ArticleFrontiers in neurology
Initial specialist validation of clinical decision support recommendations from a machine learning-enabled digital cognitive assessment.
Article in Frontiers in neurology. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Introduction: Disease-modifying therapies for Alzheimer's disease (AD) heighten demand for scalable tools enabling primary care providers (PCPs) to detect cognitive impairment and triage patients for appropriate evaluation. The brief tablet-based Linus Health Core Cognitive Evaluation (CCE) integrates the Digital Clock and Recall (DCR) and Life and Health Questionnaire (LHQ) to generate clinical decision support (CDS) and decision-tree pathways. Methods: We conducted a retrospective specialist content-validity study (June 15-27, 2023) using a modified RAND/UCLA Appropriateness Method. Five board-certified cognitive/behavioral neurologists independently rated CDS recommendations and nine predefined pathway parts for patients aged ≥55 across 21 de-identified reports. Items scored 1-9 were summarized as pooled medians with interquartile ranges; medians ≥7 indicated appropriateness. Agreement among experts was quantified using ICC [2,k] and ICC [2,1]. Results: All cognitive-impairment recommendations met the threshold. All seven borderline/impaired-DCR pathways were appropriate (median 7-8). Two pathways fell below threshold: cognitively unimpaired individuals with Green DCR scores (median 6) and a preliminary anti-amyloid treatment referral pathway (median 5). Agreement was moderate per patient [median ICC(2,k) = 0.61] and lower for individual diagnostic-concern recommendations [median ICC(2,k) = 0.25], reflecting specialist heterogeneity on borderline non-cognitive items and ceiling effects on high-rated items. Conclusion: Cognitive neurologists judged CCE-derived CDS appropriate for PCP workup and referral decisions in older adults with suspected cognitive impairment. Findings support initial content validity of assessment-linked CDS, identify refinement priorities in low-risk and emerging-therapy pathways, and motivate planned PCP appropriateness and prospective implementation studies.
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