In a recent study published in the journal JAMA Network Open, researchers evaluated the performance of the electronic Clinical Dementia Rating (eCDR) against that of other clinically administered assessments, including Clinical Dementia Rating (CDR), for cognitive impairment and dementia screening among older adults.
Alzheimer’s disease continues to be one of the major health concerns afflicting older adults and the functional and cognitive decline and disability associated with the disease drastically lowers their quality of life and often results in mortality.
Although substantial resources are being dedicated to the research on effective treatment methods for Alzheimer’s disease, the efficient assessment and identification of older individuals who are either at risk for or already present the cognitive decline associated with the disease continues to be a challenge.
An effective method for the screening and assessment of dementia and cognitive impairment that presents in Alzheimer’s disease patients is essential not only for the longitudinal monitoring of the patients, but also for clinical trials and research, and the effective management of the disease.
Furthermore, individuals with mild cognitive impairments might not be seeking medical aid. In this respect, a digital assessment method that can be administered remotely has the potential to be an effective method for the assessment and screening of cognitive impairment and dementia.
About the study
In the present study, the researchers evaluated the validity of the eCDR and compared it to CDR and other in-clinic assessment methods such as neuropsychological tests. CDR is the current, widely adopted benchmark for determining the stage of dementia.
It assesses functional and cognitive decline across various domains such as memory, problem-solving and judgment, orientation, personal care, community affairs, and hobbies and home.
However, CDR is conducted through semi-structured interviews conducted by assessors in the presence of the participant and a study partner. Furthermore, while it provides high internal consistency, responsiveness, and reliability, the long interview process and the clinical judgment requirements prevent it from being effective for longitudinal monitoring or screening for cognitive decline.
The digital eCDR is based on the item response theory analysis used in CDR and employs some of the main characteristics of CDR. However, the functional and cognitive impairment is assessed through online digital questionnaires that are completed by the participant and the study partner separately and in an unsupervised setting.
The eCDR does not require an assessor and can be administered through any personal digital device.
The participants for this study were recruited from multiple registries and research centers in the United States pertaining to brain health and Alzheimer’s disease. Individuals were included in the study if they were above the age of 55, were fluent in English, and had a study partner and access to a device connected to the internet.
Participants with a recent history of drug/alcohol dependence/abuse or a major uncontrolled/acute medical condition were excluded.
The baseline assessment using the eCDR was completed in-clinic by all participants, and the follow-up assessment was to be completed remotely within two weeks of the baseline assessment. A demographic questionnaire was used to obtain information on demographic variables including gender, age, ethnicity and race, and education.
The CDR box scores were obtained from the in-clinic assessment results available from the National Alzheimer Coordinating Centre.
The results reported that the eCDR was a valid and promising potential tool for screening and assessing older adults for functional and cognitive decline associated with Alzheimer’s disease.
The remotely administered eCDR showed high concordance with the results of the CDR administered in person, and the results were concordant at not only the item and box levels but also at global levels.
The correlation of scores for the eCDR and CDR had moderate to high accuracy, and the correlations between the eCDR scores and the other neuropsychological assessments also showed similar levels of correlation as CDR scores did with the same neuropsychological tests.
However, the researchers highlight the need for further steps to optimize, score, and validate the eCDR content for diverse populations and to test the ability of the eCDR to monitor functional and cognitive abilities remotely and longitudinally.
To summarize, the findings indicated that eCDR is a promising digital assessment method for the screening and longitudinal monitoring of dementia and functional and cognitive decline associated with Alzheimer’s disease, and can be used to efficiently assess and screen older adults.
However, further validation, optimization, and evaluation of the eCDR content is necessary for it to be widely applied to diverse populations.