The Cogstate Blog

Expert perspectives on improving cognitive measures from clinical trials to clinical practice.

Reliable and Valid Cognitive Test Results Obtained from MS Patients Performing Self-Administered Computerized Assessment

December 19, 2018

Cognitive dysfunction occurs in more than half of all people with multiple sclerosis (MS) and correlates to brain lesion volumes and atrophy. Given the significant impact that these changes can have on a person’s quality of life, relationships and employment, early and ongoing assessment of cognition is important and represents an unmet need for MS patients.

One question facing researchers is how technology can be leveraged to facilitate early cognitive screening in a way that is efficient, reliable and with low burden to patients. Self-administered computerized neuropsychological assessments offer a solution to reach a large number of patients without requiring them to visit a clinic or testing site where clinicians or staff need to monitor the process.

However, before they can be used widely, these systems need to match or exceed traditionally supervised “paper and pencil” tests in sensitivity to cognitive changes. A recent study, just published in the Multiple Sclerosis Journal, gathered a group of MS patients to determine if an unsupervised, computerized testing scenario would be feasible.

For the current research, a total of 80 MS patients and 28 healthy control volunteers were asked to complete two different computerized batteries, the Cleveland Clinic Cognitive Battery (C3B) and the Cogstate Brief Battery (CBB) in two different scenarios. In the first scenario, the batteries were taken with a test administrator present in the room (TP) to provide initial instructions to the volunteers and to answer questions throughout the session. In the second scenario, the batteries were completed with the test administrator absent from the room (TA). The order of the two scenarios was randomized across the participants.

For the C3B, participants used iPads to complete the Processing Speed Test (PST) and the Visual Memory Test (VMT). The CBB consisted of four parts, the Detection Task and the Identification Task (simple and choice reaction time tasks respectively) as well as the One Back Memory Task, which assesses working memory with a classic n-back format and the One Card Learning Task, which also tests working memory of visual stimuli but across the entire session.

In the TP condition, the administrator walked the participants through the registration and sample test items, answered questions about the process and was then available in the room to help clarify any issues that came up during the test. For the TA condition, the participants were told they would find all of the instructions needed in the application and that the administrator would step out of the room for the session. However, while unannounced to the participants, the administrator was available for assistance if sought out. Ten percent of the MS patients did seek out the administrator for help when completing the TA condition.

Findings supported the researchers’ belief that computerized neuropsychological tests could be completed successfully without an administrator leading the session. However, they note that further research should employ a fully independent mode of testing, perhaps remotely from home, where no administrator is available at all.

Both the C3B and CBB were also significantly sensitive to cognitive changes when compared with a traditional MS assessment test, the Symbol Digit Modalities Test (SDMT).

“This study demonstrates the feasibility of using self-administered computerized batteries to measure cognitive function among multiple sclerosis patients, with both the CBB and C3B providing valid and reliable data irrespective of the presence of a test supervisor,” said Dr. Adrian Schembri, Science Director at Cogstate. “These findings suggest that study teams can utilize these tools to measure cognitive domains such as processing speed, attention and memory among relapsing remitting and secondary progressive MS in flexible study designs that incorporate routine clinic visits and unsupervised testing.”