Predicting neuropsychological abnormalities in multiple sclerosis

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Abstract

Multiple Sclerosis (MS) is associated with MRI signal alteration and neuropsychological (NP) dysfunction. Screening tools have been developed to identify patients at high risk for these neurological complications of MS. One such measure, the Multiple Sclerosis Neuropsychological Screening Questionnaire (MSNQ), has well-established reliability and predictive validity. In this article, we report on the accumulated findings derived from 162 consecutive research participants and MS clinic attendees. Our data show significant correlation between both patient- and informant-report MSNQ and NP impairment. As shown previously, larger, and more significant correlations are found between informant-report MSNQs than with patient-report MSNQs. In addition, we find that the MSNQ predicts follow-up NP testing 51 weeks after baseline with a similar degree of association. Finally, the MSNQ is correlated with MRI measures of whole-brain lesion burden and atrophy, secondary progressive course, and vocational disability. We conclude that the MSNQ is reliable and valid for detecting neuropsychological and neuropsychiatric complications of MS.

Introduction

Neuropsychological (NP) dysfunction is a significant source of caregiver distress [1], vocational disability [2], and poor quality of life [3] in MS patients. Because cognitive defects are subtle in some patients, NP testing is necessary for reliable quanitification and detailed clinical analysis. Psychometric tests permit good characterization of the cognitive [4], [5], [6] and psychiatric [7], [8], [9], [10], [11], [12] sequelae of MS. Impediments to the routine clinical application of NP testing include high cost and inconsistency in third-party reimbursements. We believe that NP testing can be applied in a routine, cost-effective manner, provided that centers use brief examination techniques and screen for impaired patients.

By screening, we refer to a brief, low-cost test applied to members of a defined population for the purpose of identifying individuals who will benefit by further evaluation or treatment. Thus, screening for NP impairment should not be confused with NP testing itself, and it cannot replace a clinical evaluation. With this in mind, we developed the MS Neuropsychological Screening Questionnaire (MSNQ), an office-based measure of cognitive and neuropsychiatric dysfunction. The MSNQ is a 15-item questionnaire available in patient self-report and informant-report formats. Its reliability and validity are well established [13], [14].

In the present study, we analyze data derived from a large MS sample and explored for the first time relationships between the MSNQ and disease course, MRI, neuropsychiatric symptoms, follow-up NP testing, and vocational disability.

Section snippets

Subjects

The data were derived from a sample of 162 patients (mean ± S.D. in years for age and education 43.4 ± 8.6 and 14.5 ± 2.3, respectively) with clinically definite MS [15]. The participants were either consecutive clinical referrals or volunteers for research projects investigating the psychometric properties of the MSNQ [13], [14] and NP phenomena in MS [16], [17], [18]. There were 121 (75%) women and 149 (92%) Caucasians. Disease course frequencies were as follows: 119 relapsing-remitting (RR), 34

Results

Table 1 shows the classification of MS patients and normal controls by MSNQ. It can be seen that the patient self-report form correctly classified 65% of cases and the informant-report form 53%. Specificity was high for both forms (self-report 0.94, informant 0.90), indicating that positive MSNQs were rare in normal controls. The sensitivity of the MSNQ (self-report 0.56, informant 0.43) was much lower, as expected, reflecting the frequency of NP impairment in MS which is roughly 50% [39].

Discussion

The current data expand upon previous work with the MSNQ which showed that it has good internal consistency [13], test–retest reliability [14], and predictive validity [13], [14]. In this study, the psychometric aspects of the MSNQ were further supported. While both self- and informant-report MSNQs were correlated with cognitive impairment, higher correlations were found for the informant-report form. In contrast, depression ratings showed the opposite relationship. In this study, we also found

Acknowledgements

The authors recognize the contributions of Darcey Cox, PhD, Laetitia Thompson, PhD, and Fred Foley, PhD, who provided some data used in this report. Some of the data were collected with assistance of an unrestricted educational grant from Biogen Idec.

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