应用自适应、数字化、基于游戏的方法对多发性硬化症进行认知评估的观察性研究。
Application of an Adaptive, Digital, Game-Based Approach for Cognitive Assessment in Multiple Sclerosis: Observational Study.
机构信息
Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States.
Neuroscape, University of California, San Francisco, San Francisco, CA, United States.
出版信息
J Med Internet Res. 2021 Jan 20;23(1):e24356. doi: 10.2196/24356.
BACKGROUND
Cognitive impairment is one of the most debilitating manifestations of multiple sclerosis. Currently, the assessment of cognition relies on a time-consuming and extensive neuropsychological examination, which is only available in some centers.
OBJECTIVE
To enable simpler, more accessible cognitive screening, we sought to determine the feasibility and potential assessment sensitivity of an unsupervised, adaptive, video game-based digital therapeutic to assess cognition in multiple sclerosis.
METHODS
A total of 100 people with multiple sclerosis (33 with cognitive impairment and 67 without cognitive impairment) and 24 adults without multiple sclerosis were tested with the tablet game (EVO Monitor) and standard measures, including the Brief International Cognitive Assessment for Multiple Sclerosis (which included the Symbol Digit Modalities Test [SDMT]) and Multiple Sclerosis Functional Composite 4 (which included the Timed 25-Foot Walk test). Patients with multiple sclerosis also underwent neurological evaluations and contributed recent structural magnetic resonance imaging scans. Group differences in EVO Monitor performance and the association between EVO Monitor performance and standard measures were investigated.
RESULTS
Participants with multiple sclerosis and cognitive impairment showed worse performance in EVO Monitor compared with participants without multiple sclerosis (P=.01) and participants with multiple sclerosis without cognitive impairment (all P<.002). Regression analyses indicated that participants with a lower SDMT score showed lower performance in EVO Monitor (r=0.52, P<.001). Further exploratory analyses revealed associations between performance in EVO Monitor and walking speed (r=-0.45, P<.001) as well as brain volumetric data (left thalamic volume: r=0.47, P<.001; right thalamic volume: r=0.39, P=.002; left rostral middle frontal volume: r=0.28, P=.03; right rostral middle frontal volume: r=0.27, P=.03).
CONCLUSIONS
These findings suggest that EVO Monitor, an unsupervised, video game-based digital program integrated with adaptive mechanics, is a clinically valuable approach to measuring cognitive performance in patients with multiple sclerosis.
TRIAL REGISTRATION
ClinicalTrials.gov NCT03569618; https://clinicaltrials.gov/ct2/show/NCT03569618.
背景
认知障碍是多发性硬化症最具致残性的表现之一。目前，认知评估依赖于耗时且广泛的神经心理学检查，而这种检查仅在一些中心提供。
目的
为了实现更简单、更易获取的认知筛查，我们旨在确定一种非监督、自适应、基于视频游戏的数字疗法评估多发性硬化症患者认知功能的可行性和潜在评估敏感性。
方法
共有 100 名多发性硬化症患者（33 名认知障碍患者和 67 名无认知障碍患者）和 24 名无多发性硬化症的成年人接受了平板电脑游戏（EVO Monitor）和标准测试，包括简短国际多发性硬化症认知评估（包括符号数字模态测试[SDMT]）和多发性硬化症功能综合 4 项（包括定时 25 英尺步行测试）。多发性硬化症患者还接受了神经学评估，并提供了最近的结构磁共振成像扫描。研究了 EVO Monitor 表现的组间差异，以及 EVO Monitor 表现与标准测试之间的关联。
结果
与无多发性硬化症的参与者（P=.01）和无认知障碍的多发性硬化症参与者（均 P<.002）相比，认知障碍的多发性硬化症患者在 EVO Monitor 中的表现更差。回归分析表明，SDMT 得分较低的参与者在 EVO Monitor 中的表现较低（r=0.52，P<.001）。进一步的探索性分析显示，EVO Monitor 表现与行走速度（r=-0.45，P<.001）以及脑体积数据（左侧丘脑体积：r=0.47，P<.001；右侧丘脑体积：r=0.39，P=.002；左侧额中回前部体积：r=0.28，P=.03；右侧额中回前部体积：r=0.27，P=.03）之间存在关联。
结论
这些发现表明，EVO Monitor 是一种非监督、基于视频游戏的数字程序，集成了自适应机制，是一种评估多发性硬化症患者认知表现的有价值的临床方法。
试验注册
ClinicalTrials.gov NCT03569618；https://clinicaltrials.gov/ct2/show/NCT03569618。
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