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Validation Study of a Computer-Based Test

Robert C. Green, MD; Joanne Green, PhD; Joan M. Harrison, RNC, MN; Michael H. Kutner, PhD

Arch Neurol. 1994;51(8):779-786.

Abstract
Objective
This study examined the validity of a computer-based cognitive test that was recently designed to screen the elderly for cognitive impairment.

Design
Criterion-related validity was examined by comparing test scores of impaired patients and normal control subjects. Construct-related validity was computed through correlations between computer-based subtests and related conventional neuropsychological subtests.

Setting
University center for memory disorders.

Participants
Fifty-two patients with mild cognitive impairment by strict clinical criteria and 50 unimpaired, age- and education-matched control subjects. Control subjects were rigorously screened by neurological, neuropsychological, imaging, and electrophysiological criteria to identify and exclude individuals with occult abnormalities.

Results
Using a cut-off total score of 126, this computer-based instrument had a sensitivity of 0.83 and a specificity of 0.96. Using a prevalence estimate of 10%, predictive values, positive and negative, were 0.70 and 0.96, respectively. Computer-based subtests correlated significantly with conventional neuropsychological tests measuring similar cognitive domains. Thirteen (17.8%) of 73 volunteers with normal medical histories were excluded from the control group, with unsuspected abnormalities on standard neuropsychological tests, electroencephalograms, or magnetic resonance imaging scans.

Conclusions
Computer-based testing is a valid screening methodology for the detection of mild cognitive impairment in the elderly, although this particular test has important limitations. Broader applications of computer-based testing will require extensive population-based validation. Future studies should recognize that normal control subjects without a history of disease who are typically used in validation studies may have a high incidence of unsuspected abnormalities on neurodiagnostic studies.

Author Affiliations
From the Neurobehavioral Program, Department of Neurology, Emory University School of Medicine, the Wesley Woods Center (Drs R. Green and J. Green and Ms Harrison); and the Division of Biostatistics, Emory University School of Public Health, Atlanta, Ga (Dr Kutner).

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