CognoStroke: Automated Cognitive and Mood Assessment on the Hyper-Acute Stroke Unit

Background: Cognitive and mood impairments are common in Stroke Survivors (SSs), leading to worse outcomes and poorer quality of life measures. Current methods of assessment of mood and cognitive performance are time consuming and rely on health care professionals. This makes assessment in hyper-acute stroke units (HASU) difficult. Here we describe the use of CognoStroke, an automated assessment of mood and cognitive impairment in the HASU. Methods: Using conversational interaction delivered through a virtual, web-based agent (CognosStroke), speech analysis was performed using three large language models (GPT2, Facebook.BART-based, and RobERTa-base) to classify thresholds levels of MoCA (threshold: 22,23,24,25,26), GAD-7 (above 5 and 10), and PHQ-9 (above 5 and 10). Results are presented as Macro F1-scores (MFSs). Patients were asked about barriers to using CogonStroke. Results: A total of 151 SSs agreed to perform CognoStroke, with 75 completing the full assessment. The best MFS of 0.723 was achieved using CognoStroke for thresholding a MoCA of 26. The MFS improved further to 0.783 when single prompts or a smaller combination of prompts from the CognoStroke bank were used. For the PHQ-9 a MFS of 0.686 was achieved thresholding above 10 and on the GAD-7 a MFS of 0.617 was achieved for thresholding above 5. Single prompts or smaller prompt combinations again achieved higher MFSs. Discussion: CognoStroke has potential to classify SSs into groups with high or low cognitive and mood thresholds, highlighting benefits for improving post-stroke cognitive assessment. Challenges of automated assessment on the HASU include patient computer access, anxiety in using technology, post-stroke fatigue, and computer literacy.