Validation of a rapid remote digital test for impaired cognition using clinical dementia rating and mini-mental state examination: An observational research study
BackgroundThe Clinical Dementia Rating (CDR) and Mini-Mental State Examination (MMSE) are useful screening tools for mild cognitive impairment (MCI). However, these tests require qualified in-person supervision and the CDR can take up to 60 min to complete. We developed a digital cognitive screening...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2022-12-01
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| Series: | Frontiers in Digital Health |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fdgth.2022.1029810/full |
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| author | Ali Alim-Marvasti Ali Alim-Marvasti Ali Alim-Marvasti Narayan Kuleindiren Kirsten Harvey Kirsten Harvey Matteo Ciocca Matteo Ciocca Aaron Lin Aaron Lin Hamzah Selim Mohammad Mahmud Mohammad Mahmud |
| author_facet | Ali Alim-Marvasti Ali Alim-Marvasti Ali Alim-Marvasti Narayan Kuleindiren Kirsten Harvey Kirsten Harvey Matteo Ciocca Matteo Ciocca Aaron Lin Aaron Lin Hamzah Selim Mohammad Mahmud Mohammad Mahmud |
| author_sort | Ali Alim-Marvasti |
| collection | DOAJ |
| description | BackgroundThe Clinical Dementia Rating (CDR) and Mini-Mental State Examination (MMSE) are useful screening tools for mild cognitive impairment (MCI). However, these tests require qualified in-person supervision and the CDR can take up to 60 min to complete. We developed a digital cognitive screening test (M-CogScore) that can be completed remotely in under 5 min without supervision. We set out to validate M-CogScore in head-to-head comparisons with CDR and MMSE.MethodsTo ascertain the validity of the M-CogScore, we enrolled participants as healthy controls or impaired cognition, matched for age, sex, and education. Participants completed the 30-item paper MMSE Second Edition Standard Version (MMSE-2), paper CDR, and smartphone-based M-CogScore. The digital M-CogScore test is based on time-normalised scores from smartphone-adapted Stroop (M-Stroop), digit-symbols (M-Symbols), and delayed recall tests (M-Memory). We used Spearman's correlation coefficient to determine the convergent validity between M-CogScore and the 30-item MMSE-2, and non-parametric tests to determine its discriminative validity with a CDR label of normal (CDR 0) or impaired cognition (CDR 0.5 or 1). M-CogScore was further compared to MMSE-2 using area under the receiver operating characteristic curves (AUC) with corresponding optimal cut-offs.Results72 participants completed all three tests. The M-CogScore correlated with both MMSE-2 (rho = 0.54, p < 0.0001) and impaired cognition on CDR (Mann Whitney U = 187, p < 0.001). M-CogScore achieved an AUC of 0.85 (95% bootstrapped CI [0.80, 0.91]), when differentiating between normal and impaired cognition, compared to an AUC of 0.78 [0.72, 0.84] for MMSE-2 (p = 0.21).ConclusionDigital screening tests such as M-CogScore are desirable to aid in rapid and remote clinical cognitive evaluations. M-CogScore was significantly correlated with established cognitive tests, including CDR and MMSE-2. M-CogScore can be taken remotely without supervision, is automatically scored, has less of a ceiling effect than the MMSE-2, and takes significantly less time to complete. |
| first_indexed | 2024-04-13T04:01:13Z |
| format | Article |
| id | doaj.art-a0b1cbe6749a4b1a8434a817d78acf1e |
| institution | Directory Open Access Journal |
| issn | 2673-253X |
| language | English |
| last_indexed | 2024-04-13T04:01:13Z |
| publishDate | 2022-12-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Digital Health |
| spelling | doaj.art-a0b1cbe6749a4b1a8434a817d78acf1e2022-12-22T03:03:29ZengFrontiers Media S.A.Frontiers in Digital Health2673-253X2022-12-01410.3389/fdgth.2022.10298101029810Validation of a rapid remote digital test for impaired cognition using clinical dementia rating and mini-mental state examination: An observational research studyAli Alim-Marvasti0Ali Alim-Marvasti1Ali Alim-Marvasti2Narayan Kuleindiren3Kirsten Harvey4Kirsten Harvey5Matteo Ciocca6Matteo Ciocca7Aaron Lin8Aaron Lin9Hamzah Selim10Mohammad Mahmud11Mohammad Mahmud12Research Division, Mindset Technologies Ltd., London, United KingdomQueen Square Institute of Neurology, University College London, London, United KingdomDepartment of Medical Physics and Biomedical Engineering, University College London, London, United KingdomResearch Division, Mindset Technologies Ltd., London, United KingdomResearch Division, Mindset Technologies Ltd., London, United KingdomDepartment of Brain Sciences, Imperial College London, London, United KingdomResearch Division, Mindset Technologies Ltd., London, United KingdomDepartment of Brain Sciences, Imperial College London, London, United KingdomResearch Division, Mindset Technologies Ltd., London, United KingdomMedical School, University of Birmingham, Birmingham, United KingdomResearch Division, Mindset Technologies Ltd., London, United KingdomResearch Division, Mindset Technologies Ltd., London, United KingdomDepartment of Brain Sciences, Imperial College London, London, United KingdomBackgroundThe Clinical Dementia Rating (CDR) and Mini-Mental State Examination (MMSE) are useful screening tools for mild cognitive impairment (MCI). However, these tests require qualified in-person supervision and the CDR can take up to 60 min to complete. We developed a digital cognitive screening test (M-CogScore) that can be completed remotely in under 5 min without supervision. We set out to validate M-CogScore in head-to-head comparisons with CDR and MMSE.MethodsTo ascertain the validity of the M-CogScore, we enrolled participants as healthy controls or impaired cognition, matched for age, sex, and education. Participants completed the 30-item paper MMSE Second Edition Standard Version (MMSE-2), paper CDR, and smartphone-based M-CogScore. The digital M-CogScore test is based on time-normalised scores from smartphone-adapted Stroop (M-Stroop), digit-symbols (M-Symbols), and delayed recall tests (M-Memory). We used Spearman's correlation coefficient to determine the convergent validity between M-CogScore and the 30-item MMSE-2, and non-parametric tests to determine its discriminative validity with a CDR label of normal (CDR 0) or impaired cognition (CDR 0.5 or 1). M-CogScore was further compared to MMSE-2 using area under the receiver operating characteristic curves (AUC) with corresponding optimal cut-offs.Results72 participants completed all three tests. The M-CogScore correlated with both MMSE-2 (rho = 0.54, p < 0.0001) and impaired cognition on CDR (Mann Whitney U = 187, p < 0.001). M-CogScore achieved an AUC of 0.85 (95% bootstrapped CI [0.80, 0.91]), when differentiating between normal and impaired cognition, compared to an AUC of 0.78 [0.72, 0.84] for MMSE-2 (p = 0.21).ConclusionDigital screening tests such as M-CogScore are desirable to aid in rapid and remote clinical cognitive evaluations. M-CogScore was significantly correlated with established cognitive tests, including CDR and MMSE-2. M-CogScore can be taken remotely without supervision, is automatically scored, has less of a ceiling effect than the MMSE-2, and takes significantly less time to complete.https://www.frontiersin.org/articles/10.3389/fdgth.2022.1029810/fullMCI (mild cognitive impairment)early cognitive declinesmartphone applicationstroopdelayed recalldigit symbols modality test |
| spellingShingle | Ali Alim-Marvasti Ali Alim-Marvasti Ali Alim-Marvasti Narayan Kuleindiren Kirsten Harvey Kirsten Harvey Matteo Ciocca Matteo Ciocca Aaron Lin Aaron Lin Hamzah Selim Mohammad Mahmud Mohammad Mahmud Validation of a rapid remote digital test for impaired cognition using clinical dementia rating and mini-mental state examination: An observational research study Frontiers in Digital Health MCI (mild cognitive impairment) early cognitive decline smartphone application stroop delayed recall digit symbols modality test |
| title | Validation of a rapid remote digital test for impaired cognition using clinical dementia rating and mini-mental state examination: An observational research study |
| title_full | Validation of a rapid remote digital test for impaired cognition using clinical dementia rating and mini-mental state examination: An observational research study |
| title_fullStr | Validation of a rapid remote digital test for impaired cognition using clinical dementia rating and mini-mental state examination: An observational research study |
| title_full_unstemmed | Validation of a rapid remote digital test for impaired cognition using clinical dementia rating and mini-mental state examination: An observational research study |
| title_short | Validation of a rapid remote digital test for impaired cognition using clinical dementia rating and mini-mental state examination: An observational research study |
| title_sort | validation of a rapid remote digital test for impaired cognition using clinical dementia rating and mini mental state examination an observational research study |
| topic | MCI (mild cognitive impairment) early cognitive decline smartphone application stroop delayed recall digit symbols modality test |
| url | https://www.frontiersin.org/articles/10.3389/fdgth.2022.1029810/full |
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