Migration of digital functional capacity assessments from device resident to cloud-based delivery: Development and convergent validity.

Decentralized clinical trials are leading to rapid changes in assessment technology, including an expansion of interest in remote delivery. As technology changes, some of the updates include migration to fully cloud-based software and data management, with attendant differences in hardware, response modalities, and modifications in the level of tester engagement. It is rare to see systematic descriptions of the process of migration and upgrading of technology-related assessments. We present comparative data on successive generations of two widely used functional capacity measures, the Virtual Reality Functional Capacity Assessment Tool (VRFCAT) and the Functional Capacity Assessment and Training System (FUNSAT). Four samples of healthy older individuals completed either the original device-resident, computer-administered versions, or cloud-based, tablet-delivered versions of these tasks. For the VRFCAT, performance and correlations with age were similar across versions, although performance was slightly (5 %) faster with iPad delivery. For the FUNSAT, performance and correlations with age and cognitive task scores were generally similar across versions for English Speakers, though there were some differences related to the testing language for the cloud-based version. These results support the feasibility of migrating digital assessments to cloud-based delivery and substantiate fundamental similarity across delivery strategies.

The Efficacy of a Home-Based Functional Skills Training Program for Older Adults With and Without a Cognitive Impairment.

Background and Objectives: The performance of everyday technology-based tasks, such as online banking or shopping, can be challenging for older adults, especially those with a cognitive impairment. Technology-based tasks are cognitively demanding and require learning new skills. This study explored the efficacy of a technology-based functional skills assessment and training program (FUNSAT) among aging adults with and without mild cognitive impairment (MCI) in home settings. Research Design and Methods: One hundred and eighty-four racially/ethnically diverse male and female adults aged 65+ participated in the study. The sample included 75 noncognitively impaired (NC) older adults and 109 older adults with MCI. The FUNSAT program includes medication and money management, transportation, and shopping tasks. The MCI participants were randomized to the FUNSAT training or FUNSAT training combined with computer-based cognitive training (FUNSAT/CCT). The nonimpaired adults received the FUNSAT training only. Using alternative forms of the assessment component of the FUNSAT program, assessments occurred at baseline, post-training, and 1- and 3-month post-training. This paper reports the post-training results. Results: The findings indicated that the performance of both the nonimpaired and MCI participants improved significantly for all 6 tasks post-training. Specifically, training resulted in improvements in task completion time and task errors. Participants also reported greater confidence when performing the tasks in the real world. Discussion and Implications: Nonimpaired aging adults and those with MCI can learn to perform technology-based everyday tasks. Further, home-based technology training protocols are feasible for aging adults with and without a cognitive impairment. Clinical Trial Registration: NCT0467944 1.

Improvements in performance based measures of functional capacity and cognition after computerized functional skills training in older people with mild cognitive impairment and healthy comparators.

With no pharmacological treatments for Mild Cognitive impairment (MCI), computerized training strategies have been attempted. A computerized skills training intervention, FUNSAT, previously produced training-related gains in cognition in MCI and in comparators with normal cognition (NC). A new remotely delivered version of FUNSAT was administered to a new sample of participants with NC and MCI. Outcomes measures included cognition (BAC) and functional capacity (VRFCAT) to examine training transfer. Participants with MCI (n = 92) and NC (n = 72) trained for up to 12 weeks on FUNSAT. Half the MCI participants started with 3 weeks of computerized cognitive training (CCT). Baseline, post-training, and 30-day follow-up scores on cognition and functional capacity were compared. Participants improved on both cognition (d = 0.80) and functional capacity (d = 0.64), with no differences in training gains across MCI and NC, although treatment with CCT in MCI was associated with similar gains with fewer FUNSAT training sessions. This is the first treatment study in MCI to demonstrate transfer to untrained measures of functional capacity. NC improved in cognition and functional capacity with skills training alone. These findings have implications for other conditions, such as schizophrenia, where functional capacity is a treatment target.

Early prediction of mastery of a computerized functional skills training program in participants with mild cognitive impairment.

BACKGROUND: Cognition in MCI has responded poorly to pharmacological interventions, leading to use of computerized training. Combining computerized cognitive training (CCT) and functional skills training software (FUNSAT) produced improvements in 6 functional skills in MCI, with effect sizes >0.75. However, 4% of HC and 35% of MCI participants failed to master all 6 tasks. We address early identification of characteristics that identify participants who do not graduate, to improve later interventions. METHODS: NC participants (n = 72) received FUNSAT and MCI (n = 92) participants received FUNSAT alone or combined FUNSAT and CCT on a fully remote basis. Participants trained twice a week for up to 12 weeks. Participants "graduated" each task when they made one or fewer errors on all 3-6 subtasks per task. Tasks were no longer trained after graduation. RESULTS: Between-group comparisons of graduation status on baseline completion time and errors found that failure to graduate was associated with more baseline errors on all tasks but no longer completion times. A discriminant analysis found that errors on the first task (Ticket purchase) uniquely separated the groups, F = 41.40, p < .001, correctly classifying 94% of graduators. An ROC analysis found an AUC of .83. MOCA scores did not increase classification accuracy. CONCLUSIONS: More baseline errors, but not completion times, predicted failure to master all FUNSAT tasks. Accuracy of identification of eventual mastery was exceptional. Detection of risk to fail to master training tasks is possible in the first 15 minutes of the baseline assessment. This information can guide future enhancements of computerized training.

Computerized Cognitive and Skills Training in Older People With Mild Cognitive Impairment: Using Ecological Momentary Assessment to Index Treatment-Related Changes in Real-World Performance of Technology-Dependent Functional Tasks.

OBJECTIVES: Cognitive and functional skills training improves skills and cognitive test performance, but the true test of efficacy is real-world transfer. We trained participants with mild cognitive impairment (MCI) or normal cognition (NC) for up to 12 weeks on six technology-related skills using remote computerized functional skills assessment and training (FUNSAT) software. Using ecological momentary assessment (EMA), we measured real-world performance of the technology-related skills over 6 months and related EMA-identified changes in performance to training gains. DESIGN: Randomized clinical trial with post-training follow-up. SETTING: A total of 14 Community centers in New York City and Miami. PARTICIPANTS: Older adults with normal cognition (n = 72) or well-defined MCI (n = 92), ranging in age from 60 to 90, primarily female, and racially and ethnically diverse. INTERVENTION: Computerized cognitive and skills training. MEASUREMENTS: EMA surveys measuring trained and untrained functional skills 3 or more days per week for 6 months and training gains from baseline to end of training. RESULTS: Training gains in completion times across all 6 tasks were significant (p <0.001) for both samples, with effect sizes more than 1.0 SD for all tasks. EMA surveys detected increases in performance for both trained (p <0.03) and untrained (p <0.001) technology-related skills for both samples. Training gains in completion times predicted increases in performance of both trained and untrained technology-related skills (all p <0.001). CONCLUSIONS: Computerized training produces increases in real-world performance of important technology-related skills. These gains continued after the end of training, with greater gains in MCI participants.

Improvements in Cognitive Performance With Computerized Training in Older People With and Without Cognitive Impairment: Synergistic Effects of Skills-Focused and Cognitive-Focused Strategies.

OBJECTIVES: Both cognitively impaired (CI) and nonimpaired (NC) older people have challenges in performing everyday tasks. Previous skills training efforts in NC individuals have led to improvements in both functional skills and cognitive functioning. We evaluated the cognitive benefits of combining computerized cognitive training (CCT) with a computer-based functional skills assessment and training (CFSAT) program in a sample of CI and NC older adults. DESIGN: Randomized parallel clinical trial with two treatment conditions: up to 24 sessions of CFSAT training alone or CFSAT plus speed focused CCT. PARTICIPANTS: NC (n = 62) and CI (n = 55) older adults, ranging in age from 60-86 years (M = 73.12), primarily female (90%), and ethnically diverse (21% Hispanic, 52% African American). Participants were divided based on Montreal Cognitive Assessment scores and cognitive complaints. SETTING: Three different community centers in Miami, FL. MEASUREMENTS: The Brief Assessment of Cognition, app version, was used to measure cognitive performance across six different cognitive domains before and after training. RESULTS: All six cognitive domains improved from baseline. Multivariate analyses found the effects of the combined CFSAT and CCT to be superior. The interaction of training condition and cognitive status was not statistically significant, indicating no global impact of cognitive status on improvements in cognition across training conditions. CONCLUSIONS: CFSAT training was associated with cognitive benefits, particularly in CI participants. The combined intervention led to greater improvements. Consistent with results of previous studies, there is considerable evidence of cognitive plasticity in older adults, including those with CI.

The Computerized Functional Skills Assessment and Training Program: Sensitivity to Global Cognitive Impairment, Correlations With Cognitive Abilities, and Factor Structure.

OBJECTIVES: We evaluated a novel computer-based functional skills assessment and training (CFSAT) program, which includes ecologically valid simulations of six everyday technology-related tasks. In this report, we describe the psychometric properties of the assessment in terms of sensitivity to impairment, factor structure and correlations with cognitive performance. DESIGN: Cross-sectional baseline assessment prior to a treatment study. PARTICIPANTS: Noncognitively impaired older adults (n = 62) and cognitively impaired older adults (n = 55), that ranged in age from 60 to 86 years (M = 73.12), was primarily female (90%), and ethnically diverse (21% Hispanic, 52% African American). Participants were divided at baseline on the basis of MOCA scores and cognitive complaints. MEASUREMENTS: The Brief Assessment of Cognition (BAC), app version, was used to measure cognitive performance and completion times on the six subtasks of the CFAST constituted the functional capacity measures. RESULTS: Performance on the CFSAT and BAC discriminated the two cognitive status groups. All of the cognitive domains on the BAC correlated significantly with all six CFSAT subtasks (all p < .01). Factor analyses suggested that the CFSAT and the BAC loaded on separate factors and regression analyses indicated that executive functioning and processing speed had the largest independent association with performance on the CFSAT. CONCLUSION: The CFSAT is sensitive to functional impairments seen in cognitively impaired older adults. Cognitive performance and CFSAT scores were related but nonredundant. Thus, the CFSAT appears to identify functional deficits that could be targeted with skills training interventions, likely augmented by pharmacological or computerized cognitive training interventions.

Evaluation of a Novel Technology-Based Program Designed to Assess and Train Everyday Skills in Older Adults.

BACKGROUND AND OBJECTIVES: Performance of everyday activities is often challenging for older adults. We evaluated a novel computer-based functional skills assessment and training (CFSAT) program, which includes simulations of everyday tasks (e.g., money and medication management). RESEARCH DESIGN AND METHODS: The sample included noncognitively impaired (NC) older adults (n = 51) and cognitively impaired (CI) older adults (n = 43), who ranged in age from 60 to 86 years (M = 73.12; SD = 6.06), were primarily female (90%), and ethnically diverse (23% Hispanic, 51% African American). Participants (stratified by cognitive status) were randomized to 1 of the 2 conditions training alone (CFSAT) or CFSAT with computerized cognitive training and trained up to 24 training sessions. Task performance, using measures of completion time and efficiency (accuracy/completion time), was evaluated at baseline, the final training session, and immediately posttraining with an alternate form of the CFSAT assessment. RESULTS: Both NC and CI participants demonstrated significant performance improvements across all tasks following training (all ps < .001). The CI participants demonstrated reduced training gains compared to the NC participants (all ps < .001). Training gains did not vary as a function of training conditions. DISCUSSION AND IMPLICATIONS: The findings suggest that CFSAT is an efficacious program for assessing and training everyday task performance. CFSAT can ultimately be used as an intervention strategy to enhance functional independence for aging adults with and without cognitive impairments.

A Computerized Functional Skills Assessment and Training Program Targeting Technology Based Everyday Functional Skills.

Today, many functional skills are technology-based, so development of a technology-based training program has broad importance. Here we present a computerized functional skills training program that was paired in half of the participants with a commercially available cognitive training (CCT) program. Non-impaired older individuals (NC) aged 60+ (n=45) and similarly aged individuals with mild cognitive impairment (MCI; n=50) were randomized to receive 12 weeks of twice-weekly computerized functional skills training (CFST) or 12 weeks of twice-weekly sessions split between CCT and CFST. Skills trained were use of an ATM; internet banking; ticket kiosk; telephone and internet prescription refill; medication management; and internet shopping. As with previous functional capacity assessments, we focus on completion time for each simulation. 51 participants completed the training program, either by mastering all 6 tasks (34) or completing 12 weeks of training. 44 more participants completed 4 or more training sessions so they were also analyzed for improvement up to their last training session. Completion time for all 6 tests significantly improved from the baseline assessment to the final training session in both groups of participants (all p<0.001 with an average improvement in task completion time of 45%). Further, there was no differential improvement in MCI and NC in the 6 tests from baseline to end of training (all t<1.66, all p>0.12). Finally, combined CCT plus CFST did not differ from CSFT alone on any of the percent-change score measures (all t<1.64, all p>0.11). Both NC and MCI groups evidenced substantial improvements in performance. CCT supplementation led to similar functional gains with half as many training sessions. The NC participants proceeded through the training fairly rapidly even without CCT supplementation; MCI participants required more training but learned equivalently. These findings suggest that even in cases with memory impairments, functional skills can be efficiently learned with training.