Development of a self-administered web-based test for longitudinal cognitive assessment

Abstract

Sequential testing with brief cognitive tools has been recommended to improve cognitive screening and monitoring, however the few available tools still depend on an external evaluator and periodic visits. We developed a self-administered computerized test intended for longitudinal cognitive testing (Brain on Track). The test can be performed from a home computer and is composed of several subtests, expected to evaluate different cognitive domains, all including random elements to minimize learning effects. An initial (A) and a refined version of the test (B) were applied to patients with mild cognitive impairment or early dementia (n = 88) and age and education-matched controls. A subsample of a population-based cohort (n = 113) performed the test at home every three months to evaluate test-retest reliability. The test’s final version Cronbach’s alpha was 0.90, test scores were significantly different between patients and controls (p = 0.001), the area under the receiver operating characteristic curve was 0.75 and the smallest real difference (43.04) was lower than the clinical relevant difference (56.82). In the test-retest reliability analysis 9/10 subtests showed two-way mixed single intraclass consistency correlation coefficient >0.70. These results imply good internal consistency, discriminative ability and reliability when performed at home, encouraging further longitudinal clinical and population-based studies.

Usefulness of CogEvo, a computerized cognitive assessment and training tool, for distinguishing patients with mild Alzheimer's disease and mild cognitive impairment from cognitively normal older people

“…Numerous attempts have been made to develop cognitive function tests using computers 6–8,21,22 . Such tests are assumed to have several strong points.…”

“…In recent years, computer software has been increasingly used to assess cognitive function 6–10 . Using a computer enables the test presentations to be indicated automatically, eliminating the need for a specialized tester; this could pave the way for Internet‐based cognitive examinations.…”

Comparing Web-Based and Lab-Based Cognitive Assessment Using the Cambridge Neuropsychological Test Automated Battery: A Within-Subjects Counterbalanced Study

“…To allow the comparison with test-retest reliabilities commonly reported in the literature [ 3 , 5 , 18 , 42 ], bivariate coefficients were computed to measure the strength of the linear association of outcome measures across test settings. Spearman rank correlations are reported because of the nonnormal distribution of data.…”

Online Self-Administered Cognitive Testing Using the Amsterdam Cognition Scan: Establishing Psychometric Properties and Normative Data

“…Similar to other correlation measures, higher ICC values indicate less error variance and better test-retest reliability, but unlike other measures, ICCs take both random and systemic error (eg, practice effects) into account when calculating reliability [ 39 , 40 ]. Generally, as a criterion for acceptable test-retest reliability, ICC values of .60 or .70 and higher are recommended [ 39 , 41 - 43 ]. In agreement with these recommendations, we used a criterion of .60 to indicate which tests have acceptable reliability results and which do not.…”