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Updated: Apr 30, 2026
The Multiple Sclerosis Performance Test MSPT: An iPad-Based Disability Assessment Tool
Published on: June 30, 2014
The Symbol Digit Modalities Test is an effective cognitive screen in pediatric onset multiple sclerosis (MS)
Leigh E Charvet1, Rachel Beekman1, Nneka Amadiume1
1Lourie Center for Pediatric Multiple Sclerosis, Department of Neurology, Stony Brook Medicine, United States.
Insights
The Symbol Digit Modalities Test (SDMT) effectively screens for cognitive impairment in pediatric multiple sclerosis (MS) patients. This brief tool identified a significant portion of MS patients with cognitive deficits, aiding early detection and management.
Area of Science:
- Neurology
- Neuropsychology
- Pediatric Medicine
Background:
- Cognitive impairment affects approximately one-third of pediatric-onset multiple sclerosis (MS) patients.
- A need exists for an effective screening instrument for cognitive deficits in this population.
- The Symbol Digit Modalities Test (SDMT) is a validated measure of cognitive processing speed in adult MS.
Purpose of the Study:
- To evaluate the Symbol Digit Modalities Test (SDMT) for identifying pediatric-onset MS patients at risk of cognitive impairment.
- To assess the SDMT's sensitivity and specificity in detecting neuropsychological impairment in pediatric MS.
- To explore factors associated with SDMT performance in pediatric MS.
Main Methods:
- Seventy pediatric-onset MS patients underwent clinical evaluation including the SDMT.
- Comparison groups included 40 patients with other pediatric neurological diagnoses (OND) and 32 healthy controls (HC).
- A subset of MS patients and all HC completed neuropsychological evaluation for validation.
Main Results:
- MS patients performed significantly worse on the SDMT compared to HC (p=0.02).
- Impaired SDMT scores were found in 37% of MS, 20% of OND, and 9% of HC groups.
- The SDMT demonstrated 77% sensitivity and 81% specificity for detecting neuropsychological impairment in MS patients within one year, reaching 100% sensitivity within two months.
Conclusions:
- The Symbol Digit Modalities Test (SDMT) is a promising brief screening tool for cognitive impairment in pediatric-onset MS.
- The SDMT can help identify pediatric MS patients requiring further neuropsychological assessment.
- Older age and increased disability were associated with poorer SDMT performance, while optic neuritis history correlated with better performance.
Objective:
To evaluate the Symbol Digit Modalities Test (SDMT) as a tool for identifying pediatric-onset MS patients at risk for cognitive impairment.
Background:
The SDMT is a brief measure of cognitive processing speed that is often used in adult MS patients. Approximately one-third of pediatric-onset MS patients have cognitive impairment and there is a need for an effective screening instrument.
Design/Methods:
Seventy (70) consecutive outpatients with pediatric-onset MS underwent clinical evaluations including the SDMT and were compared to those with other pediatric neurological diagnoses (OND, n=40) and healthy controls (HC, n=32). A subset of the MS group and all healthy controls completed neuropsychological evaluation within one year of SDMT administration.
Results:
The MS group performed worse on the SDMT compared to the HC group (p=0.02). Thirty-seven percent (37%) of the MS, 20% of the OND, and 9% of HC groups scored in the impaired range. For MS participants who underwent neuropsychological testing (n=31), the SDMT showed 77% sensitivity and 81% specificity for detecting neuropsychological impairment when administered within one year and reached 100% sensitivity when the interval was under two months (n=17). Overall, older age and increased disability predicted poorer SDMT performance (age r=-0.26, p=0.03) and the Expanded Disability Status Scale score or EDSS (r=-0.47, p<0.001), while a history of optic neuritis predicted better performance (p=0.04). Optical coherence tomography measures were not related to SDMT performance.
Conclusion:
In this preliminary study, the SDMT was an effective brief screen for detecting cognitive impairment in pediatric-onset MS.
