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Measuring cognitive function by the SDMT across functional domains: Useful but not sufficient.

Justin M Leach1, Gary Cutter1, Daniel Golan2

  • 1Department of Biostatistics, University of Alabama at Birmingham, 1665 University Blvd., 1665 University Blvd. Suite #327, Birmingham, Alabama 35294, United States.

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The Symbol Digit Modalities Test (SDMT) is insufficient for differentiating cognitive impairment in people with Multiple Sclerosis (pwMS). Further assessment is needed due to the heterogeneity of cognitive function in pwMS.

Keywords:
Cognitive functionCognitive impairmentComputerized cognitive assessmentMultiple sclerosisScreeningSymbol digit modalities test

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Area of Science:

  • Neuroscience
  • Clinical Psychology
  • Rehabilitation Medicine

Background:

  • The Symbol Digit Modalities Test (SDMT) is a widely used cognitive screening tool for individuals with Multiple Sclerosis (pwMS).
  • Cognitive impairment in pwMS is recognized as a heterogeneous condition, suggesting a single screening tool may not capture the full spectrum of deficits.
  • There is a need to evaluate the comprehensive utility of the SDMT in light of this heterogeneity.

Purpose of the Study:

  • To evaluate the adequacy of the SDMT in identifying cognitive impairment across various domains.
  • To compare SDMT performance against a multi-domain cognitive assessment battery (CAB, NeuroTrax).
  • To determine if the SDMT can reliably differentiate between impaired and non-impaired cognitive functioning in pwMS.

Main Methods:

  • 113 pwMS completed both the SDMT and the CAB.
  • Cognitive impairment was defined as a score of ≥1.5 standard deviations below the normalized mean on CAB domains.
  • Logistic regression and Youden Index were used to assess SDMT's predictive accuracy for domain-specific impairment, validated on an independent cohort of 81 pwMS.

Main Results:

  • The SDMT significantly predicted cognitive impairment across all assessed domains (Odds Ratio: 0.885-0.950).
  • However, prediction metrics, including the area under the receiver operating curve (AUC), were modest, ranging from 0.623 to 0.778.
  • The observed and predicted cognitive impairment showed suboptimal alignment, indicating limitations in the SDMT's discriminatory power.

Conclusions:

  • The SDMT alone is not sufficient to accurately differentiate between cognitively impaired and non-impaired individuals with Multiple Sclerosis across multiple cognitive domains.
  • The findings highlight the limitations of relying solely on the SDMT for comprehensive cognitive assessment in pwMS.
  • Further research may be warranted to explore more comprehensive assessment strategies for cognitive function in this population.