Advancing Digital Technologies for Rapid and Reliable Cognitive Assessment

Cognitive assessment

Advancing Digital Technologies for Rapid and Reliable Cognitive Assessment 

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IntelliSpace Cognition, expanded for a more complete overview of cognition


IntelliSpace Cognition (ISC) is a data-rich digital cognitive assessment tool, delivered on an iPad Pro, that uses advanced analytics to instantly score tests and report the results in terms of cognitive domains that neurologists can easily interpret. On-demand, expedited access provides neurologists with meaningful, action-oriented insights about patients’ cognitive status. The automatic comparison of patient data to recently acquired normative data from the US population can reveal subtle cognitive impairments that may otherwise go unnoticed.
Report on tablet

The population with cognitive impairment is growing


According to the World Health Organization (WHO), there are 47 million people with advanced cognitive impairment worldwide. This figure is projected to increase to 75 million in 2030 and 132 million in 2050.1 Increasingly, neurologists, neuropsychologists, and other health care professionals are called upon to diagnose and care for this population. There may be a waiting time to obtain full neuropsychological testing. Testing may take several hours, and manual scoring can be tedious and time-consuming. The typical wait time from the neurologist’s referral to receiving the neuropsychological report is 5 to 16 weeks.2 Because of the wait and other factors, sometimes testing is not ordered at all. In fact, a market survey of US-based neurologists commissioned by Philips found that up to 63% of patients who may need neuropsychological assessment do not receive it.

 

“There is an unmet need in the US market due to the increasing number of people with neurologic disease and long waiting times for neuropsychological assessment results,” explains Dr. Murray Gillies, General Manager of Philips Digital Cognitive Diagnostics.

ISC Chart
“There is an unmet need in the US market due to the increasing number of people with neurologic disease and long waiting times for neuropsychological assessment results,” explains Dr. Murray Gillies, General Manager of Philips Digital Cognitive Diagnostics.

IntelliSpace Cognition - Market Reactions to the first release


The first release of IntelliSpace Cognition offered a brief assessment including three tests commonly used in the neurology clinic: The Mini-Mental State Examination (MMSE), Trail Making Test (TMT), and Clock Drawing Test. These foundational tests were created digitally in such a way so as to ensure construct validity and be psychometrically equivalent to the paper versions. As part of the validation study, the tests were performed by participants on paper as well as digitally, and the outcome scores of the paper and digital versions showed a high level of correlation.

 

The pilot market of IntelliSpace Cognition focused on integrating the ISC test platform into the clinical workflow. Since November 2019, IntelliSpace Cognition has been utilized and integrated into select US neurology practices.  Neurologists and their staff have assessed patients using the application and, when necessary, adapted their practice workflow to incorporate the use of the iPad Pro. Some practices scheduled separate appointments with a medical assistant to collect the data while the neurologist interpreted the results; others preferred a more hands-on approach in which the neurologist collected the data themselves during the office visit and immediately reviewed the results. The generated reports, which can be easily exported and attached to the patient’s record, are utilized as part of overall patient evaluations.

 

Neurologist feedback has been positive:

This well-validated cognitive assessment tool is destined to become an essential part of the neurologist’s clinical toolkit.  The Philips ISC expands the repertoire of cognitive testing beyond screening measures…Test instructions are easily understood by most patients. Testing on an iPad allows direct observation of behavior and allows the clinician to review the patient’s test strategy in real-time playback. Results are automatically scored and displayed in visually explicit graphics. The ISC combines detailed analytics with stunning ease of function.  It has been my pleasure to collaborate with the Philips ISC development team and see this excellent product taking shape.

Dr Deborah Black, Medical Director of Central Vermont Neurology, Berlin, VT

We introduced the ISC in a pilot phase, working with the head of the dementia clinic and the clinic manager to understand the ideal workflow of implementation. Usually we put our patients on a certain path for initial evaluation, diagnostic tests and re-evaluation and by inserting ISC as new diagnostic tool we hope to add strong clinical value to this existing workflow. Currently we are exploring ways of deploying ISC: it can be helpful at the first consult before any final decisions are made, but in certain cases it may be helpful if we perform the test later as a separate appointment, only on a select population. The test is performed by a physician assistant or medical assistant, then the neurologist reviews the report in the context of the specific case and that is how we will understand the clinical value. The goal is to provide fast and accessible help in the clinical decision-making process.  How we are going to use ISC in the clinical work on the long run is, for me personally, very exciting.

Dr Nandor Pinter, Director of Neuroimaging Research, Dent Neurologic Institute, Amherst, NY

Second Release of IntelliSpace Cognition is now available


After the success of the first release, Philips is excited to introduce an expanded release of ISC.  This version includes additional tests and a more comprehensive assessment with translation of the test results into cognitive domains. Visualizing these results by cognitive domain will not only enable ease of understanding of cognitive performance, but also create the opportunity to track cognitive abilities over  time.  This new release has undergone the same rigorous scientific validation and usability tests as its predecessor. 
ISC Monitor Report

Philips’ goal of creating an application that makes information about a patient’s cognition easily accessible to neurologists required involving neurologists and neuropsychologists from the beginning of development. The clinicians’ involvement ensured an easy-to-use platform that incorporates neuropsychological expertise for scoring and interpretation, utilizing appropriate psychometric analyses, proper standardization, normalization, and validation. 

 

Justin B. Miller, PhD, ABPP/CN, is a board-certified clinical neuropsychologist at the Cleveland Clinic Lou Ruvo Center for Brain Health and a consulting neuropsychologist for Philips.  He states: “There is a lot of potential in technology and computer assessments to improve cognitive assessments through efficiency and productivity, as well as through the richness of data that we can collect from digital assessment platforms to inform patient care.” These results can enable neurologists to better stratify patients in terms of those that need referral for a full neuropsychological assessment, or in some cases, sufficiently informs them to initiate a treatment path.

References

 

1 Wallin A, Kettunen P, Johansson PM, et al. Cognitive medicine – a new approach in health care science. BMC Psychiatry. 2018;18:42.
 

2 MarkeTech Group, Davis, CA, study of 75 neurologists with clinical practices, commissioned by Philips 2018.