Woman meditating by water and a woman horseback riding

Computer- and Smartphone-based Assessment of Cognitive Functioning in Affective Disorders in Young People

What happens if a psychiatrist should frequently assess cognitive impairment in depressed and bipolar patients using paper-and-pencil tests? The solution is an automated web-based cognitive test battery: The Internet-based Cognitive Assessment Tool (ICAT)


Cognitive dysfunction is a central complication to mental disorders and affects concentration, decision making, and everyday life of patients. Cognitive function of these patients are assessed by means of neuropsychological tests. Contemporary neuropsychological test batteries are, however, either paper- or computer-based and demand meticulous collocated supervision of psychiatrists, which is a time consuming and complicated procedure and only provides a limited assessment of cognitive functioning in a clinical setting. Other resources such as a silent room in a clinic and time scheduling are also essential for each assessment.
The “Screen for Cognitive Impairment in Psychiatry” (SCIP; [1]) is a validated and brief screening tool for psychotic disorders including bipolar disorder and depression. This test battery examines verbal learning, working memory, verbal fluency, delayed recall, and psychomotor speed. SCIP is a paper-based test battery and is used in clinical setting, in which the examiner explains the instructions and read several words and letter-number sequences to the patient. Hence, clinicians require an automated test battery based on gold-standard tasks of SCIP.
To date, CANTAB [2], NIH EXAMINER [3], CNS Vital Signs [4], CogState [5], and THINC-it [6] are the validated cognitive assessment tools for mental disorders. However, none of the applications have delivered a brief set of cognitive tests for both depressed and bipolar patients. Moreover, the current digital cognitive test batteries provide a limited assessment for this patient group.


The goals of this PhD project is to develop i) a web-based application to assess cognitive impairment called ICAT (Internet-based Cognitive Assessment Tool) and ii) a smartphone-based application to assess cognitive dysfunction and to give feedback to the patients using visual analytics.

Internet-based Cognitive Assessment Tool

ICAT is a web-based cognitive assessment tool for depressed and bipolar patients. ICAT development team includes computer scientists, health informaticians, psychiatrists, psychologists, and front- and back-end developers. The initial design of ICAT system can be found in our recent publication [7]. Significant effort is dedicated to the user-centred design considerations to deliver a highly usable application. The ICAT study is ongoing and you may find more details here. Through development of ICAT, we aim to deliver a patient-administered and automated tool that can be run out of clinical setting.

iCAT being tested


  1. Tourjman SV, Juster R-P, Purdon S, Stip E, Kouassi E, Potvin S. The screen for cognitive impairment in psychiatry (SCIP) is associated with disease severity and cognitive complaints in major depression. Int J Psychiatry Clin Pract 2018 Mar 19;1–8. PMID:29553848
  2. Robbins TW, James M, Owen AM, Sahakian BJ, McInnes L, Rabbitt P. Cambridge Neuropsychological Test Automated Battery (CANTAB): a factor analytic study of a large sample of normal elderly volunteers. Dementia 1994 Sep;5(5):266–281. PMID:7951684
  3. Kramer JH, Mungas D, Possin KL, Rankin KP, Boxer AL, Rosen HJ, Bostrom A, Sinha L, Berhel A, Widmeyer M. NIH EXAMINER: conceptualization and development of an executive function battery. J Int Neuropsychol Soc 2014 Jan;20(1):11–19. PMID:24103232
  4. Gualtieri CT, Johnson LG. Reliability and validity of a computerized neurocognitive test battery, CNS Vital Signs. Arch Clin Neuropsychol 2006 Oct;21(7):623–643. PMID:17014981
  5. Davis MT, DellaGioia N, Matuskey D, Harel B, Maruff P, Pietrzak RH, Esterlis I. Preliminary evidence concerning the pattern and magnitude of cognitive dysfunction in major depressive disorder using cogstate measures. J Affect Disord 2017 Aug 15;218:82–85. PMID:28460315
  6. Harrison JE, Barry H, Baune BT, Best MW, Bowie CR, Cha DS, Culpepper L, Fossati P, Greer TL, Harmer C, Klag E, Lam RW, Lee Y, Mansur RB, Wittchen H-U, McIntyre RS. Stability, reliability, and validity of the THINC-it screening tool for cognitive impairment in depression: A psychometric exploration in healthy volunteers. Int J Methods Psychiatr Res 2018 Sep;27(3):e1736. PMID:30088298
  7. Hafiz P, Miskowiak KW, Kessing LV, Bardram JE. Design and Implementation of a Web-based Application to Assess Cognitive Impairment in Affective Disorder. Proceedings of the 2018 International Conference on Digital Health - DH ’18 [Internet] 2018. [doi: 10.1145/3194658.3194691]



Pegah Hafiz
PhD student
DTU Compute
+45 45 25 34 19


Jakob Eyvind Bardram
DTU Compute
+45 45 25 53 11
17 DECEMBER 2018