Technology-natives and technology-adopters: Age differences in remote cognitive assessment in Alzheimer disease

Cognitive changes in the asymptomatic stages of Alzheimer disease (AD) are subtle and difficult to detect using conventional cognitive tests. High-frequency smartphone-based testing may improve sensitivity to these changes, but generational differences in technology use could influence performance. We examined generational differences in cognition using remote, high-frequency smartphone assessments.

Older adults (N = 444) from the Knight Alzheimer Disease Research Center and young and middle-aged adults (N = 113) from the Dominantly Inherited Alzheimer Network (DIAN) completed an in-clinic cognitive battery and brief smartphone tests up to four times daily for 7 days. We compared adherence, reliability, practice effects, and correlations with in-clinic measures.

Older adults showed higher adherence than younger participants (78% vs 59%). Younger adults achieved higher reliability with fewer sessions and exhibited much smaller practice effects. Smartphone to in-clinic test correlations were strong in both young-to-middle-aged and older adults.

Generational differences have important implications for the design and implementation of smartphone-based cognitive studies.