Simple Protocols Reliably Test Cognition in MS Patients

Jim Kling

July 07, 2010

July 7, 2010 (San Antonio, Texas) — Paper-based and computer-based cognitive assessment tools can be readily implemented to assess cognitive function in patients with multiple sclerosis (MS). This should make it easier for physicians to track patients' progress and prescribe treatments, which is an important component of effective patient care, according to a study presented here at the Consortium of Multiple Sclerosis Centers 24th Annual Conference and the Third Joint Meeting of Americas Committee for Treatment and Research in Multiple Sclerosis.

As many as 40% to 70% of patients with MS experience symptoms of cognitive impairment, such as memory dysfunction and verbal fluency deficits. These conditions are often underdiagnosed, in part because it can be difficult to measure cognitive function in the clinical setting.

Researchers at Stony Brook University Hospital in Stony Brook, New York, and Winthrop University Hospital in Mineola, New York, set out to develop a reliable and cost-effective assessment approach for MS-related cognitive impairment.

They enrolled 56 patients who had presented for follow-up in the MS treatment centers at their institutions and administered a preassessment questionnaire and the Multiple Sclerosis Neuropsychological Questionnaire to determine cognitive impairment as perceived by the patient. They also administered the Rey Auditory Verbal Learning Test (RAVALT), the Symbol Digit Modalities Test (SDMT), and the NeuroTrax Mindstreams Computerized Cognitive Battery (MCCB).

For each patient, a short depression scale (Patient Health Questionnaire 9) was also completed, although patients with depression were allowed to enter the study.

The researchers identified correlations between paper-based and computer-based assessment tools (SDMT and MCCB, P = .0004; RAVLT and MCCB, P = .0188).

"The results of this study demonstrate that reliable, practical, and cost-effective cognitive assessment tools can be integrated into routine clinical settings involved in MS care," the researchers wrote in their abstract.

"Cognitive impairment is such a huge problem [in MS patients], and I wasn't able to offer them much [in the way of assessment]," said presenter Sharon Friedman-Urevich, RN, coordinator of the MS Treatment Program at Winthrop University Hospital in an interview with Medscape Medical News during the meeting.

"I could refer to them to a neuropsychologist, but it takes a day and a half to complete a battery of tests, it's very costly, and many patients didn't want to go," she noted.

The tests can also be helpful when it comes to filling out forms for patient disability, which require documentation. "If you have something like REVLT that is paper based and very quick, or even better a computer-based test, then [nobody] can argue with it. It's a concrete, objective measure," Dr. Friedman-Urevich added.

The tests would be a welcome addition, but only if they're interpreted properly, cautioned Kathleen Fuchs, PhD, associate professor of clinical neurology at the University of Virginia in Charlottesville and a neuropsychologist at the James Q. Miller MS Clinic there.

"A lot of practitioners look at the physical symptoms of [MS] but not cognitive symptoms. But I get a little nervous when tools developed in a neuropsychology practice get used in the nonneuropsychology setting, just because of the interpretation of that data. Having said that, the measures that were selected were absolutely appropriate and sensitive to changes in MS," Dr. Fuchs told Medscape Medical News.

The study did not receive commercial support. Dr. Friedman-Urevich and Dr. Fuchs have disclosed no relevant financial relationships.

Consortium of Multiple Sclerosis Centers (CMSC) 24th Annual Conference and the Third Joint Meeting of Americas Committee for Treatment and Research in Multiple Sclerosis (ACTRIMS): Abstract P01. Presented June 4, 2010.


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