Abstract
BackgroundCognitive impairment and visual deterioration are two key clinical symptoms in MS and affect 50 to 80% of patients. Little is known about the influence of cognitive impairment on visual tests recommended for MS such as low contrast sensitivity testing. Our objective was to investigate whether low contrast sensitivity testing is influenced by cognitive impairment in multiple sclerosis (MS) patients.MethodsCross-sectional study including 89 patients with relapsing-remitting MS. All patients received cognitive evaluation using Rao’s Brief Repeatable Battery of Neuropsychological Testing (BRB-N). Visual assessments included low contrast sensitivity (CS) by functional acuity contrast testing and high contrast visual acuity (VA) using ETDRS charts. Retinal morphology as visual impairment correlate was measured using retinal nerve fiber layer (RNFL) thickness by optical coherence tomography.ResultsIn combined analyses using generalized estimating equation models, Paced Auditory Serial Addition Test (PASAT) and RNFL as well as and the Symbol Digit Modalities Test (SDMT) and RNFL predicted CS. To further control for a potential influence of the anterior visual system we performed partial correlation analyses between visual function and cognitive function test results but controlling for RNFL. Even when controlling for RNFL, CS was associated with PASAT performance and SDMT performance.ConclusionOur data show that: a) cognitive impairment and performance in visual function tests such as low contrast sensitivity testing are associated; b) the main cognitive domains correlating with visual test performance are information processing speed and, to a lesser degree, memory; This preliminary data needs to be substantiated in further studies investigating patients with a higher cognitive burden, healthy controls and in longitudinal settings.
Highlights
Cognitive impairment and visual deterioration are two key clinical symptoms in multiple sclerosis (MS) and affect 50 to 80% of patients
A summary of the Brief Repeatable Battery of Neuropsychological Testing (BRB-N) scores is given in Table 2. 28% of the patients were cognitively impaired according to the BRB-N
Two previous investigations studying the converse of our study focus were able to demonstrate the validity of their hypothesis, namely, that visual acuity influences performance in visually dependent cognitive tests like Symbol Digit Modalities Test (SDMT) [34,35]
Summary
Cognitive impairment and visual deterioration are two key clinical symptoms in MS and affect 50 to 80% of patients. Our objective was to investigate whether low contrast sensitivity testing is influenced by cognitive impairment in multiple sclerosis (MS) patients. The Sloan low contrast visual acuity charts [6,9,10,11] and the PelliRobson contrast sensitivity charts [10,12] have been demonstrated as superior to high contrast visual acuity testing in MS Both visual outcome measures have been shown to correlate strongly with retinal nerve fibre layer (RNFL) thickness [13], which is an important OCT marker for assessing the structural integrity of retinal axons [14,15]. Clinicianresearchers have suggested including low contrast visual acuity testing in the Multiple Sclerosis Functional Composite (MSFC), the most widely used quantitative clinical assessment tool in MS [9,17,18]
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