An Automated Mobile Cognitive Test for the Identification of Cognitive Impairment: A Cross-sectional Feasibility and...

To develop Digital Processing Speed Test (DPST), a free, automated, multilingual, artificial intelligence-based cognitive testing application, with the aim to enhance recognition of cognitive impairment in underserved communities by leveraging mobile health to improve cognitive testing's accessibility.

In this cross-sectional feasibility and diagnostic study, we determined the test performance of DPST for the identification of mild cognitive impairment (MCI) and dementia, compared with traditional cognitive tests, such as Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA). The study was conducted from January 19, 2021, to November 12, 2023. In total, 476 adult participants were recruited by consecutive sampling at waiting areas of primary and secondary care clinics. The participants completed MMSE and MoCA with trained assessors and then performed DPST independently on a mobile device. The reference standard was a clinical diagnosis of MCI/dementia by a memory specialist blinded to the DPST score.

Area under the receiver operating characteristic curve analyses showed that area under the curves were similar for the 3 tests (MMSE, 0.862; MoCA, 0.888; DPST, 0.861). Likewise, sensitivity (DPST, 85.2%; MMSE, 85.2%; MoCA, 90.2%), negative likelihood ratio (DPST, 0.197; MMSE, 0.193; MoCA, 0.129), specificity (DPST, 75.0%; MMSE, 76.5%; MoCA, 76.2%), and positive likelihood ratio (DPST, 3.41; MMSE, 3.62; MoCA, 3.79) were similar.

Digital Processing Speed Test, a free, automated, multilingual cognitive test conducted on a mobile device, has similar test performance to MMSE and MoCA. Nonetheless, DPST does not capture the multidomain cognitive deficits that characterize MCI/dementia. Moreover, test-retest reliability and interrater agreement of artificial intelligence-based handwriting recognition needs further confirmation.