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An iPad-based Measure of Processing Speed in Older Adults Hospitalized for Heart Failure
Eiran Z Gorodeski1, Anson B Rosenfeldt, Karen Fang
1Eiran Z. Gorodeski, MD, MPH Staff Cardiologist, Section of Heart Failure and Cardiac Transplantation, Tomsich Family Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic; and Associate Professor of Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Ohio. Anson B. Rosenfeldt, DPT, MBA Physical Therapist, Department of Biomedical Engineering, Cleveland Clinic, Ohio. Karen Fang, BS Medical Student, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Ohio. Cynthia Kubu, PhD Staff Neuropsychologist, Center for Neurological Restoration, Cleveland Clinic; and Professor of Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Ohio. Stephen M. Rao, PhD Staff Neuropsychologist, Center for Brain Health, Neurological Institute, Cleveland Clinic, Ohio. A. Elizabeth Jansen, MPH Program Manager, Department of Biomedical Engineering, Cleveland Clinic, Ohio. Tanujit Dey, PhD Associate Staff, Department of Quantitative Health Sciences, Cleveland Clinic, Ohio. Jay L. Alberts, PhD Vice Chair of Innovation, Neurological Institute; and Staff, Biomedical Engineering, Cleveland Clinic, Ohio.
Background:
In older adults hospitalized with heart failure (HF), cognitive impairment is associated with increased hospital readmission and mortality risk. There is no consensus on an objective, scalable method of cognitive screening in this population.
Objective:
The aim of this project was to determine the feasibility, test-retest reliability, and convergent validity of the Processing Speed Test (PST), a test of information processing, attention, and working memory administered on an iPad in older adults hospitalized with HF.
Methods:
Patients hospitalized with HF (n = 30) and age-, sex-, and education-matched controls (n = 30) participated in the study. To determine test-retest reliability, the PST was administered on an iPad on 2 occasions, separated by 12 to 48 hours. The Symbol Digit Modalities Test was administered at the first testing time point to determine convergent validity.
Results:
Test-retest reliability of the PST was 0.80 and 0.92 in individuals with HF and controls, respectively. Convergent validity was 0.72 and 0.90 for individuals with HF and controls, respectively. Time to complete the PST was similar for both individuals with HF and controls (<5 minutes).
Conclusion:
The iPad-based deployment of the PST was a feasible, reliable, and valid cognitive screen for older adults hospitalized with HF. Using a tablet-based self-administered cognitive screen in older adults with HF provides a method of cognitive assessment that is amenable to widespread clinical utilization.
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