Cognitive performance in relapsing remitting multiple sclerosis: A longitudinal study in daily practice using a brief computerized cognitive battery

Abstract

BackgroundThere is need for a cognitive test battery that can be easily used in clinical practice to detect or monitor cognitive performance in patients with multiple sclerosis (MS). In order to conduct, in this patient group, a preliminary investigation of the validity and utility of a brief computerized battery, the Cognitive Drug Research (CDR) battery, we longitudinally assessed cognition in patients with relapsing remitting (RR) MS.MethodsForty-three mildly disabled, clinically active RRMS patients were repeatedly assessed with the Digit Symbol Substitution Test (DSST), Paced Auditory Serial Addition Test (PASAT) and five composite scores derived from the CDR computerized cognitive test system (CDR System): Power of Attention, Continuity of Attention, Quality of Working Memory, Quality of Episodic Memory and Speed of Memory. The Multiple Sclerosis Functional Composite (MSFC) and Expanded Disability Status Scale (EDSS) measured disability.ResultsThe composite scores from the CDR battery generally showed excellent test-retest reliability over the repeated assessments, though was low on occasions for the Quality of Working Memory and Quality of Episodic Memory measures. The CDR measures tended to be highly correlated with other measures of cognition (DSST and PASAT) and were also strongly related to disability (EDSS and MSFC). Baseline scores indicated large impairments to visual information processing speed and attention (DSST, Cohen's d 1.1; Power of Attention d 1.4 [reaction time on tasks of focussed and sustained attention]), and a moderate impairment both to sustained attention (Continuity of Attention d 0.6) and complex information processing speed (Speed of memory d 0.7 [reaction time on tasks of working and episodic Memory]), when compared to normative data derived from healthy volunteers enrolled in a series of separate, prior clinical trials. Working memory (Quality of Working Memory) and episodic memory (Quality of Episodic Memory) were unimpaired.ConclusionsPreliminary validation of the CDR System indicated that for most, but not all measures psychometric properties were adequate and the measures were related to disability (EDSS and MSFC) and other measures of cognition.

Computerized cognitive testing for patients with multiple sclerosis

“…The system takes approximately 15-20 min to administer and could potentially replace the BRNB and MACFIMS in research and clinical settings where time and administration expertise are an issue. A study comparing the CDR to the PASAT and the Digit Symbol Substitution Test (DSST) alone showed a significant correlation between a composite score and scores from each of the two tests (Edgar et al, 2011). In the same study, most CDR measures had good test-retest reliability ( 40.7), with the exception of working and episodic memory indices.…”

Staying on the job: The relationship between work performance and cognition in individuals diagnosed with multiple sclerosis

“…otherwise not be identified in higher functioning/ lower cognitive impairment base rate populations (Binder, Iverson, & Brooks, 2003;Carey et al, 2004;Edgar et al, 2011;Hinkin et al, 2004;Jak et al, 2009;Sepulcre et al, 2006). Similar to , all impaired scores were summed to create a cognitive impairment index.…”

E-Health 2.0 Developments in Treatment and Research in Multiple Sclerosis

“…The high rater and patient burden (the MACFIMS taking around 90 minutes to administer) and the high degree of expertise needed to administer, seriously limit the utility of BRNB and MACFIMS in patient care and clinical trials [17]. A recent study reported the preliminary validation of a brief computerized cognitive battery in RRMS [17]. Previous data supported the reliability of the Symbol Digit Modalities Test (SDMT) and the Multiple Sclerosis Neuropsychological Questionnaire (MSNQ) as potential tools for screening and monitoring of cognition in MS [18].…”

“…Two neuropsychological test batteries have been developed for use in MS patients, the Brief Repeatable Neuropsychological Battery (BRNB) and the Minimal Assessment of Cognitive Functioning in Multiple Sclerosis (MACFIMS) [for brief descriptions see reference 17]. The high rater and patient burden (the MACFIMS taking around 90 minutes to administer) and the high degree of expertise needed to administer, seriously limit the utility of BRNB and MACFIMS in patient care and clinical trials [17]. A recent study reported the preliminary validation of a brief computerized cognitive battery in RRMS [17].…”

“…Neuropsychological (memory) training, aiming to improve or stabilize cognitive performance, and adjustment of coping strategies are management options. Drugs for treatment of cognitive symptoms are under study, although presently no pharmacotherapy is available [17].…”