Benefits of Remote Digital Neurological Assessment for Patients with MS

The smartphone-based Symbol Digit Modalities Test (SDMT) is a reliable tool that can aid in remote assessment of cognitive function in patients with multiple sclerosis (MS), and is comparable or superior to written SDMT, according to study results presented at the 8th Joint American Committee for Treatment and Research in Multiple Sclerosis (ACTRIMS) and European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS) MSVirtual2020 event, held September 11-13, 2020.

While neurological examination has a vital role in the assessment of patients with neurodegenerative disease, comprehensive assessment of neurological disability is frequently not possible due to limited resources. The goal of the current study was to investigate the effectiveness of a remote digital solution in the form of a smartphone-based SDMT. Given the context of the current COVID-19 pandemic, this was especially relevant to patient care.

The study cohort included 39 healthy volunteers and 154 patients with MS, including 15 patients that performed tests at home. The participants underwent full neurological examination during clinic visits, in addition to brain MRI, smartphone-based SDMT, and written SDMT.

The performance of healthy volunteers was significantly different from that of participants with MS (P <.0001). Study results strongly suggested an association between smartphone-based and SDMT results (R², 0.71; P <.0001). Higher criterion validity was reported with smartphone-based SDMT compared with written SDMT, measured by correlation with brain atrophy and T2 lesion load on brain MRI.

Corrected linear regression models strongly predicted the amount of MS-related brain injury measured by volumetric MRI (R², 0.75; P <.0001 vs R², 0.62; P <.0001). Practice effects measured by non-linear regression were evident in 87% of patients. Additionally, the threshold for identifying true test deteriorations was significantly reduced by averaging multiple sequential post-learning results.

“This study expands the validation of multiple neurological tests administered via smartphone and bring us closer to a patient-autonomous neurological examination,” concluded the researchers.

Reference

Pham L, Harris T, Varosanec M, Kosa P, Morgan V, Bielekova B. Smartphone based Symbol Digit Modalities Test reliably measures cognitive function in multiple sclerosis patients. Presented at: 8th Joint American Committee for Treatment and Research in Multiple Sclerosis and European Committee for Treatment and Research in Multiple Sclerosis MSVirtual2020 event; September 11-13, 2020. Abstract P0664