Screening Instruments for the Early Detection of Cognitive Impairment in Patients with Multiple Sclerosis

Kim, Sonya; Zemon, Vance; Rath, Joseph F.; Picone, MaryAnn; Gromisch, Elizabeth S.; Glubo, Heather; Smith-Wexler, Lucia; Foley, Frederick W.

doi:10.7224/1537-2073.2015-001

Cited by 16 publications

(13 citation statements)

References 38 publications

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“…To make a direct comparison between MoCA test scores and performance on the MACFIMS possible, a global MACFIMS score was calculated by averaging each standardised z score obtained for the various tests included in the MACFIMS. Direct comparisons between patients with MS who are cognitively intact and those who are cognitively impaired (2 or more tests < −1.5 SD on the MACFIMS battery) 53 were performed by computing t tests on total MoCA test scores and on the results obtained on the different sections of the MoCA test. A hierarchical multiple regression analysis was carried out with the global score on MACFIMS as the dependent variable.…”

Section: Discussionmentioning

confidence: 99%

Detecting Subtle Cognitive Impairment in Multiple Sclerosis with the Montreal Cognitive Assessment

Charest

Tremblay

Langlois

et al. 2020

Can. J. Neurol. Sci.

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Background: Although cognitive deficits are frequent in multiple sclerosis (MS), screening for them with tools such as the Montreal Cognitive Assessment (MoCA) test is usually not performed unless there is a subjective complaint. The Multiple Sclerosis Neuropsychological Questionnaire (MSNQ) is among the instruments most commonly used to assess self-reported subjective complaints in MS. Nonetheless, it does not always accurately reflect cognitive status; many patients with cognitive deficits thus fail to receive appropriate referral for detailed neuropsychological evaluation. The objective of this study was to examine the validity of the MoCA test to detect the presence of objective cognitive deficits among patients with MS without subjective complaints using the Minimal Assessment of Cognitive Function in MS (MACFIMS) as the gold standard. Methods: The sample included 98 patients who were recruited from a university hospital MS clinic. The MSNQ was used to select patients without subjective cognitive complaints who also completed the MACFIMS, MoCA test and MSQOL-54. Results: 23.5% of patients without subjective cognitive complaints had evidence of objective cognitive impairment on the MACFIMS (z score < -1.5 on two or more tests). The MoCA had a sensitivity of 87% and a specificity of 68% for detecting objective cognitive impairment in this patient population using a cut-off score of 27. Conclusion: A significant proportion of patients without self-reported cognitive impairment do have evidence of cognitive deficits on more exhaustive cognitive assessment. The MoCA is a rapid screening test that could be used to target patients for whom a more detailed neuropsychological assessment would be recommended.

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Section: Discussionmentioning

confidence: 99%

Detecting Subtle Cognitive Impairment in Multiple Sclerosis with the Montreal Cognitive Assessment

Charest

Tremblay

Langlois

et al. 2020

Can. J. Neurol. Sci.

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“…As cognitive function can be reliably assessed in patients with MS, this should be another clinical sign that physicians should bear in mind in order to consider clinical decisions regarding disease-modifying treatment (22). The SDMT test has proved to be a valuable screening tool for cognitive impairment and could be the starting line when assessing cognitive impairment in patients with MS when more comprehensive screening tools or staff resources are not available (27, 50). An annual reassessment with the same test or battery for all adults with MS is strongly recommended (48).…”

Section: Discussionmentioning

confidence: 99%

“…Standardized neurological examinations may be unable to detect emerging cognitive deficits and self-reported cognitive complaints by the patients (25), which can also be confounded by other subjective symptoms, such as depression and anxiety (26). It is therefore paramount to include an early screening that detects impaired cognition in patients with MS (27). This could allow for an earlier intervention (28), which would also include a better psychoeducation and specific work with patients with MS and their families (27).…”

Section: Introductionmentioning

confidence: 99%

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Cognitive Dysfunctions and Assessments in Multiple Sclerosis

et al. 2019

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Cognitive impairment has been reported at all phases and all subtypes of multiple sclerosis. It remains a major cause of neurological disability in young and middle-aged adults suffering from the disease. The severity and type of cognitive impairment varies considerably among individuals and can be observed both in early and in later stages. The areas which have commonly shown more deficits are: information processing speed, complex attention, memory, and executive function. Even though an alteration in both the white matter and in the gray matter has been found in patients with multiple sclerosis and cognitive impairment, the underlying process still remains unknown. Standardized neurological examinations fail to detect emerging cognitive deficits and self-reported cognitive complaints by the patients can be confounded by other subjective symptoms. This review is a comprehensive and short update of the literature on cognitive dysfunctions, the possible confounders and the impact of quality of life in patients with multiple sclerosis.

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“…WM requires the synchronization of neural network connections distributed in the prefrontal and parietal regions in order to integrate complex information for generating appropriate responses. These distributed brain networks are especially sensitive to the diffuse damage of white and gray substance found in multiple sclerosis (Damasceno et al, 2015;Feuillet et al, 2007;Kim et al, 2017) .…”

Section: Discussionmentioning

confidence: 99%

Frontoparietal connectivity correlates with working memory performance in multiple sclerosis

Figueroa-Vargas

Cárcamo

Henríquez-Ch

et al. 2019

Preprint

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Multiple sclerosis is a chronic demyelinating disease of the central nervous system that provokes motor, cognitive and neuropsychiatric symptoms. Cognitive symptoms are a core feature of the disease, affecting everyday life functioning in 40 to 70% of patients. Working Memory impairment is one of the most common cognitive deficits, crucially affecting goaldirected behavior. However, evidence of the neurobiological mechanisms underlying these impairments is scarce. To address this issue, we investigated a working memory task concomitantly with electroencephalographic records in twenty patients with relapsingremitting multiple sclerosis who had minimal clinical cognitive alteration, and in twenty healthy control subjects. Participants first watched a memory set of two, four, or six consonants that had to be memorized and, after a black screen that was shown for two seconds, a target stimulus was displayed. We correlated both time-frequency and functional brain connectivity with memory load and behavioral performance. We found that patients and healthy controls presented similar accuracy rates. For high memory loads, patients demonstrated longer reaction times for incorrect responses when the probe was part of the memory set, revealing an increase in cognitive effort. We then evaluated the single trial correlation between the power of the oscillatory activity and the memory load. The healthy control group showed an increase of left frontal and parietal theta activity, while the patient group did not show this increase. The analysis of the successful memory performances demonstrated that controls presented a greater medial theta activity during the maintenance stage; whereas, the patient group showed a decrease in this activity. Interestingly, cortical connectivity analyses using Granger Causality revealed that healthy controls presented a load-modulated progression of the frontal-to-parietal connectivity that indicated successful memory performance, while the patients did not show this pattern. Consistently, phase-amplitude coupling analyses showed that this connectivity was carried out by frontal delta/theta phase to parietal gamma amplitude modulation. Frontalto-parietal connectivity correlated with working memory capacity in patients measure by Paced Auditory Serial Addition Test. These results indicate that patients with multiple sclerosis present alterations in their capacity to sustain oscillatory dynamics that maintain information in working memory. Thus, differences in brain oscillations and connectivity could be useful for early detection and to study working memory alterations in multiple sclerosis, as well as to implement new therapeutic interventions using non-invasive brain stimulation.

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Screening Instruments for the Early Detection of Cognitive Impairment in Patients with Multiple Sclerosis

Cited by 16 publications

References 38 publications

Detecting Subtle Cognitive Impairment in Multiple Sclerosis with the Montreal Cognitive Assessment

Detecting Subtle Cognitive Impairment in Multiple Sclerosis with the Montreal Cognitive Assessment

Cognitive Dysfunctions and Assessments in Multiple Sclerosis

Frontoparietal connectivity correlates with working memory performance in multiple sclerosis

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