Monitoring cognition in multiple sclerosis via adaptive smartphone games-first insights from a validation study

Cognitive impairment in Multiple Sclerosis significantly undermines quality of life and working capacity yet despite its high prevalence (30%-75%) it is often neglected. Gamified and adaptive smartphone tests have great potential to assess cognition reliably and conveniently. To improve monitoring of cognition in people with MS (pwMS) we developed CoGames, a set of 6 adaptive and gamified smartphone tests. Here we present first insights into their reliability, correlations to domain-corresponding reference tests, and adherence. The games were played repeatedly over 6 weeks. We calculated correlation estimates between game-derived measures of the first two runs for the test-retest reliability analysis, correlated (partial Spearman correlation) game measures with the results of established reference tests and assessed adherence as the proportion of played- to scheduled games. We included data collected between March 2022 and October 2023 of the first 100 pwMS, mean age: 46.8 (±12.3), median EDSS: 2.5 (0-7.0), who completed the initial intensive phase of the dreaMS validation study 1 (NCT05009160). Test-retest correlation estimates ranged from r = 0.41 to 0.91. Correlation estimates to reference tests ranged from |ρ| = 0.23 to 0.66. Average adherence was 89.3% (86%-92%). Our results suggest high test-retest reliability of the CoGames and clear correlations with their reference tests. Adherence was higher than for other tests included in the dreaMS app underlining the value of gamification. Albeit these results must be confirmed in a larger population over a longer time, they support the potential of CoGames as a valid, reliable and enjoyable monitoring-tool for cognition in pwMS.