Detecting early changes in memory and speed-of-thinking to improve MS care

Dr Daniel Merlo

Monash University

| Better treatments | Social And Applied Research | Fellowship | 2022 | Investigator Led Research |


MS is a condition impacting the brain and spinal cord, affecting up to 65% of individuals with noticeable alterations in cognitive functions. These changes involve issues with memory recall, problem-solving abilities, and processing speed, significantly impacting daily tasks like work and social interactions. Detecting these subtle cognitive shifts within an MS clinic setting proves challenging, as current testing methods are time-consuming and inadequate for tracking gradual changes over time.

A research initiative has been undertaken by Dr Daniel Merlo and his team to leverage an established computerised testing system, called MSReactor. The goal is to monitor long-term cognitive fluctuations commonly observed in individuals with MS. This endeavour seeks to define alterations detected by these tests that hold clinical significance, linking them to the worsening of other MS symptoms and hindrances in daily tasks, such as work productivity.

Developing and validating tests capable of measuring these nuanced cognitive changes among people with MS could provide neurologists with invaluable insights. This deeper understanding could empower them to make more informed decisions regarding clinical care, fostering a collaborative approach to managing the condition.

Progress to Date

Significant progress has been achieved in evaluating the long-term feasibility and acceptability of computerised cognitive monitoring, encompassing approximately 600 individuals with MS over a 36-month period. Dr Merlo and his team are in the process of preparing a manuscript for publication, focusing on the extended acceptability of these tests and factors influencing adherence.

Additionally, enrolment is ongoing, involving about 1,400 participants who have completed at least one cognitive test through the MSReactor platform. A subset has undergone a short neuropsychological battery (ARCS), with some participants having multiple assessments over 12 to 24 months. Around 86 individuals engaged in cognitive tasks in the Floodlight™ MS app across various healthcare sites.

Preliminary analysis is currently ongoing to assess the predictive accuracy of MSReactor tests for changes in disability and neuropsychological assessments, followed by further analysis later in the year.

Furthermore, collaboration with the Monash Medical Artificial Intelligence (AI) group continues, focusing on developing robust machine learning models for detecting cognitive changes based on test results. The acceptability of testing intervals every 6 months for up to 3 years was evaluated using multiple scales measuring enjoyment, interest, duration, and testing-related anxiety. While a shift from positive to neutral responses occurred over the 3-year period, this shift didn't influence the likelihood of test withdrawal.

The team have also identified that individuals experiencing test-induced anxiety reported higher levels of depression and anxiety, coupled with a lower quality of life. These findings are critical for healthcare professionals, aiding in the identification of individuals needing additional support for regular cognitive monitoring. Technological approaches for cognitive monitoring effectively address the unmet need for tracking subtle changes in memory and thinking among individuals living with MS, impacting their daily activities, such as work and social engagement.

Updated 31 March 2023

Updated: 14 February, 2022

Stages of the research process

Fundamental laboratory

Laboratory research that investigates scientific theories behind the possible causes, disease progression, ways to diagnose and better treat MS.

Lab to clinic timeline: 10+ years

Research that builds on fundamental scientific research to develop new therapies, medical procedures or diagnostics and advances it closer to the clinic.

Lab to clinic timeline: 5+ years
Clinical Studies
and Clinical Trials

Clinical research is the culmination of fundamental and translational research turning those research discoveries into treatments and interventions for people with MS.

Lab to clinic timeline: 1-5 years


Grant Awarded

  • Postdoctoral Fellowship

Total Funding

  • $225,000


  • 3 years

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Detecting early changes in memory and speed-of-thinking to improve MS care