The validity of computerized Montreal cognitive assessment among aging people living with HIV: A pilot study

As the population of aging people living with HIV (PWH) increases, many have faced neurocognitive problems. Cognitive assessment plays a crucial role as the initial step in cognitive care of this specific population. We aimed to determine the validity between a traditional paper-based and tablet-based cognitive assessment tool among aging Thai PWH.

PWH aged ≥ 50 years underwent cognitive assessment using the Thai-validated Montreal Cognitive Assessment (MoCA). Participants were randomly assigned to receive either the paper-based MoCA or the tablet-based MoCA (eMoCA) first. Two weeks later, participants returned to complete the alternate version of the MoCA. Pearson correlation was used to determine the strength of the relationship between the paper-based MoCA and the eMoCA scores. Concordance correlation coefficients (CCC) were calculated, and a Bland-Altman plot was employed to determine the level of agreement between the two testing methods. Additionally, MoCA scores were compared between individuals with and without prior touchscreen tablet experience.

Among 46 participants included in the analysis, 12 (26.1%) had experience using a touchscreen tablet. The score discrepancy between the two MoCA versions ranged from - 8 to 6, with a mean (SD) difference of -1.33 (3.22). The Pearson correlation coefficient between the paper-based MoCA and the eMoCA was r = 0.54 (p = 0.001), with a concordance correlation coefficient of 0.47. The Bland-Altman plot showed 95% limits of agreement between - 7.63 and 4.98. Among participants with prior touchscreen tablet experience, scores between the paper-based MoCA and the eMoCA were comparable. However, those without prior touchscreen experience had significantly lower scores on the eMoCA compared to the paper-based MoCA (mean difference - 1.56, 95% CI -2.72 to -0.40).

The eMoCA demonstrated moderate correlation with the paper-based MoCA, with prior touchscreen tablet experience significantly affecting the validity of the MoCA scores between the two versions. Clinicians should consider individuals' level of touchscreen experience before selecting the administration modality.