Abstract
Cognitive impairments are a core feature of schizophrenia that have negative impacts on functional outcomes. However, it remains challenging to assess these impairments in clinical settings. Smartphone apps provide the opportunity to measure cognitive impairments in an accessible way; however, more research is needed to validate these cognitive assessments in schizophrenia. We assessed the initial accessibility, validity, and reliability of a smartphone-based cognitive test to measure cognition in schizophrenia. A total of 29 individuals with schizophrenia and 34 controls were included in the analyses. Participants completed the standard pen-and-paper Trail Making Tests (TMT) A and B, and smartphone-based versions, Jewels Trail Tests (JTT) A and B, at the single in-lab visit. Participants were asked to complete the JTT remotely once per week for three months. We also investigated how subjective sleep quality and mood may affect cognitive performance longitudinally. In-lab and remote JTT scores moderately and positively correlated with in-lab TMT scores. Moderate test-retest reliability was observed across the in-lab, first remote, and last remote completion times of the JTT. Additionally, individuals with schizophrenia had significantly lower performance compared to controls on both the in-lab JTT and TMT. Self-reported mood had a significant effect on JTT A performance over time but no other significant relationships were found remotely. Our results support the initial accessibility, validity and reliability of using the JTT to measure cognition in schizophrenia. Future research to develop additional smartphone-based cognitive tests as well as with larger samples and in other psychiatric populations are warranted.
Highlights
Schizophrenia is a chronically disabling psychiatric disorder estimated to affect 20 million people worldwide[1]
Our findings indicate that mindLAMP is a promising and well accepted EMA tool to assess cognitive performance in individuals with schizophrenia
We chose to only recruit individuals who already owned a smartphone as we wanted to test the mindLAMP app on varying smartphone makes, models, and operating systems, and to assess the potential of the app being used in settings where smartphones are not provided to the individual such as mental health clinics
Summary
Schizophrenia is a chronically disabling psychiatric disorder estimated to affect 20 million people worldwide[1]. Cognitive impairments are a core feature of schizophrenia and are known to impact social and occupational functioning[2,3]. While cognitive impairments influence the quality of life of individuals with schizophrenia, several factors limit their assessment in clinical settings[4]. Current assessments of cognition are limited to time and resources as they require highly trained professionals for administration, and take a long time to complete[4,5]. Cognitive assessments in psychiatry tend to rely heavily on retrospective self-reports which can be biaised[6]. Compliance to therapy and scheduled appointments is generally low in schizophrenia[7]. Long appointment duration for neuropsychological testing is not ideal for this population
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