Abstracts

Rationale: Cognitive symptoms impair quality of life (QOL) in patients with epilepsy. Correlating cognitive function to treatment modification or disease severity is a crucial component of the epilepsy neurological exam. 80% of the world’s epilepsy patients reside in low- and middle-income countries (L/MIC), where the epilepsy treatment gap (TG) is > 75%. This can be reduced by preventing risk factors; reducing stigma; and improving access to diagnosis as well as treatment. Tele-neurology is gaining momentum as a means of increasing access to epilepsy care worldwide. The goal of this study is to observe how healthy young volunteers in Pakistan, an L/MIC, interact with digital drawing tools for fundamental parts of the cognitive neurological exam. By understanding choices in device(s), application(s), and drawing instrument(s), we aim to construct a landscape to guide feasible and effective digital cognitive exam conduction internationally.

Methods: Participants included 50 evenly distributed men and women college students aged 17-21 in Pakistan who were asked to draw a clockface and/or spiral digitally using a device (desktop, laptop, tablet, or mobile phone); drawing application (substitute for paper); and instrument (mouse, stylus, or finger, as a substitute for pen) of their choice. Participants were asked to provide reasoning for their selection and to try another option, if possible, in addition to drawing with pen and paper per traditional methods. A smaller sample (N=7) were asked to scan a quick response (QR) barcode to open the task on a second device.

Results: All sampled students completed cognitive drawing tasks on mobile phones without difficulty. Most participants did not have access to tablets, and none of the participants used a stylus or mouse. Participants refrained from drawing on computers/laptops, with overall preference for mobile phones (95% of participants), followed by tablets (5%). All volunteers had drawing tools already installed on their devices, usually messaging applications. 6 out of 7 participants asked to toggle between devices via a QR code were unable to, either due to lack of access to a second device or reported lack of tools to scan with. As all mobile devices used contained cameras, this appears to be due to unfamiliarity with how to scan.

Conclusions: We conclude that mobile phones are preferred for digital drawing tasks for cognitive assessments in this L/MIC population and, secondarily, that QR codes are not an effective method to enable participants to transition between devices without education on how to use them. Our sample is limited to young, educated, healthy volunteers with means to enroll in college. We expect less comfort with technology from a sample that includes representative variability in age, education, economic resources, and health. These results can, therefore, serve as a guide of maximal technological complexity to include in digital cognitive assessments for patients with epilepsy in L/MICs to maximize accessibility. Based on these preliminary results, tele-neurology interventions prioritizing inclusivity of patients in similar L/MIC regions should be optimized for single-device mobile phone interfaces.

Funding: Please list any funding that was received in support of this abstract.: Not applicable.