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84 Feasibility and Validity of Remote Digital Assessment of Multi-Day Learning in Cognitively Unimpaired Older Adults
- Emma L. Weizenbaum, Daniel Soberanes, Stephanie Hsieh, Olivia R Schneider, Shruthi Srinivasan, Rachel F Buckley, Michael J Properzi, Dorene Rentz, Keith A Johnson, Reisa A Sperling, Kathryn V Papp, Rebecca E Amariglio
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 487-488
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- Article
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Objective:
Unsupervised remote digital cognitive assessment makes frequent testing feasible and allows for measurement of learning across days on participants’ own devices. More rapid detection of diminished learning may provide a potentially valuable metric that is sensitive to cognitive change over short intervals. In this study we examine feasibility and predictive validity of a novel digital assessment that measures learning of the same material over 7 days in older adults.
Participants and Methods:The Boston Remote Assessment for Neurocognitive Health (BRANCH) (Papp et al., 2021) is a web-based assessment administered over 7 consecutive days repeating the same stimuli each day to capture multi-day-learning slopes. The assessment includes Face-Name (verbal-visual associative memory), Groceries-Prices (numeric-visual associative memory), and Digits-Signs (speeded processing of numeric-visual associations). Our sample consisted of200 cognitively unimpaired older adults enrolled in ongoing observational studies (mean age=74.5, 63% female, 87% Caucasian, mean education=16.6) who completed the tasks daily, at home, on their own digital devices. Participants had previously completed in-clinic paper-and-pencil tests to compute a Preclinical Alzheimer’s Cognitive Composite (PACC-5). Mixed-effects models controlling for age, sex, and education were used to observe the associations between PACC-5 scores and both initial performance and multi-day learning on the three BRANCH measures.
Results:Adherence was high with 96% of participants completing all seven days of consecutive assessment; demographic factors were not associated with differences in adherence. Younger participants had higher Day 1 scores all three measures, and learning slopes on Digit-Sign. Female participants performed better on Face-Name (T=3.35, p<.001) and Groceries-Prices (T=2.00, p=0.04) on Day 1 but no sex differences were seen in learning slopes; there were no sex differences on Digit-Sign. Black participants had lower Day 1 scores on Face-Name (T=-3.34, p=0.003) and Digit Sign (T=3.44, p=0.002), but no racial differences were seen on learning slopes for any measure. Education was not associated with any measure. First day performance on Face-Name (B=0.39, p<.001), but not learning slope B=0.008, p=0.302) was associated with the PACC5. For Groceries-Prices, both Day 1 (B=0.27, p<.001) and learning slope (B=0.02, p=0.03) were associated with PACC-5. The Digit-Sign scores at Day 1 (B=0.31, p<.001) and learning slope (B=0.06, p<.001) were also both associated with PACC-5.
Conclusions:Seven days of remote, brief cognitive assessment was feasible in a sample of cognitively unimpaired older adults. Although various demographic factors were associated with initial performance on the tests, multi-day-learning slopes were largely unrelated to demographics, signaling the possibility of its utility in diverse samples. Both initial performance and learning scores on an associative memory and processing speed test were independently related to baseline cognition indicating that these tests’ initial performance and learning metrics are convergent but unique in their contributions. The findings signal the value of measuring differences in learning across days as a means towards sensitively identifying differences in cognitive function before signs of frank impairment are observed. Next steps will involve identifying the optimal way to model multi-day learning on these subtests to evaluate their potential associations with Alzheimer’s disease biomarkers.
List of contributors
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- By Samantha Besson, T. R. Gavin Bingham, Ross Buckley, Barnali Choudhury, Thomas Cottier, Brooks W. Daly, Mariel Dimsey, Aline Doussin, Mark Ellis, Jonathan Gass, Christian Häberli, Monica Hakimi, Mariana Hernández-Crespo, Caroline Hess-Klein, Pasha L. Hsieh, Christopher Kee, Stuart Kerr, Markus Krajewski, Emmanuel Laryea, Stephanie B. Leinhardt, Gabrielle Marceau, Sarah Melikian, Bryan Mercurio, Krista Nadakavukaren Schefer, Willa Obel, Colin Picker, Mark Pieth, Ben Thirkell-White, Stephan Wilske, Yvonne Wong
- Edited by Krista Nadakavukaren Schefer, Universität Basel, Switzerland
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- Book:
- Poverty and the International Economic Legal System
- Published online:
- 05 July 2013
- Print publication:
- 21 March 2013, pp xi-xxii
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