Introduction
By 2050, it is expected that the number of people with Alzheimer’s disease (AD) and related dementia (ADRD) may exceed 131 million worldwide.1 AD’s incidence rate and morbidity have steadily increased to become the fifth leading cause of death among urban and rural residents in China.2 Delivering clinical treatment and care to this population has become a public health concern. Unfortunately, no effective medical treatments are available to cure ADRD at this time.3 4 However, early screening and detection can help promote lifestyle changes, which can reduce the risks of cognitive decline.5 6 Therefore, a reliable screening tool to detect mild cognitive impairment (MCI), a stage where interventions can be delivered to postpone disease onset, is needed.
Currently, several tests are used for the clinical assessment of MCI, such as positron emission tomography imaging, structural magnetic resonance imaging (MRI) and genetic biomarkers in the peripheral blood and cerebrospinal fluid.5 7 8 However, these clinical tests are limited by their high cost, inaccessibility and invasiveness. For now, paper-based neurocognitive screening scales remain the most commonly used tools.
Established cognition screening scales such as the Mini-Mental State Examination (MMSE),9 the Montreal Cognitive Assessment (MoCA),10 the Mini-Cog Test,11 the General Practitioner Assessment of Cognition (GPCOG)12 and the Brief Alzheimer Screen (BAS)13 are commonly used to screen for dementia in the community. Challenges with the application of these screening tools include the demand for qualified assessors and other implementation resources. Furthermore, the accuracy of results in many of these screening tools is affected by the cultural background of the participants, especially in non-English-speaking countries.14 One plausible way to overcome these limitations is the utilisation of a self-administered online cognitive test.
Several computerised cognitive tests have been applied to older adults over the past few years. Two examples, the Computer-Administered Neuropsychological Screen for Mild Cognitive Impairment (CANS-MCI) and the Automatic Neuropsychological Assessment Metrics (ANAM) battery, were designed as self-administered screening tests for MCI.15 16 However, the longer administration time makes them less suitable for screening compared with the MMSE, although their self-evaluated formats are more suitable for large-scale assessment and research.17 The MemTrax, another technology-based assessment tool for MCI, has improved its administration time. However, it only captures episodic memory, which makes it insufficient to identify subtle impairments at the very early stage of cognitive dysfunction.18 As a result, a quick and comprehensive cognitive online test to identify individuals with cognitive deficits in the earliest stages of the disease has not yet been developed.
This gap in the literature led us to design a time-saving and comprehensive cognition assessment tool called the Thoven Cognitive Self-Assessment (TCSA). The objective of this study was to show the details of this tool as well as the validity and reliability of the TCSA.