Interpreting change on the Symbol Digit Modalities Test in people with relapsing multiple sclerosis using the reliable change methodology

Background: The Symbol Digit Modalities Test (SDMT) is increasingly utilized in clinical trials. A SDMT score change of 4 points is considered clinically important, based on association with employment anchors. Optimal thresholds for statistically reliable SDMT changes, accounting for test reliability and measurement error, are yet to be applied to individual cases. Objective: The aim of this study was to derive a statistically reliable marker of individual change on the SDMT. Methods: This prospective, case–control study enrolled 166 patients with multiple sclerosis (MS). SDMT scores at baseline, relapse, and 3-month follow-up were compared between relapsing and stable patient groups. Using data from the stable group and three previously published studies, candidate thresholds for reliable decline were calculated and validated against other tests and a clinically meaningful anchor—cognitive relapse. Results: Candidate thresholds for reliable decline at the 80% confidence level varied between 6 and 11 points. An SDMT change of 8 or more raw score points was deemed to offer the best balance of discriminatory power and external validity for estimating cognitive decline. Conclusion: This study illustrates the feasibility and usefulness of reliable change methodology for identifying statistically meaningful cognitive decline that could be implemented to identify change in individual patients, for both clinical management and clinical trial outcomes.

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Whole Brain Tract Disruption Better Explains Cognitive Decline in Multiple Sclerosis than Total Lesion Volume

10.26226/morressier.59a3e8b7d462b8028d895711 ◽

2017 ◽

Author(s):

Tom Fuchs

Keyword(s):

Multiple Sclerosis ◽

Cognitive Decline ◽

Lesion Volume ◽

Whole Brain

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Faculty Opinions recommendation of Cortical atrophy accelerates as cognitive decline worsens in multiple sclerosis.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.736558681.793568404 ◽

2019 ◽

Author(s):

Peter Stys

Keyword(s):

Multiple Sclerosis ◽

Cognitive Decline ◽

Cortical Atrophy

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Attitudinal Change, Cohort Replacement, and the Liberalization of Attitudes about Same-sex Relationships, 1973–2018

Sociological Perspectives ◽

10.1177/0731121421994858 ◽

2021 ◽

pp. 073112142199485

Author(s):

Ashley Wendell Kranjac ◽

Robert L. Wagmiller

Keyword(s):

Social Change ◽

General Social Survey ◽

Individual Change ◽

Same Sex ◽

Social Survey ◽

Same Sex Marriage ◽

Population Turnover ◽

Demographic Processes ◽

Lesbian And Gay Rights ◽

Using Data

Americans’ attitudes toward same-sex relationships have liberalized considerably over the last 40 years. We examine how the demographic processes generating social change in attitudes toward same-sex relationships changed over time. Using data from the 1973 to 2018 General Social Survey and decomposition techniques, we estimate the relative contributions of intracohort change and cohort replacement to overall social change for three different periods. We examine (1) the period prior to the rapid increase in attitude liberalization toward same-sex marriage rights (1973–1991), (2) the period of contentious debate about same-sex marriage and lesbian and gay rights (1991–2002), and (3) the period of legislative and judicial liberalization at the state and federal levels (2002–2018). We find that both intracohort and intercohort change played positive and significant roles in the liberalization of attitudes toward same-sex relationships in the postlegalization period, but that individual change was more important than population turnover over this period.

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Cognitive Issues in Pediatric Multiple Sclerosis

Brain Sciences ◽

10.3390/brainsci11040442 ◽

2021 ◽

Vol 11 (4) ◽

pp. 442

Author(s):

Emilio Portaccio ◽

Ermelinda De Meo ◽

Angelo Bellinvia ◽

Maria Pia Amato

Keyword(s):

Multiple Sclerosis ◽

Cognitive Impairment ◽

Cognitive Decline ◽

Pediatric Patients ◽

Leisure Activities ◽

Disease Onset ◽

Cognitive Profiles ◽

Brain Growth ◽

Network Activation ◽

Definition Of

Multiple sclerosis (MS) is one of the leading causes of disability in young adults. The onset of MS during developmental age makes pediatric patients particularly susceptible to cognitive impairment, resulting from both disease-related damage and failure of age-expected brain growth. Despite different test batteries and definitions, cognitive impairment has been consistently reported in approximately one-third of pediatric patients with MS. However, the lack of a uniform definition of cognitive impairment and the adoption of different test batteries have led to divergent results in terms of cognitive domains more frequently affected across the cohorts explored. This heterogeneity has hampered large international collaborative studies. Moreover, research aimed at the identification of risk factors (e.g., demographic, clinical, and radiological features) or protective factors (e.g., cognitive reserve, leisure activities) for cognitive decline is still scanty. Mood disorders, such as depression and anxiety, can be detected in these patients alongside cognitive decline or in isolation, and can negatively affect quality of life scores as well as academic performances. By using MRI, cognitive impairment was attributed to damage to specific brain compartments as well as to abnormal network activation patterns. However, multimodal MRI studies are still needed in order to assess the contribution of each MRI metric to cognitive impairment. Importantly, longitudinal studies have recently demonstrated failure of age-expected brain growth and of white matter (WM) and gray matter (GM) maturation plays a relevant role in determining cognitive dysfunction, in addition to MS-related direct damage. Whether these growth retardations might result in specific cognitive profiles according to the age at disease onset has not been studied, yet. A better characterization of cognitive profiles in pediatric MS patients, as well as the definition of neuroanatomical substrates of cognitive impairment and their longitudinal evolution are needed to develop efficient therapeutic strategies against cognitive impairment in this patient population.

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Long-term effectiveness in patients previously treated with cladribine tablets: a real-world analysis of the Italian multiple sclerosis registry (CLARINET-MS)

Therapeutic Advances in Neurological Disorders ◽

10.1177/1756286420922685 ◽

2020 ◽

Vol 13 ◽

pp. 175628642092268 ◽

Cited By ~ 1

Author(s):

Francesco Patti ◽

Andrea Visconti ◽

Antonio Capacchione ◽

Sanjeev Roy ◽

Maria Trojano ◽

...

Keyword(s):

Multiple Sclerosis ◽

Real World ◽

Event Analysis ◽

Treatment Change ◽

Real World Data ◽

Indirect Measure ◽

Disease Modifying Drugs ◽

Disease Modifying ◽

Using Data

Background: The CLARINET-MS study assessed the long-term effectiveness of cladribine tablets by following patients with multiple sclerosis (MS) in Italy, using data from the Italian MS Registry. Methods: Real-world data (RWD) from Italian MS patients who participated in cladribine tablets randomised clinical trials (RCTs; CLARITY, CLARITY Extension, ONWARD or ORACLE-MS) across 17 MS centres were obtained from the Italian MS Registry. RWD were collected during a set observation period, spanning from the last dose of cladribine tablets during the RCT (defined as baseline) to the last visit date in the registry, treatment switch to other disease-modifying drugs, date of last Expanded Disability Status Scale recording or date of the last relapse (whichever occurred last). Time-to-event analysis was completed using the Kaplan–Meier (KM) method. Median duration and associated 95% confidence intervals (CI) were estimated from the model. Results: Time span under observation in the Italian MS Registry was 1–137 (median 80.3) months. In the total Italian patient population ( n = 80), the KM estimates for the probability of being relapse-free at 12, 36 and 60 months after the last dose of cladribine tablets were 84.8%, 66.2% and 57.2%, respectively. The corresponding probability of being progression-free at 60 months after the last dose was 63.7%. The KM estimate for the probability of not initiating another disease-modifying treatment at 60 months after the last dose of cladribine tablets was 28.1%, and the median time-to-treatment change was 32.1 (95% CI 15.5–39.5) months. Conclusion: CLARINET-MS provides an indirect measure of the long-term effectiveness of cladribine tablets. Over half of MS patients analysed did not relapse or experience disability progression during 60 months of follow-up from the last dose, suggesting that cladribine tablets remain effective in years 3 and 4 after short courses at the beginning of years 1 and 2.

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Bidirectional Association Between Depression and Hearing Loss: Evidence From the China Health and Retirement Longitudinal Study

Journal of Applied Gerontology ◽

10.1177/07334648211042370 ◽

2021 ◽

pp. 073346482110423

Author(s):

Chao Wu

Keyword(s):

Hearing Loss ◽

Longitudinal Study ◽

Cognitive Decline ◽

Age Related ◽

Bidirectional Association ◽

Health Related ◽

Clinically Significant ◽

Using Data ◽

Bidirectional Associations ◽

Age Related Hearing Loss

The relationship between depression and age-related hearing loss (ARHL) is not fully understood. This study tested the bidirectional associations between clinically significant depressive symptoms (CSDSs) and ARHL in middle-aged and older adults using data from the China Health and Retirement Longitudinal Study. Among 3,418 participants free of baseline ARHL, baseline CSDS was associated with an increased odds of incident ARHL (odds ratio [OR]: 1.51). Cognitive decline, BMI, and arthritis partially mediated the longitudinal CSDS–ARHL association and explained 24% of the variance in the total effect. Among 4,921 participants without baseline CSDS, baseline ARHL was associated with an increased odds of incident CSDS (OR: 1.37). The bidirectional associations remained significant after adjustments for baseline demographic factors, comorbidities, and other health-related covariates. Depression may contribute to the development of ARHL, and vice versa. Interventions in depression, cognitive decline, and arthritis may delay the onset of ARHL and break the vicious circle between them.

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Cognitive reserve moderates the impact of subcortical gray matter atrophy on neuropsychological status in multiple sclerosis

Multiple Sclerosis Journal ◽

10.1177/1352458515579443 ◽

2015 ◽

Vol 22 (1) ◽

pp. 36-42 ◽

Cited By ~ 39

Author(s):

Claire M Modica ◽

Niels Bergsland ◽

Michael G Dwyer ◽

Deepa P Ramasamy ◽

Ellen Carl ◽

...

Keyword(s):

Multiple Sclerosis ◽

Cognitive Decline ◽

Cognitive Processing ◽

Gray Matter ◽

Cognitive Reserve ◽

Cognitive Outcome ◽

Brain Reserve ◽

The Impact ◽

Normal Controls

Background: Cognitive decline is characterized in multiple sclerosis (MS), but the rate and severity vary. The reserve hypothesis proposes that baseline neurological differences impact cognitive outcome in neurodegenerative disease. Objective: To elucidate how brain reserve and cognitive reserve influence subcortical gray matter (SCGM) atrophy and cognitive decline in MS over 3 years. Methods: Seventy-one MS patients and 23 normal controls underwent magnetic resonance imaging and cognitive assessment at baseline and 3-year follow-up. The influence of reserve on cognitive processing speed (CPS) and memory was examined. Results: SCGM volume and cognitive scores were lower in MS than normal controls ( P⩽0.001). Accounting for baseline, comparison of follow-up means yielded a difference between groups in SCGM volume ( P<0.001) but not cognition (NS). Cognitive reserve ( P=0.005), but not brain reserve, contributed to CPS, with only low cognitive reserve MS subjects showing decline in CPS ( P=0.029). SCGM change predicted CPS outcome in MS with low cognitive reserve ( P=0.002) but not high cognitive reserve. There were no effects in the domain of memory. Conclusions: SCGM atrophy occurs in normal controls, but significantly more so in MS. While CPS did not change in normal controls, low cognitive reserve was associated with CPS decline in MS. High cognitive reserve protect MS patients from cognitive decline related to SCGM atrophy.

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Differential Diagnosis of Cognitive Decline in Elderly Individuals With Multiple Sclerosis

Cognitive and Behavioral Neurology ◽

10.1097/wnn.0000000000000252 ◽

2020 ◽

Vol 33 (4) ◽

pp. 294-300

Author(s):

Dejan Jakimovski ◽

Kinga Szigeti ◽

Michael Jaworski ◽

Aya Ouf ◽

Bianca Weinstock-Guttman ◽

...

Keyword(s):

Multiple Sclerosis ◽

Differential Diagnosis ◽

Cognitive Decline ◽

Elderly Individuals

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An interpretative phenomenological analysis of dignity in people with multiple sclerosis

Nursing Ethics ◽

10.1177/0969733019897766 ◽

2020 ◽

Vol 27 (3) ◽

pp. 686-700 ◽

Cited By ~ 1

Author(s):

Katarína Žiaková ◽

Juraj Čáp ◽

Michaela Miertová ◽

Elena Gurková ◽

Radka Kurucová

Keyword(s):

Multiple Sclerosis ◽

Lived Experience ◽

Interpretative Phenomenological Analysis ◽

Negative Impact ◽

Phenomenological Analysis ◽

Face To Face ◽

Fighting Spirit ◽

Negative Effect ◽

Using Data

Background: Dignity is a fundamental concept in healthcare. The symptoms of multiple sclerosis have a negative effect on dignity. Understanding of lived experience of dignity in people with multiple sclerosis is crucial to support dignity in practice. Research aim: The aim was to explore the sense of dignity experienced by people with multiple sclerosis. Research design and participants: An interpretative phenomenological analysis design was adopted, using data collected through face-to-face interviews with 14 participants. Ethical considerations: The study was approved by the faculty Ethical Committee (No. EC 1828/2016). Findings: Four interconnected superordinate themes emerged from analysis: Loss of a fully-fledged life: Violating the dignity-of-self; To accept and fight: Promoting the dignity-of-self; Contempt and rudeness: Indignity-in-relation; and Those who know and see, help: Promoting dignity-in-relation. The loss of former fully-fledged life has a dramatic impact on integrity and impaired dignity-of-self. Accepting illness and changed identity impaired by multiple sclerosis was the step that the participants considered to be important for reacquiring the sense of dignity. The participants encountered misunderstandings, prejudices, embarrassment, insensitive remarks, labelling, unwillingness and impersonal treatment as indignities. Acceptance of their condition, needed support, the feeling of being part of a group, sensitivity and the sharing of problems had a positive effect on their dignity. Discussion: Continual changes in functional ability threaten an individual’s identity and were experienced as violations of dignity. Based on this, participant’s dignity-of-self was not a moral, but much more existential value. Acceptance of changed identity and fighting spirit were important for restoring their dignity-of-self. The misunderstandings, prejudices and unwillingness had a negative impact on their dignity-in-relation. On the other side, support from others in fighting promoted their dignity-in-relation. Conclusion: Dignity is manifested as a complex phenomenon of lived experience of people with multiple sclerosis and also an umbrella concept for providing good quality of person-centred care.

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