Abstract
As the burden of neurodegenerative diseases increases, time-limited clinic encounters do not allow quantification of complex neurological functions. Patient-collected digital biomarkers may remedy this, if they provide reliable information. However, psychometric properties of digital tools remain largely un-assessed. We developed a smartphone adaptation of the cognitive test, the Symbol-Digit Modalities Test (SDMT) by randomizing the test’s symbol-number codes and testing sequences. The smartphone SDMT showed comparable psychometric properties in 154 multiple sclerosis (MS) patients and 39 healthy volunteers (HV). E.g., smartphone SDMT achieved slightly higher correlations with cognitive subscores of neurological examinations and with brain injury measured by MRI (R2 = 0.75, Rho = 0.83, p < 0.0001) than traditional SDMT. Mathematical adjustment for motoric disability of the dominant hand, measured by another smartphone test, compensates for the disadvantage of touch-based test. Averaging granular home measurements of the digital biomarker also increases accuracy of identifying true neurological decline.
Highlights
With an aging population, the prevalence of chronic neurological diseases is projected to increase dramatically
Symbol-Digit Modalities Test (SDMT), and each subject could choose which version they wanted to differentiate between healthy volunteers (HV) and multiple sclerosis (MS) (Supplementary Fig. 1)
Very few have chosen the oral version of the test, and there is an overlap in the smartphone SDMT results between HV
Summary
The prevalence of chronic neurological diseases is projected to increase dramatically. Most countries already experience a shortage of neurologists. By 2025 in the United States, the average demand for neurologists is expected to eclipse the supply by 20% or more[1]. Current solutions of shifting care for neurological patients to primary care providers, while simultaneously decreasing the length of individual patient-encounters for neurologists, lead to delays or mistakes in diagnoses and suboptimal patient outcomes. A comprehensive neurological examination takes 40–60 min to perform and years to master. Such a demanding exam is rarely performed in contemporary clinical practice, depriving patients of reliable measurements of their disease progression necessary for optimal therapeutic decisions
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