J Korean Med Sci.  2020 Aug;35(34):e292. 10.3346/jkms.2020.35.e292.

A Validation Study of the Inbrain CST: a Tablet Computer-based Cognitive Screening Test for Elderly People with Cognitive Impairment

• Chin J
• Kim DE
• Lee H
• Yun J
• Lee BH
• Park J
• Yeom J
• Shin DS
• Na DL

• KMID: 2505723
• DOI: http://doi.org/10.3346/jkms.2020.35.e292

Abstract

Background
Computerized versions of cognitive screening test could have advantages over pencil-and-paper versions by eliminating rater-dependent factors and saving the time required to score the tests and report the results. We developed a computerized cognitive screening test (Inbrain Cognitive Screening Test [Inbrain CST]) that takes about 30 minutes to administer on a touchscreen computer and is composed of neuropsychological tests already shown to be sensitive in detecting early cognitive decline in Alzheimer's disease (AD). The aims of this study were to 1) introduce normative data for Inbrain CST, 2) verify its reliability and validity, 3) assess clinical usefulness, and 4) identify neuroanatomical correlates of Inbrain CST.
Methods
The Inbrain CST runs on the Microsoft Windows 10 operating system and comprises 7 subtests that encompass 5 cognitive domains: attention, language, visuospatial, memory, and executive functions. First, we recruited 480 cognitively normal elderly people (age 50–90) from communities nationwide to establish normative data for Inbrain CST. Second, we enrolled 97 patients from our dementia clinic (26 with subjective cognitive decline [SCD], 42 with amnestic mild cognitive impairment [aMCI], and 29 with dementia due to AD) and investigated sensitivity and specificity of Inbrain CST for discriminating cognitively impaired patients from those with SCD using receiver operating characteristic (ROC) curve analyses. Third, we compared the Inbrain CST scores with those from another neuropsychological test battery to obtain concurrent validity and assessed test–retest reliability. Finally, magnetic resonance imaging (MRI)-based cortical thickness analyses were performed to provide anatomical substrates for performances on the Inbrain CST.
Results
First, in the normative sample, the total score on the Inbrain CST was significantly affected by age, years of education, and gender. Second, Inbrain CST scores among the three patient groups decreased in the order of SCD, aMCI, and AD dementia, and the ROC curve analysis revealed that Inbrain CST had good discriminative power for differentiating cognitively impaired patients from those with SCD. Third, the Inbrain CST subtests had high concurrent validity and test–retest reliability. Finally, in the cortical thickness analysis, each cognitive domain score and the total score of Inbrain CST showed distinct patterns of anatomical correlates that fit into the previously known brain–behavior relationship.
Conclusion
Inbrain CST had good validity, reliability, and clinical usefulness in detecting cognitive impairment in the elderly. Furthermore, it showed neuroanatomical validity through MRI cortical thinning patterns. These results suggest that Inbrain CST is a useful cognitive screening tool with efficiency and validity to detect mild impairments in cognition in clinical settings.

Keyword

Cognitive Screening Test; Computerized Cognitive Test; Alzheimer's Disease; Amnestic Mild Cognitive Impairment; Subjective Cognitive Decline

Figure

• 

  Fig. 1 ROC curves for the Inbrain CST total score in the comparison between (A) the SCD group and the cognitively impaired group (aMCI + AD dementia), (B) SCD and aMCI, (C) the non-dementia group (SCD + aMCI) and the AD dementia group.ROC = receiver operating characteristic, CST = Cognitive Screening Test, K-MMSE = Korean-Mini Mental State Examination, SCD = subjective cognitive decline, aMCI = amnestic mild cognitive impairment, AD = Alzheimer's disease.

• 

  Fig. 2 Cortical thinning pattern correlated with the cognitive domain scores of Inbrain CST. The q value denotes the FDR-corrected P value. (A) Attention domain score. (B) Language domain score. (C) Visuospatial function domain score. (D) Memory domain score. (E) Executive function domain score. (F) Total score.CST = Cognitive Screening Test, FDR = false discovery rate.

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