The use of a computerised cognitive assessment to improve the efficiency of primary care referrals to memory services: Protocol for the ADePT study (Preprint)

2021 ◽  
Author(s):  
Chris Kalafatis ◽  
Mohammad Hadi Modarres ◽  
Panos Apostolou ◽  
Naji Tabet ◽  
Seyed-Mahdi Khaligh-Razavi
Keyword(s):  
Primary Care ◽  
Cognitive Impairment ◽  
Clinical Practice ◽  
Cognitive Assessment ◽  
Assessment Tool ◽  
Economic Benefits ◽  
Assessment Tools ◽  
Remote Memory ◽  
Memory Clinic ◽  
Potential Health

BACKGROUND Existing primary care cognitive assessment tools are crude or time-consuming screening instruments which can only detect cognitive impairment when it is well established. Due to the COVID-19 pandemic, memory services have adapted to the new environment by moving to remote patient assessments to continue meeting service user demand. However, the remote use of cognitive assessments has been variable while there has been scant evaluation of the outcome of such a change in clinical practice. Emerging research in remote memory clinics has highlighted computerised cognitive tests, such as the Integrated Cognitive Assessment (ICA), as a prominent candidate for adoption in clinical practice both during the pandemic and for post-COVID implementation as part of healthcare innovation. OBJECTIVE We initiated the Accelerating Dementia Pathway Technologies (ADePT) study. The intention of conducting this study is to develop a real-world evidence basis to support the adoption of ICA as an inexpensive screening tool for the detection of cognitive impairment and improving the efficiency of the dementia care pathway. METHODS Patients who have been referred to a memory clinic from GPs are recruited. Participants complete the ICA either at home or in the clinic along with medical history and usability questionnaires. The GP referral and ICA outcome are compared with the specialist diagnosis obtained at the memory clinic. The clinical outcomes as well as NHS reference costing data will be used to assess the potential health economic benefits of the use of the ICA in the dementia diagnosis pathway. RESULTS The ADePT study was funded in January 2020 by Innovate UK (Project reference 105837). As of September 2021, 86 participants have been recruited in the study, with 23 participants also completing a retest visit. Initially the study was designed for in person visits at the memory clinic, however in light of the COVID-19 pandemic, the study was amended to allow remote as well as face-to-face visits. The study was also expanded from a single site to 4 sites in the United Kingdom. We expect results to be published by the second quarter of 2022. CONCLUSIONS The ADePT project aims at improving the efficiency of the dementia pathway at its very beginning and supports systems integration at the intersection between primary and secondary care. The introduction of a standardised, self-administered, digital assessment tool for the timely detection of neurodegeneration as part of a decision-support system that can signpost accordingly can reduce unnecessary referrals, reduce service backlog and assessment variability. CLINICALTRIAL ISRCTN Number: 16596456

scholarly journals Accuracy of the Cognitive Assessment Battery in a Primary Care Population

2019 ◽  
Vol 9 (2) ◽  
pp. 294-301 ◽  
Author(s):  
Anna S. Kvitting ◽  
Maria M. Johansson ◽  
Jan Marcusson
Keyword(s):  
Primary Care ◽  
Logistic Regression ◽  
Cognitive Impairment ◽  
Cognitive Assessment ◽  
Characteristic Curve ◽  
Numerical Data ◽  
Assessment Tools ◽  
Binary Outcomes ◽  
Assessment Battery ◽  
Primary Care Population

Background: There are several cognitive assessment tools used in primary care, e.g., the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment. The Cognitive Assessment Battery (CAB) was introduced as a sensitive tool to detect cognitive decline in primary care. However, primary care validation is lacking. Therefore, we investigated the accuracy of the CAB in a primary care population. Objective: To investigate the accuracy of the CAB in a primary care population. Methods: Data from 46 individuals with cognitive impairment and 33 individuals who visited the primary care with somatic noncognitive symptoms were analyzed. They were investigated with the MMSE, the CAB, and a battery of neuropsychological tests; they also underwent consultation with a geriatric specialist. The accuracy of the CAB was assessed using c-statistics and the area under the receiver operating characteristic curve (AUC) was used to quantify the binary outcomes (“no cognitive impairment” or “cognitive impairment”). Results: The “cognitive impairment” group was significantly different from the unimpaired group for all the subtests of the CAB. When accuracy was based on binary significant reduction or not in one or several domains of the CAB, the AUC varied between 0.685 and 0.772. However, when a summation or logistic regression of several subcategories was performed, using the numerical values for each subcategory, the AUC was >0.9. For comparison, the AUC for the MMSE was 0.849. Conclusions: The accuracy of the CAB in a primary care population is poor to good when using binary cutoffs. Accuracy can be improved to high when using a summation or logistic regression of the numerical data of the subcategories. Considering CAB time, lack of adequate age norms, and a good accuracy for the MMSE, implementation of the CAB in primary care is not recommended at present based on the results of this study.

Cognitive assessment tools in Asia: a systematic review

2015 ◽  
Vol 28 (2) ◽  
pp. 189-210 ◽  
Author(s):  
Roshaslina Rosli ◽  
Maw Pin Tan ◽  
William Keith Gray ◽  
Pathmawathi Subramanian ◽  
Ai-Vyrn Chin
Keyword(s):  
Systematic Review ◽  
Cognitive Impairment ◽  
Cognitive Assessment ◽  
De Novo ◽  
Assessment Tools ◽  
Screening Tools ◽  
Cochrane Library ◽  
Future Research ◽  
Asian Populations ◽  
Keywords Dementia

ABSTRACTBackground:The prevalence of dementia is increasing in Asia than in any other continent. However, the applicability of the existing cognitive assessment tools is limited by differences in educational and cultural factors in this setting. We conducted a systematic review of published studies on cognitive assessments tools in Asia. We aimed to rationalize the results of available studies which evaluated the validity of cognitive tools for the detection of cognitive impairment and to identify the issues surrounding the available cognitive impairment screening tools in Asia.Methods:Five electronic databases (CINAHL, MEDLINE, Embase, Cochrane Library, and Science Direct) were searched using the keywords dementia Or Alzheimer Or cognitive impairment And screen Or measure Or test Or tool Or instrument Or assessment, and 2,381 articles were obtained.Results:Thirty-eight articles, evaluating 28 tools in seven Asian languages, were included. Twenty-nine (76%) of the studies had been conducted in East Asia with only four studies conducted in South Asia and no study from northern, western, or central Asia or Indochina. Local language translations of the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) were assessed in 15 and six studies respectively. Only three tools (the Korean Dementia Screening Questionnaire, the Picture-based Memory Intelligence Scale, and the revised Hasegawa Dementia Screen) were derivedde novofrom Asian populations. These tools were assessed in five studies. Highly variable cut-offs were reported for the MMSE (17–29/30) and MoCA (21–26/30), with 13/19 (68%) of studies reporting educational bias.Conclusions:Few cognitive assessment tools have been validated in Asia, with no published validation studies for many Asian nations and languages. In addition, many available tools display educational bias. Future research should include concerted efforts to develop culturally appropriate tools with minimal educational bias.

scholarly journals Cognitive assessment: A challenge for occupational therapists in Brazil

2017 ◽  
Vol 11 (2) ◽  
pp. 121-128 ◽  
Author(s):  
Juliana Conti
Keyword(s):  
Clinical Practice ◽  
Cognitive Assessment ◽  
Occupational Therapists ◽  
Brazilian Portuguese ◽  
Assessment Tools ◽  
Neurological Injury ◽  
Cognitive Tools ◽  
Practice Methods ◽  
Brazilian Culture

ABSTRACT Cognitive impairment is a common dysfunction after neurological injury. Cognitive assessment tools can help the therapist understand how impairments are affecting functional status and quality of life. Objective: The aim of the study was to identify instruments for cognitive assessment that Occupational Therapists (OT) can use in clinical practice. Methods: The instruments published in English and Portuguese between 1999 and 2016 were systematically reviewed. Results: The search identified 17 specific instruments for OT not validated in Brazilian Portuguese, 10 non-specific instruments for OT not validated in Brazilian Portuguese, and 25 instruments validated for Portuguese, only one of which was specific for OT (Lowenstein Occupational Therapy Cognitive Assessment). Conclusion: There are few assessment cognitive tools validated for use in the Brazilian culture and language. The majority of the instruments appear not to be validated for use by OT in clinical practice.

Short Montreal Cognitive Assessment

2016 ◽  
Vol 30 (2) ◽  
pp. 104-108 ◽  
Author(s):  
A. J. Larner
Keyword(s):  
Cognitive Impairment ◽  
Cognitive Assessment ◽  
Computerized Adaptive Testing ◽  
Montreal Cognitive Assessment ◽  
Test Accuracy ◽  
Cognitive Screening ◽  
Memory Clinic ◽  
Subjective Memory ◽  
Index Study ◽  
Diagnosis Of Dementia

The diagnostic accuracy of the short Montreal Cognitive Assessment (s-MoCA), a cognitive screening instrument recently derived by item response theory and computerized adaptive testing from the original MoCA, for the diagnosis of dementia and mild cognitive impairment (MCI) was assessed in 2 patient cohorts referred to a dedicated memory clinic in order to examine the validity and reproducibility of s-MoCA. Diagnosis used standard clinical diagnostic criteria for dementia and MCI as reference standard (prevalence of cognitive impairment = 0.43 and 0.46 in each cohort, respectively). There were significant differences in s-MoCA test scores for dementia, MCI, and subjective memory impairment ( P ≤ .01), and s-MoCA effect sizes (Cohen d) were medium to large (range: 0.65-1.42) for the diagnosis of dementia and MCI. Using the cut-off for s-MoCA specified in the index study, it proved highly sensitive (>0.9) for diagnosis of dementia but with poor specificity (≤0.25), with moderate sensitivity (≥0.75) and specificity (≥0.60) for diagnosis of MCI. In conclusion, in these pragmatic diagnostic test accuracy studies, s-MoCA proved acceptable and sensitive for the diagnosis of cognitive impairment in a memory clinic setting, with a performance similar to that of the original MoCA.

scholarly journals Patterns of Cognitive Dysfunction in Progressive MS

2013 ◽  
Vol 27 (3) ◽  
pp. 259-265 ◽  
Author(s):  
Peter Connick ◽  
Siddharthan Chandran ◽  
Thomas H. Bak
Keyword(s):  
Cognitive Impairment ◽  
Cognitive Dysfunction ◽  
High Frequency ◽  
Cognitive Assessment ◽  
Assessment Tool ◽  
Visuospatial Deficits ◽  
Relative Contribution ◽  
Visuospatial Functions ◽  
Global Influence ◽  
Addenbrooke’S Cognitive Examination

Background:Progressive MS is associated with a high frequency of cognitive impairment. However, it is not clear to what extent this reflects global dysfunction, or independent deficits in specific functions.Objective:To characterise patterns of cognitive impairment in progressive MS on a multi-dimensional cognitive assessment tool well established in neurodegenerative diseases.Methods:Patients with secondary (SPMS;n= 60) and primary progressive MS (PPMS;n= 28) were assessed using the Addenbrooke’s Cognitive Examination-Revised (ACE-R) multi-dimensional cognitive assessment scale. Independent dimensions of impairment and their relative contribution to the overall burden of cognitive dysfunction were then determined by factor analysis.Results:Two independent dimensions of impairment were seen: frontal-executive (attention, verbal fluency, recall) on one hand, and language and visuospatial functions on the other. These accounted for 55% and 45% respectively of the variance not explained by a global influence (14.2% and 11.6% respectively of total variance). Isolated language and visuospatial dysfunction was seen in both groups, whereas isolated impairment in frontal-executive functions was underrepresented in SPMS (p= 0.001) and not seen in PPMS patients (p= 0.040).Conclusions:In addition to a prominent global influence on cognitive performance, patients with progressive MS commonly exhibit language and visuospatial deficits. Evaluation of these abilities should therefore be included in clinical assessment of cognition in progressive MS.

scholarly journals Cognitive Assessment Tools Recommended in Geriatric Oncology Guidelines: A Rapid Review

2021 ◽  
Vol 28 (5) ◽  
pp. 3987-4003
Author(s):  
Gina Tuch ◽  
Wee Kheng Soo ◽  
Ki-Yung Luo ◽  
Kinglsey Frearson ◽  
Ek Leone Oh ◽  
...  
Keyword(s):  
Cancer Care ◽  
Cognitive Assessment ◽  
Assessment Tool ◽  
Geriatric Oncology ◽  
Assessment Tools ◽  
Rapid Review ◽  
Clinical Settings ◽  
Care Experience ◽  
Clock Drawing Test ◽  
Cancer Guidelines

Cognitive assessment is a cornerstone of geriatric care. Cognitive impairment has the potential to significantly impact multiple phases of a person’s cancer care experience. Accurately identifying this vulnerability is a challenge for many cancer care clinicians, thus the use of validated cognitive assessment tools are recommended. As international cancer guidelines for older adults recommend Geriatric Assessment (GA) which includes an evaluation of cognition, clinicians need to be familiar with the overall interpretation of the commonly used cognitive assessment tools. This rapid review investigated the cognitive assessment tools that were most frequently recommended by Geriatric Oncology guidelines: Blessed Orientation-Memory-Concentration test (BOMC), Clock Drawing Test (CDT), Mini-Cog, Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), and Short Portable Mental Status Questionnaire (SPMSQ). A detailed appraisal of the strengths and limitations of each tool was conducted, with a focus on practical aspects of implementing cognitive assessment tools into real-world clinical settings. Finally, recommendations on choosing an assessment tool and the additional considerations beyond screening are discussed.

scholarly journals Cognitive Assessment and Rehabilitation for Pediatric-Onset Multiple Sclerosis: A Scoping Review

Children ◽  
2020 ◽  
Vol 7 (10) ◽  
pp. 183
Author(s):  
Wei-Sheng Lin ◽  
Shan-Ju Lin ◽  
Ting-Rong Hsu
Keyword(s):  
Multiple Sclerosis ◽  
Scoping Review ◽  
Cognitive Assessment ◽  
Cognitive Rehabilitation ◽  
Assessment Tool ◽  
Assessment Tools ◽  
Systematic Research ◽  
Computer Assisted ◽  
Clinical Issue ◽  
Pediatric Onset

Cognitive impairment is increasingly recognized as an important clinical issue in pediatric multiple sclerosis (MS). However, variations regarding its assessment and remediation are noted in clinical arena. This scoping review aims to collate available evidence concerning cognitive assessment tool and cognitive rehabilitation for pediatric MS. We performed a systematic search of electronic databases (MEDLINE, PubMed, CINAHL Plus, and Web of Science) from inception to February 2020. Reference lists of included articles and trial registers were also searched. We included original studies published in English that addressed cognitive assessment tools or cognitive rehabilitation for pediatric-onset MS. Fourteen studies fulfilled our inclusion criteria. Among them, 11 studies evaluated the psychometric aspects of various cognitive assessment tools in the context of pediatric MS, and different neuro-cognitive domains were emphasized across studies. There were only three pilot studies reporting cognitive rehabilitation for pediatric-onset MS, all of which used home-based computerized programs targeting working memory and attention, respectively. Overall, more systematic research on cognitive assessment tools and rehabilitation for pediatric MS is needed to inform evidence-based practice. Computer-assisted cognitive assessment and rehabilitation appear feasible and deserve further studies.

Hippocampal Mean Diffusivity for the Diagnosis of Dementia and Mild Cognitive Impairment in Primary Care

2018 ◽  
Vol 15 (11) ◽  
pp. 1005-1012
Author(s):  
Katharina Brueggen ◽  
Martin Dyrba ◽  
Ingo Kilimann ◽  
Judith Henf ◽  
Wolfgang Hoffmann ◽  
...  
Keyword(s):  
Primary Care ◽  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Diffusion Tensor ◽  
Primary Care Patient ◽  
Mean Diffusivity ◽  
White Matter Lesions ◽  
Care Patient ◽  
Memory Clinic ◽  
Specialized Care

Background: Hippocampal mean diffusivity (MD) measured by Diffusion-Tensor Imaging is a promising diagnostic marker for Mild Cognitive Impairment (MCI) and dementia. Its performance has yet to be evaluated in primary care patients, who vary systematically from patients visiting specialized care settings. Objective: We assessed the diagnostic accuracy of hippocampus diffusivity for detecting MCI and dementia in a sample recruited from primary care, compared to a sample from specialized care. Method: One sample was recruited from a primary care intervention trial (DelpHi-MV) (n=70), and the other sample was recruited from our memory clinic (n=70). The samples were matched pairwise for diagnosis, MMSE, age, gender, and education. They included dementia patients, MCI patients and healthy subjects. Mean MD was calculated for the left and right hippocampus, corrected for partial volume effects. Within each sample, left or right hippocampal MD served as predictor for diagnostic group in logistic regressions, which were additionally controlled for white matter lesions. Results: In the primary care sample, hippocampal MD detected dementia with high cross-validated accuracy (left: AUC=.92; right: AUC=.85), but did not classify MCI with an accuracy above chance (left: AUC=.58; right: AUC=.44). In the memory clinic sample, hippocampal MD classified both dementia (left: AUC=.91; right: AUC=.91) and MCI (left: AUC=.86; right: AUC=.83) with high cross-validated accuracy. Conclusion: Hippocampal MD supported the identification of dementia but did not contribute to the detection of MCI in the primary care patient population.

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