Phototest for neurocognitive screening in multiple sclerosis

Abstract

Multiple Sclerosis (MS) is one of the most common neurological disorders. Cognitive dysfunction is considered a clinical marker of MS, where approximately half of patients with MS have cognitive impairment.Objective:The Phototest (PT) is a brief cognitive test with high diagnostic sensitivity, accuracy and cost-effectiveness for detecting cognitive deterioration. Our aim was to test the utility of the PT as a neurocognitive screening instrument for MS. Methods:The study enrolled 30 patients with different types of MS from an outpatient clinic as well as 19 healthy participants. In conjunction with the PT, the Montreal Cognitive Assessment (MoCA), Barthel Index (BI), Expanded Disability Status Scale (EDSS), and Fatigue Severity Scale (FSS) were administered. Results:The MS group obtained significantly lower results on all domains of the PT, except for the naming task. The PT showed good concurrent validity with the MoCA. In direct comparison to the MoCA, PT showed a greater area under the curve and higher levels of sensitivity and specificity for MS neurocognitive impairments. A cut-off score of 31 on the Phototest was associated with sensitivity of 100% and specificity of 76.7%. Conclusion : The PT is a valid, specific, sensitive and brief test that is not dependent on motor functions. The instrument could be an option for neurocognitive screening in MS, especially in identifying cases for further neuropsychological assessment and intervention.

Clinical utility of Phototest via teleneuropsychology in Chilean rural older adults

“…Recent studies have reported the superiority of the PT in identifying CD in general and MCI in various health contexts 29,50 , including their identification in illiterate or low-schooling subjects 51,52 , showing that PT was one of the most accurate tests to detect suspected CD, especially in patients with lower levels of education or in those coming from different cultural backgrounds. Nevertheless, in a systematic review of BCTs for early detection of dementia in LA elders, Custodio et al 53 reported difficulties in a broad spectrum of BCTs, including MoCA, ACE-R, and the Ineco Frontal screening.…”

“…In contrast, the Phototest (PT) 23 has demonstrated its usefulness in primary health care centers, since it does not use pencil or paper, which facilitates its performance and evaluation, especially in people with lower educational levels or in those who are illiterate 24,25 . It has a higher sensitivity and specificity than traditional tests with respect to dementia and MCI 26,27 and has shown to be more effective and cheaper than the Mini-Mental State Examination (MMSE) in multiple studies [27][28][29] . Finally, given its structural and managing characteristics, it is believed to be easily adapted to virtual assessment formats.…”

“…Therefore, considering that the percentage of rural seniors in LA is higher than their urban counterparty 29 , they have fewer years of schooling, higher disease burden, restricted access to specialized medical controls, and a lower probability of having contracted health insurance, it is necessary to have MCI-sensitive instruments that can be applied in rural settings through TNP. Therefore, our objective was to analyze the clinical utility of the PT to detect MCI in older adults in rural areas of Chile during the SARS-CoV-19 pandemic, using TNP.…”