Contextualized cognition: Clarifying associations between remote unsupervised performance and clinically relevant
Timothy W Brearly1,2,3,4, Daniel B Elbich1, Maria Dhinojwala5
1Department of Neurology, Penn State College of Medicine, Hershey, PA, USA.
The Clinical Neuropsychologist
|August 1, 2025
Summary
Remote cognitive tests are affected by distraction and arousal. Higher arousal and lower distraction improve performance in ambulatory cognitive assessments, especially for older adults. This aids in understanding and treating cognitive issues.
Area of Science:
- Cognitive neuroscience
- Gerontology
- Digital health
Background:
- Ambulatory cognitive assessments offer scalable metrics but their performance is influenced by contextual factors.
- Understanding these influences is crucial for accurate, unsupervised cognitive testing.
- Ecological momentary assessment (EMA) provides a method to capture real-time contextual data.
Purpose of the Study:
- To evaluate the associations between remote, unsupervised cognitive assessments and self-reported mood, arousal, stress, pain, and distraction.
- To investigate how these contextual factors influence processing speed and working memory performance.
- To examine age-stratified differences in these associations.
Main Methods:
- 190 participants (ages 18-89) completed a 14-day EMA protocol using the Mobile Monitoring of Cognitive Change (M2C2) platform.
- Participants performed ambulatory assessments of processing speed and working memory, alongside self-ratings of contextual factors 5 times daily.
- Age-stratified multilevel modeling analyzed within- and between-person associations.
Main Results:
- Momentary arousal and distraction significantly impacted cognitive task performance across all participants.
- Higher arousal and lower distraction were linked to better processing speed and working memory.
- Age-stratified analyses revealed significant between-person associations between arousal, distraction, and working memory in adults aged 65 and older.
Conclusions:
- Distraction and arousal are key factors influencing performance variability in remote, unsupervised cognitive testing.
- EMA monitoring of these factors can complement traditional supervised testing limitations.
- Findings may support individualized treatment recommendations for cognitive difficulties linked to contextual factors.
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