Blog | Wednesday, July 17, 2013

QD: News Every Day--Most online Alzheimer's tests fail on validity, reliability, ethics

An expert panel found that 16 freely accessible online tests for Alzheimer's disease scored poorly on scales of overall scientific validity, reliability and ethical factors, according to new data reported at a conference.

As many as 80% of Internet users seek health information and diagnoses online, and self-diagnosis is increasingly popular through freely accessible quizzes that call themselves "tests" for Alzheimer's disease, researchers reported at the Alzheimer's Association International Conference in Boston on July 15.

"Frankly, what we found online was distressing and potentially harmful," one author noted in a press release.

Geriatricians, human-computer interaction specialists, neuropsychologists and neuroethicists at the University of British Columbia reviewed the "tests" for scientific validity and reliability of the assessments, their human-computer interaction features, and ethics-related factors. The tests were evaluated on a scale from 1 (very poor) to 10 (excellent).

Twelve of the 16 tests scored "poor" or "very poor" for overall scientific validity and reliability, including criteria such as:
--Are the content and breadth appropriate to achieve test claims?
--Are test questions based on current, peer-reviewed evidence?
--Would the test have test-retest reliability?

All 16 tests scored "poor" or "very poor" on the evaluation criteria for ethical factors such as overly dense or absent confidentiality and privacy policies, failure to disclose commercial conflicts of interests, failure to meet the stated scope of the test and failure to word the test outcomes in an appropriate and ethical manner.

The majority of tests (10 of the 16) scored "fair" for appropriateness of human-computer interface for an older adult population, including clear and easy instructions, visual aspects such as font and contrast, and the motor tasks required being suitable for older users.

ACP Internist has published resources about Alzheimer's disease and addressing delicate issues with elderly patients.

First, not every memory problem is an indicator for Alzheimer's disease, a physician reassured his audience at an annual meeting of the American Academy of Family Physicians.

But when symptoms point toward the advent of Alzheimer's disease, the warning signs can be tricky to handle. While great advances have been made in diagnostics for Alzheimer's disease and its precursors, this new capability may only create more dilemmas for general internists.

When it is time for a tough talk about delicate issues, many physicians are also not adequately trained in how to broach the conversation. A physician offers advice on how to tackle this and other issues.

Rush University Medical Center is offering a CME course (fee required) to help internists and other clinicians properly evaluate patients' medical decision-making capacities. A fee will be assessed for four AMA PRA Category 1 credit hours, which will involve six modules requiring an expected five hours to complete over a two-month period.

The course will teach clinicians how to start a discussion of capacity with patients based on 10 key tenets; request a more thorough capacity evaluation for patients who are difficult to assess; prescribe a proper referral for capacity assessment; and use appropriate terminology and examples when working with courts in guardianship proceedings.