Innovations In Clinical Neuroscience

HOTTOP Multiple Sclerosis MAR 2018

A peer-reviewed, evidence-based journal for clinicians in the field of neuroscience

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12 Hot Topics in Multiple Sclerosis [March 2018] MEETING HIGHLIGHTS COGNITION AND MULTIPLE SCLEROSIS Cognitive reserve and cognitive fatigue in MS. At the ACTRIMS Forum 2018, researchers presented on the relationship between cognitive reserve and cognitive fatigue in patients with MS. The researchers measured cognitive reserve by proxy of years of education and intelligence quota (IQ), measured perceived fatigue by the Fatigue Severity Scale (FSS), and measured objective fatigue by the oral version of the Symbol-Digit Modalities Test (SDMT). The investigators were unable to find a relationship between education level/ IQ and either objective cognitive fatigue or perceived fatigue based on the measurement systems used, although they recommended additional studies to build on past studies that found a connection between cognitive fatigue and cognitive reserve. The effectiveness of computerized screening in detecting cognitive deficits in people with MS. Researchers investigated whether NeuroTrax (NT), a computerized neuropsychological test, can effectively measure cognitive deficiencies in patients with MS. Patients (n=80) were separated into four groups based on levels of cognitive impairment, which was measured by the Symbol- Digital Modalities Test (SDMT), and compared to healthy controls (n=15). The control group outperformed the MS group in all areas of testing via NT, which was able to successfully differentiate between the control group and the MS group 81 percent of the time. The researchers recommend the use of NT for assessing cognition in patients with MS, arguing it provides a level of specificity on the severity of cognitive deficits compared to other tests, such as the Expanded Disability Status Scale (EDSS) and SDMT. Mobile Universal Lexicon Evaluation System (MULES) in MS: evaluation of a new visual test of rapid picture naming. There are a variety of visual-based cognitive tests that are used to assess people for concussions, and these are also able to assess cognition in patients with MS. Researchers presented at the ACTRIMS Forum 2018 on the use of the Mobile Universal Lexicon Evaluation System (MULES) to measure multiple visual aspects in patients with MS, such as vision network, color perception, and object identification. The study included an MS group and a healthy control group; each participant took the MULES, King- Devick test (another vision-based rapid number test), binocular low-contrast letter acuity (LCLA) test, and high- contrast visual acuity (VA) test. Patients with MS scored an average of 19.6 seconds worse (59.6 vs. 40.0 seconds) on the MULES test compared to the control group. In the MS group, faster times on the MULES were associated with better scores on the binocular LCLA at 2.5-percent contrast and binocular high-contrast VA. Overall, the MULES adds additional value to assessing the visual ability of patients with MS. Analysis of cognitive impact on physical disability in People with Multiple Sclerosis (PwMS). At the ACTRIMS Forum 2018 in February, researchers investigated the relationship between self-reported physical/cognitive disability and fall risk in patients with MS. Patients were measured by the Multiple Sclerosis Impact Scale (MSIS-29), Modified Falls Efficacy Scale (MFES), and simple (ADL-S) and complex (ADL-C) Activities of Daily Living scales. The researchers found a statistically significant correlation between scores from these tests and fall risk. They especially noted the effect of cognitive disability on ADL, which they argue is under-recognized in patients with MS. EFFECT OF MS ON QUALITY OF LIFE The Patient Derived Ambulation Scale (PDAS): a single-item, patient-reported outcome measure of ambulation in multiple sclerosis patients. Researchers developed the Patient Derived Ambulation Scale (PDAS) as a replacement for the 500-meter walk to test ambulation in patients with MS. They found the scale easy to implement in clinical practices and favorably comparable to similar tests, such as the Walking Speed Test, Multiple Sclerosis Walking Scale 12, NeuroQOL Lower Extremity subscale, and Patient Determined Disease Steps. Voice of the patient: impact of MS symptoms on daily activities. Investigators argued that PwMS need to be included in the discussion for ways in which to assess how the disease affects their quality of life (QOL). Rather than focus on the symptoms usually measured in PwMS (e.g., walking speed, manual dexterity, vision, and speed of information processing), presenters at the ACTRIMS Forum 2018 instead focused on different symptoms, such as fatigue, incoordination, spasticity, bladder dysfunction, and pain, which were confirmed by respondents as symptoms that negatively affect the QOL of their lives. Among those five symptoms, fatigue was reported by 90.3 percent of the respondents to impact their QOL, incoordination was reported by 88.7 percent, spasticity by 75.6 percent, bladder dysfunction by 69.4 percent, and pain by 54.8 percent of the respondents. PwMS also identified 14 other symptoms, including parasthesias (22.6%) and Lhermitte's sign (3.2%). Respondents indicated that multiple symptoms often impact the same activity of daily living, which confirms the complexity of measuring how symptoms of the disease affect PwMS. MS

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