JMIR Publications

ABSTRACT

Background:

Incorporating cognitive testing into clinical practice is a challenge in MS, given the wide spectrum of both cognitive and physical impairments. Shortened paper and verbal assessments predominate but still are not used routinely. Computer-based tests are becoming more widespread however changes in how a paper test is implemented can impact what exactly is being assessed in an individual. The Symbol Digit Modalities Test (SDMT) is one validated test that already has computer-based versions and forms part of the cognitive batteries used in MS. We developed a computer-based variant of this that has the potential to be deployed on multiple devices outside of the clinic environment.

Objective:

Develop, validate and deploy a computer-based SDMT variant, the Cognition Reaction (CoRe) test that can reliably replicate the characteristics of the paper-based SDMT.

Methods:

The CoRe test was validated as an alternative to the paper SDMT, with test-retest reliability, in a MS population from two NHS sites.

Results:

SDMT and CoRe test scores were correlated and consistent with one-month retest values. Results were normally distributed and demonstrated consistency (Pearson’s correlation coefficient r = 0.947, t = 15.60, df = 28, P < .001). Lower scores were seen in patients with higher age (P < .001) and some effect was seen with increasing disability (P < .002). There was no learning effect evident. A novel metric in CoRe was found; Question Answer Velocity could be calculated. This demonstrated a small increase in speed over the 90s duration of the test in MS and healthy controls.

Conclusions:

This study validates a computer-based SDMT that can be utilised in clinic with little or no technician support. It enables accurate recording of elements of cognition relevant in MS but offers additional metrics which may offer further value. Practical aspects of its implementation will enable its deployment on multiple devices.