Cognition is often impaired in individuals with diabetes, and chronic kidney disease (CKD), a common microvascular complication, may further worsen cognitive function. However, logistical challenges associated with traditional neuropsychological assessment limit detection of cognitive impairment in research and clinical care. The goal of this project was to evaluate psychometric properties of self-administered online neurocognitive assessment (www.testmybrain.org) compared to traditional testing.We used a counterbalanced, within-subjects design comparing online neurocognitive performance to traditional in-person performance in a sample of adults with diabetes with and without CKD (type 1 diabetes N=14, type 2 diabetes N=35, CKD N=18). Associations between each online and analogous in-person test were adequate to good (rs = 0.49-0.66). The magnitude of correlations between divergent cognitive tests did not differ for online versus in-person tests. The amount of variance in age, education, HbA1c, and estimated glomerular filtration rate (eGFR) accounted for by the online versus in-person tests was similar (age R2=0.54 versus 0.23; education R2=0.37 versus 0.30; HbA1c R2=0.20 versus 0.12; eGFR R2 = 0.16 versus 0.18). The magnitude of variance accounted for in everyday functioning by the online versus in-person tests was also similar (Functional Activities Questionnaire R2=0.08 versus 0.07; Neuro-QoL Cognitive Function R2=0.14 versus 0.16; Diabetes Self-Management Questionnaire R2=0.19 versus 0.19).
In conclusion, this battery of self-administered online neurocognitive tests had adequate to good construct validity, with comparable discriminant, construct, and ecological validity to that of traditional testing. The self-administered online assessments used here have sufficient validity to increase the feasibility of cognitive testing in adults with diabetes, with and without CKD; high-risk groups for cognitive impairment.
N. Chaytor: Consultant; Self; Eli Lilly and Company. C. Barbosa-Leiker: None. L. Germine: None. S.M. McPherson: Consultant; Self; Consistent Care Company, Orthopedic Specialty Institute. Research Support; Self; Bristol-Myers Squibb Company, Managed Health Connections, LLC, Ringful Health, LLC. K.R. Tuttle: Consultant; Self; AstraZeneca, Boehringer Ingelheim International GmbH, Gilead Sciences, Inc., Goldfinch Bio. Research Support; Self; Eli Lilly and Company.
National Center For Advancing Translational Sciences (UL1TR002319)