Cognitive Screening in Primary Care: In-Person Tablet vs. Remote Smartphone Approaches

Abstract Objective: To overcome the barriers to screening and early detection of cognitive impairment in routine primary care, our team developed and validated two self-administered digital cognitive screening tools. MyCog is a tablet-based, in-clinic screener while MyCog Mobile is smartphone-based and completed remotely prior to the visit. We compare their respective use cases, diagnostic accuracy, and clinical utility for detecting cognitive impairment (CI) in older adults. Method/Data Selection: Both apps use measures adapted from the NIH Toolbox Cognition battery to assess memory and executive function. MyCog Study: 145 adults 65+ (65 with EHR-confirmed CI, 80 cognitively-normal) self-administered MyCog in-person. MyCog Mobile Study: 277 adults 65+ (100 with Mild Cognitive Impairment (MCI), 177 cognitively-normal) self-administered MyCog Mobile on smartphones. Both studies employed bootstraping, multiple modeling approaches, and decision curve analysis to assess performance. Results/Data Synthesis: Both tools demonstrated excellent discrimination and calibration. MyCog achieved C-statistic=0.886, 83% accuracy, calibration slope=0.96, sensitivity=0.81, specificity=0.85 for broadly-defined CI. MyCog Mobile achieved C-statistic=0.813, 77% accuracy, calibration slope=0.91, sensitivity=0.78, specificity=0.77 for MCI specifically. Decision curve analysis confirmed clinical utility: at 30% threshold, MyCog identified 11 additional cases per 100 patients; MyCog Mobile identified 10 additional cases per 100 versus screen-all strategy. Conclusions: MyCog and MyCog Mobile demonstrate robust diagnostic accuracy using self-administered assessments of episodic memory and executive function. They address complementary contexts: MyCog offers supervised in-clinic screening for broad CI, while MyCog Mobile enables smartphone assessment for MCI detection among adults capable of remote screening without clinic support. These scalable solutions address critical cognitive screening barriers in primary care, and facilitate earlier detection.