Childhood MS and ADEM: Investigation and Comparison of Neurocognitive Features in Children

Abstract

Cognitive deficits in adult multiple sclerosis (MS) are well documented; however, little is known regarding cognitive impairments in similar childhood conditions. This study compared cognitive profiles of children aged 7-18 years with MS (N = 9) to those with acute disseminated encephalomyelitis (ADEM) (N = 9), a similar but monophasic condition. Individual profiles showed clinically relevant impairments across all cognitive domains evaluated. Differences in severity and spread were also found. Results suggest a gradient effect, with the transient white matter disruption in ADEM resulting in subtle cognitive impairments, while the multiple insults to white matter in childhood MS are associated with more severe sequelae.

Fatigue, emotional functioning, and executive dysfunction in pediatric multiple sclerosis

“…Supporting performance-based evidence of executive dysfunction on the TMT, parents also reported a wide range of concerns with executive functioning, with rates of clinical significance ranging from 19%-42%. These findings are consistent with prior work reporting impairments in cognitive functioning (Amato, Goretti, et al, 2008;Amato et al, 2010;Banwell & Anderson, 2005;Deery et al, 2010;Ghezzi et al, 2010;MacAllister et al, 2005;Till et al, 2011) and psychiatric difficulties (Amato, Goretti, et al, 2008;Amato et al, 2010;Till et al, 2012b;Weisbrot et al, 2010) in pediatric MS. It is particularly interesting to note that within parent ratings of executive functioning in the present sample, the most frequently reported clinically significant concerns were in the domain of working memory, which has been identified as one of the most common areas of cognitive impairment in adult MS populations (Chiaravalloti & DeLuca, 2003;Foong et al, 1997;Henry & Beatty, 2006;Lima et al, 2007;Rao et al, 1991;Smith & Arnett, 2010).…”

“…Psychometric evaluations of the TMT generally demonstrate adequate test-retest reliability (e.g., Levine et al, 2004) and construct validity (e.g., Royan, Tombaugh, Rees, & Francis, 2004). TMT Part B has previously been identified as being particularly sensitive to impairment in pediatric MS (Deery et al, 2010;MacAllister et al, 2005;Till, Ho, et al, 2012). Due to available age-based normative data, only participants aged 9-18 years completed the TMT for the present study (n = 23).…”

“…However, findings in pediatric MS populations have been mixed, with some studies reporting impaired verbal fluency (Banwell & Anderson, 2005;Till et al, 2011) and working memory (MacAllister, 2010;Till, Ho, et al, 2012) and others not (Deery et al, 2010;MacAllister et al, 2005;Portaccio et al, 2009). Conflicting findings also have been reported for problem solving and concept formation in pediatric MS, with deficits observed on the Modified Card Sorting Test (Amato, Goretti, et al, 2008) but not the Wisconsin Card Sorting Task (Banwell & Anderson, 2005;Till et al, 2011;Till, Ho, et al, 2012).…”

“…Reflecting well-established findings among adult-onset cases, demyelinating diseases affecting the central nervous system, such as MS, have been associated with cognitive impairment in pediatric-onset cases (Amato, Goretti, et al, 2008, 2010Banwell & Anderson, 2005;Deery, Anderson, Jacobs, Neal, & Kornberg, 2010;Ghezzi, Goretti, Portaccio, Roscio, & Amato, 2010;MacAllister et al, 2005). In the adult literature, deficits in executive functioning are commonly noted (e.g., , and preliminary research has suggested similar executive functioning difficulties among pediatric-onset MS (Banwell & Anderson, 2005;MacAllister et al, 2005).…”

“…Overall, in pediatric MS populations, parent-rated difficulty in at least one aspect of executive functioning ranges from 19%-50% Till, Ho, et al, 2012). On performance-based tasks, difficulty with cognitive flexibility has been observed in up to 50% of pediatric MS patients (Deery et al, 2010;MacAllister et al, 2005;Till et al, 2011).…”