Self-Administered Mobile Cognitive Assessments for Individuals With Stroke: A Feasibility and Validation Study

Area of Science:

• Neuroscience
• Rehabilitation Medicine
• Digital Health

Background:

• Stroke survivors often experience cognitive deficits impacting daily functioning.
• Traditional neuropsychological assessments are resource-intensive and may not capture real-world cognitive performance.
• Mobile cognitive assessments (MCAs) offer a potential solution for frequent, in-home cognitive monitoring.

Purpose of the Study:

• To evaluate the feasibility, learning effects, stability, and validity of MCAs in individuals with stroke.
• To explore the psychometric properties of smartphone-based cognitive tests in a real-world setting.

Main Methods:

• A longitudinal observational study involving 20 participants with mild-to-moderate stroke.
• Participants completed frequent, brief, self-administered MCAs (e.g., Mobile Stroop, Spatial Memory, Trail Making, Tower of Hanoi) on smartphones over 14 days.
• Cognitive performance was assessed daily, alongside ecological momentary assessment (EMA) surveys, and compared to lab-based neuropsychological tests.

Main Results:

• High adherence rates (77-85%) were observed for repeated MCA administration.
• Learning effects were significant across most MCAs, except for the Mobile Spatial Memory Test (Forward).
• Stability estimates varied from poor to moderate, with higher reliability for the Mobile Stroop Color Word Test and lower stability for the Mobile Trail Making Test and Mobile Tower of Hanoi Test. Concordance with traditional tests was stronger for memory domains.

Conclusions:

• Smartphone-based MCAs are feasible for individuals with stroke in everyday life.
• MCAs demonstrate initial psychometric properties, including feasibility and learning effects, suggesting potential as a complementary tool.
• Further refinement of MCAs is necessary to enhance their reliability and validity for stroke rehabilitation research and clinical practice.