Background:
The association between subjective cognitive fatigue and objective cognitive dysfunction in patients with multiple sclerosis (PwMS) has been studied, with conflicting results.
Objective:
...To explore the impact of fatigue on cognitive function, while controlling for the influence of depression, disability, comorbidities, and psychotropic medications.
Methods:
PwMS completed a computerized cognitive testing battery with age- and education-adjusted cognitive domain scores. Disability (Expanded Disability Status Scale (EDSS)), cognitive fatigue, and depression were concurrently evaluated.
Results:
In all, 699 PwMS were included. Both cognitive fatigue and depression were significantly and negatively correlated with the same cognitive domains: information processing speed, executive function, attention, motor function, and memory (−0.15 ⩽ r ⩽ −0.14 for cognitive fatigue; −0.24 ⩽ r ⩽ −0.19 for depression). Multivariate analysis revealed significant but small independent correlations only between depression and neuropsychological test results, while cognitive fatigue had no independent correlation with objective cognitive function except for a trend toward impaired motor function in highly fatigued PwMS. Depression and cognitive fatigue accounted for no more than 6% of the variance in objective cognitive domain scores.
Conclusion:
Cognitive fatigue is not independently related to objective cognitive impairment. Depression may influence cognitive function of PwMS primarily when it is severe. Cognitive impairment in PwMS should not be ascribed to fatigue or mild depression.
Prior studies have reported an association between visual evoked potentials (VEPs) and cognitive performance in people with multiple sclerosis (PwMS), but the specific mechanisms that account for ...this relationship remain unclear. We examined the relationship between VEP latency and cognitive performance in a large sample of PwMS, hypothesizing that VEP latency indexes not only visual system functioning but also general neural efficiency. Standardized performance index scores were obtained for the domains of memory, executive function, visual-spatial processing, verbal function, attention, information processing speed, and motor skills, as well as global cognitive performance (NeuroTrax battery). VEP P100 component latency was obtained using a standard checkerboard pattern-reversal paradigm. Prolonged VEP latency was significantly associated with poorer performance in multiple cognitive domains, and with the number of cognitive domains in which performance was ≥ 1 SD below the normative mean. Relationships between VEP latency and cognitive performance were significant for information processing speed, executive function, attention, motor skills, and global cognitive performance after controlling for disease duration, visual acuity, and inter-ocular latency differences. This study provides evidence that VEP latency delays index general neural inefficiency that is associated with cognitive disturbances in PwMS.
The immunomodulatory effects of disease-modifying therapies for multiple sclerosis might affect the immune response to vaccines for severe acute respiratory syndrome coronavirus 2. We analyzed the ...severe acute respiratory syndrome coronavirus 2-specific antibody response and lymphocyte profile before and after Ad26.COV2.S (Johnson & Johnson) vaccination in natalizumab-treated patients with multiple sclerosis. There was a 72-fold increase in mean anti-severe acute respiratory syndrome coronavirus 2 spike immunoglobulin G levels 4 weeks after vaccination and a 137-fold increase after 6 months. Other immune signals were within normal ranges. Natalizumab-treated patients with multiple sclerosis had a robust immune response to Ad26.COV2.S vaccine, and other immune signals were not significantly affected.
Multiple sclerosis (MS) is a chronic, unpredictable, progressive, and disabling autoimmune disease with significant neurodegenerative and inflammatory components. To effectively treat and care for ...older persons with MS, it is essential to examine the factors associated with a decrease in their quality of life. Typically, MS is diagnosed between 20 and 50 years old. Although not a fatal disease, the natural history data of persons with MS reveal survival approximately 38 years after diagnosis. With the advent of disease-modifying therapies, life-span has increased substantially over the past 2 decades among people with MS. Approximately 90% of people with MS now in their 20s may live into their 70s. Their quality of life as an older adult will be impacted by what we learn today. Currently, approximately a quarter of people with MS are mature adults over 65 years old. Older adults with MS are more likely to have a decreased health-related quality of life (HRQOL). HRQOL is a multidimensional construct that refers to an individual's physical functioning, ability to perform activities of daily living, sense of well-being, satisfaction with life, perception of psychological status, and social functioning. This article focuses on the current literature in HRQOL in older persons with MS. A specific aim is to examine the factors associated with a decreased QOL in older persons with MS. Nursing screening and implementation of interventions that may reduce these factors and improve function of patients will be discussed. Although measures to improve HRQOL do not substitute for treatment of the disease, knowledge of factors that reduce HRQOL is essential to understand patient perceptions of their health and disease.
Multiple sclerosis (MS) is a chronic, unpredictable, progressive, disabling disease. It is generally diagnosed in young adult females between the ages of 20 and 40 years. Symptoms of MS may include ...profound fatigue, depression, gait disorder, spasticity, blurred vision, and bladder and bowel problems. It is an unpredictable disease and has the potential to create a stressful family life. Because MS is frequently diagnosed in early adulthood, it may affect developmental experiences such as raising a family and building and sustaining a career. Satisfaction with relationships can also be altered. MS has a significant social, psychological, and physical impact on the affected individual as well as his or her family. Partners of people with MS often become caregivers, adding to the demands and challenges of family life. As the individual's disease progresses, the capacity for self-care may decrease, and the individual may require daily assistance from family members. However, the daily assistance that family members provide to a disabled spouse, parent, partner, or child can take a physical and economic toll on the caregiver, causing caregiver burden. Caregiver burden is a multidimensional response to physical, psychological, emotional, social, and financial stressors associated with the caregiving experience. Caregivers who experience burden are more likely to have a higher risk of depression and a lower quality of life. Early recognition of caregiver burden is important in determining appropriate interventions.
This study was conducted to determine which factors (clinical and demographic) are associated with mental and physical health-related quality of life (HRQOL) among people with multiple sclerosis (MS) ...aged 60 years and older.
Data were collected at four MS centers on Long Island, New York, from a total of 211 patients. Three surveys were administered that collected demographic information and included validated questionnaires measuring quality of life (QOL), cognition, depression, and disability. Multivariate linear regression analyses examined the relationship between patient demographics and scores on standardized scales measuring mental and physical HRQOL (Multiple Sclerosis Quality of Life-54). Variables included in the regression models were selected on the basis of the Andersen Healthcare Utilization model. This framework encompasses the multiple influences on health status, including predisposing characteristics, enabling resources, need, and health behavior.
We found that mental HRQOL was negatively associated with having a high school education or less, risk of neurologic impairment, physical disability, and depression. No variables were positively associated with mental HRQOL. Physical HRQOL was negatively associated with risk of neurologic impairment, physical disability, depression, and the comorbidity of thyroid disease. However, patient employment and, surprisingly, being widowed were positively associated with physical HRQOL. These findings are consistent with those of similar studies among younger patients in which lower HRQOL was associated with increased disability, depression, risk of neurologic impairment, and lower levels of education.
The findings that patient employment and being widowed were associated with better physical HRQOL suggest that older patients have the ability to adapt and adjust to the challenges of MS over time. Clinicians should regularly screen for HRQOL in older patients with MS.
With the predicted shortage of neurologists, care of patients with multiple sclerosis (MS) may be affected. Nurse practitioners (NPs) have successfully filled the provider gaps in a variety of care ...settings, with positive effects on care outcomes, including patient satisfaction. The purpose of this study was to determine patient satisfaction with physicians (MDs) and NPs in MS centers.
This is a cross-sectional pilot study wherein a convenience sample was recruited from two MS centers. Demographic data were collected previsit, and satisfaction surveys were completed postvisit using the Patient Satisfaction Questionnaire Short Form (PSQ-18) and the Visit-Specific Satisfaction Instrument (VSQ-9). Different attributes of satisfaction and visit times were analyzed.
Patient satisfaction with both types of providers was high. All attributes of satisfaction were comparable for NPs and MDs, and they spent similar amounts of time with their patients, often exceeding the scheduled office visit duration. Encounter length was a strong determinant of patient satisfaction: VSQ-9 scores were significantly lower (
= .01) when duration was less than 20 minutes. Satisfaction was higher (
= .011) in patients who were diagnosed as having MS for 10 years or longer or had progressive MS, irrespective of provider type.
This pilot study showed that use of standardized questionnaires to determine patient satisfaction with NPs and MDs was feasible. With the impending neurologist shortage and the increased MS prevalence, a collaborative team approach between NPs and MDs may improve access to care in MS centers without compromising patient satisfaction.
Background
Dementia associated diseases (DAD) refers to clinical conditions characterized by progressive cognitive impairment (CI) that interferes with ability to function independently. However, ...cognitive impairments can vary in degree and combination of cognitive deficits across multiple cognitive domains. Traditional history and cognitive assessments in clinic are insufficient to identify these varied combinations. Therefore, a clinician may be unaware of these variations and impact on patient QOL and decision‐making. Effective quantitative analysis of cognitive function can be obtained in routine care by a validated, examiner‐independent, sensitive, and reliable computerized cognitive assessment battery (CAB‐NT). Patient reported outcomes (PRO) provide information regarding patient perception of ability across clinically relevant concerns. The BRIEF Health Literacy survey (BHL) PRO is used to find the degree to which one can read, understand, exchange, and use health information and resources. Comparison to computerized cognitive testing has not been explored in this population.
Method
Retrospective cross‐sectional analysis of patients with DAD (PwDAD) who completed both PRO BHL and CAB in routine care on the same day. CAB‐NT included 7 cognitive domains: memory (Mem), executive function (Exe), attention (Att), information processing speed (Inf), visual‐spatial (Vis), verbal function (Ver), motor skills (Mot) and global cognitive summary score (GCS). Linear regression analysis was explored with significance (p<0.05).
Result
329 PwDaD, average age of 70±13 years, 63.2% female. Linear regression was used to analyze trends between BHL and CAB. Significant correlations (p = 0.05) were found for CAB‐NT vs: BHL: GCS‐r = 0.42, Vis‐r = 0.36, Mem‐r = 0.31, Exe‐r = 0.39, Ver‐r = 0.25, Mot‐r = 0.22, Inf‐r = 0.32, and Att‐r = 0.28. One‐way ANOVA was performed between BHL (inadequate, marginal, and adequate) and the cognitive domains of the CAB‐NT. Significant differenced (p = 0.05) were found between the three BHL groups within each cognitive domain.
Conclusion
Patient centric DAD performances on CAB‐NT is related to patient‐reported health literacy. The more impaired the CAB‐NT scores, the poorer patient‐perceived health literacy reported. Patient centric recognition of CI can enhance clinician’s recognition of those people who may require additional information for health‐care decisions or incorporate health‐care proxy for effective shared decision making in routine care. Incorporation of this patient centric information can potentially lead to improved outcomes and satisfaction.
Background
Dementia associated diseases (DAD) refers to a heterogeneous group of disorders that are clinically characterized by progressive cognitive impairment (CI) that ultimately adversely ...influences an individual’s ability to function independently. CI may reflect abnormalities across multiple cognitive domains to varying degrees and combinations across various cognitive domains (CD). Identifying treatment needs and discussing treatment options requires ongoing communication between patient and provider over the disease continuum; communication capacity may be compromised but underappreciated. Impaired verbal and episodic memory function in people with DAD (PwDAD) can adversely impact communication abilities. Maintaining an effective long‐term treatment plan requires consistent monitoring of both performance ability and patient perspective (patient reported outcomes, PRO) across a continuum of patient needs (health, safety, and QoL).
Method
Retrospective review of information obtained in the course of routine care including driving status, Neuro QOL‐Anxiety Short‐Form (A‐SF); Neuro QOL‐Communication Short‐Form (C‐SF); validated multi‐domain computerized cognitive assessment battery (CAB). CAB Domain Score of Verbal Function (CAB‐V) and Memory Function (CAB‐M). CAB and PRO were completed without provider influence.
Result
530 PwDAD (62% female, average age 71.9 +/‐ 14.3 years) was used to compare patient driving status with A‐SF, C‐SF, NT‐V, NT‐M scores. T‐Tests assuming both equal and unequal variances comparing multiple PRO scores to driving status determined significance at (p<0.01). Statistically significant relationships were identified between driving status and: A‐SF, C‐SF, CAB‐V, and CAB‐M.
Conclusion
Self‐reported anxiety and ability to communicate, objective impairment in verbal, and memory function are related to driving status in PwDAD. Appreciation of disease impact, whether perceived or performance ability, across a continuum should be incorporated in routine care and monitoring of dementia disorders to optimize care and outcome by identifying issues of concern that have both visible and invisible impact both patients and clinicians to design an effective plan of care to accommodate patient centric impairment and needs. Standardized methods of routine PRO collection concerning various aspects of real‐world health outside of a clinic encounter are important to building an effective holistic treatment plan.
Background
Dementia associated diseases (DAD) refer to a group of disorders clinically characterized by progressive cognitive impairment (CI). CI may reflect abnormalities across multiple cognitive ...domains (CD) to varying degrees and combinations and interfere with the ability to carry out activities of daily living (ADL). Determination of driving ability in routine care relies on patient, family, and clinician shared‐decision making, as availability of routine on‐road driving assessment might be limited. Incorporation of patient reported outcomes (PRO) in routine care has increased, becoming more important for patient care and treatment decisions. Neuro‐QoL Cognitive Function Questionnaire (CF) provides an opportunity to assess self‐reported cognition routinely. The relationship of CF to objective computerized multi‐domain cognitive testing and self‐reported driving has not been explored. Providing easily available objective screening might be of great value for all involved in the decision to continue or stop driving in view of the profound impact loss of driving has on independence.
Method
A retrospective review of PwDAD who provided self‐reported driving status and completed both objective and subjective cognitive function (CF) measures. Subjective CF was measured by CF score which pertaining to comprehension, cognition, attention, and learning. The validated computerized cognitive assessment battery (CAB‐NT), includes 7 cognitive domains: memory(Mem), executive function(Exe), attention(Att), information processing speed(Inf), visual‐spatial(Vis), verbal function(Ver), motor skills(Mot) and a global cognitive summary score(GCS). T‐tests and regression analysis was utilized for analysis assuming both equal and unequal variances, with significance (p< 0.05).
Results
496 PwDAD, average age 73.4±8.9, 61.2% female. T‐test showed significant differences between driving status yes/no for both CF and all CAB‐NT domains. However, regression analysis showed a small effect size between CF and CAB‐NT cognitive domains scores.
Conclusion
Self‐reported driving status in PwDAD corresponds to both perceived/subjective CF and objective measures of cognitive function. However, the relationship between subjective and objective cognitive function measures is problematic. With various CDs involved in the safe effective operation of a motor vehicle, it is necessary to objectively assess this risk with objective measures. Evidence of incongruent relationship between objective and subjective cognitive function enhances the importance of incorporating objective measures of cognitive ability to safely maintain an active driving status.
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