Remote Ecological Momentary Testing of Learning and Memory in Adults With Serious Mental Illness

Schizophr Bull. 2021 Apr 29;47(3):740-750. doi: 10.1093/schbul/sbaa172.


Smartphone-based ecological mobile cognitive tests (EMCTs) can measure cognitive abilities in the real world, complementing traditional neuropsychological assessments. We evaluated the validity of an EMCT of recognition memory designed for use with people with serious mental illness, as well as relevant contextual influences on performance. Participants with schizophrenia (SZ), schizoaffective disorder, and bipolar disorder (BD) completed in-lab assessments of memory (Hopkins Verbal Learning Test, HVLT), other cognitive abilities, functional capacity, and symptoms, followed by 30 days of EMCTs during which they completed our Mobile Variable Difficulty List Memory Test (VLMT) once every other day (3 trials per session). List length on the VLMT altered between 6, 12, and 18 items. On average, participants completed 75.3% of EMCTs. Overall performance on VLMT 12 and 18 items was positively correlated with HVLT (ρ = 0.52, P < .001). People with BD performed better on the VLMT than people with SZ. Intraindividual variability on the VLMT was more specifically associated with HVLT than nonmemory tests and not associated with symptoms. Performance during experienced distraction, low effort, and out of the home location was reduced yet still correlated with the in-lab HVLT. The VLMT converged with in-lab memory assessment, demonstrating variability within person and by different contexts. Ambulatory cognitive testing on participants' personal mobile devices offers more a cost-effective and "ecologically valid" measurement of real-world cognitive performance.

Keywords: bipolar disorder; ecological momentary assessment; memory; remote cognitive testing; schizoaffective disorder; schizophrenia.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Bipolar Disorder / complications
  • Bipolar Disorder / physiopathology*
  • Cognitive Dysfunction / diagnosis*
  • Cognitive Dysfunction / etiology
  • Cognitive Dysfunction / physiopathology*
  • Ecological Momentary Assessment / standards*
  • Female
  • Humans
  • Male
  • Memory and Learning Tests / standards*
  • Middle Aged
  • Mobile Applications
  • Psychotic Disorders / complications
  • Psychotic Disorders / physiopathology*
  • Recognition, Psychology / physiology*
  • Reproducibility of Results
  • Schizophrenia / complications
  • Schizophrenia / physiopathology*
  • Smartphone
  • Telemedicine / standards*
  • Young Adult