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Background: Timely diagnosis of dementia is a global healthcare priority, particularly in low to middle income countries where rapid increases in older adult populations are expected. Objective: To investigate global perspectives on the role of brief cognitive assessments (BCAs) in dementia diagnosis, strengths and limitations of existing measures, and future directions and needs. Methods: This is a qualitative study of 18 dementia experts from different areas of the world. Participants were selected using purposeful sampling based on the following criteria: 1) practicing in countries with projected growth of older adult population of over 100%by 2050; 2) expertise in dementia diagnosis and treatment; 3) involvement in clinical practice and training; and 4) recognition as a national dementia expert based on leadership positions within healthcare system, research, and/or policy work. Participants were individually interviewed in their language of choice over secure videoconference sessions. Interviews were analyzed by a multidisciplinary team using theme identification approach. Results: Four domains with subthemes emerged illustrating participants’ perspectives: 1) strengths of BCAs; 2) limitations of BCAs; 3) needs related to the use of BCAs; and 4) characteristics of an ideal BCA. While most experts agreed that BCAs were important and useful for dementia diagnosis, the themes emphasized the need for development and validation of novel measures that are sensitive, psychometrically sound, and culturally appropriate. Conclusion: BCAs are important for guiding diagnosis and care for dementia patients. Findings provide a roadmap for novel BCA development to assist in diagnostic decision making for clinicians serving a rapidly growing and diverse dementia population.

Author(s): Tsoy, Elena; Erlhoff, Sabrina J; Goode, Collette A; Dorsman, Karen A; Kanjanapong, Suchanan; Lindbergh, Cutter A; La Joie, Renaud; Strom, Amelia; Rabinovici, Gil D; Lanata, Serggio C; Miller, Bruce L; Tomaszewski Farias, Sarah E; Kramer, Joel H; Rankin, Katherine P; Possin, Katherine L | Abstract: IntroductionComposite scores based on psychometrically rigorous cognitive assessments are well suited for early diagnosis and disease monitoring.MethodsWe developed and cross-validated the Brain Health Assessment-Cognitive Score (BHA-CS), based on a brief computerized battery, in 451 cognitively normal (CN) and 399 cognitively impaired (mild cognitive impairment [MCI] or dementia) older adults. We investigated its long-term reliability and reliable change indices at longitudinal follow-up (Nn=n340), and the association with amyloid beta (Aβ) burden in the CN subgroup with Aβ positron emission tomography (Nn=n119).ResultsThe BHA-CS was accurate at detecting cognitive impairment and exhibited excellent long-term stability. Reliable decline over one year was detected in 75% of participants with dementia, 44% with MCI, and 3% of CN. Among CN, the Aβ-positive group showed worse longitudinal performance on the BHA-CS compared to the Aβ-negative group.DiscussionThe BHA-CS is sensitive to cognitive decline in preclinical and prodromal neurodegenerative disease.