Assessing Cognitive Overload in People with Multiple Sclerosis

Cognitive complaints are common in people with multiple sclerosis (PwMS), and cognitive deficits significantly impact their quality of life and employability. These complaints are observed across various stages of the disease, including early in the disease process when standard neurocognitive tests may yield "normal" results. A commonly reported cognitive concern is the experience of “cognitive overload”, defined as a situation where the cognitive load imposed by a task surpasses an individual’s cognitive processing capacity, leading to reduced task performance and negative affective experience. To better understand and quantify cognitive overload, the field needs novel tools that can capture subtle changes in affect and cognition, which may be more reflective of early cognitive impairment and better replicate real-world cognitive challenges. For example, prior studies have shown that PwMS experience worsened cognitive performance during dual-task walking and virtual reality (VR) games under increased environmental stressors, which better align with their subjective cognitive difficulties. This study posits that cognitive overload in PwMS results in a state of dysregulated affective reactivity and acts as a harbinger of subclinical cognitive change. The overarching goals of this study involve characterizing cognitive overload in PwMS using a multimodal approach. This approach includes cognitive testing, digital facial movement analysis, patient-reported outcomes (mood, fatigue, cognition), and physiological measurements while inducing overload through cognitive testing tasks with added interference conditions. In Aim 2, we will assess the degree of overwhelm under interference conditions using established tools and novel biomarkers. Participants will undergo cognitive testing with added auditory and dual-task interference conditions to increase cognitive load. Novel physiological and facial expressivity metrics will be used to capture the experience of cognitive overload. In Aim 2, we will leverage the Brainwalk study to investigate if degree of cognitive overload in dual-task performance predicts cognitive scores (processing speed) at 2 year follow up. In Aim 3, we will explore the relationship between objective and subjective measures of cognitive load by correlating established subjective measures not previously used in MS to established objective measures of cognitive interference cost; additionally we will use structural qualitative interviews to evaluate for novel aspects of subjective overload in this population to inform survey improvement. This research is vital for improving symptom recognition related to cognitive impairment in PwMS and enhancing systematic research in this domain. The significance of this work lies in its potential to provide valuable insights into the experiences of PwMS with cognitive concerns and to develop new tools for clinical trials aimed at stabilizing cognitive impairment progression in multiple sclerosis and other neurodegenerative diseases. Project Number: 1K23HD116016-01A1 | Fiscal Year: 2025 | NIH Institute/Center: Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) | Principal Investigator: ALYSSA NYLANDER | Institution: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO, SAN FRANCISCO, CA | Award Amount: $173,232 | Activity Code: K23 | Study Section: Function, Integration, and Rehabilitation Sciences Study Section[CHHD-K] View on NIH RePORTER: https://reporter.nih.gov/project-details/1K23HD11601601A1