Abstract
Cognitive impairment is prevalent and disabling in multiple sclerosis (MS) and is severely impacting quality of life (QoL). Aside its routine assessment in clinical care, it should more often be implemented as endpoint/outcome measure in clinical trials. However, a fundamental aspect—often neglected in clinical practice and clinical trials—is the assessment of multi-tasking and dual-tasking abilities. In this perspective article, we outline why, given the nature of MS, particularly the assessment of “cognitive–cognitive dual-tasking” is relevant in MS. We delineate how knowledge from basic cognitive science can inform the assessment of this important cognitive impairment in MS. Finally, we outline how the assessment of “cognitive–cognitive dual-tasking” can be implemented in computer-based screening tools (e-health devices) that can be used not only in clinical diagnostics but also in clinical trials.
Highlights
Cognitive impairment is prevalent at all phases and all subtypes of multiple sclerosis (MS)
The usual neurological examination fails to detect emerging cognitive deficits; self-reported cognitive complaints by the patients can be confounded by other subjective symptoms [2], so the assessment of cognitive functions should become a cornerstone in routine clinical care of MS patients and is increasingly considered as an important endpoint in clinical trials [3]
Especially the symbol digit modalities tests (SDMT) has been included in recent clinical trials. This is reasonable because the SDMT has been considered to reflect a reliable and relevant cognitive screening instrument in MS [4, 5]
Summary
Cognitive impairment is prevalent at all phases and all subtypes of multiple sclerosis (MS). Often there is a strong discrepancy in a patient’s statements about difficulties occurring in daily life and the pattern of the neuropsychological profile as revealed by routinely applied neuropsychological test (batteries) in MS This is likely the case because current testings (including the SDMT) fall short of examining relevant cognitive dual- or multi-tasking abilities. This ensures that a dual-tasking assessment using the PRP (and related tasks) is quickly scalable to high case numbers in the context of clinical study situations This clinically very relevant test could be transferred to everyday clinical practice to monitor cognitive function longitudinally. This is in line with our overall strategy toward personalized MS management such that, in addition to advanced immunological, genetic, and MRI profiling of the individual patient, the clinical profiling of MS patients’ inclusive cognition needs to be widely implemented in clinical practice using digital approaches [46]
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