REMOTE MONITORING OF PATIENT COGNITIVE FUNCTION USING IMPLANTED CRM DEVICES AND A PATIENT MANAGEMENT SYSTEM

• US 20080033303A1
• Filed: 07/13/2006
• Published: 02/07/2008
• Est. Priority Date: 07/13/2006
• Status: Active Grant

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Wariar, Ramesh, Sweeney, Robert J.
• Granted Patent: US 8,337,408 B2
• Time in Patent Office: Days
• US Class Current: 600/483
• CPC Class Codes: A61B 5/0002 Remote monitoring of patients using telemetry, e.g. transmission of vital signals via a communication network A61B5/07 takes precedence; transmission systems for measured values G08C; transmission H04B; transmission of digital information H04L; wireless communication networks H04W
• CPC Class Codes: A61B 5/02028 Determining haemodynamic parameters not otherwise provided for, e.g. cardiac contractility or left ventricular ejection fraction
• CPC Class Codes: A61B 5/16 Devices for psychotechnics using teaching or educational appliances G09B1/00 - G09B7/00; Testing reaction times ; Devices for evaluating the psychological state
• CPC Class Codes: A61B 5/7275 Determining trends in physiological measurement data; Predicting development of a medical condition based on physiological measurements, e.g. determining a risk factor
• CPC Class Codes: G16H 10/20 for electronic clinical trials or questionnaires
• CPC Class Codes: G16H 40/63 for local operation
• CPC Class Codes: G16H 50/20 for computer-aided diagnosis, e.g. based on medical expert systems

Abstract

This document discusses, among other things, a system and method for remote monitoring of patient cognitive function using implanted cardiac rhythm management (CRM) devices and a patient management system. The method comprising: presenting a cognitive test to a patient via a user interface; receiving a result of the cognitive test using the user interface; and using the result of the cognitive test in determining a heart failure condition status.

Claims

1. A machine-assisted method comprising:

presenting a cognitive test to a patient via a user interface;

receiving a result of the cognitive test using the user interface; and

using the result of the cognitive test in determining a heart failure condition status.

2. The method of claim 1, further comprising:

storing the result of the cognitive test;

determining a testing trend over time, wherein the testing trend includes results of a series of instances of the cognitive test; and

using the testing trend to determine a likelihood of heart failure decompensation.

3. The method of claim 1, further comprising:

receiving a physiological indication related to the patient; and

using the physiological indication in conjunction with the result of the cognitive test to determine a likelihood of worsening of the heart failure condition status.

4. The method of claim 3, wherein using the physiological indication in conjunction with the result of the cognitive test comprises:

presenting an activity to the patient;

detecting a changed physiological indication;

correlating the changed physiological indication to the presented activity; and

determining the likelihood of worsening of the heart failure condition status using the correlation between the changed physiological indication and the presented activity.

5. The method of claim 3, further comprising:

storing the physiological indication;

determining a physiological trend over time, wherein the physiological trend includes a series of instances of the physiological indication; and

using the physiological trend to determine the likelihood of worsening of the heart failure condition status.

6. The method of claim 3, further comprising:

storing the physiological indication;

determining a physiological trend over time, wherein the physiological trend includes a series of instances of the physiological indication;

storing the result of the cognitive test;

determining a testing trend over time, wherein the testing trend includes a series of instances of the cognitive test; and

using the physiological trend and the testing trend to determine the likelihood of worsening of the heart failure condition status.

7. The method of claim 3, wherein the physiological indication is obtained from an implanted medical device.

8. The method of claim 3, wherein the physiological indication includes a heart rate, a blood flow, a blood pressure, an impedance, or a heart vibration.

9. The method of claim 3, wherein the physiological data is received before, during, or after presenting the cognitive test to the patient.

10. The method of claim 1, wherein the cognitive test is a direct cognitive test.

11. The method of claim 10, wherein the direct cognitive test includes at least one of a questionnaire, a motor task, or a reaction task.

12. The method of claim 1, wherein the cognitive test is an indirect cognitive test.

13. The method of claim 12, wherein the indirect cognitive test includes one or more of a response time or an accuracy of response.

14. The method of claim 12, wherein the indirect cognitive test is an activity which was not designed to measure cognitive function.

15. The method of claim 1, further comprising:

providing to the patient a response that is initiated or adjusted using the likelihood of heart failure decompensation.

16. The method of claim 15, wherein the response includes at least one of titrating medication, adjusting one or more settings for an implanted patient device, providing educational information to the patient, or scheduling an in-person visit.

17. The method of claim 16, wherein adjusting the settings for the implanted patient device includes adjusting the settings for cardiac resynchronization therapy.

18. The method of claim 17, wherein the prescribing and communicating is performed automatically by one or more computer systems.

19. A system comprising:

an external patient interface device to administer a cognitive test to a patient; and

an external remote server communicatively coupled to the external patient interface device, the external remote server comprising;

a communications port, adapted to receive cognitive test data from the external patient interface device; and

a processor, adapted to process the received cognitive test data and use the cognitive test data to determine a heart failure condition status.

20. The system of claim 19, wherein the processor is further configured to:

store the cognitive test data in a memory;

determine a cognitive testing trend over time, wherein the cognitive testing trend includes results of multiple instances of the cognitive test; and

use the cognitive testing trend to determine the heart failure condition status.

21. The system of claim 20, wherein the processor is further configured to use the cognitive testing trend to determine a likelihood of heart failure decompensation.

22. The system of claim 19, further comprising one or more sensor devices adapted to be communicatively coupled to the external interrogatory device.

23. The system of claim 22, wherein the one or more sensor devices includes an implantable medical device.

24. The system of claim 22, wherein the external remote server is configured to:

receive at the communications port, a physiological indication related to the patient from at least one sensor device; and

use the physiological indication and the cognitive test data to determine the heart failure condition status.

25. The system of claim 24, wherein the external remote server is further configured to use the physiological indication and the cognitive test data to determine a likelihood of a worsening of heart failure condition status.

26. A machine-readable medium including instructions that, when performed by a machine, cause the machine to:

present a cognitive test to a patient via a user interface;

receive a result of the cognitive test; and

use the result of the cognitive test to determine a heart failure condition status.

27. The machine-readable medium of claim 26, further comprising instructions to:

store the result of the cognitive test;

determine a cognitive testing trend over time, wherein the cognitive testing trend includes results of multiple instances of the cognitive test; and

use the testing trend to determine the hearth failure condition status.

28. The machine-readable medium of claim 27, further comprising instructions to use the testing trend to determine a likelihood of heart failure decompensation.

29. The machine-readable medium of claim 26, further comprising instructions to:

receive a physiological indication related to the patient; and

use the physiological indication and the result of the cognitive test to determine the heart failure condition status.

30. The machine-readable medium of claim 29, further comprising instructions to use the physiological indication and the result of the cognitive test to determine a likelihood of worsening of the heart failure condition status.

31. The machine-readable medium of claim 29, wherein the instructions to use the physiological indication and the result of the cognitive test cause the machine to:

present an activity to the patient;

detect a changed physiological indication;

correlate the changed physiological indication to the presented activity; and

determine a likelihood of worsening of the heart failure condition status using the correlation between the changed physiological indication and the presented activity.

32. The machine-readable medium of claim 29, further comprising instructions to:

store the physiological indication;

determine a physiological trend over time, wherein the physiological trend includes multiple instances of the physiological indication; and

use the physiological trend to determine a likelihood of worsening of the heart failure condition status.