Assessing cognitive impairment in Multiple Sclerosis using Smartphone-Based training Games: Results of a feasibility study
Silvan Pless1, Tim Wölfle1, Yvonne Naegelin1, Johannes Lorscheider2, Andrea Wiencierz3, Óscar Reyes Pupo4, Jose Santos5, Pasquale Calabrese6, Ludwig Kappos2
1Neurology, University Hospital Basel, 2University Hospital Basel, 3Department for Clinical Research, University of Basel, Hospital, 4Healios, 5Healios AG, 6University of Basel
As part of a smartphone-based App for monitoring MS disease activity and progression (dreaMS) we evaluated feasibility and acceptance of cognitive games as an assessment tool of cognitive domains in pwMS and healthy controls (HC).
Cognitive impairment occurs in up to 70% of people with MS (pwMS) with a high impact on quality of life. Comprehensive assessment by established neuropsychological tests is time consuming and frequently not well accepted.
Smartphone-based cognitive games from a commercially available app designed to train defined cognitive domains (short-term & working-memory, mental flexibility & processing speed, language, inhibition, visuo-construction) were included in the dreaMS App. Participants underwent a battery of neuropsychological tests at baseline and were asked to play these games twice a week for 5 weeks. Number of correct answers, speed and difficulty-level reached, were correlated to reference tests (Spearman’s rho) and compared between PwMS and HC (U Test). Acceptance and meaningfulness for MS was assessed via questionnaire and semi-structured interview at week 6.
We included 31 PwMS (mean age of 43.4±12.0 y; 68% female; median Expanded Disability Status Scale score 3.0, range 1.0-6.0) and 31 age- and sex-matched HC. Except for the domain language, all games were significantly correlated with their respective reference tests, (rho= 0.332-0.751). In all games mean performance of pwMS was lower (range: R = 0.08-0.2) and improved in both groups over the 5-week study. Mean acceptance (on a 5-point Likert scale rating over all games) was 4.6 (range: 4.15-4.9), mean perceived meaningfulness 4.69 (range: 4.52-4.84).
Correlations with established tests suggest that such games - primarily not designed for this purpose - allow reliable cognitive domain assessment. High acceptance and perceived meaningfulness is crucial for long-term adherence and motivation. Currently studies of longer duration in larger populations are initiated to further validate such games as monitoring tools for pwMS.