Computerized Neuropsychological Assessment Research Articles

Reliability, Validity, and User-Experience of Remote Unsupervised Computerized Neuropsychological Assessments in Community-Living 55- to 75-Year-Olds.

Self-administered computerized neuropsychological assessments (CNAs) provide lower cost, more accessible alternatives to traditional in-person assessments but lack critical information on psychometrics and subjective experience of older adults in remote testing environments. We used an online brief battery of computerized tasks selected from the Cogstate Brief Battery (CBB) and Cambridge Brain Sciences (CBS) to 1) determine test-retest reliability in an unsupervised setting; 2) examine convergent validity with a comprehensive 'gold standard' paper-and-pencil neuropsychological test battery administered in-person; and 3) explore user-experience of remote computerized testing and individual tests. Fifty-two participants (mean age 65.8±5.7 years) completed CBB and CBS tests on their own computer, unsupervised from home, on three occasions, and visited a research center for an in-person paper-and-pencil assessment. They also completed a user-experience questionnaire. Test-retest reliabilities varied for individual measures (ICCs = 0.20 to 0.83). Global cognition composites showed excellent reliability (ICCs > 0.8 over 1-month follow-up). A strong relationship between a combination of CNA measures and paper-and-pencil battery was found (canonical correlation R = 0.87, p = 0.04). Most tests were rated as enjoyable with easy-to-understand instructions. Ratings of general experience with online testing were mostly favorable; few had difficulty concentrating (17%) or using the computer for tasks (10%), although over one-third experienced performance anxiety (38%). A combined brief online battery selected from two CNAs demonstrated robust psychometric standards for reliability (global composite), and convergent validity with a gold standard battery, and mostly good usability and acceptability in the remote testing environment.

Computer‐administered neuropsychological assessment batteries: Validity, reliability, and user experience in an Australian sample of community‐living older adults in the CogSCAN Study

AbstractBackgroundAccess to a “gold‐standard” in‐person neuropsychological assessment to detect cognitive decline in older adults using paper‐and‐pencil (PnP) tests is limited. Computerized neuropsychological assessments (CNAs) potentially provide lower cost, scalable, accessible alternatives but critical psychometric data on the validity, reliability and user‐experience of CNAs in older adults are lacking.Method263 community‐dwelling individuals aged 60 years and older without dementia were assigned to complete two CNA batteries and one standardised neuropsychological assessment with 14 PnP tests, one week apart (Construct Validity Group) or two CNAs on two occasions, one month apart (Reliability Group). CNAs were self‐administered under supervision. Orders of CNA batteries, and of CNA and PnP sessions were counterbalanced (Figure 1). Participants completed questionnaires evaluating their experience after each CNA battery. Four CNA batteries were investigated: Cambridge Brain Sciences (CBS), CANTAB, Cogstate, and NIH Toolbox, each containing 5—8 tests; key variables recommended by the test developers were examined (Table 1).ResultParticipant characteristics are summarised in Table 2. Concurrent Validity: Modest correlations (r’s of 0.3‐0.6) between CNA and PnP measures were observed for all CNA batteries, generally aligning with corresponding domains, though notably reflecting the multidimensionality of cognitive measures (Table 3); the strongest associations (r ≥0.5) were with attention and processing speed measures across three CNA batteries, also NIH Toolbox vocabulary, memory and executive measures.Reliability: One‐month test‐retest reliabilities of individual measures were variable (Table 4); across three batteries some, typically speed measures, had reliability coefficients ≥ 0.7. User Experience: Completion rates were high (96‐100%). Usability ratings of CNAs were high on average, although variability was large for CBS (Figure 2). Ratings of acceptability were lower than usability, though on average, participants endorsed CNAs positively.ConclusionA selection of computerized measures demonstrated adequate psychometric standards for concurrent validity with ‘gold standard’ in‐person neuropsychological assessments, alongside good usability and acceptability, though test‐retest reliability was low for many measures. CogSCAN’s comprehensive comparative data will guide researchers in selecting the most suitable CNA measures for older adults. Work in progress is investigating CNA validity, reliability and user experience in older adults with cognitive decline and culturally and linguistically diverse older adults.

Predictors of acceptability and emotional response to computerized neuropsychological assessments in older adults: The CogSCAN Study

AbstractBackgroundComputers and related technologies are increasingly used for cognitive assessment. However, few studies have considered older adults’ experience using computerized neuropsychological assessment (CNA), or individual characteristics that may influence acceptability and emotional responses to computerized tests.Method205 community‐dwelling native English speakers aged 60‐95 were randomly assigned to complete two of four CNA batteries: Cogstate, CANTAB, CBS, and NIH Toolbox, on an iPad. After test completion, participants rated their emotions during testing on a Mood Adjective Checklist (MAC) with four subscales ‐ high stress (worried), low stress (relaxed), high arousal (energised), low arousal (tired), and provided ratings of test acceptability. Multiple regression analyses investigated associations of demographics (age, sex, education), cognitive level (MoCA, premorbid ability), subjective memory, mood over the past week (depression, anxiety, stress), computer/technology attitudes and experience, with the four MAC subscales and test acceptability score. Parallel analyses were performed in a subsample of participants also completing a pen‐and‐paper neuropsychological battery (PnP). Potential differences in predictors for CNA and PNP and the influence of potential confounders (PnP yes/no, CNA test pair) were examined.ResultOver half of the participants had considerable experience with computers or tablets (Table 1). Demographics were not significantly related to emotion ratings or test acceptability and were excluded from further analyses. Higher stress over the past week was associated with feeling more worried and tired during test‐taking. Higher premorbid ability was associated with feeling less relaxed (Table 2). Greater computer anxiety, higher premorbid ability and more computer experience were associated with lower CNA acceptability. Although some predictors of PnP acceptability and emotional response differed (Table 3), interactions between predictors and testing mode were non‐significant for all outcome variables (p’s> .05). Inclusion of potentially confounding variables did not alter the overall findings.ConclusionRecent mood, cognitive level, computer attitudes and experience influenced emotions during testing and test acceptability. These relationships and their potential association with CNA and PnP performance will be investigated in future work. Data on emotional response to testing and test acceptability will need to be triangulated with psychometric information about CNA and PnP measures to determine the most suitable test options for individuals.

Internet-based assessment technology for age-related cognitive impairment

With the population aging, the number of elderly with Alzheimer′s disease or other types of dementia is increasing, which seriously threatens the health and quality of life in elderly. The early screening and detection of dementia among high-risk population and appropriate interventional measures would delay the disease course, and maintain patients′ self-care abilities and dignity. Computerized neuropsychological assessment devices are economic and efficient, and suitable for screening in large population. This article reviews the theory, characteristics and application of internet-based neuropsychological assessment for age-related cognitive impairment, as well as the prospect in the future studies. Key words: Cognitive impairment; Internet technology; Screening

A Retrospective Cross-Sectional and Longitudinal Study of the Effects of Age on CNS Vital Signs Scores in High-School Athletes.

Current recommendations for concussion management acknowledge the importance of objective assessments of neuropsychological (NP) ability, and computerized NP assessments have been widely integrated into the concussion management protocols of high schools. The optimal intervals for baseline test administration in high-school athletes are currently uncertain. The ability to accurately detect subtle NP deficits is particularly important for high-school athletes, in which concussions are increasingly recognized for adverse effects to the developing brain. The aim of this study was to assess the pattern of change in neurocognitive test performance, as well as changes in different domains of NP functioning over time. Baseline computerized NP assessments were conducted at six high schools over 4academic years using CNS Vital Signs, a battery consisting of seven well-established NP tests. Data were retrospectively examined for age differences in both cross-sectional (n=3015) and longitudinal (n=1221) analyses. Moderate changes were observed across several NP domains over time (Cohen's d=0.39-0.61), with the largest improvements observed in executive functioning (mean improvement 5.78, 95% confidence interval [CI] 5.41-6.14, p<0.001), psychomotor speed (mean improvement 4.59, 95% CI 3.97-5.22, p<0.001), cognitive flexibility (mean improvement 5.11, 95% CI 4.76-5.45, p<0.001), and reaction time (mean improvement -12.44ms, 95% CI -10.10 to -14.78, p<0.001). Improvements in NP performance were most pronounced between the freshman and senior years. There is an appreciable change that occurs each year of high school in one or more domains of an NP battery, with executive functioning indicating the greatest magnitude of change. Females performed better relative to males across all time pointsthough males exhibited more substantial improvement over time.

Correlation between Allen cognitive level test and CANTAB in patients with

Background and Aim: Schizophrenia is a severe psychiatric disorder and characterized by impairments in a wide range of cognitive domains. Allen Cognitive Level Screen has been used extensively by occupational therapists as a quick screening tool to derive a view of cognitive function in people with psychiatric disabilities . Cambridge Neuropsychological Test Automated Battery (CANTAB) is a computerized neuropsychological assessment battery which is commonly used to assess an executive functioning. The purpose of this study was to examine the relationship between two measures of executive function used by different disciplines (Allen cognitive level test and CANTAB) when assessing persons with schizophrenia. Materials and Methods : In this cross-sectional study, the relation between Allen cognitive level test`s outcome and subtests of CANTAB (SWM, SSP & IED( were investigated in 30 patients with chronic schizophrenia (Mean age= 39 , man=80%,woman=20%). Allen cognitive level test was used to measure cognitive level and Spatial Span (SSP) to measure working memory capacity, Spatial Working Memory (SWM) to evaluate working memory and its strategy of usage and Intra/Extra dimensional Set Shift (IED) to assess attentional set shifting. All the data was analyzed by SPSS-16. Results: No Significant correlation was found between cognition levels of Allen test and SWM subtest (r S = -0/046; P=0/811), SSP (r S =0/009; P= -0/024) and IED (r S = -0/074; P=0/699). Conclusion: The findings of this study suggest that although patients with schizophrenia might have problems in cognitive component, they may show less problem in performing goal directed activities. In addition, the approaches of evaluation based on which the tests have been planned should be considered for investigating the correlation between two tests. It seems that the results of a top-down approach may be different from those of a bottom-up approach. Key word: Schizophrenia, Allen cognitive level test, CANTAB, executive functions