Development of a Novel Self-administered Cognitive Assessment Tool and Normative Data for Older Adults

Monsch, Raphael; Burckhardt, Amélie C; Berres, Manfred; Thomann, Alessandra; Ehrensperger, Michael M.; Steiner, Luzius A.; Goettel, Nicolai

doi:10.1097/ana.0000000000000510

Cited by 14 publications

(12 citation statements)

References 42 publications

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“…Using a tablet display and stylus this new tablet‐based dCDT provides immediate feedback to the user about dCDT metrics without requiring an external computer. In this study, the dCDT took ~2 minutes to complete and was faster than other perioperative tablet‐based applications for screening cognition 27,37 . Finally, a distinct advantage of the dCDT compared to paper‐based tests is its potential for integration with electronic medical records.…”

Section: Discussionmentioning

confidence: 90%

“…In this study, the dCDT took ~2 minutes to complete and was faster than other perioperative tablet-based applications for screening cognition. 27,37 Finally, a distinct advantage of the dCDT compared to paper-based tests is its potential for integration with electronic medical records.…”

Section: Expansionmentioning

confidence: 99%

“…Current literature exploring the impact of tablet device proficiency on computerised cognitive testing performance is mixed. [24][25][26] In terms of other interactive tablet software, the authors are aware of several computerised cognitive assessment tools, [27][28][29] which may be used in the preoperative period. However, in this setting, acceptability, efficiency of administration in addition to sensitivity are of prime importance.…”

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confidence: 99%

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A novel digital clock drawing test as a screening tool for perioperative neurocognitive disorders: A feasibility study

Buckley

Atkins

Fortunato

et al. 2020

Acta Anaesthesiol Scand

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Background We developed a digital clock drawing test (dCDT), an adaptation of the original pen and paper clock test, that may be advantageous over previous dCDTs in the perioperative environment. We trialed our dCDT on a tablet device in the preoperative period to determine the feasibility of administration in this setting. To assess the clinical utility of this test, we examined the relationship between the performance on the test and compared derived digital clock measures with the 4 A's Test (4AT), a delirium and cognition screening tool. Methods We recruited a sample of 102 adults aged 65 years and over presenting for elective surgery in a single tertiary hospital. Participants completed the 4AT, followed by both command and copy clock conditions of the dCDT. We recorded time‐based clock‐drawing metrics, alongside clock replications scored using the Montreal Cognitive Assessment (MoCA) clock scoring criteria. Results The dCDT had an acceptance rate of 99%. After controlling for demographic variables and prior tablet use, regression analyses showed higher 4AT scores were associated with greater dCDT time (seconds) for both command (β = 8.2, P = .020) and copy clocks (β = 12, P = .005) and lower MoCA‐based clock scores in both command (OR = 0.19, P = .001) and copy conditions (OR = 0.14, P = .012). Conclusion The digital clock drawing test is feasible to administer and is highly acceptable to older adults in a preoperative setting. We demonstrated a significant association between both the dCDT time and clock score metrics, with the established 4AT. Our results provide convergent validity of the dCDT in the preoperative setting.

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Section: Discussionmentioning

confidence: 90%

Section: Expansionmentioning

confidence: 99%

mentioning

confidence: 99%

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A novel digital clock drawing test as a screening tool for perioperative neurocognitive disorders: A feasibility study

Buckley

Atkins

Fortunato

et al. 2020

Acta Anaesthesiol Scand

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“…However, traditional paper and pencil assessments are lengthy and expensive and require considerable training on the part of the assessor. Given these concerns and the rising availability of personal mobile technologies, a movement to capture reliable cognitive functioning digitally has begun [9][10][11][12]. Although remote cognitive technologies are still budding, they promise several benefits in clinical and research settings.…”

Section: Introductionmentioning

confidence: 99%

Testing a Novel Web-Based Neurocognitive Battery in the General Community: Validation and Usability Study

Capizzi¹,

Fisher²,

Biagianti³

et al. 2021

J Med Internet Res

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Background In recent years, there has been increased interest in the development of remote psychological assessments. These platforms increase accessibility and allow clinicians to monitor important health metrics, thereby informing patient-centered treatment. Objective In this study, we report the properties and usability of a new web-based neurocognitive assessment battery and present a normative data set for future use. Methods A total of 781 participants completed a portion of 8 tasks that captured performance in auditory processing, visual-spatial working memory, visual-spatial learning, cognitive flexibility, and emotional processing. A subset of individuals (n=195) completed a 5-question survey measuring the acceptability of the tasks. Results Between 252 and 426 participants completed each task. Younger individuals outperformed their older counterparts in 6 of the 8 tasks. Therefore, central tendency data metrics were presented using 7 different age bins. The broad majority of participants found the tasks interesting and enjoyable and endorsed some interest in playing them at home. Only 1 of 195 individuals endorsed not at all for the statement, “I understood the instructions.” Older individuals were less likely to understand the instructions; however, 72% (49/68) of individuals over the age of 60 years still felt that they mostly or very much understood the instructions. Conclusions Overall, the tasks were found to be widely acceptable to the participants. The use of web-based neurocognitive tasks such as these may increase the ability to deploy precise data-informed interventions to a wider population.

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“…At present, the available digitised cognitive screening tools take over 10 min to administer. [18][19][20] A new tool that is easily and efficiently administered would maximise the benefits of digitised screening tools (e.g., precise and objective measurement of performance, potential for integration with electronic medical records), particularly for patients with cognitive impairment.…”

Section: Introductionmentioning

confidence: 99%

Digital clock drawing test metrics in older patients before and after endoscopy with sedation: An exploratory analysis

Buckley

Atkins

Silbert

et al. 2021

Acta Anaesthesiol Scand

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Background: In the postoperative period, clinically feasible instruments to monitor elderly patients' neurocognitive recovery and discharge-readiness, especially after short-stay procedures, are limited. Cognitive monitoring may be improved by a novel digital clock drawing test (dCDT). We screened for cognitive impairment with the 4 A Test (4AT) and then administered the dCDT pre and post short-stay procedure (endoscopy). The primary aim was to investigate whether the dCDT was sensitive to a change in cognitive status postendoscopy. We also investigated if preoperative cognitive status impacted postendoscopy dCDT variables. Methods:We recruited 100 patients ≥65 years presenting for endoscopy day procedures at a single metropolitan hospital. Participants were assessed after admission and immediately before discharge from the hospital. We administered the 4AT, followed by both command and copy clock conditions of the dCDT. We analysed the total drawing time (dCDT time), as well as scored the drawn clock against the established Montreal Cognitive Assessment (MoCA) criteria both before and after endoscopy.Results: Linear regression showed higher 4AT test scores (poorer performance) were associated with longer postoperative dCDT time (β = 5.6, p = 0.012) for the command condition after adjusting for preoperative baseline dCDT metrics, sex, age, and years of education. Conclusion:Postoperative dCDT time-based variables slowed in those with baseline cognitive impairment detected by the 4AT, but not for those without cognitive impairment. Our results suggest the dCDT, using the command mode, may help detect cognitive impairment in patients aged >65 years after elective endoscopy.

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Development of a Novel Self-administered Cognitive Assessment Tool and Normative Data for Older Adults

Abstract: This study provides normative data for a novel self-administered tablet computer application that is ultimately designed to measure the individual risk for adverse postoperative cognitive outcomes in elderly patients.

Cited by 14 publications

References 42 publications

A novel digital clock drawing test as a screening tool for perioperative neurocognitive disorders: A feasibility study

A novel digital clock drawing test as a screening tool for perioperative neurocognitive disorders: A feasibility study

Testing a Novel Web-Based Neurocognitive Battery in the General Community: Validation and Usability Study

Digital clock drawing test metrics in older patients before and after endoscopy with sedation: An exploratory analysis

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