Recovery of cognitive function after relapse in multiple sclerosis

Benedict, Ralph H. B.; Pol, Jeta; Yasin, Faizan; Hojnacki, David; Kolb, Channa; Eckert, Svetlana; Tacca, Beth; Drake, Allison; Wojcik, Curtis; Morrow, Sarah A.; Jakimovski, Dejan; Fuchs, Tom; Dwyer, Michael G.; Zivadinov, Robert; Weinstock‐Guttman, Bianca

doi:10.1177/1352458519898108

Cited by 44 publications

(31 citation statements)

References 27 publications

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“…In a recent study, SDMT scores significantly declined from baseline when MS patients experienced a relapse and recovered to slightly below baseline levels 3 months later. 9 CVLT-II scores had similar but trending results. Our results strongly agree with these findings; however, more work is needed.…”

Section: Discussionmentioning

confidence: 65%

A validation study for remote testing of cognitive function in multiple sclerosis

et al. 2020

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Objectives: Determine the validity and reliability of a remote, technician-guided cognitive assessment for multiple sclerosis (MS), incorporating the Symbol Digit Modalities Test (SDMT) and the California Verbal Learning Test, Second Edition (CVLT-II). Methods: In 100 patients, we compared conventional in-person testing to remote, web-assisted assessments, and in 36 patients, we assessed test–retest reliability using two equivalent, alternative forms. Results: In-person and remote-administered SDMT ( r = 0.85) and CVLT-II ( r = 0.71) results were very similar. Reliability was adequate and alternative forms of SDMT ( r = 0.92) and CVLT-II ( r = 0.81) produced similar results. Conclusions: Findings indicate remote assessment can provide valid, reliable measures of cognitive function in MS.

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Section: Discussionmentioning

confidence: 65%

A validation study for remote testing of cognitive function in multiple sclerosis

et al. 2020

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“…We demonstrated that the SDMT significantly declines in the RG, but not the SG. As noted previously, 20,24 relapses that present with physical or sensory symptoms may also involve cognition. In our current study, 48.8% of subjects in the RG exhibited decline of at least four points on the SDMT, a marker of clinically meaningful decline.…”

Section: Discussionmentioning

confidence: 59%

Quantifying cognition and fatigue to enhance the sensitivity of the EDSS during relapses

et al. 2020

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Background: Cognition is affected by relapses in persons with multiple sclerosis (PwMS), yet the Expanded Disability Status Scale (EDSS) does not readily detect cognitive changes. Objective: The objective of this study is to improve the detection of cognitive decline during relapses, by incorporating the Symbol Digit Modalities Test (SDMT) into the cerebral Functional System Score (CFSS) of the EDSS. Methods: This prospective study recruited PwMS from three dedicated MS centers. All subjects had EDSS, SDMT, and Fatigue Severity Scale (FSS) administered. Subjects experiencing a relapse were assigned to the relapse group (RG). Matched controls from the larger cohort were assigned to the stable group (SG). RG and SG subjects underwent the same evaluation at relapse and 3 months later. Our main outcomes were a modified CFSS (m-CFSS) and modified EDSS (m-EDSS), incorporating SDMT and FSS, accounting for cognitive performance and fatigue rating, during relapse. Results: The full cohort included 592 subjects; 80 qualified for RG and 72 were matched to the SG. The m-CFSS was significantly higher than CFSS at baseline (median = 2 vs. median = 0, p < 0.001) and relapse (median = 2 vs. median = 1, p < 0.001). The m-EDSS was higher than EDSS (median 3.0 vs. 2.5, p = 0.02) at relapse, where 35 RG subjects (43.8%) had higher m-EDSS than EDSS at relapse. Conclusion: This study demonstrates that incorporating the SDMT and FSS improves the accuracy of the EDSS, by accounting for cognitive changes, during relapse activity.

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“…Whether in clinical trials or in clinical practice, relapses may be undetected, and even experienced MS clinicians may sometimes have difficulty in identifying relapses [23,24]. For example, cognitive relapses can tend to be overlooked because associated cognitive deficits are not routinely assessed by many physicians and may sometimes not be recognized by patients [25]. In a recent long‐term pilot study, Akgün et al .…”

Section: Discussionmentioning

confidence: 99%

Patient‐ versus physician‐reported relapses in multiple sclerosis: insights from a large observational study

Schriefer¹,

Haase²,

Ettle

et al. 2020

Euro J of Neurology

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Background and purpose The patient's perspective is becoming increasingly important for endpoints in studies on multiple sclerosis. However, relapse data generated from the patient's perspective in combination with independent documentation by the physician are scarce. Our objective was to compare self‐reported relapses by the patient to physician‐documented relapses within a routine clinical practice setting of quarterly visits. Methods Two‐year data (n = 1921 patients) were extracted from two prospective, non‐interventional, multicentre cohort studies in Germany. The number of relapses independently reported by patients and physicians was analysed. In addition, inter‐rater reliability and measures of validity were evaluated. Patterns of associations were investigated in subgroup analysis of sociodemographic, clinical and patient‐reported outcome measures. Results Patients and physicians showed good overall agreement [κ = 0.78, 95% confidence interval (CI) 0.76–0.80]. Nevertheless, patients reported, on average, more relapses than physicians during follow‐up (0.55 vs. 0.44; P < 0.001). Corresponding annualized relapse rates were 0.38 (95% CI 0.36–0.39) and 0.30 (95% CI 0.29–0.31), respectively. Differences between physicians and patients were particularly pronounced in patient groups with greater disability levels, decreased health‐related quality of life or treatment satisfaction. The positive predictive value was 74.01% (95% CI 71.85–76.07), and the negative predictive value was 98.86% (95% CI 98.67–99.03). Conclusion Some disagreement on the occurrence of relapses appears in specific patient subgroups, where factors such as pseudo‐relapses or confounding factors may have promoted over‐ or under‐reporting.

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Recovery of cognitive function after relapse in multiple sclerosis

Cited by 44 publications

References 27 publications

A validation study for remote testing of cognitive function in multiple sclerosis

A validation study for remote testing of cognitive function in multiple sclerosis

Quantifying cognition and fatigue to enhance the sensitivity of the EDSS during relapses

Patient‐ versus physician‐reported relapses in multiple sclerosis: insights from a large observational study

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