Dini Michelangelo, Gamberini Giulia, Tacchini Marta, Boschetti Angela, Gradassi Alessandro, Chiveri Luca, Rodegher Mariaemma, Comi Giancarlo, Leocani Letizia
Vita-Salute San Raffaele University, Milan, Italy.
Experimental Neurophysiology Unit, Institute of Experimental Neurology (INSPE), IRCCS-Scientific Institute San Raffaele, Milan, Italy.
Eur J Neurol. 2025 Jan;32(1):e16454. doi: 10.1111/ene.16454. Epub 2024 Sep 4.
Computerized cognitive tests may extend the reach of cognitive screening and monitoring to those with mobility issues or living in remote areas. Moreover, it could enable frequent and autonomous remote cognitive assessments in people with multiple sclerosis (pwMS) on account of its reduced economic and organizational costs. This may further improve our understanding of longitudinal trends and significantly improve the standard of care for pwMS living in remote areas or with mobility limitations. We aimed to evaluate the psychometric properties of an electronic Symbol-Digit Modalities Test (eSDMT) designed to allow pwMS to perform a rapid cognitive assessment independently from home using their own PC/laptop.
Sixty-two participants underwent a neuropsychological evaluation, and then performed the eSDMT in the clinic. Forty-two participants also repeated the eSDMT at home. We assessed concurrent validity (eSDMT vs. oral SDMT), test-retest reliability (in the clinic vs. at home), discriminant validity (pwMS with/without cognitive impairment), and other psychometric characteristics of the eSDMT (effect of age, sex, and education on test scores).
We observed good-to-excellent concurrent validity (r ≥ 0.84, all p < 0.0001) and test-retest reliability (intraclass correlation coefficients [ICCs]>0.87, all p < 0.0001). Discriminant validity was excellent (area under the curves [AUCs] >0.84, all p < 0.0001). eSDMT scores were only slightly influenced by demographic characteristics (all R < 0.200).
We provided evidence which supports the use of our eSDMT as a feasible, valid, and reliable remote assessment of cognitive function in pwMS. Future studies will investigate long-term reliability and predictive power.
计算机化认知测试可能会将认知筛查和监测的范围扩大到行动不便或居住在偏远地区的人群。此外，由于其经济和组织成本降低，它可以对多发性硬化症患者（pwMS）进行频繁且自主的远程认知评估。这可能会进一步增进我们对纵向趋势的理解，并显著提高对居住在偏远地区或行动受限的pwMS的护理标准。我们旨在评估一种电子符号数字模式测试（eSDMT）的心理测量特性，该测试旨在让pwMS能够使用自己的个人电脑/笔记本电脑在家中独立进行快速认知评估。
62名参与者接受了神经心理学评估，然后在诊所进行了eSDMT测试。42名参与者还在家中重复进行了eSDMT测试。我们评估了同时效度（eSDMT与口头SDMT）、重测信度（在诊所与在家中）、区分效度（有/无认知障碍的pwMS）以及eSDMT的其他心理测量特征（年龄、性别和教育程度对测试分数的影响）。
我们观察到良好至优秀的同时效度（r≥0.84，所有p<0.0001）和重测信度（组内相关系数[ICC]>0.87，所有p<0.0001）。区分效度极佳（曲线下面积[AUCs]>0.84，所有p<0.0001）。eSDMT分数仅受到人口统计学特征的轻微影响（所有R<0.200）。
我们提供的证据支持将我们的eSDMT用作对pwMS认知功能进行可行、有效且可靠的远程评估。未来的研究将调查长期信度和预测能力。
