A Systematic Review and Meta-Analysis of the Brief Cognitive Assessment for Multiple Sclerosis (BICAMS) International Validations

Cognitive impairment is a prevalent and debilitating symptom of multiple sclerosis (MS) but is not routinely addressed in clinical care. The Brief Cognitive Assessment for Multiple Sclerosis (BICAMS) was developed in 2012 to screen and monitor MS patients’ cognition. This systematic review and meta-analysis aimed to identify, synthesise, and critically appraise current BICAMS’ international validations. The literature search was conducted using PubMed, PsycINFO and Web of Science electronic databases in August 2022. Quantitative, peer-reviewed adult studies, which followed the BICAMS international validation protocol and were published in English, were included. The search identified a total of 203 studies, of which 26 were eligible for inclusion. These reported a total of 2833 adults with MS and 2382 healthy controls (HC). The meta-analysis showed that BICAMS identified impaired cognitive functioning in adults with MS compared to HC for all three subtests: information processing speed (g = 0.854, 95% CI = 0.765, 0.944, p < 0.001), immediate verbal recall (g = 0.566, 95% CI = 0.459, 0.673, p < 0.001) and immediate visual recall (g = 0.566, 95% CI = 0.487, 0.645, p < 0.001). Recruitment sites and strategies limit the generalisability of results. BICAMS is a valid and feasible international MS cognitive assessment.

Driving ability and predictors for driving performance in Multiple Sclerosis: A systematic review

OBJECTIVE

To provide an overview of the evidence on driving ability in persons with multiple sclerosis (PwMS), specifically to (i) study the impact of MS impairment on driving ability and (ii) evaluate predictors for driving performance in MS.

METHODS

To identify relevant studies, different electronic databases were screened in accordance with PRISMA guidelines; this includes reference lists of review articles, primary studies, and trial registers for protocols. Furthermore, experts in the field were contacted. Two reviewers independently screened titles, abstracts, and full-texts to identify relevant articles targeting driving in people with MS that investigated driving-related issues with a formal driving assessment (defined as either an on-road driving assessment; or naturalistic driving in a car equipped with video cameras to record the driving; or a driving simulator with a steering wheel, a brake pedal, and an accelerator).

RESULTS

Twenty-four publications, with 15 unique samples (n = 806 PwMS), were identified. To assess driving ability, on-road tests (14 papers) and driving simulators (10 papers) were used. All studies showed moderate to high study quality in the CASP assessment. About 6 to 38% of PwMS failed the on-road tests, showing difficulties in different areas of driving. Similarly, PwMS showed several problems in driving simulations. Cognitive and visual impairment appeared to most impact driving ability, but the evidence was insufficient and inconsistent.

CONCLUSION

There is an urgent need for more research and standardized guidelines for clinicians as one in five PwMS might not be able to drive safely. On-road tests may be the gold standard in assessing driving ability, but on-road protocols are heterogeneous and not infallible. Driving simulators assess driving ability in a standardized way, but without standardized routes and driving outcomes, comparability between studies is difficult. Different aspects, such as cognitive impairment or vision problems, impact driving ability negatively and should be taken into consideration when making decisions about recommending driving cessation.

SYSTEMATIC REVIEW REGISTRATION

Identifier [10.17605/OSF.IO/WTG9J].

Driving errors that predict simulated rear-end collisions in drivers with multiple sclerosis

OBJECTIVE

Drivers with Multiple Sclerosis (MS) may have an increased crash risk. However, the driving performance deficits that contribute to crashes are not fully understood. Based on the extant literature, adjustment to stimuli errors indicate failing an on-road assessment. This study examines whether adjustment to stimuli errors can detect the occurrence of collisions in a driving simulator in drivers with MS.

METHODS

As part of a quasi-experiment, 38 participants with MS and 21 participants without MS completed visual-cognitive and driving simulator assessments, which also recorded their adjustment to stimuli maneuvers. We quantified participants' adjustment to stimuli maneuvers via initial pedal reaction time (seconds), time to collision (seconds), mean speed (meters per second), and the occurrence of rear-end collisions (collide vs. did not collide) when a simulated vehicle cut across the lane in front of them.

RESULTS

Logistic regression analyses indicated that, compared to drivers without MS, those with MS had a shorter time to collision (OR= .04, p= .001, 95% CI= [.006, .27]) and a faster mean speed (OR= 1.32, p= .04, 95% CI= [1.01, 1.74]) which increased the odds of experiencing a rear-end collision. Receiver operating characteristic curve analyses indicated that, for MS and control groups, time to collision (MS group = AUC= .94, p<.0001, Control group = AUC= .86, p<.0001) and mean speed (MS group = AUC= .76, p=.005, Control group = AUC = .78, p= .005) differentiated between participants who collided vs. did not collide. For drivers with MS, a time to collision of ≤1.81 seconds (85% sensitivity, 100% specificity, 15% error rate), and a mean speed of ≥7.83 meters per second (77% sensitivity, 76% specificity, 47% error rate) predicted the occurrence of collisions with the lowest error rate.

CONCLUSIONS

During a driving simulator assessment, adjustment to stimuli errors predicted the occurrence of rear-end collisions in drivers with MS (vs. without MS). Driving assessors may target scenarios that measure participants' adjustment to stimuli, via time to collision and mean speed, to make decisions about their visual-cognitive deficits and driving performance.