The Harvard Automated Phone Task: New Performance-Based Activities of Daily Living Tests for Early Alzheimer’s Disease

Abstract

Background: Impairment in activities of daily living is a major burden for Alzheimer’s disease dementia patients and caregivers. Multiple subjective scales and a few performance-based instruments have been validated and proven to be reliable in measuring instrumental activities of daily living in Alzheimer’s disease dementia but less so in amnestic mild cognitive impairment and preclinical Alzheimer’s disease. Objective: To validate the Harvard Automated Phone Task, a new performance-based activities of daily living test for early Alzheimer’s disease, which assesses high level tasks that challenge seniors in daily life. Design: In a cross-sectional study, the Harvard Automated Phone Task was associated with demographics and cognitive measures through univariate and multivariate analyses; ability to discriminate across diagnostic groups was assessed; test-retest reliability with the same and alternate versions was assessed in a subset of participants; and the relationship with regional cortical thickness was assessed in a subset of participants. Setting: Academic clinical research center. Participants: One hundred and eighty two participants were recruited from the community (127 clinically normal elderly and 45 young normal participants) and memory disorders clinics at Brigham and Women’s Hospital and Massachusetts General Hospital (10 participants with mild cognitive impairment). Measurements: As part of the Harvard Automated Phone Task, participants navigated an interactive voice response system to refill a prescription (APT-Script), select a new primary care physician (APT-PCP), and make a bank account transfer and payment (APT-Bank). The 3 tasks were scored based on time, errors, and repetitions from which composite z-scores were derived, as well as a separate report of correct completion of the task. Results: We found that the Harvard Automated Phone Task discriminated well between diagnostic groups (APT-Script: p=0.002; APT-PCP: p<0.001; APT-Bank: p=0.02), had an incremental level of difficulty, and had excellent test-retest reliability (Cronbach’s α values of 0.81 to 0.87). Within the clinically normal elderly, there were significant associations in multivariate models between performance on the Harvard Automated Phone Task and executive function (APT-PCP: p<0.001), processing speed (APT-Script: p=0.005), and regional cortical atrophy (APT-PCP: p=0.001; no significant association with APT-Script) independent of hearing acuity, motor speed, age, race, education, and premorbid intelligence. Conclusions: Our initial experience with the Harvard Automated Phone Task, which consists of ecologically valid, easily-administered measures of daily activities, suggests that these tasks could be useful for screening and tracking the earliest functional alterations in preclinical and early prodromal AD.

Amyloid and tau burden relate to longitudinal changes in the performance of complex everyday activities among cognitively unimpaired older adults: results from the performance-based Harvard Automated Phone Task

“…The Harvard Automated Phone Task (APT) was collaboratively developed between the Center for Alzheimer's Research and Treatment of Brigham and Women's Hospital, Massachusetts General Hospital, the Connected Health Innovation at Partners Healthcare, and Rip Road. Harvard APT comprises three tasks in which participants navigate an interactive voice response system: APT-Script, APT-PCP, and APT-Bank, as described in detail by Marshall et al ( 2015 ). Briefly, in the APT-Script task, participants are asked to call their pharmacy to refill a prescription; in the APT-PCP task, participants need to contact their health insurance company to select a new primary care physician; and in APT-Bank, participants make a bank account transfer.…”

“…Higher values indicate better performance. A detailed description of the Harvard APT and its scoring rules can be found in the first validation paper by Marshall et al ( 2015 ). Participants completed the Harvard APT annually.…”

Meaningful benefits: a framework to assess disease-modifying therapies in preclinical and early Alzheimer’s disease

“…o Navigating an interactive voice response system, as in the Harvard Automated Phone Task, [ 30 ] or…”

Using a digital tool to detect early changes in everyday functioning in older adults: A pilot study of the Assessment of Smartphone Everyday Tasks (ASSET)

“… 6 , 14 To provide a more protocolized assessment of cognition in the context of daily life, performance‐based measures have been developed in which the participant or patient is required to complete a given task. Examples of performance‐based measures of everyday functioning, targeting early changes, include the Harvard Automated Phone Task, 15 , 16 the Czaja Functional Assessment Battery, 17 and the Financial Capacity Instrument–Short Form. 18 …”

“…6,14 To provide a more protocolized assessment of cognition in the context of daily life, performance-based measures have been developed in which the participant or patient is required to complete a given task. Examples of performance-based measures of everyday functioning, targeting early changes, include the Harvard Automated Phone Task, 15,16 the Czaja Functional Assessment Battery, 17 and the Financial Capacity Instrument-Short Form. 18 As digital tools such as smartphones have become an essential part of daily life, it seems logical to utilize them for the assessment of everyday functioning, particularly in individuals who already frequently use digital tools to perform various everyday tasks.…”