Smartphone Cognitive Assessments in Adults with Early-onset Cognitive Changes: Feasibility, Acceptability, and Validity
Amy Wise1, Melissa Sotelo2, Eden Barragan2, Ashley Heywood2, Ray Fregly2, Emily Paolillo2, Hilary Heuer2, Sreya Dhanam2, Mark Sanderson-Cimeno2, Jack Taylor2, Josh Downer2, Anjali Sadarangani2, Rachel Nosheny2, Michael Weiner2, Scott Mackin2, Winnie Kwang2, Monica Camacho2, Katherine Possin2, Desiree Byrd3, Monica Rivera-Mindt3, Gil Rabinovici2, Adam Boxer2, Adam Staffaroni2
1UC Davis School of Medicine, 2University of California, San Francisco, 3Department of Neurology, Icahn School of Medicine at Mount Sinai
Objective:
To assess the feasibility, acceptability, and preliminary validity of a smartphone-based cognitive assessment in adults from racial and ethnic groups reflective of the US population who report subjective cognitive changes.
Background:
Digital health technologies can expand access to cognitive assessment, yet few studies have evaluated these for use in early-onset dementia research. BEYONDD is a multi-site observational study that validates biomarkers of early-onset cognitive and behavioral changes in underrepresented populations.
Design/Methods:
Participants from the BEYONDD cohort were invited to complete remotely delivered smartphone-based cognitive assessments (ALLFTD m-app), including executive function and episodic memory tasks. Participants also completed self-report questionnaires of technology familiarity, subjective cognitive concerns, and emotional reactions to the app. Analyses of covariance (ANCOVAs), controlling for age, sex, and education, quantified group differences in BEYONDD participants who endorsed subjective cognitive concerns compared to a sample of 123 healthy control participants from the Brain Health Registry. To enhance demographic representativeness, the normative comparison group was selected to match the BEYONDD cohort in age, sex, education, and racial/ethnic composition.
Results:
The sample included 63 participants (52 ± 6.9 years; 76% female; 43% non-Latino Black, 36% Latino, 10% non-Latino Asian, 8% multiracial). 98% reported high smartphone confidence. Adherence was high, with all participants completing all tests, and 97% found the time requirement acceptable. Emotional responses were largely positive, with 55% indicating enjoyment or excitement versus anxiety (23%), sadness (11%), or frustration (7%). After adjusting for age, sex, and education, greater confusion severity was associated with poorer executive function (b = −0.38, p < 0.001) and memory performance (b = −0.47, p = 0.004).
Conclusions:
Smartphone-based cognitive assessments were feasible, acceptable, and sensitive to self-reported cognitive changes. These results suggest that remote phone-based assessments may provide an avenue for enhancing access to research for non-traditional participants.
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