Remote Self-Administration of Cognitive Screeners for Older Adults Prior to a Primary Care Visit: Pilot Cross-Sectional Study of the Reliability and Usability of the MyCog Mobile Screening App

Psychometric Properties of MyCog 2.0: A Human-Centered Cognitive Screening Tool for Older Adults

OBJECTIVES

Self-administered, user-friendly apps that can detect initial symptoms of cognitive impairment have enormous potential to improve early detection of cognitive decline. We examine the psychometric properties of the redesigned version of MyCog, MyCog 2.0, an app-based tool for older adults that assesses executive function and episodic memory. MyCog 2.0 aims to improve usability while maintaining the psychometric validity demonstrated in the original version.

METHODS

Feedback from clinicians and patients on MyCog was gathered to inform the human-centered design improvements of MyCog 2.0. To assess the psychometric properties of the improved tool, data from a community sample (n = 200; mean age = 73 years) who had completed MyCog 2.0 were compared to an age-matched sample who had completed the original MyCog. Internal consistency and construct validity were evaluated via confirmatory factor analysis. Bayesian differential item functioning was employed to evaluate the evidence for equivalence of MyCog and MyCog 2.0.

RESULTS

Internal consistency was high for executive function and episodic memory tests (ωt = 0.84). A two-factor model showed excellent fit, demonstrating that tests measured two related yet distinct constructs, episodic memory and executive functioning, as expected. Differential item functioning between the two test versions was not observed for episodic memory performance or executive functioning accuracy; however, response time on five executive function items was found to differ across versions.

CONCLUSIONS

Findings support MyCog 2.0 as the first reliable self-administered cognitive screener designed specifically for ease of use among older adults. Findings support the internal consistency and construct validity of MyCog 2.0 and provide a foundation for the forthcoming clinical validation studies.

Validity and reliability of the Mobile Toolbox Faces and Names memory test

Validation of the Mobile Toolbox Faces and Names associative memory test is presented. Ninety-two participants self-administered Faces and Names in-person; 956 self-administered Faces and Names remotely but took convergent measures in person; and 123 self-administered Faces and Names remotely twice, 14 days apart. Internal consistency (.76-.79) and test-retest reliability (ICC = .73) were acceptable. Convergent validity with WMS-IV Verbal Paired Associates was satisfactory (immediate .54; delayed .58). The findings suggest the remotely administered Faces and Names is a reliable instrument.

Digital remote assessment of speech acoustics in cognitively unimpaired adults: feasibility, reliability and associations with amyloid pathology

BACKGROUND

Digital speech assessment has potential relevance in the earliest, preclinical stages of Alzheimer's disease (AD). We evaluated the feasibility, test-retest reliability, and association with AD-related amyloid-beta (Aβ) pathology of speech acoustics measured over multiple assessments in a remote setting.

METHODS

Fifty cognitively unimpaired adults (Age 68 ± 6.2 years, 58% female, 46% Aβ-positive) completed remote, tablet-based speech assessments (i.e., picture description, journal-prompt storytelling, verbal fluency tasks) for five days. The testing paradigm was repeated after 2-3 weeks. Acoustic speech features were automatically extracted from the voice recordings, and mean scores were calculated over the 5-day period. We assessed feasibility by adherence rates and usability ratings on the System Usability Scale (SUS) questionnaire. Test-retest reliability was examined with intraclass correlation coefficients (ICCs). We investigated the associations between acoustic features and Aβ-pathology, using linear regression models, adjusted for age, sex and education.

RESULTS

The speech assessment was feasible, indicated by 91.6% adherence and usability scores of 86.0 ± 9.9. High reliability (ICC ≥ 0.75) was found across averaged speech samples. Aβ-positive individuals displayed a higher pause-to-word ratio in picture description (B = -0.05, p = 0.040) and journal-prompt storytelling (B = -0.07, p = 0.032) than Aβ-negative individuals, although this effect lost significance after correction for multiple testing.

CONCLUSION

Our findings support the feasibility and reliability of multi-day remote assessment of speech acoustics in cognitively unimpaired individuals with and without Aβ-pathology, which lays the foundation for the use of speech biomarkers in the context of early AD.

Understanding Patient Perspectives on the Use of Gamification and Incentives in mHealth Apps to Improve Medication Adherence: Qualitative Study

BACKGROUND

Medication nonadherence remains a significant health and economic burden in many high-income countries. Emerging smartphone interventions have started to use features such as gamification and financial incentives with varying degrees of effectiveness on medication adherence and health outcomes. A more consistent approach to applying these features, informed by patient perspectives, may result in more predictable and beneficial results from this type of intervention.

OBJECTIVE

This qualitative study aims to identify patient perspectives on the use of gamification and financial incentives in mobile health (mHealth) apps for medication adherence in Australian patients taking medication for chronic conditions.

METHODS

A total of 19 participants were included in iterative semistructured web-based focus groups conducted between May and December 2022. The facilitator used exploratory prompts relating to mHealth apps, gamification, and financial incentives, along with concepts raised from previous focus groups. Transcriptions were independently coded to develop a set of themes.

RESULTS

Three themes were identified: purpose-driven design, trust-based standards, and personal choice. All participants acknowledged gamification and financial incentives as potentially effective features in mHealth apps for medication adherence. However, they also indicated that the effectiveness heavily depended on implementation and execution. Major concerns relating to gamification and financial incentives were perceived trivialization and potential for medication abuse, respectively.

CONCLUSIONS

The study's findings provide a foundation for developers seeking to apply these novel features in an app intervention for a general cohort of patients. However, the study highlights the need for standards for mHealth apps for medication adherence, with particular attention to the use of gamification and financial incentives. Future research with patients and stakeholders across the mHealth app ecosystem should be explored to formalize and validate a set of standards or framework.

Protocol for a construct and clinical validation study of MyCog Mobile: a remote smartphone-based cognitive screener for older adults

INTRODUCTION

Annual cognitive screening in older adults is essential for early detection of cognitive impairment, yet primary care settings face time constraints that present barriers to routine screening. A remote cognitive screener completed on a patient's personal smartphone before a visit has the potential to save primary care clinics time, encourage broader screening practices and increase early detection of cognitive decline. MyCog Mobile is a promising new remote smartphone-based cognitive screening app for primary care settings. We propose a combined construct and clinical validation study of MyCog Mobile.

METHODS AND ANALYSIS

We will recruit a total sample of 300 adult participants aged 65 years and older. A subsample of 200 healthy adult participants and a subsample of 100 adults with a cognitive impairment diagnosis (ie, dementia, mild cognitive impairment, cognitive deficits or other memory loss) will be recruited from the general population and specialty memory care centres, respectively. To evaluate the construct validity of MyCog Mobile, the healthy control sample will self-administer MyCog Mobile on study-provided smartphones and be administered a battery of gold-standard neuropsychological assessments. We will compare correlations between performance on MyCog Mobile and measures of similar and dissimilar constructs to evaluate convergent and discriminant validity. To assess clinical validity, participants in the clinical sample will self-administer MyCog Mobile on a smartphone and be administered a Mini-Cog screener and these data will be combined with the healthy control sample. We will then apply several supervised model types to determine the best predictors of cognitive impairment within the sample. Area under the receiver operating characteristic curve, accuracy, sensitivity and specificity will be the primary performance metrics for clinical validity.

ETHICS AND DISSEMINATION

The Institutional Review Board at Northwestern University (STU00214921) approved this study protocol. Results will be published in peer-reviewed journals and summaries provided to the study's funders.