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. 2024 Feb 1;19(2):e0297575.
doi: 10.1371/journal.pone.0297575. eCollection 2024.

Validation of a web-based self-administered test for cognitive assessment in a Swedish geriatric setting

Einar Rystedt  1 , Jakob Morén  2 , Johan Lindbäck  3 , Vitor Tedim Cruz  4   5   6 , Martin Ingelsson  1   7   8 , Lena Kilander  1 , Nuno Lunet  5   6   9 , Joana Pais  5   6 , Luis Ruano  5   6   9   10 , Gabriel Westman  2
Affiliations

Validation of a web-based self-administered test for cognitive assessment in a Swedish geriatric setting

Einar Rystedt et al. PLoS One. .

Abstract

Computerized cognitive tests have the potential to cost-effectively detect and monitor cognitive impairments and thereby facilitate treatment for these conditions. However, relatively few of these tests have been validated in a variety of populations. Brain on Track, a self-administered web-based test, has previously been shown to have a good ability to differentiate between healthy individuals and patients with cognitive impairment in Portuguese populations. The objective of this study was to validate the differential ability and evaluate the usability of Brain on Track in a Swedish memory clinic setting. Brain on Track was administered to 30 patients with mild cognitive impairment/mild dementia and 30 healthy controls, all scheduled to perform the test from home after one week and after three months. To evaluate the usability, the patient group was interviewed after completion of the testing phase. Patients scored lower than healthy controls at both the first (median score 42.4 vs 54.1, p<0.001) and the second test (median score 42.3 vs 55.0, p<0.001). The test-retest intra-class correlation was 0.87. A multiple logistic regression model accounting for effects of age, gender and education rendered an ability of Brain on Track to differentiate between the groups with an area under the receiver operation characteristics curve of 0.90 for the first and 0.88 for the second test. In the subjective evaluation, nine patients left positive comments, nine were negative whereas five left mixed comments regarding the test experience. Sixty percent of patients had received help from relatives to log on to the platform. In conclusion, Brain on Track performed well in differentiating healthy controls from patients with cognitive impairment and showed a high test-retest reliability, on par with results from previous studies. However, the substantial proportion of patients needing help to log in could to some extent limit an independent use of the platform.

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Conflict of interest statement

Authors VTC and JP have a shareholder position at Neuroinova, Lda, a start-up company that conceived Brain on Track, holds registered trademark and commercialization rights. The technological development was partially supported by the research grant Smart-Health-4-All (POCI-01-0247-FEDER-046115), co-funded by Portugal 2020, framed under the COMPETE 2020 (Competitiveness and Internationalization Operational Program) and European Regional Development Fund (ERDF) from European Union (EU). Martin Ingelsson is a paid consultant to BioArctic AB. All other authors report no conflicts of interest or disclosures. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. Overview of study participation.
Fig 2
Fig 2. Test score correlations.
Test score on MMSE and MoCA respectively with corresponding score on first BoT test from home. Controls colored green and patients red. Rho between MMSE and BoT; 0.64 (p<0.001), between MoCA and BoT; 0.64 (p<0.001). Estimated scatterplot smoother (loess) added to illustrate the relationship.
Fig 3
Fig 3
Associations between Brain on Track score and age (top) and education (bottom) by sex and group. The associations are predictions from a single multiple linear regression model including group, age, sex, education, as well as interactions between group and age, group and sex, and group and education. Each variable included in the model needs to be assigned at least one value. Therefore, the associations in the top panels are plotted for an education level of 15 years and in the bottom panels for an age of 73 years. The only interaction that was statistically significant was between group and age (p = 0.005).
Fig 4
Fig 4. Brain on Track test scores at two occasions for patients (red) and controls (green).
The box plots show the distributions of the respective test scores at the two occasions.
See this image and copyright information in PMC

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