The language and memory test: A brief multidomain digital cognitive measure for multiple sclerosis

Abstract

Background:

Accurate cognitive measures are needed for multiple sclerosis (MS). We developed the Language and Memory Test (LMT), a brief digital measure of domains vulnerable to MS: rapid naming, visuospatial memory, fine motor dexterity. The LMT is designed to test a hypothesis of lexical access as a primary driver of cognitive decline in MS.

Methods:

In this proof-of-concept study, adults with MS and controls were enrolled in three countries. Participants completed the LMT once or twice. A subset completed the Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS), subjective cognitive measures, and a tolerability questionnaire. We conducted preliminary evaluation of internal consistency, test–retest reliability, discriminative, construct, and convergent validity, and tolerability.

Results:

265 adults with MS and 115 HCs participated. The MS group performed worse than HC on all LMT subtests controlling for motor function, age, sex, and education (p-values: .03 - < .001). Retest reliability and internal consistency were broadly acceptable. Tolerability was high. LMT subtests were associated with disability and disease duration. The lexical access hypothesis was supported by three levels of evidence.

Conclusions:

The LMT is a digital cognitive tool for MS with good initial discriminative and construct validity permitting remote measurement of multiple domains in diverse populations.

Keywords

Cognition language memory outcome measurement digital tools multidomain

Get full access to this article

View all access options for this article.

References

Benedict

RHB

Amato

DeLuca

, et al. Cognitive impairment in multiple sclerosis: Clinical management, MRI, and therapeutic avenues. Lancet Neurol 2020; 19(10): 860–871.

Rao

Leo

Bernardin

, et al. Cognitive dysfunction in multiple sclerosis. I. Frequency, patterns, and prediction. Neurology 1991; 41(5):685-691, http://www.ncbi.nlm.nih.gov/pubmed/2027484 (accessed 19 July 2016).

Benedict

Cookfair

Gavett

, et al. Validity of the minimal assessment of cognitive function in multiple sclerosis (MACFIMS). J Int Neuropsychol Soc 2006; 12(4): 549–558. http://www.ncbi.nlm.nih.gov/pubmed/16981607

Boringa

Lazeron

Reuling

, et al. The brief repeatable battery of neuropsychological tests: Normative values allow application in multiple sclerosis clinical practice. Mult Scler 2001; 7(4): 263–267, http://www.ncbi.nlm.nih.gov/pubmed/11548987 (accessed 11 September 2016).

Benedict

Fischer

Archibald

, et al. Minimal neuropsychological assessment of MS patients: A consensus approach. Clin Neuropsychol 2002; 16(3): 381–397.

Langdon

Amato

Boringa

, et al. Recommendations for a brief international cognitive assessment for multiple sclerosis (BICAMS). Mult Scler 2012; 18(6): 891–898.

Brandstadter

Fabian

Leavitt

, et al. Word-finding difficulty is a prevalent disease-related deficit in early multiple sclerosis. Mult Scler 2020; 26(13): 1752–1764.

Henry

Beatty

. Verbal fluency deficits in multiple sclerosis. Neuropsychologia 2006; 44(7): 1166–1174.

Hansen

Madsen

Baaré

, et al. Verbal fluency performance is associated with white matter microstructure in a left hemisphere network in children. Neuroimage 2009; 47: S88.

10.

Levelt

WJM

. Spoken word production: A theory of lexical access. Proc Natl Acad Sci U S A 2001; 98(23): 13464–13471.

11.

Indefrey

Levelt

. The neural correlates of language production, Max Planck Institute. In: Gazzaniga

(ed.) The New Cognitive Neurosciences. 2nd ed. Cambridge: MIT Press, 2000, pp. 845–865, https://www.mpi.nl/publications/item148271/neural-correlates-language-production (accessed 21 April 2025).

12.

Tomasi

Volkow

. Network connectivity predicts language processing in healthy adults. Hum Brain Mapp 2020; 41(13): 3696–3708.

13.

Ratzan

Simani

Dworkin

, et al. Characterizing the extended language network in individuals with multiple sclerosis. medRxiv. Published Online 1 January, 2023: 2023083023294843DOI: 10.1101/2023.08.30.23294843.

14.

Duong

Whitehead

Hanratty

, et al. The nature of lexico-semantic processing deficits in mild cognitive impairment. Neuropsychologia 2006; 44(10): 1928–1935.

15.

Leavitt

Simani

Koch

, et al. The language and memory test: International feasibility study of an unsupervised digital test of cognition for neurologic populations. medRxiv. Published Online 29 January, 2025. DOI: 10.1101/2025.01.28.25321275.

16.

Learmonth

Motl

Sandroff

, et al. Validation of patient determined disease steps (PDDS) scale scores in persons with multiple sclerosis. BMC Neurol 2013; 13(1): 37.

17.

Kever

Heuer

Simani

, et al. Development and initial validation of the Cognitive Change Scale (CCS). Mult Scler 2024; 30(14): 1815–1824.

18.

Zigmond

Snaith

. The hospital anxiety and depression scale. Acta Psychiatr Scand 1983; 67(6): 361–370, http://www.ncbi.nlm.nih.gov/pubmed/6880820 (accessed 26 February 2018).

19.

Simani

Molaeipour

Kian

, et al. Correlation between cognitive changes and neuroradiological changes over time in multiple sclerosis: A systematic review and meta-analysis. J Neurol 2024; 271(8): 5498–5518.

20.

Wereszczyński

Niedźwieńska

. Deficits in spontaneous and stimulus-dependent retrieval as an early sign of abnormal aging. Scientific Reports 2022; 12(1): 1–11.

21.

Gulde

Vojta

Hermsdörfer

, et al. State and trait of finger tapping performance in multiple sclerosis. Scientific Reports 2021; 11(1): 1–8.

22.

Todd

Han

Harrison

, et al. The neural correlates of visual working memory encoding: A time-resolved fMRI study. Neuropsychologia 2011; 49(6): 1527–1536.

23.

Merlo

Foong

, et al. Long-term acceptability of MSReactor digital cognitive monitoring among people living with multiple sclerosis. Mult Scler 2025; 31(5): 595–606.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.02 MB

0.07 MB