Validation of SATURN, a free, electronic, self‐administered cognitive screening test

Abstract

Background Cognitive screening is limited by clinician time and variability in administration and scoring. We therefore developed Self‐Administered Tasks Uncovering Risk of Neurodegeneration (SATURN), a free, public‐domain, self‐administered, and automatically scored cognitive screening test, and validated it on inexpensive (<$100) computer tablets. Methods SATURN is a 30‐point test including orientation, word recall, and math items adapted from the Saint Louis University Mental Status test, modified versions of the Stroop and Trails tasks, and other assessments of visuospatial function and memory. English‐speaking neurology clinic patients and their partners 50 to 89 years of age were given SATURN, the Montreal Cognitive Assessment (MoCA), and a brief survey about test preferences. For patients recruited from dementia clinics (n = 23), clinical status was quantified with the Clinical Dementia Rating (CDR) scale. Care partners (n = 37) were assigned CDR = 0. Results SATURN and MoCA scores were highly correlated ( P < .00001; r = 0.90). CDR sum‐of‐boxes scores were well‐correlated with both tests ( P < .00001) ( r = −0.83 and −0.86, respectively). Statistically, neither test was superior. Most participants (83%) reported that SATURN was easy to use, and most either preferred SATURN over the MoCA (47%) or had no preference (32%). Discussion Performance on SATURN—a fully self‐administered and freely available (https://doi.org/10.5061/dryad.02v6wwpzr) cognitive screening test—is well‐correlated with MoCA and CDR scores.

Digital Cognitive Biomarker for Mild Cognitive Impairments and Dementia: A Systematic Review

“…The remaining 7 studies were identified as having high risk because having a quality score range between 5 and 6, with 1 study from other single/multiple cognitive tests, 4 studies from computerized test battery, 1 study from handwriting/drawing tests, and 1 study from daily living tasks and serious games. Among the high-risk studies, 5 studies rated 6 on the NOS, 4 of them did not report matching or using statistical control for age and education level [ 38 , 47 , 57 , 76 ], and 1 study did not report educational level [ 73 ]. In total, 1 out of these 5 studies did not provide the information on the method of confirming the cognitive status of normal controls, and 4 of them did not adopt the same procedure for ascertainment for control and cases [ 39 , 57 , 73 , 76 ].…”

“…Among the high-risk studies, 5 studies rated 6 on the NOS, 4 of them did not report matching or using statistical control for age and education level [ 38 , 47 , 57 , 76 ], and 1 study did not report educational level [ 73 ]. In total, 1 out of these 5 studies did not provide the information on the method of confirming the cognitive status of normal controls, and 4 of them did not adopt the same procedure for ascertainment for control and cases [ 39 , 57 , 73 , 76 ]. In addition, another 2 studies rated 5 on the NOS, as they did not report matching or control age and education level and did not use the same procedure for ascertainment for control and cases [ 77 , 78 ].…”

“…Around 90% of the studies included in our review were identified as having high quality based on NOS rating. However, eight studies did not match or control for both age and educational level, including one study using the Digital Trail-Making Test-Black and White (dTMT-B&W) [ 47 ], Self-Administered Tasks Uncovering Risk of Neurodegeneration (SATURN) [ 76 ], BrainCheck [ 83 ], Computerized Screening Test System [ 77 ], Computer-Based Cognitive Assessment Tool (CompBased-CAT) [ 61 ], Cambridge Cognitive Examination administered by Computerized Adaptive Testing (CAMCOG-CAT) [ 78 ], one study using digital clock drawing test [ 57 ], and a serious game named Episodix [ 39 ]. Given that dementia is an age-related disease, and education level was suggested to be associated with as the risk for dementia a higher level of education level may protect people against dementia by increasing “intellectual reserve” [ 84 , 85 ].…”

The practice of teleneurology in the Philippines during the COVID-19 pandemic

“…The establishment of stroke networks using teleneurology provides early access for patients requiring thrombolysis [ 7 ]. Other explored methods of teleneurology are the utilization of self-administered questionnaires for the cognitive screening test for patients with dementia [ 23 ], evaluation of disability progression on patients with amyotrophic lateral sclerosis [ 22 ], and assessment of limitations in activities of daily living for patients with neuromuscular disease [ 20 , 21 ]. In patients with multiple sclerosis, their disability status is measured by incorporating data from wearable biosensors measuring average steps per day and applications such as Google Maps ™ that uses satellite imagery to measure the maximum walking distance [ 18 , 19 ].…”

Digital Phenotyping in Clinical Neurology

“…Recent research has shown that mobile self-administered versions of cognitive batteries or individual tests distinguish healthy individuals from individuals with MCI, Alzheimer's disease, or multiple sclerosis (MS), correlates with standard neuropsychological testing, and/or shows consistent performance when comparing clinic versus home administration. 88 89 90 91 92 93 94 95 96 Additionally, several large-scale, open source platforms have been developed to support the study of cognition in health and disease through self-administered tests performed at home (testmybrain.org, 97 labinthewild.org, 98 mobiletoolbox.org).…”