Naturalistic smartphone keyboard typing reflects processing speed and executive function.

OBJECTIVE The increase in smartphone usage has enabled the possibility of more accessible ways to conduct neuropsychological evaluations. The objective of this study was to determine the feasibility of using smartphone typing dynamics with mood scores to supplement cognitive assessment through trail making tests. METHODS Using a custom-built keyboard, naturalistic keypress dynamics were unobtrusively recorded in individuals with bipolar disorder (n = 11) and nonbipolar controls (n = 8) on an Android smartphone. Keypresses were matched to digital trail making tests part B (dTMT-B) administered daily in two periods and weekly mood assessments. Following comparison of dTMT-Bs to the pencil-and-paper equivalent, longitudinal mixed-effects models were used to analyze daily dTMT-B performance as a function of typing and mood. RESULTS Comparison of the first dTMT-B to paper TMT-B showed adequate reliability (intraclass correlations = 0.74). In our model, we observed that participants who typed slower took longer to complete dTMT-B (b = 0.189, p < .001). This trend was also seen in individual fluctuations in typing speed and dTMT-B performance (b = 0.032, p = .004). Moreover, participants who were more depressed completed the dTMT-B slower than less depressed participants (b = 0.189, p < .001). A practice effect was observed for the dTMT-Bs. CONCLUSION Typing speed in combination with depression scores has the potential to infer aspects of cognition (visual attention, processing speed, and task switching) in people's natural environment to complement formal in-person neuropsychological assessments that commonly include the trail making test.