key: cord-0984478-ich26yl5 authors: Jacobs, Diane M.; Peavy, Guerry M.; Banks, Sarah J.; Gigliotti, Christina; Little, Emily A.; Salmon, David P. title: A survey of smartphone and interactive video technology use by participants in Alzheimer's disease research: Implications for remote cognitive assessment date: 2021-05-19 journal: Alzheimers Dement (Amst) DOI: 10.1002/dad2.12188 sha: da3265074adf6798b9b3d6600b0bfb458fcee00e doc_id: 984478 cord_uid: ich26yl5 INTRODUCTION: Participants from a longitudinal cohort study were surveyed to evaluate the practical feasibility of remote cognitive assessment. METHODS: All active participants/informants at the University of California San Diego Alzheimer's Disease Research Center were invited to complete a nine‐question survey assessing technology access/use and willingness to do cognitive testing remotely. RESULTS: Three hundred sixty‐nine of 450 potential participants/informants (82%) completed the survey. Overall, internet access (88%), device ownership (77%), and willingness to do cognitive testing remotely (72%) were high. Device access was higher among those with normal cognition (85%) or cognitive impairment (85%) than those with dementia (52%), as was willingness to do remote cognitive testing (84%, 74%, 39%, respectively). Latinos were less likely than non‐Latinos to have internet or device access but were comparable in willingness to do remote testing. DISCUSSION: Remote cognitive assessment using interactive video technology is a practicable option for nondemented participants in longitudinal studies; however, additional resources will be required to ensure representative participation of Latinos. to develop these methods can build upon currently available technologies for real-time, interactive clinical and cognitive assessment using personal computers, tablet computers, and smartphones. Potential barriers to widespread implementation of remote online or live interactive testing in studies of AD include lack of accessibility to reliable high-speed internet service; unavailability of personal computer, tablet, or smartphone technology; and insufficient technical skill to establish an appropriate connection. Each of these potential barriers may vary by age, education, socioeconomic status, and race/ethnicity. 1 Furthermore, little is known about the willingness of older adults to use digital devices for remote online or live interactive cognitive testing, even though ownership and use of internet-capable technologies among individuals over age 65 has increased in recent years. 2, 3 To evaluate the feasibility of remote cognitive assessment in our National Institutes of Health/National Institute on Aging (NIH/NIA)funded Alzheimer's Disease Research Center (ADRC), we surveyed participants about their use of smartphone or interactive video technology and willingness to complete cognitive assessments remotely. The ADRC longitudinal study requires annual clinical and cognitive assessments that typically are conducted in person. The cohort includes older adults across a spectrum of cognitive functioning from normal to dementia and is approximately 20% Latino. While this cohort is not representative of the general population of older adults, the demographic profile is typical of current volunteers in clinical trials and observational studies of aging and dementia who may need to transition to remote clinical assessment and cognitive testing to continue participation. The goal of the survey was to provide information about the feasibility of making the transition to remote assessment, factors that may impact such a transition, and the resources that may be needed to do so. All active participants in the University of California San Diego A nine-question survey was designed to assess capability and willingness to participate in remote cognitive assessment ( Figure 1) The Remote Assessment Technology Survey was conducted between The Table 1 . Those who completed the survey had slightly but significantly more years of education than non-completers (t[448] = 2.55; P < .05) and were less likely to be Latino (χ 2 [1] = 7.83; P < .01). Survey completers and non-completers did not differ by age or sex. The NC participants were more likely to complete the survey (89%) than were TA B L E 1 Characteristics a of the overall eligible cohort and comparisons of survey completers and non-completers scores indicated mild impairment in the CI group and moderate to severe impairment in the dementia group. The CI and dementia groups scored higher than the NC group on the Geriatric Depression Scale (GDS) but did not differ from one another and did not have scores indicative of clinically significant depression. Overall, 88% of ADRC participants for whom survey data were avail- Figure 3 . Among the 72% of respondents who indicated that they would be willing to do some cognitive testing via video chat (N = 267), desktop/laptops (68%) and smartphones (52%) are used more frequently for video chats than tablets (27% Note: All predictor variables entered each model simultaneously in a single block, therein permitting evaluation of each characteristic while holding all others constant. Diagnostic group is referenced to normal cognition; sex is referenced to female; and ethnicity is referenced to Non-Latino. Abbreviation: C.I., confidence interval. * Significant at P < .05; † Significant at P < .01; ‡ Significant at P < .001. recently published guidance details considerations and best practices for conducting remote cognitive and behavioral assessment. 13 Considerations for remote assessment include potential impacts of vision or hearing impairments, size and resolution of display screens, and reliability/stability of internet connectivity. A strength of this study is that our entire ADRC cohort was surveyed to minimize potential selection bias. In an effort to include all participants, those who did not have an e-mail address on file or who did not respond to the initial e-mail solicitation were contacted by study personnel via telephone to complete the survey. To further optimize response rate, informants/caregivers were surveyed as proxies for participants with known CI or dementia. A consideration in interpreting these results, however, is that informant/caregiver responses may not always accurately reflect the responses that participants themselves would have provided, particularly with regard to willingness to participate in remote cognitive assessments. There also are several limitations to our survey. First, because our primary aim was to determine feasibility of remote assessment, and we wanted to keep the survey as brief as possible, we did not ask follow-up questions that may have clarified the reasoning behind participants' responses. As a result, we cannot determine, for example, if those who do not use video chat do not do so because of access, knowledge, or choice. Second, although the demographic characteristics of our cohort are fairly typical of current volunteers for clinical trials and observational studies of AD, they do not represent the general population of older adults, which is more racially diverse and has, on average, less formal education than our cohort. Further, participants at our ADRC are highly motivated and dedicated to the program's aimsfor example, most of our participants have consented to lumbar puncture and brain donation-and this also may limit the generalizability of our survey results. Nevertheless, to the extent that our ADRC cohort is representative of current volunteers in AD clinical trials and longitudinal cohort studies of cognition in aging that may need to transition to remote, on-line interactive assessments, these results suggest that access to the requisite technology and willingness to participate in remote assessments are generally high among non-demented participants. Remote cognitive assessment using interactive video technology may be a practicable option for nondemented participants in longitudinal studies; however, additional resources will be required to ensure representative participation by Latinos and other groups that are underrepresented in clinical research. 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DPS is a paid consultant for Aptinx, Inc. and Biogen, Inc.