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

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Trends in digitalization suggest that older adults are increasingly familiar and comfortable with new technologies, and surveys from 2019 indicate that 77% of North Americans aged 50+ own a smartphone. In Sweden 66% of Sweden's older adults born during the 1940s use the Internet daily.

Mobile 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.

The authors of a new study employed two mobile app-based cognitive tasks building on recent findings on the functional brain architecture of episodic memory and the spatiotemporal progression of AD pathology. - First, the Mnemonic Discrimination Task for Objects and Scenes (MDT-OS), taxing pattern separation as a short-term memory task. Pattern separation is the process of discriminating among highly similar but unique pieces of information (e.g., where you parked your car today vs. yesterday).

  • Second, the Object-In-Room Recall Task (ORR-LDR) was developed to tax pattern completion (29), i.e., the ability to retrieve a stored memory based on a cue of incomplete information. The ORR-LDR was implemented as a one- to three-day long-term delayed recall task, consequently assessing long-term memory.

A total of 172 non-demented older participants completed two mobile app-based memory tasks-the Mnemonic Discrimination Task for Objects and Scenes and the long-term delayed Object-In-Room Recall Task. To determine the validity of the tasks for measuring relevant cognitive functions in this population, the authors 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.

MDT-OS and ORR-LDR were weakly-to-moderately correlated with the Preclinical Alzheimer's Cognitive Composite 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.

The scientists 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.

The authors' 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.

Read the original article on Pubmed

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