Clinical Manifestations

Cognitive tests are crucial for clinical assessment of dementia, but are biased by education, sex, and race. We examined bias in a new measure of everyday cognition called the Virtual Kitchen Challenge (VKC), which requires participants to select objects and sequence task steps on a computer touchscreen to achieve highly familiar task goals (e.g., make breakfast/lunch). We hypothesized that because of its practical nature and high familiarity, scores from the VKC will not show demographic biases relative to conventional cognitive scores.

133 older adults (Mage = 73.40±6.53, range = 61-98; 75% healthy cognition, 57% White, 36% Black, 63% female; education: M = 16.03±2.73) completed the VKC and cognitive tests from the Modified Preclinical Alzheimer's Cognitive Composite (mPACC; MMSE, HVLT-D, BVMT-D, Trail Making Test-B, Animal Fluency). VKC scores (number of screen touches, percent of steps accomplished, time spent touching distractor objects, percent of time off-screen) and a self-report questionnaire (Functional Activity Questionnaire [FAQ]) were used to evaluate functional performance. Due to the small sample sizes of some racial groups, race analyses included only White and Black categories.

Better performance on the VKC measures was significantly associated with higher mPACC scores and lower FAQ rating (all p's < .05). Black older adults performed significantly worse on mPACC tests (MMSE: p = .021, d = -.36; HVLT-D: p < .001, d = -.52; BVMT-D: p =  < .001, d=-.65; Trails B: p = .004, d = .44; Animal Fluency: p = .004, d=-.44) compared to White older adults. These two groups did not significantly differ on any VKC measure (total touches p = .230; % accomplished p = .921; time with distractor objects p = .269; % time off-screen p = .424). No significant sex differences were found in VKC or mPACC variables (all p's > .05). Education was significantly correlated with all mPACC scores (p's < .05) but not VKC (all p's > .05).

The VKC is not influenced by demographic features compared to traditional cognitive testing, underlining its potential importance as a more accurate assessment tool for cognitive decline. For this reason, it should be considered for clinical staging or as an outcome in clinical trials.