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Computerized Neurology Testing in Practice
Dr Wilner: Tell me about this computer test. How long does it take to administer?
Dr Gudesblatt: The cognitive computer test can take anywhere from 20 minutes to 45 minutes or an hour based on the number of domains you want to explore. It doesn't really matter whether the person being tested is computer savvy or not, and it doesn't require mouse movement. It requires just a click on a button. It digitalizes the whole process; it makes neuropsychiatric testing accessible, cost appropriate, and relevant; and you can repeat it easily on the cheap. Neuropsychologists will tell us that this is not neuropsychology, but they can only screen a certain number of patients per day or patients per week, and the costs are high. This allows the neurologists to actually screen many more patients and increase the referrals to neuropsychologists to really do cognitive rehabilitation and investigate this further in the population most in need and most able to be helped (ie, those on the cusp of not driving, not being employed, or needing help with finances).
Dr Wilner: Are you using this test in your practice or in clinical trials? How do you use it?
Dr Gudesblatt: We use it for both. We use it in practice and to collect clinical data. We use it in clinical trials as well. The beauty in practice is that we can now start to parse out when someone comes in, for example, with multiple sclerosis and they have a low EDSS (Kurtzke Expanded Disability Status Scale). Their physical disability is low, and you would like to think that their ability to withstand the disease is okay. You see a bunch of plaques in their head, and you're thinking that they have plenty of room to compensate. Their physical ability is good, but now we see that their cognitive profile is quite impaired, so that person will be disabled early unless we use more potent medications, at least in my opinion, to salvage brain function or prevent more disability. Once we see that they are more physically disabled, we're still not seeing that they're more cognitively disabled based on our exam, and the EDSS being cognitively insensitive, we're completely blinded to the impact of the disease on their cognition.
We can parse out who is more affected cognitively early on, and I think it is very important to take the patient's individual needs into consideration when treating and choosing different disease-modifying therapies. One medication may give you more cognitive preservation in terms of relapses or potency or efficacy, where another medication may provide less. These data are only now going to be evolved or devolved from the mess of data we have that is MRI vs clinical. The testing will allow us to homogenize the heterogeneous data we have where some people are more disabled early and some people are less disabled apparently over time because we can only measure what we're measuring.
Dr Wilner: Mark, I want to thank you very much for sharing the work you've been doing with computerized assessment and how it will help us visualize a long-term prognosis and, hopefully, response to new medications. Thanks for sharing with Medscape.
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