D5.1 - Integration of test battery for cognition and fine motor skills into icompanion app

Cognitive impairment is a significant burden for people with Multiple Sclerosis (pwMS), affecting their employment, mental health, and social activities. It is estimated that up to 70% of the estimated 2.8 million pwMS worldwide experience cognitive impairment. This impacts the patient’s information processing speed, working memory, attention, and visuospatial abilities. Traditional neuropsychological tests to assess this, such as the Symbol Digit Modalities Test (SDMT) and Nine-Hole Peg Test (9HPT), often face challenges like practice effects, improper administration, and the stress of clinical visits. All of these could result in skewed test results. As such, there is a need for reliable, accessible tools for assessing cognitive function and manual dexterity in pwMS. The CLAIMS project has contributed to the development and validation of two smartphone-based tests for integration into the icompanion app: the icompanion Symbol Test and the icompanion Finger Dexterity Test. These digital tests are designed to be used remotely by pwMS, providing them the option for continuous self-monitoring between hospital visits. The icompanion Symbol Test is based on the SDMT and measures information processing speed by counting correct symbol matches within a 90-second interval. The icompanion Finger Dexterity Test mimics the 9HPT and assesses manual dexterity by timing the sequence of steps required to "fry and serve" virtual eggs on a smartphone screen. Both tests were rigorously validated. The icompanion Symbol Test showed strong correlations with the paper-pencil SDMT (r=.63, p<.001) and significant relationships with MS-related biomarkers linked to disease progression such as thalamic volume and juxtacortical lesions. The icompanion Finger Dexterity Test demonstrated significant correlations with the 9HPT and was sensitive to differences between pwMS and healthy controls. A real-world validation study (CogMS) revealed a less strong correlation between subjective (based on patient reported outcomes) and objective (based on the icompanion Symbol Test) cognitive assessments, indicating that self-reports may not always reliably predict cognitive impairment. Objective cognitive performance was more closely linked to physical measures such as walking ability, while subjective cognition correlated with internal experiences like pain, fatigue, and depression. This highlights the importance of objective cognitive monitoring to avoid biases inherent to self-assessments. Patient feedback on the 2 digital tests was overwhelmingly positive, with a strong preference for digital assessments over traditional paper-based methods. Both digital tests received excellent usability scores, supporting their potential for widespread clinical adoption. The Symbol Test and Finger Dexterity Test will be available in the upcoming version 3.0.0 of the icompanion app. These tests offer a practical, reliable means for continuous remote self-monitoring of cognitive and finger dexterity impairments in pwMS. By providing objective assessments that correlate with important neurological biomarkers, these tools have the potential to significantly enhance patient care and disease progression monitoring.