Young Stephanie Ruth, Dworak Elizabeth McManus, Byrne Greg J, Jones Callie Madison, Yoshino Benavente Julia, Hauner Katherina K, Gershon Richard, Wolf Michael, Nowinski Cindy
Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
BMJ Open. 2025 Aug 24;15(8):e092063. doi: 10.1136/bmjopen-2024-092063.
OBJECTIVES: 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. MyCog Mobile is a self-administered, smartphone-based cognitive screener that has the potential to help overcome these screening obstacles. We compared MyCog Mobile to 'gold-standard' measures to support its reliability and validity and examined performance differences between in-person versus remote assessment. DESIGN: Cross-sectional convenience sample study comparing MyCog Mobile measures to established cognitive assessments. SETTING: Five in-person research facility locations in Georgia, Texas, New Jersey, Florida and Arizona. PARTICIPANTS: 200 adults aged 65-87 years (M=72.56, SD=5.11) who spoke English. PRIMARY OUTCOME MEASURES: Convergent and divergent validity were examined via Spearman's rho correlations between MyCog Mobile measures (MyPictures, MyFaces, MySorting and MySequences) and established measures (verbal paired associates, digit span, letter-number sequencing, Color-Word Interference Test and Trail Making Test), as well as a confirmatory factor analysis using these same measures. Internal consistency was assessed via Spearman-Brown split-half correlations. Score distributions were compared between in-person and remote administration. RESULTS: Internal consistency for all MyCog Mobile measures was above acceptable thresholds, ranging from ρ=0.71 to 0.89. Strong correlations were found between MyCog Mobile subtests and their tablet counterparts (MyPictures-Picture Sequence Memory: ρ=0.52; MySorting-dimensional change card sorting: ρ=0.55). MyPictures and MyFaces demonstrated large correlations with convergent memory measures (verbal paired associates immediate ρ=0.51 and 0.56, respectively) and small correlations with discriminant measures. Confirmatory factor analysis supported a two-factor model with subtests loading onto episodic memory and executive functioning factors as expected (χ²(25)=39.136; Comparative Fit Index (CFI) = 0.965; Tucker-Lewis Index (TLI) = 0.950; Root Mean Square Error of Approximation (RMSEA) = 0.053; Standardized Root Mean Square Residual (SRMR) = 0.040). Remote participants scored significantly higher on the MyPictures task overall (t(249)=2.98, p=0.004), while in-person participants scored higher on the MyFaces First Letter subtest and MySequences. CONCLUSIONS: MyCog Mobile offers a reliable and valid assessment of executive functioning and episodic memory in older adults. Performance may differ by setting, but further research is needed. These findings support future clinical validation studies to determine the diagnostic accuracy of MyCog Mobile to detect cognitive impairment.
目的:对老年人进行年度认知筛查对于早期发现认知障碍至关重要,但基层医疗环境面临时间限制,这对常规筛查构成了障碍。MyCog Mobile是一款基于智能手机的自我管理认知筛查工具,有可能帮助克服这些筛查障碍。我们将MyCog Mobile与“金标准”测量方法进行比较,以支持其可靠性和有效性,并研究面对面评估与远程评估之间的性能差异。 设计:横断面便利样本研究,将MyCog Mobile测量方法与既定的认知评估进行比较。 地点:佐治亚州、得克萨斯州、新泽西州、佛罗里达州和亚利桑那州的五个面对面研究机构地点。 参与者:200名65 - 87岁(M = 72.56,SD = 5.11)讲英语的成年人。 主要结局指标:通过MyCog Mobile测量方法(MyPictures、MyFaces、MySorting和MySequences)与既定测量方法(言语配对联想、数字广度、字母 - 数字排序、颜色 - 单词干扰测试和连线测验)之间的斯皮尔曼等级相关系数来检验聚合效度和区分效度,以及使用这些相同测量方法进行验证性因素分析。通过斯皮尔曼 - 布朗分半相关系数评估内部一致性。比较面对面管理和远程管理之间的分数分布。 结果:所有MyCog Mobile测量方法的内部一致性均高于可接受阈值,范围从ρ = 0.71至0.89。发现MyCog Mobile子测试与其平板电脑对应测试之间存在强相关性(MyPictures - 图片序列记忆:ρ = 0.52;MySorting - 维度变化卡片分类:ρ = 0.55)。MyPictures和MyFaces与聚合记忆测量方法显示出较大相关性(言语配对联想即时ρ分别为0.51和0.56),与区分测量方法显示出较小相关性。验证性因素分析支持一个双因素模型,子测试按预期加载到情景记忆和执行功能因素上(χ²(25) = 39.136;比较拟合指数(CFI) = 0.965;塔克 - 刘易斯指数(TLI) = 0.950;近似均方根误差(RMSEA) = 0.053;标准化均方根残差(SRMR) = 0.040)。远程参与者在MyPictures任务上的总体得分显著更高(t(249) = 2.98,p = 0.004),而面对面参与者在MyFaces首字母子测试和MySequences上得分更高。 结论:MyCog Mobile对老年人的执行功能和情景记忆提供了可靠且有效的评估。不同环境下的表现可能有所不同,但仍需要进一步研究。这些发现支持未来的临床验证研究,以确定MyCog Mobile检测认知障碍的诊断准确性。
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