Usability and Validity of a Battery of Computerised Cognitive Screening Tests for Detecting Cognitive Impairment

Abstract

Background: Computerised cognitive screening (CCS) has the potential to detect cognitive impairment in the community, which is important for the early diagnosis of dementia. Objective: The aim of this study was to investigate the ability of older adults with dementia to engage with smart phone and tablet technologies and to determine the accuracy of a battery of CCS tasks to detect cognitive impairment in comparison with the Montreal Cognitive Assessment (MoCA). Methods: Patients with mild-moderate dementia (n = 40) attending a university-linked day hospital and normal controls (n = 20) completed (i) a questionnaire detailing the frequency and breadth of their technology use, (ii) three commercially available CCS tasks, and (iii) the MoCA. Results: The three CCS tasks were completed by 85% (n = 34) of the patients with dementia and all controls; only 4 reported the task as ‘hard'. Those with dementia scored significantly lower on the CCS than controls (p < 0.001). CCS scores correlated with total MoCA scores (r = 0.78, p < 0.01). Further, the CCS scores significantly predicted MoCA scores, controlling for the effects of age, gender, educational attainment, and frequency of technology use (β = 0.71, p < 0.001), explaining 65.2% of the variance. Total CCS and MoCA scores (cut-off score <24) had similar sensitivity (94 and 95%, respectively) and accuracy (area under the curve 0.94 and 0.99, respectively, p = 0.5) in discriminating dementia from controls, though the CSS had lower specificity (60 vs. 100% for the MoCA). Conclusion: The participants had little difficulty self-administering the CCS, which is an oft-cited barrier to computerised testing in this population. Our results support the criterion and construct validity of a CCS versus the commonly used MoCA. Although further research is required, CCS for cognitive impairment may be useful in the community and, by prompting referral to specialist services, could lead to an earlier diagnosis of dementia.

Smartkuber: A Serious Game for Cognitive Health Screening of Elderly Players

“…This may reflect that the Smartkuber tasks test delayed recall through visual memory (e.g., flags, faces, shapes) rather than verbal memory, as in MoCA (using five words), utilizing different and potentially competing cognitive processing centers. 6,36,37 Adding textual elements to the minigames' memory tasks may address the issue and enhance the correlation.…”

“…1,2 Symptomatic cognitive impairment is under-recognized and underdiagnosed, even though early detection in dementia care is of great significance and has many benefits, including providing an explanation for changes in behavior and functioning and allowing the person to be involved in future care planning. [3][4][5][6] Cognitive screening represents the initial step in a process of further assessment for dementia and can help identify potential cases for assessment, thus leading to early diagnosis. 1 The existing pen-and-paper screening tests present certain intrinsic limitations, such as being biased by culture, gender, and educational level and having long test-rest periods (usually 1 month or more).…”

“…1,7 Computerized cognitive screening tests overcome some of the limitations mentioned above; however, they still have weaknesses, including limited validation of the tests and the user's potential lack of motivation. 1,6,11 Serious games for cognitive screening may be an alternative to traditional pen-and-paper and computerized cognitive screening tests, potentially motivating and engaging the user to regularly perform cognitive screening tasks, thus providing more timely cognitive-related data and facilitating the recognition of cognitive decline, triggering referral for a more comprehensive formal assessment and earlier detection of cognitive impairment. 1,12 Cognitive screening serious games have distinct advantages; they can be economical of time and cost, provide accurate and frequent response recording free of the aforementioned biases and effects (due to dynamically updated content), be self-administered or require little training, provide a pleasant experience, and reduce the psychological stress caused by the traditional screening processes.…”

“…1 The MoCA test is a brief, validated screening tool used to distinguish mild cognitive impairment from normal aging and which has been found to demonstrate high test-retest reliability and internal consistency. 6,13,14 It has been reported to be a useful tool for the detection of agerelated early cognitive decline and early dementia, as well as being an accurate screening measurement of cognitive ability. 14,15 Compared with the other widely used brief cognitive measure, that is, the minimental state examination (MMSE), 16 MoCA has been found to perform better on detecting age-related cognitive decline across the adult life span.…”

“…17 For our assessment, we use the lower cut point (e.g., 22 or 23 of 30) as suggested by recent research. 6,13,17 The current work presents, examines, and evaluates a serious game for cognitive health screening of the elderly, namely Smartkuber (Table 1, Fig. 1).…”