Dataset Information

The BRAIN test: a keyboard-tapping test to assess disability and clinical features of multiple sclerosis.

ABSTRACT:

Background

The BRadykinesia Akinesia INcordination (BRAIN) test is an online keyboard-tapping test previously validated as a sensitive tool for detecting signs of Parkinson's disease.

Objectives

To determine whether the BRAIN test can measure disability in MS and identify the presence of pyramidal or cerebellar dysfunction.

Methods

Kinesia scores (KS, number of key taps in 30 s), akinesia times (AT, mean dwell time on each key) and incoordination scores (IS, variance of travelling time between keys) were calculated in 39 MS patients. These were correlated against the Expanded Disability Status Scale (EDSS) scores, pyramidal and cerebellar functional system scores and 9-hole peg test scores.

Results

EDSS correlated with KS (r = - 0.594, p < 0.001), AT (r = 0.464, p = 0.003) and IS (r = 0.423, p = 0.007). 9-HPT scores strongly correlated with KS (r = 0.926, p < 0.001). Pyramidal scores correlated with KS (r = - 0.517, p < 0.001). Cerebellar scores correlated with KS (r = - 0.665, p < 0.001), AT (r = 0.567, p < 0.001) and IS (r = 0.546, p = 0.007). Receiver operating characteristic curves demonstrate that KS can distinguish between the presence or absence of pyramidal and cerebellar dysfunction with area under curve 0.840 (p < 0.001) and 0.829 (p < 0.001), respectively.

Conclusions

The BRAIN test can remotely measure disability in MS. Specific scores differ according to the presence and severity of pyramidal or extrapyramidal dysfunction. It demonstrates huge potential in monitoring disease progression in clinical trials.

SUBMITTER: Shribman S

PROVIDER: S-EPMC5808056 | biostudies-literature | 2018 Feb

REPOSITORIES: biostudies-literature

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Publications

The BRAIN test: a keyboard-tapping test to assess disability and clinical features of multiple sclerosis.

Shribman Samuel S Hasan Hasan H Hadavi Shahrzad S Giovannoni Gavin G Noyce Alastair J AJ

Journal of neurology 20171204 2

<h4>Background</h4>The BRadykinesia Akinesia INcordination (BRAIN) test is an online keyboard-tapping test previously validated as a sensitive tool for detecting signs of Parkinson's disease.<h4>Objectives</h4>To determine whether the BRAIN test can measure disability in MS and identify the presence of pyramidal or cerebellar dysfunction.<h4>Methods</h4>Kinesia scores (KS, number of key taps in 30 s), akinesia times (AT, mean dwell time on each key) and incoordination scores (IS, variance of tra ...[more]

PMID: 29204963

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Project description:Introduction. Studies suggest that people with multiple sclerosis (pwMS) experience continuous and subclinical physical worsening, even as early as their disease diagnosis. Validating sensitive and reproducible tests that can capture subclinical disease activity early in the disease are clinically useful and highly warranted. We aimed at validating the utility of Fitts’ Tapping Task (FTT) as reproducible measure of psychomotor performance in pwMS. Materials and Methods. Thirty newly-diagnosed pwMS (within 2 years of diagnosis and Expanded Disability Status Scale; EDSS ≤ 2.0), 30 people with migraine (pwMig), and 30 healthy controls (HCs) underwent a psychomotor assessment using the FTT, O’Connor hand dexterity test, and Visual Reaction Time Test (VRTT). Hand strength was measured using a hand-grip dynamometer. Subjects also provided patient-reported outcomes (PROs) using the 36-Item Short Form Survey (SF-36). Intrarater and interrater reproducibility was acquired on 5 HCs by two independent operators. Test−retest reproducibility was determined in 5 pwMS over a 1-week follow-up. Eight pwMS returned for the same test procedures 2 years after the baseline assessment. Bland−Altman plots were used to determine the minimally detectable change (MDC) and logistic regression models determined the ability to differentiate between newly-diagnosed pwMS and HCs. Results. FTT exhibited a high intrarater and interrater reproducibility (interclass correlation coefficient of 0.961, p < 0.001). The test−retest demonstrated an MDC of the average FTT at > 15%. PwMS had significantly a slower FTT time and O’Connor dexterity time when compared to pwMig and HCs (p < 0.001 for both). Higher Fitts’ difficulty levels (4th and 6th difficulty) and average performance on the O’Connor test were able to differentiate newly-diagnosed pwMS from HCs with 80% accuracy (p < 0.01). Slower FTT performance was correlated with worse PROs due to physical health. Over the 2-year follow-up, and despite being clinically stable (no change in EDSS), 6 out of 8 (75%) pwMS had more than a 15% worsening in their average FTT time. Conclusions. FTT is a highly-reproducible test for measuring psychomotor performance in newly-diagnosed pwMS. FTT can capture insidious worsening in psychomotor performance and cognitive function in early stages of MS.

Project description:IntroductionMultiple sclerosis (MS) is a chronic disease of the central nervous system. Estimates of MS natural history (NH) disability progression speed from clinical observations vary worldwide. This may reflect, in part, variance in censoring-bias) (missing observations) and assumptions about when irreversible disability progression events occurred. We test whether estimates of progression speed which assume midpoint survival time at irreversible disability endpoints are significantly faster than estimates which assume maximum survival time, and are more stable across study groups and time periods.MethodsOur Nova Scotia NH study population includes 2,240 definite relapsing-onset multiple sclerosis (R-MS) natural history patients with 18,078 Expanded Disability Status Scale (EDSS) clinical observations in study period 1979-2010. Progression speed is measured by rate-of-change in range EDSS 0-6 and by survival time at irreversible endpoints EDSS 1-9. Midpoint censoring-bias-reduction methods are applied to clinical observations.FindingsTypical EDSS increase per year in range EDSS 0-6, assuming midpoint survival time, is estimated to be 0.168 for all R-MS, 0.204 for eventually-DMD-treated patients and 0.155 for never-DMD-treated patients. Estimates assuming midpoint rather than maximum survival time are significantly faster: 16% faster for all R-MS natural history patients, 6% faster for eventually-DMD-treated patients, and 21% faster for never-DMD-treated patients. The variability of estimates across study groups and time periods decreased when midpoint survival time was assumed.ConclusionsEstimates of typical disease progression speed from 1979-2010 Nova Scotia clinical observations are sensitive to censoring-bias and to analysts' survival time assumptions. Censoring-bias-adjusted estimates of typical natural history disability progression speed in relapsing-onset multiple sclerosis patients are significantly faster, and less variable within and across study groups and time periods, than unadjusted estimates, and are, arguably, more relevant for various stakeholders. The application of censoring-bias-reduction methods to other multiple sclerosis clinical databases may reduce variability in estimates of disability progression speed worldwide.

Dataset Information

The BRAIN test: a keyboard-tapping test to assess disability and clinical features of multiple sclerosis.

Background

Objectives

Methods

Results

Conclusions

Publications

The BRAIN test: a keyboard-tapping test to assess disability and clinical features of multiple sclerosis.

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