DSC2580a_small.jpg

Questions about cognition and cognitive testing with Mindmore

 
 

What is cognition?

Cognition can simply be described as the thought processes that the brain uses to take in, process, store and retrieve information. Cognition is usually divided into a number of functions, or domains:

Memory, attention, language, visuospatial ability and executive function.  

 

Our cognitive functions mean that we can:  

  • Interpret and understand information

  • Maintain attention and concentration

  • Remember and learn new things

  • Plan, organize and prioritize

  • Solve problems and make good decisions

  • Understand language and communicate

Taken together, these functions are among the most important we have for a well-functioning brain health. The cognitive functions often work together - for example, attention is required to focus on information, so that it can be stored in the memory bank. Studying only a cognitive function in isolation therefore seldom gives an exhaustive picture of how an individual functions cognitively.

 

What are these tests?

Mindmore has created digital versions of evidence-based, well-established neuropsychological tests that clinics have long used, but then in the format of paper and pencil tests.

 

By digitizing these paper and pen tests, we have created a very fine-meshed instrument that can find signs of dementia, or other cognitive impairment that has arisen due to, for example, stress or depression. We have thus translated analog paper and pen tests and developed an easy-to-use tool, which the patient himself uses before the meeting with his doctor.

 

Why should our business prioritize the use of cognitive tests?

As a therapist, it can be difficult to meet patients with complaints and thoughts about their cognition. The patient often finds it difficult to put into words what is concrete that does not work as before. Today, a lot of time is spent understanding the large group of patients with stress and supporting patients who are worried about their memory and cognitive ability.

 

The cognitive profile generated through Mindmore testing is a support for the caregiver. The main purpose of the testing is to determine whether there is a cognitive influence or not, which cognitive domain it is in that case and to what extent this is affected.

 

Mindmore is used in both primary care and occupational health care - in assessments and mapping, in planning and follow-up of rehabilitation, to adapt work return and to provide a basis for medical certificates. 

 

Is this an intelligence test?

No. Cognitive tests are used to measure cognitive functions, that is, how the brain works, which cannot be equated with a person's perceived intelligence.

 

Our tests are mainly designed for medical assessment / investigation as well as research on neurodegenerative diseases, TBI (traumatic brain injury), fatigue and depression.

 

Can all staff at our clinic lead test sessions with Mindmore and interpret the results?

Mindmore trains relevant personnel around the tool before it is used. Anyone who has received the training can administer a test with Mindmore - because no specific test leader competence is required, but it can be done by, for example, a nurse.

 

Interpretation of the test results should be done by staff who have the competence for this, for example a psychologist or doctor. These can of course also administer the test itself if desired. The fact that it does not have to be the same person who leads the test and interprets the results provides flexibility and the opportunity to further streamline the process. 

 

What is a good use for cognitive testing?

Diagnosis

Cognitive tests can be used in assessment and diagnosis of all diseases, or suspicion of such, which gives a cognitive impact and where one wishes to see and follow up cognitive status. It is important to remember that what is obtained is a snapshot - the results may improve or deteriorate over time. Common disease groups where cognitive status is valuable are cognitive diseases (dementia diseases), stress-related mental illness, brain damage, neuropsychiatric conditions and neurological diseases.

For the test person and / or relatives

The results can be used to validate / confirm difficulties that a person states that they experience in everyday life, but which are not captured with other examinations. It can create a better understanding of one's own condition and how it affects everyday life. It can also provide an explanation to relatives who may distrust or do not understand the difficulties the person is experiencing.

Documentation for municipality / authority

In communication with authorities or municipalities for development assistance-assessed initiatives, it is not uncommon for concrete data on cognitive difficulties to be requested. Although aid assessors always make their own assessments, the data from a cognitive test can be very helpful. The traffic medicine center or the Swedish Social Insurance Agency can also benefit from having a better and more objective basis at its disposal.

Evaluation of treatment

Another good area of use is in the follow-up / evaluation of treatment interventions, where there is a question of whether cognition changes in some direction. Through repeated measurements, it is possible to follow a development and see whether cognition improves, deteriorates or is not affected at all. In this way, the treatment can be adapted according to what the patient responds best to. 

 

A challenge for us caregivers is double record keeping.

Are there integration systems?

Mindmore has a so-called light integration -  a cut and paste function of the results - so that relevant information can be easily copied to the journal.

 

The point is precisely not to integrate completely, as all information from the testing is not relevant to find directly in the journal, but it should first be interpreted.

 

Are these digital versions of self-assessment scales  such as KEDS, MADRS and PHQ-9?

KEDS, MADRS and PHQ-9 are examples of rating scales, ie subjective measures of how the patient himself experiences his situation today. Cognitive testing is not about asking patients how they are feeling, but about giving them data that measures brain function. This is valuable because self-assessments of cognitive function have been shown to be inconsistent with actual function.  

 

Subjective symptoms in general, such as depression, pain and fatigue, tend to correlate with each other and with measures of quality of life. However, cognitive test results tend to correlate poorly with such symptoms, but are strongly related to abilities to cope with daily activities (ADLs) and work. Therefore, it is within these functional domains that we must seek anchorage when interpreting the test results.

 


What evidence is there for your tests? 

We have used existing evidence-based, well-established neuropsychological tests that clinics have long used in the paper and pen version. There we lean confidently against the evidence that already exists.

We also conduct ongoing studies together with external researchers and universities, to further ensure the clinical quality of our tool.

Read more about the research behind Mindmore here. 

 

How are the results interpreted and who can do the interpretation?

The results do not need to be calculated manually, but in Mindmore's Results Portal, reliable and objective measurement values are automatically presented that the care provider can rely on in its clinical assessment of the patient. The result is thus a basis for the caregiver to interpret, in the same way as the result from a pen and paper test would be.

 

Certified staff (nurses, occupational therapists, doctors and psychologists), who have received training from us, are the ones who become users of our Results Portal and thus interpret the test results.

 

How often can a person be tested with Mindmore?

Learning effects can never be completely ruled out. The usual recommended interval for cognitive tests is at least 6 months - then a possible learning effect is expected to have decreased so much that it does not affect the result. For some tests, Mindmore has taken measures that reduce learning effects and also enable retesting over shorter time intervals.

 

Who should do cognitive tests - is it part of primary care's mission?

Cognitive tests can be used continuously to measure cognition both for preventive purposes, when cognitive problems have arisen and during follow-up. In short, everyone can benefit from having a cognitive measurement value.

 

The flexibility in the application of the tool is made possible by the fact that Mindmore is not an independent diagnostic tool, but is connected to e.g. anamnesis and the clinical picture in general. Testing enables cognitive influence to be considered in the clinical assessment.

 

The stage of the care process in which the tool is used must be based on the problem that it is intended to solve. The test results are an objective piece of the puzzle about the patient's cognitive status that can be a key to solving clinical problems.

 

What clinical added value does it give us to include cognitive status

in our continuous patient work?

Cognitive test results provide different reference values than the clinical ones; what the patient says is quite seldom consistent with what is seen in the testing. Using tests for complementary, objective measurement values can therefore nuance and give extra weight to an assessment / diagnosis. Repeated test sessions provide a personal, unique to the individual, cognitive profile that becomes a valuable and reliable basic measure in future investigations.

 

How long does it take for the patient to complete a test?

It depends on which test battery the patient performs. From the care staff, it takes less than a minute to administer and start a test.

Examples of time required for our most common batteries *:

  • Cognitive screening: ~ 40 minutes

  • Cognitive screening card: ~ 30 minutes

  • Exhaustion: ~ 40 minutes

  • Fatigue / Depression card: ~ 20 minutes 

  • TBI: ~ 30 minutes

  • Dementia: ~ 30 minutes 

  • Distance: ~ 50 minutes

  • Distance short: ~ 40 minutes
     

* Individual factors affect time

 

Does the patient perform the test on site or does it take place at a distance?

Mindmore has two different solutions for testing:  

 

On site at the clinic. Here, the patient performs the tests via a tablet specifically for the purpose, which is sent to your clinic when you start using Mindmore.


Remotely, where the patient is prescribed tests to perform at home via his own computer. The caregiver then creates a test invitation in our system, which the patient receives via email.

We always educate you about the solution that you are going to use. Regardless of whether testing takes place on site or remotely, the results are calculated automatically and become available in Mindmore's Results Portal after the testing.

 


How does Mindmore work with data security?

We only store personal data that is necessary. All data that belongs to  test taker is pseudonymized and all traffic in the service is encrypted. Mindmore also offers two-step authentication.

 

We use a centralized authorization structure that makes it easy to decide which user is allowed to do what in the system. We continuously spend time improving our processes and stay up to date on what is happening in software development and management of cloud services in terms of security and legal. All employees at Mindmore have signed confidentiality agreements and employment agreements that require compliance with the GDPR when handling data. The same type of agreement is concluded with consultants who work within Mindmore.

 

How do you store users 'and test takers' personal data?

Mindmore only stores pseudonymous data about test takers . No identifying information (name, email, IP address, social security number, telephone number, postal address, age, gender) is stored in Mindmore's system or is accessible by Mindmore or its subcontractors. Instead of name or social security number, a registration code is used in the system.

When we handle the users '(clinics') personal data , we use servers and cloud-based services that exist within the EU / EEA. As the person responsible for personal data for the processing of personal data, we are obliged to stop processing the personal data when we no longer have a need or purpose for the processing.

 


Does Mindmore comply with the GDPR?

Mindmore is constantly working to improve processes and increase security when handling personal data. We always sign personal data assistant agreements with our customers for handling the test takers' data. For handling personal data where Mindmore is responsible for personal data, see Privacy Policy here . If you as a user or test taker are looking for complete information about your rights, please see the Data Protection Regulation Chapter 3.

 

How do you separate our data from other customers' data?

Mindmore offers a multitenant solution. This means that each organization's data is separated via access control in the application and is only accessible to authenticated users with the correct organization affiliation and authorization.

 

You write that the product is an approved medical device.

What is it approved from the outside - MDD, MDR, SOSFS?

Mindmore provides a CE marked Class I medical device, according to MDD. You have in  The European Commission has decided that class I products that are classified according to MDR will have until May 2024 to meet all requirements according to the new regulations. We are actively working to reclassify our product to IIa according to MDR well in advance. SOSFS is about the caregiver's work with patient safety and quality and is not applicable to Mindmore. 

 

Do you also have self-assessment scales in the tool?

At present, self-assessment scales are not available through Mindmore, but it is something that is currently being developed and tested, so it can be expected to be available soon. 

 

Do you need to have good computer skills to do your tests?

No, we have not seen any such impact. In our standard data, people up to the age of 93 have performed our tests with good results. It is up to the responsible healthcare staff to decide whether the patient can handle testing that takes place digitally.

 

Are our results included in your research studies?

No, the results are yours and we do not have access to them!


Are there corresponding cognitive tests for children?

Corresponding cognitive tests for children are available, but not in digital form as Mindmore has not established standards for them yet. Read more about our standards here .