Accuracy of a self-administered online cognitive assessment in detecting amnestic mild cognitive impairment
Date
2022
Authors
Paterson, Theone S. E.
Sivajohan, Brintha
Gardner, Sandra
Binns, Malcolm A.
Stokes, Kathryn A.
Freedman, Morris
Levine, Brian
Troyer, Angela K.
Journal Title
Journal ISSN
Volume Title
Publisher
Journals of Gerontology: Series B
Abstract
Objectives: Our aim was to validate the online Brain Health Assessment (BHA) for detection of amnestic mild cognitive impairment (aMCI) compared to gold-standard neuropsychological assessment. We compared the diagnostic accuracy of the BHA to the Montreal Cognitive Assessment (MoCA). Methods: Using a cross-sectional design, community-dwelling older adults completed a neuropsychological assessment, were diagnosed as normal cognition (NC) or aMCI, and completed the BHA and MoCA. Both logistic regression (LR) and penalized logistic regression (PLR) analyses determined BHA and demographic variables predicting aMCI; MoCA variables were similarly modeled. Diagnostic accuracy was compared using area under the receiver operating characteristic curve (ROC AUC) analyses. Results: Ninety-one participants met inclusion criteria (51 aMCI, 40 NC). PLR modeling for the BHA indicated Face–Name Association, Spatial Working Memory, and age-predicted aMCI (ROC AUC = 0.76; 95% confidence interval [CI]:0.66–0.86). Optimal cut-points resulted in 21% classified as aMCI (positive), 23% negative, and 56% inconclusive. For the MoCA, digits, abstraction, delayed recall, orientation, and age predicted aMCI (ROC AUC = 0.71; 95% CI: 0.61–0.82). Optimal cut-points resulted in 22% classified positive, 8% negative, and 70% inconclusive (LR results presented within). The BHA model classified fewer participants into the inconclusive category and more as negative for aMCI, compared to the MoCA model (Stuart–Maxwell p = .004). Discussion: The self-administered BHA provides similar detection of aMCI as a clinician-administered screener (MoCA), with fewer participants classified inconclusively. The BHA has the potential to save practitioners time and decrease unnecessary referrals for a comprehensive assessment to determine the presence of aMCI.
Description
The authors would like to acknowledge the following individuals’ contributions: Michael Meagher assisted with the preparation of the CABHI grant application and provided project management. Caitlin Johnston provided project management. Komal Shaikh, Rebecca Trossman, and Rachel Downey conducted participant assessments. This research was not preregistered with an analysis plan in an independent, institutional registry. Data, analytic methods, and study materials can be made available to other researchers upon request.
Keywords
Cognitive screening, Diagnostic accuracy, eHealth, Logistic regression, Validity
Citation
Paterson, T. S. E., Sivajohan, B., Gardner, S., Binns, M. A., Stokes, K. A., Freedman, M., Levine, B., & Troyer, A. K. (2022). “Accuracy of a Self-Administered Online Cognitive Assessment in Detecting Amnestic Mild Cognitive Impairment.” Journals of Gerontology: Series B, 70(2), 341-350. DOI: https://doi.org/10.1093/geronb/gbab097