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      D-KEFS ST Failure Identifies Multiple Sclerosis Patients With Worse Objective and Self-Perceived Physical and Cognitive Disability

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          Abstract

          Background and Objectives: The Brief Repeatable Battery of Neuropsychological Test (BRB-NT) does not explore the executive functions. We combined BRB-NT and Delis-Kaplan Executive Function System Sorting Test (D-KEFS ST) to obtain a more comprehensive evaluation of cognitive impairment in Multiple Sclerosis (MS) patients.

          Methods: 137 Relapsing Remitting MS (RRMS) patients underwent a detailed neuropsychological assessment including BRB-NT, D-KEFS ST and self-administrated questionnaires, namely the Multiple Sclerosis Neuropsychological Questionnaire (MSNQ), the Fatigue Severity Scale (FSS) and the Beck Depression Inventory-Second Edition (BDI-II).

          Results: Fifty-four patients (39.4%) had normal scores in each item of both batteries (cognitive normal), while 64 patients (46.7%) failed in at least one test of BRB-NT but not of D-KEFS ST (BRB-NT impaired) and 18 (13.1%) failed in at least one test of both batteries (BRB-NT+D-KEFS ST impaired). Only one patient (0.7%) failed in D-KEFS ST, but not in BRB-NT and was excluded from further analysis. BRB-NT+D-KEFS ST impaired patients had a significant higher mean disease duration and median EDSS score (15.5 ± 13.6 years and 3.5, respectively) compared to those with only BRB-NT impaired (7.9 ± 9.2, p < 0.01 and 2.5, p < 0.05) and with cognitive normal patients (6.7 ± 9.4, p < 0.005 and 2.0, p < 0.01). SDMT was more frequently impaired in BRB-NT+D-KEFS ST impaired patients (77.8%) compared to only BRB-NT impaired ones (20.0%, p < 0.001). The failure in D-KEFS ST was associated with the number of failed BRB-NT items (OR 1.46, IC95% 1.07–1.99, p < 0.05) and with pathological SDMT z-value (OR 10.56, IC95% 2.50–44.66, p < 0.005). Compared to BRB-NT impaired patients and the cognitive normal ones, BRB-NT+D-KEFS ST impaired patients had significant higher MSNQ ( p < 0.01) and BDI-II ( p < 0.05) values.

          Conclusion: D-KEFS ST did not increase the number of cognitively impaired MS patients identified by BRB-NT, but provided a more comprehensive evaluation of cognitive decline. D-KEFS ST identified a subgroup of patients with increased self-perception of cognitive decline, depression and higher physical disability.

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          Specific impairments of planning.

          T Shallice (1982)
          An information-processing model is outlined that predicts that performance on non-routine tasks can be impaired independently of performance on routine tasks. The model is related to views on frontal lobe functions, particularly those of Luria. Two methods of obtaining more rigorous tests of the model are discussed. One makes use of ideas from artificial intelligence to derive a task heavily loaded on planning abilities. A group of patients with left anterior lesions has a specific deficit on the task. Subsidiary investigations support the inference that this is a planning impairment.
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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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              Minimal neuropsychological assessment of MS patients: a consensus approach.

              Patrick W. Beatty, John Fisk, Frederick Munschauer … (2002)
              Cognitive impairment is common in multiple sclerosis (MS), yet patients seen in MS clinics and neurologic practices are not routinely assessed neuropsychologically. In part, poor utilization of NP services may be attributed to a lack of consensus among neuropsychologists regarding the optimal approach for evaluating MS patients. An expert panel composed of neuropsychologists and psychologists from the United States, Canada, United Kingdom, and Australia was convened by the Consortium of MS Centers (CMSC) in April, 2001. Our objectives were to: (a) propose a minimal neuropsychological (NP) examination for clinical monitoring of MS patients and research, and (b) identify strategies for improving NP assessment of MS patients in the future. The panel reviewed pertinent literature on MS-related cognitive dysfunction, considered psychometric factors relevant to NP assessment, defined the purpose and optimal characteristics of a minimal NP examination in MS, and rated the psychometric and practical properties of 36 candidate NP measures based on available literature. A 90-minute NP battery, the Minimal Assessment of Cognitive Function in MS (MACFIMS), emerged from this discussion. The MACFIMS is composed of seven neuropsychological tests, covering five cognitive domains commonly impaired in MS (processing speed/working memory, learning and memory, executive function, visual-spatial processing, and word retrieval). It is supplemented by a measure of estimated premorbid cognitive ability. Recommendations for assessing other factors that may potentially confound interpretation of NP data (e.g., visual/sensory/motor impairment, fatigue, and depression) are offered, as well as strategies for improving NP assessment of MS patients in the future.
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                Author and article information

                Contributors
                Journal
                Journal ID (nlm-ta): Front Psychol
                Journal ID (iso-abbrev): Front Psychol
                Journal ID (publisher-id): Front. Psychol.
                Title: Frontiers in Psychology
                Publisher: Frontiers Media S.A.
                ISSN (Electronic): 1664-1078
                Publication date (Electronic): 24 January 2019
                Publication date Collection: 2019
                Volume: 10
                Electronic Location Identifier: 49
                Affiliations
                [1] 1Multiple Sclerosis Centre, Department of Neurosciences DNS , Padova, Italy
                [2] 2Multiple Sclerosis Centre, University Hospital-Medical School , Padova, Italy
                [3] 3Department of Neurosciences, University Hospital-Medical School , Padova, Italy
                Author notes

                Edited by: Bernhard Hommel, Leiden University, Netherlands

                Reviewed by: Fushun Wang, Nanjing University of Chinese Medicine, China; George P. Chrousos, National and Kapodistrian University of Athens, Greece

                This article was submitted to Cognition, a section of the journal Frontiers in Psychology

                Article
                DOI: 10.3389/fpsyg.2019.00049
                PMC ID: 6353833
                PubMed ID: 30733696
                SO-VID: ce9ec33d-5424-403d-9a83-c49e6442a6c3
                Copyright © Copyright © 2019 Riccardi, Puthenparampil, Rinaldi, Ermani, Perini and Gallo.
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                Date received : 02 February 2018
                Date accepted : 09 January 2019
                Page count
                Figures: 2, Tables: 2, Equations: 0, References: 52, Pages: 7, Words: 0
                Categories
                Subject: Psychology
                Subject: Original Research

                ScienceOpen disciplines: Clinical Psychology & Psychiatry
                Keywords: multiple sclerosis,neuropsychological assessment,executive functions,delis-kaplan executive function system sorting test,brief repeatable battery of neuropsychological test
                Data availability:
                ScienceOpen disciplines: Clinical Psychology & Psychiatry
                Keywords: multiple sclerosis, neuropsychological assessment, executive functions, delis-kaplan executive function system sorting test, brief repeatable battery of neuropsychological test

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