Screening for Mild Cognitive Impairment and Dementia with Automated, Anonymous Online and Telephone Cognitive Self-Tests

Abstract

Background: Many older people worry about cognitive decline. Early cognitive screening in an anonymous and easily accessible manner may reassure older people who are unnecessarily worried about normal cognitive aging while it may also expedite help seeking in case of suspicious cognitive decline.Objective: To develop and validate online and telephone-based automated self-tests of cognitive function.Methods: We examined the feasibility and validity of the self-tests in a prospective study of 117 participants of whom 34 had subjective cognitive decline (SCD), 30 had mild cognitive impairment (MCI), and 53 had dementia. The ability of these self-tests to accurately distinguish MCI and dementia from SCD was examined with ROC curves. Convergent validity was examined by calculating rank correlations between the self-tests and neuropsychological tests.Results: Both the online and telephone cognitive self-tests were feasible, because the majority of participants (86% and 80%, respectively) were able to complete them. The online self-test had adequate diagnostic accuracy in the screening for MCI and dementia versus SCD with an Area under the Curve (AUC) of 0.86 (95% CI: 0.78–0.93). The AUC of the MMSE was 0.82 (95% CI: 0.74–0.89). By contrast, the telephone self-test had lower diagnostic accuracy (AUC = 0.75, 95% CI: 0.64–0.86). Both self-tests had good convergent validity as demonstrated by moderate to strong rank correlations with neuropsychological tests.Conclusion: We demonstrated good diagnostic accuracy and convergent validity for the online self-test of cognitive function. It is therefore a promising tool in the screening for MCI and dementia.

Acceptability of collecting speech samples from the elderly via the telephone

“…Elderly volunteers, both with and without cognitive impairment, readily agreed to participate in the telephone interview, completed it in its entirety, and rated the overall approach as acceptable. These results can be compared with those of Van Mierlo and colleagues 34 who reported an 80% completion rate for their telephone screener, compared with 98% in the current study. Of note, the current study employed an interview style with many opportunities for participants to interact with the interviewer, whereas the Van Mierlo study used a fully automated self-test with all responses coming from touch-tone keys on the telephone.…”

Everyday Functioning in a Community-Based Volunteer Population: Differences Between Participant- and Study Partner-Report

“…Cognitive functioning was assessed using the Cognitive Online Self-Test Amsterdam (COST-A), an online cognitive self-test developed and validated by Van Mierlo et al (2017) . The COST-A included 10 tasks, namely, orientation, digit-sequence learning, immediate word recall, two trail-making tasks (i.e., connecting numbered dots and alternately connecting lettered and numbered dots), delayed word recall, delayed word recognition, immediate recall of word pairs, recognition of word pairs, and semantic comprehension.…”

A Neuropsychological Perspective on Defining Cognitive Impairment in the Clinical Study of Alzheimer’s Disease: Towards a More Continuous Approach

“…More recently, the Online Repeated Cognitive Assessment [60] tool used for repeated assessment has been found to be sensitive to detect cognitive changes during the preclinical stage of AD, using metrics such as learning curves across multiple days of assessment [61]. Mobile versions of existing cognitive tests, as well as novel tasks designed specifically for mobile use, have also been developed in recent years [62][63][64][65], including from academic research programs such as the Center For Healthy Aging at Penn State [66], the Harvard Aging Brain Study [67], the Dominantly Inherited Alzheimer Network (DIAN) Observational Study, [68] and Oxford University [69]. Smartphone-based assessment comes with several unique challenges (e.g., variable device specifications, privacy, popup notifications), but have the potential to reduce patient burden by avoiding the need for lengthy in clinic testing.…”