Characterizing cognitive deficits and potential predictors in multiple sclerosis: A large nationwide study applying Brief International Cognitive Assessment for Multiple Sclerosis in standard clinical care

ABSTRACT:Background:Although cognitive deficits are frequent in multiple sclerosis (MS), screening for them with tools such as the Montreal Cognitive Assessment (MoCA) test is usually not performed unless there is a subjective complaint. The Multiple Sclerosis Neuropsychological Questionnaire (MSNQ) is among the instruments most commonly used to assess self-reported subjective complaints in MS. Nonetheless, it does not always accurately reflect cognitive status; many patients with cognitive deficits thus fail to receive appropriate referral for detailed neuropsychological evaluation. The objective of this study was to examine the validity of the MoCA test to detect the presence of objective cognitive deficits among patients with MS without subjective complaints using the Minimal Assessment of Cognitive Function in MS (MACFIMS) as the gold standard.Methods:The sample included 98 patients who were recruited from a university hospital MS clinic. The MSNQ was used to select patients without subjective cognitive complaints who also completed the MACFIMS, MoCA test and MSQOL-54.Results:23.5% of patients without subjective cognitive complaints had evidence of objective cognitive impairment on the MACFIMS (z score < -1.5 on two or more tests). The MoCA had a sensitivity of 87% and a specificity of 68% for detecting objective cognitive impairment in this patient population using a cut-off score of 27.Conclusion:A significant proportion of patients without self-reported cognitive impairment do have evidence of cognitive deficits on more exhaustive cognitive assessment. The MoCA is a rapid screening test that could be used to target patients for whom a more detailed neuropsychological assessment would be recommended.

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Cognition in multiple sclerosis

Neurology ◽

10.1212/wnl.0000000000004977 ◽

2018 ◽

Vol 90 (6) ◽

pp. 278-288 ◽

Cited By ~ 138

Author(s):

James F. Sumowski ◽

Ralph Benedict ◽

Christian Enzinger ◽

Massimo Filippi ◽

Jeroen J. Geurts ◽

...

Keyword(s):

Multiple Sclerosis ◽

Cognitive Deficits ◽

Cognitive Rehabilitation ◽

Clinical Care ◽

Theoretical Models ◽

Scientific Basis ◽

Evidence Based ◽

Extensive Literature ◽

Current State ◽

Neural Bases

Cognitive decline is recognized as a prevalent and debilitating symptom of multiple sclerosis (MS), especially deficits in episodic memory and processing speed. The field aims to (1) incorporate cognitive assessment into standard clinical care and clinical trials, (2) utilize state-of-the-art neuroimaging to more thoroughly understand neural bases of cognitive deficits, and (3) develop effective, evidence-based, clinically feasible interventions to prevent or treat cognitive dysfunction, which are lacking. There are obstacles to these goals. Our group of MS researchers and clinicians with varied expertise took stock of the current state of the field, and we identify several important practical and theoretical challenges, including key knowledge gaps and methodologic limitations related to (1) understanding and measurement of cognitive deficits, (2) neuroimaging of neural bases and correlates of deficits, and (3) development of effective treatments. This is not a comprehensive review of the extensive literature, but instead a statement of guidelines and priorities for the field. For instance, we provide recommendations for improving the scientific basis and methodologic rigor for cognitive rehabilitation research. Toward this end, we call for multidisciplinary collaborations toward development of biologically based theoretical models of cognition capable of empirical validation and evidence-based refinement, providing the scientific context for effective treatment discovery.

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Validation of the Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS) in the Russian Population

Journal of the International Neuropsychological Society ◽

10.1017/s1355617721000722 ◽

2021 ◽

pp. 1-8

Author(s):

Evgeniy Evdoshenko ◽

Kristina Laskova ◽

Maria Shumilina ◽

Ekaterina Nekrashevich ◽

Maria Andreeva ◽

...

Keyword(s):

Multiple Sclerosis ◽

Cognitive Assessment ◽

Verbal Learning ◽

Cognitive Status ◽

Russian Population ◽

Cognitive Domain ◽

Control Group ◽

Retest Reliability ◽

Valid Instrument ◽

Test Retest Reliability

Abstract Objective: Cognitive dysfunction is common in multiple sclerosis (MS). The Brief International Cognitive Assessment for MS (BICAMS) battery of tests has been suggested as a measure for the evaluation of the cognitive status of MS patients. This study aims to validate the BICAMS battery in the Russian population of MS patients. Methods: Age- and sex-matched MS patients (n = 98) and healthy individuals (n = 86) were included in the study. Symbol Digit Modalities Test (SDMT), California Verbal Learning Test, 2nd edition (CVLT-II) and the Brief Visuospatial Memory Test – Revised (BVMT-R) were administered to all participants. The battery was readministered 1 month later to 44 MS patients to investigate the test–retest reliability. Results: MS patients exhibited a significantly lower performance in testing with BICAMS than the control group in all three neuropsychological tests. Test–retest reliability was good for SDMT and CVLT-II (r = .82 and r = .85, respectively) and adequate for BVMT-R (r = .70). Based on the proposed criterion for impairment as z score below 1.5 SD the mean of the control group, we found that 34/98 (35%) of MS patients were found impaired at least in one cognitive domain. Patients with Expanded Disability Status Scale score ≥3.5 performed significantly worse than controls (SDMT, p < .0001; CVLT–II, p = .03; BVMT-R, p = .0004), while those with ≤3.0 scores did not. Conclusion: This study demonstrates that the BICAMS battery is a valid instrument to identify cognitive impairment in MS patients and it can be recommended for routine use in the Russian Federation.

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Visual deficits and cognitive assessment of multiple sclerosis: confounder, correlate, or both?

Journal of Neurology ◽

10.1007/s00415-021-10437-5 ◽

2021 ◽

Author(s):

Dejan Jakimovski ◽

Ralph H. B. Benedict ◽

Bianca Weinstock-Guttman ◽

Osman Ozel ◽

Tom A. Fuchs ◽

...

Keyword(s):

Multiple Sclerosis ◽

Cognitive Assessment ◽

Visual Deficits

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The Brief International Cognitive Assessment in Multiple Sclerosis (BICAMS): Validation in Arabic and Lebanese Normative Values

Journal of the International Neuropsychological Society ◽

10.1017/s1355617721000102 ◽

2021 ◽

pp. 1-10

Author(s):

Hala Darwish ◽

Pia Zeinoun ◽

Natali Farran ◽

Husam Ghusn ◽

Bassem Yamout ◽

...

Keyword(s):

Multiple Sclerosis ◽

Psychometric Properties ◽

Cognitive Assessment ◽

Healthy Subjects ◽

Good Evidence ◽

Normative Values ◽

Arabic Version ◽

Retest Reliability ◽

Test Retest Reliability ◽

Healthy Participants

Abstract Objective: Multiple sclerosis (MS) is often associated with cognitive deficits. Accurate evaluation of the MS patients’ cognitive performance is essential for diagnosis and treatment recommendation. The Brief International Cognitive Assessment in Multiple Sclerosis (BICAMS), widely used cognitive testing battery, examines processing speed, verbal and visuospatial learning, and memory. Our study aims to examine the psychometric properties of an Arabic version of the BICAMS and to provide normative values in a Lebanese sample. Method: The BICAMS, comprised of the Symbol Digit Modalities Test (SDMT), Brief Visuospatial Memory Test-Revised (BVMT-R), and a newly developed verbal learning/memory test, the Verbal Memory Arabic Test (VMAT), were administered on healthy subjects and MS patients. The sample consisted of 180 healthy individuals, of whom 63 were retested after 2–3 weeks. Forty-three MS patients matched with 43 healthy subjects based on age, sex, and years of education were assessed. A sample of 10 MS patients was also examined on two occasions. Test–retest reliability and criterion-related validity were examined, and regression-based norms were derived. Results: The test–retest correlations showed good evidence of reliability with coefficients ranging between 0.64 and 0.73 in the healthy sample, and between 0.43 and 0.92 in the MS sample. The BICAMS was able to discriminate between MS patients and matched healthy participants on the SDMT and BVMT-R. Normative data were comparable to other studies. Conclusions: This new Arabic version of the BICAMS shows initial good psychometric properties. While good evidence of VMAT’s reliability was shown in the healthy participants, less test–retest reliability in this tool was seen in the MS group, and partial criterion-related validity was evident. This renders further examination of the VMAT. We provide regression-based norms for a Lebanese sample and encourage the use of this battery in both research and clinical settings.

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Multiple sclerosis in twins from continental Italy and Sardinia: A nationwide study

Annals of Neurology ◽

10.1002/ana.20683 ◽

2005 ◽

Vol 59 (1) ◽

pp. 27-34 ◽

Cited By ~ 48

Author(s):

Giovanni Ristori ◽

Stefania Cannoni ◽

Maria Antonietta Stazi ◽

Nicola Vanacore ◽

Rodolfo Cotichini ◽

...

Keyword(s):

Multiple Sclerosis ◽

Nationwide Study

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Klinische Umsetzbarkeit der kognitiven Screeningbatterie BICAMS bei Patienten mit Multipler Sklerose: Ergebnisse der Machbarkeitsstudie in Deutschland

Der Nervenarzt ◽

10.1007/s00115-021-01073-5 ◽

2021 ◽

Author(s):

Iris-Katharina Penner ◽

Melanie Filser ◽

Sharon Jean Bätge ◽

Alina Renner ◽

Sebastian Ullrich ◽

...

Keyword(s):

Multiple Sclerosis ◽

Cognitive Assessment ◽

Medizinische Fachangestellte

Zusammenfassung Hintergrund Patienten mit Multipler Sklerose (MS) leiden in 40–70 % der Fälle unter kognitiven Störungen. Der kognitive Status gilt erwiesenermaßen als Prädiktor für Berufsfähigkeit und frühzeitige Berentung. Eine regelmäßige Erfassung der kognitiven Leistungsfähigkeit ist somit dringend indiziert. Zielsetzung Die deutsche Fassung der international empfohlenen BICAMS (Brief International Cognitive Assessment for Multiple Sclerosis) -Batterie wurde auf Praktikabilität in der klinischen Routine neurologischer Praxen in Deutschland multizentrisch überprüft. Material und Methoden Medizinische Fachangestellte (MFAs) wurden hinsichtlich der Durchführung und Auswertung von BICAMS geschult. Alle ausgewerteten Testbögen wurden von unabhängigen neuropsychologischen Experten überprüft. Ergebnisse Insgesamt 1606 BICAMS-Datensätze wurden in 65 Zentren erhoben. Von diesen konnten 1573 analysiert werden. 49,7 % der erhobenen Datensätze wurden inklusive aller Auswerteschritte korrekt durchgeführt. Bei den anderen 50,3 % fanden sich Durchführungs‑, Auswerte- oder Transformationsfehler. Nach Bereinigung der Stichprobe durch fehlerbehaftete Fälle ergaben sich Werte der Interrater-Reliabilität pro Testverfahren in Höhe von ICC $$\geq$$ ≥ 0,953. Diskussion Grundsätzlich ist BICAMS für den Einsatz im klinischen Alltag sehr zu empfehlen. Es bleibt allerdings zu betonen, dass obgleich die Interrater-Reliabilität für die final bereinigte Stichprobe sehr hoch war, im Gesamtdatensatz 50,3 % Durchführungs‑, Auswerte- oder Transformationsfehler gefunden wurden. Daraus lässt sich die Notwendigkeit ableiten, nichtpsychologisches Personal noch eingehender in der Anwendung und Auswertung von BICAMS durch Experten zu schulen und zu supervidieren.

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Perceived Cognitive Deficits in a Sample of Persons Living With Multiple Sclerosis

Journal of Neuroscience Nursing ◽

10.1097/jnn.0000000000000314 ◽

2017 ◽

Vol 49 (5) ◽

pp. 274-279 ◽

Cited By ~ 3

Author(s):

Ashley Henneghan ◽

Alexa Stuifbergen ◽

Heather Becker ◽

Vicki Kullberg ◽

Nicole Gloris

Keyword(s):

Multiple Sclerosis ◽

Cognitive Deficits

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Brain Function Assessment of Patients with Multiple Sclerosis in the Expanded Disability Status Scale

International Journal of MS Care ◽

10.7224/1537-2073.2018-084 ◽

2020 ◽

Vol 22 (1) ◽

pp. 31-35

Author(s):

Ricardo N. Alonso ◽

Maria B. Eizaguirre ◽

Berenice Silva ◽

Maria C. Pita ◽

Cecilia Yastremiz ◽

...

Keyword(s):

Multiple Sclerosis ◽

Brain Function ◽

Cognitive Assessment ◽

Functional System ◽

Expanded Disability Status Scale ◽

Disability Status ◽

Before And After ◽

Survey Results ◽

Edss Score ◽

The Brain

Abstract Background: There is no consensus regarding assessment of the brain function functional system (FS) of the Expanded Disability Status Scale (EDSS) in patients with multiple sclerosis (MS). We sought to describe brain function FS assessment criteria used by Argentinian neurologists and, based on the results, propose redefined brain function FS criteria. Methods: A structured survey was conducted of 113 Argentinian neurologists. Considering the survey results, we decided to redefine the brain function FS scoring using the Brief International Cognitive Assessment for MS (BICAMS) battery. For 120 adult patients with MS we calculated the EDSS score without brain function FS (basal EDSS) and compared it with the EDSS score after adding the modified brain function FS (modified EDSS). Results: Of the 93 neurologists analyzed, 14% reported that they did not assess brain function FS, 35% reported that they assessed it through a nonstructured interview, and the remainder used other tools. Significant differences were found in EDSS scores before and after the inclusion of BICAMS (P < .001). Redefining the brain function FS, 15% of patients modified their basal EDSS score, as did 20% of those with a score of 4.0 or less. Conclusions: The survey results show the importance of unifying the brain function FS scoring criteria in calculating the EDSS score. While allowing more consistent brain function FS scoring, including the modified brain function FS led to a change in EDSS score in many patients, particularly in the lower range of EDSS scores. Considering the relevance of the EDSS for monitoring patients with MS and for decision making, it is imperative to further validate the modified brain function FS scoring.

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The Impact of Cognitive Deficits and Spasticity on Driving Simulator Performance in Multiple Sclerosis

10.17077/drivingassessment.1160 ◽

2005 ◽

Author(s):

Thomas D Marcotte ◽

Theodore J Rosenthal ◽

Jody Corey-Bloom ◽

Erica Roberts ◽

Sara Lampinen ◽

...

Keyword(s):

Multiple Sclerosis ◽

Cognitive Deficits ◽

Driving Simulator ◽

The Impact

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