Information processing speed is one of the most impaired cognitive functions in multiple sclerosis (MS). There are two tests widely used for evaluating information processing speed: the Symbol Digit ...Modalities Test (SDMT) and the Paced Auditory Serial Addition Test (PASAT). To analyze the relationship between processing speed and the clinical and social support variables of patients with MS.
A group of 47 patients with relapsing-remitting MS was studied, 31 were women and 16, men. Age: 39.04±13.17, years of schooling: 13.00±3.87, Expanded Disability Status Scale (EDSS): 2.78±1.81, and disease evolution: 8.07±6.26. Instruments of measure; processing speed: SDMT, PASAT, clinical variables: EDSS, Fatigue Severity Scale (FSS), Beck's Depression Inventory II (BDI-II), and social support: Medical Outcomes Study Social Support Survey (MOS).
Significant correlations were found between information processing speed and psychiatric, motor disability and social support variables. The SDMT correlated significantly and negatively with BDI-II, FSS, EDSS, and MOS (
<0.05), whereas the PASAT correlated negatively with FSS and positively with MOS (
<0.05). Information processing speed appeared as the performance predictor of these variables. The SDMT produced significant changes in EDSS (R²=0.343,
=0.000); FSS (R²=0.109,
=0.031); BDI-II (R²=0.124,
=0.018), and MOS (R²=between 0.212 and 0.379,
<0.05).
Information processing speed has influence on the clinical variables and the social support of patients with MS. These aspects are important to bear in mind for therapeutic approach.
The Treatment Burden Questionnaire (TBQ) is a self-reported measure of the effect of treatment workload on patient wellbeing. We sought to validate the TBQ in Spanish and use it to estimate the ...burden of treatment in Argentinian patients with multiple sclerosis (MS).
The TBQ was forward-backward translated into Spanish. Two focus groups and 25 semi-structured interviews focused on wording and possible item exclusion. Validation was performed in 2 steps. First, 162 patients across a range of MS severity completed the questionnaire. Confirmatory factor analysis assessed the dimensional structure of the TBQ. Construct validity was assessed by studying correlations with fatigue and quality of life (QoL). Then, in a second cohort of 171 patients, we evaluated the association between TBQ scores and patients' sex, age, education level, employment status, type of MS, disease duration, comorbidities, EDSS, pharmacological treatment and medication adherence.
The questionnaire presented a 3-factor structure in which burden was related to pharmacological treatment; comprehensive health assistance; and psycho-social-economic context. Composite reliability was > 0.8 for all factors. TBQ showed positive correlation with fatigue (r
= 0.467, p = 0.006), negative correlation with QoL (r
- 0.446, p = 0.009). For the second cohort, total TBQ score was 43 (SD 29). Lowest scores were observed on self-monitoring (0.53, SD 1.3) and highest for administrative load (4.2, SD 3.4). Inverse association was found between the TBQ score and medication adherence (r 0.243 p = 0.001). TBQ scores also correlated with daily patient pill/injection requirements (r 0.175 p = 0.020). Individuals receiving injectable treatment scored higher than patients on oral drugs (total TBQ 51 (SD 32) vs 39 (SD 27) p = 0.002).
The TBQ in Spanish is a reliable instrument and showed adequate correlation with QoL and adherence scales in MS patients. TBQ may benefit health resources allocation and provide tailor therapeutic interventions to construct a minimally disruptive care.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
The aim of the present research was to investigate cognitive pattern of patients with neuromyelitis optica (NMO) and to compare it with multiple sclerosis (MS) patients' performance.
Fourteen NMO, 14 ...relapsing remitting multiple sclerosis (RRMS), and 14 healthy control patients participated in the investigation. Neuropsychological functions were evaluated with the Brief Repeatable Neuropsychological Battery for MS; Symbol Digit Modalities Test; Digit Span; and Semantic Fluency.
Fifty-seven percent of NMO patients and 42.85% of the MS ones had abnormal performance in at least two cognitive tests. The NMO Group showed abnormal performance in verbal fluency, verbal and visual memories, with greater attention deficits. NMO patients outperformed healthy control in the paced auditory serial addition test (PASAT). However, no difference was found between NMO and RRMS patients.
The NMO Group showed more dysfunction in attention and verbal fluencies than in verbal and visual memories. When compared with the MS patients, a similar dysfunction pattern was found. O objetivo da presente pesquisa foi investigar o padrão cognitivo de pacientes com neuromielite óptica (NMO) e compará-lo com o desempenho de pacientes com esclerose múltipla (EM). Métodos: Quatorze pacientes com NMO, 14 com esclerose múltipla recorrente remitente (EMRR) e 14 participantes do Controle saudáveis participaram da presente investigação. As funções neuropsicológicas foram avaliadas com a Bateria Breve de Testes Neuropsicológicos de Rao, Teste Símbolo Digit e a Fluência Semântica. Resultados: Cinquenta e sete por cento dos pacientes com NMO e 42,85% daqueles com EM apresentaram desempenho anormal em pelo menos dois testes cognitivos. O Grupo NMO apresentarou desempenho anormal na fluência verbal e nas memórias visual e verbal, com maiores déficits de atenção. Pacientes com NMO superaram os controles saudáveis em PASAT. No entanto, não foi encontrada diferença entre os pacientes com NMO e aqueles com EMRR. Conclusões: O Grupo NMO mostrou mais disfunção nas fluências de atenção e verbais do que nas memórias verbal e visual. Quando comparados com os pacientes com EM, um padrão de disfunção semelhante foi encontrado.
Para poder cuantificar e investigar científicamente las quejas mnésicas de los pacientes, se hace necesario contar con un instrumento adaptado y que presente análisis psicométricos adecuados. El ...objetivo del presente trabajo fue estudiar propiedades psicométricas de una versión argentina del Cuestionario de Memoria Prospectiva y Retrospectiva. Para ello se administró el Cuestionario de Memoria Prospectiva y Retrospectiva de forma individual a 192 participantes sanos con más de 27 puntos en el Mini Mental State Examination. La media de edad fue de 39.67 años (DE = 12.3). La media de escolaridad fue de 14.5 años (DE = 2.72). A un subgrupo de participantes (n = 45) denominado Subgrupo A, también se les administraron pruebas de memoria prospectiva y retrospectiva. El Índice Global del Cuestionario presentó una distribución normal. Según el análisis factorial exploratorio se estableció la extracción de un factor que explicó el 35.19 % de la varianza. El coeficiente α de Cronbach fue de .87. La confiabilidad estimada por el método de la división por mitades fue de .73 y de .84 luego de la corrección con la fórmula de Spearman-Brown. No hubo correlación significativa entre las respuestas del cuestionario y los test de memoria retro y prospectiva en el subgrupo A. Estos resultados permiten concluir que el Cuestionario de Memoria Prospectiva y Retrospectiva presenta adecuados índices de confiabilidad y una estructura de un solo factor. Si bien no se asocia con el rendimiento objetivo en pruebas de memoria, muestra ser apropiado para el registro de las quejas subjetivas de los pacientes en la región de estudio.
La discapacidad física y el curso de la enfermedad son fuertes predictores del estatus laboral en los pacientes con Esclerosis Múltiple (EM). Sin embargo, la cognición no tiene el mismo grado de ...evidencia. Este estudio plantea el objetivo de investigar la relación entre la situación laboral y el rendimiento cognitivo en la EM. Se recogieron los datos de 61 pacientes con EM de curso recurrente-remitente (EMRR) que fueron a atenderse en un hospital público entre abril de 2014 y abril de 2015. El 29.5% estaban desempleados, el 54.1% estaban empleados y el 10.4% eran estudiantes o amas de casa. Se implementaron como test neuropsicológicos la Batería Neuropsicológica Breve para Esclerosis Múltiple y el test Símbolo-Dígito. Además se administraron la Escala de Estatus de Discapacidad Expandida y el Inventario de Depresión de Beck II. La evaluación se realizó de forma individual en dos sesiones, una con el neurólogo y otra con el neuropsicólogo en un consultorio privado. Las diferencias no fueron significativas en edad y años de instrucción entre los pacientes con y sin empleo. En cambio, los pacientes desempleados tenían un puntaje más bajo en el Símbolo-Dígito, así como la Escala de Estatus de Discapacidad Expandida y un Inventario de Depresión de Beck más altos que aquellos con trabajos. Los pacientes con EMRR que estaban desempleados tenían un peor desempeño en la velocidad de procesamiento de la información, más depresión y discapacidad física que aquellos que conservan sus trabajos. Palabras clave: Esclerosis múltiple; Cognición; Discapacidad; Desempleo; Atención. Employment is a very important aspect of a person's life, and that is why any health-related factor that can interfere in such activity must be identified. The reality of a Latin American country is different and should be approached as a separate object of study. Many factors that contribute to a patient losing the job can be identified in time in order to be reversed or compensated. Thus, identifying the vulnerability profile of the patients with multiple sclerosis (MS) who are at risk of losing their jobs is an important task for researchers. Physical disability and disease course are both strong predictors of work status in MS patients, however, cognition and affective variables do not have the same degree of evidence. This study raises the aim of investigating the relationship between employment status and cognitive performance in MS. With this knowledge, it would be possible to design a neuropsychological rehabilitation plan for patients, which focuses on compensating and recovering from cognitive impairment, as well as on serving as orientation for the person who is at risk of losing their job. A group difference design was used. The sample units were selected through a non-probability accidental sampling. We collected the data of 61 patients with relapsing-remitting MS (RRMS) who had attended consultation between April 2014 and April 2015, in a public hospital. 29.5% were unemployed; 54.1% were employed; and 10.4% were students or housewives. The Brief Repeatable Battery of Neuropsychology Tests adapted for Argentine population; Symbol Digit Modalities Test (SDMT), Expanded Disability Status Scale (EDSS) and Beck Depression Inventory-II (BDI-II), were administered individually in two sessions, one with a neurologist and one with the neuropsychologist in a private consulting room. Age and years of instruction differences between patients with and without employment were not significant. There were 60.8% of patients with cognitive impairment. Among them, 38.7% were unemployed. The relationship between cognitive deterioration and work status was not significant, chi square = .404, df = 1, p = .371. When comparing the groups in the cognitive battery, a meaningful difference in cognitive performance was observed between the subjects who had a job with those who were unemployed in SDMT (t = -2.421, df = 49, p = .019); performance being higher among the former. No other cognitive score showed significant results. Unemployed patients had higher EDSS and depression, than those with jobs. The cognitive tests administered, together with the BDI-II and EDSS, were included in the binary logistic regression analysis. The second model retained the SDMT and the BDI-II; both tests were able to correctly classify almost 80% of the cases. Also, both SDMT (beta = .080, p = .014) and BDI-II (beta = -.098, p = .022) shown significant effects on work status. This study is one of the first attempts in Argentina to analyze the possible determinants of unemployment, which is extremely important in the context of a lack of determining literature about the issue in Latin America. According to results, patients with RRMS who are unemployed have worse performance in speed of information processing, more depression and physical disability than those who retain their jobs. Results are in line with previous studies, although in the present research a cognitive variable showed a greater negative influence on employment status over motor difficulties or physical disability. Clinicians would be able to identify patients whose profile shows a higher tendency towards work life decline, so that they can receive early treatment and delay that progression. It is suggested the realization of a multicentric Latin American study, blind to the patients labor status, with the aim of broadening the results by improving the study methodology. Key words: Multiple sclerosis; Cognition; Disability evaluation; Unemployment; Attention.
We assessed cognitive performance and physical disability in 111 multiple sclerosis (MS) patients and 222 healthy controls in a multicenter study in Argentina to obtain the prevalence of cognitive ...impairment (CI) in a population of MS outpatients in Argentina. MS patients presented significantly lower scores in all Brief Repeatable Battery of Neuropsychology (BRB-N) tests than did the control group. The prevalence of CI was 43.2%. This study allowed us to obtain actual figures on the number of MS patients with CI in a Latin American sample. This validation is a very useful tool for clinical practice and for research studies to assess cognition in MS.
Celotno besedilo
Dostopno za:
BFBNIB, DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
PDF
