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.

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 A self-administered, artificial intelligence (AI) platform for cognitive assessment in multiple sclerosis (MS)

2020 ◽  
Author(s):  
Seyed-Mahdi Khaligh-Razavi ◽  
Maryam Sadeghi ◽  
Mahdiyeh Khanbagi ◽  
Chris Kalafatis ◽  
Seyed Massood Nabavi
Keyword(s):  
Multiple Sclerosis ◽  
Cognitive Impairment ◽  
Cognitive Dysfunction ◽  
Cognitive Assessment ◽  
Cognitive Rehabilitation ◽  
Convergent Validity ◽  
Strong Association ◽  
Therapeutic Interventions ◽  
Retest Reliability ◽  
Test Retest Reliability

Abstract Background Cognitive impairment is common in patients with multiple sclerosis (MS). Accurate and repeatable measures of cognition have the potential to be used as markers of disease activity. Methods We developed a 5-minute computerized test to measure cognitive dysfunction in patients with MS. The proposed test – named the Integrated Cognitive Assessment (ICA) – is self-administered and language-independent. 91 MS patients and 83 healthy controls (HC) took part in Substudy 1, in which each participant took the ICA test and the Brief International Cognitive Assessment for MS (BICAMS). We assessed ICA’s test-retest reliability, its correlation with BICAMS, its sensitivity to discriminate patients with MS from the HC group, and its accuracy in detecting cognitive dysfunction. In Substudy 2, we recruited 48 MS patients, 38 of which had received an 8-week physical and cognitive rehabilitation programme and 10 MS patients who did not. We examined the association between the level of serum neurofilament light (NfL) in these patients and their ICA scores and Symbol Digit Modalities Test (SDMT) scores pre- and post-rehabilitation. Results The ICA demonstrated excellent test-retest reliability (r=0.94), with no learning bias, and showed a high level of convergent validity with BICAMS. The ICA was sensitive in discriminating the MS patients from the HC group, and demonstrated high accuracy (AUC = 95%) in discriminating cognitively normal from cognitively impaired participants. Additionally, we found a strong association (r=-0.79) between ICA score and the level of NfL in MS patients before and after rehabilitation. Conclusions The ICA has the potential to be used as a digital marker of cognitive impairment and to monitor response to therapeutic interventions. In comparison to standard cognitive tools for MS, the ICA is shorter in duration, does not show a learning bias, and is independent of language.

scholarly journals Cognitive mediated eye movements during the SDMT reveal the challenges with processing speed faced by people with MS

BMC Neurology ◽  
2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Bennis Pavisian ◽  
Viral P. Patel ◽  
Anthony Feinstein
Keyword(s):  
Eye Movements ◽  
Processing Speed ◽  
Cognitive Rehabilitation ◽  
Test Area ◽  
Cognitive Test ◽  
Hierarchical Regression ◽  
Matched Healthy Control ◽  
Healthy Control ◽  
Number Of Visits ◽  
And Performance

Abstract Background The Symbol Digit Modalities Test (SDMT) is regarded as the cognitive test of choice for people with MS (pwMS). While deficits are linked to impaired processing speed, the mechanisms by which they arise are unclear. Cognitive-mediated eye movements offer one putative explanation. The objective of this study was to determine the association between eye movements and performance on the SDMT. Methods Thirty-three people with confirmed MS and 25 matched healthy control subjects (HC) were administered the oral SDMT while eye movements were recorded. Results Mean SDMT scores were significantly lower in pwMS (p < 0.038). Shorter mean saccade distance in the key area (p = 0.007), more visits to the key area per response (p = 0.014), and more total number of fixations in the test area (p = 0.045) differentiated pwMS from HCs. A hierarchical regression analysis revealed that the number of visits to the key area per response (p < 0.001; ΔR2 = 0.549) and total number of fixations in the test area (p < 0.001; ΔR2 = 0.782) were the most robust predictors of SDMT scores. Conclusion Cognitive-mediated eye movements help elucidate the processing speed challenges confronted by people with MS. Mechanistic insights such as these can potentially help inform new cognitive rehabilitation strategies.

Cognitive reserve moderates decline in information processing speed in multiple sclerosis patients

2010 ◽  
Vol 16 (5) ◽  
pp. 829-835 ◽  
Author(s):  
RALPH H.B. BENEDICT ◽  
SARAH A. MORROW ◽  
BIANCA WEINSTOCK GUTTMAN ◽  
DIANE COOKFAIR ◽  
DAVID J. SCHRETLEN
Keyword(s):  
Multiple Sclerosis ◽  
Cognitive Decline ◽  
Cognitive Dysfunction ◽  
Processing Speed ◽  
Cognitive Reserve ◽  
Cognitive Testing ◽  
Information Processing Speed ◽  
The North ◽  
Premorbid Intelligence ◽  
Multiple Sclerosis Patients

AbstractCognitive reserve is widely recognized as a moderator of cognitive decline in patients with senile dementias such as Alzheimer’s disease. The same effect may occur in multiple sclerosis (MS), an immunologic disorder affecting the central nervous system. While MS is traditionally considered an inflammatory, white matter disease, degeneration of gray matter is increasingly recognized as the primary contributor to progressive cognitive decline. Our aim was to determine if individual differences in estimated cognitive reserve protect against the progression of cognitive dysfunction in MS. Ninety-one patients assessed twice roughly 5 years apart were identified retrospectively. Cognitive testing emphasized mental processing speed. Cognitive reserve was estimated by years of education and by performance on the North American Adult Reading Test (NAART). After controlling for baseline characteristics, both years of education (p = .013) and NAART scores (p = .049) significantly improved regression models predicting cognitive decline. Symbol Digit Modalities Test (SDMT) performance showed no significant change in patients with > 14 years of education, whereas it declined significantly in patients with ≤ 14 years of education. We conclude that greater cognitive reserve as indexed by either higher premorbid intelligence or more years of education protects against the progression of cognitive dysfunction in MS. (JINS, 2010, 16, 829–835.)

scholarly journals Information Processing Speed Assessed with Letter Digit Substitution Test in Croatian Sample of Multiple Sclerosis Patients

Diagnostics ◽  
2022 ◽  
Vol 12 (1) ◽  
pp. 111
Author(s):  
Ana Jerković ◽  
Meri Matijaca ◽  
Ana Proroković ◽  
Anđela Šikić ◽  
Vana Košta ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Information Processing ◽  
Processing Speed ◽  
Convergent Validity ◽  
Information Processing Speed ◽  
Study Objective ◽  
Medication Therapy ◽  
Control Subjects ◽  
Multiple Sclerosis Patients ◽  
The Impact

Cognitive impairment is a common complaint in people with multiple sclerosis (pwMS). The study objective was to determine the psychometric properties of the letter digit substitution test (LDST) that measures information processing speed and to investigate the impact of relevant predictors of LDST achievement in pwMS. The design was cross-sectional. The study included 87 pwMS and 154 control subjects. The validity of LDST was examined, and a hierarchical regression model was used to explore relevant predictors of LDST success. The LDST had excellent construct validity, as expressed by differences between pwMS and control subjects. Convergent validity of the LDST was supported by a significant moderate correlation with the expanded disability status scale (EDSS) (ρ = −0.36; p < 0.05) and a significantly strong correlation with the multiple sclerosis impact scale (MSIS-29) physical subscale (r = −0.64; p < 0.01). The LDTS score well differentiated the pwMS considering age, education, EDSS, disease duration, comorbidity, and medication therapy. Using the LDST as a criterion variable in pwMS results showed consistent evidence for the age, education, and EDSS impact on LDST performance. The best cut-off score of ≤35 discriminated the control and MS group. LDST proved to be a valid test for assessing information processing speed in 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.

scholarly journals A self-administered, artificial intelligence (AI) platform for cognitive assessment in multiple sclerosis (MS)

2020 ◽  
Author(s):  
Seyed-Mahdi Khaligh-Razavi ◽  
Maryam Sadeghi ◽  
Mahdiyeh Khanbagi ◽  
Chris Kalafatis ◽  
Seyed Massood Nabavi
Keyword(s):  
Multiple Sclerosis ◽  
Cognitive Impairment ◽  
Cognitive Dysfunction ◽  
Cognitive Assessment ◽  
Cognitive Rehabilitation ◽  
Convergent Validity ◽  
Strong Association ◽  
Therapeutic Interventions ◽  
Retest Reliability ◽  
Test Retest Reliability

Abstract Background Cognitive impairment is common in patients with multiple sclerosis (MS). Accurate and repeatable measures of cognition have the potential to be used as markers of disease activity. Methods We developed a 5-minute computerized test to measure cognitive dysfunction in patients with MS. The proposed test – named the Integrated Cognitive Assessment (ICA) – is self-administered and language-independent. 91 MS patients and 83 healthy controls (HC) took part in Substudy 1, in which each participant took the ICA test and the Brief International Cognitive Assessment for MS (BICAMS). We assessed ICA’s test-retest reliability, its correlation with BICAMS, its sensitivity to discriminate patients with MS from the HC group, and its accuracy in detecting cognitive dysfunction. In Substudy 2, we recruited 48 MS patients, 38 of which had received an 8-week physical and cognitive rehabilitation programme and 10 MS patients who did not. We examined the association between the level of serum neurofilament light (NfL) in these patients and their ICA scores and Symbol Digit Modalities Test (SDMT) scores pre- and post-rehabilitation. Results The ICA demonstrated excellent test-retest reliability (r=0.94), with no learning bias, and showed a high level of convergent validity with BICAMS. The ICA was sensitive in discriminating the MS patients from the HC group, and demonstrated high accuracy (AUC = 95%) in discriminating cognitively normal from cognitively impaired participants. Additionally, we found a strong association (r=-0.79) between ICA score and the level of NfL in MS patients before and after rehabilitation. Conclusions The ICA has the potential to be used as a digital marker of cognitive impairment and to monitor response to therapeutic interventions. In comparison to standard cognitive tools for MS, the ICA is shorter in duration, does not show a learning bias, and is independent of language.

The Face-Symbol Test and the Symbol-Digit Test are not reliable surrogates for the Paced Auditory Serial Addition Test in multiple sclerosis

2006 ◽  
Vol 12 (5) ◽  
pp. 599-604 ◽  
Author(s):  
J Williams ◽  
K O’Rourke ◽  
M Hutchinson ◽  
N Tubridy
Keyword(s):  
Multiple Sclerosis ◽  
Cognitive Assessment ◽  
Cognitive Testing ◽  
Alternative Methods ◽  
Functional Composite ◽  
Multiple Sclerosis Functional Composite ◽  
Spearman's Rho ◽  
Spearman’S Rho ◽  
The Face ◽  
Serial Addition

The Paced Auditory Serial Addition Test (PASAT) is the chosen task for cognitive assessment in the multiple sclerosis functional composite (MSFC) and a widely used task in neuropsychological studies of people with multiple sclerosis (MS), but is unpopular with patients. The Face-Symbol Test (FST) and Symbol-Digit Tests (SDT) are alternative methods of cognitive testing in MS, which are easily administered and patient-friendly. In order to evaluate the potential of the FST as a possible surrogate for the PASAT, we directly compared the FST to the PASAT and the SDT in a cohort of 50 MS patients with varying levels of disability. There was significant correlation between SDT and FST scores (Spearman’s rho 0.80, 95% CI 0.66 - 0.88), R2 65%, with moderate inter-test agreement (κ = 0.52). In contrast, SDT and FST scores were less predictive of PASAT scores. We concluded that neither the FST nor SDT are reliable surrogates for the PASAT.

Validation of a Brief Computerized Cognitive Assessment in Multiple Sclerosis (BCCAMS) and comparison with reference batteries

2021 ◽  
pp. 135245852110540
Author(s):  
Nicolas Maubeuge ◽  
Mathilde SA Deloire ◽  
Bruno Brochet ◽  
Julie Charré-Morin ◽  
Aurore Saubusse ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Processing Speed ◽  
Cognitive Assessment ◽  
Visual Memory ◽  
Memory Test ◽  
Cognitive Test ◽  
Visuospatial Memory ◽  
Information Processing Speed ◽  
Neuropsychological Battery ◽  
Learning Test

Background: The Brief Computerized Cognitive Assessment in Multiple Sclerosis (BCCAMS) is a short neuropsychological battery for persons with multiple sclerosis (PwMS). Objectives: The main objective of the study is to validate the BCCAMS. Methods: PwMS and healthy subjects (HS) were evaluated using the BCCAMS which include two computerized tests, the Computerized Speed Cognitive Test and the Computerized Episodic Visual Memory Test (CEVMT), a newly developed visuospatial memory test, and the French learning test. The Minimal Assessment of Cognitive Function in MS (MACFIMS), including the Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS) tests, was also administered. Regression-based norms of the BCCAMS were calculated in 276 HS. BCCAMS was compared with BICAMS and MACFIMS for detection of cognitive impairment (CI). Results: Out of 120 PwMS, CI was detected using the BCCAMS, BICAMS (one impaired test), and MACFIMS (two impaired tests) in 59.1%, 50%, and 37.9%, respectively. The BCCAMS produced the same predictive value as that of the BICAMS battery for detecting CI in the MACFIMS. Conclusion: This study validated the BCCAMS as a validated computerized short assessment for information processing speed and learning in MS.

scholarly journals The Validity of the Single-Leg Heel Raise Test in People With Multiple Sclerosis: A Cross-Sectional Study

2021 ◽  
Vol 12 ◽  
Author(s):  
Mark M. Mañago ◽  
Paul W. Kline ◽  
Michael O. Harris-Love ◽  
Cory L. Christiansen
Keyword(s):  
Multiple Sclerosis ◽  
Convergent Validity ◽  
Cross Sectional Study ◽  
Functional Mobility ◽  
Muscle Performance ◽  
Healthy Control Group ◽  
Control Group ◽  
Cross Sectional ◽  
Strength Assessment ◽  
Healthy Control

Background: The single-leg heel raise test is a common clinical assessment; however, little is known about its validity in people with multiple sclerosis (MS). This study investigated the validity of the single-leg heel raise test in a group of people with MS and a healthy control group (CTL).Materials and Methods: Twenty-one people with MS (49 ± 12 years, Expanded Disability Status Scale 1.5–5.5) and 10 healthy controls (48 ± 12 years) performed the single-leg heel raise test, ankle plantarflexion isometric strength assessment using electromechanical dynamometry, and mobility measures (Timed 25-Foot Walk, 2-Min Walk Test, Functional Stair Test).Results: Convergent validity between the heel raise test and strength was moderate for participants with MS completing &lt;20 heel raises (r = 0.63, p = 0.001) but weak for the entire sample (r = 0.30, p = 0.020). Compared to the average CTL group values, the heel raise test differentiated between groups on the MS groups' weaker (p &lt; 0.001) and stronger (p = 0.003) limbs, while strength only differentiated between groups on the weaker limb (p = 0.010). Considering the weaker and strong limbs from the MS group and the CTL group average values, the mobility measures had moderate-to-strong correlations with the heel raise test on the weaker MS limb + CTL (r = 0.71–0.78) and stronger MS limb + CTL (r = 0.62–0.70), and weak-to-moderate correlations with strength on the weaker MS limb + CTL (r = 0.49–0.58, p = 0.001–0.007).Discussion: In people with MS, the single-leg heel raise test may be clinically useful as it identified impaired muscle performance and differentiated muscle performance from a healthy control group and, together with the control group, correlated with functional mobility.

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