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Remote, Online Assessments May Be Feasible Options for Tracking Cognitive Decline


Most participants were able to complete the assessments at home, and their scores correlated well with in-clinic assessments.

It may be possible to use an online assessment to identify patients at risk of cognitive decline and dementia, according to a new study.

In a report published in Alzheimer’s & Dementia, investigators explained how they developed new digital versions of the Clinical Dementia Rating (CDR) and Financial Capacity Instrument-Short Form (FCI-SF) assessments. They found these assessments could be successfully completed by most of the people who attempted them, although the tools themselves still need to be validated.

One major hurdle when conducting clinical research about Alzheimer disease (AD) and dementia is that identifying and tracking patients can be difficult and time consuming. The CDR and FCI-SF have been widely used and clinically validated, but the authors said there are challenges to delivering the 2 assessments remotely.

“Both require administration in a supervised setting with an experienced and certified rater, and therefore have high burden for administrators and participants,” they wrote.

The investigators set out to develop electronic versions of the 2 instruments (eCDR and eFCI-SF) and then invited people with and without cognitive impairment to take the tests on a computer. The new report describes the results of their feasibility analysis.

In total, 243 patients participated in the multisite study. Participants were recruited from the Brain Health Registry, an ongoing study based at the University of California, San Francisco, and from clinical cohorts at 3 AD research centers. Seventy-three percent did not have cognitive impairment, 21% had mild impairment or dementia, and 6% had an unknown diagnosis.

Participants first completed the electronic and nonelectronic versions of the CDR and FCI-SF instruments in the clinic, where staff members were available to offer assistance on the electronic versions as needed. Then, the patients were emailed a link and asked to take the electronic versions, this time without assistance. After the baseline visit, participants were asked to complete the eCDR and eFCI-SF every 6 months, with email and phone reminders.

The investigators reported that 84% of participants successfully completed the eCDR at home and 85% successfully took the eFCI-SF at home. In the case of both instruments, they found a high degree of correlation between the in-clinic assessment and at-home assessment results. The tests took 12 to 13 minutes to complete, the authors said.

They added that both electronic versions were designed to be administered without the need for a clinician to score them. In order to make that happen, they asked clinicians to identify items that carried significant weight as they scored patients, and then attempted to construct a wide range of multiple choice responses from which participants could choose.

Limitations on these findings include that most participants were White, had high levels of educational attainment, had internet access at home, and were computer literate. The participants also completed the electronic assessments in a clinic with the availability of assistance prior to being asked to take the assessments at home.

“Therefore, we could not address the degree to which the initial, supervised administration influenced the subsequent, unsupervised e‐instrument performance,” they wrote, adding that it is also possible that participants received help at home, even though they were instructed not to ask for it.

The authors said the instruments will need to be validated clinically and their feasibility in more diverse populations will need to be studied, they said. If validated, however, they said the new instruments could be valuable tools.

“This approach can ultimately have practical clinical applications in health care, epidemiology, and public health settings, to identify individuals at risk for AD and cognitive decline,” they wrote.


Howell T, Gummadi S, Bui C, et al. Development and implementation of an electronic Clinical Dementia Rating and Financial Capacity Instrument-Short Form. Alzheimers Dement (Amst). Published online July 24, 2022. doi:10.1002/dad2.12331

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