Cognitive mediated eye movements during the SDMT reveal the challenges with processing speed faced by people with MS

Pavisian, Bennis; Patel, Vaidehi; Feinstein, Anthony

doi:10.1186/s12883-019-1543-8

Cited by 6 publications

(9 citation statements)

References 34 publications

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“…In a study by Huijbregts et al, 42 found that RRMS were more vulnerable on tasks that concurrently place demands on processing speed and visual-spatial working memory, such as the OM n-back. Interestingly, in our study, we did not see a commensurate reduction in performance on the SDMT, the proposed gold standard measure 27,43 that similarly places demands on visual WMem and processing speed 44,45 ; indeed all pwMS identi ed as impaired by the SDMT were also identi ed by the OM n-back. This is in line with previous studies that have similarly found that the SDMT's ability to detect cognitive deterioration within 2-3 years is poor 46,47 , with performance estimated to decrease by only .22 decrease per year 48 .…”

Section: Discussioncontrasting

confidence: 69%

Two Year Progression of Working Memory Impairments In Early Relapsing-Remitting Multiple Sclerosis: Appraisal of Working Memory Profiles And Measurement Sensitivity

Clough¹,

Bartholomew²,

White³

et al. 2021

Preprint

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Working memory (WMem) impairments are a devastating symptom of Multiple Sclerosis (MS) that manifest as distinct profiles depending upon the type of impairment. It is unknown what WMem impairment profiles occur in early MS and how best to diagnose and measure their progression.88 participants (63 early relapsing-remitting MS, 25 healthy controls) were reviewed annually for two years (baseline, +1 year, +2 years) and completed five WMem tasks: oculomotor (OM) n-back-visual spatial sketchpad; digit-span forwards-phonological loop; California Verbal Learning Test (CVLT)-episodic buffer; digit-span backwards- central executive; symbol digit modalities test (SDMT)-cognitive processing speed. 65% of RRMS patients exhibited visual-spatial WMem impairments followed by 32% for episodic, 30% phonological loop, 24% central executive, 11% cognitive processing speed. These manifested alone (51%) or in combination (48%), with combined impairments the best marker of general WMem impairment. Significant progression in visual-spatial impairments was found for 24% of RRMS patients, with the OM n-back maintaining sensitivity to general WMem impairment and progression. No other WMem subcomponent progressed or task maintained sensitivity. The results of this study provides crucial knowledge for the creation of interventions to treat WMem impairment in early RRMS, providing key targets for treatment and endpoints for determining efficacy.

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Section: Discussioncontrasting

confidence: 69%

Two Year Progression of Working Memory Impairments In Early Relapsing-Remitting Multiple Sclerosis: Appraisal of Working Memory Profiles And Measurement Sensitivity

Clough¹,

Bartholomew²,

White³

et al. 2021

Preprint

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“…It is not surprising that there is a correlation between the SDMT and eye-tracking, as the SDMT assesses visual scanning, memory and perceptual speed, among other functions ( 26 ). Pavisian et al demonstrated that the eye-tracking behavior of MS patients differs from that of healthy individuals during the performance of the SDMT ( 9 ). We extend these findings to a more naturalistic task that is directly linked to the patients' daily lives and stress the importance of intact information processing speed for visual search in the context of real-life situations.…”

Section: Discussionmentioning

confidence: 99%

“…This decision is driven by visuospatial attention and modulates the speed of visual search (13). In general, attentional top-down control is one of the key aspects in visual search (14) and thus eye-tracking can reflect cognitive processes (7,(9)(10)(11)(12).…”

Section: Introductionmentioning

confidence: 99%

“…It will become more widespread in the foreseeable future, as the quality of cameras in laptops and tablets and the necessary software has developed to such an extent making it possible to employ them for cognitive experiments, e.g., via a web browser ( 8 ). Studies using eye-tracking while performing the SDMT have already shown that MS patients differ from healthy individuals, among other measures, with an increased total number of fixations in the test area ( 9 ). This suggests that MS patients may have uncertainties during their visual search behavior, possibly reflected by the fact that the target areas are checked multiple times for safety ( 9 ).…”

Section: Introductionmentioning

confidence: 99%

“…Studies using eye-tracking while performing the SDMT have already shown that MS patients differ from healthy individuals, among other measures, with an increased total number of fixations in the test area ( 9 ). This suggests that MS patients may have uncertainties during their visual search behavior, possibly reflected by the fact that the target areas are checked multiple times for safety ( 9 ). This might be a direct consequence of their cognitive impairment.…”

Section: Introductionmentioning

confidence: 99%

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Visual Search in Naturalistic Scenes Reveals Impaired Cognitive Processing Speed in Multiple Sclerosis

et al. 2022

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BackgroundStandardized neuropsychological testing serves to quantify cognitive impairment in multiple sclerosis (MS) patients. However, the exact mechanism underlying the translation of cognitive dysfunction into difficulties in everyday tasks has remained unclear. To answer this question, we tested if MS patients with intact vs. impaired information processing speed measured by the Symbol Digit Modalities Test (SDMT) differ in their visual search behavior during ecologically valid tasks reflecting everyday activities.MethodsForty-three patients with relapsing-remitting MS enrolled in an eye-tracking experiment consisting of a visual search task with naturalistic images. Patients were grouped into “impaired” and “unimpaired” according to their SDMT performance. Reaction time, accuracy and eye-tracking parameters were measured.ResultsThe groups did not differ regarding age, gender, and visual acuity. Patients with impaired SDMT (cut-off SDMT-z-score < −1.5) performance needed more time to find and fixate the target (q = 0.006). They spent less time fixating the target (q = 0.042). Impaired patients had slower reaction times and were less accurate (both q = 0.0495) even after controlling for patients' upper extremity function. Exploratory analysis revealed that unimpaired patients had higher accuracy than impaired patients particularly when the announced target was in unexpected location (p = 0.037). Correlational analysis suggested that SDMT performance is inversely linked to the time to first fixation of the target only if the announced target was in its expected location (r = −0.498, p = 0.003 vs. r = −0.212, p = 0.229).ConclusionDysfunctional visual search behavior may be one of the mechanisms translating cognitive deficits into difficulties in everyday tasks in MS patients. Our results suggest that cognitively impaired patients search their visual environment less efficiently and this is particularly evident when top-down processes have to be employed.

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Improvements in Cognitive Processing Speed, Disability, and Patient-Reported Outcomes in Patients with Early Relapsing-Remitting Multiple Sclerosis Treated with Natalizumab: Results of a 4-year, Real-World, Open-Label Study

Perumal

Balabanov

et al. 2022

CNS Drugs

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Background STRIVE was a prospective, 4-year, multicenter, observational, open-label, single-arm study of natalizumab treatment in anti-JC virus antibody-negative patients with early relapsing-remitting multiple sclerosis (RRMS). Objective Study objectives examined the effects of natalizumab on cognitive processing speed, confirmed disability improvement (CDI), and patient-reported outcomes (PROs). Methods Clinical and PRO secondary endpoints were assessed annually over 4 years in STRIVE. The Symbol Digit Modalities Test (SDMT) was used as a measure of cognitive processing speed. PROs were assessed using the Multiple Sclerosis Impact Score (MSIS-29) and the Work Productivity and Activity Impairment Questionnaire (WPAI). Results At all four annual assessments, the proportion of patients in the intent-to-treat (ITT) population ( N = 222) who exhibited clinically meaningful improvement in their SDMT score from baseline (i.e., change ≥ 4 points) ranged from 41.9 to 54.0%. The cumulative probability of CDI at 4 years in patients in the ITT population with a baseline Expanded Disability Status Scale score ≥ 2 ( N = 133) was 43.9%. Statistically significant reductions in the mean change from screening in the MSIS-29 physical and psychological scores, indicating improved quality of life, were observed over all 4 years ( P ≤ 0.0012 for all). A statistically significant decrease from screening in the impact of MS on regular activities, signifying an improvement in this WPAI measure, was also observed over all 4 years of the study. Conclusion These results further extend our knowledge of the effectiveness, specifically regarding improvements in cognitive processing speed, disability and PROs, of long-term natalizumab treatment in early RRMS patients. Clinicaltrials.gov NCT01485003 (5 December 2011)

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Cognitive mediated eye movements during the SDMT reveal the challenges with processing speed faced by people with MS

Cited by 6 publications

References 34 publications

Two Year Progression of Working Memory Impairments In Early Relapsing-Remitting Multiple Sclerosis: Appraisal of Working Memory Profiles And Measurement Sensitivity

Two Year Progression of Working Memory Impairments In Early Relapsing-Remitting Multiple Sclerosis: Appraisal of Working Memory Profiles And Measurement Sensitivity

Visual Search in Naturalistic Scenes Reveals Impaired Cognitive Processing Speed in Multiple Sclerosis

Improvements in Cognitive Processing Speed, Disability, and Patient-Reported Outcomes in Patients with Early Relapsing-Remitting Multiple Sclerosis Treated with Natalizumab: Results of a 4-year, Real-World, Open-Label Study

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