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99 Validation and clinical translation of a remote self-administered cognitive measure and models for cultural and linguistic adaptations through Mayo Test Drive

Published online by Cambridge University Press:  21 December 2023

Aimee James Karstens*
Mayo Clinic Minnesota, Rochester, MN, USA
Nikki H Stricker
Mayo Clinic Minnesota, Rochester, MN, USA
Correspondence: Aimee James Karstens Mayo Clinic Minnesota: Rochester, MN, US
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Despite significant recent advances in test development in research settings, neuropsychological tests and normative data used in clinical settings have fallen behind in innovation in terms of empiricism and modality of administration (Bilder & Reise, 2019). Most widely-used test paradigms were initially developed 50-150 years ago with normative data that is often limited to White American-born monolingual English samples (Pugh et al., 2022; Rabin et al., 2016). Few digital tests have successfully translated into clinical use (Collins & Riley, 2016).

Participants and Methods:

Mayo Test Development through Rapid Iteration, Validation, and Expansion (Mayo Test Drive) is a remote platform for neuropsychological test development and self-administration that is accessible through any web-based device (Stricker et al., 2022). To date, we have demonstrated rapid validation and clinical translation of the SLS in native English speaking older adults and are now beginning cultural/linguistic adaptation for further validation, and clinical translation for Spanish speakers. Mayo Test Drive’s web-based platform captures all item-level data to allow future item level analysis and application of machine learning techniques.


The broader aim of Mayo Test Drive is to provide infrastructure to include more tests, adaptations, and normative datasets to ultimately improve access and utility for diverse patient populations. Mayo Test Drive currently includes two measures: Stricker Learning Span (SLS), a novel learning and recognition memory test, and Symbols Test, an open access processing speed measure (Stricker et al., 2022; Wilks et al., 2022). The SLS was designed with consideration of learning principles from cognitive neuroscience to enhance detection of the early decline in learning observed in preclinical Alzheimer’s disease (AD). The SLS uses computer adaptive testing to adapt task difficulty trial-by-trial (e.g., increasing word span) and uses a sensitive 4-choice format to test recognition memory for each word. The SLS underwent initial piloting in older females to determine psychometric properties, test-retest reliability, convergent validity with traditional measures, and criterion validity (e.g., neuroanatomical associations).


Further validation and normative data development in the Mayo Clinic Study of Aging is ongoing, with additional criterion validation assessed by comparing brain PET (amyloid and tau) biomarker positive vs. negative groups. The SLS is equivalent to an inperson memory measure (AVLT), and the Mayo Test Drive composite including SLS and Symbols is superior to an in-person global screen (Short Test of Mental Status, like the MMSE) in distinguishing biomarker +/- older adults. To adapt the SLS for other languages/cultures, we have added community-based components to development (e.g., cognitive interviewing, additional piloting). We are beginning data-driven linguistic and remote cognitive interviewing approaches to develop an adaptation of the SLS for Spanish speakers. This study involves virtual focus groups with native Spanish speakers from different backgrounds (e.g., countries of origin, multilingualism) to examine the test paradigm, instructions, and items. Following piloting of the adaptations, next steps include normative data collection and clinical implementation. Future work involves in-person adaptation studies for lower/middle income countries including a collaboration with a Master’s level psychology graduate program in Grenada, West Indies to complete cognitive interviewing and pilot work with community members and stakeholders.

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