Contributions
Abstract: P1161
Type: Poster Sessions
Abstract Category: Pathology and pathogenesis of MS - Neuropsychology
Objective: To determine if change in Symbol Digit Modalities Test (SDMT) performance during baseline, relapse and recovery is correlated with mental status change as judged by the Cerebral Functional System (CFS) component of the Expanded Disability Status Scale (EDSS).
Methods: We evaluated 45 relapsing-remitting multiple sclerosis (RRMS) patients recruited from an NMSS funded investigation of Cognitive Dysfunction in MS Relapses. Exclusion criteria for relapse phase included optic neuritis, sensory/motor deficit compromising cognitive testing, and subtentorial neurologic signs. All underwent neurocognitive and motor performance testing and EDSS at three time points: pre-relapse baseline at least 6 months prior to relapse, relapse, and 3-month post-relapse recovery. The relapse phase exams were conducted within 48 hours of relapse and prior to or on the same day as steroid therapy. All relapses were diagnosed by a clinician or identified by MRI activity, i.e. Gadolinium Enhancing (GaD+) lesions. For the primary analysis, we calculated change in the SDMT, EDSS, and the EDSS CFS from baseline onward. The relationship between SDMT and CFS was examined.
Results: A repeated measures analysis of variance (ANOVA) showed that there were differences across time points on SDMT (F=5.918, p=0.006). There was a significant decline on SDMT from baseline to relapse (p=0.028), followed by full recovery (p=0.001). Friedman test inspecting changes in EDSS across time point approached significance (χ2=5.2, p=0.07). Wilcoxon post hoc test showed a significant decline between baseline and relapse on the EDSS (Z=-2.1, p=0.045) with no significant improvement from relapse to recovery (Z=-1.7, p=0.088). There was no correlation between the CFS and SDMT at any time point. In addition, change scores from baseline to relapse were not significantly correlated.
Conclusion: This study is the first replication of a SDMT measured cognitive involvement in MS since the work of Benedict et al (2014) and Pardini et al (2014). While the relapses reported herein are confirmed by EDSS changes, as in Benedict 2014, the CFS showed no association and thus there is little evidence that the CFS is sensitive to cognitive relapse. This observation confirms prior speculation that interview based mental status exams are not sensitive to subtle cognitive changes in MS.
Disclosure: Faizan Yasin: nothing to disclose
Jeta Pol: nothing to disclose
Curtis Wojcik: nothing to disclose
Allison Drake: nothing to disclose
Svetlana Eckert: nothing to disclose
Ralph H. B. Benedict has received research support from Accorda, Novartis, Genzyme, Biogen Idec, and Mallinkrodt, and is on the speakers' bureau for EMD Serono, and consults for Biogen Idec, Genentech, Roche, Sanofi/Genzyme, Takeda, NeuroCog Trials, and Novartis. Dr. Benedict also receives royalties for Psychological Assessment Resources.
Bianca Weinstock-Guttman has received honoraria as a speaker and as a consultant for Biogen Idec, Teva Pharmaceuticals, EMD Serono, Genzyme & Sanofi, Novarties and Acorda. Dr. Weinstock-Guttman received research funds from Biogen Idec, Teva Pharmaceuticals, EMD Serono, Genzyme & Sanofi , Novartis and Acorda.
Robert Zivadinov received personal compensation from EMD SeronoGenzyme-SanofiCelgene and Novartis for speaking and consultant fees. He received financial support for research activities from Genzyme-SanofiNovartisClaret MedicalProtembo and IMS Health.
Devon Conway has received research support paid to his institution by Novartis Pharmaceuticals and the National Multiple Sclerosis Society. He has received personal compensation for consulting for Novartis Pharmaceuticals, Arena Pharmaceuticals, and Tanabe Laboratories.
In the past 3 years, Dr. Morrow has served on advisory boards for Biogen Idec, EMD Serono, Genzyme Canada, Novartis and Roche. She has received Investigator Initiated Grant Funds from Genzyme Canada and acted as site PI for multi-center trials funded by Novartis, Genzyme, Roche
Michael G. Dwyer has received consultant fees from Claret Medical and EMD Serono and research grant
support from Novartis.
David Hojnacki provides consultancies for Biogen Idec, Teva Neurosciences, EMD Serono, Novartis and Sanofi - Genzyme for speaking and consultant fees
Abstract: P1161
Type: Poster Sessions
Abstract Category: Pathology and pathogenesis of MS - Neuropsychology
Objective: To determine if change in Symbol Digit Modalities Test (SDMT) performance during baseline, relapse and recovery is correlated with mental status change as judged by the Cerebral Functional System (CFS) component of the Expanded Disability Status Scale (EDSS).
Methods: We evaluated 45 relapsing-remitting multiple sclerosis (RRMS) patients recruited from an NMSS funded investigation of Cognitive Dysfunction in MS Relapses. Exclusion criteria for relapse phase included optic neuritis, sensory/motor deficit compromising cognitive testing, and subtentorial neurologic signs. All underwent neurocognitive and motor performance testing and EDSS at three time points: pre-relapse baseline at least 6 months prior to relapse, relapse, and 3-month post-relapse recovery. The relapse phase exams were conducted within 48 hours of relapse and prior to or on the same day as steroid therapy. All relapses were diagnosed by a clinician or identified by MRI activity, i.e. Gadolinium Enhancing (GaD+) lesions. For the primary analysis, we calculated change in the SDMT, EDSS, and the EDSS CFS from baseline onward. The relationship between SDMT and CFS was examined.
Results: A repeated measures analysis of variance (ANOVA) showed that there were differences across time points on SDMT (F=5.918, p=0.006). There was a significant decline on SDMT from baseline to relapse (p=0.028), followed by full recovery (p=0.001). Friedman test inspecting changes in EDSS across time point approached significance (χ2=5.2, p=0.07). Wilcoxon post hoc test showed a significant decline between baseline and relapse on the EDSS (Z=-2.1, p=0.045) with no significant improvement from relapse to recovery (Z=-1.7, p=0.088). There was no correlation between the CFS and SDMT at any time point. In addition, change scores from baseline to relapse were not significantly correlated.
Conclusion: This study is the first replication of a SDMT measured cognitive involvement in MS since the work of Benedict et al (2014) and Pardini et al (2014). While the relapses reported herein are confirmed by EDSS changes, as in Benedict 2014, the CFS showed no association and thus there is little evidence that the CFS is sensitive to cognitive relapse. This observation confirms prior speculation that interview based mental status exams are not sensitive to subtle cognitive changes in MS.
Disclosure: Faizan Yasin: nothing to disclose
Jeta Pol: nothing to disclose
Curtis Wojcik: nothing to disclose
Allison Drake: nothing to disclose
Svetlana Eckert: nothing to disclose
Ralph H. B. Benedict has received research support from Accorda, Novartis, Genzyme, Biogen Idec, and Mallinkrodt, and is on the speakers' bureau for EMD Serono, and consults for Biogen Idec, Genentech, Roche, Sanofi/Genzyme, Takeda, NeuroCog Trials, and Novartis. Dr. Benedict also receives royalties for Psychological Assessment Resources.
Bianca Weinstock-Guttman has received honoraria as a speaker and as a consultant for Biogen Idec, Teva Pharmaceuticals, EMD Serono, Genzyme & Sanofi, Novarties and Acorda. Dr. Weinstock-Guttman received research funds from Biogen Idec, Teva Pharmaceuticals, EMD Serono, Genzyme & Sanofi , Novartis and Acorda.
Robert Zivadinov received personal compensation from EMD SeronoGenzyme-SanofiCelgene and Novartis for speaking and consultant fees. He received financial support for research activities from Genzyme-SanofiNovartisClaret MedicalProtembo and IMS Health.
Devon Conway has received research support paid to his institution by Novartis Pharmaceuticals and the National Multiple Sclerosis Society. He has received personal compensation for consulting for Novartis Pharmaceuticals, Arena Pharmaceuticals, and Tanabe Laboratories.
In the past 3 years, Dr. Morrow has served on advisory boards for Biogen Idec, EMD Serono, Genzyme Canada, Novartis and Roche. She has received Investigator Initiated Grant Funds from Genzyme Canada and acted as site PI for multi-center trials funded by Novartis, Genzyme, Roche
Michael G. Dwyer has received consultant fees from Claret Medical and EMD Serono and research grant
support from Novartis.
David Hojnacki provides consultancies for Biogen Idec, Teva Neurosciences, EMD Serono, Novartis and Sanofi - Genzyme for speaking and consultant fees