Assessment of Neurocognitive Disorder in Primary care - Evaluating the usefulness of a digital cognitive test in clinical practice.

Anna Segernäs, Wobbie Van Den Hurk, Elisabet Classon, Anders Gustavsson, Katarina Nägga, Maria Johansson

Keywords: Mild cognitive impairment, Neurocognitive disorder, Alzheimer’s disease, Cognitive testing, Digital Health Technology

Background:

Primary care is crucial for identifying mild cognitive impairment (MCI) and early Alzheimer’s Disease (MCI-AD). Objective cognitive assessments are essential for diagnosing MCI, corroborating symptoms, assessing level of impairment, and distinguishing MCI from other conditions. However, primary care settings need more suitable tools for initial evaluations.

Research questions:

This study evaluates the clinical usability of digital cognitive testing in primary care neurocognitive investigations, focusing on test accuracy and experiences of patients and clinicians (occupational therapists; OTs).

Method:

The final sample includes 77 participants with the diagnoses: 26 subjective cognitive impairment (SCI), 28 MCI, and 23 Dementia. Cognitive tests were self-administered on the Mindmore platform and supervised by OTs. Results are compared between patient groups and normative data. Experiences were collected via hybrid surveys.

Results:

Differences between patient groups were observed in all five cognitive domains tested: Memory, Attention and processing speed, Executive functions, Visuospatial functions, and Language. The most significant differences were observed in the Memory domain. SCI group results were within one standard deviation (SD) below the norms, Dementia group results were around two SD below, and MCI group results fell between the SCI and Dementia groups.
The patients´ experience were mainly positive, with clear instructions, right level of test difficulty, and minimal stress. A digital pen was suggested for easier tablet interaction. OTs perceived the tests as reliable, but noted that many patients needed assistance, either in interacting with the tablet or with understanding or remembering test instructions.

Conclusions:

Self-administered digital cognitive tests show promising usability in this primary care. This approach could enhance the accuracy of neurocognitive investigations with minimal clinician burden, even if supervision is recommended for most patients. This could be one potential step in preparing primary care for the increased demand for neurocognitive investigations due to new early AD treatments.

Points for discussion:

What are the opportunities and barriers for the use of digital cognitive tests in neurocognitive assessments in primary care?

How will primary care be affected by the introduction of new disease-modifying treatments for Alzheimer´s disease ahead?

How should we address the utility of self-administered digital testing in an aging population with a need for professional observation and intervention to obtain reliable test results?

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