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      What Are the Minimal Detectable Changes in SDMT and Verbal Fluency Tests for Assessing Changes in Cognitive Performance in Persons with Multiple Sclerosis and Non-Multiple Sclerosis Controls?

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          Abstract

          Introduction: Cognitive impairment is frequent in persons with multiple sclerosis (PwMS) and can impact on activities of daily living. The capacity to differentiate real changes from background statistical noise induced by human, instrumentational, and environmental variations inherent to the evaluation would improve cognitive assessments. Objective: To assess the short-term reproducibility of cognitive tests in non-multiple sclerosis (non-MS) persons and PwMS. Methods: Sixty-two PwMS and 19 non-MS persons performed 2 measurements, 1 week apart, of the Symbol Digit Modalities Test (SDMT) and phonological and semantic verbal fluency. Test-retest reliability was evaluated by the intraclass correlation coefficients (ICC) and agreement by standard error of measurement (SEM) and minimum detectable change (MDC). Results: The reliability of the cognitive variables studied had moderate to high ICC values (ICC > 0.8) in both populations. The threshold to consider a significant cognitive modification evaluated by SEM and MDC was lower in PwMS compared with non-MS persons. Conclusions: SDMT and verbal fluency have good short-term reproducibility in PwMS. Specific SEM and MDC cutoffs based on the same design of evaluation (especially retest timing) and to the targeted pathological population (MS vs. healthy) should systematically be used to consider cognitive modification as significant in research protocol as well as in clinical practice.

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          Most cited references 35

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          Cognitive dysfunction in multiple sclerosis. II. Impact on employment and social functioning.

           G Leo,  L Ellington,  P. Rao (1991)
          We designed a study to assess the specific contribution of cognitive dysfunction to multiple sclerosis patients' problems in daily living. Based on the results of a comprehensive neuropsychological test battery, we classified 100 MS patients as either cognitively intact (N = 52) or cognitively impaired (N = 48). In addition to a neurologic examination, MS patients completed questionnaires on mood and social functioning, underwent a comprehensive in-home occupational therapy evaluation, and were rated by a close relative or friend regarding specific personality characteristics. While there were no significant differences between the two groups on measures of physical disability and illness duration, patients in the cognitively impaired group were less likely to be working, engaged in fewer social and avocational activities, reported more sexual dysfunction, experienced greater difficulty in performing routine household tasks, and exhibited more psychopathology than cognitively intact patients. These findings suggest that cognitive dysfunction is a major factor in determining the quality of life of patients with MS.
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            The test-retest reliability of centre of pressure measures in bipedal static task conditions--a systematic review of the literature.

            The analysis of centre of pressure (COP) excursions is used as an index of postural stability in standing. Conflicting data have been reported over the past 20 years regarding the reliability of COP measures and no standard procedure for COP measure use in study design has been established. Six online databases (January 1980 to February 2009) were systematically searched followed by a manual search of retrieved papers. Thirty-two papers met the inclusion criteria. The majority of the papers (26/32, 81.3%) demonstrated acceptable reliability. While COP mean velocity (mVel) demonstrated variable but generally good reliability throughout the different studies (r=0.32-0.94), no single measurement of COP appeared significantly more reliable than the others. Regarding data acquisition duration, a minimum of 90 s is required to reach acceptable reliability for most COP parameters. This review further suggests that while eyes closed readings may show slightly higher reliability coefficients, both eyes open and closed setups allow acceptable readings under the described conditions (r ≥ 0.75). Also averaging the results of three to five repetitions on firm surface is necessary to obtain acceptable reliability. A sampling frequency of 100 Hz with a cut-off frequency of 10 Hz is also recommended. No final conclusion regarding the feet position could be reached. The studies reviewed show that bipedal static COP measures may be used as a reliable tool for investigating general postural stability and balance performance under specific conditions. Recommendations for maximizing the reliability of COP data are provided. Copyright © 2010 Elsevier B.V. All rights reserved.
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              Differences in cognitive impairment of relapsing remitting, secondary, and primary progressive MS.

              To investigate the cognitive skills of patients with relapsing remitting multiple sclerosis (RRMS), secondary progressive MS (SPMS), and primary progressive MS (PPMS) relative to healthy control subjects and to assess whether there is heterogeneity in the type of cognitive disabilities demonstrated by patients with different MS phenotypes. RRMS patients (n = 108), SPMS patients (n = 71), PPMS patients (n = 55), and healthy control subjects (n = 67) underwent neuropsychological assessment with the Brief Repeatable Battery of Neuropsychological Tests. Relative to controls, cognitive performance of RRMS patients was deficient when tasks required higher-order working memory (WM) processes (Word List Generation, 10/36 Spatial Recall Test, Symbol Digit Modalities Test). PPMS and SPMS patients performed poorer than control subjects on all tasks. SPMS patients performed more poorly than PPMS patients when tasks required higher-order WM processes, except when speed of information processing played a relatively important role (Symbol Digit Modalities Test, Paced Auditory Serial Addition Test). Whereas RRMS patients generally performed better than the progressive subtypes, they showed relatively poor verbal fluency. MS patients with different disease courses have different cognitive profiles.
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                Author and article information

                Journal
                ENE
                Eur Neurol
                10.1159/issn.0014-3022
                European Neurology
                S. Karger AG
                0014-3022
                1421-9913
                2020
                August 2020
                07 July 2020
                : 83
                : 3
                : 263-270
                Affiliations
                aIntegrative and Clinical Neurosciences EA481, Bourgogne Franche-Comte University, Besançon, France
                bRegional Memory Centre, Department of Neurology, University Hospital of Besançon, Besançon, France
                cDepartment of Neurology, University Hospital of Besançon, Besançon, France
                dLaboratory of Clinical Functional Exploration of Movement, University Hospital of Besançon, Besançon, France
                Author notes
                *Yoshimasa Sagawa, Integrative and Clinical Neurosciences EA481, Bourgogne Franche-Comte University, FR–25000 Besançon (France), sagawajunior@gmail.com
                Article
                508607 Eur Neurol 2020;83:263–270
                10.1159/000508607
                32634812
                © 2020 S. Karger AG, Basel

                Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                Page count
                Figures: 1, Tables: 4, Pages: 8
                Categories
                Clinical Neurology: Research Article

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