The Value of Self-Reported Cognitive Performance in low, medium and high EDSS

AbstractBackgroundThe inconsistent association of patient-reported Multiple Sclerosis Neuropsychological Questionnaire (MSNQ) scores with performance-based cognitive tests in MS could be related to the degree of disability, due to certain MSNQ-questions assuming some self-dependence and intact instrumental ADLs.ObjectivesTo test whether the relation between subjective and objective cognitive performance could be moderated by physical disability as measured by the Expanded Disability Status Scale (EDSS), we assessed the correlation between MSNQ and Symbol Digit Modalities Test (SDMT) scores in different EDSS groups.MethodsFrom 288 MS patients who completed the patient-report MSNQ and a two‐question screening tool for depression, we also collected SDMT and EDSS scores. We analysed correlations in the total group and three EDSS subgroups: Low 0.0 – 3.0, Medium 3.5 – 6.0 and High 6.5 – 9.5.ResultsWe found a significant and negative correlation between patient-reported MSNQ scores and SDMT scores in the low EDSS (r = -.225, p = .044), but not in the medium and high EDSS groups, and significant positive correlations between MSNQ and depression in all subgroups.ConclusionsOur data suggest that the patient-report MSNQ has potential as a measure of cognition in patients with low EDSS-scores but not in the medium and high EDSS ranges.

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An electronic, unsupervised patient-reported Expanded Disability Status Scale for multiple sclerosis

Multiple Sclerosis Journal ◽

10.1177/1352458520968814 ◽

2020 ◽

pp. 135245852096881

Author(s):

Andrew R Romeo ◽

William M Rowles ◽

Erica S Schleimer ◽

Patrick Barba ◽

Wan-Yu Hsu ◽

...

Keyword(s):

Multiple Sclerosis ◽

Clinical Care ◽

Expanded Disability Status Scale ◽

Clinical Assessments ◽

Patient Reported ◽

Disability Status ◽

Two Measures ◽

Highly Correlated ◽

Participation In Research ◽

Good Agreement

Background: In persons with multiple sclerosis (MS), the Expanded Disability Status Scale (EDSS) is the criterion standard for assessing disability, but its in-person nature constrains patient participation in research and clinical assessments. Objective: The aim of this study was to develop and validate a scalable, electronic, unsupervised patient-reported EDSS (ePR-EDSS) that would capture MS-related disability across the spectrum of severity. Methods: We enrolled 136 adult MS patients, split into a preliminary testing Cohort 1 ( n = 50), and a validation Cohort 2 ( n = 86), which was evenly distributed across EDSS groups. Each patient completed an ePR-EDSS either immediately before or after a MS clinician’s Neurostatus EDSS evaluation. Results: In Cohort 2, mean age was 50.6 years (range = 26–80) and median EDSS was 3.5 (interquartile range (IQR) = [1.5, 5.5]). The ePR-EDSS and EDSS agreed within 1-point for 86% of examinations; kappa for agreement within 1-point was 0.85 ( p < 0.001). The correlation coefficient between the two measures was 0.91 (<0.001). Discussion: The ePR-EDSS was highly correlated with EDSS, with good agreement even at lower EDSS levels. For clinical care, the ePR-EDSS could enable the longitudinal monitoring of a patient’s disability. For research, it provides a valid and rapid measure across the entire spectrum of disability and permits broader participation with fewer in-person assessments.

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Brain atrophy at onset and physical disability in multiple sclerosis

Arquivos de Neuro-Psiquiatria ◽

10.1590/s0004-282x2012001000003 ◽

2012 ◽

Vol 70 (10) ◽

pp. 765-768 ◽

Cited By ~ 7

Author(s):

Juan Ignacio Rojas ◽

Liliana Patrucco ◽

Cristina Besada ◽

Laura Bengolea ◽

Edgardo Cristiano

Keyword(s):

Multiple Sclerosis ◽

Magnetic Resonance ◽

Brain Atrophy ◽

Physical Disability ◽

Disease Onset ◽

First Year ◽

Expanded Disability Status Scale ◽

Disability Status

The aim of this study was to investigate if brain atrophy in multiple sclerosis (MS) patients during the disease onset predicts long term disability. METHODS: MS patients with follow-up time of at least 7 years from disease onset and with baseline and second magnetic resonance 12 months later were included to measure brain atrophy. Expanded Disability Status Scale (EDSS) was categorized in three groups, EDSS=0, EDSS=1 and 2.5 and EDSS>2.5, and used as disability measure. RESULTS: Twenty-six patients were included. Mean atrophy during the first year in patients that reached an EDSS≥3 was -0.76±0.45 %, in patients with an EDSS between 1 and 2.5 was -0.59±0.56, while in patients with an EDSS of 0 it was -0.38±0.42 (p=0.003). DISCUSSION: Brain atrophy rates during the first year of disease were predictive of disease progression in our population.

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Multiple Sclerosis: Associations Between Physical Disability and Depression Are Not Mediated by Self-Reported Physical Activity

Perceptual and Motor Skills ◽

10.1177/0031512517711851 ◽

2017 ◽

Vol 124 (5) ◽

pp. 974-991 ◽

Cited By ~ 1

Author(s):

Helene Merkt ◽

Dena Sadeghi Bahmani ◽

Pasquale Calabrese ◽

Yvonne Naegelin ◽

Markus Gerber ◽

...

Keyword(s):

Physical Activity ◽

Multiple Sclerosis ◽

Depressive Symptoms ◽

Physical Disability ◽

Rating Scales ◽

Activity Levels ◽

Expanded Disability Status Scale ◽

Symptoms Of Depression ◽

Disability Status ◽

Physical Activity Levels

This study investigated the interrelatedness of physical disability, physical activity, and depression among patients with multiple sclerosis (MS). We hypothesized that self-reported physical activity would mediate the effect of disability on depressive symptoms. Twenty-seven patients with MS (mean age: 49 years; 44.5% females) completed self-rating scales covering sociodemographic variables, intake of antidepressants, physical activity, and symptoms of depression; disability was measured by the Expanded Disability Status Scale. We found a higher level of disability to be significantly associated with more symptoms of depression. While higher reported physical activity was descriptively associated with lower depression scores and unrelated to Expanded Disability Status Scale, physical activity levels did not mediate the effect of disability on depressive symptoms.

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The Effect of an Eight-week Pilates Training on Interleukine-18 Level, Fatigue, and Balance in Women With Multiple Sclerosis

Journal of Research and Health ◽

10.32598/jrh.10.6.552.4 ◽

2020 ◽

Vol 10 (6) ◽

pp. 383-392

Author(s):

Soodabeh Asvar ◽

◽

Farzaneh Taghian ◽

Keyword(s):

Multiple Sclerosis ◽

Training Program ◽

Physical Disability ◽

Berg Balance Scale ◽

Control Group ◽

Expanded Disability Status Scale ◽

Interleukin 18 ◽

Disability Status ◽

Before And After ◽

Quasi Experimental

Background: Proinflammatory cytokines increasingly cause inflammation in patients with Multiple Sclerosis (MS). In this regard, the current study aimed to shed light on the effectiveness of an eight-week Pilates training program in the level of interleukin-18, the severity of fatigue, balance, and physical disability, in females with MS. Methods: This study was a quasi-experimental research with a pre-test-post-test design and a control group and conducted in Sirjan City, Iran. A total of 30 female MS patients (Mean±SD age: 30.15±6.97 years; 2≤ expanded disability status scale≤5.5) were selected using a purposeful sampling method and divided into control and experimental groups. The experimental group conducted the Pilates exercises for eight weeks, three sessions per week (lasting 45-60 minutes), while the control group had no regular physical activity. Before and after the training program, we evaluated fatigue, physical disability, and balance using the fatigue severity scale, the expanded disability status scale, and the Berg balance scale, respectively. Also, 5 mL of blood was taken from each participant to evaluate the interleukin-18 level. Then, the independent t-test was used to compare the pretest-posttest scores. Results: The findings indicated that the Pilates training program significantly decreased the level of interleukin-18, the severity of fatigue, and the score of physical disability (P≤0.05), and increased the balance (P≤0.05), in females with MS. Conclusion: Therefore, patients with MS can make the best use of such exercises to strengthen their immune systems and performances.

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Evaluation of the symbol digit modalities test (SDMT) and MS neuropsychological screening questionnaire (MSNQ) in natalizumab-treated MS patients over 48 weeks

Multiple Sclerosis Journal ◽

10.1177/1352458510378021 ◽

2010 ◽

Vol 16 (11) ◽

pp. 1385-1392 ◽

Cited By ~ 71

Author(s):

SA Morrow ◽

PW O'Connor ◽

CH Polman ◽

AD Goodman ◽

L Kappos ◽

...

Keyword(s):

Geographic Region ◽

Cognitive Tests ◽

Expanded Disability Status Scale ◽

Open Label ◽

Neuropsychological Screening ◽

Disease Modifying Therapy ◽

Monitoring Tools ◽

Small Effect Size ◽

Disability Status ◽

Monthly Changes

Background and Objectives: Brief cognitive tests to monitor cognitive impairment in patients with multiple sclerosis (MS) are needed. Methods: Performance on monthly administrations of the Symbol Digit Modalities Test (SDMT) and the MS Neuropsychological Questionnaire (MSNQ) was assessed in 660 patients with MS in 21 countries (109 sites) for 48 weeks in an open-label, safety-extension study of natalizumab. Results: At baseline, the cohort’s mean age was 40.1 years, 67.6% were female and the median Expanded Disability Status Scale score was 2.5. Test—retest correlations were high for both SDMT (range 0.89 for weeks 0—4 to 0.96 for weeks 44—48) and MSNQ (0.82 for weeks 0—4 to 0.93 for weeks 44—48). There were no statistically significant effects of geographic region. While SDMT scores improved by 15 points over 48 weeks ( p < 0.0001), incremental monthly changes were small (effect size d < 0.3). Similar results were obtained on the MSNQ except that scores moved downward, suggesting fewer cognitive complaints over 48 weeks ( p < 0.0001), but again the incremental monthly changes were small ( d <-0.2). Conclusions: These results replicate earlier work in a smaller cohort treated with conventional disease-modifying therapy, and support the reliability of the SDMT and MSNQ as potential screening for monitoring tools for cognition over time.

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Improvement of Comorbid Psoriasis in Patients With MS Treated With Natalizumab

Neurology Neuroimmunology & Neuroinflammation ◽

10.1212/nxi.0000000000000961 ◽

2021 ◽

Vol 8 (2) ◽

pp. e961

Author(s):

Regina Berkovich ◽

Aida Yakupova ◽

Jonathan Eskenazi ◽

Noel G. Carlson ◽

Lawrence Steinman

Keyword(s):

Additional Treatment ◽

Patient Records ◽

Expanded Disability Status Scale ◽

Disease Modifying Therapies ◽

Patient Reported ◽

Disability Status ◽

Disease Modifying ◽

Topical Treatments ◽

Initiation Of Therapy ◽

Ms Therapy

ObjectiveTo present observations on administration of natalizumab to 18 patients with the comorbid MS and psoriasis, who represented a full subset of patients with such comorbidity within the patient records available.MethodsA retrospective analysis of patient records was performed. Patient histories were gathered and included date of diagnosis of MS and psoriasis, MS disease-modifying therapies (DMTs), Expanded Disability Status Scale (EDSS), reason for DMT switch, and effects on MS and psoriasis status.ResultsOn initiation of natalizumab, all 18 patients had a complete cessation of MS disease activity (within 2–8 months) with significant patient-reported improvement of psoriasis (within 1–5 months). This improvement was independent of previous MS therapy and led to 15 of 18 patients needing no additional treatment for MS and psoriasis (remaining 3 patients continued to use topical treatments for psoriasis).ConclusionsIn this cohort of 18 patients with comorbid MS and psoriasis, beneficial results on both diseases were observed after initiation of therapy with natalizumab.

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Coping Strategies and Their Impact on Quality of Life and Physical Disability of People with Multiple Sclerosis

Journal of Clinical Medicine ◽

10.3390/jcm10235607 ◽

2021 ◽

Vol 10 (23) ◽

pp. 5607

Author(s):

Silvia Cerea ◽

Marta Ghisi ◽

Marco Pitteri ◽

Maddalena Guandalini ◽

Lauren B. Strober ◽

...

Keyword(s):

Quality Of Life ◽

Multiple Sclerosis ◽

Coping Strategies ◽

Physical Disability ◽

Disease Duration ◽

Expanded Disability Status Scale ◽

Positive Reappraisal ◽

General Distress ◽

Disability Status

The aim of the study is to investigate the impact of coping strategies on Health-Related Quality of Life (HRQoL) and physical disability assessed with the Expanded Disability Status Scale (EDSS) of people with multiple sclerosis (pwMS). PwMS were asked to focus on “MS diagnosis” as the core stressor. One hundred eight pwMS completed the Coping Responses Inventory-Adult form (CRI-Adult), the Multiple Sclerosis Quality of Life-29 (MSQoL-29), and the Depression Anxiety Stress Scale-21 (DASS-21). Multiple regression analyses (first block: EDSS, disease duration, and DASS-21) revealed that physical MSQoL-29 was positively associated with Alternative Rewards and negatively with Resigned Acceptance of the CRI-Adult. The mental MSQoL-29 was positively associated with Problem-Solving and negatively with Emotional Discharge. The Expanded Disability Status Scale (EDSS; first block: disease duration and general distress) was negatively associated with Positive Reappraisal. The Analysis of covariance (ANCOVA) revealed that pwMS with lower physical disability showed higher scores in Positive Reappraisal and lower scores in Emotional Discharge than pwMS with a higher physical disability. Coping strategies can play a role on HRQoL and physical disability in pwMS above and beyond EDSS, disease duration, and general distress. Psychological interventions should be considered in pwMS since the time of diagnosis to promote engagement in adaptive coping strategies and contrast the maladaptive ones.

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Use of Accelerometers to Measure Real-Life Physical Activity in Ambulatory Individuals with Multiple Sclerosis

International Journal of MS Care ◽

10.7224/1537-2073.2014-037 ◽

2015 ◽

Vol 17 (5) ◽

pp. 215-220 ◽

Cited By ~ 6

Author(s):

Cecilie Fjeldstad ◽

Anette S. Fjeldstad ◽

Gabriel Pardo

Keyword(s):

Physical Activity ◽

Multiple Sclerosis ◽

Physical Disability ◽

Real Life ◽

Study Cohort ◽

Significant Difference ◽

Disability Status ◽

Edss Score ◽

Life Circumstances ◽

Positive Correlations

Background: Multiple sclerosis (MS) may negatively affect individuals' participation in physical activity (PA). We used accelerometers to determine PA level in individuals with MS with varying degrees of disability as measured by the Expanded Disability Status Scale (EDSS) during regular daily activities. Methods: Participants wore an accelerometer from 8 a.m. to 9 p.m. for 7 consecutive days. Activity counts recorded during this period were analyzed in 1-minute epochs and categorized into one of four PA levels: light, moderate, hard, and very hard. Results: The study cohort comprised 13 patients with MS and 12 controls. There were significant negative correlations for minutes spent in PA and EDSS measures on weekdays (r = −0.61), weekend (r = −0.64), and full week (r = −0.61) and number of steps taken on weekdays (r = −0.56), weekend (r = −0.80), and full-week average (r = −0.68). Significant positive correlations were found for minutes spent in light PA and EDSS score (r = 0.69). Significant negative correlations were found for minutes spent in moderate and hard PA and EDSS score. No significant difference was seen between the MS group and controls on any parameters (P > .05). Conclusions: This study showed that accelerometers can be used to objectively quantify PA levels in individuals with MS with different disability levels. This cohort demonstrated that the amount of PA is inversely proportional to the degree of physical disability. Collected data revealed not only the amount but also the intensity of PA performed in real-life circumstances.

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The EDSS integration with the Brief International Cognitive Assessment for Multiple Sclerosis and orientation tests

Multiple Sclerosis Journal ◽

10.1177/1352458516677592 ◽

2016 ◽

Vol 23 (9) ◽

pp. 1289-1296 ◽

Cited By ~ 20

Author(s):

Francesco Saccà ◽

Teresa Costabile ◽

Antonio Carotenuto ◽

Roberta Lanzillo ◽

Marcello Moccia ◽

...

Keyword(s):

Multiple Sclerosis ◽

Cognitive Assessment ◽

Neuropsychological Tests ◽

Functional System ◽

Male Gender ◽

Cognitive Tests ◽

Expanded Disability Status Scale ◽

Everyday Clinical Practice ◽

Disability Status ◽

Lower Education

Objective: Despite cognitive tests have been validated in multiple sclerosis (MS), a neuropsychological evaluation is not implemented in the Expanded Disability Status Scale (EDSS) scoring. Methods: We used the Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS) and orientation tests (OTs) to measure the cerebral functional system (CFS) score and to evaluate its impact on the EDSS. We compared EDSS calculated as usual (Native-EDSS) and after the use of the BICAMS and OT (NPS-EDSS). Results: We tested 604 MS patients with BICAMS, OTs, and EDSS. In all, 384 patients (63.6%) had at least one altered test at the BICAMS. Older age, lower education, higher Native-EDSS, and male gender were independently associated with at least one impaired BICAMS test. Native-EDSS was different from NPS-EDSS (−0.112; p < 0.001) in 99 patients (16%). When considering patients with a Native-EDSS ⩽ 4.0, the proportion of miscalculated EDSS was 25%. Conclusion: The use of brief neuropsychological tests leads to a more accurate CFS assessment in two-thirds of MS patients, and a more accurate EDSS calculation in 25% of patients with a score ⩽4.0. This may help clinicians to better recognize cognitive impairment in everyday clinical practice, especially in the case of isolated cognitive worsening.

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Walking speed, rather than Expanded Disability Status Scale, relates to long-term patient-reported impact in progressive MS

Multiple Sclerosis Journal ◽

10.1177/1352458512454346 ◽

2012 ◽

Vol 19 (3) ◽

pp. 326-333 ◽

Cited By ~ 23

Author(s):

LVAE Bosma ◽

JJ Kragt ◽

CH Polman ◽

BMJ Uitdehaag

Keyword(s):

Multiple Sclerosis ◽

Psychological Impact ◽

Expanded Disability Status Scale ◽

Term Outcome ◽

Long Term Outcome ◽

Early Change ◽

Patient Reported ◽

Disability Status ◽

Physical Impact

Objective: To study the relationships between 1–2 year changes in well-known physician-rated measurements (Expanded Disability Status Scale (EDSS), Timed 25-Foot Walk (T25FW), 9-Hole Peg Test (9HPT)) and the long-term (≥ 5 years) outcome in patient-reported outcome (PRO) measures (Multiple Sclerosis Impact Scale (MSIS-29), Multiple Sclerosis Walking Scale (MSWS-12)) that reflect the patient-perceived impact of disease, in progressive MS. Methods: We selected all progressive patients having at least two complete visits within 1-2 years, from a larger cohort of prospectively-followed MS patients. These were invited for another visit, at least 5 years later, consisting of another series of similar examinations, plus 2 PRO scales: the MSIS-29 and MSWS-12. We explored associations between early changes in physician-rated measurements and the long-term outcome as per the PRO measures. Results: In this study,134 patients fulfilled the selection criteria. We found that early change in T25FW was the only physician-rated change that was significantly related to long-term physical impact experienced by the patient, as was assessed by MSIS-29 (Kruskal-Wallis test: χ2=7.8, p=0.020). Early T25FW change, and to a lesser degree early 9HPT change, were significantly related to the reported long-term walking limitations, as assessed by MSWS-12 (Kruskal-Wallis test: χ2=13.8 and p=0.001 for T25FW, χ2=6.5 and p=0.038 for 9HPT). None of the early physician-rated changes were related to the long-term psychological impact experienced by the patient. Conclusion: Early changes on physician-rated scales do have long-term impact in terms of potentially predictive value of outcomes for groups of patients in progressive MS, regarding walking limitations and more global physical impact. Surprisingly, early change in T25FW, rather than early change in EDSS, was significantly associated with longer-term patient-reported disease impact. Our study data support the value of using early physician-rated examinations in clinical trials in progressive MS.

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