Tracking cognitive impairment in multiple sclerosis using the Brain on Track test: a validation study
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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.
KeywordsMultiple 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.
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.
- 2.Ruano L, Portaccio E, Goretti B, Niccolai C, Severo M, Patti F, Cilia S, Gallo P, Grossi P, Ghezzi A, Roscio M, Mattioli F, Stampatori C, Trojano M, Viterbo RG, Amato MP (2017) Age and disability drive cognitive impairment in multiple sclerosis across disease subtypes. Mult Scler 23(9):1258–1267. https://doi.org/10.1177/1352458516674367 CrossRefPubMedGoogle Scholar
- 5.Piras MR, Magnano I, Canu ED, Paulus KS, Satta WM, Soddu A, Conti M, Achene A, Solinas G, Aiello I (2003) Longitudinal study of cognitive dysfunction in multiple sclerosis: neuropsychological, neuroradiological, and neurophysiological findings. J Neurol Neurosurg Psychiatry 74(7):878–885CrossRefGoogle Scholar
- 8.Camp SJ, Stevenson VL, Thompson AJ, Ingle GT, Miller DH, Borras C, Brochet B, Dousset V, Falautano M, Filippi M, Kalkers NF, Montalban X, Polman CH, Langdon DW (2005) A longitudinal study of cognition in primary progressive multiple sclerosis. Brain 128(Pt 12):2891–2898. https://doi.org/10.1093/brain/awh602 CrossRefPubMedGoogle Scholar
- 9.Nygaard GO, Celius EG, de Rodez Benavent SA, Sowa P, Gustavsen MW, Fjell AM, Landro NI, Walhovd KB, Harbo HF (2015) A longitudinal study of disability, cognition and gray matter atrophy in early multiple sclerosis patients according to evidence of disease activity. PLoS One 10(8):e0135974. https://doi.org/10.1371/journal.pone.0135974 CrossRefPubMedPubMedCentralGoogle Scholar
- 10.Loitfelder M, Fazekas F, Koschutnig K, Fuchs S, Petrovic K, Ropele S, Pichler A, Jehna M, Langkammer C, Schmidt R, Neuper C, Enzinger C (2014) Brain activity changes in cognitive networks in relapsing-remitting multiple sclerosis - insights from a longitudinal FMRI study. PLoS One 9(4):e93715. https://doi.org/10.1371/journal.pone.0093715 CrossRefPubMedPubMedCentralGoogle Scholar
- 12.Rocca MA, Amato MP, De Stefano N, Enzinger C, Geurts JJ, Penner IK, Rovira A, Sumowski JF, Valsasina P, Filippi M, Group MS (2015) Clinical and imaging assessment of cognitive dysfunction in multiple sclerosis. Lancet Neurol 14(3):302–317. https://doi.org/10.1016/S1474-4422(14)70250-9 CrossRefPubMedGoogle Scholar
- 14.Ruano L, Sousa A, Severo M, Alves I, Colunas M, Barreto R, Mateus C, Moreira S, Conde E, Bento V, Lunet N, Pais J, Tedim Cruz V (2016) Development of a self-administered web-based test for longitudinal cognitive assessment. Sci Rep 6:19114. https://doi.org/10.1038/srep19114 CrossRefPubMedPubMedCentralGoogle Scholar
- 15.Ruano L, Severo M, Sousa A, Ruano C, Branco M, Barreto R, Moreira S, Araújo N, Pinto P, Pais J, Lunet N, Tedim Cruz V (2019) Tracking cognitive performance in the general population and in patients with mild cognitive impairment with a self-applied computerized test (Brain on Track). J Alzheimers Dis 71:541–548. https://doi.org/10.3233/JAD-190631 CrossRefPubMedGoogle Scholar
- 16.Polman CH, Reingold SC, Banwell B, Clanet M, Cohen JA, Filippi M, Fujihara K, Havrdova E, Hutchinson M, Kappos L, Lublin FD, Montalban X, O'Connor P, Sandberg-Wollheim M, Thompson AJ, Waubant E, Weinshenker B, Wolinsky JS (2011) Diagnostic criteria for multiple sclerosis: 2010 revisions to the McDonald criteria. Ann Neurol 69(2):292–302. https://doi.org/10.1002/ana.22366 CrossRefPubMedPubMedCentralGoogle Scholar
- 19.Gomes L (2011) Validação da versão portuguesa da escala de impacto da fadiga modificada e da escala de severidade da fadiga na esclerose múltipla. Universidade do Minho, BragaGoogle Scholar
- 27.A S (1982) Symbol digit modalities test: manual. Western Psychological Services, Los AngelesGoogle Scholar
- 29.Rao SM, Losinski G, Mourany L, Schindler D, Mamone B, Reece C, Kemeny D, Narayanan S, Miller DM, Bethoux F, Bermel RA, Rudick R, Alberts J (2017) Processing speed test: validation of a self-administered, iPad(R)-based tool for screening cognitive dysfunction in a clinic setting. Mult Scler. https://doi.org/10.1177/1352458516688955 CrossRefGoogle Scholar
- 30.Papathanasiou A, Messinis L, Georgiou VL, Papathanasopoulos P (2014) Cognitive impairment in relapsing remitting and secondary progressive multiple sclerosis patients: efficacy of a computerized cognitive screening battery. ISRN Neurol 2014:151379–151377. https://doi.org/10.1155/2014/151379 CrossRefPubMedPubMedCentralGoogle Scholar
- 31.Achiron A, Chapman J, Magalashvili D, Dolev M, Lavie M, Bercovich E, Polliack M, Doniger GM, Stern Y, Khilkevich O, Menascu S, Hararai G, Gurevich M, Barak Y (2013) Modeling of cognitive impairment by disease duration in multiple sclerosis: a cross-sectional study. PLoS One 8(8):e71058. https://doi.org/10.1371/journal.pone.0071058 CrossRefPubMedPubMedCentralGoogle Scholar
- 32.Edgar C, Jongen PJ, Sanders E, Sindic C, Goffette S, Dupuis M, Jacquerye P, Guillaume D, Reznik R, Wesnes K (2011) Cognitive performance in relapsing remitting multiple sclerosis: a longitudinal study in daily practice using a brief computerized cognitive battery. BMC Neurol 11:68–11. https://doi.org/10.1186/1471-2377-11-68 CrossRefPubMedPubMedCentralGoogle Scholar