Practicality of a computerized system for cognitive assessment in the elderly

Background: Early detection and diagnosis are critical to dementia care. However, many early cases remain undiagnosed as a result of the impracticality of neuropsychological testing, particularly in primary care. Mindstreams is an office-based computerized system for measuring cognitive function in multiple domains, with demonstrated validity, test-retest reliability, and sensitivity to treatment effects. This study evaluated its feasibility for assessment of the elderly. Methods: Usability data were collected after each of 2,888 consecutive initial-visit testing sessions at the first 11 clinical centers to use Mindstreams. The chi(2) goodness-of-fit test was employed to determine whether patients and supervisors more often rated tests easy versus hard to use. Separate analyses were run for non-computer users, patients older than 75 years, and poor per-formers (: l standard deviation on overall battery performance). Results: For all patients (n = 2,888; age, 64.7 +/- 18.2 years), 83% rated the tests easy to use (P < .001). Seventy-three percent of non-computer users, 70% of patients older than 75, and 69% of poor performers rated them easy to use (Ps < .001). Supervisor ratings and ease of understandability ratings were similar. For all patients, 76% of supervisor ratings indicated no patient frustration (P < .001). Seventy-eight percent of ratings for non-computer users, 76% for patients older than 75, and 74% for poor performers indicated no frustration (Ps < .001). Conclusions: Mindstreams was easily employed, including in patients with considerable cognitive impairment, supporting its practicality for in-office cognitive assessment of the elderly. The availability of such valid and practical assessment suggests the feasibility of integrating the technology within a clinical algorithm for improved detection of cognitive decline. (C) 2008 The Alzheimer's Association. All rights reserved.