Stroop for electronic touchscreen self‐administration (eStroop) as used in the remote iPACES neuro‐exergaming trial for Mild Cognitive Impairment (MCI): An initial validation report

Abstract

AbstractBackgroundIn collaboration with the Mobile Monitoring of Cognitive Change (M2C2; 1‐U2C‐AG060408‐01) Project, our team developed a tablet‐based electronic Stroop (eStroop) task. Initial development explored direct translation of the paper‐Stroop (pStroop) often used in clinical settings, and found that this resulted in ceiling effects. Herein we report on initial validation of the eStroop task from the iPACES v3 clinical trial.MethodInitial validation examined eStroop data (n = 59 sessions) serially collected from ten MCI and caregiver participants in the iPACES v3 clinical trial (mean age = 70.2, mean years of education = 16.9). Included in analyses were eStroop data for both traditional metrics (i.e., overall accuracy by block condition), response time, as well as typically constructed difference/ratio scores (i.e., AC ratio). After a baseline tele‐neuropsychological evaluation in which paper Stroop was administered, at predetermined study intervals (typically weekly), participants were automatically prompted to complete the eStroop on their iPACES Android tablet. In the eStroop, participants were presented with four blocks of 40 trials: (1) color words in black font, (2) congruent word and font color; (3) incongruent words with font color; (4) mixed congruent and incongruent trials.ResultThe paper Stroop AC Ratio (total seconds to complete paper A, divided by time to complete paper C), was moderately negatively correlated (r = ‐0.52, p < .001) with average response time on block three of eStroop (incongruent words with font color). The pStroop AC Ratio was also significantly negatively correlated with number of errors on block one (r = ‐0.42, p < .001), two (r = ‐0.26, p = 0.04), three (r = ‐0.39, p = 0.002), and four (r = ‐0.26, p = .049). A weak, significant positive correlation (r = 0.44, p < .001) was observed between the AC ratio from pStroop and eStroop. Very weak non‐significant correlations between paper Stroop AC Ratio and average response time on blocks one, two, and four of eStroop were observed.ConclusionThese pilot data provide preliminary evidence that the eStroop can serve as a remotely and self‐administered digital test for serial assessment of executive function and will be further evaluated in our current iPACES study.