Jinkook Lee1,2, Mary Ganguli3, Albert Weerman1, Sandy Chien1, Dong Young Lee4, Mathew Varghese5, Aparajit B Dey6. 1. Center for Economic and Social Research, University of Southern California, Los Angeles, California, USA. 2. Department of Economics, University of Southern California, and RAND Corporation, Santa Monica, California, USA. 3. Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania, USA. 4. Department of Psychiatry, Seoul National University, Seoul, South Korea. 5. Department of Psychiatry, National Institute of Mental Health and Neuroscience, Bengaluru, India. 6. Department of Geriatric Medicine, All India Institute of Medical Sciences, New Delhi, India.
Abstract
OBJECTIVES: To introduce cost-effective expert clinical diagnoses of dementia into population-based research using an online platform and to demonstrate their validity against in-person clinical assessment and diagnosis. DESIGN: The online platform provides standardized data necessary for clinicians to rate participants on the Clinical Dementia Rating (CDR® ). Using this platform, clinicians diagnosed 60 patients at a range of CDR levels at two clinical sites. The online consensus diagnosis was compared with in-person clinical consensus diagnosis. SETTING: All India Institute of Medical Sciences (AIIMS), Delhi, and National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India. PARTICIPANTS: Thirty patients each at AIIMS and NIMHANS with equal numbers of patients previously independently rated in person by experts as CDR is 0 (cognitively normal), CDR is 0.5 (mild cognitive impairment), and CDR is 1 or greater (dementia). MEASUREMENTS: Multiple clinicians independently rate each participant on each CDR domain using standardized data and expert clinical judgment. The overall summary CDR is calculated by algorithm. When there are discrepancies among clinician ratings, clinicians discuss the case through a virtual consensus conference and arrive at a consensus overall rating. RESULTS: Online clinical consensus diagnosis based on standardized interview data provides consistent clinical diagnosis with in-person clinical assessment and consensus diagnosis (κ coefficient = 0.76). CONCLUSION: A web-based clinical consensus platform built on the Harmonized Diagnostic Assessment of Dementia for the Longitudinal Aging Study in India interview data is a cost-effective way to obtain reliable expert clinical judgments. A similar approach can be used for other epidemiological studies of dementia. J Am Geriatr Soc 68:S54-S59, 2020.
OBJECTIVES: To introduce cost-effective expert clinical diagnoses of dementia into population-based research using an online platform and to demonstrate their validity against in-person clinical assessment and diagnosis. DESIGN: The online platform provides standardized data necessary for clinicians to rate participants on the Clinical Dementia Rating (CDR® ). Using this platform, clinicians diagnosed 60 patients at a range of CDR levels at two clinical sites. The online consensus diagnosis was compared with in-person clinical consensus diagnosis. SETTING: All India Institute of Medical Sciences (AIIMS), Delhi, and National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India. PARTICIPANTS: Thirty patients each at AIIMS and NIMHANS with equal numbers of patients previously independently rated in person by experts as CDR is 0 (cognitively normal), CDR is 0.5 (mild cognitive impairment), and CDR is 1 or greater (dementia). MEASUREMENTS: Multiple clinicians independently rate each participant on each CDR domain using standardized data and expert clinical judgment. The overall summary CDR is calculated by algorithm. When there are discrepancies among clinician ratings, clinicians discuss the case through a virtual consensus conference and arrive at a consensus overall rating. RESULTS: Online clinical consensus diagnosis based on standardized interview data provides consistent clinical diagnosis with in-person clinical assessment and consensus diagnosis (κ coefficient = 0.76). CONCLUSION: A web-based clinical consensus platform built on the Harmonized Diagnostic Assessment of Dementia for the Longitudinal Aging Study in India interview data is a cost-effective way to obtain reliable expert clinical judgments. A similar approach can be used for other epidemiological studies of dementia. J Am Geriatr Soc 68:S54-S59, 2020.
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