Researchers from Japan have shared the updated version, along with validity testing, of their iPad app for dementia screening in the journal PLoS One.
The Cognitive Assessment for Dementia, iPad version (CADi) is an iPad-based screening test for dementia that utilizes ten questions assessing several domains of cognition, with a focus on those impacted the most by dementia. According the authors, the impetus for the app was that community health screenings are particularly prevalent in their community and they wanted to create a tool for simple, mobile screening.
The first version of the CADi iPad app included questions around immediate recognition, long term memory, categorization, subtraction, backward repetition, cube rotation, pyramid rotation, making sequences, and delayed recognition.
In CADi2 iPad app, they swapped out the categorization and pyramid rotation components with tasks focused on orientation to time in an effort to improve test performance. Some items in the test include:
Item 1: Three words (cat, bus, and orange) are presented via audio slowly, one at a time. The list is presented twice. The participant is asked to select the three studied words from a set of six choices (cat, dog, bus, train, apple, and orange). Then the participant is instructed to remember these three words because they will be asked to recall them later.
Item 8: Six digits (1, 2, 3, 4, 5, and 6) are presented at random positions on the screen. The participant is asked to touch the digits on the screen from 1 to 6 in sequential order.
They recruited 27 patients with known dementia and a group of matched, healthy controls. In this validation test of CADi2, they utilized a variety of different scoring strategies that integrated both the raw score and the time to complete the test using ROC analysis. Using two different methods that both integrate the raw score and time, they achieved sensitivities and specificities of 0.96/0.89 with one technique and 0.93/0.93 with the other.
This study demonstrates interesting potential in simplifying and extending dementia screening into the community. Clearly one limitation is that a patient with more moderate or severe dementia may not be able to complete the test; as such, some assistance, though not necessarily from a healthcare professional, may be required. That being said, strategies like these are likely to become part of multi-faceted strategies for identifying patients in the community in need of care and support.