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Screen time patterns and cognitive screening outcomes (MoCA-Ina) in adolescents: a cross-sectional study
Pricilla Yani Gunawan1,2, Andraina Andraina3, Jeremiah Hilkiah Wijaya4
1Department of Neurology, Faculty of Medicine, Universitas Pelita Harapan, Jl. Jenderal Sudirman No.15, Tangerang, Banten, 15810, Indonesia. pricilla.yani@outlook.com.
Background:
Adolescent screen exposure is increasing, yet clinically interpretable thresholds for cognitive risk are unclear. This study examined associations between daily screen time and cognitive screening performance and derived a screen-time cutoff associated with cognitive impairment.
Methods:
We conducted an observational cross-sectional study (March-April 2022) at a private junior high school in Indonesia during online learning. Students completed digital questionnaires reporting educational and recreational screen time and a directly reported overall estimate; a computed overall (educational + recreational) was generated to assess reporting consistency. Cognitive function was assessed using the MoCA-Ina, with < 24 as the primary impairment threshold based on recent psychometric evidence favoring lower cutoffs for improved classification accuracy.
Results:
Sixty-seven adolescents were included (34 girls, 50.7%; 33 boys, 49.3%), with median age 13.0 years (12.0-16.0) and median MoCA-Ina 25.0 (19.0-31.0). MoCA-Ina did not differ by sex (girls 25.0 [19.0-31.0] vs. boys 26.0 [20.0-30.0]; p = 0.244). Recreational screen time correlated inversely with MoCA-Ina (ρ = -0.446, p < 0.001), as did overall screen time (ρ = -0.360, p = 0.003), whereas educational screen time was not associated (ρ = -0.061, p = 0.624). In adjusted regression, overall screen time remained negatively associated with MoCA-Ina (β = -0.24 per hour/day; 95% CI - 0.41 to - 0.07; p = 0.007), while age was positively associated (β = 0.96; 95% CI 0.07 to 1.85; p = 0.034). All variance inflation factors were below 2.5, indicating no substantial multicollinearity. ROC analysis showed fair discrimination (AUC 0.66; optimism-corrected AUC after bootstrap internal validation [1,000 resamples]: 0.63) with an optimal cutoff > 8.97 h/day (sensitivity 83.3%, specificity 48.8%, PPV 47.6%, NPV 84.0%); risk of impairment was higher above the cutoff (RR 2.98; 95% CI 1.15-7.72; p = 0.010; OR 4.77; 95% CI 1.40-16.31).
Conclusions:
High daily screen exposure was associated with poorer cognitive screening performance. The > 8.97-hour/day threshold represents a preliminary, hypothesis-generating cutoff that may help identify adolescents at elevated likelihood of cognitive impairment, pending external validation in larger, more diverse samples.
Trial Registration:
071/K-LKJ/ETIK/II/2022.
