Supplementary Material for: Validation of an Application-based Cognitive Screening Test for Older Thai Adults

Introduction
The cognitive screening usually requires a face-to-face format, which might limit its use in many circumstances. We aimed to develop a new application-based cognitive screening test (ACST) to serve as an accessible and valid tool in the community.
Methods
The ACST was developed by using paired association and digit span tests. This test was administered to 70 cognitively normal participants, 62 participants with MCI and 64 participants with dementia. The 2nd edition of the Mini-Mental State Examination (MMSE-2), and the Montreal Cognitive Assessment (MoCA) were collected by certified psychologists. The ACST was performed by a clinician. The diagnosis was made according to DSM-V criteria by an experienced geriatric neurologist blinded to the application score. Content validity, test-retest reliability, interrater reliability, and correlations between application scores and MMSE-2 and MoCA scores were analyzed.
Results
The sensitivity and specificity for distinguishing cognitively normal participants from nonnormal participants was 92.9% and 70%, respectively (cutoff point ≤ 7). The sensitivity and specificity for distinguishing between the cognitively normal group and the MCI group was 87.1% and 70%, respectively (cut point ≤ 7). The sensitivity and specificity for distinguishing cognitively normal participants from participants with dementia was 93.8% and 82.9%, respectively (cut point ≤ 6). A cutoff point ≤ 6 was considered suitable for participants aged 75 years or older or with 6 or fewer years of education.
Discussion
The ACST is an easy-to-use and valid tool for cognitive screening in older Thai adults in clinical practice. Patients with an application score ≤ 7 are considered to be at risk of cognitive impairment and to require further evaluation.