Contributions
Abstract: P611
Type: Poster
Abstract Category: Pathology and pathogenesis of MS - 24 Neuropsychology
Background: Our primary source of knowledge of cognitive dysfunction in MS is derived from research studies that require voluntary consent (VC), a requirement that may result in selected samples not fully representative of MS clinic populations. For the past 1.5 years, patients at the Cleveland Clinic Mellen Center for MS Treatment and Research completed the MS Performance Test (MSPT), a self-administered iPad®-based neurological performance assessment tool, as part of their routine clinical care. The sole MSPT cognitive measure is the Processing Speed Test (PST), a measure of information processing speed. We recently published (Rao et al., 2017) a validation study of the PST based on VC.
Goals: To determine if processing speed test performance derived from a validation study based on voluntary consent (VC group) differs from a registry of MS patients who were administered the PST as part of their routine clinical care (REG group).
Methods: The VC and REG groups consisted of 164 and 1,031 MS patients, respectively. The groups were comparable in education, sex, and race; the REG group was older than the VC group by 3.6 years (p=0.0001). PST raw scores were converted to z-scores using regression-based norms derived from a sample of healthy subjects, thus minimizing potential group differences based on demographic variables (age, education, sex).
Results: Mean (SD) PST z-scores were -0.6 (1.0) for the VC group and -1.0 (1.1) for the REG group (p=.000005; Cohen's d=0.378, medium effect size). Significant VC vs. REG group differences were observed for relapsing-remitting and secondary progressive MS patients; no group difference was observed for primary progressive MS patients, probably due to small sample sizes. Significant VC vs. REG group differences were observed only for patients >10 years post-diagnosis.
Conclusions: The PST was completed on consecutively treated MS patients, thus providing an accurate representation of a large MS center population. The results indicate that cognitive impairment was more severe in the MS clinic population than estimated from the comparison VC sample. These results raise the possibility that literature reports of cognitive impairment in MS patients have underestimated its prevalence in real world settings. The data strongly support the need to routinely assess cognitive function in clinical practice to tailor and monitor treatment and to properly counsel patients.
Study Support: Biogen
Disclosure: Dr. Rao has received honoraria, royalties or consulting fees from: Biogen, Genzyme, Novartis, American Psychological Association, International Neuropsychological Society and research funding from the National Institutes of Health, US Department of Defense, National Multiple Sclerosis Society, CHDI Foundation, Biogen, and Novartis.
Dr. Alberts has received royalties or consulting fees from Biogen and Boston Scientific and research funding from the National Institutes of Health and Biogen.
Dr. Bethoux has received royalties, honoraria or consulting fees from: Acorda TherapeutiVC, Atlas 5D, Biogen, FLEX Pharma, Ipsen, Merz, Springer Publishing, and research funding from the Consortium of MS Centers, Biogen, Acorda TherapeutiVC, Adamas Pharmaceuticals, and Atlas 5D.
Dr. Miller has received royalties from Biogen and research funding from the National Multiple Sclerosis Society, Biogen and Novartis.
Dr. Bermel has received royalties or consulting fees from Biogen, Novartis, Genentech, Genzyme, and research funding from Biogen and Genentech.
D. Schindler has received royalties from Biogen.
Drs. Rudick, Phillips and Rhodes are employed by Biogen.
M. Weber, L. Mourany, G. Losinski, C. Reece have nothing to disclose.
Abstract: P611
Type: Poster
Abstract Category: Pathology and pathogenesis of MS - 24 Neuropsychology
Background: Our primary source of knowledge of cognitive dysfunction in MS is derived from research studies that require voluntary consent (VC), a requirement that may result in selected samples not fully representative of MS clinic populations. For the past 1.5 years, patients at the Cleveland Clinic Mellen Center for MS Treatment and Research completed the MS Performance Test (MSPT), a self-administered iPad®-based neurological performance assessment tool, as part of their routine clinical care. The sole MSPT cognitive measure is the Processing Speed Test (PST), a measure of information processing speed. We recently published (Rao et al., 2017) a validation study of the PST based on VC.
Goals: To determine if processing speed test performance derived from a validation study based on voluntary consent (VC group) differs from a registry of MS patients who were administered the PST as part of their routine clinical care (REG group).
Methods: The VC and REG groups consisted of 164 and 1,031 MS patients, respectively. The groups were comparable in education, sex, and race; the REG group was older than the VC group by 3.6 years (p=0.0001). PST raw scores were converted to z-scores using regression-based norms derived from a sample of healthy subjects, thus minimizing potential group differences based on demographic variables (age, education, sex).
Results: Mean (SD) PST z-scores were -0.6 (1.0) for the VC group and -1.0 (1.1) for the REG group (p=.000005; Cohen's d=0.378, medium effect size). Significant VC vs. REG group differences were observed for relapsing-remitting and secondary progressive MS patients; no group difference was observed for primary progressive MS patients, probably due to small sample sizes. Significant VC vs. REG group differences were observed only for patients >10 years post-diagnosis.
Conclusions: The PST was completed on consecutively treated MS patients, thus providing an accurate representation of a large MS center population. The results indicate that cognitive impairment was more severe in the MS clinic population than estimated from the comparison VC sample. These results raise the possibility that literature reports of cognitive impairment in MS patients have underestimated its prevalence in real world settings. The data strongly support the need to routinely assess cognitive function in clinical practice to tailor and monitor treatment and to properly counsel patients.
Study Support: Biogen
Disclosure: Dr. Rao has received honoraria, royalties or consulting fees from: Biogen, Genzyme, Novartis, American Psychological Association, International Neuropsychological Society and research funding from the National Institutes of Health, US Department of Defense, National Multiple Sclerosis Society, CHDI Foundation, Biogen, and Novartis.
Dr. Alberts has received royalties or consulting fees from Biogen and Boston Scientific and research funding from the National Institutes of Health and Biogen.
Dr. Bethoux has received royalties, honoraria or consulting fees from: Acorda TherapeutiVC, Atlas 5D, Biogen, FLEX Pharma, Ipsen, Merz, Springer Publishing, and research funding from the Consortium of MS Centers, Biogen, Acorda TherapeutiVC, Adamas Pharmaceuticals, and Atlas 5D.
Dr. Miller has received royalties from Biogen and research funding from the National Multiple Sclerosis Society, Biogen and Novartis.
Dr. Bermel has received royalties or consulting fees from Biogen, Novartis, Genentech, Genzyme, and research funding from Biogen and Genentech.
D. Schindler has received royalties from Biogen.
Drs. Rudick, Phillips and Rhodes are employed by Biogen.
M. Weber, L. Mourany, G. Losinski, C. Reece have nothing to disclose.