Title: Proposal for Efficient Access to Cognitive Screening: using MoCA‐XpressO Pre‐screen, MoCA‐Duo Videoconference Screen, and MoCA‐Report for Post‐screen Interpretation
Abstract: Abstract Background The continuously aging population worldwide results in increased prevalence of cognitive decline and growing demand for cognitive screening. This demand is expected to increase with newly approved disease modifying therapies. However, scarce resources for professional cognitive assessments, requires efficient screening tools that are accessible and easily applied. Therefore, a simple process of brief self‐administered cognitive pre‐screening, videoconference‐screening, and an automated report with result interpretation, may be highly efficient and will increase access to cognitive screening. Method We integrated validated novel tools for accessible, home‐based cognitive pre‐screening and screening. It includes development and validation of the Montreal Cognitive Assessment (MoCA)‐XpressO: a brief self‐administered cognitive pre‐screening tool, and cognitive screening via MoCA‐Duo: videoconference version of MoCA. Finally, we developed the MoCA‐Report, an automated summary of MoCA‐Duo with result interpretation according to various cognitive domains and suggestions for further inquiries. Result The MoCA‐XpressO includes assessment of memory tasks, logical tasks, and processing speed. Validation of MoCA‐XpressO showed high accuracy (AUC 0.85) therefore may identify the healthy population with no objective cognitive impairment: the “worried‐well” who will not require further screening. Cognitive screening can then be applied via MoCA‐Duo only to selected patients with identified cognitive impairment. MoCA‐Duo by videoconferencing carries significant benefits: (1) allows home‐based validated assessment; (2) allows matching between patients and certified raters across the globe, with similar country of origin and language, which is highly valuable in cognitive evaluations. Ultimately, post‐screening interpretation is provided automatically by MoCA‐Report which presents interpretation of the scores according to normative data, present the Memory Index Score (MIS), conversion to Mini Mental State Examination and Clinical Dementia Rating scores, optional cognitive manifestations, prediction of conversion to dementia, prediction of amyloid pathology, and potential risk for driving errors. It will also explore potential eligibility for newly approved disease modifying therapies. Conclusion The estimated increase in the prevalence of dementia, and newly approved disease modifying therapies are expected to increase demand for cognitive screening. Integration of self‐administered cognitive pre‐screening by MoCA‐XpressO, and videoconference cognitive screening via MoCA‐Duo including an automated report with result interpretation, propose efficient and comprehensive cognitive screening for high volume of patients.