JMIR Publications

ABSTRACT

Background:

With the rapid aging of the global population experts anticipate a surge in prevalence of mild cognitive impairment (MCI) and dementias worldwide. It is argued, that developing more sensitive, easy to administer, and valid screening tools for MCI in a primary care setting may initiate timelier clinical and personal care planning, treatment, and early access to programs and services that can support aging in place rather than institutionalization. Different screening tests for MCI have different sensitivity and specificity for different populations. Including measures of functional competence on screening tests, making them more ecologically valid, may help to identify cognitive deficits at an earlier stage.

Objective:

We aim to conduct a preliminary evaluative study comparing the sensitivity, specificity and reliability of the BrainFx® SCREEN™ (SCREEN™) a novel digital tool designed to assess functional competence and detect early signs of cognitive impairment, with the Qmci, a validated and highly sensitive tool that detects MCI in the older adult population. We will also investigate the feasibility and integration of the SCREEN™ into primary care practice, to identify demonstrable impacts on clinical workflow, and healthcare providers’ perceptions of its success as a screening tool. Patients’ perceptions of the use and impact on their quality of life from screening using the digital tool will also be explored.

Methods:

The study is a concurrent, mixed methods, prospective design using a quasi-experimental design. Participants will be recruited from five primary care Family Health Teams (FHTs; defined by multi-disciplinary practice and capitated funding) across southwestern Ontario, Canada. Participants include healthcare providers, patients, care partners and FHT administrative executives. Patients aged 55 years old and over with no history of diagnoses of MCI, dementia or Alzheimer’s disease, and who are rostered patients in one of the FHT participating in the study, will be eligible to participate. Their care partners will help triangulate qualitative data collected from the patients. Participating FHTs will identify one OT from their site to participate in the study. This health care provider (HCP) will both administer the research protocol as well as participate in semi-structured, in-depth interviews and questionnaires. Where available the FHT managing director will be interviewed to triangulate the HCP qualitative data. Principal component analysis will be conducted on both the SCREEN™ and Qmci to better understand the test components. Tests to compare sensitivity, specificity and test-retest reliability will assess the validity of the SCREEN™ as a screening tool for MCI.

Results:

The paper describes the study protocol and activities to date. Data collection was halted early due COVID-19 restrictions on research activity, and data analysis is currently in progress.

Conclusions:

At project’s end, we anticipate having an initial comparative evaluation of the SCREEN™ as a tool for early detection of MCI in primary care older adult populations. Resource constraints on this research study limit our ability to conduct a randomized, controlled trial, however results will assist developers of the SCREEN™ to determine whether rigorous controlled testing is warranted.