Continuum of measurement: Reviewing the advantages and disadvantages of self‐administered remote cognitive tests and their examiner administered alternatives

Abstract

AbstractBackgroundFour in 10 older adults own a smartphone in their 60s and beyond (Pew Research; 2017). Correspondingly, there has been surging interest in using digital cognitive assessments remotely to inform clinical and research practice with older adults and more comparisons between self‐ and examiner‐administered tests are needed.MethodAs part of a larger study, 1120 adults completed a battery of remotely administered tests (Mobile Toolbox) and a subset of this sample completed examiner administered in‐person testing (NIH Toolbox Cognition Battery). Attention was given to making the sample reflective of the US 2020 Census during participant recruitment. Of the 1120 participants, the majority of the sample were female (57%) and Caucasian (72%) and had a mean age of 45 (SD = 21). In terms of education, equal percentages had high school (34%) or some college (34%).ResultCognitive tests of processing speed, language, executive function, attention, and episodic memory were administered via a trained examiner and correlates of these tests were self‐administered remotely via a smartphone. Using examples, we will show which aspects of cognitive assessment had the best correlations between remote self‐administration and face‐to‐face examination and which had lower correlations.ConclusionFor geriatric individuals, remote assessments can be used to help over barriers for care, such as difficulty getting to the office location due to limited mobility or lack of transportation. Remote assessments reduce participant burden and expense and increase research accessibility for older adults. Capitalizing on the omnipresent nature of internet‐connected devices, this improves opportunities to remotely monitor other dimensions relevant to cognition using smartphone apps and wearable sensors. In addition to improving access to testing, digitally administered assessments dramatically improve some individual’s tolerance to testing with shorter tests that can be administered via computer adaptive testing (CAT). Despite these benefits, some aspects of the cognitive assessment cannot be adequately replicated remotely and thus yield lower correlations to their examiner‐administered alternatives. Clinical and research implications are discussed.