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基于智能手机的非监督高频认知评估在有阿尔茨海默病风险的老年人中是可靠、有效且可行的。

Unsupervised high-frequency smartphone-based cognitive assessments are reliable, valid, and feasible in older adults at risk for Alzheimer's disease.

机构信息

Charles F. and Joanne Knight Alzheimer Disease Research Center, Department of Neurology, Washington University, School of Medicine, St. Louis, MO, USA.

Department of Psychological & Brain Sciences, Washington University in St. Louis, St. Louis, MO, USA.

出版信息

J Int Neuropsychol Soc. 2023 Jun;29(5):459-471. doi: 10.1017/S135561772200042X. Epub 2022 Sep 5.


DOI:10.1017/S135561772200042X
PMID:36062528
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9985662/
Abstract

OBJECTIVE: Smartphones have the potential for capturing subtle changes in cognition that characterize preclinical Alzheimer's disease (AD) in older adults. The Ambulatory Research in Cognition (ARC) smartphone application is based on principles from ecological momentary assessment (EMA) and administers brief tests of associative memory, processing speed, and working memory up to 4 times per day over 7 consecutive days. ARC was designed to be administered unsupervised using participants' personal devices in their everyday environments. METHODS: We evaluated the reliability and validity of ARC in a sample of 268 cognitively normal older adults (ages 65-97 years) and 22 individuals with very mild dementia (ages 61-88 years). Participants completed at least one 7-day cycle of ARC testing and conventional cognitive assessments; most also completed cerebrospinal fluid, amyloid and tau positron emission tomography, and structural magnetic resonance imaging studies. RESULTS: First, ARC tasks were reliable as between-person reliability across the 7-day cycle and test-retest reliabilities at 6-month and 1-year follow-ups all exceeded 0.85. Second, ARC demonstrated construct validity as evidenced by correlations with conventional cognitive measures ( = 0.53 between composite scores). Third, ARC measures correlated with AD biomarker burden at baseline to a similar degree as conventional cognitive measures. Finally, the intensive 7-day cycle indicated that ARC was feasible (86.50% approached chose to enroll), well tolerated (80.42% adherence, 4.83% dropout), and was rated favorably by older adult participants. CONCLUSIONS: Overall, the results suggest that ARC is reliable and valid and represents a feasible tool for assessing cognitive changes associated with the earliest stages of AD.

摘要

目的:智能手机有可能捕捉到认知的细微变化,这些变化特征是老年人群中临床前阿尔茨海默病(AD)的表现。基于生态瞬时评估(EMA)原理开发的认知动态监测(ARC)智能手机应用程序,每天对参与者进行 4 次短暂的联想记忆、处理速度和工作记忆测试,连续 7 天。ARC 的设计目的是在参与者的日常环境中使用他们自己的个人设备进行无人监督的管理。

方法:我们评估了认知正常的 268 名老年人(年龄 65-97 岁)和 22 名轻度痴呆症患者(年龄 61-88 岁)样本中 ARC 的可靠性和有效性。参与者至少完成了一个 7 天的 ARC 测试周期和常规认知评估;大多数人还完成了脑脊液、淀粉样蛋白和 tau 正电子发射断层扫描和结构磁共振成像研究。

结果:首先,ARC 任务具有可靠性,7 天周期内的个体间可靠性以及 6 个月和 1 年随访时的测试-重测可靠性均超过 0.85。其次,ARC 表现出构念效度,因为它与常规认知测量相关(综合评分之间的相关性为 0.53)。第三,ARC 测量与基线时的 AD 生物标志物负担具有相似程度的相关性,与常规认知测量相似。最后,密集的 7 天周期表明 ARC 是可行的(86.50%的参与者选择入组),具有良好的耐受性(80.42%的依从性,4.83%的失访率),并且受到老年参与者的好评。

结论:总的来说,结果表明 ARC 具有可靠性和有效性,并且是评估与 AD 最早阶段相关的认知变化的可行工具。

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引用本文的文献

[1]
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Alzheimers Dement. 2025-9

[2]
A pilot comparison of remote versus in-clinic digital cognitive assessments for older adults in primary care settings.

medRxiv. 2025-8-21

[3]
The construct validity of daily cognitive variability.

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[4]
The Mobile Toolbox for remote, self-administered cognitive assessment in older adults: associations with in-clinic cognitive testing and Alzheimer's disease biomarkers.

Alzheimers Dement (Amst). 2025-8-19

[5]
Exploring the relationship between mean performance and within-person variability on smartphone-based cognitive testing in adults across the lifespan.

NPP Digit Psychiatry Neurosci. 2025

[6]
Smartphone- and Tablet-Based Tools to Assess Cognition in Individuals With Preclinical Alzheimer Disease and Mild Cognitive Impairment: Scoping Review.

J Med Internet Res. 2025-5-27

[7]
A scoping review of remote and unsupervised digital cognitive assessments in preclinical Alzheimer's disease.

NPJ Digit Med. 2025-5-10

[8]
Objective Criteria for Subtle Cognitive Decline in Aging and Preclinical Alzheimer Disease: A Systematic Review.

Neurology. 2025-5-13

[9]
Detecting short-interval longitudinal cortical atrophy in neurodegenerative dementias via cluster scanning: A proof of concept.

medRxiv. 2025-3-17

[10]
Mayo Normative Studies: regression-based normative data for remote self-administration of the Stricker Learning Span, Symbols Test, and Mayo Test Drive Screening Battery Composite and validation in individuals with mild cognitive impairment and dementia.

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本文引用的文献

[1]
Bridging the Technological Divide: Stigmas and Challenges With Technology in Digital Brain Health Studies of Older Adults.

Front Digit Health. 2022-4-29

[2]
A highly feasible, reliable, and fully remote protocol for mobile app-based cognitive assessment in cognitively healthy older adults.

Alzheimers Dement (Amst). 2022-4-5

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Sharper in the morning: Cognitive time of day effects revealed with high-frequency smartphone testing.

J Clin Exp Neuropsychol. 2021-10

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Unsupervised mobile cognitive testing for use in preclinical Alzheimer's disease.

Alzheimers Dement (Amst). 2021-9-30

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Is comprehensiveness critical? Comparing short and long format cognitive assessments in preclinical Alzheimer disease.

Alzheimers Res Ther. 2021-9-13

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Alzheimers Dement (Amst). 2021-7-20

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Gerontology. 2021

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Age impairs mnemonic discrimination of objects more than scenes: A web-based, large-scale approach across the lifespan.

Cortex. 2021-4

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Associations between NIH Toolbox Cognition Battery and brain amyloid and tau pathology in non-demented older adults.

Alzheimers Dement (Amst). 2020-5-15

[10]
A soluble phosphorylated tau signature links tau, amyloid and the evolution of stages of dominantly inherited Alzheimer's disease.

Nat Med. 2020-3-11

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