Buyukturkoglu Korhan, Dworkin Jordan D, Leiva Victor, Provenzano Frank A, Guevara Pamela, De Jager Philip L, Leavitt Victoria M, Riley Claire S
Department of Neurology, Columbia University Irving Medical Center, 630 W. 168th Street, PH 18-324, New York, NY 10032, USA; The Center for Translational and Computational Neuroimmunology, NY, USA; Columbia University MS Center, NY, USA.
Department of Psychiatry, Columbia University and the New York State Psychiatric Institute, NY, USA.
Mult Scler Relat Disord. 2022 Dec;68:104247. doi: 10.1016/j.msard.2022.104247. Epub 2022 Oct 17.
Prior studies in multiple sclerosis (MS) support reliability of telehealth-delivered cognitive batteries, although, to date, none have reported relationships of cognitive test performance to neural correlates across administration modalities. In this study we aimed to compare brain-behavior relationships, using the Symbol Digit Modalities Test (SDMT), the most reliable and sensitive cognitive measure in MS, measured from patients seen via telehealth versus in-person.
SDMT was administered to individuals with MS either in-person (N=60, mean age=39.7) or remotely via video conference (N=51, mean age=47.4). Magnetic resonance imaging (MRI) data was collected in 3-Tesla scanners. Using 3-dimensional T1 images cerebral, cortical, deep gray, cerebral white matter and thalamic nuclei volumes were calculated. Using a meta-analysis approach with an interaction term for participant group, individual regression models were run for each MRI measure having SDMT scores as the outcome variable in each model. In addition, the correlation and average difference between In-person and Remote group associations across the MRI measures were calculated. Finally, for each MRI variable I score was quantified to test the heterogeneity between the groups.
Administration modality did not affect the association of SDMT performance with MRI measures. Brain tissue volumes showing high associations with the SDMT scores in one group also showed high associations in the other (r = 0.83; 95% CI = [0.07, 0.86]). The average difference between the In-person and the Remote group associations was not significant (β - β = 0.14, 95% CI = [-0.04, 0.34]). Across MRI measures, the average I value was 14%, reflecting very little heterogeneity in the relationship of SDMT performance to brain volume.
We found consistent relationships to neural correlates across in-person and remote SDMT administration modalities. Hence, our study extended the findings of the previous studies demonstrating the feasibility of remote administration of the SDMT.
先前针对多发性硬化症（MS）的研究支持远程医疗提供的认知测试组合的可靠性，不过，迄今为止，尚无研究报告认知测试表现与不同管理方式下神经相关性之间的关系。在本研究中，我们旨在使用符号数字模态测试（SDMT）（MS中最可靠、最敏感的认知测量方法），比较通过远程医疗与亲自就诊的患者的脑-行为关系。
对MS患者进行SDMT测试，其中60人亲自测试（平均年龄=39.7岁），51人通过视频会议远程测试（平均年龄=47.4岁）。在3特斯拉扫描仪中收集磁共振成像（MRI）数据。利用三维T1图像计算大脑、皮质、深部灰质、脑白质和丘脑核体积。采用带有参与者组交互项的荟萃分析方法，针对每个MRI测量指标运行个体回归模型，每个模型中以SDMT分数作为结果变量。此外，计算亲自测试组和远程测试组在MRI测量指标上的关联之间的相关性和平均差异。最后，对每个MRI变量的I值进行量化，以检验两组之间的异质性。
管理方式不影响SDMT表现与MRI测量指标之间的关联。在一组中与SDMT分数高度相关的脑组织体积在另一组中也显示出高度相关（r = 0.83；95%置信区间=[0.07, 0.86]）。亲自测试组和远程测试组关联之间的平均差异不显著（β - β = 0.14，95%置信区间=[-0.04, 0.34]）。在MRI测量指标中，平均I值为14%，这表明SDMT表现与脑体积之间的关系异质性很小。
我们发现在亲自测试和远程SDMT管理方式下，与神经相关性的关系是一致的。因此，我们的研究扩展了先前研究的结果，证明了远程进行SDMT测试的可行性。
