Preliminary convergent validation of a novel, remotely-administered screening tool for visuospatial and executive function in epilepsy

Many adults with epilepsy suffer deficits in visuospatial and executive function (VEF). Assessment typically requires written responses, and cannot be performed remotely. Lack of remote assessments limits generalizability of epilepsy cognition research, as many patients cannot drive to appointments. We report the preliminary feasibility of 3 novel VEF tasks in a small cohort of epilepsy patients, and test concordance with the Visuospatial/Executive subscore of the Montreal Cognitive Assessment (MoCA) test.

We designed three tasks to screen VEF: a visuospatial discrimination task, and a two-part, visual trailmaking test. These tasks rely on verbal responses, and can be administered via videoconference. We prospectively recruited adults in the Epilepsy Monitoring Unit, excluding those with severe cognitive, visual, or motor impairments. We administered the MoCA and the three novel tasks, comparing a composite visuospatial processing (VSP) score against the MoCA Visuospatial/Executive subscore (VES), using Spearmans rank correlation.

Of 21 participants recruited (median [IQR] age 38 [28,51] years; 15 women, 5 men, 1 nonbinary), 19 (90%) had attained a high-school education. Nineteen (90%) completed all assessments. Total MoCA score ranged from 6-30, with median 26 (IQR 21, 28). Median MoCA VES was 4 (IQR 3,5). The novel VSP score ranged from -9 to 1, median 0 (IQR -2, 1). The VSP score correlated moderately with the MoCA VES (rho = 0.61, p=0.006).

Our novel assessment of visuospatial and executive function is feasible in epilepsy patients. Our composite VSP score correlates with the MoCA Visuospatial/Executive subscore. These novel tasks may provide a suitable adjunct to the MoCA, to screen visuospatial and executive function when in-person assessment is not feasible. Further study is needed, with remote video formats, larger cohorts, and neurotypical controls, to confirm construct validity and establish norms.