Wu Min, Feng Jialin, Sun Ruini, Zhang Shangyang, Zhang Yongjin, Yang Fengjie, Zhang Xiaoyi, Ye Yunxian, Gong Ni, Liao Jing
Department of Medical Statistics and Epidemiology, Sun Yat-sen University, Guangzhou, Guangdong, China.
School of Nursing, Jinan University, Guangzhou, Guangdong, China.
J Neuroeng Rehabil. 2025 Jun 11;22(1):132. doi: 10.1186/s12984-025-01665-1.
The practicality of implementing digital cognitive screening tests in primary health care (PHC) for the detection of cognitive impairments, particularly among populations with lower education levels, remains unclear. The aim of this study is to assess the validity and usability of digital cognitive screening tests in PHC settings.
We utilized a randomized crossover design, whereby 47 community-dwelling participants aged 65 and above were randomized into two groups. One group completed the paper-based Mini-Mental State Examination (MMSE) and Clock Drawing Test (CDT) first, followed by the tablet-based digital version after a two-week washout period, while the other group did the reverse. Validity was assessed by Spearman correlation, linear mixed-effects models, sensitivity specificity, and area under the curve (AUC). Usability was assessed through the Usefulness, Satisfaction, and Ease of Use (USE) questionnaire, participant preferences and assessment duration. Regression analyses were conducted to explore the impact of usability on digital test scores, controlling for cognitive level, education, age, and gender.
Regarding validity, digital tests showed moderate correlations with paper-based versions and superior AUC performance. The AUC was 0.65 for the MMSE versus 0.82 for the electronic MMSE (eMMSE), and 0.45 for the CDT compared to 0.65 for the electronic CDT (eCDT). Regarding usability, while older participants gave positive feedback on digital tests (P < 0.001), they preferred paper-based versions. The eMMSE took significantly longer to complete than the MMSE, averaging 7.11 min versus 6.21 min (P = 0.01). Notably, digital test scores were minimally affected by subjective attitudes but strongly linked to test duration (β = -0.62, 95% CI: -1.07 to -0.17).
Digital cognitive tests are valid and feasible in PHC settings but face implementation challenges, especially in usability and adaptability among individuals with lower education levels.
在初级卫生保健（PHC）中实施数字认知筛查测试以检测认知障碍的实用性，尤其是在教育水平较低的人群中，仍不明确。本研究的目的是评估数字认知筛查测试在初级卫生保健环境中的有效性和可用性。
我们采用随机交叉设计，将47名65岁及以上的社区居民随机分为两组。一组先完成纸质版简易精神状态检查表（MMSE）和画钟试验（CDT），在两周的洗脱期后再完成基于平板电脑的数字版本，而另一组则顺序相反。通过Spearman相关性、线性混合效应模型、敏感性特异性和曲线下面积（AUC）评估有效性。通过有用性、满意度和易用性（USE）问卷、参与者偏好和评估持续时间评估可用性。进行回归分析以探讨可用性对数字测试分数的影响，同时控制认知水平、教育程度、年龄和性别。
在有效性方面数字测试与纸质版本显示出中等相关性且具有更好的AUC表现。MMSE的AUC为0.65，而电子MMSE（eMMSE）为0.82，CDT为0.45，而电子CDT（eCDT）为0.65。在可用性方面，虽然老年参与者对数字测试给予了积极反馈（P < 0.001），但他们更喜欢纸质版本。完成eMMSE的时间明显长于MMSE，平均为7.11分钟，而MMSE为6.21分钟（P = 0.01）。值得注意的是，数字测试分数受主观态度影响最小，但与测试持续时间密切相关（β = -0.62，95% CI：-1.07至-0.17）。
数字认知测试在初级卫生保健环境中是有效且可行的，但面临实施挑战，特别是在教育水平较低的个体中的可用性和适应性方面。
