Unsupervised Mobile App-based Cognitive Testing in a Population-based Study of Older Adults Born 1944

Overview

Journal Front Digit Health

Specialty Medical Informatics

Date 2022 Nov 25

PMID 36426215

Authors

Fredrik Ohman

David Berron

Kathryn V Papp

Silke Kern

Johan Skoog

Timothy Hadarsson Bodin

Anna Zettergren

Ingmar Skoog

Michael Scholl

Affiliations

Soon will be listed here.

Abstract

Background: Mobile app-based tools have the potential to yield rapid, cost-effective, and sensitive measures for detecting dementia-related cognitive impairment in clinical and research settings. At the same time, there is a substantial need to validate these tools in real-life settings. The primary aim of this study was thus to evaluate the feasibility, validity, and reliability of mobile app-based tasks for assessing cognitive function in a population-based sample of older adults.

Method: A total of 172 non-demented (Clinical Dementia Rating 0 and 0.5) older participants (aged 76-77) completed two mobile app-based memory tasks-the Mnemonic Discrimination Task for Objects and Scenes (MDT-OS) and the long-term (24 h) delayed Object-In-Room Recall Task (ORR-LDR). To determine the validity of the tasks for measuring relevant cognitive functions in this population, we assessed relationships with conventional cognitive tests. In addition, psychometric properties, including test-retest reliability, and the participants' self-rated experience with mobile app-based cognitive tasks were assessed.

Result: MDT-OS and ORR-LDR were weakly-to-moderately correlated with the Preclinical Alzheimer's Cognitive Composite (PACC5) ( = 0.3-0.44, < .001) and with several other measures of episodic memory, processing speed, and executive function. Test-retest reliability was poor-to-moderate for one single session but improved to moderate-to-good when using the average of two sessions. We observed no significant floor or ceiling effects nor effects of education or gender on task performance. Contextual factors such as distractions and screen size did not significantly affect task performance. Most participants deemed the tasks interesting, but many rated them as highly challenging. While several participants reported distractions during tasks, most could concentrate well. However, there were difficulties in completing delayed recall tasks on time in this unsupervised and remote setting.

Conclusion: Our study proves the feasibility of mobile app-based cognitive assessments in a community sample of older adults, demonstrating its validity in relation to conventional cognitive measures and its reliability for repeated measurements over time. To further strengthen study adherence, future studies should implement additional measures to improve task completion on time.

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References

Berron D, Cardenas-Blanco A, Bittner D, Metzger C, Spottke A, Heneka M . Higher CSF Tau Levels Are Related to Hippocampal Hyperactivity and Object Mnemonic Discrimination in Older Adults. J Neurosci. 2019; 39(44):8788-8797. PMC: 6820211. DOI: 10.1523/JNEUROSCI.1279-19.2019. View

Goldberg T, Harvey P, Wesnes K, Snyder P, Schneider L . Practice effects due to serial cognitive assessment: Implications for preclinical Alzheimer's disease randomized controlled trials. Alzheimers Dement (Amst). 2016; 1(1):103-11. PMC: 4876902. DOI: 10.1016/j.dadm.2014.11.003. View

Weston P, Nicholas J, Henley S, Liang Y, Macpherson K, Donnachie E . Accelerated long-term forgetting in presymptomatic autosomal dominant Alzheimer's disease: a cross-sectional study. Lancet Neurol. 2018; 17(2):123-132. PMC: 5958413. DOI: 10.1016/S1474-4422(17)30434-9. View

Maass A, Berron D, Harrison T, Adams J, La Joie R, Baker S . Alzheimer's pathology targets distinct memory networks in the ageing brain. Brain. 2019; 142(8):2492-2509. PMC: 6658874. DOI: 10.1093/brain/awz154. View

Pratap A, Chaibub Neto E, Snyder P, Stepnowsky C, Elhadad N, Grant D . Indicators of retention in remote digital health studies: a cross-study evaluation of 100,000 participants. NPJ Digit Med. 2020; 3:21. PMC: 7026051. DOI: 10.1038/s41746-020-0224-8. View

Sliwinski M, Mogle J, Hyun J, Munoz E, Smyth J, Lipton R . Reliability and Validity of Ambulatory Cognitive Assessments. Assessment. 2016; 25(1):14-30. PMC: 5690878. DOI: 10.1177/1073191116643164. View

Rentz D, Papp K, Mayblyum D, Sanchez J, Klein H, Souillard-Mandar W . Association of Digital Clock Drawing With PET Amyloid and Tau Pathology in Normal Older Adults. Neurology. 2021; 96(14):e1844-e1854. PMC: 8105970. DOI: 10.1212/WNL.0000000000011697. View

Germine L, Reinecke K, Chaytor N . Digital neuropsychology: Challenges and opportunities at the intersection of science and software. Clin Neuropsychol. 2019; 33(2):271-286. DOI: 10.1080/13854046.2018.1535662. View

Smith P, Need A, Cirulli E, Chiba-Falek O, Attix D . A comparison of the Cambridge Automated Neuropsychological Test Battery (CANTAB) with "traditional" neuropsychological testing instruments. J Clin Exp Neuropsychol. 2013; 35(3):319-28. DOI: 10.1080/13803395.2013.771618. View

10.

Morris J . Clinical dementia rating: a reliable and valid diagnostic and staging measure for dementia of the Alzheimer type. Int Psychogeriatr. 1997; 9 Suppl 1:173-6; discussion 177-8. DOI: 10.1017/s1041610297004870. View

11.

Karlsen R, Karr J, Saksvik S, Lundervold A, Hjemdal O, Olsen A . Examining 3-month test-retest reliability and reliable change using the Cambridge Neuropsychological Test Automated Battery. Appl Neuropsychol Adult. 2020; 29(2):146-154. DOI: 10.1080/23279095.2020.1722126. View

12.

Duzel E, Berron D, Schutze H, Cardenas-Blanco A, Metzger C, Betts M . CSF total tau levels are associated with hippocampal novelty irrespective of hippocampal volume. Alzheimers Dement (Amst). 2018; 10:782-790. PMC: 6280588. DOI: 10.1016/j.dadm.2018.10.003. View

13.

Papp K, Rentz D, Maruff P, Sun C, Raman R, Donohue M . The Computerized Cognitive Composite (C3) in an Alzheimer's Disease Secondary Prevention Trial. J Prev Alzheimers Dis. 2020; 8(1):59-67. PMC: 7755110. DOI: 10.14283/jpad.2020.38. View

14.

Calamia M, Markon K, Tranel D . The robust reliability of neuropsychological measures: meta-analyses of test-retest correlations. Clin Neuropsychol. 2013; 27(7):1077-105. DOI: 10.1080/13854046.2013.809795. View

15.

Folstein M, Folstein S, McHugh P . "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975; 12(3):189-98. DOI: 10.1016/0022-3956(75)90026-6. View

16.

Berron D, Glanz W, Clark L, Basche K, Grande X, Gusten J . A remote digital memory composite to detect cognitive impairment in memory clinic samples in unsupervised settings using mobile devices. NPJ Digit Med. 2024; 7(1):79. PMC: 10965892. DOI: 10.1038/s41746-024-00999-9. View

17.

Ohman F, Hassenstab J, Berron D, Scholl M, Papp K . Current advances in digital cognitive assessment for preclinical Alzheimer's disease. Alzheimers Dement (Amst). 2021; 13(1):e12217. PMC: 8290833. DOI: 10.1002/dad2.12217. View

18.

Kourtis L, Regele O, Wright J, Jones G . Digital biomarkers for Alzheimer's disease: the mobile/ wearable devices opportunity. NPJ Digit Med. 2019; 2. PMC: 6526279. DOI: 10.1038/s41746-019-0084-2. View

19.

Sperling R, Johnson K, Doraiswamy P, Reiman E, Fleisher A, Sabbagh M . Amyloid deposition detected with florbetapir F 18 ((18)F-AV-45) is related to lower episodic memory performance in clinically normal older individuals. Neurobiol Aging. 2012; 34(3):822-31. PMC: 3518678. DOI: 10.1016/j.neurobiolaging.2012.06.014. View

20.

Lancaster C, Koychev I, Blane J, Chinner A, Wolters L, Hinds C . Evaluating the Feasibility of Frequent Cognitive Assessment Using the Mezurio Smartphone App: Observational and Interview Study in Adults With Elevated Dementia Risk. JMIR Mhealth Uhealth. 2020; 8(4):e16142. PMC: 7163418. DOI: 10.2196/16142. View