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Dorociak KE, Mattek N, Lee J, Leese MI, Bouranis N, Imtiaz D, Doane BM, Bernstein JPK, Kaye JA, Hughes AM. The Survey for Memory, Attention, and Reaction Time (SMART): Development and Validation of a Brief Web-Based Measure of Cognition for Older Adults. Gerontology 2021; 67:740-752. [PMID: 33827088 DOI: 10.1159/000514871] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 01/30/2021] [Indexed: 11/19/2022] Open
Abstract
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.
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Affiliation(s)
| | - Nora Mattek
- Oregon Center for Aging & Technology, Oregon Health & Science University, Portland, Oregon, USA
| | - Jonathan Lee
- Oregon Center for Aging & Technology, Oregon Health & Science University, Portland, Oregon, USA
| | - Mira I Leese
- Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota, USA
| | - Nicole Bouranis
- Oregon Center for Aging & Technology, Oregon Health & Science University, Portland, Oregon, USA
| | - Danish Imtiaz
- Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota, USA
| | - Bridget M Doane
- Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota, USA
| | - John P K Bernstein
- Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota, USA.,Department of Clinical Psychology, Louisiana State University, Baton Rouge, Louisiana, USA
| | - Jeffrey A Kaye
- Oregon Center for Aging & Technology, Oregon Health & Science University, Portland, Oregon, USA
| | - Adriana M Hughes
- Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota, USA.,Department of Psychiatry, University of Minnesota, Minneapolis, Minnesota, USA.,Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, Minnesota, USA
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Beattie Z, Miller LM, Almirola C, Au-Yeung WTM, Bernard H, Cosgrove KE, Dodge HH, Gamboa CJ, Golonka O, Gothard S, Harbison S, Irish S, Kornfeld J, Lee J, Marcoe J, Mattek NC, Quinn C, Reynolds C, Riley T, Rodrigues N, Sharma N, Siqueland MA, Thomas NW, Truty T, Wall R, Wild K, Wu CY, Karlawish J, Silverberg NB, Barnes LL, Czaja S, Silbert LC, Kaye J. The Collaborative Aging Research Using Technology Initiative: An Open, Sharable, Technology-Agnostic Platform for the Research Community. Digit Biomark 2020; 4:100-118. [PMID: 33442584 DOI: 10.1159/000512208] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 10/09/2020] [Indexed: 12/11/2022] Open
Abstract
Introduction Future digital health research hinges on methodologies to conduct remote clinical assessments and in-home monitoring. The Collaborative Aging Research Using Technology (CART) initiative was introduced to establish a digital technology research platform that could widely assess activity in the homes of diverse cohorts of older adults and detect meaningful change longitudinally. This paper reports on the built end-to-end design of the CART platform, its functionality, and the resulting research capabilities. Methods CART platform development followed a principled design process aiming for scalability, use case flexibility, longevity, and data privacy protection while allowing sharability. The platform, comprising ambient technology, wearables, and other sensors, was deployed in participants' homes to provide continuous, long-term (months to years), and ecologically valid data. Data gathered from CART homes were sent securely to a research server for analysis and future data sharing. Results The CART system was created, iteratively tested, and deployed to 232 homes representing four diverse cohorts (African American, Latinx, low-income, and predominantly rural-residing veterans) of older adults (n = 301) across the USA. Multiple measurements of wellness such as cognition (e.g., mean daily computer use time = 160-169 min), physical mobility (e.g., mean daily transitions between rooms = 96-155), sleep (e.g., mean nightly sleep duration = 6.3-7.4 h), and level of social engagement (e.g., reports of overnight visitors = 15-45%) were collected across cohorts. Conclusion The CART initiative resulted in a minimally obtrusive digital health-enabled system that met the design principles while allowing for data capture over extended periods and can be widely used by the research community. The ability to monitor and manage health digitally within the homes of older adults is an important alternative to in-person assessments in many research contexts. Further advances will come with wider, shared use of the CART system in additional settings, within different disease contexts, and by diverse research teams.
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Affiliation(s)
- Zachary Beattie
- Oregon Center for Aging & Technology, Oregon Health & Science University, Portland, Oregon, USA.,National Institute on Aging, Layton Aging & Alzheimer's Disease Research Center, Oregon Health & Science University, Portland, Oregon, USA.,Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA
| | - Lyndsey M Miller
- Oregon Center for Aging & Technology, Oregon Health & Science University, Portland, Oregon, USA.,School of Nursing, Oregon Health & Science University, Portland, Oregon, USA
| | - Carlos Almirola
- Center for Cognitive Neuroscience and Aging, Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Wan-Tai M Au-Yeung
- Oregon Center for Aging & Technology, Oregon Health & Science University, Portland, Oregon, USA.,National Institute on Aging, Layton Aging & Alzheimer's Disease Research Center, Oregon Health & Science University, Portland, Oregon, USA.,Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA
| | - Hannah Bernard
- Oregon Center for Aging & Technology, Oregon Health & Science University, Portland, Oregon, USA.,National Institute on Aging, Layton Aging & Alzheimer's Disease Research Center, Oregon Health & Science University, Portland, Oregon, USA.,Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA
| | - Kevin E Cosgrove
- Oregon Center for Aging & Technology, Oregon Health & Science University, Portland, Oregon, USA.,National Institute on Aging, Layton Aging & Alzheimer's Disease Research Center, Oregon Health & Science University, Portland, Oregon, USA.,Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA
| | - Hiroko H Dodge
- Oregon Center for Aging & Technology, Oregon Health & Science University, Portland, Oregon, USA.,National Institute on Aging, Layton Aging & Alzheimer's Disease Research Center, Oregon Health & Science University, Portland, Oregon, USA.,Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA
| | - Charlene J Gamboa
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois, USA
| | - Ona Golonka
- Oregon Center for Aging & Technology, Oregon Health & Science University, Portland, Oregon, USA.,National Institute on Aging, Layton Aging & Alzheimer's Disease Research Center, Oregon Health & Science University, Portland, Oregon, USA.,Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA
| | - Sarah Gothard
- Oregon Center for Aging & Technology, Oregon Health & Science University, Portland, Oregon, USA.,National Institute on Aging, Layton Aging & Alzheimer's Disease Research Center, Oregon Health & Science University, Portland, Oregon, USA.,Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA
| | - Sam Harbison
- Oregon Center for Aging & Technology, Oregon Health & Science University, Portland, Oregon, USA.,National Institute on Aging, Layton Aging & Alzheimer's Disease Research Center, Oregon Health & Science University, Portland, Oregon, USA.,Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA
| | - Stephanie Irish
- Oregon Center for Aging & Technology, Oregon Health & Science University, Portland, Oregon, USA.,National Institute on Aging, Layton Aging & Alzheimer's Disease Research Center, Oregon Health & Science University, Portland, Oregon, USA.,Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA
| | - Judith Kornfeld
- Oregon Center for Aging & Technology, Oregon Health & Science University, Portland, Oregon, USA.,National Institute on Aging, Layton Aging & Alzheimer's Disease Research Center, Oregon Health & Science University, Portland, Oregon, USA.,Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA
| | - Jonathan Lee
- Oregon Center for Aging & Technology, Oregon Health & Science University, Portland, Oregon, USA.,National Institute on Aging, Layton Aging & Alzheimer's Disease Research Center, Oregon Health & Science University, Portland, Oregon, USA.,Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA
| | - Jennifer Marcoe
- Oregon Center for Aging & Technology, Oregon Health & Science University, Portland, Oregon, USA.,National Institute on Aging, Layton Aging & Alzheimer's Disease Research Center, Oregon Health & Science University, Portland, Oregon, USA.,Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA
| | - Nora C Mattek
- Oregon Center for Aging & Technology, Oregon Health & Science University, Portland, Oregon, USA.,National Institute on Aging, Layton Aging & Alzheimer's Disease Research Center, Oregon Health & Science University, Portland, Oregon, USA.,Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA
| | - Charlie Quinn
- Oregon Center for Aging & Technology, Oregon Health & Science University, Portland, Oregon, USA.,National Institute on Aging, Layton Aging & Alzheimer's Disease Research Center, Oregon Health & Science University, Portland, Oregon, USA.,Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA
| | - Christina Reynolds
- Oregon Center for Aging & Technology, Oregon Health & Science University, Portland, Oregon, USA.,National Institute on Aging, Layton Aging & Alzheimer's Disease Research Center, Oregon Health & Science University, Portland, Oregon, USA.,Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA
| | - Thomas Riley
- Oregon Center for Aging & Technology, Oregon Health & Science University, Portland, Oregon, USA.,National Institute on Aging, Layton Aging & Alzheimer's Disease Research Center, Oregon Health & Science University, Portland, Oregon, USA.,Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA
| | - Nathaniel Rodrigues
- Oregon Center for Aging & Technology, Oregon Health & Science University, Portland, Oregon, USA.,National Institute on Aging, Layton Aging & Alzheimer's Disease Research Center, Oregon Health & Science University, Portland, Oregon, USA.,Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA
| | - Nicole Sharma
- Oregon Center for Aging & Technology, Oregon Health & Science University, Portland, Oregon, USA.,National Institute on Aging, Layton Aging & Alzheimer's Disease Research Center, Oregon Health & Science University, Portland, Oregon, USA.,Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA
| | - Mary Alice Siqueland
- Oregon Center for Aging & Technology, Oregon Health & Science University, Portland, Oregon, USA.,National Institute on Aging, Layton Aging & Alzheimer's Disease Research Center, Oregon Health & Science University, Portland, Oregon, USA.,Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA
| | - Neil W Thomas
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Timothy Truty
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois, USA
| | - Rachel Wall
- Oregon Center for Aging & Technology, Oregon Health & Science University, Portland, Oregon, USA.,National Institute on Aging, Layton Aging & Alzheimer's Disease Research Center, Oregon Health & Science University, Portland, Oregon, USA.,Department of Neurology, Portland Veterans Affairs Medical Center, Portland, Oregon, USA
| | - Katherine Wild
- Oregon Center for Aging & Technology, Oregon Health & Science University, Portland, Oregon, USA.,National Institute on Aging, Layton Aging & Alzheimer's Disease Research Center, Oregon Health & Science University, Portland, Oregon, USA.,Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA
| | - Chao-Yi Wu
- Oregon Center for Aging & Technology, Oregon Health & Science University, Portland, Oregon, USA.,National Institute on Aging, Layton Aging & Alzheimer's Disease Research Center, Oregon Health & Science University, Portland, Oregon, USA.,Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA
| | - Jason Karlawish
- Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Nina B Silverberg
- Division of Neuroscience, National Institute on Aging, National Institute of Health, Bethesda, Maryland, USA
| | - Lisa L Barnes
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois, USA
| | - Sara Czaja
- Center for Cognitive Neuroscience and Aging, Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA.,Center on Aging and Behavioral Research, Division of Geriatrics and Palliative Medicine, Weil Cornell Medicine, New York, New York, USA
| | - Lisa C Silbert
- Oregon Center for Aging & Technology, Oregon Health & Science University, Portland, Oregon, USA.,National Institute on Aging, Layton Aging & Alzheimer's Disease Research Center, Oregon Health & Science University, Portland, Oregon, USA.,Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA.,Department of Neurology, Portland Veterans Affairs Medical Center, Portland, Oregon, USA
| | - Jeffrey Kaye
- Oregon Center for Aging & Technology, Oregon Health & Science University, Portland, Oregon, USA.,National Institute on Aging, Layton Aging & Alzheimer's Disease Research Center, Oregon Health & Science University, Portland, Oregon, USA.,Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA
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