Incorporating Digital Cognitive Assessments in Real-World Practice: Nicole Fowler, PhD


The director of research for internal medicine and geriatrics at Indiana University School of Medicine discussed the advantages digital assessments bring to clinics, and what role they will play in the coming years. [WATCH TIME: 3 minutes]

WATCH TIME: 3 minutes

"The most current sort of way that we’ve been doing diagnosis of patients has been clinical, both history, physical, and then a battery of neuropsychological tests. Maybe with some imaging, but that’s expensive. It takes a series of appointments sometimes to be able to find someone who knows how to do the neuropsychological testing and interpret the results, which aren’t easy, especially in more rural health systems."

As new, novel therapeutics for Alzheimer disease (AD) enter the market, the importance of early identification of those at risk for developing the neurodegenerative condition is more critical than ever. Comprised of several institutions across the US, the DAVOS Alzheimer’s Collaborative DIGITAL Demonstration Project was conducted to understand the feasibility, acceptability, and implementation of digital cognitive screening in primary care settings.

Presented at the 2023 Alzheimer’s Association International Conference (AAIC), held July 16-20, in Amsterdam, the Netherlands, a study from the project assessed patient’s willingness to use the Linus Health Digital Clock and Recall (DCR) test. Over the 7-month project, 3343 screening attempts were made, with patients refusing the test more than half (54.6%) the time. Regardless of their presenting concern, 48% of patients who completed the screenings were scored either impaired or likely impaired.

The DCR test includes the DCTclock, which has ties back to the original clock drawing test developed in the early 1900s. In the mid 1980s, Edith Kaplan, a clinical researcher at the time, introduced the Boston Process Approach (BPA), a process-based approach to neuropsychological testing later incorporated by Linus that changed the way the clock-drawing test was used. The BPA essentially suggests than an analysis of the strategy or process by which tasks and neuropsychological tasks are completed, along with errors made during test completion, conveys significant information regarding underlying brain cognition and is as important as the overall summary scores.

During AAIC 2023, NeurologyLive® sat down with senior investigator Nicole Fowler, PhD, director of research for internal medicine and geriatrics at Indiana University School of Medicine, to discuss the future of digital cognitive assessments. Fowler provided insight on the benefits they bring, the transition primary care clinics will need to make, and how they will be used with the emergence of blood-based biomarkers.

1. Swartzell K, Willis D, Hammers D, et al. Implementation of cognitive screening in primary care: DIGITAL-Indiana University Health System and Indiana University- A Davos Alzheimer’s Collaborative flagship site program. Presented at: AAIC 2023; June 16-20; Amsterdam, Netherlands.
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