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Andrade PS, de Cerqueira ACR, Colodetti AC, Schmidt FDR, Barreiros JMG, Teixeira AL, de Souza LC. Cognitive assessment of Brazilian patients with multiple sclerosis: weighing the impact of disability and depressive symptoms. Dement Neuropsychol 2022; 16:276-283. [PMID: 36619836 PMCID: PMC9762392 DOI: 10.1590/1980-5764-dn-2021-0050] [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: 05/26/2021] [Revised: 12/08/2021] [Accepted: 01/12/2022] [Indexed: 01/11/2023] Open
Abstract
Multiple sclerosis (MS) is the most common demyelinating disease of the central nervous system. Cognition is not routinely assessed in patients with MS though they frequently have cognitive complaints or dysfunction. Objective The aim of this study was to compare the cognitive status of patients with MS with age, sex, and schooling matched controls and to evaluate the potential influence of clinical parameters on cognition. Methods A total of 35 patients with MS (mean±SD age 37.9 years±11.44, M/F: 12/23) and 33 healthy controls (mean±SD age 38.8 years±12.6, M/F: 12/21) were enrolled in this study. All subjects underwent a structured clinical assessment and the cognitive tools are as follows: Paced Auditory Serial Addition Test (PASAT), Symbol Digit Modalities Test (SDMT), Rey Auditory Verbal Learning Test (RAVLT), Digit Span, and Verbal Fluency Tests (letters F, A, and S and animal category). Psychopathology was assessed with the Mini International Neuropsychiatric Interview and the Beck Depression Inventory (BDI). The Expanded Disability Status Scale (EDSS) was used for patients. Results Patients performed worse than controls in almost all tests, with approximately 70% of patients presenting cognitive impairment. The most affected cognitive domain was episodic memory (45.7%), followed by verbal fluency (42.8%) and information processing speed (22.8%). SDMT was inversely correlated with disease severity, as assessed by the EDSS. Depression did not influence cognitive performance in this cohort. Conclusions Cognitive dysfunction is common among patients with MS. While motor impairment was associated with information processing speed, depression did not influence cognitive performance.
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Affiliation(s)
- Patricia Semionato Andrade
- Universidade Federal de Minas Gerais, Programa de Pós-Graduação
em Neurociências, Belo Horizonte MG, Brazil
- Universidade do Estado do Rio de Janeiro Ambulatório de
Neuroimunologia, Hospital Universitário Pedro Ernesto, Rio de Janeiro RJ,
Brazil
| | - Ana Cláudia Rodrigues de Cerqueira
- Universidade do Estado do Rio de Janeiro Ambulatório de
Neuroimunologia, Hospital Universitário Pedro Ernesto, Rio de Janeiro RJ,
Brazil
| | - Ana Carolina Colodetti
- Universidade do Estado do Rio de Janeiro Ambulatório de
Neuroimunologia, Hospital Universitário Pedro Ernesto, Rio de Janeiro RJ,
Brazil
| | - Felipe da Rocha Schmidt
- Universidade do Estado do Rio de Janeiro Ambulatório de
Neuroimunologia, Hospital Universitário Pedro Ernesto, Rio de Janeiro RJ,
Brazil
| | - José Maurício Godoy Barreiros
- Universidade do Estado do Rio de Janeiro Ambulatório de
Neuroimunologia, Hospital Universitário Pedro Ernesto, Rio de Janeiro RJ,
Brazil
| | - Antônio Lúcio Teixeira
- Universidade Federal de Minas Gerais, Programa de Pós-Graduação
em Neurociências, Belo Horizonte MG, Brazil
- Faculdade Santa Casa Belo Horizonte, Programa de Pós-Graduação,
Belo Horizonte MG, Brazil
| | - Leonardo Cruz de Souza
- Universidade Federal de Minas Gerais, Programa de Pós-Graduação
em Neurociências, Belo Horizonte MG, Brazil
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Grzegorski T, Losy J. Cognitive impairment in multiple sclerosis - a review of current knowledge and recent research. Rev Neurosci 2018; 28:845-860. [PMID: 28787275 DOI: 10.1515/revneuro-2017-0011] [Citation(s) in RCA: 89] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 05/19/2017] [Indexed: 11/15/2022]
Abstract
Multiple sclerosis (MS) is a chronic, progressive disease of the central nervous system that is characterised by inflammatory damage to the myelin sheath. Though often neglected, cognitive impairment is a common feature of MS that affects 43-70% of patients. It has a sophisticated neuroanatomic and pathophysiologic background and disturbs such vital cognitive domains as speed of information processing, memory, attention, executive functions and visual perceptual functions. In recent years there has been growing interest in neuroimaging findings with regard to cognitive impairment in MS. The possible options of managing cognitive dysfunction in MS are pharmacologic interventions, cognitive rehabilitation and exercise training; however, not enough evidence has been presented in this field. The aim of our article is to provide current knowledge on cognitive impairment in MS based on the most recent scientific results and conclusions with regard to affected cognitive domains, neuropsychological assessment, underlying mechanisms of this disturbance, neuroimaging findings and therapeutic options.
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Damasceno A, Amaral JMSDS, Barreira AA, Becker J, Callegaro D, Campanholo KR, Damasceno LA, Diniz DS, Fragoso YD, Franco PS, Finkelsztejn A, Jorge FMH, Lana–Peixoto MA, Matta APDC, Mendonça ACR, Noal J, Paes RA, Papais–Alvarenga RM, Pereira AG, Spedo CT, Damasceno BP. Normative values of the Brief Repeatable Battery of Neuropsychological Tests in a Brazilian population sample: discrete and regression–based norms. ARQUIVOS DE NEURO-PSIQUIATRIA 2018; 76:163-169. [DOI: 10.1590/0004-282x20180006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2017] [Accepted: 12/12/2017] [Indexed: 11/22/2022]
Abstract
ABSTRACT Objective Cognitive dysfunction is common in multiple sclerosis. The Brief Repeatable Battery of Neuropsychological Tests (BRB–N) was developed to assess cognitive functions most–frequently impaired in multiple sclerosis. However, normative values are lacking in Brazil. Therefore, we aimed to provide continuous and discrete normative values for the BRB–N in a Brazilian population sample. Methods We recruited 285 healthy individuals from the community at 10 Brazilian sites and applied the BRB–N version A in 237 participants and version B in 48 participants. Continuous norms were calculated with multiple–regression analysis. Results Mean raw scores and the 5th percentile for each neuropsychological measure are provided, stratified by age and educational level. Healthy participants' raw scores were converted to scaled scores, which were regressed on age, sex and education, yielding equations that can be used to calculate predicted scores. Conclusion Our normative data allow a more widespread use of the BRB–N in clinical practice and research.
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Affiliation(s)
| | | | | | - Jefferson Becker
- Hospital São Lucas, Brasil; Pontifícia Universidade Católica do Rio Grande do Sul, Brasil
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Burton RL, O'Connell ME. Telehealth Rehabilitation for Cognitive Impairment: Randomized Controlled Feasibility Trial. JMIR Res Protoc 2018; 7:e43. [PMID: 29422453 PMCID: PMC5824099 DOI: 10.2196/resprot.9420] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 12/14/2017] [Accepted: 01/01/2018] [Indexed: 11/29/2022] Open
Abstract
Background Nonpharmacological interventions are needed to support the function of older adults struggling with subjective cognitive impairment (SCI), mild cognitive impairment (MCI), and dementia due to Alzheimer disease (AD). Telerehabilitation aims to provide rehabilitation at a distance, but cognitive rehabilitation by videoconferencing has not been explored. Objective The objective of this study was to compare goal-oriented cognitive rehabilitation delivered in-person with videoconferencing to determine whether telehealth cognitive rehabilitation appears feasible. Methods Random assignment to in-person or telehealth videoconferencing cognitive rehabilitation with a combined between-subjects, multiple baseline single-case experimental design, cognitive rehabilitation was delivered by a therapist to 6 participants with SCI (n=4), MCI (n=1), or dementia due to AD (n=1). Results Two of the 6 participants randomly assigned to the telehealth condition withdrew before beginning the intervention. For those who participated in the intervention, 6 out of 6 goals measured with the Canadian Occupational Performance Measure improved for those in the in-person group, and 7 out of 9 goals improved for those in the telehealth group. Conclusions Delivery of cognitive rehabilitation by telehealth appeared feasible but required modifications such as greater reliance on caregivers and clients for manipulating materials.
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Affiliation(s)
- Rachel L Burton
- Department of Psychology, University of Saskatchewan, Saskatoon, SK, Canada
| | - Megan E O'Connell
- Department of Psychology, University of Saskatchewan, Saskatoon, SK, Canada
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Jaywant A, Barredo J, Ahern DC, Resnik L. Neuropsychological assessment without upper limb involvement: a systematic review of oral versions of the Trail Making Test and Symbol-Digit Modalities Test. Neuropsychol Rehabil 2016; 28:1055-1077. [PMID: 27756192 DOI: 10.1080/09602011.2016.1240699] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The Trail Making Test (TMT) and written version of the Symbol Digit Modalities Test (SDMT) assess attention, processing speed, and executive functions but their utility is limited in populations with upper limb dysfunction. Oral versions of the TMT and SDMT exist, but a systematic review of their psychometric properties and clinical utility has not been conducted, which was the goal of this study. Searches were conducted in PubMed and PsycINFO, test manuals, and the reference lists of included articles. Four measures were identified: the SDMT-oral, oral TMT-A, oral TMT-B, and the Mental Alternation Test (MAT). Two investigators independently reviewed abstracts to identify peer-reviewed articles that reported on these measures in adult populations. From each article, one investigator extracted information on reliability, validity, responsiveness, minimum detectable change, normative data, and demographic influences. A second investigator verified the accuracy of the data in a random selection of 10% of papers. The quality of the evidence for each psychometric property was rated on a 4-point scale (unknown, poor, adequate, excellent). Results showed excellent evidence for the SDMT-oral, adequate evidence for the oral TMT-B and MAT, and adequate to poor evidence for the oral TMT-A. These findings inform the clinical assessment of attention, processing speed, and executive functions in individuals with upper limb disability.
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Affiliation(s)
- Abhishek Jaywant
- a Center of Excellence for Neurorestoration and Neurotechnology , Providence VA Medical Center , Providence , RI , USA.,b Department of Psychiatry and Human Behavior , Warren Alpert Medical School of Brown University , Providence , RI , USA
| | - Jennifer Barredo
- a Center of Excellence for Neurorestoration and Neurotechnology , Providence VA Medical Center , Providence , RI , USA.,c Brown Institute for Brain Science , Brown University , Providence , RI , USA
| | - David C Ahern
- b Department of Psychiatry and Human Behavior , Warren Alpert Medical School of Brown University , Providence , RI , USA.,d The Miriam Hospital , Providence , RI , USA
| | - Linda Resnik
- a Center of Excellence for Neurorestoration and Neurotechnology , Providence VA Medical Center , Providence , RI , USA
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Neves MR, Passos AM, Ferreira A, Sousa C, Sá A, Sá MJ. BRBN-T validation: adaptation of the Selective Reminding Test and Word List Generation. ARQUIVOS DE NEURO-PSIQUIATRIA 2016; 73:867-72. [PMID: 26465404 DOI: 10.1590/0004-282x20150134] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Accepted: 06/02/2015] [Indexed: 11/21/2022]
Abstract
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.
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Bordignon S, Zibetti MR, Trentini CM. O Procedimento Selective Reminding na Avaliação da Memória e Aprendizagem: Um Levantamento de Estudos Brasileiros. PSICOLOGIA: TEORIA E PESQUISA 2016. [DOI: 10.1590/0102-3772e32221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO Os pesquisadores têm à sua disposição uma variedade de métodos que auxiliam a compreensão dos processos de memória e aprendizagem. O presente artigo tem como objetivo revisitar o procedimento de recordação seletiva, apresentando suas características e variações, e realizar um levantamento de estudos brasileiros que fizeram uso do mesmo. São apresentadas as diferenças entre a recordação seletiva e o procedimento padrão em tarefas de aprendizagem por recordação livre. Constatou-se que, no Brasil, além de diferentes tarefas, são utilizadas formas de aplicações distintas do procedimento. A utilização da recordação seletiva apresenta relevância no estudo da memória e da aprendizagem, em especial na busca pela diferenciação entre as dificuldades normais de memórias e os déficits patológicos dessa função cognitiva.
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Utility of the INECO frontal screening (IFS) in the detection of executive dysfunction in patients with relapsing-remitting multiple sclerosis (RRMS). Neurol Sci 2015; 36:2035-41. [DOI: 10.1007/s10072-015-2299-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 06/16/2015] [Indexed: 10/23/2022]
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Management of relapsing–remitting multiple sclerosis in Latin America: Practical recommendations for treatment optimization. J Neurol Sci 2014; 339:196-206. [DOI: 10.1016/j.jns.2014.02.017] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Accepted: 02/17/2014] [Indexed: 12/13/2022]
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Abstract
Cognitive impairment (CI) is a serious complication of multiple sclerosis (MS), and the domains affected are well established, but new affected domains such as theory of mind are still being identified. The evidence that disease-modifying therapies (DMTs) improve and prevent the development of CI in MS is not solid. Recent studies on the prevalence of CI in MS among people treated with DMT, although not as solid as studies completed prior to DMT introduction, suggest that CI remains a problem even among people on DMTs and that CI occurs frequently even at the very earliest stages of MS. Functional MRI studies and studies using diffusion tractography show that the impact of lesions on cognition depends on the particular cortical networks affected and their plasticity. Cognitive rehabilitation and L-amphetamine appear promising symptomatic treatments for CI in MS, while, cholinesterase inhibitors and memantine have failed, and data on Ginkgo and exercise are limited. We need more work to understand better CI in MS and develop treatments for this serious complication of MS.
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Affiliation(s)
- Jesus Lovera
- Department of Neurology, Louisiana State University Health Sciences Center-New Orleans, 1542 Tulane Ave, Rm 718A, New Orleans, LA 70112, USA.
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Finkelsztejn A, Gabbai AA, Fragoso YD, Carrá A, Macías-Islas MA, Arcega-Revilla R, García-Bonitto J, Oehninger-Gatti CL, Orozco-Escobar G, Tarulla A, Vergara F, Vizcarra D. Latin American algorithm for treatment of relapsing-remitting multiple sclerosis using disease-modifying agents. ARQUIVOS DE NEURO-PSIQUIATRIA 2012; 70:799-806. [PMID: 23060107 DOI: 10.1590/s0004-282x2012001000009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2012] [Accepted: 07/10/2012] [Indexed: 11/22/2022]
Abstract
OBJECTIVE It is estimated that circa 50,000 individuals have relapsing-remitting multiple sclerosis in Latin America. European and North-American algorithms for the treatment of multiple sclerosis do not foresee our regional difficulties and the access of patients to treatment. METHODS The Latin American Multiple Sclerosis Forum is an independent and supra-institutional group of experts that has assessed the latest scientific evidence regarding efficacy and safety of disease-modifying treatments. Accesses to treatment and pharmacovigilance programs for each of the eight countries represented at the Forum were also analyzed. RESULTS A specific set of guidelines based upon evidence-based recommendations was designed for Latin America. Future perspectives of multiple sclerosis treatment were also discussed. CONCLUSIONS The present paper translated an effort from representatives of eight countries discussing a matter that cannot be adapted to our region directly from purely European and North-American guidelines for treatment.
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Silva JLD, Ribeiro LTC, Dos Santos NRP, Beserra VCADS, Fragoso YD. The influence of diabetes mellitus II on cognitive performance. Dement Neuropsychol 2012; 6:80-84. [PMID: 29213778 PMCID: PMC5619245 DOI: 10.1590/s1980-57642012dn06020003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background The association between diabetes mellitus and cognitive dysfunction is
becoming increasingly clear, rendering it necessary for physicians in charge
of diabetic patients to have the means to assess cognitive performance.
Simple tests that can be applied during routine consultations may be useful
for monitoring cognitive function during the course of diabetes. Objective The objective of the present study was to assess cognition in diabetes
mellitus type II (DM-II) using simple tests that can be incorporated into
routine medical practice. Methods A cross-sectional study including healthy controls and DM-II patients was
carried out between May and September 2011. Volunteers aged 60 years and
over were assessed by means of figure recognition, verbal fluency and the
10×36 tests. Results A group of 100 participants was divided into a subgroup of 50 DM-II patients
and a subgroup of 50 healthy volunteers. No statistical difference regarding
demographic characteristics was found between the two groups. Results on the
10×36 test showed significantly worse performance among DM-II
patients (p<0.0001). Assessment of the DM-II subgroup in terms of disease
duration showed statistically significant differences (p<0.001) on figure
recognition and verbal fluency, with worse cognitive performance among
individuals with longer disease duration, irrespective of gender or age. Conclusion Figure recognition, verbal fluency and 10×36 tests are easy to apply
and could be used in routine medical practice for the early detection of
cognitive dysfunction among patients with DM-II.
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Affiliation(s)
| | | | | | | | - Yara Dadalti Fragoso
- MD, MSc, PhD, Head of the Department of Neurology, Universidade Metropolitana de Santos, Santos SP, Brazil
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