Computerized Cognitive Assessment in Primary Care to Identify Patients with Suspected Cognitive Impairment

Abstract

The incidence and prevalence in those over age 65 of neurodegenerative disorders and chronic diseases, which often have deleterious effects on cognition, are rapidly increasing in western societies. Primary care physicians (PCPs) provide the majority of medical treatment for older people and in order to effectively care for their patients with suspected cognitive impairment, they must have tools that will allow them to accurately assess their patient's cognitive function. This knowledge will assist the PCPs in formulating a diagnosis of dementia or cognitive impairment and provide an indication of risk of progression to dementia. It will also assist with monitoring response to treatment and care decisions, including medication management, capacity judgments, and the need for family involvement. Tests currently used in primary care, such as the Mini-Mental State Examination, do not accurately assess patients with mild cognitive impairments, and other tests more suitable for this purpose require further validation and may be too time-consuming in the primary care setting. A possible solution is the use of patient-administered computerized cognitive testing in the PCP's office. This systematic review identified eleven test batteries and three were judged potentially appropriate for cognitive assessment in the PCP's office. These three varied in their presentation format and the quality of cross-sectional validation studies, and none had longitudinal data for dementia prediction. Thus the existing test batteries show potential for use in primary care but further study is needed to demonstrate their feasibility and effectiveness in this setting.

Automated tests for diagnosing and monitoring cognitive impairment: a diagnostic accuracy review

“…56 The authors of the review concluded that the Hopkins Verbal Learning Test had better sensitivity for the detection of MCI in older adults than the computerised tests. They also identified that one automated test, CogState, enabled the identification of cognitive deficits beyond mild impairments in memory; for example, CogState detected more functional deficits than the Hopkins Verbal Learning Test or MMSE.…”

“…They also identified that one automated test, CogState, enabled the identification of cognitive deficits beyond mild impairments in memory; for example, CogState detected more functional deficits than the Hopkins Verbal Learning Test or MMSE. 56 The authors, however, did not address if these tests had the potential to facilitate timely diagnosis or if they were effective in monitoring disease progression. Appendix 1 explains measures for assessing an index test against a reference standard.…”

“…None of the previously conducted relevant reviews 56,57,103 in this area carried out a diagnostic accuracy review. They were narrative reviews 56,57,103 that provided a summary of the battery of tests used and then rated this evidence on validity and reliability, comprehensiveness, and usability.…”

“…The authors of a UK-based review 56 investigated the use of several available computerised automated tests and assessed their sensitivity and specificity for detection of MCI compared with two well-validated penand-paper tests: the Hopkins Verbal Learning Test and the MMSE. 56 The authors of the review concluded that the Hopkins Verbal Learning Test had better sensitivity for the detection of MCI in older adults than the computerised tests.…”

“…They were narrative reviews 56,57,103 that provided a summary of the battery of tests used and then rated this evidence on validity and reliability, comprehensiveness, and usability. Our review focused on automated computerised tests that were self-administered and had a minimum level of involvement from health-care professionals.…”