JMIR Publications

ABSTRACT

Background:

Accumulating evidence shows that subtle alterations in daily functioning are among the earliest and strongest signals that predict cognitive decline and dementia. A survey is a small slice of everyday functioning; nevertheless, completing a survey is a complex and cognitively demanding task that requires attention, working memory, executive functioning, and short- and longer-term memory. Examining older people’s survey response behaviors, which focus on how respondents complete surveys irrespective of the content being sought by the questions, may represent a valuable but often neglected resource that can be leveraged to develop behavior-based early markers of cognitive decline and dementia that are cost-effective, unobtrusive, and scalable for use in large population samples.

Objective:

This paper describes the protocol of a multiyear research project funded by the U.S. National Institute on Aging to develop early markers of cognitive decline and dementia derived from survey response behaviors at older ages.

Methods:

Two types of indices summarizing different aspects of older adults’ survey response behaviors are created. Indices of subtle reporting mistakes are derived from questionnaire answer patterns in a number of population-based longitudinal aging studies. In parallel, paradata indices are generated from computer use behaviors recorded on the backend server of a large online panel study. We will conduct in-depth examinations of the properties of the created questionnaire answer pattern and paradata indices for the purpose of evaluating their concurrent validity, sensitivity to change, and predictive validity. We will synthesize the indices using individual participant data meta-analysis and conduct feature selection to identify the optimal combination of indices for predicting cognitive decline and dementia.

Results:

We have conducted a preliminary investigation to test the utility of the questionnaire answer patterns and paradata indices for the prediction of cognitive decline and dementia. These early results are based on only a subset of indices but are suggestive of the findings that we anticipate will emerge from the planned analyses of multiple behavioral indices derived from many diverse studies.

Conclusions:

Survey response behaviors are a relatively inexpensive data source but they are seldomly used directly for epidemiological research on cognitive impairment at older ages. This study is anticipated to develop an innovative yet unconventional approach which may complement existing approaches aimed at early detection of cognitive decline and dementia.