JMIR Publications

ABSTRACT

Background:

Digital short cognitive tests administered by medical assistants (MAs) in general practitioners (GP) practices have great potential for the timely identification of patients with possible dementia, because they can lead to targeted specialist referrals or to immediate reassurance of patients in regard to their perceived concerns. However, integration of this testing approach into clinical practice requires good usability for the test itself, especially for cognitively impaired older adults.

Objective:

Within this implementation study the digital version of the Montreal Cognitive Assessment (MoCA Duo) was conducted by MAs in general practice. Patients subsequently gave feedback on the interaction regarding the usability and workload of the digital test and the MAs rated the effort for the patients.

Methods:

In total, 10 GPs took part in the study. Within their practices, 299 GP patients (aged 51 to 97) with cognitive concerns completed the MoCA Duo administered by MAs. Subsequently, patients and MAs completed digital questionnaires regarding the interaction with the app. Usability was measured using the adapted System Usability Scale, perceived workload using the NASA-Task load index. Results of the MoCA Duo were supplied to the GPs for their consultation with the patient.

Results:

The results indicated good usability for the MoCA Duo. Self-assessment by the patients indicated that 64% could perform in the test to the best of their ability, affected by their MoCA score. We found significant higher usability ratings by patients with better MoCA scores, as well as for younger patients. Furthermore, the perceived workload showed overall medium workload. We found significant correlations between the subjective perceived workload of the patients, and the assessment by MAs. Self-assessments as well as assessments by the MAs were significantly influenced by the MoCA scores and the age of the participants.

Conclusions:

The results indicate good usability of the digital MoCA within the sample, supporting the idea that the resulting scores are adequate to assess the cognitive status without dependence on technological affinity. Furthermore, the results highlight the relevance of heterogenous samples for comparable evaluation studies, based on the significant effect of cognitive status and age on usability and workload.