Cognitive Health Tests Given Online Show ‘Promise’ in Study

Assessing the cognitive health of people with multiple sclerosis (MS) can be performed using online telehealth, with results similar to in-person testing, researchers working with a patient group reported.

The study, “A validation study for remote testing of cognitive function in multiple sclerosis,” was published in the Multiple Sclerosis Journal.

Evaluating cognitive function is important for the management of, and research into, MS. Traditionally, assessments of thinking skills are done in person, and under the supervision of a specialist such as a neuropsychologist. But in-person assessments are not always practical, whether because hundreds or thousands of patients are taking part in a study, or because world events such as the COVID-19 pandemic make in-person hospital visits inadvisable.

Researchers in the U.S. developed a remote, technician-guided and web-based tool to assess cognition in MS patients using California Verbal Learning Test, Second Edition (CVLT-II) and the Symbol Digit Modalities Test (SDMT), two validated measurements of assessing memory and processing speed.

In a previous study, this research team showed that CVLT-II assessments performed by conventional in-person and remotely yielded comparable results.

“Herein, we aimed to replicate these results and extend them to the SDMT,” the scientists wrote.

In total, 100 adults with either relapsing-remitting MS or secondary progressive MS  underwent two assessments using the CVLT-II and SDMT: one online and the other in person. Half of these participants did the online assessment first, while the other half started with the in-person assessment. At least one week separated the two evaluations.

Results showed scores between remote and in-person assessments to be strongly and significantly correlated. That is, a person given a specific score on one of the assessments was likely to earn the same or a similar score on the other assessment. The correlations did not change significantly based on whether participants did remote or in-person testing first.

“Results indicate SDMT and CVLT-II data collected through remote, web-based, technician-guided administration yield similar results to standard, validated in-person measures of the same assessments,” the researchers wrote.

In a separate analysis, 36 MS patients were given two equivalent, alternative forms of online SDMT and CVLT-II tests to determine their reliability. Scores on both forms were highly correlated, suggesting that they can be used interchangeably.

“Reliability was adequate and alternative forms of SDMT and CVLT-II produced similar results,” the researchers wrote.

A preliminary analysis indicated that males and people without a college education tended to have significantly poorer CVLT-II scores, compared to females and those with a college education. Longer disease duration was associated with significantly poorer SDMT scores.

Individuals reporting a recent relapse had significantly lower scores on both the CVLT-II and SDMT.

“Cognitive decline occurs in relapses and can be missed by routine neurological care,” the researchers wrote, adding that “assessing patients in a guided, remote manner ensures reliable assessment of cognition on an as-needed basis and could detect cognitive relapses.”

Although virtual and in-person assessments were feasibly equivalent in this study, more research into virtual testing is needed. The researchers noted that it may be necessary to establish alternate standards for what constitutes a “normal” cognitive test in a virtual setting.

It also “remains to be seen if the work will translate to an insurance-based, routine clinical practice,” they added.

Overall, the results suggest that such web-based evaluations “show promise for appraisal of cognition when circumstances prevent patient attendance in the neurology clinic,” the team concluded.

This study was partly funded by the National MS Society, which noted in a release that “applying this method may help to increase cognitive screening, and alert physicians to problems before clinic visits.”

Other sources of funding were the National Institute of Environmental Health Sciences and the National Institute of Nursing Research, both agencies within the National Institutes of Health.