Diagnostic Accuracy of Digital Solutions for Screening for Cognitive Impairment: A Systematic Review and Meta-Analysis
Source abstract
Abstract
The early detection of cognitive impairment is essential in order to initiate interventions and guarantee access to healthcare services. Digital solutions are emerging in the literature as an alternative approach to cognitive screening. Our primary goal is to synthesize the evidence on digital solutions’ diagnostic ability to screen for cognitive impairment and their accuracy. A secondary goal is to distinguish whether the ability to screen for cognitive impairment varies as a function of the type of digital solution: paper-based or innovative digital solutions. A systematic review and meta-analysis of digital solutions’ diagnostic accuracy were conducted, including 25 studies. Digital solutions presented a variable diagnostic accuracy range. Innovative digital solutions offered at least 0.78 of sensitivity but showed lower specificity levels than the other subgroup. Paper-based digital solutions revealed at least 0.72 of specificity, but sensitivity started at 0.49. Most digital solutions do not demand the presence of a trained professional and include an automatic digital screening system and scoring, which can enhance cognitive screening and monitoring. Digital solutions can potentially be used for cognitive screening in the community and clinical practice, but more investigation is needed for an evidence-based decision. A careful assessment of the accuracy levels and quality of evidence of each digital solution is recommended.
Source: crossref · Quality: baseline
Research context
OpenAlex topics: Dementia and Cognitive Impairment Research · Health, Environment, Cognitive Aging · Functional Brain Connectivity Studies
SciVX discovery tags are terminology-based. OpenAlex topics are source-provided classifications.
Affiliations
Department of Medical Sciences, University of Aveiro, 3810-193 Aveiro, Portugal
Center for Health Technology and Services Research—CINTESIS@RISE, School of Health Sciences, University of Aveiro, 3810-193 Aveiro, Portugal
EPIUnit—Institute of Public Health, Laboratory for Integrative and Translational Research in Population Health (ITR), University of Porto, 4050-600 Porto, Portugal
Neuroinova, Lda., 4410-463 Vila Nova de Gaia, Portugal
IEETA—Institute of Electronics and Informatics Engineering of Aveiro, Department of Medical Sciences, University of Aveiro, 3810-193 Aveiro, Portugal
Funding
PRR—Plano de Recuperação e Resiliência · NextGenerationEU funds at the University of Aveiro
References (81)
Show source-provided references
1. Does this patient have dementia?10.1001/jama.297.21.2391 ↗
2. Systematic review: Factors associated with risk for and possible prevention of cognitive decline in later life10.7326/0003-4819-153-3-201008030-00258 ↗
3. Ritchie, K., Carriere, I., Ritchie, C.W., Berr, C., Artero, S., and Ancelin, M.-L. (2010). Designing prevention programmes to reduce incidence of dementia: Prospective cohort study of modifiable risk factors. BMJ, 341.10.1136/bmj.c3885 ↗
4. Dementia prevention, intervention, and care10.1016/S0140-6736(17)31363-6 ↗
5. Physical frailty is associated with incident Mild Cognitive Impairment in community-based older persons10.1111/j.1532-5415.2009.02671.x ↗
6. US Preventive Services Task Force (2020). Screening for cognitive impairment in older adults: US Preventive Services Task Force recommendation statement. JAMA, 323, 757–763.10.1001/jama.2020.0435 ↗
7. Early detection of Mild Cognitive Impairment (MCI) in primary care
8. NIA-AA Research Framework: Toward a biological definition of Alzheimer’s disease10.1016/j.jalz.2018.02.018 ↗
9. Mild Cognitive Impairment: A concept in evolution10.1111/joim.12190 ↗
10. Higher risk of progression to dementia in Mild Cognitive Impairment cases who revert to normal10.1212/WNL.0000000000000055 ↗
11. Limpawattana, P., and Manjavong, M. (2021). The Mini-Cog, Clock Drawing Test, and Three-Item Recall Test: Rapid cognitive screening tools with comparable performance in detecting Mild NCD in older patients. Geriatrics, 6.10.3390/geriatrics6030091 ↗
12. De Roeck, E.E., De Deyn, P.P., Dierckx, E., and Engelborghs, S. (2019). Brief cognitive screening instruments for early detection of Alzheimer’s disease: A systematic review. Alzheimer’s Res. Ther., 11.10.1186/s13195-019-0474-3 ↗
13. What is the best dementia screening instrument for general practitioners to use?10.1097/01.JGP.0000216181.20416.b2 ↗
14. “Mini-mental state”: A practical method for grading the cognitive state of patients for the clinician10.1016/0022-3956(75)90026-6 ↗
15. The Montreal Cognitive Assessment, MoCA: A brief screening tool for Mild Cognitive Impairment10.1111/j.1532-5415.2005.53221.x ↗
16. The NUCOG: Validity and reliability of a brief cognitive screening tool in neuropsychiatric patients10.1080/j.1440-1614.2006.01923.x ↗
17. Comparison of the Saint Louis University Mental Status examination and the Mini-Mental State Examination for detecting dementia and mild neurocognitive disorder—A pilot study10.1097/01.JGP.0000221510.33817.86 ↗
18. Self-Administered Gerocognitive Examination (SAGE): A brief cognitive assessment instrument for Mild Cognitive Impairment (MCI) and early dementia10.1097/WAD.0b013e3181b03277 ↗
19. The utility of the Addenbrooke’s Cognitive Examination Version Three in early-onset dementia10.1159/000439248 ↗
20. Alzheimer’s Quick Test: Assessment of parietal lobe function10.1080/09084280701509257 ↗
21. Scenery Picture Memory Test: A new type of quick and effective screening test to detect early stage Alzheimer’s disease patients10.1111/j.1447-0594.2009.00576.x ↗
22. Buschke, H., Kuslansky, G., Katz, M., Stewart, W., Sliwinski, M., Eckholdt, H., and Lipton, R. (1999). Screening for dementia with the Memory Impairment Screen. Neurology, 52.10.1037/t28561-000 ↗
23. The Mini-Cog as a screen for dementia: Validation in a population-based sample10.1046/j.1532-5415.2003.51465.x ↗
24. The Mini-Cog: A cognitive ‘vital signs’ measure for dementia screening in multi-lingual elderly10.1002/1099-1166(200011)15:11<1021::AID-GPS234>3.0.CO;2-6 ↗
25. Is the Clock Drawing Test a screening tool for the diagnosis of Mild Cognitive Impairment? A systematic review10.1017/S1041610209990676 ↗
26. Can MoCA and MMSE be interchangeable cognitive screening tools? A systematic review10.1093/geront/gny126 ↗
27. Early detection of Mild Cognitive Impairment (MCI) in an at-home setting
28. Diaz-orueta, U., Blanco-Campal, A., Lamar, M., Libon, D.J., and Burke, T. (2020). Marrying past and present neuropsychology: Is the future of the process-based approach technology-based?. Front. Psychol., 11.10.3389/fpsyg.2020.00361 ↗
29. Comparing the electronic and standard versions of the Montreal Cognitive Assessment in an outpatient memory disorders clinic: A validation study10.3233/JAD-170896 ↗
30. MobileCogniTracker10.1007/s12652-018-0827-y ↗
31. Lauraitis, A., Maskeliūnas, R., Damaševičius, R., and Krilavičius, T. (2020). A mobile application for smart computer-aided self-administered testing of cognition, speech, and motor impairment. Sensors, 20.10.3390/s20113236 ↗
32. Initial validation of a web-based self-administered neuropsychological test battery for older adults and seniors10.1080/13803395.2015.1038220 ↗
33. Assmann, K.E., Bailet, M., Lecoffre, A.C., Galan, P., Hercberg, S., Amieva, H., and Kesse-Guyot, E. (2016). Comparison between a self-administered and supervised version of a web-based cognitive test battery: Results from the NutriNet-Santé cohort study. J. Med. Internet Res., 18.10.2196/jmir.4862 ↗
34. Morris, R.G., Evenden, J.L., Sahakian, B.J., and Robbins, T.W. (1987). Cognitive Neurochemistry, Oxford University Press.
35. Bevilacqua, R., Barbarossa, F., Fantechi, L., Fornarelli, D., Paci, E., Bolognini, S., Giammarchi, C., Lattanzio, F., Paciaroni, L., and Riccardi, G.R. (2023). Radiomics and artificial intelligence for the diagnosis and monitoring of Alzheimer’s disease: A systematic review of studies in the field. J. Clin. Med., 12.10.3390/jcm12165432 ↗
36. Bevilacqua, R., Felici, E., Cucchieri, G., Amabili, G., Margaritini, A., Franceschetti, C., Barboni, I., Paolini, S., Civerchia, P., and Raccichini, A. (2023). Results of the italian RESILIEN-T pilot study: A mobile health tool to support older people with Mild Cognitive Impairment. J. Clin. Med., 12.10.3390/jcm12196129 ↗
37. A survey on computer-assisted Parkinson’s disease diagnosis10.1016/j.artmed.2018.08.007 ↗
38. Lumsden, J., Edwards, E.A., Lawrence, N.S., Coyle, D., and Munafò, M.R. (2016). Gamification of cognitive assessment and cognitive training: A systematic review of applications and efficacy. JMIR Serious Games, 4.10.2196/games.5888 ↗
39. Macaskill, P., Gatsonis, C., Deeks, J., Harbord, R., and Takwoingi, Y. (2010). Cochrane Handbook for Systematic Reviews of Diagnostic Test Accuracy, Cochrane.
40. Moher, D., Liberati, A., Tetzlaff, J., Altman, D.G., and Group, T.P. (2009). Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA statement. PLoS Med., 6.10.1371/journal.pmed.1000097 ↗
41. Silva, A., Rocha, N., Martins, A., and Pais, J. (2022, March 31). Diagnostic accuracy of digital solutions to screen for cognitive impairment: A systematic review. Available online: http://srdta.cochrane.org/.
42. Cohen, J.F., Korevaar, D.A., Altman, D.G., Bruns, D.E., Gatsonis, C.A., Hooft, L., Irwig, L., Levine, D., Reitsma, J.B., and de Vet, H.C.W. (2016). STARD 2015 guidelines for reporting diagnostic accuracy studies: Explanation and elaboration. BMJ Open, 6.10.1136/bmjopen-2016-012799 ↗
43. Macaskill, P., Takwoingi, Y., Deeks, J.J., and Gatsonis, C. (2023). Cochrane Handbook for Systematic Reviews of Diagnostic Test Accuracy, John Wiley & Sons, Ltd.10.1002/14651858.ED000163 ↗
44. Clinical tests: Sensitivity and specificity10.1093/bjaceaccp/mkn041 ↗
45. QUADAS-2: A revised tool for the quality assessment of diagnostic accuracy studies10.7326/0003-4819-155-8-201110180-00009 ↗
46. GRADE guidelines: 21 part 1. Study design, risk of bias, and indirectness in rating the certainty across a body of evidence for test accuracy10.1016/j.jclinepi.2019.12.020 ↗
47. GRADE guidelines: 21 part 2. Test accuracy: Inconsistency, imprecision, publication bias, and other domains for rating the certainty of evidence and presenting it in evidence profiles and summary of findings tables10.1016/j.jclinepi.2019.12.021 ↗
48. Dinnes, J., Deeks, J.J., Leeflang, M.M., and Li, T. (2023). Cochrane Handbook for Systematic Reviews of Diagnostic Test Accuracy, John Wiley & Sons, Ltd.10.1002/14651858.ED000163 ↗
49. Takwoingi, Y., Dendukuri, N., Schiller, I., Rücker, G., Jones, H.E., Partlett, C., and Macaskill, P. (2023). Cochrane Handbook for Systematic Reviews of Diagnostic Test Accuracy, John Wiley & Sons, Ltd.
50. Graphical enhancements to summary receiver operating characteristic plots to facilitate the analysis and reporting of meta-analysis of diagnostic test accuracy data10.1002/jrsm.1439 ↗
51. Freeman, S.C., Kerby, C.R., Patel, A., Cooper, N.J., Quinn, T., and Sutton, A.J. (2019). Development of an interactive web-based tool to conduct and interrogate meta-analysis of diagnostic test accuracy studies: MetaDTA. BMC Med. Res. Methodol., 19.10.1186/s12874-019-0724-x ↗
52. Kokubo, N., Yokoi, Y., Saitoh, Y., Murata, M., Maruo, K., Takebayashi, Y., Shinmei, I., Yoshimoto, S., and Horikoshi, M. (2018). A new device-aided cognitive function test, User eXperience-Trail Making Test (UX-TMT), sensitively detects neuropsychological performance in patients with dementia and Parkinson’s disease. BMC Psychiatry, 18.10.1186/s12888-018-1795-7 ↗
53. Rhodius-meester, H.F.M., Paajanen, T., Koikkalainen, J., Mahdiani, S., Bruun, M., Baroni, M., Lemstra, A.W., Scheltens, P., Herukka, S., and Pikkarainen, M. (2020). cCOG: A web-based cognitive test tool for detecting neurodegenerative disorders. Alzheimer’s Dement., 12.10.1002/dad2.12083 ↗
54. Further validation of the Internet-based Dementia Risk Assessment10.3233/JAD-140297 ↗
55. Kalafatis, C., Modarres, M.H., Apostolou, P., and Marefat, H. (2021). Validity and cultural generalisability of a 5-minute AI-based, computerised cognitive assessment in Mild Cognitive Impairment and Alzheimer’s dementia. Front. Psychiatry, 12.10.3389/fpsyt.2021.706695 ↗
56. A brief computerized paired associate test for the detection of Mild Cognitive Impairment in community-dwelling older adults10.3233/JAD-160370 ↗
57. Alegret, M., Muñoz, N., Roberto, N., Rentz, D.M., Valero, S., Gil, S., Marquié, M., Hernández, I., Riveros, C., and Sanabria, A. (2020). A computerized version of the Short Form of the Face-Name Associative Memory Exam (FACEmemory®) for the early detection of Alzheimer’s disease. Alzheimer’s Res. Ther., 12.10.1186/s13195-020-00594-6 ↗
58. CogEvo, a cognitive function balancer, is a sensitive and easy psychiatric test battery for age-related cognitive decline10.1111/ggi.13847 ↗
59. Computerized Cognitive Screen (CoCoSc): A self-administered computerized test for screening for cognitive impairment in community social centers10.3233/JAD-170196 ↗
60. Computerized cognitive testing for use in clinical trials: A comparison of the NIH Toolbox and Cogstate C3 Batteries
61. Contributions of the Computer-Administered Neuropsychological Screen for Mild Cognitive Impairment (CANS-MCI) for the diagnosis of MCI in Brazil10.1017/S1041610214000726 ↗
62. Development of a computerized tool for the chinese version of the Montreal Cognitive Assessment for screening Mild Cognitive Impairment10.1017/S1041610214002269 ↗
63. Scharre, D.W., Chang, S., Nagaraja, H.N., Vrettos, N.E., and Bornstein, R.A. (2017). Digitally translated Self-Administered Gerocognitive Examination (eSAGE): Relationship with its validated paper version, neuropsychological evaluations, and clinical assessments. Alzheimer’s Res. Ther., 9.10.1186/s13195-017-0269-3 ↗
64. Feasibility and validity of the self-administered computerized assessment of Mild Cognitive Impairment with older primary care patients10.1097/WAD.0000000000000036 ↗
65. Screening for Mild Cognitive Impairment and dementia with automated, anonymous online and Telephone Cognitive Self-Tests10.3233/JAD-160566 ↗
66. The Computerized Self Test (CST): An interactive, internet accessible cognitive screening test for dementia10.3233/JAD-2010-1354 ↗
67. The MemTrax Test compared to the Montreal Cognitive Assessment estimation of Mild Cognitive Impairment10.3233/JAD-181003 ↗
68. Usability and validity of a battery of computerised cognitive screening tests for detecting cognitive impairment10.1159/000433432 ↗
69. Validation of a computerized Hong Kong-vigilance and memory test (HK-VMT) to detect early cognitive impairment in healthy older adults10.1080/13607863.2018.1523878 ↗
70. Validity, reliability, and psychometric properties of a computerized, cognitive assessment test (Cognivue®)10.5498/wjp.v10.i1.1 ↗
71. A brief digital cognitive assessment for detection of cognitive impairment in cuban older adults10.3233/JAD-200985 ↗
72. Validity of the MemTrax Memory Test compared to the Montreal Cognitive Assessment in the detection of Mild Cognitive Impairment and dementia due to Alzheimer’s disease in a chinese cohort10.3233/JAD-200936 ↗
73. Yan, M., Yin, H., Meng, Q., Wang, S., Ding, Y., Li, G., Wang, C., and Chen, L. (2021). A Virtual Supermarket Program for the screening of Mild Cognitive Impairment in older adults: Diagnostic accuracy study. JMIR Serious Games, 9.10.2196/preprints.30919 ↗
74. Ye, S., Sun, K., Huynh, D., Phi, H.Q., Ko, B., Huang, B., and Ghomi, R.H. (2022). A computerized cognitive test battery for detection of dementia and Mild Cognitive Impairment: Instrument validation study. JMIR Aging, 5.10.2196/preprints.36825 ↗
75. Accuracy of a self-administered online cognitive assessment in detecting Amnestic Mild Cognitive Impairment
76. Cheah, W., Hwang, J., Hong, S., Fu, L., and Chang, Y. (2022). A digital screening system for Alzheimer disease based on a neuropsychological test and a convolutional neural network: System development and validation. JMIR Med. Inform., 10.10.2196/31106 ↗
77. Montreal Cognitive Assessment in detecting cognitive impairment in chinese elderly individuals: A population-based study10.1177/0891988711422528 ↗
78. Practice parameter: Early detection of dementia: Mild Cognitive Impairment (an evidence-based review). Report of the Quality Standards Subcommittee of the American Academy of Neurology10.1212/WNL.56.9.1133 ↗
79. A meta-analysis of the accuracy of the Mini-Mental State Examination in the detection of dementia and Mild Cognitive Impairment10.1016/j.jpsychires.2008.04.014 ↗
80. World Health Organization (2014). WHO Handbook for Guideline Development.
81. Reitsma, J.B., Rutjes, A.W., Whiting, P., Yang, B., Leeflang, M.M., Bossuyt, P.M., and Deeks, J.J. (2023). Cochrane Handbook for Systematic Reviews of Diagnostic Test Accuracy, John Wiley & Sons, Ltd.10.1002/14651858.ED000163 ↗