Investigating the viability of a digital neurocognitive measuring tool in older adults using the Asenze population-based cohort

Abstract

Cognitive health disparities in low-resource settings remain a critical concern. Traditional neuropsychological assessments are often inaccessible due to resource constraints, necessitating scalable alternatives. This study examined the feasibility of NeuroScreen, a digital neuropsychological screening tool, for use among older adults residing in a peri-urban area of KwaZulu-Natal, South Africa. Using secondary data from the Asenze population-based cohort, the neurocognitive performance of 239 caregivers living without HIV, black, and aged 40-79 was examined across six cognitive domains. Descriptive statistics were analysed first, followed by inferential statistics. Age, education and SES significantly influenced cognitive outcomes. Older participants demonstrated slower processing speed and reduced motor speed, while lower education was associated with poorer executive function and visual discrimination. Compared to international norms, the cohort exhibited significantly slower processing speed and weaker motor function as expected, but better delayed recall. Verbal learning and delayed recall were comparable across age groups and international low- resource cohorts. Overall, the basic feasibility of NeuroScreen was demonstrated in this study. It has strong potential as a cost-effective, scalable neuropsychological screening tool for resource-limited environments. However, localised validation, normative data, longitudinal follow-up and compensatory strategies for digital literacy disparities are essential to enhance its cultural relevance and ensure equitable and contextually appropriate cognitive screening in diverse populations.