New App makes MS Cognitive Assessment Easier and Faster?
Johns Hopkins Medicine researchers report they have developed and validated a tablet-based app that offers a faster, easier and more accurate way for health care providers who don’t have specialized training to assess the cognitive function of people with multiple sclerosis (MS). Multiple sclerosis is a chronic neurologic illness that affects the central nervous system, resulting in a variety of symptoms including motor issues, fatigue, visual disturbance, memory and concentration concerns, and mood changes.
MS is the most common form of disability in young adults other than traumatic injury. Diagnosis usually occurs between the ages of 20 and 50, and it is estimated that 1 million people in the United States are living with the disease. MS is most common among women — three women are diagnosed for every one man.
In a study comparing the app, called iCAMS, to a standard, paper-based assessment tool, researchers say they found that the app produced highly accurate results while reducing test time from about 23 to 14 minutes. Study results are described in the July 2019 online issue of the International Journal of MS Care.
Meghan Beier, Ph.D., M.A., assistant professor of physical medicine and rehabilitation at the Johns Hopkins University School of Medicine and lead author of the study report, says that “results suggest that 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.”
According to Beier, up to 65% of people with MS experience cognitive problems. People with MS often require more time to perform mental tasks and face difficulty learning and retaining new information. Identifying cognitive issues earlier may help preserve and even improve function with targeted interventions such as cognitive rehabilitation, says Beier. Since cognitive decline can also be a result of aging, cardiovascular disease, depression and other conditions, specialized assessment tests have been developed to identify MS-related cognitive impairments. Certain exercises that improve learning ability, such as spaced learning and self-generated learning, may help MS-related cognitive difficulties. Therefore, it is important to identify these challenges.
Currently used paper testing tools are time consuming, or specially trained psychometrists must administer them. A study based in the United Kingdom involving the assessment and management of cognitive problems among people with MS shows that only 8% of MS specialists are using MS-validated cognition assessment tools.
In a bid to improve that record, Beier and her team adapted an internationally validated cognitive assessment tool for MS patients, called the Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS), to a digital tablet format. BICAMS, composed of three subtests, measures processing speed, or how fast the brain can take in and process environmental information such as recognizing a stoplight and sending a signal to the foot to push the brake; the ability to learn verbal information, such as remembering key aspects of the story a family member told; and the ability to learn visual information, such as creating a mental map of a hotel the person is visiting.
In the tablet-based app, researchers incorporated the BICAMS version of processing and visual learning tests, but for copyright reasons they used a comparable alternative subtest to assess verbal learning ability. iCAMS uses automatic prompts and written instructions to help medical assistants or other staff members guide patients through instructions to complete the assessment.