AAIC21: Cognitive assessment studies hint at promise using self-testing, telehealth routes

Research findings presented Monday at the Alzheimer's Association International Conference (AAIC) provide preliminary support for remote, self-administered cognitive testing of older adults using the Survey for Memory, Attention, and Reaction Time (SMART) assessment tool. Meanwhile, another study presented at AAIC suggests that telehealth-based evaluation of cognition in older adults may offer similar results to traditional in-person testing.

Researchers of the first study noted that the SMART protocol has been deployed in longitudinal cohort studies of older adults for over two years. "The SMART consists of four face-valid cognitive tasks available in the public domain assessing visual memory, attention, processing speed and executive functioning," they explained.

The trial included 44 older adults classified as cognitively intact and 25 with mild cognitive impairment (MCI). The SMART was sent to participants via email once per month and they completed the assessment using their computer, tablet or smart phone. Participants also completed a neuropsychological battery and self- and informant-rated measures of everyday cognition. Primary SMART outcomes comprised subtest completion time, while secondary meta-metrics included SMART executive functioning subtasks, such as click count and total completion time.

Slower completion tied to reduced global cognition

The SMART executive functioning subtasks were the strongest predictors of cognitive status. Longer total completion time was correlated with reduced global cognition and lower self- and informant-rated perceptions of everyday cognition. Further, the SMART was rated as highly usable, with no difference between the MCI and cognitively intact groups. Over three-months, 87% of participants completed the SMART within the first three days of receiving the tool, with 100% completion following a reminder call.

"Given the prevalence of executive functioning deficits among non-amnestic MCI presentations, the SMART may prove particularly valuable for increasing access to cognitive assessment for diverse, heterogenous older adults with increased vascular risk factors, medical comorbidities and health disparities," the authors said.

Meanwhile, the second study built on earlier work that the researchers said had found "essentially equivalent results across teleneuropsychological versus traditional in-person test conditions, with intraclass correlations around .80 and high levels of satisfaction with the procedures." They said additional findings found that teleneuropsychological techniques were able to discriminate older adults with and without cognitive impairment similar to traditional in-person assessment.

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