Examining the Association Between Performance on Computerized Tests and Disability Progression in Patients with Relapsing-Remitting Multiple Sclerosis

June 2022

More than half of people with multiple sclerosis (MS) develop cognitive impairment. Early detection of subtle changes in cognition could inform therapy decisions. Currently, there are no convenient and reliable tools to monitor cognition that can be incorporated into routine clinical practice for MS patients. The ability to detect changes in cognition could help to predict disease progression.

The objectives of this study were to develop models to assign patients with relapsing-remitting MS to classification groups using reaction times on repeated computerized tests and to evaluate the association between classification groups and disease progression.

Patients in the study completed an online battery of cognitive screening tests, called MSReactor, consisting of tasks for psychomotor function, attention, and working memory. The tests measure speed of reaction time and accuracy of responses and can be completed in <10 minutes.

The investigators analyzed data from 460 patients who completed ≥3 tasks over ≥6 months at home. The mean time since disease onset was 10.3 years, and 83% were receiving treatment with a high-efficacy therapy. The mean follow-up time was 2.2 years, and the median number of test observations was 5.

Latent class mixed modeling analysis was used to group patients into 3 classes based on the trajectory of performance on the MSReactor tasks. Class 1 of each model had the slowest reaction time and, thus, the worst cognitive performance, at baseline and throughout the study and class 3, the fastest. Patients could be in different classes for different task models, but 14% were in class 1 for all 3 task models.

The performance on tasks at baseline was the strongest predictor of class assignment for all tasks. Other characteristics independently associated with assignment to class 1 were older age and greater disability for the psychomotor function model and younger age for the working memory model. In contrast, only the performance on the task at baseline was associated with assignment for the attention task model.

Investigators evaluated the association between class assignment and disability progression over 6 months as defined by scores on the Expanded Disability Status Scale. Patients were 3.7 times more likely to have progression of disability if they were in class 1 for the attention task, and 2.6 times more likely to have progression of disability if they were in class 1 for the working memory task compared with class 2.

The investigators suggested that these tests could be used to monitor patients in routine clinical care to inform therapy choices. They also suggested that longitudinal computerized testing would also be useful as outcomes measures for cognition in clinical trials of therapies for MS.

“The brevity, ease of use, rapid stabilization of practice-related effects, and ability to deploy standardized tasks could allow regular cognitive monitoring to be implemented at scale,” the investigators proposed.


Merlo D, Stankovich J, Bai C, et al. Association between cognitive trajectories and disability progression in patients with relapsing-remitting multiple sclerosis. Neurology. 2021;97:e2020-e2031.

Related Items

Subscribe to Value-Based Care in Neurology

Stay up to date with the latest news in neurology by subscribing to receive the free VBCN e‑Newsletter.