A Brief Digital Neuropsychological Protocol – I: Using Artificial Intelligence Assisted Technology to Assess Process and Errors

Abstract Background There is an urgent need for neuropsychological screening tests that are easily deployed and reliable. We have developed a digital neuropsychological screening protocol that is administered on a tablet, automatically scored using artificial intelligence, and requires approximately 10 minutes to administer. This tablet‐administered protocol assesses the requisite neurocognitive constructs associated with emergent neurodegenerative illness Method The digital protocol was administered to 77 ambulatory care/ memory clinic patients (Table1). The protocol is comprised of a 6‐word version of the Philadelphia (repeatable) Verbal Learning Test [P(r)VLT], three trials of 5 digits backward (BDST), and the ‘animal' fluency test. The protocol provides a panel of six traditional measures as would be obtained using paper/ pencil tests and manual scoring of (P[r]VLT free recall/ recognition hits, backward digit span, ‘animal' fluency output); a variety of outcome measures quantifying errors and the process used to bring tests to fruition; and two separate, norm‐referenced summary scores measuring executive control and memory. Result Cluster analysis using the panel of 6 traditional measures classified participants into normal (nl = 23), amnestic MCI (aMCI = 17), dysexecutive MCI (dMCI = 23), and dementia (dementia = 23) groups. Subsequent analyses of error and process variables operationally defined key features associated with amnesia including rapid forgetting such as (P[r]VLT immediate free recall trial 2 vs. delay free recall (aMCI & dementia < dMCI & nl; p< 0.001), the production of extra‐list intrusion errors (dementia > nl; p< 0.002); profligate responding to recognition foils (aMCI & dementia > dMCI & nl; p< 0.001); key features underlying reduced executive measures (i.e., BDST perseveration/ related errors (dMCI & dementia > aMCI & nl, < 0.050); and the strength of semantic association from successive ‘animal' fluency responses (nl & dMCI > dementia; p< 0.028). The novel executive and memory index scores dissociated all four groups from each other (p< 0.014). Conclusion This digitally administered and scored protocol yields patterns of impaired performance similar to paper/ pencil tests. The availability of both traditional and error/ process measures suggests that subtle, nuanced indications of early emergent illness may be identified in a fast, efficient, yet comprehensive way.