Introducing Multiple Screener: An unsupervised digital screening tool for cognitive deficits in MS

L van Dongen; B Westerik; K van der Hiele; L H Visser; M M Schoonheim; L Douw; J W R Twisk; B A de Jong; J J G Geurts; H E Hulst

doi:10.1016/j.msard.2019.101479

Introducing Multiple Screener: An unsupervised digital screening tool for cognitive deficits in MS

Mult Scler Relat Disord. 2020 Feb:38:101479. doi: 10.1016/j.msard.2019.101479. Epub 2019 Oct 30.

Authors

L van Dongen¹, B Westerik¹, K van der Hiele², L H Visser³, M M Schoonheim¹, L Douw¹, J W R Twisk⁴, B A de Jong⁵, J J G Geurts¹, H E Hulst⁶

Affiliations

¹ Department of Anatomy & Neurosciences, Amsterdam Neuroscience, MS Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.
² Department of Psychology, Health, Medical and Neuropsychology Unit, Leiden University, Leiden, the Netherlands.
³ Department of Neurology, Elisabeth-Tweesteden Hospital, Tilburg, the Netherlands; Department of Care Ethics, University of Humanistic Studies, Utrecht, the Netherlands.
⁴ Department of Epidemiology and Biostatistics, Amsterdam Public Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.
⁵ Department of Neurology, Amsterdam Neuroscience, MS Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.
⁶ Department of Anatomy & Neurosciences, Amsterdam Neuroscience, MS Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands. Electronic address: he1.hulst@amsterdamumc.nl.

PMID: 31760365
DOI: 10.1016/j.msard.2019.101479

Abstract

Background: Cognitive 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.

Objective: To develop a time-efficient, unsupervised, digital tool to screen for cognitive deficits in MS.

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 (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.

Results: ICCs 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).

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, ultimately allowing for easy monitoring of cognitive decline in patients with MS.

Keywords: Cognitive impairment; Digital Screening tool; Multiple Sclerosis; Norm scores.

MeSH terms

Adult
Aged
Cognitive Dysfunction / diagnosis*
Cognitive Dysfunction / etiology*
Diagnosis, Computer-Assisted / standards*
Feasibility Studies
Humans
Middle Aged
Multiple Sclerosis / complications*
Neuropsychological Tests / standards*