The performance test section includes tests of:
Visuomotor functioning (eye-hand coordination)*
Precise manipulation of tools according to what eyes see has been a speciality for humans in ancient times. With the introduction of small electronic devices like cell phones, pods, etc., fine-tuned, precise, and rapid movements of the fingers has come inevitable to everybody.
Doing the Figure Drawing Test with a Staedtler Digital Pencil on a Samsung Galaxy Tablet S3 9.7"
Doing the Pen-to-Point Test with a Staedtler Digital Pencil on a Samsung Galaxy Tablet S3 9.7"
The Cognitive Function Scanner Mobile Performance Test Suite comprises two tests of visuomotor functioning: the Figure Drawing Test for continuous motion and the Pen-to-Point Test for discrete motion. Both tests are developed especially for the cognitive Function Scanner system combining the experience from various drawing tests and pin-and-peg tests. The two tests are taken separately for each body half/brain hemisphere beginning each test with the dominant hand.
The test layouts are displayed on the tablet. The tablet enters pen-only mode that allows the client to rest his or her hand on the surface during the tests. Width of pen tip is 0.7 mm.
In the Figure Drawing Test the client has to trace a curved line with a digital pinpoint pen (or as in the photo a digital pencil) without ink, while in the Pen-to-Point Test the client has to point with the tip of the pen (or digital pencil) as accurately as possible into the centres of small crosses distributed along a straight line in the centre of the screen (the latter being a simulation of a pin-to-hole test). The parameters of each of the two tests are:
Psychometric parameters for each hand:
In addition to these psychometric parametres a complete reproduction of the client's drawing is generated to elucidate an eventual neglect problem or other qualiatative signs of dysfunction.
The Spatial capacity is essential in relation to navigation, driving, reading and writing, etc., etc. Tests of visuospatial functioning come in many variants, some two-dimensional, others three-dimensional. In the Cognitive Functional Scanner systems we have chosen the Parallelogram Test, i.e., a two-dimensional type, because it fits well with the tablet screen.
The Parallelogram Test consists of 10 sets of each three parallelograms, all displayed on
the tablet at the same time. The three parallelograms in each set have a thick base line,
two of them being arranged
nose-to-nose on the same baseline that always points
towards the client. The orientation of the base line of the third and separate
parallelogram in each set differs from those on the shared baseline. It may point in any
direction. The task for the client is to imagine that he or she rotates the separate
parallelogram of each set so that its baseline becomes congruent with that of the two
parallelograms sharing the baseline. Having reached that far, the client must point out the
corner of the congruent parallelogram on the common baseline that corresponds to the dotted
corner of the
The tablet enters pen-only mode allowing the client to rest his or her hand on the surface during the test. The digital pen (or pencil) is used for the pointing.
The psychometric parameters of the test are:
In addition to these psychometric parametres a complete response process chart is drawn showing the exact response positions and latencies for each of the single subtasks allowing for qualitative evaluation.
Visual attention and vigilance*
The capability of keeping sustained attention (to maintain a certain level of arousal) is essential for survival. In the Cognitive Function Scanner systems the testing of visual attention and vigilance is done using the Bourdon-Wiersma Test modified for use on a tablet computer. The Bourdon-Wiersma Test was chosen because its culture-free graphic objects.
The Bourdon-Wiersma Test used in the Cognitive Function Scanner systems consists of
37 rows of 25 dot-groups of three, four, or five dots each. The dot-groups are rotated
differently calling for the client's spatial capacity. Each row includes eight
three-dot-groups, nine four-dot-groups, and eight five-dot-groups distributed at random.
The client's task is to search the rows marking all four-dot groups with the pinpoint pen
(or digital pencil) leaving a virtual
ink mark across every four-dot-group on the
ink marking is used to provide visual feedback and prevent confusion.
Because attention is closely linked to time, time is measured for each row so that
variation in performance time can be used as a measure of vigilance. In addition to time
the number of errors is recorded for each row. The performance of the first and the last
row is excluded from the calculations of the overall performance partly because it cannot
be defined precisely when a client begins searching, and partly because the test should
terminate even if the last dot-groups in the lowest row are not detected/marked.
The psychometric parameters of the test are:
In addition to these psychometric parametres a complete chart of the client's errors (unmarked or incorrectly marked dot groups) is generated to elucidate an eventual neglect problem or other deficits that need a qualitative approach.
The Continuous Graphics Test is a test of simulated handwriting, thus calling for visuospatial capacity, visuomotor capacity, working memory, and capacity to turn a mental image into complex coordinated action. The Continuous Graphics Test was originally developed by Andersen (1978) to detect subclinical fluctuations in consciousness in epileptics, in whom it was expected that interruption in the neural and psychological processes could be responsible for the lack of continuity during the drawing of the patterns. Although the test was developed for use within a certain group of patients, decreased performance is not related to any specific cerebral disorder.
Doing the Continuous Graphics Test using a Staedtler Digital Pencil on a Samsung Galaxy Tablet model S3 9.7" (pattern not shown).
The Continuous Graphics Test used in the Cognitive Function Scanner systems includes three rhythmically shifting graphic patterns. Due to the limited amount of space available on a tablet computer the response line is broken into two parts in the mobile version (in the PC-version the response line is one unbroken string of squares). The client's task is to copy each pattern on the rows of squares (56 squares in total) using the pinpoint pen (or digital pencil) leaving no visual trace and thus delivering no feedback to the client. He or she will have the model available only while copying the first repetitions of the patterns on the middle line. The remaining part of the pattern must be filled in from memory. Because of lack of visual feedback from the "invisible" drawing the client has to remember the pattern and to be aware of how far he or she has drawn. The performance is evaluated automatically by means of an artificial neural network especially trained for this task.
The psychometric parameters of the test are:
In addition to these psychometric parametres complete reproductions of the client's drawings are made added with information on latencies and error positions allowing for qualitative evaluation.
Auditory reaction time and vigilance
The Reaction-time Test in the Cognitive Function Scanner system is a test of continuous simple reaction-time and vigilance over a period of approximately 7 minutes. It is composed of a series of audible stimuli, each as a constant tone at 440 Hz. The tones are randomly distributed with two to six second intervals, and presented to the client via the built-in loudspeaker of the device.
The client responds to the test by swiping the
corner of the rim of the device with the index finger. When the app
hears a swipe
the clock is read and the tone stops. Using audible response sensing instead of screen
touching the slowness of the touchscreen technology is eliminated that otherwise would
delay and invalidate the measurement. A total of 78 stimuli are given, of which the first
three are omitted from the analysis. They are present to allow the subject a chance to
familiarize with the stimuli and for the psychologist to check if the client complies with
Reaction Time Test - response process chart (printable like the response process charts produced by any test in the Cognitive Function Scanner Mobile app).
The psychometric parameters of the test are:
The learning and memory section includes tests of:
Memory for faces - Face Recognition Test
The Face Recognition Test consists of three series of portraits presented on the screen of your mobile device. The portraits are ordinary male citizens not known to the public. The first series is composed of nine portraits, which the subject is asked to look at carefully so that he will be able to point them out when he sees them among 25 other portraits. Every stimulus picture is shown for five seconds. The second series consists of 34 portraits, among which are the nine stimulus portraits. This series is run immediately after the first series and the subject is asked to respond "yes" or "no" to every portrait presented. The subject gives his responses at his own pace via touch buttons on the smartphone or tablet. Once a response has been given, correction is not possible. The test also includes a retention section to be taken approximately 1 hour after the the learning section.
Responding to the Face Recognition Test on a smartphone
Selection and sequence of the stimulus pictures are made according to a random procedure each time the test is initialized in order to reduce the test re-test effect. The parameters of the test are:
The second test in the system is the Word Recognition Test offering 20 different languages independently of the language used for the entire examination. The languages available are Czech, Danish, Dutch, English, Faroese, Finnish, French, German, Greenlandic, Icelandic, Italian, Norwegian, Polish, Portuguese, Russian, Sami, Serbo-Croatian, Spanish, Swedish, and Turkish.
The Word Recognition Test is technically parallel to the Face Recognition Test, thus allowing comparison of the functioning of the two brain hemispheres. The test consists of three series of adjectives presented on the computer screen. The first series is composed of nine words, which the subject is asked to look at carefully so that he will be able to point them out when he sees them among 25 other words. Every stimulus word is shown for five seconds. The second series consists of 34 words, among which are the nine stimulus words. This series is run immediately after the first series and the subject is asked to respond "yes" or "no" to every word presented. Once a response has been given, correction is not possible. The test also includes a retention section to be taken approximately 1 hour after the the learning section.
The following two photos show example screens of the Word Recognition Test on a smartphone. The first photo shows the screen from which the language is chosen for the words to be learned. The second photo shows the response screen of the immediate recognition section of the Word Recognition Test.
Flags guiding the choise of language independently of the language of the entire test session (client's mother tongue is recommended for the test)
Responding to the Word Recognition Test on a smartphone
As with the Face Recognition Test selection and sequence of the stimulus words are made according to a random procedure each time the test is initialized in order to reduce the test re-test effect. The parameters of the test are:
In the Number Learning Test the subject is asked to remember eight two-digit numbers, which are randomly generated by the smartphone or tablet in the interval 21-99. The numbers are shown on the screen at intervals of three seconds. When the numbers are presented, the subject is asked to read them aloud concurrently with their appearance on the screen. When all eight numbers have been shown, the subject is asked to respond. He may enter the numbers in any order he likes by means of the numeric keyboard appearing to the right or to the left of the screen according to information on handedness entered at an earlier point of the examination. If some numbers are missing, only the missing numbers are shown to him again. After a few seconds, when the screen is cleared, the subject has to enter all eight numbers again. If some of the numbers are still missing, these are shown again. The test continues with this selective reminding until the subject has learned all eight numbers, or to the maximum of 10 trials.
Responding to the Number Learning Test on a smartphone. The keyboard is automatically left-alligned in case of left-handed clients
Summary result page following completion of the learning section of the Number Learning Test on a smartphone
The number series is automatically changed each time the test is initialized.
Like the three former tests the Number Learning Test includes a section of retention in which the subject is asked to enter the numbers he remembers. This entry is made approximately 1 hour after the learning process is completed. The parameters of the test are:
The Sound Recognition Test is a new test to the Cognitive Function Scanner system. It is made over the same model as the Face Recognition Test and the Word Recognition Test but offers environmental sounds as objects. The new test is included to offer a learning and memory test suitable for the assessment of learning and memory of blind people. All sounds are authentic recordings from actual life situations.
The test consists of three series of sounds presented via the smartphone's loudspeaker or headphone set. The first series is composed of nine sounds, which the subject is asked to carefully listen to so that he will be able to point them out when he is presented for them among 25 other sounds. Every sound stimulus is presented for five seconds with a pause of two seconds so that the client can distinguish between the presented sounds. The second series consists of 34 sounds, among which are the nine stimulus sounds. This series is run immediately after the first series and the subject is asked to respond "yes" or "no" to every sound presented via two touch buttons located in the lower corners of the smartphone or tablet making tactile navigation possible via the rim of the smartphone or tablet. Once a response has been given, correction is not possible. The test also includes a retention section to be taken approximately 1 hour after the the learning section.
Summary result page following completion of the retention section of the Sound Recognition Test on a smartphone
As with the Face Recognition Test and the Word Recognition Test selection and sequence of the stimulus sounds are made according to a random procedure each time the test is initialized in order to reduce the test re-test effect. The parameters of the test are:
The Cognitive Function Scanner Mobile app runs on smartphones and tablets driven by the Android operating system, for example devices produced by Samsung. The app has shown to work on Android releases from version 6.0. The current version of Cognitive Function Scanner Mobile, 4.01.04, takes up approximately 30 MB of the device memory.
Please note that the Figure Drawing Test, the Pen-to-Point Test, the Parallelogram Test, The Bourdon-Wiersma Test and the Continuous Graphics Test all demand a tablet featuring a sharp-tipped pen compatible with Samsung's S-Pens. These pencil tests appear equal in size independently of the screen resolution of your test device. Currently Samsung's Galaxy Tablet S3 (9.7") with S-Pen and Samsung's Tablet S4 (10.5") with S Pen are available from most computer stores.
Instead of using the S-Pen that comes along with select Samsung tablets you may want to obtain a genuine pencil like the Staedtler Noris Digital Pencil (EAN 4007817035368) designed for Samsung. Neither Samsung's S-Pen nor the Staedtler Noris Digital Pencil need to be charged, i.e., there is no risk of running out of power during an examination session.
The Cognitive Function Scanner Mobile app is delivered with reference values obtained by the PC-version. The reference values covering the age span from 25 to 75 years are collected via large-scale investigations of representative samples of the Danish general population, N=1,026 and N=711, respectively.
Download and installation
The Cognitive Function Scanner Mobile app is available on Google Play in the Nordic countries, i.e., Denmark, Finland, Iceland, Norway, and Sweden. Please note that the app is double locked to prevent it from being used by layman. Only neuropsychologists and clinical psychologists are entitled to register by the developer and obtain a user license and a validation code to unlock the app.
Please note that the pencil tests only run on a Samsung Tablet S3 with S Pen, Samsung Tablet S4 with S Pen, or a tablet completely compatible with one of those tablets.
The prototype to the Cognitive Function Scanner system was developed back in 1982 in the labs of the Danish National Institute of Occupational Health. The purpose was to establish an efficient, standardized, and reliable method for assessment of cognitive status of the general public.
The prototype was built over a Tektronix 4052 desktop computer and a Tektronix 4956 graphics tablet. Both instruments had undergone technical modifications. As computer screens those days were monochrome a slide projector controlled by the computer was used for the display of portrait photos in a test of face recognition.
The Cognitive Function Scanner was, among other things, used in two large-scale longitudinal studies (1982-83 and 1993-94) of cognitive performance of the general Danish population. The results from these two studies were published in two supplement volumes to the scientific journal Acta Neurologica Scandinavica in 1990 and 1997.
At these occasions an extensive statistical material was collected across several age groups, gender and schooling (vocational training) and a set of norms was established for 45 psychometric parameters covering learning and memory, psychomotor functioning, visuospatial functioning, attention, perception, and vigilance. The norms cover the age span from 25 to 75 years.
The Cognitive Function Scanner prototype. Glostrup Hospital, Denmark 1982
After the Cognitive Function Scanner came commercially available in 1988 it has mostly been used in traditional clinical work within neurology and psychiatry, i.e. neuropsychological assessment with a diagnostic purpose the users being university hospitals and district hospitals all over the Nordic countries. For decades the technical solutions of the system together with the unparalleled set of norms probably made the Cognitive Function Scanner to the most distinctive system of its kind.
The first commercially available Cognitive Function Scanner for the PC, 1989
In addition to learning and memory tests the prototype and all releases of the Cognitive Function Scanner for the PC-environment included tests of visuomotor functioning, visuospatial functioning, attention, vigilance and concentration to ensure a high degree of comprehensiveness and ecological validity of the battery. These tests were done by means of very accurate graphics tablets featuring pens resembling ordinary ballpoint pens.
With the introduction of the Cognitive Function Scanner release 3-1 in 1996 a detailed time-linked continuous recording of the response process was included. In complex clinical cases these qualitative data can act as a valuable support for the interpretation of psychometric results. In addition to cognitive functioning and style the qualitative data elucidates and documents personality traits related to collaboration during the examination.
Especially for the testing of reaction-time in relation to acquisition or renewal of a driving license, a stand-alone version of the continuous Reaction Time Test was introduced by the late 1990s and marketed as the RT-Profile Test.
With introduction of mobile computers, tablets, and smartphones, etc. demands to portable and highly efficient neuropsychological test systems has grown. Today the Cognitive Function Scanner for the PC is replaced by the Cognitive Function Scanner Mobile apps for smartphones and tablets. Like the original system, the mobile versions are comprehensive state-of-the-art assessment tools including tests of learning and memory, true pencil tests for eye-hand coordination, visuospatial functioning, perception, attention, and vigilance.
Cognitive Function Scanner Mobile is an application for use exclusively by professional neuropsychologists. To run the application the user needs a user license key and a validation key from the developer. License keys and validation keys are supplied only to neuropsychologists who can prove their qualifications.
The purpose of the Cognitive Function Scanner Mobile application is to provide a standardised and reliable instrument for testing neuropsychological functioning of humans, i.e., to provide indicators of attention, memory, perception, visuomotor functioning and visuospatial functioning. To do so the Cognitive Function Scanner Mobile application collects data during the testing and stores these data into files on the test device.
During the test of reaction time the microphone of the device is active. The microphone is used to detect the onset of sound stimuli and of client responses, respectively. The reason for using sound as 'stimulus-response-carrier' is that touchscreen technology is too slow and imprecise in relation to normal human reaction time. No sound information received by the device is stored by the application, and because the app doesn't have permission for Internet access during the testing, no sound information leaves the test device.
The examining neuropsychologist has the full and entire responsibility at all times for all data entered or otherwise recorded by the application. No information is automatically transmitted by the application to any external party, neither to the developer of the application nor to anybody else.
Q: In your photos on this website you use what looks like a wooden pencil. Can an ordinary pencil be used on the tablet?
A: No, an ordinary pencil cannot be used on the tablet, but the German pencil producer Staedtler makes a digital pencil that can replace the S Pen. It has EAN number 4007817035368. It is such a pencil you see in the photos.
Q: Is it possible to obtain a Samsung S Pen and use it on a tablet that did not include the S Pen from the beginning?
A: No, it is not possible, because Samsung use a different technology (magnetic resonance) for their tablets with S Pen than with their 'ordinary' tablets (capacitive technology).
Q: When a person draws or writes that person usually rests a hand on the item on which the drawing or writing takes place. Is it possible to rest one's finger or hand on the tablet screen while doing the pen-based tests?
A: Yes, it is possible to rest fingers/hands on the screen during the pen-based tests. The tablet is in pen mode and is immune to finger/hand touching.
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