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Is There a Better Screening Tool for Cognitive Function and Employment Status in Patients With MS?


 

References

INDIANAPOLIS—NeuroTrax computerized cognitive testing (NT-CCT) provides an easy, independent, objective screening tool highly predictive of employment status in patients with multiple sclerosis (MS), according to research presented at the 2015 CMSC Annual Meeting. Lead author Mark Gudesblatt, MD, and colleagues said that objective assessment of cognitive function, such as NT-CCT provides, is an important adjunct to Expanded Disability Status Scale (EDSS) in routine MS care. Dr. Gudesblatt is a neurologist at South Shore Neurologic Associates in Patchogue, New York.

Cognitive impairment is common in patients with MS. Routine cognitive screening in MS care, however, is not common. Employment status may be affected by cognitive impairment, but this may not be apparent on routine EDSS assessment. “MS affects cognitive domains differently in people with MS,” said Dr. Gudesblatt. “Easily available and utilized objective cognitive screens are needed to evaluate cognition in MS independent of EDSS or MRI.”

The Symbol Digit Modalities Test (SDMT) is not commonly used in routine MS care. As a single-score cognitive measure, the SDMT does not provide information about individual cognitive domains or the presence or degree of impairment in multiple domains. Computerized cognitive screening tools, in comparison, provide scores for individual cognitive domains.

To explore the predictability and effect size between the SDMT and the NT-CCT domains in patients with MS who self-reported their employment status, Dr. Gudesblatt and colleagues conducted a retrospective review of patients with MS referred for screening cognitive testing in the course of routine clinical care. Patients were evaluated with the oral version of the SDMT and the NT-CCT on the same day.

The study included 113 MS patients, mean age 48.9, and 85% were female. The standardized SDMT score significantly correlated with NT-CCT Global Cognitive Score (GCS) and executive function. The SDMT and NT-CCT GCS both predicted employment status. The effect size of the NT-CCT GCS was 0.83, and for SDMT it was 0.70. For the NT-CCT Executive Function index the effect size was 0.87. In the NeuroTrax Catch Game, with scores standardized for age and education, overall score predicted employment. Unemployed patients with MS had NT-CCT cognitive domain index scores less than one standard deviation below average for cognitively health age and education norms.

“Unemployed patients with MS demonstrated reduced cognitive function relative to employed patients,” Dr. Gudesblatt and colleagues reported. SDMT and NT-CCT screening both significantly differentiate patients with MS who are employed and those who are not. However, NT-CCT predictability of employment provided a greater effect size for this differentiation.

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