JMIR Publications

ABSTRACT

Introduction: Dementia is common in older adults; therefore, screening is important for clinical care and epidemiological surveillance. In Thailand, web-based cognitive assessment tools remain underdeveloped despite their potential for widespread implementation. This study aimed to develop a digital instrument to evaluate cognitive and functional abilities and to explore optimal cutoff scores for identifying cognitive impairment.

Methods:

We developed a web-based application—the Healthy Brain Test—that allows patients or family members to complete cognitive and functional assessments at home. The battery includes electronic versions of the Thai Mental State Examination (e-TMSE), a clock drawing test, and a category verbal fluency test. It also includes digital versions of the short form of the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE-16) and cognitive instrumental activities of daily living (IADLs). We computed correlations; generated receiver operating characteristic curves; and estimated sensitivity and specificity using PASW Statistics version 18 (SPSS Inc, Chicago, IL, USA).

Results:

We enrolled 198 participants (69% female; median age 69.4 years), and 57.1% had more than 6 years of formal education. Forty-four participants had major neurocognitive disorder, 58 had mild neurocognitive disorder, and 96 were normal controls. The e-TMSE correlated strongly with the paper-and-pencil Thai Mental State Examination (r = 0.837, p < 0.001). Category verbal fluency, IQCODE-16, and cognitive IADLs showed similarly significant correlations (p < 0.0001). For e-TMSE, the area under the curve was 0.84 (bootstrapped 95% CI 0.78–0.89); a cutoff of ≤ 23 yielded 88.64% sensitivity and 70.13% specificity for diagnosing major neurocognitive disorder. Conclusion: The e-TMSE, clock drawing, verbal fluency, IQCODE-16, and IADL assessments correlated significantly with established cognitive tests. The Healthy Brain Test web-based tool provides a practical, accessible option for early detection of cognitive impairment in clinical and community settings. Further research is needed to confirm effectiveness in broader, unsupervised populations.