Researchers examined data from 121 studies with a total of 15,832 adult participants who had no prior diagnosis of dementia or mild cognitive impairment and underwent assessments either in-person or via virtual visits using videoconference or telephone.
Compared with in-person assessments, videoconference assessments were effective for diagnosing dementia with good reliability (kappa 0.63 and 0.51, respectively) in two studies included in the analysis. In a third study, researchers found that virtual assessments done via video were 100% sensitive and specific compared with in-person evaluations for diagnosing dementia.
"I'm not surprised that virtual video cognitive assessments might work as well as in-person exams because clinicians can still gather information about patient's symptoms of cognitive changes such as decreased ability to remember recent events, collateral history from friends or family members who know the patient well, and conduct cognitive testing in much the same way as we would in-person," said lead study author Dr. Jennifer Watt, a geriatrician at St. Michael's Hospital-Unity Health Toronto and an assistant professor in the Department of Medicine at the University of Toronto in Canada.
"Video-based cognitive assessments may be an accurate and reliable alternative to in-person cognitive assessments," Dr. Watt said, but noted that this is based on only three studies and further research is needed to confirm these findings.
While researchers didn't identify any studies that directly compared virtual telephone assessments to in-person assessments, they did find several studies highlighting how factors such as hearing impairment and experience level with technology might influence the efficacy of virtual visits, Dr. Watt said by email.
Only two types of virtual cognitive tests were compared with in-person tests in more than two studies facilitating meta-analysis, the Telephone Interview for Cognitive Status (TICS) and the modified TICS.
For the TICS assessment (maximum score of 41), researchers determined an optimal cutoff suggestive of dementia of 22 to 23 points overall, and 28 or 30 points when conducted in English. When researchers looked at an optimal cutoff score of 26 points, they found a pooled sensitivity of 0.80 and pooled specificity of 0.90.
For the modified TICS assessment (maximum score of 41), researchers set an optimal cutoff score of 27 and found a pooled sensitivity of 0.85 and a pooled specificity of 0.89.
One limitation of the analysis is that the experience and training of persons administering the cognitive tests in each of the studies in the analysis wasn't always clearly articulated, nor was the participants' baseline level of cognitive function, the researchers note in the Journal of the American Geriatrics Society.
Even so, the study results support a growing body of literature reflecting the increasing reliance on telehealth in geriatrics and demonstrating that virtual cognitive assessment is feasible, reliable, and valid as an alternative to in-person visits, said C. Munro Cullum, scientific director of the Texas Alzheimer's Research and Care Consortium at the University of Texas Southwestern Medical Center in Dallas.
"The findings from this paper aren't surprising at all," Cullum, who wasn't involved in the study, said by email. "They focused on studies using brief cognitive screening tests in studies using DSM clinical diagnoses, and all the studies have been supportive in the literature."
SOURCE: https://bit.ly/3op3Ljl Journal of the American Geriatrics Society, online May 4, 2021.
By Lisa Rapaport
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