Submitted to: International Journal of Geriatric Psychiatry
Publication Type: Peer reviewed journal
Publication Acceptance Date: 1/29/2013
Publication Date: 4/16/2013
Citation: Espeland, M.A., Katula, J.A., Rushing, J., Kramer, A., Jennings, J., Sink, K.M., Nadkarni, N.K., Reid, K.F., Castro, C.M., Church, T., Kerwin, D.R., Williamson, J.D., Marttoli, R.A., Rushing, S., Marsiske, M., Rapp, S.R. 2013. Performance of a computer-based assessment of cognitive function measures in two cohorts of seniors. International Journal of Geriatric Psychiatry. DOI: 10.1002/gps.3949. Interpretive Summary: This study describes the use of computerized tests of cognitive ability in older adults. This is an important study as with increasing numbers of people with dementia and age-related cognitive decline, more rapid, reliable and cost effective methods to evaluate cognitive function is needed. For the first time, this study systematically evaluated the use of computer administered cognitive testing and compared performance to traditional interviewer administered cognitive function testing. The major findings of the study show that computer-based assessments of cognitive function had consistent relationships with interviewer-administered assessments of cognitive function, age, and measures of physical function. Important factors that were shown to limit the successful completion of computerized cognitive testing were age and prior computer usage. Overall, this study supports the widespread use of computer-based cognitive function assessment in clinical trials of older populations.
Technical Abstract: Computer-administered assessment of cognitive function is being increasingly incorporated in clinical trials, however its performance in these settings has not been systematically evaluated. The Seniors Health and Activity Research Program (SHARP) pilot trial (N=73) developed a computer-based tool for assessing memory performance and executive functioning. The Lifestyle Interventions and Independence for Seniors (LIFE) investigators incorporated this battery in a full scale multicenter clinical trial (N=1635). We describe relationships that test scores have with those from interviewer-administered cognitive function tests and risk factors for cognitive deficits and describe performance measures (completeness, intra-class correlations). Computer-based assessments of cognitive function had consistent relationships across the pilot and full scale trial cohorts with interviewer-administered assessments of cognitive function, age, and a measure of physical function. In the LIFE cohort, their external validity was further demonstrated by associations with other risk factors for cognitive dysfunction: education, hypertension, diabetes, and physical function. Acceptable levels of data completeness (>83%) were achieved on all computer-based measures, however rates of missing data were higher among older participants (odds ratio=1.06 for each additional year; p<0.001) and those who reported no current computer use (odds ratio=2.71; p<0.001). Intra-class correlations among clinics were at least as low (ICC less than or equal to 0.013) as for interviewer measures (ICC less than or equal to 0.023), reflecting good standardization. All cognitive measures loaded onto the first principal component (global cognitive function), which accounted for 40% of the overall variance. Our results support the use of computer-based tools for assessing cognitive function in multicenter clinical trials of older individuals.