The University of Southampton
University of Southampton Institutional Repository
Warning ePrints Soton is experiencing an issue with some file downloads not being available. We are working hard to fix this. Please bear with us.

A rapid electronic cognitive assessment measure for multiple sclerosis: validation of CoRe (COgnitive Reaction), an electronic version of the Symbol Digit Modalities Test

A rapid electronic cognitive assessment measure for multiple sclerosis: validation of CoRe (COgnitive Reaction), an electronic version of the Symbol Digit Modalities Test
A rapid electronic cognitive assessment measure for multiple sclerosis: validation of CoRe (COgnitive Reaction), an electronic version of the Symbol Digit Modalities Test
Background: incorporating cognitive testing into routine clinical practice is a challenge in multiple sclerosis (MS), given the wide spectrum of both cognitive and physical impairments people can have and the time that testing requires. Shortened paper and verbal assessments predominate but still are not used routinely. Computer-based tests are becoming more widespread; however, changes in how a paper test is implemented can impact what exactly is being assessed in an individual. The Symbol Digit Modalities Test (SDMT) is one validated test that forms part of the cognitive batteries used in MS and has some computer-based versions. We developed a tablet-based SDMT variant that has the potential to be ultimately deployed to patients' own devices.

Objective: this paper aims to develop, validate, and deploy a computer-based SDMT variant, the Cognition Reaction (CoRe) test, that can reliably replicate the characteristics of the paper-based SDMT.

Methods: we carried out analysis using Pearson and intraclass correlations, as well as a Bland-Altman comparison, to examine consistency between the SDMT and CoRe tests and for test-retest reliability. The SDMT and CoRe tests were evaluated for sensitivity to disability levels and age. A novel metric in CoRe was found: question answering velocity could be calculated. This was evaluated in relation to disability levels and age for people with MS and compared with a group of healthy control volunteers.

Results: SDMT and CoRe test scores were highly correlated and consistent with 1-month retest values. Lower scores were seen in patients with higher age and some effect was seen with increasing disability. There was no learning effect evident. Question answering velocity demonstrated a small increase in speed over the 90-second duration of the test in people with MS and healthy controls.

Conclusions: this study validates a computer-based alternative to the SDMT that can be used in clinics and beyond. It enables accurate recording of elements of cognition relevant in MS but offers additional metrics that may offer further value to clinicians and people with MS.
Cognition, EHealth, Electronic assessment, Multiple sclerosis, Neurology, Patient reported outcomes
1438-8871
Middleton, Rod
a04e5280-c2e4-4a11-84cb-1bb213deaf63
Pearson, Owen R
2b0b11cf-0040-458a-8d29-8d407da0c3d1
Ingram, Gillian
f36d5448-b367-446b-a1c6-2e7b780a92b0
Craig, Elaine M
57b88a53-82b3-415a-bff4-2ea16ce0a640
Rodgers, William J
f6939094-9f9c-492b-b3cb-8e002551aecc
Downing-Wood, Hannah
284c788d-fe60-45ee-b3cc-3580c99d7052
Hill, Joseph
9c901600-6c43-4923-84cd-6283edab34c3
Tuite-Dalton, Katherine
e742f796-7a91-4368-a312-dadbdb0f803e
Roberts, Christopher
8c99665d-a3aa-4ccb-90d8-8fb2feeb10cb
Watson, Lynne
53bea2e4-617f-4b8d-a1da-95d8b1f3ec0d
Ford, David V
ccfc0bc6-fcf3-433d-9341-35ba7c165735
Nicholas, Richard
64d008d8-016a-4fde-a9b7-0aae90c686bf
Galea, Ian
66209a2f-f7e6-4d63-afe4-e9299f156f0b
Middleton, Rod
a04e5280-c2e4-4a11-84cb-1bb213deaf63
Pearson, Owen R
2b0b11cf-0040-458a-8d29-8d407da0c3d1
Ingram, Gillian
f36d5448-b367-446b-a1c6-2e7b780a92b0
Craig, Elaine M
57b88a53-82b3-415a-bff4-2ea16ce0a640
Rodgers, William J
f6939094-9f9c-492b-b3cb-8e002551aecc
Downing-Wood, Hannah
284c788d-fe60-45ee-b3cc-3580c99d7052
Hill, Joseph
9c901600-6c43-4923-84cd-6283edab34c3
Tuite-Dalton, Katherine
e742f796-7a91-4368-a312-dadbdb0f803e
Roberts, Christopher
8c99665d-a3aa-4ccb-90d8-8fb2feeb10cb
Watson, Lynne
53bea2e4-617f-4b8d-a1da-95d8b1f3ec0d
Ford, David V
ccfc0bc6-fcf3-433d-9341-35ba7c165735
Nicholas, Richard
64d008d8-016a-4fde-a9b7-0aae90c686bf
Galea, Ian
66209a2f-f7e6-4d63-afe4-e9299f156f0b

Middleton, Rod, Pearson, Owen R, Ingram, Gillian, Craig, Elaine M, Rodgers, William J, Downing-Wood, Hannah, Hill, Joseph, Tuite-Dalton, Katherine, Roberts, Christopher, Watson, Lynne, Ford, David V, Nicholas, Richard and Galea, Ian (2020) A rapid electronic cognitive assessment measure for multiple sclerosis: validation of CoRe (COgnitive Reaction), an electronic version of the Symbol Digit Modalities Test. Journal of Medical Internet Research, 22 (9), [e18234]. (doi:10.2196/18234).

Record type: Article

Abstract

Background: incorporating cognitive testing into routine clinical practice is a challenge in multiple sclerosis (MS), given the wide spectrum of both cognitive and physical impairments people can have and the time that testing requires. Shortened paper and verbal assessments predominate but still are not used routinely. Computer-based tests are becoming more widespread; however, changes in how a paper test is implemented can impact what exactly is being assessed in an individual. The Symbol Digit Modalities Test (SDMT) is one validated test that forms part of the cognitive batteries used in MS and has some computer-based versions. We developed a tablet-based SDMT variant that has the potential to be ultimately deployed to patients' own devices.

Objective: this paper aims to develop, validate, and deploy a computer-based SDMT variant, the Cognition Reaction (CoRe) test, that can reliably replicate the characteristics of the paper-based SDMT.

Methods: we carried out analysis using Pearson and intraclass correlations, as well as a Bland-Altman comparison, to examine consistency between the SDMT and CoRe tests and for test-retest reliability. The SDMT and CoRe tests were evaluated for sensitivity to disability levels and age. A novel metric in CoRe was found: question answering velocity could be calculated. This was evaluated in relation to disability levels and age for people with MS and compared with a group of healthy control volunteers.

Results: SDMT and CoRe test scores were highly correlated and consistent with 1-month retest values. Lower scores were seen in patients with higher age and some effect was seen with increasing disability. There was no learning effect evident. Question answering velocity demonstrated a small increase in speed over the 90-second duration of the test in people with MS and healthy controls.

Conclusions: this study validates a computer-based alternative to the SDMT that can be used in clinics and beyond. It enables accurate recording of elements of cognition relevant in MS but offers additional metrics that may offer further value to clinicians and people with MS.

Text
Rapid Electronic Cognitive Assessment - Accepted Manuscript
Available under License Creative Commons Attribution.
Download (824kB)

More information

Accepted/In Press date: 2 August 2020
Published date: 23 September 2020
Additional Information: ©Rod M Middleton, Owen R Pearson, Gillian Ingram, Elaine M Craig, William J Rodgers, Hannah Downing-Wood, Joseph Hill, Katherine Tuite-Dalton, Christopher Roberts, Lynne Watson, David V Ford, Richard Nicholas, UK MS Register Research Group. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 23.09.2020.
Keywords: Cognition, EHealth, Electronic assessment, Multiple sclerosis, Neurology, Patient reported outcomes

Identifiers

Local EPrints ID: 445287
URI: http://eprints.soton.ac.uk/id/eprint/445287
ISSN: 1438-8871
PURE UUID: f7cf5117-7308-445d-bb13-59aa862ee0a4
ORCID for Ian Galea: ORCID iD orcid.org/0000-0002-1268-5102

Catalogue record

Date deposited: 01 Dec 2020 17:31
Last modified: 26 Nov 2021 02:47

Export record

Altmetrics

Contributors

Author: Rod Middleton
Author: Owen R Pearson
Author: Gillian Ingram
Author: Elaine M Craig
Author: William J Rodgers
Author: Hannah Downing-Wood
Author: Joseph Hill
Author: Katherine Tuite-Dalton
Author: Christopher Roberts
Author: Lynne Watson
Author: David V Ford
Author: Richard Nicholas
Author: Ian Galea ORCID iD

Download statistics

Downloads from ePrints over the past year. Other digital versions may also be available to download e.g. from the publisher's website.

View more statistics

Atom RSS 1.0 RSS 2.0

Contact ePrints Soton: eprints@soton.ac.uk

ePrints Soton supports OAI 2.0 with a base URL of http://eprints.soton.ac.uk/cgi/oai2

This repository has been built using EPrints software, developed at the University of Southampton, but available to everyone to use.

We use cookies to ensure that we give you the best experience on our website. If you continue without changing your settings, we will assume that you are happy to receive cookies on the University of Southampton website.

×