Research Article
Dement Geriatr Cogn Disord
DOI: 10.1159/000520521

Received: August 28, 2021
Accepted: October 25, 2021
Published online: December 15, 2021

The Correlation between a New Online Cognitive
Test (the Brain Assessment) and Widely Used
In-Person Neuropsychological Tests
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: There are several problems with standard inperson neuropsychological assessments, such as habituation, necessity of human resources, and difficulty of in-person assessment under societal conditions during the outbreak of coronavirus disease 2019. Thus, we developed an
online cognitive test (the Brain Assessment [BA]). In thisstudy, we investigated the correlation between the results of
the BA and those of established neuropsychological tests.
Participants and Methods: Seventy-seven elderly persons(mean 71.3 ± 5.1 years old; range 65–86; male:female =45:32) were recruited through the internet. Correlations
were evaluated between the BA and the following widelyused neuropsychological tests: the mini-mental state examination (MMSE), the Raven’s colored progressive matrices(RCPM), the logical memory I and II of the Rivermead Behavioral Memory Test, the word fluency (WF) test, and the TrailMaking TestA/B. Results: We found moderate correlations
between the total cognitive score of the BA and the total
score of the MMSE (r = 0.433, p < 0.001), as well as between

karger@karger.com
www.karger.com/dem© 2021 S. Karger AG, Baselthe total BA score and the total RCPM score (r = 0.582, p <0.001) and time to complete the RCPM (r = 0.455, p < 0.001).
Moderate correlations were also observed between the cognitive score of the memory of words BA subtest and the LM-I
(r = 0.518, p < 0.001), the mental rotation subtest and figure
drawing (r = 0.404, p < 0.001), the logical reasoning subtest
and total RCPM score (r = 0.491, p < 0.001), and the memoryof numbers and words subtests and WF (memory of numbers and total WF: r = 0.456, p < 0.001; memory of words andtotal WF: r = 0.571, p < 0.001). Discussion: We found that the
BA showed moderate correlations between established neuropsychological tests for intellect, memory, visuospatial
function, and frontal function. The MMSE and the RCPM reflect Spearman’s s-factor and g-factor, respectively, and thus
the BA also covered both factors. Conclusion: The BA is a
useful tool for assessing the cognitive function of generally
healthy elderly persons.
© 2021 S. Karger AG, Basel

Introduction

To assess cognitive function, neuropsychological examinations are performed. In particular, the mini-mental
state examination (MMSE) [1] is frequently used across
Correspondence to:
Masayuki Satoh, satou-masayuki @ aiit.ac.jp

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Keywords
Brain assessment · Correlation · Mini-mental state
examination · Raven’s colored progressive matrices

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Dement Geriatr Cogn Disord
DOI: 10.1159/000520521

Table 1. Characteristics of participants
N = 77 (M:F = 45:32)

Mean ± SD

Characteristics
Age, years
Education, years
Cognitive function
MMSE
RCPM
Score
Time, sec
RBMT
LM-I
LM-II
Figure drawing
WF
TMT
A, secB, sec71.3±5.1
15.3±1.928.7±1.731.7±3.8
275±8611.7±3.910.6±3.817.3±1.0
57.0±13.1
113±34135±47F, female; LM, logical memory; M, male; N, number; RBMT,
Revermead behavioral memory test; RCPM, Raven’s colored
progressive matrices; SD, standard deviation; TMT, trail-making test;
WF, word fluency.

awareness may bring forth the motivation to improve aspects of an individual’s lifestyle, which is critical for dementia prevention.
In this study, we investigated the correlations between
the results of the BA and those of established neuropsychological tests. As the primary outcomes, we examined
the relationship between the BA and the MMSE as well as
between the BA and the Raven’s colored progressive matrices (RCPM) [7]. The RCPM is a cognitive test that reflects nonverbal intellect. The secondary outcomes werethe correlations between the results of the BA and thoseof other neuropsychological tests frequently used in theclinic.
Participants and Methods
Participants
We recruited participants through the internet. Our initial plan
was to conduct a nonpharmacological intervention of physical exercise, and we announced this by sending a direct e-mail to about
1 million elderly persons (≥65 years old), all of whom were members of SAISON Credit Card, which is the parent company of Research Institute of Brain Activation. Though we did not proceedwith the physical exercise component of that study, we were able
to collect the data from the cognitive test portion of the study,
which is what is reported here. Participants were required to perform an online cognitive test created by our group (the BA) [3] asSatoh/Tabei/Abe/Kamikawa/Fujita/Ota

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the world for screening cognitive decline. However, the
COVID-19 pandemic has significantly altered the delivery of health care, including neuropsychological evaluations [2]. There are several problems with the standard
in-person neuropsychological assessments. (i) The first is
habituation; because most neuropsychological tests have
only 1 version, the user can become accustomed to thecontents of the test through repeated testing [3]. This habituation may allow the participant to achieve a higherscore that surpasses their actual abilities and is not truly
reflective of performance. (ii) The second limitation of
in-person testing is cross-sectional evaluation. The cognitive function of a participant may be considered normal
if the score is within a normal limit at a given timepoint,
but the speed of cognitive decline over time is typicallynot assessed, and this parameter is better reflective of actual changes due to aging. (iii) The third limitation is a
shortage of human resources. In order to carry out inperson neuropsychological assessments, professionals
such as speech therapists are necessary. However, in mostmedical and care institutions, the availability of such professionals is insufficient. (iv) Finally, in-person assessment is difficult due to the outbreak of COVID-19. Perhaps a serendipitous effect of the COVID-19 crisis is thediscovery that standard paper and pencil clinical neuropsychological evaluations can be administered electronically using a digital medium [2]. Recently, there havebeen several reports that evaluated cognitive function using digital devices such as iPads [4], digital pens [5], anda digital clock-drawing test [6]. Though the data in these
papers show how digital technology can calculate potentially sensitive clinical neurocognitive biomarkers to flag
early emergent neurodegenerative illness, the first andsecond limitations listed above (habituation and crosssectional testing) are still problematic.
To resolve these problems, we have developed an online cognitive test named the Brain Assessment (BA) thatcovers 5 fields: number memory, word memory, mental
rotation, working memory (N-back test), and judgment[3]. The cardinal features of the BA include 5 different
versions to avoid habituation, conciseness (30 min), theautomated scoring system, easy access on website without
a risk of COVID-19, and the basic data based on a large
population of 5,000 subjects with a wide age range of 40–
89. Further, the differences in the levels of difficulties
among the 5 versions were standardized by use of the cognitive score (to be specified in our previous paper [3]). By
performing the BA every year, participants will be able todetect any abnormal rates of cognitive decline, even if theresults at a given timepoint are within normal limits. This

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0.460<0.001
0.413<0.001
0.377
0.001
0.287
0.011
0.379
0.001
−0.455<0.001
0.582<0.001
0.433<0.001
r
p
Total

0.361
0.001
0.270
0.018
0.274
0.016
0.218
0.057
0.331
0.003
−0.2800.014
0.491<0.001
0.396
0.000
Logical reasoning
Judgment

r
p

0.370
0.001
0.157
0.171
0.170
0.138
0.261
0.022
0.242
0.034
−0.278
0.014
0.280
0.014
0.301
0.008
N-back test
Working memory

r
p

0.266
0.019
0.248
0.031
0.404
<0.001
0.084
0.468
0.098
0.398
−0.3730.001
0.521<0.001
0.242
0.034
r
p
Mental rotation test

0.412
<0.001rp
Words

Visuospatial

0.323
0.004
0.399
<0.001rp
Numbers
Memory

0.365
0.001

MMSE
subtestcognitive domains

0.421<0.001

LM-I
score

General intellectBrain assessment

time

RBMT
RCPM

Memory0.531<0.001

0.352
0.002
0.414
<0.001

Dement Geriatr Cogn Disord
DOI: 10.1159/000520521

well as a battery of widely used neuropsychological tests. Seventyseven elderly persons (mean 71.3 ± 5.1 years old; range 65–86;
male: female = 45:32) agreed to participate in the examinations.
Participant characteristics are summarized in Table 1.

0.199
0.083

Brain Assessment and Widely Used
Neuropsychological Tests

and the total score of the MMSE. BA, brain assessment; MMSE,
mini-mental state examination.

LM-II

Cognitive Assessments
The BA was invented by our group for the purpose of evaluating the degree of cognitive decline [3]. The BA has 5 versions andcan be completed on the internet within 30 min. Based on the results of our preceding research, cognitive scores (CSs) were calculated using the following formula: CS = ([raw score] − [mean ofraw scores])/(SD of raw scores) × 10 + 50. For more details, see ourprevious paper [3]. According to our previous studies [8–10], thefollowing neuropsychological tests were administered. To quantify intellectual function, the MMSE and the RCPM [7] were administered. RCPM measures not only the score a participant canachieve but also the performance time, which reflects the psychomotor speed of the individual. Memory was evaluated using logicalmemory I and II of the Rivermead Behavioral Memory Test
(RBMT) [11], which consists of immediate and delayed recall of ashort story. The RBMT has 4 stories across which the difficulty andnumber of words and sentences are identical. The assessment ofconstructional ability was based on the method described by Struband Black [12]. A 3-dimensional cube was shown to the examinees
and they were asked to draw it. The hand-drawn on paper was recorded by video, and the drawing was scored by assigning 1 of 4
possible grades (0: poor, 1: fair, 2: good, and 3: excellent). Frontal
function was assessed by 2 types of tasks: word fluency (WF) andthe Trail-Making TestA/B (TMT-A/B). The WF test consisted of
2 domains: category and letters. For the categorical WF, participants were asked to name as many animals as possible in 1 min.

Fig. 1. The correlation between the total cognitive score of the BA

0.213
0.063

30

0.381
0.001

28

0.518
<0.00126−0.390<0.001

24

Total score of MMSE

0.433
<0.001

22

0.342
0.002

20

Table 2. Pearson’s correlation coefficients between the results of the BA and neuropsychological examinations

0

0.307
0.007

10

letter

20

WF

30

Figure drawing

Frontal function

40

category

50

The yellow and red boxes indicate fair and moderate correlation, respectively (small: 0.0–0.2, fair: 0.2–0.4, moderate: 0.4–0.7, and strong: 0.7–1.0). LM, logical memory; MMSE, mini-mental state
examination; RBMT, Revermead behavioral memory test; RCPM, Raven’s colored progressive matrices; TMT, trail-making test; WF, word fluency; BA, brain assessment.

−0.3680.003−0.3980.001−0.2250.077−0.2420.050−0.2960.019−0.2850.020−0.1720.177−0.1930.120−0.3070.014−0.419<0.001−0.3890.002−0.373
0.002

B

60

TMT

r = 0.433
p < 0.001

A70

Visuospatial

Total cognitive score of brain assessment

80

80
70
Total cognitive score of brain assessment80

r = 0.582
p < 0.001

70

60

60

50

50

40

40

30

30

20

20

10

10

0

6

r = –0.455
p < 0.001

16

Total score of RCPM

26

36

0

0

200

400

600

Total time of RCPM

800

1,000

Fig. 2. The correlation between the total cognitive score of the BA and the total score and the total time taken tocomplete the RCPM. BA, brain assessment; RCPM, Raven’s colored progressive matrices.

For the letter WF, for each of 4 phonemes ka, sa, ta, and te, theparticipants were asked to name objects with that phoneme at the
beginning of the word [13]. These phonemes are the most frequently used in Japanese language. We used the average scores ofthese 4 phonemes for statistical analysis. It is generally acceptedthat the cognitive processing of categorical and letter WF is somewhat different, categorical WF being more reflective of memory
function than letter WF.
Statistical Analyses
We calculated correlation coefficients between the CSs of the
BA and the results of each neuropsychological assessment. The
data were distributed parametrically, thus Pearson’s correlation
coefficient was used. The results were interpreted as indicative ofsmall (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 pvalue was under 0.05. All statistical analyses were performed using
IBM SPSS Statistics 23 software.

p < 0.001) and performance time of the RCPM (Fig. 2,
right. r = 0.455, p < 0.001). As for the secondary analyses,
significant correlations were observed between the resultsof the BA subtests and those of the related neuropsychological examinations (Table 2; Fig. 3–7). There were moderate associations between the CS of the memory of words
and the LM-I (Fig. 3; r = 0.518, p < 0.001), the mental
rotation and figure drawing (Fig. 4; r = 0.404, p < 0.001),
the logical reasoning and total score of RCPM (Fig. 5;
r = 0.491, p < 0.001), and the memory of numbers andwords subtests and WF (memory of numbers and total
WF: r = 0.456, p < 0.001; memory of words and total WF:
r = 0.571, p < 0.001) (Fig. 6).
Discussion

The results of the statistical analyses are summarizedin Table 2. The primary outcomes are shown in Figures 1
and 2. There was a moderate association between the total
CS of the BA and the total score of the MMSE (Fig. 1, r =0.433, p < 0.001), as well as between the total CS of the BA
and the total score of the RCPM (Fig. 2, left. r = 0.582,
4

Dement Geriatr Cogn Disord
DOI: 10.1159/000520521

We investigated the correlations between the results of
the BA and those of established neuropsychological tests,
and found moderate correlations between them for intellect, memory, visuospatial function, and frontal function.
The results of the present study are summarized as follows: (i) there were moderate correlations between the
BA total score and the MMSE total score, as well as between the BA total score and the RCPM score and RCPM
Satoh/Tabei/Abe/Kamikawa/Fujita/Ota

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Results

Immediate recall

Cognitive scores of memory of numbersof brain assessment

90
80

70

60

60

50

50

40

40

30

30

20

20

10

10
0

5

10

15

20

80

Cognitive scores of memory of wordsof brain assessment25
r = 0.518
p < 0.001

70

0

0

5

10

15

20

80

60

50

50

40

40

30

30

20

20

10

10

0

5

10

15

Logical memory-I of RBMT

20

25

0

25
r = 0.381
p = 0.001

70

60

0

r = 0.199
p = 0.083

80

70

0

Delayed recall

90

r = 0.323
p = 0.004

0

5

10

15

Logical memory-II of RBMT

20

25time; (ii) there were moderate correlations between thememory of words of the BA and the LM-I, and the BAs
mental rotation subtest and the figure drawing test; and(iii) the results of memory of words and numbers of the
BA showed moderate correlations with the letter and category WF. Based on these findings, we believe that the BA
is relevant to the assessment of the cognitive function.

According to Spearman [14], the intellect can be divided
into 2 factors, that is, the specific (s-factor) and the generalfactor (g-factor). The former refers to the cognitive functionof each cognitive domain – for example, language, calculation, visuospatial function – while the latter shows the cognitive functions of reasoning and thinking, which regulate
and integrate the s-factors of the cognitive domains. The

Brain Assessment and Widely Used
Neuropsychological Tests

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Fig. 3. The correlation between cognitive scores of the memory of numbers/words subtest of the BA and the scoresof LM-I/-II of the RBMT. BA, brain assessment; RBMT, Rivermead behavioral memory test; LM-I/-II, logicalmemory-I and II.

Total score

Cognitive scores of logical reasoning of brain assessment

90
80

90

30
20

0

5

10

Score of figure-drawing

40

30

30

20

20

10

10

Total score of RCPM

26

31

36

20

r = –0.280
p = 0.014

70

21

15

Total time

80

40

16

40

tal rotation subtest and the figure drawing score. BA, brain assessment.

50

11

50

Fig. 4. The correlation between the cognitive score of the BA men-

50

6

60

0

60

1

r = 0.404
p < 0.001

70

10

60

0

80

90

r = 0.491
p < 0.001

70

100

Cognitive scores of mental rotationof brain assessment

MMSE and the RCPM are thought to reflect the function of
the s-factor and g-factor, respectively. Moreover, the total
performance time of the RCPM reflects the psychomotor
speed. Therefore, we suggest that as the BA was correlatedwith the MMSE and RCPM, it may also be considered ameasure of the multifaceted aspects of cognitive function.
It was not surprising that there were significant correlations between the BA memory of words subtest and theLM-I results, and between the mental rotation subtest of
the BA and the figure drawing task. Both the memory ofwords and the LM-I tests are based on the memory of language, and reflect the recent memory. The mental rotation and the figure drawing test reflect visuospatial function, that is, the perception of visual stimuli, as well as
one’s ability to maintain and manipulate this information. We also observed significant correlations between
the results of memory of words and numbers of the BA
with the results of the letter and category WF. It is understood that both tasks depend on a common process of
retrieving the targets from memory storage.

0

0

100

200

300

400

500

600

Total time of RCPM

700

800

900

Fig. 5. The correlation between cognitive scores of the BA logical reasoning subtest and the total RCPM score
and time taken to complete the RCPM. BA, brain assessment; RCPM, Raven’s colored progressive matrices.

Fig. 6. The correlations between cognitive scores of the memory of numbers/words of the BA and the total, letter,

6

Dement Geriatr Cogn Disord
DOI: 10.1159/000520521(For figure see next page.)
Satoh/Tabei/Abe/Kamikawa/Fujita/Ota

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and category WF. BA, brain assessment; WF, word fluency.

Numbers

Words

90

80

80

70

70

60

60

50

50

40

40

30

30

Cognitive scores of memory of numbers of brain assessment

20

40

60

80

Total word fluency

80
70
60
50
40
30
r = 0.414
p < 0.001

10
0

0

5

10

Letter word fluency

15

0

100

90

20

20

40

60

80

Total word fluency

100

70
60
50
40
30
20

r = 0.531
p < 0.001

10
0

80

80

70

70

20

80

90

0

5

10

Letter word fluency

15

20

60

60

50

50

40

40

30

30

20

20

r = 0.352
p = 0.002

100

r = 0.571
p < 0.001

10

Cognitive scores of memory of words of brain assessment

10
0

20

r = 0.456
p < 0.001

20

0

10

20

Category word fluency30

r = 0.412
p < 0.001

10
40

0

0

10

20

Category word fluency

30

40

Brain Assessment and Widely Used
Neuropsychological Tests

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TMT-A

Cognitive scores of N-back task of brain assessment

100
90

r = –0.285
p = 0.020

80

90

70

60

60

50

50

40

40

30

30

20

20

10

10
20

70

120

170

Time of TMT-A

220

270

r = –0.296
p = 0.019

80

70

0

TMT-B

100

0

20

70

120

170

220

270

Time of TMT-B

320

370

420

Fig. 7. The correlations between cognitive scores of the N-back task of the BA and the time to complete the TMTA/B. BA, brain assessment; TMT, trail-making test.

Statement of Ethics
This study received approval from the Advanced Institute ofIndustrial Technology Research Ethics Committee (ApprovalNo.:19009) and was conducted in accordance with the Helsinki
Declaration of 1975. All of the participants provided informed
consent in writing or by clicking a button on the internet site used
to run the assessment and collect the data.

8

Dement Geriatr Cogn Disord
DOI: 10.1159/000520521

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.

Funding Sources
The study was conducted without any funding sources.

Author Contributions
Masayuki Satoh took part in design of this study, interpretationof data, and writing the manuscript. Ken-ichi Tabei was involved
in interpretation of data and revision for important intellectual
content. Makiko Abe and Chiaki Kamikawa took part in acquisition and interpretation of data. Saiko Fujita took part in analysesof data. Yoshinori Ota was involved in design of this study andacquisition of data.

Data Availability Statement
All data analyzed during this study are included in this article.
Further enquiries can be directed to the corresponding author.
Satoh/Tabei/Abe/Kamikawa/Fujita/Ota

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This study has several limitations. First, the number ofparticipants was not so large. This study dealt with theresults of 77 participants. The reason for this is that due
to the ongoing outbreak of COVID-19, we could not perform in-person assessment in a larger population. Second, the participants in the present study were cognitively normal. We are now collecting data from patients withdementia and mild cognitive impairment. Lastly, thepresent study lacked temporal assessment over time thatis mentioned in the introduction as one of the limitationsof standard in-person neuropsychological assessments.
Despite these limitations, we can reasonably conclude
that the BA is a useful tool for assessing the cognitive
function of normal elderly persons.

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Brain Assessment and Widely Used
Neuropsychological Tests

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