JMIR Publications

ABSTRACT

Background:

As smartphone technology has become nearly ubiquitous, there is growing literature to suggest ecological momentary cognitive testing (EMCT) offers advantages to traditional pen-and-paper psychological assessment. We introduce a newly developed platform for self-administration of cognitive tests in ecologically valid ways.

Objective:

To develop a HIPAA-compliant EMCT smartphone-based platform for frequent and repeated testing of cognitive abilities in everyday life. This study examined the psychometric properties of seven mobile cognitive tests within our platform among persons with and without bipolar disorder (BD). Ultimately, if shown to have adequate psychometric properties, EMCTs may be useful in research on BD and other neurological and psychiatric illnesses.

Methods:

Forty-five persons with BD and 21 demographically-comparable healthy volunteer participants (aged 18-65) completed smartphone-based EMCTs three times daily for 14 days. Each EMCT session lasted for approximately 1.5 minutes, only 2-3 tests were administered in any given session, no test was given more than once per day, and alternate test versions were administered at each session.

Results:

Mean adherence to the EMCT protocol was 69.7%, resulting in 3,965 valid and complete tests across the full sample. Participants were significantly more likely to miss tests on later versus earlier study days. Adherence did not differ by diagnostic status, suggesting that BD does not interfere with EMCT participation. In most tests, age and education were related to EMCT performance in expected directions. Average performances on the majority of EMCTs were moderately-to-strongly correlated with lab-based neuropsychological performance (the NIH Toolbox). Practice effects were observed in five tests, with significant differences in practice effects by BD status in three tests.

Conclusions:

While additional reliability and validity data are needed, this study provides initial psychometric support for EMCTs in the assessment cognitive performance in real-world contexts in BD.