A research team spent years evaluating the diagnostic accuracy of BrainCheck compared to commonly-used cognitive assessments, and physicians just might benefit from their findings
BrainCheck Assess, a battery of rapid digital neurocognitive tests, provides a sensitive and specific metric for age-related cognitive impairment in older adults, with the advantages of a mobile, digital, and easy-to-use test, according to a recent study published in JMIR Aging.
Dr. Karina Soto-Ruiz, director of clinical development at BrainCheck, and colleagues sought to determine the accuracy and validity of BrainCheck Assess as a diagnostic aid for age-related cognitive impairment, as compared against physician diagnosis and other commonly used neurocognitive screening tests, including the Saint Louis University Mental Status (SLUMS) exam, the Mini-Mental State Examination (MMSE), and the Montreal Cognitive Assessment (MoCA).
Methods
The team of researchers tested 583 volunteers over the age of 49 from various community centers and living facilities in Houston, Texas.
The volunteers were divided into five cohorts: a normative population and four comparison groups for the SLUMS exam, the MMSE, the MoCA, and physician diagnosis. Each comparison group completed their respective assessment and BrainCheck Assess.
BrainCheck Assess significantly correlated to the SLUMS exam, MMSE and MoCA
BrainCheck Assess correlated to the SLUMS exam, with coefficients ranging from 0.5 to 0.7. Correlation coefficients for the MMSE and BrainCheck and the MoCA and BrainCheck were also significant. Of the 18 subjects evaluated by a physician, 9 (50%) were healthy, 6 (33%) were moderately impaired, and 3 (17%) were severely impaired. A significant difference was found between the severely and moderately impaired subjects and the healthy subjects (P=.02).
The researchers derived a BrainCheck Assess composite score that showed stronger correlations with the standard assessments. Receiver operating characteristic (ROC) curve analysis of this composite score found a sensitivity of 81% and a specificity of 94%.
Although commonly used in clinical practice, none of the exams noted above are considered the “gold standard” for cognitive screening. While they have relatively high sensitivities and specificities, each contains shortcomings.
Limitations of the MoCA, MMSE, and SLUMS exam in assessing cognitive impairment
The MMSE relies heavily on memory and language, with little emphasis on other cognitive domains, such as executive function and visuospatial attention.
The SLUMS exam includes tests of executive function but is inferior to the MMSE when assessing activities of daily living (ADLs) and functionality.
Furthermore, these screening tools are verbally administered by a physician or test administrator, with responses and scores recorded with pen and paper.
When integrated into a physician assessment, the tools may be time-consuming, and the need for a test administrator may increase expenses but adds no additional physician reimbursement.
While the screening instruments are relatively simple to administer, it is uncertain whether the instruments are commonly administered and scored as intended in routine clinical practice. For example, a European study reported significant score discrepancies between MMSEs performed by general practitioners and neuropsychologists.
How digital cognitive assessment can help physicians
Digital neurocognitive testing has several advantages that include the following:
- Elimination of potential practice effects and floor or ceiling effects, typically seen in pen-and-paper versions
- Automated administration and scoring of the test items
- Automatic integration with electronic medical records
In addition, digital testing can be readily delegated to a technician, thus focusing the clinician’s time on interpretation and decision making, rather than test administration and scoring.
