Cognitive Assessment using Mobile Phones

Test of memory, attention and reaction time are used for many purposes, including research on patients with brain injury, stroke or cognitive impairment, and assessment of impairment due to alcohol, drugs, or lack of sleep. These tests can be done in the lab, usually using a computer, or in the field, sometimes user paper-based tests or and sometimes with portable computers or other electronic devices

Electronic devices don't get much more portable than mobile phones, and we have been using them as platforms for cognitive assessments for a few years now. The screen size does place some limitations on the tests that can be administered, but a broad range of tests can be effectively used, and these cover most of the functions of interest. The test illustrated on the left is the arrow flanker task. The response is a left or right key press corresponding  to the direction of the central arrow.

There are several advantages to the ultra-portable approach:

  • Assessments can be made in an everyday life setting - home or work - and the unfamiliar and artificial surroundings of the lab avoided.
  • Assessments can be made frequently, and at different times during the day, and a profile of the person's performance built up
  • Links between different aspects of a person's life can be studied. If you miss breakfast does it have an effect on your memory and concentration later in the day? What about if you are stressed, or didn't sleep well last night. Or maybe you have had a few drinks. How much does that really affect you?
  • Data can be transmitted over the network after each assessment, so that data are promptly available for review, 

 

The everyday life approach to cognitive assessment is similar to the use of Ecological Momentary Assessment to measure subjective experiences. An example of this is the recently completed study looking at effects of alcohol consumption on performance

Tests can run on any JavaŽ phone as well as on Android smartphones. Large numbers of people already own suitable phones and are familiar with using them. Thus large scale studies involving data collection during the person's daily life are practical. The phone can automatically transmit results to the server allowing data to be reviewed immediately. The main limitation is screen size, but all the core tests can be run on a standard mobile phone. 

The application requirements depend on the specific study protocol, so we generally provide solutions tailored to a user's needs.  A broad selection of tests is available for inclusion, or additional tests may be developed to meet a user's requirements.  A sample application for the JavaŽ phone is available for evaluation, and can be obtained by clicking here.  

As well as the everyday life/EMA paradigm, the portable testing approach may also be useful in other ways:

  • Field studies, where investigators take phones into a research location such as a pub, club, or workplace, and recruit participants within that setting. Unlike the everyday setting, the testing is supervised, and in general these are cross-sectional studies - a single assessment of function is made. An example is the field study on alcohol carried out in Edinburgh pubs
  • Laboratory-type studies where for one reason or another a PC-based test system is not suitable. We cal this the Portable Laboratory. Data are typically stored on the phone and uploaded to a PC, rather than transmitted via the network. Here is some more on the mobile laboratory.

Such testing may use mobile phones. Tests are also available for tablet computers, which offer a broader range of tests due to the larger screen size.

One concern with everyday assessment is that it is unsupervised, and the circumstances of testing are unknown. Thus it is important to obtain data that can give information about performance parameters. Two studies illustrate this. The first (Tiplady 2004, British Psychological Society) was an initial evaluation in which a mobile phone was used in a lab-based study. The second (Tiplady, Paterson, Scholey 2005, European Behavioural Pharmacology Society) took the mobile phone into peoples' homes, and assessed cognitive function in an everyday setting. The phone automatically sent data back to the central server. Both these studies showed that reaction time increased with task complexity, as illustrated on the right.. This helps to confirm that volunteers are "on-task", and using the tests in a similar way to those in laboratory studies.. 

 

Mobile phones can also be used to administer mood scales, for example visual analogue scales. Paper scales are usually 100 mm long, while limitations of screen size means that scales on a mobile phone are much shorter. A study presented recently at the British Psychological Society showed that 21 mm scales on a mobile phone are just as sensitive to change as 100 mm paper scales