Top

Published in:

01-01-2020 | Multiple Sclerosis | Original Article

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

Authors: Luis Ruano, Mariana Branco, Milton Severo, Andreia Sousa, Juliana Castelo, Isabel Araújo, Joana Pais, João Cerqueira, Maria Pia Amato, Nuno Lunet, Vítor Tedim Cruz

Published in: Neurological Sciences | Issue 1/2020

Abstract

Background

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.

Methods

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.

Results

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.

Conclusion

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

Available only for authorised users

Amato MP, Zipoli V, Portaccio E (2006) Multiple sclerosis-related cognitive changes: a review of cross-sectional and longitudinal studies. J Neurol Sci 245(1–2):41–46. https://doi.org/10.1016/j.jns.2005.08.019 CrossRefPubMed

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 CrossRefPubMed

Kujala P, Portin R, Ruutiainen J (1997) The progress of cognitive decline in multiple sclerosis. A controlled 3-year follow-up. Brain 120(Pt 2):289–297CrossRef

Amato MP, Ponziani G, Siracusa G, Sorbi S (2001) Cognitive dysfunction in early-onset multiple sclerosis: a reappraisal after 10 years. Arch Neurol 58(10):1602–1606CrossRef

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):878–885CrossRef

Bergendal G, Fredrikson S, Almkvist O (2007) Selective decline in information processing in subgroups of multiple sclerosis: an 8-year longitudinal study. Eur Neurol 57(4):193–202. https://doi.org/10.1159/000099158 CrossRefPubMed

Hohol MJ, Guttmann CR, Orav J, Mackin GA, Kikinis R, Khoury SJ, Jolesz FA, Weiner HL (1997) Serial neuropsychological assessment and magnetic resonance imaging analysis in multiple sclerosis. Arch Neurol 54(8):1018–1025CrossRef

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 CrossRefPubMed

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 CrossRefPubMedPubMedCentral

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 CrossRefPubMedPubMedCentral

11.

Pardini M, Uccelli A, Grafman J, Yaldizli O, Mancardi G, Roccatagliata L (2014) Isolated cognitive relapses in multiple sclerosis. J Neurol Neurosurg Psychiatry 85(9):1035–1037. https://doi.org/10.1136/jnnp-2013-307275 CrossRefPubMed

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 CrossRefPubMed

13.

Lapshin H, O'Connor P, Lanctot KL, Feinstein A (2012) Computerized cognitive testing for patients with multiple sclerosis. Mult Scler Relat Disord 1(4):196–201. https://doi.org/10.1016/j.msard.2012.05.001 CrossRefPubMed

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 CrossRefPubMedPubMedCentral

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 CrossRefPubMed

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 CrossRefPubMedPubMedCentral

17.

Kurtzke JF (1983) Rating neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS). Neurology 33(11):1444–1452CrossRef

18.

Freitas S, Simoes MR, Alves L, Santana I (2011) Montreal Cognitive Assessment (MoCA): normative study for the Portuguese population. J Clin Exp Neuropsychol 33(9):989–996. https://doi.org/10.1080/13803395.2011.589374 CrossRefPubMed

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, Braga

20.

Campos RC, Gonçalves B (2011) The Portuguese version of the Beck Depression Inventory-II (BDI-II). Eur J Psychol Assess 27(4):258–264. https://doi.org/10.1027/1015-5759/a000072 CrossRef

21.

Cavaco S, Goncalves A, Pinto C, Almeida E, Gomes F, Moreira I, Fernandes J, Teixeira-Pinto A (2013) Trail Making Test: regression-based norms for the Portuguese population. Arch Clin Neuropsychol 28(2):189–198. https://doi.org/10.1093/arclin/acs115 CrossRefPubMed

22.

Cavaco S, Goncalves A, Pinto C, Almeida E, Gomes F, Moreira I, Fernandes J, Teixeira-Pinto A (2013) Semantic fluency and phonemic fluency: regression-based norms for the Portuguese population. Arch Clin Neuropsychol 28(3):262–271. https://doi.org/10.1093/arclin/act001 CrossRefPubMed

23.

Baeta É (2002) Bateria para avaliação neuropsicológica de adultos com epilepsia. Psicologia 16:79–96CrossRef

24.

Stroop JR (1935) Studies of interference in serial verbal reactions. J Exp Psychol 18(6):643–662. https://doi.org/10.1037/h0054651 CrossRef

25.

Santana I, Duro D, Freitas S, Alves L, Simoes MR (2013) The Clock Drawing Test: Portuguese norms, by age and education, for three different scoring systems. Arch Clin Neuropsychol 28(4):375–387. https://doi.org/10.1093/arclin/act016 CrossRefPubMed

26.

Benedict RHB, Groninger L, Schretlen D, Dobraski M, Shpritz B (1996) Revision of the brief visuospatial memory test: Studies of normal performance, reliability, and, validity. Psychol Assess 8(2):145–153CrossRef

27.

A S (1982) Symbol digit modalities test: manual. Western Psychological Services, Los Angeles

28.

Younes M, Hill J, Quinless J, Kilduff M, Peng B, Cook SD, Cadavid D (2007) Internet-based cognitive testing in multiple sclerosis. Mult Scler 13(8):1011–1019. https://doi.org/10.1177/1352458507077626 CrossRefPubMed

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 CrossRef

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 CrossRefPubMedPubMedCentral

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 CrossRefPubMedPubMedCentral

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 CrossRefPubMedPubMedCentral

33.

Potagas C, Giogkaraki E, Koutsis G, Mandellos D, Tsirempolou E, Sfagos C, Vassilopoulos D (2008) Cognitive impairment in different MS subtypes and clinically isolated syndromes. J Neurol Sci 267(1–2):100–106. https://doi.org/10.1016/j.jns.2007.10.002 CrossRefPubMed

Title: Tracking cognitive impairment in multiple sclerosis using the Brain on Track test: a validation study
Authors: Luis Ruano
Mariana Branco
Milton Severo
Andreia Sousa
Juliana Castelo
Isabel Araújo
Joana Pais
João Cerqueira
Maria Pia Amato
Nuno Lunet
Vítor Tedim Cruz
Publication date: 01-01-2020
Publisher: Springer International Publishing
Keyword: Multiple Sclerosis
Published in: Neurological Sciences / Issue 1/2020
Print ISSN: 1590-1874
Electronic ISSN: 1590-3478
DOI: https://doi.org/10.1007/s10072-019-04088-8

Keynote webinar | Spotlight on medication adherence

Springer Medicine

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

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2020

“Less is better”—always true?

Sensorimotor Perceptive Rehabilitation Integrated (SPRInt) program: exercises with augmented movement feedback associated to botulinum neurotoxin in idiopathic cervical dystonia—an observational study

Association of plasma trimethylamine-N-oxide levels with post-stroke cognitive impairment: a 1-year longitudinal study

On “Lack of association between dopamine transporter loss and non-motor symptoms in patients with Parkinson’s disease: a detailed PEST analysis of 12 striatal subregions”

Atypical neuroimaging findings in patients with acquired hepatocerebral degeneration

Evidence for hyperprolactinemia in migraineurs: a systematic review and meta-analysis