A voice recognition-based digital cognitive screener for dementia detection in the community: Development and validation study

Xuhao Zhao, Ruofei Hu, Haoxuan Wen, Guohai Xu, Ting Pang, Xindi He, Yaping Zhang, Ji Zhang, Christopher Chen, Xifeng Wu, Xin Xu, Xuhao Zhao, Ruofei Hu, Haoxuan Wen, Guohai Xu, Ting Pang, Xindi He, Yaping Zhang, Ji Zhang, Christopher Chen, Xifeng Wu, Xin Xu

Abstract

Introduction: To facilitate community-based dementia screening, we developed a voice recognition-based digital cognitive screener (digital cognitive screener, DCS). This proof-of-concept study aimed to investigate the reliability, validity as well as the feasibility of the DCS among community-dwelling older adults in China.

Methods: Eligible participants completed demographic, clinical, and the DCS. Diagnosis of mild cognitive impairment (MCI) and dementia was made based on the Montreal Cognitive Assessment (MoCA) (MCI: MoCA < 23, dementia: MoCA < 14). Time and venue for test administration were recorded and reported. Internal consistency, test-retest reliability and inter-rater reliability were examined. Receiver operating characteristic (ROC) analyses were conducted to examine the discriminate validity of the DCS in detecting MCI and dementia.

Results: A total of 103 participants completed all investigations and were included in the analysis. Administration time of the DCS was between 5.1-7.3 min. No significant difference (p > 0.05) in test scores or administration time was found between 2 assessment settings (polyclinic or community center). The DCS showed good internal consistency (Cronbach's alpha = 0.73), test-retest reliability (Pearson r = 0.69, p < 0.001) and inter-rater reliability (ICC = 0.84). Area under the curves (AUCs) of the DCS were 0.95 (0.90, 0.99) and 0.77 (0.67, 086) for dementia and MCI detection, respectively. At the optimal cut-off (7/8), the DCS showed excellent sensitivity (100%) and good specificity (80%) for dementia detection.

Conclusion: The DCS is a feasible, reliable and valid digital dementia screening tool for older adults. The applicability of the DCS in a larger-scale community-based screening stratified by age and education levels warrants further investigation.

Keywords: MCI; MoCA; dementia; digital cognitive screening; reliability; validity.

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2022 Zhao, Hu, Wen, Xu, Pang, He, Zhang, Zhang, Chen, Wu and Xu.

Figures

FIGURE 1
FIGURE 1
Administration process of DCS.
FIGURE 2
FIGURE 2
Flow diagram of participants.
FIGURE 3
FIGURE 3
Participants test score on the DCS by cognitive outcomes.
FIGURE 4
FIGURE 4
Bland-Altman plot of machine and manual scoring.
FIGURE 5
FIGURE 5
Receiver Operating Characteristic (ROC) curves of the DCS for discriminating among participants with MCI and dementia.

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