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Cohen HR, Holtzer R. The association between perceived social support and cognition in older adults with and without multiple sclerosis. Mult Scler Relat Disord 2023; 78:104913. [PMID: 37506614 PMCID: PMC10592268 DOI: 10.1016/j.msard.2023.104913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 06/12/2023] [Accepted: 07/22/2023] [Indexed: 07/30/2023]
Abstract
BACKGROUND Advances in treatments for Multiple Sclerosis (MS) have resulted in a growing number of aging individuals with MS. Research has shown that perceived social support has protective effects against age-related cognitive decline but no study to date has examined the relationship between perceived social support and cognition in older adults with MS. The current study addressed this gap in knowledge examining the association between perceived social support and cognition in older adults with and without MS. METHODS Participants were older adults with MS (n = 67, mean age = 64.75 years;%female = 64.2) and controls (n = 71, mean age = 68.25 years;%female = 57.7) Linear regression models examined the associations of total and domain scores of perceived social support with cognition in the entire sample, and then stratified by group status. RESULTS Analyses revealed that total perceived social support, emotional/informational support, and positive social interaction were associated with cognition in the total sample. In stratified analyses, emotional/informational support was significantly associated with cognition in the MS group; however, this association became insignificant when analyses adjusted for depressive symptoms. Positive social interaction was significantly associated with cognition in the control group. Notably, this association remained significant even after adjusting for depressive symptoms. CONCLUSION These findings suggest that distinct dimensions of perceived social support may have differential relationships with cognitive function in older adults with MS and healthy controls.
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Affiliation(s)
- Hannah R Cohen
- Ferkauf Graduate School of Psychology, Yeshiva University, 1165 Morris Park Ave, The Bronx, NY 10461, USA.
| | - Roee Holtzer
- Ferkauf Graduate School of Psychology, Yeshiva University, 1165 Morris Park Ave, The Bronx, NY 10461, USA; Department of Neurology, Albert Einstein College of Medicine, 1300 Morris Park Ave, The Bronx, NY 10416, USA.
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Walker LAS, Gardner C, Freedman MS, MacLean H, Rush C, Bowman M. Research-to-Practice Gaps in Multiple Sclerosis Care for Patients with Subjective Cognitive, Mental Health, and Psychosocial Concerns in a Canadian Center. Int J MS Care 2020; 21:243-248. [PMID: 31889928 DOI: 10.7224/1537-2073.2017-090] [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: 11/18/2022]
Abstract
Background People with multiple sclerosis (MS) are at increased risk for cognitive impairment, mental health concerns, and psychosocial issues, which can negatively affect disease outcomes and quality of life. Current MS care guidelines recommend integrated interdisciplinary services to address these concerns; however, issues can be overlooked during routine care. To date, there is inadequate research on how often these issues are identified and addressed during routine MS care. Methods One hundred medical records were randomly selected and reviewed (55 relapsing-remitting MS, 17 secondary progressive MS, 8 primary progressive MS, and 20 other or subtype not indicated). All visits to, and contacts with (ie, telephone, e-mail), an MS clinic over 1 year were included in the analysis to determine the proportion of patients presenting with cognitive, mental health, and psychosocial concerns and the proportion of patients offered associated services. Results Of the 25 patients with at least one identified concern, treatment recommendations occurred for 13 (52%). Rates of identification of cognitive, mental health, and psychosocial concerns in standard clinical practice were significantly lower than the identified prevalence in epidemiologic studies. Demographic factors had no bearing on who was offered treatment. Patients with concerns access MS clinic services more often than those without. Conclusions Discrepancies between reported and expected frequencies may be due to overreliance on patient self-disclosure and concerns by the health care team that inadequate resources are available to address issues. An interdisciplinary team model may help address these issues.
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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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Hansen S, Muenssinger J, Kronhofmann S, Lautenbacher S, Oschmann P, Keune PM. Cognitive screening in Multiple Sclerosis: the Five-Point Test as a substitute for the PASAT in measuring executive function. Clin Neuropsychol 2016; 31:179-192. [PMID: 27707354 DOI: 10.1080/13854046.2016.1241894] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
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.
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Affiliation(s)
- Sascha Hansen
- a Department of Neurology , Klinikum Bayreuth GmbH, Betriebsstätte Hohe Warte , Bayreuth , Germany.,b Department of Physiological Psychology , Otto-Friedrich-University , Bamberg , Germany
| | - Jana Muenssinger
- a Department of Neurology , Klinikum Bayreuth GmbH, Betriebsstätte Hohe Warte , Bayreuth , Germany
| | - Simona Kronhofmann
- a Department of Neurology , Klinikum Bayreuth GmbH, Betriebsstätte Hohe Warte , Bayreuth , Germany
| | - Stefan Lautenbacher
- b Department of Physiological Psychology , Otto-Friedrich-University , Bamberg , Germany
| | - Patrick Oschmann
- a Department of Neurology , Klinikum Bayreuth GmbH, Betriebsstätte Hohe Warte , Bayreuth , Germany
| | - Philipp M Keune
- a Department of Neurology , Klinikum Bayreuth GmbH, Betriebsstätte Hohe Warte , Bayreuth , Germany.,b Department of Physiological Psychology , Otto-Friedrich-University , Bamberg , Germany
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Affiliation(s)
- Dawn Langdon
- Royal Holloway, University of London, Egham, Surrey, TW20 0EX, UK
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Polychroniadou E, Bakirtzis C, Langdon D, Lagoudaki R, Kesidou E, Theotokis P, Tsalikakis D, Poulatsidou K, Kyriazis O, Boziki M, Papadopoulos G, Boura E, Sintila L, Hatzigeorgiou S, Ziamos C, Ioannidis P, Karacostas D, Grigoriadis N. Validation of the Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS) in Greek population with multiple sclerosis. Mult Scler Relat Disord 2016; 9:68-72. [DOI: 10.1016/j.msard.2016.06.011] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 06/21/2016] [Accepted: 06/25/2016] [Indexed: 10/21/2022]
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Roy S, Benedict RHB, Drake AS, Weinstock-Guttman B. Impact of Pharmacotherapy on Cognitive Dysfunction in Patients with Multiple Sclerosis. CNS Drugs 2016; 30:209-25. [PMID: 26884145 DOI: 10.1007/s40263-016-0319-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Cognitive impairment is a common symptom of multiple sclerosis (MS), adversely impacting many spheres of daily functioning. Yet the effectiveness of pharmacological interventions for cognitive impairment in MS is unclear. Clinicians and patients alike would benefit from formal guidelines regarding effective management of cognitive symptoms. We reviewed the background on the measurement, pathophysiology and risk factors for cognitive dysfunction in MS, and then examined the published clinical trials of pharmacotherapy, including both disease-modifying treatments (DMTs) and symptom-management therapies (SMTs). Our review of DMTs revealed only a single well-designed, randomized, controlled trial where intramuscular interferon (IFN)-β1a, administered once weekly, was compared with placebo. The results showed significant benefits in terms of cognitive processing speed and memory. Less convincing but promising data have shown the potential benefits of IFN-β1b and natalizumab. The literature on SMTs is replete with placebo-controlled, single-centre studies, with a failure to replicate initially promising results. The results for SMTs such as acetylcholinesterase inhibitors and psychostimulants are mixed. Some encouraging data show promise but not to a threshold of indication for standard clinical use. Numerous methodological factors hamper research in this area. Acknowledging the lack of firm conclusions, we argue that all DMTs are likely to benefit cognition and that, if otherwise safe, SMTs with some empirical support may be attempted at the discretion of the treating clinician. We offer some guidance on the assessment and monitoring of cognitive function to inform off-license treatment of cognitive impairment in MS patients.
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Affiliation(s)
- Shumita Roy
- Department of Neurology, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York (SUNY), Buffalo, NY, USA
| | - Ralph H B Benedict
- Department of Neurology, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York (SUNY), Buffalo, NY, USA.
| | - Allison S Drake
- Department of Neurology, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York (SUNY), Buffalo, NY, USA
| | - Bianca Weinstock-Guttman
- Department of Neurology, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York (SUNY), Buffalo, NY, USA
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Hansen S, Muenssinger J, Kronhofmann S, Lautenbacher S, Oschmann P, Keune PM. Cognitive screening tools in multiple sclerosis revisited: sensitivity and specificity of a short version of Rao's Brief Repeatable Battery. BMC Neurol 2015; 15:246. [PMID: 26612613 PMCID: PMC4660646 DOI: 10.1186/s12883-015-0497-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 11/17/2015] [Indexed: 11/17/2022] Open
Abstract
Background Cognitive deficits are common in multiple sclerosis (MS) and require continuous monitoring. In routine examinations, screening instruments such as the Brief Repeatable Battery (BRB) may serve this purpose. It was suggested that even a shortened version of the BRB, comprising the Symbol Digit Modalities Test (SDMT), Paced Auditory Serial Addition Test (PASAT) and Selective Reminding Test (SRT), may be feasible. However, an evaluation of sensitivity and specificity of the short BRB in comparison to an independent battery of established tests has not yet occurred. Therefore in the current study, this short version of the BRB was matched against the gold standard of an extensive test battery comprehensively assessing neuropsychological functions. Methods 127 MS-patients were tested with a short version of the BRB and an extensive procedure. The latter served as the gold standard for defining sensitivity and specificity. Results For subtests of the short BRB, estimates of sensitivity (38-44 %) and specificity (81-94 %) were obtained. Combining subtests into a single indicator of cognitive deficits yielded increased sensitivity (78 %), while reducing specificity (65 %). Conclusion The short BRB is reasonably sensitive and specific in detecting cognitive deficits. However, these qualities only emerge, if the short BRB is administered as a whole, whereas sensitivity is considerably lower than suggested by previous work, when relying on subtests separately (SDMT, PASAT, SRT). While the short BRB may not be regarded as conclusive as an extensive test battery, it represents a valid and economic screening instrument. Electronic supplementary material The online version of this article (doi:10.1186/s12883-015-0497-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sascha Hansen
- Department of Neurology, Klinikum Bayreuth GmbH, Betriebsstätte Hohe Warte, Neurologische Klinik, Sekretariat Prof. Dr. Oschmann, z.Hd. Sascha Hansen, Hohe Warte 8, DE-95445, Bayreuth, Germany. .,Department of Physiological Psychology, Otto-Friedrich-University Bamberg, Bamberg, Germany.
| | - Jana Muenssinger
- Department of Neurology, Klinikum Bayreuth GmbH, Betriebsstätte Hohe Warte, Neurologische Klinik, Sekretariat Prof. Dr. Oschmann, z.Hd. Sascha Hansen, Hohe Warte 8, DE-95445, Bayreuth, Germany.
| | - Simona Kronhofmann
- Department of Neurology, Klinikum Bayreuth GmbH, Betriebsstätte Hohe Warte, Neurologische Klinik, Sekretariat Prof. Dr. Oschmann, z.Hd. Sascha Hansen, Hohe Warte 8, DE-95445, Bayreuth, Germany.
| | - Stefan Lautenbacher
- Department of Physiological Psychology, Otto-Friedrich-University Bamberg, Bamberg, Germany.
| | - Patrick Oschmann
- Department of Neurology, Klinikum Bayreuth GmbH, Betriebsstätte Hohe Warte, Neurologische Klinik, Sekretariat Prof. Dr. Oschmann, z.Hd. Sascha Hansen, Hohe Warte 8, DE-95445, Bayreuth, Germany.
| | - Philipp M Keune
- Department of Neurology, Klinikum Bayreuth GmbH, Betriebsstätte Hohe Warte, Neurologische Klinik, Sekretariat Prof. Dr. Oschmann, z.Hd. Sascha Hansen, Hohe Warte 8, DE-95445, Bayreuth, Germany. .,Department of Physiological Psychology, Otto-Friedrich-University Bamberg, Bamberg, Germany.
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Cardoso M, Olmo NR, Fragoso YD. Systematic Review of Cognitive Dysfunction in Pediatric and Juvenile Multiple Sclerosis. Pediatr Neurol 2015; 53:287-92. [PMID: 26233264 DOI: 10.1016/j.pediatrneurol.2015.06.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Revised: 05/21/2015] [Accepted: 06/09/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND Cognitive dysfunction is a common finding in individuals with multiple sclerosis at all ages. Cognitive impairment may drastically affect the life of younger patients with multiple sclerosis who are still undergoing education and schooling. METHODS We carried out a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations to assess the published data on multiple sclerosis and cognition in pediatric or juvenile patients. Only articles presenting original data on patients with multiple sclerosis diagnosed before age 18 years of age were included. RESULTS Thirty-two articles fulfilled the inclusion criteria for this systematic review. The conclusion from all articles was that cognitive dysfunction in multiple sclerosis starting before the age of 18 years is both significant and disruptive and must be routinely assessed. However, assessment methods were heterogeneous and often very expensive to perform, whereas proposals for treatment were virtually absent in the literature. CONCLUSION Cognitive dysfunction can be a significant symptom of multiple sclerosis of early onset, but its impact and management needs to be better assessed. A task force should be created to study and manage cognitive dysfunction in pediatric and juvenile multiple sclerosis.
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Affiliation(s)
- Mariana Cardoso
- Department of Neurology, Universidade Metropolitana de Santos, Santos, São Paulo, Brazil; Post-graduation in Neurology, Ipemed, Belo Horizonte, Minas Gerais, Brazil; Neuroimmunology Angiocorpore, Santos, São Paulo, Brazil
| | - Neide Regina Olmo
- Department of Neurology, Universidade Metropolitana de Santos, Santos, São Paulo, Brazil
| | - Yara Dadalti Fragoso
- Department of Neurology, Universidade Metropolitana de Santos, Santos, São Paulo, Brazil; Neuroimmunology Angiocorpore, Santos, São Paulo, Brazil.
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Romero K, Shammi P, Feinstein A. Neurologists׳ accuracy in predicting cognitive impairment in multiple sclerosis. Mult Scler Relat Disord 2015. [DOI: 10.1016/j.msard.2015.05.009] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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The Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS): normative values with gender, age and education corrections in the Italian population. BMC Neurol 2014; 14:171. [PMID: 25204350 PMCID: PMC4172942 DOI: 10.1186/s12883-014-0171-6] [Citation(s) in RCA: 92] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Accepted: 08/28/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND BICAMS (Brief International Cognitive Assessment for Multiple Sclerosis) has been recently developed as brief, practical and universal assessment tool for cognitive impairment in MS subjects. It includes the Symbol Digit Modalities Test (SDMT), the California Verbal Learning Test-2 (CVLT2) and the Brief Visuospatial Memory Test-Revised (BVMT-R) . In this study we aimed at gathering regression based normative data for the BICAMS battery in the Italian population. METHODS Healthy subjects were consecutively recruited among patient friends and relatives. Corrections for demographics were calculated using multivariable linear regression models. Test-retest reliability was assessed using the Pearson correlation coefficient. RESULTS The BICAMS battery was administered to 273 healthy subjects (180 women, mean age 38.9 ± 13.0 years, mean education 14.9 ± 3.0 years). Test-retest reliability was good for all the tests. CONCLUSIONS The study provided normative data of the BICAMS for the Italian population confirming good test-retest reliability which can facilitate the use of the battery in clinical practice, also for longitudinal patient assessments.
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Buhse M, Banker WM, Clement LM. Factors associated with health-related quality of life among older people with multiple sclerosis. Int J MS Care 2014; 16:10-9. [PMID: 24688350 DOI: 10.7224/1537-2073.2012-046] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND This study was conducted to determine which factors (clinical and demographic) are associated with mental and physical health-related quality of life (HRQOL) among people with multiple sclerosis (MS) aged 60 years and older. METHODS Data were collected at four MS centers on Long Island, New York, from a total of 211 patients. Three surveys were administered that collected demographic information and included validated questionnaires measuring quality of life (QOL), cognition, depression, and disability. Multivariate linear regression analyses examined the relationship between patient demographics and scores on standardized scales measuring mental and physical HRQOL (Multiple Sclerosis Quality of Life-54). Variables included in the regression models were selected on the basis of the Andersen Healthcare Utilization model. This framework encompasses the multiple influences on health status, including predisposing characteristics, enabling resources, need, and health behavior. RESULTS We found that mental HRQOL was negatively associated with having a high school education or less, risk of neurologic impairment, physical disability, and depression. No variables were positively associated with mental HRQOL. Physical HRQOL was negatively associated with risk of neurologic impairment, physical disability, depression, and the comorbidity of thyroid disease. However, patient employment and, surprisingly, being widowed were positively associated with physical HRQOL. These findings are consistent with those of similar studies among younger patients in which lower HRQOL was associated with increased disability, depression, risk of neurologic impairment, and lower levels of education. CONCLUSIONS The findings that patient employment and being widowed were associated with better physical HRQOL suggest that older patients have the ability to adapt and adjust to the challenges of MS over time. Clinicians should regularly screen for HRQOL in older patients with MS.
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Affiliation(s)
- Marijean Buhse
- SUNY Stony Brook School of Nursing, Stony Brook, NY, USA (MB); and KJT Group, Honeoye Falls, NY, USA (WMB, LMC)
| | - Wendy M Banker
- SUNY Stony Brook School of Nursing, Stony Brook, NY, USA (MB); and KJT Group, Honeoye Falls, NY, USA (WMB, LMC)
| | - Lynn M Clement
- SUNY Stony Brook School of Nursing, Stony Brook, NY, USA (MB); and KJT Group, Honeoye Falls, NY, USA (WMB, LMC)
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Tekok-Kilic A, Benedict RHB, Zivadinov R. Update on the relationships between neuropsychological dysfunction and structural MRI in multiple sclerosis. Expert Rev Neurother 2014; 6:323-31. [PMID: 16533137 DOI: 10.1586/14737175.6.3.323] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Multiple sclerosis (MS) is a chronic inflammatory disease of the CNS, characterized by demyelination and neurodegeneration. Besides the sensory and motor deficits that are the hallmark of this disease, approximately 50% of MS patients are cognitively impaired. Over the years, structural neuroimaging has been used widely in MS patients for both diagnostic and research purposes. Various conventional and nonconventional magnetic resonance imaging (MRI) measures have provided important information about the degree and mechanisms of cerebral pathology, and these measures correlate with cognitive and affective disturbances. In this article, recent contributions to the literature regarding the correlation between MRI and neuropsychological function in MS are reviewed.
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Affiliation(s)
- Ayda Tekok-Kilic
- Department of Neurology, State University of New York, Buffalo School of Medicine and Biomedical Sciences, Buffalo, NY, USA.
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Bagnato F, Ohayon JM, Ehrmantraut M, Chiu AW, Riva M, Ikonomidou VN. Clinical and imaging metrics for monitoring disease progression in patients with multiple sclerosis. Expert Rev Neurother 2014; 6:599-612. [PMID: 16623658 DOI: 10.1586/14737175.6.4.599] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Multiple sclerosis (MS) is an autoimmune disease of the CNS leading to clinical disability in 250,000-350,000 young adults in the USA and Europe. The disease affects both white matter (WM) and gray matter (GM) tissues of the brain and spinal cord. While WM disease is easily quantified using currently available magnetic resonance imaging (MRI) techniques, identification and quantification of GM disease present a daily challenge. Nonconventional brain and spinal cord MRI techniques, including magnetization transfer, MRI spectroscopy and diffusion tensor imaging, have improved our understanding of MS pathology in the deep GM. The sensitivity of high-resolution MRI obtained at a high magnetic field will improve the detection of spinal cord and brain cortical GM disease. The appropriate use of the above-mentioned techniques has the potential to more accurately explain the level of disability in MS patients.
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Affiliation(s)
- Francesca Bagnato
- Neuroimmunology Branch, NIND-NIH, 10 Center Drive, Building 10, Room 5B16, Bethesda, MD 20892-1400, USA.
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Benedict RHB, Amato MP, Boringa J, Brochet B, Foley F, Fredrikson S, Hamalainen P, Hartung H, Krupp L, Penner I, Reder AT, Langdon D. Brief International Cognitive Assessment for MS (BICAMS): international standards for validation. BMC Neurol 2012; 12:55. [PMID: 22799620 PMCID: PMC3607849 DOI: 10.1186/1471-2377-12-55] [Citation(s) in RCA: 261] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2012] [Accepted: 06/22/2012] [Indexed: 11/22/2022] Open
Abstract
An international expert consensus committee recently recommended a brief battery of tests for cognitive evaluation in multiple sclerosis. The Brief International Cognitive Assessment for MS (BICAMS) battery includes tests of mental processing speed and memory. Recognizing that resources for validation will vary internationally, the committee identified validation priorities, to facilitate international acceptance of BICAMS. Practical matters pertaining to implementation across different languages and countries were discussed. Five steps to achieve optimal psychometric validation were proposed. In Step 1, test stimuli should be standardized for the target culture or language under consideration. In Step 2, examiner instructions must be standardized and translated, including all information from manuals necessary for administration and interpretation. In Step 3, samples of at least 65 healthy persons should be studied for normalization, matched to patients on demographics such as age, gender and education. The objective of Step 4 is test-retest reliability, which can be investigated in a small sample of MS and/or healthy volunteers over 1–3 weeks. Finally, in Step 5, criterion validity should be established by comparing MS and healthy controls. At this time, preliminary studies are underway in a number of countries as we move forward with this international assessment tool for cognition in MS.
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Affiliation(s)
- Ralph H B Benedict
- Buffalo General Medical Center, Department of Neurology, Suite E2, 100 High Street, Buffalo, NY 14203, USA.
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Messinis L, Kosmidis MH, Lyros E, Papathanasopoulos P. Assessment and rehabilitation of cognitive impairment in multiple sclerosis. Int Rev Psychiatry 2010; 22:22-34. [PMID: 20233112 DOI: 10.3109/09540261003589372] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Patients with multiple sclerosis (MS) have a substantial risk of cognitive dysfunction, even in the earliest stages of the disease, where there is minimum physical disability. Despite the high prevalence rates and the significant impact of cognitive dysfunction on quality of life in this population, cognitive functions are not routinely assessed due to the high cost and time consumption. This article provides an overview of the current state of knowledge related to cognition in MS and on the optimal approach to neuropsychological assessment of this population. It then focuses on the pharmacological and other treatment options available for MS patients with, or at risk for developing, cognitive impairment. The available immune-modulating agents may reduce the development of new lesions and therefore prevent or minimize the progression of cognitive decline. However, there is currently insufficient evidence concerning the efficiency of symptomatic treatment in MS. There is also currently no optimal non-pharmacological treatment strategy for cognitive decline in MS, as the studies published to date report heterogeneous results. Nevertheless, non-pharmacological treatments such as cognitive rehabilitation may benefit some MS patients. As cognition is increasingly recognized as a major feature of MS, its assessment and rehabilitation will become a greater priority.
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Affiliation(s)
- Lambros Messinis
- Department of Neurology, Neuropsychology Section, University of Patras Medical School, Patras, Greece.
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Shevil E, Finlayson M. Pilot study of a cognitive intervention program for persons with multiple sclerosis. HEALTH EDUCATION RESEARCH 2010; 25:41-53. [PMID: 19651639 DOI: 10.1093/her/cyp037] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Cognitive impairments are prevalent in multiple sclerosis (MS) and can significantly limit participation in daily activities. Although the clinical depiction of cognitive impairments in MS has been well investigated, strategies to manage cognitive difficulties are less well studied. This pilot study tested a 5-week, group-based community program addressing strategies to self-manage MS cognitive changes. The goals of the program were to increase participants' knowledge of cognitive impairments, increase levels of self-efficacy to manage cognitive difficulties and increase use of management strategies. Participants were taught various cognitive compensatory strategies and practiced their implementation between sessions. Thirty-five individuals with MS with mild-to-moderate cognitive impairments participated in the program. All participants exhibited increased knowledge of cognitive impairments and their daily impact. Participants significantly increased levels of self-efficacy in their ability to manage cognitive difficulties (chi(2)(2)=37.15, P < or = 0.0001). Self-efficacy scores were maintained at follow-up (chi(1)(2)=1.48, P = 0.2230). Although the number of strategies participants used did not change significantly (chi(2)(2)=2.82, P = 0.2446), they reported increased effectiveness of strategies and being able to generalize strategies to other activities. Study results point to the potential benefits of self-management programs to address cognitive symptoms in MS. Study limitations include no control group and use of non-standardized outcome measures.
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Affiliation(s)
- Eynat Shevil
- Department of Occupational Therapy, School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, PO Box 39040, Ramat Aviv, Tel Aviv 69978, Israel.
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18
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Smestad C, Sandvik L, Landrø NI, Celius EG. Cognitive impairment after three decades of multiple sclerosis. Eur J Neurol 2009; 17:499-505. [DOI: 10.1111/j.1468-1331.2009.02889.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Shevil E, Finlayson M. Process evaluation of a self-management cognitive program for persons with multiple sclerosis. PATIENT EDUCATION AND COUNSELING 2009; 76:77-83. [PMID: 19118971 DOI: 10.1016/j.pec.2008.11.007] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2008] [Revised: 10/01/2008] [Accepted: 11/10/2008] [Indexed: 05/27/2023]
Abstract
OBJECTIVE Cognitive changes are highly prevalent in multiple sclerosis (MS) however evidence-based research on cognitive rehabilitation programs for this population is only beginning to emerge. This article presents results from a process evaluation of a group-based, self-management cognitive intervention program developed specifically for people with MS. METHODS Quantitative and qualitative data were collected using focus group interviews, facilitator reflection notes, and program evaluations. The data were used to identify the strengths and limitations of the program and to document recommendations for future development. Forty-one individuals met eligibility criteria and were enrolled in the program. RESULTS Overall, participants reported that the program had a positive impact on their ability to manage cognitive symptoms. Program components that contributed to successful application of cognitive management strategies included increasing participant's knowledge of cognitive changes, problem-solving through cognitive challenges, practicing strategies through homework assignments, and conducting the program in a group format. Participants recommended that caregivers be included in future programs. CONCLUSION Both content and structural components of the program facilitated participants' ability to manage cognitive changes and contributed to behavior changes made by the participants. PRACTICE IMPLICATIONS This study points to the benefits of incorporating self-management programs into the cognitive rehabilitation process in MS.
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Affiliation(s)
- Eynat Shevil
- Department of Occupational Therapy, School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, PO Box 39040, Ramat Aviv, Tel Aviv 69978, Israel.
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20
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Strober L, Englert J, Munschauer F, Weinstock-Guttman B, Rao S, Benedict RHB. Sensitivity of conventional memory tests in multiple sclerosis: comparing the Rao Brief Repeatable Neuropsychological Battery and the Minimal Assessment of Cognitive Function in MS. Mult Scler 2009; 15:1077-84. [PMID: 19556311 DOI: 10.1177/1352458509106615] [Citation(s) in RCA: 151] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Cognitive impairment is common in multiple sclerosis (MS) affecting roughly 45-60% of patients. Because memory deficits have significant impact on employment, caregiver burden, and social functioning, neuropsychological (NP) assessment is often recommended. Two widely used and validated NP batteries for MS are the Rao Brief Repeatable Neuropsychological Battery (BRNB) and the Minimal Assessment of Cognitive Function in MS (MACFIMS). Although similar, these batteries differ in the specific auditory/verbal and visual/spatial memory tests employed. The relative sensitivity of these memory tests is unknown. METHODS The BRNB and MACFIMS have considerable overlap but different memory tests: the former includes the Selective Reminding Test (SRT) and the 10/36 Spatial Recall Test (10/36) and the latter the California Verbal Learning Test, Second Edition (CVLT2) and Brief Visuospatial Memory Test, Revised (BVMTR). In 65 patients with MS and 46 demographically matched controls, we compared the sensitivity of these tests, and secondarily their respective batteries. RESULTS The BRNB and MACFIMS were comparable in their overall sensitivity to disease status. Although the BVMTR showed greater discriminative validity than the 10/36, the CVLT2 and SRT were comparable in sensitivity. The SDMT was the most sensitive NP test across both batteries. CONCLUSIONS We conclude that the BRNB and MACFIMS have comparable sensitivity among patients with MS. The sensitivity of the auditory/verbal memory tests from these batteries is similar, but the BVMTR appears to be more sensitive than the 10/36. Clinical implications are discussed.
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Affiliation(s)
- L Strober
- The Cleveland Clinic Foundation, Cleveland, Ohio, USA
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21
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Benedict RHB, Duquin JA, Jurgensen S, Rudick RA, Feitcher J, Munschauer FE, Panzara MA, Weinstock-Guttman B. Repeated assessment of neuropsychological deficits in multiple sclerosis using the Symbol Digit Modalities Test and the MS Neuropsychological Screening Questionnaire. Mult Scler 2008; 14:940-6. [PMID: 18573822 DOI: 10.1177/1352458508090923] [Citation(s) in RCA: 143] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Brief cognitive performance tests and self-report measures of neuropsychological symptoms have been proposed for screening purposes in multiple sclerosis (MS) clinics. To better understand the reliability of screening methods, two tests, the Symbol Digit Modalities Test (SDMT) and the MS Neuropsychological Screening Questionnaire (MSNQ), were administered to 76 patients with MS and 25 healthy controls, matched on demographic characteristics. METHODS Tests were administered at monthly intervals, over 6 months. In addition, the Beck Depression Inventory Fast Screen for medical patients (BDIFS) was administered to monitor for changes in depression. Our objectives were to determine the reliability of these measures and the relative contribution of cognitive impairment and depression in predicting self-report MSNQ scores. RESULTS Results showed that both the SDMT and MSNQ have good to excellent reproducibility over repeated testing. In MS, there are minimal practice effects over successive tests, in the order of 0.2 SD for SDMT and minimal change in the MSNQ. Regression analyses modeled to predict MSNQ based on SDMT and BDIFS showed significant contribution for both, but with the majority of variance being accounted for depression. CONCLUSIONS We conclude that these brief screening tests provide some independent information about the mental status of patients with MS and are reliable, even when used in monthly, successive examinations.
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Affiliation(s)
- R H B Benedict
- School of Medicine, State University of New York at Buffalo, Buffalo, New York, USA.
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22
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Achiron A, Doniger GM, Harel Y, Appleboim-Gavish N, Lavie M, Simon ES. Prolonged response times characterize cognitive performance in multiple sclerosis. Eur J Neurol 2007; 14:1102-8. [PMID: 17880565 DOI: 10.1111/j.1468-1331.2007.01909.x] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Cognitive impairment is amongst the main symptoms affecting multiple sclerosis (MS) and should be comprehensively and accurately assessed. To study the added value of a computerized neuropsychological battery enabling the measurement of response times in the cognitive domains, 58 randomly selected MS patients and 71 age-, gender- and education-matched healthy subjects were evaluated. Construct and discriminant validity were assessed for the standard Neuropsychological Screening Battery for Multiple Sclerosis (NSBMS) and the Mindstreams Computerized Cognitive Battery (MCCB). The MCCB demonstrated good construct validity in comparison with the NSBMS in memory (P < 0.001), executive function (P < 0.001), attention (P < 0.05) and information processing (P < 0.05) domains. In addition, it showed high discriminant validity most prominently for executive function, attention and motor skills (P < 0.001). Response times measured by the computerized battery were longer in all cognitive domains and varied with cognitive load, demonstrating that response time deficits in MS are associated with particular task demands. We conclude that in MS prolonged response times on a range of cognitive tasks signify abnormal conduction within demyelinative tracts.
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Affiliation(s)
- A Achiron
- Multiple Sclerosis Center, Sheba Medical Center, Tel-Hashomer, Israel.
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Rogers JM, Panegyres PK. Cognitive impairment in multiple sclerosis: evidence-based analysis and recommendations. J Clin Neurosci 2007; 14:919-27. [PMID: 17659875 DOI: 10.1016/j.jocn.2007.02.006] [Citation(s) in RCA: 138] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2006] [Accepted: 02/05/2007] [Indexed: 11/25/2022]
Abstract
Cognitive impairment is common in multiple sclerosis (MS), occurring at all stages of the disease, and can be a major source of vocational disability, social impairment, and impoverished quality of life. Dysfunction in free recall from long-term memory, speed of information processing, working memory, and abstract reasoning are frequently observed in MS. Despite weak correlation with disease duration and physical disability status, the degree of cognitive impairment in MS has been related to the extent of topographically specific neuronal tissue damage and loss. Additional clinical factors including disease course, fatigue, affective disturbance, and medication can impact on the degree of MS-related cognitive impairment. We suggest that the symbol digits modalities test, paced auditory serial addition task, the clock drawing test and the MS neuropsychological screening questionnaire be considered as valid and relevant screening tests for cognitive impairment in MS.
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Affiliation(s)
- Jeffrey M Rogers
- Neurosciences Unit, Health Department of Western Australia, Perth, Western Australia, Australia
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Parmenter BA, Weinstock-Guttman B, Garg N, Munschauer F, Benedict RHB. Screening for cognitive impairment in multiple sclerosis using the Symbol digit Modalities Test. Mult Scler 2007; 13:52-7. [PMID: 17294611 DOI: 10.1177/1352458506070750] [Citation(s) in RCA: 253] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Cognitive impairment is common in multiple sclerosis (MS), yet difficult to detect during routine neurologic examination. Therefore, brief screening tests that identify patients who may benefit from a more thorough assessment or treatment are needed. We investigated the utility of the Symbol Digit Modalities Test (SDMT) as a screen for cognitive dysfunction because it can be administered and scored in about 5 minutes. One hundred MS patients and 50 healthy controls, matched on demographic variables, participated in the study. Examination procedures included the neuropsychological (NP) tests included in the Minimal Assessment of Cognitive Function in MS (MACFIMS) battery. Patients were considered impaired if they performed one and a half standard deviations below controls on two or more MACFIMS variables, excluding the SDMT. Bayesian statistics showed that a total score of 55 or lower on the SDMT accurately categorized 72% of patients, yielding sensitivity of 0.82, specificity of 0.60, positive predictive value (PPV) of 0.71, and negative predictive value (NPV) of 0.73. These results suggest that the effectiveness of the SDMT as a screen for cognitive impairment in MS is roughly equal to that of other psychometric and questionnaire methods.
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Affiliation(s)
- B A Parmenter
- Department of Neurology, Division of Developmental and Behavioral Neurosciences, State University of New York at Buffalo School of Medicine and Biomedical Sciences, Buffalo, NY, USA
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Scherer P, Penner IK, Rohr A, Boldt H, Ringel I, Wilke-Burger H, Burger-Deinerth E, Isakowitsch K, Zimmermann M, Zahrnt S, Hauser R, Hilbert K, Tiel-Wilck K, Anvari K, Behringer A, Peglau I, Friedrich H, Plenio A, Benesch G, Ehret R, Nippert I, Finke G, Schulz I, Bergtholdt B, Breitkopf S, Kaskel P, Reischies F, Kugler J. The Faces Symbol Test, a newly developed screening instrument to assess cognitive decline related to multiple sclerosis: first results of the Berlin Multi-Centre FST Validation Study. Mult Scler 2007; 13:402-11. [PMID: 17439910 DOI: 10.1177/1352458506069674] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Reliable, language-independent, short screening instruments to test for cognitive function in patients with multiple sclerosis (MS) remain rare, despite the high number of patients affected by cognitive decline. We developed a new, short screening instrument, the Faces Symbol Test (FST), and compared its diagnostic test characteristics with a composite of the Digit Symbol Substitution Test (DSST) and the Paced Auditory Serial Addition Test (PASAT), in 108 MS patients and 33 healthy controls. An Informant-Report Questionnaire, a Self-Report Questionnaire, and a neurologist's estimation of the Every Day Life Cognitive Status were also applied to the MS patients. The statistical analyses comprised of a receiver operating characteristic analysis for test accuracy and for confounding variables. The PASAT and DSST composite score estimated that 36.5% of the MS patients had cognitive impairment. The FST estimated that 40.7% of the MS patients were cognitively impaired (sensitivity 84%; specificity 85%). The FST, DSST and PASAT results were significantly correlated with the patients' physical impairment, as measured by the Expanded Disability Status Scale (EDSS). The results suggest that the FST might be a culture-free, sensitive, and practical short screening instrument for the detection of cognitive decline in patients with MS, including those in the early stages. Multiple Sclerosis 2007; 13: 402-411. http://msj.sagepub.com
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Affiliation(s)
- P Scherer
- Kantstr. 125, D-10625 Berlin, Germany. schererpw@berlin. sireco. net
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