Computerized Cognitive Test May Be a Valid Assessment for Patients With MS

PHILADELPHIA—A computerized tool is a valid means of performing cognitive testing for patients with multiple sclerosis (MS), according to research presented at the 66th Annual Meeting of the American Academy of Neurology.

NeuroTrax provides a global cognitive score along with scores for individual cognitive domains. Results of NeuroTrax assessments correlate well with results of the Symbol Digit Modalities Test (SDMT), which provides a single, global score “and does not allow us to appreciate the richness and variability of domains of cognition that can be impaired differentially,” according to Mark Gudesblatt, MD.

Mark Gudesblatt, MD

“Easily utilized objective cognitive screens are needed to evaluate the cognitive impact of MS independent of Expanded Disability Status Scale score or MRI,” said Dr. Gudesblatt, a neurologist at South Shore Neurologic Associates in Patchogue, New York. “Additional studies of cognitive screening tools and correlation to previously utilized clinical trial measures are necessary to facilitate widespread acceptance and incorporation of these tools into routine MS care and patient management.”

Dr. Gudesblatt and his colleagues conducted a retrospective review of data for 113 consecutive patients with MS who were referred for cognitive testing during the course of routine clinical care. The patients were evaluated with the oral version of SDMT and NeuroTrax testing on the same day. The researchers used Centofanti (1975) age norms to standardize the SDMT raw scores. Patients’ ages ranged between approximately 20 and 83, and the population’s mean age was approximately 49. About 85% of participants were female. Patients had an average of about 15 years of education.

The patients’ standardized SDMT scores significantly correlated with NeuroTrax global cognitive scores. Standardized SDMT scores also significantly correlated with NeuroTrax scores on seven individual cognitive domain indices, including executive function, memory, attention, visual spatial processing, information processing speed, motor skill, and verbal function. The three individual cognitive domain scores on NeuroTrax that most strongly correlated with SDMT scores were executive function, memory, and attention.

In addition, SDMT score was correlated with the number of NeuroTrax index scores greater than 1 SD below average for norms of cognitive health, age, and education. The researchers classified SDMT subgroups, according to the SDMT manual, as less than 1 SD below average, less than 1.5 SD below average (low), less than 2 SD below average (moderately low), and 2 or more SD below average (very low). Mean NeuroTrax global cognitive scores for these subgroups were 99.1, 93.0, 83.9, and 76.9, respectively. The researchers observed a similar pattern for all NeuroTrax domain index scores, especially executive function and attention. Neurotrax’s ability to identify individual domains of impairment and categorize the number of domains that were impaired “improves our ability to identify and appreciate the variable impact and burden of neurologic diseases like MS,” said Dr. Gudesblatt.

This retrospective review supports the construct validity of the NeuroTrax cognitive assessment tool, said Dr. Gudesblatt. “Routine use of cognitive screening in the care of patients with MS is not as common as is likely warranted,” he added. “Computerized cognitive testing may provide an easy, independent, objective screening tool that taps into broader sets of cognitive domains.”

—Erik Greb