Supervised Digital Neuropsychological Tests for Cognitive Decline in Older Adults: Usability and Clinical Validity Study

Francesca Lunardini, Matteo Luperto, Marta Romeo, Nicola Basilico, Katia Daniele, Domenico Azzolino, Sarah Damanti, Carlo Abbate, Daniela Mari, Matteo Cesari, Nunzio Alberto Borghese, Simona Ferrante

Research output: Contribution to journalArticlepeer-review


BACKGROUND: Dementia is a major and growing health problem, and early diagnosis is key to its management. OBJECTIVE: With the ultimate goal of providing a monitoring tool that could be used to support the screening for cognitive decline, this study aims to develop a supervised, digitized version of 2 neuropsychological tests: Trail Making Test and Bells Test. The system consists of a web app that implements a tablet-based version of the tests and consists of an innovative vocal assistant that acts as the virtual supervisor for the execution of the test. A replay functionality is added to allow inspection of the user's performance after test completion. METHODS: To deploy the system in a nonsupervised environment, extensive functional testing of the platform was conducted, together with a validation of the tablet-based tests. Such validation had the two-fold aim of evaluating system usability and acceptance and investigating the concurrent validity of computerized assessment compared with the corresponding paper-and-pencil counterparts. RESULTS: The results obtained from 83 older adults showed high system acceptance, despite the patients' low familiarity with technology. The system software was successfully validated. A concurrent validation of the system reported good ability of the digitized tests to retain the same predictive power of the corresponding paper-based tests. CONCLUSIONS: Altogether, the positive results pave the way for the deployment of the system to a nonsupervised environment, thus representing a potential efficacious and ecological solution to support clinicians in the identification of early signs of cognitive decline.

Original languageEnglish
Article numbere17963
JournalJMIR mHealth and uHealth
Issue number9
Publication statusPublished - Sep 21 2020


  • aging
  • Bells Test
  • computerized testing
  • dementia
  • early diagnosis
  • eHealth
  • mild cognitive impairment
  • neuropsychological assessment
  • Trail Making Test

ASJC Scopus subject areas

  • Health Informatics


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