A comparison of remote and in-clinic digital cognitive assessments for older adults in primary care settings

Abstract

Background: Timely identification of mild cognitive impairment (MCI) is critical for maximizing early intervention opportunities in older adults at risk for dementia. This study evaluated the feasibility, acceptability, and validity of novel digital cognitive tests in primary care.

Methods: In a two-phase pilot study across three clinics, 51 older adults completed digital cognitive assessments remotely on personal devices followed by supervised tablet-based cognitive screening in-clinic and the Montreal Cognitive Assessment (MoCA). Surveys and interviews assessed patient and provider acceptability. Digital test completion rates were examined to assess feasibility.

Results: Completion rates ranged from 61.5% - 76% for the at-home assessments and 81.8% for in-clinic testing. Participants generally preferred at-home testing. Providers found in-clinic testing acceptable but identified barriers related to device access and EMR integration. All but one digital test showed moderate correlations with the MoCA.

Conclusion: Digital cognitive screening-whether remote or in-clinic-shows promise for primary care implementation.

Keywords: Alzheimer’s disease; Cognitive Screening; Digital Assessment; Early Detection; Mild Cognitive Impairment; Primary Care.

Figure 1.. Protocol schedules for each phase of piloting.

Note. PCP = Primary Care Provider, t-MoCA and MoCA = Telephone version and standard version, respectively, of the Montreal Cognitive Screening Assessment, BOCA = Boston Cognitive Assessment, DCR = Digital Clock and Recall test, CANTAB PAL = Cambridge Neuropsychological Test Automated Battery Paired Associates Learning test, M2C2 = Mobile Monitoring of Cognitive Change.