scholarly journals Assessing Cognitive Function in Multiple Sclerosis With Digital Tools: Observational Study

10.2196/25748 ◽  
2021 ◽  
Vol 23 (12) ◽  
pp. e25748
Author(s):  
Wan-Yu Hsu ◽  
William Rowles ◽  
Joaquin A Anguera ◽  
Annika Anderson ◽  
Jessica W Younger ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Cognitive Assessment ◽  
Preliminary Evidence ◽  
Digital Tools ◽  
Group Level ◽  
Cognitive Measures ◽  
Cognitive Evaluation ◽  
Serial Addition ◽  
Assessment Sensitivity ◽  
Improve Access

Background Cognitive impairment (CI) is one of the most prevalent symptoms of multiple sclerosis (MS). However, it is difficult to include cognitive assessment as part of MS standard care since the comprehensive neuropsychological examinations are usually time-consuming and extensive. Objective To improve access to CI assessment, we evaluated the feasibility and potential assessment sensitivity of a tablet-based cognitive battery in patients with MS. Methods In total, 53 participants with MS (24 [45%] with CI and 29 [55%] without CI) and 24 non-MS participants were assessed with a tablet-based cognitive battery (Adaptive Cognitive Evaluation [ACE]) and standard cognitive measures, including the Symbol Digit Modalities Test (SDMT) and the Paced Auditory Serial Addition Test (PASAT). Associations between performance in ACE and the SDMT/PASAT were explored, with group comparisons to evaluate whether ACE modules can capture group-level differences. Results Correlations between performance in ACE and the SDMT (R=–0.57, P<.001), as well as PASAT (R=–0.39, P=.01), were observed. Compared to non-MS and non-CI MS groups, the CI MS group showed a slower reaction time (CI MS vs non-MS: P<.001; CI MS vs non-CI MS: P=.004) and a higher attention cost (CI MS vs non-MS: P=.02; CI MS vs non-CI MS: P<.001). Conclusions These results provide preliminary evidence that ACE, a tablet-based cognitive assessment battery, provides modules that could potentially serve as a digital cognitive assessment for people with MS. Trial Registration ClinicalTrials.gov NCT03569618; https://clinicaltrials.gov/ct2/show/NCT03569618

scholarly journals Assessing Cognitive Function in Multiple Sclerosis With Digital Tools: Observational Study (Preprint)

2020 ◽  
Author(s):  
Wan-Yu Hsu ◽  
William Rowles ◽  
Joaquin A Anguera ◽  
Annika Anderson ◽  
Jessica W Younger ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Cognitive Assessment ◽  
Preliminary Evidence ◽  
Digital Tools ◽  
Group Level ◽  
Cognitive Measures ◽  
Cognitive Evaluation ◽  
Serial Addition ◽  
Assessment Sensitivity ◽  
Improve Access

BACKGROUND Cognitive impairment (CI) is one of the most prevalent symptoms of multiple sclerosis (MS). However, it is difficult to include cognitive assessment as part of MS standard care since the comprehensive neuropsychological examinations are usually time-consuming and extensive. OBJECTIVE To improve access to CI assessment, we evaluated the feasibility and potential assessment sensitivity of a tablet-based cognitive battery in patients with MS. METHODS In total, 53 participants with MS (24 [45%] with CI and 29 [55%] without CI) and 24 non-MS participants were assessed with a tablet-based cognitive battery (Adaptive Cognitive Evaluation [ACE]) and standard cognitive measures, including the Symbol Digit Modalities Test (SDMT) and the Paced Auditory Serial Addition Test (PASAT). Associations between performance in ACE and the SDMT/PASAT were explored, with group comparisons to evaluate whether ACE modules can capture group-level differences. RESULTS Correlations between performance in ACE and the SDMT (R=–0.57, <i>P</i><.001), as well as PASAT (R=–0.39, <i>P</i>=.01), were observed. Compared to non-MS and non-CI MS groups, the CI MS group showed a slower reaction time (CI MS vs non-MS: <i>P</i><.001; CI MS vs non-CI MS: <i>P</i>=.004) and a higher attention cost (CI MS vs non-MS: <i>P</i>=.02; CI MS vs non-CI MS: <i>P</i><.001). CONCLUSIONS These results provide preliminary evidence that ACE, a tablet-based cognitive assessment battery, provides modules that could potentially serve as a digital cognitive assessment for people with MS. CLINICALTRIAL ClinicalTrials.gov NCT03569618; https://clinicaltrials.gov/ct2/show/NCT03569618

scholarly journals Does cognitive dysfunction correlate with neurofilament light polypeptide levels in the CSF of patients with multiple sclerosis?

2019 ◽  
Vol 47 (5) ◽  
pp. 2187-2198 ◽  
Author(s):  
Thaleia Kalatha ◽  
Marianthi Arnaoutoglou ◽  
Theodoros Koukoulidis ◽  
Eleni Hatzifilippou ◽  
Emmanouil Bouras ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Cognitive Dysfunction ◽  
Verbal Learning ◽  
Preliminary Evidence ◽  
Enzyme Linked Immunosorbent Assay ◽  
Neurofilament Light ◽  
Potential Biomarker ◽  
Z Scores ◽  
Learning Test ◽  
Serial Addition

Objective To investigate whether neurofilament light polypeptide (NfL) level in cerebrospinal fluid (CSF), currently a prognostic biomarker of neurodegeneration in patients with multiple sclerosis (MS), may be a potential biomarker of cognitive dysfunction in MS. Methods This observational case–control study included patients with MS. CSF levels of NfL were determined using enzyme-linked immunosorbent assay. Cognitive function was measured with the Brief International Cognitive Assessment for MS (BICAMS) battery and Paced Auditory Serial Addition Test (PASAT3), standardized to the Greek population. Results Of 39 patients enrolled (aged 42.7 ± 13.6 years), 36% were classified as cognitively impaired according to BICAMS z-scores (–0.34 ± 1.13). Relapsing MS was significantly better than progressive forms regarding BICAMS z-score (mean difference [MD] 1.39; 95% confidence interval [CI] 0.54, 2.24), Symbol Digit Modality Test score (MD 1.73; 95% CI 0.46, 3.0) and Greek Verbal Learning Test (MD 1.77; 95% CI 0.82, 2.72). An inversely proportional association between CSF NfL levels and BICAMS z-scores was found in progressive forms of MS (rp = –0.944). Conclusions This study provides preliminary evidence for an association between CSF NfL levels and cognition in progressive forms of MS, which requires validation in larger samples.

scholarly journals Validity and Reliability of Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS) in Indonesia and the Correlation with Quality of Life

2019 ◽  
Vol 2019 ◽  
pp. 1-7
Author(s):  
Riwanti Estiasari ◽  
Yuhyi Fajrina ◽  
Diatri Nari Lastri ◽  
Syarli Melani ◽  
Kartika Maharani ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Multiple Sclerosis ◽  
Cognitive Impairment ◽  
Cognitive Function ◽  
Cognitive Assessment ◽  
Verbal Learning ◽  
Retest Reliability ◽  
Cognitive Evaluation ◽  
Test Retest Reliability

Introduction. Multiple Sclerosis (MS) can affect cognitive function that might interfere with quality of life. Processing speed and memory are the most common area of cognitive impairment. Cognitive evaluation in daily practice is often difficult to be performed since it needs neuropsychological expert and is time-consuming. Brief International Cognitive Assessment for MS (BICAMS) is valid and practical for cognitive evaluation. This study aims to validate BICAMS in Indonesian MS patients and healthy controls (HC) and to analyse the effect of cognitive impairment on quality of life. Methods. BICAMS, which composes Symbol Digits Modalities Test (SDMT), California Verbal Learning Test-Second Edition (CVLT-II), and Brief Visuospatial Memory Test-Revised (BVMT-R), was translated and cross-culturally adapted to Indonesian from the original BICAMS and then administered to 40 Indonesian MS patients and 66 HC matched by sex, age, and education. Test-retest reliability was performed on 16-MS patients and 42 HC. Quality of life was measured using Multiple Sclerosis Quality of Life (MSQOL-54) instrument. Results. The SDMT, CVLT-II, and BVMT-R score in MS patients were significantly lower than those in HC (effect size, r: 0.61, 0.36, and 0.47, respectively). Test-retest reliability for all tests was satisfactory with correlation coefficient for SDMT, CVLT-II, and BVMT-R in MS subjects 0.86, 0.81, and 0.83, respectively. Using 5th percentile of HC score as cut-off, 15% MS subjects had impairment in one test, 27.5% in two tests, and 40% in three tests. BICAMS was moderately correlated with EDSS but was not correlated with disease duration and relapse rate. SDMT score correlated with physical function and physical and mental role limitation. Conclusion. BICAMS is valid and reliable for assessing cognitive function of Indonesia MS patients.

Cognitive Impairment in Multiple Sclerosis - Recent Advances and Future Prospects

2010 ◽  
Vol 5 (1) ◽  
pp. 69 ◽  
Author(s):  
Dawn Langdon ◽  
Keyword(s):  
Multiple Sclerosis ◽  
Cognitive Impairment ◽  
Memory Function ◽  
Unmet Need ◽  
Cognitive Test ◽  
Long Term Memory ◽  
Cognitive Measures ◽  
Magnetic Resonance Imaging Mri ◽  
Serial Addition

Multiple sclerosis (MS) is characterised not only by physical disability but also by gradual cognitive impairment. A large proportion of patients exhibit signs of cognitive deficit that negatively affect their quality of life. Reduced processing speed is often seen with the disease and several tests have been developed to measure its severity, including the Paced Auditory Serial Addition Test (PASAT) and the Symbol Digit Modality Test (SDMT). Long-term memory function is also commonly impaired in MS and studies suggest problems in primary registration of information. Also affected are executive functions used in novel planning and problem-solving. To evaluate cognitive function, cognitive test batteries with varying effectiveness have been introduced. The correlation of cognitive performance with magnetic resonance imaging (MRI) results remains inconsistent as multiple pathologies lead to the observed impairments. Therefore, combinations of MRI data are most successful at predicting deficiencies. The efficacy of current MS treatments in terms of cognition is unclear, making their clinical evaluation a great unmet need; the same is true of universal, validated cognitive measures that can be easily administered to MS patients around the world.

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

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.

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

Validation of the Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS) in the Russian Population

2021 ◽  
pp. 1-8
Author(s):  
Evgeniy Evdoshenko ◽  
Kristina Laskova ◽  
Maria Shumilina ◽  
Ekaterina Nekrashevich ◽  
Maria Andreeva ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Cognitive Assessment ◽  
Verbal Learning ◽  
Cognitive Status ◽  
Russian Population ◽  
Cognitive Domain ◽  
Control Group ◽  
Retest Reliability ◽  
Valid Instrument ◽  
Test Retest Reliability

Abstract Objective: Cognitive dysfunction is common in multiple sclerosis (MS). The Brief International Cognitive Assessment for MS (BICAMS) battery of tests has been suggested as a measure for the evaluation of the cognitive status of MS patients. This study aims to validate the BICAMS battery in the Russian population of MS patients. Methods: Age- and sex-matched MS patients (n = 98) and healthy individuals (n = 86) were included in the study. Symbol Digit Modalities Test (SDMT), California Verbal Learning Test, 2nd edition (CVLT-II) and the Brief Visuospatial Memory Test – Revised (BVMT-R) were administered to all participants. The battery was readministered 1 month later to 44 MS patients to investigate the test–retest reliability. Results: MS patients exhibited a significantly lower performance in testing with BICAMS than the control group in all three neuropsychological tests. Test–retest reliability was good for SDMT and CVLT-II (r = .82 and r = .85, respectively) and adequate for BVMT-R (r = .70). Based on the proposed criterion for impairment as z score below 1.5 SD the mean of the control group, we found that 34/98 (35%) of MS patients were found impaired at least in one cognitive domain. Patients with Expanded Disability Status Scale score ≥3.5 performed significantly worse than controls (SDMT, p < .0001; CVLT–II, p = .03; BVMT-R, p = .0004), while those with ≤3.0 scores did not. Conclusion: This study demonstrates that the BICAMS battery is a valid instrument to identify cognitive impairment in MS patients and it can be recommended for routine use in the Russian Federation.

Visual deficits and cognitive assessment of multiple sclerosis: confounder, correlate, or both?

2021 ◽  
Author(s):  
Dejan Jakimovski ◽  
Ralph H. B. Benedict ◽  
Bianca Weinstock-Guttman ◽  
Osman Ozel ◽  
Tom A. Fuchs ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Cognitive Assessment ◽  
Visual Deficits
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