| dc.description | A sustainable health care system needs access to high quality and cost efficient tools for
assessment and monitoring of cognitive health in order to provide the best possible habilitation,
treatment, rehabilitation, and follow-up of persons with conditions that may affect cognitive
function. Researchers need flexible and accessible tools that can be administered on a large scale
to create the evidence-based and personalized treatments of tomorrow to prevent or ameliorate
cognitive deficits. The traditional neuropsychological tests used today put high demand on
resources for administration and scoring, and further have geographical and methodological
constraints reducing their applicability. Self-administered web-based neuropsychological test
platforms can mitigate these problems, but there is a need to document psychometric properties
such as validity and reliability, and the usability of these new tools. The overarching aim of this
thesis was to evaluate core psychometric properties and the usability of Memoro, a new selfadministered
web-based neuropsychological test platform developed by me and my supervisor in
collaboration with members of the Trondheim fMRI group.
In Paper 1 the aims were to investigate validity, effects of computer familiarity,
education, age, and the feasibility of Memoro-administered tests in healthy older and senior adult
volunteers. By comparing Memoro tests to traditional neuropsychological tests it was found
moderate correlations indicating acceptable and good concurrent validity. Further, factor analyses
indicated similar factor structures in the Memoro and traditional tests. Across the two samples in
this study small to moderate effects of age and education was detected as expected. Furthermore,
associations between computer familiarity and test performance on both the Memoro and
traditional tests were present. However, these associations diminished after adjusting for potential
confounding of age and education. More participants preferred Memoro over the traditional tests
after completing both batteries. Some technical problems which led to missing data was
encountered which were rectified for future administration by adjusting test stop criteria and
keyboard functionality.
In Paper 2 the aims were to investigate the reliability and practice effects of Memoro tests
in older adults, and to establish how different reliability estimation methods can lead to
differences in results. The Memoro tests showed similar test-retest reliability estimates to that of
other computerized and web-based tests in previous studies. Moderate practice effects were found on all cognitive measures. The level of practice effects was not found to be related to
demographic variables or level of computer familiarity. Further, large variations in reliability
estimates were encountered across the different estimation methods, highlighting the importance
of using the study-appropriate method and making it clear to readers how reliability was
estimated and which measures that are reported.
In Paper 3 Memoro facilitated the assessment of cognitive function in a sample of adult
and older adult patients with diabetes type 1 and healthy controls. The aims of the study were to
compare the cognitive function of subgroups of the patients that have impaired awareness of
hypoglycemia (low blood sugar) to those who have normal awareness, and to assess if cognitive
function in patients with impaired awareness of hypoglycaemia was related to their historical SHburden.
It was found that the patients having impaired awareness of hypoglycemia showed lower
performance on tests dependent on hippocampus and dentate gyrus function. These are
interesting findings since these brain areas have been shown to be particularly sensitive to the
effects of severe hypoglycemia. Further, it was found that greater severe hypoglycemia burden
was associated with more misunderstanding of instructions and invalid test results. The findings
indicate that patients with diabetes type 1 and impaired awareness of hypoglycemia have reduced
cognitive function due to exposure to more episodes of severe hypoglycemia.
Summarized, the findings of the three studies included in this thesis demonstrate that
Memoro include both valid and reliable measures of cognitive function and that Memoro can be
used for administration of neuropsychological tests in large cohorts and clinical populations.
Several specific areas that may be further improved to optimize the psychometric properties and
usability of Memoro were identified. Some of these may also be of relevance for new, as well as
existing web-based tests. The biggest challenges ahead are neither the technology nor user
acceptability, but rather in development and quality control. | nb_NO |
