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Binng D, Splonskowski M, Jacova C. Distance Assessment for Detecting Cognitive Impairment in Older Adults: A Systematic Review of Psychometric Evidence. Dement Geriatr Cogn Disord 2021; 49:456-470. [PMID: 33291097 DOI: 10.1159/000511945] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 09/30/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Distance or remote cognitive assessments, administered via phone or computer platforms, have emerged as possible alternatives to traditional assessments performed during office visits. Distance refers to any nontraditional assessment feature, not only or necessarily location. We conducted a systematic review to examine the psychometric soundness of these approaches. METHOD We searched PubMed, PsycINFO, AgeLine, and Academic Search Premier for articles published between January 2008 and June 2020. Studies were included if participants were over the age of 50, a structured assessment of cognitive function in older adults was evaluated, the assessment method was deemed distant, and validity and/or reliability data were reported. Assessment distance was defined as having any of the following features: use of an electronic test interface, nonroutine test location (e.g., home), test self-administered, and test unsupervised. Distance was categorized as low, intermediate, or high. RESULTS/DISCUSSION Twenty-six studies met inclusion criteria. Sample sizes ranged from n = 8 to 8,627, and the mean age ranged from 57 to 83. Assessments included screens, brief or full batteries, and were performed via videoconferencing, phone, smartphone, or tablet/computer. Ten studies reported on low distance, 11 on intermediate distance, and 5 studies for high distance assessments. Invalid performance data were observed with older age and cognitive impairment. Convergent validity data were reported consistently and suggested a decline with increasing distance: r = 0.52-0.80 for low, 0.49-0.75 for intermediate, and 0.41-0.53 for high distance. Diagnostic validity estimates presented a similar pattern. Reliability data were reported too inconsistently to allow evaluation. CONCLUSION The validity of cognitive assessments with older adults appears supported at lower but not higher distance. Less is known about the reliability of such assessments. Future research should delineate the person and procedure boundaries for valid and reliable test results.
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Affiliation(s)
- Davina Binng
- School of Graduate Psychology, Pacific University, Hillsboro, Oregon, USA
| | | | - Claudia Jacova
- School of Graduate Psychology, Pacific University, Hillsboro, Oregon, USA,
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Abd Razak MA, Ahmad NA, Chan YY, Mohamad Kasim N, Yusof M, Abdul Ghani MKA, Omar M, Abd Aziz FA, Jamaluddin R. Validity of screening tools for dementia and mild cognitive impairment among the elderly in primary health care: a systematic review. Public Health 2019; 169:84-92. [PMID: 30826688 DOI: 10.1016/j.puhe.2019.01.001] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 12/14/2018] [Accepted: 01/02/2019] [Indexed: 12/30/2022]
Abstract
OBJECTIVES This systematic review aims to provide updated and comprehensive evidence on the validity and feasibility of screening tools for mild cognitive impairment (MCI) and dementia among the elderly at primary healthcare level. STUDY DESIGN A review of articles was performed. METHODS A search strategy was used by using electronic bibliographic databases including PubMed, Embase and CENTRAL for published studies and reference list of published studies. The articles were exported to a bibliographic database for further screening process. Two reviewers worked independently to screen results and extract data from the included studies. Any discrepancies were resolved and confirmed by the consensus of all authors. RESULTS There were three screening approaches for detecting MCI and dementia - screening by a healthcare provider, screening by a self-administered questionnaire and caretaker informant screening. Montreal Cognitive Assessment (MoCA) was the most common and preferable tool for MCI screening (sensitivity [Sn]: 81-97%; specificity [Sp]: 60-86%), whereas Addenbrooke's Cognitive Examination (ACE) was the preferable tool for dementia screening (Sn: 79-100%; Sp: 86%). CONCLUSION This systematic review found that there are three screening approaches for detecting early dementia and MCI at primary health care. ACE and MoCA are recommended tools for screening of dementia and MCI, respectively.
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Affiliation(s)
- M A Abd Razak
- Institute for Public Health, Ministry of Health Malaysia, Jalan Bangsar, 50590 Kuala Lumpur, W.P. Kuala Lumpur, Malaysia.
| | - N A Ahmad
- Institute for Public Health, Ministry of Health Malaysia, Jalan Bangsar, 50590 Kuala Lumpur, W.P. Kuala Lumpur, Malaysia.
| | - Y Y Chan
- Institute for Public Health, Ministry of Health Malaysia, Jalan Bangsar, 50590 Kuala Lumpur, W.P. Kuala Lumpur, Malaysia.
| | - N Mohamad Kasim
- Institute for Public Health, Ministry of Health Malaysia, Jalan Bangsar, 50590 Kuala Lumpur, W.P. Kuala Lumpur, Malaysia.
| | - M Yusof
- Women and Child Hospital Kuala Lumpur, Ministry of Health Malaysia, Jalan Dr Latiff, 50586 Kuala Lumpur, W.P. Kuala Lumpur, Malaysia.
| | - M K A Abdul Ghani
- Klinik Rafeeq & Nurul, Sungai Rengit, 81620 Pengerang, Johor, Malaysia.
| | - M Omar
- Kuala Selangor Health District, Ministry of Health Malaysia, Jalan Semarak, 45000 Kuala Selangor, Selangor, Malaysia.
| | - F A Abd Aziz
- Institute for Public Health, Ministry of Health Malaysia, Jalan Bangsar, 50590 Kuala Lumpur, W.P. Kuala Lumpur, Malaysia.
| | - R Jamaluddin
- Institute for Public Health, Ministry of Health Malaysia, Jalan Bangsar, 50590 Kuala Lumpur, W.P. Kuala Lumpur, Malaysia.
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Handal N, LePage J, Dayley P, Baldwin B, Roeser A, Kay J, Theobald HA, Nellamattathil M, Drotar S, Weir C, Tindell N, Tice K. Validation, reliability, and specificity of CliniCom™ Psychiatric Assessment Software. Psychiatry Res 2018; 265:334-340. [PMID: 29778712 DOI: 10.1016/j.psychres.2018.05.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 05/11/2018] [Indexed: 12/29/2022]
Abstract
The purpose of this study was to determine the specificity and reproducibility of CliniCom™ Psychiatric Assessment Software to appropriately diagnose five prevalent mental health disorders. This online assessment tool incorporates proprietary algorithms for its propensity assessment. Unlike other questionnaires, which require a survey per specific mental disorder, CliniCom can simultaneously assess multiple mental disorders for an individual. CliniCom was concordant with other commonly used assessment tools in diagnosing five prevalent disorders including: Attention Deficit and Hyperactivity Disorder, Generalized Anxiety Disorder, Major Depressive Disorder, Obsessive Compulsive Disorder, and Social Phobia. The online tool was overall 78% concordant in diagnosing the same disorder during a test-retest analysis. When subjects exhibited two, three, or four disorders, the tool was less consistent in diagnosing the same set of disorders during the test-retest analysis (53% concordant). However, if evaluated as individual disorders within subjects, the more persistent disorders had a higher rate of concordance: MDD (83.3%), ADHD (81.0%), and OCD (68.4%). This study proposes CliniCom as an online assessment tool that demonstrates specificity in identifying specific psychiatric conditions and shows reproducibility over multiple administrations.
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Affiliation(s)
- Nelson Handal
- Dothan Behavioral Medicine Clinic and Harmonex Neuroscience Research, 408 Healthwest Drive, Dothan, AL 36303, USA.
| | - James LePage
- Dothan Behavioral Medicine Clinic and Harmonex Neuroscience Research, 408 Healthwest Drive, Dothan, AL 36303, USA
| | - Philip Dayley
- Dothan Behavioral Medicine Clinic and Harmonex Neuroscience Research, 408 Healthwest Drive, Dothan, AL 36303, USA
| | - Barbara Baldwin
- Dothan Behavioral Medicine Clinic and Harmonex Neuroscience Research, 408 Healthwest Drive, Dothan, AL 36303, USA
| | - Amellia Roeser
- Dothan Behavioral Medicine Clinic and Harmonex Neuroscience Research, 408 Healthwest Drive, Dothan, AL 36303, USA
| | - Joni Kay
- Dothan Behavioral Medicine Clinic and Harmonex Neuroscience Research, 408 Healthwest Drive, Dothan, AL 36303, USA
| | - Heather Ann Theobald
- Dothan Behavioral Medicine Clinic and Harmonex Neuroscience Research, 408 Healthwest Drive, Dothan, AL 36303, USA
| | - Michael Nellamattathil
- Dothan Behavioral Medicine Clinic and Harmonex Neuroscience Research, 408 Healthwest Drive, Dothan, AL 36303, USA
| | - Scott Drotar
- Dothan Behavioral Medicine Clinic and Harmonex Neuroscience Research, 408 Healthwest Drive, Dothan, AL 36303, USA
| | - Connor Weir
- Dothan Behavioral Medicine Clinic and Harmonex Neuroscience Research, 408 Healthwest Drive, Dothan, AL 36303, USA
| | - Neil Tindell
- Dothan Behavioral Medicine Clinic and Harmonex Neuroscience Research, 408 Healthwest Drive, Dothan, AL 36303, USA
| | - Kevin Tice
- Dothan Behavioral Medicine Clinic and Harmonex Neuroscience Research, 408 Healthwest Drive, Dothan, AL 36303, USA
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Brief Report: Using the Internet to Identify Persons with Cognitive Impairment for Participation in Clinical Trials. Brain Sci 2017; 7:brainsci7040036. [PMID: 28379188 PMCID: PMC5406693 DOI: 10.3390/brainsci7040036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 03/31/2017] [Accepted: 03/31/2017] [Indexed: 11/16/2022] Open
Abstract
Identifying, recruiting, and enrolling persons in clinical trials of dementia treatments is extremely difficult. One approach to first-wave screening of potential participants is the use of online assessment tools. Initial studies using the Dementia Risk Assessment (DRA)—which includes a previously validated recognition memory test—support the use of this self-administered assessment to identify individuals with “suspected MCI” or “suspected dementia.” In this study, we identified between 71 and 622 persons with suspected dementia and between 128 and 1653 persons with suspected mild cognitive impairment (depending on specific criteria) over the course of 22 months. Assessment tools that can inexpensively and easily identify individuals with higher than average risk for cognitive impairment can facilitate recruitment for large-scale clinical trials for dementia treatments.
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Troyer AK, Rowe G, Murphy KJ, Levine B, Leach L, Hasher L. Development and evaluation of a self-administered on-line test of memory and attention for middle-aged and older adults. Front Aging Neurosci 2014; 6:335. [PMID: 25540620 PMCID: PMC4261807 DOI: 10.3389/fnagi.2014.00335] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Accepted: 11/27/2014] [Indexed: 11/17/2022] Open
Abstract
There is a need for rapid and reliable Internet-based screening tools for cognitive assessment in middle-aged and older adults. We report the psychometric properties of an on-line tool designed to screen for cognitive deficits that require further investigation. The tool is composed of measures of memory and executive attention processes known to be sensitive to brain changes associated with aging and with cognitive disorders that become more prevalent with age. Measures included a Spatial Working Memory task, Stroop Interference task, Face-Name Association task, and Number-Letter Alternation task. Normative data were collected from 361 healthy adults age 50–79 who scored in the normal range on a standardized measure of general cognitive ability. Participants took the 20-minute on-line test on their home computers, and a subset of 288 participants repeated the test 1 week later. Analyses of the individual tasks indicated adequate internal consistency, construct validity, test-retest reliability, and alternate version reliability. As expected, scores were correlated with age. The four tasks loaded on the same principle component. Demographically-corrected z-scores from the individual tasks were combined to create an overall score, which showed good reliability and classification consistency. These results indicate the tool may be useful for identifying middle-aged and older adults with lower than expected scores who may benefit from clinical evaluation of their cognition by a health care professional.
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Affiliation(s)
- Angela K Troyer
- Neuropsychology and Cognitive Health Program, Baycrest Centre for Geriatric Care Toronto, ON, Canada ; Department of Psychology, University of Toronto Toronto, ON, Canada
| | - Gillian Rowe
- Neuropsychology and Cognitive Health Program, Baycrest Centre for Geriatric Care Toronto, ON, Canada ; Department of Psychology, University of Toronto Toronto, ON, Canada
| | - Kelly J Murphy
- Neuropsychology and Cognitive Health Program, Baycrest Centre for Geriatric Care Toronto, ON, Canada ; Department of Psychology, University of Toronto Toronto, ON, Canada
| | - Brian Levine
- Department of Psychology, University of Toronto Toronto, ON, Canada ; Rotman Research Institute, Baycrest Centre for Geriatric Care Toronto, ON, Canada
| | - Larry Leach
- Neuropsychology and Cognitive Health Program, Baycrest Centre for Geriatric Care Toronto, ON, Canada
| | - Lynn Hasher
- Department of Psychology, University of Toronto Toronto, ON, Canada ; Rotman Research Institute, Baycrest Centre for Geriatric Care Toronto, ON, Canada
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Preventing cognitive decline in preclinical Alzheimer's disease. Curr Opin Pharmacol 2013; 14:18-22. [PMID: 24565007 DOI: 10.1016/j.coph.2013.10.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Revised: 10/08/2013] [Accepted: 10/22/2013] [Indexed: 11/22/2022]
Abstract
Alzheimer's disease (AD) is a chronic neurodegenerative disease leading to cognitive decline, dementia, and ultimately death. Despite extensive R&D efforts, there are no diseases modifying treatments for AD available. The stage in which patients receive a clinical diagnosis of probable AD may be too late for disease modifying pharmacotherapy. Prevention strategies may be required to successfully tackle AD. Preclinical AD applies to over half of all healthy elderly subjects and manifests by signs of amyloid deposition and/or neuronal injury in the brain, preceding the stage in which symptoms of dementia, cognitive and functional impairment become observable. Prevention trials in preclinical AD require longer and larger clinical trials using biomarkers and cognitive endpoints, which requires collaboration across academia, government and industry.
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