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

Hsu, Wan-Yu; Rowles, William; Anguera, Joaquin A.; Zhao, Chao; Anderson, Annika; Alexander, Amber; Sacco, Simone; Henry, Roland G.; Gazzaley, Adam; Bove, Riley

doi:10.2196/27440

Cited by 6 publications

(10 citation statements)

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“…All participants with MS were recruited as part of studies to determine the feasibility [ 20 ] and preliminary efficacy [ 34 ] of a digital cognitive treatment, as previously described [ 34 ]. As part of a published study in which another tablet-based assessment (ie, EVO Monitor) was investigated [ 35 ], this study contains data that have not been analyzed or published in a larger trial (clinicaltrials.gov NCT03569618). The analysis of this study was based on baseline performance data (ie, before any cognitive intervention) of our feasibility [ 20 ] and efficacy [ 34 ] trials, where participants underwent cognitive testing, including ACE and the SDMT.…”

Section: Methodsmentioning

confidence: 99%

“…The analysis of this study was based on baseline performance data (ie, before any cognitive intervention) of our feasibility [ 20 ] and efficacy [ 34 ] trials, where participants underwent cognitive testing, including ACE and the SDMT. The 2-hour baseline session began with standard measures (SDMT, the Paced Auditory Serial Addition Test [PASAT], the California Verbal Learning Test Second Edition, and the Brief Visuospatial Memory Test Revised), followed by digital cognitive assessment with ACE (BRT, Boxed, SAAT, Spatial Span) and EVO Monitor (data presented in [ 35 ]). Standard measures were administered by a study coordinator.…”

Section: Methodsmentioning

confidence: 99%

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Assessing Cognitive Function in Multiple Sclerosis With Digital Tools: Observational Study

Hsu¹,

Rowles²,

Anguera³

et al. 2021

J Med Internet Res

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Background Cognitive impairment (CI) is one of the most prevalent symptoms of multiple sclerosis (MS). However, it is difficult to include cognitive assessment as part of MS standard care since the comprehensive neuropsychological examinations are usually time-consuming and extensive. Objective To improve access to CI assessment, we evaluated the feasibility and potential assessment sensitivity of a tablet-based cognitive battery in patients with MS. Methods In total, 53 participants with MS (24 [45%] with CI and 29 [55%] without CI) and 24 non-MS participants were assessed with a tablet-based cognitive battery (Adaptive Cognitive Evaluation [ACE]) and standard cognitive measures, including the Symbol Digit Modalities Test (SDMT) and the Paced Auditory Serial Addition Test (PASAT). Associations between performance in ACE and the SDMT/PASAT were explored, with group comparisons to evaluate whether ACE modules can capture group-level differences. Results Correlations between performance in ACE and the SDMT (R=–0.57, P<.001), as well as PASAT (R=–0.39, P=.01), were observed. Compared to non-MS and non-CI MS groups, the CI MS group showed a slower reaction time (CI MS vs non-MS: P<.001; CI MS vs non-CI MS: P=.004) and a higher attention cost (CI MS vs non-MS: P=.02; CI MS vs non-CI MS: P<.001). Conclusions These results provide preliminary evidence that ACE, a tablet-based cognitive assessment battery, provides modules that could potentially serve as a digital cognitive assessment for people with MS. Trial Registration ClinicalTrials.gov NCT03569618; https://clinicaltrials.gov/ct2/show/NCT03569618

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Assessing Cognitive Function in Multiple Sclerosis With Digital Tools: Observational Study

Hsu¹,

Rowles²,

Anguera³

et al. 2021

J Med Internet Res

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“…Of the 18 articles included, 12 sought to compare apps with a neurologist exam, disability scale, or recognized standardized tests [11][12][13][15][16][17][18][19][20][21][22][23]. The feasibility of implementing an app designed for remote monitoring of persons with MS was evaluated in 3 studies [24][25][26], 2 articles compared quality of life questionnaires with app-based functional tests and clinician-reported outcomes [25,27], and 2 apps assessed the local weather's impact on persons with MS-reported fatigue and app functional test results [25,28].…”

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

“…These measures of physical disability were done by tap tests [16], shape drawing tests [11,13], pinching tests [12], assessment of passively acquired keyboard metrics [18,20], or using a level test wherein one must balance their phone in order to keep a ball in a designated screen area [17]. Visual symptoms were measured in 2 apps using tests of steering around obstacles [15] or a mobile vision test [11]. Cognitive function was measured in 6 apps: 3 apps used an electronic version of the Symbol Digit Modalities Test (SDMT) [11][12][13]18,19]; 1 used a go-no go test coupled with multitasking and visuomotor steering [15]; 1 used a battery of attention, working memory, and goal management evaluations [22]; and 1 measured keystroke dynamics including keystroke latency, emoji use, and word length [20,21].…”

Section: Convergence With the Neurological Exammentioning

confidence: 99%

“…Visual symptoms were measured in 2 apps using tests of steering around obstacles [15] or a mobile vision test [11]. Cognitive function was measured in 6 apps: 3 apps used an electronic version of the Symbol Digit Modalities Test (SDMT) [11][12][13]18,19]; 1 used a go-no go test coupled with multitasking and visuomotor steering [15]; 1 used a battery of attention, working memory, and goal management evaluations [22]; and 1 measured keystroke dynamics including keystroke latency, emoji use, and word length [20,21]. Ambulation was measured in 3 apps using an app-based timed 25-foot walk test (T25FW) [11,13], 2-minute walk test (2MWT) [23], U-turn test [12], or maximum distance walked test [11,13].…”

Section: Convergence With the Neurological Exammentioning

confidence: 99%

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Remote Testing Apps for Multiple Sclerosis Patients: Scoping Review of Published Articles and Systematic Search and Review of Public Smartphone Apps

Michaud¹,

Penny²,

Cull³

et al. 2023

JMIR Neurotech

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Background Many apps have been designed to remotely assess clinical status and monitor symptom evolution in persons with multiple sclerosis (MS). These may one day serve as an adjunct for in-person assessment of persons with MS, providing valuable insight into the disease course that is not well captured by cross-sectional snapshots obtained from clinic visits. Objective This study sought to review the current literature surrounding apps used for remote monitoring of persons with MS. Methods A scoping review of published articles was conducted to identify and evaluate the literature published regarding the use of apps for monitoring of persons with MS. PubMed/Medline, EMBASE, CINAHL, and Cochrane databases were searched from inception to January 2022. Cohort studies, feasibility studies, and randomized controlled trials were included in this review. All pediatric studies, single case studies, poster presentations, opinion pieces, and commentaries were excluded. Studies were assessed for risk of bias using the Scottish Intercollegiate Guidelines Network, when applicable. Key findings were grouped in categories (convergence to neurological exam, feasibility of implementation, impact of weather, and practice effect), and trends are presented. In a parallel systematic search, the Canadian Apple App Store and Google Play Store were searched to identify relevant apps that are available but have yet to be formally studied and published in peer-reviewed publications. Results We included 18 articles and 18 apps. Although many MS-related apps exist, only 10 apps had published literature supporting their use. Convergence between app-based testing and the neurological exam was examined in 12 articles. Most app-based tests focused on physical disability and cognition, although other domains such as ambulation, balance, visual acuity, and fatigue were also evaluated. Overall, correlations between the app versions of standardized tests and their traditional counterparts were moderate to strong. Some novel app-based tests had a stronger correlation with clinician-derived outcomes than traditional testing. App-based testing correlated well with the Multiple Sclerosis Functional Composite but less so with the Expanded Disability Status Scale; the latter correlated to a greater extent with patient quality of life questionnaire scores. Conclusions Although limited by a small number of included studies and study heterogeneity, the findings of this study suggest that app-based testing demonstrates adequate convergence to traditional in-person assessment and may be used as an adjunct to and perhaps in lieu of specific neurological exam metrics documented at clinic visits, particularly if the latter is not readily accessible for persons with MS.

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The Making and Evaluation of Digital Games Used for the Assessment of Attention: Systematic Review

Wiley¹,

Robinson²,

Mandryk³

2021

JMIR Serious Games

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Background Serious games are now widely used in many contexts, including psychological research and clinical use. One area of growing interest is that of cognitive assessment, which seeks to measure different cognitive functions such as memory, attention, and perception. Measuring these functions at both the population and individual levels can inform research and indicate health issues. Attention is an important function to assess, as an accurate measure of attention can help diagnose many common disorders, such as attention-deficit/hyperactivity disorder and dementia. However, using games to assess attention poses unique problems, as games inherently manipulate attention through elements such as sound effects, graphics, and rewards, and research on adding game elements to assessments (ie, gamification) has shown mixed results. The process for developing cognitive tasks is robust, with high psychometric standards that must be met before these tasks are used for assessment. Although games offer more diverse approaches for assessment, there is no standard for how they should be developed or evaluated. Objective To better understand the field and provide guidance to interdisciplinary researchers, we aim to answer the question: How are digital games used for the cognitive assessment of attention made and measured? Methods We searched several databases for papers that described a digital game used to assess attention that could be deployed remotely without specialized hardware. We used Rayyan, a systematic review software, to screen the records before conducting a systematic review. Results The initial database search returned 49,365 papers. Our screening process resulted in a total of 74 papers that used a digital game to measure cognitive functions related to attention. Across the studies in our review, we found three approaches to making assessment games: gamifying cognitive tasks, creating custom games based on theories of cognition, and exploring potential assessment properties of commercial games. With regard to measuring the assessment properties of these games (eg, how accurately they assess attention), we found three approaches: comparison to a traditional cognitive task, comparison to a clinical diagnosis, and comparison to knowledge of cognition; however, most studies in our review did not evaluate the game’s properties (eg, if participants enjoyed the game). Conclusions Our review provides an overview of how games used for the assessment of attention are developed and evaluated. We further identified three barriers to advancing the field: reliance on assumptions, lack of evaluation, and lack of integration and standardization. We then recommend the best practices to address these barriers. Our review can act as a resource to help guide the field toward more standardized approaches and rigorous evaluation required for the widespread adoption of assessment games.

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

Cited by 6 publications

References 0 publications

Assessing Cognitive Function in Multiple Sclerosis With Digital Tools: Observational Study

Assessing Cognitive Function in Multiple Sclerosis With Digital Tools: Observational Study

Remote Testing Apps for Multiple Sclerosis Patients: Scoping Review of Published Articles and Systematic Search and Review of Public Smartphone Apps

The Making and Evaluation of Digital Games Used for the Assessment of Attention: Systematic Review

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