Contributions
Abstract: P289
Type: Poster
Abstract Category: Clinical aspects of MS - Paediatric MS
Background: Disrupted development of working memory and processing speed is a potential outcome in children with acquired demyelinating syndromes (ADS) due to injury to maturing neural networks. Longitudinal cognitive evaluations of childhood ADS have not been previously reported.
Objective: To examine changes in working memory and processing speed using serial cognitive testing within the first two years post-ADS, and clinical-demographic predictors of age-expected cognitive maturation.
Methods: Participants included 37 youth with ADS recruited from two children´s hospitals, 12 of whom were subsequently diagnosed with MS. Of these patients, 27 (17 monophasic ADS; 10 MS) underwent two neuropsychological evaluations, conducted at 6 and 24 months post-ADS. Change in age-normed scores on the Oral Symbol Digit Modalities Test (SDMT) and the WJ-III Auditory Working Memory (AWM) and Visual Matching (VM) subtests were examined using repeated measures ANOVA and Reliable Change Index (RCI) analyses. Changes in cognitive scores were correlated with age at incident demyelinating event (mean=11.2±2.6) and socioeconomic status (SES) using Spearman correlation.
Results: Patients lost to attrition did not differ from those retested with respect to age at onset, disease severity, and IQ. Patients with MS were older at onset (13.0±2.2 yrs) as compared to children with monophasic ADS (11.1±2.6 yrs; p=.063). Both groups showed higher z-scores at baseline in comparison with follow-up on the SDMT (p=.040), AWM (p=.007) and VM (p=.045). Across groups, RCI analyses showed a significant decline in age-expected performance over time among 11%, 26%, and 15% of patients on the SDMT, AWM and VM subtests, respectively. Decline on these measures was equally likely among MS and monophasic ADS patients. Lower z-score at follow-up was associated with lower SES on VM (r=.52, p=.028) and older age at onset on the SDMT
(r=-.41, p=.052).
Conclusion: Both monophasic ADS and MS confer a risk for declining cognitive efficiency over time. Older age at onset may increase the vulnerability for cognitive slowing given that white matter pathways supporting neural efficiency are maturing. The relationship between SES and cognitive slowing suggests that environmental factors can be targeted to improve cognitive outcomes. Further research will determine if monophasic ADS patients “catch up” over time, and the potential for cognitive deterioration in children with chronic demyelination.
Disclosure:
Elisea De Somma: Nothing to disclose
Mahsa Sadeghi: Nothing to disclose
Julia O´Mahony: Nothing to disclose
Brian Brooks: Nothing to disclose
Ann Yeh: Nothing to disclose
Brenda Banwell: Dr Banwell serves as a consultant to Novartis, and as an advisor for clinical trials for Biogen, Sanofi, and Tevaneuroscience
Christine Till: Nothing to disclose
Source of Funding: This project was supported by the Multiple Sclerosis Society Scientific Research Foundation.
Abstract: P289
Type: Poster
Abstract Category: Clinical aspects of MS - Paediatric MS
Background: Disrupted development of working memory and processing speed is a potential outcome in children with acquired demyelinating syndromes (ADS) due to injury to maturing neural networks. Longitudinal cognitive evaluations of childhood ADS have not been previously reported.
Objective: To examine changes in working memory and processing speed using serial cognitive testing within the first two years post-ADS, and clinical-demographic predictors of age-expected cognitive maturation.
Methods: Participants included 37 youth with ADS recruited from two children´s hospitals, 12 of whom were subsequently diagnosed with MS. Of these patients, 27 (17 monophasic ADS; 10 MS) underwent two neuropsychological evaluations, conducted at 6 and 24 months post-ADS. Change in age-normed scores on the Oral Symbol Digit Modalities Test (SDMT) and the WJ-III Auditory Working Memory (AWM) and Visual Matching (VM) subtests were examined using repeated measures ANOVA and Reliable Change Index (RCI) analyses. Changes in cognitive scores were correlated with age at incident demyelinating event (mean=11.2±2.6) and socioeconomic status (SES) using Spearman correlation.
Results: Patients lost to attrition did not differ from those retested with respect to age at onset, disease severity, and IQ. Patients with MS were older at onset (13.0±2.2 yrs) as compared to children with monophasic ADS (11.1±2.6 yrs; p=.063). Both groups showed higher z-scores at baseline in comparison with follow-up on the SDMT (p=.040), AWM (p=.007) and VM (p=.045). Across groups, RCI analyses showed a significant decline in age-expected performance over time among 11%, 26%, and 15% of patients on the SDMT, AWM and VM subtests, respectively. Decline on these measures was equally likely among MS and monophasic ADS patients. Lower z-score at follow-up was associated with lower SES on VM (r=.52, p=.028) and older age at onset on the SDMT
(r=-.41, p=.052).
Conclusion: Both monophasic ADS and MS confer a risk for declining cognitive efficiency over time. Older age at onset may increase the vulnerability for cognitive slowing given that white matter pathways supporting neural efficiency are maturing. The relationship between SES and cognitive slowing suggests that environmental factors can be targeted to improve cognitive outcomes. Further research will determine if monophasic ADS patients “catch up” over time, and the potential for cognitive deterioration in children with chronic demyelination.
Disclosure:
Elisea De Somma: Nothing to disclose
Mahsa Sadeghi: Nothing to disclose
Julia O´Mahony: Nothing to disclose
Brian Brooks: Nothing to disclose
Ann Yeh: Nothing to disclose
Brenda Banwell: Dr Banwell serves as a consultant to Novartis, and as an advisor for clinical trials for Biogen, Sanofi, and Tevaneuroscience
Christine Till: Nothing to disclose
Source of Funding: This project was supported by the Multiple Sclerosis Society Scientific Research Foundation.