Current State of Self-Administered Brief Computerized Cognitive Assessments for Detection of Cognitive Disorders in Older Adults: A Systematic Review

Abstract

Early diagnosis of cognitive disorders in older adults is a major healthcare priority with benefits to patients, families, and health systems. Rapid advances in digital technology offer potential for developing innovative diagnostic pathways to support early diagnosis. Brief self-administered computerized cognitive tools in particular hold promise for clinical implementation by minimizing demands on staff time. In this study, we conducted a systematic review of self-administered computerized cognitive assessment measures designed for the detection of cognitive impairment in older adults. Studies were identified via a systematic search of published peer-reviewed literature across major scientific databases. All studies reporting on psychometric validation of brief (≤30 minutes) self-administered computerized measures for detection of MCI and all-cause dementia in older adults were included. Seventeen studies reporting on 10 cognitive tools met inclusion criteria and were subjected to systematic review. There was substantial variability in characteristics of validation samples and reliability and validity estimates. Only 2 measures evaluated feasibility and usability in the intended clinical settings. Similar to past reviews, we found variability across measures with regard to psychometric rigor and potential for widescale applicability in clinical settings. Despite the promise that self-administered cognitive tests hold for clinical implementation, important gaps in scientific rigor in development, validation, and feasibility studies of these measures remain. Developments in technology and biomarker studies provide potential avenues for future directions on the use of digital technology in clinical care.

Clinical outcome measures in dementia with Lewy bodies trials: critique and recommendations

“…Several computerized batteries are sensitive enough to detect a cognitive change in clinical trials for other neurodegenerative diseases, and the Cognitive Drug Research Computerized Assessment System has been used in multiple DLB trials [ 44 , 55 , 57 , 104 – 110 ]. Whilst such computerized cognitive assessments appear promising, there is a clear need for their further development and validation in DLB [ 104 , 111 , 112 ].…”

Self-administered Web-Based Tests of Executive Functioning and Perceptual Speed: Measurement Development Study With a Large Probability-Based Survey Panel

“…Internet-based surveys have received widespread attention as methods of large-scale data collection in many fields of health research. Although internet surveys have traditionally focused on the collection of self-reported data (eg, participants’ subjective attitudes, health behaviors, and self-reported medical conditions), interest in the ability to conduct objective testing of cognitive abilities over the internet has substantially increased in recent years [ 1 - 4 ]. Cognitive capacities are relevant to people’s ability to understand and act on information and serve as a basis for higher-order functioning and well-being.…”

“…The lack of standardization is particularly fraught for tests that are timed. Cognitive functioning scores may potentially differ markedly depending on participants’ computer skills and the used device [ 13 , 14 ], such as whether the test is taken on a laptop computer with a physical keyboard versus a tablet or smartphone without a keyboard [ 1 , 15 ]. Moreover, although self-administered web-based testing increases flexibility and convenience of test administration in participants’ daily lives, this comes with the potential costs of excessive measurement errors and biases associated with environmental influences (eg, the location where the test is taken and interruption by people or devices).…”

“…Furthermore, as normative data may not be comparable across different modes of administration, norms should be made accessible specifically for web-based cognitive testing and generated from large and representative samples [ 13 ]. To date, available web-based cognitive tests have been predominantly developed for detecting age-related cognitive impairments in small and selected samples and lack normative information that could be applied in population-based studies [ 1 , 3 ].…”

A Paradox in Digital Memory Assessment: Increased Sensitivity With Reduced Difficulty

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