Normative values of the Rao's Brief Repeatable Battery in an Italian young adolescent population: the influence of age, gender, and education

Assessment of cognitive functions in patients with multiple sclerosis applying the normative values of the Rao's brief repeatable battery in the Portuguese population

Background

The Brief Repeatable Battery of Neuropsychological Tests (BRBN-T) is one of the most sensitive and used measures for detecting cognitive impairment in Multiple Sclerosis (MS).

Objective

The aim of this study was to adapt and validate this battery to the Portuguese population of MS patients.

Methods

The Portuguese version of the BRBN-T was applied to a stratified control national sample of 326 individuals considering sex, age, educational level and geographic location and also a clinical sample of 115 MS patients from several national hospitals. Through the exploration of its psychometrics properties, the Portuguese BRBN-T norms were produced.

Results

The normative data is presented as a regression-based formula to adjust test scores for gender, education and age, and the results reveal the BRBN-T has the ability to differentiate between MS patients and healthy participant’s cognitive performance.

Conclusion

This study demonstrated in our clinical population a good ability to detect cognitive impairment. Its clearly contributed to reinforcing the neuropsychological assessment in Portugal in patients with MS, by providing a new set of instruments, which can be used in the clinical practice, and in future studies. Moreover, it will allow a rigorous and precise support in relation to neuropsychological assessment for future longitudinal studies and clinical trials.

Cognitive Assessment and Rehabilitation for Pediatric-Onset Multiple Sclerosis: A Scoping Review

Cognitive impairment is increasingly recognized as an important clinical issue in pediatric multiple sclerosis (MS). However, variations regarding its assessment and remediation are noted in clinical arena. This scoping review aims to collate available evidence concerning cognitive assessment tool and cognitive rehabilitation for pediatric MS. We performed a systematic search of electronic databases (MEDLINE, PubMed, CINAHL Plus, and Web of Science) from inception to February 2020. Reference lists of included articles and trial registers were also searched. We included original studies published in English that addressed cognitive assessment tools or cognitive rehabilitation for pediatric-onset MS. Fourteen studies fulfilled our inclusion criteria. Among them, 11 studies evaluated the psychometric aspects of various cognitive assessment tools in the context of pediatric MS, and different neuro-cognitive domains were emphasized across studies. There were only three pilot studies reporting cognitive rehabilitation for pediatric-onset MS, all of which used home-based computerized programs targeting working memory and attention, respectively. Overall, more systematic research on cognitive assessment tools and rehabilitation for pediatric MS is needed to inform evidence-based practice. Computer-assisted cognitive assessment and rehabilitation appear feasible and deserve further studies.

Associations between cognitive impairment at onset and disability accrual in young people with multiple sclerosis

Differently from the adult multiple sclerosis (MS) population, the predictive value of cognitive impairment in early-onset MS is still unknown. We aim to evaluate whether cognitive performances at disease onset predict disease progression in young people with MS. This is a retrospective study on early onset (<25 years) MS patients, who had a baseline cognitive evaluation at disease onset. Demographic and longitudinal clinical data were collected up to 7 years follow up. Cognitive abilities were assessed at baseline through the Brief Repeatable Battery. Associations between cognitive abilities and clinical outcomes (occurrence of a relapse, and 1-point EDSS progression) were evaluated with stepwise logistic and Cox regression models. We included 51 patients (26 females), with a mean age at MS onset of 17.2 ± 3.9 years, and an EDSS of 2.5 (1.0–6.0). Over the follow-up, twenty-five patients had at least one relapse, and 7 patients had 1-point EDSS progression. Relapse occurrence was associated with lower 10/36 SPART scores (HR = 0.92; p = 0.002) and higher WLG scores (HR = 1.05; p = 0.01). EDSS progression was associated with lower SDMT score (OR: 0.70; p = 0.04). Worse visual memory and attention/information processing were associated with relapses and with increased motor disability after up to 7-years follow-up. Therefor, specific cognitive subdomains might better predict clinical outcomes than the overall cognitive impairment in early-onset MS.