The Survey for Memory, Attention, and Reaction Time (SMART): Development and Validation of a Brief Web-Based Measure of Cognition for Older Adults

Katherine E Dorociak; Nora Mattek; Jonathan Lee; Mira I Leese; Nicole Bouranis; Danish Imtiaz; Bridget M Doane; John P K Bernstein; Jeffrey A Kaye; Adriana M Hughes

doi:10.1159/000514871

The Survey for Memory, Attention, and Reaction Time (SMART): Development and Validation of a Brief Web-Based Measure of Cognition for Older Adults

Gerontology. 2021;67(6):740-752. doi: 10.1159/000514871. Epub 2021 Apr 7.

Authors

Affiliations

¹ Palo Alto Veterans Affairs Health Care System, Palo Alto, California, USA.
² Oregon Center for Aging & Technology, Oregon Health & Science University, Portland, Oregon, USA.
³ Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota, USA.
⁴ Department of Clinical Psychology, Louisiana State University, Baton Rouge, Louisiana, USA.
⁵ Department of Psychiatry, University of Minnesota, Minneapolis, Minnesota, USA.
⁶ Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, Minnesota, USA.

Abstract

Introduction: Brief, Web-based, and self-administered cognitive assessments hold promise for early detection of cognitive decline in individuals at risk for dementia. The current study describes the design, implementation, and convergent validity of a fWeb-based cognitive assessment tool, the Survey for Memory, Attention, and Reaction Time (SMART), for older adults.

Methods: A community-dwelling sample of older adults (n = 69) was included, classified as cognitively intact (n = 44) or diagnosed with mild cognitive impairment (MCI, n = 25). Participants completed the SMART at home using their computer, tablet, or other Internet-connected device. The SMART consists of 4 face-valid cognitive tasks available in the public domain assessing visual memory, attention/processing speed, and executive functioning. Participants also completed a battery of standardized neuropsychological tests, a cognitive screener, and a daily function questionnaire. Primary SMART outcome measures consisted of subtest completion time (CT); secondary meta-metrics included outcomes indirectly assessed or calculated within the SMART (e.g., click count, total CT, time to complete practice items, and time of day the test was completed).

Results: Regarding validity, total SMART CT, which includes time to complete test items, practice items, and directions, had the strongest relationship with global cognition (β = -0.47, p < 0.01). Test item CT was significantly greater for the MCI group (F = 5.20, p = 0.026). Of the SMART tasks, the executive functioning subtests had the strongest relationship with cognitive status as compared to the attention/processing speed and visual memory subtests. The primary outcome measures demonstrated fair to excellent test-retest reliability (intraclass correlation coefficient = 0.50-0.76).

Conclusions: This study provides preliminary evidence for the use of the SMART protocol as a feasible, reliable, and valid assessment method to monitor cognitive performance in cognitively intact and MCI older adults.

Keywords: Cognition; Cognitive screening; Computerized testing; Mild cognitive impairment; Technology.

Publication types

Research Support, N.I.H., Extramural
Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

Aged
Attention
Cognition*
Cognitive Dysfunction* / diagnosis
Humans
Internet
Neuropsychological Tests
Reaction Time
Reproducibility of Results
Surveys and Questionnaires

Abstract

Publication types

MeSH terms

Grants and funding