13 September 2022
Developing a method of delivering experimenter-led online cognitive assessments
We caught up with Victoria Leong from Nanyang Technological University and University of Cambridge who told us how the COVID-19 pandemic has required a shift to web-based testing and how CANTABTM tasks can be used as part of a rigorous online cognitive testing methodology.
Can you tell us a bit about yourself?
I am a developmental cognitive neuroscientist who studies parent-infant neural dynamics during social interaction, particularly in the context of play, communication, and social learning. I am Associate Professor of Psychology and Medicine at Nanyang Technological University (Singapore) and Honorary Senior Fellow with the Department of Paediatrics, Cambridge University (UK). I am also Deputy Director of the Cambridge-NTU Centre for Lifelong Individualised Learning which aims to develop neuropersonalised training programmes for flexible lifespan learning. I am a recipient of the Federation of Associations in Behavioral and Brain Sciences Early Career Impact Award (2022), MOE Social Sciences and Humanities Research Fellowship (Singapore, 2021), Parke Davis Exchange Fellowship (Harvard, 2015), Sutasoma Junior Research Fellowship (Cambridge, 2013-15), Cognitive Science Society Glushko Dissertation Prize (2014) and I hold awards from the Wellcome Trust, British Academy, UK Economic & Social Research Council, and Rosetrees Medical Trust.
Assisting me on this blog is Kean Mun Lee, a Psychology (BSc) graduate from the University of Nottingham. He is a Research Assistant at the Cambridge-NTU Centre for Lifelong Individualised Learning.
Can you tell us more about the research?
The COVID-19 pandemic brought human lab-based psychological research to a halt. During this period of suspension, interest in online experimental alternatives to in-person testing has grown significantly. This study conducted by the Centre for Lifelong Learning and Individualized Cognition (CLIC) examines the opportunities and challenges brought about by web-based testing, and proposes a new supervised online testing methodology, Remote Guided Testing (RGT). RGT is intended to be used as a web-based method of delivering cognitive assessments that is performed in the presence of an online experimenter. This method expands the range of possibilities for web-based testing using CANTABTM.
What methods did you use?
In RGT, the experimental rigour of lab-based testing is replicated online as a highly curated data collection method. A standardised operating procedure is used, where the experimenter follows a script which clearly lays out how they should guide and supervise participants through each step of the experimental procedure online. This includes obtaining informed consent, providing technical support for software installation, troubleshooting problems, monitoring performance, providing feedback where appropriate, and debriefing. The experimenter guides the participants through each of these steps using a secure video conferencing platform.
We compared data from a range of classical cognitive tasks with the aim of assessing the relationship between executive function (cognitive flexibility, working memory, inhibition) and flexible learning. These datasets were collected either in person (traditional lab-based testing) or using the new RGT method in a cohort of 85 healthy Singaporean young adults (face-to-face (F2F; n=41) and RGT(n=44)).
In total, each participant completed 10 online experimental tasks assessing aspects of executive functioning (cognitive flexibility, working memory, and inhibitory control), learning, and verbal intelligence. These tasks were delivered using 3 different experimental web platforms: CANTABTM (Cambridge Cognition), i-ABC, and Inquisit 5 (Millisecond Software); or delivered verbally by the experimenter.
For the study, CANTABTM was used to administer the Intra-Extra Dimensional (IED) set shift task and the Spatial Working Memory (SWM) task.
Why did you choose CANTABTM for your study?
CANTABTM offers several advantages, such as simple and precise control of experimental parameters, automatic calculation of key performance indices, centralized and secure data storage on professional servers, and relatively low administrative costs per head.
Furthermore, since most of the CANTABTM tests are non-verbal, this makes CANTABTM ideal for testing diverse populations and for cross-national studies.
What were the key findings and their implications?
Results indicated that, across all data quality and performance measures, RGT data was statistically-equivalent to in-person data collected in the lab. We observed no significant difference in task performance between F2F and RGT participants for any delivery platform or experimental task, with the notable and interesting exception of a measured verbal intelligence task (WASI Vocabulary), where RGT participants scored significantly higher than F2F participants.
We assessed whether participants’ demographics (gender, ethnicity, education, home-dwelling) or their testing modality (F2F/RGT) could explain differences in WASI Vocabulary task performance. Of the factors examined, only the testing modality (F2F/RGT) was noted to be a significant predictor.
One potential explanation for the observed difference in verbal intelligence could be due to the use of face masks in the F2F testing (in compliance with prevailing COVID-19 guidance). This could have reduced participants’ general willingness to communicate with the experimenter, consistent with data from a large-scale randomized control study indicating that mask-wearing by physicians during consultations negatively impacted doctor-patient communication, perceived empathy, and relational continuity (Wong et al., 2013). Therefore, in clinical settings, remote testing methods not requiring the use of personal protective equipment such as masks may, in fact, be beneficial to reduce the communication barrier between experimenter and participant, yielding improved performance on verbal tasks.
Although RGT was used in a research context, our findings suggest that the RGT method could also be a useful alternative for clinical neuropsychological assessments, particularly in situations where in-person meetings would be difficult or impossible. For example, a person who uses a wheelchair or lives in a care home may find it easier to be tested in their home environment, particularly during winter when daylight hours are short, and there can be significant weather deterrents to travel such as ice or snow. Therefore, there is wide potential for the RGT method to be used in tandem with traditional F2F methods across both clinical and nonclinical settings.
Full details of the study findings published in JMIR can be found here https://www.jmir.org/2022/1/e28368/authors
What are your next steps?
CLIC is currently working on a larger study to explore the relationship between executive function (specifically cognitive flexibility), learning, creativity, academic skills (like language and mathematics) and life skills (like problem solving) in a larger group of healthy adults and adolescents in Singapore.
Leong, V., Raheel, K., Sim, J. Y., Kacker, K., Karlaftis, V. M., Vassiliu, C., Kalaivanan, K., Chen, S., Robbins, T. W., Sahakian, B. J., & Kourtzi, Z. (2022). A New Remote Guided Method for Supervised Web-Based Cognitive Testing to Ensure High-Quality Data: Development and Usability Study. Journal of Medical Internet Research, 24(1), e28368. https://doi.org/10.2196/28368
Wong, C. K., Yip, B. H., Mercer, S., Griffiths, S., Kung, K., Wong, M. C., Chor, J., & Wong, S. Y. (2013). Effect of facemasks on empathy and relational continuity: A randomised controlled trial in primary care. BMC Family Practice, 14, 200. https://doi.org/10.1186/1471-2296-14-200
Victoria Leong and Kean Mun Lee, Cambridge-NTU Centre for Lifelong Individualised Learning