A novel computer adaptive word list memory test optimized for remote assessment: Psychometric properties and associations with neurodegenerative biomarkers in older women without dementia

Abstract

Introduction: This study established the psychometric properties and preliminary validity of the Stricker Learning Span (SLS), a novel computer adaptive word list memory test designed for remote assessment and optimized for smartphone use.

Methods: Women enrolled in the Mayo Clinic Specialized Center of Research Excellence (SCORE) were recruited via e-mail or phone to complete two remote cognitive testing sessions. Convergent validity was assessed through correlation with previously administered in-person neuropsychological tests (n = 96, ages 55-79) and criterion validity through associations with magnetic resonance imaging measures of neurodegeneration sensitive to Alzheimer's disease (n = 47).

Results: SLS performance significantly correlated with the Auditory Verbal Learning Test and measures of neurodegeneration (temporal meta-regions of interest and entorhinal cortical thickness, adjusting for age and education). Test-retest reliabilities across two sessions were 0.71-0.76 (two-way mixed intraclass correlation coefficients).

Discussion: The SLS is a valid and reliable self-administered memory test that shows promise for remote assessment of aging and neurodegenerative disorders.

Keywords: Alzheimer's disease; Mayo Test Drive; Stricker Learning Span; Symbols Test; aging; cortical thickness; entorhinal cortex; hippocampus; learning; mobile health; reliability; smartphone; validity; web.

FIGURE 1

Example Mayo Test Drive screen shots. Note: Mayo Test Drive subtest screen shots are depicted here on a smartphone. A, Stricker Learning Span (SLS) is a computer adaptive word list memory test. Practice item SLS stimuli are displayed. Copyright © 2020 Mayo Foundation for Medical Education and Research. Used with permission from Mayo Foundation for Medical Education and Research, all rights reserved. B, Symbols Test is a processing speed measure. Copyright © 2017 Washington University in St. Louis. Used with permission from J. Hassenstab

FIGURE 2

Example learning slopes for the Auditory Verbal Learning Test (AVLT) and the Stricker Learning Span (SLS). Note: Data from two participants were selected to display example high and low performers on the SLS. The high performer (blue dashed line) showed high average learning performance on the AVLT (AVLT trials 1–5 total = 55, normative score of 57 T). The low performer (black solid line) showed mildly to moderately impaired learning performance on the AVLT (AVLT 1–5 total = 28, normative score of 28 T). These same two individuals showed a similar pattern of performance across SLS learning trials (panel B). The high performer (blue dashed line) showed a strongly positive learning slope over the 5 learning trials (SLS 1–5 total = 67), and a max span of 21. The greater slope increase seen on trials 3–5 on the SLS relative to the AVLT may indicate that our adaptive testing format is successfully raising the ceiling for this high performer. The low performer (black solid line) showed a comparatively flat learning slope (SLS 1–5 total = 34), and a max span of 8