Unsupervised, frequent and remote: a novel platform for personalised digital phenotyping of spatial working memory and image recognition in humans

Spatial working memory and image recognition tests are commonly used to facilitate the diagnosis of hippocampal-related neurological disorders such as Alzheimers disease due to their relatively high specificity and sensitivity to damage to the medial temporal lobes compared to standard commonly used clinical tests. Pathological changes in Alzheimers disease start years before the formal diagnosis is made, partially due to testing too late. To address this challenge, we developed a novel digital platform, hAge ( healthy Age), which integrates double spatial alternation, image recognition and visuospatial tasks for frequent remote unsupervised assessment of spatial and non-spatial working memory. 191 healthy adults (67% females, 18-81 years old) participated in the study. In line with findings using standard laboratory tests, we showed that performance on the spatial alternation task negatively correlated with inter-trial periods and performance levels on image recognition and visuospatial tasks can be controlled by varying image similarity. Importantly, we demonstrated that frequent engagement with the double spatial alternation task leads to a strong practice effect, previously identified as a potential measure of cognitive decline in MCI patients. Finally, we discuss how lifestyle and motivation confounds may present a serious challenge for cognitive assessment in real-world uncontrolled environments.