Expanding the use of brief cognitive assessments to detect suspected early‐stage cognitive impairment in primary care

Abstract

IntroductionMild cognitive impairment remains substantially underdiagnosed, especially in disadvantaged populations. Failure to diagnose deprives patients and families of the opportunity to treat reversible causes, make necessary life and lifestyle changes and receive disease‐modifying treatments if caused by Alzheimer's disease. Primary care, as the entry point for most, plays a critical role in improving detection rates.MethodsWe convened a Work Group of national experts to develop consensus recommendations for policymakers and third‐party payers on ways to increase the use of brief cognitive assessments (BCAs) in primary care.ResultsThe group recommended three strategies to promote routine use of BCAs: providing primary care clinicians with suitable assessment tools; integrating BCAs into routine workflows; and crafting payment policies to encourage adoption of BCAs.DisscussionSweeping changes and actions of multiple stakeholders are necessary to improve detection rates of mild cognitive impairment so that patients and families may benefit from timely interventions.

Clinical classification of memory and cognitive impairment with multimodal digital biomarkers

“…Consistent with the recent consensus work group requirements for brief cognitive assessments, the DCRP can be completed under 5 min, available in multiple languages, with the capability of integrating with electronic health records. 17 The current study shows that the DCRP also meets the rigorous requirements of the consensus work group that clinically relevant brief cognitive assessments are recommended to show 80% sensitivity and specificity.…”

“…The acoustic features are more commonly extracted from longer speech samples such as picture description or spontaneous speech tasks, the acoustic features identified in the short verbal recall task of the DCRP are consistent with those noted in other studies. 17,25,30,36 Acoustic voice timing features included in this analysis have been shown to be reliable to changes in environment noise and recording equipment, making them ideal for in-clinic and mobile screening (feature sets and mean (SD) values detailed in Table S5). 43,44 In particular, five speech timing and acoustic voice features extracted from the DCRP verbal recall carried substantial importance in predicting memory impairment on the RAVLT.…”

“…Previous research has indicated that a reliable, objective, digital assessment may significantly increase the accuracy in identifying early cognitive impairment and those likely to convert to AD. 17 Recently, the Digital Clock and Recall (DCR) has emerged as a novel analysis of graphomotor and delayed recall memory performance. The DCR, a medical device registered in the United States, European Union (EU), and Canada, combines a digital clock drawing test (DCTclock), with a three-word immediate and delayed verbal recall test.…”

Scalable plasma and digital cognitive markers for diagnosis and prognosis of Alzheimer's disease and related dementias

“…In particular, use of most traditional assessments (e.g., the Mini-Mental State Examination) in routine healthcare workflows has been limited by their poor sensitivity to milder stages of impairment, 29 limited validity in diverse populations, 30 and costly training, time, and administration demands. 31,32 To address these limitations, substantial progress has been made in development of sensitive and reliable digital cognitive assessments highlighting their potential as scalable and efficient clinical markers not requiring access to highly trained specialists, lengthy clinical evaluations, or complex scoring and interpretation algorithms. 31,32 Examining the combination of scalable digital cogni- TabCAT-BHA is a brief, multidomain battery that showed excellent sensitivity to mild cognitive impairment (MCI) and typical and atypical dementias, [33][34][35] high reliability in tracking change over time, 34 and associations with Aβ-and tau-PET burden.…”

“…31,32 To address these limitations, substantial progress has been made in development of sensitive and reliable digital cognitive assessments highlighting their potential as scalable and efficient clinical markers not requiring access to highly trained specialists, lengthy clinical evaluations, or complex scoring and interpretation algorithms. 31,32 Examining the combination of scalable digital cogni- TabCAT-BHA is a brief, multidomain battery that showed excellent sensitivity to mild cognitive impairment (MCI) and typical and atypical dementias, [33][34][35] high reliability in tracking change over time, 34 and associations with Aβ-and tau-PET burden. 36 In accordance with the U.S. National Alzheimer's Project Act 37 to improve detection of cognitive impairment following a concern, the sample included older adult participants with subjective or objective cognitive impairment.…”