Information processing speed as a prognostic marker of physical impairment and progression in patients with multiple sclerosis

Hechenberger, Stefanie; Helmlinger, Birgit; Ropele, Stefan; Pirpamer, Lukas; Bachmaier, Gerhard; Damulina, Anna; Pichler, Alexander; Khalil, Michael; Enzinger, Christian; Pinter, Daniela

doi:10.1016/j.msard.2021.103353

Cited by 11 publications

(7 citation statements)

References 39 publications

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“…Raw scores of the SDMT [ 19 ], VLMT [ 20 ], and BVMT [ 21 ] were transformed to normative scores ( z -scores) correcting for demographics (SDMT: age, education [ 19 ]; VLMT: age [ 20 ]; BVMT: age [ 21 ]) using respective norms of each cognitive assessment. CI in one cognitive test was defined by a z -score < -1.5 [ 7 ].…”

Section: Methodsmentioning

confidence: 99%

“…In addition to its easy and brief administration, the SDMT has clinical and scientific advantages [ 5 ]. For instance, it has a high test–retest reliability and good validity, alternative forms with consistent reliability exist, it is able to discriminate between pwMS and healthy individuals, and correlates with neurological symptoms and MS-related brain damage over time [ 5 , 7 – 9 ]. Consequently, the SDMT has become part of the most widely used MS-specific neuropsychological test batteries, such as the Brief Repeatable Battery for Neuropsychological Test (BRB), and the Brief International Cognitive Assessment in MS (BICAMS; currently recommended for use as cognitive screening-tool in pwMS by an expert consensus committee) [ 5 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of a self-administered iPad®-based processing speed assessment for people with multiple sclerosis in a clinical routine setting

Hechenberger,

Helmlinger,

Tinauer

et al. 2024

J Neurol

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Background Limited resources often hinder regular cognitive assessment of people with multiple sclerosis (pwMS) in standard clinical care. A self-administered iPad®-based cognitive screening-tool (Processing Speed Test; PST) might mitigate this problem. Objective To evaluate the PST in clinical routine. Methods We investigated the feasibility of the PST in both a quiet and a waiting room setting. We assessed the validity of the PST in comparison with the established Symbol Digit Modalities Test (SDMT). We explored associations between processing speed assessments and the Brief International Cognitive Assessment for MS (BICAMS), magnetic resonance imaging (MRI) parameters, and psychological factors. Additionally, we explored the ability of the PST to detect impairment in processing speed compared to the SDMT. Results The PST was feasible in the waiting room setting. PST and SDMT correlated comparably with the BICAMS, MRI parameters, and psychological variables. Of 172 pwMS, 50 (30.8%) showed cognitive impairment according to the BICAMS; respective values were 47 (27.3%) for the SDMT and 9 (5.2%) for the PST. Conclusions The PST performed in a waiting room setting correlates strongly with established cognitive tests. It thus may be used to assess processing speed in a resource-efficient manner and complement cognitive assessment in clinical routine. Despite comparable validity of the PST and SDMT, we identified more pwMS with impaired processing speed using normative data of the SDMT compared to the PST and advise caution, that the common cut-off score of – 1.5 SD from the current PST is not appropriate in Europe.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Evaluation of a self-administered iPad®-based processing speed assessment for people with multiple sclerosis in a clinical routine setting

Hechenberger,

Helmlinger,

Tinauer

et al. 2024

J Neurol

Self Cite

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“…Using age- and education-normative data, SDMT raw scores were transformed to z -scores ( 6 ). First, the threshold for below-average SDMT performance was set to a conservative and widely accepted threshold for cognitive impairment of z < −1.5 ( 19 , 21 , 22 ). Additionally, we performed an exploratory analyses with the aim to determine if eye tracking would detect differences even if the threshold for impairment is less conservative at SDMT z < −1.…”

Section: Methodsmentioning

confidence: 99%

Visual Search in Naturalistic Scenes Reveals Impaired Cognitive Processing Speed in Multiple Sclerosis

et al. 2022

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BackgroundStandardized neuropsychological testing serves to quantify cognitive impairment in multiple sclerosis (MS) patients. However, the exact mechanism underlying the translation of cognitive dysfunction into difficulties in everyday tasks has remained unclear. To answer this question, we tested if MS patients with intact vs. impaired information processing speed measured by the Symbol Digit Modalities Test (SDMT) differ in their visual search behavior during ecologically valid tasks reflecting everyday activities.MethodsForty-three patients with relapsing-remitting MS enrolled in an eye-tracking experiment consisting of a visual search task with naturalistic images. Patients were grouped into “impaired” and “unimpaired” according to their SDMT performance. Reaction time, accuracy and eye-tracking parameters were measured.ResultsThe groups did not differ regarding age, gender, and visual acuity. Patients with impaired SDMT (cut-off SDMT-z-score < −1.5) performance needed more time to find and fixate the target (q = 0.006). They spent less time fixating the target (q = 0.042). Impaired patients had slower reaction times and were less accurate (both q = 0.0495) even after controlling for patients' upper extremity function. Exploratory analysis revealed that unimpaired patients had higher accuracy than impaired patients particularly when the announced target was in unexpected location (p = 0.037). Correlational analysis suggested that SDMT performance is inversely linked to the time to first fixation of the target only if the announced target was in its expected location (r = −0.498, p = 0.003 vs. r = −0.212, p = 0.229).ConclusionDysfunctional visual search behavior may be one of the mechanisms translating cognitive deficits into difficulties in everyday tasks in MS patients. Our results suggest that cognitively impaired patients search their visual environment less efficiently and this is particularly evident when top-down processes have to be employed.

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“…4 Moreover, reduced processing speed correlates with global and regional brain atrophy, physical disability, and disease progression. 5,6 The Symbol Digit Modalities Test (SDMT) is the most used test to assess processing speed in MS patients. 7 However, it should be noted that it is not a pure test of processing speed, and other domains such as attention, working memory, learning, and visual abilities are also involved.…”

Section: Introductionmentioning

confidence: 99%

The impact of cigarette smoking on cognitive processing speed and brain atrophy in multiple sclerosis

et al. 2023

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Background: Smoking is associated with an increased risk of multiple sclerosis (MS) and disability worsening. The relationship between smoking, cognitive processing speed, and brain atrophy remains uncertain. Objective: To quantify the impact of smoking on processing speed and brain volume in MS and to explore the longitudinal relationship between smoking and changes in processing speed. Methods: A retrospective study of MS patients who completed the processing speed test (PST) between September 2015 and March 2020. Demographics, disease characteristics, smoking history, and quantitative magnetic resonance imaging (MRI) were collected. Cross-sectional associations between smoking, PST performance, whole-brain fraction (WBF), gray matter fraction (GMF), and thalamic fraction (TF) were assessed using multivariable linear regression. The longitudinal relationship between smoking and PST performance was assessed by linear mixed modeling. Results: The analysis included 5536 subjects of whom 1314 had quantitative MRI within 90 days of PST assessment. Current smokers had lower PST scores than never smokers at baseline, and this difference persisted over time. Smoking was associated with reduced GMF but not with WBF or TF. Conclusion: Smoking has an adverse relationship with cognition and GMF. Although causality is not demonstrated, these observations support the importance of smoking cessation counseling in MS management.

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Information processing speed as a prognostic marker of physical impairment and progression in patients with multiple sclerosis

Cited by 11 publications

References 39 publications

Evaluation of a self-administered iPad®-based processing speed assessment for people with multiple sclerosis in a clinical routine setting

Evaluation of a self-administered iPad®-based processing speed assessment for people with multiple sclerosis in a clinical routine setting

Visual Search in Naturalistic Scenes Reveals Impaired Cognitive Processing Speed in Multiple Sclerosis

The impact of cigarette smoking on cognitive processing speed and brain atrophy in multiple sclerosis

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