As the complexity and geographic distribution of clinical trials increase, there is a growing need for more efficient cognitive testing of participants. Traditional “pencil and paper” neuropsychological tests have been the gold standard but require expert administration and manual data collection. To scale to hundreds of patients located around the world, computerized cognitive testing offers wider accessibility, greater standardization and enhanced data management.
However, before these computerized tests gain widespread acceptance among researchers in specific therapeutic indications, they must be validated in each population to demonstrate their ability to detect even subtle changes in cognition.
The Cogstate Brief Battery (CBB), a collection of four computerized cognitive tests, has demonstrated in clinical trials its sensitivity to cognitive change across a wide group of conditions, including dementia, Alzheimer’s disease, schizophrenia, and HIV/AIDS.
One population that has not been as extensively investigated for computerized testing is oncology patients treated for a non-CNS cancer. Almost 30% of survivors experience mild cognitive deficits after chemotherapy treatment. Specifically, breast cancer patients, who experience prevalent treatment-related cognitive side effects in memory and executive functioning, need to be assessed.
In a recent paper published in The Clinical Neuropsychologist, researchers investigated the Cogstate Brief Battery’s correlation with traditional neuropsychological tests in a group of breast cancer patients and healthy control volunteers. The researchers articulated the need for such a study, by stating, “The handful of studies that have reported the use of Cogstate tests with non-CNS cancer patients have used varied criteria to define cognitive impairment and most did not (a) compare performance on Cogstate tests with traditional neuropsychological tests, (b) include a (health control) group for comparison, or (c) evaluate associations with real-world functioning.”
As part of a larger study, 53 women (26 breast cancer survivors and 27 healthy controls) completed testing with the CBB and with traditional tests that were best matched to the same cognitive functions of each CBB component test. For processing speed and reaction time, the WAIS-IV Processing Speed Index (PSI) was matched with the CBB’s Detection test; for attention, the WAIS-IV Digit Span Forward (DSF) was matched to the Identification test; for working memory, the WAIS-IV Digit Span Backward (DSB) was matched to the One Back test; and for learning and memory, the Hopkins Verbal Learning Test-Revised (HVLT-R) was matched with the One Card Learning test of the CBB.
As part of the parent study, participants also completed the Functional Activities Questionnaire, to measure their daily living dependencies, as well as the Brief Symptom Inventory to assess mood.
One of the criticisms of computer-based tests is the possible lack of user adeptness with a laptop and mouse versus pencil and paper. Each participant’s performance was evaluated using recommended integrity checkpoints from Cogstate. Of the original 66 participants, 13 were removed because of scores that were below the minimum for the population norm.
The results for this small sample size were encouraging as significant correlations were found between the CBB and the traditional cognitive tests.
“Significant positive correlations were found between the Cogstate Brief Battery tests and traditional neuropsychological tests, although the traditional tests specifically hypothesized to correlate with Cogstate tests did not reach statistical significance,” concluded the researchers. “Analysis of Covariance results showed preliminary support for criterion validity, as the patient and control groups differed on the traditional test of working memory, with a trend towards significance for the Cogstate test of working memory, controlled for age, race, and mood.”
In particular, the Cogstate One Back test of working memory was correlated better with the WAIS-IV PSI and HVLT-R than the WAIS-IV DSB. Overall, three of the four Cogstate tests were significantly correlated with at least one traditional test, showing the need for expanded research.
“The results from this exploratory investigation encourage further investigation of the Cogstate tests as potential screening tools for mild cognitive dysfunction,” wrote the study authors. “We recommend future research with larger sample sizes and longitudinal designs to better evaluate the stability of sensitivity across time.”
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