Rapid, Remote, and Reliable: Smartphone-Based Burst Cognitive Assessments in Alzheimer’s Disease.
We rely on complex memory and thinking skills to function in everyday life, however, these skills fluctuate constantly due to fatigue, stress, and anxiety—and these fluctuations increase as we age. Despite this, when we study people at risk for Alzheimer's disease (AD), we test memory and thinking in "one-shot" in an unfamiliar place (usually a clinic or hospital exam room). Some perform really well on a “good” day and others may perform more poorly on a “bad” day. These fluctuations make it extraordinarily difficult to measure true abilities. In this study, we propose to use smartphones to test memory and thinking in short "bursts" requiring less than 3 minutes each to complete. Participants can take tests wherever it is safe to use a smartphone and they take the tests multiple times per day, which provides much more accurate and reliable tests to better understand how memory and thinking change in very early AD.
I am developing smartphone-based cognitive assessments for use by older adults in global Alzheimer's disease observational studies and clinical trials.
Using smartphones to assess cognition is, of course, not a new idea, but we leverage the ubiquity of smartphones with a unique approach that maximizes the validity and reliability of cognitive assessments. We are using careful psychometric methods to develop extremely brief and repeatable cognitive tests that participants complete on their personal smartphones. Instead of focusing on a "single-shot" assessment that can produce unreliable data, we are repeatedly sampling cognition in our participants’ natural environments--the very places in which we rely on complex cognitive operations in daily life.
About the Researcher
Jason Hassenstab, PhD, is the Cognition Core director for the Dominantly-Inherited Alzheimer Network-Trials Unit (DIAN-TU) and directs cognition for the DIAN observational study. He is currently an assistant professor of neurology and of psychological and brain sciences at Washington University in St. Louis, where he also directs neuropsychological efforts for the Charles F. and Joanne Knight Alzheimer’s Disease Research Center. His research is focused on detection of cognitive changes in the earliest stages of Alzheimer’s disease (AD) and their relationship to fluid biomarkers and neuroimaging indicators of AD pathology. His laboratory is developing remote cognitive assessment techniques using ecological momentary assessment and measurement burst designs for use in cohort studies and clinical trials. Prior to pursuing academics, Dr. Hassenstab toured internationally as a professional jazz saxophonist and made hundreds of dollars. He completed a bachelor’s degree in Jazz and Contemporary Music Performance from New York University and a PhD in psychology under mentorship of Dr. Antonio Convit at New York University School of Medicine and Fordham University. He then completed an NIH-sponsored Kirchstein National Research Service Award Postdoctoral Fellowship at Brown University with Drs. Ronald Cohen, Lawrence Sweet, and Steven Salloway. He joined the faculty at Washington University in St. Louis in 2010.
After a short and somewhat frustrating career as a saxophonist, I decided that a career treating patients as a family medicine doctor better suited my lifestyle, which is precisely why I pursed a PhD in clinical psychology and now work in academics. Ok, that doesn’t make sense, but that’s a good summary of my career path—a series of happy accidents while pursuing various passion projects. I toured as a jazz saxophonist for a few years with different bands with the goal of becoming the greatest saxophonist on the planet. I probably would have told anyone about my goal with utter sincerity at age 19 or so. As one might expect, after a few years of cheap hotels, daily tour bus rides, and scant remuneration, I came to realize that the life of a professional musician was not exactly what I had anticipated. I then left the road, and returned to finish my undergraduate studies at NYU and prepare for medical school. I was told by my advisor that I needed a few extra credits in sciences so I decided to try out a neuroscience class because I saw a brain scan online and thought it looked interesting. I had never been exposed to any formal education in neurosciences or psychology and was immediately smitten (and forever driven) by a deep desire to understand human behavior. I quickly dropped all notions of medical school and pursued a PhD in clinical psychology, thinking that a life as a therapist, complete with lots of tweed, leather elbow patches, black turtlenecks, and a comprehensive Jedi-like understanding of the human condition, was attainable and indirectly in my path.
In graduate school, I quickly gravitated towards the more quantitative end of psychology and specialized in neuropsychological assessment. As a postdoctoral fellow at Brown University, I became fascinated with cognition in neurodegenerative disorders like Alzheimer’s disease (AD), but also quite frustrated with the state of cognitive testing at the time. As a field, we were moving more and more towards earlier detection of cognitive changes, but we were still stuck in our old habits and giving the same paper and pencil cognitive tests that have been administered forever, that were never designed to be sensitive to early disease. We also continued to focus on “one-shot” cognitive assessments, where we subjected our patients to consecutive hours of highly focused and extremely taxing cognitive assessments, while ignoring factors like practice effects, test anxiety, fatigue from traveling to the clinic or from hours of endless examinations, or the effects of recent stressors. I looked into computerized assessments, web-based assessments, and smartphone-based assessments, but was totally dissatisfied with what was available. They all seemed to miss several critical factors that I felt were of utmost importance. First, we use cognition all the time, from the moment we wake up in the morning until we fall asleep. Second, we use cognition everywhere we go: at home, work, school, shopping, driving, literally everywhere. Third, why do we have to test people in one concentrated testing session, where we “test limits” and sample cognition in our patients during “optimal conditions.” These limitations are precisely why I created the Ambulatory Research in Cognition (ARC) smartphone app. We address each of these limitations by using a familiar device (nearly 95 percent of U.S. adults own and regularly use smartphones) and by sampling rapidly and frequently over several days at a time. Most importantly, we combine the results, so that we can get an idea of how people function overall and in many different scenarios (tired, awake, stressed, happy, sad, at work, at home, traveling, eating, etc.), and we consider the results across all these conditions. This is how we get what I consider to be a more accurate picture of a person’s true level of cognitive functioning.
I developed ARC previously and have already put it to use in the DIAN studies, where our participants are typically 20-50 years old and are already quite used to smartphones. However, the app needs additional tests, and most importantly, more development, to make it more useful for older adults so that we can apply this technology in AD prevention studies right away. The BrightFocus award has allowed me to begin this critical process. We have plans to work with human factors design firms, experts in technology for seniors, and other academic investigators to continue to refine and improve our application so that even those older adults who are more technologically “challenged” can pick up a smartphone and know exactly how to use (and hopefully benefit from) the ARC application right away. A big, big, BIG thank you to the foundation and of course its donors for supporting me in this effort.
First published on: August 29, 2018
Last modified on: August 29, 2018