When Nicolas Tremblay put three electroencephalogram (EEG) electrodes into a baseball cap, he was trying to build a tool to track focus in children with ADHD. He was pitching the device at a health hackathon last October when a nurse from the Montreal Heart Institute approached him with an idea: What if it could be modified for use in hospitals to diagnose patients with delirium?
Delirium—a sudden state of confusion characterized by reduced awareness of the sufferer’s environment—comes on suddenly and can last from hours to days. The American Delirium Society estimates the condition affects more than 7 million hospitalized Americans each year and, according to a Harvard Health report, delirium is the most common complication of hospitalization in people 65 and older.
Compared to hospitalized patients without delirium, those who suffer delirium tend to stay longer in the hospital and are more likely to develop dementia or other types of cognitive impairment and need long-term care after leaving hospital. Delirium is commonly detected via the Confusion Assessment Method, which helps health professionals identify problems with attention, memory, orientation and visual ability. Essentially, patients are asked a set of questions to assess their mental state. Though the method is standardized, it is not an objective test for the condition. What’s more, this approach doesn’t detect delirium early.
“Current methods are only able to detect delirium when the brain is already malfunctioning,” Tremblay said. “When delirium is detected at a later stage, it takes longer to bring the patient back. It costs a lot to the hospital because they have to keep the patient in hospital to revert delirium.”
NeuroServo set about creating a device to catch attention problems in hospitalized patients early, before these deficits manifest physically. Its educational tool, the electrode-fitted hat, measures electrical activity in the brain and signals attention—or lack thereof—via a built-in light that changes color. The device can also send EEG results via Bluetooth to a tablet app used by a teacher.
With input from doctors and nurses, NeuroServo developed a sterile version of the device, a disposable plastic strip holding three EEG electrodes that can be adhered to the patient’s forehead. It attaches to a portable EEG module that clips onto the patient’s jacket.
Using EEG to detect delirium isn’t a new concept; there is scientific proof that delirium can be found with EEG, Tremblay said. But using a traditional EEG on large numbers of patients just isn’t practical: The equipment is cumbersome, the process can require as many as 256 electrodes placed all over the scalp and a neurologist is needed to interpret the results.
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NeuroServo’s device uses several algorithms specialized in a specific area of signal analysis, Tremblay said.
“The sum of these analyses is then used to return an easy-to-read graph and results to the nurse or caregiver,” he said.
As for the number of electrodes, NeuroServo’s electronics and algorithms are designed to obtain the best medical-grade EEG signal out of the forehead. ”This allows us to carefully track brain signals in the prefrontal cortex who is responsible for executive functions like attention control or cognitive flexibility,” Tremblay said.
He hopes to keep serving the educational market even as NeuroServo makes a push into the medtech sector. The company is still selling the cap for kids with ADHD, and the device is currently in a pilot study in France in children with autism spectrum disorder. As for its use as a delirium diagnostic tool, the Montreal Heart Institute is kicking off a pilot study this month. McGill University Health Centre will start a pilot later this year, and NeuroServo is working on a third study at a hospital in Boston.
What comes next depends on the outcome of those studies.
“We are waiting for the pilot results to be able to apply for approval from Health Canada, the FDA and so on,” Tremblay said.
NeuroServo is just one player working to make EEG possible for an area in which it has historically not been viable. Mountain View, California-based Ceribell came up with a portable device that quickly detects nonconvulsive seizures in ICU patients. Like NeuroServo’s device, Ceribell’s system doesn’t require a specialist to read its results—instead, it converts EEG signals into sound for a yes/no diagnosis within minutes.