Low contrast visual acuity testing is associated with cognitive performance in multiple sclerosis: a cross-sectional pilot study

Abstract

BackgroundCognitive impairment and visual deterioration are two key clinical symptoms in MS and affect 50 to 80% of patients. Little is known about the influence of cognitive impairment on visual tests recommended for MS such as low contrast sensitivity testing. Our objective was to investigate whether low contrast sensitivity testing is influenced by cognitive impairment in multiple sclerosis (MS) patients.MethodsCross-sectional study including 89 patients with relapsing-remitting MS. All patients received cognitive evaluation using Rao’s Brief Repeatable Battery of Neuropsychological Testing (BRB-N). Visual assessments included low contrast sensitivity (CS) by functional acuity contrast testing and high contrast visual acuity (VA) using ETDRS charts. Retinal morphology as visual impairment correlate was measured using retinal nerve fiber layer (RNFL) thickness by optical coherence tomography.ResultsIn combined analyses using generalized estimating equation models, Paced Auditory Serial Addition Test (PASAT) and RNFL as well as and the Symbol Digit Modalities Test (SDMT) and RNFL predicted CS. To further control for a potential influence of the anterior visual system we performed partial correlation analyses between visual function and cognitive function test results but controlling for RNFL. Even when controlling for RNFL, CS was associated with PASAT performance and SDMT performance.ConclusionOur data show that: a) cognitive impairment and performance in visual function tests such as low contrast sensitivity testing are associated; b) the main cognitive domains correlating with visual test performance are information processing speed and, to a lesser degree, memory; This preliminary data needs to be substantiated in further studies investigating patients with a higher cognitive burden, healthy controls and in longitudinal settings.

Clinical and cognitive implications of cerebrospinal fluid oligoclonal bands in multiple sclerosis patients

“…Evaluation of verbal memory in MS patients supported a main deficit in information retrieval, followed by encoding as disability increased, with infrequent storage deficit [41]. Visual acuity could affect the performance on RCFT and further interpret lower visual memory scores; however, our patients reported adequate visual acuity and visual performance was more related to information processing tests (with no significant differences between OCB subgroups in our study) and to a lesser degree to memory [42]. Very recently, a positive association between visuospatial memory and glutamate levels in the hippocampal, thalamic and cingulate regions has been detected in MS patients, but not in healthy participants [43].…”

Pattern of gray matter volumes related to retinal thickness and its association with cognitive function in relapsing–remitting MS

“…A fMRI study with a go/no‐go response discrimination task detected an increased activation of the precuneus, the posterior part of the cingulum and the insular cortex in MS patients compared to healthy controls (Loitfelder et al., 2014). Previous studies provided already evidence for an association between OCT outcomes, visual function, and neuropsychological measurements (Toledo & Sepulcre, 2008; Wieder et al., 2013). In our small subgroup of patients with a neuropsychological assessment, we performed an explorative post hoc analysis.…”

“…Investigating focal cortical volume patterns might help to identify regions that are important hubs in functional or structural networks and might contribute to the disability of MS patients. Previous studies indicated, that impairment of visual function might be as well associated with cognitive function in MS (Toledo et al., 2008; Wieder et al., 2013). The purpose of this study was to investigate to what extent OCT measures correlate with cortical areas that are not part of the primary visual system, and to explore if there is a distinctive pattern of association with cortical regions and if these associations might be linked to neuropsychological performance.…”

Slope of psychometric functions and termination rule analysis for low contrast acuity charts

“…1,2 Letter acuity charts typically use high contrast optotypes, but charts using low contrast letters have also been developed and have been shown to be useful in measuring visual deficits in a variety of disease states. [24][25][26] There has been no previous study of the slope of the psychometric function for low-contrast visual acuity charts. There are a number of reasons to expect that Probit Size will typically be larger (i.e.…”