Brief Computer‐Based Information Processing Measures are Linked to White Matter Integrity in Pediatric‐Onset Multiple Sclerosis

Abstract

BACKGROUND AND PURPOSE Pediatric‐onset multiple sclerosis (POMS) is a demyelinating disorder with unique clinical challenges. A brief computer‐administered cognitive screening battery measuring processing speed (Cogstate) and the Brief International Cognitive Assessment in MS (BICAMS) detect cognitive impairment in POMS. The neuroanatomic correlates of these deficits are incompletely understood. The purpose of this study is to define the neuroanatomic underpinnings of deficits identified with cognitive screening batteries in POMS. METHODS Participants with POMS and age‐matched healthy controls (HCs) were screened with Cogstate and BICAMS. Diffusion tensor imaging assessed region‐wise and tractography‐based fractional anisotropy (FA). RESULTS The POMS (n = 15) and HC (n = 21) groups were matched on age (mean ages 17.9 ± 3.2 vs. 17.8 ± 3.3 years, respectively) and on an estimate of general intellectual functioning. The Cogstate composite revealed significant slowing in POMS relative to HCs (P = .004), but the BICAMS composite did not significantly distinguish the groups (P = .10). The Cogstate composite showed moderate‐to‐strong correlations with regional FA (r = –.67 to –.82) and significantly associated with uncinate fasciculus FA following multiple comparisons correction (P = .002) in POMS. However, the BICAMS composite measure showed only weak‐to‐moderate correlations with FA in POMS (r = –.19 to –.57), with none surviving multiple comparisons correction. CONCLUSIONS Computer‐administered measures of cognitive processing are particularly sensitive in POMS and are closely linked to white matter FA.

Cognitive Assessment and Rehabilitation for Pediatric-Onset Multiple Sclerosis: A Scoping Review

“…Findings yielded by commonly used tools were sometimes discrepant across studies. For instance, SDMT has been recommended and widely used as a screening tool in adult and pediatric MS [ 26 , 29 ], whereas its sensitivity in pediatric MS was occasionally challenged [ 17 , 21 , 30 , 31 ], particularly in early stage of the disease. Brief international cognitive assessment for multiple sclerosis (BICAMS) and a Cogstate brief battery were shown to exhibit comparable sensitivity in detecting cognitive impairment in POMS [ 19 ].…”

“…Brief international cognitive assessment for multiple sclerosis (BICAMS) and a Cogstate brief battery were shown to exhibit comparable sensitivity in detecting cognitive impairment in POMS [ 19 ]. These two batteries were subsequently employed in a study investigating the neuroanatomical correlates of cognitive impairment in POMS; however, the findings cast doubt on the discriminative power of BICAMS [ 31 ]. Trail making test (TMT)-B performance more readily differentiated between POMS and controls compared to TMT-A in earlier studies [ 13 , 30 ], whereas the reverse was found in later studies [ 21 , 32 ].…”

“…Trail making test (TMT)-B performance more readily differentiated between POMS and controls compared to TMT-A in earlier studies [ 13 , 30 ], whereas the reverse was found in later studies [ 21 , 32 ]. Bartlett et al reported that verbal memory as assessed by Rey auditory verbal learning test (RAVLT) was impaired in POMS [ 31 ], while Storm Van’s Gravesande et al found no significant verbal memory deficit in POMS using Verbaler Lern- und Merkfähigkeitstest (the German version of RAVLT) [ 21 ]. Discrepant results were also reported with regard to visuospatial memory tapped by brief visuospatial memory test-revised (BVMTR) versus Rey–Osterrieth figure tests [ 15 , 21 ].…”

Cognitive Functioning in Patients with Pediatric-Onset Multiple Sclerosis, an Updated Review and Future Focus

“…Additional examination of brief batteries includes a recent study, which examined the efficacy of using a 15-min battery (Brief International Cognitive Assessment of MS: BICAMS) including measures of visual learning (brief visuospatial memory test—revised: BVMT-R), verbal learning (Rey auditory verbal learning test: RAVLT), and attention (SDMT), compared to a 15-min computer-administered battery of speeded processing tasks (Cogstate brief battery) and found similar detection rates of cognitive dysfunction across batteries [69]. Similarly, Bartlett et al (2018) compared Cogstate and BICAMS outcomes in patients with POMS and found that the Cogstate composite score revealed slowing in the POMS group compared to controls, while the BICAMS composite did not differentiate the groups [70]. Interestingly, other disease-related measures may also help in identifying/screening for cognitive impairment in patients with POMS.…”

“…There has been limited examination of DTI and cognitive functioning, but Bartlett et al (2019), using Cogstate and BICAMS, found that the Cogstate composite showed correlations with regional FA and correlated significantly with uncinated fasciculus FA. BICAMS only showed weak to moderate correlations with FA [70]. De Meo and colleagues [92] found general abnormalities in patients with POMS on DT-MRI, as well as differences in increased activation of the left thalamus, anterior insula, and anterior corpus callosum (ACC) and decreased recruitment of the right precuneus on fMRI compared to healthy controls during a continuous performance test (assessing sustained attention).…”