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Jackson DA, Nicholson R, Bergmann C, Wilken J, Kaczmarek O, Bumstead B, Buhse M, Zarif M, Penner IK, Hancock LM, Golan D, Doniger GM, Bogaardt H, Barrera M, Covey TJ, Gudesblatt M. Cognitive impairment in people with multiple sclerosis: Perception vs. performance - factors that drive perception of impairment differ for patients and clinicians. Mult Scler Relat Disord 2023; 69:104410. [PMID: 36399966 DOI: 10.1016/j.msard.2022.104410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 10/10/2022] [Accepted: 11/10/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND Neurologists' perceptions of the presence of cognitive impairment (CI) in people with multiple sclerosis (PwMS) may not always align with findings of objective cognitive assessment. The accuracy of self-reported CI in PwMS can also be highly variable across individuals, and may not align with objective measurement of cognitive disturbances. Research suggests that additional factors impact perceived cognitive ability, such as depression and fatigue. Objective cognitive screening regardless of patient or neurologist perception has been recommended but still is often limited in routine care. Moreover, comprehensive neuropsychological assessment is even less routinely done. OBJECTIVE To explore how neurologists' perceptions of PwMS' CI compare to the perception of the patient by determining whether PwMS and their clinicians are accurate in detecting the presence and degree of CI as defined by a multi-domain validated computerized test battery in PwMS, as well as investigate what factors influence perception of CI in each group. METHODS PwMS completed a computerized multi-domain cognitive testing battery, and self-reported measures of disease impact (MSIS-29), fatigue (MFIS), and depression (BDI-II). Disability was assessed by the clinician using the Expanded Disability Status Scale (EDSS). Clinicians and patients also provided an estimation of cognitive deficits along a Likert scale. RESULTS In this cohort of PwMS (N=202, age range: 20 to 88, gender: 71% female), their level of accuracy in detecting attention deficits (k = -.028, p = .010) was low but statistically significant. In contrast, clinicians' accuracy in detecting global CI (k = -.037, p < .001) and a number of specific domain deficits was moderate. Fatigue (p < .001) and cognitive performance (p = .012) significantly predicted patient perceived cognitive deficits. Clinician perceived cognitive performance was significantly predicted by multiple factors: cognitive scores (p < .001), physical disability (p = .011), age (p = .021), and depression (p = .038). CONCLUSION The need to objectively screen for CI in PwMS, regardless of perception, can be aided by a better understanding of the agreement and discrepancies between the patient and clinician regarding perceived cognitive disturbances and the presence of CI defined by a multi-dimensional objective screening battery.
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Affiliation(s)
- Daija A Jackson
- The Chicago School of Professional Psychology, Washington, D.C., USA.
| | | | | | - Jeffrey Wilken
- Washington Neuropsychology Research Group, Fairfax, VA, USA
| | | | | | | | - Myassar Zarif
- South Shore Neurologic Associates, Patchogue, NY, USA
| | - Iris-Katharina Penner
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Laura M Hancock
- University of Wisconsin School of Medicine, Madison, WI, USA; William S. Middleton VA Medical Center, Madison, WI, USA
| | - Daniel Golan
- Multiple Sclerosis and Neuroimmunology Center, Clalit Health Services, Nazareth, Israel; Department of Neurology, Lady Davis Carmel Medical Center, Haifa, Israel; Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
| | | | - Hans Bogaardt
- School of Allied Health Science and Practice, University of Adelaide, Adelaide, Australia
| | - Marissa Barrera
- Katz School of Science & Health, Yeshiva University, New York, NY, USA
| | - Thomas J Covey
- Department of Neurology, Division of Cognitive and Behavioral Neurosciences, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA; Neuroscience Program, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
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Golan D, Sagiv S, Glass-Marmor L, Miller A. Mobile-phone-based e-diary derived patient reported outcomes: Association with clinical disease activity, psychological status and quality of life of patients with multiple sclerosis. PLoS One 2021; 16:e0250647. [PMID: 33951061 PMCID: PMC8099126 DOI: 10.1371/journal.pone.0250647] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 04/12/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The applicability of mobile digital technology to promote clinical care of people with multiple sclerosis (pwMS) is gaining increased interest as part of the implementation of patient-centered approaches. We aimed at assessing adherence to a smartphone-based e-diary, which was designed to collect patient-reported outcomes (PROs). Secondary objectives were to evaluate the construct and predictive validity of e-diary derived PROs and to explore the various factors that were associated with changes in PROs over time. MATERIALS AND METHODS In this observational cohort study patients downloaded an MS tailored e-diary into their personal smartphones. Report of PROs was enquired once monthly for a period of one year through a smartphone-based application, using previously validated tools. An e-diary derived bodily function summary score (eBF) was defined as the sum of scores depicting vision, limbs function, pain, bowl/ bladder dysfunction, pseudobulbar affect and spasticity. Multiple linear regression and analysis of covariance were used to determine the association between PROs, clinician-reported outcomes (ClinROs) of disease activity and quality of life (QoL). Regression coefficient analysis was used to compare the slope of change in eBF before and after a relapse. RESULTS 97 pwMS downloaded the e-diary [Female: 64 (66%), EDSS 3.4±2.1]. 76 patients (78%) completed the 12-month study period. 53 patients (55%) submitted ≥75% of requested surveys. Anxiety was negatively associated with adherence to periodic PROs assessments by the e-diary. E-diary derived PROs were significantly correlated with corresponding functional system scores (0.38< r <0.8, P<0.001). eBF score significantly predicted QoL (β = -0.36, P = 0.001) while EDSS did not. Change in eBF score over time was independently associated with the occurrence of an MS relapse (F = 4.4, P = 0.04), anxiety (F = 6.4, P = 0.01) and depression (F = 5.1, P = 0.03). Individual regression slopes of eBF scores were significantly higher pre-relapse than post-relapse (3.0±3.3 vs. -0.8±2.0, P = 0.007). CONCLUSION Adherence of pwMS to recording in an e-diary collecting PROs was high. Changes in e-diary derived PROs over time predict clinical MS relapses on the group level and thus carry the potential of usage in clinical research as well as for improved MS care in real world setting.
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Affiliation(s)
- Daniel Golan
- Multiple Sclerosis Center & Department of Neurology, Lady Davis Carmel Medical Center, Haifa, Israel
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Smadar Sagiv
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Lea Glass-Marmor
- Multiple Sclerosis Center & Department of Neurology, Lady Davis Carmel Medical Center, Haifa, Israel
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Ariel Miller
- Multiple Sclerosis Center & Department of Neurology, Lady Davis Carmel Medical Center, Haifa, Israel
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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3
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Chen MH, Goverover Y. Self-awareness in multiple sclerosis: Relationships with executive functions and affect. Eur J Neurol 2021; 28:1627-1635. [PMID: 33527564 DOI: 10.1111/ene.14762] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 01/26/2021] [Accepted: 01/27/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND OBJECTIVES Deficits in self-awareness can be observed in persons with multiple sclerosis (pwMS). The present study aimed to investigate two types of self-awareness (intellectual and online) among pwMS, which will inform clinical care. Intellectual awareness refers to knowledge of one's own abilities; online awareness refers to real-time monitoring and regulation of one's performance. METHODS The study sample consisted of 95 pwMS and 65 healthy controls (HCs). Intellectual awareness was defined as discrepancy between participant's and informant's reports of participant's functioning. Online awareness was operationalized by change in self-assessment of performance after engaging in a functional task. RESULTS PwMS had significantly worse intellectual awareness than HCs regarding money management (confidence interval [CI] 0.44 to 1.99), task performance (CI -0.01 to 2.5), social interaction (CI 0.29 to 2.45), and problem solving (CI 0.87 to 2.8) abilities, but not sensory symptoms. Executive functioning was positively associated with intellectual awareness in HCs, while depressive and anxiety symptoms were negatively related to intellectual awareness in pwMS. In contrast, online awareness was not significantly different between groups; both groups were able accurately to assess their performance after engaging in a functional task. CONCLUSIONS Intellectual awareness, but not online awareness, is impaired in pwMS. Among pwMS, affective symptomatology may distort their perception of functional status. Persons with MS may benefit from actually performing a functional task during the assessment and treatment process, which may lead to a more accurate estimate of their own abilities.
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Affiliation(s)
- Michelle H Chen
- Kessler Foundation, East Hanover, New Jersey, USA.,Department of Physical Medicine and Rehabilitation, New Jersey Medical School, Rutgers University, Newark, New Jersey, USA
| | - Yael Goverover
- Kessler Foundation, East Hanover, New Jersey, USA.,Department of Occupational Therapy, Steinhardt School of Culture, Education, and Human Development, New York University, New York, New York, USA
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4
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Golan D, Doniger GM, Srinivasan J, Sima DM, Zarif M, Bumstead B, Buhse M, Van Hecke W, Wilken J, Gudesblatt M. The association between MRI brain volumes and computerized cognitive scores of people with multiple sclerosis. Brain Cogn 2020; 145:105614. [PMID: 32927305 DOI: 10.1016/j.bandc.2020.105614] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 08/19/2020] [Accepted: 08/25/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Computerized cognitive assessment facilitates the incorporation of multi-domain cognitive monitoring into routine clinical care. The predictive validity of computerized cognitive assessment among people with multiple sclerosis (PwMS) has scarcely been investigated. OBJECTIVE To explore the associations between brain volumes and cognitive scores from a computerized cognitive assessment battery (CAB, NeuroTrax) among PwMS. METHODS PwMS were evaluated with the CAB and underwent brain MRI within 40 days. Cognitive assessment yielded age- and education-adjusted scores in 9 cognitive domains: memory, executive function, attention, information processing speed, visual spatial, verbal function, motor skills, problem solving, and working memory. The global cognitive score (GCS) is the average of all domain scores. MRI brain and lesion volumes were assessed with icobrain ms, a fully automated tissue and lesion segmentation and quantification software. RESULTS 91 PwMS were included [Age: 52.1 ± 11.7 years, 64 (70%) female, EDSS: 3.4 ± 2.0, 79 (87%) with a relapsing remitting course]. Significant correlations were found between the GCS and whole brain, white matter, grey matter, thalamic, lateral ventricles, hippocampal and lesion volumes (Correlation coefficients: 0.46, 0.40, 0.25, 0.42, -0.36, 0.21, -0.3, respectively). Regression analysis revealed that lateral ventricles and thalamic volumes were the most consistent predictors of all cognitive domain scores. CONCLUSION Computerized cognitive scores were significantly associated with quantified MRI. These findings support the predictive validity of multi-domain computerized cognitive assessment for people with multiple sclerosis.
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Affiliation(s)
- Daniel Golan
- Department of Neurology & Multiple Sclerosis Center, Lady Davis Carmel Medical Center, Haifa, Israel; Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
| | - Glen M Doniger
- Department of Clinical Research, NeuroTrax Corporation, Modiin, Israel
| | | | - Diana M Sima
- Research and Development Department, icometrix, Leuven, Belgium
| | - Myassar Zarif
- South Shore Neurologic Associates, Patchogue, NY, USA
| | | | | | - Wim Van Hecke
- Research and Development Department, icometrix, Leuven, Belgium
| | - Jeffrey Wilken
- Washington Neuropsychology Research Group, Fairfax, VA, USA; Department of Neurology, Georgetown University, Washington DC, USA
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Morelli ME, Baldini S, Sartori A, D'Acunto L, Dinoto A, Bosco A, Bratina A, Manganotti P. Early putamen hypertrophy and ongoing hippocampus atrophy predict cognitive performance in the first ten years of relapsing-remitting multiple sclerosis. Neurol Sci 2020; 41:2893-2904. [PMID: 32333180 DOI: 10.1007/s10072-020-04395-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 04/03/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND The first years of relapsing-remitting multiple sclerosis (RRMS) constitute the most vulnerable phase for the progression of cognitive impairment (CImp), due to a gradual decrease of compensatory mechanisms. In the first 10 years of RRMS, the temporal volumetric changes of deep gray matter structures must be clarified, since they could constitute reliable cognitive biomarkers for diagnostic, prognostic, and therapeutic purposes. METHODS Forty-five cognitively asymptomatic patients with RRMS lasting ≤ 10 years, and with a brain MRI performed in a year from the neuropsychological evaluation (Te-MRI), were included. They performed the Brief International Cognitive Assessment battery for MS. Thirty-one brain MRIs performed in the year of diagnosis (Td-MRI) and 13 brain MRIs of age- and sex-matched healthy controls (HCs) were also included in the study. The relationships between clinical features, cognitive performances, and Te- and Td-MRI volumes were statistically analyzed. RESULTS Cognitively preserved (CP) patients had significantly increased Td-L-putamen (P = 0.035) and Td-R-putamen volume (P = 0.027) with respect to cognitively impaired (CI) ones. CI patients had significantly reduced Te-L-hippocampus (P = 0.019) and Te-R-hippocampus volume (P = 0.042) compared, respectively, with Td-L-hippocampus and Td-R-hippocampus volume. Td-L-putamen volume (P = 0.011) and Te-L-hippocampus volume (P = 0.023) were independent predictors of the Symbol Digit Modalities Test score in all patients (r2 = 0.31, F = 6.175, P = 0.001). CONCLUSION In the first years of RRMS, putamen hypertrophy and hippocampus atrophy could represent promising indices of cognitive performance and reserve, and become potentially useful tools for diagnostic, prognostic, and therapeutic purposes.
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Affiliation(s)
- Maria Elisa Morelli
- Multiple Sclerosis Center, Neurology Unit, Department of Medical Sciences, University Hospital and Health Services of Trieste, University of Trieste, Strada di Fiume, 447, 34149, Trieste, Italy.
| | - Sara Baldini
- Multiple Sclerosis Center, Neurology Unit, Department of Medical Sciences, University Hospital and Health Services of Trieste, University of Trieste, Strada di Fiume, 447, 34149, Trieste, Italy
| | - Arianna Sartori
- Multiple Sclerosis Center, Neurology Unit, Department of Medical Sciences, University Hospital and Health Services of Trieste, University of Trieste, Strada di Fiume, 447, 34149, Trieste, Italy
| | - Laura D'Acunto
- Multiple Sclerosis Center, Neurology Unit, Department of Medical Sciences, University Hospital and Health Services of Trieste, University of Trieste, Strada di Fiume, 447, 34149, Trieste, Italy
| | - Alessandro Dinoto
- Multiple Sclerosis Center, Neurology Unit, Department of Medical Sciences, University Hospital and Health Services of Trieste, University of Trieste, Strada di Fiume, 447, 34149, Trieste, Italy
| | - Antonio Bosco
- Multiple Sclerosis Center, Neurology Unit, Department of Medical Sciences, University Hospital and Health Services of Trieste, University of Trieste, Strada di Fiume, 447, 34149, Trieste, Italy
| | - Alessio Bratina
- Multiple Sclerosis Center, Neurology Unit, Department of Medical Sciences, University Hospital and Health Services of Trieste, University of Trieste, Strada di Fiume, 447, 34149, Trieste, Italy
| | - Paolo Manganotti
- Multiple Sclerosis Center, Neurology Unit, Department of Medical Sciences, University Hospital and Health Services of Trieste, University of Trieste, Strada di Fiume, 447, 34149, Trieste, Italy
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Bartels RM, Harkins L, Beech AR. The Influence of Fantasy Proneness, Dissociation, and Vividness of Mental Imagery on Male's Aggressive Sexual Fantasies. JOURNAL OF INTERPERSONAL VIOLENCE 2020; 35:964-987. [PMID: 29294653 DOI: 10.1177/0886260517691523] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Many researchers have studied the prevalence and content of men's aggressive sexual fantasies, including their link with rape-supportive cognition. However, little to no research has examined the link between imaginal ability and the use of such fantasies. Based on existing research and theory, we propose that men who hold hostile beliefs toward women will use aggressive sexual fantasies more often if they possess a greater ability to engage in a "rich fantasy life." Operationally, we argue this involves (a) a proneness to fantasize in general, (b) an ability to vividly envision mental imagery, and (c) frequent experiences of dissociation. To test this, the present study hypothesized that a latent variable termed "rich fantasy life," via "hostile beliefs about women," influences the use of "aggressive sexual fantasies." A sample of 159 community males was recruited. Each participant completed a measure of fantasy proneness, dissociation, and vividness of mental imagery, along with two measures that assess hostile beliefs about women. Assessing how often the participants fantasized about rape-related and sadistic themes provided a measure of aggressive sexual fantasies. Structural equation modeling (along with bootstrapping procedures) indicated that the data had a very good fit with the hypothesized model. The results offer an important contribution to our understanding of aggressive sexual fantasies, which may have implications for clinical assessment and treatment. The limitations of the study are discussed, along with suggestions for future research.
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Affiliation(s)
| | - Leigh Harkins
- University of Ontario Institute of Technology, Oshawa, Canada
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7
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Frahm N, Hecker M, Zettl UK. Polypharmacy among patients with multiple sclerosis: a qualitative systematic review. Expert Opin Drug Saf 2020; 19:139-145. [DOI: 10.1080/14740338.2020.1720646] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- Niklas Frahm
- Neuroimmunology Section, Department of Neurology, University Medicine Rostock, Rostock, Germany
| | - Michael Hecker
- Neuroimmunology Section, Department of Neurology, University Medicine Rostock, Rostock, Germany
| | - Uwe Klaus Zettl
- Neuroimmunology Section, Department of Neurology, University Medicine Rostock, Rostock, Germany
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8
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Mazancieux A, Souchay C, Casez O, Moulin CJA. Metacognition and self-awareness in Multiple Sclerosis. Cortex 2018; 111:238-255. [PMID: 30530267 DOI: 10.1016/j.cortex.2018.11.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 07/03/2018] [Accepted: 11/09/2018] [Indexed: 10/27/2022]
Abstract
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.
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Affiliation(s)
| | - Céline Souchay
- LPNC CNRS 5105, Université Grenoble Alpes, Grenoble, France
| | - Olivier Casez
- Department of Neurology, Université Grenoble Alpes, Grenoble, France
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9
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Reilly S, Hynes SM. A Cognitive Occupation-Based Programme for People with Multiple Sclerosis: A Study to Test Feasibility and Clinical Outcomes. Occup Ther Int 2018; 2018:1614901. [PMID: 29853813 PMCID: PMC5954939 DOI: 10.1155/2018/1614901] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 03/19/2018] [Indexed: 11/18/2022] Open
Abstract
Cognitive impairments are common in MS and affect personal, social, and occupational functioning. There is a developing body of evidence highlighting the role of cognitive rehabilitation, but there is still no evidence for a validated holistic approach. The aim of this study was to assess the effectiveness of Cognitive Occupation-Based Programme for People with Multiple Sclerosis (COB-MS) for improving daily life and cognitive impairment. This study used an experimental pretest/posttest design with eight-week follow-up. Participants were recruited from MS networks using convenience sampling. The primary outcome measure was the GAS. Secondary outcomes included the OSA-DLS, CVLT-II, BVMT-R, SDMT, TMT, BRIEF-A, and EMQ-R. Twelve participants were recruited, aged 39-73 years (mean: 55.08; SD: 9.61). There were statistically significant improvements in the GAS (p < .002), CVLT-II: total free recall (p < .000), short delay free recall (p < .018), long delay free recall (p < .008), BVMT-R total recall (p < .000), TMT part B (p < .044), and EMQ-R (p < .006). Except for the BRIEF-A, clinically significant improvements were observed in secondary outcome measures at posttest and follow-up. Limitations include selection bias and subtle practice effects in cognitive measures. Results suggest that a larger scale study is justified considering improvements seen in daily life and cognitive measures.
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Affiliation(s)
- Sean Reilly
- Discipline of Occupational Therapy, National University of Ireland Galway, Galway, Ireland
| | - Sinéad M. Hynes
- Discipline of Occupational Therapy, National University of Ireland Galway, Galway, Ireland
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10
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dasNair R, Griffiths H, Clarke S, Methley A, Kneebone I, Topcu G. Everyday memory measures in multiple sclerosis: a systematic review. Neuropsychol Rehabil 2018; 29:1543-1568. [PMID: 29498324 DOI: 10.1080/09602011.2018.1434081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Everyday memory is one of the most affected cognitive functions in multiple sclerosis (MS). Assessing everyday memory problems is crucial for monitoring the impact of memory deficits on individuals' day-to-day lives and evaluating the effectiveness of interventions that aim to improve cognitive functions. The aim of this systematic review was to identify the research literature on everyday memory measures used with people with MS, describe the types of measures used, and summarise their psychometric properties. Empirical studies of cognitive function in MS using standardised everyday memory measures were included. Online databases (MEDLINE, PsycINFO, PsycARTICLES, Embase) and Google Scholar were searched. Forty-four studies met the inclusion criteria. A total of 12 measures were identified, with varied uses and administration methods. The majority of papers did not report any psychometric properties for MS populations. The few papers that did, reported that the measures have good reliability and appear to have good face, concurrent, and ecological validity, but these need to be evaluated further. This review presents researchers and clinicians with an overview of the various everyday memory measures used in studies with people with MS, to help them choose the appropriate measure for their evaluations.
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Affiliation(s)
- Roshan dasNair
- Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham , Nottingham , UK.,Institute of Mental Health, Nottinghamshire Healthcare Trust , Nottingham , UK
| | - Holly Griffiths
- Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham , Nottingham , UK
| | - Sara Clarke
- Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham , Nottingham , UK
| | - Abigail Methley
- Neuropsychology Department, Salford Royal NHS Foundation Trust , Salford , UK.,Section for Clinical and Health Psychology, School of Psychological Sciences, University of Manchester , Manchester , UK
| | - Ian Kneebone
- Discipline of Clinical Psychology, Graduate School of Health, University of Technology Sydney , Sydney , Australia
| | - Gogem Topcu
- Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham , Nottingham , UK
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11
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Siengsukon CF, Aldughmi M, Kahya M, Lynch S, Bruce J, Glusman M, Ness Norouzinia A, Billinger S. Individuals with mild MS with poor sleep quality have impaired visuospatial memory and lower perceived functional abilities. Disabil Health J 2018; 11:116-121. [PMID: 28495217 DOI: 10.1016/j.dhjo.2017.04.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 04/18/2017] [Accepted: 04/24/2017] [Indexed: 01/22/2023]
Abstract
BACKGROUND Sleep disturbances are common in individuals with Multiple Sclerosis (MS), but the impact of poor sleep quality on cognitive and physical function in individuals with MS is less clear. OBJECTIVE/HYPOTHESIS The purpose of this study was to examine the relationship between sleep quality and cognitive and physical function in individuals with mild MS. METHODS Forty individuals with relapsing-remitting or secondary-progressive MS (50.3 ± 11.6 years of age) participated. The Pittsburgh Sleep Quality Index (PSQI) was used to index sleep quality. A PSQI of ≤5 was considered good sleep quality and >5 was considered poor sleep quality. Cognitive function was assessed using a battery of cognitive tests, and physical function was assessed using 2 objective measures and a self-report measure. RESULTS Thirteen individuals (32.5%) indicated good sleep quality and 27 (67.5%) of the participants reported poor sleep quality. Those with good sleep quality performed significantly better on a visuospatial memory test (p = 0.025) and reported higher functional abilities (p < 0.001) compared to those with poor sleep quality. There was no difference in performance on the cognitive tests of verbal memory, information processing, or executive function, or the objective function measures. Individuals with poor sleep quality had higher levels of fatigue, depression, and anxiety, and lower quality of life. CONCLUSIONS Visuospatial memory appears to be the memory domain particularly associated with poor sleep quality in people with mild MS. Also, individuals with mild MS with poor sleep quality may underestimate their functional abilities.
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Affiliation(s)
- Catherine F Siengsukon
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, 3901 Rainbow Blvd, Mailstop 2002, Kansas City, KS, 66160, USA.
| | - Mayis Aldughmi
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, 3901 Rainbow Blvd, Mailstop 2002, Kansas City, KS, 66160, USA
| | - Melike Kahya
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, 3901 Rainbow Blvd, Mailstop 2002, Kansas City, KS, 66160, USA
| | - Sharon Lynch
- Department of Neurology, University of Kansas Medical Center, 3901 Rainbow Blvd, Mailstop 2012, Kansas City, KS, 66160, USA
| | - Jared Bruce
- Department of Psychology, University of Missouri-Kansas City, 5030 Cherry St, Kansas City, MO, 64110, USA
| | - Morgan Glusman
- Department of Psychology, University of Missouri-Kansas City, 5030 Cherry St, Kansas City, MO, 64110, USA
| | - Abigail Ness Norouzinia
- Department of Psychology, University of Missouri-Kansas City, 5030 Cherry St, Kansas City, MO, 64110, USA
| | - Sandra Billinger
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, 3901 Rainbow Blvd, Mailstop 2002, Kansas City, KS, 66160, USA
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12
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Gay MC, Bungener C, Thomas S, Vrignaud P, Thomas PW, Baker R, Montel S, Heinzlef O, Papeix C, Assouad R, Montreuil M. Anxiety, emotional processing and depression in people with multiple sclerosis. BMC Neurol 2017; 17:43. [PMID: 28231828 PMCID: PMC5324294 DOI: 10.1186/s12883-017-0803-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2016] [Accepted: 01/20/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite the high comorbidity of anxiety and depression in people with multiple sclerosis (MS), little is known about their inter-relationships. Both involve emotional perturbations and the way in which emotions are processed is likely central to both. The aim of the current study was to explore relationships between the domains of mood, emotional processing and coping and to analyse how anxiety affects coping, emotional processing, emotional balance and depression in people with MS. METHODS A cross-sectional questionnaire study involving 189 people with MS with a confirmed diagnosis of MS recruited from three French hospitals. Study participants completed a battery of questionnaires encompassing the following domains: i. anxiety and depression (Hospital Anxiety and Depression Scale (HADS)); ii. emotional processing (Emotional Processing Scale (EPS-25)); iii. positive and negative emotions (Positive and Negative Emotionality Scale (EPN-31)); iv. alexithymia (Bermond-Vorst Alexithymia Questionnaire) and v. coping (Coping with Health Injuries and Problems-Neuro (CHIP-Neuro) questionnaire. Relationships between these domains were explored using path analysis. RESULTS Anxiety was a strong predictor of depression, in both a direct and indirect way, and our model explained 48% of the variance of depression. Gender and functional status (measured by the Expanded Disability Status Scale) played a modest role. Non-depressed people with MS reported high levels of negative emotions and low levels of positive emotions. Anxiety also had an indirect impact on depression via one of the subscales of the Emotional Processing Scale ("Unregulated Emotion") and via negative emotions (EPN-31). CONCLUSIONS This research confirms that anxiety is a vulnerability factor for depression via both direct and indirect pathways. Anxiety symptoms should therefore be assessed systematically and treated in order to lessen the likelihood of depression symptoms.
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Affiliation(s)
- Marie-Claire Gay
- Psychology Department, University of Paris West, Nanterre, France.
| | - Catherine Bungener
- Laboratory of Psychopathology, University of Paris Descartes, Paris, France.,Health Psychology, Université Paris Sorbonne Cité, Paris, France
| | - Sarah Thomas
- Clinical Research Unit, Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, UK
| | - Pierre Vrignaud
- Psychology Department, University of Paris West, Nanterre, France
| | - Peter W Thomas
- Clinical Research Unit, Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, UK
| | - Roger Baker
- Clinical Research Unit, Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, UK
| | | | - Olivier Heinzlef
- Neurology Department, Hospital of Poissy-St-Germain en Laye, Paris, France
| | | | - Rana Assouad
- Neurology Department, GHPS Pitié Salpêtrière, Paris, France
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A systematic review of anxiety amongst people with Multiple Sclerosis. Mult Scler Relat Disord 2016; 10:145-168. [PMID: 27919483 DOI: 10.1016/j.msard.2016.10.003] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 10/05/2016] [Accepted: 10/10/2016] [Indexed: 11/20/2022]
Abstract
BACKGROUND Multiple Sclerosis (MS) is a chronic neurological disease, which poses significant psychological challenges. The purpose of this systematic review was to identify factors that are associated with anxiety in people with MS (PwMS). It aimed to examine the strength of evidence for factors associated with anxiety symptoms and identify limitations of existing studies. METHOD AND RESULTS One hundred and thirty one studies met inclusion criteria and were included in the review. A narrative synthesis was then conducted. Anxiety was found to be associated with a variety of demographic, physical, psychological, cognitive and social factors. A consistent finding was that anxiety was strongly associated with both high level of disability and low quality of life. A strong association between anxiety and depression was also found. CONCLUSION Implications for these results are discussed and a preliminary model of understanding anxiety in the context of MS is outlined. Given the overlap between anxiety and depression, a transdiagnostic treatment approach is suggested. In light of the shortcomings of extant studies, suggestions for future research are offered.
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Strober LB, Binder A, Nikelshpur OM, Chiaravalloti N, DeLuca J. The Perceived Deficits Questionnaire: Perception, Deficit, or Distress? Int J MS Care 2016; 18:183-90. [PMID: 27551243 DOI: 10.7224/1537-2073.2015-028] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Cognitive dysfunction affects approximately 43% to 70% of individuals with multiple sclerosis (MS) and is an important determinant of several functional outcomes in MS and quality of life. Brief neuropsychological test batteries have been developed specifically for use in MS and are widely used to aid clinicians in assessing levels of cognitive impairment in MS. Neuropsychologists and neurologists also frequently use briefer screening measures, such as the Perceived Deficits Questionnaire (PDQ), to assist in determining whether a more extensive neuropsychological evaluation is warranted. However, despite the ease of such measures, the relationship between self-report and objective cognitive impairment has been inconsistent, at best. Moreover, factors such as depression, fatigue, anxiety, and personality have been found to be more related to reports of cognitive difficulties. The purpose of the present study was to clarify the relationship between subjective cognitive concerns and objective cognitive impairment while accounting for related symptoms. METHODS We examined the association of self-reported cognitive concerns on the PDQ with objective cognitive measures, as well as depression, anxiety, fatigue, and self-efficacy. RESULTS There was no relationship between self-reported cognitive concerns and objective performance. Rather, reports on the PDQ were more correlated with reports of depression, anxiety, fatigue, and self-efficacy. CONCLUSIONS Depression and poor self-efficacy can contribute to reports of cognitive difficulties. Effective treatment to improve these factors seems warranted given the impact of perceived cognitive impairment on outcomes in MS and the potential for more accurate self-reports.
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15
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Meltzer EP, Kapoor A, Fogel J, Elbulok-Charcape MM, Roth RM, Katz MJ, Lipton RB, Rabin LA. Association of psychological, cognitive, and functional variables with self-reported executive functioning in a sample of nondemented community-dwelling older adults. APPLIED NEUROPSYCHOLOGY-ADULT 2016; 24:364-375. [PMID: 27282245 DOI: 10.1080/23279095.2016.1185428] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Subjective executive functioning (EF) measures provide valuable information about real-world difficulties, although it is unclear what variables actually associate with subjective EF scores. We investigated subjective EF in 245 nondemented, community-dwelling older adults (aged 70 and above) from the Einstein Aging Study. Partial correlational analyses controlling for age were performed between the nine Behavior Rating Inventory of Executive Function-Adult version (BRIEF-A) clinical scales and objective EF tests, self-reported mood and personality, and informant-reported activities of daily living. The significance level was set at p < .006 for all analyses (two-tailed). Most notably, higher worry/oversensitivity, physiological anxiety, and fear of aging were significantly associated with increased EF difficulties on all nine BRIEF-A scales. Additionally, increased EF difficulties on five or more BRIEF-A scales were significantly associated with lower conscientiousness, higher neuroticism, and higher depressive symptom scores. The only objective neuropsychological test that significantly correlated with increased EF difficulties (on four BRIEF-A scales) was a measure of practical judgment. Overall, results indicate that interpretation of subjective EF scores must account for self-report of mood and personality. Moreover, the BRIEF-A only minimally taps objective EF as measured by performance-based measures. We discuss the theoretical and practical implications of these findings.
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Affiliation(s)
- Erica P Meltzer
- a Department of Psychology , Queens College of the City University of New York , Queens , NY , USA.,b Department of Psychology , Brooklyn College and the Graduate Center of the City University of New York , New York , NY , USA
| | - Ashu Kapoor
- c Department of Psychology, Ferkauf Graduate School of Psychology , Yeshiva University , Bronx , NY , USA.,d Department of Neurology , Albert Einstein College of Medicine , Bronx , NY , USA
| | - Joshua Fogel
- e Department of Business Management , Brooklyn College of the City University of New York , Brooklyn , NY , USA
| | - Milushka M Elbulok-Charcape
- b Department of Psychology , Brooklyn College and the Graduate Center of the City University of New York , New York , NY , USA
| | - Robert M Roth
- f Department of Psychiatry , Geisel School of Medicine at Dartmouth College , Lebanon , NH , USA
| | - Mindy J Katz
- d Department of Neurology , Albert Einstein College of Medicine , Bronx , NY , USA
| | - Richard B Lipton
- d Department of Neurology , Albert Einstein College of Medicine , Bronx , NY , USA
| | - Laura A Rabin
- a Department of Psychology , Queens College of the City University of New York , Queens , NY , USA.,b Department of Psychology , Brooklyn College and the Graduate Center of the City University of New York , New York , NY , USA.,d Department of Neurology , Albert Einstein College of Medicine , Bronx , NY , USA.,f Department of Psychiatry , Geisel School of Medicine at Dartmouth College , Lebanon , NH , USA
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16
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Atteinte de la mémoire épisodique verbale dans la sclérose en plaques : revue critique des processus cognitifs concernés et de leur exploration. Rev Neurol (Paris) 2015; 171:624-45. [DOI: 10.1016/j.neurol.2015.02.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Revised: 02/01/2015] [Accepted: 02/13/2015] [Indexed: 11/22/2022]
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17
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Miller DM, Bethoux F, Victorson D, Nowinski CJ, Buono S, Lai JS, Wortman K, Burns JL, Moy C, Cella D. Validating Neuro-QoL short forms and targeted scales with people who have multiple sclerosis. Mult Scler 2015; 22:830-41. [PMID: 26238464 DOI: 10.1177/1352458515599450] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 07/13/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND Multiple sclerosis (MS) is a chronic, progressive, and disabling disease of the central nervous system with dramatic variations in the combination and severity of symptoms it can produce. The lack of reliable disease-specific health-related quality of life (HRQL) measures for use in clinical trials prompted the development of the Neurology Quality of Life (Neuro-QOL) instrument, which includes 13 scales that assess physical, emotional, cognitive, and social domains, for use in a variety of neurological illnesses. OBJECTIVE The objective of this research paper is to conduct an initial assessment of the reliability and validation of the Neuro-QOL short forms (SFs) in MS. METHODS We assessed reliability, concurrent validity, known groups validity, and responsiveness between cross-sectional and longitudinal data in 161 recruited MS patients. RESULTS Internal consistency was high for all measures (α = 0.81-0.95) and ICCs were within the acceptable range (0.76-0.91); concurrent and known groups validity were highest with the Global HRQL question. Longitudinal assessment was limited by the lack of disease progression in the group. CONCLUSIONS The Neuro-QOL SFs demonstrate good internal consistency, test-re-test reliability, and concurrent and known groups validity in this MS population, supporting the validity of Neuro-QOL in adults with MS.
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Affiliation(s)
| | | | - David Victorson
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, USA
| | - Cindy J Nowinski
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, USA
| | - Sarah Buono
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, USA
| | - Jin-Shei Lai
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, USA
| | - Katy Wortman
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, USA
| | - James L Burns
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, USA
| | - Claudia Moy
- Office of Clinical Research, National Institute of Neurological Disorders and Stroke (NINDS), USA
| | - David Cella
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, USA
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Beier M, Amtmann D, Ehde DM. Beyond depression: Predictors of self-reported cognitive function in adults living with MS. Rehabil Psychol 2015; 60:254-62. [PMID: 26192051 DOI: 10.1037/rep0000045] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To investigate the association between self-reported cognition and demographic/psychosocial variables in individuals with a self-reported diagnosis of multiple sclerosis (MS). DESIGN Secondary longitudinal analysis of mailed self-report surveys over a period of 2 years. SETTING Community. PARTICIPANTS 407 community-dwelling individuals from the Pacific Northwest with a self-reported diagnosis of MS. MAIN OUTCOME MEASURES Subjective general cognitive concerns and subjective executive difficulties as measured by the Neuro-QOL Applied Cognition-Executive Function-Short Form (SF) and the Applied Cognition-General Concerns-SF. RESULTS Univariate and multiple linear regression analyses were used to identify statistically significant longitudinal predictors of perceived cognitive difficulties 2 years later. Fatigue and anxiety were statistically significant predictors of general cognitive concerns. Fatigue and perceived stress were statistically significant predictors of perceived executive difficulties. Fatigue was the strongest predictor in both models. CONCLUSIONS In MS, perceived cognitive impairment is frequently linked to depression without consideration of other possible contributors. This study suggests that in people with MS, fatigue is a stronger predictor of self-reported cognitive function 2 years later than depression.
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Affiliation(s)
- Meghan Beier
- Department of Rehabilitation Medicine, University of Washington School of Medicine
| | - Dagmar Amtmann
- Department of Rehabilitation Medicine, University of Washington School of Medicine
| | - Dawn M Ehde
- Department of Rehabilitation Medicine, University of Washington School of Medicine
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Hancock LM, Bruce JM, Bruce AS, Lynch SG. Processing speed and working memory training in multiple sclerosis: A double-blind randomized controlled pilot study. J Clin Exp Neuropsychol 2015; 37:113-27. [DOI: 10.1080/13803395.2014.989818] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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20
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Perceived cognitive decline in multiple sclerosis impacts quality of life independently of depression. Rehabil Res Pract 2014; 2014:128751. [PMID: 25254118 PMCID: PMC4165883 DOI: 10.1155/2014/128751] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Revised: 07/18/2014] [Accepted: 08/05/2014] [Indexed: 01/22/2023] Open
Abstract
Background/Aim. The aim of this study is to examine the effects of perceived cognitive dysfunction and of depression, on self-reported QoL, in a Greek population sample of MS patients. Methods. One hundred outpatients diagnosed with MS completed the Short-Form-36 Health Survey (SF-36), as well as the Perceived Deficits Questionnaire (PDQ) and the Depression subscale of the Mental Health Inventory (MHI), as part of a clinical evaluation which included the Expanded Disability Status Scale (EDSS) estimation. Multiple linear regression was conducted to determine the best linear combination of age, gender, education, EDSS, depression, attention/concentration, retrospective memory, prospective memory, and planning/organization, for predicting QoL scores. Results. In the multivariate regression analysis models, EDSS (P < 0.05), depression (P < 0.001), perceived planning/organization (P < 0.05), and perceived retrospective memory dysfunction (P < 0.05) independently predict quality of life scores. Age, sex, education level, and perceived attention/concentration dysfunction, as well as perceived prospective memory dysfunction, do not independently predict quality of life scores. Conclusions. Perceived planning/organization impairment and perceived retrospective memory impairment in MS patients predict QoL independently of the severity of disease and the severity of depression and therefore should be considered in the assessment of patient health status as well as in the design of treatment interventions and rehabilitation.
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Thelen JM, Lynch SG, Bruce AS, Hancock LM, Bruce JM. Polypharmacy in multiple sclerosis: relationship with fatigue, perceived cognition, and objective cognitive performance. J Psychosom Res 2014; 76:400-4. [PMID: 24745782 DOI: 10.1016/j.jpsychores.2014.02.013] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Revised: 02/21/2014] [Accepted: 02/28/2014] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Patients with multiple sclerosis (MS) commonly use a variety of medications to slow disease progression, alleviate symptoms, and treat comorbid conditions. Polypharmacy has been linked to adverse outcomes in other patient groups, but has not been studied extensively in MS. We investigated the impact of polypharmacy on fatigue, objective neuropsychological performance, and subjective cognitive impairment in a sample of patients with MS. METHODS MS patients (n=85) completed a medication inventory, self-report questionnaires, and a battery of neurocognitive tests. MS patients with polypharmacy were compared to MS patients without polypharmacy, using multivariate analysis of covariance (MANCOVA). RESULTS After controlling for disease characteristics, MS patients with polypharmacy (n=28) exhibited prospective memory deficits and reported significantly more fatigue and subjective cognitive problems than MS patients without polypharmacy. CONCLUSION Clinicians and patients should carefully weigh the costs and benefits of prescribing multiple medications, as these may contribute to iatrogenic fatigue and cognitive problems in MS. Moreover, researchers should account for polypharmacy when conducting studies examining fatigue and cognition in MS.
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Affiliation(s)
- Joanie M Thelen
- Department of Psychology, University of Missouri - Kansas City, Kansas City, MO, United States
| | - Sharon G Lynch
- Landon Center on Aging, University of Kansas Medical Center, Kansas City, KS, United States
| | - Amanda S Bruce
- Department of Psychology, University of Missouri - Kansas City, Kansas City, MO, United States
| | - Laura M Hancock
- Alpert Medical School of Brown University, Providence, RI, United States
| | - Jared M Bruce
- Department of Psychology, University of Missouri - Kansas City, Kansas City, MO, United States.
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The nature of verbal memory impairment in multiple sclerosis: a list-learning and meta-analytic study. J Int Neuropsychol Soc 2013; 19:995-1008. [PMID: 24059259 DOI: 10.1017/s1355617713000957] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The primary purpose of this study was to test the hypothesis that multiple sclerosis (MS) patients have impaired acquisition rather than a retrieval deficit. Verbal memory impairment in MS was examined in 53 relapsing-remitting MS patients and 31 healthy controls (HC), and in a meta-analysis of studies that examined memory functioning in MS with list-learning tasks. The MS group demonstrated significantly lower acquisition and delayed recall performance than the HC group, and the meta-analysis revealed that the largest effect sizes were obtained for acquisition measures relative to delayed recall and recognition. Our data argue against a retrieval deficit as the sole explanation for verbal memory impairment in MS, and make a consistent case for the position that deficient acquisition contributes to the memory dysfunction of MS patients. Deficient acquisition may result from demyelination in relevant white matter tracts that reduces encoding efficiency as a result of impaired speed of information processing.
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Langdon DW, Benedict RHB, Wicklein EM, Beckmann K, Fredrikson S. Reports of patients and relatives from the CogniCIS study about cognition in clinically isolated syndrome: what are our patients telling us? Eur Neurol 2013; 69:346-51. [PMID: 23635720 DOI: 10.1159/000345698] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2011] [Accepted: 11/06/2012] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To assess the Multiple Sclerosis Neuropsychological Questionnaire (MSNQ) in patients with clinically isolated syndrome (CIS). METHODS 130 European CIS patients and 60 relatives completed the MSNQ. RESULTS The mean (SD) MSNQ score for CIS patients was 15.5 (10.8) and for their informants 11.3 (9.6). Neither the CIS patient nor relative MSNQ report scores correlated with any of the cognitive test scores in the Brief Repeatable Battery of Neuropsychological Tests, but they were significantly related to psychosocial scales including depression. CONCLUSIONS In CIS, patient and relative MSNQ scores are influenced by psychosocial variables rather than actual objective cognitive status. Formal cognitive test assessment is recommended for CIS patients.
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Affiliation(s)
- D W Langdon
- Royal Holloway, University of London, London, UK.
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Scanlan JN, Preston J. Computer-based cognitive exercises plus group classes for generalisation improved verbal memory and use of memory strategies by people with multiple sclerosis. Aust Occup Ther J 2013; 60:150-1. [PMID: 23551010 DOI: 10.1111/1440-1630.12036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Roberg BL, Bruce JM, Lovelace CT, Lynch S. How Patients With Multiple Sclerosis Perceive Cognitive Slowing. Clin Neuropsychol 2012; 26:1278-95. [DOI: 10.1080/13854046.2012.733413] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Self-assessment of cognition in Multiple Sclerosis: the role of personality and anxiety. Cogn Behav Neurol 2012; 24:115-21. [PMID: 21904202 DOI: 10.1097/wnn.0b013e31822a20ae] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE : To investigate the role of personality and anxiety to self-report measures of cognition in patients with multiple sclerosis (MS). BACKGROUND : Self-report measures of cognition have consistently been shown to correlate better with depressed mood than neuropsychological test performance in patients with MS, with few studies focusing on the role of anxiety and personality. METHOD : One hundred eight MS patients completed the following: (a) patient and informant report Multiple Sclerosis Neuropsychological Questionnaire (MSNQ); (b) Hospital Anxiety and Depression Scale; (c) cognitive assessment with the Brief Repeatable Battery of Neuropsychological Tests; and (d) personality assessment using the self-report NEO Five-Factor Inventory. RESULTS : Higher patient MSNQ (P-MSNQ) scores (greater reported cognitive dysfunction) were significantly correlated with lower scores on the Paced Auditory Serial Addition Test (PASAT; r=-0.20, P<0.05), increased depression (r=0.45, P<0.01) and anxiety (r=0.54, P<0.01), higher neuroticism (r=0.51, P<0.01), and lower conscientiousness (r=-0.35, P<0.01). After controlling for demographic variables, significant predictors of P-MSNQ scores were anxiety (ΔR=0.272, P<0.001), conscientiousness (ΔR=0.067, P=0.002), and performance on the PASAT (ΔR=0.050, P=0.005). Depression and neuroticism did not contribute significant variance in comparison to anxiety. CONCLUSIONS : Overall, patient self-reports of cognition did not correspond well to neuropsychological performance. Anxiety and conscientiousness contributed significantly to patients' perceptions of their cognitive failings and thus should be taken into account when addressing these complaints.
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Subjective memory in multiple sclerosis is associated with initial-trial learning performance. J Int Neuropsychol Soc 2011; 17:557-61. [PMID: 21411038 DOI: 10.1017/s1355617711000336] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Subjective reports of memory functioning are often included as part of neuropsychological evaluations. However, information from subjective measures often conflicts with formal testing results. The current study explored the relationships among self-reported memory functioning and objective learning and memory measures. Sixty-four multiple sclerosis (MS) patients completed a self-report memory questionnaire (Memory Functioning Questionnaire, MFQ) and objective measures of learning and memory (California Verbal Learning Test-II, CVLT-II; Open-Trial Selective Reminding Test, OT-SRT; and Prose Memory, PM). Significant positive correlations were found between self-reported memory functioning and recall following initial exposure to material: OT-SRT Trial 1 (r = .42; p = .001); CVLT-II Trial 1 (r = .39; p = .002): PM Immediate Recall (r = .28; p = .028). Subjective memory was unrelated to recall performance on subsequent learning trials, aggregate learning scores, or delayed free recall. Results suggest that self-reported memory functioning in MS patients may be specifically related to single-trial learning.
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28
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Bruce JM, Lynch SG. Personality traits in multiple sclerosis: association with mood and anxiety disorders. J Psychosom Res 2011; 70:479-85. [PMID: 21511079 DOI: 10.1016/j.jpsychores.2010.12.010] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2010] [Revised: 12/14/2010] [Accepted: 12/17/2010] [Indexed: 10/18/2022]
Abstract
BACKGROUND Patients with multiple sclerosis (MS) frequently experience depression and anxiety. Several studies also document personality differences between MS patients and controls. Few studies, however, have examined the relationship between mood/anxiety and core personality traits in MS. OBJECTIVES The purpose of the present investigation was to examine the association between anxiety, mood, and personality disturbances in MS. METHODS A structured psychiatric interview and validated self-report measures of personality, depression, and anxiety were administered to 85 MS patients and 20 normal controls. RESULTS Findings suggested a significant association between psychopathology and core personality dysfunction in MS. Depressed/anxious MS patients exhibited more neuroticism, less extroversion, less agreeableness, and less conscientiousness than mentally healthy MS patients and normal controls. In contrast, nondepressed/nonanxious MS patients' core personality traits did not substantially differ from normal controls. CONCLUSIONS Though longitudinal studies are needed, findings provide hope that the successful treatment of MS patients' mood and anxiety symptoms may also partially ameliorate disordered personality characteristics. Consistent with previous research, an increased understanding of MS patients' personality characteristics may also aid with preventative psychiatric and medical treatment.
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Affiliation(s)
- Jared M Bruce
- University of Missouri-Kansas City, Kansas City, MO 64110, USA.
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