In the field of cognitive science, neuropsychological assessment tools serve as a cornerstone for understanding how our brains influence behavior. Historically, standardized assessments have been crucial in unearthing the complex relationships between brain function and behavior, shaping the neuropsychological inquiries that can be asked, enhancing the understanding of specific brain functions, providing standardized tools for clinical outcomes research, and informing the identification and management of neurological conditions. 

However, as the landscape of neuropsychological assessment evolves, there's a growing shift towards methods that are more reflective of real-world settings. Ecological Momentary Cognitive Testing (EMCT) is an innovative approach leveraging smartphone technology to assess cognition in real-time and natural environments. As opposed to traditional methods that typically rely on a single time point to assess and characterize an individual’s performance, EMCT  utilizes repeated, brief, real-time assessments to capture cognitive performance as it ebbs and flows within individuals over time in naturalistic settings. This approach is particularly beneficial for understanding cognitive fluctuations influenced by various contextual factors, such as emotional state and environmental distractions. 

The increasing adoption of EMCT highlights the need for developing robust normative standards. This ensures that these tools are not only reliable but also effective in enhancing diagnosis, prediction, and treatment of cognitive conditions. In a new paper published by the Journal of Medical Internet Research, Paolillo and colleagues presents normative data from a diverse sample of U.S. adults using NeuroUX mobile cognitive tests, emphasizing the practicality and immediacy of these assessments. 

Their study spanned a 10-day period, during which participants engaged with a series of eight NeuroUX cognitive tests on their smartphones. 

Tests administered included:

  • Memory List – 12 word list length: This task evaluates recognition memory by having participants learn a list of words, perform a distractor task, and then identify previously shown words from a mix of target and distractor words.
  • Memory Matrix: This task assesses visual working memory by requiring participants to identify highlighted tiles on a grid, with the grid size and number of highlighted tiles increasing as they successfully recall the highlighted tiles.
  • Matching Pair: This task evaluates processing speed by having participants quickly identify matching tiles in a matrix displaying various shapes and colors, with the matrix size increasing progressively.
  • Quick Tap 1: This task measures processing speed by requiring participants to quickly tap a target image that appears at random intervals, with incorrect responses recorded for missed taps or premature taps before the target appears.
  • Quick Tap 2: This task evaluates response inhibition using a go/no-go paradigm where participants must quickly tap target images while refraining from tapping foil images that appear randomly at intervals between 1 to 5 seconds.
  • Odd One Out: This task assesses visual working memory and processing speed by having participants quickly identify and tap the one different symbol among six presented symbols, where five share similar features.
  • CopyKat: This task evaluates visual working memory by having participants replicate a sequentially lit pattern of colored tiles on a grid, with the grid size increasing following each correct response.
  • Hand Swype: This task assesses cognitive flexibility by requiring participants to swipe in response to hands pointing or moving in various directions, with instructions changing throughout the task, while tracking the proportion of errors and median response times for correct trials.

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This comprehensive paper examined various factors, including the consistency of test results upon repeated administrations and the influence of practice on performance. Moreover, it explored demographic variables, offering insights into how aspects such as age, sex, and race might impact cognitive performance, as well as differences in cognitive performance by smartphone type and context (e.g., home vs. away from home; alone vs. not alone).

Specific details provided in this manuscript include:

  • Alternate form test-retest reliability: Cumulative ICCs to examine how the number of repeated administrations impacts the test-retest reliability of each test 
  • Practice effects. For scores with significant practice effects, mixed effects models with linear splines tested whether there was a change point at which improvements in performance leveled off
  • Test-retest interval as a predictor of score changes across sequential sessions for each test
  • Associations between demographics and the average performance and within-person variability in performance for each NeuroUX test
  • Differences in aggregate NeuroUX test performance by smartphone software type and version
  • Age-stratified analyses to understand whether relationships with sex, race and ethnicity, or smartphone type differed between younger (<50 y) and older (≥50 y) adults
  • Within-person fluctuations in NeuroUX test performance by contextual and environmental factors (reported for each session via EMA)

Not included in the manuscript but available upon request from the NeuroUX team are uncorrected T-scores and demographically-adjusted T scores for these eight tests.

Feedback from study participants was overwhelmingly positive, with many finding the tests both easy to navigate and beneficial for understanding their cognitive abilities. The willingness of participants to share their results with healthcare providers signifies a promising shift towards integrating cognitive self-monitoring into routine health care.

By enhancing the understanding and application of mobile cognitive testing, we open new doors for personalized health care interventions and advanced cognitive research. These tools offer the potential for more nuanced clinical decision-making and could be a significant step forward in tailoring interventions to individual needs.

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