van den Berg Rosanne L, van der Landen Sophie M, Keijzer Matthijs J, van Gils Aniek M, van Dam Maureen, Ziesemer Kirsten A, Jutten Roos J, Harrison John E, de Boer Casper, van der Flier Wiesje M, Sikkes Sietske Am
Alzheimer Center Amsterdam, Neurology, Amsterdam University Medical Center, Amsterdam, The Netherlands.
Neurodegeneration, Amsterdam Neuroscience, Amsterdam, The Netherlands.
J Med Internet Res. 2025 May 27;27:e65297. doi: 10.2196/65297.
Assessment of cognitive decline in the earliest stages of Alzheimer disease (AD) is important but challenging. AD is a neurodegenerative disease characterized by gradual cognitive decline. Disease stages range from preclinical AD, in which individuals are cognitively unimpaired, to mild cognitive impairment (MCI) and dementia. Digital technologies promise to enable detection of early, subtle cognitive changes. Although the field of digital cognitive biomarkers is rapidly evolving, a comprehensive overview of the reporting of psychometric properties (ie, validity, reliability, responsiveness, and clinical meaningfulness) is missing. Insight into the extent to which these properties are evaluated is needed to identify the validation steps toward implementation.
This scoping review aimed to identify the reporting on quality characteristics of smartphone- and tablet-based cognitive tools with potential for remote administration in individuals with preclinical AD or MCI. We focused on both psychometric properties and practical tool characteristics.
This scoping review was conducted following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. In total, 4 databases (PubMed, Embase, Web of Science, and PsycINFO) were systematically searched from January 1, 2008, to January 5, 2023. Studies were included that assessed the psychometric properties of cognitive smartphone- or tablet-based tools with potential for remote administration in individuals with preclinical AD or MCI. In total, 2 reviewers independently screened titles and abstracts in ASReview, a screening tool that combines manual and automatic screening using an active learning algorithm. Thereafter, we manually screened full texts in the web application Rayyan. For each included study, 2 reviewers independently explored the reported information on practical and psychometric properties. For each psychometric property, examples were provided narratively.
In total, 11,300 deduplicated studies were identified in the search. After screening, 50 studies describing 37 different digital tools were included in this review. Average administration time was 13.8 (SD 10.1; range 1-32) minutes, but for 38% (14/37) of the tools, this was not described. Most tools (31/37, 84%) were examined in 1 language. The investigated populations were mainly individuals with MCI (34/37, 92%), and fewer tools were examined in individuals with preclinical AD (8/37, 22%). For almost all tools (36/37, 97%), construct validity was assessed through evaluation of clinical or biological associations or relevant group differences. For a small number of tools, information on structural validity (3/37, 8%), test-retest reliability (12/37, 32%), responsiveness (6/37, 16%), or clinical meaningfulness (0%) was reported.
Numerous smartphone- and tablet-based tools to assess cognition in early AD are being developed, whereas studies concerning their psychometric properties are limited. Often, initial validation steps have been taken, yet further validation and careful selection of psychometrically valid outcome scores are required to demonstrate clinical usefulness with regard to the context of use, which is essential for implementation.
在阿尔茨海默病（AD）的最早阶段评估认知衰退很重要，但具有挑战性。AD是一种神经退行性疾病，其特征是认知功能逐渐衰退。疾病阶段从临床前AD（个体认知功能未受损）到轻度认知障碍（MCI）和痴呆症。数字技术有望实现对早期细微认知变化的检测。尽管数字认知生物标志物领域正在迅速发展，但缺少对心理测量特性（即效度、信度、反应性和临床意义）报告的全面概述。需要了解这些特性的评估程度，以确定实施的验证步骤。
本范围综述旨在确定关于基于智能手机和平板电脑的认知工具质量特征的报告，这些工具具有对临床前AD或MCI个体进行远程管理的潜力。我们关注心理测量特性和实用工具特征。
本范围综述按照PRISMA-ScR（系统评价和Meta分析扩展版的首选报告项目）指南进行。从2008年1月1日至2023年1月5日，对4个数据库（PubMed、Embase、科学网和PsycINFO）进行了系统检索。纳入的研究评估了具有对临床前AD或MCI个体进行远程管理潜力的基于智能手机或平板电脑的认知工具的心理测量特性。共有2名评审员在ASReview（一种结合手动和自动筛选并使用主动学习算法的筛选工具）中独立筛选标题和摘要。此后，我们在网络应用程序Rayyan中手动筛选全文。对于每项纳入研究，2名评审员独立探究关于实用和心理测量特性的报告信息。对于每个心理测量特性，以叙述方式提供示例。
在检索中总共识别出11300项去重研究。筛选后，本综述纳入了50项描述37种不同数字工具的研究。平均管理时间为13.8（标准差10.1；范围1 - 32）分钟，但38%（14/37）的工具未描述此时间。大多数工具（31/37，84%）仅用1种语言进行了测试。所研究的人群主要是MCI个体（34/37，92%），而在临床前AD个体中测试的工具较少（8/37，22%）。几乎所有工具（36/37，97%）的结构效度通过评估临床或生物学关联或相关组差异来评估。少数工具报告了关于结构效度（3/37，8%）、重测信度（12/37，32%）、反应性（6/37，16%）或临床意义（0%）的信息。
正在开发许多基于智能手机和平板电脑的工具来评估早期AD的认知情况，而关于其心理测量特性的研究有限。通常已经采取了初步验证步骤，但需要进一步验证并仔细选择心理测量有效的结果分数，以证明在使用背景下的临床实用性，这对于实施至关重要。
