22 November 2021
Using CANTAB to identify undiagnosed dementia cases using a web-based pre-screening tool in the MOPEAD project
We recently caught up with Dr. Mercè Boada, the project coordinator of MOPEAD, and Medical Director of Ace Alzheimer Center Barcelona to discuss her recent publication supporting the use of CANTAB for the early detection of undiagnosed people with cognitive impairment.
The project coordinator of Models of Patient Engagement for Alzheimer’s Disease (MOPEAD), and Medical Director of Ace Alzheimer Center Barcelona, Dr. Mercè Boada, spoke to us about her recent publication in which the CANTAB tasks were found to be useful for the early detection of cognitive impairment.
Can you tell us more about your research group?
We are a specialized multidisciplinary research group from Ace Alzheimer Center Barcelona, involved in the fields of cognitive decline and dementia, and have a broad approach in basic, clinical, neuropsychological, social and basic research. In our Memory Clinic we annually care for about 7,000 people, of which more than 4,000 suffer from dementia (3,000 of them, Alzheimer's type); and participate in numerous global clinical trials targeting all stages of the disease progression. We are a research group with the aim of raising awareness for the promotion of early Alzheimer’s diagnosis.
For the MOPEAD project, the cognitive tests that were selected are CANTAB’s Spatial Working Memory (SWM) and Paired Associates Learning (PAL).The tests were administered by our neuropsychology team, led by Dr. Montse Alegret, and composed by 7 Psychologists with a great experience in Clinical and Research Neuropsychology.
It is important to keep in mind that the Models of Patient Engagement for Alzheimer’s Disease (MOPEAD) project is a novel patient engagement procedure implemented simultaneously in five Memory Clinics from different European countries with the aim of moving toward the earliest Alzheimer’s disease detection. In addition to our coordinating site, Ace Alzheimer Center Barcelona, in this project also participated the following four sites with extensive experience in cognition: University Medical Centre in Ljubljana (Slovenia), Karolinska Institutet in Stockholm (Sweden), VU Medical Center in Amsterdam (Netherlands), and University Medical Center in Cologne (Germany).
What is the rationale behind your study?
Alzheimer's disease represents one of the major health problems of the 21st century. The World Health Organization has warned of its social and health impact and encourages governments to take measures to reduce it. Moreover, international experts are convinced that Alzheimer’s disease-modifying therapies will be soon available. Thus, the challenge now is to increase patient engagement and find people with Alzheimer’s disease in their prodromal or dementia stages who are “hidden” in their communities and who would not have consulted without online campaigns.
The aim of this study was to assess the validity of this method for identifying patients with mild cognitive impairment or Alzheimer’s disease dementia among the elderly population.
Which methods did you use?
We designed a landing page that adapted its appearance to the browser’s regional configuration. Once an individual agreed to participate in the study, they were asked to provide basic demographic data (age, gender and schooling). If they were aged between 65 and 85 years and had not a previous diagnosis of cognitive impairment, they were then redirected to a website to complete the two CANTAB cognitive tests (Spatial Working Memory (SWM) and Paired Associates Learning (PAL).
After taking performances on the two cognitive tests and age, gender and schooling of each participant, the system used a model designed by Cambridge Cognition Ltd. to classify him/her with a positive or a negative pre-screening result (with and without cognitive impairment, respectively). Then, a maximum of 33 consecutive participants with a positive pre-screening per study center were invited to undergo a clinical diagnosis following the same procedure.
What are your key findings?
Among the subset of 91 patients with a positive pre-screening result who underwent full clinical assessment, 49 of them (53.8%) were diagnosed with mild cognitive impairment or Alzheimer’s disease dementia. They were people from the community who had not been previously diagnosed and would not have consulted without this type of patient engagement procedure.
What are the implications of your study?
Our results support the validity of a web-based pre-screening tool to identify individuals with prodromal or mild Alzheimer’s disease that could possibly have remained undiagnosed or be diagnosed at a later stage.
Moreover, with the aim of moving toward the earliest Alzheimer’s disease diagnosis, we hope that MOPEAD innovative procedures will inspire other researchers in the design of future patient engagement ideas and innovative strategies for achieving the early detection of people with Alzheimer’s disease worldwide.
Why did you choose CANTAB?
Our neuropsychological team, led by Dr. Montse Alegret, compared different cognitive tools and selected the Paired Associates Learning and the Spatial Working Memory subtests of CANTAB to discriminate between people with and without risk of developing Alzheimer’s disease. They were chosen as the best cognitive measures to discriminate between people with and without cognitive impairment, and to detect early Alzheimer’s disease, because of their high sensibility and specificity values and normative data; based on scientific research; being language independent execution tests, but with translated instructions available for different countries; computerized tests available to execute on the internet at home; and short enough to ensure compliance (less than 15 minutes).
What are the next steps for your research?
The MOPEAD project includes three additional innovative patient engagement models: an open-house initiative at the memory clinics, a primary care-based patient engagement initiative and a tertiary care strategy carried out by Diabetes Clinics. The comparison of data obtained from these four patient engagement strategies will allow to demonstrate their validity for identifying patients with mild cognitive impairment or Alzheimer’s disease dementia among the elderly population.
 Rodrigo A, Trigueros P, Jamilis L, Alegret M, Rodríguez O, Tárraga L, et al. Identification of undiagnosed dementia cases using a web-based pre-screening tool: The MOPEAD project. Alzheimer’s Dement 2021;17:1307–16. https://doi.org/10.1002/alz.12297.
 Boada M, Rodrigo A, Jessen F, Wimblad B, Kramberger M, Visser PJ, et al. Complementary pre-screening strategies to uncover hidden prodromal and mild Alzheimer’s disease: Results from the MOPEAD project. Alzheimer’s Dement 2021:1–9. https://doi.org/10.1002/alz.12441.
Mercè Boada Rovira - Ace Alzheimer Center Barcelona