Research Article
Dement Geriatr Cogn Disord
DOI: 10.1159/000526907

Received: May 11, 2022
Accepted: August 30, 2022
Published online: December 1, 2022

Shorter Version of the Brain Assessment
Is Suitable for Longitudinal Public
Cognitive Evaluations
Masayuki Satoh a Ken-ichi Tabei b Makiko Abe a Chiaki Kamikawa a
Saiko Fujita c Yoshinori Ota caDepartment of Dementia and Neuropsychology, Advanced Institute of Industrial Technology, Tokyo Metropolitan

Public University Corporation, Tokyo, Japan; bSchool of Industrial Technology, Advanced Institute of Industrial
Technology, Tokyo Metropolitan Public University Corporation, Tokyo, Japan; cResearch Institute of Brain
Activation, Tokyo, Japan

Abstract
Introduction: We have developed an online cognitive test
(Brain Assessment [BA]) which exhibits moderate correlations with established neuropsychological tests. We made ashort version of the BA that requires only 10 min and investigated correlations with the original version. Participantsand Methods: Three hundred and twenty-three subjects(26–82 years old, mean age 41.9 years) were recruited via theinternet and performed the original version of the BA online,
and, for the analyses of the original and short version, theresults of the whole and of the first 2 min were utilized, respectively. Correlations were evaluated between both versions, and 144 subjects agreed to be interviewed about BA
utilization. Results: Correlations between the short and original versions of the BA were strong (memory of numbers, r =0.72: total, r = 0.73) or moderate (memory of words, r = 0.66;
visuospatial, r = 0.42; working memory, r = 0.53; judgment, r= 0.54). We found a strong negative correlation between the“memory of words” subtest and age (short version, r = −0.85;

Karger@karger.com
www.karger.com/dem© 2022 S. Karger AG, Baseloriginal version, r = −0.88). Regarding the interview, mostwanted to be assessed by the short version every year. In thecase of a concerning score, they would then want to be examined by the original version of the BA and/or more specific neuropsychological tests. Discussion: We found thatthe short and the original versions of the BA exhibited strong
correlations, and the correlation coefficients between age
and subtest scores were almost the same between the two
versions. Conclusion: The short version of the BA will be useful to perform cognitive assessments in the clinic.
© 2022 S. Karger AG, Basel

Introduction

There are several problems with standard in-person
neuropsychological assessments, such as habituation,commitment of human resources, lack of cross-sectional
evaluation, and difficulty of in-person assessments undersocietal conditions during the era of COVID-19. Thus, wedeveloped an online cognitive test (the Brain Assessment[BA]) that covers five fields: number memory, word
memory, mental rotation, working memory (N-backtest), and judgment [1]. The N-back test was first repreCorrespondence to:
Masayuki Satoh, satou-masayuki @ aiit.ac.jp

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Keywords
Brain Assessment · Short version · Correlation · Cognitive
declineTable 1. Mean CSs of the short version of the BA by age in 5- or 10-year increments
Age

25–30
31–35
36–40
41–50
51–60
61–70
71–80
(81–85)
TotalaSubject
numbers

MemoryVisuospatial

WorkingmemoryJudgment

Total

m/f

numbers
m/f

words
m/f

m/f

m/f

m/f

m/f

37/37
29/37
26/45
14/17
15/19
12/14
11/9
(0/1)
144/179

73.3/76.9
71.8/73.5
75.4/10.5
73.8/63.5
65.2/60.5
61.3/53.5
52.4/58.5(/15.0)65.9/65.3

67.1/66.2
65.8/68.8
69.7/63.5
67.0/61.2
48.8/59.2
53.0/55.1
49.8/48.7(/34.0)58.2/60.4

61.8/55.6
67.1/54.6
65.5/53.6
68.6/51.1
58.9/55.8
62.7/47.8
44.2/39.5(/37.0)60.3/51.1

65.2/65.1
67.3/60.1
63.1/62.7
68.1/59.4
61.8/65.5
65.0/53.0
50.0/58.4(/38.0)62.3/60.6

69.0/60.1
73.3/62.1
68.9/60.3
68.9/56.8
66.5/50.9
57.7/49.9
51.3/51.7(/34.0)63.6/56.0

67.3/64.8
69.1/63.8
68.5/62.1
69.3/58.4
60.2/58.4
59.9/51.9
49.5/51.4(/31.6)62.1/58.7

CS. cognitive score; f, female; m, male. a Total mean values did not contain subjects over 80 years of age.

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Dement Geriatr Cogn Disord
DOI: 10.1159/000526907

ed to utilize the BA at a health center, three concerns
arose, including a lack of time for completing the assessment. At the time of the health check, participants haveto undergo several kinds of examinations, including measurements of visual acuity, hearing, height, and bodyweight, in addition to electrocardiograms, chest X-rays,
and other tests. They are so busy that they do not haveenough time to perform the BA, which requires almost 30
min. Lack of space was another concern. In order for participants to perform the BA, many personal computers
are needed, although space is limited in the health center.
Finally, it is impossible to reliably ascertain a participant’s
performance at home. We had considered having individuals perform the BA at their home beforehand, but werealized that we could not determine if the participant
performed the test reliably.
In order to solve these problems, we developed a shortversion of the BA that can be performed easily. The original version consists of five subtests, each of which takes
5 min [1]. Each test of the short version takes 2 min, suchthat it needs only 10 min to complete. In the current
study, we investigated correlations between two versionsof the BA and interviewed participants regarding the desired utilization of the short version in the clinical setting.
Subjects and Methods
Subjects
We recruited participants via the internet over a 1-week period.
The BA was made under the estimation that the subjects performed the test using digital devices. We may say that it is reasonable to recruit the subjects who would have the skill for digital de-

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sented by Kirchner [2]. In this test, the subject is presented with a sequence of stimuli and is required to do some
operation about the current stimulus related to the one
from n steps earlier in the sequences. The load factor n
can be adjusted to make the task more or less difficult.
The cardinal features of the BA include five different versions to avoid habituation, conciseness (30 min), an automated scoring system, easy online access to mitigate
risk of COVID-19, and a base data set based on a large
population of 5,000 subjects with a wide age range (40–89). The contents of the questions of the five versions
were similar, and the differences in the difficulty levels
among these versions were standardized by use of a cognitive score (CS) specified in our previous paper [1]. We
found that the BA displayed moderate correlations between established neuropsychological tests [3] such as the
Mini-Mental State Examination (MMSE) [4] and the Raven’s Colored Progressive Matrices (RCPM) [5] for intellect, memory, visuospatial function, and frontal lobe
function.
One of the most important characteristics of the BA isthat it can reveal not only cognitive state but also longitudinal changes in cognitive function. The results of the BA
can be described as abnormal if the longitudinal change
is worse than the normal inclination, even if the absolutescore itself is within normal limits. By repeating this test
over several years, a subject can determine the degree of
their cognitive decline, and in cases where the declination
is worse than a normal trajectory, BA performance may
promote an improvement in lifestyle and related diseases[3]. Therefore, we expect that the BA is suitable to be carried out during annual health checks. When we attempt-

Fig. 1. Correlations between age and the short and original versions of the BA and correlations between both versions. BA, Brain Assessment; CS, cognitive score.
(Figure continued on next page.)

Short Version of the BA
The contents of the short version of the BA were the same as
those of the original version [1]. Many questions were prepared,

Short Version of Brain Assessment

and the subjects were required to answer them as many as possible
during the time set in advance. The level of the cognitive function
including the psychomotor speed and mental set change of eachsubject might be reflected to the number of the questions to which
the subject could answer in the limited time. Participants carriedout the original version of the BA online. For the analyses of theoriginal and short version, the results of the whole and of the first
2 min were utilized, respectively. Each subtest of the original version required 5 min, while the short version requires 2 min. So,
subjects will be able to perform the short version of the BA inaround 10 min. According to the procedures of the original version, we standardized the raw scores (CSs) using the mean andstandard deviation (50 and 16, respectively) and then calculated
the mean CS for each sex and age. For more details about the calculation of CSs, please see our previous papers [1, 3].

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vices. We announced this study by sending a direct e-mail toaround one million adults who had a SAISON credit card, issued
by the parent company of the Research Institute of Brain Activation. Three hundred and twenty-six participants were recruited toperform both the original and short version of the BA online. As
mentioned below in detail, the contents the short and original version were the same. Three participants did not finish the BA correctly; thus, the data from a total of 323 subjects (male 144, female
179; 26–82 years old, mean age 41.9 years) were utilized for statistical analyses. The number of subjects from each age range isshown in Table 1.

1

Statistical Analyses
According to our previous experiments [1, 3], we calculated themean CS of the short and the original version of the BA for eachsex and age, plotted the relationships between ages and mean CSs
in figures, and calculated a formula for cognitive changes. Then,
we calculated the correlation coefficients of CSs between two versions of the BA. The data were distributed parametrically; thus,
Pearson’s correlation coefficients were used. The results were in-

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Dement Geriatr Cogn Disord
DOI: 10.1159/000526907

terpreted as indicative of small (0.0–0.2), fair (0.2–0.4), moderate(0.4–0.7), and strong (0.7–1.0) associations. We regarded the results as significant if the p value was under 0.05. All statistical analyses were performed using IBM SPSS Statistics 23 software.

Results

Mean CSs from the short version of the BA are shownin the Table 1. Because the numbers of subjects were
small, averages were calculated in 10-year categories forparticipants over 40 years of age. The number of subjects
over 80 was only one, so the results over 80 were omitted
in the calculation of total mean values. As a whole, thetendencies were almost the same as the findings of ourprevious study of the original version [1]. First, the values
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Interviews to Subjects
After taking both versions of the BA, subjects were asked about
the utilization of the BA as follows: (1) which version of the BA isbetter?, (2) why do you think so?, and (3) during health checks,
what is the best way to utilize both versions of the BA?: namely, use
the original version every year or use the short version every year
and if there is something amiss, then perform the original versionof the BA and/or close neuropsychological examinations. One
hundred and forty-four subjects (male 58, female 86; mean age
40.5 ± 14.1 years) answered the questions.

Fig. 2. Interview results regarding the utili-zation of the short and the original versionof the BA. BA, Brain Assessment.

MemoryShort version versus age
Original version versus age
Short versus original version

numbers

words

−0.49
−0.45
0.72

−0.85
−0.88
0.66

Mental rotation N-back test

Judgment

Total

−0.32
−0.20
0.42

−0.26
−0.26
0.54

−0.48
−0.48
0.73

−0.35
−0.38
0.53

gradually worsened by age. Second, the memory of words
was better in females versus males. Finally, female visuospatial ability was worse compared with males.
The results of the statistical analyses are summarized
in Figure 1 and Table 2. The correlation coefficients of theshort and the original version of the BA against age weresimilar (Table 2). Both versions showed strong negative
correlations in memory of words (short version, r = −0.85;
original version, r = −0.88). The correlation of both versions against age was moderate in memory of numbers(short version, r = −0.49; original version, r = −0.45) andin the total assessment (short version, r = −0.48; original
version, r = −0.48). As for other subtests, the coefficients
revealed fair correlations across both versions (visuospatial, short version r = −0.35, original version r = −0.20;
working memory, short version r = −0.35, original version, r = −0.38; judgment, short version, r = −0.26; origi-

nal version, r = −0.26). The correlations between the shortand the original version of the BA were also strong (memory of numbers, r = 0.72: total assessment, r = 0.73) ormoderate (memory of words, r = 0.66; visuospatial, r =0.42; working memory, r = 0.53; judgment, r = 0.54)(Fig. 1; Table 2).
The results of the subject interview are presented in
Figure 2. For the first question, 65.3% of subjects repliedthat the short version is better than the original one. In
the second question, they regarded that each version has
its own advantages: the short version has good facility inusage, while the original version can provide a more detailed assessment. For the last question, most subjects
wanted to be assessed by the short version every year, andif the cognitive changes are worse than that by normal aging, then examined by the original version of the BA and/or additional neuropsychological tests.

Short Version of Brain Assessment

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Table 2. Pearson’s correlation coefficients between age and the results of the short and original versions of the BA
and between the two versions

Discussion

We investigated correlations between age and both theshort and original versions of the BA, as well as correlations between the two versions. The results of the present
study are summarized as follows: (1) there were strong
correlations between the short and the original versionsof the BA, (2) the correlation coefficients between age andthe subtests were almost the same between the two versions, (3) for “memory of words,” both versions exhibitedstrong correlations, (4) in the subject interview, manythought that the short version was better because of its
utility, and (5) the combination of the two BA versions isthought to be useful for annual health checks. Based onthese findings, we believe that the short version of the BA
is relevant to the assessment of cognitive function, similar
to the original version.
We believe that the short version of the BA would be
useful in actual clinical settings. The primary problem
with the original version is a longer administration time
for the purpose of general health checks. The short version takes only 10 min, and individuals can perform it
during the waiting period before a health check. In order
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DOI: 10.1159/000526907

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Fig. 3. Tablet- and printer-based device incorporating the shortversion of the BA. Behind the tablet, there is a panel on which theinformation about the device is described. The description of thepanel includes the title of the assessment, necessary time to do, how
to perform these tests, and the name of the supplier. On the screen,
the five subtests are represented with brief explanations about eachtest, and the subject can start each test by touching the name of thesubtest. After the assessment, results and additional information
can be printed depending on the characteristics of the institution,
including a URL code introducing detailed neuropsychologicaland neuroimaging assessments, the name and the telephone number of the institution. This small device can be set in a small spacein the waiting room of the health center. BA, Brain Assessment.

to solve a second problem, namely, the lack of space, we
prepared a tablet version of the short version (Fig. 3). In
this case, subjects answer by touching the display screen,
and their results are printed out by a small printer beside
the tablet. The report sheet contains the results of the tests
along with advice and contact information such as the
hospital telephone number. If necessary, subjects can receive the original version of the BA and/or neuropsychological tests for more detailed assessments. Along with theadvantage of the tablet version, we have to mention its
disadvantage in the clinical settings. There will be many
distractors in the waiting room of the health check center,
for example, others’ voices, sound of the television, andin some cases, the back ground music. It is recommended
that the tablet is set at the relatively quiet place as the corner of the room, and the subject will concentrate on thetest eagerly in order to get the good results about his/her
own cognitive function. But we cannot completely deny
the possibility that the distractors in the room might affect the results of the tests.
Both versions exhibited wide variation in the results
for the mental rotation, N-back test, and the judgment
test. This phenomenon suggests that visuospatial ability
and working memory are fairly different depending on
individuals. As such, in order to assess age-based declines
of cognitive function correctly, current results as well as
alterations over several years are important, as closely explained in our previous paper [1]. The results of the patient interview suggest that it is necessary to distinguishthe utility of each version of the BA depending on thesituation. We believe that it is appropriate to use the shortversion at annual health checks, and if alterations of cognitive function are worse than what is expected by normal
aging, the subject should receive more detailed assessments by in-person neuropsychological examination
and/or online assessments by the original version of theBA.
This study has several limitations. First, the number ofparticipants was small. This study examined the results of
323 participants, while that of the original version studied
5,000 individuals. However, the strong correlation between the two versions suggests the validity of the shortversion. Second, in-person assessments using general
neuropsychological tests were not performed in the present study due to the ongoing outbreak of COVID-19.
Lastly, we did not perform longitudinal assessments,
which is one of the advantages of the BA. Despite theselimitations, we can reasonably conclude that the shortversion of the BA, like the original one, can determine
cognitive function correctly.

Statement of Ethics

Funding Sources

This study received approval from the Advanced Institute ofIndustrial Technology Research Ethics Committee (Approval No.
19009) and was conducted in accordance with the Helsinki Declaration of 1975. All of the participants provided informed consent
in writing or online on the site used to run the assessment and collect data.

Conflict of Interest Statement
The Department of Dementia and Neuropsychology, Master
Program of Innovation for Design and Engineering, Advanced Institute of Industrial Technology, was established using donations
provided by the Research Institute of Brain Activation.

The study was conducted without any funding sources.

Author Contributions
Masayuki Satoh: design of the study, interpretation of data, andwriting the manuscript. Ken-ichi Tabei: interpretation of data andrevision for important intellectual content. Makiko Abe: acquisition and interpretation of data. Chiaki Kamikawa: acquisition andinterpretation of data. Saiko Fujita: analyses of data. Yoshinori
Ota: design of the study and acquisition of data.

Data Availability Statement
All data analyzed during this study are included in this article.
Further inquiries can be directed to the corresponding author.

Short Version of Brain Assessment

1 Satoh M, Tabei K, Fujita S, Ota Y. Online tool(Brain Assessment) for the detection of cognitive function changes during aging. Dement
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2 Kirchner WK. Age differences in short-term
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Exp Psychol. 1958;55(4):352–8.
3 Satoh M, Tabei K, Abe M, Kamikawa C, Fujita S, Ota Y. The correlation between a new
online cognitive test (the Brain Assessment)

and widely used in-person neuropsychological tests. Dement Geriatr Cogn Disord. 2021;
50(5):473–81.
4 Folstein MF, Folstein SE, McHugh PR. “Minimental state.” A practical method for grading
the cognitive state of patients for the clinician.
J Psychiatr Res. 1975;12(3):189–98.
5 Raven JC. Coloured progressive matrices Sets
A, Ab, B. New York: Oxford Psychologists
Press; 1995.

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