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Nyári A, Kokas Z, Szamosi S, Fricska-Nagy Z, Kincses ZT, Füvesi J, Biernacki T, Klivényi P, Bencsik K, Sandi D. Fatigue and depression influence the prevalence of anxiety in patients with multiple sclerosis. Neurol Sci 2024:10.1007/s10072-024-07737-9. [PMID: 39174771 DOI: 10.1007/s10072-024-07737-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Accepted: 08/19/2024] [Indexed: 08/24/2024]
Abstract
BACKGROUND There is scarce information in Middle-Eastern Europe regarding the prevalence of anxiety in patients with multiple sclerosis (pwMS) and its association with different clinical-demographic factors. OBJECTIVE We aimed to determine the prevalence of anxiety in Hungarian MS patients and to analyze associated factors. MATERIALS AND METHODS We evaluated 260 PwMS with the STAI-5 anxiety questionnaire. Fatigue (FIS), depression (BDI-II) and cognition (BICAMS) were also measured. Patients underwent standard neurological evaluations to evaluate Expanded Disability Status Scale (EDSS), and also measured the fine motor skills of the hand with the 9-hole peg test (9HPT), and the walking distance with the 25-foot walking test (T25FW). RESULTS We identified 23.1% (N = 60) of the patients with anxiety (only state, trait or both forms concurrently). According to our two univariate, multivariable logistic regression analysis, fatigue and depression are strongly associated with both state and trait anxiety. In the absence of fatigue, the odds of trait anxiety are 82% lower (OR: 0.18; 95% CI: 0.06-0.53; p = 0.002), while in the case of pwMS without depression, the odds are reduced by 81% (OR: 0.19; CI95%= 0.07-0.51, p = 0.001). This association with fatigue (OR: 0.33; CI95%= 0.13-0.85, p = 0.021) and depression (OR: 0.14; CI95%=0.06-0.35; p < 0.001) can also be statistically verified on state anxiety. Importantly, a significant association with state anxiety was found in SPSM patients as well (OR: 34.94; CI95%=2.55-479.61; p = 0.008). CONCLUSIONS Anxiety was strongly associated with fatigue, depression, and secondary progressive disease form. These results emphasize the burden of psychiatric morbidity in pwMS.
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Affiliation(s)
- Aliz Nyári
- Department of Neurology, Albert Szent-Györgyi Faculty of Medicine and Clinical Center, University of Szeged, Szeged, Hungary
| | - Zsófia Kokas
- Department of Neurology, Albert Szent-Györgyi Faculty of Medicine and Clinical Center, University of Szeged, Szeged, Hungary
| | - Szabolcs Szamosi
- Department of Neurology, Albert Szent-Györgyi Faculty of Medicine and Clinical Center, University of Szeged, Szeged, Hungary
| | - Zsanett Fricska-Nagy
- Department of Neurology, Albert Szent-Györgyi Faculty of Medicine and Clinical Center, University of Szeged, Szeged, Hungary
| | - Zsigmond Tamás Kincses
- Department of Radiology, Albert Szent-Györgyi Faculty of Medicine and Clinical Center, University of Szeged, Szeged, Hungary
| | - Judit Füvesi
- Department of Neurology, Albert Szent-Györgyi Faculty of Medicine and Clinical Center, University of Szeged, Szeged, Hungary
| | - Tamás Biernacki
- Department of Neurology, Albert Szent-Györgyi Faculty of Medicine and Clinical Center, University of Szeged, Szeged, Hungary
| | - Péter Klivényi
- Department of Neurology, Albert Szent-Györgyi Faculty of Medicine and Clinical Center, University of Szeged, Szeged, Hungary
| | - Krisztina Bencsik
- Department of Neurology, Albert Szent-Györgyi Faculty of Medicine and Clinical Center, University of Szeged, Szeged, Hungary
| | - Dániel Sandi
- Department of Neurology, Albert Szent-Györgyi Faculty of Medicine and Clinical Center, University of Szeged, Szeged, Hungary.
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Nyári A, Kokas Z, Szamosi S, Fricska-Nagy Z, Füvesi J, Kincses ZT, Biernacki T, Vécsei L, Klivényi P, Bencsik K, Sandi D. The 7-year follow-up of the Hungarian BICAMS validation cohort implies that cognitive performance may improve in multiple sclerosis patients. Neurol Sci 2024; 45:3369-3378. [PMID: 38280085 DOI: 10.1007/s10072-024-07347-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 01/22/2024] [Indexed: 01/29/2024]
Abstract
BACKGROUND Cognitive impairment (CI) is a frequent symptom of multiple sclerosis (MS) and has a great impact on the patients' quality of life, so screening is essential. The brief international cognitive assessment for multiple sclerosis (BICAMS) was developed for this purpose. However, longitudinal data is lacking with the use of the battery. OBJECTIVE This study is to assess the performance of patients after 5 and 7 years of the original BICAMS validation study and to identify any influencing factors. METHODS BICAMS was used to measure cognitive function of 52 relapsing-remitting MS patients (RRMS) from the original validation study after 5 years (n = 43) and again, after 7 years (n = 42). Patients filled out the fatigue impact scale (FIS) and multiple sclerosis quality of life-54 (MSQoL-54) questionnaire, and we evaluated expanded disability status scale (EDSS). RESULTS There was an improvement in the BVMT-R and the CVLT-II assessments at both the 5-year (p<0.001 and p=0.025) and the 7-year retest (p<0.001 and p=0.002). The prevalence of CI significantly decreased at the 5-year mark (p=0.021) but remained stable after that. There was no deterioration in MSQoL scores during the study. The basic cognitive performance is the most important influencing factor, but the duration of the disease, the EDSS score, and the escalation of the therapy also affect the cognitive scores. CONCLUSION This is the longest longitudinal study utilizing the BICAMS battery, reinforcing its feasibility as a clinical screening tool. It seems that cognitive performance may improve in the long term and early initiation of effective therapy may influence this outcome.
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Affiliation(s)
- Aliz Nyári
- Department of Neurology, Albert Szent-Györgyi Faculty of Medicine and Clinical Center, University of Szeged, Szeged, Hungary
| | - Zsófia Kokas
- Department of Neurology, Albert Szent-Györgyi Faculty of Medicine and Clinical Center, University of Szeged, Szeged, Hungary
| | - Szabolcs Szamosi
- Department of Neurology, Albert Szent-Györgyi Faculty of Medicine and Clinical Center, University of Szeged, Szeged, Hungary
| | - Zsanett Fricska-Nagy
- Department of Neurology, Albert Szent-Györgyi Faculty of Medicine and Clinical Center, University of Szeged, Szeged, Hungary
| | - Judit Füvesi
- Department of Neurology, Albert Szent-Györgyi Faculty of Medicine and Clinical Center, University of Szeged, Szeged, Hungary
| | - Zsigmond Tamás Kincses
- Department of Neurology, Albert Szent-Györgyi Faculty of Medicine and Clinical Center, University of Szeged, Szeged, Hungary
- Department of Radiology, Albert Szent-Györgyi Faculty of Medicine and Clinical Center, University of Szeged, Szeged, Hungary
| | - Tamás Biernacki
- Department of Neurology, Albert Szent-Györgyi Faculty of Medicine and Clinical Center, University of Szeged, Szeged, Hungary
| | - László Vécsei
- Department of Neurology, Albert Szent-Györgyi Faculty of Medicine and Clinical Center, University of Szeged, Szeged, Hungary
- ELKH - SZTE Neuroscience Research Group, Szeged, Hungary
| | - Péter Klivényi
- Department of Neurology, Albert Szent-Györgyi Faculty of Medicine and Clinical Center, University of Szeged, Szeged, Hungary
| | - Krisztina Bencsik
- Department of Neurology, Albert Szent-Györgyi Faculty of Medicine and Clinical Center, University of Szeged, Szeged, Hungary
| | - Dániel Sandi
- Department of Neurology, Albert Szent-Györgyi Faculty of Medicine and Clinical Center, University of Szeged, Szeged, Hungary.
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Abualhasan A, Naseer MA, Shalaby N, El-Jaafary SI, Farghaly M, Shehata HS, Doma ES, Al-Azayem SA. Reliability and validity of the Arabic version of brief international cognitive assessment for multiple sclerosis in Egyptian pediatric multiple sclerosis patients. Mult Scler Relat Disord 2024; 82:105374. [PMID: 38134604 DOI: 10.1016/j.msard.2023.105374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 12/02/2023] [Accepted: 12/10/2023] [Indexed: 12/24/2023]
Abstract
BACKGROUND & OBJECTIVES About one-third of pediatric-onset MS (POMS) patients report cognitive impairment. This case-control study aimed to assess the reliability and validity of the Arabic version of the Brief International Cognitive Assessment for MS (BICAMS) in Egyptian POMS patients. METHODS A case-control study was conducted on 30 POMS patients aged 9 to 17 years old and 30 healthy controls. Both groups underwent the following tests: neuropsychological testing using the BICAMS-validated Arabic version battery involving the Symbol Digit Modality Test (SDMT), California Verbal Learning Test 2nd edition (CVLT-II) and revised Brief Visuospatial Retention Test (BVRT-R). Test-retest data were obtained from MS patients and controls 2 weeks following the primary evaluation. Mean variances between both groups were evaluated, controlling for age, gender, and educational level. RESULTS MS patients scored significantly lower on the SDMT, CVLT-II, and BVMT-R tests than healthy controls (P-value <0.001). Test-retest reliability was satisfactory for SDMT, CVLT-II total, and BVRT-R in MS patients and controls with r values of 0.73, 0.83, and 0.80, respectively. CONCLUSION BICAMS is a feasible approach to cognitive screening in POMS and adults. The Arabic version of BICAMS is a reliable and valid tool for the cognitive assessment of pediatric MS patients in different clinical and research settings.
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Affiliation(s)
| | | | - Nevin Shalaby
- Department of Neurology, Cairo University, Cairo, Egypt
| | | | - Marwa Farghaly
- Department of Neurology, Cairo University, Cairo, Egypt.
| | | | - Ebtehal S Doma
- Department of Neurology, Cairo University, Cairo, Egypt.
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Takla TN, Chargo AN, Daugherty AM, Fritz NE. Cognitive Contributors of Backward Walking in Persons with Multiple Sclerosis. Mult Scler Int 2023; 2023:5582242. [PMID: 37600498 PMCID: PMC10438976 DOI: 10.1155/2023/5582242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 07/26/2023] [Accepted: 07/29/2023] [Indexed: 08/22/2023] Open
Abstract
Purpose Individuals with multiple sclerosis (MS) are at an increased fall risk due to motor and cognitive dysfunction. Our past studies suggest that backward walking (BW) velocity predicts fall risk; however, specific cognitive domains associated with BW velocity remain understudied. The goal of this study was to determine the specific contributions of cognitive functioning to BW velocity in persons with MS. We hypothesized that better visuospatial memory, verbal immediate recall, and faster information processing speed would contribute to faster BW velocity, and deficits in these domains would partially account for disease severity-related impairment in BW velocity. Methods Participants completed demographic questionnaires, walking tests, and cognitive assessments. Applied structural equation modeling was used to test our hypothesized model of competing cognitive mediators. Within the model, disease severity was a predictor of BW via three intercorrelated cognitive mediators. Results Participants included 39 individuals with relapsing-remitting MS. Results indicated that 35.3% of the significant total effect of disease severity on BW was accounted for by specific cognitive deficits. Verbal immediate recall had the largest contribution, followed by visuospatial memory and information processing speed. Conclusions When examining the unique effects of cognitive domains on disease severity-related deficits in BW, a meaningful source of impairment related to visuospatial memory and verbal immediate recall was demonstrated. Considering the utility of BW velocity as a predictor of falls, these results highlight the importance of assessing cognition when evaluating fall risk in MS. Cognitive-based intervention studies investigating fall prevention may find BW as a more specific and sensitive predictor of fall risk than forward walking.
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Affiliation(s)
- Taylor N. Takla
- Neuroimaging and Neurorehabilitation Laboratory, Wayne State University, Detroit, MI, USA
- Translational Neuroscience Program, Wayne State University, Detroit, MI, USA
| | - Alexis N. Chargo
- Department of Psychology, Wayne State University, Detroit, MI, USA
- Institute of Gerontology, Wayne State University, Detroit, MI, USA
| | - Ana M. Daugherty
- Translational Neuroscience Program, Wayne State University, Detroit, MI, USA
- Department of Psychology, Wayne State University, Detroit, MI, USA
- Institute of Gerontology, Wayne State University, Detroit, MI, USA
| | - Nora E. Fritz
- Neuroimaging and Neurorehabilitation Laboratory, Wayne State University, Detroit, MI, USA
- Translational Neuroscience Program, Wayne State University, Detroit, MI, USA
- Department of Health Care Sciences, Wayne State University, Detroit, MI, USA
- Department of Neurology, Wayne State University, Detroit, MI, USA
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Can Demirdöğen B, Kiliç OO, Yilmaz AA, Mungan S, Neşelioğlu S, Erel Ö. Neurocognitive impairment in multiple sclerosis and its association with thiol-disulfide homeostasis and ischemia-modified albumin. J Neurosci Res 2023; 101:508-523. [PMID: 36602284 DOI: 10.1002/jnr.25163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 12/05/2022] [Accepted: 12/15/2022] [Indexed: 01/06/2023]
Abstract
This study aimed to assess the possible association between cognitive impairment and two important biochemical biomarkers of oxidative stress, thiol-disulfide homeostasis (TDH), and ischemia-modified albumin (IMA) in patients with multiple sclerosis (MS). This study included 85 patients with MS (38 treatment-naïve relapsing-remitting MS (RRMS), 31 RRMS on fingolimod therapy, and 16 secondary progressive MS (SPMS)) and 33 healthy controls. Cognitive evaluation was carried out by applying the Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS) test battery and the scores were adjusted for age and years of education. Plasma TDH was assessed using an automated method and plasma IMA levels were determined using the cobalt-albumin binding assay. Plasma native thiol and total thiol levels were significantly decreased in patients with SPMS when compared with the naïve patients and healthy controls. Cognitive impairment was detected in 47.4% of naïve patients, 64.5% of patients on fingolimod therapy, and 80% of patients with SPMS. Naïve patients or patients on fingolimod therapy who were cognitively impaired had significantly decreased levels of native thiol and total thiol compared to the cognitively normal patients. Logistic regression analysis revealed total thiol and native thiol to be significantly associated with cognitive impairment in naïve patients and patients on fingolimod therapy. Significant correlations were determined between BICAMS scores, TDH, IMA, clinical indices of disease severity (EDSS and MSSS), and magnetic resonance imaging parameters. This study has shown for the first time that plasma TDH parameters are associated with cognitive impairment in MS.
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Affiliation(s)
- Birsen Can Demirdöğen
- Department of Biomedical Engineering, TOBB University of Economics and Technology, Ankara, Turkey
| | - Osman Oğuzhan Kiliç
- Department of Biomedical Engineering, TOBB University of Economics and Technology, Ankara, Turkey
| | - Ata Ayhan Yilmaz
- Department of Biomedical Engineering, TOBB University of Economics and Technology, Ankara, Turkey
| | - Semra Mungan
- Neurology Clinic, Ankara City Hospital, Ankara, Turkey
| | - Salim Neşelioğlu
- Department of Biochemistry, Faculty of Medicine, Yildirim Beyazit University, Ankara, Turkey
| | - Özcan Erel
- Department of Biochemistry, Faculty of Medicine, Yildirim Beyazit University, Ankara, Turkey
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A Systematic Review and Meta-Analysis of the Brief Cognitive Assessment for Multiple Sclerosis (BICAMS) International Validations. J Clin Med 2023; 12:jcm12020703. [PMID: 36675637 PMCID: PMC9863826 DOI: 10.3390/jcm12020703] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 01/03/2023] [Accepted: 01/09/2023] [Indexed: 01/17/2023] Open
Abstract
Cognitive impairment is a prevalent and debilitating symptom of multiple sclerosis (MS) but is not routinely addressed in clinical care. The Brief Cognitive Assessment for Multiple Sclerosis (BICAMS) was developed in 2012 to screen and monitor MS patients’ cognition. This systematic review and meta-analysis aimed to identify, synthesise, and critically appraise current BICAMS’ international validations. The literature search was conducted using PubMed, PsycINFO and Web of Science electronic databases in August 2022. Quantitative, peer-reviewed adult studies, which followed the BICAMS international validation protocol and were published in English, were included. The search identified a total of 203 studies, of which 26 were eligible for inclusion. These reported a total of 2833 adults with MS and 2382 healthy controls (HC). The meta-analysis showed that BICAMS identified impaired cognitive functioning in adults with MS compared to HC for all three subtests: information processing speed (g = 0.854, 95% CI = 0.765, 0.944, p < 0.001), immediate verbal recall (g = 0.566, 95% CI = 0.459, 0.673, p < 0.001) and immediate visual recall (g = 0.566, 95% CI = 0.487, 0.645, p < 0.001). Recruitment sites and strategies limit the generalisability of results. BICAMS is a valid and feasible international MS cognitive assessment.
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Karpuz Seren B, Acikgoz M, Piri Cinar B, Aciman Demirel E, Celebi U, Atasoy HT. The relationship between alexithymia, reading the mind in the eyes and cognition in patients with multiple sclerosis. Mult Scler Relat Disord 2022; 68:104196. [PMID: 36223703 DOI: 10.1016/j.msard.2022.104196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 08/29/2022] [Accepted: 09/25/2022] [Indexed: 12/15/2022]
Abstract
AIM The purpose of this study was to determine the frequency of alexithymia, difficulty in recognizing one's own and others' emotions, to determine the ability to read the mind in the eyes that evaluates the emotions of others, and to assess the relationship between these parameters and demographic characteristics, cognition, anxiety and depression in people with multiple sclerosis (PwMS). MATERIAL AND METHOD Seventy patients presenting to the neurology clinic and diagnosed with MS and 70 healthy volunteers with similar demographic characteristics were included in the study. The California Verbal Learning Test II (CVLT II), Symbol Digit Modalities Test (SDMT), Revised Brief Visuospatial Memory Test (BVMT-R), and Trail-Making Test (TMT) were applied to determine all participants' cognitive status. All participants were also administered Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Toronto Alexithymia Scale-20 (TAS-20), Reading the Mind in the Eyes Test (RMET), Fatigue Impact Scale (FIS) and Short Form 36 Health Survey (SF-36) for quality of life. RESULTS Alexithymia levels were higher in the PwMS than in the control group, 24.2% of the PwMS and 4.2% of the control group being alexithymic. The PwMS group exhibited poorer performance on all cognitive tests and in BDI, BAI, FIS and SF-36 scale scores than the control group. No difference was determined between the groups' RMET scores. Depression and anxiety levels increased in line with alexithymia levels in the PwMS group, while RMET scores decreased. No association was determined between alexithymia levels and age, sex, duration of disease, degree of disability, cognition, or fatigue. RMET scores were not affected by age, sex, duration of disease, degree of disability, anxiety, or fatigue, but were lower among individuals with poor cognition and in depressive patients. CONCLUSION Neuropsychiatric symptoms have been the subject of considerable research in MS in recent years and these clinical characteristics in patients have begun being closely monitored. PwMS are capable of experiencing difficulty in identifying emotions in themselves and others, and their social lives can be affected. In addition, the fact that this exhibits an association with cognition based on RMET is particularly noteworthy.
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Affiliation(s)
- Burcu Karpuz Seren
- Zonguldak Bulent Ecevit University Faculty of Medicine Neurology Department, Zonguldak, Turkey
| | - Mustafa Acikgoz
- Zonguldak Bulent Ecevit University Faculty of Medicine Neurology Department, Zonguldak, Turkey.
| | - Bilge Piri Cinar
- Zonguldak Bulent Ecevit University Faculty of Medicine Neurology Department, Zonguldak, Turkey
| | - Esra Aciman Demirel
- Zonguldak Bulent Ecevit University Faculty of Medicine Neurology Department, Zonguldak, Turkey
| | - Ulufer Celebi
- Zonguldak Bulent Ecevit University Faculty of Medicine Neurology Department, Zonguldak, Turkey
| | - Hüseyin Tugrul Atasoy
- Zonguldak Bulent Ecevit University Faculty of Medicine Neurology Department, Zonguldak, Turkey
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Bellew D, Davenport L, Monaghan R, Cogley C, Gaughan M, Yap SM, Tubridy N, Bramham J, McGuigan C, O'Keeffe F. Interpreting the clinical importance of the relationship between subjective fatigue and cognitive impairment in multiple sclerosis (MS): How BICAMS performance is affected by MS-related fatigue. Mult Scler Relat Disord 2022; 67:104161. [PMID: 36126538 DOI: 10.1016/j.msard.2022.104161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 07/31/2022] [Accepted: 09/04/2022] [Indexed: 10/31/2022]
Abstract
BACKGROUND There is evidence that subjective fatigue can influence cognitive functioning in multiple sclerosis (MS). DeLuca et al.'s (2004) Relative Consequence Model proposes that impairments to other high-level cognitive functions, such as memory, result from the disease's effect on information processing speed. OBJECTIVE The primary aims of the study were to investigate both 1) the relationship between subjective fatigue and cognitive functioning, as measured by the widely used Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS) in MS; and 2) the consequential effect of fatigue on information processing speed as predicted by the Relative Consequence Model. METHODS 192 participants with MS attending tertiary referral MS centre completed the Modified Fatigue Impact Scale and BICAMS. RESULTS Multiple correlation analyses determined that there were statistically significant relationships between all domains assessed by the BICAMS and levels of fatigue, such that higher levels of self-reported fatigue were associated with lower performance on information-processing, and visual and verbal learning. After controlling for information processing speed, the strength of correlation between fatigue and learning performance weakened. Linear regression analysis showed that fatigue predicted the most variance in verbal learning and 11.7% of the overall variance in BICAMS performance. CONCLUSION Subjective fatigue and objective cognitive performance in MS are related. Caution is advised in the interpretation of BICAMS scores in cases where high levels of fatigue are present, and more detailed neuropsychological assessments may be required in order to accurately identify objective cognitive impairment independent of subjective fatigue.
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Affiliation(s)
- David Bellew
- School of Psychology, University College Dublin, Belfield, Dublin 4, Ireland
| | - Laura Davenport
- Department of Neurology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Ruth Monaghan
- Department of Neurology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Clodagh Cogley
- Department of Neurology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Maria Gaughan
- Department of Neurology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Siew Mei Yap
- Department of Neurology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Niall Tubridy
- Department of Neurology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Jessica Bramham
- School of Psychology, University College Dublin, Belfield, Dublin 4, Ireland
| | - Christopher McGuigan
- Department of Neurology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Fiadhnait O'Keeffe
- Department of Neurology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland.
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Khedr EM, Desoky T, Gamea A, Ezzeldin MY, Zaki AF. Fatigue and brain atrophy in Egyptian patients with relapsing remitting multiple sclerosis. Mult Scler Relat Disord 2022; 63:103841. [DOI: 10.1016/j.msard.2022.103841] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 04/29/2022] [Accepted: 04/30/2022] [Indexed: 11/26/2022]
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Ostellino S, Benso A, Politano G. The integration of clinical data in the assessment of multiple sclerosis - A review. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2022; 221:106900. [PMID: 35623208 DOI: 10.1016/j.cmpb.2022.106900] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 05/18/2022] [Accepted: 05/18/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND AND OBJECTIVES Multiple Sclerosis (MS) is a neurological disease associated with various and heterogeneous clinical characteristics. Given its complex nature and its unpredictable evolution over time, there isn't an established and exhaustive clinical protocol (or tool) for its diagnosis nor for monitoring its progression. Instead, different clinical exams and physical/psychological evaluations need to be taken into account. The Expanded Disability Status Scale (EDSS) is the most used clinical scale, but it suffers from several limitations. Developing computational solutions for the identification of bio-markers of disease progression that overcome the downsides of currently used scales is crucial and is gaining interest in current literature and research. METHODS This Review focuses on the importance of approaching MS diagnosis and monitoring by investigating correlations between cognitive impairment and clinical data that refer to different MS domains. We review papers that integrate heterogeneous data and analyse them with statistical methods to understand their applicability into more advanced computational tools. Particular attention is paid to the impact that computational approaches can have on personalized-medicine. RESULTS Personalized medicine for neuro-degenerative diseases is an unmet clinical need which can be addressed using computational approaches able to efficiently integrate heterogeneous clinical data extracted from both private and publicly available electronic health databases. CONCLUSIONS Reliable and explainable Artificial Intelligence are computational approaches required to understand the complex and demonstrated interactions between MS manifestations as well as to provide reliable predictions on the disease evolution, representing a promising research field.
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Affiliation(s)
- Sofia Ostellino
- Department of Control and Computer Engineering, Politecnico di Torino, Italy.
| | - Alfredo Benso
- Department of Control and Computer Engineering, Politecnico di Torino, Italy.
| | - Gianfranco Politano
- Department of Control and Computer Engineering, Politecnico di Torino, Italy.
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Real-World Evidence for Favourable Quality-of-Life Outcomes in Hungarian Patients with Relapsing-Remitting Multiple Sclerosis Treated for Two Years with Oral Teriflunomide: Results of the Teri-REAL Study. Pharmaceuticals (Basel) 2022; 15:ph15050598. [PMID: 35631424 PMCID: PMC9145304 DOI: 10.3390/ph15050598] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 05/06/2022] [Accepted: 05/09/2022] [Indexed: 02/04/2023] Open
Abstract
Relapsing-remitting multiple sclerosis (RRMS) is a degenerative, inflammatory disease of the central nervous system in which symptoms and disability progression vary significantly among patients. Teri-REAL was a prospective, real-world observational study that examined quality-of-life (QoL) and treatment outcomes in a Hungarian cohort of RRMS patients treated with once-daily oral teriflunomide. QoL was assessed at baseline, 12, and 24 months with the Multiple Sclerosis Quality of Life-54 (MSQoL-54) questionnaire. Other measurements included disease progression (Patient Determined Disease Steps [PDDS]), clinical efficacy (relapses), fatigue (Fatigue Impact Scale [FIS]), depression (Beck Depression Inventory [BDI]), cognition (Brief International Cognitive Assessment in MS [BICAMS]), persistence and safety. 212 patients were enrolled (69.1% female, 50.5% treatment naïve), with 146 (69%) completing the study. Statistically significant improvements in subscales of the MSQoL-54 versus baseline were found at Month 12 and Month 24. Significant improvements were also observed for individual components of the BICAMS score at 24 months, while PDDS, FIS and BDI scores remained stable. The mean annualised relapse rate was 0.08 ± 0.32. There were 93 safety events, most of which were mild to moderate. Improved QoL and cognitive outcomes in teriflunomide-treated patients over 2 years offer a unique perspective to this real-world study.
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Rivera D, Usuga DR, Mendoza EMF, Arelis AA, Barajas BVR, Islas MÁM, Krch D, Lequerica AH, Arango-Lasprilla JC. Validation of the Norma Latina neuropsychological assessment battery in individuals with multiple sclerosis in Mexico. Mult Scler Relat Disord 2022; 59:103685. [DOI: 10.1016/j.msard.2022.103685] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 01/23/2022] [Accepted: 02/11/2022] [Indexed: 10/19/2022]
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13
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Information Processing Speed Assessed with Letter Digit Substitution Test in Croatian Sample of Multiple Sclerosis Patients. Diagnostics (Basel) 2022; 12:diagnostics12010111. [PMID: 35054278 PMCID: PMC8774378 DOI: 10.3390/diagnostics12010111] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 12/29/2021] [Accepted: 12/30/2021] [Indexed: 12/12/2022] Open
Abstract
Cognitive impairment is a common complaint in people with multiple sclerosis (pwMS). The study objective was to determine the psychometric properties of the letter digit substitution test (LDST) that measures information processing speed and to investigate the impact of relevant predictors of LDST achievement in pwMS. The design was cross-sectional. The study included 87 pwMS and 154 control subjects. The validity of LDST was examined, and a hierarchical regression model was used to explore relevant predictors of LDST success. The LDST had excellent construct validity, as expressed by differences between pwMS and control subjects. Convergent validity of the LDST was supported by a significant moderate correlation with the expanded disability status scale (EDSS) (ρ = −0.36; p < 0.05) and a significantly strong correlation with the multiple sclerosis impact scale (MSIS-29) physical subscale (r = −0.64; p < 0.01). The LDTS score well differentiated the pwMS considering age, education, EDSS, disease duration, comorbidity, and medication therapy. Using the LDST as a criterion variable in pwMS results showed consistent evidence for the age, education, and EDSS impact on LDST performance. The best cut-off score of ≤35 discriminated the control and MS group. LDST proved to be a valid test for assessing information processing speed in pwMS.
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Covey TJ, Golan D, Doniger GM, Sergott R, Zarif M, Bumstead B, Buhse M, Kaczmarek O, Mebrahtu S, Bergmann C, Wilken J, Gudesblatt M. The relationship between cognitive impairment, cognitive fatigue, and visual evoked potential latency in people with multiple sclerosis. Mult Scler Relat Disord 2022; 57:103349. [DOI: 10.1016/j.msard.2021.103349] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 10/15/2021] [Accepted: 10/24/2021] [Indexed: 10/20/2022]
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15
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Tunisian version of the brief international cognitive assessment for multiple sclerosis: Validation and normative values. Mult Scler Relat Disord 2021; 58:103444. [PMID: 34929452 DOI: 10.1016/j.msard.2021.103444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 11/30/2021] [Accepted: 12/01/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND The Brief International cognitive assessment for Multiple sclerosis (BICAMS) is a specific batterie used to identify cognitive impairment in Multiple Sclerosis (MS) in a reliable and easy way. To date, for the Arabic-speaking Tunisian MS patients, there is no consensus for the use of specific cognitive batteries in MS. OBJECTIVE The aim of our work was to develop and validate the Tunisian version of the BICAMS (T-BICAMS) and to determine our own normative values. MATERIAL AND METHODS Patients diagnosed with MS and followed up in the department of Neurology of Razi Hospital were recruited and matched to healthy controls according to age, sex and educational level. T-BICAMS validity was established by comparing MS and healthy controls for symbol digit modalities test (SDMT), brief visual memory test (BVMT-R) and Tunisian verbal learning tests (TVLT) which was used instead of the California verbal learning test (CVLT-II). RESULTS The 104 MS patients and 104 healthy controls were comparable for age, sex and educational level. The MS group exhibited lower performances in all T-BICAMS domains compared to healthy controls: SDMT (x003Dp<10-3), BVMT-R (p = 0.002) and TVLT (p x003D<10-3). T-BICAMS Cronbach alpha value was 0.741. Normative values were identified for patients with MS: SDMT [39-40], BVMT-R [26-27] and TVLT [43-44]. Cognitive impairment was identified among 76 patients (73.1%). Males, lower educational levels and progressive MS were associated with a more severe cognitive impairment. CONCLUSIONS The current study has established the BICAMS as a valid and reliable tool for the identification of cognitive impairment in the Tunisian MS population.
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Connection between microstructural alterations detected by diffusion MRI and cognitive dysfunction in MS: A model-free analysis approach. Mult Scler Relat Disord 2021; 57:103442. [PMID: 34896877 DOI: 10.1016/j.msard.2021.103442] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 11/26/2021] [Accepted: 12/01/2021] [Indexed: 01/15/2023]
Abstract
BACKGROUND Cognitive decline is a prominent symptom of MS. Clear connection between cognitive status and white matter microstructural changes has not been unequivocally observed to date. OBJECTIVE To characterise the relationship between white matter microstructure and cognitive performance a partial least squares (PLS) approach was used. METHODS 53 RR MS patients' T1 and DTI images and BICAMS subtests were used in our analysis. Standard FSL pipeline was used to obtain diffusion parameters. A PLS approach was applied to reveal the diffusion parameter patterns responsible for the cognitive dysfunction. RESULTS The first latent variable (LV) was mainly associated with demyelination, while the second and third explained axonal damage. While the first two LV represented mainly Brief Visuospatial Memory Test (BVMT) and Single Digit Modality Test (SDMT), the third LV depicted diffusion alterations mainly the verbal subtest. The first LVs spatial map showed demyelination in the corpus callosum. The second LVs spatial map showed the diffusion alterations in the thalamus. The third LV depicted diffusion alterations in the putative left superior longitudinal fascicle. CONCLUSION Visual memory demanding tasks versus language functions depend on distinct patterns of diffusion parameters and the spatial organisation. Axial diffusivity alterations, a putative marker of irreversible axonal loss explained around 20% of variability in the cognitive functions.
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Spedo CT, Pereira DDA, Frndak SE, Marques VD, Barreira AA, Smerbeck A, Silva PHRD, Benedict RHB. Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS): discrete and regression-based norms for the Brazilian context. ARQUIVOS DE NEURO-PSIQUIATRIA 2021; 80:62-68. [PMID: 34852072 PMCID: PMC9651501 DOI: 10.1590/0004-282x-anp-2020-0526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 01/26/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND The Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS) has been recently developed as a brief, practical, and feasible tool for cognitive impairment in multiple sclerosis (MS). OBJECTIVE This study aimed to provide continuous and discrete normative values for the BICAMS in the Brazilian context. METHODS Normatization was achieved using six hundred and one healthy controls from the community assessed at five Brazilian geopolitical regions. RESULTS Mean raw scores, T scores, percentiles, and Z scores for each BICAMS measure are provided, stratified by age and educational level. Regression-based norms were provided by converting raw scores to scaled scores, which were regressed on age, gender, and education, yielding equations that can be used to calculate the predicted scores. Regression analyses revealed that age, gender, and education significantly influenced test results, as in previous studies. CONCLUSIONS The normative data of the BICAMS to the Brazilian context presented good representativeness, improving its use in daily clinical practice.
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Affiliation(s)
- Carina Tellaroli Spedo
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Hospital das Clínicas de Ribeirão Preto, Departamento de Neurociências e Ciências do Comportamento, Ribeirão Preto SP, Brazil.,Instituto Brasileiro de Neuropsicologia e Ciências Cognitivas, Brasília DF, Brazil
| | | | - Seth Edward Frndak
- State University of New York, School of Medicine and Biomedical Sciences, Departments of Neurology and Psychiatry, Buffalo, New York, United States
| | - Vanessa Daccach Marques
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Hospital das Clínicas de Ribeirão Preto, Departamento de Neurociências e Ciências do Comportamento, Ribeirão Preto SP, Brazil
| | - Amilton Antunes Barreira
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Hospital das Clínicas de Ribeirão Preto, Departamento de Neurociências e Ciências do Comportamento, Ribeirão Preto SP, Brazil
| | - Alan Smerbeck
- Institute of Technology Rochester, Rochester, New York, United States
| | - Pedro Henrique Rodrigues da Silva
- Universidade de São Paulo, Faculdade de Filosofia, Ciências e Letras de Ribeirão Preto, Departamento de Física, Laboratório Inbrain, Ribeirão Preto SP, Brazil
| | - Ralph H B Benedict
- State University of New York, School of Medicine and Biomedical Sciences, Departments of Neurology and Psychiatry, Buffalo, New York, United States
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Correlation of the symbol digit modalities test with the quality of life and depression in Japanese patients with multiple sclerosis. Mult Scler Relat Disord 2021; 57:103427. [PMID: 34861614 DOI: 10.1016/j.msard.2021.103427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 11/16/2021] [Accepted: 11/21/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND This study aimed to evaluate the association between cognitive impairment and health-related quality of life (HRQOL), fatigue, and depression in Japanese patients with multiple sclerosis (MS). METHODS The Brief International Cognitive Assessment for MS (BICAMS) was performed in 184 Japanese patients with MS. The Functional Assessment of MS (FAMS), Fatigue Severity Scale (FSS), and Beck Depression Inventory-Second Edition (BDI-II) were used to evaluate HRQOL, fatigue, and depression, respectively. RESULTS Multiple linear regression analysis demonstrated positive correlations of the Symbol Digit Modalities Test (SDMT) with the scores on the FAMS subscales of mobility, symptoms, emotional well-being, and additional concerns and with the total FAMS score even after controlling for the Expanded Disability Status Scale score, age at examination, and duration of education. The SDMT score in the BICAMS battery had negative correlations with the BDI-II score, as revealed by multiple linear regression analysis. None of the three tests in the BICAMS had any correlation with the FSS score. CONCLUSION The SDMT has a significant relationship with HRQOL and depression in Japanese patients with MS.
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Veréb D, Kovács MA, Kocsis K, Tóth E, Bozsik B, Király A, Kincses B, Faragó P, Fricska-Nagy Z, Bencsik K, Klivényi P, Kincses ZT, Szabó N. Functional Connectivity Lateralisation Shift of Resting State Networks is Linked to Visuospatial Memory and White Matter Microstructure in Relapsing-Remitting Multiple Sclerosis. Brain Topogr 2021; 35:268-275. [PMID: 34807323 PMCID: PMC8860794 DOI: 10.1007/s10548-021-00881-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 11/05/2021] [Indexed: 11/28/2022]
Abstract
Laterality patterns of resting state networks (RSN) change in various neuropsychiatric conditions. Multiple sclerosis (MS) causes neuro-cognitive symptoms involving dysfunctional large-scale brain networks. Yet, whether healthy laterality patterns of RSNs are maintained in MS and whether altered laterality patterns explain disease symptoms has not been explicitly investigated. We analysed functional MRI and diffusion tensor imaging data from 24 relapsing–remitting MS patients and 25 healthy participants. We performed group-level independent component analysis and used dual regression to estimate individual versions of well-established RSNs. Voxelwise laterality indices were calculated for each RSN. Group differences were assessed via a general linear model-based approach. The relationship between functional laterality and white matter microstructural asymmetry was assessed using Tract-Based Spatial Statistics. Spearman’s correlation was calculated between laterality indices and Brief International Cognitive Assessment for Multiple Sclerosis scores. Functional laterality of the dorsal attention network showed a significant leftward shift in the MS group in the posterior intraparietal sulcus (p < 0.033). Default-mode network laterality showed a significant leftward shift in the MS group in the angular gyrus (p < 0.005). Diminished dorsal attention network laterality was associated with increased fractional anisotropy asymmetry in the superior longitudinal fasciculus (p < 0.02). In the default-mode network, leftward laterality of the angular gyrus was associated with higher BVMT-R scores (R = − 0.52, p < 0.023). Our results confirm previous descriptions of RSN dysfunction in relapsing–remitting MS and show that altered functional connectivity lateralisation patterns of RSNs might contibute to cognitive performance and structural remodellation even in patients with mild clinical symptoms.
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Affiliation(s)
- Dániel Veréb
- Department of Radiology, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary.,Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Márton Attila Kovács
- Department of Radiology, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Krisztián Kocsis
- Department of Radiology, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Eszter Tóth
- Department of Radiology, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Bence Bozsik
- Department of Radiology, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - András Király
- Department of Radiology, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Bálint Kincses
- Department of Psychiatry, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary.,Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Péter Faragó
- Department of Neurology, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Zsanett Fricska-Nagy
- Department of Neurology, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Krisztina Bencsik
- Department of Neurology, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Péter Klivényi
- Department of Neurology, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Zsigmond Tamás Kincses
- Neuroimaging Research Group, Department of Radiology, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Semmelweis u. 6, 6725, Hungary.
| | - Nikoletta Szabó
- Department of Neurology, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
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20
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Botchorishvili N, Shiukashvili N, Mikeladze N, Dzagnidze A, Mikava N, Tighashvili M, Janelidze M. Validity and reliability of the Georgian-language brief international cognitive assessment for multiple sclerosis (BICAMS). BMC Neurol 2021; 21:218. [PMID: 34107913 PMCID: PMC8188683 DOI: 10.1186/s12883-021-02249-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 05/17/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Cognitive impairment is one of the common features of multiple sclerosis (MS). Despite high prevalence, cognitive decline is often overlooked by neurologists. The Brief International Cognitive Assessment for MS (BICAMS) was therefore introduced by the international expert committee as a brief and effective tool for the assessment and monitoring of cognitive functions in patients with MS. The validity and reliability of BICAMS have been demonstrated in many countries. Our aim was to validate the BICAMS in Georgian patients with MS. METHODS A total of 68 patients with MS and 68 matched controls were assessed by the Georgian-language BICAMS. All healthy controls and seven patients were re-evaluated with identical tests to assess retest reliability. RESULTS In comparison to healthy controls, patients with MS performed significantly worse on all tests in the assessment battery. Test-retest reliability measures were good for all tests. The prevalence of cognitive impairment in patients with MS was 43%. CONCLUSION The Georgian-language BICAMS is a reliable and valid battery for the assessment of cognitive function in patients with MS.
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Affiliation(s)
| | - Nino Shiukashvili
- School of Natural Sciences and Medicine, Ilia State University, Kakutsa Cholokashvili avenue 3/5, 0162, Tbilisi, Georgia
| | - Nina Mikeladze
- Tbilisi State Medical University, Vazha Pshavela avenue 33, 0177, Tbilisi, Georgia
| | - Ann Dzagnidze
- Tbilisi State Medical University, Vazha Pshavela avenue 33, 0177, Tbilisi, Georgia
| | - Nino Mikava
- S. Khechinashvili University Hospital, Chavchavadze avenue 33, 0179, Tbilisi, Georgia
| | - Maia Tighashvili
- S. Khechinashvili University Hospital, Chavchavadze avenue 33, 0179, Tbilisi, Georgia
| | - Marina Janelidze
- Tbilisi State Medical University, Vazha Pshavela avenue 33, 0177, Tbilisi, Georgia
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21
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Sandi D, Fricska-Nagy Z, Bencsik K, Vécsei L. Neurodegeneration in Multiple Sclerosis: Symptoms of Silent Progression, Biomarkers and Neuroprotective Therapy-Kynurenines Are Important Players. Molecules 2021; 26:molecules26113423. [PMID: 34198750 PMCID: PMC8201043 DOI: 10.3390/molecules26113423] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 06/01/2021] [Accepted: 06/03/2021] [Indexed: 12/17/2022] Open
Abstract
Neurodegeneration is one of the driving forces behind the pathogenesis of multiple sclerosis (MS). Progression without activity, pathopsychological disturbances (cognitive impairment, depression, fatigue) and even optic neuropathy seems to be mainly routed in this mechanism. In this article, we aim to give a comprehensive review of the clinical aspects and symptomology, radiological and molecular markers and potential therapeutic targets of neurodegeneration in connection with MS. As the kynurenine pathway (KP) was evidenced to play an important role in the pathogenesis of other neurodegenerative conditions (even implied to have a causative role in some of these diseases) and more and more recent evidence suggest the same central role in the neurodegenerative processes of MS as well, we pay special attention to the KP. Metabolites of the pathway are researched as biomarkers of the disease and new, promising data arising from clinical evaluations show the possible therapeutic capability of KP metabolites as neuroprotective drugs in MS. Our conclusion is that the kynurenine pathway is a highly important route of research both for diagnostic and for therapeutic values and is expected to yield concrete results for everyday medicine in the future.
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Affiliation(s)
- Dániel Sandi
- Albert Szent-Györgyi Clinical Centre, Department of Neurology, Faculty of General Medicine, University of Szeged, H-6725 Szeged, Hungary; (D.S.); (Z.F.-N.); (K.B.)
| | - Zsanett Fricska-Nagy
- Albert Szent-Györgyi Clinical Centre, Department of Neurology, Faculty of General Medicine, University of Szeged, H-6725 Szeged, Hungary; (D.S.); (Z.F.-N.); (K.B.)
| | - Krisztina Bencsik
- Albert Szent-Györgyi Clinical Centre, Department of Neurology, Faculty of General Medicine, University of Szeged, H-6725 Szeged, Hungary; (D.S.); (Z.F.-N.); (K.B.)
| | - László Vécsei
- Albert Szent-Györgyi Clinical Centre, Department of Neurology, Faculty of General Medicine, University of Szeged, H-6725 Szeged, Hungary; (D.S.); (Z.F.-N.); (K.B.)
- MTA-SZTE Neuroscience Research Group, University of Szeged, H-6725 Szeged, Hungary
- Interdisciplinary Excellence Centre, University of Szeged, H-6725 Szeged, Hungary
- Correspondence: ; Tel.: +36-62-545-384; Fax: +36-62-545-597
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22
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Hämäläinen P, Leo V, Therman S, Ruutiainen J. Validation of the Finnish version of the Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS) and evaluation of the applicability of the Multiple Sclerosis Neuropsychological Questionnaire (MSNQ) and the Fatigue Scale for Motor and Cognitive Functions (FSMC). Brain Behav 2021; 11:e02087. [PMID: 33960700 PMCID: PMC8213644 DOI: 10.1002/brb3.2087] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 01/05/2021] [Accepted: 02/08/2021] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVES Cognitive impairment is frequent in multiple sclerosis (MS) as approximately half of the patients manifest some degree of cognitive impairment. The Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS) has been designed for brief cognitive evaluation. The purpose of the study was to validate the BICAMS along with the Finnish versions of one self-rating questionnaire each for cognition and fatigue. METHODS A total of 65 MS patients and 45 healthy controls (HC) were assessed with the BICAMS, the Multiple Sclerosis Neuropsychological Questionnaire (MSNQ), and the Fatigue Scale for Motor and Cognitive Functions (FSMC) twice, approximately within nine days. RESULTS MS patients scored markedly lower than the HCs on each of the three tests of the BICAMS. Of the patients, 60% scored at least 1.5 SD below the mean of the HCs on at least one test; 49% on the SDMT, 26% on the CVLT-II, and 28% on the BVMT-R. Correlation coefficients for the repeated measurement were between 0.75 and 0.89 for the three tests in the whole study sample. MS patients reported more cognitive symptoms and more fatigue than the HCs. Cronbach's alpha was 0.94 for the MSNQ and 0.98 for the FSMC. Correlation coefficient for the repeated measurement was 0.91 for the MSNQ and between 0.92 and 0.94 for the FSMC scores for the whole study sample. CONCLUSIONS The present study supports the validity of the Finnish version of the BICAMS. The SDMT was the most sensitive of the three BICAMS tests and showed cognitive impairment in half of the patients. The Finnish versions of the MSNQ and the FSMC proved useful tools in approaching concerns related to cognition and fatigue.
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Affiliation(s)
- Päivi Hämäläinen
- Masku Neurological Rehabilitation Centre, The Finnish Neuro Society, Masku, Finland
| | - Vera Leo
- Masku Neurological Rehabilitation Centre, The Finnish Neuro Society, Masku, Finland.,Cognitive Brain Research Unit, Department of Psychology and Logopedics, Faculty of Medicine, Helsinki, Finland
| | - Sebastian Therman
- Mental Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Juhani Ruutiainen
- Masku Neurological Rehabilitation Centre, The Finnish Neuro Society, Masku, Finland.,Department of Neurology, University of Turku, Turku, Finland
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Farghaly M, Langdon DW, Shalaby NM, Shehata HS, Abokrysha NT, Hassan A, Hegazy MI, Elmazny A, Ahmed S, Shaheen S, Othman AS, Yacoub O, Kishk NA. Reliability and validity of Arabic version of the brief international cognitive assessment for multiple sclerosis: Egyptian dialect. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2021. [DOI: 10.1186/s41983-021-00303-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Abstract
Background
Given the diversity of multiple sclerosis (MS) symptoms including cognitive impairment in certain domains, the need to develop a rapid and at the same time thorough tool for cognitive assessment is mandatory and represents an unmet need in the clinical and research fields of MS. The Brief International Cognitive Assessment for MS (BICAMS) is a good and practical tool to achieve this mission but is not present in the Arabic language for Arabic speaking countries yet.
Objectives
To assess the reliability and validity of Arabic version of the BICAMS (Egyptian dialect).
Methods
Ninety Egyptian MS patients and 85 matched healthy controls underwent neuropsychological testing using the BICAMS Arabic version (Egyptian dialect) battery including the Symbol Digit Modality Test (SDMT), California Verbal Learning Test 2nd edition (CVLT-II), and revised Brief Visuospatial Retention Test- (BVRT-R). Test–retest data were obtained from MS patients 2 weeks after the initial assessment. Mean differences between both groups were assessed controlling for age, gender, and educational level.
Results
The MS patients scored significantly lower on the SDMT, CVLT-II, and BVMT-R tests compared to healthy controls (p<0.001). For MS patients’ group, intra-observer (test–retest) reliability was satisfactory for SDMT, CVLT-II total, and BVRT-R total with r values of 0.85, 0.61, and 0.68, respectively.
Conclusion
BICAMS Arabic version is a reliable and valid tool for cognitive assessment of Arabic speaking MS patients in different clinical and research settings.
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Skorve E, Lundervold AJ, Torkildsen Ø, Myhr KM. A two-year longitudinal follow-up of cognitive performance assessed by BICAMS in newly diagnosed patients with MS. Mult Scler Relat Disord 2020; 46:102577. [PMID: 33296975 DOI: 10.1016/j.msard.2020.102577] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 10/09/2020] [Accepted: 10/11/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Cognitive impairment is common in patients with multiple sclerosis (MS) and may occur at any stage and with any subtype of the disease. Screening and monitoring of cognitive function should therefore be implemented into everyday clinical neurology practice. The Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS) was developed for this purpose. Although several cross-sectional studies have validated BICAMS, longitudinal studies evaluating its use as part of a clinical follow-up routine are still lacking. OBJECTIVE To investigate cognitive function and trajectories of change assessed by the BICAMS test battery in a cohort of newly diagnosed relapsing-remitting MS (RRMS) patients examined at baseline and after 12 and 24 months. METHODS BICAMS was used to assess cognitive function in 58 RRMS patients, who also filled in the Hospital Anxiety and Depression Scale (HADS) and the Fatigue Scale for Motor and Cognitive Functions (FSMC), and underwent standard neurological evaluations at baseline and at the two follow-ups. RESULTS A total of 27 patients (46.6%) were defined as cognitively impaired at baseline on at least one test, and 22 (37.9%) were defined as impaired at follow-up after 24 months. Throughout the study, 8 (13.8%) and 4 (6.9%) patients were consistently defined as impaired on two or three tests, respectively. The mean raw scores on two BICAMS subtests (SDMT and CVLT-II) improved significantly from baseline to the first follow-up, and then remained stable the next year, whereas the visual memory test (BVMT-R) were overall unchanged from baseline to the end of the study. The correlations between the scores on HADS, FSMC and the BICAMS subtests were non-significant at baseline, but weak to moderate negative correlations were found at the one- and two-year follow-ups. CONCLUSION The patients showed improved test results from baseline to the first follow-up examination, indicating that an effect of previous practise should be taken into account when interpreting the results. With results showing both trajectories of stability and change, our study supported the validity of including BICAMS as part of a clinical follow-up routine of RRMS patients. Anxiety, depression, fatigue and cognition should always be assessed at the same time to reveal interaction effects that are expected to affect the daily-life functioning of at least some of the RRMS patients.
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Affiliation(s)
- Ellen Skorve
- Neuro-SysMed, Department of Neurology, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway.
| | - Astri J Lundervold
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
| | - Øivind Torkildsen
- Neuro-SysMed, Department of Neurology, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Kjell-Morten Myhr
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
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Veréb D, Tóth E, Bozsik B, Király A, Szabó N, Kincses B, Kocsis K, Faragó P, László V, Bencsik K, Klivényi P, Kincses ZT. Altered brain network function during attention-modulated visual processing in multiple sclerosis. Mult Scler 2020; 27:1341-1349. [PMID: 33016839 DOI: 10.1177/1352458520958360] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Multiple sclerosis may damage cognitive performance in several domains, including attention. Although attention network deficits were described during rest, studies that investigate their function during task performance are scarce. OBJECTIVE To investigate connectivity within and between task-related networks in multiple sclerosis during a visual attention task as a function of cognitive performance. METHODS A total of 23 relapsing-remitting multiple sclerosis (RRMS) patients and 29 healthy controls underwent task-functional magnetic resonance imaging (fMRI) scans using a visual attention paradigm on a 3T scanner. Scans were analysed using tensor-independent component analysis (TICA). Functional connectivity was calculated within and between components. We assessed cognitive function with the Brief International Cognitive Assessment for MS (BICAMS) battery. RESULTS TICA extracted components related to visual processing, attention, executive function and the default-mode network. Subject scores of visual/attention-related and executive components were greater in healthy controls (p < 0.032, p < 0.023). Connectivity between visual/attention-related and default-mode components was higher in patients (p < 0.043), correlating with Brief Visuospatial Memory Test-Revised (BVMT-R) scores (R = -0.48, p < 0.036). Patients showed reduced connectivity between the right intraparietal sulcus (rIPS) and frontal eye field (rFEF), and bilateral frontal eye fields (p < 0.012, p < 0.003). Reduced rIPS-rFEF connectivity came with lower Symbol Digit Modalities Test (SDMT)/BVMT-R scores in patients (R = 0.53, p < 0.02, R = 0.46, p < 0.049). CONCLUSION Attention-related networks show altered connectivity during task performance in RRMS patients, scaling with cognitive disability.
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Affiliation(s)
- Dániel Veréb
- Department of Neurology, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Eszter Tóth
- Department of Neurology, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Bence Bozsik
- Department of Neurology, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - András Király
- Department of Neurology, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Nikoletta Szabó
- Department of Neurology, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Bálint Kincses
- Department of Neurology, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Krisztián Kocsis
- Department of Neurology, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Péter Faragó
- Department of Neurology, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Vécsei László
- Department of Neurology, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Krisztina Bencsik
- Department of Neurology, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Péter Klivényi
- Department of Neurology, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Zsigmond Tamás Kincses
- Department of Neurology, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary/Neuroimaging Research Group, Department of Radiology, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
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Yigit P, Acikgoz A, Mehdiyev Z, Dayi A, Ozakbas S. The relationship between cognition, depression, fatigue, and disability in patients with multiple sclerosis. Ir J Med Sci 2020; 190:1129-1136. [PMID: 33006048 DOI: 10.1007/s11845-020-02377-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 09/22/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Multiple sclerosis (MS) is a chronic, progressive, and neurodegenerative central nervous system disorder. MS usually causes disability, cognitive deficiency, fatigue, and depression symptoms. OBJECTIVES To assess cognitive functions of people with MS (pwMS) and investigate the impact of depression, fatigue, and disability on cognitive functions. METHODS We administered the Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS) battery to assess 200 pwMS. The Expanded Disability Status Scale (EDSS) was used to evaluate disability levels. Fatigue Severity Scale (FSS) and the Beck Depression Inventory (BDI) were used, respectively, for fatigue and depression levels. RESULTS EDSS and FSS scores were significantly higher in those with a disease duration of 5 years or more. Those with the EDSS ≥ 4 were found to have lower BICAMS performances and higher FSS scores. There was a significant difference in Symbol Digit Modalities Test (SDMT) performances between the groups with and without fatigue (FSS ≥ 4 and FSS < 4, respectively). When depression and fatigue symptoms concur or in the existence of just one of them or none of them, significant differences in terms of SDMT performances have been shown. CONCLUSION The level of disability and fatigue adversely affects the cognitive functions of pwMS; depression has no significant effect. BICAMS that is specific for MS can be beneficial to assess the cognitive state of pwMS.
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Affiliation(s)
- Pinar Yigit
- Department of Neurology, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey.
| | - Ayla Acikgoz
- Vocational School of Health Services, Dokuz Eylul University, Izmir, Turkey
| | - Zaur Mehdiyev
- Department of Neurology, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Ayfer Dayi
- Department of Physiology, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Serkan Ozakbas
- Department of Neurology, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
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Clinical features and physical performance in multiple sclerosis patients with and without cognitive impairment: a cross-sectional study. Int J Rehabil Res 2020; 43:316-323. [PMID: 32804701 DOI: 10.1097/mrr.0000000000000428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The factors associated with cognitive functions in patients with multiple sclerosis (PwMS) are not yet clear. The aims of this study were (1) to compare clinical features and physical performance in healthy controls, and PwMS with and without cognitive impairment, and (2) to determine the relationship between cognitive domains and demographics characteristics, clinical features and physical performance in PwMS. A total of 112 PwMS and 25 healthy controls participated in this study. Cognitive functions were evaluated by Brief Repeatable Battery of Neuropsychological Tests (BRB-N). Based on cognitive performances by BRB-N, PwMS were divided into two groups as MS patients with impaired (MS-I, n: 57) and with normal (MS-N, n: 55) cognitive functions. For clinical features, fatigue, mood and sleep quality were evaluated by the Fatigue Impact Scale, Beck's Depression Inventory, Pittsburgh Sleep Quality Index, respectively. For physical performances, balance and walking capacity were evaluated by posturography and Six-Minute Walking Test, respectively. The results showed that the education years, postural stability and walking capacity in MS-N and healthy controls were higher than in MS-I (P < 0.05). In addition, visuospatial memory was correlated with both postural stability under all sensory conditions and walking capacity; verbal memory was correlated with education years, postural stability on eyes closed-foam surface and walking capacity; verbal fluency was correlated with only walking capacity; information processing speed was correlated with education years, postural stability under all sensory conditions and walking capacity (P < 0.001). This study suggests that the interventions that aim to improve physical performance might protect and even improve cognitive functions in PwMS.
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Alboudi A, Hadid A, Ali AR, Alshaikh F, Aqleh H. Normative values of the Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS) in an Arab population: Corrected for age, sex and education. Mult Scler Relat Disord 2020; 44:102305. [PMID: 32570183 DOI: 10.1016/j.msard.2020.102305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 06/01/2020] [Accepted: 06/12/2020] [Indexed: 11/30/2022]
Abstract
Background Cognitive impairment is common in multiple sclerosis (MS) patients with 43-70% of patients being affected. The international cognitive assessment for MS BICAMS is a new battery for cognitive assessment in MS patients. It was suggested in 2012 that international validation efforts be undertaken. Objective To utilize regression to provide normative values for the BICAMS while correcting for age, gender and education, as well as assess test-retest reliability, in an Arab population. Methods Healthy subjects were recruited from different areas in Dubai. Corrections for demographics were calculated using multiple linear regression. Test-retest reliability was assessed using the Pearson correlation coefficient. Results Two hundred eighty-one healthy subjects were enrolled (174 women, mean age 30±10.3 years, mean education 17.8±3.7 years). Test re-test results showed significant correlation between baseline and retest scores. Regression-based equations were derived for the BICAMS. Conclusion This large-scale validation study provides evidence to support the facilitation of international implementation of the BICAMS assessment by focusing on the Arab population. Next steps include validation efforts in an Arab MS patient population to further support the use of the BICAMS in day to day practice and for longitudinal patient assessment.
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Affiliation(s)
- Ayman Alboudi
- Mercy Health Saint Mary, Grand Rapids, Michgan, US; Rashid hospital, Dubai, UAE.
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Alarcón AN, Ayala OD, García JR, Montañés P. Validation of the Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS) in a Colombian Population. Mult Scler Relat Disord 2020; 42:102072. [PMID: 32330844 DOI: 10.1016/j.msard.2020.102072] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 03/21/2020] [Accepted: 03/24/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Cognitive impairment has been recognized as an important factor in multiple sclerosis (MS) in the past few years. One brief, reliable and valid tool to assess cognition in MS is the BICAMS, which encompasses the Symbol Digit Modalities Test (SDMT), the California Verbal Learning Test (CVLT II), and the Brief Visuospatial Memory Test - Revised (BVMT-R). Continuing with the international initiative to validate the BICAMS in different countries, here we present the results obtained from the efforts in validating such test in the Colombian population. METHOD 100 healthy controls and 50 MS patients participated in the study, group matched for age, education and gender. Subjects completed all three tests of the BICAMS. Instead of the CVLT-II, the Colombian validated form PAMCL (Prueba de Aprendizaje y Memoria con Codificación Libre) was used. Test-retest measures were obtained for 16 patients in order to test for reliability. RESULTS Evidence of criterion validity was obtained, MS group performing significantly worse than HC group in all three tests (SDMT: p= .001, d= 0.59; PAMCL: p= .03, d= 0.38; BVMT-R: p<.001, d= 0.58). Test-retest was also obtained, finding significant correlations for all three tests (SDMT: r=0.932, p<.00; BVMT-R: r=0.863, p<.001; PAMCL: r=0.889, p<.001). Standardization of raw scores to uncontrolled scaled scores was done and these scores were then adjusted for age and years of schooling using a multiple linear regression. CONCLUSIONS The BICAMS proved to be a valid and sensitive tool to screen for cognitive impairment in MS patients.
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Affiliation(s)
- Andrea N Alarcón
- Departamento de Psicología, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Oscar D Ayala
- Departamento de Psicología, Universidad Nacional de Colombia, Bogotá, Colombia
| | | | - Patricia Montañés
- Departamento de Psicología, Universidad Nacional de Colombia, Bogotá, Colombia
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Maltby VE, Lea RA, Ribbons K, Lea MG, Schofield PW, Lechner-Scott J. Comparison of BICAMS and ARCS for assessment of cognition in multiple sclerosis and predictive value of employment status. Mult Scler Relat Disord 2020; 41:102037. [PMID: 32200339 DOI: 10.1016/j.msard.2020.102037] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 02/19/2020] [Accepted: 03/01/2020] [Indexed: 01/17/2023]
Abstract
BACKGROUND Cognitive impairment is common in multiple sclerosis (MS) but not adequately monitored by Expanded Disability Status Scale assessment. The Audio Recorded Cognitive Screen (ARCS) and Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS) are easy-to-use tools to assess cognitive function in clinical practice. OBJECTIVE To compare the sensitivity of ARCS to BICAMS and their relative predictive value for employment status. METHODS MS patients and healthy controls were assessed using the ARCS and the BICAMS consecutively. Receiver Operating Characteristic (ROC) curve analyses were used to compare the two tests. A step-wise, logistic regression analysis was used to identify the cognitive test(s) that best predicted employment status and quality of life. RESULTS Total ARCS, memory and attention domain scores were moderately correlated with all BICAMS tests (r = 0.3-0.5; P ≤ 0.05). Total ARCS predicts cognitive impairment with good sensitivity and specificity relative to the BICAMS tests (AUC = 0.8; P = 0.00045). Total ARCS detects higher levels of impairment than BICAMS in MS patients (44% versus 21%). The memory domain of the ARCS and the BVMT-R were the best predictors of employment status (OR = 1.12 and 1.14, P < 0.05). CONCLUSION BICAMS and ARCS have comparable sensitivity for cognitive impairment in MS. Memory assessment from either tests is the best predictor of employment status; however, the BICAMS is a better predictor of work productivity.
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Affiliation(s)
- Vicki E Maltby
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia; Centre for Brain and Mental Health Research, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia; Department of Neurology, John Hunter Hospital, New Lambton Heights, NSW, Australia.
| | - Rodney A Lea
- Centre for Brain and Mental Health Research, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia; Institute of Health and Biomedical Innovation, School of Biomedical Sciences, Queensland University of Technology, Brisbane, QLD, Australia.
| | - Karen Ribbons
- Centre for Brain and Mental Health Research, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia; Department of Neurology, John Hunter Hospital, New Lambton Heights, NSW, Australia.
| | - Marino G Lea
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia.
| | - Peter W Schofield
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia; Department of Neurology, John Hunter Hospital, New Lambton Heights, NSW, Australia; Neuropsychiatry Service, Hunter New England Local Health District, NSW, Australia.
| | - Jeannette Lechner-Scott
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia; Centre for Brain and Mental Health Research, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.
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Can semantic fluency be used as an alternative or additional measure in the abbreviated Minimal Assessment of Cognitive Function in Multiple Sclerosis (aMACFIMS)? J Neurol Sci 2019; 410:116640. [PMID: 31884353 DOI: 10.1016/j.jns.2019.116640] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 12/17/2019] [Accepted: 12/18/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND The abbreviated Minimal Assessment of Cognitive Function in Multiple Sclerosis (aMACFIMS) was designed using four shortened measures from the MACFIMS. Semantic fluency was suggested as an alternative task; however, its equivalency as part of this battery has yet to be examined. OBJECTIVES 1) To determine the optimal semantic fluency raw score cut-offs; 2) compare the modified aMACFIMS (with semantic fluency) to the standard aMACFIMS (with phonemic fluency); and 3) compare the expanded aMACFIMS (with both verbal fluency measures) to the Brief International Cognitive Assessment in MS (BICAMS). METHODS Receiver-operating-characteristic curves were used to identify the optimal cut-off at -1.5 and - 2.0 standard deviation (SD) impairment criteria (n = 335). The diagnostic accuracies were compared between the different versions of the aMACFIMS and BICAMS (n = 146). RESULTS The raw score cut-offs for semantic fluency (13 and 11 words) had high sensitivity (100%) and specificity (96.6% - 98.6%). The modified aMACFIMS did not significantly differ from the standard aMACFIMS. The expanded aMACFIMS had stronger specificity (84.8%) and positive predictive value (85.9%) than the BICAMS. CONCLUSIONS Semantic fluency can be used as an alternative, though including both measures results in the most effective aMACFIMS version. Using semantic fluency may be especially valuable when evaluating older PwMS.
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Biernacki T, Sandi D, Kincses ZT, Füvesi J, Rózsa C, Mátyás K, Vécsei L, Bencsik K. Contributing factors to health-related quality of life in multiple sclerosis. Brain Behav 2019; 9:e01466. [PMID: 31709732 PMCID: PMC6908891 DOI: 10.1002/brb3.1466] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 09/09/2019] [Accepted: 10/05/2019] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Health-related quality of life (HRQoL) is lower in people with multiple sclerosis (PwMS) compared to the healthy population, psychological symptoms accompanying multiple sclerosis (MS) have a serious impact on the HRQoL of PwMS. Data regarding the subject, however, remain conflicting. OBJECTIVES To evaluate the patients' sociodemographic attributes, education, fatigue, depression, and cognitive impairment level of impact on the HRQoL for the whole cohort as well as comparing the sexes. MATERIALS AND METHODS Three hundred and twenty-two relapse-remitting MS patients filled out the Fatigue Impact Scale (FIS), Beck Depression Inventory (BDI), MS Quality of Life-54 (MSQoL-54) questionnaires, cognitive impairment were identified using Brief International Cognitive Assessment for MS (BICAMS) test. The patients' data were acquired from our clinic's MS registry or from patients' files. RESULTS Depression and fatigue were found to have the most ubiquitous and robust effect on the overall and any given subdivision of the HRQoL composite. Other factors had a slight effect on some of the subscales when the whole cohort was evaluated. When the genders were compared, differences were found on 10 domains. CONCLUSION Psychopathological symptoms have a more powerful influence on the HRQoL of MS patients than physical impairment, also these symptoms influence men's and women's HRQoL with different power. This invokes the need for complex and personalized care in the treatment of PwMS. Ours is the first study to show a difference between the sexes in this regard.
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Affiliation(s)
- Tamás Biernacki
- Department of Neurology, Faculty of General Medicine, Albert Szent-Györgyi Clinical Centre, University of Szeged, Szeged, Hungary
| | - Dániel Sandi
- Department of Neurology, Faculty of General Medicine, Albert Szent-Györgyi Clinical Centre, University of Szeged, Szeged, Hungary
| | - Zsigmond Tamás Kincses
- Department of Neurology, Faculty of General Medicine, Albert Szent-Györgyi Clinical Centre, University of Szeged, Szeged, Hungary
| | - Judit Füvesi
- Department of Neurology, Faculty of General Medicine, Albert Szent-Györgyi Clinical Centre, University of Szeged, Szeged, Hungary
| | - Csilla Rózsa
- Jahn Ferenc Dél-Pest Hospital, Budapest, Hungary
| | | | - László Vécsei
- Department of Neurology, Faculty of General Medicine, Albert Szent-Györgyi Clinical Centre, University of Szeged, Szeged, Hungary.,MTA - SZTE Neuroscience Research Group, Szeged, Hungary
| | - Krisztina Bencsik
- Department of Neurology, Faculty of General Medicine, Albert Szent-Györgyi Clinical Centre, University of Szeged, Szeged, Hungary
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The Norwegian translation of the brief international cognitive assessment for multiple sclerosis (BICAMS). Mult Scler Relat Disord 2019; 36:101408. [PMID: 31610403 DOI: 10.1016/j.msard.2019.101408] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 09/17/2019] [Accepted: 09/19/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND Cognitive impairment is a common symptom in all stages of multiple sclerosis (MS), yet it is underreported and not routinely evaluated. The Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS) is a short and easily administered test battery for screening of cognitive impairment in MS that can be completed within 15 min and incorporated into routine clinical practice. The test battery consists of the oral version of the Symbols Digit Modalities Test (SDMT) and the initial learning trials of the California Verbal Learning Test 2nd edition (CVLT-II) and the Brief Visuospatial Memory Test Revised (BVMT-R). OBJECTIVE To investigate if the Norwegian version of the BICAMS could identify cognitive impairment in early stages of MS and be used as part of routine follow-up procedures. METHODS A total of 65 relapsing-remitting MS (RRMS) patients and 68 healthy controls were examined with the BICAMS test battery. A randomly selected subset of 29 controls were retested 1-4 weeks after baseline. All participants were screened for anxiety and depression using the Hospital Anxiety and Depression Scale (HADS). RESULTS There were statistically significant differences between the patients with MS and the healthy controls on all three subtests, and the differences remained significant for the CVLT-II (p = 0.003) and BVMT-R (p = 0.011) after adjusting for education. There were no statistically significant correlations between BICAMS scores and anxiety and depression. SDMT and BVMT-R results in the control group at baseline and re-test were strongly correlated (r ≥ 0.70, p < 0.001), and CVLT-II achieved an adequate value of r = 0.60 (p = 0.001). On the SDMT, there was a statistically significant improvement between the two test-sessions. Cognitive impairment, defined as an abnormal test score on ≥1 subtest, was identified in 46.2% of the patient sample, whereas 15.4% were considered cognitively impaired on ≥2 subtests. CONCLUSION This study supports that the Norwegian version of the BICAMS should be included as a screening procedure for cognitive impairment in Norwegian MS patients.
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Validity and Reliability of Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS) in Indonesia and the Correlation with Quality of Life. Neurol Res Int 2019; 2019:4290352. [PMID: 31263596 PMCID: PMC6556319 DOI: 10.1155/2019/4290352] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 05/02/2019] [Indexed: 11/18/2022] Open
Abstract
Introduction Multiple Sclerosis (MS) can affect cognitive function that might interfere with quality of life. Processing speed and memory are the most common area of cognitive impairment. Cognitive evaluation in daily practice is often difficult to be performed since it needs neuropsychological expert and is time-consuming. Brief International Cognitive Assessment for MS (BICAMS) is valid and practical for cognitive evaluation. This study aims to validate BICAMS in Indonesian MS patients and healthy controls (HC) and to analyse the effect of cognitive impairment on quality of life. Methods BICAMS, which composes Symbol Digits Modalities Test (SDMT), California Verbal Learning Test-Second Edition (CVLT-II), and Brief Visuospatial Memory Test-Revised (BVMT-R), was translated and cross-culturally adapted to Indonesian from the original BICAMS and then administered to 40 Indonesian MS patients and 66 HC matched by sex, age, and education. Test-retest reliability was performed on 16-MS patients and 42 HC. Quality of life was measured using Multiple Sclerosis Quality of Life (MSQOL-54) instrument. Results The SDMT, CVLT-II, and BVMT-R score in MS patients were significantly lower than those in HC (effect size, r: 0.61, 0.36, and 0.47, respectively). Test-retest reliability for all tests was satisfactory with correlation coefficient for SDMT, CVLT-II, and BVMT-R in MS subjects 0.86, 0.81, and 0.83, respectively. Using 5th percentile of HC score as cut-off, 15% MS subjects had impairment in one test, 27.5% in two tests, and 40% in three tests. BICAMS was moderately correlated with EDSS but was not correlated with disease duration and relapse rate. SDMT score correlated with physical function and physical and mental role limitation. Conclusion BICAMS is valid and reliable for assessing cognitive function of Indonesia MS patients.
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Yalachkov Y, Soydaş D, Bergmann J, Frisch S, Behrens M, Foerch C, Gehrig J. Determinants of quality of life in relapsing-remitting and progressive multiple sclerosis. Mult Scler Relat Disord 2019; 30:33-37. [PMID: 30735970 DOI: 10.1016/j.msard.2019.01.049] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 01/06/2019] [Accepted: 01/29/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND Numerous factors can affect multiple sclerosis (MS) patients' quality of life (QoL). We investigated how physical impairment, upper extremity function, cognitive impairment, cognitive reserve, symptoms of psychological distress, depression, fatigue as well as age and disease duration contribute to patient-reported measures of QoL in relapse-remitting MS (RRMS) and progressive MS (PMS). METHODS 39 patients with RRMS and 16 patients with PMS were evaluated for physical impairment (EDSS assessed by a neurologist), upper extremity function (9-hole peg test), cognitive deficits (broad neuropsychological test battery), cognitive reserves (highest obtained degree of education and vocabulary), symptoms of psychological distress (Symptom Checklist-90-R), depression (Beck Depression Inventory) and fatigue (Fatigue Scale for Motor and Cognitive Functions). The effects of these variables on QoL, as measured with the EQ-5D-3L, were tested with a multivariate analysis of variance. RESULTS Degree of education, MS disease type, disease duration, BDI and SCL-90-R-scores affected significantly the EQ-5D index. Post-hoc analysis revealed that patients with university education, RRMS, shorter disease duration as well as less depression and psychological distress symptoms had significantly higher EQ-5D indices. No significant effects were observed for measures of physical disability, cognitive impairment or fatigue. CONCLUSIONS Depression and psychological distress symptoms are among the factors with the most essential impact on subjective well-being in MS patients. Since they can be targeted by both psychopharmacological and psychotherapeutic treatment, focusing on mental comorbidity could substantially increase QoL in MS.
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Affiliation(s)
- Yavor Yalachkov
- University Hospital Frankfurt, Department of Neurology, Frankfurt am Main, Germany.
| | - Dilara Soydaş
- University Hospital Frankfurt, Department of Neurology, Frankfurt am Main, Germany
| | - Johannes Bergmann
- University Hospital Frankfurt, Department of Neurology, Frankfurt am Main, Germany
| | - Stefan Frisch
- University Hospital Frankfurt, Department of Neurology, Frankfurt am Main, Germany; Institute of Psychology, Goethe-University, Frankfurt am Main, Germany
| | - Marion Behrens
- University Hospital Frankfurt, Department of Neurology, Frankfurt am Main, Germany
| | - Christian Foerch
- University Hospital Frankfurt, Department of Neurology, Frankfurt am Main, Germany
| | - Johannes Gehrig
- University Hospital Frankfurt, Department of Neurology, Frankfurt am Main, Germany
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Tóth E, Faragó P, Király A, Szabó N, Veréb D, Kocsis K, Kincses B, Sandi D, Bencsik K, Vécsei L, Kincses ZT. The Contribution of Various MRI Parameters to Clinical and Cognitive Disability in Multiple Sclerosis. Front Neurol 2019; 9:1172. [PMID: 30728801 PMCID: PMC6351478 DOI: 10.3389/fneur.2018.01172] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 12/18/2018] [Indexed: 11/13/2022] Open
Abstract
Next to the disseminated clinical symptoms, cognitive dysfunctions are common features of multiple sclerosis (MS). Over the recent years several different MRI measures became available representing the various features of the pathology, but the contribution to various clinical and cognitive functions is not yet fully understood. In this multiparametric MRI study we set out to identify the set of parameters that best predict the clinical and cognitive disability in MS. High resolution T1 weighted structural and high angular resolution diffusion MRI images were measured in 53 patients with relapsing remitting MS and 53 healthy controls. Clinical disability was inflicted by EDSS and cognitive functions were evaluated with the BICAMS tests. The contribution of lesion load, partial brain, white matter, gray matter and subcortical volumes as well as the diffusion parameters in the area of the lesions and the normal appearing white matter were examined by model free, partial least square (PLS) approach. Significance of the predictors was tested with Variable Importance in the Projection (VIP) score and 1 was used for threshold of significance. The PLS analysis indicated that the axial diffusivity of the NAWM contributed the most to the clinical disability (VIP score: 1.979). For the visuo-spatial working memory the most critical contributor was the size of the bilateral hippocampi (VIP scores: 1.183 and 1.2 left and right respectively). For the verbal memory the best predictors were the size of the right hippocampus (VIP score: 1.972), lesion load (VIP score: 1.274) and the partial brain volume (VIP score: 1.119). In case of the information processing speed the most significant contribution was from the diffusion parameters (fractional anisotropy, mean and radial diffusivity, VIP scores: 1.615, 1.321 respectively) of the normal appearing white matter. Our results indicate that various MRI measurable factors of MS pathology contribute differently to clinical and cognitive disability. These results point out the importance of the volumetry of the subcortical structures and the diffusion measures of the white matter in understanding the disability progression.
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Affiliation(s)
- Eszter Tóth
- Department of Neurology, Albert Szent-Györgyi Clinical Centre, University of Szeged, Szeged, Hungary
| | - Péter Faragó
- Department of Neurology, Albert Szent-Györgyi Clinical Centre, University of Szeged, Szeged, Hungary
| | - András Király
- Department of Neurology, Albert Szent-Györgyi Clinical Centre, University of Szeged, Szeged, Hungary
| | - Nikoletta Szabó
- Department of Neurology, Albert Szent-Györgyi Clinical Centre, University of Szeged, Szeged, Hungary
| | - Dániel Veréb
- Department of Neurology, Albert Szent-Györgyi Clinical Centre, University of Szeged, Szeged, Hungary
| | - Krisztián Kocsis
- Department of Neurology, Albert Szent-Györgyi Clinical Centre, University of Szeged, Szeged, Hungary
| | - Bálint Kincses
- Department of Neurology, Albert Szent-Györgyi Clinical Centre, University of Szeged, Szeged, Hungary
| | - Dániel Sandi
- Department of Neurology, Albert Szent-Györgyi Clinical Centre, University of Szeged, Szeged, Hungary
| | - Krisztina Bencsik
- Department of Neurology, Albert Szent-Györgyi Clinical Centre, University of Szeged, Szeged, Hungary
| | - László Vécsei
- Department of Neurology, Albert Szent-Györgyi Clinical Centre, University of Szeged, Szeged, Hungary.,MTA-SZTE Neuroscience Research Group, University of Szeged, Szeged, Hungary
| | - Zsigmond Tamás Kincses
- Department of Neurology, Albert Szent-Györgyi Clinical Centre, University of Szeged, Szeged, Hungary.,Department of Radiology, Albert Szent-Györgyi Clinical Centre, University of Szeged, Szeged, Hungary
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Sousa C, Rigueiro-Neves M, Miranda T, Alegria P, Vale J, Passos AM, Langdon D, Sá MJ. Validation of the brief international cognitive assessment for multiple sclerosis (BICAMS) in the Portuguese population with multiple sclerosis. BMC Neurol 2018; 18:172. [PMID: 30332999 PMCID: PMC6192303 DOI: 10.1186/s12883-018-1175-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 10/07/2018] [Indexed: 02/04/2023] Open
Abstract
Background The validation of international cognitive batteries in different multiple sclerosis (MS) populations is essential. Our objective was to obtain normative data for the Portuguese population of the Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS) and assess its reliability. Methods The BICAMS was applied to 105 MS patients and 60 age, gender and education matched healthy controls (HC). In order to test its reliability, BICAMS was re-administered in a subset of 25 patients after a 7-month interval. Results Most participants were women, with a mean age of 37, 21 years and a mean of 14,08 years of education. The vast majority of the MS patients (92.4%) had the relapsing remitting type, 58.1% were professionally active, mean disease duration was 6.52 years, median EDSS score was 1.5 (range: 0–6.0) and the median MSSS score was 2.01 (IQR range: 3.83). The MS group presented significantly higher scores of anxiety and depression than HC and 47,4% had fatigue. The MS group performed significantly worse than the control group across the three neuropsychological tests, yielding the following values: SDMT: t(165) = 3.77, p = .000; CVLT-II: t(165) = 2.98, p = .003; and BVMT-R: t(165) = 2.94, p = .004. The mean raw scores for Portuguese normative data were as follows: SDMT: 58.68 ± 10.02; CVLT-II: 60.47 ± 10.12; and BVMT-R: 24.68 ± 5.52. Finally, test–retest reliability coefficients for each test were as follows: SDMT: r = .90; CVLT-II: r = .71; and BVMT-R: r = .84. Conclusions The Portuguese version of BICAMS here in described is a reliable monitoring instrument for identifying MS patients with cognitive impairment.
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Affiliation(s)
- Cláudia Sousa
- MS Clinic, Department of Neurology, Centro Hospitalar São João Porto, Alameda Prof. Hernâni Monteiro, 4200 - 319, Porto, Portugal.
| | | | - Telma Miranda
- MS Clinic, Department of Neurology, Centro Hospitalar São João Porto, Alameda Prof. Hernâni Monteiro, 4200 - 319, Porto, Portugal
| | - Paulo Alegria
- Department of Neurology, Hospital Beatriz Ângelo, Loures, Portugal
| | - José Vale
- Department of Neurology, Hospital Beatriz Ângelo, Loures, Portugal
| | | | - Dawn Langdon
- Department of Psychology, Royal Holloway, University of London, London, UK
| | - Maria José Sá
- MS Clinic, Department of Neurology, Centro Hospitalar São João Porto, Alameda Prof. Hernâni Monteiro, 4200 - 319, Porto, Portugal.,Faculty of Health Sciences, University Fernando Pessoa, Porto, Portugal
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Filser M, Schreiber H, Pöttgen J, Ullrich S, Lang M, Penner IK. The Brief International Cognitive Assessment in Multiple Sclerosis (BICAMS): results from the German validation study. J Neurol 2018; 265:2587-2593. [PMID: 30171410 DOI: 10.1007/s00415-018-9034-1] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 08/21/2018] [Accepted: 08/22/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Recent research has convincingly shown that the ability to work mainly depends on the cognitive status in multiple sclerosis (MS). An international committee of experts recommended a brief neuropsychological battery to evaluate cognitive performance in MS. BICAMS comprises three tests, the Symbol Digit Modalities Test (SDMT), the learning trials of the California Verbal Learning Test II (CVLT-II), and the Brief Visuospatial Memory Test-Revised (BVMT-R). OBJECTIVE To validate BICAMS on a sample of German MS patients and healthy controls (HCs). METHODS According to the international guidelines for validation, examiner's instructions were standardized and translated into German. Due to the availability of better normative data for future applications in routine clinical care and classification of individual performance degree, the Rey Auditory Verbal Learning Test (RAVLT) (German version: Verbaler Lern- und Merkfähigkeits-Test, VLMT) was chosen instead of CVLT-II. 172 MS patients and 100 HCs entered the study. BICAMS was administered at baseline and retest (after 3-4 weeks). RESULTS The groups did not differ in age, gender or education. Mean age of MS patients was 43.33 years (SD 11.64); 68% were female and 86.9% had relapsing-remitting MS. Patients performed significantly worse than HCs on the SDMT (p < 0.01) and on BVMT-R (p < 0.05) but not on VLMT. In addition, BICAMS was shown to be reliable over time: r = 0.71 for BVMT-R, r = 0.72 for VLMT and r = 0.85 for SDMT. SDMT z-score proved to be a good predictor for the ability to work in a full-time (p < 0.001) as well as in a part-time job (p < 0.001). VLMT z-score turned out to be a significant predictor only for the ability to work in a part-time job, while BVMT-R z-score showed no significant predictive value. CONCLUSION In this German validation study with the VLMT, the modified BICAMS (BICAMS-M) turned out to reliably detect cognitive problems in MS patients and to monitor cognitive performance over time. SDMT revealed the best predictive value for working ability. Moreover, only the SDMT was able to predict the ability to work in a part-time or full-time job. Following these results, application of the SDMT is recommended for medical statements on working ability of MS patients.
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Affiliation(s)
- M Filser
- Cogito Center for Applied Neurocognition and Neuropsychological Research, Düsseldorf, Germany
| | - H Schreiber
- Neurological Practice and Neuropoint Academy, Ulm, Germany
| | - J Pöttgen
- Institut für Neuroimmunologie und Multiple Sklerose, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - S Ullrich
- .05 Statistikberatung, Düsseldorf, Germany
| | - M Lang
- Neurological Practice and Neuropoint Academy, Ulm, Germany
| | - I K Penner
- Cogito Center for Applied Neurocognition and Neuropsychological Research, Düsseldorf, Germany. .,Department of Neurology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.
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Gromisch ES, Portnoy JG, Foley FW. Response to screening ability of cognitive function by two measures in patients with multiple sclerosis. J Neurol Sci 2018; 391:154-155. [DOI: 10.1016/j.jns.2018.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 06/12/2018] [Indexed: 10/14/2022]
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Eizaguirre MB, Vanotti S, Merino Á, Yastremiz C, Silva B, Alonso R, Garcea O. The Role of Information Processing Speed in Clinical and Social Support Variables of Patients with Multiple Sclerosis. J Clin Neurol 2018; 14:472-477. [PMID: 30198225 PMCID: PMC6172515 DOI: 10.3988/jcn.2018.14.4.472] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 03/30/2018] [Accepted: 03/30/2018] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND AND PURPOSE Information processing speed is one of the most impaired cognitive functions in multiple sclerosis (MS). There are two tests widely used for evaluating information processing speed: the Symbol Digit Modalities Test (SDMT) and the Paced Auditory Serial Addition Test (PASAT). To analyze the relationship between processing speed and the clinical and social support variables of patients with MS. METHODS A group of 47 patients with relapsing-remitting MS was studied, 31 were women and 16, men. Age: 39.04±13.17, years of schooling: 13.00±3.87, Expanded Disability Status Scale (EDSS): 2.78±1.81, and disease evolution: 8.07±6.26. Instruments of measure; processing speed: SDMT, PASAT, clinical variables: EDSS, Fatigue Severity Scale (FSS), Beck's Depression Inventory II (BDI-II), and social support: Medical Outcomes Study Social Support Survey (MOS). RESULTS Significant correlations were found between information processing speed and psychiatric, motor disability and social support variables. The SDMT correlated significantly and negatively with BDI-II, FSS, EDSS, and MOS (p<0.05), whereas the PASAT correlated negatively with FSS and positively with MOS (p<0.05). Information processing speed appeared as the performance predictor of these variables. The SDMT produced significant changes in EDSS (R²=0.343, p=0.000); FSS (R²=0.109, p=0.031); BDI-II (R²=0.124, p=0.018), and MOS (R²=between 0.212 and 0.379, p<0.05). CONCLUSIONS Information processing speed has influence on the clinical variables and the social support of patients with MS. These aspects are important to bear in mind for therapeutic approach.
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Affiliation(s)
- María Bárbara Eizaguirre
- Multiple Sclerosis Clinic and University of Buenos Aires Neurology Center, Ramos Mejía Hospital, Buenos Aires, Argentina.
| | - Sandra Vanotti
- Multiple Sclerosis Clinic and University of Buenos Aires Neurology Center, Ramos Mejía Hospital, Buenos Aires, Argentina
| | - Ángeles Merino
- Multiple Sclerosis Clinic and University of Buenos Aires Neurology Center, Ramos Mejía Hospital, Buenos Aires, Argentina
| | - Cecilia Yastremiz
- Multiple Sclerosis Clinic and University of Buenos Aires Neurology Center, Ramos Mejía Hospital, Buenos Aires, Argentina
| | - Berenice Silva
- Multiple Sclerosis Clinic and University of Buenos Aires Neurology Center, Ramos Mejía Hospital, Buenos Aires, Argentina
| | - Ricardo Alonso
- Multiple Sclerosis Clinic and University of Buenos Aires Neurology Center, Ramos Mejía Hospital, Buenos Aires, Argentina
| | - Orlando Garcea
- Multiple Sclerosis Clinic and University of Buenos Aires Neurology Center, Ramos Mejía Hospital, Buenos Aires, Argentina
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Reen GK, Silber E, Langdon DW. Best Methods of Communicating Clinical Trial Data to Improve Understanding of Treatments for Patients with Multiple Sclerosis. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2018; 21:762-766. [PMID: 30005747 DOI: 10.1016/j.jval.2017.12.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 12/07/2017] [Accepted: 12/21/2017] [Indexed: 06/08/2023]
Abstract
BACKGROUND Patients' understanding of treatment risks and benefits is a prerequisite for shared decision making. Yet, patients with multiple sclerosis (MS) do not accurately understand treatment information provided in regular clinical consultations. OBJECTIVES To identify the best methods of communicating clinical trial data to improve the understanding of treatments among patients with MS and to also examine the relationship between patients' understanding with decisional conflict, individual traits, and MS symptoms. METHODS A repeated-measures study was used. A sample of relapsing-remitting patients with MS was recruited from National Health Service sites in the United Kingdom. Patients were presented with hypothetical treatment risks and benefits from faux clinical trials. Treatments were communicated using absolute terms, relative terms, and numbers needed to treat/harm. The presence of baseline information with each method was also manipulated. Patients' understanding and conflict in treatment decisions were assessed. Individual traits and MS symptoms were also recorded. RESULTS Understanding was better when treatments were communicated in absolute terms (mean 3.99 ± 0.93) compared with relative terms (mean 2.93 ± 0.91; P < 0.001) and numbers needed to treat/harm (mean 2.89 ± 0.88; P < 0.001). Adding baseline information to all methods significantly improved understanding (mean 5.04 ± 0.96) compared with no baseline information (mean 1.50 ± 0.74; P < 0.001). Understanding was not related to conflict in treatment decisions (r = -0.131; P = 0.391). Numeracy, IQ, and cognitive impairments were significantly related to patients' understanding of treatments. CONCLUSIONS Treatment risks and benefits should ideally be communicated using absolute terms, alongside baseline information. Patients with MS with low numeracy, low IQ, and reduced cognitive skills should be supported during treatment education.
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Affiliation(s)
- Gurpreet K Reen
- Department of Psychology, Royal Holloway, University of London, Egham, UK.
| | - Eli Silber
- Department of Neurology, King's College Hospital NHS Foundation Trust, London, UK
| | - Dawn W Langdon
- Department of Psychology, Royal Holloway, University of London, Egham, UK
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Corfield F, Langdon D. A Systematic Review and Meta-Analysis of the Brief Cognitive Assessment for Multiple Sclerosis (BICAMS). Neurol Ther 2018; 7:287-306. [PMID: 29923070 PMCID: PMC6283796 DOI: 10.1007/s40120-018-0102-3] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Indexed: 12/13/2022] Open
Abstract
Abstract Multiple sclerosis (MS) is a neurological disease of the central nervous system which can lead to a range of severe physical disabilities. A large proportion of those affected will experience cognitive impairment, which is associated with a worse prognosis. Effective assessment of cognition in MS has been problematic due to a lack of suitable scales. The Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS) was developed in 2010 as part of an international endeavour to facilitate cognitive assessment. Aim The aim of this systematic review and meta-analysis was to synthesise the available literature published as part of the BICAMS international validation protocol. Methods A literature search conducted using PubMed, PsycINFO and Google Scholar identified 16 studies for inclusion in the systematic review, 14 of which could be included in a meta-analysis. Results BICAMS has been widely validated across 11 languages and 14 individual cultures and locations. The meta-analysis demonstrated that BICAMS identified significantly reduced cognitive functioning in adults with MS compared to healthy controls. This was true for all three cognitive domains assessed by BICAMS: information processing speed (g = 0.943, 95% CI 0.839, 1.046, g < 0.001), immediate verbal recall memory (g = 0.688, 95% CI 0.554, 0.822, p < 0.001) and immediate visual recall memory (g = 0.635, 95% CI 0.534, 0.736, p < 0.001). Conclusion BICAMS has been widely applied across cultures and languages to assess cognition in MS. BICAMS offers a feasible, cost-effective means of assessing cognition in MS worldwide. Further validation studies are underway to support this project.
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Affiliation(s)
- Freya Corfield
- Psychology Department, Royal Holloway, University of London, Egham, Surrey, UK
| | - Dawn Langdon
- Psychology Department, Royal Holloway, University of London, Egham, Surrey, UK.
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de Caneda MAG, Cuervo DLM, Marinho NE, de Vecino MCA. The Reliability of the Brief Visuospatial Memory Test - Revised in Brazilian multiple sclerosis patients. Dement Neuropsychol 2018; 12:205-211. [PMID: 29988357 PMCID: PMC6022983 DOI: 10.1590/1980-57642018dn12-020014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Cognitive Impairment (CI) is a common and distressing problem in Multiple Sclerosis (MS). Its identification is complicated and sometimes omitted in the routine evaluation by neurologists. The BICAMS (Brief International Cognitive Assessment for Multiple Sclerosis) is a promising tool to overcome this difficulty. However, there is some concern regarding the subjectivity in scoring of the BVMT-R (Brief Visuospatial Memory Test - Revised), one of its components. Objective To evaluate the reliability of the BVMT-R in a sample of Brazilian MS patients, with the measure being administered and scored by neurologists. Methods BICAMS was applied to seventy subjects comprising forty patients diagnosed with MS and thirty healthy controls. In the MS patients group, the coefficients of agreement between three different raters, using the same protocols, and the internal consistency of the BVMT-R were assessed. Also, the coefficients of correlation of the BVMT-R with the other tests of the BICAMS, CVLT II (California Verbal Learning Test II) and SDMT (Symbol Digit Modalities Test), and their respective effect sizes were calculated. Results the BVMT-R presented a moderate inter-rater coefficient of agreement (k=0.62), an excellent Intraclass Correlation Coefficient (ICC=0.85), and high internal consistency (α=0.92). The correlation between the BVMT-R and CVLT II was moderate (ρ=0.36; p<0.025), but strong with the SDMT (ρ=0.60; p<0.01), with a large effect size. Conclusion The BVMT-R is a reliable instrument for assessing CI in patients with MS, having a significant association with information processing speed, an aspect which should be considered when evaluating its score.
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Affiliation(s)
- Marco Aurélio G de Caneda
- Multiple Sclerosis Center, Department of Neurology, Hospital Moinhos de Vento, Porto Alegre, RS, Brazil
| | | | - Nathércia Estevam Marinho
- Multiple Sclerosis Center, Department of Neurology, Hospital Moinhos de Vento, Porto Alegre, RS, Brazil
| | - Maria Cecília A de Vecino
- Multiple Sclerosis Center, Department of Neurology, Hospital Moinhos de Vento, Porto Alegre, RS, Brazil
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Cognition During and After Multiple Sclerosis Relapse as Assessed With the Brief International Cognitive Assessment for Multiple Sclerosis. Sci Rep 2018; 8:8169. [PMID: 29802384 PMCID: PMC5970258 DOI: 10.1038/s41598-018-26449-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 05/10/2018] [Indexed: 11/08/2022] Open
Abstract
There is some evidence that cognition may be impaired during multiple sclerosis (MS) relapse. The aims of this study were to assess the cognitive status with the Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS) in MS patients during relapse, in stable patients, and in healthy controls; to evaluate cognitive changes up to 3 months after relapse; and to estimate the impact of different factors on cognition after relapse. BICAMS was performed in 60 relapsing, 30 stable patients and 30 controls. Relapsing MS patients were assessed during relapse and one and three months after relapse. SDMT score was lower in relapsing than in stable patients. The mean scores of all BICAMS tests were higher one month after relapse than during relapse (p < 0.001). SDMT score after relapse improved in younger patients, who had more severe relapse (p < 0.05). BVMT-R score improved more in men, in patients with biologically active interferon-beta, in patients treated with methylprednisolone and in patients who were rehabilitated (p < 0.05). CVLT-II score improved in women and in patients with shorter relapse (p < 0.05). A neuropsychological assessment, like the evaluation of physical disability, is important during relapse. BICAMS may be suitable for a quick and effective assessment of cognition during relapse.
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Costa SL, DeLuca J, Costanza K, Chiaravalloti ND. Comparing the Open Trial – Selective Reminding Test results with the California Learning Verbal Test II in multiple sclerosis. APPLIED NEUROPSYCHOLOGY-ADULT 2018; 26:488-496. [PMID: 29617157 DOI: 10.1080/23279095.2018.1448818] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Silvana L. Costa
- Kessler Foundation, Neuropsychology and Neuroscience, West Orange, New Jersey, USA
- Kessler Foundation Research Center, West Orange, New Jersey, USA
| | - John DeLuca
- Kessler Foundation, Neuropsychology and Neuroscience, West Orange, New Jersey, USA
- Kessler Foundation Research Center, West Orange, New Jersey, USA
- University of Medicine and Dentistry of New Jersey, Newark, New Jersey, USA
| | - Kristen Costanza
- Kessler Foundation, Neuropsychology and Neuroscience, West Orange, New Jersey, USA
| | - Nancy D. Chiaravalloti
- Kessler Foundation, Neuropsychology and Neuroscience, West Orange, New Jersey, USA
- Kessler Foundation Research Center, West Orange, New Jersey, USA
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Coghe G, Corona F, Marongiu E, Fenu G, Frau J, Lorefice L, Crisafulli A, Galli M, Concu A, Marrosu MG, Pau M, Cocco E. Fatigue, as measured using the Modified Fatigue Impact Scale, is a predictor of processing speed improvement induced by exercise in patients with multiple sclerosis: data from a randomized controlled trial. J Neurol 2018; 265:1328-1333. [PMID: 29574556 DOI: 10.1007/s00415-018-8836-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 03/13/2018] [Accepted: 03/16/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND Few studies have evaluated the impact of physical activity (PA) on cognition and fatigue, and none have considered the effects of PA on the relationship between cognition and fatigue. OBJECTIVES We evaluated the effect of PA in people with multiple sclerosis (pwMS) in a 6-month-long single-blind randomized controlled trial. We focused on the impact of exercise on cognition, fatigue, and the relationship between cognition and fatigue. METHODS We recruited pwMS, who were then randomly assigned 1:1 to either a PA protocol group or a control group (CG). All patients underwent assessments using the Brief International Cognitive Assessment for Multiple Sclerosis including symbol digit modality test (SDMT), Berg Balance Scale (BBS), gait analysis, 6-Minute Walk Test, Timed Up and Go (TUG) test, and the Modified Fatigue Impact Scale (MFIS) at the beginning of the study (T0), at the end of the study (EOS) 24 weeks after T0, and at 24 weeks following the EOS (FU). RESULTS A Wilcoxon test revealed a significant effect of exercise in the PA group, but not in the CG. Significant differences between T0 and EOS were found in the spatiotemporal parameters of gait, and performance on the SDMT, TUG, BBS, and MFIS. These differences were also present during the FU period. A regression model revealed that the baseline MFIS score predicted processing speed improvement (R2 = 0.65, p < 0.01), as the SDMT T score increased by 0.3 for each one-unit increase in the MFIS score at T0. CONCLUSION PA affects multiple aspects of the pathology in pwMS. Patients with greater fatigue must not be discouraged from exercise, as they may greatly benefit from PA. Specifically, PA was shown to improve information processing speed.
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Affiliation(s)
- Giancarlo Coghe
- Department of Medical Sciences and Public Health, Multiple Sclerosis Center, University of Cagliari, Cagliari, Italy.
| | - Federica Corona
- Department of Mechanical, Chemical and Materials Engineering, University of Cagliari, Cagliari, Italy
| | - Elisabetta Marongiu
- Sports Physiology Lab, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Giuseppe Fenu
- Department of Medical Sciences and Public Health, Multiple Sclerosis Center, University of Cagliari, Cagliari, Italy
| | - Jessica Frau
- Department of Medical Sciences and Public Health, Multiple Sclerosis Center, University of Cagliari, Cagliari, Italy
| | - Lorena Lorefice
- Department of Medical Sciences and Public Health, Multiple Sclerosis Center, University of Cagliari, Cagliari, Italy
| | - Antonio Crisafulli
- Sports Physiology Lab, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Manuela Galli
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Alberto Concu
- Sports Physiology Lab, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Maria Giovanna Marrosu
- Department of Medical Sciences and Public Health, Multiple Sclerosis Center, University of Cagliari, Cagliari, Italy
| | - Massimiliano Pau
- Department of Mechanical, Chemical and Materials Engineering, University of Cagliari, Cagliari, Italy
| | - Eleonora Cocco
- Department of Medical Sciences and Public Health, Multiple Sclerosis Center, University of Cagliari, Cagliari, Italy
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Gromisch ES, Portnoy JG, Foley FW. Comparison of the abbreviated minimal assessment of cognitive function in multiple sclerosis (aMACFIMS) and the brief international cognitive assessment for multiple sclerosis (BICAMS). J Neurol Sci 2018; 388:70-75. [PMID: 29627034 DOI: 10.1016/j.jns.2018.03.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 02/01/2018] [Accepted: 03/05/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Cognitive impairment is a prevalent and often intrusive problem among persons with multiple sclerosis (PwMS). Valid and reliable assessments, including quick screening measures, are crucial. The Brief International Cognitive Assessment for MS (BICAMS) was developed for this reason. While it lends itself to use in locations where formal neuropsychological resources might be limited, it does not include measures of verbal fluency or executive functioning, domains assessed as part of the Minimal Assessment of Cognitive Function in MS (MACFIMS). OBJECTIVE Given previous evidence that shortened MACFIMS measures have strong criterion validity, this study aimed to determine which of these should be included in the abbreviated MACFIMS (aMACFIMS), and how the aMACFIMS compares to the BICAMS. METHODS One hundred forty-seven PwMS were included in the analyses. A stepwise logistic regression was used to determine the measures in the aMACFIMS. Receiver-operating-characteristic (ROC) curves assessed the classification accuracy, sensitivity, and specificity. The batteries' sensitivity, specificity, and predictive values were then compared. RESULTS Compared to the BICAMS, the final aMACFIMS had higher specificity (87% versus 72%) and positive predictive value (86% versus 77%), but lower sensitivity (71% versus 81%). CONCLUSION The aMACFIMS has several benefits, including reduced administration time and the addition of a verbal fluency/executive functioning measure.
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Affiliation(s)
- Elizabeth S Gromisch
- Mandell Center for Multiple Sclerosis, Mount Sinai Rehabilitation Hospital, Trinity Health of New England, 490 Blue Hills Avenue, Hartford, CT 06112, USA.
| | - Jeffrey G Portnoy
- Ferkauf Graduate School of Psychology, Yeshiva University, 1300 Morris Park Avenue, Bronx, NY 10468, USA
| | - Frederick W Foley
- Ferkauf Graduate School of Psychology, Yeshiva University, 1300 Morris Park Avenue, Bronx, NY 10468, USA; Holy Name Medical Center Multiple Sclerosis Center, 718 Teaneck Road, Teaneck, NJ 07666, USA
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Grzegorski T, Losy J. Cognitive impairment in multiple sclerosis - a review of current knowledge and recent research. Rev Neurosci 2018; 28:845-860. [PMID: 28787275 DOI: 10.1515/revneuro-2017-0011] [Citation(s) in RCA: 95] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 05/19/2017] [Indexed: 11/15/2022]
Abstract
Multiple sclerosis (MS) is a chronic, progressive disease of the central nervous system that is characterised by inflammatory damage to the myelin sheath. Though often neglected, cognitive impairment is a common feature of MS that affects 43-70% of patients. It has a sophisticated neuroanatomic and pathophysiologic background and disturbs such vital cognitive domains as speed of information processing, memory, attention, executive functions and visual perceptual functions. In recent years there has been growing interest in neuroimaging findings with regard to cognitive impairment in MS. The possible options of managing cognitive dysfunction in MS are pharmacologic interventions, cognitive rehabilitation and exercise training; however, not enough evidence has been presented in this field. The aim of our article is to provide current knowledge on cognitive impairment in MS based on the most recent scientific results and conclusions with regard to affected cognitive domains, neuropsychological assessment, underlying mechanisms of this disturbance, neuroimaging findings and therapeutic options.
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Ozakbas S, Yigit P, Cinar BP, Limoncu H, Kahraman T, Kösehasanoğulları G. The Turkish validation of the Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS) battery. BMC Neurol 2017; 17:208. [PMID: 29207954 PMCID: PMC5717821 DOI: 10.1186/s12883-017-0993-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2017] [Accepted: 11/28/2017] [Indexed: 11/17/2022] Open
Abstract
Background Cognitive impairment may be seen in as many as 43–70% of patients with multiple sclerosis (MS) and may be observed in all MS subtypes. The Brief International Cognitive Assessment in Multiple Sclerosis (BICAMS) battery may be used to evaluate cognition status. The purpose of the current study is to validate the BICAMS battery in Turkish. Methods Patients with MS attending our clinic between September 2014 and April 2015 were invited to participate. Healthy control participants were matched in terms of age, gender and years of education. Results One hundred seventy-three MS patients and 153 healthy control participants were enrolled in the study. MS patients performed significantly worse in all trials than the members of the healthy control group. In addition, cognitive dysfunction was identified in 78 of the 173 (45.1%) patients. In the MS with cognitive impairment group, 64 out of 151 (42.4%) subjects were RRMS patients, 12 out of 18 (66.7%) were secondary progressive MS patients, and 2 out of 4 (50%) were primer progressive MS patients. Conclusions The BICAMS has been proposed for assessing cognitive impairment in MS patients. This study shows that the battery is suitable for use in Turkey.
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Affiliation(s)
- Serkan Ozakbas
- Department of Neurology, Dokuz Eylul University, Izmir, Turkey
| | - Pinar Yigit
- Department of Neurology, Dokuz Eylul University, Izmir, Turkey
| | - Bilge Piri Cinar
- Department of Neurology, Samsun Training and Researce Hospital, Samsun, Turkey.
| | - Hatice Limoncu
- Department of Neurology, Dokuz Eylul University, Izmir, Turkey
| | - Turhan Kahraman
- School of Physical Therapy and Rehabilitation Department, İzmir Katip Celebi University, Izmir, Turkey
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Vanotti S, Caceres FJ. Cognitive and neuropsychiatric disorders among MS patients from Latin America. Mult Scler J Exp Transl Clin 2017; 3:2055217317717508. [PMID: 28979791 PMCID: PMC5617097 DOI: 10.1177/2055217317717508] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 06/04/2017] [Indexed: 11/20/2022] Open
Abstract
Cognitive and neuropsychiatric disorders in patients with multiple sclerosis have been extensively documented. The focus of this review will be on cognitive and neuropsychiatric disorders in multiple sclerosis patients from Latin America, in the context of international literature. Multicentre studies carried out in Latin America have shown that 43% of the patients have cognitive impairment and 34.5% in early stages of the disease, 29% depression and 20.9% neuropsychiatric disorders. The profile of cognitive impairment corresponds to alterations in visual and verbal memory, in attention, in information processing speed and in verbal fluency. The neuropsychiatric profile showed disorders in anxiety, depression, apathy and irritability domains. In the region, there exist validations of the multiple sclerosis neuropsychological screening questionnaire (MSNQ), the brief repeatable battery of neuropsychological tests (BRB-N) and the brief international cognitive assessment for multiple sclerosis (BICAMS), as well as of the paced auditory serial addition test (PASAT) and the symbol digit modalities test (SDMT). A study showed that 53% of the patients who met the NEDA3 condition had cognitive impairment. This finding highlights the need for taking cognitive assessment into account when determining therapeutic efficacy.
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Affiliation(s)
| | - Fernando J Caceres
- Multiple Sclerosis Clinic, INEBA - Neurosciences Institute of Buenos Aires, Argentina
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