Dr. Stephen Rao from the Cleveland Clinic (Ohio, USA) presented a new tablet-based screening method for cognitive dysfunction at the Consortium of Multiple Sclerosis Centers (CMSC) annual meeting in Nashville, Tennessee (May 30–June 2, 2018).
Cognitive dysfunction occurs in more than 50% of multiple sclerosis (MS) patients and can have a profound impact on the patients’ professional and private lives, explained Dr. Rao. While there are several paper-and-pencil neuropsychological tests that can detect cognitive dysfunction, these take up to 10 minutes per patient and require staff involvement. Many MS clinics are simply too busy to routinely administer these tests, Dr. Rao explained. The iPad-based Multiple Sclerosis Performance Test (MSPT), developed with Biogen, aims to save doctors some valuable time whilst also improving patient care through facilitating routine screening.
In essence, the MSPT app suite consists of a series of tests that assess not only cognitive function but also motor functions and visual acuity. A simple “peg-into-holes” test assesses manual dexterity, and a video-recorded walking speed test assesses lower extremity function. Visual acuity is measured through a contrast sensitivity test, and cognitive function is assessed through a processing speed test (PST) based on the Symbol Digit Modalities Test (SDMT), which is a well-established paper-and-pencil test validated for use in MS patients.
The iPad-based PST for cognitive function seems promising in terms of test-retest reliability, and correlated well with the paper-and-pencil SDMT in a validation study of 165 MS patients and 217 healthy controls. What’s more, the PST seemed to be slightly better at discriminating between MS patients and healthy controls compared to the SDMT, and also correlated better with cerebral T2 lesion load than the SDMT. A larger study encompassing the MSPT app suite will gather longitudinal data on 11,000 patients from 10 MS clinics in the US and in Europe, and the data will be correlated with other clinical and socio-economic parameters.
Dr. Rao explained that these iPad-based tests can be administered as patients arrive at the clinic, before their medical consultation, allowing the doctor and the patient time to review the results together during the consultation. A longitudinal profile of the patient’s cognitive status and other metrics can then be built upon repeated testing, which can be used to help guide patient management and treatment decisions.
For further reading on this topic, including an interview with Dr. Rao, see Clinical Neurology News.