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Lookup NU author(s): Dr Ríona McArdle
This is the final published version of a review published in its final definitive form in 2022. For re-use rights please refer to the publishers terms and conditions.
BackgroundRemote cognitive assessments are increasingly needed to assist in the detection ofcognitive disorders, but the diagnostic accuracy of telephone and video based cognitivescreening remains unclear.ObjectivesThe primary objective of this review was to assess the test accuracy of remote (telephoneand video call), multidomain cognitive screening assessments against the clinicaldiagnosis of dementia.The main secondary objective was to assess for potential differences in cognitivetestscoring when using a remote platform, we also reviewed those studies where aremotescreener was compared to the equivalent face-to-face test.Search methodsWe searched MEDLINE, Embase, PsycINFO, CINAHL, Web of Science, LILACS,CENTRAL, andUS National Institutes of Health Ongoing Trials Register ClinicalTrials.gov(www.clinicaltrials.gov/) databases on [2 June 2021]. We also searched ALOIS, theCDCIG Specialized Register.We performed forward and backward searching of includedcitations.Selection criteriaWe included cross-sectional studies, where a remote, multidomain assessment wasadministeredalongside a clinical diagnosis of dementia or equivalent face-to-face test.Data collection and analysisTwo review authors independently assessed risk of bias and extracted data,disagreementswere moderated by a third author. Our primary analysis was the accuracyof remoteassessments against a clinical diagnosis of dementia. Where data wereavailable wereported test accuracy as sensitivity and specificity. We did not performquantitativemeta-analysis as there were too few studies at individual test level.For those studies comparing remote versus in-person use of an equivalent screeningtest,if data allowed, we described correlations, reliability, differences in scoresand theproportion classified as having cognitive impairment for each test.Main resultsThe review contains 31 studies (19 differing tests, 3075 participants), of which sevenstudies (six telephone, one video call, n=756 participants) were relevant to our primaryobjective of describing test accuracy against a clinical diagnosis of dementia. Allstudieswere at unclear or high risk of bias in at least one domain, but were lowrisk inapplicability to the review question. Overall, sensitivity of remote toolsvaried with valuesbetween 26-100%, and specificity between 65-100%, with no clearlysuperior test.Across the 24 papers comparing equivalent remote and in-person tests (14 telephone,10video call), agreement between tests was good, but rarely perfect (correlationco-efficientrange: 0.48-0.98).Authors' conclusionsDespite the common and increasing use of remote cognitive assessment, supportingevidenceon test accuracy is limited. Available data do not allow us to suggest a preferredtest. Remote testing is complex, and this is reflected in the heterogeneity seen intestsused, their application and their analysis. More research is needed to describeaccuracyof contemporary approaches to remote cognitive assessment. While data comparingremote and in-person use of a test were reassuring, thresholds and scoring rules derivedfrom in-person testing may not be applicable when the equivalent test is adapted forremote use.
Author(s): Beishon LC, Elliott E, Hietamies TM, Mc Ardle R, O'Mahony A, Elliott AR, Quinn TJ
Publication type: Review
Publication status: Published
Journal: Cochrane Database of Systematic Reviews
Online publication date: 08/04/2022
Acceptance date: 28/03/2022
ISSN (electronic): 1469-493X
ePrints DOI: 10.57711/8bz8-fg02
Notes: Protocol first published: Issue 9, 2020