Contributions
Abstract: P844
Type: Poster Sessions
Abstract Category: Pathology and pathogenesis of MS - Neuropsychology
Introduction: Cognitive impairment (CI) is present in more than half of people with multiple sclerosis (MS). Cognitive rehabilitation can improve various domains of CI, but access to specialists is limited. Unsupervised in-home digital therapeutics could significantly expand access to cognitive rehabilitation. However, feasibility of deployment in an MS population and correlations with standard clinical measures must be clarified.
Objectives: 1) To assess the feasibility of treating patients with MS using a videogame-based digital therapeutic for CI. 2) To identify tests of processing speed that would allow evaluation of the tool's efficacy in an unsupervised setting.
Methods: At the UCSF MS Center, 50 participants with MS and 25 without MS completed a baseline neurological evaluation (EDSS; MSFC components). Cognitive tests included paper-and-pencil (BICAMS), as well as computer- and tablet-based tests (including Match: an unsupervised test of executive functions and processing speed, developed at UCSF). Then, 21 of these 50 MS participants were assigned to an in-home, tablet-based, cognitive digital therapeutic tool for 25 minutes daily, 5 days weekly, for 8 weeks (Akili Evo), followed by a repeat in-clinic evaluation.
Results: There was high enthusiasm for this first-of-its-kind in-home digital therapeutic tool. Enrollment was completed in 3.5 months. Raw SDMT scores correlated significantly with unsupervised tests, including Match (Pearson r=0.71), as well as with 3 of the 4 computerized cognition tests (p< 0.05 for each). Overall, Match showed slightly greater correlation than did SDMT with age, clinical, and other cognitive tests.
Of 21 MS participants enrolled to use the Akili Evo digital therapeutic at home, mean (SD) SDMT z-score was -0.92 (1.16), and 20 completed the 8 week study. Average number of monthly sessions was 20 (median (SD): 22.5 (8.0)); 3 participants completed < 10 monthly sessions (median (SD): 7.5 (0.2) due to vertigo or impaired vision. Over the 8-week period, scores of processing speed improved significantly, including SDMT (paired t-test, p=0.006), and Match (p=0.010). A larger, randomized, controlled clinical trial of 60 participants is ongoing and will complete August 2018, efficacy data will be reported.
Conclusions: Deploying an in-home digital tool to improve processing speed in MS is feasible, shows preliminary efficacy, and its effects on cognition may be captured using unsupervised evaluations in the home.
Disclosure: RB has received research support from the National Multiple Sclerosis Society, Hilton Foundation, California Initiative to Advance Precision Medicine, Doris Duke Award, Sherak Foundation, and Akili Interactive; and has received personal compensation for medical legal consulting and for serving on the advisory boards of Roche-Genentech, Genzyme-Sanofi and Novartis.
C Zhao, P. Garcha, G. Rush, W. Rowles, J. Morrissey: none.
K Possin: nothing to disclose.
A Feinstein: nothing to disclose.
J Anguera: nothing to disclose.
Abstract: P844
Type: Poster Sessions
Abstract Category: Pathology and pathogenesis of MS - Neuropsychology
Introduction: Cognitive impairment (CI) is present in more than half of people with multiple sclerosis (MS). Cognitive rehabilitation can improve various domains of CI, but access to specialists is limited. Unsupervised in-home digital therapeutics could significantly expand access to cognitive rehabilitation. However, feasibility of deployment in an MS population and correlations with standard clinical measures must be clarified.
Objectives: 1) To assess the feasibility of treating patients with MS using a videogame-based digital therapeutic for CI. 2) To identify tests of processing speed that would allow evaluation of the tool's efficacy in an unsupervised setting.
Methods: At the UCSF MS Center, 50 participants with MS and 25 without MS completed a baseline neurological evaluation (EDSS; MSFC components). Cognitive tests included paper-and-pencil (BICAMS), as well as computer- and tablet-based tests (including Match: an unsupervised test of executive functions and processing speed, developed at UCSF). Then, 21 of these 50 MS participants were assigned to an in-home, tablet-based, cognitive digital therapeutic tool for 25 minutes daily, 5 days weekly, for 8 weeks (Akili Evo), followed by a repeat in-clinic evaluation.
Results: There was high enthusiasm for this first-of-its-kind in-home digital therapeutic tool. Enrollment was completed in 3.5 months. Raw SDMT scores correlated significantly with unsupervised tests, including Match (Pearson r=0.71), as well as with 3 of the 4 computerized cognition tests (p< 0.05 for each). Overall, Match showed slightly greater correlation than did SDMT with age, clinical, and other cognitive tests.
Of 21 MS participants enrolled to use the Akili Evo digital therapeutic at home, mean (SD) SDMT z-score was -0.92 (1.16), and 20 completed the 8 week study. Average number of monthly sessions was 20 (median (SD): 22.5 (8.0)); 3 participants completed < 10 monthly sessions (median (SD): 7.5 (0.2) due to vertigo or impaired vision. Over the 8-week period, scores of processing speed improved significantly, including SDMT (paired t-test, p=0.006), and Match (p=0.010). A larger, randomized, controlled clinical trial of 60 participants is ongoing and will complete August 2018, efficacy data will be reported.
Conclusions: Deploying an in-home digital tool to improve processing speed in MS is feasible, shows preliminary efficacy, and its effects on cognition may be captured using unsupervised evaluations in the home.
Disclosure: RB has received research support from the National Multiple Sclerosis Society, Hilton Foundation, California Initiative to Advance Precision Medicine, Doris Duke Award, Sherak Foundation, and Akili Interactive; and has received personal compensation for medical legal consulting and for serving on the advisory boards of Roche-Genentech, Genzyme-Sanofi and Novartis.
C Zhao, P. Garcha, G. Rush, W. Rowles, J. Morrissey: none.
K Possin: nothing to disclose.
A Feinstein: nothing to disclose.
J Anguera: nothing to disclose.