Validity of a multi-domain computerized cognitive assessment battery for patients with multiple sclerosis

Background: Computerized cognitive batteries may facilitate the integration of neuropsychological assessments into routine clinical care of patients with multiple sclerosis (PwMS).

Objective: To assess the construct and criterion validity of a computerized, multi-domain cognitive assessment battery (CAB, NeuroTrax) in MS.

Methods: 81 PwMS and 15 healthy controls (HC) completed the CAB and a set of traditional neuropsychological tests recommended for MS on the same day. Principal component factor analysis was used to assess construct validity. For criterion validity, the gold standard definition of cognitive impairment was a score of ≥1.5SD below average on at least one cognitive domain, based upon traditional test normative data. Receiver operating characteristic (ROC) analysis was used to examine the ability of the CAB to discriminate cognitively impaired PwMS.

Results: Traditional and computerized tests of memory, processing speed, visuospatial and executive function converged by factor analysis. Computerized tests detected cognitive impairment with 85% sensitivity and 70% specificity. PwMS classified as impaired on only the computerized battery had significantly prolonged response times and a higher rate of unemployment compared with PwMS classified as unimpaired on both batteries. Poor executive function was more likely to be revealed by the CAB.

Conclusion: The specific computerized assessment battery evaluated is valid for cognitive screening of people with MS and may be more likely to detect prolonged response times and impaired executive function.