However, the Brain on Track was not available in English as of 2022. The Brain on Track self-administered web-based test for longitudinal cognitive assessment was developed in 2014, in Portugal. To the best of our knowledge, to date, only one test has been specifically designed for at-home longitudinal cognitive monitoring. These tests showed good neuropsychological parameters, but were primarily designed for single use cases and are not validated for longitudinal cognitive tracking. At home approaches have also been developed and validated (e.g., the Computer Assessment of Mild Cognitive Impairment, COGselftest, and MicroCog ). The National Institutes of Health Toolbox Cognition Battery, the Cognitive Stability Index, CogState, BrainCheck, Neurotrack, CNS Vitals can replace existing paper screening tests like Montreal Cognitive Assessment (MoCA), but they still require a trained evaluator administering the test to a patient. In the last two decades, the availability of computerized cognitive testing with diagnostic accuracy comparable to traditional pen-and-paper neuropsychological testing have improved significantly. Such a test could be performed at home or in the clinic by using randomly selected non-repeating tasks to minimize practice effects. Therefore, there is a clear need for a self-administered cognitive test that can be repeated periodically and is resistant to practice effects. Second, the number of variations of standard tests is often limited resulting in practice effects. While this approach has a high sensitivity and specificity for the detection of dementia, it is time and resource intensive. First, they ubiquitously rely on trained professionals. Standard cognitive assessments are not suited for weekly/monthly cognitive evaluations. In addition, longitudinal monitoring is essential for testing novel interventions designed to reduce or reverse cognitive aging. Longitudinal monitoring of cognitive health can help clinicians assess if an underlying condition is causing cognitive decline and guide timely therapeutic interventions. Many treatable health conditions (e.g., sleep disorders, hypertension, diabetes, heart failure, hypothyroid), deficiencies (e.g., vitamin B12, tryptophan), as well as lack of movement and social interactions can affect memory and thinking. BOCA is available online gratis at Peer Review reports BOCA has the potential to reduce the cost and improve the quality of longitudinal cognitive tracking essential for testing novel interventions designed to reduce or reverse cognitive aging. The effect of the screen size tested by BOCA administration on a large computer screen and re-administration of the BOCA to the same participant on a smartphone was insignificant (β = 0.82, p = 0.17 positive β indicates greater score on a smartphone). The practice effect tested by daily BOCA administration over 10 days was insignificant (β = 0.03, p = 0.68). The study revealed strong ( R = 0.94, p < 0.001) test-retest reliability of the total BOCA score one week after participants’ initial administration. BOCA demonstrated strong correlation with Montreal Cognitive Assessment (MoCA) ( R = 0.90, p < 0.001). The Cronbach’s alpha was 0.87 implying good internal consistency. Test scores were significantly different between patients and controls ( p < 0.001) suggesting good discriminative ability. BOCA was administered to patients with cognitive impairment ( n = 50) and age- and education-matched controls ( n = 50).

BOCA evaluates eight cognitive domains: 1) Memory/Immediate Recall, 2) Combinatorial Language Comprehension/Prefrontal Synthesis, 3) Visuospatial Reasoning/Mental rotation, 4) Executive function/Clock Test, 5) Attention, 6) Mental math, 7) Orientation, and 8) Memory/Delayed Recall. BOCA uses randomly selected non-repeating tasks to minimize practice effects. The goal of this project was to validate BOCA. We developed a self-administered 10-min at-home test intended for longitudinal cognitive monitoring, Boston Cognitive Assessment or BOCA. Longitudinal cognitive testing is essential for developing novel preventive interventions for dementia and Alzheimer’s disease however, the few available tools have significant practice effect and depend on an external evaluator.

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