CoGames: Development of an adaptive smartphone-based and gamified monitoring tool for cognitive function in Multiple Sclerosis.

Aim: As part of the development of a smartphone-based app for monitoring MS disease activity and progression (dreaMS, NCT05009160), we developed six gamified tests with multiple difficulty levels as a monitoring tool for cognition. This study quantified the relative difficulty between levels and investigated their reliability, ability to depict practice effects, and user acceptance.

Methods: Healthy volunteers played each game, covering five cognitive domains, twice per day for 11 consecutive days. Linear mixed models determined the relative difficulty of the levels. Spearman's correlation of the two daily repetitions measured test-retest reliability. Difficulty increased daily except for days 2, 6, and 11, when the easiest level ("Beginner") was repeated to estimate practice effects. Participants rated enjoyment and other components of acceptance on a 5-point scale.

Results: We included 82 participants from April to July 2023 in Basel, Switzerland, of which 76 (51 female, age: 40.3 ± 13.9 years, range 18-69) completed the study according to protocol. Generally, mean performances decreased with higher difficulty levels. Across all levels of all games, the median test-retest correlation was 0.825 (range of medians 0.55-0.9). Mean performance in level "Beginner" improved across all games. The mean enjoyment rating was 3.9 (range: 3.1-4.3).

Conclusion: Our study showed that the CoGames yield reliable measures across different cognitive domains and difficulty levels and were enjoyable to play. The observed practice effects must be considered, but also indicate sensitivity to change. These results support the hypothesis that adaptive gamified digital tests can serve as a reliable and well-accepted monitoring tool of cognition in PwMS.