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The computer-based Symbol Digit Modalities Test: establishing age-expected performance in healthy controls and evaluation of pediatric MS patients

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Abstract

Decreased information processing speed (IPS) is frequently reported in pediatric multiple sclerosis (MS) patients. The computerized version of the Symbol Digit Modalities Test (c-SDMT) measures IPS over eight consecutive trials per session and additionally captures changes in performance within the session. Here, we establish normative c-SDMT performance and test–retest reliability in healthy children (HC) and explore differences in the overall c-SDMT-performance between HC and MS patients. This cross-sectional study included 478 HC (237 female, 49.5%) divided into five age groups (2 years each), and 27 MS patients (22 female, 81.5%) aged 8–18 years. The average time to complete the c-SDMT increased with age (|r| 0.70, 95% CI −0.74, −0.64). Test–retest reliability was high (ICC = 0.91) in HC. The total time to complete the c-SDMT did not differ between children with MS and sex- and age- matched HC (p = 0.23). However, MS patients were less likely to show faster performance across all the successive eight trials compared to HC (p = 0.0001). Healthy children demonstrate faster IPS with increasing age, as well as during successive trials of the c-SDMT. The inability of pediatric MS patients to maintain the increase in processing speed over successive trials suggests a reduced capacity for procedural learning, possibly resulting from cognitive fatigue.

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Acknowledgements

We would like to thank the Ontario Science Centre and the wonderful children who participated in the study, the volunteers Adam Fath, Bahareh Fouladi, Mariam Bakshi, Christy Cheung, Amanda Yee, Nivetha Sivanathan, Kristen Maunder, Maria Berseneva, Talia Goldberg and Jauana Ponnudurai who helped collect the data and Lauren Sergio from York University for her support.

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Authors and Affiliations

  1. Division of Neurology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Canada

    Sandra Bigi, E. A. Yeh & N. Akbar

  2. Division of Child Neurology, Department of Pediatrics, The University Children’s Hospital, University of Bern, Freiburgstrasse 15, 3010, Bern, Switzerland

    Sandra Bigi

  3. Departments of Internal Medicine and Community Health Sciences, University of Manitoba, Winnipeg, Canada

    R. A. Marrie

  4. Department of Psychology, York University, Toronto, Canada

    C. Till

  5. Department of Psychiatry, University of Toronto, Toronto, Canada

    A. Feinstein

  6. The Children’s Hospital of Philadelphia, Perelman School of Medicine, University of Philadelphia, Philadelphia, PA, USA

    B. L. Banwell

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  1. Sandra Bigi
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  2. R. A. Marrie
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  3. C. Till
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  4. E. A. Yeh
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  5. N. Akbar
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  6. A. Feinstein
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  7. B. L. Banwell
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Corresponding author

Correspondence to Sandra Bigi.

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Funding

This study was funded through a grant for prospective researchers provided by the Swiss National Science Foundation (PBBSP3_144296) as well as support through the Anna Müller Grocholski Foundation, Switzerland.

Conflict of interest

S. Bigi received educational grants provided by the Swiss Multiple Sclerosis Society, the Bangerter-Rhyner Foundation and Biogen-Dompe as well as a fellowship for prospective researchers provided by the Swiss National Science Foundation and a research fellowship provided by the Anna Müller Grocholski Foundation. R. A. Marrie receives research funding from: Canadian Institutes of Health Research, Public Health Agency of Canada, Research Manitoba, Health Sciences Centre Foundation, Multiple Sclerosis Society of Canada, Multiple Sclerosis Scientific Foundation, Rx & D Health Research Foundation, National MS Society, and has conducted clinical trials funded by Sanofi-Aventis. C. Till has no disclosures to report. E. Ann Yeh has no disclosures to report. N. Akbar has received personal fees/speaker honorarium from EMD Serono Canada, outside of the submitted work. A. Feinstein serves as an editorial board member of Multiple Sclerosis and chairs the Medical Advisory Committee of the Multiple Sclerosis Society of Canada. He has received book royalties from Cambridge University Press, Johns Hopkins University Press, Amadeus Press and Tafelberg. Research support comes from the Multiple Sclerosis Society of Canada, the Canadian Institutes of Health Research and Biogen Idec. He has received Speaker’s Honoraria from Merck Serono, Teva Pharmaceutical Industries Ltd., and Novartis. B. Banwell serves as a consultant for Biogen Idec, Novartis, Sanofi, and Teva Neuroscience.

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Bigi, S., Marrie, R.A., Till, C. et al. The computer-based Symbol Digit Modalities Test: establishing age-expected performance in healthy controls and evaluation of pediatric MS patients. Neurol Sci 38, 635–642 (2017). https://doi.org/10.1007/s10072-017-2813-0

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  • DOI: https://doi.org/10.1007/s10072-017-2813-0

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