Development and Preliminary Validation of ORCA-PD, an Online Rapid Cognitive Assessment for Parkinson Disease: Mixed Methods Study
Development and Preliminary Validation of ORCA-PD, an Online Rapid Cognitive Assessment for Parkinson Disease: Mixed Methods Study
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Original abstract
Abstract Background Traditional in-person neuropsychological tests for Parkinson disease (PD) lack accessibility, scalability, and PD specificity. Mobility impairments hinder access to in-person assessments, and long waiting times for expert evaluation limit scalability. Common tools for cognitive screening, such as the Montreal Cognitive Assessment, are generic and not specific to PD. Objective The goal of this study was to address these challenges by leveraging the internet. This study aimed to develop a sensitive tool to detect cognitive impairments in early- to mid-stage PD in an accessible and scalable manner. Methods We developed the Online Rapid Cognitive Assessment for Parkinson’s Disease (ORCA-PD), a brief (~15 min), fully self-administered tool, tailored to detect PD-specific impairments remotely. In a cross-sectional study, 112 participants from diverse geographical locations completed the ORCA-PD and a usability questionnaire. Task selection for ORCA-PD was guided by meta-analyses and comprehensive reviews, which demonstrated medium-to-high sensitivity to PD compared to healthy controls. Results Participants from more than 30 geographical locations showed a 93% (135/145) completion rate, with median usability ratings of 4 to 5 (IQRs 0-1) out of 5, indicating strong usability across a diverse sample. The ORCA-PD score significantly correlated with the Montreal Cognitive Assessment score (ρ=0.45, 95% CI 0.21-0.64; P <.001; n=56), supporting convergent validity. The ORCA-PD scores also followed expected significant trends: neurotypical controls scored higher than participants with PD (β=4.18; P =.048) and participants with PD without mild cognitive impairment scored higher than participants with PD with mild cognitive impairment (β=7.22; P =.046), confirming 2 discriminative abilities. Conclusions ORCA-PD demonstrated usability and preliminary validity. ORCA-PD offers an accessible, scalable, and PD-sensitive cognitive screening test that could complement traditional in-person, supervised tools.