Virtual assessments show promise for dementia, MCI diagnosis

Virtual cognitive assessments may achieve reliable and accurate diagnoses of dementia or mild cognitive impairment (MCI), though critical knowledge gaps still exist, a recent meta-analysis has found.

Drawing from the databases of Medline, Embase, CDSR, PsycINFO, and CENTRAL, as well as from the gray literature, the researchers identified 121 studies (n=15,832) eligible for analysis. Only papers using in-person cognitive assessments as a reference, identifying virtual test cut-offs for dementia or MCI, or describing correlations between virtual and in-person results were included.

Overall, there were 84 virtual cognitive tests employed, some of which had different versions or had subtests. Most (69.4 percent) studies administered tests through the phone; in turn, the Telephone Interview for Cognitive Status (TICS) or modified TICS were the most commonly used tests (33.9 percent).

Only three studies focused on the accuracy and reliability of virtual compared with in-person cognitive assessments. Weighted kappa estimates were 0.51 and 0.763 in two studies, respectively, suggesting good reliability. The third study, on the other hand, found 100-percent sensitivity and specificity for dementia diagnosis, though the patient sample had been highly selected.

Focusing on specific inventories, only the TICS and modified TICS had >2 studies with extractable data that compared outcomes with in-person assessments. Across all languages, TICS had an optimal dementia diagnosis cut-off value of 26, resulting in a pooled sensitivity and specificity of 0.80 and 0.90, respectively, with an area under the curve (AUC) of 0.92. In English alone, the cut-off value changed to 29, with respective accuracy estimates of 0.72, 0.85, and 0.86.

Modified TICS had a cut-off of 27 for diagnosing dementia, which yielded sensitivity, specificity, and AUC values of 0.85, 0.89, and 0.94, respectively.

“[A]lthough there is evidence supporting virtual cognitive testing and assessments, important knowledge gaps related to telephone assessments, in particular, must be filled,” the researchers said.