The relation between memory and decision-making in multiple sclerosis patients

A systematic review to explore patients' MS knowledge and MS risk knowledge

Living with a chronic illness poses particular challenges, including maintaining current disease knowledge to optimise self-management and interaction with health professionals. People with Multiple Sclerosis (MS) are increasingly encouraged to participate in shared decision making. Making informed decisions is likely to rely on adequate knowledge about the condition and its associated risks. The aim of this systematic review is to explore patients' existing MS knowledge and MS risk knowledge, and how these relate to demographic and disease variables. A literature search was conducted using PsycINFO, PubMed and Cochrane Library. Eligible studies were published peer-reviewed reporting quantitative measures of MS knowledge and MS risk knowledge in adult MS patients. Eighteen studies met inclusion criteria comprising a total sample of 4,420 patients. A narrative synthesis was undertaken because studies employed various measures. Suboptimal levels of MS knowledge and MS risk knowledge were generally identified across studies. Greater self-reported adherence and a willingness to take medication were related to higher MS knowledge, while educational level was a significant predictor of both MS knowledge and MS risk knowledge. Associations with other demographic and disease-related variables were mixed for both knowledge domains. Direct comparison of results across studies were limited by methodological, sampling and contextual heterogeneity. The review's findings and implications for future research and clinical practice are considered from this perspective.

Insights for Healthcare Providers on Shared Decision-Making in Multiple Sclerosis: A Narrative Review

Shared decision-making (SDM) between the patient and their healthcare provider (HCP) in developing treatment plans is increasingly recognized as central to improving treatment adherence and, ultimately, patient outcomes. In multiple sclerosis (MS), SDM is particularly crucial for optimizing treatment in a landscape that has grown more complex with the availability of newer, high-efficacy MS therapies. However, little direct evidence on the effectiveness of SDM is available to guide practice. Multiple factors, including patient age, ethnic background, perceptions, invisible MS symptoms, and psychological comorbidities can influence a patient's willingness and ability to participate in SDM. HCPs need to appreciate these factors and ask the right questions to break down obstacles to SDM. The HCP has a responsibility to help patients feel adequately informed and comfortable in having an active role in their care. This review identifies potential barriers to SDM and provides a strategy for HCPs to overcome these obstacles through patient (and caregiver) discussions to ensure optimal patient satisfaction with treatment and thus the best possible outcomes for their patients.

A reassessment of the Resistance to Framing scale

Risky-choice and attribute framing effects are well-known cognitive biases, where choices are influenced by the way information is presented. To assess susceptibility to these framing types, the Resistance to Framing scale is often used, although its performance has rarely been extensively tested. In an online survey among university students from Bulgaria (N = 245) and North America (N = 261), we planned to examine the scale's psychometric properties, structural validity, and measurement invariance. However, some of these examinations were not possible because the scale displayed low and mostly non-significant inter-item correlations as well as low item-total correlations. Followingly, exploratory item response theory analyses indicated that the scale's reliability was low, especially for high levels of resistance to framing. This suggests problems with the scale at a basic level of conceptualization, namely that the items may not represent the same content domain. Overall, the scale in its current version is of limited use, at least in university student samples, due to the identified problems. We discuss potential remedies to these problems, as well as provide open code and data ( https://osf.io/j5n6f ) which facilitates testing the scale in other samples (e.g., general population, different languages and countries) to obtain a comprehensive picture of its performance.

Cognitive impairment in multiple sclerosis: "classic" knowledge and recent acquisitions

Multiple sclerosis (MS) is a central nervous system (CNS) disease characterized by inflammation, axonal demyelination, and neurodegeneration, which can have a strong impact on all aspects of the life of the patient. Multiple sclerosis causes motor, sensory, cerebellar, and autonomic dysfunctions, as well as cognitive and psychoemotional impairment. The most frequently compromised cognitive domains are complex attention/information processing, memory, executive and visuospatial functions. Recently, alterations have also been evidenced in complex cognitive functions, such as social cognition, moral judgment, and decision-making. Cognitive impairment is characterized by high variability and can affect work skills, social interactions, coping strategies and more generally the quality of life of patients and their families. With the use of sensitive and easy-to-administer test batteries, an increasingly accurate and early diagnosis is feasible: this allows to determine the effectiveness of possible preventive measures, to predict the future progression of the disease and to improve the quality of life of patients. There is currently limited evidence regarding the efficacy, on cognitive impairment, of disease-modifying therapies. The most promising approach, which has received strong empirical support, is cognitive rehabilitation.

Generalization of Skill for a Working Memory Recognition Procedure in Children: The Benefit of Starting with Easy Materials

When children practice a new task, they need to learn both the task procedure and the materials tested. It is often unclear if improvements with practice reflect learning of the task procedure or familiarity with the materials. We sought to examine learning of the task procedure by switching from one set of materials to another in a working memory recognition task. We recruited 70 children (34 female, M = 11.27 years, SD = 0.62, ranging from 10.08 to 12.39) in the United States who were to remember sequences of orientations and of shapes for recognition immediately following the list. Half of the children began with orientation, an easier task, and the other half began with difficult-to-name shapes, a harder task. When children began with the easier task, the acquisition of the recognition task skill in the easy condition transferred to the more difficult task, optimizing the mean performance across tasks. Transfer was less potent when children began with the more difficult task. The results showed that sufficient practice is crucial to avoid poor initial performance, which might be important for the student’s rate of progress and task engagement.