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Evaluation of the Electronic Clinical Dementia Rating for Dementia Screening

IMPORTANCE: The Clinical Dementia Rating (CDR) is a well-validated instrument widely used to detect and stage dementia due to Alzheimer disease. The digital Electronic Clinical Dementia Rating (eCDR) can be remotely self-administered and automatically scored, with potential to facilitate efficient d...

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Autores principales: Nosheny, Rachel L., Yen, Daniel, Howell, Taylor, Camacho, Monica, Moulder, Krista, Gummadi, Shilpa, Bui, Chau, Kannan, Sandhya, Ashford, Miriam T., Knight, Kristen, Mayo, Connie, McMillan, Maureen, Petersen, Ronald C., Stricker, Nikki H., Roberson, Erik D., Chambless, Carol, Gersteneker, Adam, Martin, Roy, Kennedy, Richard, Zhang, Yue, Kukull, Walter, Flenniken, Derek, Fockler, Juliet, Truran, Diana, Mackin, R. Scott, Weiner, Michael W., Morris, John C., Li, Yan
Formato: Online Artículo Texto
Lenguaje:English
Publicado: American Medical Association 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10502518/
https://www.ncbi.nlm.nih.gov/pubmed/37707812
http://dx.doi.org/10.1001/jamanetworkopen.2023.33786
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author Nosheny, Rachel L.
Yen, Daniel
Howell, Taylor
Camacho, Monica
Moulder, Krista
Gummadi, Shilpa
Bui, Chau
Kannan, Sandhya
Ashford, Miriam T.
Knight, Kristen
Mayo, Connie
McMillan, Maureen
Petersen, Ronald C.
Stricker, Nikki H.
Roberson, Erik D.
Chambless, Carol
Gersteneker, Adam
Martin, Roy
Kennedy, Richard
Zhang, Yue
Kukull, Walter
Flenniken, Derek
Fockler, Juliet
Truran, Diana
Mackin, R. Scott
Weiner, Michael W.
Morris, John C.
Li, Yan
author_facet Nosheny, Rachel L.
Yen, Daniel
Howell, Taylor
Camacho, Monica
Moulder, Krista
Gummadi, Shilpa
Bui, Chau
Kannan, Sandhya
Ashford, Miriam T.
Knight, Kristen
Mayo, Connie
McMillan, Maureen
Petersen, Ronald C.
Stricker, Nikki H.
Roberson, Erik D.
Chambless, Carol
Gersteneker, Adam
Martin, Roy
Kennedy, Richard
Zhang, Yue
Kukull, Walter
Flenniken, Derek
Fockler, Juliet
Truran, Diana
Mackin, R. Scott
Weiner, Michael W.
Morris, John C.
Li, Yan
author_sort Nosheny, Rachel L.
collection PubMed
description IMPORTANCE: The Clinical Dementia Rating (CDR) is a well-validated instrument widely used to detect and stage dementia due to Alzheimer disease. The digital Electronic Clinical Dementia Rating (eCDR) can be remotely self-administered and automatically scored, with potential to facilitate efficient dementia screening and staging. OBJECTIVE: To evaluate the association of the eCDR with the CDR and other in-clinic assessments for screening older adults for cognitive impairment. DESIGN, SETTING, AND PARTICIPANTS: This multisite, cross-sectional study used baseline data from a longitudinal, observational study from 2020 to 2023, including up to 3 years of follow-up. Participants were enrolled from 3 Alzheimer Disease Research Centers and the Brain Health Registry. Participants (aged ≥55 years, with a study partner, and no acute or unstable major medical conditions) were recruited during in-clinic visits or by automated emails. EXPOSURES: Participants completed the Uniform Data Set Version 3 (UDS; including the CDR) in supervised clinical research settings, and then completed the eCDR remotely, online and unsupervised, using their own device. MAIN OUTCOMES AND MEASURES: The primary outcomes were eCDR scores (item; categorical box and global; continuous box and global), CDR scores (item; categorical box and global), and UDS assessment scores. Associations were evaluated using linear and logistic regressions. RESULTS: A total of 3565 participants were contacted, and 288 were enrolled. Among 173 participants with item-level data (mean [SD] age, 70.84 [7.65] years; 76 women [43.9%]), eCDR to CDR concordance was 90% or higher for 33 items (63%) and 70% to 89% for 13 items (25%). Box (domain) level concordance ranged from 80% (memory) to 99% (personal care). The global score concordance rate was 81%. κ statistics were fair to moderate. Among 206 participants with box and global scores (mean [SD] age, 71.34 [7.68] years; 95 women [46.1%]), eCDR continuous global score was associated with CDR global (categorical) score with an area under the receiver operating characteristic curve of 0.79 (95% CI, 0.70-0.87). Correlations between eCDR and in-clinic UDS assessments were similar to those between CDR sum of box scores and the same in-clinic assessments. CONCLUSIONS AND RELEVANCE: These findings suggest that the eCDR is valid and has potential use for screening and assessment of older adults for cognitive and functional decline related to Alzheimer disease. Instrument optimization and validation in diverse cohorts in remote settings are crucial for evaluating scalability and eCDR utility in clinical research, trials, and health care settings.
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spelling pubmed-105025182023-09-16 Evaluation of the Electronic Clinical Dementia Rating for Dementia Screening Nosheny, Rachel L. Yen, Daniel Howell, Taylor Camacho, Monica Moulder, Krista Gummadi, Shilpa Bui, Chau Kannan, Sandhya Ashford, Miriam T. Knight, Kristen Mayo, Connie McMillan, Maureen Petersen, Ronald C. Stricker, Nikki H. Roberson, Erik D. Chambless, Carol Gersteneker, Adam Martin, Roy Kennedy, Richard Zhang, Yue Kukull, Walter Flenniken, Derek Fockler, Juliet Truran, Diana Mackin, R. Scott Weiner, Michael W. Morris, John C. Li, Yan JAMA Netw Open Original Investigation IMPORTANCE: The Clinical Dementia Rating (CDR) is a well-validated instrument widely used to detect and stage dementia due to Alzheimer disease. The digital Electronic Clinical Dementia Rating (eCDR) can be remotely self-administered and automatically scored, with potential to facilitate efficient dementia screening and staging. OBJECTIVE: To evaluate the association of the eCDR with the CDR and other in-clinic assessments for screening older adults for cognitive impairment. DESIGN, SETTING, AND PARTICIPANTS: This multisite, cross-sectional study used baseline data from a longitudinal, observational study from 2020 to 2023, including up to 3 years of follow-up. Participants were enrolled from 3 Alzheimer Disease Research Centers and the Brain Health Registry. Participants (aged ≥55 years, with a study partner, and no acute or unstable major medical conditions) were recruited during in-clinic visits or by automated emails. EXPOSURES: Participants completed the Uniform Data Set Version 3 (UDS; including the CDR) in supervised clinical research settings, and then completed the eCDR remotely, online and unsupervised, using their own device. MAIN OUTCOMES AND MEASURES: The primary outcomes were eCDR scores (item; categorical box and global; continuous box and global), CDR scores (item; categorical box and global), and UDS assessment scores. Associations were evaluated using linear and logistic regressions. RESULTS: A total of 3565 participants were contacted, and 288 were enrolled. Among 173 participants with item-level data (mean [SD] age, 70.84 [7.65] years; 76 women [43.9%]), eCDR to CDR concordance was 90% or higher for 33 items (63%) and 70% to 89% for 13 items (25%). Box (domain) level concordance ranged from 80% (memory) to 99% (personal care). The global score concordance rate was 81%. κ statistics were fair to moderate. Among 206 participants with box and global scores (mean [SD] age, 71.34 [7.68] years; 95 women [46.1%]), eCDR continuous global score was associated with CDR global (categorical) score with an area under the receiver operating characteristic curve of 0.79 (95% CI, 0.70-0.87). Correlations between eCDR and in-clinic UDS assessments were similar to those between CDR sum of box scores and the same in-clinic assessments. CONCLUSIONS AND RELEVANCE: These findings suggest that the eCDR is valid and has potential use for screening and assessment of older adults for cognitive and functional decline related to Alzheimer disease. Instrument optimization and validation in diverse cohorts in remote settings are crucial for evaluating scalability and eCDR utility in clinical research, trials, and health care settings. American Medical Association 2023-09-14 /pmc/articles/PMC10502518/ /pubmed/37707812 http://dx.doi.org/10.1001/jamanetworkopen.2023.33786 Text en Copyright 2023 Nosheny RL et al. JAMA Network Open. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the CC-BY License.
spellingShingle Original Investigation
Nosheny, Rachel L.
Yen, Daniel
Howell, Taylor
Camacho, Monica
Moulder, Krista
Gummadi, Shilpa
Bui, Chau
Kannan, Sandhya
Ashford, Miriam T.
Knight, Kristen
Mayo, Connie
McMillan, Maureen
Petersen, Ronald C.
Stricker, Nikki H.
Roberson, Erik D.
Chambless, Carol
Gersteneker, Adam
Martin, Roy
Kennedy, Richard
Zhang, Yue
Kukull, Walter
Flenniken, Derek
Fockler, Juliet
Truran, Diana
Mackin, R. Scott
Weiner, Michael W.
Morris, John C.
Li, Yan
Evaluation of the Electronic Clinical Dementia Rating for Dementia Screening
title Evaluation of the Electronic Clinical Dementia Rating for Dementia Screening
title_full Evaluation of the Electronic Clinical Dementia Rating for Dementia Screening
title_fullStr Evaluation of the Electronic Clinical Dementia Rating for Dementia Screening
title_full_unstemmed Evaluation of the Electronic Clinical Dementia Rating for Dementia Screening
title_short Evaluation of the Electronic Clinical Dementia Rating for Dementia Screening
title_sort evaluation of the electronic clinical dementia rating for dementia screening
topic Original Investigation
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10502518/
https://www.ncbi.nlm.nih.gov/pubmed/37707812
http://dx.doi.org/10.1001/jamanetworkopen.2023.33786
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