Comparison of Computerized and Paper-and-Pencil Memory Tests in Detection of Mild Cognitive Impairment and Dementia: A Systematic Review and Meta-analysis of Diagnostic Studies

Abstract Objectives To compare the diagnostic performance of computerized and paper-and-pencil memory tests in detection of mild cognitive impairment (MCI) and dementia. Design Diagnostic studies comparing computerized or paper-and-pencil memory tests with the standard diagnostic criterion for MCI or dementia were identified from OVID databases. The primary outcome was the diagnostic performance of memory tests for detection of MCI, and detection of dementia was the secondary outcome. Risk of bias and reporting quality in included studies was assessed. Setting and Participants Participants with MCI and dementia in any kind of setting. Measures Bivariate random-effects models were used to combine the diagnostic performance of memory tests and presented with a summary receiver-operating characteristic curve. Results A total of 58 studies with 18,450 participants with mean age ranging from 55 to 84 years were included. For the verbal memory tests on patients with MCI, computerized tests showed diagnostic accuracy of 0.89 sensitivity (95% confidence interval [CI] 0.69–0.97) and 0.82 specificity (95% CI 0.70–0.90), whereas paper-and-pencil tests showed diagnostic accuracy of 0.86 sensitivity (95% CI 0.82–0.90) and 0.82 specificity (95% CI 0.76–0.86). For the visual memory tests on MCI patients, computerized tests showed diagnostic accuracy of 0.79 sensitivity (95% CI 0.71–0.84) and 0.80 specificity (95% CI 0.71–0.86), whereas paper-and-pencil tests showed diagnostic accuracy of 0.80 sensitivity (95% CI 0.67–0.89) and 0.68 specificity (95% CI 0.51–0.81). The findings were also comparable to those with dementia. Conclusions/Implications Both verbal and visual computerized memory tests showed comparable diagnostic performance to the paper-and-pencil tests. Computerized cognitive tests show a great potential to use as an alternative to paper-and-pencil tests. When the records can be digitalized, long-term monitoring of cognitive function will be feasible for better management of dementia.