P.L.ONG1, H.H.C.HERNANDEZ1, P.ANTHONY1, S.L.ANG1, M.S.NUR BAZILAH1, P.Y.S.YEW1, N.ALI1, J.P.LIM1, W.S.LIM1, J.CHEW1
Tan Tock Seng Hospital1
The COVID-19 pandemic spurred the need for cognitive assessment adapted for telemedicine. However, the reproducibility of F2F versus VC-based cognitive screening tools remains to be established, particularly in older adults with cognitive impairment. We aim to examine the reliability and agreement between F2F and VC administrations of the Abbreviated Mental Test (AMT), modified version of the Chinese Mini-Mental State Examination (CMMSE) and Chinese Frontal Assessment Battery (CFAB) in older adults with known or suspected cognitive impairment.
Patients recruited consecutively from a Memory Clinic in a tertiary hospital, underwent F2F followed by remote VC-based assessment by the same assessor within 3 weeks. We evaluated reliability using intraclass correlation coefficients (ICC, two-way random effects model), mean difference between VC and F2F-based assessments using paired sample t-tests and agreement using Bland-Altman plots.
Fifty-six subjects (Mean age 65.1±5.4 years, 91% very-mild to mild dementia; 9% moderate dementia using the Clinical Dementia Rating) completed AMT and CMMSE, of which 30 subjects completed CFAB. ICC showed good reliability for 3 assessments (AMT:0.80(95%CI 0.68-0.88); CMMSE:0.80(95%CI 0.63-0.88); CFAB:0.82(95%CI 0.66-0.91). However, VC-AMT and VC-CMMSE scores were significantly higher compared to F2F (mean difference[VC minus F2F], AMT:0.3±1.9,P=0.03; CMMSE:1.3±2.9,P=0.001). Bland-Altman plots indicated wide 95% limits of agreement (AMT-2.6 to 1.9; CMMSE:-6.9 to 3.2; CFAB:-3.6 to 3.2), exceeding a priori-defined levels of error.
We provide preliminary evidence for the reliability of VC-based assessment in older adults at an earlier stage of cognitive impairment, but further studies are required to identify patient and environmental factors influencing agreement between F2F and VC-based cognitive assessment.