Distraction adds to the cognitive burden in multiple sclerosis

Abstract

Background:

Cognitive dysfunction in multiple sclerosis (MS) causes numerous limitations in activities of daily living.

Objectives:

To develop an improved method of cognitive assessment in people with MS using novel real-world distracters.

Methods:

A sample of 99 people with MS and 55 demographically matched healthy controls underwent testing with the Minimal Assessment of Cognitive Functioning in Multiple Sclerosis (MACFIMS) and a modified version of the computerized Symbol Digit Modalities Test (c-SDMT). Half of the subjects completed the c-SDMT with built-in real-world distracters and half without.

Results:

The mean time on the c-SDMT was significantly greater in MS subjects than healthy controls for both distracter (p = 0.001) and non-distracter (p < 0.001) versions. Significantly more MS subjects were impaired on the c-SDMT with distracters than the traditional SDMT (47.1% vs 30.3%, p = 0.04). There were no differences in impairment between the c-SDMT with and without distracters (47.1% vs 37.5%, p = 0.34). The distracter version had a sensitivity of 81% and specificity of 88% in detecting global cognitive impairment.

Conclusions:

The incorporation of distracters improves the sensitivity of a validated computerized version of the SDMT relative to the non-distracter and traditional versions and offers a quick and easy means of detecting cognitive impairment in people with MS.

Keywords

Multiple sclerosis neuropsychology cognitive assessment information processing speed computerized testing cognitive reserve

Get full access to this article

View all access options for this article.

References

Huijbregts

SCJ

Kalkers

de Sonneville

LMJ

. Differences in cognitive impairment of relapsing remitting, secondary, and primary progressive MS. Neurology 2004; 63(2): 335–339.

Benedict

RHB

Cookfair

Gavett

. Validity of the minimal assessment of cognitive function in multiple sclerosis (MACFIMS). J Int Neuropsychol Soc 2006; 12: 549–558.

Zipoli

Goretti

Hakiki

. Cognitive impairment predicts conversion to multiple sclerosis in clinically isolated syndromes. Mult Scler 2010; 16(1): 62–67.

Deloire

Ruet

Hamel

. Early cognitive impairment in multiple sclerosis predicts disability outcome several years later. Mult Scler 2010; 16(5): 581–587.

Rao

Leo

Ellington

. Cognitive dysfunction in multiple sclerosis. II. Impact on employment and social functioning. Neurology 1991; 41(5): 692–696.

Benedict

RHB

Fischer

Archibald

. Minimal neuropsychological assessment of MS patients: A consensus approach. Clin Neuropsychol 2002; 16(3): 381–397.

Rao

. A manual for the brief repeatable battery of neuropsychological tests in multiple sclerosis. New York: National Multiple Sclerosis Society, 1990.

Langdon

Amato

Boringa

. Recommendations for a Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS). Mult Scler 2012; 18(6): 891–898.

Drake

Weinstock-Guttman

Morrow

. Psychometrics and normative data for the Multiple Sclerosis Functional Composite: Replacing the PASAT with the Symbol Digit Modalities Test. Mult Scler 2010; 16(2): 228–237.

10.

Sumowski

Chiaravalloti

DeLuca

. Cognitive reserve protects against cognitive dysfunction in multiple sclerosis. J Clin Exp Neuropsychol 2009; 31(8): 913–926.

11.

Polman

Reingold

Banwell

. Diagnostic criteria for multiple sclerosis: 2010 revisions to the McDonald criteria. Ann Neurol 2011; 69(2): 292–302.

12.

Kurtzke

. Rating neurologic impairment in multiple sclerosis: An expanded disability status scale (EDSS). Neurology 1983; 33: 1444–1452.

13.

Akbar

Honarmand

Kou

. Validity of a computerized version of the Symbol Digit Modalities Test in multiple sclerosis. J. Neurol 2011; 258(3): 373–379.

14.

Gronwall

. Paced auditory serial-addition task: A measure of recovery from concussion. Percept Mot Skills 1977; 44: 367–373.

15.

Rao

Leo

Bernardin

. Cognitive dysfunction in multiple sclerosis. I. Frequency, patterns, and prediction. Neurology 1991; 41: 685–691.

16.

Delis

Kramer

Kaplan

. California verbal learning test manual (Adult version). 2nd ed. San Antonio, TX: Psychological Corporation, 2000.

17.

Benedict

. Brief visuospatial memory test—revised: professional manual. Odessa, FL: Psychological Assessment Resources, 1997.

18.

Delis

Kaplan

Kramer

. California sorting test. San Antonio, TX: Psychological Corporation, 2001.

19.

Benton

Sivan

Hamsher

. Contributions to neuropsychological assessment. 2nd ed. New York: Oxford University Press, 1994.

20.

Benton

Hamsher

. Multilingual aphasia examination. Iowa City, IA: AJA Associates, 1989.

21.

Fisk

Doble

. Construction and validation of a fatigue impact scale for daily administration (D-FIS). Qual Life Res 2002; 11: 263–272.

22.

Zigmond

Snaith

. The hospital anxiety and depression scale. Acta Psychiatr Scand 1983; 67: 361–370.

23.

Holdnack

. Wechsler test of adult reading (WTAR). San Antonio, TX: Psychological Corporation, 2001.

24.

Wechsler

. Wechsler adult intelligence scale: third edition (WAIS-III). San Antonio, TX: Psychological Corporation, 1997.

25.

Houtchens

Benedict

Killiany

. Thalamic atrophy and cognition in multiple sclerosis. Neurology 2007; 69(12): 1213–1223.

26.

Lazeron

Boringa

Schouten

. Brain atrophy and lesion load as explaining parameters for cognitive impairment in multiple sclerosis. Mult Scler 2005; 11: 524–531.

27.

Walker

LAS

Cheng

Berard

. Tests of information processing speed: What do people with multiple sclerosis think about them? Int J MS Care 2012; 14: 92–99.

28.

Stern

. What is cognitive reserve? Theory and research application of the reserve concept. J Int Neuropsychol Soc 2002; 8: 448–460.

29.

Stern

Alexander

Prohovnik

. Relationship between lifetime occupation and parietal flow: Implications for a reserve against Alzheimer’s disease pathology. Neurology 1995; 45(1): 55–60.

30.

Sumowski

Wylie

Gonnella

. Premorbid cognitive leisure independently contributes to cognitive reserve in multiple sclerosis. Neurology 2010; 75: 1428–1431.

31.

Kesler

Adams

Blasey

. Premorbid intellectual functioning, education, and brain size in traumatic brain injury: An investigation of the cognitive reserve hypothesis. Appl Neuropsychol 2003; 10(3): 153–162.

32.

Sumowski

Wylie

Chiaravalloti

. Intellectual enrichment lessens the effect of brain atrophy on learning and memory in multiple sclerosis. Neurology 2010; 74: 1942–1945.

33.

LaPointe

Maitland

Blanchard

. The effects of auditory distraction on visual cognitive performance in multiple sclerosis. J Neuroophthalmol 2005; 25: 92–94.

34.

Hughes

Auditory distraction: A duplex-mechanism account. PsyCh J 2014; 3(1): 30–41.

35.

Macken

Phelps

Jones

. What causes auditory distraction? Psychon Bull Rev 2009; 16(1): 139–144.