Development of a self-administered web-based test for longitudinal cognitive assessment.

Luis Ruano,Virgílio Bento,Andreia Sousa,Sandra Moreira,Márcio Colunas,Nuno Lunet,Cátia Mateus,Milton Severo,Joana Pais,Eduardo Conde,Vítor Tedim Cruz,Vítor Tedim Cruz,Vítor Tedim Cruz,Rui Barreto,Ivânia Alves,Joana Pais

doi:10.1038/srep19114

Abstract

Sequential testing with brief cognitive tools has been recommended to improve cognitive screening and monitoring, however the few available tools still depend on an external evaluator and periodic visits. We developed a self-administered computerized test intended for longitudinal cognitive testing (Brain on Track). The test can be performed from a home computer and is composed of several subtests, expected to evaluate different cognitive domains, all including random elements to minimize learning effects. An initial (A) and a refined version of the test (B) were applied to patients with mild cognitive impairment or early dementia (n = 88) and age and education-matched controls. A subsample of a population-based cohort (n = 113) performed the test at home every three months to evaluate test-retest reliability. The test’s final version Cronbach’s alpha was 0.90, test scores were significantly different between patients and controls (p = 0.001), the area under the receiver operating characteristic curve was 0.75 and the smallest real difference (43.04) was lower than the clinical relevant difference (56.82). In the test-retest reliability analysis 9/10 subtests showed two-way mixed single intraclass consistency correlation coefficient >0.70. These results imply good internal consistency, discriminative ability and reliability when performed at home, encouraging further longitudinal clinical and population-based studies.

Highlights

Patients with central nervous system (CNS) diseases at risk for cognitive deterioration
As an initial base for subtest development, we used simple computerized cognitive training exercises from an existing online platform (Cogweb), being developed by elements from the same research team since 200518. This web-based platform includes more than 60 cognitive training exercises that target different cognitive domains, allowing for remote cognitive training programs in the patient’s living environment. These exercises already passed through extensive usability testing in a wide spectrum of ages and disease models, and it was demonstrated that patients could use them independently and repeatedly from their home computers[18]
We describe the assembling of Brain on Track, a web-based self-administered test intended for longitudinal cognitive testing, and present the results of its early validation process

Summary

Introduction

It could prove useful to identify patients in prodromal phases of progressive neurodegenerative diseases to enroll in clinical trials. Computerized cognitive tests have existed for several decades, they have several known advantages for use in clinical and research settings: the reduced costs, the ability to accurately measure and store test responses and latency times, the minimization of examiner subjectivity and the potential for multiple test versions, allowing for adaptive testing[12,13]. Most of the existing computerized cognitive tests have been designed to mirror the comprehensive neuropsychological assessment batteries[15], applied by a trained professional in a clinical setting and not designed for screening or monitoring cognitive impairment[16]. We aimed to develop a web-based self-administered test intended for longitudinal cognitive screening and monitoring

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Conclusion