Unlocking Cognitive Research During Lockdown: Bringing Cognitive Assessment Home

Web-based testing supports patients in engaging with research from the comfort of their own homes—fostering an environment for inclusive and representative research—but are the results robust? New research, published in the Journal of Medical Internet Research, makes the case for CANTAB cognitive assessments.

Traditionally, scientists assess cognition using thorough, but infrequent, assessments in the laboratory or clinic. In efforts to curb coronavirus disease (COVID-19) transmission rates, most researchers have postponed this form of face-to-face assessment and are actively seeking remote alternatives. With the ubiquity of electronic devices and fast-paced internet connections, web-based testing is a compelling option. However, before departing from the tightly controlled laboratory environment, researchers must first be satisfied that they can obtain the same quality data online as they would in-person. Promising new research, published in the Journal of Medical Internet Research, demonstrates that performance on the Cambridge Neuropsychological Test Automated Battery (CANTAB) is comparable when delivered unsupervised online or in-person in the laboratory.

“In recent years there has been a movement to bring research to the patients and to tailor it to their lives. In times of a pandemic, being able to deliver your cognitive tests remotely becomes even more relevant and mitigates some of the risks that come with conducting research during a crisis.” Study author and Operational Scientist at Cambridge Cognition, Rosa Backx.

The study recruited 51 healthy adults (aged 20-77 years) who completed CANTAB assessments in two settings: supervised in the laboratory on standardized computing hardware and at-home on their personal devices via the web. Three criteria were set for web-based testing to show acceptable comparability: (1) high levels of intersetting reliability, (2) equivalence with in-person tests, and (3) agreement across test settings.

As measured by errors, correct trials, and response sensitivity, CANTAB performance showed good comparability between web-based assessments delivered at home and supervised administration in the laboratory. However, as expected from previous experience, translation was not easy for the reaction time measures. The researchers believe a key contributor to the difference between test settings was computer hardware. Although the same computer hardware was used for all the in-person assessments, the web-based assessments were delivered on participants’ own devices. The result was inconsistent latency measurement between devices and therefore participants. Researchers can standardize response times further by specifying equipment to be used or sending equipment to participants at home.

“Where scientists are keen to use remote testing in the place of, or in addition to, in-person testing we need to establish multiple forms of comparability. Outcome measures can be highly correlated across different test settings, but high correlations can occur in the context of systematic differences in the scale and spread of the data. Only by looking at additional measures such as agreement and equivalence, is it possible to establish whether these measurements are capturing a similar level of variance on a similar scale. We found this to be particularly important for response times, which were highly correlated across settings, but were significantly longer on web-based testing.” Study author and Senior Scientist at Cambridge Cognition, Dr Caroline Skirrow.

Amid the COVID-19 pandemic, there is a pressing need to incorporate remote assessments into both clinical and academic research. Overall, this study presents web-based CANTAB tests delivered on participants’ own devices as a good alternative to in-person administered cognitive assessments. However, if researchers are interested specifically in response latency measures, standardized devices should be used to improve consistency across measurements.

About Cambridge Cognition

Cambridge Cognition is a neuroscience technology company developing digital health products to better understand, detect, and treat conditions affecting brain health. The company’s software products assess cognitive health in patients worldwide to improve clinical trial outcomes, identify and stratify patients early, and improve global efficiency in pharmaceutical and health care industries.
For further information, visit https://www.cambridgecognition.com/cantab/

Original article

Backx R, Skirrow C, Dente P, Barnett JH, Cormack FK (2020)
Comparing Web-Based and Lab-Based Cognitive Assessment Using the Cambridge Neuropsychological Test Automated Battery: A Within-Subjects Counterbalanced Study
J Med Internet Res 2020;22(8):e16792
DOI: 10.2196/16792
URL: https://www.jmir.org/2020/8/e16792/

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