<b><i>Introduction:</i></b> 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. <b><i>Method:</i></b> 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. <b><i>Results/Discussion:</i></b> Twenty-six studies met inclusion criteria. Sample sizes ranged from <i>n</i> = 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: <i>r</i> = 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. <b><i>Conclusion:</i></b> 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.
Objective Individuals with subjective cognitive decline (SCD) are approximately twice as likely to develop dementia and less likely to seek cognitive assessment. Home-based cognitive assessment (HBCA) could reduce many practical and emotional barriers associated with in-person cognitive testing. We aimed to explore the relationship between SCD and likelihood of HBCA participation across various modalities. Method A nation-wide sample of 483 community-dwelling adults age 50 years and older (M = 63.61 ± 5.47) were recruited via Amazon Mechanical Turk, an online crowdsourcing website, to complete a survey. SCD was measured using the SCD-MyCog Questionnaire. A score of 7/24 endorsed symptoms classified respondents into SCD and non-SCD. Likelihood of participation in HBCA was measured using 4 likert-scale items (e.g., “How likely would you be to participate in HBCA via computer?”). Total likelihood was calculated by summing items. Results Regression revealed SCD symptom burden predicted likelihood of participation in HBCA [F(1, 481) = 12.42, B = .097, [.043–.150], p < .001, r^2 = .025]. Likelihood was higher in SCD (15.25 ± 3.3) than non-SCD (14.23 ± 3.5). When looking at specific HBCA modalities, SCD were more likely than non-SCD to participate in computer and videoconferencing modalities (1.36 ± 0.6 vs1.68 ± 0.87, p < .001; 2.26 ± 1.11 vs 2.58 ± 1.16, p < .001). There was no relationship with iPad or smartphone modalities. Conclusion SCD endorsement was associated with increased likelihood of engagement in HBCA. It is possible that HBCA can help overcome barriers to help-seeking in this group. SCD may prefer videoconferencing and computer modalities.
Objective Individuals endorsing subjective cognitive decline (SCD) are at risk for dementia, likely to endorse depression and anxiety but often don’t seek cognitive assessment. Here we examined the relationship between SCD and acceptance of cognitive assessment. Method A nation-wide sample of 483 adults age 50 and older completed an online survey via the crowdsourcing website, Amazon Mechanical Turk. The SCD-MyCog Questionnaire was used to calculate total SCD score and determine SCD and non-SCD groups (>7/24 = SCD). Items from The Perceptions Regarding Investigational Screening for Memory in Primary Care were summed to create total Assessment Acceptance. Anxiety and depressive symptoms were measured using Patient-Reported Outcome Measurement Information System scales. Results A hierarchical regression showed SCD total score adding to the prediction of assessment acceptance (R2 change = 8.5%). Once age (R2 change = 0.2%), and depression and anxiety (R2 change = 0.5%) were entered in steps 1 and 2. Step 3 coefficients were − .016, −.047, .019, and .18. The SCD group had an overall acceptance score > 1 SD higher than non-SCD (17.4 ± 2.32 and 15.46 ± 3.46). Conclusion SCD endorsed more acceptance even when anxiety and depression symptoms were accounted for. This finding is at odds with reduced help-seeking behavior among SCD. Further research is warranted to understand the specific barriers to seeking assessment among SCD.
Background:The association between subjective cognitive decline (SCD) symptom burden and affective symptoms (i.e., depression and anxiety) is well established, but its interpretation remains elusive: are affective symptoms causally related to SCD or do they reflect independent neurobiological processes? We sought to further the understanding of the SCD/affective symptom association by examining the moderating effects of risk factors for AD/dementia (female gender, older age, and positive family history). Method: A nation-wide sample of community-dwelling 483 adults between ages 50 and 79 (66.5% female; 14.5% age > 70; 27% with positive family history) completed an online survey via the crowdsourcing website Amazon Mechanical Turk. Respondents answered demographic questions, completed the Subjective Cognitive Decline Questionnaire (SCD-Q MyCog) (0-25, M=4.71, SD=5.77), and the PROMIS anxiety (7-35, M=13.04, SD=5.68), and depression (8-40, M=13.18, SD=6.32) measures. Linear regression was conducted to evaluate the interaction of each risk factor with SCD total in the prediction of depression and anxiety (separate models). Result:The interaction term was statistically significant for gender, both in relation to depression (b=-0.28, t[479]=-3.42, p <.001), and anxiety (b=-0.21, t[479]=-2.27, p=.02). In both cases, the SCD/affective symptom correlation was lower for females than for males: SCD/depression: female, r=.239; male, r=.543 and SCD/anxiety: females, r=.260; males, r=.445), respectively. There were no significant interactions with age or family history.
Older adults often find it difficult to use everyday technology proficiently. We hypothesized that these difficulties would be exacerbated in those with subjective cognitive decline (SCD), that is, self-perceived worsening of cognitive functions that has been associated with increased risk of future dementia. Here we investigated the relationship between SCD symptom burden and technology proficiency. A nation-wide sample of adults (N=483) ages 50-79 (66.5% female; 14.5% age >70) completed an online survey via a crowdsourcing website, Amazon Mechanical Turk. The survey included the Subjective Cognitive Decline Questionnaire (SCD-Q MyCog) (0-25, M=4.71, SD=5.77), questions about respondents’ proficiency with computer, smartphone, and tablet (4-12, M=9.72, SD=1.97), and the PROMIS depression (M=13.18, SD=6.32) and anxiety (M=13.04, SD=5.68) scales. Linear regression was used to examine the ability of technology proficiency to predict SCD score. We also probed the interaction of technology proficiency with age (<70 vs. >70 years), and adjusted for covariates. We found that the age/technology interaction (B=-0.80), older age (B=7.49), lower education (B=-1.08), higher depression (B=0.20) and anxiety (B=0.16) symptoms predicted higher SCD burden (R-squared=.16). For respondents >70 years low technology proficiency predicted high SCD burden (B=-.79) whereas for those <70 years no relationship was found. Our study draws attention to older adults’ self-experienced cognitive function in the digital era. The association between low technology proficiency and SCD may signal the adverse impact of the digital era on those who experienced technology only later in life. It is equally possible that declining technology proficiency is an indicator of emerging neurodegenerative disease.
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