Many people with multiple sclerosis (MS) experience debilitating cognitive problems that make it difficult for them to function at home and in the workplace. Despite this, most MS patients never undergo cognitive testing. When they do, they are often told that they fall into the “normal ranges” of the cognitive tests, despite their own experiences, which tell them that they have significant problems. Part of the problem is that existing cognitive tests are very imperfect in their ability to detect MS-related cognitive problems. Neuropsychological testing relies on people’s ability to sit in a quiet room and perform a single task. This does not reflect “real life” well – indeed, many MS patients find multi-tasking particularly difficult. Additionally, many MS patients find that the number of tests included during a full neuropsychological testing session are overwhelming, fatiguing and frustrating.

Modern neuroscience no longer views intelligence/memory as something that develops on its own. Instead, cognition develops hand-in-hand with movement, illustrated well by considering how babies develop language/higher levels of thought in parallel with the ability to move their bodies. The Automated Test of Embodied Cognition (ATEC) draws on the modern understanding of brain-body interconnectedness to measure cognition in action and thus, produce a more refined and complete picture of someone’s cognitive strengths and weaknesses. Measuring cognition in action is a paradigm shift that is particularly relevant for MS, where patients often experience the most noticeable problems when multitasking. This proposal aims to evaluate the ATEC’s performance within people with MS, including individuals across the full spectrum of disease (pre-clinical, relapsing and progressive MS), and examining how the test performs over time. It addresses the Focus Area “Biology and Measurement of MS Symptoms”.

This research will advance MS patient care in several ways. First, it will establish how the ATEC performs within the MS population, including those with higher levels of physical disability. Once this has been established, the ATEC can then be introduced as a sensitive outcome measure in clinical trials testing treatments intended to improve cognition. Often, these clinical trials fail because the tests chosen to measure cognition are not sensitive enough to detect a change. The ATEC has the potential to transform clinical trials focused on MS cognition, making it far more likely that helpful treatments can be discovered.

In addition to its impact on future research into MS cognition, the ATEC is digitally administered with automated scoring. This means that there is high potential to develop it into an automated testing strategy that could be administered via an app or online. Since one of the main reasons that MS patients are not routinely evaluated for cognitive problems is the national lack of skilled neuropsychologists, the development and validation of this test as a digital alternative would vastly increase the number of patients who have access to neurocognitive testing. Having insight into one’s cognitive strengths and weaknesses often improves quality of life for MS patients, allowing them to emphasize their strengths and develop strategies to compensate for their relative weaknesses.

This Exploration/Hypothesis Development Award will lay the groundwork for the ATEC to transform MS-associated neurocognitive testing. During the two-year period of the award, we will be able to delineate how well the test performs across the clinical spectrum of MS patients and establish the parameters to guide which patients will gain the most from the test. At the conclusion of this two-year award, we anticipate that the ATEC will be sufficiently developed to serve as an outcome measure for cognitively-focused clinical trials. Future work would emphasize scalability of the platform (e.g. app/online development for wide implementation), and the ATEC could be seen as a routine clinical test within ten years.