Digital Cognitive Phenotyping using a Smartphone Application Among Community‐Dwelling Older Malaysians in the Transforming Cognitive Frailty in Later‐Life Self‐Sufficiency (AGELESS) Study

Abstract

AbstractBackgroundThe WHO’s dementia research blueprint highlighted assessment tools of cognition and function development as a strategic goal with specific need for validated tools in lower‐ to middle‐income countries (LMIC). The limited availability of such tools in LMICs is attributed to the population diversity. Malaysia is a multi‐ethnic, multi‐cultural, and multi‐religious LMIC within Southeast Asia. Challenges include cultural and educational bias and requirement for multiple translations for written tools. This study, therefore, aimed to develop and evaluate a digital tool using a smartphone application within an existing ageing cohort in Malaysia.MethodThe Transforming Cognitive Frailty into Later‐Life Self‐Sufficiency (AGELESS) study combined three pre‐existing longitudinal studies of ageing from 2013, involving individuals aged 55y recruited through electoral rolls and sampling frames. Individuals attending AGELESS health checks were invited to download a smartphone application digital protocol developed as part of a collaboration established through the Davos Alzheimer’s Collaborative. Participants were assisted in registration and assessment completion (Figure 1).ResultRecruitment commenced in October 2022 through four mass screening activities each involving 100 participants. 141 were recruited into a pilot to test feasibility. Twenty‐three of the 141 (16.3%) completed all 10 tasks delivered in‐person (5 tasks) and remotely (5 tasks). The protocol was modified so two tasks were completed in‐person and an additional eleven tasks were completed remotely. The fourth screening recruited 53 participants of whom 22 (41.5%) completed all assessments. The basic characteristics of the participants recruited are summarized in Table 1. Issues identified were shared with the Boston University team following each session. Initially, registering or issues with starting tasks occurred with Android smartphones. Other difficulties included environmental noise and difficulties with instructions provided.ConclusionThe recruitment and initial cognitive assessment using a smartphone application of older Malaysians appear feasible, but adaptions are required to facilitate this process. Changes in the apps Android software and protocol adjustments enhanced completion rates by 150%. Future developments will focus on processes to ensure completion of the assessment not just at baseline but also at regular follow‐up intervals.