Abstract
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Objective:Frequent and remote cognitive assessment may improve sensitivity to subtle cognitive decline associated with preclinical Alzheimer’s disease (AD). The objective of this study was to evaluate the feasibility and acceptability of repeated remote memory assessment in late middle-aged and older adults.
Participants and Methods:We recruited participants from a longitudinal aging cohort to complete three medial temporal lobe-based memory paradigms (Object-In-Room Recall [ORR], Mnemonic Discrimination for Objects and Scenes [MDT-OS], Complex Scene Recognition [CSR]) using the neotiv application at repeated intervals over one year. We conducted initial telephone calls to perform screening, consent, and download instructions. Participants were assigned 24 remote sessions on a smartphone or tablet and were alerted via push notification when an assignment was ready to complete. Participants were randomly assigned to: (1) complete memory tests every other week or (2) complete memory tests for multiple days within one week every other month. Each remote session lasts approximately 10 minutes and includes one memory paradigm and brief usability/acceptability questionnaires followed by a delayed retrieval session 90 minutes later. Feasibility metrics examined included participation, retention, compliance, and usability/acceptability.
Results:Of 150 participants recruited, 113 consented and were enrolled into the study (participation rate = 75%). Current retention rate is 75%, with 85/113 currently active (n=73) or completed (n=12). Of the 85 active or completed participants, the mean age is 68.7 (range = 4882), 64% are women, 70% used a smartphone (30% tablet), 84 are cognitively unimpaired and 1 has mild cognitive impairment. The primary threat to retention was participants consenting into the study but never registering in the app or completing their first scheduled assignment. After enrollment, 130 telephone calls were made by study staff to facilitate registration into the app or to remind participants to complete tasks. 74-80% of participants completed delayed retrieval tasks within 30 minutes of push notification, but average retrieval time was 125137 minutes post-learning trials. Regarding acceptability/usability, 94% agreed the application was easy to use, 56% enjoyed completing the mobile memory tests (36% felt neutral), 40% prefer remote mobile memory tests to standard in-person paper and pencil tests, and 50% understood the test instructions. 87% felt the frequency of tests assigned was “just right” (13% “too often”) and 90% felt the test length was “just right” (7% too short, 3% too long). Participants who completed all 24 sessions to date (n=12) all endorsed being “satisfied” or “very satisfied” with the platform and visit schedule, as well as recommended continued use of this type of cognitive testing.
Conclusions:Remote memory assessment using smartphones and tablets is feasible and acceptable for cognitively unimpaired late middle-aged and older adults. Follow-up by study staff was needed to ensure adequate retention. Comprehension of instructions and compliance with completing delayed retrieval tasks within the expected timeframe was lower than expected. These feedback will be incorporated into an updated version of the app to improve compliance and retention. Longitudinal data collection is ongoing and results will be updated with a larger sample. Results will be compared across frequency schedule groups.
