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Tunisian version of the brief international cognitive assessment for multiple sclerosis: Validation and normative values. Mult Scler Relat Disord 2021; 58:103444. [PMID: 34929452 DOI: 10.1016/j.msard.2021.103444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 11/30/2021] [Accepted: 12/01/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND The Brief International cognitive assessment for Multiple sclerosis (BICAMS) is a specific batterie used to identify cognitive impairment in Multiple Sclerosis (MS) in a reliable and easy way. To date, for the Arabic-speaking Tunisian MS patients, there is no consensus for the use of specific cognitive batteries in MS. OBJECTIVE The aim of our work was to develop and validate the Tunisian version of the BICAMS (T-BICAMS) and to determine our own normative values. MATERIAL AND METHODS Patients diagnosed with MS and followed up in the department of Neurology of Razi Hospital were recruited and matched to healthy controls according to age, sex and educational level. T-BICAMS validity was established by comparing MS and healthy controls for symbol digit modalities test (SDMT), brief visual memory test (BVMT-R) and Tunisian verbal learning tests (TVLT) which was used instead of the California verbal learning test (CVLT-II). RESULTS The 104 MS patients and 104 healthy controls were comparable for age, sex and educational level. The MS group exhibited lower performances in all T-BICAMS domains compared to healthy controls: SDMT (x003Dp<10-3), BVMT-R (p = 0.002) and TVLT (p x003D<10-3). T-BICAMS Cronbach alpha value was 0.741. Normative values were identified for patients with MS: SDMT [39-40], BVMT-R [26-27] and TVLT [43-44]. Cognitive impairment was identified among 76 patients (73.1%). Males, lower educational levels and progressive MS were associated with a more severe cognitive impairment. CONCLUSIONS The current study has established the BICAMS as a valid and reliable tool for the identification of cognitive impairment in the Tunisian MS population.
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Significance of the Diagnosis of Executive Functions in Patients with Relapsing-Remitting Multiple Sclerosis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910527. [PMID: 34639827 PMCID: PMC8507634 DOI: 10.3390/ijerph181910527] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 09/28/2021] [Accepted: 10/06/2021] [Indexed: 12/02/2022]
Abstract
Multiple sclerosis (MS) is a progressive chronic disease of the Central Nervous System (CNS). Cognitive decline occurs rather rarely in relapsing–remitting multiple sclerosis (RRMS) compared to other types. The present study aimed to assess executive functions (EF) in relation to clinical and demographic variables in patients with RRMS. The study involved 22 individuals with RRMS (aged 23 to 49 years) and 22 matching controls. All the individuals with RRMS were in the remission phase. The assessments were carried out using MoCA, BDI-II, Halstead Category Test, Porteus Maze Test, verbal fluency tasks and Stroop Colour-Word Interference Test. The findings show that the two groups differed significantly in all the tests. All patients with RRMS in the remission phase presented at least one cognitive deficit, observed in general cognitive functioning, abstract reasoning or other executive functions, i.e., fluency, interference suppression, planning, or ability to modify activity in response to feedback. The deficits in most cases (except for those measured with the MoCA, Category Tests and phonemic fluency), are not related to intensity of depression and duration of the disease. Findings suggest that the diagnostic process in the case of patients with RRMS may include psychological assessment focusing on potentially existing cognitive, mainly executive, deficits and their severity.
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Leavitt VM, Brandstadter R, Fabian M, Sand IK, Klineova S, Krieger S, Lewis C, Lublin F, Miller A, Pelle G, Buyukturkoglu K, Jager PLD, Li P, Riley CS, Tsapanou A, Sumowski JF. Dissociable cognitive patterns related to depression and anxiety in multiple sclerosis. Mult Scler 2020; 26:1247-1255. [PMID: 31233379 PMCID: PMC6928451 DOI: 10.1177/1352458519860319] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Individuals with multiple sclerosis (MS) frequently present with depression and anxiety, as well as cognitive impairment, challenging clinicians to disentangle interrelationships among these symptoms. OBJECTIVE To identify cognitive functions associated with anxiety and depression in MS. METHODS Mood and cognition were measured in 185 recently diagnosed patients (Reserve Against Disability in Early Multiple Sclerosis (RADIEMS) cohort), and an independent validation sample (MEM CONNECT cohort, n = 70). Partial correlations evaluated relationships of cognition to anxiety and depression controlling for age, sex, education, and premorbid verbal intelligence. RESULTS In RADIEMS cohort, lower anxiety was associated with better nonverbal memory (rp = -0.220, p = 0.003) and lower depression to better attention/processing speed (rp = -0.241, p = 0.001). Consistently, in MEM CONNECT cohort, lower anxiety was associated with better nonverbal memory (rp = -0.271, p = 0.028) and lower depression to better attention/processing speed (rp = -0.367, p = 0.002). Relationships were unchanged after controlling for T2 lesion volume and fatigue. CONCLUSION Consistent mood-cognition relationships were identified in two independent cohorts of MS patients, suggesting that cognitive correlates of anxiety and depression are separable. This dissociation may support more precise models to inform treatment development. Treatment of mood symptoms may mitigate effects on cognition and/or treatment of cognition may mitigate effects on mood.
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Affiliation(s)
- Victoria M. Leavitt
- Translational Cognitive Neuroscience Laboratory, Department of Neurology, Columbia University Irving Medical Center, New York, New York
- Multiple Sclerosis Center, Department of Neurology, Columbia University Irving Medical Center, New York, New York
| | - Rachel Brandstadter
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York
- Corinne Goldsmith Dickinson Center for Multiple Sclerosis, Mount Sinai Hospital, New York, New York
| | - Michelle Fabian
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York
- Corinne Goldsmith Dickinson Center for Multiple Sclerosis, Mount Sinai Hospital, New York, New York
| | - Ilana Katz Sand
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York
- Corinne Goldsmith Dickinson Center for Multiple Sclerosis, Mount Sinai Hospital, New York, New York
| | - Sylvia Klineova
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York
- Corinne Goldsmith Dickinson Center for Multiple Sclerosis, Mount Sinai Hospital, New York, New York
| | - Stephen Krieger
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York
- Corinne Goldsmith Dickinson Center for Multiple Sclerosis, Mount Sinai Hospital, New York, New York
| | - Christina Lewis
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York
- Corinne Goldsmith Dickinson Center for Multiple Sclerosis, Mount Sinai Hospital, New York, New York
| | - Fred Lublin
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York
- Corinne Goldsmith Dickinson Center for Multiple Sclerosis, Mount Sinai Hospital, New York, New York
| | - Aaron Miller
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York
- Corinne Goldsmith Dickinson Center for Multiple Sclerosis, Mount Sinai Hospital, New York, New York
| | - Gabrielle Pelle
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York
- Corinne Goldsmith Dickinson Center for Multiple Sclerosis, Mount Sinai Hospital, New York, New York
| | - Korhan Buyukturkoglu
- Translational Cognitive Neuroscience Laboratory, Department of Neurology, Columbia University Irving Medical Center, New York, New York
- Multiple Sclerosis Center, Department of Neurology, Columbia University Irving Medical Center, New York, New York
| | - Phillip L. De Jager
- Multiple Sclerosis Center, Department of Neurology, Columbia University Irving Medical Center, New York, New York
- Center for Translational & Computational Neuroimmunology, Department of Neurology, Columbia University Irving Medical Center
| | - Peipei Li
- Translational Cognitive Neuroscience Laboratory, Department of Neurology, Columbia University Irving Medical Center, New York, New York
- Multiple Sclerosis Center, Department of Neurology, Columbia University Irving Medical Center, New York, New York
| | - Claire S. Riley
- Multiple Sclerosis Center, Department of Neurology, Columbia University Irving Medical Center, New York, New York
| | - Angeliki Tsapanou
- Multiple Sclerosis Center, Department of Neurology, Columbia University Irving Medical Center, New York, New York
| | - James F. Sumowski
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York
- Corinne Goldsmith Dickinson Center for Multiple Sclerosis, Mount Sinai Hospital, New York, New York
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Identifying Perceptual, Motor, and Cognitive Components Contributing to Slowness of Information Processing in Multiple Sclerosis with and without Depressive Symptoms. SPANISH JOURNAL OF PSYCHOLOGY 2020; 23:e21. [DOI: 10.1017/sjp.2020.23] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Increasing findings suggest that different components of the stimulus-response pathway (perceptual, motor or cognitive) may account for slowed performance in Multiple Sclerosis (MS). It has also been reported that depressive symptoms (DS) exacerbate slowness in MS. However, no prior studies have explored the independent and joint impact of MS and DS on each of these components in a comprehensive manner. The objective of this work was to identify perceptual, motor, and cognitive components contributing to slowness in MS patients with and without DS. The study includes 33 Relapsing-Remitting MS patients with DS, 33 without DS, and 26 healthy controls. Five information processing components were isolated by means of ANCOVA analyses applied to five Reaction Time tasks. Perceptual, motor, and visual search components were slowed down in MS, as revealed by ANCOVA comparisons between patients without DS, and controls. Moreover, the compounding effect of MS and DS exacerbated deficits in the motor component, and slowed down the decisional component, as revealed by ANCOVA comparisons between patients with and without DS. DS seem to exacerbate slowness caused by MS in specific processing components. Identifying the effects of having MS and of having both MS and DS may have relevant implications when targeting cognitive and mood interventions.
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McNicholas N, O'Connell K, Yap SM, Killeen RP, Hutchinson M, McGuigan C. Cognitive dysfunction in early multiple sclerosis: a review. QJM 2018; 111:359-364. [PMID: 28371862 DOI: 10.1093/qjmed/hcx070] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Indexed: 11/14/2022] Open
Abstract
Cognitive impairment is a common and disabling feature of Multiple Sclerosis (MS), including early MS, and may even pre-date any physical symptoms. It contributes even more to withdrawal from work than physical disability. Here, we provide an overview of cognitive impairment in MS, particularly in early MS where it is most commonly under-reported and under-treated. We address the presenting features of CI, its impact on quality of life, and its validated assessments (in particular the use of Brief International Cognitive Assessment in MS for use in a clinical setting). We review the insights radiology has given us into the pathogenesis of cognitive impairment in MS, particularly in early CI and in cognitively preserved MS patients. We review current treatments for cognitive impairment, primarily cognitive rehabilitation. We address the evidence for its associated co-morbidities, which may exacerbate or trigger CI, and should therefore be addressed early in the disease course (smoking, alcohol, mood, fatigue and potential co-existing sleep disorders, exercise, and vitamin D). The article supports the importance for early recognition and management of cognitive impairment in MS, before it becomes an established and irreversible entity.
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Affiliation(s)
- N McNicholas
- Department of Neurology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - K O'Connell
- Department of Neurology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - S M Yap
- Department of Neurology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - R P Killeen
- Department of Neuroradiology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - M Hutchinson
- Department of Neurology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - C McGuigan
- Department of Neurology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
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