Background: Cognitive dysfunction in multiple sclerosis (MS) causes numerous limitations in activities of daily living. Objectives: To develop an improved method of cognitive assessment in people with MS using novel real-world distracters. Methods: A sample of 99 people with MS and 55 demographically matched healthy controls underwent testing with the Minimal Assessment of Cognitive Functioning in Multiple Sclerosis (MACFIMS) and a modified version of the computerized Symbol Digit Modalities Test (c-SDMT). Half of the subjects completed the c-SDMT with built-in real-world distracters and half without. Results: The mean time on the c-SDMT was significantly greater in MS subjects than healthy controls for both distracter (p = 0.001) and non-distracter (p < 0.001) versions. Significantly more MS subjects were impaired on the c-SDMT with distracters than the traditional SDMT (47.1% vs 30.3%, p = 0.04). There were no differences in impairment between the c-SDMT with and without distracters (47.1% vs 37.5%, p = 0.34). The distracter version had a sensitivity of 81% and specificity of 88% in detecting global cognitive impairment. Conclusions: The incorporation of distracters improves the sensitivity of a validated computerized version of the SDMT relative to the non-distracter and traditional versions and offers a quick and easy means of detecting cognitive impairment in people with MS.

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Keywords cognitive assessment, cognitive reserve, computerized testing, information processing speed, Multiple sclerosis, neuropsychology
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Journal Multiple Sclerosis
Patel, V.P. (Viral P.), Zambrana, A. (Aaron), Walker, L.A.S, Herrmann, N. (Nathan), & Feinstein, A. (Anthony). (2017). Distraction adds to the cognitive burden in multiple sclerosis. Multiple Sclerosis, 23(1), 106–113. doi:10.1177/1352458516641208