Verbal fluency deficits in multiple sclerosis

Cognitive impairment in multiple sclerosis: from phenomenology to neurobiological mechanisms

Multiple sclerosis (MS) is an autoimmune-mediated disease of the central nervous system characterized by inflammation, demyelination and chronic progressive neurodegeneration. Among its broad and unpredictable range of clinical symptoms, cognitive impairment (CI) is a common and disabling feature greatly affecting the patients' quality of life. Its prevalence is 20% up to 88% with a wide variety depending on the phenotype of MS, with highest frequency and severity in primary progressive MS. Involving different cognitive domains, CI is often associated with depression and other neuropsychiatric symptoms, but usually not correlated with motor and other deficits, suggesting different pathophysiological mechanisms. While no specific neuropathological data for CI in MS are available, modern research has provided evidence that it arises from the disease-specific brain alterations. Multimodal neuroimaging, besides structural changes of cortical and deep subcortical gray and white matter, exhibited dysfunction of fronto-parietal, thalamo-hippocampal, default mode and cognition-related networks, disruption of inter-network connections and involvement of the γ-aminobutyric acid (GABA) system. This provided a conceptual framework to explain how aberrant pathophysiological processes, including oxidative stress, mitochondrial dysfunction, autoimmune reactions and disruption of essential signaling pathways predict/cause specific disorders of cognition. CI in MS is related to multi-regional patterns of cerebral disturbances, although its complex pathogenic mechanisms await further elucidation. This article, based on systematic analysis of PubMed, Google Scholar and Cochrane Library, reviews current epidemiological, clinical, neuroimaging and pathogenetic evidence that could aid early identification of CI in MS and inform about new therapeutic targets and strategies.

Microstructural analysis of verbal fluency performance in relapsing-remitting multiple sclerosis based on the impact of disability level

Verbal fluency (VF) evaluates language and cognitive abilities. This study compared VF in Relapsing-Remitting Multiple Sclerosis (RRMS) and healthy controls (HC), examining variables including correct responses (CR), mean cluster size (MCS), switches (S), and fluency difference score (FDS). RRMS participants were subgrouped by Expanded Disability Status Scale (EDSS), to explore the relationship between MS severity and VF. Twenty-four RRMS participants and matched HCs underwent Mini-Mental State Exam and VF Test. Statistical analysis compared VF between RRMS subgroups based on severity levels, and in HC. RRMS significantly impacted the CR, and S (CRSF p = 0.01, SSF p = 0.002; CRPF=0.002, SPF p = 0.002), while there was no significant difference in FDS between RRMS groups (p = 0.9). No significant relationship was found between EDSS scores, and VF subtests (CRSF p = 0.061, MCSSF p = 0.46, SSF p = 0.051, CRPF p = 0.521, MCSPF p = 0.966, SPF p = 0.599). In RRMS, our results demonstrate impairments in all VF parameters except the MCSSF+PF, and FDS. This study suggests that intact MCSSF+PF may reflect preserved verbal memory and word recall, while significant switching differences may indicate impaired cognitive flexibility. Similar FDS to those of HC suggest that no performance discrepancy in subtests in RRMS. Intact MCS might be a distinctive pattern in the early clinical stage of MS.

Prominent role of executive functioning on the Phonemic Fluency Test in people with multiple sclerosis

OBJECTIVE

Executive functioning (EF) can be one of the earliest, despite under-detected, impaired cognitive domains in patients with multiple sclerosis (pwMS). However, it is still not clear the role of EF on verbal fluency tests given the presence of information processing speed (IPS) deficits in pwMS.

METHOD

Performance of a group of 43 pwMS without IPS impairment as measured with the Symbol Digit Modalities Test (SDMT) and a group of 32 healthy controls (HC) was compared on the Phonemic and Semantic Fluency Tests. For each group, we scored the number of words generated (i) in the early time interval (i.e., first 15 sec, semi-automatic process) and (ii) in the late time interval (i.e., from 15 to 60 sec, controlled process).

RESULTS

Globally, pwMS produced significantly fewer words than HC on the Phonemic but not on the Semantic Fluency Test. Crucially, in the Phonemic Fluency Test pwMS generated significantly fewer words than HC in the late time interval, whereas no significant difference between the two groups emerged in the early time interval.

CONCLUSIONS

These findings suggest that executive dysfunction is the core element on the Phonemic Fluency Test also in pwMS and it deserves attention in both research and clinical practice.

Role of white matter in cognitive impairment among relapsing remitting multiple sclerosis patients

BACKGROUND

Multiple Sclerosis (MS) associated cognitive impairment is believed to be mostly connected with damage to gray matter. The contribution of white matter is still poorly understood. We aim to examine the relationship between cognition and white matter tracts among relapsing remitting MS (RRMS) patients.

METHODS

Thirty RRMS patients were selected undergo the (3-seconds-interstimulus-interval paced auditory serial addition test) PASAT-3, the (symbol digit modalities test (SDMT) and full-brain MRI scans on a SIEMENS 3 Tesla Verio scanner. Diffusion Tensor Imaging (DTI) parameters, such as fractional anisotropy (FA) and mean diffusivity (MD) were examined in 37 white matter (WM) tracts. WM tracts were selected from the association pathways, projection pathways, commissural pathways by applying Human Connectome project (HCP)842 tractography atlas after DTI data reconstruction and registration to HCP1065 diffusion template in DSI Studio (version March 2021) In SPSS v26, Spearman's rank correlation analysis was used to examine the connection between DTI WM tracts and cognitive scores. The power of the study was increased by using false discovery rate (FDR) software.

RESULTS

The mean scores on the PASAT-3 and SDMT were 31.5 ± 12.8 and 46.9 ± 16.7 respectively. Better cognitive performance was correlated to higher FA values, while lower cognitive function was correlated to higher MD values. There was a positive correlation between FA values in the right medial lemniscus and superior cerebellar peduncle and SDMT scores (p 0.05). Additionally, there was a trend for significance between the FA values in the left corticothalamic tract and SDMT scores. MD values in the superior cerebellar peduncle, left arcuate Fasciculus and left extreme capsule were negatively correlated with SDMT scores (p<0.05). PASAT-3 scores were negatively correlated with MD values in the right cerebellum, however, there was no significant correlation between PASAT-3 and FA values.

CONCLUSIONS

White matter tracts, particularly the superior cerebellar peduncle, contribute to the cognitive impairment in RRMS. Larger sample sizes for longitudinal research are necessary.

Optimising verbal fluency analysis in neurological patients with dysarthria: examples from Parkinson's disease and hereditary ataxia

BACKGROUND

Verbal fluency tests (VFTs) are widely used to assess cognitive-linguistic performance in neurological diseases. However, the influence of dysarthria on performance in tests requiring oral responses is unclear in ataxia and Parkinson's disease.

OBJECTIVES

To determine the impact of dysarthria on VFT performance and evaluate the validity and reliability of alternative methods for analyzing VFT data.

METHOD

Trained raters evaluated dysarthria using VFT recordings in people with ataxia (N = 61) or Parkinson's disease (PD; N = 69). Total Correct Items scores and qualitative parameters (intrusions, ambiguous verbalizations, perseverations, and interjections) were compared across semantic, phonemic, and alternating fluency tasks. Disease severity was considered as a covariate in the regression model.

RESULTS

VFT dysarthria ratings correlated with the benchmark (ground truth) dysarthria scores derived from a monologue. Ambiguous responses resulting from unclear speech impeded the rater's ability to determine if a response was correct. Regression analysis indicated that more severe dysarthria ratings predicted diminished scores in all three tasks (semantic fluency, phonemic fluency and alternating fluency) in the ataxia group. The contribution of disease severity to semantic, phonemic and alternating fluency was reduced substantially in the ataxia group after accounting for dysarthria severity in the model in both groups.

CONCLUSIONS

Dysarthria severity can be estimated based on speech samples derived from VFT. Dysarthria can lead to lower total correct items and is associated with more ambiguous verbalizations in VFT. Dysarthria severity should be considered when interpreting VFT performance in common movement disorders.

Narrative recall in relapsing-remitting multiple sclerosis: A potentially useful speech task for detecting subtle cognitive changes

Our research studied relapsing-remitting multiple sclerosis (RRMS). In half of the RRMS cases, mild cognitive difficulties are present, but often remain undetected despite their adverse effects on individuals' daily life. Detecting subtle cognitive alterations using speech analysis have rarely been implemented in MS research. We applied automatic speech recognition technology to devise a speech task with potential diagnostic value. Therefore, we used two narrative tasks adjusted for the neural and cognitive characteristics of RRMS; namely narrative recall and personal narrative. In addition to speech analysis, we examined the information processing speed, working memory, verbal fluency, and naming skills. Twenty-one participants with RRMS and 21 gender-, age-, and education-matched healthy controls took part in the study. All the participants with RRMS achieved a normal performance on Addenbrooke's Cognitive Examination. The following parameters of speech were measured: articulation and speech rate, the proportion, duration, frequency, and average length of silent and filled pauses. We found significant differences in the temporal parameters between groups and speech tasks. ROC analysis produced high classification accuracy for the narrative recall task (0.877 and 0.866), but low accuracy for the personal narrative task (0.617 and 0.592). The information processing speed affected the speech of the RRMS group but not that of the control group. The higher cognitive load of the narrative recall task may be the cause of significant changes in the speech of the RRMS group relative to the controls. Results suggest that narrative recall task may be effective for detecting subtle cognitive changes in RRMS.

Multimodal emotion perception in young and elderly patients with multiple sclerosis

BACKGROUND

Studies suggest that emotion recognition and empathy are impaired in patients with MS (pwMS). Nonetheless, most studies are restricted to young samples, to facial emotion recognition and to self-report assessments of empathy. The aims of this study are to determine the impact of MS and age on multimodal emotion recognition (facial emotions and vocal emotional bursts) and on socioemotional sensitivity (as reported by the participants and their informants). We also aim to investigate the associations between emotion recognition, socioemotional sensitivity, and cognitive measures.

METHODS

We recruited 13 young healthy controls (HC), 14 young pwMS, 14 elderly HC and 15 elderly pwMS. They underwent a short neuropsychological battery, an experimental emotion recognition task including facial emotions and vocal emotional bursts. Both participants and their study informants completed the Revised-Self Monitoring Scale (RSMS) to assess the participant's socioemotional sensitivity.

RESULTS

There was a significant effect of age and group on recognition of both facial emotions and emotional vocal bursts, HC performing significantly better than pwMS, and young participants performing better than elderly participants (no interaction effect). The same effects were observed on self-reported socioemotional sensitivity. However, lower socioemotional sensitivity in pwMS was not reported by the informants. Finally, multimodal emotion recognition did not correlate with socioemotional sensitivity, but it correlated with global cognitive severity.

CONCLUSION

PwMS present with multimodal emotion perception deficits. Our results extend previous findings of decreased emotion perception and empathy to a group of elderly pwMS, in which advancing age does not accentuate these deficits. However, the decreased socioemotional sensitivity reported by pwMS does not appear to be observed by their relatives, nor to correlate with their emotion perception impairments. Future studies should investigate the real-life impacts of emotion perception deficits in pwMS.

Digital Biomarkers in Multiple Sclerosis

For incurable diseases, such as multiple sclerosis (MS), the prevention of progression and the preservation of quality of life play a crucial role over the entire therapy period. In MS, patients tend to become ill at a younger age and are so variable in terms of their disease course that there is no standard therapy. Therefore, it is necessary to enable a therapy that is as personalized as possible and to respond promptly to any changes, whether with noticeable symptoms or symptomless. Here, measurable parameters of biological processes can be used, which provide good information with regard to prognostic and diagnostic aspects, disease activity and response to therapy, so-called biomarkers Increasing digitalization and the availability of easy-to-use devices and technology also enable healthcare professionals to use a new class of digital biomarkers-digital health technologies-to explain, influence and/or predict health-related outcomes. The technology and devices from which these digital biomarkers stem are quite broad, and range from wearables that collect patients' activity during digitalized functional tests (e.g., the Multiple Sclerosis Performance Test, dual-tasking performance and speech) to digitalized diagnostic procedures (e.g., optical coherence tomography) and software-supported magnetic resonance imaging evaluation. These technologies offer a timesaving way to collect valuable data on a regular basis over a long period of time, not only once or twice a year during patients' routine visit at the clinic. Therefore, they lead to real-life data acquisition, closer patient monitoring and thus a patient dataset useful for precision medicine. Despite the great benefit of such increasing digitalization, for now, the path to implementing digital biomarkers is widely unknown or inconsistent. Challenges around validation, infrastructure, evidence generation, consistent data collection and analysis still persist. In this narrative review, we explore existing and future opportunities to capture clinical digital biomarkers in the care of people with MS, which may lead to a digital twin of the patient. To do this, we searched published papers for existing opportunities to capture clinical digital biomarkers for different functional systems in the context of MS, and also gathered perspectives on digital biomarkers under development or already existing as a research approach.

Significance of the Diagnosis of Executive Functions in Patients with Relapsing-Remitting Multiple Sclerosis

Multiple sclerosis (MS) is a progressive chronic disease of the Central Nervous System (CNS). Cognitive decline occurs rather rarely in relapsing–remitting multiple sclerosis (RRMS) compared to other types. The present study aimed to assess executive functions (EF) in relation to clinical and demographic variables in patients with RRMS. The study involved 22 individuals with RRMS (aged 23 to 49 years) and 22 matching controls. All the individuals with RRMS were in the remission phase. The assessments were carried out using MoCA, BDI-II, Halstead Category Test, Porteus Maze Test, verbal fluency tasks and Stroop Colour-Word Interference Test. The findings show that the two groups differed significantly in all the tests. All patients with RRMS in the remission phase presented at least one cognitive deficit, observed in general cognitive functioning, abstract reasoning or other executive functions, i.e., fluency, interference suppression, planning, or ability to modify activity in response to feedback. The deficits in most cases (except for those measured with the MoCA, Category Tests and phonemic fluency), are not related to intensity of depression and duration of the disease. Findings suggest that the diagnostic process in the case of patients with RRMS may include psychological assessment focusing on potentially existing cognitive, mainly executive, deficits and their severity.

Verbal Fluency Tasks: Influence of Age, Gender, and Education and Normative Data for the Spanish Native Adult Population

OBJECTIVE

Phonological and semantic verbal fluency (VF) tasks are frequently used to assess language and executive functions in both clinical and research settings. F, A, and S are the most commonly used letters in phonological tasks across languages and cultures. Unfortunately, the lack of norms for the native Spanish population for these letters, and for certain semantic categories such as "proper names," may lead to misinterpretation of scores due to demographic differences. The aim of the present study was to provide normative data for F, A, and S and for "proper names," "animals," and "fruits and vegetables" for the native Spanish population.

METHOD

257 healthy subjects took part in the study (ages: 17-100 years, 3-20 years of education). Correlation, multiple regression, and t-tests were used to select the most appropriate variables for stratification.

RESULTS

Education was the best predictor of performance in all tasks, followed by age. Given that t-test results showed no differences related to gender, with the only exception of the semantic category "animals," this variable was not considered for stratification. Consequently, the data were stratified in two education levels (<13, ≥13 years of education) and in two age levels (<60, ≥60) within the low-educational level group. Mean, standard deviation, and percentile scores for each group are provided.

CONCLUSIONS

The present norms provide a reference for clinicians assessing VF. This data may also facilitate comparisons with other normative studies in cross-cultural and cross-linguistic research.

Underpinnings of verbal fluency in Multiple Sclerosis

The cognitive and language processes underlying verbal fluency remain unclear. While some cognitive processes related to memory and executive functioning have been more associated with category and letter verbal fluency, other less studied aspects of language ability could be also related. We discuss the contribution of the recent study by Lebkuecher and colleagues (2021) about the role of language in verbal fluency, and the data from other studies evaluating the cognitive and neuroimaging correlates of verbal fluency in MS.

Predicting Neuropsychological Impairment in Relapsing Remitting Multiple Sclerosis: The Role of Clinical Measures, Treatment, and Neuropsychiatry Symptoms

OBJECTIVE

This retrospective observational study aimed to define neuropsychological impairment (NI) profiles and determine the influence of clinical, demographic, and neuropsychiatric measures in specific cognitive domains in a cohort of relapsing-remitting multiple sclerosis (RRMS) patients.

METHODS

Ninety-one RRMS patients underwent a neurological examination and a brief neuropsychological assessment. Patients were classified according to the disease-modifying therapies (DMTs) received (platform or high-efficacy). Differences between groups and multiple regression analyses were performed to determine the predictive value of the assessed measures in cognitive performance.

RESULTS

More than two-thirds of the patients showed NI. Specifically, mild to moderate NI was presented in approximately half of the participants. Paced Auditory Serial Addition Test (PASAT-3) and Symbol Digit Modalities Test (SDMT) were the most frequently impaired cognitive tests (45.3% and 41.3%, respectively) followed by phonemic verbal fluency (PVF) (27.8%). Expanded Disability Status Scale (EDSS), age, depressive symptoms, and disease duration were the best predictors of SDMT (R2 = .34; p < .01), whereas disease duration, EDSS, and anxiety-state levels predicted PASAT-3 (R2 = .33, p < .01). Educational level, age, EDSS, and depressive symptoms demonstrated the strongest association with PVF (R2 = .31, p < .01).

CONCLUSIONS

Our results indicated a significant prevalence of NI in RRMS patients that was not dependent on the DMT type. In addition to the meaningful working memory (PASAT-3) and information processing speed (SDMT) impairments found, PVF deficits may also be an important marker of cognitive impairment in RRMS patients. This study supports the relevance of standard clinical measures and reinforces the importance of quantifying clinical and neuropsychiatric symptoms to predict subsequent cognitive performance on a similar multiple sclerosis phenotype and disease stage.

Social cognition and executive functioning in multiple sclerosis: A cluster-analytic approach

Multiple sclerosis (MS) is associated with deficits in social cognition, the process underlying social interaction and cognitive function. However, the relationships between executive impairment and social cognition remain unclear in MS. Previous studies exclusively focused on group comparisons between healthy controls and patients with MS, treating the latter as a homogeneous population. The variability of socio- and neurocognitive profiles in this pathology therefore remains underexplored. In the present study, we used a cluster analytic approach to explore the heterogeneity of executive and social cognition skills in MS. A total of 106 patients with MS were compared with 53 healthy matched controls on executive (e.g., working memory) and social cognition (facial emotion recognition and theory of mind) performances. A cluster analysis was then performed, focusing on the MS sample, to explore the presence of differential patterns of interaction between executive and social cognition difficulties and their links to sociodemographic, clinical and cognitive variables. We identified three distinct functional profiles: patients with no executive or social cognition deficits (Cluster 1); patients with difficulties in facial emotion recognition and theory of mind and, to a lesser extent, executive functioning (Cluster 2); and patients with executive functioning difficulties only (Cluster 3). Clinical characteristics (disease duration, disability, fatigue) did not differ between clusters. CONCLUSIONS: These results suggest that there are qualitative differences in the social cognition and executive difficulties that are commonly found among patients with MS. If replicated, the identification of these profiles in clinical practice could allow for more individualized rehabilitation.

Multiple sclerosis, emotion perception and social functioning

People with multiple sclerosis (MS) can experience problems in interpreting others' emotions from faces or voices. However, to date little is known about whether difficulties in emotion perception in MS are related to broader aspects of social functioning. Also, there are few studies reporting the effect of MS on more ecologically valid assessments of emotion perception using multimodal videos. The current study looks at (1) the effect of MS on perceiving emotions from faces, voices and multimodal videos; (2) the possible role of slowed processing and executive dysfunction in emotion perception problems in MS and (3) the relationship between emotion perception and broader social functioning in MS. 53 people with MS and 31 healthy controls completed tasks of emotion perception and cognition, and assessed their levels of social support and social participation. Participants with MS performed worse than demographically matched controls on all measures of emotion perception. Emotion perception performance was related to cognitive measures in those with MS. Also, significant associations were found between emotion perception difficulties in MS and poorer social function. In particular, people with MS who had poorer emotion perception also reported lower levels of social support from their friends, and regression analysis showed that this prediction was maintained even when disease severity and cognitive function were taken into account. These results show that problems with emotion perception in MS extend to more realistic tasks and may predict key aspects of social functioning.

Cognitive Processes Underlying Verbal Fluency in Multiple Sclerosis

Background: Verbal fluency (VF) has been associated with several cognitive functions, but the cognitive processes underlying verbal fluency deficits in Multiple Sclerosis (MS) are controversial. Further knowledge about VF could be useful in clinical practice, because these tasks are brief, applicable, and reliable in MS patients. In this study, we aimed to evaluate the cognitive processes related to VF and to develop machine-learning algorithms to predict those patients with cognitive deficits using only VF-derived scores.

Methods: Two hundred participants with MS were enrolled and examined using a comprehensive neuropsychological battery, including semantic and phonemic fluencies. Automatic linear modeling was used to identify the neuropsychological test predictors of VF scores. Furthermore, machine-learning algorithms (support vector machines, random forest) were developed to predict those patients with cognitive deficits using only VF-derived scores.

Results: Neuropsychological tests associated with attention-executive functioning, memory, and language were the main predictors of the different fluency scores. However, the importance of memory was greater in semantic fluency and clustering scores, and executive functioning in phonemic fluency and switching. Machine learning algorithms predicted general cognitive impairment and executive dysfunction, with F1-scores over 67–71%.

Conclusions: VF was influenced by many other cognitive processes, mainly including attention-executive functioning, episodic memory, and language. Semantic fluency and clustering were more explained by memory function, while phonemic fluency and switching were more related to executive functioning. Our study supports that the multiple cognitive components underlying VF tasks in MS could serve for screening purposes and the detection of executive dysfunction.

A network-based cognitive training induces cognitive improvements and neuroplastic changes in patients with relapsing-remitting multiple sclerosis: an exploratory case-control study

Cognitive impairments are commonly observed in patients with multiple sclerosis and are associated with lower levels of quality of life. No consensus has been reached on how to tackle effectively cognitive decline in this clinical population non-pharmacologically. This exploratory case-control study aims to investigate the effectiveness of a hypothesis-based cognitive training designed to target multiple domains by promoting the synchronous co-activation of different brain areas and thereby improve cognition and induce changes in functional connectivity in patients with relapsing-remitting multiple sclerosis. Forty-five patients (36 females and 9 males, mean age 44.62 ± 8.80 years) with clinically stable relapsing-remitting multiple sclerosis were assigned to either a standard cognitive training or to control groups (sham training and non-active control). The standard training included twenty sessions of computerized exercises involving various cognitive functions supported by distinct brain networks. The sham training was a modified version of the standard training that comprised the same exercises and number of sessions but with increased processing speed load. The non-active control group received no cognitive training. All patients underwent comprehensive neuropsychological and magnetic resonance imaging assessments at baseline and after 5 weeks. Cognitive and resting-state magnetic resonance imaging data were analyzed using repeated measures models. At reassessment, the standard training group showed significant cognitive improvements compared to both control groups in memory tasks not specifically targeted by the training: the Buschke Selective Reminding Test and the Semantic Fluency test. The standard training group showed reductions in functional connectivity of the salience network, in the anterior cingulate cortex, associated with improvements on the Buschke Selective Reminding Test. No changes were observed in the sham training group. These findings suggest that multi-domain training that stimulates multiple brain areas synchronously may improve cognition in people with relapsing-remitting multiple sclerosis if sufficient time to process training material is allowed. The associated reduction in functional connectivity of the salience network suggests that training-induced neuroplastic functional reorganization may be the mechanism supporting performance gains. This study was approved by the Regional Ethics Committee of Yorkshire and Humber (approval No. 12/YH/0474) on November 20, 2013.

Brain dysconnectivity relates to disability and cognitive impairment in multiple sclerosis

The pathophysiology of cognitive dysfunction in multiple sclerosis (MS) is still unclear. This magnetoencephalography (MEG) study investigates the impact of MS on brain resting-state functional connectivity (rsFC) and its relationship to disability and cognitive impairment. We investigated rsFC based on power envelope correlation within and between different frequency bands, in a large cohort of participants consisting of 99 MS patients and 47 healthy subjects. Correlations were investigated between rsFC and outcomes on disability, disease duration and 7 neuropsychological scores within each group, while stringently correcting for multiple comparisons and possible confounding factors. Specific dysconnections correlating with MS-induced physical disability and disease duration were found within the sensorimotor and language networks, respectively. Global network-level reductions in within- and cross-network rsFC were observed in the default-mode network. Healthy subjects and patients significantly differed in their scores on cognitive fatigue and verbal fluency. Healthy subjects and patients showed different correlation patterns between rsFC and cognitive fatigue or verbal fluency, both of which involved a shift in patients from the posterior default-mode network to the language network. Introducing electrophysiological rsFC in a regression model of verbal fluency and cognitive fatigue in MS patients significantly increased the explained variance compared to a regression limited to structural MRI markers (relative thalamic volume and lesion load). This MEG study demonstrates that MS induces distinct changes in the resting-state functional brain architecture that relate to disability, disease duration and specific cognitive functioning alterations. It highlights the potential value of electrophysiological intrinsic rsFC for monitoring the cognitive impairment in patients with MS.

Self-Reported Changes in Cognition, Communication and Swallowing in Multiple Sclerosis: Data from the Swedish Multiple Sclerosis Registry and from a National Survey

PURPOSE

The aim of this study was to investigate self-reported cognition, speech, communication and swallowing changes in a large sample of individuals with multiple sclerosis (MS) in Sweden. A second aim was to update information about speech and language pathology (SLP) services received by people with MS (pwMS).

METHOD

Self-ratings of cognition, speech/communication and swallowing registered by pwMS between 2012 and 2018 were retrieved from the Swedish MS Registry. In addition, more detailed information about speech, communication, swallowing and provision of SLP services was collected using an online survey distributed via a national patient organization.

RESULTS

In total, entries from 5,289 pwMS were retrieved from the MS Registry. Nearly two thirds of the respondents reported that cognition was affected to some degree, whereas approximately one third perceived some difficulties with speech/communication. A smaller group reported swallowing problems. The majority of those who reported problems with speech/communication also reported problems with cognition. Among the 440 individuals who responded to the MS survey, word-finding difficulties were the most frequently self-reported problem related to communication, and the second most common problem was getting off topic. In all, close to four out of five respondents experienced at least one symptom related to speech and communication, such as speech-related fatigue or imprecise articulation. Swallowing difficulties were reported by one out of four respondents in the MS survey. As a result of their speech difficulties, up to one in three experienced changes in professional or social roles and participation. A limited number of respondents had received SLP services, the most common intervention being voice training.

CONCLUSIONS

In MS, changes associated with cognition as well as speech/communication are frequent, cognitive-linguistic symptoms being the most common. Swallowing difficulties are also relatively prevalent. Access to SLP services seems to be insufficient compared to prevalence of perceived symptoms. Considering that the majority of pwMS are part of the working-age population, access to SLP services must be more highly prioritized and must address cognitive-linguistic problems as well as voice, speech and swallowing dysfunction.

Naming error in multiple sclerosis patients: A pilot study in Isfahan, Iran

Background:

Although cognitive impairment is common in multiple sclerosis (MS) patients, language difficulties are controversy and little information is available on nonEnglish languages. Therefore, the present cross-sectional study was conducted to assess the naming accuracy in Persian relapsing-remitting MS (RRMS) patients.

Materials and Methods:

Thirty RRMS patients were recruited from Kashani Comprehensive MS Center, Isfahan, Iran. Their performance on measures of mini mental state examination (MMSE), Expanded Disability Status Scale, and Naming Test was compared with control participants.

Results:

MS patients were found to have much more naming errors than the control group (2.1 ± 1.8 vs. 0.54 ± 1.1 P = 0.02). Average MMSE score of MS patients was 27.23 (range = 18–30, standard deviation [SD] = 2) versus 28.96 (range = 19–30, SD = 3.2) in controls.

Conclusion:

The present study suggests that naming ability can be impaired in RRMS regardless of disability score. Specific language function tests including naming should be considered in the process of evaluating and rehabilitating patients with MS.

Can semantic fluency be used as an alternative or additional measure in the abbreviated Minimal Assessment of Cognitive Function in Multiple Sclerosis (aMACFIMS)?

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.

Prevalence of self-reported language impairment in multiple sclerosis and the association with health-related quality of life: An international survey study

BACKGROUND

Language impairment has only recently begun to be considered a clinical manifestation of MS. A decline in language abilities can lead to restricted participation in everyday activities that require communication, including vocational, social, and educational contexts.

OBJECTIVES

The objectives of this study were to identify the prevalence and nature of self-reported language impairment in MS using a validated MS-specific patient-reported outcome measure and to determine the association with health-related quality of life (HRQoL) and demographic and clinical variables.

METHODS

In this cross-sectional study, 160 persons with MS completed the language items of the Speech pathology-specific questionnaire for persons with MS (SMS) to assess language and the 12-Item Short Form Survey (SF-12) to assess HRQoL. Participants were recruited internationally through professional MS bodies and support groups and completed all questionnaires online.

RESULTS

75% of persons with MS in this sample self-reported a language impairment. Of the total sample, 65.7% reported difficulty with word retrieval, 53.8% reported difficulty with expressive language, 49.4% reported difficulty with confrontational naming, and 40.6% reported difficulty with receptive language in spoken discourse. Statistical analyses revealed that age, sex, educational status, country of residence, disease duration, age at time of diagnosis, MS subtype, and medication management, were not associated with the prevalence of self-reported language impairment. Participants with self-reported language impairment had lower HRQoL than those without language impairment, scoring lower on both the SF-12 mental and physical component summary scores, with medium to large effect sizes (Cohen's d = 0.66 - 0.83). Participants with self-reported language impairment had higher rates of unemployment than those without language impairment (χ² = 18.2; p < 0.001).

CONCLUSION

Language can be compromised in persons with MS regardless of clinical and demographic characteristics and is associated with lower HRQoL. These findings indicate that frontline healthcare providers need to be aware of potential language impairment in MS and should make timely referrals to speech pathologists for further evaluation and support. Further research is needed to investigate the underlying neural mechanisms of language impairment in MS. In future, this will help guide the design of evidence-based intervention for these symptoms.

The association between executive functioning, coping styles and depressive symptoms in patients with Multiple Sclerosis

OBJECTIVES

To investigate the direct, mediated and moderated relationships between executive functioning, coping and depressive symptoms in patients with multiple sclerosis (MS).

METHODS

Cross-sectional cohort study of routine follow-up visits, including a standardized (neuro)psychological evaluation of 68 MS patients. Coping was measured with the Coping Inventory for Stressful Situations; Depressive symptoms with the subscale depression of the Hospital Anxiety and Depression Scale. Cognitive tests were reduced to a single 'executive function' factor by means of confirmatory factor analysis. Path analyses tested mediating and moderating effects of coping on the relation between executive functioning and depressive symptoms.

RESULTS

Consistently, the executive functioning factor was not related to task-oriented and emotion-oriented coping. Better executive functioning, however, and less reliance on avoidance coping, was related to more depressive symptoms. Testing of the mediating path showed that executive dysfunctioning was indeed significantly related to more depressive symptoms by less reliance on avoidance coping. There was no additional direct effect of executive functioning on depressive symptoms and also no moderating effect of any coping style on the association between cognition and depressive symptoms.

CONCLUSION

Our findings suggest that task-oriented and emotion-oriented coping do not influence the relationship between executive functioning and depression in MS patients, but their mental health might benefit from more reliance on avoidance coping.

Changes in temporal features of speech in secondary progressive multiple sclerosis (SPMS) - case studies

Multiple sclerosis (MS) is a chronic inflammatory disease which, in addition to affecting motor and cognitive functions, may involve language disorders. Despite the importance of speech and language disorders in the quality of life of patients, there are only a few studies about language and speech production difficulties in MS. The aim of this research is to describe the limitation patterns of speech and temporal characteristics of the suprasegmental level in two SPMS cases related to various types of spontaneous speech tasks. We assumed the change of the cognitive load has a greater effect on spontaneous speech in MS patients than in controls. Two SPMS patients, and two sex-, age- and education matched healthy controls were studied. We applied verbal fluency tests (phonemic, episodic, semantic, verb), digit span test, non-word repetition test, Corsi Block Tapping Test, Stroop Colour and Word Test, and Trail Making Test. Token Test was used to measure speech comprehension. The four speech tasks required relatively different degrees of cognitive effort: (a) spontaneous narrative about own life; (b) event description; (c) picture description; (d) narrative recall. Our results show that there are differences between MS patients and controls: MS patients produced slower speech and articulation rate, and they had more and longer pauses in every speech task. Speech tasks and the degree of the cognitive load had a greater effect on MS patients than on control speakers.

Association Between White Matter Microstructure and Verbal Fluency in Patients With Multiple Sclerosis

Verbal fluency refers to the ability to generate words quickly and efficiently according to predefined phonological or semantic criteria. Deficits in verbal fluency limit patients’ ability to communicate effectively and to function well in social setups. Multiple sclerosis (MS) patients suffer from various cognitive impairments, and some of them experience language deficits as well. The goal of this study is to examine the contribution of the dorsal and ventral language pathways to verbal fluency in MS patients. All patients (N = 33) underwent diffusion MRI (dMRI) and fluency measurements. Diffusion parameters were calculated along dorsal and ventral language-related pathways and their right-hemispheric homologs, identified individually in each patient. Significant correlations were found between fluency measures and mean fractional anisotropy (FA) in several pathways, including the left fronto-temporal arcuate fasciculus (AF_ft), bilateral inferior fronto-occipital fasciculus (IFOF), and bilateral frontal aslant tract. Along-tract correlations revealed a more selective pattern of associations: letter-based fluency was associated with FA in a segment of the left AF_ft (dorsal pathway), while category-based fluency was associated with FA in a segment of the right IFOF (ventral pathway). The observed pattern of associations, mapping letter-based fluency to the dorsal stream and category-based fluency to the ventral stream, fits well within the dual stream framework of language processing. Further studies will be necessary to assess whether these associations generalize to the typical adult population or whether they are tied to the clinical state.

Metacognition and self-awareness in Multiple Sclerosis

Although a large range of literature on awareness and metacognition focuses on different neurological populations, little attention has been paid to Multiple Sclerosis (MS). This paper gathers literatures related to studies of anosognosia and the theoretical construct of metacognition which both offer a means to operationalize and measure awareness in MS. We focused on both a clinical concern, regarding the relationship between subjective and objective evolution of cognitive performance, and the theoretical issue of metacognitive processes implicated in disease awareness. We identified 26 papers with findings related to awareness of cognitive impairment in MS using questionnaire-based or performance-based methods. We found support for the idea that the relationship between subjective evaluation and neuropsychological evaluation depends on disease duration and is strongly modulated by other variables, such as mood state. We propose that the metacognitive deficit for memory tasks in this population arises from memory impairment. Finally, we discuss methodological issues, variability in MS patients, and the domain specificity of metacognitive impairment.

Cognitive-motor interference during gait in patients with Multiple Sclerosis: a mixed methods Systematic Review

BACKGROUND

Cognitive-motor interference (CMI) has been proposed as a valid marker of daily life impairment in Multiple Sclerosis (MS). The heterogeneity and scarce number of studies regarding CMI in MS has hampered the synthesis of the existing evidence. The present systematic review employed a mixed methods approach with the aim of identifying and describing variables under which CMI is particularly useful to assess patients with MS.

RESULTS

MS patients showed significant CMI. The motor variables that were most sensitive in detecting significant CMI were velocity (m/s), cadence (steps/min), and double support (% gait cycle), which was also specific for MS. Among the cognitive tasks, Alternate Alphabet and Serial Subtracting 7 s were sensitive, whereas Verbal Fluency were both sensitive and specific to CMI in MS.

CONCLUSIONS

CMI should be assessed in MS with a standardised dual task such as the Verbal Fluency task while walking, with measurements of the double support time and the effect on the cognitive task. The clinical usefulness of CMI in the assessment of patients with MS is discussed.

Cognitive and Language Deficits in Multiple Sclerosis: Comparison of Relapsing Remitting and Secondary Progressive Subtypes

Objective:

The objective of this study was to investigate the pattern and severity of cognitive and language impairment in Greek patients with Relapsing-remitting (RRMS) and Secondary Progressive Multiple Sclerosis (SPMS), relative to control participants.

Method:

A prospective study was conducted in 27 patients with multiple sclerosis (PwMS), (N= 15) with RRMS, (N= 12) with SPMS, and (N= 12) healthy controls. All participants were assessed with a flexible comprehensive neuropsychological – language battery of tests that have been standardized in Greece and validated in Greek MS patients. They were also assessed on measures of disability (Expanded Disability Status Scale; EDSS), fatigue (Fatigue Severity Scale; FSS) and depression (Beck Depression Inventory - fast screen; BDI-FS).

Results:

Our results revealed that groups were well matched on baseline demographic and clinical characteristics. The two clinical groups (RRMS; SPMS) did not differ on overall global cognitive impairment but differed in the initial encoding of verbal material, mental processing speed, response inhibition and set-shifting. RRMS patients differed from controls in the initial encoding of verbal material, learning curve, delayed recall of verbal information, processing speed, and response inhibition. SPMS patients differed in all utilized measures compared to controls. Moreover, we noted increased impairment frequency on individualized measures in the progressive SPMS group.

Conclusion:

We conclude that MS patients, irrespective of clinical subtype, have cognitive deficits compared to healthy participants, which become increasingly worse when they convert from RRMS to SPMS.On the contrary,the pattern of impairment remains relatively stable.

Comparison of the abbreviated minimal assessment of cognitive function in multiple sclerosis (aMACFIMS) and the brief international cognitive assessment for multiple sclerosis (BICAMS)

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.

Cognitive impairment in multiple sclerosis - a review of current knowledge and recent research

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.

A factor analytic investigation of the Mercy Evaluation of Multiple Sclerosis

OBJECTIVE

Neurocognitive deficits commonly are an accompanying feature of Multiple Sclerosis (MS). A brief, yet comprehensive neuropsychological battery is desirable for assessing the extent of these deficits. Therefore, the present study examined the validity of the Mercy Evaluation of Multiple Sclerosis (MEMS) for use with the MS population.

METHODS

Archival data from individuals diagnosed with MS (N = 378) by independent neurologists was examined. Cognitive domains assessed included processing speed and attention, learning, and memory, visuospatial, language, and executive functioning. A mean battery index was calculated to provide a general indicator of cognitive impairment within the current sample.

RESULTS

Overall performance across participants was found to be in the lower limits of the average range. Results of factor analytic statistical procedures yielded a four-factor solution, accounting for 67% of total variance within the MEMS. Four neurocognitive measures exhibited the highest sensitivity in detecting cognitive impairment, constituting a psychometrically established brief cognitive screening battery, which accounted for 83% of total variance within the mean battery index score.

CONCLUSION

Overall, the results of the current study suggest appropriate construct validity of the MEMS for use with individuals with MS, as well as provide support for previously established cognitive batteries.

Social Cognition Abilities in Patients With Different Multiple Sclerosis Subtypes

OBJECTIVES

Multiple sclerosis (MS) can be associated with impaired social cognition. However, social cognition skills have never been explored in the different subtypes of MS. The first aim of this study was to examine whether MS subtypes differ on the course of social cognition. The second aim was to explore the relationship between social cognition performances and executive abilities and mood variables.

METHODS

Sixty-two patients with MS and 33 healthy matched controls performed experimental tasks assessing facial emotion recognition, theory of mind (ToM), and cognitive functioning, in particular executive functions.

RESULTS

Patients differed from controls on both measures of social cognition. On the ToM measures, patients with progressive MS scored significantly lower than healthy participants. Patients with primary progressive MS performed worse than both healthy participants and patients with relapsing-remitting MS on the recognition of fearful facial expressions, while patients with secondary progressive MS performed worse on the recognition of facial expressions of sadness. Patients' social cognition difficulties were correlated with processing speed, working memory, and verbal fluency.

CONCLUSIONS

These preliminary results suggested that there may be qualitative differences in social cognition difficulties among the phenotypes. Furthermore, these impairments were related to executive functions, but unrelated to patients' disability or level of depression. These data highlight the need for research to determine the real impact of these deficits on interpersonal relationships among patients and to confirm these disorders in a larger population with progressive forms of MS. (JINS, 2017, 23, 653-664).

Neuropsychological Assessment in Multiple Sclerosis

Abstract. Neuropsychological deficits in multiple sclerosis (MS) are common. Over the past decades, many different procedures have been employed in diagnosing these deficits. Even though certain aspects of cognitive performance such as information processing speed and working memory may be affected more frequently than other cognitive functions, no specific deficit profile has been established in MS. This article provides an overview of the neuropsychological diagnostic procedures in MS and allows the reader to reach an informed decision on the applicability of specific procedures and the availability of study data in the context of MS. Additionally, it makes recommendations on the compilation of both screening procedures and extensive test batteries.

Individual Differences in Cognitive Function in Older Adults Predicted by Neuronal Selectivity at Corresponding Brain Regions

Relating individual differences in cognitive abilities to neural substrates in older adults is of significant scientific and clinical interest, but remains a major challenge. Previous functional magnetic resonance imaging (fMRI) studies of cognitive aging have mainly focused on the amplitude of fMRI response, which does not measure neuronal selectivity and has led to some conflicting findings. Here, using local regional heterogeneity analysis, or H_corr, a novel fMRI analysis technique developed to probe the sparseness of neuronal activations as an indirect measure of neuronal selectivity, we found that individual differences in two different cognitive functions, episodic memory and letter verbal fluency, are selectively related to H_corr-estimated neuronal selectivity at their corresponding brain regions (hippocampus and visual-word form area, respectively). This suggests a direct relationship between cognitive function and neuronal selectivity at the corresponding brain regions in healthy older adults, which in turn suggests that age-related neural dedifferentiation might contribute to rather than compensate for cognitive decline in healthy older adults. Additionally, the capability to estimate neuronal selectivity across brain regions with a single data set and link them to cognitive performance suggests that, compared to fMRI-adaptation—the established fMRI technique to assess neuronal selectivity, H_corr might be a better alternative in studying normal aging and neurodegenerative diseases, both of which are associated with widespread changes across the brain.

Executive function is an important consideration for coping strategy use in people with multiple sclerosis

INTRODUCTION

Executive function deficits are prevalent in people with multiple sclerosis (PwMS), and PwMS use less adaptive coping than healthy controls. This cross-sectional study assessed whether there is a relationship between executive function and coping in PwMS.

METHOD

One hundred and seven participants with relapsing remitting or secondary progressive MS (n = 83 and 24, respectively; age M = 48.8 ± 11.1 years) completed measures of coping and executive function.

RESULTS

A positive relationship was found between verbal fluency and use of active, emotional, and instrumental social support coping, and total executive function and substance abuse coping. There was a negative relationship between coping strategies and core (social support, acceptance, religion, restraint, and total coping), higher order (denial and humor), and total executive function indices (acceptance, religion, behavioral disengagement, denial, and total coping).

CONCLUSION

These directional differences provide support for the importance of specific executive functions in coping strategy utilization. Understanding these relationships will assist psychologists and neuropsychologists with patient psychoeducation, adaptive coping strategy intervention and management for PwMS with reduced executive function ability.

Cognitive screening in Multiple Sclerosis: the Five-Point Test as a substitute for the PASAT in measuring executive function

OBJECTIVE

The Paced Auditory Serial Addition Test (PASAT) is frequently employed to measure executive functions in patients with Multiple Sclerosis (MS). In the past, the PASAT has often been criticized because of its stressful and demanding requirements. Continuous utilization might also reduce its validity. The Five-Point Test (FPT) by Regard, Strauss, and Knapp ((1982) Children's production on verbal and non-verbal fluency tasks. Perceptual and Motor Skills, 55, 839-844.) is a short test of figural fluency which might serve as a substitute.

METHOD

116 patients diagnosed with MS were tested with a short version of the Brief Repeatable Battery (BRB) by Rao and the Cognitive Function Study Group of the National Multiple Sclerosis Society including the PASAT, as well as the FPT. A factor analysis was computed and the frequency of cognitive impairment was calculated for both the original short version of the BRB and the alternative version (involving the FPT).

RESULTS

In the factor analysis, PASAT and FPT loaded highest on the same factor (two factors were extracted). The estimation of the frequency of cognitive impairment showed that replacing the PASAT with the FPT did not considerably alter the proportion of patients identified as cognitively impaired.

CONCLUSIONS

The FPT proved to be a viable alternative to the PASAT in this study. It may be recommended as a possible replacement in neuropsychological screening of MS-patients with the advantage of avoiding the indicated limitations of the PASAT.

Language disorders in multiple sclerosis: A systematic review

BACKGROUND

Although cognitive impairments are common in patients with multiple sclerosis (MS), language impairments are not well defined.

OBJECTIVE

The goal of this review was to examine the presence and nature of language disorders associated with MS.

METHOD

A search of PubMed and PsycINFO databases was conducted using combinations of the following terms: language disorders, language pathology, language impairment, multiple sclerosis, communication, language and speech. Studies were chosen based on the original language of the text, year of publication, peer-review status and specificity of the results regarding language and communication disorders.

RESULTS

This review covers 30 articles from 13 countries. The studies involved patients with different types of MS. Various language impairments were reported in MS. However, since the methods used in the studies varied widely, it is difficult to draw any conclusions thus far.

CONCLUSION

Given the various cognitive deficits in MS, it is expected that higher language abilities would be affected. This aspect should be investigated in future studies.

Cognitive impairment in MS: rehabilitation approaches

Cognitive deficits have been reported in 45%-70% of patients with multiple sclerosis (MS). Like other symptoms of MS, cognitive deficits are highly variable. Slowed information processing and memory and learning dysfunction are regarded as the most frequent cognitive deficits in MS. Both white and gray matter damages have been suggested to contribute to cognitive impairments in MS. There is no direct relationship between cognitive deficits and physical disability, disease duration or course of the disease. In addition to cognitive impairments, neuropsychiatric symptoms are observed in MS, the most common being alterations in mood state. Neurobehavioral deficits have multidimensional effects on the activities of daily living and quality of life. Consequently, attention should be paid to early diagnosis and treatment. Based on studies on cognitive retraining and more multimodal neuropsychological rehabilitation, both approaches show promise in the treatment of cognitive impairments and their harmful effects. This review introduces the frequency and characteristics of cognitive impairments, as well as main findings on the effects of neuropsychological rehabilitation in MS.

Normative data for phonemic and semantic verbal fluency test in the adult French-Quebec population and validation study in Alzheimer's disease and depression

OBJECTIVE

Verbal fluency tasks are principally used to assess lexical access and have shown usefulness for differential diagnosis. The purpose of Study 1 was to provide normative data in the adult French-Quebec population (Canada) for semantic verbal fluency (animals), for two sets of phonemic verbal fluency (TNP and PFL), and for letter P alone (60 seconds per category/letter). The objectives of Study 2 were to establish the diagnostic and predictive validity of the present tasks and normative data in Alzheimer's disease (AD) and major depressive episode (MDE).

METHOD

The normative sample consisted of 932 participants aged 19-91 years. Based on multiple linear regressions, equations to calculate Z-scores were provided. To assess validity, performance of 62 healthy participants was compared to 62 participants with AD and 41 with MDE aged over 50.

RESULTS

Age and education, but not gender, predicted performance on each verbal fluency task. Healthy adults aged 50 and younger had a better performance on semantic than phonemic verbal fluency. In comparison to MDE, AD participants had lower performance on animals and TNP, but not on letter P. Ninety percent of people with a Z-score ≤ -1.50 on semantic verbal fluency had AD and the global accuracy was 76.6%. Test-retest reliability over one year was high for both animals (r = .711) and TNP (r = .790) in healthy older participants, but dropped for animals in people with AD (r = .493).

CONCLUSIONS

These data will strengthen accurate detection of verbal fluency deficits in French-Quebec adults.

Decline of Neuropsychological Abilities in a Large Sample of Patients with Multiple Sclerosis: A Two-Year Longitudinal Study

OBJECTIVE

In this longitudinal study, we monitored two large groups of multiple sclerosis (MS) patients and healthy controls (HC) for 2 years, with the aim of comparing their neuropsychological profile over time.

METHOD

Three hundred and twenty-two patients with MS and 303 HC were administered the Brief Repeatable Battery of Neuropsychological tests (BRB-N); neuropsychiatric measures were also administered. Two follow-ups were scheduled at 1 and 2 years, respectively.

RESULTS

A linear mixed model (LMM) with random intercept was run by considering participants' performance on each test of the BRB-N at the three assessment points (baseline and follow-ups) as the within-subjects variable, and group (patients and controls) as the between-subjects factor. The interaction term was statistically significant for the tests: Symbol Digit Modalities test (SDMT) (p = 0.044), Paced Auditory Serial Addition test (PASAT) (p = 0.011) and Word List Generation (WLG) (p < 0.001), whereas for the PASAT-3 approached statistical significance (p = 0.05). In addition, a LMM with random intercept was also run by identifying three groups (controls, relapsing-remitting course of MS (i.e. RR-MS), and prog-MS). The interaction term was statistically significant for: PASAT-3 (p = 0.017), PASAT-2 (p = 0.0026), and WLG (p = 0.0022).

CONCLUSIONS

Our results corroborate on a very large scale evidence that the abilities tapped by the tasks SDMT, PASAT and WLG are particularly sensitive to MS, and further extend this issue by showing that these abilities are likely to be more sensitive than others to the progression of the disease, as compared to HC.

Construct Validity of Fluency and Implications for the Factorial Structure of Memory

Fluency is an important construct in clinical assessment and in cognitive taxonomies. In the Cattell–Horn–Carroll (CHC) model, Fluency is represented by several narrow factors that form a subset of the long-term memory encoding and retrieval (Glr) broad factor. The CHC broad classification of Fluency was evaluated in five data sets, and the CHC narrow classification was evaluated in an additional two data sets. The results suggest that Fluency tests are more strongly related to processing speed (Gs) and acquired knowledge (Gc) than to Glr, but Fluency may also be represented as a distinct broad factor. In the two additional data sets with a large number of Fluency tests, the CHC Fluency narrow factors failed to replicate with confirmatory factor analysis. An alternative and simpler narrow structure of Fluency was found, supporting the factorial distinction of semantic versus orthographic Fluency. The results have important implications for the factorial structure of memory, the classification of Fluency tests, and the assessment of Fluency.