Digital technology can streamline neurology referrals

Cognitive assessment

Leveraging digital technology to equip neurologists with an instant overview of patient cognition

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There is a clinical need to streamline  referrals for neuropsychological assessments

According to a recent market survey, US neurologists refer only 13%* of patients for a full neuropsychological assessment when ideally they would like to send 36%.1This suboptimal referral rate reflects an unmet need which can be attributed to long waiting times to receive neuropsychological assessment results, healthcare cost burdens, and an insufficient number of nearby neuropsychology practices.1 Philips addresses these issues with the digital cognitive assessment tool IntelliSpace Cognition, developed with rich clinical insights, to provide neurologists with more information about patient cognitive status, help stratify patients, and decide which need a full neuropsychological assessment.

IntelliSpace Cognition offers instant and comprehensive results to enable neurologist action


IntelliSpace Cognition provides the neurologist with an overview of cognition in clear and understandable cognitive domains. The application integrates instructions, automated scoring, and a full digital record, allowing playback of how individual tasks were performed. The cognitive performance of the patient can be tracked over time to monitor changes in cognition. 

IntelliSpace Cognition immediately analyzes test data for an overview of patient cognition to help in making referral decisions

The current clinical workflow at a neurology office may not provide a neurologist sufficient information about cognition. The neurologist, needs to decide who should be referred to a neuropsychologist for a full neuropsychology assessment in an objective manner. IntelliSpace Cognition offers objective results through normed cognitive domains and provides a more robust measure of cognition to help enable physician to take the most appropriate course of action and, when necessary, a firm justification for referral. At the neurologist’s office, IntelliSpace Cognition requires supervision by a healthcare professional and integrates into the workflow of the practice. IntelliSpace Cognition helps evaluate a patient’s cognitive performance by first facilitating high quality data collection for well-known validated neuropsychological tests, applying artificial intelligence to score them, and then using a structural equation model to map the outcome measures onto well recognized cognitive domains.2 These domains have been normed for a healthy peer group of the US population. After seeing the concept, 75%of neurologists felt confident that IntelliSpace Cognition would help in selecting which patients need a neuropsychological assessment.3
Dr. Justin B. Miller, a board-certified clinical neuropsychologist at the Cleveland Clinic Lou Ruvo Center for Brain Health and a consultant for Philips, emphasizes the need to streamline patient referrals for full neuropsychologic assessments. More specifically, he remarks that “routing referrals to neuropsychologists can be improved if neurologists have a richer picture of patient cognitive strengths and weaknesses relative to age peers and other demographic factors.” He states that with the instant overview of patient cognition, “IntelliSpace Cognition could facilitate and refine neurologist evaluations to find the appropriate patient referrals.” After learning about the features of IntelliSpace Cognition, 75% of neurologists agreed that using it could increase their confidence in making correct referral decisions for comprehensive neuropsychological assessments.1
IntelliSpace Cognition PDP

IntelliSpace Cognition to follow changes in cognition


While it’s important to be well informed before making the initial decision for a referral, it is almost inevitable that the choice of treatment for a neurological disease will also impact the patient’s cognition. Only in very rare situations would it be possible to repeat full neuropsychological assessments to monitor the patient’s progress. With IntelliSpace Cognition, the cognitive domain score can be compared between periodic assessments and used to monitor and, thus helping to inform any treatment adaptation.
Longitudinal tracking report
While IntelliSpace Cognition is designed specifically for the use case of aiding the healthcare professional in assessing cognition, it is a Medical Device and engineered to the appropriate standards so it can serve as the basis for further clinical innovation. Current research is investigating how sensitive cognitive biomarkers may detect mild cognitive impairment (MCI) and may eventually result in more targeted clinical decision support and better disease management.4 Dr. Murray Gillies, General Manager of the Philips IntelliSpace Cognition, stated; “Once we have established ISC in the neurology clinic, we will continue to grow its clinical utility. There’s certainly a lot happening in at the intersection of neurology and informatics.4
*Of the ideal 36% of patients that neurologists would like to send for full neuropsychological assessments.

More articles

References

 

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

2 Vermeent S, Dotsch R, Schmand B, et al. Evidence of validity for a newly developed digital cognitive test battery. Frontiers. 2019 [article under revision]
 

3 Based on a 2019 Philips study of 100 neurologists in the US
 

4 Scharre D. The digital future of cognitive screening. Practical Neurology. 2017.

Justin Miller interview.