Computerized assessment of executive functioning: Validation of the CNS Vital Signs executive functioning scores in a sample of community-dwelling older adults

Abstract

Objective: Computerized assessment of cognitive functioning has gained significant popularity over recent years, yet options for clinical assessment of executive functioning (EF) are lacking. One computerized testing platform, CNS Vital Signs (CNS-VS), offers tests designed to measure EF but requires further validation. The goal of the present study was to validate CNS-VS executive scores against standard clinical measures of EF. We also sought to determine whether a modified CNS-VS composite score that included variables purported to measure inhibition, switching, and working memory would outperform the currently available CNS-VS Executive Function Index. Method: A sample of 73 cognitively healthy older adults completed four tests from the Delis-Kaplan Executive Function System, the Digit Span subtest from the Wechsler Adult Intelligence Scale-fourth edition, and three CNS-VS tasks purported to measure inhibition, switching, and working memory. Results: Performances on the CNS-VS tests were predicted by performances on standard paper-and-pencil measures. Although the currently available CNS-VS Executive Function Index predicted unique variance in a well-validated paper-and-pencil EF composite score, our Modified CNS-VS EF composite accounted for unique variance above and beyond the original CNS-VS Executive Function Index, while the reverse was not true. Conclusions: The present results support the construct validity of CNS-VS EF tests but also suggest that modifications to their current composite scores would improve the prediction of EF performance.

Keywords:

• Executive function
• computerized assessment
• older adults
• teleneuropsychology
• technology

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The data that support the findings of this study are available from the corresponding author, [LAD], upon reasonable request.

Notes

1 Although the instruction text has been translated into 50 languages, the normative sample consists only of individuals who were administered the tests in English. There are no normative data available for these translations.

2 The CWIT also contains a fourth condition, which assesses branching and was not included in this study.

3 We consider the EF Index to be broader in that the Shifting Attention Test requires that the examined both inhibit the old rule and shift to the new rule. In contrast, the Cognitive Flexibility Index attempts to remove the inhibition variance by subtracting the number of inhibition errors. Of course, selecting one condition over the other is an academic exercise with no practical ramifications, since both scores are essentially identical, at least in this sample.

4 The D-KEFS raw scores in this study were converted to scaled scores using the normative reference group for adults aged 60–69 years. By doing so, D-KEFS scores could be standardized and combined into a single composite without correcting for age. The 60–69-year-old age band was selected because the scores within this age band encompassed the widest range of raw scores (as compared to other age bands) and would therefore have the highest probability of avoiding floor or ceiling effects (Delis et al., 2001). We used a similar procedure in other prior studies (Suchy, Brothers, et al., 2022; Suchy, Mullen, et al., 2020).

Additional information

Funding

This work was supported by the American Psychological Foundation Lorraine D. Eyde Fund Grant and internal grants from the University of Utah Department of Psychology.