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. 2025 May 27:27:e65297.
doi: 10.2196/65297.

Smartphone- and Tablet-Based Tools to Assess Cognition in Individuals With Preclinical Alzheimer Disease and Mild Cognitive Impairment: Scoping Review

Rosanne L van den Berg  1   2   3 , Sophie M van der Landen  1   2 , Matthijs J Keijzer  1   2   4 , Aniek M van Gils  1   2 , Maureen van Dam  1   2 , Kirsten A Ziesemer  5 , Roos J Jutten  1   2 , John E Harrison  1   2   6   7 , Casper de Boer  1   2 , Wiesje M van der Flier  1   2   8 , Sietske Am Sikkes  1   2   3
Affiliations

Smartphone- and Tablet-Based Tools to Assess Cognition in Individuals With Preclinical Alzheimer Disease and Mild Cognitive Impairment: Scoping Review

Rosanne L van den Berg et al. J Med Internet Res. .

Abstract

Background: Assessment of cognitive decline in the earliest stages of Alzheimer disease (AD) is important but challenging. AD is a neurodegenerative disease characterized by gradual cognitive decline. Disease stages range from preclinical AD, in which individuals are cognitively unimpaired, to mild cognitive impairment (MCI) and dementia. Digital technologies promise to enable detection of early, subtle cognitive changes. Although the field of digital cognitive biomarkers is rapidly evolving, a comprehensive overview of the reporting of psychometric properties (ie, validity, reliability, responsiveness, and clinical meaningfulness) is missing. Insight into the extent to which these properties are evaluated is needed to identify the validation steps toward implementation.

Objective: This scoping review aimed to identify the reporting on quality characteristics of smartphone- and tablet-based cognitive tools with potential for remote administration in individuals with preclinical AD or MCI. We focused on both psychometric properties and practical tool characteristics.

Methods: This scoping review was conducted following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. In total, 4 databases (PubMed, Embase, Web of Science, and PsycINFO) were systematically searched from January 1, 2008, to January 5, 2023. Studies were included that assessed the psychometric properties of cognitive smartphone- or tablet-based tools with potential for remote administration in individuals with preclinical AD or MCI. In total, 2 reviewers independently screened titles and abstracts in ASReview, a screening tool that combines manual and automatic screening using an active learning algorithm. Thereafter, we manually screened full texts in the web application Rayyan. For each included study, 2 reviewers independently explored the reported information on practical and psychometric properties. For each psychometric property, examples were provided narratively.

Results: In total, 11,300 deduplicated studies were identified in the search. After screening, 50 studies describing 37 different digital tools were included in this review. Average administration time was 13.8 (SD 10.1; range 1-32) minutes, but for 38% (14/37) of the tools, this was not described. Most tools (31/37, 84%) were examined in 1 language. The investigated populations were mainly individuals with MCI (34/37, 92%), and fewer tools were examined in individuals with preclinical AD (8/37, 22%). For almost all tools (36/37, 97%), construct validity was assessed through evaluation of clinical or biological associations or relevant group differences. For a small number of tools, information on structural validity (3/37, 8%), test-retest reliability (12/37, 32%), responsiveness (6/37, 16%), or clinical meaningfulness (0%) was reported.

Conclusions: Numerous smartphone- and tablet-based tools to assess cognition in early AD are being developed, whereas studies concerning their psychometric properties are limited. Often, initial validation steps have been taken, yet further validation and careful selection of psychometrically valid outcome scores are required to demonstrate clinical usefulness with regard to the context of use, which is essential for implementation.

Keywords: cognition; digital biomarkers; digital health; mild cognitive impairment; preclinical Alzheimer disease; psychometrics; scoping review; smartphone-based assessment; tablet-based assessment.

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Conflict of interest statement

Conflicts of Interest: MJK was an employee of Neurocast BV. JEH is an employee of and shareholder in Scottish Brain Sciences and a paid consultant to Cambridge Cognition. SAMS is a scientific advisory board member of Prothena Biosciences and Cogstate; provides consultancy services to AriBio Co. Ltd and Biogen; receives license fees from Brain Research Center, Green Valley, vTv Therapeutics, Alzheon, Vivoryon Therapeutics, and Roche; and is the developer of the Amsterdam Instrumental Activities of Daily Living Questionnaire. All license fees are for the organization. WMvdF’s research programs have been funded by the Netherlands Organisation for Health Research and Development (ZonMW), the Dutch Research Council, the European Union Joint Programme – Neurodegenerative Disease Research, the European Union Innovative Health Initiative, Alzheimer Nederland, Dutch Brain Foundation – Cardiovascular Research Netherlands, Health~Holland, Top Sector Life Sciences and Health, Dioraphte Foundation, Gieskes-Strijbis Fund, Equilibrio Foundation, Edwin Bouw Fund, Pasman Foundation, Alzheimer & Neuropsychiatry Foundation, Philips, Biogen MA Inc, Novartis Nederland, Life Molecular Imaging, Avid Radiopharmaceuticals, Roche Nederland BV, Fujifilm, Eisai, and Combinostics. WMvdF holds the Pasman chair. WMvdF is the recipient of A Personalized Medicine Approach for Alzheimer’s Disease, which is a public-private partnership receiving funding from ZonMW (73305095007) and Health~Holland, Top Sector Life Sciences and Health (public-private partnership allowance; LSHM20106). WMvdF is the recipient of Timely, Accurate, and Personalized diagnosis of dementia which receives funding from ZonMw (10510032120003). Timely, Accurate, and Personalized diagnosis of dementia receives cofinancing from Avid Radiopharmaceuticals and Amprion. All funding is paid to her institution. WMvdF has been an invited speaker at Biogen MA Inc, Danone, Eisai, WebMD Neurology (Medscape), Novo Nordisk, Springer Healthcare, and the European Brain Council. WMvdF is a consultant for Oxford Health Policy Forum CIC, Roche, Biogen MA Inc, and Eisai. WMvdF has participated in the advisory boards of Biogen MA Inc, Roche, and Eli Lilly and Company. WMvdF is a member of the steering committee of Evoke and Evoke+ (Novo Nordisk). All funding is paid to her institution. WMvdF is a member of the steering committee of Project Alzheimer’s Value Europe and Think Brain Health Global. WMvdF was an associate editor of Alzheimer’s Research & Therapy in 2020 and 2021. WMvdF is an associate editor at Brain. All other authors declare no other conflicts of interest.

Figures

Figure 1
Figure 1
PRISMA flowchart of the search and selection procedure of the studies included in the scoping review.
See this image and copyright information in PMC

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