There is considerable evidence that persons with multiple sclerosis (PwMS) who experience cognitive impairments (CI) are at risk of having significant limitations in activities of daily living (ADLs). However, ADL assessment often consists of proxies or self-report of ADLs. The current study examined whether the performance of instrumental ADLs (I-ADL) is impaired in PwMS with and without CI, by using the internet to assess actual everyday life functional activity.

Participants included 72 PwMS and 48 matched healthy controls (HC).  PwMS were divided into MS-CI (n = 25) and MS–not–impaired (n = 47) groups based on the Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS) scores. All participants performed the Actual Reality^TM (AR) test, measuring I-ADL using authentic websites. AR uses actual internet sites to assess the following functional activity: book a flight to Florida (i.e., United.com), puchase pizza (i..e, pizzahut.com) and purchase cookies for a party. For successful performance, participants must adhere to specified task requirements such as price range, destination, delivery rates, and preferences.

The MS-CI performed significantly worse on AR compared with HC and MS-not-impaired. Additionally, the MS-not-impaired performed significantly worse than HC on AR, despite not displaying cognitive impairment.

While CI in MS results in significant limitations in the performance of I-ADL, PwMS who do not show evidence of CI can have limitations in I-ADL. AR assessment is a valid and reliable tool sensitive to CI. It should be used in addition to traditional cognitive assessments to detect early functional deterioration through the course of MS.