Accuracy of a Self-Administered Online Cognitive Assessment in Detecting Amnestic Mild Cognitive Impairment

Abstract

Objectives Our aim was to validate the online Brain Health Assessment (BHA) for detection of amnestic mild cognitive impairment (aMCI) compared to gold-standard neuropsychological assessment. We compared the diagnostic accuracy of the BHA to the Montreal Cognitive Assessment (MoCA). Methods Using a cross-sectional design, community-dwelling older adults completed a neuropsychological assessment, were diagnosed as normal cognition (NC) or aMCI, and completed the BHA and MoCA. Both logistic regression (LR) and penalized logistic regression (PLR) analyses determined BHA and demographic variables predicting aMCI; MoCA variables were similarly modeled. Diagnostic accuracy was compared using area under the receiver operating characteristic curve (ROC AUC) analyses. Results Ninety-one participants met inclusion criteria (51 aMCI, 40 NC). PLR modeling for the BHA indicated Face–Name Association, Spatial Working Memory, and age-predicted aMCI (ROC AUC = 0.76; 95% confidence interval [CI]: 0.66–0.86). Optimal cut-points resulted in 21% classified as aMCI (positive), 23% negative, and 56% inconclusive. For the MoCA, digits, abstraction, delayed recall, orientation, and age predicted aMCI (ROC AUC = 0.71; 95% CI: 0.61–0.82). Optimal cut-points resulted in 22% classified positive, 8% negative, and 70% inconclusive (LR results presented within). The BHA model classified fewer participants into the inconclusive category and more as negative for aMCI, compared to the MoCA model (Stuart–Maxwell p = .004). Discussion The self-administered BHA provides similar detection of aMCI as a clinician-administered screener (MoCA), with fewer participants classified inconclusively. The BHA has the potential to save practitioners time and decrease unnecessary referrals for a comprehensive assessment to determine the presence of aMCI.

Challenges and Solutions for Data Analysis in an Adult Lifespan Study of over 100,000 Online Cognitive Test Completions

“…As such, factors such as ageappropriate stimuli, and familiarity with computers were taken into account when designing and extensively piloting the web-based platform (Troyer et al, 2014). Second, it was psychometrically validated, which is rare for online tests, and confirmed that the test consistently obtained the same results when repeated (reliability), and that it measures what it attempts to measure (validity; Paterson et al, 2021;Troyer et al, 2014). Lastly, it was developed as a screening tool for memory concerns, and reliably distinguishes people who are 'worried well' from those who should be seeing a health care professional.…”

The adverse effect of modifiable dementia risk factors on cognition amplify across the adult lifespan

“…Online testing allows collection of a large sample of individuals from different ages, to gain insights on how risk factor effects vary by age. The online assessment we used has been psychometrically validated, and demonstrated adequate internal consistency, test-retest reliability, alternate version reliability, and construct validity [22], plus adequate convergent validity when compared to clinician-administered neuropsychological tests of the same constructs [23]. Moreover, the test was designed to be suitable for older adults [22], and also provides greater sensitivity at the high end of function [23] than the Montreal Cognitive Assessment [24], offering sensitivity to assess a relatively healthy sample.…”

“…The online assessment we used has been psychometrically validated, and demonstrated adequate internal consistency, test-retest reliability, alternate version reliability, and construct validity [22], plus adequate convergent validity when compared to clinician-administered neuropsychological tests of the same constructs [23]. Moreover, the test was designed to be suitable for older adults [22], and also provides greater sensitivity at the high end of function [23] than the Montreal Cognitive Assessment [24], offering sensitivity to assess a relatively healthy sample. The use of measures ostensibly sensitive to downstream effects of dementia risk factors was achieved by the combination of online testing (to obtain large sample sizes) and a sensitive assessment suited to detect changes in people with risk factors (e.g., distributed damage due to subtle vascular brain changes, white matter changes, and reduced reserve capacity, leading to earlier onset of clinically-evident neurodegeneration [25]).…”

Sex differences and Modifiable Dementia Risk Factors Synergistically Influence Memory over the Adult Lifespan

“…The assessment was developed to be suitable for older adults, and was psychometrically validated showing acceptable internal consistency, test-retest reliability, and alternate version reliability (38). It also showed good construct validity compared to traditional neuropsychological tests of the same constructs, and sensitivity at the higher end of function, making it suitable to assess a relatively healthy sample (39).…”