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32 Influence of Prior Experience with Computer-Based Technology on Tablet-Based Neurocognitive Test Performance: Data from a sample of cognitively impaired South African older adults
- Nina S Steenkamp, Hetta-Mari Gouse, Rhiannon Changuion, Christopher M Ferraris, Daphne Tsapalas, Nana Asiedu, Anthony F Santoro, Kevin G. F. Thomas, Reuben N Robbins
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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. 713-714
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Objective:
The global prevalence of persons living with dementia will soon exceed 50 million. Most of these individuals reside in low- and middle-income countries (LMICs). In South Africa, one such LMIC, the physician-to-patient ratio of 9:10 000 severely limits the capacity of clinicians to screen, assess, diagnose, and treat dementias. One way to address this limitation is by using mobile health (mHealth) platforms to scale-up neurocognitive testing. In this paper, we describe one such platform, a brief tablet-based cognitive assessment tool (NeuroScreen) that can be administered by lay health-providers. It may help identify patients with cognitive impairment (related, for instance, to dementia) and thereby improve clinical care and outcomes. However, there is a lack of data regarding (a) the acceptability of this novel technology for delivery of neurocognitive assessments in LMIC-resident older adults, and (b) the influence of technology-use experience on NeuroScreen performance of LMIC-resident older adults. This study aimed to fill that knowledge gap, using a sample of cognitively impaired South African older adults.
Participants and Methods:Participants were 60 older adults (63.33% female; 91.67% right-handed; age M = 68.90 years, SD = 9.42, range = 50-83), all recruited from geriatric and memory clinics in Cape Town, South Africa. In a single 1-hour session, they completed the entire NeuroScreen battery (Trail Making, Number Speed, Finger Tapping, Visual Discrimination, Number Span Forward, Number Span Backward, List Learning, List Recall) as well as a study-specific questionnaire assessing acceptability of NeuroScreen use and overall experience and comfort with computer-based technology. We summed across 11 questionnaire items to derive a single variable capturing technology-use experience, with higher scores indicating more experience.
Results:Almost all participants (93.33%) indicated that NeuroScreen was easy to use. A similar number (90.00%) indicated they would be comfortable completing NeuroScreen at routine doctor's visits. Only 6.67% reported feeling uncomfortable using a tablet, despite about three-quarters (76.67%) reporting never having used a tablet with a touchscreen before. Almost one in five participants (18.33%) reported owning a computer, 10.00% a tablet, and 70.00% a smartphone. Correlations between test performance and technology-use experience were statistically significant (or strongly tended toward significance) for most NeuroScreen subtests that assessed higherorder cognitive functioning and that required the participant to manipulate the tablet themselves: Trail Making 2 (a measure of cognitive switching ability), r = .24, p = .05; Visual Discrimination A (complex processing speed [number-symbol matching]), r = .38, p = .002; Visual Discrimination B (pattern recognition), r = .37, p = .004; Number Speed (simple information processing speed), r = .36, p = .004. For the most part, there were no such significant associations when the NeuroScreen subtest required only verbal input from the participant (i.e., on the list learning and number span tasks).
Conclusions:NeuroScreen, a tablet-based neurocognitive screening tool, appears feasible for use among older South Africans, even if they are cognitively impaired and have limited technological familiarity. However, test performance might be influenced by amount of technology-use experience; clinicians using the battery must consider this in their interpretations.
52 Demographic influences on test performance may not be universal: considerations from a cross-country comparison of South Africa and Zimbabwe
- Shathani Rampa, Desiree Byrd, Primrose Nyamayaro, Hetta Gouse, Reuben N Robbins
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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. 730-731
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Objective:
Appropriate adjustments to normative data for neuropsychological (NP) tests are imperative for their equitable use in brain health practices. Age and education are known to be strong predictors of test performance. In settings where validated tests are not available, common practice has been to adapt and apply them in similar fashion as settings where they were developed. However, demographic adjustments cannot be assumed de facto to be universal in their strength and domain associations. For example, South Africa (SA) and Zimbabwe are neighboring countries with some similarities in their demographic makeup, but with vastly different sociopolitical trajectories- Zimbabwe was colonially occupied until 1980 and SA was oppressed under Apartheid until 1994- which have impacted access to and quality of education by severely limiting educational opportunities for native citizens. The present study explored whether the direction and strength of relationships between age and education on NP test performance were similar or not between SA and Zimbabwe adults living with and without HIV.
Participants and Methods:Data was extracted from two IRB-approved studies in SA and Zimbabwe with similar inclusion and exclusion criteria. The SA sample (n=214) was comprised of 56% females, 48% HIV-positive adults, mean age of 34 years, and a nine-year range in education (3-14 years). The Zimbabwe sample (n=212) was comprised of 68% females, 67% HIV-positive adults, mean age of 36 years, and a thirteen-year range in education (7-20 years). Participants completed NeuroScreen, a tablet-based battery of 12 brief NP tests adapted for indigenous SA and Zimbabwe languages. The two study samples were analyzed separately. Zero order correlations between each of the tests and age and gender were conducted to determine the influence of the demographic variables. Relationships with moderate correlations (r>0.3) in both samples were further analyzed using univariate ANOVA to examine the main effects and interactions of age and education
Results:Overall, there was a similar pattern of results across samples, with nine tests showing no-to-low associative relationships with age and education respectively. Moderate, significant relationships were found between age, education and three tests of processing speed (Visual Discrimination A, Visual discrimination B, and Number Speed) in both samples. Age and education had different effects on Visual discrimination A across samples with a significant main effect for age but not education in SA [F(40,83)=3.060, p<0.01], whilst Zimbabwe had a significant main effect for education but not age [F(10,87)=4.541, p<0.01]. Visual Discrimination B and Number Speed showed significant main effects for both variables in both samples. However, there was a significant interaction for both tests in Zimbabwe only.
Conclusions:The current study is novel in its exploration of country-specific relationships between NP test performance and demographic factors in settings where assessment science is emergent. Results demonstrate the presence of differential relationships between demographic variables on test performance which raises questions about the source of these differences. One important potential source is the socio-cultural context of each country and the intersection of demographic factors in these contexts. Further research is required to explore these considerations.
93 Acceptability and Usability of Tablet-Based Neuropsychological Tests among South African and Ugandan Adolescents With and Without HIV
- Christopher M Ferraris, Rebecca Dunayev, Nour Kanaan, Courtney E Kirsch, Corey Morrison, Nana Asiedu, Daphne Tsapalas, Anthony F Santoro, Nicole J Phillips, Jacqueline Hoare, Angel Nanteza, Joy L Gumikiriza-Onoria, Victor Musiime, Sahera Dirajlal-Fargo, Reuben N Robbins
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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. 495-496
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Objective:
Neuropsychological (NP) tests are increasingly computerized, which automates testing, scoring, and administration. These innovations are well-suited for use in resource-limited settings, such as low- to middle- income countries (LMICs), which often lack specialized testing resources (e.g., trained staff, forms, norms, equipment). Despite this, there is a dearth of research on their acceptability and usability which could affect performance, particularly in LMICs with varying levels of access to computer technology. NeuroScreen is a tablet-based battery of tests assessing learning, memory, working memory, processing speed, executive functions, and motor speed. This study evaluated the acceptability and usability of NeuroScreen among two groups of LMIC adolescents with and without HIV from Cape Town, South Africa and Kampala, Uganda.
Participants and Methods:Adolescents in Cape Town (n=131) and Kampala (n=80) completed NeuroScreen and questions about their use and ownership of, as well as comfort with computer technology and their experiences completing NeuroScreen. Participants rated their technology use -comfort with and ease-of-use of computers, tablets, smartphones, and NeuroScreen on a Likert-type scale: (1) Very Easy/Very Comfortable to (6) Very Difficult/Very Uncomfortable. For analyses, responses of Somewhat Easy/Comfortable to Very Easy/Comfortable were collapsed to codify comfort and ease. Descriptive statistics assessed technology use and experiences of using the NeuroScreen tool. A qualitative question asked how participants would feel receiving NeuroScreen routinely in the future; responses were coded as positive, negative, or neutral (e.g., “I would enjoy it”). Chi-squares assessed for group differences.
Results:South African adolescents were 15.42 years on average, 50.3% male, and 49% were HIV-positive. Ugandan adolescents were 15.64 years on average, 50.6% male, and 54% HIVpositive. South African participants were more likely than Ugandan participants to have ever used a computer (71% vs. 49%; p<.005), or tablet (58% vs. 40%; p<.05), whereas smartphone use was similar (94% vs 87%). South African participants reported higher rates of comfort using a computer (86% vs. 46%; p<.001) and smartphone (96% vs. 88%; p<.05) compared to Ugandan participants. Ugandan adolescents rated using NeuroScreen as easier than South African adolescents (96% vs. 87%; p<.05).). Regarding within-sample differences by HIV status, Ugandan participants with HIV were less likely to have used a computer than participants without HIV (70% vs. 57%; p<.05, respectively).The Finger Tapping test was rated as the easiest by both South African (73%) and Ugandan (64%) participants. Trail Making was rated as the most difficult test among Ugandan participants (37%); 75% of South African participants reported no tasks as difficult followed by Finger Tapping as most difficult (8%). When asked about completing NeuroScreen at routine doctor’s visits, most South Africans (85%) and Ugandans (72%) responded positively.
Conclusions:This study found that even with low prior tablet use and varying levels of comfort in using technology, South African and Ugandan adolescents rated NeuroScreen with high acceptability and usability. These data suggest that scaling up NeuroScreen in LMICs, where technology use might be limited, may be appropriate for adolescent populations. Further research should examine prior experience and comfort with tablets as predictors NeuroScreen test performance.
Detection of inadequate effort on the California Verbal Learning Test-Second edition: Forced choice recognition and critical item analysis
- JAMES C. ROOT, REUBEN N. ROBBINS, LUKE CHANG, WILFRED G. VAN GORP
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- Journal:
- Journal of the International Neuropsychological Society / Volume 12 / Issue 5 / September 2006
- Published online by Cambridge University Press:
- 08 September 2006, pp. 688-696
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The Forced Choice Recognition (FCR) and the Critical Item Analysis (CIA) indices of the California Verbal Learning Test-II (CVLT-II) have been identified by the CVLT-II test developers as potentially useful, brief screening indicators of effort in neuropsychological assessment. This retrospective study analyzes performance on these measures in three groups: (1) clinically referred individuals; (2) forensically referred individuals not suspected of inadequate effort; and (3) forensically referred individuals whose performance on freestanding tests of effort suggested inadequate effort. Performances on FCR were analyzed for their relation to actual memory impairment and with regard to concrete and abstract distractor endorsement. FCR and CIA performances were analyzed for agreement with formal tests of inadequate effort and their test characteristics. Incremental validity was assessed by hierarchical logistic regression with previously identified indices for detection of inadequate effort on the CVLT. Results indicate that (1) FCR and CIA performances are not related to decreased memory performance; (2) FCR and CIA indices exhibit higher specificity and lower sensitivity, with higher positive predictive value than negative predictive value; and (3) FCR and CIA indices exhibit modest incremental validity with previously identified indices. Implications for use of FCR and CIA indices in inadequate effort detection are discussed (JINS, 2006, 12, 688–696.)