Table 5.

Domain 4 Ideal Brief Cognitive Assessment (BCA): themes and exemplary quotes

Themes	Quotes
Cultural validity and applicability across diverse populations	Neurologist, Asia: I think one thing that’s very important to take into account is education level, and also language proficiencies, or like, you know, occupational complexity, needs to be taken into account for such screening tools. Neurologist, South America: I think we would need to have a simpler test that could be used by a general practitioner. This is an idea that we need to have for all the poorest countries, in fact any country. There should be a set of relatively simple tests with good sensitivity and good specificity for individuals with low education. The ideal would be a test that had little influence by education. So that you could apply the same test without distinction. Geriatrician, South America: I think that in [country] the rural population represents around 35 percent of the total population, they have another type of culture, another type of environment, they do other type of activities. So, making an adaptation specifically for rural areas can be a possibility.
Brevity (length < 10 minutes) and ease of administration	Geriatrician, Asia: I feel it needs to be short for people, both providers and participants, to be willing to do them. I would say around 10–15 minutes. If it can be less than 10 minutes, even better. Neurologist, Africa: If we had a kind of a short, sweet assessment, like a short, sweet questionnaire, that any nurse, or clinical officer, or doctor out there could administer, something that would take, like, 5 minutes, you know, or even less. You know, so, maybe just a couple of questions just to get a history and just a couple of – maybe one or two tests – just to get a feel for whether there’s an objective problem. That would be really helpful if it could be rolled out across the public health system as well as the private health system.
Assessment of multiple cognitive domains as well as daily function to assist with differential diagnosis	Neuropsychologist, Africa: And we don’t have any functional tests, as well, apart from cognitive tests. You know, we need to be able to have functional tests. Neurologist, South America: It [BCA] is only dedicated to exploring Alzheimer’s disease. So, I lost cases of vascular, frontotemporal, and others … [BCA] tells you, “you have dementia,” but not a subtype ofdementia.
Sensitivity to early detection of cognitive impairment	Neurologist, Asia: I think a good screening test that helps to pick up the MCI or very early dementia is one that can be tailored, or that their score can differ for each different category, or that it can encompass all of them. Like, a screening test can pick up MCI in different individuals that have different educational backgrounds – so that’s one thing that I would be concerned about. Neuropsychologist, Europe: So, if we are able to collect data from – from typical, normal, cognitively intact elders and see what the normal activity in their daily living is, of course the data can come from sensors. We can create algorithms in which after putting data in we’ll be able to understand any differences … we can detect a small difference which could be dementia onset stage.
Potential for technology-assisted administration	Neuropsychologist, Europe: Oh, technology based. It’s easier, it’s accessible to anyone who wants to assess from the therapeutic team, yes, it could be technological. Geriatrician, Asia: Many older adults use smartphones these days. However, they are some who struggle to operate these devices. This group, I think, they would need administrators or supervisors to be with them. Computerized tools are said to help with reducing human resources, but if it cannot be self-administered it may not be much different.