Conference Coverage

Can technology automate assessments of patients with MS in the clinic?



An iPad-based series of neuroperformance tests and patient-reported outcomes along with fully automated MRI analysis may facilitate the clinical evaluation of patients with multiple sclerosis, according to research described at the meeting held by the Americas Committee for Treatment and Research in Multiple Sclerosis.

Laura Baldassari, MD, clinical neuroimmunology fellow at the Mellen Center at the Cleveland Clinic

Dr. Laura Baldassari

An analysis of data collected using these methods found that patient-reported outcomes and MRI measures correlate with neuroperformance test results, said Laura Baldassari, MD, a clinical neuroimmunology fellow at the Mellen Center for Multiple Sclerosis at the Cleveland Clinic. Such assessments “could potentially enable us to better tune in to disability worsening and treatment response in our patients.”

The Multiple Sclerosis Performance Test (MSPT) collects patient-reported outcomes and tests patients’ processing speed, contrast sensitivity, manual dexterity, and walking speed. The MSPT is designed for supervised or independent administration with an assistant and has been “incorporated into routine clinical care at the Mellen Center,” Dr. Baldassari said. Before seeing their provider, patients complete the MSPT with a biomedical assistant, which usually takes 30-40 minutes. The data are scored instantly and “integrated into the electronic medical record for use during the clinical encounter.”

Dr. Baldassari and her research colleagues analyzed associations between the neuroperformance metrics, patient-reported outcome measures, and quantitative MRI metrics. The analysis included 976 patients who completed the MSPT between December 2015 and December 2017 and had an MRI within 3 months of a clinical encounter. T2 lesion volume, normalized whole brain volume or whole brain fraction, thalamic volume, and cross-sectional upper cervical spinal cord area at the level of C2 on MRI were calculated using a fully automated method.

Patient-reported outcomes included Quality of Life in Neurological Disorders (Neuro-QoL) upper and lower extremity function, Patient-Reported Outcomes Measurement Information System (PROMIS) physical, and Patient Determined Disease Steps (PDDS).

The researchers used Spearman correlation coefficients to examine the relationships between each neuroperformance test, patient-reported outcome, and MRI measure. Linear regression models determined which clinical demographic, patient-reported outcome, or MRI characteristic predicted neuroperformance test results.

Patients had a mean age of about 48 years, and the population was predominantly female and white with relapsing remitting MS.

“There were significant correlations between all neuroperformance tests and all patient-reported outcomes except for the contrast sensitivity test and PROMIS physical,” Dr. Baldassari said. “The processing speed test was most strongly correlated with the PDDS as well as the Neuro-QoL lower extremity. The contrast sensitivity test was correlated with Neuro-QoL lower extremity as well.” The manual dexterity test correlated with PDDS and Neuro-QoL upper and lower extremity and the walking speed test correlated with PDDS and Neuro-QoL lower extremity.

“With worsening self-reported functions, these neuroperformance test results demonstrated impairment as well,” she said.

The neuroperformance tests and all MRI metrics had significant, moderate correlations. “The strongest correlations here are between the processing speed test and whole brain fraction and T2 lesion volume; contrast sensitivity and T2 lesion volume, whole brain fraction, and thalamic volume; manual dexterity test and T2 lesion volume and whole brain fraction; and walking speed test and whole brain fraction and cord area,” she said.

“The strongest predictors of each neuroperformance test varied, which highlights the unique complementary contribution of each patient-reported outcome measure and MRI metric to the complex domains of disability in MS,” Dr. Baldassari said.

Comprehensive, quantitative MS assessments may lead to detailed patient profiles, which could support more precise clinical care and observational studies. In future studies, the researchers plan to examine how these measures relate over time.

The MSPT was developed by the Cleveland Clinic in partnership with Biogen. Dr. Baldassari reported receiving funding through the National Multiple Sclerosis Society and personal fees for serving on a scientific advisory board for Teva. His coauthors’ disclosures included the contribution of intellectual property to the MSPT, for which they could receive royalties.

SOURCE: Baldassari L et al. ACTRIMS Forum 2019, Abstract 32.

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