Traditional paper-and-pencil neuropsychological batteries used to document cognitive deficits in multiple sclerosis (MS) patients lack timing precision. This makes it difficult to accurately measure psychomotor slowing, a central cognitive symptom of MS. Additionally, traditional batteries lack multiple alternate forms necessary to control for practice effects when assessing cognition over time. Finally such batteries are lengthy and expensive. Computerized neuropsychological batteries address many of these shortcomings. They measure response time more precisely, require less administration time, include alternate forms, and are ideal for rapid screening/triage. Although there are normative data on the reliability and validity of computerized measures, there have been no controlled validation studies with MS patients. The current study was designed to validate a computerized neuropsychological battery (ANAM) for use with relapsing-remitting (RR) MS patients. Prior to initiation of interferon-beta-1a (Avonex) treatment, subjects participated in a neuropsychological evaluation consisting of traditional and computerized measures. Moderate-to-high correlations were found between computerized and traditional measures. Computerized tests accurately predicted performance on key traditional tests. The battery was also concordant with traditional measures in identifying RR MS patients with and without neurocognitive impairment. Findings are discussed with respect to increased accuracy and accessibility of neuropsychological evaluations for MS patients.

Background: Caring for someone with multiple sclerosis (MS) can be a stressful experience that requires clinical attention. We investigated the impact of caregiver stress on the emotional well-being and physical health of the MS care partner using the North American Research Committee on Multiple Sclerosis (NARCOMS) Registry. Methods: Care partners of NARCOMS participants were invited to complete an online questionnaire that captured demographic characteristics, health status, caregiver burden as measured by the Zarit Caregiver Burden Interview, and impact of caregiving on employment. Results: Of 1446 care partners who agreed to participate, 1333 had complete data. Most were men (n = 825, 61.9%), with a mean (SD) age of 51.1 (11.2) years. The mean (SD) Zarit total score was 24.6 (15.1), placing the overall group in the mild caregiver burden range. Compared with male care partners, female care partners reported higher levels of burden and stress and more medication use for stress/anxiety and mood disorders. Male care partners were more likely to report physical concerns. Care partners of people with primary progressive MS reported greater perceived burden than did partners of people with secondary progressive MS and relapsing-remitting MS. More than 40% of care partners (559 of 1288) had missed work during the past year owing to caregiving responsibilities. Conclusions: Care partners of people with MS have substantial physical and psychological health concerns and experience an adverse impact on employment. Future research should evaluate how to mitigate the adverse effects of caregiving and evaluate positive aspects of the role.

In patients with multiple sclerosis (MS), attention and information-processing-speed impairment contribute to dysfunction in other cognitive domains (learning, memory). Treatment for MS-related attention and processing-speed deficits may have dual benefits: improvement of function in these domains and in overall cognitive efficiency. The objective of this study was to determine whether adjunctive treatment of fatigue with modafinil ameliorates deficits in attention and cognitive domains reliant on attention. Relapsing-remitting MS patients receiving intramuscular interferon beta-1a (IM IFNβ-1a) were screened for attention problems with four well-validated, reliable, standardized neurocognitive measures sensitive to attention impairment. Those scoring at least 1 standard deviation below normative expectations on at least two of the measures were eligible for continued participation. Participants with normal values on all physical screening measures were randomized to one of two groups: continued IM IFNβ-1a alone or plus modafinil. Significant mean group differences were found at 4 months on multiple measures of fatigue and cognitive functioning. Patients on combination therapy reported significantly less fatigue (P <.05) and performed significantly better (P <.05) than those in the monotherapy group on measures tapping simple attention span, working memory, and phonemic verbal fluency. Combination therapy was generally well tolerated. No serious adverse events were reported by patients in either treatment arm. This study was developed as a proof of concept that attention-enhancing medications could be used to address fatigue, cognition, and mood in MS patients. The results demonstrate the need for a larger study to determine relative safety and efficacy.