suffix");
for (int i = 1; i <= N_REG_RECALL; ++i) {
QString this_q = xstring(strnum("memory_", i));
reg1 += fieldSummary(
strnum(REGISTER_TRIAL1_PREFIX, i),
QString("%1 %2 (%3 1)").arg(prefix_registered, this_q,
suffix_trial));
reg2 += fieldSummary(
strnum(REGISTER_TRIAL2_PREFIX, i),
QString("%1 %2 (%3 2)").arg(prefix_registered, this_q,
suffix_trial));
recallcat += fieldSummary(
strnum(RECALL_CATEGORY_CUE_PREFIX, i),
QString("%1 %2 %3").arg(prefix_recalled, this_q,
suffix_cat_recall));
recallmc += fieldSummary(
strnum(RECALL_MC_CUE_PREFIX, i),
QString("%1 %2 %3").arg(prefix_recalled, this_q,
suffix_mc_recall));
}
QStringList lines = completenessInfo();
lines.append(fieldSummary(EDUCATION12Y_OR_LESS, xstring("education_s")));
lines += fieldSummaries("q", "_s", " ", QPREFIX, 1, 8);
lines += reg1;
lines += reg2;
lines += fieldSummaries("q", "_s", " ", QPREFIX, 9, 22);
lines += recallcat;
lines += recallmc;
lines += fieldSummaries("q", "_s", " ", QPREFIX, 23, N_QUESTIONS);
lines.append("");
lines.append(scorePhrase(xstring("subscore_visuospatial"), vsp, 5));
lines.append(scorePhrase(xstring("subscore_naming"), naming, 3));
lines.append(scorePhrase(xstring("subscore_attention"), attention, 6));
lines.append(scorePhrase(xstring("subscore_language"), language, 3));
lines.append(scorePhrase(xstring("subscore_abstraction"), abstraction, 2));
lines.append(scorePhrase(xstring("subscore_memory"), memory, 5));
lines.append(scorePhrase(xstring("subscore_orientation"), orientation, 6));
lines.append("");
lines.append(standardResult(xstring("category"), category));
lines.append("");
lines += summary();
return lines;
}
OpenableWidget* Moca::editor(const bool read_only)
{
QVector<QuPagePtr> pages;
const bool crippled = !hasExtraStrings();
const NameValueOptions education_options{
{xstring("education_option0"), 0},
{xstring("education_option1"), 1},
};
const NameValueOptions options_q12{
{xstring("q12_option0"), 0},
{xstring("q12_option1"), 1},
{xstring("q12_option2"), 2},
{xstring("q12_option3"), 3},
};
const NameValueOptions options_recalled{
{TextConst::notRecalled(), 0},
{TextConst::recalled(), 1},
};
const NameValueOptions options_corr_incorr = CommonOptions::incorrectCorrectInteger();
const NameValueOptions options_yesno = CommonOptions::noYesInteger();
const QString correct_date = " " + datetime::nowDate().toString(datetime::LONG_DATE_FORMAT);
const QString recalled = xstring("recalled");
auto addpage = [&pages]
(const QString& title,
std::initializer_list<QuElement*> elements,
QuPage::PageType type = QuPage::PageType::Inherit,
bool allow_scroll = true) -> void {
auto p = new QuPage(elements);
p->setTitle(title);
p->setType(type);
if (!allow_scroll) {
p->allowScroll(false);
}
pages.append(QuPagePtr(p));
};
auto text = [this](const QString& xstringname) -> QuElement* {
return new QuText(xstring(xstringname));
};
auto boldtext = [this](const QString& xstringname) -> QuElement* {
return (new QuText(xstring(xstringname)))->setBold();
};
auto italic = [](const QString& text) -> QuElement* {
return (new QuText(text))->setItalic(true);
};
auto mcq = [this](const QString& fieldname,
const NameValueOptions& options,
bool mandatory = true) -> QuElement* {
return new QuMcq(fieldRef(fieldname, mandatory), options);
};
auto grid1 = [this](const QString& fieldname_prefix,
const QString& question_prefix,
int first,
int last,
const NameValueOptions& options,
bool mandatory = true) -> QuElement* {
QVector<QuestionWithOneField> qfields;
for (int i = first; i <= last; ++i) {
qfields.append(QuestionWithOneField(
fieldRef(strnum(fieldname_prefix, i), mandatory),
xstring(strnum(question_prefix, i))
));
}
Q_ASSERT(!qfields.empty());
return new QuMcqGrid(qfields, options);
};
auto grid2 = [this](const QString& fieldname_prefix,
const QString& first_xstring_name,
const QString& xstring_prefix,
int first,
int last,
const NameValueOptions& options,
bool mandatory = true) -> QuElement* {
QVector<QuestionWithOneField> qfields;
for (int i = first; i <= last; ++i) {
qfields.append(QuestionWithOneField(
fieldRef(strnum(fieldname_prefix, i), mandatory),
xstring(first_xstring_name) + " " +
xstring(strnum(xstring_prefix, i))
));
}
Q_ASSERT(!qfields.empty());
return new QuMcqGrid(qfields, options);
};
auto viewblob = [this](const QString& blob_id_fieldname) -> QuElement* {
FieldRefPtr fr = fieldRef(blob_id_fieldname, false, true, true);
return new QuImage(fr);
};
auto canvas = [this, &crippled]
(const QString& blob_id_fieldname, const QString& image_filename)
-> QuElement* {
const QString filename = crippled ? IMAGE_MISSING : image_filename;
QuCanvas* c = new QuCanvas(
blobFieldRef(blob_id_fieldname, true),
uifunc::resourceFilename(filename));
c->setAllowShrink(true);
return c;
};
auto image = [&crippled](const QString& image_filename) -> QuImage* {
const QString filename = crippled ? IMAGE_MISSING : image_filename;
return new QuImage(uifunc::resourceFilename(filename));
};
addpage(xstring("title_preamble"), {
getClinicianQuestionnaireBlockRawPointer(),
text("education_instructions"),
mcq(EDUCATION12Y_OR_LESS, education_options),
});
addpage(xstring("title_prefix_singular") + " 1", {
text("trail_instructions"),
canvas(TRAILPICTURE_BLOBID, IMAGE_PATH),
}, QuPage::PageType::Patient, false);
addpage(xstring("title_prefix_singular") + " 2", {
text("cube_instructions"),
canvas(CUBEPICTURE_BLOBID, IMAGE_CUBE),
}, QuPage::PageType::Patient, false);
addpage(xstring("title_prefix_singular") + " 3–5", {
text("clock_instructions"),
canvas(CLOCKPICTURE_BLOBID, IMAGE_CLOCK),
}, QuPage::PageType::Patient, false);
addpage(xstring("title_prefix_plural") + " 6–8", {
text("naming_instructions"),
image(IMAGE_ANIMALS),
}, QuPage::PageType::ClinicianWithPatient);
addpage(xstring("title_prefix_plural") + " 1–8 " + xstring("scoring"), {
viewblob(TRAILPICTURE_BLOBID),
viewblob(CUBEPICTURE_BLOBID),
viewblob(CLOCKPICTURE_BLOBID),
grid1(QPREFIX, "q", 1, 8, options_corr_incorr),
});
addpage(xstring("title_prefix_plural") + " " + xstring("title_memorize"), {
text("memory_instruction1"),
grid2(REGISTER_TRIAL1_PREFIX, "registered", "memory_",
1, N_REG_RECALL, options_yesno),
text("memory_instruction2"),
grid2(REGISTER_TRIAL2_PREFIX, "registered", "memory_",
1, N_REG_RECALL, options_yesno),
text("memory_instruction3"),
});
addpage(xstring("title_prefix_plural") + " 9–12", {
text("digit_forward_instructions"),
grid1(QPREFIX, "q", 9, 9, options_corr_incorr),
text("digit_backward_instructions"),
grid1(QPREFIX, "q", 10, 10, options_corr_incorr),
text("tapping_instructions"),
grid1(QPREFIX, "q", 11, 11, options_corr_incorr),
text("q12"),
mcq(strnum(QPREFIX, 12), options_q12),
});
addpage(xstring("title_prefix_plural") + " 13–15", {
text("repetition_instructions_1"),
grid1(QPREFIX, "q", 13, 13, options_corr_incorr),
text("repetition_instructions_2"),
grid1(QPREFIX, "q", 14, 14, options_corr_incorr),
text("fluency_instructions"),
new QuCountdown(60),
grid1(QPREFIX, "q", 15, 15, options_yesno),
});
addpage(xstring("title_prefix_plural") + " 16–17", {
text("abstraction_instructions"),
grid1(QPREFIX, "q", 16, 17, options_corr_incorr),
});
QVector<QuestionWithOneField> qf_recall;
for (int i = 1; i <= N_REG_RECALL; ++i) {
// Strings range from 1-5 but questions from 18-22.
int qnum = i + 17;
QString fieldname = strnum(QPREFIX, qnum);
qf_recall.append(QuestionWithOneField(
fieldRef(fieldname),
recalled + " " + xstring(strnum("memory_", i))));
connect(fieldRef(fieldname).data(), &FieldRef::valueChanged,
this, &Moca::updateMandatory);
}
addpage(xstring("title_prefix_plural") + " 18–22", {
text("recall_instructions"),
new QuMcqGrid(qf_recall, options_recalled),
});
QVector<QuElement*> cat_elements;
QVector<QuElement*> mc_elements;
cat_elements.append(text("category_recall_instructions"));
mc_elements.append(text("mc_recall_instructions"));
for (int i = 1; i <= N_REG_RECALL; ++i) {
QString tag = strnum(RECALL_TAG_PREFIX, i);
cat_elements.append(grid1(RECALL_CATEGORY_CUE_PREFIX,
"category_recall_", i, i, options_recalled)
->addTag(tag));
mc_elements.append(grid1(RECALL_MC_CUE_PREFIX,
"mc_recall_", i, i, options_recalled)
->addTag(tag));
connect(fieldRef(strnum(RECALL_CATEGORY_CUE_PREFIX, i)).data(),
&FieldRef::valueChanged,
this, &Moca::updateMandatory);
}
cat_elements.append(boldtext("no_need_for_extra_recall")->addTag(SKIP_LABEL));
mc_elements.append(boldtext("no_need_for_extra_recall")->addTag(SKIP_LABEL));
QuPagePtr cat_recall_page((new QuPage(cat_elements))
->setTitle(xstring("title_prefix_plural") + " 18–22 " +
xstring("category_recall_suffix"))
->addTag(CATEGORY_RECALL_PAGE_TAG));
pages.append(cat_recall_page);
QuPagePtr mc_recall_page((new QuPage(mc_elements))
->setTitle(xstring("title_prefix_plural") + " 18–22 " +
xstring("mc_recall_suffix"))
->addTag(MC_RECALL_PAGE_TAG));
pages.append(mc_recall_page);
addpage(xstring("title_prefix_plural") + " 23–28", {
text("orientation_instructions"),
grid1(QPREFIX, "q", 23, 28, options_corr_incorr),
italic(xstring("date_now_is")),
italic(correct_date),
});
addpage(TextConst::examinerComments(), {
new QuText(TextConst::examinerCommentsPrompt()),
(new QuTextEdit(fieldRef(COMMENTS, false)))
->setHint(TextConst::examinerComments()),
});
m_questionnaire = new Questionnaire(m_app, pages);
m_questionnaire->setType(QuPage::PageType::Clinician);
m_questionnaire->setReadOnly(read_only);
updateMandatory();
return m_questionnaire;
}
// ============================================================================
// Task-specific calculations
// ============================================================================
int Moca::subScore(const int first, const int last) const
{
return sumInt(values(strseq(QPREFIX, first, last)));
}
int Moca::totalScore() const
{
// MOCA instructions:
// - "The total possible score is 30 points"
// - "TOTAL SCORE: Sum all subscores listed on the right-hand side. Add one
// point for an individual who has 12 years or fewer of formal education,
// for a possible maximum of 30 points."
//
// - The subscores add up to 30.
// - So, presumably this means "add one point if you have <=12 years of
// education AND your score is less than 30", or equivalently "add one
// point... and take the maximum of (your score, 30)".
int score = subScore(FIRST_Q, N_QUESTIONS);
if (score < MAX_QUESTION_SCORE) {
score += valueInt(EDUCATION12Y_OR_LESS); // extra point for this
}
return score;
}
// ============================================================================
// Signal handlers
// ============================================================================
void Moca::updateMandatory()
{
if (!m_questionnaire) {
return;
}
int n_cat = 0;
int n_mc = 0;
for (int i = 1; i <= N_REG_RECALL; ++i) {
const int qnum = i + 17;
const QVariant v = value(strnum(QPREFIX, qnum));
const bool cat_required = v.toInt() == 0; // also true if NULL
const QString recall_field = strnum(RECALL_CATEGORY_CUE_PREFIX, i);
const QString tag = strnum(RECALL_TAG_PREFIX, i);
fieldRef(recall_field)->setMandatory(cat_required);
m_questionnaire->setVisibleByTag(tag, cat_required, false,
CATEGORY_RECALL_PAGE_TAG);
const bool mc_required = cat_required &&
valueInt(strnum(RECALL_CATEGORY_CUE_PREFIX, i)) == 0;
m_questionnaire->setVisibleByTag(tag, mc_required, false,
MC_RECALL_PAGE_TAG);
n_cat += cat_required;
n_mc += mc_required;
}
const bool require_cat_skip_label = n_cat == 0;
const bool require_mc_skip_label = n_mc == 0;
m_questionnaire->setVisibleByTag(SKIP_LABEL, require_cat_skip_label, false,
CATEGORY_RECALL_PAGE_TAG);
m_questionnaire->setVisibleByTag(SKIP_LABEL, require_mc_skip_label, false,
MC_RECALL_PAGE_TAG);
}