| Objective To develop a questionnaire for screening visuospatial cognition and build a tabletbased computerized Visuospatial Cognition Assessment System(VCAS)for patients with vestibular dysfunction(VP)and validate the two assessment tools separately.Methods 1.Relevant questions were compiled from literature and patient interviews and subjected to experts’ consultation.Subsequently,129 VP were included as participants to evaluate the questionnaire after the expert letter consultation,the results were analyzed,and some questions were eliminated.Finally,224 VP and 105 healthy controls(HC)were included as participants in evaluating the questionnaire,and the results were tested for reliability and validity.2.The VCAS assessment dimensions,including spatial memory,spatial navigation,and mental rotation,and test content,including weeding,maze,card rotation,and three-dimensional(3D)driving tests,were determined based on expert interviews.Subsequently,VCAS was developed based on Unity3D using the C#language and ILruntime hot update framework development technology,combined with the A*algorithm,prime tree algorithm,and dynamic route rendering.Further,the online test was built using relevant game business logic.Finally,HC and 78 VP were recruited for the VCAS test.Some participants were retested in two weeks.and all test results were examined for reliability.Results 1.The initial questionnaire consisted of 22 questions after the expert letter consultation.Through project analysis,six items were deleted and 16 were retained,covering three dimensions,including spatial navigation and navigation strategies(eight questions),secondary chronic mental alterations(four questions),and spatial memory(four questions).The Cronbach’s alpha for the questionnaire was 0.886,and for each dimension ranged from 0.631 to 0.871.The questionnaire demonstrated good retest reliability,with correlation coefficients between the total score and the retest reliability of each dimension ranging from 0.523 to 0.748.A significant positive correlation was observed between the total score of the questionnaire and that of the cognitive failure questionnaire(r=0.647,P<0.001).The χ2/df value in the validated factor analysis was 2.996,and the root-mean-square approximation error was 0.102.VP in the high DHI subgroup had higher scores than HC on both total and all dimensions(P<0.05).2.In validating the content validity of the VCAS,the breadth of the forward task group of the weeding test was longer than that of the backward task group(t=0.583,P<0.001).The number of steps and time of the three difficulty maze groups,including 8 × 8,10 × 10,and 12× 12,in the maze test were significantly different(P<0.001).No ceiling and floor effects were observed in the card rotation test.In the 3D driving test,the number of errors and response time of the Map 4 group were statistically different from both the Map 2 and Map 3 groups(P<0.05).In validating the discriminant validity of VCAS,HC had a longer span in the forward weeding test than the VP group(P<0.05)and weeded at a significantly faster rate than the VP(P<0.05).In the 12×12 maze,the VP took longer and took more steps than the HC(P<0.05);however,no significant difference was observed between the two groups in the 8×8 and 10×10 difficulty mazes(P>0.05).In the card rotation and 3D driving task,no significant difference was observed in the performance of the two groups(P>0.05).In total,37 individuals participated in the retest of the VCAS,and the within-group correlations for all test metrics ranged from 0.576 to 0.992.Conclusion 1.The preliminary questionnaire demonstrated a certain degree of reliability and validity,which must be optimized in the future.2.VCAS is a tablet-based visuospatial ability test suitable for efficiently and conveniently assessing the performance of VP in the three spatial cognitive sub-dimensions,including spatial memory,spatial navigation,and mental rotation,in a one-stop manner.VCAS provides a test tool for assessing the visuospatial cognitive ability of VP and has potential clinical applications. |
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