C-TOC (Cognitive Testing on Computer): investigating the usability and validity of a novel self-administered cognitive assessment tool in aging and early dementia

• Published in: Alzheimer disease and associated disorders Vol. 29; no. 3; p. 213
• Main Authors: Jacova, Claudia, McGrenere, Joanna, Lee, Hyunsoo S, Wang, William W, Le Huray, Sarah, Corenblith, Emily F, Brehmer, Matthew, Tang, Charlotte, Hayden, Sherri, Beattie, B Lynn, Hsiung, Ging-Yuek R
• Format: Journal Article
• Language: English
• Published: United States 01.07.2015
• Subjects: Aged; Aged, 80 and over; Aging; Cognition - physiology; Cognition Disorders - diagnosis; Cognition Disorders - physiopathology; Dementia - diagnosis; Dementia - physiopathology; Early Diagnosis; Executive Function - physiology; Female; Humans; Male; Middle Aged; Neuropsychological Tests
• ISSN: 1546-4156
• DOI: 10.1097/WAD.0000000000000055

Cognitive Testing on Computer (C-TOC) is a novel computer-based test battery developed to improve both usability and validity in the computerized assessment of cognitive function in older adults. C-TOC's usability was evaluated concurrently with its iterative development to version 4 in subjects with and without cognitive impairment, and health professional advisors representing different ethnocultural groups. C-TOC version 4 was then validated against neuropsychological tests (NPTs), and by comparing performance scores of subjects with normal cognition, Cognitive Impairment Not Dementia (CIND) and Alzheimer disease. C-TOC's language tests were validated in subjects with aphasic disorders. The most important usability issue that emerged from consultations with 27 older adults and with 8 cultural advisors was the test-takers' understanding of the task, particularly executive function tasks. User interface features did not pose significant problems. C-TOC version 4 tests correlated with comparator NPT (r=0.4 to 0.7). C-TOC test scores were normal (n=16)>CIND (n=16)>Alzheimer disease (n=6). All normal/CIND NPT performance differences were detected on C-TOC. Low computer knowledge adversely affected test performance, particularly in CIND. C-TOC detected impairments in aphasic disorders (n=11). In general, C-TOC had good validity in detecting cognitive impairment. Ensuring test-takers' understanding of the tasks, and considering their computer knowledge appear important steps towards C-TOC's implementation.