29 May 2018
Revolutionising the detection of cognitive impairment in multiple sclerosis with technology
Cognitive dysfunction is a leading cause of disability in multiple sclerosis (MS), yet practical restraints mean it often goes unassessed in routine clinical care. Promising new research, published in Frontiers in Neurology, suggests the Cambridge Neuropsychological Test Automated Battery (CANTAB) may offer a brief and sensitive technological solution.
This study is the first to investigate the use of CANTAB in the routine clinical evaluation of MS patients. It is anticipated that these highly sensitive and quick-to-administer iPad-based tests will enable clinicians to overcome many of the barriers traditionally associated with cognitive testing in routine clinical practice. These barriers include the time and labour intensive nature of cognitive testing as a result of specialist personnel being required to administer pen-and-paper tests and interpret the results.
“Cognitive difficulties are common in MS yet they remain under-recognised in routine clinical care, due to the practical restraints traditionally associated with paper-and-pencil-based cognitive testing. We explored whether it was possible to detect cognitive impairment in patients with MS using a brief, computerised cognitive test battery delivered as part of their wider routine clinical check-ups” says Dr Jack Cotter, Clinical Science Team Lead and lead author of the study from Cambridge Cognition.
The study involved 90 MS patients attending routine appointments at the Anne Rowling Regenerative Neurology Clinic in Edinburgh. During the appointments, patients completed three computerised CANTAB tasks which were automatically administered by the software using in-built instructions. The tasks were as follows: (i) Match to Sample to assess the cognitive domains of processing speed and attention, (ii) Paired Associates Learning for visuospatial episodic memory, and (iii) Spatial Working Memory to assess working memory and executive function. The whole cognitive assessment battery only took 15 minutes to complete.
Following testing, participant scores were instantly processed and compared to a large normative dataset to provide clinicians with a clear indication of each patient’s performance - relative to age, sex and education-matched peers. Of this sample, 44% exhibited cognitive impairment in at least one cognitive domain. Executive function was the most commonly affected aspect of cognition and was compromised in over half of these impaired patients.
“We have shown that using a brief, computerised cognitive test battery, cognitive impairment among patients with MS can be quickly identified and fed back to clinicians with minimal resource requirements or burden on staff time. We believe these tasks help provide a practical approach to cognitive testing in everyday clinical care” says Dr Cotter.
The researchers believe their work highlights the issue of cognitive dysfunction in MS and offers a ground-breaking, technological solution for sensitive and practical clinical assessments.
This blog post is re-published from the Frontiers news blog.