Computerized cognitive testing in aging

To the Editor: The review article of Wild et al., ‘‘Status of Computerized Cognitive Testing in Aging: A Systematic Review,’’ published in the November 2008 issue of the Journal [1], constitutes a significant milestone for computerized assessment. However, the article appears to contain several inaccuracies that misrepresent the Mindstreams battery. First, Table 2 lists the age range for Mindstreams as .50 years, and the ‘‘largest sample size’’ as 213, apparently based on papers published in 2005 and 2006 [2,3]. Because these studies dealt exclusively with the elderly, details for only the relevant portion of the normative database were reported. However, the actual age range of the Mindstreams normative database as of those studies was .9 years, and the current sample size is 1569 [4]. Given that age ranges for most of the batteries in Table 2 were not limited to the elderly, we feel that these numbers better represent the Mindstreams battery. Second, since the time of the literature review performed by the authors, approximately eight papers demonstrating the validity and practicality of Mindstreams were published. Among these is a paper in the January 2008 issue of this Journal on the usability of Mindstreams in a cohort of 2888 elderly individuals [4] that included previously unavailable information. The authors cited the paper in their Discussion, but it was not considered by the raters in judging the validity and practicality of the battery. In a related issue, the exclusion criteria stated that studies of populations other than those with early dementia/ mild cognitive impairment (MCI) were excluded, but such conditions (e.g., Parkinson’s disease) were mentioned in the Results. We therefore feel that the Mindstreams battery is better represented by considering publications that involve other conditions. Presently, 27 full-length publications support the validity of Mindstreams, in addition to a report by the U.S. Navy [5]. We disagree with the authors that the number of publications should have little bearing on the overall rating of a battery, particularly if the publications report on independent, investigator-initiated studies. This is the case for all Mindstreams publications, but not for the one article located on the Computer-Administered Neuropsychological Screen for Mild Cognitive Impairment (CANS-MCI) and highlighted by the authors. That paper was authored solely by employees of the company that developed the battery. Third, we wish to clarify that Mindstreams was developed for repeat testing, and that alternate-form test-retest reliability