Tracking cognitive impairment in multiple sclerosis using the Brain on Track test: a validation study

  • Luis RuanoEmail author
  • Mariana Branco
  • Milton Severo
  • Andreia Sousa
  • Juliana Castelo
  • Isabel Araújo
  • Joana Pais
  • João Cerqueira
  • Maria Pia Amato
  • Nuno Lunet
  • Vítor Tedim Cruz
Original Article



The accurate and regular monitoring cognitive performance in multiple sclerosis (MS) patients is critical to develop new prevention and management strategies for cognitive impairment (CI). The Brain on Track (BoT) test is a self-administered web-based tool developed for cognitive screening and monitoring. The objective of this study was to validate the use of the BoT in MS, by assessing its ability to distinguish between MS patients and matched controls, as well as detect CI among MS patients, by analysing its correlation with standard cognitive tests and its reliability and learning effects in repeatable use.


The BoT was applied in 30 patients with MS consecutively selected and 30 age- and education-matched controls, first in a hospital clinic, under supervision, and then 1 week later from home. After these first two trials, MS patients repeated the test from home every 4 weeks for 3 months. A standard neuropsychological battery was also applied to MS patients at baseline.


The Cronbach’s alpha was 0.89. Test scores were significantly different between MS patients and controls (Cohen’s d = 0.87; p < 0.01). Among MS patients, scores were significantly lower in those with CI documented in the standard neuropsychological battery than in their cognitively preserved counterparts (Cohen’s d = 2.0; p < 0.001). The BoT scores presented a good correlation with standard neuropsychological tests, particularly for information processing speed. Regarding test–retest reliability, 10/11 subtests presented two-way mixed single intraclass consistency correlation coefficients > 0.70.


The BoT showed good neuropsychological parameters in MS patients, endorsing the use of self-administered computerized tests in this setting.


Multiple sclerosis Cognitive impairment Cognitive assessment Computer-assisted decision-making 



The authors gratefully acknowledge all the patients and volunteers that participated in the study and the help of head nurses Maria dos Anjos e Neusa Sá and of “Liga de amigos do Hospital de São Sebastião” in their recruitment.

Funding information

This work was supported by the Programa Operacional Competitividade e Internacionalização (POCI) (POCI-01-0145-FEDER-016867) and by the Fundação para a Ciência e a Tecnologia, in the context of the Epidemiology Research Unit - Instituto de Saúde Pública da Universidade do Porto (EPIUnit) (POCI-01-0145-FEDER-006862; FCT UID/DTP/04750/2013) and by an unrestricted research grant from Biogen Idec (PRT-MSG-14-10645).

Compliance with ethical standards

All the enrolled patients provided informed consent, and the study was approved by the ethical committees of all recruiting institutions (Hospital de Braga and Centro Hospitalar de Entre Douro e Vouga).

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Conflict of interest

VTC and JP have a shareholder position in Neuroinova, Lda a start-up company that conceived Brain on Track, holds registered trademark and commercialization rights. AS and IA have received fees for patients’ cognitive assessments and study coordination from Neuroinova. The other authors declare that they have no conflict of interests.


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Copyright information

© Fondazione Società Italiana di Neurologia 2019

Authors and Affiliations

  • Luis Ruano
    • 1
    • 2
    • 3
    Email author
  • Mariana Branco
    • 1
    • 2
  • Milton Severo
    • 2
    • 3
  • Andreia Sousa
    • 1
  • Juliana Castelo
    • 1
  • Isabel Araújo
    • 1
  • Joana Pais
    • 3
  • João Cerqueira
    • 4
    • 5
    • 6
  • Maria Pia Amato
    • 7
  • Nuno Lunet
    • 2
    • 3
  • Vítor Tedim Cruz
    • 1
    • 8
    • 9
  1. 1.Neurology DepartmentCentro Hospitalar de Entre Douro e VougaSanta Maria da FeiraPortugal
  2. 2.Departamento de Ciências da Saúde Pública e Forenses e Educação Médica Faculdade de Medicina da Universidade do PortoPortoPortugal
  3. 3.EPIUnit, Institute of Public HealthUniversity of PortoPortoPortugal
  4. 4.2CA BragaBragaPortugal
  5. 5.Life and Health Sciences Research Institute (ICVS), School of Health SciencesUniversity of MinhoBragaPortugal
  6. 6.ICVS/3B’s - PT Government Associate LaboratoryGuimarãesPortugal
  7. 7.Department NEUROFARBA, Section NeurosciencesUniversity of FlorenceFlorenceItaly
  8. 8.IRCCS Fondazione Don Carlo GnocchiFlorenceItaly
  9. 9.Neurology DepartmentHospital Pedro Hispano, Unidade Local de Saúde de MatosinhosSra. da HoraPortugal

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