iCAMS App May Help Doctors Identify MS Cognitive Symptoms

This app is a research tool for medical professionals to use in determining treatment protocols and is not available to patients as a diagnostic device.

It’s known that MS can be a difficult disease to diagnose.

The trouble with diagnosing MS

As a “diagnosis of exclusion,” MS cannot be confirmed as a diagnosis without first ruling out many other diseases and disorders in tandem with the emergence of symptoms and markers that suggest its presence.

Problems with motor symptoms can streamline the process a little bit; MS is best known for its impact on the musculoskeletal system. Also, major neurological problems associated with the optic nerve may make an MS diagnosis more apparent.

But what about the problem of cognitive dysfunction?

The invisible symptoms of MS

For many people with MS, these “invisible” symptoms are the only ones they experience. As many as 60 percent of all people with MS suffer from cognitive impairments.1

These include cognitive “fog,” memory impairment, issues with conversational speech, concentration and focus, and basic calculation functions necessary to do one’s job or manage household bills.

Cognitive symptoms can be just as fatiguing

These “invisible” symptoms can be easily as fatiguing as the motor or visual symptoms that others with MS experience.

People who only show cognitive symptoms may encounter obstacles at the diagnostic stage. Without MS’s more obvious markers (tremors, muscle weakness, spasticity, or extreme visual disturbance), nailing down a diagnosis may take many more tests and money and require more “time and space.”

The danger of waiting

For someone with active MS, “time and space” may be a luxury they can’t afford. Untreated demyelination—while waiting for tests to come back and for doctors to check all the diagnostic boxes—may mean some will face more and worsening symptoms and, potentially, more progressive damage to the central nervous system.

Researchers have noted that those with cognitive dysfunction may also experience more disability as the disease progresses, leading to higher rates of disability.

New century, new applications

Medical devices are a booming component of 21st-century medicine, so it’s no surprise that a new app has been developed to help clarify an MS diagnosis in those with less-than-obvious symptoms.

This new app was inspired by nearly 10 years of foundational work with a more conventional diagnostic instrument known as BICAMS.

The Brief International Cognitive Assessment for MS (BICAMS)

Before 2010, cognitive assessments for people demonstrating neurological deficit required lengthy, in-depth paper-and-pencil testing, which held many limitations and weren’t particularly valid. This meant that cognitive impairment for many with undiagnosed MS might be overlooked, misunderstood, or ignored as a legitimate symptom.2

In 2010, an international research team in London sought to streamline these neuropsychological tests to make them brief, standardized, and easier to use among both specialists and non-specialists. Their goal was twofold:

  • To expedite and improve these tests so they could have a wider application
  • To making cognitive impairment a bigger focus in research and outcomes

BICAMS went on to become a leading source for better understanding what the authors at Research Outreach call “the knowledge gap surrounding cognition in MS.”2

A robust and valid testing tool

As recently as 2018, a Neurology and Therapy meta-analysis by researchers Corfield and Langdon confirmed BICAMS to be "a relatively robust" testing tool "across a variety of cultures, languages and locations” as well as “a valid measure of cognition in MS” which has led to “increased awareness of MS cognition, which will improve cognitive symptom management.”3

And then came iCAMS

iCAMS is the recent tablet application that does the work of BICAMS without the barrier of paperwork.

A recent study conducted at Johns Hopkins University School of Medicine4 was able to show “excellent agreement … between iCAMS and paper versions of the BICAMS tests,” with the application of the iCAMS app saving around 10 minutes per use.

Any person with MS who goes in for a neurologist visit can tell you that saving 10 minutes at any time is groundbreaking.

Measuring changes in cognitive dysfunction more objectly

What’s even more important is this: not only can these tests help to identify and establish levels of cognitive dysfunction, but they can also help to measure any changes—improvements or deficits—more objectively.

iCAMS clearly makes this possible in a way that is affordable, reliable, and applicable across specialists.

Technology, for the win

The study's lead author, Meghan Beier PhD MA reported that "in addition to saving time and being easier to administer, a tablet-based test eliminates the need to store paper-based records and makes sharing information easier on electronic medical records. The app may also reduce the rate of errors in calculating and transferring scores."5

The study involved 100 patients but new efforts by the research team to validate the iCAMS app will include larger and more diverse testing populations and better instrument design to make it more user-friendly.

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