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Abstract
Abstract. Neuropsychological deficits in multiple sclerosis (MS) are common. Over the past decades, many different procedures have been employed in diagnosing these deficits. Even though certain aspects of cognitive performance such as information processing speed and working memory may be affected more frequently than other cognitive functions, no specific deficit profile has been established in MS. This article provides an overview of the neuropsychological diagnostic procedures in MS and allows the reader to reach an informed decision on the applicability of specific procedures and the availability of study data in the context of MS. Additionally, it makes recommendations on the compilation of both screening procedures and extensive test batteries.
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Affiliation(s)
- Sascha Hansen
- Klinikum Bayreuth GmbH, Betriebsstätte Hohe Warte, Department of Neurology, Bayreuth, Germany
- Otto-Friedrich-University, Department of Physiological Psychology, Bamberg, Germany
| | - Stefan Lautenbacher
- Otto-Friedrich-University, Department of Physiological Psychology, Bamberg, Germany
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Abstract
Of the more than two million people worldwide with multiple sclerosis, 40% to 65% experience cognitive impairment, many of them early in the course of the disease. Cognitive impairment has been found in patients with all subtypes of multiple sclerosis. Because both pharmacologic and nonpharmacologic interventions may improve patients' brain function, cognitive assessment should be a routine part of the clinical evaluation. Traditional paper-and-pencil neuropsychological tests and batteries can help detect and monitor patients' cognitive problems. Computerized cognitive batteries also show promise. Controversy continues over which test is most reliable at assessing cognitive impairment in both everyday clinical practice and research. Each battery has possible disadvantages, such as practice effects, poor sensitivity and specificity, and questionable applicability to multiple sclerosis. Based on our review of the literature, we describe the tests that are currently being used or that might be used in assessing cognitive deficits in patients with multiple sclerosis, and we summarize the strengths and limitations of each.
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Waldman AT, Chahin S, Lavery AM, Liu G, Banwell BL, Liu GT, Balcer LJ. Binocular low-contrast letter acuity and the symbol digit modalities test improve the ability of the Multiple Sclerosis Functional Composite to predict disease in pediatric multiple sclerosis. Mult Scler Relat Disord 2016; 10:73-8. [PMID: 27919503 DOI: 10.1016/j.msard.2016.08.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 06/24/2016] [Accepted: 08/25/2016] [Indexed: 12/14/2022]
Abstract
BACKGROUND Outcome measures to capture disability, such as the Multiple Sclerosis Functional Composite (MSFC), were developed to enhance outcome measurements for clinical trials in adults with multiple sclerosis (MS). The MSFC initially included three components: a timed 25-foot walk [T25FW], 9-hole peg test [9HPT], and the Paced Auditory Serial Addition Task [PASAT]. Modifications to the original MSFC, such as adding binocular low-contrast letter acuity (LCLA) or substituting the symbol digit modalities test (SDMT) for the PASAT, improved the capacity to capture neurologic impairment in adults. Similar outcome scales for pediatric MS have not yet been established. OBJECTIVE To determine whether the three-component MSFC or a modified MSFC with LCLA and the SDMT better identifies neurological deficits in pediatric MS. METHODS We evaluated 5 measures (T25FW, 9HPT, Children's PASAT [ChiPASAT], SDMT, and binocular LCLA [Sloan charts, 1.25% contrast]) in children with MS (disease onset <18 years) and healthy controls. To be able to compare measures whose scores have different scales, Z-scores were also created for each test based on the numbers of standard deviations from a control group mean, and these individual scale scores were combined to create composite scores. Logistic regression models, accounting for age, were used to determine whether the standard 3-component MSFC or modified versions (including 4 or 5 metrics) best distinguished children with MS from controls. RESULTS Twenty pediatric-onset MS subjects, aged 6-21 years, and thirteen healthy controls, aged 6-19 years, were enrolled. MS subjects demonstrated worse scores on the 9HPT (p=0.004) and SDMT (p=0.001), but not the 25FTW (adjusted for height, p=0.63) or the ChiPASAT (p=0.10): all comparisons adjusted for age. Decreased (worse) binocular LCLA scores were associated with MS (vs. control status, p=0.03, logistic regression; p=0.08, accounting for age). The MSFC composite score for the traditional 3 components did not differ between the groups (p=0.28). Replacing the ChiPASAT with the SDMT (OR 0.72, p=0.05) better distinguished MS from controls. A modified MSFC-4 with the SDMT replacing the ChiPASAT and including binocular 1.25% LCLA had the greatest capacity to distinguish pediatric MS from controls (OR 0.89, p=0.04, logistic regression). Including all 5 metrics as a composite MSFC-5 did not improve the model (p=0.18). CONCLUSIONS A modified MSFC (25FTW, 9HPT, SMDT, and binocular 1.25% LCLA) is more sensitive than the traditional MSFC or its components to capture the subtle impairments that characterize pediatric MS and should be validated in order to be considered for future pediatric MS trials.
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Arli B, Bilen S, Titiz AP, Ulusoy EK, Mungan S, Gurkas E, Oztekin ZN, Ozcan M, Ak F. Comparison of Cognitive Functions Between Obstructive Sleep Apnea Syndrome and Simple Snoring Patients: OSAS May Be a Modifiable Risk Factor for Cognitive Decline. Appl Neuropsychol Adult 2014; 22:282-6. [PMID: 25496060 DOI: 10.1080/23279095.2014.925901] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
By comparing neurocognitive test results from patients with obstructive sleep apnea syndrome (OSAS) and those from patients with simple snoring, we aimed to establish whether OSAS negatively influences cognition. Patients with mild-to-severe OSAS (n = 29) and nonhypoxic simple-snoring patients (n = 30) were admitted to the study. All participants in both groups were evaluated with polysomnography and neurocognitive tests, including the Stroop Test, Rey Auditory Verbal Learning Test, Judgment of Line Orientation, Trail-Making Test, and Symbol Digit Modalities Test (SDMT). Significant differences were identified between the groups for test scores on the Rey 1, SDMT, and Stroop tests. We propose that accurate OSAS diagnosis and treatment might help to prevent cognitive decline.
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Affiliation(s)
- Berna Arli
- a Neurology , Ankara Numune Education and Research Hospital , Ankara , Turkey
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Weier K, Penner IK, Magon S, Amann M, Naegelin Y, Andelova M, Derfuss T, Stippich C, Radue EW, Kappos L, Sprenger T. Cerebellar abnormalities contribute to disability including cognitive impairment in multiple sclerosis. PLoS One 2014; 9:e86916. [PMID: 24466290 PMCID: PMC3899307 DOI: 10.1371/journal.pone.0086916] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Accepted: 12/16/2013] [Indexed: 01/11/2023] Open
Abstract
The cerebellum is known to be involved not only in motor but also cognitive and affective processes. Structural changes in the cerebellum in relation to cognitive dysfunction are an emerging topic in the field of neuro-psychiatric disorders. In Multiple Sclerosis (MS) cerebellar motor and cognitive dysfunction occur in parallel, early in the onset of the disease, and the cerebellum is one of the predilection sites of atrophy. This study is aimed at determining the relationship between cerebellar volumes, clinical cerebellar signs, cognitive functioning and fatigue in MS. Cerebellar volumetry was conducted using T1-weighted MPRAGE magnetic resonance imaging of 172 MS patients. All patients underwent a clinical and brief neuropsychological assessment (information processing speed, working memory), including fatigue testing. Patients with and without cerebellar signs differed significantly regarding normalized cerebellar total volume (nTCV), normalized brain volume (nBV) and whole brain T2 lesion volume (LV). Patients with cerebellar dysfunction likewise performed worse in cognitive tests. A regression analysis indicated that age and nTCV explained 26.3% of the variance in SDMT (symbol digit modalities test) performance. However, only age, T2 LV and nBV remained predictors in the full model (r2 = 0.36). The full model for the prediction of PASAT (Paced Auditory Serial Addition Test) scores (r2 = 0.23) included age, cerebellar and T2 LV. In the case of fatigue, only age and nBV (r2 = 0.17) emerged as significant predictors. These data support the view that cerebellar abnormalities contribute to disability, including cognitive impairment in MS. However, this contribution does not seem to be independent of, and may even be dominated by wider spread MS pathology as reflected by nBV and T2 LV.
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Affiliation(s)
- Katrin Weier
- Department of Neurology, University Hospital Basel, Basel, Switzerland
- * E-mail:
| | - Iris K. Penner
- Department of Neurology, University Hospital Basel, Basel, Switzerland
- Department of Cognitive Psychology and Methodology, University of Basel, Basel, Switzerland
| | - Stefano Magon
- Department of Neurology, University Hospital Basel, Basel, Switzerland
| | - Michael Amann
- Department of Neurology, University Hospital Basel, Basel, Switzerland
- Department of Radiology, Division of Neuroradiology, University Hospital Basel, Basel, Switzerland
| | - Yvonne Naegelin
- Department of Neurology, University Hospital Basel, Basel, Switzerland
| | - Michaela Andelova
- Department of Neurology, University Hospital Basel, Basel, Switzerland
| | - Tobias Derfuss
- Department of Neurology, University Hospital Basel, Basel, Switzerland
| | - Christoph Stippich
- Department of Radiology, Division of Neuroradiology, University Hospital Basel, Basel, Switzerland
| | - Ernst-Wilhelm Radue
- Medical Image Analysis Center (MIAC) AG, University Hospital Basel, Basel, Switzerland
| | - Ludwig Kappos
- Department of Neurology, University Hospital Basel, Basel, Switzerland
| | - Till Sprenger
- Department of Neurology, University Hospital Basel, Basel, Switzerland
- Department of Radiology, Division of Neuroradiology, University Hospital Basel, Basel, Switzerland
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Piri Cinar B, Ozakbas S, Idiman E. Evaluation of clinical parameters during and after treatment of attack in patients with clinically isolated syndrome: comparison of the results with that of multiple sclerosis patients. Clin Neurol Neurosurg 2013; 115:2432-7. [PMID: 24140010 DOI: 10.1016/j.clineuro.2013.09.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Revised: 08/30/2013] [Accepted: 09/08/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVES The aim of the present study was to examine the changes in the measurement of functions during and after pulse methylprednisolone (MP) treatment during a clinically isolated syndrome (CIS) attack, using the multiple sclerosis functional composite (MSFC) and Expanded Disability Status Scale (EDSS), and to compare the results with that of MS patients. PATIENTS AND METHOD The present study included 44 patients with CIS and 26 patients with clinically definite multiple sclerosis (MS), as the control group. All patients were having an acute attack and were treated with 1000-mg intravenous methylprednisolone. The scales were administered before-and after-treatment, and at 30 days after treatment. RESULTS A 5-days treatment was adequate in 36.9% of CIS patients and 62.5% of MS patients (p=0.003). A moderate correlation was found between Auditory Consonant Trigram Test (ACT) and paced auditory serial addition test in CIS patients before-treatment. A poor correlation was found between EDSS scores and ACT in CIS patients at all measurement periods. The level of correlation between EDSS and ACT scores was similar in MS patients. CONCLUSION Although MS and CIS patients show similar response to corticosteroid treatment and had similar fatigue characteristics, overall cognitive functioning was better in CIS patients.
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Sonder JM, Burggraaff J, Knol DL, Polman CH, Uitdehaag BMJ. Comparing long-term results of PASAT and SDMT scores in relation to neuropsychological testing in multiple sclerosis. Mult Scler 2013; 20:481-8. [DOI: 10.1177/1352458513501570] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background and objectives: The Symbol Digit Modalities Test (SDMT) shows advantages over the Paced Auditory Serial Addition Test (PASAT) as a cognitive test in patients with multiple sclerosis (MS). To determine which of these tests is most valid and reliable over time as an indicator of the cognitive state of MS patients, long-term test results of both tests were compared in relation to scores of the Brief Repeatable Battery of Neuropsychological tests (BRBN). Methods: For 485 MS patients visiting the VU University Medical Center Amsterdam for different research projects, a total number of 1078 visits with BRBN (including PASAT and SDMT) was planned. Observed and model-based correlations were used to calculate the construct validity of the SDMT and PASAT 3 seconds test (PASAT3) by comparing correlations with the BRBN-sumscore. The test-retest reliability of each test was also computed. Results: For the construct validity, higher correlations were found between SDMT and BRBN compared to PASAT3 and BRBN, especially for the model-based correlations at baseline. The reliability of the measurements was good for all instruments, with the highest coefficients for the SDMT. Conclusion: As a single assessment tool for cognition in MS, the SDMT is more valid and reliable compared to PASAT3.
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Affiliation(s)
- Judith M Sonder
- Department of Epidemiology and Biostatistics, The Netherlands
- Department of Neurology, VU University Medical Center, The Netherlands
| | | | - Dirk L Knol
- Department of Epidemiology and Biostatistics, The Netherlands
| | - Chris H Polman
- Department of Neurology, VU University Medical Center, The Netherlands
| | - Bernard MJ Uitdehaag
- Department of Epidemiology and Biostatistics, The Netherlands
- Department of Neurology, VU University Medical Center, The Netherlands
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Kiiski H, Reilly R, Lonergan R, Kelly S, O'Brien M, Kinsella K, Bramham J, Burke T, O'Donnchadha S, Nolan H, Hutchinson M, Tubridy N, Whelan R. Change in PASAT performance correlates with change in P3 ERP amplitude over a 12-month period in multiple sclerosis patients. J Neurol Sci 2011; 305:45-52. [DOI: 10.1016/j.jns.2011.03.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2010] [Revised: 02/28/2011] [Accepted: 03/04/2011] [Indexed: 11/24/2022]
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Whelan R, Lonergan R, Kiiski H, Nolan H, Kinsella K, Bramham J, O’brien M, Reilly R, Hutchinson M, Tubridy N. A high-density ERP study reveals latency, amplitude, and topographical differences in multiple sclerosis patients versus controls. Clin Neurophysiol 2010; 121:1420-6. [DOI: 10.1016/j.clinph.2010.03.019] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2009] [Revised: 03/16/2010] [Accepted: 03/17/2010] [Indexed: 11/24/2022]
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Horowski S, Zettl UK, Benecke R, Walter U. Sonographic basal ganglia alterations are related to non-motor symptoms in multiple sclerosis. J Neurol 2010; 258:195-202. [DOI: 10.1007/s00415-010-5707-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2010] [Accepted: 08/09/2010] [Indexed: 10/19/2022]
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Whelan R, Lonergan R, Kiiski H, Nolan H, Kinsella K, Hutchinson M, Tubridy N, Reilly RB. Impaired information processing speed and attention allocation in multiple sclerosis patients versus controls: a high-density EEG study. J Neurol Sci 2010; 293:45-50. [PMID: 20399448 DOI: 10.1016/j.jns.2010.03.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2009] [Revised: 03/10/2010] [Accepted: 03/11/2010] [Indexed: 11/20/2022]
Abstract
BACKGROUND The no-go P3a is a variant of the P300 event-related potential (ERP) that indexes speed of information processing and attention allocation. The aim of this study was to compare ERP findings with results from the paced auditory serial addition test (PASAT) and to quantify latency, amplitude and topographical differences in P3a ERP components between multiple sclerosis (MS) patients and controls. PATIENTS AND METHODS Seventy-four subjects (20 relapsing remitting (RRMS) patients, 20 secondary progressive (SPMS) patients and 34 controls) completed a three-stimulus oddball paradigm (target, standard, and non-target). Subjects participated in separate visual and auditory tasks while data were recorded from 134 EEG channels. Latency differences were tested using an ANCOVA. Topographical differences were tested using statistical parametric mapping. RESULTS Visual P3a amplitude correlated with PASAT score in all MS patients over frontal and parietal areas. There were significant differences in latency, amplitude, and topography between MS patients and controls in the visual condition. RRMS and SPMS patients differed in visual P3a latency and amplitude at frontal and parietal scalp regions. In the auditory condition, there were latency differences between MS patients and controls only over the parietal region. CONCLUSION The present results demonstrate that information processing speed and attention allocation are impaired in MS.
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Affiliation(s)
- R Whelan
- Department of Neurology, St. Vincent's University Hospital, University College Dublin, Dublin, Ireland.
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Weinges-Evers N, Brandt AU, Bock M, Pfueller CF, Dörr J, Bellmann-Strobl J, Scherer P, Urbanek C, Boers C, Ohlraun S, Zipp F, Paul F. Correlation of self-assessed fatigue and alertness in multiple sclerosis. Mult Scler 2010; 16:1134-40. [DOI: 10.1177/1352458510374202] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Fatigue is the most common symptom in multiple sclerosis patients, but is difficult to measure; quantification thus relies on self-assessed questionnaires. Objective: To evaluate a battery of neuropsychological tests regarding their capacity to objectify self-reported fatigue. Methods: We assessed the correlation between age, gender, education, Kurtzke’s Expanded Disability Status Scale, depression, fatigue and neuropsychological testing using a cross-sectional approach in 110 multiple sclerosis patients. Fatigue was measured with the Fatigue Severity Scale. Cognition was measured using a series of neuropsychological tests including three subtests of the Test of Attentional Performance, the Brief Repeatable Battery of Neuropsychological Tests and the Faces Symbol Test. Results: According to the Fatigue Severity Scale 51.4% of the cohort were fatigued (scores ≥4). Age, education and depression showed a significant correlation with the Fatigue Severity Scale. Only 5.5% of the cohort exhibited cognitive impairment in the Brief Repeatable Battery of Neuropsychological Tests scores. After correction for age, education, Expanded Disability Status Scale and depression, Fatigue Severity Scale scores were an independent predictor of performance in the alertness subtest of the Test of Attentional Performance (standardized coefficient beta = 0.298, p = 0.014). Conclusion: The alertness subtest of the Test of Attentional Performance may offer an objective method of evaluating self-reported fatigue, and may therefore — in addition to the Fatigue Severity Scale — be a suitable tool for the assessment of multiple sclerosis patients complaining of fatigue.
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Affiliation(s)
- Nicholetta Weinges-Evers
- NeuroCure Clinical Research Center, Charité - University Medicine Berlin, Germany, Cecilie Vogt Clinic, Charité - University Medicine Berlin, Germany
| | - Alexander U Brandt
- NeuroCure Clinical Research Center, Charité - University Medicine Berlin, Germany, Mediber GmbH, Berlin, Germany
| | - Markus Bock
- NeuroCure Clinical Research Center, Charité - University Medicine Berlin, Germany, Cecilie Vogt Clinic, Charité - University Medicine Berlin, Germany
| | - Caspar F Pfueller
- NeuroCure Clinical Research Center, Charité - University Medicine Berlin, Germany, Cecilie Vogt Clinic, Charité - University Medicine Berlin, Germany
| | - Jan Dörr
- NeuroCure Clinical Research Center, Charité - University Medicine Berlin, Germany, Cecilie Vogt Clinic, Charité - University Medicine Berlin, Germany
| | | | - Peter Scherer
- Neurology Practice Scherer, Kantstrasse 125, 10625 Berlin, Germany
| | - Carsten Urbanek
- Department of Psychiatry and Psychotherapy, Campus Benjamin Franklin, Charité - University Medicine Berlin, Germany
| | - Claudia Boers
- NeuroCure Clinical Research Center, Charité - University Medicine Berlin, Germany
| | - Stephanie Ohlraun
- NeuroCure Clinical Research Center, Charité - University Medicine Berlin, Germany
| | - Frauke Zipp
- Cecilie Vogt Clinic, Charité - University Medicine Berlin, Germany
| | - Friedemann Paul
- NeuroCure Clinical Research Center, Charité - University Medicine Berlin, Germany, Cecilie Vogt Clinic, Charité - University Medicine Berlin, Germany,
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Forn C, Belenguer A, Belloch V, Sanjuan A, Parcet MA, Ávila C. Anatomical and functional differences between the Paced Auditory Serial Addition Test and the Symbol Digit Modalities Test. J Clin Exp Neuropsychol 2010; 33:42-50. [DOI: 10.1080/13803395.2010.481620] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Cristina Forn
- a Universitat Jaume I, Departament de Psicologia Bàsica, Clínica i Psicobiología , Castelló de la Plana, Spain
| | - Antonio Belenguer
- b Hospital General de Castelló, Servicio de Neurología , Castelló de la Plana, Spain
| | | | - Ana Sanjuan
- a Universitat Jaume I, Departament de Psicologia Bàsica, Clínica i Psicobiología , Castelló de la Plana, Spain
| | - M. Antonia Parcet
- a Universitat Jaume I, Departament de Psicologia Bàsica, Clínica i Psicobiología , Castelló de la Plana, Spain
| | - César Ávila
- a Universitat Jaume I, Departament de Psicologia Bàsica, Clínica i Psicobiología , Castelló de la Plana, Spain
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Drake AS, Weinstock-Guttman B, Morrow SA, Hojnacki D, Munschauer FE, Benedict RHB. Psychometrics and normative data for the Multiple Sclerosis Functional Composite: replacing the PASAT with the Symbol Digit Modalities Test. Mult Scler 2009; 16:228-37. [PMID: 20028710 DOI: 10.1177/1352458509354552] [Citation(s) in RCA: 191] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The MS Functional Composite (MSFC) is a continuous scale of neurological disability for patients with multiple sclerosis (MS). Cognition is represented by the Paced Auditory Serial Addition Test (PASAT), although the Symbol Digit Modalities Test (SDMT) has been proposed as a promising alternative. MSFC scores were calculated using either the PASAT or the SDMT with the following reference populations: National Multiple Sclerosis Society (NMSS) Task Force, 400 MS patients, and 100 normal controls. A subgroup of 115 patients was followed longitudinally, with a test-retest interval of 2.3 +/- 1.2 years. Pearson correlations were calculated and analyses of variance (ANOVAs) were used to assess relationships among the MSFC components and composite scores, and differences in performance between patients and controls. Longitudinal changes were also assessed. Logistic regression was performed to determine which MSFC scores are most predictive of diagnosis, course, and work disability. All MSFCs had similar test-retest reliability and correlations with other measures including neurological disability, depression, and fatigue. The SDMT showed slightly better validity with respect to predicting diagnosis, course, and work disability, although the amount of variance accounted for was similar for each version of the MSFC. Our data, derived from a large sample of MS patients and normal controls, supports the validity of both PASAT and SDMT versions of the MSFC. Because the SDMT has slightly better predictive validity and has a relatively easier administration procedure, some clinicians and researchers may wish to replace the PASAT with the SDMT in future calculations of the MSFC using the calculation methods provided in this manuscript.
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Affiliation(s)
- A S Drake
- Department of Neurology, State University of New York (SUNY) at Buffalo School of Medicine, Buffalo, NY, USA
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Abstract
Cognitive impairment is common in multiple sclerosis (MS), occurring at all stages of the disease, even at the earliest, and can be a major source of disability, social impairment, and impoverished quality of life. Cognitive dysfunction is mainly focused on working memory, conceptual reasoning, verbal fluency, speed of information processing, attention and executive function. Measures of information-processing speed appear to be the most robust and sensitive markers of cognitive impairment in MS patients. Cognitive testing in MS patients is complex and cognitive screening tests are time- and cost-saving test instruments. A comprehensive and sensitive cognitive test procedure should be administered to detect cognitive dysfunction, and recent studies demonstrate that single, predominantly speed-related cognitive tests may be superior to extensive and time-consuming test batteries in screening cognitive decline. Additional clinical factors, including disease course, fatigue, and affective disturbance, can impact the degree of MS-related cognitive impairment. Despite weak correlation with disease duration and physical disability status, the degree of cognitive impairment in MS has been related to the extent of topographically specific neuronal tissue damage and loss. Numerous studies have applied conventional and quantitative magnetic resonance imaging (MRI) techniques to correlate the profile and degree of cognitive impairment with various MRI-detectable abnormalities. The burden of MRI-visible lesions does not fully account for the degree of MS-related cognitive impairment. Nonconventional MRI findings suggest the extent of subtle tissue damage in normal-appearing white and grey matter to correlate best with the severity of cognitive impairment in MS patients. Structural MRI approaches have recently been extended by functional MRI studies scrutinizing the brain's ability for adaptive functional reorganization in the presence of widespread tissue damage. Cognitive impairment in MS seems to be not simply the result of tissue destruction, but also a balance between tissue destruction, tissue repair, and adaptive functional reorganization. These findings highlight the need to screen for cognitive deficits in MS patients to conduct potential cognitive rehabilitation intervention.
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Affiliation(s)
- F Reuter
- Pôle de Neurosciences Cliniques, Service de Neurologie, CHU Timone, Rue Saint Pierre, 13385 Marseille cedex 5, France
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Kocer B, Unal T, Nazliel B, Biyikli Z, Yesilbudak Z, Karakas S, Irkec C. Evaluating sub-clinical cognitive dysfunction and event-related potentials (P300) in clinically isolated syndrome. Neurol Sci 2008; 29:435-44. [PMID: 19002651 DOI: 10.1007/s10072-008-1020-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2008] [Accepted: 09/09/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVE This study investigated the presence of sub-clinical cognitive dysfunction in patients with clinically isolated syndrome (CIS) and the abnormalities of cognitive event-related potentials (ERPs). METHODS Subclinical cognitive dysfunction was assessed in 20 patients with CIS and in 20 healthy controls. RESULTS Patients had impairments in verbal learning and long-term memory, evaluating attention, executive function and visuospatial skills, in decreasing order of frequency. SDLT and SIT were the most, and COWAT and BNT were the least affected tests. The N200 and P200 latencies were prolonged, and N100, N200 and P200 amplitudes were reduced in the patients relative to the controls, from the Fz, Cz and Pz electrode positions (p<0.05). CONCLUSION Detailed cognitive testing is valuable in determining subclinical cognitive dysfunction in CIS patients. ERP abnormalities as well as abnormalities in detailed cognitivetesting in patients with CIS are helpful in the diagnosis of sub-clinical cognitive dysfunction.
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Grabner RH, Popotnig F, Ropele S, Neuper C, Gorani F, Petrovic K, Ebner F, Strasser-Fuchs S, Fazekas F, Enzinger C. Brain activation patterns elicited by the `Faces Symbol Test' — a pilot fMRI study. Mult Scler 2008; 14:354-63. [DOI: 10.1177/1352458507084030] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The Faces Symbol Test (FST) has recently been proposed as a brief and patient-friendly screening instrument for the assessment of cognitive dysfunction in patients with multiple sclerosis (MS). However, in contrast to well-established MS screening tests such as the Paced Auditory Serial Addition Test, the neural correlates of the FST have not been investigated so far. In the present study, we developed a functional MRI (fMRI) version of the FST to provide first data on brain regions and networks involved in this test. A sample of 19 healthy participants completed a version of the FST adapted for fMRI, requiring matching of faces and symbols in a multiple choice test and two further experimental conditions drawing on cognitive subcomponents (face matching and symbol matching). Imaging data showed a differential involvement of a fronto-parieto-occipital network in the three conditions. The most demanding FST condition elicited brain activation patterns related with sustained attention and executive control. These results suggest that the FST recruits brain networks critical for higher-order cognitive functions often impaired in MS patients. Multiple Sclerosis 2008; 14: 354—363. http://msj.sagepub.com
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Affiliation(s)
- RH Grabner
- Institute of Psychology, University of Graz, Austria, Section of Neuroradiology, Department of Radiology, Medical University of Graz, Austria
| | - F. Popotnig
- Institute of Psychology, University of Graz, Austria
| | - S. Ropele
- Department of Neurology, Medical University of Graz, Austria
| | - C. Neuper
- Institute of Psychology, University of Graz, Austria
| | - F. Gorani
- Department of Neurology, Medical University of Graz, Austria
| | - K. Petrovic
- Department of Neurology, Medical University of Graz, Austria
| | - F. Ebner
- Section of Neuroradiology, Department of Radiology, Medical University of Graz, Austria
| | | | - F. Fazekas
- Department of Neurology, Medical University of Graz, Austria
| | - C. Enzinger
- Section of Neuroradiology, Department of Radiology, Medical University of Graz, Austria, , , Department of Neurology, Medical University of Graz, Austria
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Abstract
PURPOSE OF REVIEW For a long time, cognitive impairment in multiple sclerosis patients has been considered less important than, for instance, physical disability. This is no longer true because of the crucial role that cognitive deficits play in the good day-to-day adjustment of patients. This review highlights recent progress made in this area. A special focus lies on studies investigating the neural correlates of cognitive impairment in multiple sclerosis patients as detectable by conventional, quantitative and functional magnetic resonance imaging. RECENT FINDINGS Measures of information-processing speed appear to be the most robust and sensitive markers of cognitive impairment in multiple sclerosis patients. Recent studies demonstrate that single, predominantly speed-related cognitive tests may be superior to extensive and time-consuming test batteries in screening overall cognitive decline. Quantitative magnetic-resonance-imaging findings suggest the extent of subtle tissue damage in normal-appearing white and grey matter to correlate best with the severity of cognitive impairment in multiple sclerosis patients. SUMMARY From neuropsychological test data, and findings from magnetic resonance imaging and functional magnetic resonance imaging it is evident that cognitive impairment in multiple sclerosis is not just the result of tissue destruction, but rather a balance between tissue destruction, tissue repair, and adaptive functional reorganization.
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Affiliation(s)
- Stefanie Hoffmann
- Max Planck Institute of Human Cognitive and Brain Sciences, Leipzig, Germany
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