Acceptance of Unsupervised App-Based Cognitive Assessment in Outpatient Care: An Implementation Study

Background: The use of unsupervised digital cognitive assessments provides considerable opportunities for early and comprehensive testing for Alzheimer disease, minimizing the demand on time and personnel resources in medical practices. However, the acceptance within health care has yet to be assessed. Objective: In this implementation study, the acceptance of an app-based, repeated cognitive assessment for early symptoms of Alzheimer disease in the outpatient care setting from both physicians' and patients' perspectives was examined. Methods: In total, 15 primary care practices participated, where patients with self- or relative-reported memory problems could be prescribed an app (neotivCare app [neotiv GmbH]) for comprehensive cognitive testing. Patients used the app to test their episodic memory function weekly for 12 weeks at home. After the testing period and the final consultation, physicians and patients received questionnaires to assess the app's acceptance. Results: We received completed questionnaires from physicians for 45 patients. In addition, we received 45 completed questionnaires from the patients themselves. The physicians reported that, for most patients, the app supported their decision- making in the diagnostic process (26/45, 58%). In addition, most physicians found the app's information dependable (34/45, 76%) and felt more certain in their decisions (38/45, 84%). From the patients' perspective, a majority felt thoroughly tested (34/45, 76%), and only a few considered the time commitment for the cognitive tests to be too burdensome (7/45, 16%). Furthermore, despite the weekly cognitive testing and the lengthy 12-week testing period, a majority of patients participated in all tests (39/54, 72%). Conclusions: Our results indicate a high level of acceptance by physicians and patients, suggesting significant potential for the implementation of unsupervised digital cognitive assessments into routine health care. In the future, acceptance should be assessed in large-scale studies, with a particular focus on the impact on health care delivery and patient outcomes.