Computer-automated dementia screening using a touch-tone telephone

Arch Intern Med. 2001 Nov 12;161(20):2481-7. doi: 10.1001/archinte.161.20.2481.


Background: This study investigated the sensitivity and specificity of a computer-automated telephone system to evaluate cognitive impairment in elderly callers to identify signs of early dementia.

Methods: The Clinical Dementia Rating Scale was used to assess 155 subjects aged 56 to 93 years (n = 74, 27, 42, and 12, with a Clinical Dementia Rating Scale score of 0, 0.5, 1, and 2, respectively). These subjects performed a battery of tests administered by an interactive voice response system using standard Touch-Tone telephones. Seventy-four collateral informants also completed an interactive voice response version of the Symptoms of Dementia Screener.

Results: Sixteen cognitively impaired subjects were unable to complete the telephone call. Performances on 6 of 8 tasks were significantly influenced by Clinical Dementia Rating Scale status. The mean (SD) call length was 12 minutes 27 seconds (2 minutes 32 seconds). A subsample (n = 116) was analyzed using machine-learning methods, producing a scoring algorithm that combined performances across 4 tasks. Results indicated a potential sensitivity of 82.0% and specificity of 85.5%. The scoring model generalized to a validation subsample (n = 39), producing 85.0% sensitivity and 78.9% specificity. The kappa agreement between predicted and actual group membership was 0.64 (P<.001). Of the 16 subjects unable to complete the call, 11 provided sufficient information to permit us to classify them as impaired. Standard scoring of the interactive voice response-administered Symptoms of Dementia Screener (completed by informants) produced a screening sensitivity of 63.5% and 100% specificity. A lower criterion found a 90.4% sensitivity, without lowering specificity.

Conclusions: Computer-automated telephone screening for early dementia using either informant or direct assessment is feasible. Such systems could provide wide-scale, cost-effective screening, education, and referral services to patients and caregivers.

Publication types

  • Evaluation Study
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Algorithms
  • Artificial Intelligence
  • Cost-Benefit Analysis
  • Decision Trees
  • Dementia / classification
  • Dementia / diagnosis*
  • Diagnosis, Computer-Assisted / economics
  • Diagnosis, Computer-Assisted / instrumentation
  • Diagnosis, Computer-Assisted / methods*
  • Diagnosis, Computer-Assisted / standards*
  • Discriminant Analysis
  • Feasibility Studies
  • Geriatric Assessment
  • Humans
  • Mass Screening / economics
  • Mass Screening / instrumentation
  • Mass Screening / methods*
  • Mass Screening / standards*
  • Mental Status Schedule
  • Middle Aged
  • Models, Statistical
  • Psychiatric Status Rating Scales / standards*
  • Referral and Consultation
  • Sensitivity and Specificity
  • Severity of Illness Index
  • Telecommunications / economics
  • Telecommunications / standards*
  • Telephone / economics
  • Telephone / standards*