Computerized cognitive testing in aging
Ely Simon2009, Alzheimers & Dementia
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The paper discusses the implications of computerized cognitive testing in aging, specifically addressing the Mindstreams battery and its 11 subtests. There is a critique regarding the self-administered nature of some cognitive assessments, emphasizing the importance of technician presence for validity and patient comfort. The authors express uncertainty about the recommendations for evaluating various cognitive testing batteries, particularly regarding the CANS-MCI.
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Journal of Molecular Neuroscience, 2004
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Neuropsychological assessment: computerized batteries or standard tests
Psychiatria Danubina, 2010
In clinical neuropsychology a huge number of neuropsychological tests have been developed, and the corpus of these instruments is always increasing. Because of this, the question has been raised as to which are the most usefull instruments that provide the best neuropsychological profiles of the subjects. In the actual literature, there are polemics about the advantages and disadvantages of computerized neuropsychological batteries versus standard paper and pencil tests. In the present increased level of neuropsychological evaluation, computerized batteries still are not used in the majority of tests in clinical neuropsychology. Besides the impressive collection of neuropsychological instruments, the role of the educated and experienced clinician in neuropsychological evaluation is irreplaceable.
Raiders of the Lost Boat
IsraeEl Al
Wachsmann, S. and K. Raveh, 1986. Raiders of the Lost Boat. IsraeEl Al 15: 6-11.
Alzheimer’s & Dementia 5 (2009) 439–440
Correspondence
Computerized cognitive testing in aging
To the Editor:
The review article of Wild et al., ‘‘Status of Computerized
Cognitive Testing in Aging: A Systematic Review,’’ published in the November 2008 issue of the Journal [1], constitutes a significant milestone for computerized assessment.
However, the article appears to contain several inaccuracies
that misrepresent the Mindstreams battery.
First, Table 2 lists the age range for Mindstreams as .50
years, and the ‘‘largest sample size’’ as 213, apparently based
on papers published in 2005 and 2006 [2,3]. Because these
studies dealt exclusively with the elderly, details for only the
relevant portion of the normative database were reported.
However, the actual age range of the Mindstreams normative
database as of those studies was .9 years, and the current sample size is 1569 [4]. Given that age ranges for most of the batteries in Table 2 were not limited to the elderly, we feel that
these numbers better represent the Mindstreams battery.
Second, since the time of the literature review performed by
the authors, approximately eight papers demonstrating the validity and practicality of Mindstreams were published. Among
these is a paper in the January 2008 issue of this Journal on
the usability of Mindstreams in a cohort of 2888 elderly individuals [4] that included previously unavailable information.
The authors cited the paper in their Discussion, but it was not
considered by the raters in judging the validity and practicality
of the battery. In a related issue, the exclusion criteria stated that
studies of populations other than those with early dementia/
mild cognitive impairment (MCI) were excluded, but such
conditions (e.g., Parkinson’s disease) were mentioned in the
Results. We therefore feel that the Mindstreams battery is better
represented by considering publications that involve other
conditions. Presently, 27 full-length publications support the
validity of Mindstreams, in addition to a report by the U.S.
Navy [5]. We disagree with the authors that the number of
publications should have little bearing on the overall rating
of a battery, particularly if the publications report on independent, investigator-initiated studies. This is the case for all
Mindstreams publications, but not for the one article located
on the Computer-Administered Neuropsychological Screen
for Mild Cognitive Impairment (CANS-MCI) and highlighted
by the authors. That paper was authored solely by employees of
the company that developed the battery.
Third, we wish to clarify that Mindstreams was developed
for repeat testing, and that alternate-form test-retest reliability
data for Mindstreams was reported by Schweiger et al. [6].
Parenthetically, we should clarify that Mindstreams consists
of 11 subtests rather than nine, as stated by the authors.
In addition, we disagree with the assignment of the highest
rating for the ‘‘Administrator/Interface’’ scale to a self-administered battery. Although the cost savings of such a battery are
obvious, important clinical observations may be lost with such
an administration. We therefore believe that requiring the presence of a technician offers the best balance between minimizing
cost and maximizing the validity and utility of a battery. Indeed,
as indicated by the authors, the presence of a technician reduces
patient anxiety, thus enhancing validity.
Finally, the conclusions drawn by the authors on the basis
of this review are unclear. The authors state that because of
a certain incomparability across batteries, each battery must
be considered individually. However, the paper concludes
with a recommendation for CANS-MCI. Furthermore, it is
unclear why this battery is recommended as user-friendly,
when papers reporting on the usability of other batteries
(e.g., Mindstreams [4] or COGDRAS-D [7]) are cited in support. In summary, we believe that the review of Wild et al. [1]
makes an important contribution to the field, but its implications should be qualified by considering the above points.
Glen M. Doniger
Ely S. Simon
Department of Clinical Science
NeuroTrax Corporation
Newark, New Jersey
References
[1] Wild K, Howieson D, Webbe F, Seelye A, Kaye J. Status of computerized cognitive testing in aging: a systematic review. Alzheimers Dement
2008;4:428–37.
[2] Doniger GM, Zucker DM, Schweiger A, Dwolatzky T, Chertkow H,
Crystal H, et al. Towards a practical cognitive assessment for detection
of early dementia: a 30-minute computerized battery discriminates as
well as longer testing. Curr Alzheimer Res 2005;2:117–24.
[3] Doniger GM, Dwolatzky T, Zucker DM, Chertkow H, Crystal H,
Schweiger A, et al. Computerized cognitive testing battery identifies
mild cognitive impairment and mild dementia even in the presence of
depressive symptoms. Am J Alzheimers Dis Other Dement 2006;
21:28–36.
[4] Fillit HM, Simon ES, Doniger GM, Cummings JL. Practicality of a computerized system for cognitive assessment in the elderly. Alzheimers
Dement 2008;4:14–21.
1552-5260/09/$ – see front matter Ó 2009 The Alzheimer’s Association. All rights reserved.
440
G.M. Doniger and E.S. Simon / Alzheimer’s & Dementia 5 (2009) 439–440
[5] Melton JL. Psychometric evaluation of the Mindstreams neuropsychological screening tool. NEDU technical report 06-10. Panama City,
FL: Navy Experimental Diving Unit.
[6] Schweiger A, Doniger GM, Dwolatzky T, Jaffe D, Simon ES. Reliability
of a novel computerized neuropsychological battery for mild cognitive
impairment. Acta Neuropsychol 2003;1:407–13.
[7] Collerton J, Collerton D, Arai Y, Barrass K, Eccles M, Jagger C, et al. A
comparison of computerized and pencil-and-paper tasks in assessing
cognitive function in community-dwelling older people in the Newcastle
85 1 Pilot Study. J Am Geriatr Soc 2007;55:1630–5.
doi:10.1016/j.jalz.2009.03.003
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