Posted by: Thixia | April 3, 2008

Screening Battery Assesses MS-Specific Cognitive Dysfunction

 

Screening Battery Assesses MS-Specific Cognitive Dysfunction

WASHINGTON, DC-

Because cognitive dysfunction in patients with multiple sclerosis (MS) is linked to higher rates of unemployment and a decline in activities of daily living, early recognition of cognitive deficits is vital. A new method may assist health care providers in detecting MS-related cognitive dysfunction accurately and objectively, according to Corey Burchette, MA, and colleagues of the Neurology Center of Fairfax in Virginia. In their pilot study, the Brief Cognitive Screening Test was shown to assess patients with more precise results than the Mini-Mental State Examination (MMSE).

“We hope that this objective screening battery (which can be administered by any trained technician) will provide an objective means to evaluate possible cognitive dysfunction,” noted the researchers, who presented their findings on the efficacy of their new screening battery in MS patients at the 21st Annual Meeting of the Consortium of Multiple Sclerosis Centers.

There is an important clinical need for an objective cognitive screening method that specifically targets MS patients in the outpatient setting, the researchers stated. They noted that since the MMSE does not assess the most common domains affected by MS-attention, memory, and information processing speed-it may not be a reliable tool. In addition, because many health care facilities do not have access to a neuropsychologist, a screening battery that allows administration by a variety of health care professionals would be useful.

The 30-minute Brief Cognitive Screening Test was administered by a technician to; 20 patients with MS at the Neurology Center of Fairfax. Two slightly different screening batteries were used, including one for patients younger than 50 and another for those older than 50. The MMSE was also administered to all patients. The Brief Cognitive Screening Test included measures of the primary cognitive domains impacted by MS, using traditional and well-known subtests (eg, Paced Auditory Serial Addition Test [PASAT], Boston Naming) with proven accuracy, as well as a self-report mood inventory. Each cognitive measure was assessed based on normative cut-offs; patients performed either “above the cut-off” (within normal range) or “below the cut-off” (below expectation).

A MORE EFFECTIVE SCREENING TOOL

While 100% of patients taking the MMSE performed well above the cut-off (mean score, 29.4), 60% of patients scored below the cut-off on at least one key cognitive measure of the Brief Cognitive Screening Test. Regarding specific memory and mental flexibility tests, 25% of subjects performed below the normal range. The measure of mood is a valid component of the Brief Cognitive Screening Test, the researchers noted, as 40% of the patients indicated symptoms similar to mood disorder. According to qualitative analysis of these findings, three patients who had a perfect score on the MMSE performed below the fifth percentile on the PASAT.

“Until a computerized screening battery is available for use in the outpatient clinic, it appears that the modified screening battery is more effective than the MMSE in the detection of possible cognitive assessed in the MS patient population,” the investigators concluded.

Notably, this study assessed only a small sample of patients, and the battery designed for patients younger than 50 may need to be modified, as their total time to complete the test was 44.6 minutes. Future research on this screening battery, the researchers suggested, should include patients without MS.         

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