CANTAB Mobile: experience of use of a digital memory assessment tool in UK primary care

Background

Assessing subjective memory complaints in primary care settings supports the early identification of objective deficits.

Early identification processes mean that (i) support care planning and management can be put in place for those with objective deficits, and (ii) reassurance can be provided for those without objective deficits (the worried-well).

For the first time, Cambridge Cognition have described audit results of using CANTAB Mobile as a tool to conduct early memory assessments in primary care.

Figure 1. CANTAB Mobile

 

Methods

Data was collated from 913 patients in 13 primary care practices in the UK (2012 – 2017) on the reasons for seeking CANTAB Mobile testing, the results and post-test routes to referral.

CANTAB Mobile was used to administer the CANTAB Paired Associates Learning (PAL) test, an adaptive test of visuospatial memory.

Patients were categorized as having a clinically relevant memory deficit (Red), being in the borderline range (Amber) or having memory in the normal range (Green). These categorizations were based on a comparison between patient performance and normative data.

 

Results

Patients were primarily referred to the clinic based on their own concerns or that of a family member. Patients were less frequently referred by a healthcare professional.

The flow of patients from presenting concerns to diagnostic outcomes is presented in Figure 2.

Figure 2. Alluvial diagram showing patient journey (n=872) from presenting concerns(left), to the outcome of CANTAB Mobile assessment, to outcome of diagnosis on the right. Flows are coloured by CANTAB Mobile outcome, with red indicating clinically significant memory impairment, and green age-appropriate performance, with Amber being borderline. Grey blocks indicate missing data. 

 

Analysis using chi-square test with FDR correction for multiple comparisons showed cognitive problems (Red or Amber category) were seen significantly more often following reports from family members (“Family”, “Patient and Family”, “Family and HCP”), compared to a health check or healthcare professional concerns, or concerns from patients alone (as illustrated in Figure 2). 

Data were available for the majority of patients following a Red CANTAB outcome, of whom just over half were referred for a secondary care assessment. In these patients, dementia or MCI was seen in 64.5% of cases. A range of other issues were diagnosed in a further 26.7% of patients, with 13.5% being discharged back to primary care monitoring without diagnosis.

 

Conclusions

Patient and family concerns motivated the majority of assessments with CANTAB Mobile in primary care. These concerns were followed by a positive memory screen result more frequently than assessments following healthcare professional concerns.

In the patients who were referred to secondary care, dementia or MCI were diagnosed in 64% with a further 26.7% having memory problems secondary to other conditions.

These data illustrate both the need for these objective memory assessments and their outcome in identifying neurodegenerative, neurological and reversible causes of cognitive difficulties.

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Tags : mobile | primary care | alzheimer's disease | mci