Neuropsychological Assessment Using Portable Automated Rapid Testing in Cognitively Healthy Older Adults: Test-Retest...

Remote, scalable cognitive assessment could improve detection and longitudinal monitoring of age-related cognitive change, but few studies have validated comprehensive digital neuropsychological batteries administered entirely at home.

This study aims to evaluate the feasibility, acceptability, and short-term test-retest reliability of a remotely delivered digital neuropsychological battery (portable automated rapid testing [PART]) in cognitively healthy older adults.

We screened 82 English-speaking, cognitively healthy older adults aged 50 to 85 years and mailed configured tablets to participants. Researchers remotely administered a battery of neuropsychological assessments spanning language fluency (Boston Naming Test, verbal fluency: letter "F," supermarket items, and animals), memory (verbal paired associates, word list recall, and logical memory recall), praxis memory (clock drawing and constructional praxis [CP]), and executive functioning (trail making test [TMT]) using the PART app twice, approximately 1 month apart. Task comfortability was summarized with a comfort index based on participants' self-reports after completing each task. Reliability analyses included paired t tests to detect group-level shifts in performance, Pearson correlations for short-term stability, and Bland-Altman limits of agreement (LoA) to quantify bias and within-person variability. Performance across all tasks was also compared to comparative samples from large normative studies using equivalent paper-and-pencil versions of these tasks.

A total of 72 participants completed the first time point (T1), 64 completed the second time point (T2), and the analytic sample comprised a total of 63 participants. Overall comfort was high across sessions (mean comfort index was 88% at T1 and 84% at T2). Memory and executive function measures showed moderate test-retest correlations (r=0.39-0.73), while clock drawing and CP showed low or nonsignificant associations, likely due to ceiling effects. Paired tests indicated small but significant practice effects for verbal paired associates (t₆₂=-3.10; P=.003) and word list (t₅₇=-2.50; P=.02), with substantial practice effects for logical memory (story A: t₅₆=-2.95; P=.005) and TMT part A (t₅₀=-3.97; P<.001) and part B (t₄₂=-2.05; P=.05). Bland-Altman analyses revealed minimal mean bias for many tasks but notably wide LoA for TMT (part A: LoA=-44.7 to 29.2 seconds; part B: LoA=-78.1 to 57.9 seconds). Importantly, in descriptive comparisons, our sample generally overlapped within ±1 SD of the medians in comparative paper-and-pencil normative samples.

PART was well tolerated among healthy older adults and reproduces group-level normative patterns with moderate short-term reliability for several conventional measures. However, nontrivial within-person variability, practice effects, ceiling effects, and wide LoAs for some measures (eg, TMT, CP, and clock drawing) limit interpretation of individual change. Future work should validate alternative digital outcome metrics (eg, stylus interactions and speech recordings), extend sampling to more diverse and lower-education cohorts, and evaluate more ecologically valid designs to improve sensitivity for detecting meaningful within-person cognitive fluctuations.