Usability study and pilot validation of a computer-based emotion recognition test for older adults with Alzheimer's disease and amnestic mild cognitive impairment

ABSTRACT

Objectives: This study aimed to carry out a pilot validation of Affect-GRADIOR, a computer-based emotion recognition test, with older adults. The study evaluated its usability, reliability and validity for the screening of people with Alzheimer´s disease (AD) and amnestic mild cognitive impairment (aMCI).

Methods: The test was administered to 212 participants (76.37 ± 6.20 years) classified into three groups (healthy controls, n = 69; AD, n = 84; and aMCI, n = 59) on the basis of detailed neurological, neuropsychological, laboratory and neuro-imaging evidence. Data on usability were collected by means of a questionnaire and automated evaluation.

Results: The validated test comprised 53 stimuli and 7 practice items (one per emotion). Participants reported that Affect-GRADIOR was accessible and user-friendly. It had high internal consistency (ordinal Cronbach's α = 0.96). Test-retest reliability correlations were significant and robust (r = 0.840, p < 0.001). Exploratory factor analysis supported a seven-factor model of the emotions assessed (neutral expression, happiness, surprise, disgust, sadness, anger and fear). Receiver operating characteristic curve analyses suggested that the test discriminated healthy older adults from AD and aMCI cases. Correct answer score improved MMSE predictive power from 0.547 to 0.560 (Cox & Snell R², p = 0.012), and Affect-GRADIOR speed of processing score improved MMSE predictive power from 0.547 to 0.563 (Cox & Snell R², p = 0.010).

Conclusions: Affect-GRADIOR is a valid instrument for the assessment of the facial recognition of emotions in older adults with and without cognitive impairment.

KEYWORDS:

• Emotion
• affect
• Alzheimer disease
• mild cognitive impairment
• neuropsychology

Acknowledgments

This work has been supported by the Iberian Research Institute of Psycho-sciences (IBIP, INTRAS Foundation) and the University of Salamanca. We thank all participants and carers for accepting to take part in the study, and we would like to thank Nurse Visitación de las Heras, from the Department of Neurology of Burgos University Hospital, and Neuropsychologist María José Viñas, from INTRAS Foundation´ Memory Clinic, who played a key role in the recruitment of the participants. JAGC, the corresponding author, had full access to all the data in the study and has final responsibility in the decision to submit it for publication.

Disclosure of interests

The authors have no competing interests.