COMPUTER SIMULATIONS FOR ASSESSING EVERYDAY COGNITIVE FUNCTIONING IN OLDER ADULTS

Abstract

To evaluate the validity, reliability and acceptability to users of five brief computer simulations of cognitively demanding, ecologically relevant activities when administered to older adults with no cognitive impairment, mild cognitive impairment and mild dementia. Five modules of the Simulation-Based Assessment of Cognition (SIMBAC) were developed for use on a computer tablet: recognizing faces, remembering names, filling a pillbox, using an automated teller machine (ATM), and a telephone renewal of a medication prescription. One hundred and sixty-one individuals >60 years of age were administered SIMBAC and separately given a clinical evaluation and classified as having no cognitive impairment (N=81), mild cognitive impairment (N=52) or mild dementia (N=28). Module scores for accuracy and time to complete (sec.) were calculated and summed for overall scores that were compared across groups; overall scores were also correlated with proxy-reported functional status questionnaires. Test-retest reliability was assessed over approximately one month. Participants rated the ecological relevance, face validity and user acceptability of each module. Clinical groups differed in both overall SIMBAC accuracy and time scores (p < 0.0001; p = 0.0015, respectively). Accuracy and time scores for the entire sample correlated with proxy-reported instrumental activities of daily living scores (rho = 0.68, -0.45, respectively; p<0.0001). SIMBAC demonstrated excellent ecological validity, face validity and user acceptability. Test-retest Intraclass correlation coefficients for total accuracy and total time scores were high (0.79 and 0.88, respectively).