Hernandez Herb Howard C, Ong Poh Ling, Anthony Philomena, Ang Siew Ling, Salim Nur Bazilah Mohd, Yew Pey Ying Suzanne, Ali Noorhazlina Bte, Lim Jun Pei, Lim Wee Shiong, Chew Justin
Department of Geriatric Medicine, Tan Tock Seng Hospital, Singapore.
Dementia Care, Nursing Specialty, Tan Tock Seng Hospital, Singapore.
Ann Geriatr Med Res. 2022 Mar;26(1):42-48. doi: 10.4235/agmr.22.0005. Epub 2022 Mar 2.
The coronavirus disease 2019 (COVID-19) pandemic has spurred the rapid adoption of telemedicine. However, the reproducibility of face-to-face (F2F) versus remote videoconference-based cognitive testing remains to be established. We assessed the reliability and agreement between F2F and remote administrations of the Abbreviated Mental Test (AMT), modified version of the Chinese Mini-Mental State Examination (mCMMSE), and Chinese Frontal Assessment Battery (CFAB) in older adults attending a memory clinic.
The participants underwent F2F followed by remote videoconference-based assessment by the same assessor within 3 weeks. Reliability was evaluated using intraclass correlation coefficients (ICC; two-way mixed, absolute agreement), the mean difference between remote and F2F-based assessments using paired-sample t-tests, and agreement using Bland-Altman plots.
Fifty-six subjects (mean age, 76±5.4 years; 74% mild; 19% moderate dementia) completed the AMT and mCMMSE, of which 30 completed the CFAB. Good reliability was noted based on the ICC values-AMT: ICC=0.80, 95% confidence interval [CI] 0.68-0.88; mCMMSE: ICC=0.80, 95% CI 0.63-0.88; CFAB: ICC=0.82, 95% CI 0.66-0.91. However, remote AMT and mCMMSE scores were higher compared to F2F-mean difference (i.e., remote minus F2F): AMT 0.3±1.1, p=0.03; mCMMSE 1.3±2.9, p=0.001. Significant differences were observed in the orientation and recall items of the mCMMSE and the similarities and conflicting instructions of CFAB. Bland-Altman plots indicated wide 95% limits of agreement (AMT -1.9 to 2.6; mCMMSE -4.3 to 6.9; CFAB -3.0 to 3.8), exceeding the a priori-defined levels of error.
While the remote and F2F cognitive assessments demonstrated good overall reliability, the test scores were higher when performed remotely compared to F2F. The discrepancies in agreement warrant attention to patient selection and environment optimization for the successful adaptation of telemedicine for cognitive assessment.
2019年冠状病毒病（COVID-19）大流行促使远程医疗迅速得到应用。然而，面对面（F2F）与基于远程视频会议的认知测试的可重复性仍有待确定。我们评估了在记忆门诊就诊的老年人中，F2F与远程进行的简易精神状态检查表（AMT）、中文版简易精神状态检查表（mCMMSE）修订版和中文版额叶评估量表（CFAB）之间的可靠性和一致性。
参与者先接受F2F评估，然后在3周内由同一名评估者通过远程视频会议进行评估。使用组内相关系数（ICC；双向混合，绝对一致性）评估可靠性，使用配对样本t检验评估远程评估与基于F2F评估之间的平均差异，并使用Bland-Altman图评估一致性。
56名受试者（平均年龄76±5.4岁；74%为轻度；19%为中度痴呆）完成了AMT和mCMMSE评估，其中30名完成了CFAB评估。根据ICC值显示出良好的可靠性——AMT：ICC = 0.80，95%置信区间[CI] 0.68 - 0.88；mCMMSE：ICC = 0.80，95% CI 0.63 - 0.88；CFAB：ICC = 0.82，95% CI 0.66 - 0.91。然而，远程AMT和mCMMSE得分高于F2F得分——平均差异（即远程得分减去F2F得分）：AMT为0.3±1.1，p = 0.03；mCMMSE为1.3±2.9，p = 0.001。在mCMMSE的定向和回忆项目以及CFAB的相似性和冲突指令方面观察到显著差异。Bland-Altman图显示一致性的95%界限较宽（AMT为 -1.9至2.6；mCMMSE为 -4.3至6.9；CFAB为 -3.0至3.8），超过了预先定义的误差水平。
虽然远程和F2F认知评估总体上显示出良好的可靠性，但与F2F评估相比，远程评估时测试得分更高。一致性方面的差异值得关注患者选择和环境优化，以成功将远程医疗应用于认知评估。
