As many as 70% of patients with multiple sclerosis (MS) develop cognitive impairment.1 The appropriate detection of cognitive difficulties can help prompt behavioral and pharmacologic interventions.

Researchers Seek a Faster Way to Test Cognitive Function

Current standard-of-care techniques for measuring cognitive function in MS are paper-based, which can be time consuming.2 In an effort to expedite the process, researchers at Johns Hopkins Medicine developed iCAMS, a digital adaptation of the Brief International Cognitive Assessment for Multiple Sclerosis, or BICAMS.3 BICAMS, which is composed of 3 subtests, assesses processing speed, and the ability to learn visual and verbal information. The tablet app incorporates the processing and visual learning tests in BICAMS, along with a comparable alternative test for verbal learning ability.4

“Our goal is to reduce barriers for patients to receive the testing that may benefit their treatment and health through the use of digital technology,” said Abbey Hughes, PhD, MA, assistant professor of physical medicine and rehabilitation at Johns Hopkins University School of Medicine and co-author of the study.4


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Putting a New Technology to the Test

The investigators enrolled 100 adults aged 18 to 79 years with a confirmed diagnosis of MS. Participants were predominantly women (74%) and had relapsing-remitting MS (78%). Research assistants administered paper and tablet tests to participants, who were exposed to the material once, to evaluate inter-rater reliability, parallel forms reliability, and concurrent validity. Responses were recorded on both administration methods, and each research assistant used a stopwatch to measure time spent to administer and score the tests.3

The BICAMS and iCAMS tests yielded identical results 93% of the time, validating the accuracy of the iCAMS test. The tablet test took approximately 14 minutes to complete, compared with 23 minutes for the paper-based assessment.

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A More Convenient Assessment

The investigators concluded that the tablet app is a reliable and fast method for administering the BICAMS. “Using the iCAMS app may make cognitive assessments of multiple sclerosis more convenient in a clinic setting, and therefore will be used more often to identify learning and memory problems,” said Meghan Beier, PhD, MA, assistant professor of physical medicine and rehabilitation at the Johns Hopkins University School of Medicine and lead author of the study.4

Dr Beier noted that the medical assistants found the experience to be positive. “It was quick and very easy to learn how to administer,” added Katie Rutter, BS, a medical assistant who participated in the study. “Participants enjoyed testing on an iPad and often told me how much fun it was.”

In addition to saving time and simplifying the cognitive assessment process, Dr Beier noted that a tablet-based test eliminates the need to store paper-based records, makes it easier to share information on electronic health records, and may reduce errors in calculating and transferring scores.

References

  1. Grzegorski T, Losy J. Cognitive impairment in multiple sclerosis – a review of current knowledge and recent research. Rev Neurosci. 2017;28(8):845-860.
  2. Khaligh-Razavi SM, Habibi S, Sadeghi M, et al. Integrated cognitive assessment: speed and accuracy of visual processing as a reliable proxy to cognitive performance. Sci Rep. 2019;9(1):1102.
  3. Beier M, Alschuler K, Amtmann D, Hughes A, Madathil R, Ehde D. iCAMS: assessing the reliability of a BICAMS tablet application [published online July 11, 2019]. Int J MS Care. doi:10.7224/1537-2073.2018-108
  4. New app offers faster and easier assessment for multiple sclerosis. Johns Hopkins University. September 9, 2019. Accessed October 4, 2019.