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

Article type: Research Article

Authors: Kochan, Nicole A.^{a; *} | Heffernan, Megan^a | Valenzuela, Michael^{a; b} | Sachdev, Perminder S.^{a; c; h} | Lam, Ben C.P.^a | Fiatarone Singh, Maria^{d; e} | Anstey, Kaarin J.^{f; g; h} | Chau, Tiffany^a | Brodaty, Henry^{a; h}

Affiliations: [a] Centre for Healthy Brain Ageing (CHeBA), Discipline of Psychiatry and Mental Health, UNSW Medicine and Health, University of New South Wales, Sydney, Australia | [b] Skin2Neuron Pty Ltd, Sydney, Australia | [c] Neuropsychiatric Institute, The Prince of Wales Hospital, Sydney, Australia | [d] Sydney School of Health Sciences and Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia | [e] Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA | [f] School of Psychology, University of New South Wales, Sydney, Australia | [g] Neuroscience Research Australia, Sydney, Australia | [h] UNSW Ageing Futures Institute, University of New South Wales, Sydney, Australia

Correspondence: [*] Correspondence to: Nicole A. Kochan, PhD, Centre for Healthy Brain Ageing (CHeBA), Discipline of Psychiatry and Mental Health, UNSW Medicine and Health, University of New South Wales NSW 2056, Australia. Tel.: +61 612 9385 7357; E-mail: n.kochan@unsw.edu.au.

Abstract: Background: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. Objective: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. Methods: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. Results: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%). Conclusion: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.

Keywords: Healthcare acceptability, mental status and dementia tests, neuropsychological tests, psychometrics

DOI: 10.3233/JAD-220665

Journal: Journal of Alzheimer's Disease, vol. 90, no. 4, pp. 1629-1645, 2022