The feasibility and psychometric rigor of using high-frequency, smartphone-based assessments for cognitive screening in older adults

Objective: The psychometric rigor of unsupervised, smartphone-based assessments and factors that impact remote protocol engagement are critical to evaluate prior to the use of such methods in clinical cognitive contexts. We evaluated the reliability and validity of a high-frequency, smartphone-based cognitive assessment protocol, while also investigating factors that may impact adherence, including time of day and receipt of feedback vs. no feedback. Methods: Cognitively unimpaired participants (N=120, Mage=68.8, 67.5% female, 88% White, Meducation=16.5 years) completed 8 consecutive days of the Mobile Monitoring of Cognitive Change (M2C2), a mobile app-based testing platform, with brief daily morning, afternoon, and evening sessions. Tasks included measures of visual working memory, processing speed, and episodic memory. Traditional neuropsychological assessments included measures from the Alzheimer’s Preclinical Composite battery (PACC). Results: Findings showed overall high compliance (89.3%) across M2C2 sessions and high rates of self-reported protocol acceptability. There was evidence of faster reaction time and greater initial compliance among participants who expected to receive performance feedback. Within-subjects reliabilities were all  .85 by day 5. We observed excellent convergent and divergent validity in our comparison of M2C2 tasks and traditional neuropsychological assessments. Conclusions: This study supports the feasibility, acceptability, and reliability of self-administered, high-frequency cognitive assessment via smartphones in older adults. Insights into factors affecting adherence, performance, and protocol implementation are discussed.