Feasibility and validity of ecological momentary cognitive testing among older adults with mild cognitive impairment

Abstract

It is critical to intervene early in the mild cognitive impairment (MCI) stage of the Alzheimer's disease trajectory, but traditional cognitive testing methods are costly, burdensome, and difficult to access. We examined adherence and validity data to a 30-day self-administered ecological momentary cognitive testing protocol among a sample of older adults with MCI and cognitively normal controls to evaluate feasibility, tolerability, and initial validity in comparison to standard neuropsychological tests. Participants included 48 participants with MCI (Mean age = 72 years, SD = 7 years) and 46 demographically-matched cognitively normal (NC) control participants (Mean age = 70 years, SD = 7 years). Participants completed traditional neuropsychological testing to determine MCI status, followed by 30 days of remote ecological momentary cognitive testing. Ecological momentary assessment (EMA) surveys were administered 3 times per day for 30 days (possible total = 90), and mobile cognitive tests were administered every other day (for a total of 15 administrations). Mobile cognitive tests included the Variable Difficulty List Memory Test (VLMT; measure of learning and memory), Memory Matrix (measure of visual working memory), and the Color Trick Test (measure of executive function). EMA and mobile cognitive test adherence, fatigue effects, mobile cognitive test performance and group differences, and psychometrics (reliability, convergent validity, ceiling effects, and practice effects) were examined. Overall mean-level adherence to the mobile cognitive tests was 85% and did not differ by MCI status. The reliability of stable between-person individual differences for the VLMT and Memory Matrix were very high. Moreover, although the reliability of within-person change for Memory Matrix was adequate, the corresponding reliability for VLMT was somewhat low. Averaged performance on the mobile cognitive tests was correlated with lab-based tests measuring the same construct. Participants with MCI performed worse than NCs on the VLMT and Color Trick Test, and there was no evidence of fatigue effects for these two tests. These findings support the feasibility and potential for ecological momentary cognitive testing to support clinical trials and for measuring cognitive changes over time in persons with increased risk for Alzheimer's disease such as those with MCI.

Remote Self-Administration of Cognitive Screeners for Older Adults Prior to a Primary Care Visit: Pilot Cross-Sectional Study of the Reliability and Usability of the MyCog Mobile Screening App

“…A small body of emerging research supports the feasibility of self-administered cognitive screeners on personal smartphones in research contexts [ 10 - 12 ]. The cognitive assessments in these studies vary in administration frequency, length, and structure but tend to find high levels of adherence (70% or higher), receive positive feedback in exit surveys, and show convergent validity with established cognitive screening measures [ 11 , 13 , 14 ]. However, no screeners to date have been validated for clinical use before a primary care visit [ 15 ].…”

Web-based cognitive assessment in older adults: Where do we stand?

“…Although there have been few studies conducted on mobile assessments as this field is fairly new, recent studies show that mobile tools can in some cases achieve high between-person reliability (i.e., whether inter-individual differences are comparable over repeated testing) [46 ▪▪ ,50–54] and good test-retest reliability over intervals ranging from several days to several months[46 ▪▪ ,50,55,56 ▪ ]. This suggests that high-frequency measurement can be used with confidence to assess within-person fluctuations in cognitive performance.…”

“…In terms of user experience, studies show good-to-high completion rates, with relatively low drop-out rates, even for cognitive assessments completed several times per day [46 ▪▪ ,50,51,54,55,56 ▪ ]. Older participants have shown a tendency to stay engaged in remote studies for longer durations compared to younger participants [62].…”

Conducting CNS trials during a public health emergency – Lessons learned from the COVID-19 pandemic: A joint ISCTM/ECNP working group consensus paper

“…On the other hand, researchers published evidence showing the feasibility of utilizing ecological momentary cognitive testing in clinical trials of persons with increased risk for Alzheimer's disease such as those with mild cognitive impairment ( Moore et al., 2022 ). The authors collected neuropsychological data in the lab (pre-COVID) then switched to remote administrations (during COVID) and did not find any differences in how the tests related to measures of interest.…”