Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Sep 15, 2020
Date Accepted: Oct 28, 2020
Application of an adaptive, digital game-based approach in cognitive assessment in multiple sclerosis: a pilot study
ABSTRACT
Background:
Cognitive impairment (CI) is one of the most debilitating manifestations of multiple sclerosis (MS).
Objective:
To enable simpler, more accessible screening, we sought to determine feasibility of using in-game metrics derived from an unsupervised, adaptive, videogame-based digital therapeutic previously reported to improve processing speed in MS.
Methods:
100 people with MS (33 with CI and 67 without CI) and 24 non-MS adults were tested with the tablet game (EVO Monitor) and standard measures including Brief International Cognitive Assessment for Multiple Sclerosis [BICAMS, including the Symbol Digit Modalities Test (SDMT)] and MS Functional Composite 4 [MSFC4, which included the Timed 25-Foot Walk test]. MS patients also underwent neurological evaluations and contributed recent structural MRIs. Group differences in EVO Monitor performance and association between EVO Monitor and standard measures were investigated.
Results:
CI MS participants showed worse performance in EVO Monitor compared to non-MS (p=.01) and non-CI MS participants (all p<.002). Regression analyses indicated that participants with a lower SDMT score showed lower performance in EVO Monitor (r=0.52, p<.001). Further exploratory analyses revealed associations between performance in EVO Monitor and walking speed (r=-0.45, p<.001), as well as brain volumetric data (left thalamic volume: r=0.47, p<.001; right thalamic volume: r=0.39, p=.002; left rostral middle frontal volume: r=0.28, p=.03; right rostral middle frontal volume: r=0.27, p=.03).
Conclusions:
These findings suggest that EVO Monitor, an unsupervised, videogame-based digital program integrated with adaptive mechanics, is a clinically valuable approach to measuring cognitive performance in MS. Clinical Trial: Trial Registration: clinicaltrials.gov NCT03569618.
Citation
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