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Cognitive Testing on Mobile & Wearable Devices Cognitive Testing on Mobile & Wearable Devices Krystyna Zaluski CANTAB Connect Prodromal Alzheimer’s – Background © Cambridge Cognition 2016. All rights reserved Page 1 Cognition Kit Overview A neuroscience digital health company - Measuring cognition accurately Validated by over 30 A measure of cognitive Trusted by the world’s top years of neuroscience function in over 100 pharmaceutical research indications companies Cognition Kit Technology Platforms for Cognitive Testing Research tools High Frequency At-home testing In-clinic tools Tools for clinical and testing Cognitive tests that can Cognitive assessments research trials to detect Frequent monitoring be completed by for clinical use that can effects of drugs and of cognitive ability participants at home identify those who environmental changes using wearable require further devices investigation Neuroanalytics Consultancy We provide expertise in the design, analysis and interpretation of neuropsychological endpoints in cognitive studies and clinical trials with extensive experience using research and analytic approaches. Cognition Kit Overview CANTAB COGNITIVE SCIENCE CANTAB has been used to assess over 250,000 Participants worldwide Cognition Kit Specific to Cognitive Domain Cognition Kit Specific to Neural Mechanisms – Digital Biomarker Rapid Visual Information Reaction Time Processing Spatial Working Memory Episodic Memory Cognition Kit Sensitive to Disease State – Cognitive Signature 4 3 diagnosis AD MCI score 2 PD 1 Worse performance Worse 0 AT_cat EF_cat EM_cat PS_cat WorkingWM_cat Attention Executive Episodicdomain Processing Function Memory speed Memory Cognition Kit Cognition is subject to daily fluctuations Cognition Kit How to measure Cognition in the real world Cognition Kit Daily assessment across platforms and devices Cognition Kit software enables an individual to complete an assessment on a range of mobile Drawing tasks to measure and wearable devices without having to visit a memory and executive function. clinic or be helped by a health care professional. Emotional recognition tasks to measure social cognition. N-back tasks to measure memory and attention. Cognition Kit Best Practice Approach Decisions are made with the individual in mind Patient Experience Cog Test Cognitive test selection and Validity adaptation designed with scientific rigor Meaningful Large Data Sets of objective Data cognitive measurement and passive data points Cognition Kit Cognition Kit – Validation Process Cognition Kit Page 12 Developing a cognitive test for high-frequency testing ❯ N-back task activates a network of areas in the brain including frontal and parietal regions (Owen et al., 2005). ❯ There is significant variation across and within days on n-back performance, partly linked to mood and motivation (Brose et al., 2012). Rose & Ebmeier. Journal of affective disorders 90 (2006): 149-161. Owen et al., Human brain mapping 25 (2005): 46-59. Cognition Kit Brose, Schmiedek, Lövdén & Lindenberger. Emotion 12 (2012): 605. Phase 1: Proof of concept study in healthy volunteers Study design: ❯ 10 (4 females) aged 25-55 ❯ Sensor data (heart rate, skin temperature, GSR) measured continuously between 0900- 1900 ❯ 4 CANTAB tasks (SWM, RVP, AST, ERT) and the PANAS administered each day after 1700 ❯ Cognitive & mood assessment scheduled hourly Presentation = 600 ms ISI = 600 ms 2-back match Cormack et al, AAIC 2016 Cognition Kit Phase 1: Detailed cognitive data 1-minute micro-tests capture meaningful across-time variation and correlate with gold-standard computerised tests. Revealed issues with device and dynamic range of the test. intercept intercept 1 linear linear r=–0.52 –0.82 1 age 0.9 age –0.52 0.35 1 SWM.Errors SWM.Errorsv –0.28 0.32 0.32 1 RVPA 0.8 RVPA 0.19 0.04 0.09 0.19 1 RVP.False.Alarm RVP.False. 1 Alarm 0.36 –0.65 0.08 –0.33 –0.39 AST.correct Baseline performance Baseline 30 40 50 AST.correct 1 age 0.34 –0.28 –0.48 –0.45 0.40 –0.25 –1 0 1 Cormack et al, AAIC 2016 Cognition Kit Phase 2: Design refinement using web-based testing Findings from phase 1: ❯ A number of participants rapidly reached ceiling ❯ People were giving symbols names — verbal recording of the stimuli, and familiarity with symbols over time ❯ Issues with the device used in the proof-of-concept: battery life, limited display, discontinuation Questions for phase 2: ❯ Change of symbol design and larger bank of symbols to reduce availability of verbal strategies ❯ Could we titrate the difficulty level without increasing the n: role of symbol complexity, timing parameters, and number of symbols ❯ Decision to use Apple iWatch Cognition Kit Phase 2: Participant Experience ❯ Refining task to increase dynamic range ❯ Converted task for web-based testing with redesigned stimuli ❯ Crowd-sourced A-B testing using Amazon m-turk ❯ Series of experiments exploring the impact of task parameters on participant performance using: • Presentation time • Symbol design • Number of unique symbols n = 994 participants aged 20–64 in total n = 88 also completed CANTAB Spatial Working memory test and CANTAB PAL (episodic memory) Cognition Kit Phase 2: Cognitive Test Validity Iterative A-B experimentation determined: r=-0.41 ❯ Significant effect of stimulus presentation time on P<0.001 performance ❯ Significant impact of number of symbols in trial ❯ Symbol design (e.g. number of segments + arrangement) did not significantly impact performance Correlations with CANTAB test — significant r=-0.10 P=0.37 association with SWM, but not PAL. Confirms sensitivity to working memory performance. Cognition Kit Phase 3: In-person testing and iterative design ❯ Would the same parameters work on the watch? ❯ How would participants perform over an extended time? Is the paradigm and testing schedule tolerable? ❯ What are some of the barriers to compliance? How can we make sure that patients understand the app and the tasks? ❯ N=7 subjects over 3 weeks. ❯ Apple watch ❯ N-back testing x3 times a day Cognition Kit Cognitive Testing on Mobile & Wearable Devices [email protected] CANTAB Connect Prodromal Alzheimer’s – Background © Cambridge Cognition 2016. All rights reserved Page 20 Cognition Kit .
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