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. 2021 Nov;85(8):3075-3083.
doi: 10.1007/s00426-020-01452-8. Epub 2020 Dec 17.

Digital pen technology for conducting cognitive assessments: a cross-over study with older adults

A Heimann-Steinert  1 , A Latendorf  2 , A Prange  3 , D Sonntag  3 , U Müller-Werdan  2
Affiliations

Digital pen technology for conducting cognitive assessments: a cross-over study with older adults

A Heimann-Steinert et al. Psychol Res. 2021 Nov.

Abstract

Many digitalized cognitive assessments exist to increase reliability, standardization, and objectivity. Particularly in older adults, the performance of digitized cognitive assessments can lead to poorer test results if they are unfamiliar with the computer, mouse, keyboard, or touch screen. In a cross-over design study, 40 older adults (age M = 74.4 ± 4.1 years) conducted the Trail Making Test A and B with a digital pen (digital pen tests, DPT) and a regular pencil (pencil tests, PT) to identify differences in performance. Furthermore, the tests conducted with a digital pen were analyzed manually (manual results, MR) and electronically (electronic results, ER) by an automized system algorithm to determine the possibilities of digital pen evaluation. ICC(2,k) showed a good level of agreement for TMT A (ICC(2,k) = 0.668) and TMT B (ICC(2,k) = 0.734) between PT and DPT. When comparing MR and ER, ICC(2,k) showed an excellent level of agreement in TMT A (ICC(2,k) = 0.999) and TMT B (ICC(2,k) = 0.994). The frequency of pen lifting correlates significantly with the execution time in TMT A (r = 0.372, p = 0.030) and TMT B (r = 0.567, p < 0.001). A digital pen can be used to perform the Trail Making Test, as it has been shown that there is no difference in the results due to the type of pen used. With a digital pen, the advantages of digitized testing can be used without having to accept the disadvantages.

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Figures

Fig. 1
Fig. 1
Procedure of the cross-over design study. PT pencil test, DPT digital pen tests, MR manual results, ER electronic results
Fig. 2
Fig. 2
A participant (right) connects the numbers of the TMT A with a digital pen. The process can be seen live by the researcher (left)
Fig. 3
Fig. 3
Possible errors detected by the electronic evaluation
Fig. 4
Fig. 4
Bland–Altman plot of differences between PT and DPT vs. mean values with the presentation of level of agreement for TMT A and TMT B
Fig. 5
Fig. 5
Bland–Altman plot of differences between MR and ER vs. mean values with the presentation of level of agreement for TMT A and TMT B
See this image and copyright information in PMC

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