Reliability and Validity of Smartphone Cognitive Testing for Frontotemporal Lobar Degeneration

Adam M Staffaroni ¹, Annie L Clark ¹, Jack C Taylor ¹

¹Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco.
²Department of Neurology, Columbia University, New York, New York.
³Department of Neurology, Mayo Clinic, Rochester, Minnesota.
⁴Department of Quantitative Health Sciences, Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota.
⁵Department of Neurology, Case Western Reserve University, Cleveland, Ohio.
⁶Department of Neurosciences, University of California, San Diego, La Jolla.
⁷Department of Radiology, University of North Carolina, Chapel Hill.
⁸Department of Neurology, Indiana University, Indianapolis.
⁹Department of Neurology, Vanderbilt University, Nashville, Tennessee.
¹⁰Department of Neurology, University of Washington, Seattle.
¹¹Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota.
¹²Department of Neurology, Institute for Precision Health, University of California, Los Angeles.
¹³Department of Neurology, Knight Alzheimer Disease Research Center, Washington University, Saint Louis, Missouri.
¹⁴Department of Psychiatry, Knight Alzheimer Disease Research Center, Washington University, Saint Louis, Missouri.
¹⁵Department of Neuroscience, Mayo Clinic, Jacksonville, Florida.
¹⁶Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia.
¹⁷Division of Neurology, University of British Columbia, Musqueam, Squamish & Tsleil-Waututh Traditional Territory, Vancouver, Canada.
¹⁸Department of Neurology, Nantz National Alzheimer Center, Houston Methodist and Weill Cornell Medicine, Houston Methodist, Houston, Texas.
¹⁹Department of Neurology, UCLA (University of California, Los Angeles).
²⁰Department of Neurology, University of Colorado, Aurora.
²¹Department of Neurology, David Geffen School of Medicine, UCLA.
²²Department of Neurology, University of Alabama, Birmingham.
²³Tanz Centre for Research in Neurodegenerative Diseases, Division of Neurology, University of Toronto, Toronto, Ontario, Canada.
²⁴Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston.
²⁵Department of Epidemiology and Biostatistics, University of California, San Francisco.
²⁶Department of Psychological & Brain Sciences, Washington University, Saint Louis, Missouri.

⁰Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco.

Jama Network Open +

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April 1, 2024

View abstract on PubMed

Summary

Smartphone cognitive tests offer a reliable and valid method for remote Frontotemporal Lobar Degeneration (FTLD) evaluations. These tools show promise for improving early detection and accessibility in FTLD research.

Area Of Science

Neuroscience
Digital Health
Cognitive Science

Background

Frontotemporal Lobar Degeneration (FTLD) presents diagnostic challenges due to rare incidence and non-specific early symptoms.
Standard neuropsychological tests often lack sensitivity for early-stage FTLD and require in-person administration, increasing participant burden.
Remote, accessible cognitive assessments are needed to overcome barriers in FTLD clinical trial recruitment and management.

Purpose Of The Study

To assess the reliability and validity of smartphone-based cognitive assessments for remote FTLD evaluations.
To determine if smartphone cognitive tests can aid in the early detection of FTLD.
To compare the sensitivity of smartphone tests versus traditional measures in identifying early FTLD symptoms.

Main Methods

A cohort study involving 360 participants (controls and FTLD patients) who completed remote smartphone-based executive functioning and memory tasks.
Participants performed tests multiple times over two weeks, with data analyzed in discovery and validation cohorts.
Evaluated internal consistency, test-retest reliability, and associations with clinical measures and brain volume.

Main Results

Smartphone tests demonstrated moderate-to-excellent reliability (ICC: 0.77-0.95) and supported validity through correlations with disease severity, traditional tests, and brain volume.
Tests accurately differentiated individuals with dementia from controls (AUC: 0.93) and were more sensitive to early FTLD symptoms than the MoCA (AUC: 0.82 vs 0.68).
Preclinical participants with pathogenic variants showed worse performance on app tasks compared to controls, unlike traditional measures.

Conclusions

Smartphone-based cognitive assessments provide a feasible, reliable, and valid approach for remote FTLD evaluations.
These digital tools can potentially enhance early detection and serve as a complementary method to traditional in-person assessments.
Further validation in diverse populations and longitudinal studies are recommended to explore their full utility.