JMIR Publications

ABSTRACT

Background:

Daily activities have been associated with lab-based neurocognitive performance. However, much of this research has used in-person neuropsychological testing that requires participants to travel to a lab or clinic, which may not always be feasible and does not allow for the examination of real-time relationships between cognition and behavior. Thus, there is a need to understand the real-time relationship between activities in the real-world and neurocognitive functioning in order to improve tracking of symptoms or disease states, and aid in early identification of neurocognitive deficits among at-risk individuals.

Objective:

We used a smartphone-based ecological momentary cognitive assessment (EMCA) platform to examine real-time relationships between daily activities and neurocognitive performance (executive functioning, verbal learning) in participants’ everyday environments.

Methods:

One hundred and three adults aged 50-74 years (67 persons with HIV; Mean age: 59, SD: 6.4 years) were recruited from University of California, San Diego HIV Neurobehavioral Research Program and the San Diego community. Participants completed our EMCA protocol for 14 days. Participants reported their current daily activities four times per day; following two of the four daily EMA surveys, participants were administered the mobile Color-Word Interference Test (mCWIT) and mobile Verbal Learning Test (mVLT; each once per day). Activities were categorized into cognitively stimulating activities, passive leisure activities, and IADLs. Multilevel modeling was used to examine same-survey and lagged within-person and between-person effects of each activity type on mobile cognitive performance.

Results:

On average, participants completed 91% of the EMA surveys, 85% of the mCWIT trials, and 80% of the mVLT trials, and reported engaging in passive leisure activities on 17% of surveys, passive leisure activities on 33% of surveys, and IADLs on 20% of surveys. Adherence and activity percentages did not differ by HIV status. Within-persons, engagement in cognitively stimulating activities was associated with better mCWIT performance (beta=-1.12, P=.007), whereas engagement in passive leisure activities was associated with worse mCWIT performance (beta=0.94, P=.005). There were no lagged associations. At the aggregate between-person level, a greater percentage of time spent in cognitively stimulating activities was associated with better mean mVLT performance (beta=0.07, P=.02), whereas a greater percentage of time spent in passive leisure activities was associated with worse mean mVLT performance (beta=-0.07, P=.01). IADLs were not associated with mobile cognitive performance.

Conclusions:

Smartphones present unique opportunities for assessing neurocognitive performance and behavior in participants’ own environment. Measurement of cognition and daily functioning outside of clinic settings may generate novel insights on the dynamic association of daily behaviors and neurocognitive performance, and may add new dimensions to understanding the complexity of human behavior.