A neuropsychologist consult is typically the first step for a neurologist in aiding in the diagnosis and monitoring of neurological conditions. But timely appointments for an assessment by these specialists can be difficult to obtain, even under the best of circumstances. To better enable neurologists to assess which patients are most in need of a consultation with a neuropsychologist, Royal Philips NV has launched an artificial intelligence (AI)-based cognitive assessment tool in the U.S.
Known as Philips Intellispace Cognition, the digital, cloud-based assessment tool takes established neuropsychological tests and enables their administration by a medical assistant via a tablet in an office setting. Scoring of the difficult-to-assess test, which includes elements such as drawing a clock, joining numbered dots and remembering a sequence of numbers, is done almost instantaneously via AI and returned to the neurologist, who uses it to review disease progression or to determine if further consultation with a neuropsychologist will be required.
"In the U.S., there is a need for the psychological assessment. If you speak to the referring physician, like the neurologist, he will often have to wait between two and three months to be able to get an appointment for a patient and get the report back of the cognitive functioning," Murray Gillies, general manager of digital cognitive diagnostics at Amsterdam-based Philips, told BioWorld MedTech. "For the neurologists we spoke to, this was really an issue.
"What we decided to create is a platform to allow the neurologist or the referring physician to be able to have an assessment of cognition and be able to stratify the patients and decide which ones should be sent for the full neuropsychological assessment and which ones they would know enough after doing Intellispace Cognition to be able to decide what to do," he added.
Even as the number of patients with neurological conditions continue to rise, there are a limited number of neuropsychologists who are able to perform diagnostic or subsequent assessments. In a survey of 100 neurologists in the U.S., 92% said they were looking for new solutions to address this lack of access to cognitive assessment.
Philips worked closely with neurologists and neuropsychologists designing Intellispace Cognition in an iterative manner to address their needs and to ensure that the system fit into existing physician workflows.
Intellispace Cognition was tested in a clinical trial at four sites in the U.S. The results are based on normative data from 300 healthy people. Patients are roughly matched to cognitive expectations for their particular age and education level. To ensure that the results were comparable to traditional assessments, Philips compared them to more than 700 assessments by neuropsychologists. Dual measurements were conducted to compare the consistency across paper and digital modalities.
Philips conducted usability studies to validate with 15 neurologists that they could interpret and act upon the assessment results that they received. In addition, Philips conducted usability testing with patients to ensure that they could easily use the digital assessment on the tablet. Intellispace Cognition recently cleared as a class 2 medical device by the U.S. FDA.
"There is a real need for quantitative measures to assess the cognitive impairment of people with neurological disease," said Joseph Fritz, CEO of Dent Neurologic Institute, which is the first neurology practice to use Intellispace Cognition. "Computerized tools and intelligent algorithms offer new opportunities in this area to improve care. The depth of information now available and the efficiency with which we can perform assessments can be very helpful for providing feedback to patients and families sooner and developing treatment plans more quickly."
Reading the results
The report from Intellispace Cognition that is returned to the neurologist compares the individual patient results to average, normative data in healthy people across a variety of domains, such as memory. They also can be monitored via repeat tests to assess changes in a particular patient over time.
Intellispace Cognition is expected to prove useful across patient groups with a variety of neurological conditions, including dementia, stroke, Parkinson's disease and epilepsy. For oncologic neurologists, it could help monitor the effect that chemotherapy is having on the brain. The expectation is that the test could enable very sensitive and early-stage measurement that could quickly enable more effective patient treatment.
"It's really an aid in helping a health care professional, like a neurologist, to assess the performance of the patients, and his specific needs. We did a lot of focus groups with various hospitals and combinations of neurologists and neuropsychologists," said Gillies. "The average neurologist, you would like to see an overview of a difficult domains, which functions are impaired and how that has developed over time. So, the first assessment compared to the second assessment compared to the third, and then be able to see whether his interventions have had an effect on the cognitive performance of the patient."
Intellispace Cognition is designed for use by physicians with patients, but it also could prove useful for clinical trials. Gillies said pharmaceutical companies already have reached out to Philips regarding using the system in studies, where it's difficult to offer reliable and standardized cognitive assessments across various sites.
He noted that the normative patient data remains in a raw format, so it can be adjusted to suit any specific comparative needs of a study. Many neurological indications are notorious for faring poorly in clinical trials of new drug candidates, so any advances to improve the clinical trial process could prove helpful.
Philips already offers more than 70 clinical applications via its Intellispace Portal 9.0, which is its advanced visualization platform that is designed to enable access and analysis of various kinds of health care data, with a current focus on radiology and cardiology.
The ultimate vision for Intellispace Cognition is to integrate these cognitive assessment results with neuroimaging results that can quantify aspects such as brain volume and high-density EEG monitoring that can define brain wave activity. This would enable an integrated analysis of these disparate kinds of data for more precise diagnosis and treatment monitoring. Neuroimaging represents a substantial portion of the use of Philips' magnetic resonance imaging – and the company is part of the trio of dominant imaging players that also includes GE and Siemens.
"While dealing with the rising tide of neurological disease remains a great challenge, our solution will facilitate robust and reliable cognitive assessment with greater efficiency and scale than traditional methods," summed up Jeroen Tas, chief innovation and strategy officer at Philips. "[By] combining this with imaging-based diagnostics[,] we aim to offer care providers more meaningful insights into the health of their patients and potentially open up new possibilities for treatment in the future."