Skip to main content
Top
Published in: Journal of Neurology 5/2024

Open Access 20-02-2024 | Neurological Tests | Original Communication

A Delphi consensus to identify the key screening tests/questions for a digital neurological examination for epidemiological research

Authors: Vasco Ribeiro Ferreira, Carol Brayne, Paolo Ragonese, Carlos Ketzoian, Marta Piccioli, Lorenzo Tinti, Carlo Casali, Cherubino di Lorenzo, Claudia Ramos, João Azevedo, Adriana Gomes, Roderick Stewart, Hein Haas, Stan Hoppenbrouwer, Esther Metting, Valentina Gallo

Published in: Journal of Neurology | Issue 5/2024

Login to get access

Abstract

Background

Most neurological diseases have no curative treatment; therefore, focusing on prevention is key. Continuous research to uncover the protective and risk factors associated with different neurological diseases is crucial to successfully inform prevention strategies. eHealth has been showing promising advantages in healthcare and public health and may therefore be relevant to facilitate epidemiological studies.

Objective

In this study, we performed a Delphi consensus exercise to identify the key screening tests to inform the development of a digital neurological examination tool for epidemiological research.

Methods

Twelve panellists (six experts in neurological examination, five experts in data collection—two were also experts in the neurological examination, and three experts in participant experience) of different nationalities joined the Delphi exercise. Experts in the neurological examination provided a selection of items that allow ruling out neurological impairment and can be performed by trained health workers. The items were then rated by them and other experts in terms of their feasibility and acceptability.

Results

Ten tests and seven anamnestic questions were included in the final set of screening items for the digital neurological examination. Three tests and five anamnestic questions were excluded from the final selection due to their low ratings on feasibility.

Conclusion

This work identifies the key feasible and acceptable screening tests and anamnestic questions to build an electronic tool for performing the neurological examination, in the absence of a neurologist.
Literature
1.
go back to reference Feigin VL, Vos T, Nichols E, Owolabi MO, Carroll WM, Dichgans M et al (2020) The global burden of neurological disorders: translating evidence into policy. Lancet Neurol 19(3):255–265CrossRefPubMed Feigin VL, Vos T, Nichols E, Owolabi MO, Carroll WM, Dichgans M et al (2020) The global burden of neurological disorders: translating evidence into policy. Lancet Neurol 19(3):255–265CrossRefPubMed
2.
go back to reference Feigin VL, Nichols E, Alam T, Bannick MS, Beghi E, Blake N et al (2019) Global, regional, and national burden of neurological disorders, 1990–2016: a systematic analysis for the global burden of disease study 2016. Lancet Neurol 18(5):459–480CrossRef Feigin VL, Nichols E, Alam T, Bannick MS, Beghi E, Blake N et al (2019) Global, regional, and national burden of neurological disorders, 1990–2016: a systematic analysis for the global burden of disease study 2016. Lancet Neurol 18(5):459–480CrossRef
3.
go back to reference Olesen J (2015) The cost of neurological disorders in Europe. J Neurol Sci 357:e500–e501CrossRef Olesen J (2015) The cost of neurological disorders in Europe. J Neurol Sci 357:e500–e501CrossRef
4.
go back to reference World Health Organization (2006) Neurological disorders: public health challenges. WHO, Geneva, p 218 World Health Organization (2006) Neurological disorders: public health challenges. WHO, Geneva, p 218
5.
go back to reference World Health Organization (2022) Follow-up to the political declaration of the third high-level meeting of the general assembly on the prevention and control of non-communicable diseases. In: Seventy-fifth world health assembly World Health Organization (2022) Follow-up to the political declaration of the third high-level meeting of the general assembly on the prevention and control of non-communicable diseases. In: Seventy-fifth world health assembly
7.
go back to reference Gallo V, Vanacore N, Bueno-de-Mesquita HB, Vermeulen R, Brayne C, Pearce N et al (2016) Physical activity and risk of Amyotrophic Lateral Sclerosis in a prospective cohort study. Eur J Epidemiol 31(3):255–266CrossRefPubMedPubMedCentral Gallo V, Vanacore N, Bueno-de-Mesquita HB, Vermeulen R, Brayne C, Pearce N et al (2016) Physical activity and risk of Amyotrophic Lateral Sclerosis in a prospective cohort study. Eur J Epidemiol 31(3):255–266CrossRefPubMedPubMedCentral
8.
go back to reference (2023) The transforming landscape of dementia research. Nat Aging 3(5):459 (2023) The transforming landscape of dementia research. Nat Aging 3(5):459
9.
go back to reference Ballard C, Gauthier S, Corbett A, Brayne C, Aarsland D, Jones E (2011) Alzheimer’s disease. Lancet 377(9770):1019–1031CrossRefPubMed Ballard C, Gauthier S, Corbett A, Brayne C, Aarsland D, Jones E (2011) Alzheimer’s disease. Lancet 377(9770):1019–1031CrossRefPubMed
10.
go back to reference Frisoni GB, Boccardi M, Barkhof F, Blennow K, Cappa S, Chiotis K et al (2017) Strategic roadmap for an early diagnosis of Alzheimer’s disease based on biomarkers. Lancet Neurol 16(8):661–676CrossRefPubMed Frisoni GB, Boccardi M, Barkhof F, Blennow K, Cappa S, Chiotis K et al (2017) Strategic roadmap for an early diagnosis of Alzheimer’s disease based on biomarkers. Lancet Neurol 16(8):661–676CrossRefPubMed
11.
go back to reference Colditz GA, Manson JE, Hankinson SE (1997) The nurses’ health study: 20-year contribution to the understanding of health among women. J Womens Health 6(1):49–62CrossRefPubMed Colditz GA, Manson JE, Hankinson SE (1997) The nurses’ health study: 20-year contribution to the understanding of health among women. J Womens Health 6(1):49–62CrossRefPubMed
12.
go back to reference Hagan KA, Munger KL, Ascherio A, Grodstein F (2016) Epidemiology of major neurodegenerative diseases in women: contribution of the nurses’ health study. Am J Public Health 106(9):1650–1655CrossRefPubMedPubMedCentral Hagan KA, Munger KL, Ascherio A, Grodstein F (2016) Epidemiology of major neurodegenerative diseases in women: contribution of the nurses’ health study. Am J Public Health 106(9):1650–1655CrossRefPubMedPubMedCentral
13.
go back to reference Hughes KC, Gao X, Kim IY, Rimm EB, Wang M, Weisskopf MG et al (2016) Intake of antioxidant vitamins and risk of Parkinson’s disease: antioxidant vitamin intake and PD. Mov Disord 31(12):1909–1914CrossRefPubMedPubMedCentral Hughes KC, Gao X, Kim IY, Rimm EB, Wang M, Weisskopf MG et al (2016) Intake of antioxidant vitamins and risk of Parkinson’s disease: antioxidant vitamin intake and PD. Mov Disord 31(12):1909–1914CrossRefPubMedPubMedCentral
14.
go back to reference Palacios N, Fitzgerald KC, Hart JE, Weisskopf MG, Schwarzschild MA, Ascherio A et al (2014) Particulate matter and risk of parkinson disease in a large prospective study of women. Environ Health 13(1):80CrossRefPubMedPubMedCentral Palacios N, Fitzgerald KC, Hart JE, Weisskopf MG, Schwarzschild MA, Ascherio A et al (2014) Particulate matter and risk of parkinson disease in a large prospective study of women. Environ Health 13(1):80CrossRefPubMedPubMedCentral
15.
go back to reference Iwaki H, Hughes KC, Gao X, Schwarzschild MA, Ascherio A (2018) The association between restless legs syndrome and premotor symptoms of Parkinson’s disease. J Neurol Sci 394:41–44CrossRefPubMed Iwaki H, Hughes KC, Gao X, Schwarzschild MA, Ascherio A (2018) The association between restless legs syndrome and premotor symptoms of Parkinson’s disease. J Neurol Sci 394:41–44CrossRefPubMed
16.
go back to reference Ott A, Stolk RP, Van Harskamp F, Pols HAP, Hofman A, Breteler MMB (1999) Diabetes mellitus and the risk of dementia: the Rotterdam Study. Neurology 53(9):1937–1937CrossRefPubMed Ott A, Stolk RP, Van Harskamp F, Pols HAP, Hofman A, Breteler MMB (1999) Diabetes mellitus and the risk of dementia: the Rotterdam Study. Neurology 53(9):1937–1937CrossRefPubMed
17.
go back to reference Gallo V, Wark PA, Jenab M, Pearce N, Brayne C, Vermeulen R et al (2013) Prediagnostic body fat and risk of death from amyotrophic lateral sclerosis: the EPIC cohort. Neurology 80(9):829–838CrossRefPubMedPubMedCentral Gallo V, Wark PA, Jenab M, Pearce N, Brayne C, Vermeulen R et al (2013) Prediagnostic body fat and risk of death from amyotrophic lateral sclerosis: the EPIC cohort. Neurology 80(9):829–838CrossRefPubMedPubMedCentral
18.
go back to reference Gallo V, Bueno-De-Mesquita HB, Vermeulen R, Andersen PM, Kyrozis A, Linseisen J et al (2009) Smoking and risk for amyotrophic lateral sclerosis: analysis of the EPIC cohort. Ann Neurol 65(4):378–385CrossRefPubMed Gallo V, Bueno-De-Mesquita HB, Vermeulen R, Andersen PM, Kyrozis A, Linseisen J et al (2009) Smoking and risk for amyotrophic lateral sclerosis: analysis of the EPIC cohort. Ann Neurol 65(4):378–385CrossRefPubMed
19.
go back to reference Yang FC, Chen HJ, Lee JT, Chen SJ, Sung YF, Kao CH et al (2018) Increased risk of Parkinson’s disease following tension-type headache: a nationwide population-based cohort study. Oncotarget 9(2):2148–2157CrossRefPubMed Yang FC, Chen HJ, Lee JT, Chen SJ, Sung YF, Kao CH et al (2018) Increased risk of Parkinson’s disease following tension-type headache: a nationwide population-based cohort study. Oncotarget 9(2):2148–2157CrossRefPubMed
20.
go back to reference Chen H, Ding D, Wang J, Zhao Q, Meng H, Li H et al (2015) Parkinson’s disease research in a prospective cohort in China. Parkinsonism Relat Disord 21(10):1200–1204CrossRefPubMedPubMedCentral Chen H, Ding D, Wang J, Zhao Q, Meng H, Li H et al (2015) Parkinson’s disease research in a prospective cohort in China. Parkinsonism Relat Disord 21(10):1200–1204CrossRefPubMedPubMedCentral
21.
go back to reference Gallo V, Brayne C, Forsgren L, Barker RA, Petersson J, Hansson O et al (2015) Parkinson’s disease case ascertainment in the EPIC Cohort: the NeuroEPIC4PD study. Neurodegener Dis 15(6):331–338CrossRefPubMed Gallo V, Brayne C, Forsgren L, Barker RA, Petersson J, Hansson O et al (2015) Parkinson’s disease case ascertainment in the EPIC Cohort: the NeuroEPIC4PD study. Neurodegener Dis 15(6):331–338CrossRefPubMed
22.
go back to reference Demers M, Blanchette AK, Mullick AA, Shah A, Woo K, Solomon J et al (2019) Facilitators and barriers to using neurological outcome measures in developed and developing countries. Physiother Res Int 24(1):e1756CrossRefPubMed Demers M, Blanchette AK, Mullick AA, Shah A, Woo K, Solomon J et al (2019) Facilitators and barriers to using neurological outcome measures in developed and developing countries. Physiother Res Int 24(1):e1756CrossRefPubMed
23.
go back to reference Franzen SRP, Chandler C, Siribaddana S, Atashili J, Angus B, Lang T (2017) Strategies for developing sustainable health research capacity in low and middle-income countries: a prospective, qualitative study investigating the barriers and enablers to locally led clinical trial conduct in Ethiopia, Cameroon and Sri Lanka. BMJ Open 7(10):e017246CrossRefPubMedPubMedCentral Franzen SRP, Chandler C, Siribaddana S, Atashili J, Angus B, Lang T (2017) Strategies for developing sustainable health research capacity in low and middle-income countries: a prospective, qualitative study investigating the barriers and enablers to locally led clinical trial conduct in Ethiopia, Cameroon and Sri Lanka. BMJ Open 7(10):e017246CrossRefPubMedPubMedCentral
24.
go back to reference Peterson CB, Hamilton C, Hasvold P (2016) From innovation to implementation: eHealth in the WHO European region. WHO Regional Office for Europe, Copenhagen, Denmark, p 98 Peterson CB, Hamilton C, Hasvold P (2016) From innovation to implementation: eHealth in the WHO European region. WHO Regional Office for Europe, Copenhagen, Denmark, p 98
27.
go back to reference Jain S, Iverson LM (2023) Glasgow Coma scale [Internet]. StatPearls Publishing, Treasure Island, FL Jain S, Iverson LM (2023) Glasgow Coma scale [Internet]. StatPearls Publishing, Treasure Island, FL
28.
go back to reference Weiner WJ, Goetz CG, Shin RK, Lewis SL (2012) Neurology for the non-neurologist. Lippincott Williams & Wilkins, USA Weiner WJ, Goetz CG, Shin RK, Lewis SL (2012) Neurology for the non-neurologist. Lippincott Williams & Wilkins, USA
29.
30.
go back to reference Nasreddine ZS, Phillips NA, Bédirian V, Charbonneau S, Whitehead V, Collin I et al (2005) The Montreal cognitive assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc 53(4):695–699CrossRefPubMed Nasreddine ZS, Phillips NA, Bédirian V, Charbonneau S, Whitehead V, Collin I et al (2005) The Montreal cognitive assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc 53(4):695–699CrossRefPubMed
31.
go back to reference Liu CH, Hsu LL, Hsiao CT, Hsieh SI, Chang CW, Huang ES et al (2018) Core neurological examination items for neurology clerks: a modified Delphi study with a grass-roots approach. PLoS ONE 13(5):e0197463CrossRefPubMedPubMedCentral Liu CH, Hsu LL, Hsiao CT, Hsieh SI, Chang CW, Huang ES et al (2018) Core neurological examination items for neurology clerks: a modified Delphi study with a grass-roots approach. PLoS ONE 13(5):e0197463CrossRefPubMedPubMedCentral
32.
go back to reference Haddad AF, Burke JF, Mummaneni PV, Chan AK, Safaee MM, Knightly JJ et al (2021) Telemedicine in neurosurgery: standardizing the spinal physical examination using a modified Delphi method. Neurospine 18(2):292–302CrossRefPubMedPubMedCentral Haddad AF, Burke JF, Mummaneni PV, Chan AK, Safaee MM, Knightly JJ et al (2021) Telemedicine in neurosurgery: standardizing the spinal physical examination using a modified Delphi method. Neurospine 18(2):292–302CrossRefPubMedPubMedCentral
33.
go back to reference McNamara L, Scott KM, Boyd RN, Novak I (2021) Consensus of physician behaviours to target for early diagnosis of cerebral palsy: a Delphi study. J Paediatr Child Health 57(7):1009–1015CrossRefPubMed McNamara L, Scott KM, Boyd RN, Novak I (2021) Consensus of physician behaviours to target for early diagnosis of cerebral palsy: a Delphi study. J Paediatr Child Health 57(7):1009–1015CrossRefPubMed
34.
go back to reference Kosa P, Barbour C, Wichman A, Sandford M, Greenwood M, Bielekova B (2018) NeurEx: digitalized neurological examination offers a novel high-resolution disability scale. Ann Clin Transl Neurol 5(10):1241–1249CrossRefPubMedPubMedCentral Kosa P, Barbour C, Wichman A, Sandford M, Greenwood M, Bielekova B (2018) NeurEx: digitalized neurological examination offers a novel high-resolution disability scale. Ann Clin Transl Neurol 5(10):1241–1249CrossRefPubMedPubMedCentral
35.
go back to reference Iverson G (2011) Finger to nose test. In: Kreutzer JS, DeLuca J, Caplan B (eds) Encyclopedia of clinical neuropsychology. Springer, New York, NY Iverson G (2011) Finger to nose test. In: Kreutzer JS, DeLuca J, Caplan B (eds) Encyclopedia of clinical neuropsychology. Springer, New York, NY
36.
go back to reference Bo K (2019) Finger nose proprioceptive test (case study). Clin Med 19(Suppl 3):20CrossRef Bo K (2019) Finger nose proprioceptive test (case study). Clin Med 19(Suppl 3):20CrossRef
37.
go back to reference Amer M, Hubert G, Sullivan SJ, Herbison P, Franz EA, Hammond-Tooke GD (2012) Reliability and diagnostic characteristics of clinical tests of upper limb motor function. J Clin Neurosci 19(9):1246–1251CrossRefPubMed Amer M, Hubert G, Sullivan SJ, Herbison P, Franz EA, Hammond-Tooke GD (2012) Reliability and diagnostic characteristics of clinical tests of upper limb motor function. J Clin Neurosci 19(9):1246–1251CrossRefPubMed
Metadata
Title
A Delphi consensus to identify the key screening tests/questions for a digital neurological examination for epidemiological research
Authors
Vasco Ribeiro Ferreira
Carol Brayne
Paolo Ragonese
Carlos Ketzoian
Marta Piccioli
Lorenzo Tinti
Carlo Casali
Cherubino di Lorenzo
Claudia Ramos
João Azevedo
Adriana Gomes
Roderick Stewart
Hein Haas
Stan Hoppenbrouwer
Esther Metting
Valentina Gallo
Publication date
20-02-2024
Publisher
Springer Berlin Heidelberg
Published in
Journal of Neurology / Issue 5/2024
Print ISSN: 0340-5354
Electronic ISSN: 1432-1459
DOI
https://doi.org/10.1007/s00415-024-12254-y

Other articles of this Issue 5/2024

Journal of Neurology 5/2024 Go to the issue