Clinical Manifestations.

Abstract

Tools for web-based testing to detect cognitive impairment are still underdeveloped in Thailand. Our aim was to generate a web-based instrument to assess cognitive and functional abilities and to explore its ability for diagnosis of dementia and MCI. We have developed a web application for cognitive and functional assessment to detect cognitive impairment. We hoped that subjects or family members could use this web-based tests at home as self-screening. These web-based tests included an electronic version of the Thai Mental State Examination (e-TMSE), a clock drawing test, a category verbal fluency test, a short form of the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE), and Thai activities of daily living scale (Thai ADL). Correlations, receiver operator curves (ROCs), sensitivity, and specificity were analyzed using SPSS (version 18). A total of 198 participants (69% female, mean age 66.7 ± 10 years). 57.1% had education of more than 6 years. Forty-four were Major Neurocognitive Disorder, fifty-eight were Mild Neurocognitive Disorder (MCI), and ninety-six were normal controls. The e-TMSE correlated with both paper-pencil based TMSE(r = 0.80,p<0.001) as well as clock drawing test (r = 0.470 p<0.001). There were also statistically significant high correlations between digital and paper & pencil tests (e.g, category verbal fluency test, A short form of the IQCODE, and ADL). For diagnosis of dementia, e-TMSE achieved an AUC of 0.84 (95% bootstrapped CI [0.78, 0.90]. The cut-off score ≤23 offered sensitivity and specificity of 88.6% and 70.1% respectively. For diagnosis of dementia with the combination of 5 e-tests, the AUC was 0.832 (p<0.001), while for MCI diagnosis, the AUC was 0.615 (p = 0.013). The area under the ROC of the IQCODE combined with ADL scale test was 0.907 (p<0.001). We demonstrated that our web application that included: e-TMSE, clock drawing test, category verbal fluency test, IQCODE and Thai-ADL scale showed good correlation between digital vs paper-pencil tests. Individual e-test and combination of them can offer self screening for MCI and dementia.