# The Virtual Kitchen Challenge—Version 2: Validation of a Digital Assessment of Everyday Function in Older Adults

## TL;DR

The Virtual Kitchen Challenge—Version 2 is a digital tool that efficiently and accurately assesses everyday functioning in older adults, including those with mild dementia.

## Contribution

VKC-2 introduces an objective, standardized digital assessment of everyday function with strong validity and reliability across cognitive aging stages.

## Key findings

- VKC-2 scores significantly differentiate between healthy cognition and cognitive impairment after controlling for demographics.
- Strong correlations exist between VKC-2 scores and real-world kitchen performance, cognitive tests, and self/informant reports.
- Retest reliability of VKC-2 is moderate to excellent, with improved reliability when cognitive status remains stable.

## Abstract

Conventional methods of functional assessment include subjective self- or informant report, which may be biased by personal characteristics, cognitive abilities, and lack of standardization (eg, influence of idiosyncratic task demands). Traditional performance-based assessments offer some advantages over self- or informant reports but are time-consuming to administer and score.

This study aims to evaluate the validity and reliability of the Virtual Kitchen Challenge—Version 2 (VKC-2), an objective, standardized, and highly efficient alternative to current functional assessments for older adults across the spectrum of cognitive aging, from preclinical to mild dementia.

A total of 236 community-dwelling, diverse older adults completed a comprehensive neuropsychological evaluation to classify cognitive status as healthy, mild cognitive impairment, or mild dementia, after adjustment for demographic variables (age, education, sex, and estimated IQ). Participants completed 2 everyday tasks (breakfast and lunch) in a virtual kitchen (VKC-2) using a touchscreen interface to select objects and sequence steps. Automated scoring reflected completion time and performance efficiency (eg, number of screen interactions, percentage of time spent off-screen, interactions with distractor objects). Participants also completed the VKC-2 tasks using real objects (Real Kitchen). All participants and informants for 219 participants completed questionnaires regarding everyday function. A subsample of participants (n=143) performed the VKC-2 again in a second session, 4-6 weeks after the baseline, for retest analyses. Analyses evaluated construct and convergent validity, as well as retest and internal reliability, of VKC-2 automated scores.

A principal component analysis showed that the primary VKC-2 automated scores captured a single dimension and could be combined into a composite score reflecting task efficiency. Construct validity was supported by analyses of covariance results showing that participants with healthy cognition obtained significantly better VKC-2 scores than participants with cognitive impairment (all Ps<.001), even after controlling for demographics and general computer visuomotor dexterity. Convergent validity was supported by significant correlations between VKC-2 scores and performance on the Real Kitchen (r=−0.58 to 0.64, Ps<.001), conventional cognitive test scores (r=−0.50 to −0.22, Ps<.001), and self- and informant report questionnaires evaluating everyday function (r=0.25 to 0.43, Ps<.001). Intraclass correlation coefficients (ICCs) indicated moderate to excellent retest reliability (ICC=0.70-0.90) for VKC-2 scores after 4-6 weeks. Reliability improved in analyses including only participants who reported no change in cognitive status between time 1 and time 2 (n=123). Spearman-Brown correlations showed acceptable to good internal consistency between the VKC-2 tasks (breakfast and lunch) for all scores (0.77-0.84), supporting the use of total scores.

The VKC-2 is an efficient, valid, and sensitive measure of everyday function for diverse older adults and holds promise to improve the status quo of functional assessment in aging, particularly when informants are unavailable or unreliable.