title: C-TOC (Cognitive Testing on Computer): investigating the usability and validity of a novel self-administered cognitive assessment tool in aging and early dementia.
abstract: BACKGROUND
  Cognitive Testing on Computer (C-TOC) is a novel computer-based test battery developed to improve both usability and validity in the computerized assessment of cognitive function in older adults.
  
  
  METHODS
  C-TOC's usability was evaluated concurrently with its iterative development to version 4 in subjects with and without cognitive impairment, and health professional advisors representing different ethnocultural groups. C-TOC version 4 was then validated against neuropsychological tests (NPTs), and by comparing performance scores of subjects with normal cognition, Cognitive Impairment Not Dementia (CIND) and Alzheimer disease. C-TOC's language tests were validated in subjects with aphasic disorders.
  
  
  RESULTS
  The most important usability issue that emerged from consultations with 27 older adults and with 8 cultural advisors was the test-takers' understanding of the task, particularly executive function tasks. User interface features did not pose significant problems. C-TOC version 4 tests correlated with comparator NPT (r=0.4 to 0.7). C-TOC test scores were normal (n=16)>CIND (n=16)>Alzheimer disease (n=6). All normal/CIND NPT performance differences were detected on C-TOC. Low computer knowledge adversely affected test performance, particularly in CIND. C-TOC detected impairments in aphasic disorders (n=11).
  
  
  CONCLUSIONS
  In general, C-TOC had good validity in detecting cognitive impairment. Ensuring test-takers' understanding of the tasks, and considering their computer knowledge appear important steps towards C-TOC's implementation.
authors.affiliation: *Division of Neurology Department of Medicine; ∥Division of Geriatrics, Department of Medicine, University of British Columbia ‡Computer Science, University of British Columbia †Hospital Clinic for Alzheimer Disease and Related Disorders, Vancouver Coastal Health, University of British Columbia, Vancouver, BC, Canada §Department of Computer Science, University of Michigan Flint, Flint Township, MI.
authors.forename: Claudia
authors.initials: C
authors.lastname: Jacova
authors.forename: Joanna
authors.initials: J
authors.lastname: McGrenere
authors.forename: Hyunsoo S
authors.initials: HS
authors.lastname: Lee
authors.forename: William W
authors.initials: WW
authors.lastname: Wang
authors.forename: Sarah
authors.initials: S
authors.lastname: Le Huray
authors.forename: Emily F
authors.initials: EF
authors.lastname: Corenblith
authors.forename: Matthew
authors.initials: M
authors.lastname: Brehmer
authors.forename: Charlotte
authors.initials: C
authors.lastname: Tang
authors.forename: Sherri
authors.initials: S
authors.lastname: Hayden
authors.forename: B Lynn
authors.initials: BL
authors.lastname: Beattie
authors.forename: Ging-Yuek R
authors.initials: GY
authors.lastname: Hsiung
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D003071:Cognition / Q000502:physiology*; D003072:Cognition Disorders / Q000175:diagnosis* / Q000503:physiopathology; D003704:Dementia / Q000175:diagnosis* / Q000503:physiopathology; D042241:Early Diagnosis; D056344:Executive Function / Q000502:physiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests