Computerised cognitive assessment in patients with traumatic brain injury: an observational study of feasibility and sensitivity relative to established clinical scales.

Background

Online technology could potentially revolutionise how patients are cognitively assessed and monitored. However, it remains unclear whether assessments conducted remotely can match established pen-and-paper neuropsychological tests in terms of sensitivity and specificity.

Methods

This observational study aimed to optimise an online cognitive assessment for use in traumatic brain injury (TBI) clinics. The tertiary referral clinic in which this tool has been clinically implemented typically sees patients a minimum of 6 months post-injury in the chronic phase. Between March and August 2019, we conducted a cross-group, cross-device and factor analyses at the St. Mary's Hospital TBI clinic and major trauma wards at Imperial College NHS trust and St. George's Hospital in London (UK), to identify a battery of tasks that assess aspects of cognition affected by TBI. Between September 2019 and February 2020, we evaluated the online battery against standard face-to-face neuropsychological tests at the Imperial College London research centre. Canonical Correlation Analysis (CCA) determined the shared variance between the online battery and standard neuropsychological tests. Finally, between October 2020 and December 2021, the tests were integrated into a framework that automatically generates a results report where patients' performance is compared to a large normative dataset. We piloted this as a practical tool to be used under supervised and unsupervised conditions at the St. Mary's Hospital TBI clinic in London (UK).

Findings

The online assessment discriminated processing-speed, visual-attention, working-memory, and executive-function deficits in TBI. CCA identified two significant modes indicating shared variance with standard neuropsychological tests (r = 0.86, p < 0.001 and r = 0.81, p = 0.02). Sensitivity to cognitive deficits after TBI was evident in the TBI clinic setting under supervised and unsupervised conditions (F (15,555) = 3.99; p < 0.001).

Interpretation

Online cognitive assessment of TBI patients is feasible, sensitive, and efficient. When combined with normative sociodemographic models and autogenerated reports, it has the potential to transform cognitive assessment in the healthcare setting.

Funding

This work was funded by a National Institute for Health Research (NIHR) Invention for Innovation (i4i) grant awarded to DJS and AH (II-LB-0715-20006).

Informations de copyright

© 2023 The Authors.

Déclaration de conflit d'intérêts

Prof. Hampshire reports grants from NIHR, and is owner/director of H2 Cognitive Designs Ltd and Future Cognition Ltd, which produce online assessment technology and provide online survey data collection for third parties. Dr. Hellyer is co-founder and co-owner of H2 Cognitive Designs Ltd and H2 Cognitive Designs Ltd. Prof. Sharp reports grants from NIHR Invention for innovation (i4i); NIHR Imperial Biomedical Research Centre; Advance Brain Health Clinic & Aligned Research programme Football Association (FA); Advance Brain Health Clinic & Aligned Research programme; Rugby Football Union & Premiership Rugby; ADVANCE Charity; Armed Services Trauma Rehabilitation Outcome Study (ADVANCE); Action Medical Research; UK Dementia Research Institute Care & Technology Centre; Era-Net-Neuron European collaborative award; St Mary’s Development Charity; Royal British Legion Centre for Blast Studies. Prof. Sharp also took park in the Early Detection of Neurodegenerative diseases (EDoN) project and the Rugby Football Union concussion advisory board. Mr. Trender reports payments from Imperial NHS trust, Imperial College London, the Engineering and Physical Sciences Research Council, and H2 Cognitive Designs Ltd. Dr. David reports grants from the Medical Research Council (Clinical Research Fellowship). Miss Bălăeţ reports payments from the Medical Research Council Doctoral Training Programme. Dr. Graham reports grants from Alzheimer’s Research UK (Clinical Research Fellowship). Mr. Friedland reports payments for expert testimony outside this study. Dr. Li reports grants from LML: UK DRI Pilot Grant 2021 and is trustee of Headway West London. Miss Helen Lai reports payments from Imperial College London (President’s PhD Scholarship) and the UK Dementia Research Institute Care & Technology Centre. Dr. Bourke reports payments for medicolegal imaging analysis outside this work and payments as part of the BRAN travel grant. All the other authors have nothing to disclose.