Remote App‐Based Assessment of Memory and Executive Functioning in Aging and Pre‐Clinical Alzheimer’s Disease in a Diverse Sample of Older Adults

Abstract

AbstractBackgroundMobile, valid and engaging cognitive assessments are essential for detecting and tracking change in research participants and patients at risk for Alzheimer’s Disease and Related Dementias (ADRDs). This pilot study aims to determine the feasibility and generalizability of at‐home, app‐based cognitive assessments included in the mobile cognitive app performance platform (mCAPP), to detect cognitive changes associated with aging and preclinical AD.MethodThe mCAPP includes three gamified tasks (Figure 1): (1) a “concentration” memory task that includes learning and matching hidden card pairs with increasing memory load, pattern separation features (lure vs. non‐lure), and spatial memory (2) a stroop‐like task (“brick drop”) with speeded word and color identification and response inhibition components and (3) a digit‐symbol coding‐like task (“space imposters”) with increasing pairs and incidental learning components. Participants completed the NACC UDS3 and additional paper and pencil tests. Participants used the mCAPP at home for two weeks. Participants included sixty older adults (73% female; age = 71.9±4.6, education = 16.6±2.4; 50% White, 48% Black/African American, 2% Multiracial) without cognitive impairment enrolled in the Penn ADRC cohort.ResultParticipants played 12±5.1 sessions over two weeks for 11.5±2.8 min/session, with 68% playing more than the assigned sessions. Almost all participants (98%) used a smartphone and 62% played games on their phone. Usability rating was 6.3±0.8 (1‐7 scale) and most participants reported task difficulty was just right (70%‐95%). 68% reported preferring mobile device based cognitive assessment to standard in‐person cognitive batteries. All tasks showed lower performance with increasing cognitive load (p’s<.05). Age and education correlated with both mCAPP and traditional cognitive measures. Concentration performance correlated with UDS3 memory measures and the PACC overall (p’s<.05), however when examined by self‐identified racial group, relationships remained significant in White participants, but not in Black/African American participants (Figure 2). Brick drop performance correlated with the Stroop task (p<.05) and space imposters performance correlated with the Digit Symbol Substitution Test (p<.001) within all groups.ConclusionThis pilot study shows app usability for at‐home use in a diverse cohort of older adults. Performance across measures indicate initial reliability and validity of mCAPP with attention needed to differences in performance across participants with diverse sociodemographic backgrounds.