A Videogame-Based Digital Therapeutic to Improve Processing Speed in People with Multiple Sclerosis: A Feasibility Study

Abstract

Introduction Self-administered in-home digital therapeutics could expand access to cognitive rehabilitation for individuals with multiple sclerosis (MS), over half of whom experience cognitive impairment (CI). However, feasibility in an MS population must be clarified. This study was conducted to assess the feasibility of deploying a videogame-like digital treatment for CI in MS, including initial efficacy and barriers to adherence. Methods In this pilot study, 21 participants with MS completed an in-clinic baseline neurological evaluation. Cognitive tests included paper-and-pencil Brief International Cognitive Assessment for Multiple Sclerosis [BICAMS—which included the Symbol Digit Modalities Test (SDMT)] and other unsupervised tablet-based tests (including Match: an unsupervised test of executive functions and processing speed, developed at UCSF; and the Cogstate MS Battery). Participants then completed an in-home, tablet-based, videogame-like investigational digital treatment (Project: EVO™) for 25 min daily, 5 days weekly, for 4 weeks. This was followed by a repeat in-clinic evaluation. Results Of the 21 participants (mean [standard deviation, SD] age 53.8 [11.6] years, median Expanded Disability Status Scale (EDSS) 2.5 [SD 2.0, IQR [2–3.5]]) enrolled to use the digital therapeutic at home (mean [SD] SDMT z score: − 0.21 [1.16]), 18 completed the study, during which they completed an average of 19.7 days (median [SD]: 20.5 [8.4]). Overall, 78% of these 18 participants completed 75% of prescribed days (i.e., at least 15), and 50% completed all 20 days or more. Over the 4-week period, scores of processing speed improved significantly (based on one-sided t test), including SDMT ( p = 0.003) and Match ( p = 0.006). The Cogstate DET test (psychomotor function) also increased ( p = 0.006). Mean increase in SDMT was 3.6 points. Male sex, not being employed, and higher baseline anxiety all were significantly associated with greater improvement in SDMT over the 4-week period. Interestingly, lower baseline cognitive scores were associated with greater number of sessions completed (e.g., SDMT: p = 0.003, R 2 = 0.44). Adjusting for employment, a proxy for time available, did not significantly improve the model fit. Discussion Deploying an in-home digital tool to improve processing speed in MS is feasible, and shows preliminary efficacy. A larger, randomized controlled clinical trial is ongoing. Electronic supplementary material The online version of this article (10.1007/s40120-018-0121-0) contains supplementary material, which is available to authorized users.

Application of an Adaptive, Digital, Game-Based Approach for Cognitive Assessment in Multiple Sclerosis: Observational Study

“…Previously, we showed that EVO-AKL-T01, a video game–based digital tool similar to EVO Monitor, is an effective in-home cognitive remediation program for MS [ 17 , 18 ]. The high adherence rate during the 4- to 6-week home-based cognitive rehabilitation strategy indicated that remote digital tools are well accepted by patients with MS, who may have limited access to cognitive assessment or treatment.…”

“…A group of 24 adults without MS (non-MS) (mean age: 46.0, SEM 3.72 years) with no chronic autoimmune diseases were also recruited from the UCSF staff, willing family members of patients in the clinic, and other eligible and willing volunteers. All participants with MS were recruited as part of studies to determine the feasibility [ 18 ] and preliminary efficacy [ 17 ] of the EVO platform as a digital therapeutic to improve processing speed in people with MS. The analysis of this study was based on baseline performance data (ie, before any cognitive intervention) of our feasibility [ 18 ] and efficacy [ 17 ] trials.…”

“…All participants with MS were recruited as part of studies to determine the feasibility [ 18 ] and preliminary efficacy [ 17 ] of the EVO platform as a digital therapeutic to improve processing speed in people with MS. The analysis of this study was based on baseline performance data (ie, before any cognitive intervention) of our feasibility [ 18 ] and efficacy [ 17 ] trials. All procedures performed in the study involving human participants were approved by the Committee for Human Research at the University of California, San Francisco.…”

“…This approach can mitigate potential ceiling and floor effects when interindividual variability is high, and leads to more reliable assessments that can be completed in a timely manner [ 8 , 16 ]. Furthermore, digital tools can be easily applied in different settings, including patients’ homes, which substantially improves health care accessibility for patients who have difficulties with travel to the clinic due to cognitive or physical disabilities [ 14 , 17 , 18 ].…”

“…We previously evaluated whether a video game–based digital tool, EVO-AKL-T01 (Akili), could improve cognition in MS [ 17 , 18 ]. After these studies, we looked to better characterize cognitive function using similar tools based on these cognitive therapeutics.…”