{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T08:07:23Z","timestamp":1791274043382,"version":"4.1.0"},"reference-count":16,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,9,13]],"date-time":"2023-09-13T00:00:00Z","timestamp":1694563200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Aging Neurosci."],"abstract":"Background<\/jats:title>Current primary care cognitive assessment tools are either crude or time-consuming instruments that can only detect cognitive impairment when it is well established. This leads to unnecessary or late referrals to memory services, by which time the disease may have already progressed into more severe stages. Due to the COVID-19 pandemic, some memory services have adapted to the new environment by shifting to remote assessments of patients to meet service user demand. However, the use of remote cognitive assessments has been inconsistent, and there has been little evaluation of the outcome of such a change in clinical practice. Emerging research has highlighted computerized cognitive tests, such as the Integrated Cognitive Assessment (ICA), as the leading candidates for adoption in clinical practice. This is true both during the pandemic and in the post-COVID-19 era as part of healthcare innovation.<\/jats:p><\/jats:sec>Objectives<\/jats:title>The Accelerating Dementias Pathways Technologies (ADePT) Study was initiated in order to address this challenge and develop a real-world evidence basis to support the adoption of ICA as an inexpensive screening tool for the detection of cognitive impairment and improving the efficiency of the dementia care pathway.<\/jats:p><\/jats:sec>Methods<\/jats:title>Ninety-nine patients aged 55\u201390 who have been referred to a memory clinic by a general practitioner (GP) were recruited. Participants completed the ICA either at home or in the clinic along with medical history and usability questionnaires. The GP referral and ICA outcome were compared with the specialist diagnosis obtained at the memory clinic.<\/jats:p>Participants were given the option to carry out a retest visit where they were again given the chance to take the ICA test either remotely or face-to-face.<\/jats:p><\/jats:sec>Results<\/jats:title>The primary outcome of the study compared GP referral with specialist diagnosis of mild cognitive impairment (MCI) and dementia. Of those the GP referred to memory clinics, 78% were necessary referrals, with ~22% unnecessary referrals, or patients who should have been referred to other services as they had disorders other than MCI\/dementia. In the same population the ICA was able to correctly identify cognitive impairment in ~90% of patients, with approximately 9% of patients being false negatives. From the subset of unnecessary GP referrals, the ICA classified ~72% of those as not having cognitive impairment, suggesting that these unnecessary referrals may not have been made if the ICA was in use. ICA demonstrated a sensitivity of 93% for dementia and 83% for MCI, with a specificity of 80% for both conditions in detecting cognitive impairment. Additionally, the test-retest prediction agreement for the ICA was 87.5%.<\/jats:p><\/jats:sec>Conclusion<\/jats:title>The results from this study demonstrate the potential of the ICA as a screening tool, which can be used to support accurate referrals from primary care settings, along with the work conducted in memory clinics and in secondary care. The ICA\u2019s sensitivity and specificity in detecting cognitive impairment in MCI surpassed the overall standard of care reported in existing literature.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fnagi.2023.1243316","type":"journal-article","created":{"date-parts":[[2023,9,13]],"date-time":"2023-09-13T17:43:08Z","timestamp":1694626988000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":10,"title":["The use of the integrated cognitive assessment to improve the efficiency of primary care referrals to memory services in the accelerating dementia pathway technologies study"],"prefix":"10.3389","volume":"15","author":[{"given":"Mohammad Hadi","family":"Modarres","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chris","family":"Kalafatis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Panos","family":"Apostolou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naji","family":"Tabet","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seyed-Mahdi","family":"Khaligh-Razavi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2023,9,13]]},"reference":[{"key":"ref1","volume-title":"Practical statistics for medical research","author":"Altman","year":"1991"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"456","DOI":"10.1159\/000511945","article-title":"Distance assessment for detecting cognitive impairment in older adults: a systematic review of psychometric evidence","volume":"49","author":"Binng","year":"2020","journal-title":"Dement. Geriatr. Cogn. Disord."},{"key":"ref5","doi-asserted-by":"publisher","first-page":"870","DOI":"10.1002\/gps.1167","article-title":"Characteristics of the GPCOG, a screening tool for cognitive impairment","volume":"19","author":"Brodaty","year":"2004","journal-title":"Int. J. Geriatr. Psychiatry"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"936","DOI":"10.1002\/(SICI)1099-1166(199911)14:11<936::AID-GPS39>3.0.CO;2-1","article-title":"Validation of a 6 item cognitive impairment test with a view to primary care usage","volume":"14","author":"Brooke","year":"1999","journal-title":"Int. J. Geriatr. Psychiatry"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"2021","DOI":"10.3399\/BJGPO.2021.0058","article-title":"Clinical judgement of GPs for the diagnosis of dementia: a diagnostic test accuracy study","volume":"5","author":"Creavin","year":"2021","journal-title":"BJGP open"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"72","DOI":"10.1093\/ageing\/afaa228","article-title":"Mild cognitive impairment: the Manchester consensus","volume":"50","author":"Dunne","year":"2021","journal-title":"Age Ageing"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"864","DOI":"10.1016\/j.jalz.2019.06.4598","article-title":"The integrated cognitive assessment \u2013 employing artificial intelligence for the detection of cognitive impairment","volume":"15","author":"Kalafatis","year":"2019","journal-title":"Alzheimer\u2019s Dement."},{"key":"ref14","doi-asserted-by":"publisher","first-page":"6695","DOI":"10.3389\/fpsyt.2021.706695","article-title":"Validity and cultural Generalisability of a 5-minute AI-based, computerised cognitive assessment in mild cognitive impairment and Alzheimer\u2019s dementia","volume":"12","author":"Kalafatis","year":"2021","journal-title":"Front. Psych."},{"key":"ref15","doi-asserted-by":"publisher","first-page":"e34475","DOI":"10.2196\/34475","article-title":"The use of a computerized cognitive assessment to improve the efficiency of primary care referrals to memory services: protocol for the accelerating dementia pathway technologies (ADePT) study","volume":"11","author":"Kalafatis","year":"2022","journal-title":"JMIR Res. Protocols"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"P1355","DOI":"10.1016\/j.jalz.2019.06.3870","article-title":"Employing artificial intelligence in the development of a self-administered, computerised cognitive assessment for the assessment of neurodegeneration","volume":"15","author":"Kalafatis","year":"2019","journal-title":"Alzheimer\u2019s Dement."},{"key":"ref17","doi-asserted-by":"publisher","first-page":"1102","DOI":"10.1038\/s41598-018-37709-x","article-title":"Integrated cognitive assessment: speed and accuracy of visual processing as a reliable proxy to cognitive performance","volume":"9","author":"Khaligh-Razavi","year":"2019","journal-title":"Sci. Rep."},{"key":"ref18","doi-asserted-by":"publisher","first-page":"193","DOI":"10.1186\/s12883-020-01736-x","article-title":"A self-administered, artificial intelligence (AI) platform for cognitive assessment in multiple sclerosis (MS)","volume":"20","author":"Khaligh-Razavi","year":"2020","journal-title":"BMC Neurol."},{"key":"ref20","doi-asserted-by":"publisher","first-page":"1159","DOI":"10.1016\/B978-0-12-407824-6.00109-9","article-title":"The Mini-mental state examination and other neuropsychological assessment tools for detecting cognitive decline","author":"Mahendran","year":"2015","journal-title":"Diet Nutr. Dement. Cogn. Decline"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"579934","DOI":"10.3389\/fpsyt.2020.579934","article-title":"Implementing remote memory clinics to enhance clinical care during and after COVID-19","volume":"11","author":"Owens","year":"2020","journal-title":"Front. Psych."},{"key":"ref27","doi-asserted-by":"publisher","first-page":"99","DOI":"10.1159\/000438454","article-title":"When a little knowledge can be dangerous: false-positive diagnosis of behavioral variant frontotemporal dementia among community clinicians","volume":"41","author":"Shinagawa","year":"2016","journal-title":"Dement. Geriatr. Cogn. Disord."},{"key":"ref28","doi-asserted-by":"publisher","DOI":"10.1101\/2022.05.09.22274765","article-title":"Health economic analysis of the integrated cognitive assessment tool to aid dementia diagnosis in the United Kingdom","author":"Shore","year":"2022","journal-title":"med Rxiv"}],"container-title":["Frontiers in Aging Neuroscience"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fnagi.2023.1243316\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,13]],"date-time":"2023-09-13T17:43:11Z","timestamp":1694626991000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fnagi.2023.1243316\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,9,13]]},"references-count":16,"alternative-id":["10.3389\/fnagi.2023.1243316"],"URL":"https:\/\/doi.org\/10.3389\/fnagi.2023.1243316","relation":{},"ISSN":["1663-4365"],"issn-type":[{"value":"1663-4365","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,9,13]]},"article-number":"1243316"}}