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Lenne B, Degraeve B, Davroux J, Norberciak L, Kwiatkowski A, Donze C. Improving cognition in people with multiple sclerosis: study protocol for a multiarm, randomised, blinded trial of multidomain cognitive rehabilitation using a video-serious game (E-SEP cognition). BMJ Neurol Open 2023; 5:e000488. [PMID: 38033375 PMCID: PMC10685921 DOI: 10.1136/bmjno-2023-000488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 10/15/2023] [Indexed: 12/02/2023] Open
Abstract
Introduction Multiple sclerosis (MS) is a prevalent neurological disease characterised by disseminated areas of demyelination and atrophy within the central nervous system, inducing cognitive disorders in 45%-65% of persons with MS (PwMS). Neuropsychology and neuroimaging studies provide evidence of the effectiveness of cognitive rehabilitation interventions, including memory and attention. Recently, serious game therapy (SGT) has been used in rehabilitation to improve cognitive processing speed. The aim of this study is to describe the protocol of a randomised controlled trial (RCT) to test the efficacy of a tablet-based cognitive home intervention among ambulatory PwMS, in comparison to a standardised neuropsychological rehabilitation. Methods and analysis This will be a parallel-assignment, double-blinded, RCT. One hundred and fifty (75 per arm) PwMS will be randomly assigned to receive cognitive rehabilitation session over 4 months (four 20-min sessions/week) of either: (1) tablet-based SGT or (2) conventional cognitive exercises. The same assessor will evaluate outcome measures at three points: at baseline (T0), after the 16 therapy sessions weeks (T1), and 6 months after the end of treatment (T2). The primary outcomes were the scores from the Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS). Data analysis will be performed to compare the efficacy of the two treatments. We expect superior efficiency of tablet-based SGT in contrast to conventional cognitive exercises, based on BICAMS measures of speed processing information and episodic memory. Ethics and dissemination The trial protocol is registered on ClinicalTrials.Gov (NCT04694534) and benefits from a favourable opinion from an ethics committee (RC-P0066-2018-A00411-54).
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Affiliation(s)
- Bruno Lenne
- ETHICS (EA7446), Lille Catholic University, Lille, France
- Neurology, Lille Catholic Institute Hospital Group, Lomme, Hauts-de-France, France
| | | | - Jessy Davroux
- Rehabilitation clinic, Lille Catholic Institute Hospital Group, Lomme, Hauts-de-France, France
| | - Laurène Norberciak
- Biostatistics department / Delegation for clinical research and innovation, Lille Catholic Institute Hospital Group, Lomme, Hauts-de-France, France
| | - Arnaud Kwiatkowski
- ETHICS (EA7446), Lille Catholic University, Lille, France
- Neurology, Lille Catholic Institute Hospital Group, Lomme, Hauts-de-France, France
| | - Cécile Donze
- ETHICS (EA7446), Lille Catholic University, Lille, France
- Rehabilitation clinic, Lille Catholic Institute Hospital Group, Lomme, Hauts-de-France, France
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2
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Giannouli V, Tsolaki M. Liberating older adults from the bonds of vascular risk factors: What is their impact on financial capacity in amnestic mild cognitive impairment? Psychiatry Clin Neurosci 2022; 76:246-250. [PMID: 35262231 DOI: 10.1111/pcn.13348] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 01/29/2022] [Accepted: 02/28/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND There is a pressing need to clarify whether vascular risk factors (VRFs) are related to the heterogeneous cognitive performance found in mild cognitive impairment (MCI) and whether the number of VRFs relates to financial capacity impairment in patients with amnestic MCI (aMCI). METHODS A total of 112 participants were divided into three groups: patients with single-domain aMCI, patients with multiple-domain aMCI, and healthy controls (HCs), while taking into consideration whether participants had a diagnosis of one VRF or disease, or more than one VRF or disease. Patients with aMCI with VRFs (one and more than one VRF) and HCs did not differ significantly in age, education, and sex. Mini-Mental State Examination, 15-item Geriatric Depression Scale, and Legal Capacity for Property Law Transactions Assessment Scale (LCPLTAS) were administered to all groups. RESULTS Diagnosis (P <0.001) and VRFs (P = 0.006) showed significant main effects on LCPLTAS but no interaction (P = 0.654). Patients with aMCI with high vascular burden were more frequently of the multiple-domain subtype, whereas patients with no vascular burden were more frequently of the single-domain subtype. A larger vascular burden is correlated with lower LCPLTAS scores. DISCUSSION Vascular burden plays an important role in the heterogeneity of aMCI by impairing financial capacity.
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Affiliation(s)
- Vaitsa Giannouli
- School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
- Department of Psychology, University of Western Macedonia, Florina, Greece
| | - Magda Tsolaki
- School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Bangma DF, Tucha O, Tucha L, De Deyn PP, Koerts J. How well do people living with neurodegenerative diseases manage their finances? A meta-analysis and systematic review on the capacity to make financial decisions in people living with neurodegenerative diseases. Neurosci Biobehav Rev 2021; 127:709-739. [PMID: 34058557 DOI: 10.1016/j.neubiorev.2021.05.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 05/18/2021] [Accepted: 05/20/2021] [Indexed: 12/13/2022]
Abstract
Self and proxy reported questionnaires indicate that people living with a neurodegenerative disease (NDD) have more difficulties with financial decision-making (FDM) than healthy controls. Self-reports, however, rely on adequate insight into everyday functioning and might, therefore, be less reliable. The present study provides a comprehensive overview and meta-analysis of studies evaluating FDM in people living with an NDD. For this, the reliability of performance-based tests to consistently identify FDM difficulties in people living with an NDD compared to healthy controls is evaluated. Furthermore, the associations between FDM and disease severity, performances on standard measures of cognition and demographics are evaluated. All 47 included articles, consistently reported lower performances on performance-based FDM tests of people living with an NDD (including Alzheimer's disease, mild cognitive impairment, frontotemporal dementia, Parkinson's disease, multiple sclerosis or Huntington's disease) compared to healthy controls. The majority of studies, however, focused on Alzheimer's disease and mild cognitive impairment (k = 38). FDM performance appears to be related to cognitive decline, specifically in working memory, processing speed and numeracy.
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Affiliation(s)
- Dorien F Bangma
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, the Netherlands; Department of Psychology, University of Amsterdam, Amsterdam, the Netherlands
| | - Oliver Tucha
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, the Netherlands; Department of Department of Psychiatry and Psychotherapy, University Medical Center Rostock, Rostock, Germany; Department of Psychology, Maynooth University, National University of Ireland, Maynooth, Ireland
| | - Lara Tucha
- Department of Department of Psychiatry and Psychotherapy, University Medical Center Rostock, Rostock, Germany
| | - Peter P De Deyn
- Department of Neurology and Alzheimer Center Groningen, University Medical Center Groningen, Groningen, the Netherlands; Institute Born-Bunge, University of Antwerp, Antwerp, Belgium; Department of Neurology and Memory Clinic, Middelheim General Hospital (ZNA), Antwerp, Belgium
| | - Janneke Koerts
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, the Netherlands.
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Yael G, Nancy C, John D. Money Management in Multiple Sclerosis: The Role of Cognitive, Motor, and Affective Factors. Front Neurol 2019; 10:1128. [PMID: 31708860 PMCID: PMC6819515 DOI: 10.3389/fneur.2019.01128] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 10/09/2019] [Indexed: 01/12/2023] Open
Abstract
Introduction: Few studies have examined the motor, cognitive, and emotional factors involved in effective money management in persons with multiple sclerosis (MS). The aim of this study was to assess money management in persons MS and examine whether cognitive, motor, and emotional processes can predict money management. Methods: This study included 72 persons with MS and 26 healthy controls (HC). Using an a priori definition of efficient vs. inefficient money management skills, based on the money management questionnaire (self and others), and performance on Actual Reality™ (AR) money management items, MS participants were divided into two groups: efficient or inefficient money management (MS Efficient- MM, n = 34 vs. MS Inefficient-MM, n = 38). These groups were compared on cognitive, motor, and emotional variables. Results: Participants in the MS efficient MM group performed significantly better on executive function and processing speed measures, as well as performance on the 25WT. The MS Efficient -MM group also showed significantly less affective symptomatology (depressive and state anxiety). Importantly, HC performed similarly to the Efficient MM group on these tests. Good executive functioning and low depressive symptomatology predicted efficient money management. Conclusions: This study characterizes some of the major problems and underlying impairments persons with MS are encountering in money management. Practitioners working with persons with MS should be aware that executive function impairments together with depressive symptomatology could signal possible money management dysfunction. The early identification of at-risk persons for money management difficulties could have a profound impact on the quality of life for this subsample of the MS population.
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Affiliation(s)
- Goverover Yael
- Department of Occupational Therapy, New York University, New York, NY, United States.,Kessler Foundation, West Orange, NJ, United States
| | - Chiaravalloti Nancy
- Kessler Foundation, West Orange, NJ, United States.,Department of Physical Medicine and Rehabilitation, New Jersey Medical School, Rutgers University, Newark, NJ, United States
| | - DeLuca John
- Kessler Foundation, West Orange, NJ, United States.,Department of Physical Medicine and Rehabilitation, New Jersey Medical School, Rutgers University, Newark, NJ, United States
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Sunderaraman P, Cosentino S, Lindgren K, James A, Schultheis M. Informant Report of Financial Capacity for Individuals With Chronic Acquired Brain Injury: An Assessment of Informant Accuracy. J Head Trauma Rehabil 2019; 33:E85-E94. [PMID: 29601341 PMCID: PMC6163092 DOI: 10.1097/htr.0000000000000382] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Primarily, to investigate the association between informant report and objective performance on specific financial capacity (FC) tasks by adults with chronic, moderate to severe acquired brain injury, and to examine the nature of misestimates by the informants. DESIGN Cross-sectional design. SETTING A postacute, community-based rehabilitation center. PARTICIPANTS Data were obtained from 22 chronic acquired brain injury (CABI) adults, mean age of 46.6 years (SD = 8.67), mean years of education of 13.45 years (SD = 2.15), with moderate to severe acquired brain injury (86% had traumatic brain injury), with a mean postinjury period of 17.14 years (SD = 9.5). Whereas the CABI adults completed the Financial Competence Assessment Inventory interview-a combination of self-report and performance-based assessment, 22 informants completed a specifically designed parallel version of the interview. RESULTS Pearson correlations and 1-sample t tests based on the discrepancy scores between informant report and CABI group's performance were used. The CABI group's performance was not associated with its informant's perceptions. One-sample t tests revealed that informants both underestimated and overestimated CABI group's performance. CONCLUSIONS Results indicate lack of correspondence between self- and informant ratings. Further investigation revealed that misestimations by informants occurred in contrary directions with CABI adults' performance being inaccurately rated. These findings raise critical issues related to assuming that the informant report can be used as a "gold standard" for collecting functional data related to financial management, and the idea that obtaining objective data on financial tasks may represent a more valid method of assessing financial competency in adults with brain injury.
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Affiliation(s)
- Preeti Sunderaraman
- Cognitive Neuroscience Division of the Taub Institute for Research on Alzheimer's Disease and the Aging Brain, and the G. H. Sergievsky Center (Drs Sunderaraman and Cosentino) and Department of Neurology (Dr Cosentino), Columbia University Medical Center, New York City, New York; Bancroft Brain Injury Services, Cherry Hill, New Jersey (Dr Lindgren); and Psychology Department, Drexel University, Philadelphia, Pennsylvania (Ms James and Dr Schultheis)
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Mulligan R, Basso MR, Lau L, Reynolds B, Whiteside DM, Combs D, Bornstein RA. Validity of the Verbal Concept Attainment Test in multiple sclerosis. J Clin Exp Neuropsychol 2019; 41:331-340. [PMID: 30642223 PMCID: PMC6428607 DOI: 10.1080/13803395.2018.1562048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 12/10/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE As many as 70% of people with multiple sclerosis (MS) have clinically significant cognitive impairment, and most of these individuals exhibit executive dysfunction. Most research concerning executive dysfunction in MS has focused upon nonverbal measures. The Verbal Concept Attainment Test (VCAT) has demonstrated construct validity as an executive function measure in people infected with HIV and in people with focal brain lesions, but its validity among people with MS is unknown. The current study evaluated the VCAT's criterion, diagnostic, and ecological validity in people with MS. METHOD A comprehensive neuropsychological battery was administered to 44 healthy individuals and 97 people with MS. Based on existing norms, they were classified as impaired or unimpaired, resulting in 65 people with MS categorized as unimpaired and 32 as impaired. They were administered a battery assessing neuropsychological impairment and disability status. RESULTS The VCAT correlated with most measures of neuropsychological function, but its largest correlations occurred with measures of executive function, working memory, and verbal memory. Regarding classification accuracy, the VCAT achieved satisfactory sensitivity and specificity in identifying neuropsychological impairment in people with MS. The VCAT achieved moderate correlations with measures of disability status. CONCLUSIONS The data provide evidence for an optimal VCAT cutoff score for establishing neuropsychological impairment in people with MS, and they demonstrate that the VCAT possesses acceptable criterion, diagnostic, and ecological validity. As such, these data support the inclusion of the VCAT in research and clinical practice involving people with MS.
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Affiliation(s)
- Ryan Mulligan
- a Department of Psychology , University of Tulsa , Tulsa , OK
| | - Michael R Basso
- a Department of Psychology , University of Tulsa , Tulsa , OK
| | - Lily Lau
- a Department of Psychology , University of Tulsa , Tulsa , OK
| | | | | | - Dennis Combs
- c Department of Psychology , University of Texas at Tyler , Tyler, TX
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Sunderaraman P, Cosentino S, Lindgren K, James A, Schultheis MT. An examination of financial capacity and neuropsychological performance in chronic acquired brain injury (CABI). Brain Inj 2019; 33:991-1002. [PMID: 30712402 DOI: 10.1080/02699052.2019.1570340] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
PRIMARY OBJECTIVE Financial Capacity (FC) is known to be impaired in the acute and subacute stages of brain injury. The current study sought to examine FC in the context of chronic, moderate to severe acquired brain injury (CABI). RESEARCH DESIGN The Financial Competence Assessment Inventory (FCAI), developed in Australia, was adapted to examine the integrity of FC in an American sample. METHODS AND PROCEDURES Healthy comparison (HC) participants were recruited from the community, whereas participants with CABI were recruited from a community-based rehabilitation center. Participants completed the FCAI and a neuropsychological battery. FCAI performance in the current study was compared against previously published Australian data. Multiple regression analyses examined group (CABI vs. HC) as a predictor of FC. Bivariate correlations examined the cognitive correlates of FCAI in the CABI group. MAIN OUTCOMES AND RESULTS The HC group in the current study obtained similar mean scores as those in the Australian sample. CABI group membership predicted lower performance on each FCAI dimension. In the CABI group, attention, working memory, delayed verbal memory, abstract reasoning and impulsivity were uniquely associated with FCAI dimensions. CONCLUSIONS Findings underscore the importance of continued monitoring of FC even after the subacute stage of injury, and identify cognitive impairments that may be particularly detrimental for specific dimensions of FC.
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Affiliation(s)
- Preeti Sunderaraman
- a Cognitive Neuroscience Division of the Taub Institute for Research on Alzheimer's Disease and the Aging Brain, G.H. Sergievsky Center, and Department of Neurology , Columbia University Medical Center , New York , New York , USA
| | - Stephanie Cosentino
- a Cognitive Neuroscience Division of the Taub Institute for Research on Alzheimer's Disease and the Aging Brain, G.H. Sergievsky Center, and Department of Neurology , Columbia University Medical Center , New York , New York , USA
| | - Karen Lindgren
- b Bancroft Brain Injury Services , Cherry Hill, New Jersey , USA
| | - Angela James
- c Psychology Department , Drexel University , Philadelphia , Pennsylvania , USA
| | - Maria T Schultheis
- c Psychology Department , Drexel University , Philadelphia , Pennsylvania , USA
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Kalb R, Beier M, Benedict RH, Charvet L, Costello K, Feinstein A, Gingold J, Goverover Y, Halper J, Harris C, Kostich L, Krupp L, Lathi E, LaRocca N, Thrower B, DeLuca J. Recommendations for cognitive screening and management in multiple sclerosis care. Mult Scler 2018; 24:1665-1680. [PMID: 30303036 PMCID: PMC6238181 DOI: 10.1177/1352458518803785] [Citation(s) in RCA: 229] [Impact Index Per Article: 38.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Purpose: To promote understanding of cognitive impairment in multiple sclerosis (MS), recommend optimal screening, monitoring, and treatment strategies, and address barriers to optimal management. Methods: The National MS Society (“Society”) convened experts in cognitive dysfunction (clinicians, researchers, and lay people with MS) to review the published literature, reach consensus on optimal strategies for screening, monitoring, and treating cognitive changes, and propose strategies to address barriers to optimal care. Recommendations: Based on current evidence, the Society makes the following recommendations, endorsed by the Consortium of Multiple Sclerosis Centers and the International Multiple Sclerosis Cognition Society:
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Affiliation(s)
- Rosalind Kalb
- National Multiple Sclerosis Society, New York, NY, USA
| | - Meghan Beier
- Division of Rehabilitation Psychology and Neuropsychology, Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Leigh Charvet
- Department of Neurology, Langone Medical Center, New York University, New York, NY, USA
| | | | - Anthony Feinstein
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | | | | | - June Halper
- The Consortium of Multiple Sclerosis Centers and International Organization of Multiple Sclerosis Nurses, Multiple Sclerosis Nurses International Certification Board, Hackensack, NJ, USA
| | - Colleen Harris
- Multiple Sclerosis Center, University of Calgary, Calgary, AB, Canada
| | - Lori Kostich
- The Mandell Center for Multiple Sclerosis, Mount Sinai Rehabilitation Hospital, Hartford, CT, USA
| | - Lauren Krupp
- Department of Neurology, NYU Langone Health, New York University, New York, NY, USA
| | - Ellen Lathi
- The Elliot Lewis Center for Multiple Sclerosis Care, Wellesley, MA, USA
| | | | - Ben Thrower
- Emory University, Atlanta, GA, USA/Andrew C. Carlos Multiple Sclerosis Institute at Shepherd Center, Atlanta, GA, USA
| | - John DeLuca
- Department of Physical Medicine and Rehabilitation and Department of Neurology, Rutgers New Jersey Medical School, Newark, NJ, USA
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Medetsky H, Sunderaraman P, Cosentino S. Investing: the case for recognition as an independent capacity. J Elder Abuse Negl 2018; 30:320-331. [PMID: 29932845 DOI: 10.1080/08946566.2018.1487894] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
In this article, we provide support for the need to recognize investing as an independent capacity. A comparison of the definitions and models of financial and investing capacities revealed significant differences between them. A review of the status of investing capacity assessment revealed that there are currently no investing capacity specific assessment instruments (ICSAIs). Implications for researchers and clinicians resulting from the lack of recognition of investing as an independent capacity are discussed and used as a rational for the need to develop ICSAIs. The benefits of ICSAI development for financial, legal, and clinical professionals as well as for investors are discussed, and a direction for future investing capacity research is proposed.
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Affiliation(s)
- Herbert Medetsky
- a Psychiatric Consultation Service , New York Community Hospital , Brooklyn , NY , USA
| | - Preeti Sunderaraman
- b Cognitive Neuroscience Division of the Taub Institute for Research on Alzheimer's Disease and the Aging Brain , New York , NY , USA.,c The Gertrude H. Sergievsky Center , New York , NY , USA
| | - Stephanie Cosentino
- b Cognitive Neuroscience Division of the Taub Institute for Research on Alzheimer's Disease and the Aging Brain , New York , NY , USA.,c The Gertrude H. Sergievsky Center , New York , NY , USA.,d Department of Neurology , Columbia University Medical Center , New York , NY , USA
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