Test-retest reliability, practice effects and estimates of change: A study on the Mindmore digital cognitive assessment tool.

The present study aimed to establish test-retest reliability and investigate practice effects of the Mindmore cognitive assessment tool, a digital adaptation of traditional pencil and paper tests designed for self-administration. Additionally, normative change scores for the most frequently used tests were derived. A total of 149 healthy Swedish adults (aged 20-79) completed the test battery twice, 1 month apart. The battery assessed attention and processing speed, memory, language, visuospatial functions, and executive functions. Test-retest reliability, measured by ICC and Spearman coefficients, and practice effects were estimated for 22 main-scores and 33 sub-scores. Regression models were used to assess change in performance while controlling for demographics, computer equipment, testing location (online or in-laboratory) and baseline performance for 12 main-scores and nine sub-scores. Test-retest reliability was good for 11 main-scores (≥0.70), satisfactory for five (0.60-0.69), and minimal for six (<0.60) albeit three having satisfactory sub-scores. Practice effects were observed for tests with a major speed component, but not for reaction time, sustained attention, verbal memory and naming (alternate forms), nor visuospatial functions. Trackpad negatively influenced change for one test. Demographics and testing location did not significantly affect the change scores. Our study provides support for test-retest reliability and practice effects of the Mindmore cognitive assessment tool which were comparable to those of traditional tests. These findings, together with the normative change scores, can aid researchers and clinicians in interpreting test results and distinguishing between normal variations in performance and changes indicative of clinical impairment.

Montreal Cognitive Assessment: Normative Data for Cognitively Healthy Swedish 80- to 94-Year-Olds.

BACKGROUND: The Montreal Cognitive Assessment (MoCA) is sensitive to cognitive impairment; however, it is also sensitive to demographic and socio-cultural factors. This necessitates reliable sub-population norms, but these are often lacking for older adults. OBJECTIVE: To present demographically adjusted regression-based MoCA norms for cognitively healthy Swedish older adults. METHODS: A pseudo-random sample of community-dwelling 80- to 94-year-olds, stratified by age and gender, was invited to the study. Initial telephone interviews and medical records searches (n = 218) were conducted to screen for cognitive impairment. N = 181 eligible participants were administered a protocol including the Swedish version of the MoCA and assessments of global cognition (Mini-Mental State Examination, MMSE) and depression (Patient Health Questionnaire-9, PHQ-9). Individuals scoring in the range of possible cognitive impairment on the MMSE or more than mild depression on the PHQ-9 were excluded (n = 23); three discontinued the test-session. RESULTS: Norms were derived from the remaining n = 158. They were evenly distributed by gender, on average 85 years old, and with a mean education of 11 years. MoCA scores were independently influenced by age and education, together explaining 17.2% of the total variance. Higher age and lower education were associated with lower performance and 46% performed below the original cut-off (< 26/30). CONCLUSION: The negative impact of increasing age on MoCA performance continues linearly into the nineties in normal aging. Demographic factors should be considered when interpreting MoCA performance and a tool for computing demographically corrected standard scores is provided.

Swedish Normative Data for Mindmore: A Comprehensive Cognitive Screening Battery, Both Digital and Self-Administrated.

OBJECTIVE: Cognitive impairment is a key element in most mental disorders. Its objective assessment at initial patient contact in primary care can lead to better adjusted and timely care with personalised treatment and recovery. To enable this, we designed the Mindmore self-administrative cognitive screening battery. What is presented here is normative data for the Mindmore battery for the Swedish population. METHOD: A total of 720 healthy adults (17 to 93 years) completed the Mindmore screening battery, which consists of 14 individual tests across five cognitive domains: attention and processing speed, memory, language, visuospatial functions and executive functions. Regression-based normative data were established for 42 test result measures, investigating linear, non-linear and interaction effects between age, education and sex. RESULTS: The test results were most affected by age and to a lesser extent by education and sex. All but one test displayed either linear or accelerated age-related decline, or a U-shaped association with age. All but two tests showed beneficial effects of education, either linear or subsiding after 12 years of educational attainment. Sex affected tests in the memory and executive domains. In three tests, an interaction between age and education revealed an increased benefit of education later in life. CONCLUSION: This study provides normative models for 14 traditional cognitive tests adapted for self-administration through a digital platform. The models will enable more accurate interpretation of test results, hopefully leading to improved clinical decision making and better care for patients with cognitive impairment.

A quick test of cognitive speed (AQT): regression-based norms for cognitively healthy 80 to 94-year olds.

Slowed processing speed is part of normal aging but also a symptom of many diseases, including dementia. A Quick Test of Cognitive Speed (AQT) consists of three conditions: color naming (AQT1), form naming (AQT2) and dual color-form naming (AQT3) and offers a user-friendly assessment of processing speed that is used internationally to identify cognitive impairment in elderly patients. Appropriate age-norms have however been lacking. This study provides regression-based norms derived from a Swedish sample of 158 cognitively healthy 80 to 94-year olds. The results show age effects in all three conditions, a non-linear education effect in AQT1, and age by gender interactions in AQT2 and AQT3: men performed worse with increasing age, but women remained on a par. However, irrespective of age and gender, AQT2 and AQT3 mean raw and predicted scores were slower than the hitherto recommended cutoff criteria for suspected cognitive impairment.

Comparing Traditional and Digitized Cognitive Tests Used in Standard Clinical Evaluation - A Study of the Digital Application Minnemera.

The purpose of this study was to compare a new digitized cognitive test battery, Minnemera, with its correspondent traditional paper-based cognitive tests. Eighty-one healthy adults between the ages of 21 and 85 participated in the study. Participants performed the two different test versions (traditional paper-based and digitized) with an interval of four weeks between the tests. Test presentation (the order of the test versions presented) was counterbalanced in order to control for any possible test learning effects. The digitized tests were constructed so that there were only minor differences when compared to the traditional paper-based tests. Test results from the paper-based and digitized versions of the cognitive screening were compared within individuals by means of a correlation analysis and equivalence tests. The effects of demographic variables (age, gender and level of education) and test presentation were explored for each test measure and each test version through linear regression models. For each test measure, a significant correlation between traditional and digitized version was observed ranging between r = 0.34 and r = 0.67 with a median of r = 0.53 (corresponding to a large effect size). Score equivalence was observed for five out of six tests. In line with previous traditional cognitive studies, age was found to be the most prominent predictor of performance in all digitized tests, with younger participants performing better than older adults. Gender was the second strongest predictor, where women outperformed men in tests measuring verbal memory; men performed better than women in tests with a strong visual component. Finally, the educational level of the test subjects had an effect on executive functions, with a higher educational level linked to a better inhibition response and working memory span. This study suggests that the tests in the Minnemera cognitive screening battery are acceptably comparable to the traditional paper-based counterparts.

Don't look back in anger: the rewarding value of a female face is discounted by an angry expression.

The modulating effect of emotional expression on the rewarding nature of attractive and nonattractive female faces in heterosexual men was explored in a motivated viewing paradigm. This paradigm, which is an indicator of neural reward, requires the viewer to expend effort to maintain or reduce image-viewing times. Males worked to extend the viewing time for happy and neutral attractive faces but to reduce the viewing time for the attractive angry faces. Attractive angry faces were rated as more aesthetically pleasing than the nonattractive faces; however, the males worked to reduce their viewing time to a level comparable with the nonattractive neutral and happy faces. Therefore, the addition of an angry expression onto an otherwise attractive face renders it unrewarding and aversive to potential mates. Mildly happy expressions on the nonattractive faces did little to improve their attractiveness or reward potential, with males working to reduce viewing time for all nonattractive faces.