Unsupervised mobile app-based cognitive testing in a population-based study of older adults born 1944

Abstract

BackgroundMobile app-based tools have the potential to yield rapid, cost-effective, and sensitive measures for detecting dementia-related cognitive impairment in clinical and research settings. At the same time, there is a substantial need to validate these tools in real-life settings. The primary aim of this study was thus to evaluate the feasibility, validity, and reliability of mobile app-based tasks for assessing cognitive function in a population-based sample of older adults.MethodA total of 172 non-demented (Clinical Dementia Rating 0 and 0.5) older participants (aged 76–77) completed two mobile app-based memory tasks—the Mnemonic Discrimination Task for Objects and Scenes (MDT-OS) and the long-term (24 h) delayed Object-In-Room Recall Task (ORR-LDR). To determine the validity of the tasks for measuring relevant cognitive functions in this population, we assessed relationships with conventional cognitive tests. In addition, psychometric properties, including test-retest reliability, and the participants’ self-rated experience with mobile app-based cognitive tasks were assessed.ResultMDT-OS and ORR-LDR were weakly-to-moderately correlated with the Preclinical Alzheimer's Cognitive Composite (PACC5) (r = 0.3–0.44, p < .001) and with several other measures of episodic memory, processing speed, and executive function. Test-retest reliability was poor–to-moderate for one single session but improved to moderate–to-good when using the average of two sessions. We observed no significant floor or ceiling effects nor effects of education or gender on task performance. Contextual factors such as distractions and screen size did not significantly affect task performance. Most participants deemed the tasks interesting, but many rated them as highly challenging. While several participants reported distractions during tasks, most could concentrate well. However, there were difficulties in completing delayed recall tasks on time in this unsupervised and remote setting.ConclusionOur study proves the feasibility of mobile app-based cognitive assessments in a community sample of older adults, demonstrating its validity in relation to conventional cognitive measures and its reliability for repeated measurements over time. To further strengthen study adherence, future studies should implement additional measures to improve task completion on time.

Feasibility and acceptability of remote smartphone cognitive testing in frontotemporal dementia research

“…Remote data collection using the ALLFTD Mobile App (ALLFTD‐mApp), a comprehensive battery of cognitive, speech/language, and motor tasks, is both feasible and generally well accepted in the context of multicenter FTD research. Although some differences in familiarity were observed between age and diagnostic groups, smartphone familiarity was generally high among all participants, including older adults and symptomatic participants, mirroring recent findings showing high acceptability and adherence in older adult populations 47–49 . Participants considered the time commitment to be acceptable, and many endorsed a willingness to complete additional tasks.…”

“…Although some differences in familiarity were observed between age and diagnostic groups, smartphone familiarity was generally high among all participants, including older adults and symptomatic participants, mirroring recent findings showing high acceptability and adherence in older adult populations. 47 , 48 , 49 Participants considered the time commitment to be acceptable, and many endorsed a willingness to complete additional tasks. Task completion rates were acceptable and consistent with studies in similar populations 47 , 48 .…”

Remote and unsupervised digital memory assessments can reliably detect cognitive impairment in Alzheimer’s disease

“…The strongest relationship for both measures, however, was found with the mPACC. These findings nicely support earlier work using the neotiv memory tasks in samples with cognitively unimpaired individuals and MCI patients (Berron et al, 2023;Öhman et al, 2022). Furthermore, baseline performance in the MDT-S and the ORR-DR was associated with future decline in the mPACC in this study, demonstrating first evidence of its prognostic validity regarding future cognitive decline.…”

“…This is particularly true for unsupervised and remote digital assessments that are completed in an unstandardized environment of the participant’s choice. Recent work using smartphone-based cognitive assessments in samples of older participants could successfully demonstrate high construct validity across various cognitive domains (Nicosia et al, 2022b; Öhman et al, 2022; Papp et al, 2021; Singh et al, 2023; Vyshedskiy et al, 2022). Both the ORR and the MDT-OS are intended to measure memory.…”

“…The aim of the present study was to evaluate the feasibility and usability of unsupervised and remote digital memory assessments, their construct validity in reference to traditional neuropsychological assessments, their retest reliability as well as their relationship with fluid and imaging biomarkers of AD. To that end, we implemented two non-verbal memory tasks based on recent insights into the functional anatomy of episodic memory, available on the neotiv digital platform (https://www.neotiv.com/en) (Berron et al, 2022; Öhman et al, 2022), in a subset of the Swedish BioFINDER-2 study.…”