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C-TOC (Cognitive Testing on Computer)

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Introduction:

Cognitive Testing on Computer (C-TOC) is a novel computer-based test battery developed to improve both usability and validity in the computerized assessment of cognitive function in older adults.

Methods:

C-TOC’s usability was evaluated concurrently with its iterative development to version 4 in subjects with and without cognitive impairment, and health professional advisors representing different ethnocultural groups. C-TOC version 4 was then validated against neuropsychological tests (NPTs), and by comparing performance scores of subjects with normal cognition, Cognitive Impairment Not Dementia (CIND) and Alzheimer disease. C-TOC’s language tests were validated in subjects with aphasic disorders.

Results:

The most important usability issue that emerged from consultations with 27 older adults and with 8 cultural advisors was the test-takers’ understanding of the task, particularly executive function tasks. User interface features did not pose significant problems. C-TOC version 4 tests correlated with comparator NPT (r=0.4 to 0.7). C-TOC test scores were normal (n=16)>CIND (n=16)>Alzheimer disease (n=6). All normal/CIND NPT performance differences were detected on C-TOC. Low computer knowledge adversely affected test performance, particularly in CIND. C-TOC detected impairments in aphasic disorders (n=11).

Discussion:

In general, C-TOC had good validity in detecting cognitive impairment. Ensuring test-takers’ understanding of the tasks, and considering their computer knowledge appear important steps towards C-TOC’s implementation.
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Keywords: Alzheimer disease; computerized cognitive testing; interface design; mild cognitive impairment; neuropsychological testing; normal cognitive aging; usability

Document Type: Research Article

Affiliations: 1: Division of Neurology, Hospital Clinic for Alzheimer Disease and Related Disorders, Vancouver Coastal Health, University of British Columbia, Vancouver, BC, Canada 2: Computer Science, University of British Columbia 3: Division of Neurology, Computer Science, University of British Columbia 4: Division of Neurology 5: Department of Computer Science, University of Michigan Flint, Flint Township, MI 6: Hospital Clinic for Alzheimer Disease and Related Disorders, Vancouver Coastal Health, University of British Columbia, Vancouver, BC, Canada, Department of Medicine; Division of Geriatrics, Department of Medicine, University of British Columbia

Publication date: July 1, 2015

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