Validity of digital Trail Making Test and Bells Test in elderlies

Continuous home-based cognitive monitoring through digital neuropsychological tests has the potential to detect early signs of cognitive decline in the elderlies, thus allowing to adopt preventive measures. However, digital tests suffer from two main limitations: the elderlies’ reduced familiarity with technology and the lack of normative data. Therefore, clinical validation is required before computerized neuropsychological assessment could juxtapose traditional paper-and-pencil tests in the identification of early signs of cognitive decline. In this study, we have developed tablet-based digitized versions of three neuropsychological tests commonly used to screen for dementia, Trail Making Test (A and B versions) and Bells Test, with the twofold aim of evaluating the system usability and acceptance and investigating the concurrent validity of the computerized assessment compared to the corresponding paper-and-pencil tests. Results emerged from the first 41 older adults are promising. System acceptance was very high, notwithstanding the patients’ low familiarity with technology. System validation reports a good ability of the digital tests to retain the same predictive power of the corresponding paper-based tests. Altogether, results suggest that computerized neuropsychological assessment may represent an efficacious, ecological and cost-effective solution for home monitoring of the elder’s cognitive status, thus supporting clinicians in the identification of early signs of cognitive decline.