Development and Validation of the IC3: An Online Remote Assessment Technology for Deep Phenotyping and Monitoring of Cognitive Impairment After Stroke

Automated cognitive assessments tailored to specific clinical scenarios have the potential to revolutionize health care and clinical research. Stroke survivors experience significant burden from underdiagnosed cognitive deficits. To address this, we developed a digital cognitive battery (IC3 [the Imperial Comprehensive Cognitive Assessment in Cerebrovascular Disease]) highly optimized for stroke survivors, and specifically designed for unsupervised administration in patients with mild to moderate stroke, thus enabling detailed remote diagnosis and monitoring of a variety post-stroke cognitive impairments. In a study involving 90 stroke survivors and over 6,000 age-matched healthy adults, the battery demonstrated high concordance with the Montreal Cognitive Assessment (MoCA), a commonly used supervised clinical neuropsychological assessment (<i>r</i> = .58, <i>p</i> < .001) and close correlation with patients' quality of life (<i>r</i> = .51, <i>p</i> < .001). In patients deemed to be cognitively unimpaired based on the standard MoCA cut-off (≥26/30, education-corrected), IC3 detected prevalence of impairment as high as 54% in a subset of tasks (<i>M</i> = 30.2%, range = 4%-54%). Importantly, performance on the IC3 remained consistent in both supervised and unsupervised settings in the controls, with minimal learning effects over time. This work provides the first evidence of the robustness and clinical potential of this technology for remote application in stroke, and potentially other neurological settings.