The Paced Auditory Serial Addition Task (PASAT): normative data for the Italian population

The Paced Auditory Serial Addition Task (PASAT) is a neuropsychological instrument designed to measure attention, working memory and speed of information processing in a complex manner. It is currently used to evaluate different neurological diseases. the purpose of this study was to establish PASAT normative data for the healthy Italian population using the standardized methodology of Equivalents Scores. the brief PASAT auditory version included in the Multiple Sclerosis Functional Composite was administered to 146 healthy Italian participants, distributed for gender (70 men; 76 women), age (range 18-83) and education (8-19). We found that age and education, but not gender, were significant PASAT score predictors. PASAT normative Italian data may represent a useful application for clinicians and researchers to document mild executive deficits in different neurological populations.

Application of an Adaptive, Digital, Game-Based Approach for Cognitive Assessment in Multiple Sclerosis: Observational Study

Background Cognitive impairment is one of the most debilitating manifestations of multiple sclerosis. Currently, the assessment of cognition relies on a time-consuming and extensive neuropsychological examination, which is only available in some centers. Objective To enable simpler, more accessible cognitive screening, we sought to determine the feasibility and potential assessment sensitivity of an unsupervised, adaptive, video game–based digital therapeutic to assess cognition in multiple sclerosis. Methods A total of 100 people with multiple sclerosis (33 with cognitive impairment and 67 without cognitive impairment) and 24 adults without multiple sclerosis were tested with the tablet game (EVO Monitor) and standard measures, including the Brief International Cognitive Assessment for Multiple Sclerosis (which included the Symbol Digit Modalities Test [SDMT]) and Multiple Sclerosis Functional Composite 4 (which included the Timed 25-Foot Walk test). Patients with multiple sclerosis also underwent neurological evaluations and contributed recent structural magnetic resonance imaging scans. Group differences in EVO Monitor performance and the association between EVO Monitor performance and standard measures were investigated. Results Participants with multiple sclerosis and cognitive impairment showed worse performance in EVO Monitor compared with participants without multiple sclerosis (P=.01) and participants with multiple sclerosis without cognitive impairment (all P<.002). Regression analyses indicated that participants with a lower SDMT score showed lower performance in EVO Monitor (r=0.52, P<.001). Further exploratory analyses revealed associations between performance in EVO Monitor and walking speed (r=–0.45, P<.001) as well as brain volumetric data (left thalamic volume: r=0.47, P<.001; right thalamic volume: r=0.39, P=.002; left rostral middle frontal volume: r=0.28, P=.03; right rostral middle frontal volume: r=0.27, P=.03). Conclusions These findings suggest that EVO Monitor, an unsupervised, video game–based digital program integrated with adaptive mechanics, is a clinically valuable approach to measuring cognitive performance in patients with multiple sclerosis. Trial Registration ClinicalTrials.gov NCT03569618; https://clinicaltrials.gov/ct2/show/NCT03569618

Application of an Adaptive, Digital, Game-Based Approach for Cognitive Assessment in Multiple Sclerosis: Observational Study (Preprint)

BACKGROUND Cognitive impairment is one of the most debilitating manifestations of multiple sclerosis. Currently, the assessment of cognition relies on a time-consuming and extensive neuropsychological examination, which is only available in some centers. OBJECTIVE To enable simpler, more accessible cognitive screening, we sought to determine the feasibility and potential assessment sensitivity of an unsupervised, adaptive, video game–based digital therapeutic to assess cognition in multiple sclerosis. METHODS A total of 100 people with multiple sclerosis (33 with cognitive impairment and 67 without cognitive impairment) and 24 adults without multiple sclerosis were tested with the tablet game (EVO Monitor) and standard measures, including the Brief International Cognitive Assessment for Multiple Sclerosis (which included the Symbol Digit Modalities Test [SDMT]) and Multiple Sclerosis Functional Composite 4 (which included the Timed 25-Foot Walk test). Patients with multiple sclerosis also underwent neurological evaluations and contributed recent structural magnetic resonance imaging scans. Group differences in EVO Monitor performance and the association between EVO Monitor performance and standard measures were investigated. RESULTS Participants with multiple sclerosis and cognitive impairment showed worse performance in EVO Monitor compared with participants without multiple sclerosis (<i>P</i>=.01) and participants with multiple sclerosis without cognitive impairment (all <i>P</i>&lt;.002). Regression analyses indicated that participants with a lower SDMT score showed lower performance in EVO Monitor (<i>r</i>=0.52, <i>P</i>&lt;.001). Further exploratory analyses revealed associations between performance in EVO Monitor and walking speed (<i>r</i>=–0.45, <i>P</i>&lt;.001) as well as brain volumetric data (left thalamic volume: <i>r</i>=0.47, <i>P</i>&lt;.001; right thalamic volume: <i>r</i>=0.39, <i>P</i>=.002; left rostral middle frontal volume: <i>r</i>=0.28, <i>P</i>=.03; right rostral middle frontal volume: <i>r</i>=0.27, <i>P</i>=.03). CONCLUSIONS These findings suggest that EVO Monitor, an unsupervised, video game–based digital program integrated with adaptive mechanics, is a clinically valuable approach to measuring cognitive performance in patients with multiple sclerosis. CLINICALTRIAL ClinicalTrials.gov NCT03569618; https://clinicaltrials.gov/ct2/show/NCT03569618

Der Multiple Sclerosis Functional Composite korreliert mit der sozialmedizinischen Leistungsempfehlung zur Erwerbsfähigkeit von Rehabilitanden mit Multipler Sklerose

Zusammenfassung Ziel der Studie Der Multiple Sclerosis Functional Composite (MSFC) bewertet mit den Untertests Lauf- und Handfunktion sowie Kognition die Funktionseinschränkungen der Multiplen Sklerose (MS). In der medizinischen Rehabilitation könnte der MSFC sich als hilfreiches Assessmentinstrument für die sozialmedizinische Leistungsempfehlung zur Erwerbsfähigkeit (SLE) am Ende der stationären Rehabilitation erweisen. Ziel der Studie war, eine Korrelation des MSFC mit der SLE zu überprüfen, deren Gültigkeit sechs Monate nach der Rehabilitation erfragt wurde. Methodik In einer retrospektiven, unizentrischen Längsschnittstudie wurde der MSFC zu Beginn (t0) und zum Ende (t1) der stationären Rehabilitation bei 84 Rehabilitanden mit MS im erwerbsfähigen Alter erhoben. Der MSFC (Gesamtscore, Untertests) wurde mit der SLE am Ende der Rehabilitation korreliert (positive SLE: ≥ 3h täglich, negative SLE: < 3h täglich). Sechs Monate nach der Rehabilitation wurde der Return to Work (RTW) erfragt (positiver RTW: ≥ 3h täglich, negativer RTW: < 3h täglich). Ergebnis 70 der 84 Rehabilitanden (83 %) erhielten eine positive SLE. Sie zeigten hinsichtlich epidemiologischer, MS- und rehabilitations-spezifischer Charakteristika keinen Unterschied zu den 14 Rehabilitanden mit negativer SLE. Rehabilitanden mit positiver SLE wiesen im Vergleich zu denen mit negativer SLE signifikant bessere MSFC-Werte im Gesamtscore (z-Score: + 0,11 vs. −0,55, p < 0,001), in den Untertests Kognition (PASAT-3: 42,3 Punkte vs. 27,7 Punkte; p < 0,001) und Lauffunktion (T25FW: 5,1 s vs. 6,7s; p = 0,002) auf. Hingegen war die Handfunktion (NHPT: 23,4 s vs. 26,5s; p = 0,064) ohne signifikanten Unterschied. Beide Gruppen zeigten im Verlauf der Rehabilitation (t0; t1) nichtsignifikante Verbesserungen (Gesamtscore, Untertests). Bei 31 der 84 Rehabilitanden (37 %) konnte der RTW nach sechs Monaten erhoben werden. 90 % der 31 Rehabilitanden beurteilten die SLE als zutreffend. Eine positive SLE korrelierte signifikant mit einem positiven RTW nach sechs Monaten (r = 0,411; p = 0,022). Keine signifikante Assoziation bestand zwischen dem MSFC(t1) (Gesamtscore, Untertests) und dem RTW nach sechs Monaten. Schlussfolgerung Auf Funktionsebene korreliert der MSFC im Gesamtscore (z-Score ≥ 0) signifikant mit einer positiven SLE bei Entlassung, deren Validität mit dem RTW sechs Monate nach der Rehabilitation belegt wurde. Maßgeblich waren die Untertests Kognition und Lauffunktion. In der medizinischen Rehabilitation der MS bietet sich daher der Einsatz des MSFC an, um basierend auf dem ermittelten Funktionsniveau eine fundierte Teilhabeempfehlung in Form der SLE zu entwickeln.

THE EFFECT OF CHEMOKINE CXCL-13 ON THE CLINICAL AND FUNCTIONAL STATUS OF PATIENTS WITH MULTIPLE SCLEROSIS IN REMISSION

Introduction. CXCL-13 can be involved in the development of MS, and its level in peripheral blood may have diagnostic and / or prognostic significance. The purpose of this study is to assess the level of CXCL-13 in serum and its relationship with the clinical and functional state of patients with remitting MS in remission. Materials and methods. The study involved 67 patients (28 men and 39 women) with a relapsing MS in remission. All patients were examined by scales and questionaries EDSS, Multiple Sclerosis Functional Composite, Multiple Sclerosis Impact Scale 29, Fatigue Severity Scale. On the day of the clinical examination venous blood samples were taken from patients and healthy donors, serum was isolated, and the level of CXCL-13 was assessed by enzyme immunoassay method. Results and discussion. It was revealed that CXCL-13 in the serum in patients with MS was significantly lower than in healthy volunteers. A relationship was found between serum CXCL-13 and the severity of neurological deficit according to EDSS, with walking speed of 25 feet, with an assessment of the quality of life and fatigue. Conclusions. Despite the association of CXCL-13 with the clinical and functional state of MS patients, at present time this chemokine cannot be considered to be a diagnostic or prognostic marker in MS patients.

Avaliação neuropsicológica em adultos com Esclerose Múltipla: Revisão sistemática

A Esclerose múltipla (EM) é considerada uma doença crônica que acomete mais frequentemente jovens adultos. Estima-se que 2,3 milhões de pessoas no mundo são afetadas pela doença. Pessoas com EM costumam apresentar alterações cognitivas e na sua qualidade de vida. A presente pesquisa visa identificar e discutir os instrumentos de avaliação neuropsicológica utilizados atualmente com pessoas com diagnóstico de EM. Para tanto, foi realizada uma revisão sistemática da literatura cientifica. Este estudo mostrou a importância da investigação das funções cognitivas em pessoas com diagnóstico de EM. As baterias breves mais utilizadas evidenciadas na revisão sistemática são Brief International Cognitive Assessment of Multiple Sclerosis (BICAMS), Multiple Sclerosis Functional Composite Measure (MSFC) e Brief Repeatable Battery of Neuropsychological Test (BNR-N). Os testes mais utilizados na avaliação neuropsicológica de paciente com EM são PASAT e SDMT, que enfocam a avaliação da velocidade de processamento.

Effect of different doses of gadolinium contrast agent on clinical outcomes in MS

Objective The objective of this paper is to evaluate potential dose-dependent adverse effects of gadolinium-based contrast agents (GBCAs) on MS progression. Methods Outcomes from a cohort of 612 secondary progressive MS (SPMS) patients, enrolled in a two-year, placebo-controlled (negative) trial assessing the efficacy of MBP8298, were acquired. Patients received one to four (infrequent cohort; IFR) or 5–11 (frequent cohort; FR) GBCA injections between week 4 and week 104. The primary outcome was the change in Expanded Disability Status Scale (EDSS) and time to confirmed EDSS progression. Secondary outcomes included the changes in the Multiple Sclerosis Functional Composite (MSFC), Timed 25-Foot Walk (T25FW), 9-Hole-Peg Test (9HPT), and Paced Auditory Serial Addition Test (PASAT) from baseline to week 104. Results The 512 IFR and 100 FR participants showed no differences in baseline demographics or disease history. The mean change from baseline to week 104 in EDSS was +0.21 (IFR) and +0.13 (FR); MSFC –0.38 (IFR) and –0.14 (FR); T25FW +1.28 (IFR) and +0.55 (FR); 9HPT –0.06 (IFR) and –0.08 (FR); and PASAT +0.22 (IFR) and +0.20 (FR). The FR to IFR progression hazard ratio equaled 0.68 ( p = 0.09). There were no significant differences in any of the outcomes between the two cohorts. Conclusion There were no differences in the disability progression measures between the two cohorts, indicating that gadolinium does not result in greater clinical worsening in SPMS after a two-year period.