The Faces Symbol Test, a newly developed screening instrument to assess cognitive decline related to multiple sclerosis: first results of the Berlin Multi-Centre FST Validation Study

Abstract

Reliable, language-independent, short screening instruments to test for cognitive function in patients with multiple sclerosis (MS) remain rare, despite the high number of patients affected by cognitive decline. We developed a new, short screening instrument, the Faces Symbol Test (FST), and compared its diagnostic test characteristics with a composite of the Digit Symbol Substitution Test (DSST) and the Paced Auditory Serial Addition Test (PASAT), in 108 MS patients and 33 healthy controls. An Informant-Report Questionnaire, a Self-Report Questionnaire, and a neurologist's estimation of the Every Day Life Cognitive Status were also applied to the MS patients. The statistical analyses comprised of a receiver operating characteristic analysis for test accuracy and for confounding variables. The PASAT and DSST composite score estimated that 36.5% of the MS patients had cognitive impairment. The FST estimated that 40.7% of the MS patients were cognitively impaired (sensitivity 84%; specificity 85%). The FST, DSST and PASAT results were significantly correlated with the patients' physical impairment, as measured by the Expanded Disability Status Scale (EDSS). The results suggest that the FST might be a culture-free, sensitive, and practical short screening instrument for the detection of cognitive decline in patients with MS, including those in the early stages.

Sonographic basal ganglia alterations are related to non-motor symptoms in multiple sclerosis

“…Patients with SN hyperechogenicity tended to have higher scores on the U-UDI compared to those without (1.7 [0.7-2.7] vs. 0.7 [0.3-2.0]; p = 0.075), as did patients with brainstem raphe hypoechogenicity compared to those indicate the referring cut-off value reported to discriminate patients with normal and impaired cognitive function [29]. Note that the patient group with the combined TCS abnormality performed worse on all three tests.…”

“…For assessment of cognitive dysfunction, the 3-second Paced Auditory Serial Addition Test (PASAT) and the Faces Symbol Test (FST) were applied [28,29]. While both PASAT and FST were developed as measures of sustained attention and speed of information processing, these tests have been demonstrated to evaluate different cognitive domains in MS patients, with only a partial correlation between these tests [30].…”

Social Cognition Impairments in Patients with Multiple Sclerosis and Comparison with Imaging Studies, Disease Duration and Grade of Disability

“…A positive correlation was found between the difficulty in emotional facial expression recognition and the degree of disability [44]. Patients with a higher grade of disability demonstrated greater difficulties in affective prosody recognition [75].…”

“…Such tasks could be accompanied by pictures. Decoding complex emotions from voice is measured by "Reading the Mind in the Voice" [41] and the "Voice Emotion Identification Test" [42] and prediction of intentions and emotions-by "Reading the Mind in the Eyes" [43] and the "Facial Symbol Test", [44] which are sensitive indicators of the socioperceptual component involved in the immediate recognition of mental states [45]. Even more informative is the "Cambridge Mindreading Face Voice Battery", [46] which combines verbal and dynamic visual stimuli.…”

Cognitive screening in multiple sclerosis

“…The Faces Symbol Test (FST) [8,[19][20][21] is a test that measures attention, working memory and information processing speed. First data suggested a good test-retest reliability for the FST (r = 0.89; internal consistency, Cronbach's α = 0.91) [8] and a satisfactory sensitivity and specificity [19,20].…”