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Miro’s preliminary construct validity was
investigated through a concurrent validity
study comparing Miro
scores to analogous
comparator test scores in normal and
impaired populations.
Normal controls83 / 1765.4 (49-89)19
Impaired42 / 5871.0 (33-92)33
(% F/M = percent female / percent male)
Fifty-two participants were tested on a battery of comparator neuropsychological tests and analogous
Miro modules. Analysis is based on 19 normal participants and 33 participants with brain impairment.
Assessment. Eighty-eight percent of participants were assessed in their homes by clinical
neuropsychologists, 12% were assessed at Johns Hopkins University Medical Center. Fifty percent of
participants were assessed with comparator tests prior to Miro assessment; 50% were assessed with Miro
prior to comparator assessment. Comparator tests were hand-scored by the administering neuropsychologist
and entered into a spreadsheet. Miro performance data was automatically uploaded from the iPad to Miro’s
HIPAA-compliant cloud-based server.

Missing data. Correlations for each variable were calculated with participants whose results included both
Miro and comparator scores. Participants were excluded from the correlation of individual variables when
missing either Miro or comparator scores (or both) for that variable.

Standardization of scores. Standardization of scores occurred via a two-step process: 1. Subtracting the mean
from the normal subject reference set, 2. Rescaling centered scores by the standard deviation of reference set
scores. The mean score of the normal reference set was set to 0 and the standard deviation was set to 1.
Miro module scores demonstrate significant correlation with comparator test scores. Estimated Spearman
correlations for most Miro and comparator test scores are greater than 0.5 and are significantly different than
zero with p-values of 0.05 or lower. Statistical results provide preliminary evidence that Miro scores quantify
brain function comparably to comparator, in-depth, clinician-administered neuropsychological assessment
Sample correlations between independent variables on Miro and comparator tests
Chart-A-CourseDesign Fluency (DKEFS)0.691.2E-06
Hungry BeesDigit Span backward (WAIS IV)0.653.4E-07
Hungry BeesDigit Span forward (WAIS IV)0.612.4E-06
Treasure TombCoding (WAIS IV)0.611.4E-08
Bolt BotIowa Trail Making Test0.541.5E-05
Spy GamesHopkins Verbal Learning Test (HVLT)0.525.1E-04
As expected, concurrent validity between independent variables from Miro’s self-administered,
clinician-supervised tablet assessment and comparator clinician-administered pencil-paper based testing
was moderate, ranging from (0.42) to (0.69). These results are similar to test-retest reliability for standard,
in-depth neuropsychological test scores3. Relatively modest correlation is expected given comparator test
challenges with inter- and intra-rater reliability, blunt scores, and low levels of sensitivity and specificity for
differentiating disorders. Statistically significant Spearman correlations between Miro scores and their
comparator analogues suggest that Miro and comparator exams quantify equivalent functional abilities. Low
p-values indicate a high degree of confidence in the correlations. This is notable given the study’s limited
sample size, the large proportion of normals who demonstrate a narrow range of functional ability, and the
large proportion of mildly impaired participants with near-normal abilities.

It is important to note that the sample set of Normal Controls exhibits a narrow range of performance on
Miro modules. The narrow range of scores from the normal controls dampens potential correlation with
comparator scores, whereas the broader performance range of impaired participants strengthens potential
correlation. Also noteworthy is the fact that more than half of the impaired participants volunteered to
participate as Normal Controls but failed the screening test by a slim margin (1-2 points below the
normal-group inclusion threshold of 26 on the MoCA4). Many of these mildly impaired participants
participated in the study not as Normal Controls, but as MCI participants.
3 Grant L. Iverson. Interpreting change on the
WAIS-III/WMS-III in clinical samples. Archives of
Clinical Neuropsychology. 2001; Snow WG. WAIS-R
test-retest reliability in a normal elderly sample.
Journal of Clinical Experimental Neuropsychology.
4 Damian AM, The Montreal Cognitive Assessment
and the mini-mental state examination as screening
instruments for cognitive impairment: item analyses
and threshold scores. Dementia and Geriatric
Cognitive Disorders. March 201
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