Novel unsupervised comprehensive tool for monitoring vascular cognitive impairment following stroke

Background Stroke is a leading cause of death and disability worldwide. Cognitive difficulties occur in up to 86% of acute stroke cases (Demeyere et al., 2015) and persist in a third. Despite the numerous efforts made thus far, developing effective therapeutic interventions for vascular cognitive impairment remains a large unmet need (Zotin et al., 2021). This is in part due to the heterogeneity of the disease mechanisms, and cognitive profiles exhibited by patients. To better understand the range of factors that contribute to long‐term cognitive outcomes after vascular insult, there is a growing need for in‐depth longitudinal assessments of cognitive function that are scalable and cost‐efficient. To address this gap and to capitalise on the recent growth of telemedicine technology driven by the pandemic, we developed a self‐administered unsupervised, adaptable, and in‐depth online cognitive assessment tool specifically for patients with stroke. Method This self‐administered web‐based tool offers an in‐depth cognitive profiling through 23 tasks spanning both domain‐general (attention and executive functioning) and domain‐specific deficits (memory, language, visual neglect, number skills, apraxia), together with neuropsychiatric questionnaires. In total, the assessment lasts one hour and is compatible with a variety of devices and operating systems. In light of these specifications, the battery has been named IC3 ( I mperial C ollege C omprehensive assessment for C erebrovascular disease; https://ic3study.co.uk/ ) Result We present results outlining the normative ranges for the assessment in age and education matched controls and in a modest sample of patients following stroke. Furthermore, we present an overview of our validation studies which examine the battery’s specificity and sensitivity, and test‐retest reliability. We also discuss a comparison against established clinical batteries (e.g. CAT and MoCA). Finally, as the assessment has been designed to be self‐administered remotely, we also present a validation against face‐to‐face supervised delivery of the battery. Conclusion IC3 is the first assessment to offer in‐depth unsupervised cognitive phenotyping of patients with vascular brain insult, while also allowing scalable and cost‐efficient longitudinal monitoring. The assessment fares well against various validation methods, making it an attractive tool for understanding the mechanisms of recovery in a plethora of vascular disorders.