Optimizing mobile cognitive assessment reduces administration time while maintaining screening accuracy in older...

Area of Science:

• Gerontology
• Neurology
• Digital Health

Background:

• Rising dementia prevalence necessitates efficient screening tools for older adults.
• Current digital cognitive assessments can be lengthy, leading to participant fatigue and reduced adherence.
• There is a need for brief, accurate, and accessible cognitive impairment screening methods.

Purpose of the Study:

• To develop and validate a brief mobile application, the Digital Assessment of Cognitive Impairment (DACI), for accurate identification of cognitive impairment (CI) in older adults.
• To assess the diagnostic performance and completion time of a full-length and a compact version of the DACI.
• To evaluate DACI's potential to improve screening accessibility and reduce participant fatigue.

Main Methods:

• Initial validation involved 304 older adults completing a full-length DACI and a paper-and-pencil Cognitive Impairment Screening Test (CIST).
• Machine learning (CatBoost model) was used to analyze performance, with subsequent feature selection to create a compact DACI version.
• A second validation with 297 participants assessed the compact DACI's diagnostic accuracy and time efficiency.

Main Results:

• The initial CatBoost model achieved an AUC of 0.813 and sensitivity of 0.903, with an average completion time of 321 seconds.
• The compact DACI, utilizing two essential subtests, demonstrated improved diagnostic performance (AUC = 0.871) with a significantly reduced completion time of 91 seconds.
• DACI effectively identified cognitively impaired individuals with minimal test duration.

Conclusions:

• The brief, mobile-based Digital Assessment of Cognitive Impairment (DACI) accurately identifies cognitive impairment in older adults.
• DACI's short duration and ease of use can decrease fatigue, enhance adherence, and improve the accessibility of cognitive screening.
• The app offers a promising tool for rapid, remote cognitive assessment, potentially aiding early detection and intervention for cognitive decline.