An App-Based Digit Symbol Substitution Test for Assessment of Cognitive Deficits in Adults With Major Depressive Disorder: Evaluation Study
Open accessAbstract
Background: Cognitive dysfunction is an impairing core symptom of depression. Among adults with major depressive disorder (MDD) treated with antidepressants, residual cognitive symptoms interfere with patient-reported outcomes. The foregoing characterization of cognitive symptoms provides the rationale for screening and assessing the severity of cognitive symptoms at point of care. However, clinical neurocognitive assessments are time-consuming and difficult, and they require specialist expertise to interpret them. A smartphone-delivered neurocognitive test may offer an effective and accessible tool that can be readily implemented into a measurement-based care framework. Objective: We aimed to evaluate the use of a smartphone-delivered app-based version of the established Cognition Kit Digit Symbol Substitution Test (DSST) neurocognitive assessment compared to a traditional paper-and-pencil version. Methods: Convergent validity and test-retest reliability of the 2 versions were evaluated. Patient satisfaction with the app was also assessed. Results: Assessments made using the app-based Cognition Kit DSST were highly correlated with the standard paper-and-pencil version of the test, both at the baseline visit (r=0.69, df=27; P<.001) and at the end-of-study visit (r=0.82, df=27; P<.001), and they were positively evaluated by 30 patients as being user-friendly, easy to navigate, and preferable over the paper-and-pencil version of the DSST. However, although the app-based Cognition Kit DSST was validated in patients with MDD, it still needs to be evaluated in healthy controls. Conclusions: App-based DSST may facilitate a more personalized, convenient, and cost-effective method of cognitive assessment, helping to guide measurement-based care and psychotherapeutic and pharmacologic treatment options for patients with MDD. Trial Registration: ClinicalTrials.gov NCT03999567; https://tinyurl.com/2p8pnyv7
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Several studies have demonstrated the potential of using digital biomarkers (based on sensor data from wearable devices or mobile apps) for the prediction and detection of depression.
“Several studies have demonstrated the potential of using digital biomarkers (based on sensor data from wearable devices or mobile apps) for the prediction and detection of depression.[71][72][73]”
From Digital health technologies and major depressive disorder (2023) · cites this paper as [73]
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References 28 · Cited by 7
- Authors
- McIntyre, R. S., Lipsitz, O., Rodrigues, N. B., Subramaniapillai, M., Nasri, F., Lee, Y., Fehnert, B., King, J., Chrones, L., Kratiuk, K., Uddin, S., Rosenblat, J. D., Mansur, R. B., & McCue, M.
- Affiliations
- University Health Network (CA)
- Corresponding author
- McIntyre, Roger S
- ORCID
- Venue
- JMIR Mental Health
- Publisher
- JMIR Publications Inc.
- Published
- 2022-10-27
- Volume
- 9
- Issue
- 10
- Pages
- e33871
- ISSN
- 2368-7959 (ISSN-L)
- PMC
- PMC9650567
- OpenAlex
- W4307494781
- Cited by
- 7
- References
- 28
- Citations by year
- 2026: 2 · 2025: 2 · 2024: 2 · 2023: 1
- FWCI
- 1.10
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- JMIR Mental Health (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Topics
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Social Sciences › Psychology › Clinical Psychology › Historical and Modern Theater Studies
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Keywords
- major depressive disorder, cognitive impairment, Digit Symbol Substitution Test, mobile health apps, measurement-based care, convergent validity, test-retest reliability, patient satisfaction, antidepressants
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