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Multiple sclerosis, EDSS, and objective cognitive function: a walking scale with no apparent brains and limited thought
Author(s): ,
M Gudesblatt
Affiliations:
South Shore Neurologic Associates, Patchogue
,
K Wissemann
Affiliations:
South Shore Neurologic Associates, Patchogue
,
M Zarif
Affiliations:
South Shore Neurologic Associates, Patchogue
,
B Bumstead
Affiliations:
South Shore Neurologic Associates, Patchogue
,
L Fafard
Affiliations:
South Shore Neurologic Associates, Patchogue
,
K Blitz
Affiliations:
South Shore Neurologic Associates, Patchogue
,
M Buhse
Affiliations:
South Shore Neurologic Associates, Patchogue;Stony Brook University, Stony Brook, NY
,
C Sullivan
Affiliations:
Neuropsychological Associates, Fairfax, VA;Georgetown University Hospital, Department of Neurology and Washington Neuropsychology Research Group, Washington, DC
,
J Wilken
Affiliations:
Neuropsychological Associates, Fairfax, VA;Georgetown University Hospital, Department of Neurology and Washington Neuropsychology Research Group, Washington, DC
,
G Doniger
Affiliations:
NeuroTrax Corporation, Bellaire, TX, United States
I Topalli
Affiliations:
Biogen, Inc., Cambridge, United Kingdom
ECTRIMS Online Library. Gudesblatt M. Sep 15, 2016; 146205; P365
Mark Gudesblatt
Mark Gudesblatt
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Abstract: P365

Type: Poster

Abstract Category: Clinical aspects of MS - Clinical assessment tools

Background: Multiple Sclerosis (MS) is measured by MRI, relapse rates and EDSS. EDSS scale primarily driven by motor-walking impairment. Cognitive impairment, independent of EDSS, in people with MS (PwMS) impacts: employment, driving, fall risk, Quality of Life (QoL). EDSS is universally accepted to measure treatment efficacy but cognitive function does not impact EDSS. Cognitive function varies independently of walking ability and is an important aspect of PwMS disease impact.

Objective: Investigate the sensitivity of EDSS impairment reflecting PwMS cognitive ability.

Methods: PwMS completed a computerized cognitive assessment battery (NeuroTrax) with analysis of 7 cognitive domains (CD) and a global cognitive score (GCS) reflecting an average of these domain scores. The number of CD impaired (greater than one standard deviation from age- and education-matched norms) were also explored for each CD. EDSS-groups were defined: low-EDSS (0-2.5), moderate-EDSS (3-4.5), high-EDSS (5-6.5) and severe-EDSS (>7). Percent overlap of NeuroTrax cognitive scores across both adjacent EDSS-groups and extreme EDSS groups (low & severe) were calculated.

Results: 258 PwMS (72.5% female, average age = 46.2±10.2). PwMS-GCS had an average overlap: 65.0% across adjacent EDSS-groups, and 42.4% across extreme EDSS-groups. The overlap of the adjacent and extreme cognitive domain scores were respectively: memory (65.3% and 65.3%), executive function (65.1 % and 35.1%), attention (60.3% and 38.1%), information processing speed (58.0% and 42.5%), visual spatial (65.6% and 63.2%), verbal function (70.1% and 66.4%), and motor skills (55.2% and 32.3%). The overlap of the number of CD scores impaired >1SD was: 72.2% across adjacent groups, and 38.1% across extreme EDSS-groups.

Conclusions: EDSS is insensitive to assess individual PwMS cognitive ability and does not predict accumulated cognitive disability. Cognitive impairment in PwMS, independently of EDSS, correlates with many important milestones. EDSS use as a solitary gold standard in measuring unique accumulated PwMS disability should be reconsidered.

Disclosure: Glen Doniger is an employee of NeuroTrax Corporation

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