Initial validation of a web-based self-administered neuropsychological test battery for older adults and seniors

Development of a self-administered online battery for remote assessment of executive functions and verbal memory: equivalence with face-to-face administration, preliminary norms, and acceptance

OBJECTIVES

Interest in teleneuropsychology services increased considerably after the COVID-19 pandemic. However, the utility of unsupervised administration of computerized tests remains largely unexplored. In the present study, we developed a brief computerized battery that assesses self-reported cognitive abilities and performances on executive functioning and verbal memory. We investigated the equivalence of the self-administration online (SAO) procedure and the face-to-face (FTF) administration. Preliminary normative data were developed and the acceptance of the SAO procedure was explored.

METHODS

A community sample of 169 Greek adults [94 women; mean age: 41.95 (SD = 13.40) years, mean years of education: 15.10 (SD = 2.65)] completed the SAO assessment. A subgroup of 40 participants was tested in a counterbalanced way both with SAO and FTF. Participants' performances were compared with paired sample t-tests and the agreement between the two methods was estimated with intraclass correlation coefficients (ICCs). Multiple linear regression analyses were applied to investigate the effect of demographic characteristics on SAO measures.

RESULTS

No difference between SAO and FTF scores was observed. ICCs indicated moderate to good agreement (.418-.848) for most measures. Age was positively associated with self-reported cognitive state and negatively with neuropsychological performances and the level of acceptance of the SAO procedure. Approximately 80% of participants reported satisfaction from the SAO assessment, 69% good compliance with the instructions, but less than 30% belief that the FTF assessment could be adequately replaced.

CONCLUSION

SAO testing is feasible and well accepted among Greek adults yielding equivalent results with FTF testing. Despite the wide satisfaction, though, notable reluctance was noted for the substitution of FTF with SAO procedures.

Participation and engagement in online cognitive testing

Web-based testing of cognitive abilities allows for large-scale assessments without geographical constraints. Yet, the extent to which it can reach populations beyond the typical demographic groups recruited for cognitive studies is unclear. This study focused on comparing the characteristics of individuals from a general population study (HUNT4) who chose to participate in a cognitive study (HUNT4-Hjernetrim) with those who did not. Additionally, we investigated participants' engagement and user experience. We obtained data on socio-demographics, health conditions (both physical and mental), self-reported cognitive or learning difficulties, and lifestyle factors of Hjernetrim participants and non-participants from the HUNT4 database. Hjernetrim involved 13 cognitive tests, administered through the online platform Memoro. We used logistic regressions to assess participation biases and linear regressions to assess participants' engagement and user experience. Of 65,851 HUNT4 participants invited via regular mail to Hjernetrim, 5634 (9.4%, aged 13-97, 54% women) participated. The best represented in the sample were 50-79-year-olds, women, tertiary educated, living alone, from urban areas, not occupationally active, and reporting memory complaints. Individuals who were aged 80+, had motor or vision impairments, and teenagers with learning disabilities, were underrepresented. Participants were more likely to have mental health problems, have or survived cancer and less likely to have cardiovascular disease. Participants logged on mainly during weekdays, the preferred time of day varied by age. On average, participants used 42 min and completed 78% of the tasks. Using PCs provided the most complete data. In terms of user experiences, 65% were positive while 14% were negative or reported technical difficulties. Overall, the study demonstrated that web-based methodology allowed for a relatively well-represented sample that included groups typically difficult to reach. The presence of somatic and mental diseases had a variable influence on participation. Participants finished most tests and reported positive experiences overall.

Computerized Cognitive Test Batteries for Children and Adolescents-A Scoping Review of Tools For Lab- and Web-Based Settings From 2000 to 2021

OBJECTIVE

Cognitive functioning is essential to well-being. Since cognitive difficulties are common in many disorders, their early identification is critical, notably during childhood and adolescence. This scoping review aims to provide a comprehensive literature overview of computerized cognitive test batteries (CCTB) that have been developed and used in children and adolescents over the past 22 years and to evaluate their psychometric properties.

METHOD

Among 3192 records identified from three databases (PubMed, PsycNET, and Web of Science) between 2000 and 2021, 564 peer-reviewed articles conducted in children and adolescents aged 3 to 18 years met inclusion criteria. Twenty main CCTBs were identified and further reviewed following PRISMA guidelines. Relevant study details (sample information, topic, location, setting, norms, and psychometrics) were extracted, as well as administration and instrument characteristics for the main CCTBs.

RESULTS

Findings suggest that CCTB use varies according to age, location, and topic, with eight tools accounting for 85% of studies, and the Cambridge Neuropsychological Test Automated Battery (CANTAB) being most frequently used. Few instruments were applied in web-based settings or include social cognition tasks. Only 13% of studies reported psychometric properties.

CONCLUSIONS

Over the past two decades, a high number of computerized cognitive batteries have been developed. Among these, more validation studies are needed, particularly across diverse cultural contexts. This review offers a comprehensive synthesis of CCTBs to aid both researchers and clinicians to conduct cognitive assessments in children in either a lab- or web-based setting.

Female advantage in verbal learning revisited: a HUNT study

The argument for a female advantage in word list learning is often based on partial observations that focus on a single component of the task. Using a large sample (N = 4403) of individuals 13-97 years of age from the general population, we investigated whether this advantage is consistently reflected in learning, recall, and recognition and how other cognitive abilities differentially support word list learning. A robust female advantage was found in all subcomponents of the task. Semantic clustering mediated the effects of short-term and working memory on long-delayed recall and recognition, and serial clustering on short-delayed recall. These indirect effects were moderated by sex, with men benefiting more from reliance on each clustering strategy than women. Auditory attention span mediated the effect of pattern separation on true positives in word recognition, and this effect was stronger in men than in women. Men had better short-term and working memory scores, but lower auditory attention span and were more vulnerable to interference both in delayed recall and recognition. Thus, our data suggest that auditory attention span and interference control (inhibition), rather than short-term or working memory scores, semantic and/or serial clustering on their own, underlie better performance on word list learning in women.

Visual function correlates with neurodevelopment in a population cohort of school-aged children born extremely preterm

AIM

To investigate visual function and neurodevelopment in a geographically defined population cohort of school-aged children born extremely preterm.

METHODS

All children born extremely preterm in Central Norway between 2006 and 2011 (n=65) were identified, and 36 (median age, min/max: 13, 10/16) were included. Best-corrected visual acuity (BCVA), contrast sensitivity (four spatial frequencies), parent-reported challenges and neuropsychological testing in learning, executive functions, motor skills, perception, reaction time, working and visual memory, processing speed, and pattern separation were measured. Brain MRI (3T) was acquired and read by a neuroradiologist.

RESULTS

Median (min/max) BCVA letter score was 85 (35/91) in the better and 82 (13/89) in the worse eye. ROP participants (n=7) had lower contrast sensitivity in the two highest spatial frequencies (p = 0.024 and p = 0.004). Parent-reported challenges correlated negatively with BCVA (learning: p = 0.014; executive functions: p = 0.002; motor skills: p = 0.000; and perception: p = 0.001), while motor skills correlated negatively with one (p = 0.010) and perception with two (p = 0.003 and p = 0.009) of four spatial frequencies. Neuropsychological tests were reduced relative to norms. None had MRI-verified preterm brain injury.

CONCLUSION

Visual function was subnormal and correlated with parent-reported challenges in a small cohort of extremely preterm school-aged children, indicating that visual function may be a marker of neurodevelopmental outcomes.

Association of Psychological distress and Physical Health with Subjective and Objective Memory in Older Adults

ObjectivesTo investigate how indicators of psychological stress and physical health differentially influence subjective and objective memory in older adults. Methods: 404 adults aged ≥55 without cognitive impairment participated in remote assessment of physical health (PHY; multimorbidity, body-mass-index), psychological distress (PDS; perceived stress, anxiety, depression), subjective memory complaints (SM), and task-based objective memory performance (OM). Results: Separately, both PHY and PDS significantly predicted SM (p < 0.01), but only PHY was associated with OM (p = 0.05). Combined models showed that PHY and PDS maintained significant association with SM (p < 0.01, R² = 0.30), while only PHY was associated with OM (p = .07, R² = 0.03; for associative OM, p = 0.04). Discussion: SM is associated with participants' psychological profile, highlighting the importance of addressing these factors when assessing SM. The results also reveal that remotely-administered OM tasks are more immune to participants' psychological profile, and support previously-established links between physical health and objective and subjective memory function.

The survey for memory, attention, and reaction time (SMART): Preliminary normative online panel data and user attitudes for a brief web-based cognitive performance measure

ObjectiveThe Survey for Memory, Attention, and Reaction Time (SMART) was recently introduced as a brief (<5 min), self-administered, web-based measure of cognitive performance in older adults. The purpose of this study was threefold: (1) to develop preliminary norms on the SMART; (2) to examine the relationship between demographic variables (i.e. age, sex, education), device type used, and SMART performance; and (3) to assess user attitudes of the SMART. Method A sample of 1,050 community-dwelling adults (M age =59.5 (15.2), M education = 16.5 (2.1), 67.1% female, 96% white) was recruited from an ongoing web-based research cohort. Participants completed the SMART, which consists of four face-valid cognitive tasks assessing visual memory, attention/processing speed, and executive functioning. SMART performance outcome metrics were subtest completion time (CT), click count, and total CT. Participants provided demographic information and completed a survey of user attitudes toward the SMART (i.e. usability, acceptability). Results Older age was the only demographic variable associated with slower SMART total CT (r = .60, p <.001). Education was not associated with SMART CT or click counts overall (p > .05). Male sex was generally associated with longer SMART CT (p < .001, partial eta squared = .14) on all sub-tests. Regarding acceptability, 97.3% indicated willingness to take the SMART again, with more than half willing to complete it on a weekly basis. Conclusion The preliminary normative data on the SMART indicates that it is a feasible and well-accepted web-based cognitive assessment tool that can be administered on multiple device platforms.

Poor Response Inhibition and Symptoms of Inattentiveness Are Core Characteristics of Lifetime Illicit Substance Use among Young Adults in the General Norwegian Population: The HUNT Study

BACKGROUND

Impairments in neurocognitive functioning are associated with substance use behavior. Previous studies in neurocognitive predictors of substance use typically use self-report measures rather than neuropsychological performance measures and suffer from low sample sizes and use of clinical diagnostic cut offs.

METHODS

Crossectional data from the HUNT4 Study (Helseundersøkelsen i Trøndelag) was used to study executive neuropsychological performance and self-reported measures of neurocognitive function associated with a history of illicit substance use in a general population sample of young adults in Norway. We performed both between group comparisons and logistic regression modeling and controlled for mental health symptomatology.

RESULTS

Subjects in our cohort with a self-reported use of illicit substances had significantly higher self-reported mental health and neurocognitive symptom load. A logistic regression model with substance use as response included sex, commission errors and self-reported inattentiveness and anxiety as significant predictors. After 10-fold cross-validation this model achieved a moderate area under the receiver-operator curve of 0.63. To handle the class imbalance typically found in such population data, we also calculated balanced accuracy with a optimal model cut off of 0.234 with a sensitivity of 0.50 and specificity of 0.76 as well as precision recall-area under the curve of 0.28.

CONCLUSIONS

Subtle cognitive dysfunction differentiates subjects with and without a history of illicit substance use. Neurocognitive factors outperformed the effects of depressive symptoms on substance use behavior in this cohort. We highlight the need for using adequate statistical tools for evaluating the performance of models in unbalanced datasets.

Semantic Self-Images and Well-Being in Young and Older Adults: Does the Accessibility Matter?

In the present study we investigated whether and how age group, dimensions of well-being and their interactions predicted the phenomenological properties of semantic self-images, taking also into account the different levels of accessibility of self-images (i.e., order of generation). Results on the first self-image revealed that, independently of age, higher levels of life satisfaction predicted higher likelihood of positive than negative statement and higher levels of negative affect and life satisfaction predicted higher levels of personal relevance of the self-image. When all self-images were considered, for higher levels of life satisfaction neutral and positive self-images were more likely than negative ones, and for lower levels of positive affect, neutral images were more likely than negative ones. Moreover, young adults were more likely than older adults to report neutral rather than negative self-images and, for higher levels of positive affect, they were more likely to report neutral and positive images instead of negative ones. These results suggest that the accessibility of semantic self-images should be taken into account in the investigation of the complex association between well-being and semantic self-images. Theoretical and practical implications of these results are discussed.

Assessing the Views of Professionals, Patients, and Care Partners Concerning the Use of Computer Tools in Memory Clinics: International Survey Study

Background

Computer tools based on artificial intelligence could aid clinicians in memory clinics in several ways, such as by supporting diagnostic decision-making, web-based cognitive testing, and the communication of diagnosis and prognosis.

Objective

This study aims to identify the preferences as well as the main barriers and facilitators related to using computer tools in memory clinics for all end users, that is, clinicians, patients, and care partners.

Methods

Between July and October 2020, we sent out invitations to a web-based survey to clinicians using the European Alzheimer’s Disease Centers network and the Dutch Memory Clinic network, and 109 clinicians participated (mean age 45 years, SD 10; 53/109, 48.6% female). A second survey was created for patients and care partners. They were invited via Alzheimer Europe, Alzheimer’s Society United Kingdom, Amsterdam Dementia Cohort, and Amsterdam Aging Cohort. A total of 50 patients with subjective cognitive decline, mild cognitive impairment, or dementia (mean age 73 years, SD 8; 17/34, 34% female) and 46 care partners (mean age 65 years, SD 12; 25/54, 54% female) participated in this survey.

Results

Most clinicians reported a willingness to use diagnostic (88/109, 80.7%) and prognostic (83/109, 76.1%) computer tools. User-friendliness (71/109, 65.1%); Likert scale mean 4.5, SD 0.7), and increasing diagnostic accuracy (76/109, 69.7%; mean 4.3, SD 0.7) were reported as the main factors stimulating the adoption of a tool. Tools should also save time and provide clear information on reliability and validity. Inadequate integration with electronic patient records (46/109, 42.2%; mean 3.8, SD 1.0) and fear of losing important clinical information (48/109, 44%; mean 3.7, SD 1.2) were most frequently indicated as barriers. Patients and care partners were equally positive about the use of computer tools by clinicians, both for diagnosis (69/96, 72%) and prognosis (73/96, 76%). In addition, most of them thought favorably regarding the possibility of using the tools themselves.

Conclusions

This study showed that computer tools in memory clinics are positively valued by most end users. For further development and implementation, it is essential to overcome the technical and practical barriers of a tool while paying utmost attention to its reliability and validity.

5 Years of Exercise Intervention Did Not Benefit Cognition Compared to the Physical Activity Guidelines in Older Adults, but Higher Cardiorespiratory Fitness Did. A Generation 100 Substudy

Background: Aerobic exercise is proposed to attenuate cognitive decline in aging. We investigated the effect of different aerobic exercise interventions and cardiorespiratory fitness (CRF) upon cognition throughout a 5-year exercise intervention in older adults. Methods: 106 older adults (52 women, age 70-77 years) were randomized into high-intensity interval training (HIIT; ∼90% peak heart rate), moderate-intensity continuous training (MICT; ∼70% peak heart rate), or control for 5 years. The HIIT and MICT groups performed supervised training twice weekly, while the control group was asked to follow the national physical activity guidelines (30 min of physical activity/day). At baseline, 1-, 3-, and 5-year follow-up, participants partook in cognitive testing (spatial memory, verbal memory, pattern separation, processing speed, working memory, and planning ability), underwent clinical testing, and filled out health-related questionnaires. Linear mixed models were used to assess the effects of the exercise group and CRF (measured as peak and max oxygen uptake) on each cognitive test. The effects of changes in CRF on changes in each cognitive test score throughout the intervention were also assessed. The associations between baseline CRF and cognitive abilities at the follow-ups were investigated using linear regressions. Results: There was no group-by-time interaction on the cognitive measures, and neither HIIT nor MICT participation was associated with better cognitive performance than control at any time point during the 5-year intervention. All groups increased their CRF similarly during the 1st year and subsequently declined back to baseline levels after 5 years. A higher CRF was associated with higher processing speed throughout the intervention while increasing CRF during the intervention was associated with better working memory and worse pattern separation. Higher CRF at baseline predicted consistently better processing speed and verbal memory performance. Conclusion: In this first 5-year randomized controlled trial investigating the effects of HIIT, MICT, and physical activity according to national guidelines on cognition, we observed no effect of exercise intervention group on cognition when compared to following the national physical activity guidelines. Still, the results showed that higher CRF and increasing CRF benefited multiple, but not all, cognitive abilities in older adults. Clinical Trial Registration: www.ClinicalTrials.gov, identifier [NCT01666340].

Tele-neuropsychological assessment tools in Italy: a systematic review on psychometric properties and usability

Background

The current COVID-19 pandemic has abruptly catalysed a shift towards remote assessment in neuropsychological practice (tele-neuropsychology, t-NPs). Although the validity of t-NPs diagnostics is gaining recognition worldwide, little is known about its implementation in Italy. The present review by the Italian working group on tele-neuropsychology (TELA) aims at describing the availability, psychometric properties, and feasibility of t-NPs tools currently available in Italy.

Methods

Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. This work was pre-registered on the Prospective Register of Systematic Reviews (PROSPERO; CRD42021239687). Observational studies reporting telephone-, videoconference- or web-based assessment of cognition/behaviour in Italian both healthy participants (HPs) and patients were included. Bias assessment was performed through ad hoc scales.

Results

Fourteen studies were included from an initial N = 895 (4 databases searched). Studies were subdivided into those focused on psychometric properties and those characterized by a predominant applied nature. The majority of studies addressed either adult/elderly HPs or neurological/internal patients. Multi-domain screening tools for cognition, behaviour, mood/anxiety and quality of life were the most represented. Findings regarding validity, reliability, sensitivity, specificity and clinical usability were reported for cognitive screenings — the telephone- and videoconference-based Mini-Mental State Examination and the Telephone Interview for Cognitive Status.

Discussion

Positive albeit preliminary evidence regarding psychometric properties and feasibility in both clinical and non-clinical populations of Italian t-NPs brief screening tools are herewith provided. Further studies exploring clinical usability of t-NPs and psychometric properties/feasibility of tests for the in-depth assessment of specific cognitive domains are necessary.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10072-021-05719-9.

Initial Adaptation of the General Cognitive Assessment Battery by Cognifit™ for Bulgarian Older Adults

BACKGROUND

Online neuropsychological assessment batteries may facilitate the screening of cognitive functions in older adults and could be useful for early diagnosis and detection of cognitive impairments.

OBJECTIVE

The primary aim of this study was to assess the psychometric qualities of an online multi-domain cognitive assessment battery (General Cognitive Assessment Battery (GCAB) by Cognifit™) applied for the first time in Bulgaria.

METHODS

A total of 20 healthy older adults (6 male and 14 female, aged 60-82) completed the GCAB as well as the Mini-Mental State Examination (MMSE) and the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) neuropsychological battery. Descriptive statistics were used to describe the demographic characteristics of the sample and the scores on the GCAB and the CERAD battery. The internal consistency of the GCAB was evaluated using item analysis and measured with Cronbach's alpha. The concurrent validity of the GCAB was assessed with respect to the CERAD using Spearman's r after verifying the linear relationship between the GCAB and CERAD scores.

RESULTS

The GCAB showed good concurrent validity when compared with the corresponding CERAD tests. The correlation coefficients ranged from 0.67 for working memory to 0.47 for short-term auditory memory. We found very good reliability of the GCAB, with the inter-class correlation coefficient higher than 0.8 for all cognitive domains. There were no significant correlations between MMSE and GCAB scores.

CONCLUSION

The GCAB was found to be valid for the cognitive screening of Bulgarian healthy older adults and may provide an adequate assessment of their cognitive status. The GCAB showed good concurrent validity when compared with the CERAD battery, measuring similar cognitive constructs. Further work is necessary to explore its validity and reliability.

Distance Assessment for Detecting Cognitive Impairment in Older Adults: A Systematic Review of Psychometric Evidence

INTRODUCTION

Distance or remote cognitive assessments, administered via phone or computer platforms, have emerged as possible alternatives to traditional assessments performed during office visits. Distance refers to any nontraditional assessment feature, not only or necessarily location. We conducted a systematic review to examine the psychometric soundness of these approaches.

METHOD

We searched PubMed, PsycINFO, AgeLine, and Academic Search Premier for articles published between January 2008 and June 2020. Studies were included if participants were over the age of 50, a structured assessment of cognitive function in older adults was evaluated, the assessment method was deemed distant, and validity and/or reliability data were reported. Assessment distance was defined as having any of the following features: use of an electronic test interface, nonroutine test location (e.g., home), test self-administered, and test unsupervised. Distance was categorized as low, intermediate, or high.

RESULTS/DISCUSSION

Twenty-six studies met inclusion criteria. Sample sizes ranged from n = 8 to 8,627, and the mean age ranged from 57 to 83. Assessments included screens, brief or full batteries, and were performed via videoconferencing, phone, smartphone, or tablet/computer. Ten studies reported on low distance, 11 on intermediate distance, and 5 studies for high distance assessments. Invalid performance data were observed with older age and cognitive impairment. Convergent validity data were reported consistently and suggested a decline with increasing distance: r = 0.52-0.80 for low, 0.49-0.75 for intermediate, and 0.41-0.53 for high distance. Diagnostic validity estimates presented a similar pattern. Reliability data were reported too inconsistently to allow evaluation.

CONCLUSION

The validity of cognitive assessments with older adults appears supported at lower but not higher distance. Less is known about the reliability of such assessments. Future research should delineate the person and procedure boundaries for valid and reliable test results.

Web-Based Assessment of the Phenomenology of Autobiographical Memories in Young and Older Adults

Autobiographical memories (ABMs) produce rich phenomenological experiences. Although few standardized and comprehensive measures of the phenomenology of ABMs have been developed, a web-based assessment of the full range of phenomenological properties is still missing. In the present study, we aimed to fill this gap and tested the psychometric properties of a web-based version of the Assessment of the Phenomenology of Autobiographical Memory (APAM) in a group of young and older adults. Specifically, taking advantage of the flexibility of web-based assessment methodology, we tested the rating consistency of APAM items, asking participants to rate the phenomenology of their ABMs with respect to seven cues, administered in one per day in seven different days. In each session, we also collected ratings of mood and arousal. Using linear mixed modeling (LMM), we could examine whether the phenomenology ratings differed with respect to age group while controlling for sex, age of the memory, arousal, mood, and specificity of the memory. Results revealed an adequate level of consistency of ratings in both young and older adults. Moreover, LMMs revealed a more intense experience of recollection and reliving (i.e., sensory and emotional) and a higher confidence in memory accuracy in older compared to younger adults. The theoretical and practical usefulness of a web-based assessment of the phenomenology of ABMs are discussed.

A brief web-based screening plus emotional-disorder health education was associated with improvement of mental health awareness and service-seeking attitudes among patients seeking nonpsychiatric clinical services in China

OBJECTIVES

Low recognition and intervention rates of emotional disorders among nonpsychiatric clinical patients are primarily attributable to poor mental health awareness of patients and a paucity of mental health care resources. This study aims to investigate the association of a resource-saving brief web-based emotional-disorder self-screening plus a health self-education program (BWBED-SS + HSE) with improved mental health awareness and service-seeking attitudes among nonpsychiatric clinical patients.

METHOD

A sample of 2065 patients seeking health services in nonpsychiatric clinical settings underwent BWBED-SS + HSE using mobile terminals. Participants were defined as being at high risk of anxiety and/or depression according to the optimal cut-off point of ≥11 on the Huaxi emotional-distress index (HEI).

RESULTS

The rate of participants at high risk of anxiety and/or depression was 6.63%. Following participation in the BWBED-SS + HSE, after controlling for demographics, type of hospital, and test time, the rates of participants considering themselves as having an emotional disorder and willing to seek mental health services among those at high risk of anxiety and/or depression increased from 29.93% to 47.45% (adjusted odds ratio [aOR] = 2.28, p = .002) and from 11.68% to 29.93% (aOR = 3.65, p < .001), respectively.

CONCLUSIONS

The BWBED-SS + HSE were associated with improved mental health awareness and service-seeking attitudes among patients seeking nonpsychiatric clinical services in China.

The Survey for Memory, Attention, and Reaction Time (SMART): Development and Validation of a Brief Web-Based Measure of Cognition for Older Adults

INTRODUCTION

Brief, Web-based, and self-administered cognitive assessments hold promise for early detection of cognitive decline in individuals at risk for dementia. The current study describes the design, implementation, and convergent validity of a fWeb-based cognitive assessment tool, the Survey for Memory, Attention, and Reaction Time (SMART), for older adults.

METHODS

A community-dwelling sample of older adults (n = 69) was included, classified as cognitively intact (n = 44) or diagnosed with mild cognitive impairment (MCI, n = 25). Participants completed the SMART at home using their computer, tablet, or other Internet-connected device. The SMART consists of 4 face-valid cognitive tasks available in the public domain assessing visual memory, attention/processing speed, and executive functioning. Participants also completed a battery of standardized neuropsychological tests, a cognitive screener, and a daily function questionnaire. Primary SMART outcome measures consisted of subtest completion time (CT); secondary meta-metrics included outcomes indirectly assessed or calculated within the SMART (e.g., click count, total CT, time to complete practice items, and time of day the test was completed).

RESULTS

Regarding validity, total SMART CT, which includes time to complete test items, practice items, and directions, had the strongest relationship with global cognition (β = -0.47, p < 0.01). Test item CT was significantly greater for the MCI group (F = 5.20, p = 0.026). Of the SMART tasks, the executive functioning subtests had the strongest relationship with cognitive status as compared to the attention/processing speed and visual memory subtests. The primary outcome measures demonstrated fair to excellent test-retest reliability (intraclass correlation coefficient = 0.50-0.76).

CONCLUSIONS

This study provides preliminary evidence for the use of the SMART protocol as a feasible, reliable, and valid assessment method to monitor cognitive performance in cognitively intact and MCI older adults.

Web-Based Cognitive Testing of Older Adults in Person Versus at Home: Within-Subjects Comparison Study

Background

Web-based research allows cognitive psychologists to collect high-quality data from a diverse pool of participants with fewer resources. However, web-based testing presents unique challenges for researchers and clinicians working with aging populations. Older adults may be less familiar with computer usage than their younger peers, leading to differences in performance when completing web-based tasks in their home versus in the laboratory under the supervision of an experimenter.

Objective

This study aimed to use a within-subjects design to compare the performance of healthy older adults on computerized cognitive tasks completed at home and in the laboratory. Familiarity and attitudes surrounding computer use were also examined.

Methods

In total, 32 community-dwelling healthy adults aged above 65 years completed computerized versions of the word-color Stroop task, paired associates learning, and verbal and matrix reasoning in 2 testing environments: at home (unsupervised) and in the laboratory (supervised). The paper-and-pencil neuropsychological versions of these tasks were also administered, along with questionnaires examining computer attitudes and familiarity. The order of testing environments was counterbalanced across participants.

Results

Analyses of variance conducted on scores from the computerized cognitive tasks revealed no significant effect of the testing environment and no correlation with computer familiarity or attitudes. These null effects were confirmed with follow-up Bayesian analyses. Moreover, performance on the computerized tasks correlated positively with performance on their paper-and-pencil equivalents.

Conclusions

Our findings show comparable performance on computerized cognitive tasks in at-home and laboratory testing environments. These findings have implications for researchers and clinicians wishing to harness web-based testing to collect meaningful data from older adult populations.

Feasibility and validation of a web-based platform for the self-administered patient collection of demographics, health status, anxiety, depression, and cognition in community dwelling elderly

The coronavirus disease pandemic has brought a new urgency for the development and deployment of web-based applications which complement, and offer alternatives to, traditional one-on-one consultations and pencil-and-paper (PaP) based assessments that currently dominate clinical research. We have recently developed a web-based application that can be used for the self-administered collection of patient demographics, self-rated health, depression and anxiety, and cognition as part of a single platform. In this study we report the findings from a study with 155 cognitively healthy older adults who received established PaP versions, as well as our novel computerized measures of self-rated health, depression and anxiety, and cognition. Moderate to high correlations were observed between PaP and web- based measures of self-rated health (r = 0.77), depression and anxiety (r = 0.72), and preclinical Alzheimer’s disease cognitive composite (PACC) (r = .61). Test-retest correlations were variable with high correlations for a measure of processing speed and a measure of delayed episodic memory. Taken together, these data support the feasibility and validity of utilization of this novel web-based platform as a new alternative for collecting patient demographics and the assessment of self-rated health, depression and anxiety, and cognition in the elderly.

Allocentric representation in the human amygdala and ventral visual stream

The hippocampus and the entorhinal cortex are considered the main brain structures for allocentric representation of the external environment. Here, we show that the amygdala and the ventral visual stream are involved in allocentric representation. Thirty-one young men explored 35 virtual environments during high-resolution functional magnetic resonance imaging (fMRI) of the medial temporal lobe (MTL) and were subsequently tested on recall of the allocentric pattern of the objects in each environment-in other words, the positions of the objects relative to each other and to the outer perimeter. We find increasingly unique brain activation patterns associated with increasing allocentric accuracy in distinct neural populations in the perirhinal cortex, parahippocampal cortex, fusiform cortex, amygdala, hippocampus, and entorhinal cortex. In contrast to the traditional view of a hierarchical MTL network with the hippocampus at the top, we demonstrate, using recently developed graph analyses, a hierarchical allocentric MTL network without a main connector hub.

Construct validity, ecological validity and acceptance of self-administered online neuropsychological assessment in adults

Objective: The goal of this project was to explore the initial psychometric properties (construct and ecological validity) of self-administered online (SAO) neuropsychological assessment (using the www.testmybrain.org platform), compared to traditional testing, in a clinical sample, as well as to evaluate participant acceptance. SAO assessment has the potential to expand the reach of in-person neuropsychological assessment approaches.Method: Counterbalanced, within-subjects design comparing SAO performance to in-person performance in adults with diabetes with and without Chronic Kidney Disease (CKD). Forty-nine participants completed both assessment modalities (type 1 diabetes N = 14, type 2 diabetes N = 35; CKD N = 18).Results: Associations between SAO and analogous in-person tests were adequate to good (r = 0.49-0.66). Association strength between divergent cognitive tests did not differ between SAO versus in-person tests. SAO testing was more strongly associated with age than in-person testing (age R2=0.54 versus 0.23), while prediction of education, HbA1c, and estimated glomerular filtration rate (eGFR) did not differ significantly between test modalities (education R2=0.37 versus 0.30; HbA1c R2=0.20 versus 0.12; eGFR R2 = 0.41 versus 0.33). Associations with measures of everyday functioning were also similar (Functional Activities Questionnaire R2=0.08 versus 0.07; Neuro-QoL R2=0.14 versus 0.16; Diabetes Self-Management Questionnaire R2=0.19 versus 0.19).Conclusions: The selected SAO neuropsychological tests had acceptable construct validity (including divergent, convergent, and criterion-related validity), and similar ecological validity to that of traditional testing. These SAO assessments were acceptable to participants and appear appropriate for use in research applications, although further research is needed to better understand the strengths and weaknesses in other clinical populations.

Analyzing large Alzheimer's disease cognitive datasets: Considerations and challenges

Recent data-sharing initiatives of clinical and preclinical Alzheimer's disease (AD) have led to a growing number of non-clinical researchers analyzing these datasets using modern data-driven computational methods. Cognitive tests are key components of such datasets, representing the principal clinical tool to establish phenotypes and monitor symptomatic progression. Despite the potential of computational analyses in complementing the clinical understanding of AD, the characteristics and multifactorial nature of cognitive tests are often unfamiliar to computational researchers and other non-specialist audiences. This perspective paper outlines core features, idiosyncrasies, and applications of cognitive test data. We report tests commonly featured in data-sharing initiatives, highlight key considerations in their selection and analysis, and provide suggestions to avoid risks of misinterpretation. Ultimately, the greater transparency of cognitive measures will maximize insights offered in AD, particularly regarding understanding the extent and basis of AD phenotypic heterogeneity.

cCOG: A web-based cognitive test tool for detecting neurodegenerative disorders

INTRODUCTION

Web-based cognitive tests have potential for standardized screening in neurodegenerative disorders. We examined accuracy and consistency of cCOG, a computerized cognitive tool, in detecting mild cognitive impairment (MCI) and dementia.

METHODS

Clinical data of 306 cognitively normal, 120 mild cognitive impairment (MCI), and 69 dementia subjects from three European cohorts were analyzed. Global cognitive score was defined from standard neuropsychological tests and compared to the corresponding estimated score from the cCOG tool containing seven subtasks. The consistency of cCOG was assessed comparing measurements administered in clinical settings and in the home environment.

RESULTS

cCOG produced accuracies (receiver operating characteristic-area under the curve [ROC-AUC]) between 0.71 and 0.84 in detecting MCI and 0.86 and 0.94 in detecting dementia when administered at the clinic and at home. The accuracy was comparable to the results of standard neuropsychological tests (AUC 0.69-0.77 MCI/0.91-0.92 dementia).

DISCUSSION

cCOG provides a promising tool for detecting MCI and dementia with potential for a cost-effective approach including home-based cognitive assessments.

Older Black Adults' Satisfaction and Anxiety Levels After Completing Alternative Versus Traditional Cognitive Batteries

OBJECTIVE

The objective of this study was to examine satisfaction, test anxiety, and performance using computer-based cognitive batteries versus a paper-and-pencil neuropsychological battery among older Blacks.

METHOD

Self-identified Black adults (n = 87, age range: 55-86; mean education = 14) completed two computer-based tests (CogState and Joggle) and a paper-and-pencil neuropsychological battery. After each battery, participants reported their testing anxiety and satisfaction using the batteries. Descriptive, correlational, and regression analyses compared satisfaction, anxiety, and performance across the batteries.

RESULTS

Majority of the participants reported more satisfaction with the computer-based (Joggle: 66%; CogState: 77%) than the neuropsychological (52%) battery. Participants also reported less testing anxiety after completing the computer-based batteries than the neuropsychological battery, F(2, 172) = 22.96, p < .001. Older adults' familiarity and comfort level with the computer were not associated with their performance on the computer-based tests (p > .05). Although testing anxiety was not associated with performance across the batteries, age and education quality were uniquely associated with performance on the CogState and neuropsychological batteries.

CONCLUSIONS

Computer-based cognitive batteries appear to be less intimidating than the commonly used paper-and-pencil neuropsychological tests for Black adults. Thus, these cognitive batteries may be useful tools for monitoring older Blacks' cognitive status.

Comparing Web-Based and Lab-Based Cognitive Assessment Using the Cambridge Neuropsychological Test Automated Battery: A Within-Subjects Counterbalanced Study

Background

Computerized assessments are already used to derive accurate and reliable measures of cognitive function. Web-based cognitive assessment could improve the accessibility and flexibility of research and clinical assessment, widen participation, and promote research recruitment while simultaneously reducing costs. However, differences in context may influence task performance.

Objective

This study aims to determine the comparability of an unsupervised, web-based administration of the Cambridge Neuropsychological Test Automated Battery (CANTAB) against a typical in-person lab-based assessment, using a within-subjects counterbalanced design. The study aims to test (1) reliability, quantifying the relationship between measurements across settings using correlational approaches; (2) equivalence, the extent to which test results in different settings produce similar overall results; and (3) agreement, by quantifying acceptable limits to bias and differences between measurement environments.

Methods

A total of 51 healthy adults (32 women and 19 men; mean age 36.8, SD 15.6 years) completed 2 testing sessions, which were completed on average 1 week apart (SD 4.5 days). Assessments included equivalent tests of emotion recognition (emotion recognition task [ERT]), visual recognition (pattern recognition memory [PRM]), episodic memory (paired associate learning [PAL]), working memory and spatial planning (spatial working memory [SWM] and one touch stockings of Cambridge), and sustained attention (rapid visual information processing [RVP]). Participants were randomly allocated to one of the two groups, either assessed in-person in the laboratory first (n=33) or with unsupervised web-based assessments on their personal computing systems first (n=18). Performance indices (errors, correct trials, and response sensitivity) and median reaction times were extracted. Intraclass and bivariate correlations examined intersetting reliability, linear mixed models and Bayesian paired sample t tests tested for equivalence, and Bland-Altman plots examined agreement.

Results

Intraclass correlation (ICC) coefficients ranged from ρ=0.23-0.67, with high correlations in 3 performance indices (from PAL, SWM, and RVP tasks; ρ≥0.60). High ICC values were also seen for reaction time measures from 2 tasks (PRM and ERT tasks; ρ≥0.60). However, reaction times were slower during web-based assessments, which undermined both equivalence and agreement for reaction time measures. Performance indices did not differ between assessment settings and generally showed satisfactory agreement.

Conclusions

Our findings support the comparability of CANTAB performance indices (errors, correct trials, and response sensitivity) in unsupervised, web-based assessments with in-person and laboratory tests. Reaction times are not as easily translatable from in-person to web-based testing, likely due to variations in computer hardware. The results underline the importance of examining more than one index to ascertain comparability, as high correlations can present in the context of systematic differences, which are a product of differences between measurement environments. Further work is now needed to examine web-based assessments in clinical populations and in larger samples to improve sensitivity for detecting subtler differences between test settings.

Reliability and acceptability of using a social robot to carry out cognitive tests for community-dwelling older adults

AIM

To improve access to cognitive testing for older adults, the reliability and acceptability of a speech-based cognitive test administered by a social robot were investigated.

METHODS

The Japanese version of the Telephone Interview for Cognitive Status was administered by a social robot to participants recruited from retirement homes and adult daycare facilities. The robot's dialogue and gestures were preprogrammed, while the researcher controlled the timing of proceeding to the next question and scored participants' responses. We examined the internal consistency, alternate form reliability (experiment 1) and test-retest reliability (experiment 2) of the cognitive test. The acceptability of the cognitive test was also examined using a questionnaire in experiment 2.

RESULTS

A total of 66 individuals (mean age 81.2 ± 5.8 years) participated in experiment 1; the internal consistency (Cronbach's α) of the test was 0.691 and its alternate form reliability (measured by interclass correlation coefficient) was 0.728. A total of 40 of these individuals (mean age 82.0 ± 5.4 years) also participated in experiment 2, and the test-retest reliability was 0.818. According to the questionnaire responses, over half of the participants wanted (or very much wanted) to use the robot version of the test to measure the deterioration of their cognitive function.

CONCLUSIONS

A robot-administered cognitive test might have satisfactory reliability and acceptability to community-dwelling older adults if those aspects of the test implemented by the researcher can also be successfully automated. Geriatr Gerontol Int 2019; 19: 552-556.

A systematic review of reviews of neurocognitive functioning in eating disorders: The state-of-the-literature and future directions

OBJECTIVE

In recent years there has been increasing clinical and empirical interest in neurocognitive functioning in eating disorders (EDs), which has resulted in numerous quantitative and qualitative reviews. However, there has yet to be a comprehensive synthesis or critical review of this literature to identify future directions to advance the field in this area. Therefore the aim of this systematic review of systematic reviews was to (a) characterize the existing literature on neurocognitive functioning in EDs based on recent reviews (i.e., published since 2010), (b) describe related limitations, and (c) suggest avenues for future research to address gaps in the current literature.

METHOD

Electronic databases were queried for reviews of neurocognitive domains (i.e., inhibitory control, decision-making, central coherence, set-shifting, working memory, and attention bias) in EDs, which identified 28 systematic and meta-analytic reviews.

RESULTS

Broadly, the literature indicates deficits across these neurocognitive domains in EDs, though heterogeneity was noted in the magnitude of these effects, which varied to some extent across ED subtypes, sample characteristics, and methodological approaches.

DISCUSSION

While these reviews have generally suggested varying patterns of neurocognitive deficits across EDs, there remain critical limitations regarding the methodological quality of these studies (e.g., the lack of prospective designs, consideration of confounding influences, or examination of interrelationships between neurocognitive domains and relationships between neurocognition and other relevant behavioral constructs). Specifically, we outline 10 key areas that are imperative to address in future research in this area in order to move our field forward.

Predicting Remembering: Judgments of Prospective Memory After Traumatic Brain Injury

PURPOSE

Adults with traumatic brain injuries (TBIs) often struggle with prospective memory (PM), the ability to remember to complete tasks in the future, such as taking medicines on a schedule. Metamemory judgments (or how well we think we will do at remembering) are linked to strategy use and are critical for managing demands of daily living. The current project used an Internet-based virtual reality tool to assess metamemory judgments of PM following TBI.

METHOD

Eighteen adults with moderate to severe TBI and 20 healthy controls (HCs) played Tying the String, a virtual reality game with PM items embedded across the course of a virtual work week. Participants studied PM items and made two judgments of learning about the likelihood of recognizing the CUE, that is, when the task should be done, and of recalling the TASK, that is, what needed to be done.

RESULTS

Participants with TBI adjusted their metamemory expectations downward, but not enough to account for poorer recall performance. Absolute difference scores of metamemory accuracy showed that healthy adults were underconfident across PM components, whereas adults with TBI were markedly overconfident about their ability to recall TASKs.

CONCLUSIONS

Adults with TBI appear to have a general knowledge that PM tasks will be difficult but are poor monitors of actual levels of success. Because metamemory monitoring is linked to strategy use, future work should examine using this link to direct PM intervention approaches.

Online Self-Administered Cognitive Testing Using the Amsterdam Cognition Scan: Establishing Psychometric Properties and Normative Data

Background

Online tests enable efficient self-administered assessments and consequently facilitate large-scale data collection for many fields of research. The Amsterdam Cognition Scan is a new online neuropsychological test battery that measures a broad variety of cognitive functions.

Objective

The aims of this study were to evaluate the psychometric properties of the Amsterdam Cognition Scan and to establish regression-based normative data.

Methods

The Amsterdam Cognition Scan was self-administrated twice from home—with an interval of 6 weeks—by 248 healthy Dutch-speaking adults aged 18 to 81 years.

Results

Test-retest reliability was moderate to high and comparable with that of equivalent traditional tests (intraclass correlation coefficients: .45 to .80; .83 for the Amsterdam Cognition Scan total score). Multiple regression analyses indicated that (1) participants’ age negatively influenced all (12) cognitive measures, (2) gender was associated with performance on six measures, and (3) education level was positively associated with performance on four measures. In addition, we observed influences of tested computer skills and of self-reported amount of computer use on cognitive performance. Demographic characteristics that proved to influence Amsterdam Cognition Scan test performance were included in regression-based predictive formulas to establish demographically adjusted normative data.

Conclusions

Initial results from a healthy adult sample indicate that the Amsterdam Cognition Scan has high usability and can give reliable measures of various generic cognitive ability areas. For future use, the influence of computer skills and experience should be further studied, and for repeated measurements, computer configuration should be consistent. The reported normative data allow for initial interpretation of Amsterdam Cognition Scan performances.

Can a tablet-based cancellation test identify cognitive impairment in older adults?

Background and objective

There has been a growing interest in using computerized cognitive assessment to detect age-related cognitive disorders. We have developed a tablet-based cancellation test (e-CT), previously shown as a reliable measure of executive functions and free of effect of familiarity with computer-based devices in healthy older adults. This study aimed to investigate the influence of demographics and current daily use of computer-based devices in older adults with Mild Cognitive Impairment (MCI) and Alzheimer’s disease (AD). We further studied the ability of the e-CT to discriminate MCI and AD patients from older adults with normal cognition (NC).

Methods

The e-CT was administered to 325 older adults (NC = 112, MCI = 129, AD = 84). Subjects also performed the K-T test, a paper-and-pencil cancellation test from which the e-CT was developed. Multiple linear regression analyses were conducted to assess the contribution of demographics and current daily use of computer-based devices on the e-CT in patient groups. The Receiver Operating Characteristic (ROC) curves and the Area Under the Curve (AUC) were established to compare the efficacy of the e-CT and the K-T test to classify subjects into diagnostic groups.

Results

In the MCI group, age (B = -0.37, p<0.001) and current daily use of computer-based devices (B = 5.85, p<0.001) were associated with the number of correct cancellations of the e-CT. In the AD group, only current daily use of a computer-based device was a significant contributor (B = 6.28, p<0.001). The e-CT (AUC = 0.811; 95% confidence interval [CI]: 0.756–0.867) and the K-T (AUC = 0.837; CI: 0.787–0.887) showed good and comparable diagnostic accuracy to discriminate between MCI and NC subjects. To discriminate between NC and AD, both tests showed high diagnostic accuracy, with the AUC values of 0.923 (CI: 0.876–0.971) and 0.929 (95%CI: 0.886–0.972) for the e-CT and the K-T, respectively.

Conclusion

The e-CT presents satisfying discriminative validity and is a promising tool for detection of early cognitive impairment in older adults.

Reliability and validity of a self-administered tool for online neuropsychological testing: The Amsterdam Cognition Scan

INTRODUCTION

To facilitate large-scale assessment of a variety of cognitive abilities in clinical studies, we developed a self-administered online neuropsychological test battery: the Amsterdam Cognition Scan (ACS). The current studies evaluate in a group of adult cancer patients: test-retest reliability of the ACS and the influence of test setting (home or hospital), and the relationship between our online and a traditional test battery (concurrent validity).

METHOD

Test-retest reliability was studied in 96 cancer patients (57 female; M_age = 51.8 years) who completed the ACS twice. Intraclass correlation coefficients (ICCs) were used to assess consistency over time. The test setting was counterbalanced between home and hospital; influence on test performance was assessed by repeated measures analyses of variance. Concurrent validity was studied in 201 cancer patients (112 female; M_age = 53.5 years) who completed both the online and an equivalent traditional neuropsychological test battery. Spearman or Pearson correlations were used to assess consistency between online and traditional tests.

RESULTS

ICCs of the online tests ranged from .29 to .76, with an ICC of .78 for the ACS total score. These correlations are generally comparable with the test-retest correlations of the traditional tests as reported in the literature. Correlating online and traditional test scores, we observed medium to large concurrent validity (r/ρ = .42 to .70; total score r = .78), except for a visuospatial memory test (ρ = .36). Correlations were affected-as expected-by design differences between online tests and their offline counterparts.

CONCLUSIONS

Although development and optimization of the ACS is an ongoing process, and reliability can be optimized for several tests, our results indicate that it is a highly usable tool to obtain (online) measures of various cognitive abilities. The ACS is expected to facilitate efficient gathering of data on cognitive functioning in the near future.

Cognitive deficits associated with impaired awareness of hypoglycaemia in type 1 diabetes

AIMS/HYPOTHESIS

The aim of this study was to compare cognitive function in adults with type 1 diabetes who have impaired awareness of hypoglycaemia with those who have normal awareness of hypoglycaemia. A putative association was sought between cognitive test scores and a history of severe hypoglycaemia.

METHODS

A total of 68 adults with type 1 diabetes were included: 33 had impaired and 35 had normal awareness of hypoglycaemia, as confirmed by formal testing. The groups were matched for age, sex and diabetes duration. Cognitive tests of verbal memory, object-location memory, pattern separation, executive function, working memory and processing speed were administered.

RESULTS

Participants with impaired awareness of hypoglycaemia scored significantly lower on the verbal and object-location memory tests and on the pattern separation test (Cohen's d -0.86 to -0.55 [95% CI -1.39, -0.05]). Participants with impaired awareness of hypoglycaemia had reduced planning ability task scores, although the difference was not statistically significant (Cohen's d 0.57 [95% CI 0, 1.14]). Frequency of exposure to severe hypoglycaemia correlated with the number of cognitive tests that had not been performed according to instructions.

CONCLUSIONS/INTERPRETATION

Impaired awareness of hypoglycaemia was associated with diminished learning, memory and pattern separation. These cognitive tasks all depend on the hippocampus, which is vulnerable to neuroglycopenia. The findings suggest that hypoglycaemia contributes to the observed correlation between impaired awareness of hypoglycaemia and impaired cognition.