Three screening batteries to detect cognitive impairment in multiple sclerosis

Importance of Identifying Cognitive Impairment in Multiple Sclerosis

This article aims to highlight the impact of cognitive impairment on outcomes and quality of life for people with multiple sclerosis (MS) and to review current evidence for the efficacy of disease-modifying therapies (DMTs) and other interventions. In addition, we provide clinical practice insights regarding screening and management of cognitive impairment in people with MS. Evidence suggests that cognitive deterioration often accompanies magnetic resonance imaging changes. Neocortical volume and deep grey matter atrophy correlate with cognitive impairment. Similarly, cognitive decline is predictive of a higher lesion burden. Cognitive impairment is an important clinical measure of disability and negatively impacts quality of life. Phase 3 studies suggest that DMTs such as natalizumab, ozanimod and fingolimod may provide long-lasting, clinically meaningful effects on cognition in people with MS. Further data are needed to support the use of adjunct cognitive behavioural and exercise interventions for people with MS who have cognitive impairment. More data are needed to define appropriate management strategies for cognitive impairment in people with MS. Baseline and periodic screening for cognitive impairment and inclusion of cognitive impairment as a clinical trial endpoint will help to inform efforts to manage this important aspect of MS.

Cognitive measures used in adults with multiple sclerosis: A systematic review

Cognitive problems are common in people with Multiple Sclerosis (MS), and researchers and clinicians have used a vast array of measures to assess cognition. Our aim was to systematically identify cognitive measures routinely used in MS research, and outline their different uses. Previous recommendations of cognitive measures to use in MS have relied on expert consensus approaches. We believe this systematic review is a starting point for an evidence-based approach to recommend cognitive tests for use with people with MS. We systematically searched electronic databases using relevant search terms for studies that assessed cognitive functioning in MS (last search in February 2020). From 11,854 abstracts retrieved, based on title and abstract review, 2563 remained. Data were extracted from 1526 studies. Studies used 5665 measures of cognition, with 316,053 people with MS. Substitutional style tests, serial addition tests, and word list learning tests were the most commonly used individual tests, and the Brief Repeatable Battery of Neuropsychological Tests was the most commonly used battery. Some of the most frequently used measures were potentially inappropriate due to measuring irrelevant domains of cognition, and issues with sensitivity. Further research is needed to ascertain the psychometric properties, and acceptability of measures for people with MS.

Study Protocol: Strategies and Techniques for the Rehabilitation of Cognitive and Motor Deficits in Patients with Multiple Sclerosis

MS clinical features vary between patients. In approximately 60% of cases, cognitive deficits are associated with motor disabilities, with consequences on both walking and maintaining balance and cognitive efficiency. Multimodal programs are very infrequent for MS patients and cognitive rehabilitation is not provided by the Italian health system, which only favors access to motor rehabilitation. Dual-task studies showed how motor and cognitive skills are closely associated. Therefore, physiotherapy exercises may favor an indirect improvement in cognition. The aim of this study is to understand which rehabilitative approach may increase both cognitive and motor efficiency, avoiding the waste of time and resources. In this multi-site single-blind parallel controlled clinical trial, we will compare three rehabilitative approaches: cognitive training, motor training and combined cognitive–motor training. We also aim to evaluate: whether self-perception and objective improvement correspond; the impact of each rehabilitation program on patients’ QoL, mood and self-perception; and long-term effects. A total of 60 patients will be randomly assigned to one of the three treatments for two 45-min sessions/week for 12 weeks. All participants will undergo a complete cognitive, motor, clinical assessment together with mood, self-perception, and QoL questionnaires before, immediately after and 6 months after the training period.

Understanding visual-spatial perceptual deficits in individuals with multiple sclerosis: an analysis of patient performance on the Hooper Visual Organization Test and Visual Form Discrimination

Purpose: Although the cognitive sequelae of multiple sclerosis have been recognized for more than four decades, the focus of research has been on studying the more common deficits of the disease, including those involving memory and information processing speed. Less understood and investigated are the visual-spatial perceptual disturbances of multiple sclerosis, which can be difficult to assess and interpret given the potential confounds associated with the physical problems and other cognitive disturbances of the disorder.Materials and methods: This study examined the visual-spatial perceptual deficits of multiple sclerosis in 40 participants diagnosed with this condition using two measures generally unaffected by the aforementioned confounds, the Hooper Visual Organization Test and Visual Form Discrimination.Results: Results revealed both measures to be sensitive to the impairments of multiple sclerosis but suggested that they are assessing somewhat different aspects of visual-spatial perception in this population, given their relationship with one another and with disease-related variables.Conclusions: In this light, findings indicate that a complete and accurate understanding of the visual-spatial perceptual sequelae of multiple sclerosis requires the administration of more than a single measure.

Association between symbol digit modalities test and regional cortex thickness in young adults with relapsing-remitting multiple sclerosis

BACKGROUND

Multiple sclerosis (MS) is a demyelinating disease of the central nervous system, predominating within young adults. Cognitive disorders are common in MS and have are associated with several Magnetic Resonance Imaging (MRI) markers, especially brain atrophy. Many have found the symbol digit modalities test (SDMT) to be the most sensitive individual cognitive measure relevant to MS. However, the relationship between SDMT and regional brain cortex thickness in young adults with relapsing-remitting multiple sclerosis (YA-RRMS) has been little explored. The purpose of this study was to investigate the association between the SDMT and regional cortex thickness in YA-RRMS by FreeSurfer, which is an automatic brain structure segmentation method.

METHOD

Twenty-eight YA-RRMS patients (18-35 years old) were enrolled in the present study. Informed consent and information including gender, age, disease duration, number of relapses, annual relapse rate was collected from all patients. Clinical cognitive evaluations (SDMT and auditory verbal learning test (AVLT)) and daily performance: activities of daily living (ADL) were assessed in the present study. MRI scans were performed at the Institute of Neurosurgery of Tiantan Hospital. Twenty-eight matched healthy controls (HC) MRI data were obtained from Tiantan Hospital database. Data on thirty-four points of bilateral cortical structure thickness using statistically defined brain regions-of-interest from FreeSurfer were obtained from all participants.

RESULTS

Patients with RRMS exhibited extensively thinner cerebellar cortex compared with HC. SDMT scores were significantly correlated with AVLT subentries (IM, immediate memory; DRM, delayed recall memory; LTRM, long-term recognition memory) in YA-RRMS patients (P < 0.05). SDMT was strongly correlated with regional cortex thickness differences of the right temporal pole (r = 0.68) and bilateral parahippocampal areas (right r = 0.62; left r = 0.60), and moderately correlated with regional cortex thickness differences including the left superior temporal and right insula (r = 0.57 and 0.56, respectively) in YA-RRMS patients.

CONCLUSION

The present study has shown the SDMT is strongly correlated with selected cortex regions including the bilateral parahippocampal area and the right temporal pole which are involved in geometric structures processing.

A Randomized Computer-Assisted Rehabilitation Trial of Attention in Pediatric Multiple Sclerosis: A Post Hoc Analysis

Cognitive impairment (CI) is a remarkable feature in pediatric-onset multiple sclerosis (POMS). The Symbol Digit Modalities Test (SDMT) is increasingly used to explore CI in MS. Recently, a four-point worsening on the SDMT score has been demonstrated to correlate with a clinically meaningful cognitive worsening in adult MS. We conducted a post hoc analysis of a randomized computer-assisted rehabilitation trial for attention impairment in POMS to test the clinical meaningfulness of the changes in SDMT scores at the end of the trial (delta SDMT). A four-point SDMT cut-off was applied. POMS patients exposed to specific computer training (ST) and non-specific training (nST) were compared. Data of 16 POMS (9 females, age 15.75 ± 1.74 years) patients were analyzed. At the end of the trial, 25% of patients reported no clinically significant changes (−3 to 3), 12.5% a clinically significant worsening (≤−4) and 62.5% a clinically significant improvement (≥4) in the delta SDMT. The proportion of patients reporting a clinically meaningful improvement was significantly (p = 0.008) higher (100%) in patients exposed to ST in comparison to those (25%) exposed to nST. The use of the four-point SDMT cut-off may be useful to assess the clinical meaningfulness of results from cognitive rehabilitation trials.

Cognition in acute relapses: A psychometric evaluation and its correlation with event-related potential, P300 in multiple sclerosis

OBJECTIVE

During acute relapses of multiple sclerosis (MS), physical symptoms attract utmost care. However, cognitive impairment may constitute an substantial part of a new relapse. In this study, we evaluated the cognitive status of MS patients during acute relapses.

MATERIALS AND METHODS

We enrolled 35 definite MS patients and 21 healthy subjects. Neuropsychometric tests and the event-related potential, P300 were administered to the MS patients before corticosteroid treatment, and 3 months later. The control subjects were tested only once.

RESULTS

The differences between the scores of the Timed 25-Foot Walk test, the Brief Repeatable Battery subtests (10/36 SPART, SDMT, SRT, SRT-LTM) in the relapse and remission phases were statistically significant (p = .005, p = .007, p = .05, p = .029, p = .001, respectively). The latencies of P300 waves during the relapses were significantly prolonged than the ones in the remission and the controls' (p = .004, p < .001, respectively).

CONCLUSIONS

In this study, we observed a significant involvement of visual-spatial perception, remote memory, and recall, as well as P300 latencies in acute relapses. The inclusion of cognitive assessment during a relapse can provide accurate information on cognitive status for future treatment modalities.

iCAMS: Assessing the Reliability of a Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS) Tablet Application

Background

This study aimed to develop a Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS) tablet application, "iCAMS," and examine equivalency between the original paper-based and the tablet-based assessments.

Methods

This study enrolled 100 participants with physician-confirmed multiple sclerosis (MS). Interrater reliability, parallel forms reliability, and concurrent validity were evaluated by incorporating two test administrators in each session: one scoring participant responses with the original paper assessments and the other with iCAMS. Although the participant was exposed to the material only once, responses were recorded on both administration methods. In addition to the standard test procedures, each research assistant used a stopwatch to measure the amount of time required to administer and score each version of BICAMS.

Results

Pearson correlation coefficients (r) revealed strong and significant correlations for all three tests. Excellent agreement was observed between iCAMS and paper versions of the BICAMS tests, with all intraclass correlation coefficients exceeding 0.93. The scores from all the cognitive tests were not statistically significantly different, indicating no proportional bias. Including scoring, administration of the iCAMS application saved approximately 10 minutes over the paper version.

Conclusions

Preliminary findings suggest that the tablet application iCAMS is a reliable and fast method for administering BICAMS.

The Impact of Cognitive Dysfunction on Locomotor Rehabilitation Potential in Multiple Sclerosis

Background:

Cognitive dysfunction is a frequent manifestation of multiple sclerosis (MS) but its effect on locomotor rehabilitation is unknown.

Objective:

To study the impact of cognitive impairment on locomotor rehabilitation outcome in people with MS.

Methods:

We performed a retrospective analysis involving ambulatory patients with MS who were admitted for intensive, inpatient, multidisciplinary rehabilitation at the National Multiple Sclerosis Center of Melsbroek between the years 2012 and 2017. The Brief Repeatable Battery of Neuropsychological Tests (BRB-N) was used to determine the cognitive status of subjects as either impaired (COG–) or preserved (COG+). Locomotor outcome was compared between groups with the difference in 6-minute walk test (6MWT) measured at admission and discharge (Δ6MWT). In addition, individual test scores of the BRB-N for attention (Paced Auditory Serial Addition Test 2” and 3”), visuospatial learning/memory (7/24 Spatial Recall Test), verbal learning/memory (Selective Reminding Test) and verbal fluency (Controlled Oral Word Association Test) were correlated to the Δ6MWT.

Results:

A total of 318 complete and unique records were identified. Both groups showed a significant within-group Δ6MWT during hospitalization (COG+: 47.51 m; COG–: 40.97 m; P < .01). In contrast, Δ6MWT values were comparable between groups. The odds of achieving a minimal clinical important difference on the 6MWT did not differ significantly between both groups. Only attention/concentration was significantly correlated with Δ6MWT (r = 0.16, P = .013).

Conclusion:

Cognitive impairment based on BRB-N results appears not to impede locomotor rehabilitation in ambulatory patients with MS. Attentional deficits are correlated to the extent of locomotor rehabilitation, suggesting the presence of a subtle effect of cognition.

What is the meaning of PASAT rejection in multiple sclerosis?

BACKGROUND

Paced Auditory Serial Addition Test (PASAT) is one of the most used neuropsychological tests in multiple sclerosis (MS), specially for screening. However, the applicability of the test is limited because of the rejection of the test completion in a proportion of patients. We aimed to investigate the clinical, neuropsychological, and MRI findings associated to PASAT rejection.

METHODS

Cross-sectional and observational study. A total of 343 patients with MS underwent neuropsychological testing and structural MRI.

RESULTS

One hundred and twenty-one (35.3%) of patients declined the administration of the test. Among those patients that declined the administration, rejection occurred before the onset of test in 35.5%, during or after the practice in 43%, and during the test administration in 21.5%. Rejection of the test was associated to a worse performance in all cognitive tests administered, but not to depression or baseline fatigue scales. In regression analysis, education, cognitive impairment, EDSS, and white matter lesion load were independently associated to rejection of the test.

CONCLUSIONS

Paced Auditory Serial Addition Test rejection is associated with a higher probability of cognitive impairment in MS. This suggests that patients that reject the administration of PASAT should be further examined with a neuropsychological battery to evaluate the possibility of cognitive dysfunction.

Repeatable Battery for the Assessment of Neuropsychological Status (RBANS): preliminary utility in adult neuro-oncology

Background

Neurocognitive assessments have become integral to comprehensive neuro-oncology care. Existing screening tools may be insensitive to cognitive changes caused by medical treatments. Research supports the clinical value and psychometric properties of the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) in various medical populations; however, there is minimal evidence for its use in neuro-oncology. The purpose of the current study was to further explore the cognitive profile of patients with primary brain tumor (PBT) using the RBANS and to assess rates of below-expectation performance compared to normative data and estimated intellectual functioning.

Methods

Data were collected on 82 PBT patients (54% male; age range, 19-81 years). All patients were administered the RBANS-Update and the Advanced Clinical Solutions-Test of Premorbid Functioning (TOPF) according to standardized instructions. Cognitive strengths and weaknesses were identified for PBT patients. Descriptive analyses, t tests, and chi-squared tests were utilized to identify and compare cognitive profiles.

Results

Overall, cognitive performance was low average for PBT patients. When compared to standardization data, PBT patients performed significantly worse across all 5 RBANS indexes, with Attention and Memory showing the largest discrepancies. Estimated intelligence analyses reflected greater deficits in cognitive functioning than when compared to a normal distribution.

Conclusions

Preliminary research demonstrates the RBANS is an efficient screening tool to assess cognitive deficits in PBT patients. Data also support the importance of comparison to self, rather than normative distribution in ensuring proper identification and classification of patients.

Symbol Digit Modalities Test: A valid clinical trial endpoint for measuring cognition in multiple sclerosis

BACKGROUND

The need for more robust outcomes in multiple sclerosis (MS) clinical trials has been a main priority of the field for decades. Dissatisfaction with existing measures has led to several consensus meetings and initiatives over the past few decades in hopes of defining and gaining acceptance of measures that are valid, reliable, sensitive to change and progression, and most importantly, relevant to those living with MS. The Multiple Sclerosis Outcome Assessments Consortium (MSOAC) was formed for this purpose.

OBJECTIVE

The objective of this paper is to describe the results of the MSOAC plan to obtain qualification for a cognitive performance measure that meets these requirements.

METHODS

Using data from 14 MS disease-modifying registration trials, we completed a comprehensive examination of the psychometric qualities of the Symbol Digit Modalities Test (SDMT) and the Paced Auditory Serial Addition Test (PASAT) with the goal of compiling evidence to support the utilization of one of these measures in future clinical trials.

RESULTS AND CONCLUSION

Consistent with the published literature, the SDMT proved superior to the PASAT. The SDMT should be considered the measure of choice for MS trials in assessing cognitive processing speed.

A machine learning pipeline for multiple sclerosis course detection from clinical scales and patient reported outcomes

In this work we present a machine learning pipeline for the detection of multiple sclerosis course from a collection of inexpensive and non-invasive measures such as clinical scales and patient-reported outcomes. The proposed analysis is conducted on a dataset coming from a clinical study comprising 457 patients affected by multiple sclerosis. The 91 collected variables describe patients mobility, fatigue, cognitive performance, emotional status, bladder continence and quality of life. A preliminary data exploration phase suggests that the group of patients diagnosed as Relapsing-Remitting can be isolated from other clinical courses. Supervised learning algorithms are then applied to perform feature selection and course classification. Our results confirm that clinical scales and patient-reported outcomes can be used to classify Relapsing-Remitting patients.

Psychiatric and physical comorbidities and pain in patients with multiple sclerosis

Background

It has been observed that patients with multiple sclerosis (MS), who have psychiatric and physical comorbidities such as depression and COPD, have an increased risk of experiencing more pain. In this study, we have distinguished between pain intensity and pain affect, as the latter, particularly, requires treatment. Furthermore, while pain and comorbidities have been assessed using questionnaires, this is possibly a less reliable method for those who are cognitively vulnerable.

Objective

The aim of this study was to determine whether psychiatric and physical comorbidities can predict pain intensity and pain affect in MS patients, susceptible to cognitive impairment.

Methods

Ninety-four patients with MS and 80 control participants participated in this cross-sectional study. Besides depression and anxiety, 47 additional comorbidities were extracted from patients’ medical records. Depression and anxiety were assessed using the Beck Depression Inventory and the Symptom Check List-90. Pain was assessed using the Number of Words Chosen Affective, Coloured Analog Scale, and the Faces Pain Scale. Cognitive functions, for example, memory and executive functions, were assessed using several neuropsychological tests.

Results

The main findings indicate that psychiatric comorbidities (depression and anxiety) predict both pain intensity and pain affect and that total physical comorbidity predicts only pain affect in MS patients, susceptible to cognitive impairment.

Conclusion

Both psychiatric and physical comorbidities predict pain affect. All three clinical outcomes enhance MS patients’ suffering.

Cognitive Impairment in Multiple Sclerosis: A Review of Neuropsychological Assessments

Of the more than two million people worldwide with multiple sclerosis, 40% to 65% experience cognitive impairment, many of them early in the course of the disease. Cognitive impairment has been found in patients with all subtypes of multiple sclerosis. Because both pharmacologic and nonpharmacologic interventions may improve patients' brain function, cognitive assessment should be a routine part of the clinical evaluation. Traditional paper-and-pencil neuropsychological tests and batteries can help detect and monitor patients' cognitive problems. Computerized cognitive batteries also show promise. Controversy continues over which test is most reliable at assessing cognitive impairment in both everyday clinical practice and research. Each battery has possible disadvantages, such as practice effects, poor sensitivity and specificity, and questionable applicability to multiple sclerosis. Based on our review of the literature, we describe the tests that are currently being used or that might be used in assessing cognitive deficits in patients with multiple sclerosis, and we summarize the strengths and limitations of each.

Rapid cognitive screening in multiple sclerosis accomplished by the Free Recall and Recognition Test

This study sought to investigate the feasibility of the Free Recall and Recognition Test (FRRT) as a practical screening tool for cognitive impairment in multiple sclerosis (MS). Persons with MS (n =227) were consecutively recruited and assessed with four cognitive tests; FRRT, Symbol Digit Modalities Test (SDMT), Paced Auditory Serial Addition Test (PASAT), and the Mini-Mental State Examination (MMSE). Disease severity was assessed by the Expanded Disability Status Scale (EDSS). The FRRT, which was completed by 99% of the cohort in approximately 5 minutes per assessment, correlated significantly with the other cognitive tests, as well as with the disease severity rating. A cut-off of 4 for the FRRT recall rendered 90% sensitivity and 25% specificity, and a cut-off of 4.2 for the FRRT recognition resulted in 70% sensitivity and 51% specificity. We conclude that the FRRT proved feasible as a practical screening tool for cognitive impairment in MS within a clinical setting. Multiple Sclerosis 2007; 13: 272–274. http://msj.sagepub.com

Screening Instruments for the Early Detection of Cognitive Impairment in Patients with Multiple Sclerosis

BACKGROUND

Cognitive impairments are common in individuals with MS and adversely affect functioning. Early detection of cognitive impairment, therefore, would enable earlier, and possibly more effective, treatment. We sought to compare self-reports with a short neuropsychological test as possible screening tools for cognitive impairment.

METHODS

One hundred patients with MS were tested with the Minimal Assessment of Cognitive Function in Multiple Sclerosis; z scores were used to derive the Cognitive Index (CI). Receiver operator characteristic curve analyses were performed, with criteria for impairment set at -1.5 and -2.0 SD below the mean. Scores from two self-reports (the Multiple Sclerosis Neuropsychological Screening Questionnaire-Patient Version and the Behavior Rating Inventory of Executive Function-Adult Version [BRIEF-A]) and a neuropsychological test (the Symbol Digit Modalities Test [SDMT]) were entered as test variables. Exploratory regression analyses were conducted with 1) CI and self-reports and 2) CI and the Problem-Solving Inventory (PSI).

RESULTS

Classification accuracy was high or moderately high for SDMT when the criterion was -2.0 or -1.5 SD, respectively, but low for the self-reports. Hierarchical linear regression showed that the SDMT alone was the best predictor of cognitive impairment; adding the self-reports did not improve the model. Exploratory analyses indicated that certain self-reports (BRIEF-A, PSI) provided some explanatory power in separate models.

CONCLUSIONS

The SDMT is a more accurate screening tool for cognitive impairment; however, self-reports provide additional information and may complement objective testing. Results suggest that screening for cognitive impairment may require a multidimensional approach.

Elevated rates of memory impairment in military service-members and veterans with posttraumatic stress disorder

INTRODUCTION

Studies investigating the neurocognitive effects of posttraumatic stress disorder (PTSD) routinely find "deficits" in various cognitive domains. However, the rate of cognitive impairment in individuals with PTSD remains unclear, as studies have focused on null hypothesis testing (NHT) and inferring patterns of impairment rather than empirically determining the rate of cognitive impairment in this sample.

METHOD

This study examined rates of cognitive impairment using a domain-specific approach in non-treatment-seeking Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn service members and veterans with (n = 92) and without (n = 79) PTSD and without substance abuse/dependence who passed a performance validity measure and were matched on age, education, estimated IQ, and ethnicity. Chi-square analyses were used to compare the rate of cognitive impairment across groups based on normative scores using three cutoffs (-1, -1.5, and -2 SDs). NHT was also used to compare performances across groups.

RESULTS

Individuals with PTSD showed higher rates of impairment in memory (-1-SD cutoff) than controls, but equivalent rates of impairment in attention, processing speed, and executive functioning; no significant differences were found on NHT. Impairment in any domain was also more prevalent in PTSD (-1-, -1.5-, and -2-SD cutoffs). No differences were found on NHT or rates of impairment in individuals with PTSD with (n = 34) and without (n = 58) depression.

CONCLUSIONS

Patients with PTSD were more likely to meet criteria for memory impairment and to show impairment in any domain than controls. Patients with PTSD and comorbid depression were no more likely to be impaired in any cognitive domain or to have lower scores on individual cognitive tasks than patients with PTSD alone. Clinicians noting cognitive impairment in individuals with PTSD should exercise caution before ascribing that impairment to another etiology if deficits are limited to memory.

RBANS factor structure in older adults with suspected cognitive impairment: Evidence for a 5-factor structure

Previous research has yielded minimal empirical support for the theoretically formulated five-factor structure of the RBANS, a brief, yet comprehensive standardized neuropsychological test battery used to assess cognitive impairment. The present study tested the theoretically formulated five-factor structure, as well as three alternative factor solutions, using a combination of exploratory and confirmatory factor analytic approaches. The present study utilized archival data from a clinical sample of 150 older adults who were evaluated at an outpatient neuropsychological service. A total of four RBANS models were specified using confirmatory factor analysis. Results of the five-factor model demonstrated good to excellent fit following modifications to the model. Results of chi-square difference tests demonstrated that the five-factor model was statistically superior to the two- and three-factor models (p < .001). In summary, results provide support for the theoretically derived five-factor structure of the RBANS in a clinical sample of older adults. Cautious interpretation of the RBANS index scores as five distinct cognitive domains may be warranted, particularly when there is minimal discrepancy across performance on the tests that comprise each index.

BRBN-T validation: adaptation of the Selective Reminding Test and Word List Generation

Objective This study aims to present the Selective Reminding Test(SRT) and Word List Generation (WLG) adaptation to the Portuguese population, within the validation of the Brief Repeatable Battery of Neuropsychological Tests (BRBN-T)for multiple sclerosis (MS) patients.Method 66 healthy participants (54.5% female) recruited from the community volunteered to participate in this study.Results A combination of procedures from Classical Test Theory (CTT) and Item Response Theory (ITR) were applied to item analysis and selection. For each SRT list, 12 words were selected and 3 letters were chosen for WLG to constitute the final versions of these tests for the Portuguese population.Conclusion The combination of CTT and ITR maximized the decision making process in the adaptation of the SRT and WLG to a different culture and language (Portuguese). The relevance of this study lies on the production of reliable standardized neuropsychological tests, so that they can be used to facilitate a more rigorous monitoring of the evolution of MS, as well as any therapeutic effects and cognitive rehabilitation.

Effort in acute traumatic brain injury: considering more than pass/fail

PURPOSE/OBJECTIVE

Performance validity is often conceptualized as a dichotomous process. Effort likely lies on a continuum, however, and psychologists' tendency to rely on pass/fail descriptors of one's effort may not be the only approach. The current study aims to show that when performance validity is considered on a continuum, it may provide clinical information related to cognitive functioning.

RESEARCH METHOD/DESIGN

Forty-four patients with moderate or severe traumatic brain injury were evaluated with the Repeatable Battery for the Assessment of Neuropsychological Status upon their emergence from posttraumatic amnesia. From this data, previously developed effort index scores and "other cognitive functions" index scores were calculated.

RESULTS

Performance on the effort index significantly accounted for the patients' performance on a cognitive composite score after considering education and severity of injury.

CONCLUSIONS/IMPLICATIONS

Findings suggest that more in-depth analysis of validity test performance is beneficial to gauge a patient's level of effort and is important to consider when interpreting results and in treatment planning.

A one-year follow-up study of the Symbol Digit Modalities Test (SDMT) and the Paced Auditory Serial Addition Test (PASAT) in relapsing-remitting multiple sclerosis: an appraisal of comparative longitudinal sensitivity

Background

Neuropsychological batteries are infrequently used to assess cognitive impairment in multiple sclerosis because they are time-consuming and require trained personnel. The Symbol Digit Modalities Test (SDMT) is suggested to be a useful screening tool to measure cognitive impairment in multiple sclerosis patients and is more valid and reliable over time than the Paced Auditory Serial Addition Test (PASAT). The purpose of this study was to evaluate which of these tests was more sensitive to cognitive impairment at one-year follow-up.

Methods

A total of 237 patients with relapsing-remitting multiple sclerosis and 57 healthy controls underwent a complete neuropsychological assessment. One year later, we assessed 196 patients using the Brief Repeatable Battery of Neuropsychological Tests. We also administered other executive function and prospective memory tests, together with fatigue and depression questionnaires.

Results

A total of 33.8% of patients were classified as cognitively impaired. The SDMT and the PASAT 3 seconds test (PASAT3) had a sensitivity of 0.809 and 0.783, respectively, thereby classifying patients as cognitively impaired. Analysis of 196 patients one year later showed 31.6% had cognitive impairment compared with 27.6% at the first assessment. The sensitivity to detect cognitive impairment after one year was 0.824 for SDMT and 0.796 for PASAT3. When the predictors were removed from the comparative standard battery, SDMT still showed a slightly higher sensitivity. Both SDMT and PASAT3 correlated significantly with all tests, but SDMT showed higher correlation values. Furthermore, SDMT was completed by all subjects while PASAT3 was completed by 86.9% of patients and 94.7% of controls.

Conclusions

SDMT is simpler to administer than PASAT3 and may be slightly more sensitive to MS cognitive impairment. It could thus be a suitable test to assess cognitive impairment routinely in people with relapsing-remitting multiple sclerosis.

Evaluating Neurocognitive Deficits in Patients With Multiple Sclerosis Via a Brief Neuropsychological Approach

Recent research demonstrates neurocognitive deficits are present early in the sequelae of multiple sclerosis (MS). This is an important consideration given the functional activities of daily living, such as employment, that can be impacted by neurocognitive dysfunction. This study investigated the utility of a brief neuropsychological battery, the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), to evaluate neurocognitive deficits in patients with MS and to examine the relationship between a measure of functional disability (Expanded Disability Status Scale [EDSS]) and the RBANS. Participants were 49 patients with MS (Mage = 45.39 years) who completed the RBANS as part of a neuropsychological assessment and 49 demographically matched healthy controls (Mage = 45.39 years). Multivariate analysis of variance revealed that the two groups differed on the RBANS. Descriptive discriminant analysis indicated the groups differed on domains of attention, language, immediate memory, and delayed memory. EDSS scores were a good predictor of neurocognitive dysfunction in patients with advanced disability but not for patients with mild disability. The RBANS seems to be effective in identifying cognitive dysfunction in patients with MS, and caution should be used in extrapolating cognitive deficits for patients with low EDSS scores.

Perceived cognitive difficulties and cognitive test performance as predictors of employment outcomes in people with multiple sclerosis

Perceived cognitive difficulties and cognitive impairment are important determinants of employment in people with multiple sclerosis (pwMS). However, it is not clear how they are related to adverse work outcomes and whether the relationship is influenced by depressive symptoms. Thus, this study examined perceived and actual general cognitive and prospective memory function, and cognitive appraisal accuracy, in relation to adverse work outcomes. The possible mediating and/or moderating role of depression was also examined. A cross-sectional community-based sample of 111 participants (33 males, 78 females) completed the Multiple Sclerosis Work Difficulties Questionnaire (MSWDQ), Beck Depression Inventory - Fast Screen (BDI-FS), and questions related to their current or past employment. They then underwent cognitive testing using the Screening Examination for Cognitive Impairment, Auditory Consonant Trigrams test, Zoo Map Test, and Cambridge Prospective Memory Test. Perceived general cognitive and prospective memory difficulties in the workplace and performance on the respective cognitive tests were found to predict unemployment and reduced work hours since MS diagnosis due to MS. Depression was also related to reduced work hours, but it did not explain the relationship between perceived cognitive difficulties and the work outcomes. Nor was it related to cognitive test performance. The results highlight a need to address the perceptions of cognitive difficulties together with cognitive impairment and levels of depression in vocational rehabilitation programs in pwMS.

Multiple sclerosis symptom management

Multiple sclerosis (MS) is the most common cause of nontraumatic disability in young adults. The increasing emphasis on early treatment with disease-modifying therapies has the goal of preventing long-term disability. However, current disease treatments are only partially effective, and most patients experience a variety of neurologic symptoms at various times during their disease course. Because these symptoms often have a profound impact on social, occupational and physical performance, effective symptom management is an important component of therapy to maintain quality of life. Effective symptom management often requires a multidisciplinary team approach. This review outlines general principles of the management of MS symptoms.

Visual search as a tool for a quick and reliable assessment of cognitive functions in patients with multiple sclerosis

Background

Despite the high frequency of cognitive impairment in multiple sclerosis, its assessment has not gained entrance into clinical routine yet, due to lack of time-saving and suitable tests for patients with multiple sclerosis.

Objective

The aim of the study was to compare the paradigm of visual search with neuropsychological standard tests, in order to identify the test that discriminates best between patients with multiple sclerosis and healthy individuals concerning cognitive functions, without being susceptible to practice effects.

Methods

Patients with relapsing remitting multiple sclerosis (n = 38) and age-and gender-matched healthy individuals (n = 40) were tested with common neuropsychological tests and a computer-based visual search task, whereby a target stimulus has to be detected amongst distracting stimuli on a touch screen. Twenty-eight of the healthy individuals were re-tested in order to determine potential practice effects.

Results

Mean reaction time reflecting visual attention and movement time indicating motor execution in the visual search task discriminated best between healthy individuals and patients with multiple sclerosis, without practice effects.

Conclusions

Visual search is a promising instrument for the assessment of cognitive functions and potentially cognitive changes in patients with multiple sclerosis thanks to its good discriminatory power and insusceptibility to practice effects.

Modeling of cognitive impairment by disease duration in multiple sclerosis: a cross-sectional study

BACKGROUND/AIMS

Large-scale population studies measuring rates and dynamics of cognitive decline in multiple sclerosis (MS) are lacking. In the current cross-sectional study we evaluated the patterns of cognitive impairment in MS patients with disease duration of up to 30 years.

METHODS

1,500 patients with MS were assessed by a computerized cognitive battery measuring verbal and non-verbal memory, executive function, visual spatial perception, verbal function, attention, information processing speed and motor skills. Cognitive impairment was defined as below one standard deviation (SD) and severe cognitive impairment as below 2SD for age and education matched healthy population norms.

RESULTS

Cognitive performance in our cohort was poorer than healthy population norms. The most frequently impaired domains were information processing speed and executive function. MS patients with secondary-progressive disease course performed poorly compared with clinically isolated syndrome, relapsing-remitting and primary progressive MS patients. By the fifth year from disease onset, 20.9% of patients performed below the 1SD cutoff for impairment, p=0.005, and 6.0% performed below the 2SD cutoff for severe cognitive impairment, p=0.002. By 10 years from onset 29.3% and 9.0% of patients performed below the 1SD and 2SD cutoffs, respectively, p=0.0001. Regression modeling suggested that cognitive impairment may precede MS onset by 1.2 years.

CONCLUSIONS

The rates of cognitive impairment in this large sample of MS patients were lower than previously reported and severe cognitive impairment was evident only in a relatively small group of patients. Cognitive impairment differed significantly from expected normal distribution only at five years from onset, suggesting the existence of a therapeutic window during which patients may benefit from interventions to maintain cognitive health.

Influence of IQ in interpreting MMSE scores in patients with multiple sclerosis

The Mini-Mental State Examination (MMSE) and Wechsler Adult Intelligence Scale-Fourth Edition (WAIS-IV) were administered to 46 outpatients diagnosed with multiple sclerosis (MS). MMSE total raw score was significantly and positively correlated with all WAIS-IV indexes, even when controlling for the effects of participant educational level, with the strongest relationship being with Full Scale IQ. These results suggest that clinicians consider patient intellectual functioning, in particular Full Scale IQ, when diagnosing neurocognitive impairment based on screening with the MMSE in individuals with MS.

Assessing the validity of a computer-generated cognitive screening instrument for patients with multiple sclerosis

Background:

Neuropsychological testing requires considerable time, expense, and expertise to administer. These factors can limit patient access. Computerized cognitive testing has been proposed as an alternative.

Objectives:

The objective of this paper is to validate a brief, simple-to-use computer-generated cognitive assessment screening battery for multiple sclerosis (MS) patients that has minimal motor involvement.

Methods:

A sample of 96 MS patients and 98 healthy controls completed a computer-generated battery that included the Stroop, Symbol Digit Modalities Test (C-SDMT), a two- and four-second visual analog of the Paced Auditory Serial Addition Test (PVSAT-2, PVSAT-4), and simple and choice reaction time tests. The Minimal Assessment of Cognitive Function in MS was used to define cognitive impairment in the MS sample.

Results:

Each newly developed test successfully distinguished between cognitively impaired patients and healthy controls as well as cognitively intact patients. A combination of three computerized tests (C-SDMT, PVSAT-2, PVSAT-4) with a mean administration time of 10 minutes had a sensitivity of 82.5% and specificity of 87.5% in detecting cognitive impairment. Good test-retest reliability was obtained for each measure.

Conclusions:

Good sensitivity and specificity, brevity, ease of administration, and a limited motor component highlight the feasibility of introducing this computer-generated cognitive screening instrument in a busy MS clinic.

Cognitive differences among depressed and non-depressed MCI participants: a project FRONTIER study

OBJECTIVE

Depression is the most commonly reported psychiatric symptom in patients with mild cognitive impairment (MCI). However, more research is needed examining the impact of depression on cognitive functioning in MCI patients. The purpose of this study was to examine differences in cognitive functioning in a sample of community- based, depressed, and non-depressed MCI patients.

METHODS

One hundred and five participants with MCI were included in this study. Participants were recruited from Project FRONTIER, a study of rural health. Depression was assessed via the Geriatric Depression Scale (GDS-30), and cognition was measured using the Repeatable Battery for the Assessment of Neuropsychological Status.

RESULTS

The results indicated that depressed MCI participants performed significantly worse than their non-depressed counterparts on several cognitive measures. MCI participants with depression scored significantly lower on immediate memory (t = 3.4, p < 0.01) and delayed memory (t = 2.8, p < 0.01) indices than their non-depressed counterparts.

CONCLUSIONS

The results of this study indicated that MCI participants with depression experienced greater deficits in cognitive functioning than their non-depressed counterparts. Depressed MCI participants exhibited greater deficits in both immediate and delayed memory. Thus, identifying and treating depression in individuals with MCI may improve memory and cognitive functioning.

Reliability and equivalence of alternate forms for the Symbol Digit Modalities Test: implications for multiple sclerosis clinical trials

BACKGROUND

Cognitive impairment is common in multiple sclerosis (MS), but is seldom assessed in clinical trials investigating the effects of disease-modifying therapies. The Symbol Digit Modalities Test (SDMT) is a particularly promising tool due to its sensitivity and robust correlation with brain magnetic resonance imaging (MRI) and vocational disability. Unfortunately, there are no validated alternate SDMT forms, which are needed to mitigate practice effects.

OBJECTIVE

The aim of the study was to assess the reliability and equivalence of SDMT alternate forms.

METHODS

Twenty-five healthy participants completed each of five alternate versions of the SDMT - the standard form, two versions from the Rao Brief Repeatable Battery, and two forms specifically designed for this study. Order effects were controlled using a Latin-square research design.

RESULTS

All five versions of the SDMT produced mean values within 3 raw score points of one another. Three forms were very consistent, and not different by conservative statistical tests. The SDMT test-retest reliability using these forms was good to excellent, with all r values exceeding 0.80.

CONCLUSIONS

For the first time, we find good evidence that at least three alternate versions of the SDMT are of equivalent difficulty in healthy adults. The forms are reliable, and can be implemented in clinical trials emphasizing cognitive outcomes.

Recommendations for a Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS)

Background: Cognitive impairment in MS impacts negatively on many patients at all disease stages and in all subtypes. Full clinical cognitive assessment is expensive, requiring expert staff and special equipment. Test versions and normative data are not available for all languages and cultures.

Objective: To recommend a brief cognitive assessment for multiple sclerosis (MS) that is optimized for small centers, with one or few staff members, who may not have neuropsychological training and constructed to maximize international use.

Methods: An expert committee of twelve members representing the main cultural groups that have so far contributed considerable data about MS cognitive dysfunction was convened. Following exhaustive literature review, peer-reviewed articles were selected to cover a broad spectrum of cultures and scales that targeted cognitive domains vulnerable to MS. Each was rated by two committee members and candidates scales were rated on psychometric qualities (reliability, validity, and sensitivity), international application, ease of administration, feasibility in the specified context, and acceptability to patients.

Results: The committee recommended the Symbol Digit Modalities Test, if only 5 minutes was available, with the addition of the California Verbal Learning Test – Second Edition and the Brief Visuospatial Memory Test – Revised learning trials if a further 10 minutes could be allocated for testing.

Conclusions: A brief cognitive assessment for MS has been recommended. A validation protocol has been prepared for language groups and validation studies have commenced.

Reliability and validity of the Repeatable Battery for the Assessment of Neuropsychological Status in community-dwelling elderly

INTRODUCTION

The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) is a widely used screening instrument in neuropsychological assessment and is a brief, individually administered measure. The present study aims to assess the reliability and validity of the Chinese version of the RBANS in community-dwelling elderly.

MATERIAL AND METHODS

All subjects come from the community-dwelling elderly in Shanghai, China. They completed a questionnaire concerning demographic information, the mini-mental state examination (MMSE) and the Chinese version of the RBANS. To test for internal consistency, Cronbach's α was calculated for all six RBANS indices. Correlations between each of the RBANS and MMSE subtests were conducted to measure the concurrent validity. A confirmatory factor analysis (CFA) was conducted to test the construct validity.

RESULTS

The final sample of participants included 236 community-dwelling elderly. The mean total score on the RBANS was 86.02 (±14.19). The RBANS total score showed strong internal consistency (r = 0.806), and the coefficient α value for each of the RBANS scales ranged from 0.142 to 0.727. The total RBANS score was highly correlated with that of the MMSE (r = 0.594, p<0.001), and the RBANS subtests also demonstrated strong correlations with most of the MMSE subtests. The results of the CFA indicated an acceptable fit between the Chinese version of the RBANS and the original.

CONCLUSIONS

The Chinese version of the RBANS had relatively good reliability and validity in a community-dwelling elderly sample. It may be a useful screening instrument for conducting cognitive assessments in community-dwelling elderly.

Cognitive functioning in multiple sclerosis

In this article, the nature and course of cognitive dysfunction in MS are reviewed, particularly in the context of recent advances in our understanding of the diffuse nature of neuropathology in MS, and in the context of specific factors that may confer risk or protection for the development of cognitive impairment. In addition, assessment and screening approaches of MS-related cognitive dysfunction are discussed. MS is a condition not only restricted to the adult population, and this article includes a brief description of cognition in pediatric-onset MS. Finally, promising intervention approaches to treat cognitive problems in MS are summarized.

Long-term low-level arsenic exposure is associated with poorer neuropsychological functioning: a Project FRONTIER study

Exposure to elements in groundwater (toxic or beneficial) is commonplace yet, outside of lead and mercury, little research has examined the impact of many commonly occurring environmental exposures on mental abilities during the aging process. Inorganic arsenic is a known neurotoxin that has both neurodevelopmental and neurocognitive consequences. The aim of this study was to examine the potential association between current and long-term arsenic exposure and detailed neuropsychological functioning in a sample of rural-dwelling adults and elders. Data were analyzed from 434 participants (133 men and 301 women) of Project FRONTIER, a community-based participatory research study of the epidemiology of health issues of rural-dwelling adults and elders. The results of the study showed that GIS-based groundwater arsenic exposure (current and long-term) was significantly related to poorer scores in language, visuospatial skills, and executive functioning. Additionally, long-term low-level exposure to arsenic was significantly correlated to poorer scores in global cognition, processing speed and immediate memory. The finding of a correlation between arsenic and the domains of executive functioning and memory is of critical importance as these are cognitive domains that reflect the earliest manifestations of Alzheimer's disease. Additional work is warranted given the population health implications associated with long-term low-level arsenic exposure.

Are the indices of the RBANS sufficient for differentiating Alzheimer's disease and subcortical vascular dementia?

Alzheimer's disease (AD) and subcortical vascular dementia (SVaD) are among the most prevalent dementias and they often show specific patterns of cognitive dysfunction. This study examined whether differences exist between groups on the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) that could assist with differential diagnosis. The examiners utilized the NINCDS-ADRDA and the NINDS-AIREN criteria to identify 39 probable AD and 29 probable SVaD patients. A battery of neuropsychological tests was performed and neuroimaging was reviewed for all subjects. Analyses revealed that the SVaD group performed significantly better on the Delayed Memory Index (DMI) and its subtests measuring Recognition, Contextual Memory, and Figure Recall. In contrast to previous research, there were no differences between groups on immediate memory tasks, and post hoc analyses revealed no differences on any other index or subtest. The results also suggested that the DMI and its subtests and the Story Memory subtest of the Immediate Memory Index have better sensitivity to AD, better specificity to SVaD, and roughly equivalent positive predictive power compared with other components of the RBANS. Overall, findings suggest that the indices and subtests of the RBANS may be limited in differentiating AD versus SVaD, except for the DMI and its subtests.

Diagnostic accuracy of percent retention scores on RBANS verbal memory subtests for the diagnosis of Alzheimer's disease and mild cognitive impairment

Previous research has supported the use of percent retention scores in the neuropsychological assessment of memory, and many widely used memory measures provide for the calculation and normative comparison of these scores. The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), an increasingly utilized assessment tool for cognitive impairment, provides normative data on delayed memory total raw scores only. The current study was aimed at determining the diagnostic accuracy of a novel percent retention score calculated from RBANS verbal memory subtests (delayed recall minus last learning trial) when distinguishing between normal controls, individuals diagnosed with Mild Cognitive Impairment, and individuals diagnosed with Alzheimer's disease. Results revealed excellent diagnostic accuracy of the RBANS percent retention scores when discriminating between the three groups. Findings suggest that RBANS percent retention scores provide excellent diagnostic accuracy offering supplementary information to clinicians and researchers alike.

Psychometrics and normative data for the Multiple Sclerosis Functional Composite: replacing the PASAT with the Symbol Digit Modalities Test

The MS Functional Composite (MSFC) is a continuous scale of neurological disability for patients with multiple sclerosis (MS). Cognition is represented by the Paced Auditory Serial Addition Test (PASAT), although the Symbol Digit Modalities Test (SDMT) has been proposed as a promising alternative. MSFC scores were calculated using either the PASAT or the SDMT with the following reference populations: National Multiple Sclerosis Society (NMSS) Task Force, 400 MS patients, and 100 normal controls. A subgroup of 115 patients was followed longitudinally, with a test-retest interval of 2.3 +/- 1.2 years. Pearson correlations were calculated and analyses of variance (ANOVAs) were used to assess relationships among the MSFC components and composite scores, and differences in performance between patients and controls. Longitudinal changes were also assessed. Logistic regression was performed to determine which MSFC scores are most predictive of diagnosis, course, and work disability. All MSFCs had similar test-retest reliability and correlations with other measures including neurological disability, depression, and fatigue. The SDMT showed slightly better validity with respect to predicting diagnosis, course, and work disability, although the amount of variance accounted for was similar for each version of the MSFC. Our data, derived from a large sample of MS patients and normal controls, supports the validity of both PASAT and SDMT versions of the MSFC. Because the SDMT has slightly better predictive validity and has a relatively easier administration procedure, some clinicians and researchers may wish to replace the PASAT with the SDMT in future calculations of the MSFC using the calculation methods provided in this manuscript.

Repeatable battery for assessment of neuropsychological status in early Parkinson's disease

Adequate reliability and valid factor structure are prerequisites for appropriate use of a measure in a population. Although the Repeatable Battery for Assessment of Neuropsychological Status (RBANS) has been used to examine cognition in Parkinson's disease (PD), its reliability and factor structure have not been examined in this population. This study examined the reliability and factor structure of the RBANS in participants with de novo PD recruited for two NIH Exploratory Trials in Parkinson's Disease (NET-PD), using Cronbach's alpha and factor analysis. Confirmatory factor analysis (CFA) was implemented on the factor structure proposed in the RBANS manual, and exploratory factor analysis (EFA) was conducted to identify a valid factor structure given the proposed one was not supported. The RBANS exhibited poor reliability in participants with NET-PD. Cronbach's alpha ranged from 0.03 to 0.74 for the five domains and the full scale. CFA results indicated that the proposed factor structure in the RBANS manual was not supported in this sample. EFA identified a two-factor structure for six of the 12 RBANS items. Six items were eliminated due to low correlation with other items or severe ceiling effects. This new factor structure was validated by another CFA. The two domains have fair reliability. Cronbach's alpha ranged from 0.65 to 0.74 for the two factors in the two datasets. These results suggest that the current RBANS domain and total scores may not provide valid measurement of the neuropsychological status for patients with early PD.

PRACTICAL METHODS FOR THE CLINICAL ASSESSMENT OF INFORMATION PROCESSING SPEED

The rate at which individuals are capable of processing information is considered a sensitive indicator of brain dysfunction, particularly among clinical populations whose neurocognitive impairments generally are considered relatively mild in nature. Assessment of information processing speed often is confounded, however, by comorbid impairments in other constructs of neurocognition, including attentional capacity, visuospatial perception, language, immediate memory, and motor speed/coordination. This investigation examined the effect of controlling for various potential confounders on the strength of associations among several potential measures of information processing speed. Participants were 64 patients diagnosed with clinically definite multiple sclerosis. Analysis indicated consistent significant and positive associations among measures of processing speed, which generally persisted despite simultaneous statistical control of potential confounding factors. Results imply that examined confounding variables are similarly related to the measures of processing speed. Therefore, any of the measures of information processing speed considered in this study may be used as a proxy for the more direct measure of this construct derived from the Sternberg Memory Scanning Test.

The brief neuropsychological battery for children: a screening tool for cognitive impairment in childhood and juvenile multiple sclerosis

Background

A critical problem with neuropsychological assessment in children and adolescents with multiple sclerosis (MS) is the absence of a standardized, well-validated neuropsychological battery specifically tailored for detecting disease-related cognitive problems in this age range.

Objective

To develop a Brief Neuropsychological Battery for Children (BNBC) with MS.

Methods

We assessed cognitive functions in 61 patients with childhood and juvenile MS and 58 demographically matched healthy controls through an extensive neuropsychological battery.

Results

In MS patients, we found a proportion of cognitive impairment of 41%. In the BNBC, we included the tests with higher discriminating ability (the Selective Reminding Test, the Symbol Digit Modalities Test, the Trail Making Test, and the Vocabulary test from the Wechsler Intelligence Scale for children). The BNBC yielded a sensitivity of 96% and a specificity of 76%.

Conclusion

Our findings provide preliminary evidence of the usefulness of the BNBC as a screening tool for detecting cognitive impairment in childhood and juvenile MS cases.