Web-Based Cognitive Testing of Older Adults in Person Versus at Home: Within-Subjects Comparison Study

Cyr, Andrée-Ann; Romero, Kristoffer; Galin-Corini, Laura · 2021 · Crossref

DOI: 10.2196/23384

archive: archived pipeline: cataloged verified

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Summary

This study addresses the growing need for valid remote cognitive assessment methods for older adults, particularly in the context of limited mobility and the rise of tele-neuropsychology. While web-based research offers cost-effective access to diverse populations, concerns persist regarding whether unsupervised home testing yields comparable results to supervised laboratory settings for older adults, who may have lower technology familiarity or higher stress in novel environments. The researchers aimed to determine if performance on computerized cognitive tasks differs between home and laboratory environments in healthy adults aged 65 and older, and whether such performance correlates with computer attitudes or familiarity. The study employed a within-subjects design involving 32 community-dwelling healthy adults. Participants completed computerized versions of the word-color Stroop task, paired associates learning (PAL), and verbal and matrix reasoning tasks in two settings: unsupervised at home using personal devices and supervised in a laboratory using standardized equipment. Testing sessions were spaced 24 hours apart, with the order of environments counterbalanced to control for practice effects. Additionally, participants completed paper-and-pencil neuropsychological equivalents (Wechsler Memory Scale-IV and Delis-Kaplan Executive Function System) and questionnaires assessing computer anxiety, attitudes, and familiarity. Statistical analyses included mixed analyses of variance and Bayesian inferential testing to evaluate equivalence, alongside Pearson correlations to assess validity against standard clinical measures. The results demonstrated no significant effect of the testing environment on performance for any of the computerized cognitive tasks. Analyses of reaction times, accuracy, and learning scores for the Stroop, PAL, and reasoning tasks revealed no differences between home and laboratory conditions. These null findings were supported by Bayesian analyses, which provided evidence for the null hypothesis of no meaningful difference. Furthermore, there were no significant correlations between task performance and participants’ computer familiarity or attitudes. However, performance on the computerized tasks correlated positively with scores on their corresponding paper-and-pencil neuropsychological equivalents, indicating that the web-based measures validly reflect cognitive ability as assessed by traditional clinical tools. The findings suggest that web-based cognitive testing is a viable alternative to in-person laboratory testing for older adults, producing comparable data without the need for supervision. This supports the use of remote assessment protocols in both research and clinical practice, potentially expanding access to cognitive screening for populations with restricted mobility. The lack of association between performance and technology familiarity further indicates that older adults can reliably complete these tasks regardless of their comfort level with computers. These results encourage the adoption of web-based methods to enhance the generalizability of aging research and facilitate tele-neuropsychological evaluations.

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• cognitive capacity variation