Usability of an At-Home Tablet-Based Cognitive Test in Older Adults With and Without Cognitive Impairment
Authors: Bayer Thomas A. , Liu Yanchen , Vishnepolskiy Igor , Baez Day , Sanders Lisbeth , Williams Rebecca , Sanders Jeff , Serpico Anthony , Gravenstein Stefan 
Published: September 2023

Mobile device-based cognitive screening has the potential to overcome the limitations in diagnostic precision and efficiency that characterize conventional pen and paper cognitive screening. Several mobile device-based cognitive testing platforms have demonstrated usability in carefully selected populations. However, the usability of take-home mobile device-based cognitive screening in typical adult primary care patients requires further investigation. This study set out to test the usability of a prototype mobile device-based cognitive screening test in older adult primary care patients across a range of cognitive performance. Participants completed the St. Louis University Mental Status Examination (SLUMS) and then used a study-supplied mobile device application at home for 5 days. The application presented 7 modules: 5 digital adaptations of conventional cognitive tests, 1 game-like experience, and 1 free verbal response module. Participants completed the System Usability Scale (SUS) after using the application. A total of 51 individuals participated, with a median (IQR) age of 81 (74–85) years. Cognitive impairment (SLUMS score < 27) was present in 30 (59%) of participants. The mean (95% Confidence Interval [CI]) SUS score was 76 (71–81), which indicates good usability. Usability scores were similar across ranges of cognitive impairment. SLUMS score predicted early withdrawal from the study with an area under the receiver operating characteristic curve (95% CI) of 0.78 (0.58-0.97). Take-home mobile device-based cognitive testing is a usable strategy in older adult primary care patients across a range of cognitive function, but less viable in persons with severe cognitive impairment. Take-home mobile device-based testing could be part of a flexible cognitive testing and follow-up strategy that also includes mobile device-based testing in healthcare settings and pen-and-paper cognitive testing, depending on patient preferences and abilities.

AUTHOR SUMMARY

Performance-based cognitive screeners play a critical role in the identification, triage, and management of persons with Major Neurocognitive Disorder in primary care, neurology, and geriatric psychiatry. Commonly used tests consume valuable medical provider time, can be unpleasant for patients, and provide minimal information about specific domains of cognition. Cognitive testing on a take-home mobile device could address these limitations. We tested the usability of a prototype cognitive testing application using take-home devices in 51 older adult primary care patients across a range of cognitive function. Participants found that the application had good usability, but more severe cognitive impairment predicted voluntary withdrawal from the study. These findings establish that take-home mobile device-based cognitive testing is usable among older adult primary care patients, especially those with less severe cognitive impairment.