Cognitive impairment in pediatric-onset multiple sclerosis is detected by the Brief International Cognitive Assessment for Multiple Sclerosis and computerized cognitive testing

2017 ◽  
Vol 24 (4) ◽  
pp. 512-519 ◽  
Author(s):  
Leigh E Charvet ◽  
Michael Shaw ◽  
Ariana Frontario ◽  
Dawn Langdon ◽  
Lauren B Krupp
Keyword(s):  
Multiple Sclerosis ◽  
Cognitive Impairment ◽  
Cognitive Assessment ◽  
Outpatient Setting ◽  
Cognitive Testing ◽  
Cognitive Screening ◽  
Healthy Control ◽  
Computer Based ◽  
Brief Cognitive Assessment ◽  
Pediatric Onset

Background: Cognitive impairment is a common and troubling feature of pediatric-onset multiple sclerosis (POMS). Brief cognitive assessment in the outpatient setting can identify and longitudinally monitor cognitive involvement so that early intervention is possible. Objectives: The goal of this study was to measure the sensitivity of two cognitive assessment approaches that are brief, repeatable, and suitable for clinical practice and for multicenter investigation. Methods: Participants with POMS ( n = 69) were consecutively evaluated as part of outpatient neurologic visits and compared to healthy control participants (HC, n = 66) using the Brief International Cognitive Assessment for MS (BICAMS) approach and timed information processing measures from Cogstate, a computer-based assessment. Results: There was strong agreement in the detection rate of impairment between both assessments, with 26% for the BICAMS and 27% for Cogstate. Two of the Cogstate tasks were the most sensitive individual measures. Conclusion: Both the BICAMS and Cogstate timed processing measures offer practical, sensitive, and standardized approaches for cognitive screening assessment in POMS.

scholarly journals Application of an Adaptive, Digital, Game-Based Approach for Cognitive Assessment in Multiple Sclerosis: Observational Study

10.2196/24356 ◽  
2021 ◽  
Vol 23 (1) ◽  
pp. e24356 ◽  
Author(s):  
Wan-Yu Hsu ◽  
William Rowles ◽  
Joaquin A Anguera ◽  
Chao Zhao ◽  
Annika Anderson ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Cognitive Impairment ◽  
Video Game ◽  
Cognitive Assessment ◽  
Walking Speed ◽  
Group Differences ◽  
Cognitive Screening ◽  
Multiple Sclerosis Functional Composite ◽  
Adaptive Video ◽  
Assessment Sensitivity

Background Cognitive impairment is one of the most debilitating manifestations of multiple sclerosis. Currently, the assessment of cognition relies on a time-consuming and extensive neuropsychological examination, which is only available in some centers. Objective To enable simpler, more accessible cognitive screening, we sought to determine the feasibility and potential assessment sensitivity of an unsupervised, adaptive, video game–based digital therapeutic to assess cognition in multiple sclerosis. Methods A total of 100 people with multiple sclerosis (33 with cognitive impairment and 67 without cognitive impairment) and 24 adults without multiple sclerosis were tested with the tablet game (EVO Monitor) and standard measures, including the Brief International Cognitive Assessment for Multiple Sclerosis (which included the Symbol Digit Modalities Test [SDMT]) and Multiple Sclerosis Functional Composite 4 (which included the Timed 25-Foot Walk test). Patients with multiple sclerosis also underwent neurological evaluations and contributed recent structural magnetic resonance imaging scans. Group differences in EVO Monitor performance and the association between EVO Monitor performance and standard measures were investigated. Results Participants with multiple sclerosis and cognitive impairment showed worse performance in EVO Monitor compared with participants without multiple sclerosis (P=.01) and participants with multiple sclerosis without cognitive impairment (all P<.002). Regression analyses indicated that participants with a lower SDMT score showed lower performance in EVO Monitor (r=0.52, P<.001). Further exploratory analyses revealed associations between performance in EVO Monitor and walking speed (r=–0.45, P<.001) as well as brain volumetric data (left thalamic volume: r=0.47, P<.001; right thalamic volume: r=0.39, P=.002; left rostral middle frontal volume: r=0.28, P=.03; right rostral middle frontal volume: r=0.27, P=.03). Conclusions These findings suggest that EVO Monitor, an unsupervised, video game–based digital program integrated with adaptive mechanics, is a clinically valuable approach to measuring cognitive performance in patients with multiple sclerosis. Trial Registration ClinicalTrials.gov NCT03569618; https://clinicaltrials.gov/ct2/show/NCT03569618

Taking the tester out of the SDMT: A proof of concept fully automated approach to assessing processing speed in people with MS

2018 ◽  
Vol 25 (11) ◽  
pp. 1506-1513 ◽  
Author(s):  
Viral Prakash Patel ◽  
Lingkai Shen ◽  
Jonathan Rose ◽  
Anthony Feinstein
Keyword(s):  
Multiple Sclerosis ◽  
Speech Recognition ◽  
Processing Speed ◽  
Cognitive Assessment ◽  
Convergent Validity ◽  
Cognitive Testing ◽  
Proof Of Concept ◽  
Matched Healthy Control ◽  
Automated Speech Recognition ◽  
Healthy Control

Background: One factor hindering the widespread use of cognitive testing for people with multiple sclerosis (pwMS) is the need for a tester to administer tests. Objective: To undertake a proof of concept study assessing the feasibility of a fully automated speech recognition version of the Symbol Digit Modalities Test (auto-SDMT) in detecting abnormalities in processing speed in pwMS. Methods: A sample of 50 pwMS and 32 matched healthy control (HC) subjects was tested with the auto-SDMT and the Brief International Cognitive Assessment for MS (BICAMS). Results: The percentages of MS participants impaired on the auto-SDMT and the traditional oral SDMT were 34% and 32%, respectively. Excellent convergent validity was found between the two tests (MS: r = −0.806, p < 0.001 and HC: r = −0.629, p < 0.001). The auto-SDMT had a similar sensitivity and specificity to the traditional oral SDMT in predicting overall impairment on the BICAMS. Conclusion: The auto-SDMT is a sensitive measure for detecting processing speed deficits in pwMS. The test, the first entirely computer administrated oral response version of the SDMT, uses speech recognition technology, thereby eliminating the need for a human tester. Replication of the results is required in a larger representative sample of pwMS.

scholarly journals A Rapid Electronic Cognitive Assessment Measure for Multiple Sclerosis: Validation of Cognitive Reaction, an Electronic Version of the Symbol Digit Modalities Test

10.2196/18234 ◽  
2020 ◽  
Vol 22 (9) ◽  
pp. e18234
Author(s):  
Rod M Middleton ◽  
Owen R Pearson ◽  
Gillian Ingram ◽  
Elaine M Craig ◽  
William J Rodgers ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Question Answering ◽  
Wide Spectrum ◽  
Electronic Version ◽  
Cognitive Testing ◽  
Paper Test ◽  
Assessment Measure ◽  
Healthy Control ◽  
Computer Based ◽  
Highly Correlated

Background Incorporating cognitive testing into routine clinical practice is a challenge in multiple sclerosis (MS), given the wide spectrum of both cognitive and physical impairments people can have and the time that testing requires. Shortened paper and verbal assessments predominate but still are not used routinely. Computer-based tests are becoming more widespread; however, changes in how a paper test is implemented can impact what exactly is being assessed in an individual. The Symbol Digit Modalities Test (SDMT) is one validated test that forms part of the cognitive batteries used in MS and has some computer-based versions. We developed a tablet-based SDMT variant that has the potential to be ultimately deployed to patients’ own devices. Objective This paper aims to develop, validate, and deploy a computer-based SDMT variant, the Cognition Reaction (CoRe) test, that can reliably replicate the characteristics of the paper-based SDMT. Methods We carried out analysis using Pearson and intraclass correlations, as well as a Bland-Altman comparison, to examine consistency between the SDMT and CoRe tests and for test-retest reliability. The SDMT and CoRe tests were evaluated for sensitivity to disability levels and age. A novel metric in CoRe was found: question answering velocity could be calculated. This was evaluated in relation to disability levels and age for people with MS and compared with a group of healthy control volunteers. Results SDMT and CoRe test scores were highly correlated and consistent with 1-month retest values. Lower scores were seen in patients with higher age and some effect was seen with increasing disability. There was no learning effect evident. Question answering velocity demonstrated a small increase in speed over the 90-second duration of the test in people with MS and healthy controls. Conclusions This study validates a computer-based alternative to the SDMT that can be used in clinics and beyond. It enables accurate recording of elements of cognition relevant in MS but offers additional metrics that may offer further value to clinicians and people with MS.

Assessing the validity of a computer-generated cognitive screening instrument for patients with multiple sclerosis

2013 ◽  
Vol 19 (14) ◽  
pp. 1905-1912 ◽  
Author(s):  
Helen Lapshin ◽  
Krista L Lanctôt ◽  
Paul O’Connor ◽  
Anthony Feinstein
Keyword(s):  
Multiple Sclerosis ◽  
Cognitive Impairment ◽  
Neuropsychological Testing ◽  
Screening Instrument ◽  
Cognitive Testing ◽  
Healthy Controls ◽  
Cognitive Screening ◽  
Good Test ◽  
Administration Time ◽  
Motor Component

Background: Neuropsychological testing requires considerable time, expense, and expertise to administer. These factors can limit patient access. Computerized cognitive testing has been proposed as an alternative. Objectives: The objective of this paper is to validate a brief, simple-to-use computer-generated cognitive assessment screening battery for multiple sclerosis (MS) patients that has minimal motor involvement. Methods: A sample of 96 MS patients and 98 healthy controls completed a computer-generated battery that included the Stroop, Symbol Digit Modalities Test (C-SDMT), a two- and four-second visual analog of the Paced Auditory Serial Addition Test (PVSAT-2, PVSAT-4), and simple and choice reaction time tests. The Minimal Assessment of Cognitive Function in MS was used to define cognitive impairment in the MS sample. Results: Each newly developed test successfully distinguished between cognitively impaired patients and healthy controls as well as cognitively intact patients. A combination of three computerized tests (C-SDMT, PVSAT-2, PVSAT-4) with a mean administration time of 10 minutes had a sensitivity of 82.5% and specificity of 87.5% in detecting cognitive impairment. Good test-retest reliability was obtained for each measure. Conclusions: Good sensitivity and specificity, brevity, ease of administration, and a limited motor component highlight the feasibility of introducing this computer-generated cognitive screening instrument in a busy MS clinic.

Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS) and performance of everyday life tasks: Actual Reality

2015 ◽  
Vol 22 (4) ◽  
pp. 544-550 ◽  
Author(s):  
Yael Goverover ◽  
Nancy Chiaravalloti ◽  
John DeLuca
Keyword(s):  
Multiple Sclerosis ◽  
Everyday Life ◽  
Cognitive Assessment ◽  
Functional Performance ◽  
Cognitive Screening ◽  
Actual Reality ◽  
Life Tasks ◽  
Brief Cognitive Assessment ◽  
And Performance ◽  
Assess Quality

Background: Recently, a brief cognitive assessment (Brief International Cognitive Assessment for Multiple Sclerosis: BICAMS) has been recommended for use with patients diagnosed with multiple sclerosis (MS) to screen for cognitive impairments. However, the relationship between the BICAMS and everyday life activity has not been examined. The aim of this study was to examine whether the BICAMS can predict performance of activities of daily living using Actual RealityTM (AR) in persons with MS. Method: A between-subjects design was utilized to compare 41 individuals with MS and 32 healthy controls (HC) performing BICAMS and an AR task. Participants were asked to access the internet to purchase a flight ticket or cookies, and were administered the BICAMS and questionnaires to assess quality of life (QOL), affect symptomatology, and prior internet experience. Results: Participants with MS performed significantly worse than HC on the BICAMS and the AR. Additionally, better BICAMS performance was associated with more independent AR performance. Self-reports of QOL were not correlated with AR or BICAMS performance. Conclusions: Individuals with MS have greater problems with actual everyday life tasks as compared to HC. The BICAMS is a promising cognitive screening tool to predict actual functional performance in participants with MS.

scholarly journals A Rapid Electronic Cognitive Assessment Measure for Multiple Sclerosis: Validation of Cognitive Reaction, an Electronic Version of the Symbol Digit Modalities Test (Preprint)

2020 ◽  
Author(s):  
Rod M Middleton ◽  
Owen R Pearson ◽  
Gillian Ingram ◽  
Elaine M Craig ◽  
William J Rodgers ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Question Answering ◽  
Wide Spectrum ◽  
Electronic Version ◽  
Cognitive Testing ◽  
Paper Test ◽  
Assessment Measure ◽  
Healthy Control ◽  
Computer Based ◽  
Highly Correlated

BACKGROUND Incorporating cognitive testing into routine clinical practice is a challenge in multiple sclerosis (MS), given the wide spectrum of both cognitive and physical impairments people can have and the time that testing requires. Shortened paper and verbal assessments predominate but still are not used routinely. Computer-based tests are becoming more widespread; however, changes in how a paper test is implemented can impact what exactly is being assessed in an individual. The Symbol Digit Modalities Test (SDMT) is one validated test that forms part of the cognitive batteries used in MS and has some computer-based versions. We developed a tablet-based SDMT variant that has the potential to be ultimately deployed to patients’ own devices. OBJECTIVE This paper aims to develop, validate, and deploy a computer-based SDMT variant, the Cognition Reaction (CoRe) test, that can reliably replicate the characteristics of the paper-based SDMT. METHODS We carried out analysis using Pearson and intraclass correlations, as well as a Bland-Altman comparison, to examine consistency between the SDMT and CoRe tests and for test-retest reliability. The SDMT and CoRe tests were evaluated for sensitivity to disability levels and age. A novel metric in CoRe was found: question answering velocity could be calculated. This was evaluated in relation to disability levels and age for people with MS and compared with a group of healthy control volunteers. RESULTS SDMT and CoRe test scores were highly correlated and consistent with 1-month retest values. Lower scores were seen in patients with higher age and some effect was seen with increasing disability. There was no learning effect evident. Question answering velocity demonstrated a small increase in speed over the 90-second duration of the test in people with MS and healthy controls. CONCLUSIONS This study validates a computer-based alternative to the SDMT that can be used in clinics and beyond. It enables accurate recording of elements of cognition relevant in MS but offers additional metrics that may offer further value to clinicians and people with MS.

scholarly journals Application of an Adaptive, Digital, Game-Based Approach for Cognitive Assessment in Multiple Sclerosis: Observational Study (Preprint)

2020 ◽  
Author(s):  
Wan-Yu Hsu ◽  
William Rowles ◽  
Joaquin Anguera ◽  
Chao Zhao ◽  
Annika Anderson ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Cognitive Impairment ◽  
Video Game ◽  
Cognitive Assessment ◽  
Walking Speed ◽  
Group Differences ◽  
Cognitive Screening ◽  
Multiple Sclerosis Functional Composite ◽  
Adaptive Video ◽  
Assessment Sensitivity

BACKGROUND Cognitive impairment is one of the most debilitating manifestations of multiple sclerosis. Currently, the assessment of cognition relies on a time-consuming and extensive neuropsychological examination, which is only available in some centers. OBJECTIVE To enable simpler, more accessible cognitive screening, we sought to determine the feasibility and potential assessment sensitivity of an unsupervised, adaptive, video game–based digital therapeutic to assess cognition in multiple sclerosis. METHODS A total of 100 people with multiple sclerosis (33 with cognitive impairment and 67 without cognitive impairment) and 24 adults without multiple sclerosis were tested with the tablet game (EVO Monitor) and standard measures, including the Brief International Cognitive Assessment for Multiple Sclerosis (which included the Symbol Digit Modalities Test [SDMT]) and Multiple Sclerosis Functional Composite 4 (which included the Timed 25-Foot Walk test). Patients with multiple sclerosis also underwent neurological evaluations and contributed recent structural magnetic resonance imaging scans. Group differences in EVO Monitor performance and the association between EVO Monitor performance and standard measures were investigated. RESULTS Participants with multiple sclerosis and cognitive impairment showed worse performance in EVO Monitor compared with participants without multiple sclerosis (<i>P</i>=.01) and participants with multiple sclerosis without cognitive impairment (all <i>P</i>&lt;.002). Regression analyses indicated that participants with a lower SDMT score showed lower performance in EVO Monitor (<i>r</i>=0.52, <i>P</i>&lt;.001). Further exploratory analyses revealed associations between performance in EVO Monitor and walking speed (<i>r</i>=–0.45, <i>P</i>&lt;.001) as well as brain volumetric data (left thalamic volume: <i>r</i>=0.47, <i>P</i>&lt;.001; right thalamic volume: <i>r</i>=0.39, <i>P</i>=.002; left rostral middle frontal volume: <i>r</i>=0.28, <i>P</i>=.03; right rostral middle frontal volume: <i>r</i>=0.27, <i>P</i>=.03). CONCLUSIONS These findings suggest that EVO Monitor, an unsupervised, video game–based digital program integrated with adaptive mechanics, is a clinically valuable approach to measuring cognitive performance in patients with multiple sclerosis. CLINICALTRIAL ClinicalTrials.gov NCT03569618; https://clinicaltrials.gov/ct2/show/NCT03569618

COGNITIVE REHABILITATION IN MULTIPLE SCLEROSIS

2015 ◽  
Vol 86 (11) ◽  
pp. e4.7-e4
Author(s):  
Jamie Campbell ◽  
Mara Cercignani ◽  
Dawn Langdon ◽  
Waqar Rashid
Keyword(s):  
Multiple Sclerosis ◽  
Cognitive Impairment ◽  
Case Report ◽  
Treatment Group ◽  
Cognitive Assessment ◽  
Cognitive Rehabilitation ◽  
Outpatient Setting ◽  
Visuospatial Memory ◽  
Post Intervention ◽  
Home Based

Background/aimsTo explore the feasibility and efficacy of computerised, home-based cognitive rehabilitation in patients with multiple sclerosis using neuropsychological assessment and structural and functional MRI techniques.Materials, methods or case report38 patients with MS and evidence of cognitive impairment on the Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS) test battery were enrolled and randomly assigned to undergo computerised cognitive rehabilitation (n=19) for six weeks or to a control condition (n=19). All patients underwent MRI at baseline (T1) and post-intervention (T2). Changes in cortical activations were explored using an n-back fMRI paradigm.ResultsCompared to baseline, patients in the treatment group showed significant improvement in the Brief Visuospatial Memory Test at T2 (p=0.035) and exhibited altered cortical fMRI activations compared to controls.ConclusionOur preliminary data support the hypothesis that home-based, computerised cognitive rehabilitation is a feasible and effective approach to improving cognitive performance in patients with MS and may reflect underlying changes in brain activations.BICAMS is a sensitive and easy to administer tool for identifying cognitive impairment in MS in the outpatient setting. Identification of cognitive impairment may have important treatment implications in the future.

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