Computerised cognitive testing could help predict disease progression in relapsing-remitting multiple sclerosis (RRMS) patients and better inform treatment decisions, according to Australian neurologists.
A study of 460 RRMS patients enrolled in Monash University’s online cognitive performance tracker ‘MSRreactor’ between 2016 and 2019 showed that visual attention and working memory tasks could identify patients who were 3.7 and 2.6 times more likely to experience six-month disability progression, respectively.
Just five tests over a minimum of 180 days helped separate patients who were most to least likely to experience three-year disease progression with 64% to 89% accuracy, the authors wrote in Neurology.
Slower baseline reaction times, age and disability were key predictors of cognitive decline and disability progression, with each 50 ms increase in baseline psychomotor function test reaction time and one unit increase in disability score conferring a 338% and 40% greater chance of worsening disease, they reported.
Notably, baseline therapy did not seem to affect patients’ risk of disease progression, though this “may reflect [the study’s] lack of power to detect an association between therapy and class assignation due to the low proportion of low-efficacy treatments”.
It could also indicate that predicted reaction time trajectories are not easily affected by disease modifying therapy, particularly over a relatively short period of time, the study authors wrote.
Despite this, they suggested that early detection of patients at risk of cognitive decline could help neurologists select or switch disease-slowing therapies, prompt neuropsychological evaluation and improve management of existing symptoms.
Though cognition is rarely measured as a primary outcome in clinical trials due to low sensitivity to change and greater resource requirements for neuropsychological testing, the authors’ computerised modelling did identify patients who were more likely to experience sustained reaction time slowing and higher probability of confirmed disease progression.
While less specific than neuropsychological testing, computerised testing could detect subtle changes, even within conventional tests’ normal ranges and may be easier to implement in clinical practice, with brevity, ease of use, rapid stabilisation of practice-related effects and ability to deploy standardised tasks allowing for regular cognitive monitoring at scale, the authors suggested.
Previous studies have “highlighted the need for ‘validated cognitive monitoring tools that can be practically and seamlessly incorporated into the clinical MS centre setting’, preferably tablet based”, they wrote.
“Computerised tests that serially assess reaction times could fill the routine monitoring gap.”
Further, patients could perform some of these tests at home, and have done with high persistence and adherence.
“The clinical utility of automated self-administered cognitive assessment tools hold great potential for early identification of cognitive changes in MS.”
“Further work is needed to examine the effectiveness of early detection of cognitive changes in improving cognition-associated adverse MS outcomes, such as employment and productivity measures,” they concluded.