Abstract
BackgroundCognitive deficits affect up to 70% of all patients with Multiple Sclerosis (MS) and have a significant impact on quality of life. Cognitive assessments need to be performed by a neuropsychologist and are often time-consuming, hampering timely identification and adequate monitoring of cognitive decline in MS. ObjectiveTo develop a time-efficient, unsupervised, digital tool to screen for cognitive deficits in MS. MethodsA digital (adjusted) version of the Brief International Cognitive Assessment for MS, including the Symbol Digit Modalities Test (SDMT, information processing speed), the California Verbal Learning Test (CVLT-II, verbal memory) and the Spatial Recall Test (SPART, visuospatial memory) was developed: Multiple Screener (intellectual property of Sanofi Genzyme).Firstly, the clarity and feasibility of the tool was confirmed by 16 patients with MS (mean age 50.9 years (SD 9.4, range 37–68). Next, in 60 healthy controls (HCs, mean age 44.5 years (SD 14.0, range 18–67), intraclass correlation coefficients (ICC) were calculated to describe how strongly the digital version resembled the paper and pencil-based assessment. Finally, 236 HCs (mean age 42.8 years (SD 12.8, range 18–69) were included to obtain norm scores for each test. ResultsICCs between digital and paper and pencil-based assessment were excellent to good (SDMT (ICC 0.79, confidence interval (CI) 0.67–0.87); CVLT-II (ICC 0.77, CI 0.64–0.85); SPART (ICC 0.61, CI 0.42–0.75)). For each test, a regression-based correction for the effect of age was applied on the raw scores before converting them to norm Z-scores. Additionally, the SDMT scores needed correction for education and the CVLT-II for education and sex (subgroups were created). ConclusionsPerformance on an adjusted, digital version of the BICAMS correlates highly with the standard paper-and-pencil based test scores in HCs. Multiple Screener is an unsupervised, digital tool, with available norm scores, ultimately allowing for easy monitoring of cognitive decline in patients with MS.
Highlights
Cognitive deficits affect up to 70% of all patients with Multiple Sclerosis (MS) and have a significant impact on work participation and quality of life (Rao et al, 1991; Chiaravalloti and DeLuca, 2008; Van der Hiele et al, 2014)
Good (SPART) to excellent (SDMT and CVLT-II) consistency was found between the paper and pencil-based and digital versions of the tests
The clarity and feasibility of the tests were re-evaluated by 6 tool-naïve patients with MS, who confirmed that the digital tool was self-explanatory
Summary
Cognitive deficits affect up to 70% of all patients with MS and have a significant impact on work participation and quality of life (Rao et al, 1991; Chiaravalloti and DeLuca, 2008; Van der Hiele et al, 2014). Still baseline and follow-up measurements of cognitive functioning are often lacking in clinical practice because objective cognitive assessment is time consuming and requires specialized personnel This is definitely the case in the Netherlands, and applies to other countries as was demonstrated in a recent investigation across the UK (Klein et al, 2018). Methods: A digital (adjusted) version of the Brief International Cognitive Assessment for MS, including the Symbol Digit Modalities Test (SDMT, information processing speed), the California Verbal Learning Test (CVLTII, verbal memory) and the Spatial Recall Test (SPART, visuospatial memory) was developed: Multiple Screener (intellectual property of Sanofi Genzyme). Conclusions: Performance on an adjusted, digital version of the BICAMS correlates highly with the standard paper-and-pencil based test scores in HCs. Multiple Screener is an unsupervised, digital tool, with available norm scores, allowing for easy monitoring of cognitive decline in patients with MS
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