Cognitive Testing and Mobile Technology

Psychologists and scientists have long recognized that human cognition is what separates us from other forms of life (Au, Piers, & Devine, S, 2017). Understanding how to evaluate our cognitive abilities across a broad array of contexts, including assessing the integrity of our cognition in the face of injury or disease are thus top priorities for researchers and clinicians alike. Knowledge of cognition can be useful not only in healthcare but also in nonpathological scenarios where people simply want to be aware of their cognitive abilities or optimize their cognitive power.

The History of Cognitive Testing

Systematic strategies for evaluating cognition have been developed and iterated for over 150 years (Sternin, Burns, & Owen, 2019). Back in the 1800s, though, much of this assessment was derived only from observation and subjective reporting. For instance, in the famous case of Phineas Gage, a railroad worker who suffered an accident in which an iron bar was driven through his eye socket, observations of extreme behavioral changes were the basis of understanding how Gage’s injury affected his cognitive abilities (O’Driscoll & Leach, 1998).

The 1900s century saw the development of more standardized tests for cognition, driven first by James Cattell, who coined the term “mental tests,” and Alfred Binet. However, by the second half of the 20th century, an entire field of cognition had been developed, along with a wide array of cognitive tests that were regularly employed and believed to be valid measures of cognition (Sternin, Burns, & Owen, 2019). These tests included the Stroop task, the Weschler Adult Intelligence Scale, and the Weschler Memory Scale.

In addition to these widely utilized tests, other types of cognitive assessments have been used in parallel for specific purposes. For instance, IQ tests are used to evaluate intelligence and suitability for areas of employment (McGill, Dombrowski, & Canivez, 2018). At the same time, mental status examinations that focus on cognition, such as  the Montreal Cognitive Assessment test and Mini-Mental Status Examination (Finney, Minagar, & Heilman, 2016) have been designed to evaluate different areas of cognition including attention, memory, language, and executive functions, and are often employed in healthcare settings when patients appear to be suffering from cognitive decline or display abnormal behavior.

Digital Media has Transformed Cognitive Testing

While cognitive tests have been successfully implemented over the past century, a major limitation to these tests is that they have generally been deployed in laboratory settings that are not representative of real-world scenarios. The problem with testing cognition in a laboratory is that data is only collected at discrete points in time, limiting its volume, and because it is collected outside of a natural environment, it may not capture critical aspects of cognition or behavior.

Today, our digital reality allows us to record and measure cognition outside a laboratory setting, potentially enhancing the value of this data and the relevant interventions we may be able to apply. These opportunities are afforded largely due to much of the world now being connected through mobile devices and digital media. Research into the issue of reliability and validity of cognitive tests administered via digital media have indeed shown that these tasks have good construct validity as well as between-person reliability and within-person variability (Sliwinski, Mogle, & Hyun, 2016).  

Cognitive Testing via Mobile Phones and Ecological Momentary Assessment

While technological innovations have provided novel ways to assess cognition, digital media have offered new opportunities for deploying cognitive tests and for collecting data on cognition. Ecological momentary assessment (EMA), for instance, provides a way to collect cognitive data from people while they remain in their natural environments, enhancing ecological validity (Shiffman, Stone, & Hufford, 2008).

There are several reasons that EMA can be particularly useful in the cognitive domain (Moore, Swendsen, & Depp, 2017). In addition to enabling the evaluation of cognitive abilities in real-world settings, EMA can help provide insight into cognitive changes that may occur immediately following injury or that signal disease onset (Schweitzer, 2016).

As such, it has been suggested that embedding relevant technologies in homes may provide an effective way to detect cognitive changes and identify potentially problematic underlying pathologies (Au, Piers, & Devine, S, 2017). In the case of cognition-related diseases like Alzheimer’s disease and other dementias, slight changes in cognition may be more likely to be recognized when cognitive status is continuously monitored in real-time than when this status is evaluated at discrete points in time by a clinician in a laboratory setting.

Cognitive assessment through mobile technologies and mobile EMA can provide clinicians with a more dynamic understanding of someone’s cognitive abilities and empower them to provide appropriate guidance related to their cognition. From a research perspective, these digital approaches to cognitive assessment also provide ways for us to better understand aspects of cognition and cognitive change and to develop more and better ways to help people to enhance their cognition through strategies that involve things like behavioral change. 

The ability to present mobile cognitive tests to study participants and patients is a standard part of the mEMA Premium License. Book a call to learn more about how it can be applied to your study. 

References

Au, R., Piers, R.J., & Devine, S. (2017). How technology is reshaping cognitive assessment: Lessons from the Framingham heart study. Neuropsychology,31(8), 846-861. https://doi.org/10.1037/neu0000411

Finney, G.R., Minagar, A., & Heilman, K.M. (2016). Assessment of mental status. Neurologic Clinics, 34(1), 1-16.  https://doi.org/10.1016/j.ncl.2015.08.001

Koo, B.M. & Vizer, L.M. (2019). Mobile technology for cognitive assessment of older adults: A scoping review. Innovation in Aging, 3(1). https://doi.org/10.1093/geroni/igy038

McGill, R.J., Dombrowski, S.C., & Canivez, G.L.  (2018). Cognitive profile analysis in school psychology: History, issues, and continued concerns. Journal of School Psychology,71, 108-121. https://doi.org/10.1016/j.jsp.2018.10.007

Moore, R.C., Swendsen, J., & Depp, C.A. (2017). Applications for self-administered mobile cognitive assessments in clinical research: A systematic review. International Journal of Methods in Psychiatric Research, 26(4). https://doi.org/10.1002/mpr.1562

O’Driscoll, K. & Leach, J.P. (1998). “No long Gage: an iron bar through the head.” BMJ, 317(7174), 1673-1674.  doi: https://doi.org/10.1136/bmj.317.7174.1673a 

Schweitzer, P. et al. (2016). Feasibility and validity of mobile cognitive testing in the investigation of age-related cognitive decline. International Journal of Methods in Psychiatric Research, 26(3). https://doi.org/10.1002/mpr.1521

Shiffman, S., Stone, A.A., & Hufford, M.R. (2008). Ecological momentary assessment. Annual Reviews in Clinical Psychology, 4, 1-32. DOI: 10.1146/annurev.clinpsy.3.022806.091415

 

 

Sliwinski, M.J. et al. (2018). Reliability and validity of ambulatory cognitive assessments. Assessment, 25(1), 14-30. https://doi.org/10.1177/1073191116643164