Boston cognitive assessment (BOCA) — a comprehensive self-administered smartphone- and computer-based at-home test for longitudinal tracking of cognitive performance

Abstract

Longitudinal cognitive testing is essential for developing novel preventive interventions for dementia and Alzheimer’s disease; however, the few available tools have significant practice effect and depend on an external evaluator. We developed a self-administered 10-min at-home test intended for longitudinal cognitive monitoring, Boston Cognitive Assessment or BOCA. The goal of this project was to validate BOCA. BOCA uses randomly selected non-repeating tasks to minimize practice effects. BOCA evaluates eight cognitive domains: 1) Memory/Immediate Recall, 2) Combinatorial Language Comprehension/Prefrontal Synthesis, 3) Visuospatial Reasoning/Mental rotation, 4) Executive function/Clock Test, 5) Attention, 6) Mental math, 7) Orientation, and 8) Memory/Delayed Recall. BOCA was administered to patients with cognitive impairment (n = 50) and age- and education-matched controls (n = 50). Test scores were significantly different between patients and controls (p < 0.001) suggesting good discriminative ability. The Cronbach’s alpha was 0.87 implying good internal consistency. BOCA demonstrated strong correlation with Montreal Cognitive Assessment (MoCA) (R = 0.90, p < 0.001). The study revealed strong (R = 0.94, p < 0.001) test-retest reliability of the total BOCA score one week after participants’ initial administration. The practice effect tested by daily BOCA administration over 10 days was insignificant (β = 0.03, p = 0.68). The effect of the screen size tested by BOCA administration on a large computer screen and re-administration of the BOCA to the same participant on a smartphone was insignificant (β = 0.82, p = 0.17; positive β indicates greater score on a smartphone). BOCA has the potential to reduce the cost and improve the quality of longitudinal cognitive tracking essential for testing novel interventions designed to reduce or reverse cognitive aging. BOCA is available online gratis at www.bocatest.org.

Validation and Convergent Validity of the Boston Cognitive Assessment (BOCA) in an Italian Population: A Comparative Study with the Montreal Cognitive Assessment (MoCA) in Alzheimer’s Disease Spectrum

“…Both MoCA and BOCA tests were effective in differentiating between groups of healthy individuals, mild cognitive impairment, and dementia. These data agree with previous validation studies (Vyshedskiy et al 2022, Gold et al 2022) [7,12] and support the usefulness of BOCA as a screening tool for the detection of cognitive impairment.…”

“…As previously described (Vyshedskiy et al 2022) [7], the data in transit is encrypted using SSL. SSL stands for Secure Sockets Layer, a security protocol that creates an encrypted link between a web server and a web browser.…”

“…Recently, a self-administered 10-min-digital tool called Boston Cognitive Assessment (BOCA) has been developed (Vyshedskiy et al 2022) [7] demonstrating good internal consistency, adequate content validity, and strong test-retest reliability. BOCA demonstrated strong correlation with Montreal Cognitive Assessment (MoCA) and potentially represents a valid tool for early detection and monitoring of cognitive deficits, particularly in individuals at risk of cognitive impairments and dementia (Vyshedskiy et al, 2022) [7].…”

Assessment of Pragmatic Abilities and Cognitive Substrates (APACS) Brief Remote: a novel tool for the rapid and tele-evaluation of pragmatic skills in Italian

“…A difference in perceived difficulty with the remote administration of the test was found between individuals who used a computer and individuals who used a smartphone, with the latter group reporting a higher level of difficulty. The device, however, did not affect the performance in the test, as no significant differences in the APACS Brief Remote test emerged between the two groups, in line with other works that reported similar performance in neuropsychological tests administered with different devices (e.g., Alegret et al, 2021;Vyshedskiy et al, 2022). We believe that the greater difficulty experienced by participants using a smartphone might be due to a range of factors that become especially important when assessing communication, such as screen size constraints (Dunaway & Soroka, 2021), risks for pop-up notifications (Marra et al, 2020), and workload elevation (Hancock et al, 2015).…”

Digital Cognitive Biomarker for Mild Cognitive Impairments and Dementia: A Systematic Review

“…Again, test batteries showed group differences that varied largely ( g : 0.2–2.1). Test batteries including BHA [ 44 ], Computerized Dementia Screening Test (CDST) [ 59 ], Computerized Cognitive Screen (CoCoSc) [ 60 ], ComBased-CAT [ 61 ], and Boston Cognitive Assessment (BoCA) [ 62 ] showed large group differences, especially for subsets measuring memory, attention, and working memory. Moreover, performance in daily living tasks (i.e., Computer-based functional skills assessment and training (CFSAT)) showed moderate to large group differences ( g : 0.7–1.2) [ 63 ].…”