A Stepwise Approach Towards Diagnostic Workup in Dementia Using Online Cognitive Tools (Alzheimer's & Dementia 2021)

15525279, 2021, S6, Downloaded from https://alz-journals.onlinelibrary.wiley.com/doi/10.1002/alz.055436 by NHMRC National Cochrane Australia, Wiley Online Library on [21/03/2023].
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DOI: 10.1002/alz.055436
C L I N I C A L M A N I F E S TAT I O N S
PODIUM PRESENTATION
A stepwise approach towards diagnostic workup in dementia

using online cognitive tools
Hanneke FM Rhodius- Meester1,2 Antti Tolonen3 Aniek M Van Gils1

Juha Koikkalainen3 Frederik Barkhof4,5 Sanna-Kaisa Herukka6
Tuomo Hänninen6 Tiia Ngandu7,8 Miia Kivipelto8,9,10
Steen Gregers Hasselbalch11 Patrizia Mecocci12 Anne Remes13
Hilkka Soininen14 Philip Scheltens15 Wiesje M van der Flier15,16 Jyrki Lötjönen3
1
Alzheimer Center Amsterdam, Department
of Neurology, Amsterdam Neuroscience, VU Abstract
University Medical Center, Amsterdam UMC,
Background: Dementia affects more and more people worldwide. Unfortunately, only
Amsterdam, Netherlands
2
Department of Internal-Geriatric Medicine,
half of dementia cases are well recognized. This indicates a need for both efficient and
Amsterdam UMC, VUmc, Amsterdam tailored tools for diagnosis. To improve the number of correctly diagnosed patients
Cardiovascular Sciences Institute, Amsterdam,
Netherlands
while retaining cost-effectiveness, we study a stepwise data-driven approach for the
3
Combinostics Ltd, Tampere, Finland diagnostic workup. By using the online cognitive test tool cCOG [1] as prescreener, we
4
Institutes of Neurology and Healthcare aim to select the right diagnostic workup for each patient.
Engineering, University College London, Methods: We included 710 subjects from three memory clinic cohorts (PredictND,
London, United Kingdom
5
VPH-DARE and Amsterdam dementia cohort) with different types of dementia and
Department of Radiology and Nuclear
Medicine, Amsterdam Neuroscience, Vrije subjective cognitive decline (SCD). All patients performed a neuropsychological (NP)
Universiteit Amsterdam, Amsterdam UMC,
test battery (consisting of MMSE, RAVLT, TMT-A and B and Animal Fluency) and had
6 MRI of the brain. A subset of 214 subjects additionally performed cCOG. To verify
Kuopio University Hospital, Kuopio, Finland
7
Karolinska Institutet, Stockholm, Sweden
results we imputed missing cCOG based on corresponding NP tests [1]. From MRI, mul-
8
Finnish Institute for Health and Welfare, tiple imaging biomarkers were defined [2]. We tested a stepwise diagnostic approach,
Helsinki, Finland starting with screening using cCOG, then if needed testing with NP test battery and
9
Medical Unit Aging, Karolinska University MRI, using the Disease State Index (DSI) classifier [2]. At each step patients were
Hospital, Stockholm, Sweden
10
selected for the next step based on DSI model’s confidence (Figure 1).
Dey, University of Eastern Finland, Kuopio,
Finland Results: The stepwise approach was as accurate as performing all tests in every patient
11
Rigshospitalet, Copenhagen University (Table 1), but it reduced the number of tests done especially in SCD patients consider-
Hospital, Copenhagen, Denmark
ably, with NP in only 57% and MRI in 38% (Table 2). This was also reflected in reduced
Alzheimer’s Dement. 2021;17(Suppl. 6):e055436. wileyonlinelibrary.com/journal/alz © 2021 the Alzheimer’s Association 1 of 3

https://doi.org/10.1002/alz.055436
15525279, 2021, S6, Downloaded from https://alz-journals.onlinelibrary.wiley.com/doi/10.1002/alz.055436 by NHMRC National Cochrane Australia, Wiley Online Library on [21/03/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
2 of 3 CLINICAL MANIFESTATIONS
12
Institute of Gerontology and Geriatrics,
Department of Medicine, University of cost per patient in typical memory clinic population (from estimated 510 € to 238-243
Perugia, Perugia, Italy
€). For dementia patients the reduction in number of tests and costs was smaller.
13
Unit of Clinical Neuroscience, Neurology
and Medical Research Center, University of Conclusion: This study suggest that using a stepwise approach, applying online cogni-
Oulu, Oulo, Finland tive tests as prescreening at home, can reduce the number of patient visits to clinic and
14
University of Eastern Finland, Kuopio, costs. The results were as accurate as with the standard traditional work-up. Online
Finland
15
cognitive testing is therefore a promising tool to funnel the patient flow to memory
Alzheimer Center Amsterdam, Department
of Neurology, Amsterdam Neuroscience, Vrije clinics, also in times of social distancing. References: [1] Rhodius-Meester, H.F.M. et al.
Alzheimers Dement 2020 Aug25;12(1) [2] Bruun, M. et al. Alzheimers Dement 2018
16 Aug17;10.
Department of Epidemiology and
Biostatistics, Amsterdam Neuroscience, Vrije
Correspondence
Aniek M Van Gils, Alzheimer Center Amster-
dam, Department of Neurology, Amsterdam
Neuroscience, VU University Medical Center,
Amsterdam UMC, Amsterdam, Netherlands
Email: [email protected]
FIGURE 1
15525279, 2021, S6, Downloaded from https://alz-journals.onlinelibrary.wiley.com/doi/10.1002/alz.055436 by NHMRC National Cochrane Australia, Wiley Online Library on [21/03/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
3 of 3
CLINICAL MANIFESTATIONS
TA B L E 1
TA B L E 2

A Stepwise Approach Towards Diagnostic Workup in Dementia Using Online Cognitive Tools (Alzheimer's & Dementia 2021)

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15525279, 2021, S6, Downloaded from https://alz-journals.onlinelibrary.wiley.com/doi/10.1002/alz.055436 by NHMRC National Cochrane Australia, Wiley Online Library on [21/03/2023].

A stepwise approach towards diagnostic workup in dementia

Hanneke FM Rhodius- Meester1,2 Antti Tolonen3 Aniek M Van Gils1

Alzheimer’s Dement. 2021;17(Suppl. 6):e055436. wileyonlinelibrary.com/journal/alz © 2021 the Alzheimer’s Association 1 of 3

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