A Brief Digital Cognitive Assessment for Detection of Cognitive Impairment in Cuban Older Adults

Article type: Research Article

Authors: Rodríguez-Salgado, Ana M.^{a; b; 1} | Llibre-Guerra, Jorge J.^{a; b; c; *; 1} | Tsoy, Elena^d | Peñalver-Guia, Ana Ibis^a | Bringas, Giosmany^a | Erlhoff, Sabrina J.^d | Kramer, Joel H.^{b; d} | Allen, Isabel Elaine^e | Valcour, Victor^{b; d} | Miller, Bruce L.^{b; d} | Llibre-Rodríguez, Juan J.^f | Possin, Katherine L.^{b; d}

Affiliations: [a] Department of Neurology, National Institute of Neurology and Neurosurgery, La Havana, Cuba. | [b] Global Brain Health Institute, University of California San Francisco, San Francisco, CA, USA. | [c] Department of Neurology, Washington University in St Louis, St Louis, MO, USA. | [d] Department of Neurology,Memory and Aging Center, University of California San Francisco, San Francisco, CA, USA. | [e] Department of Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, CA, USA. | [f] Alzheimer Research Center, Havana School of Medicine, La Havana, Cuba.

Correspondence: [*] Correspondence to: Jorge J. Llibre Guerra, MD, MSc, Department of Neurology, National Institute of Neurology and Neurosurgery, 29 y D Vedado, La Havana, Cuba. E-mail: jorge.llibre@gbhi.org.

Note: [1] These authors contributed equally to this work.

Abstract: Background:Rapid technological advances offer a possibility to develop cost-effective digital cognitive assessment tools. However, it is unclear whether these measures are suitable for application in populations from Low and middle-income countries (LMIC). Objective:To examine the accuracy and validity of the Brain Health Assessment (BHA) in detecting cognitive impairment in a Cuban population. Methods:In this cross-sectional study, 146 participants (cognitively healthy = 53, mild cognitive impairment (MCI) = 46, dementia = 47) were recruited at primary care and tertiary clinics. The main outcomes included: accuracy of the BHA and the Montreal Cognitive Assessment (MoCA) in discriminating between controls and cognitively impaired groups (MCI and dementia) and correlations between the BHA subtests of memory, executive functions, and visuospatial skills and criterion-standard paper-and-pencil tests in the same domains. Results:The BHA had an AUC of 0.95 (95% CI: 0.91–0.98) in discriminating between controls and cognitively impaired groups (MCI and dementia, combined) with 0.91 sensitivity at 0.85 specificity. In discriminating between control and MCI groups only, the BHA tests had an AUC of 0.94 (95% CI: 0.90–0.99) with 0.71 sensitivity at 0.85 specificity. Performance was superior to the MoCA across all diagnostic groups. Concurrent and discriminant validity analyses showed moderate to strong correlations between the BHA tests and standard paper-and-pencil measures in the same domain and weak correlations with standard measures in unrelated domains. Conclusion:The BHA has excellent performance characteristics in detecting cognitive impairment including dementia and MCI in a Hispanic population in Cuba and outperformed the MoCA. These results support potential application of digital cognitive assessment for older adults in LMIC.

Keywords: Mild cognitive impairment, primary care, tablet-based cognitive screening

DOI: 10.3233/JAD-200985

Journal: Journal of Alzheimer's Disease, vol. 79, no. 1, pp. 85-94, 2021