Introduction: The diagnosis of vascular cognitive impairment relies on bedside tools to quantify the degree of disease burden. Given the critical importance of implementing early interventions, it is becoming increasingly important to investigate more sensitive and easily administered tools for accurately characterizing these deficits.
Hypothesis: The current study aims to evaluate the effectiveness of using Miro, a tablet-based mobile application, developed by The Cognitive Healthcare Company, designed to measure the same cognitive domains as traditional pencil-and-paper tests but (1) require less administration time; (2) provide reliable scoring; (3) offer greater ease of use; and (4) capture and analyze informative data, like speech, fine motor function and eye movements, that are not typically used in clinical settings.
Methods: Subjects were recruited from the Stroke and Cognitive Disorders Clinic. Subjects were randomized to undergo pencil-and-paper or iPad testing first. The battery of tests in each medium take roughly 60 minutes to complete. In this ongoing study, there will be 3 total participant visits over one year, to evaluate rate of decline or improvement in each medium.
Results: 11 subjects have been enrolled in the study thus far. These subjects have a mean age of 64.6 ± 9.48 and years of education 16.3 ± 2.61.There were strong Spearman rho correlations between pencil and paper testing and iPad testing on digit span forwards (0.848, p < 0.002), digit span backwards (0.946, p < 0.001), symbol digit coding (0.936, p < 0.001), Trails A and B (0.794, p < 0.006). When asked to rate their preference on a 7-point Likert scale (1=iPad based, 4=no preference, 7=paper based), subjects reported a mean score of 3.36 (SD 1.55), demonstrating a slight but not statistically significant preference for iPad. Technicians uniformly found the iPad app easier to administer and less time-consuming for them.
Conclusions: Given the growing population of individuals with vascular cognitive impairment, it is crucial to test whether this accessible, cost-effective, mobile testing modality can be effectively utilized to assess change in cognitive function after stroke. Our preliminary results indicate that iPad based interventions area promising means to meet this goal.