4. Assessing cognitive decline in MS

Question 1

What percentage of MS patients suffer from cognitive impairment?

And which 2 domains are mostly affected?

Answer 1

50%

1. Cognitive slowing (slowing of information processing speed): the core deficit which already begins early in the disease –> demyelination causes that information cannot really move fast across the axons anymore.
2. Visual memory impairment

Question 2

Which 2 domains are almost never affected?

Answer 2

1. “Simple” attention: e.g. repeating digits

2. Verbal abilities: e.g. naming, comprehension

Question 3

What percentage of MS patients have cognitive impairments at the following times:

• At diagnosis
• After 5 years
• After 10 years

Answer 3

• At diagnosis: 25% has cognitive impairments
• After 5 years: 50% has cognitive impairments (and 56% will get unemployed within 5 years –> severe impact on daily life, social relationships, QoL)
• After 10 years: numbers stabilize, so it happens within the first 5 years

Question 4

What are the 3 main test batteries in research to detect cognitive problems in MS?

Answer 4

1. BRB-N = Brief Repeatable Battery of Neuropsychological tests
2. MACFIMS = Minimal Assessment of Cognitive Function in MS
3. BICAMS = Brief International Cognitive Assessment for MS

Question 5

BRB-N: how long?

And which 5 tests are included in this battery?

Answer 5

30 minutes

1. Selective Reminding Test: verbal memory –> 15WT, but in the 2nd trial only the ones they forgot are repeated
2. 10/36 Spatial Recall Test: spatial memory –> put black dots on locations that were black
3. Symbol Digit Modalities Test (SDMT): attention & speed of information processing –> recode symbols according to a key
4. Paced Auditary Serial Addition Test (PASAT): working memory, attention, speed of information processing –> patients have to add up numbers (severe learning effects)
5. Word List Generation: verbal fluency & memory retrieval (category or letters)

Question 6

Which test is sensitive for changes in cognitive performance?

At which amount of point-drop are there (1) problems at work and (2) drop in cognitive performance

Answer 6

SDMT

1. Problems at work –> 3-4 points
2. Drop in cognitive performance –> 7-8 points

Question 7

MACFIMS: how long?

And which 3 extra tests are included in this battery?

Answer 7

90 minutes

1. Judgement of Line Orientation Test: visuospatial processing –> identify lines according to the picture that is shown (easy test)
2. Brief Visuospatial Memory Test: spatial memory –> draw figures out of your head (replacement of the 10/36 Spatial Recall Test)
3. D-KEFS Trail Making Test: executive functioning (concept shifting)

Question 8

BICAMS: how long?

And which 3 tests are included here?

Answer 8

15 minutes

1. SDMT: processing speed & working memory
2. BVMT: spatial memory
3. California Verbal Learning Test: verbal memory

Question 9

Multiple Screener

What aspect is most important in a good screening instrument?

Answer 9

Sensitivity, because you want to know the patients that are suffering from cognitive impairment.

Question 10

What is sensitivity and what is specificity?

Answer 10

Sensitivity = the number of patients identified with cognitive impairment that are indeed suffering from cognitive impairments

Specificity = the number of patients identified as cognitively preserved that are indeed cognitively preserved

Question 11

Cognitive training (responders vs. non-responders)

What difference was found between responders and non-responders?

And what can we learn from this?

Answer 11

A difference in the functional connectivity of the brain –> non-responders had a higher connectivity between the default mode network & attention networks.

This may be some kind of last resort of the brain to try to manage itself in times of pathology. So if you’re brain is already changing, you might be too late for cognitive therapy.