Assessment Instruments for Cognitive Function
Table of Contents
Assessment Instruments for Cognitive Function
The ubiquity of smartphones and tablets has led to a shift from traditional lab-based cognitive assessments to remote testing. Traditional cognitive testing typically occurs in controlled lab or clinic-based settings, where participants complete pen-and-paper tests. This method ensures a standardized environment but fails to capture the complexities of cognitive function over time and across different contexts. In contrast, remote testing via smartphones offers significant advantages including increased accessibility, enabling a broader and more diverse participant pool. It also supports continuous monitoring, which helps in detecting subtle cognitive changes and understanding variable interactions more effectively. Moreover, remote testing can reduce logistical costs and can boost participant engagement through gamified elements.
Despite these benefits, challenges such as device compatibility, data security, and ensuring participant compliance without direct supervision remain. Several platforms have recently become available to facilitate studies that perform remote cognitive assessments. We describe a few platforms that pilots can explore further.
NeuroUX
NeuroUX facilitates cognitive and behavioural data collection for clinical and academic studies using mobile technologies. Their platform offers validated cognitive tests including memory, psychomotor tests, executive function, emotion and social recognition, and attention. In addition to mobile cognitive tests, they also support EMAs, passive data collection from smartphone sensors (including GPS location), and Fitbit integration. They also support custom development and enhancements to their app.
Xpresso from MoCA
Xpresso from MoCA [1] [2] is a test that was designed by the group that developed the MoCA Test—or Montreal Cognitive Assessment— which is a widely adopted medical screening test used by healthcare professionals for early detection of cognitive decline and mild cognitive impairment (MCI). XpressO is a smartphone and tablet version that is designed to quickly test memory and brain performance on an individual’s own device. The test takes about 7 minutes and assesses processing speed, executive function and memory and provides a performance score stating low or elevated risk of cognitive decline. The test was validated to have strong association with standard MoCA (~85% accuracy in predicting MoCA score of < 25/30)
Neoiv Digital Cognitive Tests
Neotiv is a suite of digital cognitive tests that can be performed on a smartphone that is designed for detecting early preclinical cognitive impairment. Some of the tests that this platform supports includes digit symbol substitution, trail making, face name association, mnemonic discrimination, pattern completion and complex scene recognition. Each of these tests is designed to test specific brain regions. In a recent validation study with199 participants (97 healthy, 59 with subjective cognitive decline and 43 with MCI diagnosis), they showed that the diagnostic accuracy for discriminating memory impairment from no impairment is high (cross-validated AUC = 0.83, 95% CI [0.66, 0.99]) with a sensitivity of 0.82 and a specificity of 0.72 [3].
[1] Klil‐Drori, Sivan, Katie C. Bodenstein, Lara Kojok, Johanna Gruber, Shuo Mila Sun, Youssef Ghantous, and Ziad S. Nasreddine. “Montreal Cognitive Assessment MoCA‐XpressO: Validation of a Digital Self‐administered Cognitive Pre‐screening Tool for the General Adult Population.” Alzheimer’s & Dementia 19 (2023).
[2] Klil-Drori S, Bodenstein KC, Sun S, et al. Montreal Cognitive Assessment (MoCA) XpressO: Validation of a digital self-administered cognitive prescreening tool. Journal of the American Geriatric Society. 2024; 1-7.
[3] Berron, D., Glanz, W., Clark, L. et al. A remote digital memory composite to detect cognitive impairment in memory clinic samples in unsupervised settings using mobile devices. npj Digital Medicine 7, 79 (2024).