The Use of Digital Neurocognitive Assessments to Assess Traumatic Brain Injury and Dementia in Older Trauma Patients: An Emergency Department Feasibility Study.

Background/

Objectives

Older adults are disproportionately affected by traumatic brain injuries (TBIs), representing a significant portion of TBI-related hospitalizations and deaths. The objective of this study was to evaluate the feasibility and effectiveness of BrainCheck (Braincheck, Inc., Austin, TX, USA), a digital cognitive assessment tool, in detecting acute TBI-related cognitive deficits in the context of dementia-related cognitive impairment in older adult emergency department (ED) patients.

Methods

From March 2020 to November 2023, participants aged 65+ with mild TBI, as defined by the American College of Rehabilitation Medicine (ACRM) diagnostic criteria, and individuals with isolated orthopedic injuries were recruited from 14 U.S. type 1 and 2 trauma centers. After informed consent, each subject was assessed by well-validated neurocognitive tests to characterize pre- and postinjury cognitive status. The Clinical Dementia Rating (CDR) and Functional Activities Questionnaire (FAQ) were used to assess cognitive impairment, with the informant sections used to classify preinjury status. The Rivermead Post-Concussion Symptoms Questionnaire (RPQ16) was used to assess injury-related symptoms, and the tablet-based BrainCheck Battery was tested as a diagnostic platform for injury-related deficits across several functional domains. Spearman's correlation was used to assess BrainCheck's internal validity and its relationship with self-reported cognitive symptoms. Technology familiarity was self-reported on a 1 (lowest) to 5 (highest) Likert scale. ROC curves evaluated the tool's accuracy in identifying cognitive impairment associated with TBI in the context of pre-existing cognitive impairment.

Results

For the 101 mTBI and 52 orthopedic trauma control patients, BrainCheck demonstrated strong internal validity, with significant correlations among its component tests, indicating its effectiveness in assessing cognitive impairment. However, low correlations with RPQ16 self-reported symptoms suggest that BrainCheck and the self-reported questionnaire assess different aspects of cognitive functions.

Conclusions

While BrainCheck effectively identified cognitive impairment, the composite battery and scoring did not differentiate TBI and dementia. Technology familiarity did not affect test outcomes. BrainCheck is a useful tool for evaluating cognitive function in adults aged ≥ 65 years with and without TBI in ED settings.