The use of a computerised cognitive assessment to improve the efficiency of primary care referrals to memory services: Protocol for the ADePT study (Preprint)

BACKGROUND Existing primary care cognitive assessment tools are crude or time-consuming screening instruments which can only detect cognitive impairment when it is well established. Due to the COVID-19 pandemic, memory services have adapted to the new environment by moving to remote patient assessments to continue meeting service user demand. However, the remote use of cognitive assessments has been variable while there has been scant evaluation of the outcome of such a change in clinical practice. Emerging research in remote memory clinics has highlighted computerised cognitive tests, such as the Integrated Cognitive Assessment (ICA), as a prominent candidate for adoption in clinical practice both during the pandemic and for post-COVID implementation as part of healthcare innovation. OBJECTIVE We initiated the Accelerating Dementia Pathway Technologies (ADePT) study. The intention of conducting this study is to 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. METHODS Patients who have been referred to a memory clinic from GPs are recruited. Participants complete the ICA either at home or in the clinic along with medical history and usability questionnaires. The GP referral and ICA outcome are compared with the specialist diagnosis obtained at the memory clinic. The clinical outcomes as well as NHS reference costing data will be used to assess the potential health economic benefits of the use of the ICA in the dementia diagnosis pathway. RESULTS The ADePT study was funded in January 2020 by Innovate UK (Project reference 105837). As of September 2021, 86 participants have been recruited in the study, with 23 participants also completing a retest visit. Initially the study was designed for in person visits at the memory clinic, however in light of the COVID-19 pandemic, the study was amended to allow remote as well as face-to-face visits. The study was also expanded from a single site to 4 sites in the United Kingdom. We expect results to be published by the second quarter of 2022. CONCLUSIONS The ADePT project aims at improving the efficiency of the dementia pathway at its very beginning and supports systems integration at the intersection between primary and secondary care. The introduction of a standardised, self-administered, digital assessment tool for the timely detection of neurodegeneration as part of a decision-support system that can signpost accordingly can reduce unnecessary referrals, reduce service backlog and assessment variability. CLINICALTRIAL ISRCTN Number: 16596456