"systems and methods for assessing cognition"

Abstract

Described embodiments relate to a method for assessing visual cognition of a subject. The method includes presenting a reference image and a first prompt to a subject, the reference image comprising at least one line and a plurality of spaced insignia; receiving a first drawn image from a subject, the first drawn image having been drawn by the subject in response to receiving the reference image and the first prompt; comparing the first drawn image and the reference image; and based on the comparison, determining a first measure of visual cognition of the subject.

Description

[0001] "Systems and methods for assessing cognition"

[0002] Technical Field

[0003] Described embodiments relate generally to methods and systems for assessing cognition of a subject. In particular, embodiments relate to assessing visual cognition of a subject.

[0004] Background

[0005] Vision has been shown to be a dominant sense in driving children’s cognitive learning and is a fundamental factor in the learning process. Unresolved visual deficits can impair the ability of a child to respond fully to educational instruction. Some paediatric conditions that can affect visual cognition in children are cerebral visual impairment, learning disability, intellectual disability, autistic spectrum disorder, and cerebral palsy.

[0006] Many children with visual efficiency and / or visual processing problems do not typically show overt symptoms and therefore do not seek eye care. It is not until there is evidence of a learning concern that educators / parents may request a comprehensive evaluation of vision. Therefore, a potential delay in diagnosing these visual deficits may result.

[0007] Unfortunately, standard eye and vision assessment in children is often limited to assessing refractive errors and eye health, and does not detect abnormalities in cognition, such as abnormalities in visual perception. Though standardised tests are available to evaluate visual perception, these tests are generally time-consuming and require training and expertise. Some standardised tests may require or be advantageously completed by the utilisation of a participants’ precision of fine motor skills.

[0008] It is desired to address or ameliorate one or more shortcomings or disadvantages associated with prior systems and methods for assessing cognition, or to at least provide a useful alternative thereto.

[0009] Throughout this specification the word "comprise", or variations such as "comprises" or "comprising", will be understood to imply the inclusion of a stated element, integer or step, or group of elements, integers or steps, but not the exclusion of any other element, integer or step, or group of elements, integers or steps. Any discussion of documents, acts, materials, devices, articles or the like which has been included in the present specification is not to be taken as an admission that any or all of these matters form part of the prior art base or were common general knowledge in the field relevant to the present disclosure as it existed before the priority date of each of the appended claims.

[0010] Summary

[0011] Some embodiments relate to a method for assessing visual cognition of a subject, the method comprising: presenting a reference image and a first prompt to a subject, the first prompt instructing the subject to draw a copy of the reference image in a different orientation, and the reference image comprising a plurality of spaced insignia and at least one line; receiving a first drawn image from a subject, the first drawn image having been drawn by the subject in response to receiving the reference image and the first prompt; comparing the first drawn image and the reference image; and based on the comparison, determining a first measure of visual cognition of the subject.

[0012] The first prompt may instruct the subject to draw a rotated copy of the reference image. In some embodiments, the first prompt instructs the subject to draw an inverted copy of the reference image. In some embodiments, the first prompt instructs the subject to draw a rotated and inverted copy of the reference image.

[0013] Some embodiments relate to a method for assessing visual cognition of a subject, the method including: presenting a reference image and a first prompt to a subject, the reference image comprising a plurality of spaced insignia and at least one line; receiving a first drawn image from a subject, the first drawn image having been drawn by the subject in response to receiving the reference image and the first prompt; comparing the first drawn image and the reference image; and based on the comparison, determining a first measure of visual cognition of the subject.

[0014] In some embodiments, the first prompt instructs the subject to copy the reference image. The first prompt may instruct the subject to draw a transposed copy of the reference image. In some embodiments, the first prompt instructs the subject to draw a laterally inverted copy of the reference image. In some embodiments, the first prompt instructs the subject to draw a vertically inverted copy of the reference image.

[0015] The first prompt may be presented to the subject visually. In some embodiments, the first prompt is presented to the subject audibly.

[0016] In some embodiments of the present disclosure, the plurality of spaced insignia form a grid. The plurality of insignia may comprise a 4 by 4 square grid of 16 insignia. Each insignia of the plurality of insignia may comprise a dot.

[0017] In some embodiments, the reference image comprises at least one straight line that intersects at least four insignia of the plurality of spaced insignia. The reference image may comprise at least one straight line that intersects only two insignia of the plurality of spaced insignia.

[0018] In some embodiments, the reference image comprises at least one diagonal line that is diagonal with respect to the plurality of spaced insignia or the reference image boundary. The reference image may comprise at least one crossing line that crosses a vertical midline of the plurality of spaced insignia. The reference image may comprise at least one line crossing over another line in the reference image.

[0019] In some embodiments, the reference image comprises at least one line that bypasses at least one insignia of the plurality of insignia. The reference image may comprise at least one vertical line that intersects at least two insignia of the plurality of insignia. The reference image may comprise at least two connected lines. According to some embodiments, the method further includes: receiving a second drawn image from a subject, the second drawn image having been drawn by the subject in response to a second prompt; comparing the second drawn image with a second reference image; and based on the comparison, determining a second measure of visual cognition of the subject.

[0020] In some embodiments, the reference image is presented on a display of a device, and wherein the device includes an input interface for the user to submit the first drawn image for comparison.

[0021] Some embodiments of the present disclosure relate to a computer-implemented method for assessing visual cognition of a subject, the method including: generating a reference image comprising a plurality of spaced insignia and at least one line; causing the first image to be displayed to a subject, causing a prompt to be delivered to the subject; receiving an input corresponding to a drawing by the subject in response to the first prompt; comparing the received input with the generated reference image; and determining a measure of cognition of the subject based on the comparison.

[0022] The prompt may instruct the subject to copy the reference image. The prompt may instructs the subject to draw a transposed copy of the reference image. In some embodiments, the prompt instructs the subject to draw a laterally inverted copy of the reference image. In some embodiments, the prompt instructs the subject to draw a vertically inverted copy of the reference image.

[0023] In some embodiments, the prompt is presented via a display screen. In some embodiments, the plurality of spaced insignia form a grid. The plurality of insignia may comprise a 4 by 4 square grid of 16 insignia. The plurality of insignia may each comprise a dot.

[0024] In some embodiments, the reference image comprises at least one straight line that intersects at least two insignia of the plurality of spaced insignia. The reference image may comprise at least one straight line that intersects only two insignia of the plurality of spaced insignia. In some embodiments, the reference image comprises at least one diagonal line that is diagonal with respect to the plurality of spaced insignia or the reference image boundary.

[0025] In some embodiments, the reference image comprises at least one crossing line that crosses a vertical midline of the plurality of spaced insignia. The reference image may comprise at least one line crossing over another line in the reference image. The reference image may comprise at least one line that bypasses at least one insignia of the plurality of insignia.

[0026] In some embodiments, the reference image comprises at least one vertical line that intersects at least two insignia of the plurality of insignia. In some embodiments, the reference image comprises at least two connected lines.

[0027] In some embodiments, the computer-implemented method further includes: receiving a second input corresponding to a second drawing by the subject, the second drawing having been drawn by the subject in response to a second prompt; comparing the second input with a second reference image; and based on the comparison, determining a second measure of visual cognition of the subject.

[0028] Some embodiments of the present disclosure relates to a device including an image, the image comprising: a plurality of spaced insignia; and one or more lines comprising at least one of: a vertical straight line that joins a minimum of two insignia of the plurality of spaced insignia for testing visual discrimination and spatial attention skills, at least one line that passes over a vertical midline axis of the plurality of spaced insignia for testing visual discrimination and spatial attention skills, at least one line that bypasses at least one insignia of the plurality of insignia for assessing visual decision-making skills, and at least one line that crosses over a pre-existing line for testing visual discrimination and spatial attention skills.

[0029] The one or more lines may be interconnected. The image may comprise three or more lines, the three or more lines may comprise at least three of: a vertical straight line that joins a minimum of two insignia of the plurality of spaced insignia for testing visual discrimination and spatial attention skills, at least one line that passes over a vertical midline axis of the plurality of spaced insignia for testing visual discrimination and spatial attention skills, at least one line that bypasses at least one insignia of the plurality of insignia for assessing visual decision-making skills, and at least one line that crosses over a pre-existing line for testing visual discrimination and spatial attention skills.

[0030] Some embodiments relate to a non-transitory computer readable medium including data pertaining to an image, the image comprising: a plurality of spaced insignia; and one or more lines comprising at least one of: a vertical straight line that joins a minimum of two insignia of the plurality of spaced insignia for testing visual discrimination and spatial attention skills, at least one line that passes over a vertical midline axis of the plurality of spaced insignia for testing visual discrimination and spatial attention skills, at least one line that bypasses at least one insignia of the plurality of insignia for assessing visual decision-making skills, and at least one line that crosses over a pre-existing line for testing visual discrimination and spatial attention skills. According to some embodiments of the method disclosed herein, the reference image comprises: a plurality of spaced insignia; and one or more lines comprising at least one of: a vertical straight line that joins a minimum of two insignia of the plurality of spaced insignia for testing visual discrimination and spatial attention skills, at least one line that passes over a vertical midline axis of the plurality of spaced insignia for testing visual discrimination and spatial attention skills, at least one line that bypasses at least one insignia of the plurality of insignia for assessing visual decision-making skills, and at least one line that crosses over a pre-existing line for testing visual discrimination and spatial attention skills.

[0031] According to some embodiments of the computer-implemented method disclosed herein, the reference image comprises: a plurality of spaced insignia; and one or more lines comprising at least one of: a vertical straight line that joins a minimum of two insignia of the plurality of spaced insignia for testing visual discrimination and spatial attention skills, at least one line that passes over a vertical midline axis of the plurality of spaced insignia for testing visual discrimination and spatial attention skills, at least one line that bypasses at least one insignia of the plurality of insignia for assessing visual decision-making skills, and at least one line that crosses over a pre-existing line for testing visual discrimination and spatial attention skills.

[0032] Brief Description of Drawings

[0033] Figure 1 shows a flowchart illustrating a method for assessing visual cognition of a subject, according to some embodiments.

[0034] Figure 2 shows an example reference image that may be used for assessing visual cognition of a subject, according to some embodiments. Figure 3 shows an example template that may be presented to a subject for assessing visual cognition of the subject, according to some embodiments.

[0035] Figure 4 shows a further example reference image, according to some alternative embodiments.

[0036] Figure 5 shows a further example template, according to some other embodiments.

[0037] Figure 6 shows an example of a data collection entry that may be collected when performing the method of Figure 1 with the subject, according to some embodiments.

[0038] Figure 7 shows an example table of results of a test study of performing the method of Figure 1 with a plurality of subjects, according to some embodiments.

[0039] Figure 8 shows an example system for assessing visual cognition of a subject, according to some embodiments.

[0040] Description of Embodiments

[0041] Described embodiments relate generally to methods and systems for assessing cognition of a subject. In particular, embodiments relate to assessing visual cognition of a subject.

[0042] Visual cognition or visual perception may include the ability to see, identify, understand and interpret a visual scene, the ability to combine the visual scene with prior knowledge to produce a higher-level visual interpretation, and / or to make a decision based on the perceived visual scene or the visual interpretation.

[0043] In the present application, references to the terms “draw”, “drawn”, or “drawing” may refer to physical acts performed by a subject to make lines or marks on a physical material, such as writing on paper. In some embodiments, references to the terms “draw”, “drawn”, or “drawing” may refer to physical acts performed by a subject via an input device to produce virtual lines or marks in a digital medium, such as by using a finger or stylus to interact with a graphical user interface of a touch screen computing device.

[0044] In the present application, a subject may be a person whose cognition or cognitive ability is being assessed. According to some embodiments, the subject may be a child. According to some embodiments, the subject may be a child between the ages of 5 to 12 years old. According to some other embodiments, the subject may be a child younger than 5, a youth older than 12, or an adult. Accordingly, the complexity of one or more lines on the reference image or the complexity of the image manipulation prompted may be adapted depending on the age of the subject. In some embodiments, an instructor may be a person providing prompts to a subject to facilitate or assist in the facilitation of an assessment of the subject’s cognition or cognitive ability. In some embodiments, an instructor may be an electronic device and / or system configured to provide prompts to a subject to facilitate or assist in the facilitation of an assessment of the subject’s cognition or cognitive ability. The electronic device and / or system may include a processor, memory, and / or a display. The memory may store code accessible to the processor to cause the processor to perform the method disclosed herein. In some embodiments, the instructor is a person using an electronic device and / or system to carry out the method disclosed herein. For example, the person may supplement delivery of instructions or prompts to the subject whilst the electronic device is programmed to accept the subject’s drawings.

[0045] Some embodiments relate to tools for assessing visual cognition of a subject. While many tools exist for assessing a child’s development, most of these emphasise the assessment of fine motor skills rather than cognition. None of the existing tools test the visualisation and visual sequencing elements of visual cognition in the manner of the present disclosure.

[0046] The Wold Visuo-Motor test involves three sub-tests. The first sub-test tests a subject’s speed and accuracy of repeatedly drawing vertical lines between adjacent dots on a grid of dots (wherein the pattern in already begun). The second sub-test tests a subject’s speed and accuracy of repeatedly drawing horizontal lines between adjacent dots on a grid of dots (wherein the pattern in already begun). The third sub-test tests a subject’s speed and accuracy of repeatedly drawing horizontal lines between adjacent dots on a grid of dots (wherein the pattern in already begun), wherein the adjacent dots are spaced further from each other than the second sub-test. However, this test is a fine motor test and does not test visual cognition.

[0047] The Beery-Buktnica Developmental Test of Visual-Motor Integration, (Beery VMI), tests a subject’s ability to copy different patterns of increasing difficulty. However, this test is a fine motor test and does not test visual cognition.

[0048] The Test of Visual Analysis Skills (TVAS) tests a subject’s ability to copy a variety of patterns on respective grids of dots. TVAS is very fine-motor dependent testing. This test does not test the visualisation and visual sequencing elements of visual cognition. In some embodiments, other visual motor testing such as at least one of: Wold Visuo- Motor test, Beery VMI, and TV AS may be performed together with embodiments of the present disclosure. These other visual motor testing may assist (training or) identifying issues with a subjects’ fine motor skills.

[0049] Embodiments of the present disclosure may test a subject’s visual perception, visual processing, visual analysis, and / or visual cognition. Embodiments of the present disclosure may improve a subject’s visual perception, visual processing, visual analysis, and / or visual cognition. The relevant skills being tested and / or improved by the described system and method may include visual discrimination skills, visual decisionmaking skills, spatial attention skills, visual planning skills, visual sequencing skills, visualisation skills, visual memory skills, and sequential memory skills.

[0050] According to some embodiments of the present disclosure, there is provided a simple rapid screening tool that could be added to traditional vision screenings to identify children at risk of visual cognition delays early in their education. Some embodiments relate to a simple dot pattern task that may be a cost-effective screening tool of visual cognition that is quick and easy to administer. Some embodiments relate to a simple, inexpensive, and quick screening tool that focuses on the visual analysis aspects of visual cognition such as visual discrimination, spatial attention, decision making, visualisation, memory, sequential memory, and planning & sequencing skills.

[0051] Figure 1 shows a flowchart setting out a method 100 for assessing visual cognition of a subject according to some embodiments.

[0052] At step 102, method 100 begins by a reference image being accessed. In some embodiments, the reference image may be retrieved from a storage location, such as a database. In some embodiments, the reference image may be generated based on a set of rules, as described in further detail below with reference to Figures 2 and 4. The reference image may include a number of visual features.

[0053] At 104, the reference image is presented to a subject. In some embodiments, an instructor may present the reference image to the subject. In some embodiments, the reference image comprises a drawing or print on a sheet. According to some other embodiments, the reference image may be presented to the subject electronically. The reference image may include a number of visual features. For example, in some embodiments the reference image comprises a plurality of spaced insignia. The insignia of the reference image may be dots, filled squares, triangles, shapes or other markings or symbols. The plurality of spaced insignia of the reference image may form a grid. The reference image may also comprise at least one line. The reference image may therefore comprise the plurality of spaced insignia and the at least one line. The reference image may comprise the at least one line residing in the plurality of insignia. In some embodiments, the at least one line connects at least two of the plurality of spaced insignia. Example reference images are described in further detail below with reference to Figures 2 and 4.

[0054] At 106, a prompt is presented to the subject. The prompt may instruct the subject to perform a drawing. The prompt may be presented to the subject visually or audibly. In some embodiments, an instructor may present the prompt to the subject. According to some embodiments, the prompt may be presented to the subject electronically.

[0055] The prompt may instruct the subject to copy the reference image, with or without modification. The prompt may instruct the subject to create a copy of the reference image with one or more manipulations to the copy. For example, in some embodiments, the prompt may instruct the subject to copy the reference image without modification. In some embodiments, the prompt may instruct the subject to draw a copy of the reference image in a different orientation. In some embodiments, the prompt may instruct the subject to draw a transposed copy of the reference image. In some embodiments, the prompt may instruct the subject to draw an inverted or mirrored copy of the reference image. In some embodiments, the prompt instructs the subject to draw an laterally (or horizontally) inverted or mirrored copy of the reference image. In some embodiments, the prompt may instruct the subject to draw a vertically inverted or mirrored copy of the reference image. In some embodiments, the prompt instructs the subject to draw a rotated copy of the reference image. The prompt may instruct clockwise or counterclockwise rotation. The prompt may instruct 90 degrees rotation. In some embodiments, the prompt may instruct the subject to draw a copy of the reference image transformed with at least one of: vertical inversion, horizontal inversion, 90 degrees clockwise rotation, and 90 degrees counterclockwise rotation.

[0056] In some embodiments, the prompt instructs the subject to draw at least one line. In some embodiments, the prompt instruct the subject to draw a plurality of connected lines. In some embodiments, the prompt instructs the subject to draw the plurality of connected lines without lifting their input device. In some embodiments, the prompt instructs the subject to draw the plurality of connected lines, permitting lifting their input device, but prohibiting recontinuing drawing at a different position. In some embodiments, the prompt instructs the subject to draw the plurality of connected lines without retracing over previously drawn lines. In some embodiments, the prompt instructs the subject to draw the plurality of connected lines from a particular starting point.

[0057] At 110, a drawing template is presented to the subject. The drawing template may be presented to the subject by the instructor. In some embodiments, the drawing template is presented to the subject electronically. In some embodiments, the subject may also be presented or given access to a drawing device, such as a pen or stylus. In some embodiments, the subject may be presented with an instruction as to how to use the drawing device or how to draw. For example, the subject may be shown a type of finger gesture on a tablet device that can be used to draw on the tablet display.

[0058] In some embodiments, presentation of two or more of the reference image at 104, the prompt at 106 and the drawing template at 110 may be performed simultaneously, on a single sheet of paper or on the display of a computing device, for example.

[0059] At 115, a drawn image is received from the subject. In some embodiments, the drawn image may be received by the instructor. In some embodiments, the drawn image may be received electronically. The drawn image may be generated by the subject drawing on the drawing template to create the drawn image in response to receiving the reference image and the prompt. The drawing may be received in a physical form, such as in the form of a piece of marked paper, or in an electronic form, such as in the form of an electronic document that has recorded drawing actions made by the user via an input device.

[0060] At 120, the drawn image received at step 115 and the reference image delivered at step 104 are compared. In some embodiments, the comparison may be performed with a modified or transformed version of the reference image that corresponds with the prompt instruction. For example, where the prompt instructed the subject to drawn an inverted and / or rotated version of the reference image, the reference image may be similarly inverted and / or rotated prior to being compared to the drawn image. In some embodiments, comparing the drawn image and the reference image may include counting the number of lines in the drawn image that match the lines in the reference image. This may be referred to as counting a number of matches.

[0061] In some embodiments, comparing the drawn image and the reference image may include counting the number of lines in the drawn image that do not match the lines in the reference image. This accordingly may be referred to as counting a number of errors.

[0062] In some embodiments, the comparison is performed by the instructor at 120.

[0063] In some embodiments, the step 120 may also include monitoring the subject performing the drawing. Accordingly, the monitoring of the subject performing the drawing may be performed before the drawing is received at 115.

[0064] The monitoring of the subject performing the drawing may include observing at least one of: whether the subject lifts their input device from the drawing template before completing their drawing, how many times the subject lifts their input device from the drawing template before completing their drawing, whether the subject places their input device down in a different location from that at which they lifted the input device, whether the subject retraces over previously drawn lines or reverses their direction of drawing, and how many times the subject retraces over previously drawn lines or reverses their direction of drawing.

[0065] At 125, a measure of visual cognition is determined based on the comparison made at step 120. In some embodiments, the measure of visual cognition may be a visual cognition score. According to some embodiments, the visual cognition score may be determined based on whether the subject received a pass grade for one or more presented assessments. The pass grade may be determined based on the comparison made at step 120.

[0066] In some embodiments, a pass grade may be determined by comparing the number of matches determined at step 120 and a predetermined threshold of matches. The predetermined threshold of matches may be retrieved from reference materials or from a memory location. According to some embodiments, the predetermined threshold may be equal to the number of lines in the reference image. In some embodiments, the subject is determined to have achieved a pass grade when the number of matches equals or exceeds the predetermined threshold of matches. In some embodiments, the predetermined threshold of matches may be determined based on a statistical distribution of the number of matches determined from a plurality of past performances of method 100 by a plurality of subjects. For example, the predetermined threshold of matches may be determined based on an average number of matches achieved by the plurality of subjects of the plurality of past performances of method 100.

[0067] In some embodiments, a score is determined based on the number of matches calculated at step 125. In some embodiments, the score is determined to be equal to the number of matches. In some embodiments, the score is determined based on deducting a maximum attainable score by a difference between the number of lines in the reference image and the number of matches.

[0068] In some embodiments, the pass grade is determined by comparing the number of errors and a predetermined threshold of errors. The predetermined threshold of errors may be retrieved from reference materials or from a memory location. According to some embodiments, the predetermined threshold may be zero. In some embodiments, the subject is determined to have achieved a pass grade when the number of errors is calculated to be equal to or below the predetermined threshold of errors. The predetermined threshold of errors may be determined based on a statistical distribution of the number of errors determined from the plurality of past performances of method 100 by the plurality of subjects. For example, the predetermined threshold of errors may be determined based on an average number of errors achieved by the plurality of subjects of the plurality of past performances of method 100.

[0069] In some embodiments, a score is determined based on the number of errors. In some embodiments, the score is determined based on deducting the maximum attainable score by the number of errors calculated.

[0070] In some embodiments, the score is determined based on whether the pass grade was achieved. For example, in some embodiments, the score may be increased by 2 points if the pass grade was attained. According to some embodiments, attaining the pass grade may occur when the number of matches equals the number of lines in the reference image. In some embodiments, if a subject does not achieve the pass grade, method 100 may continue by repeating steps 104 to 125 of method 100 again, presenting the subject with the same reference image and prompt. In some embodiments, these steps may be repeated if it is determined that a subject did not achieve the pass grade but the subject shows they understood that they made an error. For example, this may occur if the subject recognises they did not achieve the pass grade, the subject recognises an error in their drawing, or the subject recognises each error of a plurality of errors made in their drawing. In some embodiments, if it is determined at 125 that the subject did not achieve the pass grade, the subject’s score may be reset to 0 before steps 104 to 125 of method 100 are repeated. According to some embodiments, upon attaining a pass grade at the repeated performance of step 125, a repeated score may be determined. The repeated score may be determined to be a reduced score with respect to the attainable score of passing the assessment at a first attempt. For example, in some embodiments, the repeated may be 1 point. In some embodiments, the repeated score may be an average of the score in the prior performance and the score accrued in the repeated performance. In some embodiments, if the participant did not achieve the pass grade in the repeated attempt, the repeated score is determined to be 0 points.

[0071] After achieving a pass grade at 125, method 100 may be repeated from either step 102, by accessing a new reference image, or from step 106, by presenting a new prompt to the subject with respect to the same reference image. At least one of: a second number of matches, a second number of errors, a second score, a second pass grade, a second predetermined threshold of matches, a second predetermined threshold of errors, and a second maximum attainable score may be determined.

[0072] Where a new prompt, being a second prompt, is presented, the second prompt may provide a different instruction to the instruction provided in the first prompt in the first instance of 106. Accordingly, in some embodiments, the second prompt may instruct the subject to draw a copy of the first reference image in a different orientation than the instruction in the first prompt. Accordingly, in some embodiments, a subsequent prompt may instruct the subject to draw a copy of the reference image in a different orientation than the instruction(s) in the one or more previous prompts. Requiring the subject to manipulate the pattern in multiple orientations assesses visualisation, visual memory and sequential memory skills. In some embodiments, when performing the second instance of method 100, step 125 may further include determining a cumulative score based on the score in the first instance of 125 and the second score in the second instance of 125. The cumulative score may be determined by adding the first score in the first instance of 125 and the second score in the second instance of 125 together. The cumulative score may be used to determine a second measure of visual cognition at 125.

[0073] The second measure of visual cognition may be determined based on a comparison of the cumulative score and a statistical distribution of cumulative scores determined from the plurality of past performances of method 100 by the plurality of subjects. The second measure of visual cognition may be determined based on the cumulative score and the average of cumulative scores achieved by the plurality of subjects of the plurality of past performances of method 100.

[0074] In some embodiments, the first measure of visual cognition may also be based on at least one of: whether the subject lifts their input device from the drawing template before completing their drawing, how many times the subject lifts their input device from the drawing template before completing their drawing, whether the subject places their input device down in a different location from that at which they lifted the input device, whether the subject retraces over previously drawn lines or reverses their direction of drawing, and how many times the subject retraces over previously drawn lines or reverses their direction of drawing.

[0075] In some embodiments, the second measure of visual cognition may also be based on at least one of: whether the subject lifts their input device from the drawing template before completing their drawing, how many times the subject lifts their input device from the drawing template before completing their drawing, whether the subject retraces over previously drawn lines or reverses their direction of drawing, and how many times the subject retraces over previously drawn lines or reverses their direction of drawing.

[0076] In some embodiments, the instructor may begin recording a first time duration for the subject to begin drawing to completing the drawing. In some embodiments, the instructor may begin recording a second time duration from the start or end of the delivery of the prompt to the subject’s completion of the drawing. In some embodiments, the first measure of visual cognition may also be based on at least one of: the first time duration and the second time duration.

[0077] In some embodiments, the second measure of visual cognition may also be based on at least one of: the first time duration and the second time duration.

[0078] In some embodiments, the instructor may access assessment instructions in how to perform one or more embodiments of method 100. The assessment instructions may be accessed from memory of the computing device. The assessment instructions may include at least one of: how to communicate with the subject, how to perform one or more of the method steps of method 100, whether to measure the duration in time of the subject completing the drawing, how to measure the duration in time of the subject completing the drawing, whether to assess retracing of the drawing, how to compare the drawn image to the reference image, how to determine a score, and how to determine a measure of visual cognition.

[0079] Figure 2 shows an example reference image 200 for assessing visual cognition of a subject according to some embodiments. Reference image 200 may be the reference image accessed at step 102 of method 100 as described above. Reference image 200 may be referred to as device 200.

[0080] Reference image 200 includes a plurality of visual features. Specifically, reference image 200 includes a plurality of spaced insignia and one or more lines. In some embodiments, reference image 200 includes 16 or more spaced insignia. In some embodiments, reference image 200 includes at least one line that connects at least two of the spaced insignia.

[0081] In the illustrated embodiment, reference image 200 includes 16 spaced insignia, including insignia 219, and 7 lines joining various ones of the spaced insignia, including lines 203 and 205.

[0082] As shown in Figure 2, the plurality of spaced insignia may form a grid. Specifically, the reference image 200 may include a 4 by 4 square grid of 16 spaced insignia. Each row of insignia may be aligned with a respective row axis. Each column of insignia may be aligned with a respective column axis. As shown in Figure 2, the plurality of insignia may be dots. In some other embodiments, the plurality of insignia may be filled squares, triangles, shapes or other symbols. In some embodiments, the plurality of insignia may form a square grid. However, the arrangement of the insignia is not limited to such a shape. In some other embodiments, the plurality of insignia may form a simple polygon like shape, such as a rectangle, or another arrangement, such as a spoked polyhedron. A subset of three or more insignia may be aligned with an axis. The spacing between the insignia may be consistent with respect to an axis. In some other embodiments, the spacing between the insignia may be irregular with respect to an axis.

[0083] In some embodiments, the one or more lines fill the grid so that each insignia of the plurality of insignia is intersected by a line of the one or more lines. In some other embodiments, the one or more lines do not fill the grid, wherein at least one insignia of the plurality of insignia is not intersected by any line of the one or more lines.

[0084] As shown in Figure 2, in some embodiments reference image 200 includes a plurality of lines. Reference image 200 is shown in Figure 2 to include lines 203, 205, 210, 212, 215, 218, 220, 222.

[0085] The reference image 200 may comprise at least one straight line that joins at least four insignia together. As shown in Figure 2, reference image 200 may include line 203 that joins four insignia together, and line 222 which joins four insignia together. According to some embodiments, use of one straight line that joins at least four insignia together in the reference image 200 in the method 100 may help test a subject’s visual discrimination skills.

[0086] The reference image 200 may comprise at least one straight line that intersects only two insignia of the plurality of insignia. In some embodiments, the reference image 2000 may comprise a straight line that intersects only two insignia of the plurality without bypassing any other insignia. According to some embodiments, use of lines that intersect only two insignia may help test a subject’s visual decision-making skills. As shown in Figure 2, reference image 200 may include line 205 that intersects only two insignia without bypassing any other insignia. As shown in Figure 2, reference image 200 may also include line 210 that intersects only two insignia without bypassing any other insignia. Line 205 and line 210 may intersect a same insignia.

[0087] Reference image 200 may include at least one diagonal line. For example, as shown in Figure 2, reference image 200 includes a diagonal line 212, and a second diagonal line 218. According to some embodiments, the use of the diagonal line in the reference image 200 in method 100 may test a subject’s visual discrimination skills.

[0088] Reference image 200 may include at least one line that passes over a vertical midline axis of the plurality of spaced insignia. For example, as shown in Figure 2, reference image includes lines 203, 212, 215, 218, and 222 which pass over the vertical midline axis of the plurality of spaced insignia.

[0089] Reference image 200 may include at least one line that crosses over a pre-existing line. For example, as shown in Figure 2, reference image includes line 212 and 218, and either may be defined as crossing over a pre-existing line (in one case line 212 may cross preexisting line 218, or in another case line 218 may cross pre-existing line 212).

[0090] According to some embodiments, at least one line that crosses over a pre-existing line and / or passes the vertical midline of the working grid in the reference image 200 in method 100 assesses visual discrimination and spatial attention skills.

[0091] Reference image 200 may include at least one line that bypasses at least one insignia of the plurality of insignia. For example, as shown in Figure 2, reference image 200 includes line 218 which bypasses insignia 219. According to some embodiments, use of at least one line that bypasses at least one insignia of the plurality of insignia in the reference image 200 in method 100 may assess visual decision-making skills. One or more bypassed insignia may not be intersected by any other line.

[0092] Reference image 200 may include a vertical straight line that joins a minimum of two insignia of the plurality of spaced insignia. For example, as shown in Figure 2, reference image 200 includes vertical lines 205 and 220 which each join at least two insignia. According to some embodiments, the vertical straight line that joins a minimum of two insignia of the plurality of spaced insignia in the reference image 200 in method 100 will assess visual discrimination and spatial attention skills.

[0093] Reference image 200 should include a plurality of lines that join together to form a pattern. For example, as shown in Figure 2, reference image 200 includes lines 203, 205, 210, 212, 215, 218, 220, and 222 which are all joined together to form a pattern. Figure 2 is an example of reference image 200 having all lines joined together to form a pattern. In some embodiments, the reference image 200 may include one or more visual cues 225 to inform a subject to draw a pattern from a start point to an end point. In some embodiments, visual cue may be one or more arrow shapes on one or more lines of the reference image 200. As shown in Figure 2, the visual cue may be one arrow shape at the end point of one line 222 of a plurality of continuously connected lines, explicitly indicating an end point and implicitly indicating a start point. In some embodiments, the visual cue may be one arrow shape at the start point of one line of a plurality of continuously connected lines, explicitly indicating a start point and implicitly indicating an end point.

[0094] The image may comprise three or more lines, the three or more lines comprising at least three of: a vertical straight line, such as line 205, that joins a minimum of two insignia of the plurality of spaced insignia for testing visual discrimination and spatial attention skills; a line, such as line 222, that passes over a vertical midline axis of the plurality of spaced insignia for testing visual discrimination and spatial attention skills; a line, such as line 218, that bypasses at least one insignia of the plurality of insignia for assessing visual decision-making skills; and a line, such as line 212, that crosses over a pre-existing line for testing visual discrimination and spatial attention skills.

[0095] In some embodiments, the subject may be instructed or prompted to draw the pattern from start to finish in one continuous action / draw. In some embodiments, the subject may be instructed or prompted to draw the pattern from start to finish in one continuous action / draw from one end point of the joined plurality of lines to another end point of the joined plurality of lines. The subject may be permitted to lift their writing device or finger from the image for drawing. According to some embodiments, the plurality of joined lines in the reference image 200 in method 100 will assess visual planning and sequencing skills.

[0096] Figure 3 shows an example of a template image 300 according to some embodiments. Template image 300 may also be referred to as drawing template 300 or device 300. Template image 300 may comprise the same plurality of insignia as those shown on reference image 200. In some other embodiments, the template image 300 may have the same number of insignia as the reference image but a different dimensionality, for example reference image 200 may comprise a 3 by 4 grid of insignia whilst template image 300 may comprise a 4 by 3 grid of insignia. In some other embodiments, the template image 300 may have a different number of insignia to reference image 200. n some other embodiments, the template image 300 may have a different number of insignia and a different dimensionality to reference image 200. Template image 300 may be presented to a subject at step 110 of method 100. The subject may be prompted to draw on the template image 300 and then submit the subsequently drawn image to be received by an instructor at step 115, compared with the reference image 200 at step 120, and then a measure of visual cognition may be determined at step 125 based on the comparison. The plurality of insignia on the template image 300 may be the same number of insignia as the plurality of insignia on the reference image 200. In some other embodiments, the plurality of insignia on template image 300 may comprise less insignia or more insignia than the plurality of insignia on the reference image 200.

[0097] Figure 4 shows a reference image 400 according to some alternative embodiments. Reference image 400 may be referred to as device 400. The reference image 400 may include more than 16 insignia. As shown in Figure 4, the reference image 400 may include 32 insignia 405. In some embodiments, as shown in Figure 4, the insignia 405 may comprise filled squares. As shown in Figure 4, the reference image 400 may form a grid. As shown in Figure 4, the reference image 400 may form a rectangular grid.

[0098] The reference image 400 may comprise at least one straight line 410 that joins at least four insignia together. The reference image 400 may comprise at least one straight line 415 that intersects only two insignia of the plurality of insignia without bypassing any other insignia. Reference image 400 may include at least one diagonal line 420. Reference image 400 may include at least one line 425 that passes over a vertical midline axis of the plurality of spaced insignia. Reference image 400 may include at least one line 430 that crosses over a pre-existing line. Reference image 400 may include at least one line 435 that bypasses at least one insignia 440 of the plurality of insignia. Reference image 400 may include a vertical straight line 445 that joins a minimum of two insignia of the plurality of spaced insignia.

[0099] Figure 5 shows a drawing template 500 according to some alternative embodiments. Drawing template 500 may be referred to as template image 500 or device 500. The drawing template 500 may include more than 16 insignia. As shown in Figure 5, the drawing template 500 may include 32 insignia. In some embodiments, as shown in Figure 5, the drawing template 500 insignia may comprise filled squares. Figure 6 shows an example of a data collection entry 600 that may be generated when performing method 100 according to some embodiments. Data collection entry 600 may comprise notation by an instructor in paper or digital form, or a data structure in memory of an instructing device. Data collection entry 600 may comprise a subject identifying field 602 to identify the subject tested via method 100. Data collection entry 600 may comprise an age identifying field 604 to identify an age of the subject tested via method 100. Data collection entry 600 may comprise a first test result 606 to record a first score from conducting a first instance of method 100 with the subject. Data collection entry 600 may comprise a second test result 607 to record a second score from conducting a second instance of method 100 with the subject. Data collection entry 600 may comprise a third test result 608 to record a third score from conducting a third instance of method 100 with the subject. Data collection entry 600 may comprise a total score 609 to record a cumulative score from conducting method 100 with the subject.

[0100] Figure 7 shows an example table of results 700 collected during a test study conducted by performing method 100 with a plurality of subjects. Table of results 700 may comprise notation by an instructor in paper or digital form, or a data structure in memory of an instructing device. Table of results may include demographic entries 702, subject numbers 704, and distribution of scores 706.

[0101] Demographic entries 702 may comprise one or more demographic categories. Demographic entries 702 may comprise a plurality of age groups. The age groups may be ages 5, 6, 7, 8, 9, 10, 11, and 12, for example, as shown in Figure 7.

[0102] Subject numbers 704 may be the number of subjects of the total number of subjects per age group. For example, as shown in Figure 7, age 5 may have 32 subjects, age 6 may have 33 subjects, age 7 may have 31 subjects, age 8 may have 40 subjects, age 9 may have 30 subjects, age 10 may have 39 subjects, age 11 may have 34 subjects, and age 12 may have 35 subjects. Subject numbers 704 may be expressed as a number of subjects or a percentage of a plurality of subjects.

[0103] Distribution of scores 706 may be data pertaining to a number or percentage of subjects for a given age achieving a given score. Distribution of scores 706 may be represented as cumulative number s / counting. As shown in Figure 7, distribution of scores 706 may be expressed as cumulative percentages. For example, as shown in Figure 7, the age group 12 did not have any subjects which scored 1, 2, or 3 points; however, 3% of 12 year old subjects achieved a score of 4, 20% of 12 year old subjects achieved a score of 4 or 5, and 100% of 12 year old subjects achieved a score of 4, 5, or 6.

[0104] According to some embodiments, a statistical distribution for each age group of subjects may be determined based on table of results 700. According to some embodiments, a measure of visual cognition may be determined at step 125 in method 100 based on a comparison of a subject’s cumulative score and table of results 700. According to some embodiments, a measure of visual cognition may be determined at step 125 in method 100 based on a comparison of a subject’s cumulative score and the statistical distribution for the subject’s demographic, such as the subject’s age. According to some embodiments, a measure of visual cognition may be determined at step 125 in method 100 based on a comparison of a subject’s cumulative score and a threshold cumulative score based on a predetermined percentile of a statistical distribution of cumulative scores for the subject’s age.

[0105] Figure 8 shows a block diagram illustrating an example system 800 for assessing visual cognition, according to some embodiments. System 800 may include a user device 810. System 800 may include a server system 820 communicatively coupled with user device 810 via a network 805.

[0106] User device 810 may be a computing device such as a personal computer, laptop computer, desktop computer, tablet, or smart phone, for example. User device 810 comprises a processor 812 configured to read and execute program code. Processor 812 may include one or more data processors for executing instructions, and may include one or more of a microprocessor, microcontroller-based platform, a suitable integrated circuit, and one or more application-specific integrated circuits (ASIC's).

[0107] User device 810 further comprises at least one memory 814. Memory 814 may include one or more memory storage locations which may include volatile and non-volatile memory, and may be in the form of ROM, RAM, flash or other memory types. Memory 814 may also comprise system memory, such as a BIOS.

[0108] Memory 814 is arranged to be accessible to processor 812, and to store data that can be read and written to by processor 812. Memory 814 may also contain program code that is executable by processor 812, to cause processor 812 to perform various functions. For example, processor 812 executing program code stored in memory 814 may be caused to perform method 100. Program code may include an operating system application, which may be a mobile operating system if user device 810 is a mobile device, a desktop operating system if user computing device 810 is a desktop device, or an alternative operating system.

[0109] Display 816 may comprise an electronic display screen configured to communicate data to a user. For example, display 816 may be configured to display reference image 200 and / or the drawing template 300 to a subject.

[0110] User device 810 may further comprise user input peripherals 818. These may include one or more of a touch screen display, mouse, keyboard, speaker, microphone, and camera, for example. User input 818 may be used to receive data and instructions from a user.

[0111] User device 810 also comprises a communications module 819, to facilitate communication between user device 810 and other remote or external devices. Communications module 819 may allow for wired or wireless communication between user device 810 and external devices, and may utilise Wi-Fi, USB, Bluetooth, or other communications protocols. According to some embodiments, communications module 819 may facilitate communication between device 810 and server system 820 via network 805, for example.

[0112] Network 805 may comprise one or more local area networks or wide area networks that facilitate communication between elements of system 800. For example, according to some embodiments, network 805 may be the internet. However, network 805 may comprise at least a portion of any one or more networks having one or more nodes that transmit, receive, forward, generate, buffer, store, route, switch, process, or a combination thereof, etc. one or more messages, packets, signals, some combination thereof, or so forth. Network 805 may include, for example, one or more of: a wireless network, a wired network, an internet, an intranet, a public network, a packet-switched network, a circuit- switched network, an ad hoc network, an infrastructure network, a public-switched telephone network (PSTN), a cable network, a cellular network, a satellite network, a fibre-optic network, or some combination thereof.

[0113] Server system 820 may comprise one or more computing devices and / or server devices, such as one or more servers, databases, and / or processing devices in communication over a network, with the computing devices hosting one or more application programs, libraries, APIs or other software elements. The components of server system 820 may provide server-side functionality to one or more client applications executing on user device 810. The server-side functionality may include operations such as user account management, login, and data editing, saving, publishing, and sharing functions. According to some embodiments, server system 820 may comprise a cloud based server system. While a single server system 820 is shown, server system 820 may comprise multiple systems of servers, databases, and / or processing devices.

[0114] Server system 820 may comprise at least one processor 822 and a data store 825. Processor 822 may include one or more data processors for executing instructions, and may include one or more of a microprocessor, microcontroller-based platform, a suitable integrated circuit, and one or more application-specific integrated circuits (ASIC's). Data store 825 may include one or more memory storage locations, and may be in the form of ROM, RAM, flash or other memory types. Server system 820 may include additional functional components to those illustrated and described, such as one or more firewalls (and / or other network security components), load balancers, and or other components.

[0115] According to some embodiments, processor 812 executing program code may be configured to perform each step of method 100. For example, processor 812 may access a reference image 200 / 400 at step 102. This may be by retrieving the reference image from memory 814, receiving the reference image from server system 820, or by generating the reference image based on one or more rules, for example. The processor 812 may cause the reference image to be displayed to a subject via display 816 at step 104. At step 106, processor 812 may display a prompt to the user via display 816, instructing the subject to copy the reference image with or without modification. At step 110, processor 812 may cause a drawing template 300 / 500 to be presented to the subject via display 816. At step 115, processor 812 may receive a drawn image via user input 818. At step 120, processor 812 may be caused to compare the reference image with the drawn image, and to compare image features to determine a pass grade and / or score, which may be calculated using one or more predetermined thresholds retrieved from memory 814 or received from server system 820. At step 125, processor 812 may then determine a measure of visual cognition, which may be displayed on display 816, stored in memory 814, or sent to server system 820.

[0116] In some embodiments, processor 812 may perform a subset of the steps of method 100, and the remaining steps may be performed by a human instructor or assessor. According to some alternative embodiments, processor 822 of server system 820 or another external processing device executing program code may be configured to perform each step of method 100. For example, processor 822 may access a reference image 200 / 400 at step 102. This may be by retrieving the reference image from data store 825, receiving the reference image from user device 810, or by generating the reference image based on one or more rules, for example. The processor 822 may transmit a signal to user device 810 to cause the reference image to be displayed to a subject via display 816 at step 104. At step 106, processor 822 may transmit a signal to user device 810 to cause user device 810 to display a prompt to the user via display 816, instructing the subject to copy the reference image with or without modification. At step 110, processor 822 may transmit a signal to user device 810 to cause user device 810 to present a drawing template 300 / 500 the subject via display 816. At step 115, processor 822 may receive a signal containing data transmitted from user device 810 pertaining to a drawn image via user input 818. At step 120, processor 822 may be caused to compare the reference image with the drawn image, and to compare image features to determine a pass grade and / or score, which may be calculated using one or more predetermined thresholds retrieved from data store 825 or received from user device 810. At step 125, processor 822 may then determine a measure of visual cognition, and then may perform at least one: transmit the measure of visual cognition to user device 810 to cause user device 810 to display the measure of visual cognition on display 816, transmitted the measure of visual cognition to user device 810 to be stored in memory 814, or store the measure of visual cognition in data store 825.

[0117] In some embodiments, processor 822 may perform a subset of the steps of method 100, and the remaining steps may be performed by at least one of: user device 810, and a human instructor or assessor.

[0118] It will be appreciated by persons skilled in the art that numerous variations and / or modifications may be made to the above-described embodiments, without departing from the broad general scope of the present disclosure. The present embodiments are, therefore, to be considered in all respects as illustrative and not restrictive.

Claims

CLAIMS:

1. A method for assessing visual cognition of a subject, the method comprising: presenting a reference image and a first prompt to a subject, the first prompt instructing the subject to draw a copy of the reference image in a different orientation, and the reference image comprising a plurality of spaced insignia and at least one line; receiving a first drawn image from a subject, the first drawn image having been drawn by the subject in response to receiving the reference image and the first prompt; comparing the first drawn image and the reference image; and based on the comparison, determining a first measure of visual cognition of the subject.

2. The method of claim 1, wherein the first prompt instructs the subject to draw a rotated copy of the reference image.

3. The method of claim 1, wherein the first prompt instructs the subject to draw an inverted copy of the reference image.

4. The method of claim 1, wherein the first prompt instructs the subject to draw a rotated and inverted copy of the reference image.

5. A method for assessing visual cognition of a subject, the method including: presenting a reference image and a first prompt to a subject, the reference image comprising a plurality of spaced insignia and at least one line;receiving a first drawn image from a subject, the first drawn image having been drawn by the subject in response to receiving the reference image and the first prompt; comparing the first drawn image and the reference image; and based on the comparison, determining a first measure of visual cognition of the subject.

6. The method of claim 5, wherein the first prompt instructs the subject to copy the reference image.

7. The method of claim 5, wherein the first prompt instructs the subject to draw a transposed copy of the reference image.

8. The method of claim 5, wherein the first prompt instructs the subject to draw a laterally inverted copy of the reference image.

9. The method of claim 5, wherein the first prompt instructs the subject to draw a vertically inverted copy of the reference image.

10. The method of any one of claims 1 to 9, wherein the first prompt is presented to the subject visually.

11. The method of any one of claims 1 to 10, wherein the first prompt is presented to the subject audibly.

12. The method of any one of claims 1 to 11, wherein the plurality of spaced insignia form a grid.

13. The method of claim 12, wherein the plurality of insignia comprise a 4 by 4 square grid of 16 insignia.

14. The method of any one of claims 1 to 13, wherein each insignia of the plurality of insignia comprises a dot.

15. The method of any one of claims 1 to 14, wherein the reference image comprises at least one straight line that intersects at least four insignia of the plurality of spaced insignia.

16. The method of any one of claims 1 to 15, wherein the reference image comprises at least one straight line that intersects only two insignia of the plurality of spaced insignia.

17. The method of any one of claims 1 to 16, wherein the reference image comprises at least one diagonal line that is diagonal with respect to the plurality of spaced insignia or the reference image boundary.

18. The method of any one of claims 1 to 17, wherein the reference image comprises at least one crossing line that crosses a vertical midline of the plurality of spaced insignia.

19. The method of any one of claims 1 to 18, wherein the reference image comprises at least one line crossing over another line in the reference image.

20. The method of any one of claims 1 to 19, wherein the reference image comprises at least one line that bypasses at least one insignia of the plurality of insignia.

21. The method of any one of claims 1 to 20, wherein the reference image comprises at least one vertical line that intersects at least two insignia of the plurality of insignia.

22. The method of any one of claims 1 to 21, wherein the reference image comprises at least two connected lines.

23. The method of any one of claims 1 to 22, further including:receiving a second drawn image from a subject, the second drawn image having been drawn by the subject in response to a second prompt; comparing the second drawn image with a second reference image; and based on the comparison, determining a second measure of visual cognition of the subject.

24. The method of any one of claims 1 to 23, wherein the reference image is presented on a display of a device, and wherein the device includes an input interface for the user to submit the first drawn image for comparison.

25. A computer-implemented method for assessing visual cognition of a subject, the method including: generating a reference image comprising a plurality of spaced insignia and at least one line; causing the first image to be displayed to a subject, causing a prompt to be delivered to the subject; receiving an input corresponding to a drawing by the subject in response to the first prompt; comparing the received input with the generated reference image; and determining a measure of cognition of the subject based on the comparison.

26. The computer-implemented method of claim 25, wherein the prompt instructs the subject to copy the reference image.

27. The computer-implemented method of claim 25, wherein the prompt instructs the subject to draw a transposed copy of the reference image.

28. The computer-implemented method of claim 25, wherein the prompt instructs the subject to draw a laterally inverted copy of the reference image.

29. The computer-implemented method of claim 25, wherein the prompt instructs the subject to draw a vertically inverted copy of the reference image.

30. The computer-implemented method of any one of claims 25 to 29, wherein the prompt is presented via a display screen.

31. The computer-implemented method of any one of claims 25 to 30, wherein the plurality of spaced insignia form a grid.

32. The computer-implemented method of claim 31, wherein the plurality of insignia comprise a 4 by 4 square grid of 16 insignia.

33. The computer-implemented method of any one of claims 25 to 32, wherein the plurality of insignia each comprise a dot.

34. The computer-implemented method of any one of claims 25 to 33, wherein the reference image comprises at least one straight line that intersects at least two insignia of the plurality of spaced insignia.

35. The computer-implemented method of any one of claims 25 to 34, wherein the reference image comprises at least one straight line that intersects only two insignia of the plurality of spaced insignia.

36. The computer-implemented method of any one of claims 25 to 35, wherein the reference image comprises at least one diagonal line that is diagonal with respect to the plurality of spaced insignia or the reference image boundary.

37. The computer-implemented method of any one of claims 25 to 36, wherein the reference image comprises at least one crossing line that crosses a vertical midline of the plurality of spaced insignia.

38. The computer-implemented method of any one of claims 25 to 37, wherein the reference image comprises at least one line crossing over another line in the reference image.

39. The computer-implemented method of any one of claims 25 to 38, wherein the reference image comprises at least one line that bypasses at least one insignia of the plurality of insignia.

40. The computer-implemented method of any one of claims 25 to 39, wherein the reference image comprises at least one vertical line that intersects at least two insignia of the plurality of insignia.

41. The computer-implemented method of any one of claims 25 to 40, wherein the reference image comprises at least two connected lines.

42. The computer-implemented method of any one of claims 25 to 41, further including: receiving a second input corresponding to a second drawing by the subject, the second drawing having been drawn by the subject in response to a second prompt; comparing the second input with a second reference image; and based on the comparison, determining a second measure of visual cognition of the subject.

43. A device including an image, the image comprising: a plurality of spaced insignia; andone or more lines comprising at least one of: a vertical straight line that joins a minimum of two insignia of the plurality of spaced insignia for testing visual discrimination and spatial attention skills, at least one line that passes over a vertical midline axis of the plurality of spaced insignia for testing visual discrimination and spatial attention skills, at least one line that bypasses at least one insignia of the plurality of insignia for assessing visual decision-making skills, and at least one line that crosses over a pre-existing line for testing visual discrimination and spatial attention skills.

44. The device according to claim 43, wherein the one or more lines are interconnected.

45. A non-transitory computer readable medium including data pertaining to an image, the image comprising: a plurality of spaced insignia; and one or more lines comprising at least one of: a vertical straight line that joins a minimum of two insignia of the plurality of spaced insignia for testing visual discrimination and spatial attention skills, at least one line that passes over a vertical midline axis of the plurality of spaced insignia for testing visual discrimination and spatial attention skills, at least one line that bypasses at least one insignia of the plurality of insignia for assessing visual decision-making skills, andat least one line that crosses over a pre-existing line for testing visual discrimination and spatial attention skills.

46. The non-transitory computer readable medium according to claim 45, wherein the one or more lines are interconnected.

47. The method according to any one of claims 1 to 24, wherein the reference image comprises: a plurality of spaced insignia; and one or more lines comprising at least one of: a vertical straight line that joins a minimum of two insignia of the plurality of spaced insignia for testing visual discrimination and spatial attention skills, at least one line that passes over a vertical midline axis of the plurality of spaced insignia for testing visual discrimination and spatial attention skills, at least one line that bypasses at least one insignia of the plurality of insignia for assessing visual decision-making skills, and at least one line that crosses over a pre-existing line for testing visual discrimination and spatial attention skills.

48. A computer-implemented method according to any one of claims 25 to 42, wherein the reference image comprises: a plurality of spaced insignia; and one or more lines comprising at least one of:a vertical straight line that joins a minimum of two insignia of the plurality of spaced insignia for testing visual discrimination and spatial attention skills, at least one line that passes over a vertical midline axis of the plurality of spaced insignia for testing visual discrimination and spatial attention skills, at least one line that bypasses at least one insignia of the plurality of insignia for assessing visual decision-making skills, and at least one line that crosses over a pre-existing line for testing visual discrimination and spatial attention skills.

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