Early detection of cognitive decline in the elderly has become of heightened importance in parallel with the recent advances in therapeutics. Computerized assessment might be uniquely suited to early detection of changes in cognition in the elderly. We present here a systematic review of the status of computer-based cognitive testing, focusing on detection of cognitive decline in the aging population.

Methods

All studies purporting to assess or detect age-related changes in cognition or early dementia/mild cognitive impairment by means of computerized testing were included. Each test battery was rated on availability of normative data, level of evidence for test validity and reliability, comprehensiveness, and usability. All published studies relevant to a particular computerized test were read by a minimum of two reviewers, who completed rating forms containing the abovementioned criteria.

Results

Of the 18 test batteries identified from the initial search, 11 were appropriate to cognitive testing in the elderly and were subjected to systematic review. Of those 11, five were either developed specifically for application with the elderly or have been used extensively with that population. Even within the computerized testing genre, great variability existed in manner of administration, ranging from fully examiner-administered to fully self-administered. All tests had at least minimal reliability and validity data, commonly reported in peer-reviewed articles. However, level of rigor of validity testing varied widely.

Conclusion

All test batteries exhibited some of the strengths of computerized cognitive testing: standardization of administration and stimulus presentation, accurate measures of response latencies, automated comparison in real time with an individual's prior performance as well as with age-related norms, and efficiencies of staffing and cost. Some, such as the Mild Cognitive Impairment Screen, adapted complicated scoring algorithms to enhance the information gathered from already existing tests. Others, such as CogState, used unique interfaces and subtests. We found that although basic indices of psychometric properties were typically addressed, sufficient variability exists that currently available computerized test batteries must be judged on a case-by-case basis.

References

[1]C.J. Golden, A.B. Sivan. Ethical challenges in neuropsychological test development. S.S. Bush. A casebook of ethical challenges in neuropsychology. 2005; The Psychology Press: New York
[2]J.N. Browndyke, P. Schatz. Ethical challenges with the use of information technology and telecommunications in neuropsychology. S.S. Bush. A casebook of ethical challenges in neuropsychology. 2005; The Psychology Press: New York
[3]R.E. Schlegel, K. Gilliland. Development and quality assurance of computer-based assessment batteries. Arch Clin Neuropsychol. 22S: 2007; S49–S61
[4]I. Chalmers, D.G. Altman. Systematic reviews. 1995; BMJ Publishing Group: London
[5]M.H. Kabat, R.L. Kane, A.L. Jefferson, R.K. DiPino. Construct validity of selected Automated Neuropsychological Assessment Metrics (ANAM) battery measures. Clin Neuropsychol. 15: 2001; 498–507
[6]D. Levinson, D. Reeves, J. Watson, M. Harrison. Automated neuropsychological assessment metrics (ANAM) measures of cognitive effects of Alzheimer's disease. Arch Clin Neuropsychol. 20: 2005; 403–408
[7]D.L. Reeves, K.P. Winter, J. Bleiberg, R.L. Kane. ANAM Genogram: Historical perspectives, description, and current endeavors. Arch Clin Neuropsychol. 22 (Suppl 1): 2007; S15–S37
[8]R.L. Kane, T. Roebuck-Spencer, P. Short, M. Kabat, J.A. Wilken. Identifying and monitoring cognitive deficits in clinical populations using automated neuropsychological assessment metrics (ANAM) tests. Arch Clin Neuropsychol. 22 (Suppl 1): 2007; S115–S126
[9]T. Roebuck-Spencer, W. Sun, A.N. Cernich, K. Farmer, J. Bleiberg. Assessing change with the Automated Neuropsychological Assessment Metrics (ANAM): issues and challenges. Arch Clin Neuropsychol. 22 (Suppl 1): 2007; S79–S87
[10]P. Short, A. Cernich, J.A. Wilken, R.L. Kane. Initial construct validation of frequently employed ANAM measures through structural equation modeling. Arch Clin Neuropsychol. 22 (Suppl 1): 2007; S15–S37
[11]J.B. Tornatore, E. Hill, J. Laboff, M.E. McGann. Self-administered screening for mild cognitive impairment: Initial validation of a computerized test battery. J Neuropsychiatr Clin Neurosci. 17: 2005; 98–105
[12]T.W. Robbins, M. James, A.M. Owen, B.J. Sahakian, L. McInnes, P.M. Rabbitt. Cambridge Neuropsychological Test Automated Battery (CANTAB): a factor analytic study of a large sample of normal elderly volunteers. Dementia. 5: 1994; 266–281
[13]B.J. Sahakian, A.M. Owen. Computerized assessment in neuropsychiatry using CANTAB: discussion paper. J Royal Soc Med. 85: 1992; 399–402
[14]P.J. Fray, T.W. Robbins, B.J. Sahakian. Neuropsychiatric applications of CANTAB. Int J Geriatr Psychiatr. 11: 1996; 329–336
[15]C. Lowe, P.M. Rabbitt. Test/re-test reliability of the CANTAB and ISPOCD neuropsychological batteries: theoretical and practical issues. Neuropsychologia. 36: 1998; 915–923
[16]C.R. De Luca, S.J. Wood, V. Anderson, J. Buchanan, T.M. Proffitt, K. Mahony, et al. Normative data from the Cantab: I—development of executive function over the lifespan. J Clin Exp Neuropsychol. 25: 2003; 242–254
[17]K.S. Fowler, M.M. Saling, E.L. Conway, J.M. Semple, W.J. Louis. Computerized neuropsychological tests in the early detection of dementia: prospective findings. J Int Neuropsychol Soc. 3: 1997; 139–146
[18]K.S. Fowler, M.M. Saling, E.L. Conway, J.M. Semple, W.J. Louis. Paired associate learning in the early detection of DAT. J Int Neuropsychol Soc. 8: 2002; 58–71
[19]C.A. De Jager, E. Milwain, M. Budge. Early detection of isolated memory deficits in the elderly: the need for more sensitive neuropsychological tests. Psychol Med. 32: 2002; 483–491
[20]C.T. Gualtieri, L.G. Johnson. Neurocognitive testing supports a broader concept of mild cognitive impairment. Am J Alzheimers Dis Other Demen. 20: 2005; 359–366
[21]C.T. Gualtieri, L.G. Johnson. Reliability and validity of a computerized neurocognitive test battery, CNS Vital Signs. Arch Clin Neuropsychol. 21: 2006; 623–643
[22]A. Veroff, N. Cutler, J.J. Sramek, P.L. Prior, W. Mickelson, J.K. Hartman. A new assessment for neuropsychopharmacologic research: the Computerized Neuropsychological Test Battery. J Geriatr Psychiatry Neurol. 4: 1991; 211–217
[23]N.R. Cutler, R.C. Shrotriya, J.J. Sramek, A.E. Veroff, R.D. Seifert, L.A. Reich, et al. The use of the Computerized Neuropsychological Test Battery (CNTB) in an efficacy and safety trial of BMY 21,502 in Alzheimer's disease. Ann N Y Acad Sci. 695: 1993; 332–336
[24]A.E. Veroff, N.C. Bodick, W.W. Offen, J.J. Sramek, N.R. Cutler. Efficacy of xanomeline in Alzheimer disease: cognitive improvement measured using the Computerized Neuropsychological Test Battery (CNTB). Alz Dis Assoc Disord. 4: 1998; 304–312
[25]P.M. Simpson, D.J. Surmon, K.A. Wesnes, G.K. Wilcock. The Cognitive Drug Research Computerized Assessment System for demented patients: a validation study. Int J Geriatr Soc. 6: 1991; 95–102
[26]E. Mohr, D. Walker, C. Randolph, M. Sampson, T. Mendis. Utility of clinical trial batteries in the measurement of Alzheimer's and Huntington's dementia. Int Psychogeriatr. 8: 1996; 397–411
[27]C. Ballard, J. O'Brien, A. Gray, F. Cormack, G. Ayre, E. Rowan, et al. Attention and fluctuating attention in patients with dementia with Lewy bodies and Alzheimer disease. Arch Neurol. 58: 2001; 977–982
[28]J. DeLepeliere, J. Heyrman, F. Baro, F. Buntinx. A combination of tests for the diagnosis of dementia had a significant diagnostic value. J Clin Epidemiol. 58: 2005; 217–225
[29]A. Collie, P. Maruff, D.G. Darby, M. McStephen. The effects of practice on the cognitive test performance of neurologically normal individuals assessed at brief test-retest intervals. JINS. 9: 2003; 419–428
[30]M.G. Falleti, P. Maruff, A. Collie, D. Darby. Practice effects associated with the repeated assessment of cognitive function using the CogState battery at 10-minute, one week and one month test-retest intervals. J Clin Exp Neuropsychol. 28: 2006; 1095–1112
[31]D. Darby, P. Maruff, A. Collie, M. McStephen. Mild cognitive impairment can be detected by multiple assessments in a single day. Neurology. 59: 2002; 1042–1046
[32]P. Maruff, A. Collie, D. Darby, J. Weaver-Cargin, M. McStephen. Subtle cognitive decline in mild cognitive impairment (technical document). 2002; CogState Ltd: Australia
[33]J.W. Cargin, P. Maruff, A. Collie, C. Masters. Mild memory impairment in healthy older adults is distinct from normal aging. Brain Cogn. 60: 2006; 146–155
[34]D.M. Erlanger, T. Kaushik, D. Broshek, J. Freemand, D. Feldman, J. Festa. Developments and validations of a web-based screening tool for monitoring cognitive status. J Head Trauma Rehabil. 17: 2002; 458–476
[35]P.A. Lichtenberg, A.S. Johnson, D.M. Erlanger, T. Kaushik, M.E. Maddens, K. Imam, et al. Enhancing cognitive screening in geriatric care: use of an internet-based system. Int J Healthcare Inf Sys Informatics. 1: 2006; 47–57
[36]D.L. Trenkle, W.R. Shankle, S.P. Azen. Detecting cognitive impairment in primary care: performance assessment of three screening instruments. J Alzheimers Dis. 11: 2007; 323–335
[37]W.R. Shankle, A.K. Romney, J. Hara, D. Fortier, M.B. Dick, J.M. Chen, et al. Methods to improve the detection of mild cognitive impairment. Proc Natl Acad Sci USA. 102: 2005; 4919–4924
[38]R.C. Green, J. Green, J.M. Harrison, M.H. Kutner. Screening for cognitive impairment in older individuals. Arch Neurol. 51: 1994; 779–786
[39]R.W. Elwood. MicroCog: assessment of cognitive functioning. Neuropsychol Rev. 11: 2001; 89–100
[40]J.A. Johnson, J.O. Rust. Correlational analysis of MicroCog: assessment of cognitive functioning with the Wechsler Adult Intelligence Scale-III for a clinical sample of veterans. Psychol Rep. 93: 2003; 1261–1266
[41]E. Helmes, M. Miller. A comparison of MicroCog and the Wechsler Memory Scale (3rd ed.) in older adults. Appl Neuropsychol. 13: 2006; 28–33
[42]G.M. Doniger, D.M. Zucker, A. Schweiger, T. Dwolatzky, H. Chertkow, H. Crystal, et al. Towards a practical cognitive assessment for detection of early dementia: a 30-minute computerized battery discriminates as well as longer testing. Curr Alzheimer Res. 2: 2005; 117–124
[43]T. Dwolatzky, V. Whitehead, G.M. Doniger, E.S. Simon, A. Schweiger, D. Jaffe, et al. Validity of a novel computerized cognitive battery for mild cognitive impairment. BMC Geriatrics. 3: 2003; 1–12
[44]T. Dwolatzky, V. Whitehead, G.M. Doniger, E.S. Simon, A. Schweiger, D. Jaffe, et al. Validity of the Mindstreams computerized cognitive battery for mild cognitive impairment. J Mol Neurosci. 24: 2004; 33–44
[45]G.M. Doniger, T. Dwolatzky, D.M. Zucker, H. Chertkow, H. Crystal, A. Schweiger, et al. Computerized cognitive testing battery identifies mild cognitive impairment and mild dementia even in the presence of depressive symptoms. Am J Alzheimers Dis Other Demen. 21: 2006; 28–36
[46]T. Buchanan. Online assessment: desirable of dangerous? Professional Psychology Research and Practice. 33: 2002; 148–154
[47]J.N. Butcher, J.N. Perry, M.M. Atlis. Validity and utility of computer-based test interpretation. Psychol Assess. 12: 2000; 6–18
[48]A.D. Mead, F. Drasgow. Equivalence of computerized and paper-and-pencil cognitive ability tests: a meta-analysis. Psychol Bull. 114: 1993; 449–458
[49]P.D. Raymond, A.D. Hinton-Bayre, M. Radel, M.J. Ray, N.A. Marsh. Test-retest norms and reliable change indices for the Microcog battery in a healthy community population over 50 years of age. Clin Neuropsychol. 20: 2006; 261–270
[50]R. Kane, G.G. Kay. Computerized assessment in neuropsychology: a review of tests and test batteries. Neuropsychol Rev. 3: 1992; 1–118
[51]P. Schatz, J. Browndyke. Applications of computer-based neuropsychological assessment. J Head Trauma Rehabil. 17: 2002; 395–410
[52]A.N. Cernich, D.M. Brennana, L.M. Barker, J. Bleiberg. Sources of error in computerized neuropsychological assessment. Arch Clin Neuropsychol. S22: 2007; S39–S48
[53]H.M. Fillitt, E.S. Simon, G.M. Doniger, J.L. Cummings. Practicality of a computerized system for cognitive assessment in the elderly. Alzheimer's & Dementia. 4: 2008; 14–21
[54]J. Collerton, D. Collerton, A. Yasumichi, K. Barrass, M. Eccles, C. Jagger, et al. A comparison of computerized and pencil-and-paper tasks in assessing cognitive function in community-dwelling older people in the Newcastle 85+ pilot study. J Am Geriatr Soc. 55: 2007; 1630–1635

Citing Literature

Volume4, Issue6

November 2008

Pages 428-437

Status of computerized cognitive testing in aging: A systematic review

Abstract

Background

Methods

Results

Conclusion

References

Citing Literature

References

Information

About Wiley Online Library

Help & Support

Opportunities

Connect with Wiley

Status of computerized cognitive testing in aging: A systematic review

Abstract

Background

Methods

Results

Conclusion

References

Citing Literature

References

Related

Information