The Italian validation of the minimal assessment of cognitive function in multiple sclerosis (MACFIMS) and the application of the Cognitive Impairment Index scoring procedure in MS patients

Abstract

Cognitive dysfunction occurs in almost 50-60% of patients with multiple sclerosis (MS) even in early stages of the disease and affects different aspects of patient's life. Aims of the present study were (1) to introduce and validate an Italian version of the minimal assessment of cognitive functions in MS (MACFIMS) battery and (2) to propose the use of the Cognitive Impairment Index (CII) as a scoring procedure to define the degree of impairment in relapsing-remitting (RRMS) and secondary-progressive (SPMS) patients. A total of 240 HC and 123 MS patients performed the Italian version of the MACFIMS composed by the same tests as the original except for the Paced Auditory Serial Addition Test. The CII was derived for each score of the 11 scales for participants of both groups. The results of the study show that cognitive impairment affects around 50% of our sample of MS patients. In RRMS group, only the 15.7% of patients reported a severe impairment, while in the group of SPMS, the 51.4% of patients felt in the "severely impaired" group. Results are in line with previously reported percentages of impairment in MS patients, showing that the calculation of the CII applied to the Italian version of the MACFIMS is sensitive and reliable in detecting different degrees of impairment in MS patients.

Validation of the French version of the minimal assessment of cognitive function in multiple sclerosis (MACFIMS)

“…The main objectives of this study were to evaluate cognitive assessment using the MACFIMS The domains with more frequent impairment were learning (FLT-TL, BVMT-R-TL) followed by IPS (SDMT), delayed memory (FLT-DR, BVMT-DR), verbal fluency and working memory (PASAT). We did not observe significant differences between PwMS and HS in the JLOT test, as reported in some other studies (Argento et al, 2018;Migliore et al, 2017). The mean scores of the ECCC were not different between PwMS and HS.…”

“…The seven NP tests assess working memory (WM), information processing speed (IPS), verbal and visual learning and memory, executive function (EF), visual perception, spatial processing and verbal fluency. MACFIMS has been validated for English-speaking subjects ( (Benedict et al, 2006) as well as some other languages (Dusankova et al, 2012;Eshagi et al, 2012;Argento et al, 2018) but not for French-speaking subjects, and there are no normative data for most of the individual tests for French-speaking subjects.…”

Motor, cognitive, and combined rehabilitation approaches on MS patients’ cognitive impairment

“…The Italian validation of MACFIMS gives the possibility to describe degrees of global CI [ 28 ]: we have used the CII to establish the cognitive benefit obtained by pMS after the three kinds of rehabilitative approaches. Both Reha1 and Reha2 groups had a higher number of participants who were cognitively preserved after the treatment program and a very lower number of participants who remained severely impaired (Fig.…”

“…The clinical assessment was performed by a trained clinician who administered the EDSS and the multiple sclerosis functional composite (MSFC), composed by the timed 25-foot walk test (T25FT), the 9-hole peg test (9HPT), and the paced auditory serial addition test (PASAT) [ 26 ]. The neuropsychological assessment was performed by a trained psychologist and was composed by the Italian version of minimal assessment of cognitive functioning in multiple sclerosis (MACFIMS) [ 27 , 28 ] and the multiple sclerosis neuropsychological questionnaire (MSNQ) [ 29 ]. pMS have also completed questionnaires for the assessment of depression (Beck Depression Inventory — BDI) [ 30 ] and anxiety (State Trait Anxiety Inventory — Y1 e Y2–STAY 1–2) [ 31 ].…”

Study Protocol: Strategies and Techniques for the Rehabilitation of Cognitive and Motor Deficits in Patients with Multiple Sclerosis

“…Neuropsychological evaluation through the Minimal Assessment of Cognitive Functioning in Multiple Sclerosis battery (MACFIMS) [26], in the Italian version [27]. This battery consists of seven tests:…”