While multiple sclerosis (MS) is most often diagnosed in adults, symptoms can begin much earlier in life. Pediatric onset MS (POMS) affects 8,000-10,000 children under the age of 18 in the U.S., while an additional estimated 10,000 have at least one symptom. Diagnosis can be difficult as physicians often default to more common childhood disorders for neuromuscular development.
Cognitive impairment, seen in almost half of adult MS patients, is also experienced by approximately one-third of children with MS with significant progression in the first two years after initial symptoms. Early detection of this decline can help parents, teachers and caregivers prepare and plan interventions to maximize cognitive development and maintain academic progress.
Physicians need fast, accurate and accessible assessment tools to provide a baseline followed by scheduled follow-up tests to measure cognitive change over time. Developed by a global committee for adult MS patients, the Brief International Cognitive Assessment for MS (BICAMS) includes three tests, the oral trial condition of the Symbol Digit Modalities Test (SDMT), the learning trials of the California Verbal Learning Test (CVLT-II and the Brief Visual Memory Test.
Along with the traditional pencil and paper format of BICAMS, computerized tests of cognition have gained popularity with researchers for their sensitivity, efficiency and ease of use. In a recent study published in Multiple Sclerosis Journal, researchers compared BICAMS with a set of computerized tests from Cogstate to judge their validity among a POMS cohort.
“Extensive cognitive assessment in POMS requires resources and tools that are unavailable outside of a few specialist centers,” wrote the researchers. “Could a brief cognitive screen identify children and young people at risk of significant cognitive impairment and identify those who require more extensive cognitive assessment and management? The purpose of this study was to test two cognitive assessment approaches in a consecutively recruited outpatient sample of POMS participants.”
A group of children (median age of 16) recently diagnosed with POMS were recruited, through their parents, along with a group of healthy, age-matched children, to participate in a controlled assessment using both the BICAMS and a Cogstate computerized battery. While BICAMS has been used for years among adult MS patients, it had not been validated for use in children. The Cogstate battery, selected for this study consisted of three tests measuring processing speed, continuous visual attention and working memory, and provided access to a large normative database of over 50,000 individuals (ages 10-99) for targeted age comparisons and benchmarks.
Both assessment tools detected cognitive impairment in the POMS group. The BICAMS classified 26% of participants as impaired, and the Cogstate battery classified 27% of participants as impaired. In fact, two of the Cogstate tests, the Detection (processing speed) and the Identification (visual attention) tests were the most sensitive among the two batteries.
“The higher impairment rate found using either of the two Cogstate tasks indicates that these computer-based speeded information processing measures may be most sensitive to the detection of MS-related impairment overall,” wrote the study authors.
By demonstrating the usability and tolerability of BICAMS and the Cogstate battery for children, the researchers suggest that these assessment tools can be confidently used for future POMS research. For globally distributed study participants, Cogstate’s computerized platform holds an advantage over traditional tests.
“Incorporating the information processing measures in Cogstate may contribute to greater sensitivity of a single measure and is an approach that is very feasible both in the clinical setting and for multicenter research,” concluded the researchers. “A strength of the Cogstate measures is the near-absence of practice effects and therefore may be particularly useful for detecting change over time.”
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