Brief Repeatable Battery Of Neuropsychological Tests Research Articles

Cognitive phenotypes in patients with relapsing-remitting multiple sclerosis with different disease duration, applying the international classification of cognitive disorders in MS (IC-CoDiMS)

Objective: Cognitive impairment is experienced by 40–70% of multiple sclerosis patients, with information processing speed and memory most affected. Until now, cognitive results classified patients as impaired and not impaired. With this dichotomous approach, it is difficult to identify, in a heterogeneous group of patients with cognitive impairment, which cognitive domain(s) are most altered. This study aims to identify cognitive phenotypes in a clinical cohort of adult patients with Relapsing-Remitting Multiple Sclerosis (RRMS) using the International Classification of Cognitive Disorders in MS (IC-CoDiMS) and to characterize their clinical features. Methods: Three hundred patients with RRMS underwent neuropsychological assessment with the Brief Repeatable Battery of Neuropsychological Tests (BRBN-T) and the Brief International Cognitive Multiple Sclerosis (BICAMS). Results: In our cohort, the mean age was 41.38 [11.48 SD] years, and 205 [68.3%] were women. At the −1 SD threshold, 49% were cognitively intact, 25% had uni-domain impairment, 17% had bi-domain impairment, and 9% had multi-domain impairment. Processing speed was the most frequent single-domain impairment, followed by memory and verbal fluency. At the −1.5 SD threshold, 74.7% were cognitively intact, 17% had uni-domain impairment, 6% had bi-domain impairment, had bi-domain impairment, and 3.0% had multi-domain impairment. Memory was the most frequent single-domain impairment, followed by processing speed and verbal fluency. Conclusions: This study corroborates the importance of determining cognitive phenotypes through taxonomy (IC-CoDiMS). In addition, it contributes to improving the classification of cognitive phenotypes in patients with RRMS to enhance the development of more effective treatments and cognitive interventions.

5 -Alpha-dihydroxyprogesterone may contribute to perceptual processing and attention of the cases with relapsing remitting multiple sclerosis

ABSTRACT Neurosteroids (NSs) are endogenous steroid hormones, which are synthesised and metabolised within the central nervous system (CNS). NSs aid myelination and glial differentiation and modulate cognitive functions. Herein, we aim to investigate the relationship between NS levels, 5-alpha-dihydroxyprogesterone (5-α-DHP) and allopregnanolone (ALPG), and their relationship with cognitive changes in relapsing remitting MS patients. A total of 43 cases with well controlled, relapsing remitting MS composed the study group. The control group included 21 age and gender matched healthy controls (HC). MS patients were assessed by calculating Expanded Disability Status Scale (EDSS) scores, and the Brief Repeatable Battery of Neuropsychological Tests (BRBNT) was performed in both MS group and HC. Levels of 5-α-DHP and ALPG levels were also evaluated for each participant. The median level of 5-α-DHP was 48 [IQR: 39.2–144.2] pg/mcgL in the MS group and 68.4 [IQR: 57.1–365.9] pg/mcgL in HC (p = 0.02). The median ALPG level was found to be 56.5 [IQR: 37.7–75.4] pg/mcgL in the MS group and 43.9 [IQR: 29.4–70.2] pg/mcgL in HC (p = 0.1). In both groups 5-α-DHP levels were positively correlated with Symbol Digit Modalities Test (SDMT) scores (HC: p = 0.01, r = 0.3 and MS: p = 0.03, r = 0.3). In the MS group, higher EDSS scores were associated with lower scores on Spatial Recall Test (SPART)-Delayed (p = 0.009, r= −0.4) and SDMT (p = 0.01, r= −0.4). The disease duration was negatively correlated with the scores on SPART-Immediate, SPART-Delayed and SDMT (p = 0.02, r= −0.4; p = 0.005, r= −0.4 and p = 0.05, r= −0.3). 5-α-DHP may be lower even in well-controlled cases. 5-α-DHP may contribute to better perceptual processing and attention in cases with MS.

Cognitive impairment in multiple sclerosis phenotypes: Neuropsychological assessment in a portuguese sample

Background Cognitive impairment affects 40–65% of MS patients, encompassing all disease stages and types of clinical courses. This estimation is based on different instruments used and population normative data. Objective This study aims to assess the cognitive function in a hospital-based cohort of Portuguese MS patients, to allow estimating the prevalence of cognitive impairment in different phenotypes. Methods Three hundred and thirteen patients with Multiple Sclerosis (MS) underwent neuropsychological assessment with the brief repeatable battery of neuropsychological tests (BRBN-T) and the brief international cognitive assessment for multiple sclerosis (BICAMS). Results Differences were observed in the cognitive impairment profile of different disease phenotypes and of the different disease severity stages. RRMS patients performed better in the cognitive test of the BRBN-T and BICAMS than those with progressive disease phenotypes. Relationships between cognitive impairment and disability and professional status were relevant. Although similarities could be observed in the cognitive profile of the MS phenotypes, with predominant involvement of verbal memory, verbal fluency, and information processing speed, the latter was found to be more frequent as the disease progressed. Conclusion This study contributes to improve knowledge about the cognitive profile of the different MS phenotypes and understand the cognitive characteristics of Portuguese patients.

Selective Cerebellar Atrophy Associates with Depression and Fatigue in the Early Phases of Relapse-Onset Multiple Sclerosis.

Cerebellar dysfunctions have been associated to depressive disorders and cognitive impairment in neurodegenerative diseases. The objective is to analyze the associations between cerebellar atrophy, depression, and fatigue in the early phases of relapse-onset multiple sclerosis (RRMS). Sixty-one RRMS patients and 50 healthy controls (HC) were enrolled and clinically evaluated by means of expanded disability status scale (EDSS), Rao's brief repeatable battery of neuropsychological tests (BRB-NT), Delis-Kaplan executive function system sorting test, beck depression inventory II (BDI-II), and fatigue severity scale (FSS). The relationships between MRI variables and clinical scores were assessed. Depressed RRMS (dRRMS) had significantly lower Vermis Crus I volume compared with not depressed RRMS (ndRRMS) (p = 0.009). Vermis Crus I volume was lower in dRRMS suffering from fatigue than in ndRRMS without fatigue (p = 0.01). The hierarchical regression models which included demographic and clinical data (age, sex, and disease duration, FSS or BDI-II) and cerebellar volumes disclosed that cerebellar lobule right V atrophy explained an increase of 4% of the variability in FSS (p = 0.25) and Vermis Crus I atrophy explained an increase of 6% of variability in BDI-II (p = 0.049). Since clinical onset, atrophy of specific cerebellar lobules associates with important clinical aspects of RRMS. Cerebellar pathology may be one of the determinants of fatigue and depression that contribute to worsen disability in RRMS.

D-KEFS ST Failure Identifies Multiple Sclerosis Patients With Worse Objective and Self-Perceived Physical and Cognitive Disability.

Background and Objectives: The Brief Repeatable Battery of Neuropsychological Test (BRB-NT) does not explore the executive functions. We combined BRB-NT and Delis-Kaplan Executive Function System Sorting Test (D-KEFS ST) to obtain a more comprehensive evaluation of cognitive impairment in Multiple Sclerosis (MS) patients.Methods: 137 Relapsing Remitting MS (RRMS) patients underwent a detailed neuropsychological assessment including BRB-NT, D-KEFS ST and self-administrated questionnaires, namely the Multiple Sclerosis Neuropsychological Questionnaire (MSNQ), the Fatigue Severity Scale (FSS) and the Beck Depression Inventory-Second Edition (BDI-II).Results: Fifty-four patients (39.4%) had normal scores in each item of both batteries (cognitive normal), while 64 patients (46.7%) failed in at least one test of BRB-NT but not of D-KEFS ST (BRB-NT impaired) and 18 (13.1%) failed in at least one test of both batteries (BRB-NT+D-KEFS ST impaired). Only one patient (0.7%) failed in D-KEFS ST, but not in BRB-NT and was excluded from further analysis. BRB-NT+D-KEFS ST impaired patients had a significant higher mean disease duration and median EDSS score (15.5 ± 13.6 years and 3.5, respectively) compared to those with only BRB-NT impaired (7.9 ± 9.2, p < 0.01 and 2.5, p < 0.05) and with cognitive normal patients (6.7 ± 9.4, p < 0.005 and 2.0, p < 0.01). SDMT was more frequently impaired in BRB-NT+D-KEFS ST impaired patients (77.8%) compared to only BRB-NT impaired ones (20.0%, p < 0.001). The failure in D-KEFS ST was associated with the number of failed BRB-NT items (OR 1.46, IC95% 1.07–1.99, p < 0.05) and with pathological SDMT z-value (OR 10.56, IC95% 2.50–44.66, p < 0.005). Compared to BRB-NT impaired patients and the cognitive normal ones, BRB-NT+D-KEFS ST impaired patients had significant higher MSNQ (p < 0.01) and BDI-II (p < 0.05) values.Conclusion: D-KEFS ST did not increase the number of cognitively impaired MS patients identified by BRB-NT, but provided a more comprehensive evaluation of cognitive decline. D-KEFS ST identified a subgroup of patients with increased self-perception of cognitive decline, depression and higher physical disability.

Aerobic Capacity Is Not Associated with Most Cognitive Domains in Patients with Multiple Sclerosis-A Cross-Sectional Investigation.

(1) Background: Cognitive impairment is highly prevalent in multiple sclerosis (MS). Staying physically fit may be associated with preservation of cognitive performance in persons with MS (pwMS); (2) Objective: To investigate the association between aerobic capacity and the cognitive domains of information processing, learning and memory, and verbal fluency as well as single and composite z-scores of the Brief Repeatable Battery of Neuropsychological tests (BRBNT) in pwMS; (3) Methods: All subjects first performed the BRBNT and then a maximal oxygen consumption (VO2-max) test on a bicycle ergometer as a measure of aerobic capacity. Simple and multiple (adjusting for age, sex, and education level) regression analyses were performed to evaluate the relationship between aerobic capacity and cognitive performance in different domains. Published international norms were used to compute z-scores for each individual and composite BRBNT score. Furthermore, cognitive impairment was defined as one or more z-scores ≤−1.5 standard deviation (SD) of healthy controls; (4) Results: Eighty-four subjects were included (44.9 ± 9 years, 16.3 ± 2 education years, Expanded Disability Status Scale (EDSS): 2.6 ± 1.4, MS-type (relapsing-remitting, primary progressive, or secondary progressive): 73/6/5, disease duration: 9.9 ± 7 years, VO2-max: 28.4 ± 7.0 mL O2/min/kg). No significant associations between aerobic capacity and cognitive performance in the individual BRBNT tests were found, except that a weak relationship was found between aerobic capacity and the composite processing speed z-score (R2 = 0.06, p = 0.02). The average global BRBNT z-score (−0.2 ± 0.66) was not associated with aerobic capacity. Comparison of the cognitively impaired group (34.5%) with the nonimpaired group (65.5%) showed lower aerobic capacity in the impaired group (25.9 ± 1 vs. 29.7 ± 1 mLO2/min/kg, p = 0.02); (5) Conclusions: Limited support was found for an association between performance in most cognitive domains and aerobic capacity in the present MS group with a third of patients showing signs of cognitive impairments.

Rehabilitative approach in early stages of multiple sclerosis

Patients with multiple sclerosis (MS) since the earliest stages experiencing motor and cognitive problems, such as lower motor fluidity, reduced attention spans, memory impairments. The progressive loss of integration ability of the central nervous system resulting in a disconnection damage. First affected are fast systems with high level of integration. “Dual tasking” often leads to a poorer performance. Aim of the study is to verify the value of early rehabilitation in reducing the impact of these symptoms on daily living. We conducted a case-control study including 15 patients with EDSS < 3, divided into three groups: 5 underwent 10 sessions of adapted physical activity (APA); 5 had 10 cognitive-motor training sessions (individual rehabilitation project-IRP), 5 not underwent rehabilitation treatment (control). Patients had initial and final motor-cognitive assessments using Berg Balance Scale (BBS), Ten Meter Walking Test (TMWT) at different speeds and performing a cognitive task (Word List Generation-WLG), Brief Repeatable Battery of Neuropsychological Tests (BRB-NT), Trail Making Test (TMT) and Digit Span. TMWT final evaluation showed variations in IRP and APA. The number of words generated in usual and quick speed, not changed in Control, was reduced in APA, increased in IRP. BBS score variation was statistically significant in IRP and APA (IRP initial median score: 52, final median score: 55). At BRB-NT, after cognitive training, results a significant improvement in IRP ( t -test: p 0,005). IRP and APA show a greater ability in balance control and global fluidity; IRP has better performance in “dual tasking”, probably related to an exercise focused on individual specific impairments. These data support the value of individualized rehabilitation treatment, since the early stage of the disease, moreover APA could represent a good tool in the maintenance phase.

Cognitive performance, fatigue and event-related potentials in patients with clinically isolated syndrome

ObjectivesCognitive impairment and fatigue are regarded as important aspects of multiple sclerosis. The aim of this study was to evaluate cognitive performance, the level of fatigue and parameters of event-related potentials (ERP) in patients diagnosed with clinically isolated syndrome (CIS). Patients and methodsThe study comprised 44 patients with CIS and 45 healthy controls. Cognitive performance was assessed using the Brief Repeatable Battery of Neuropsychological Tests (BRBNT), fatigue - using the Fatigue Severity Scale (FSS) and Modified Fatigue Impact Scale (MFIS). Auditory ERP were performed and the parameters of N200 and P300 components were analyzed. Neuropsychological and electrophysiological measures were referred to clinical and radiological features of the disease activity. ResultsForty five% of patients failed in at least one test from BRBNT, mainly within the domains of memory and attention. In 18% of patients FSS corresponded with moderate or severe fatigue. The mean latency of N200 and P300 was significantly longer and amplitude of P300 was lower in those patients with CIS than in the controls. Significant correlations were found between the results of MFIS and tests evaluating verbal memory and attention, as well as between N200 latency and results of tests for verbal memory. ConclusionsCognitive performance and fatigue deserve attention from the earliest clinical stage of MS. Abnormalities of event-related potentials in CIS suggest early impact of the disease on functional neural networks.

Event-related potentials and cognitive performance in multiple sclerosis patients with fatigue

The aim of this study was to evaluate event-related potentials (ERP) and cognition in multiple sclerosis (MS) patients with regard to fatigue and disease-related variables. The study comprised 86 MS patients and 40 controls. Fatigue was assessed using the Fatigue Severity Scale (FSS/FSS-5) and the Modified Fatigue Impact Scale (MFIS/MFISmod). N200 and P300 components of auditory ERP were analyzed. Cognition was evaluated by means of Brief Repeatable Battery of Neuropsychological Tests (BRBNT). The results of ERP and BRBNT were compared between non-fatigued, moderately and severely fatigued MS patients and controls. P300 latency was significantly longer in the whole MS group and in the fatigued patients than in the controls. A positive correlation was found between P300 latency and MFIS/MFISmod results, independent from age and MS-related variables. The fatigued patients scored less than non-fatigued ones in tests evaluating memory, visuomotor abilities and attention. Results of these tests correlated significantly with fatigue measures, independently from MS-related variables. Fatigue in MS patients showed significant relationships with impairment within the memory and attention domains. Parameters of auditory ERP, as electrophysiological biomarkers of cognitive performance, were not independently linked to fatigue.

BRBN-T validation: adaptation of the Selective Reminding Test and Word List Generation.

Objective This study aims to present the Selective Reminding Test(SRT) and Word List Generation (WLG) adaptation to the Portuguese population, within the validation of the Brief Repeatable Battery of Neuropsychological Tests (BRBN-T)for multiple sclerosis (MS) patients.Method 66 healthy participants (54.5% female) recruited from the community volunteered to participate in this study.Results A combination of procedures from Classical Test Theory (CTT) and Item Response Theory (ITR) were applied to item analysis and selection. For each SRT list, 12 words were selected and 3 letters were chosen for WLG to constitute the final versions of these tests for the Portuguese population.Conclusion The combination of CTT and ITR maximized the decision making process in the adaptation of the SRT and WLG to a different culture and language (Portuguese). The relevance of this study lies on the production of reliable standardized neuropsychological tests, so that they can be used to facilitate a more rigorous monitoring of the evolution of MS, as well as any therapeutic effects and cognitive rehabilitation.

Cognitive performance profile in different phenotypes of MS with cognitive complaints

BackgroundThe relationship between cognitive impairment and disease course and severity of multiple sclerosis (MS) is not well understood. ObjectiveThe aim of the study was to evaluate whether cognitive complaints in different clinical phenotypes and severity stages of MS are associated with differences in the profile of cognitive impairment. Methods196 MS patients (relapsing-remitting RRMS n=138; secondary progressive SPMS n=32; primary progressive PPMS n=26) with perceived cognitive deficits underwent neuropsychological assessment with the brief repeatable battery of neuropsychological tests (BRBNT). Mood, impact of the disease, and quality of life were evaluated with self-reports. ResultsOnly minor differences were observed in the cognitive impairment profile of different disease phenotypes and different disease severity stages. RRMS patients performed better only in one cognitive test of the BRBNT, than patients with progressive disease types. When RRMS, SPMS, and PPMS groups were evaluated separately, PPMS showed more pronounced cognitive impairments than RRMS and SPMS. The relationships between cognitive impairment and severity of disability as well as duration of disease were weak. ConclusionMS patients with cognitive complaints tend to have a relatively similar cognitive impairment profile which is not dependent on the disease course and severity.

The relationship between cognitive function and depression severity in multiple sclerosis patients: Application of the Brief Repeatable Battery of Neuropsychological Tests (BRBNT) in Lithuania

Multiple sclerosis (MS) is an inflammatory and neurodegenerative disorder that affects primarily the cerebral white matter, thereby causing both physical and psychological disability. The purpose of this study was to investigate the possible relationship between cognitive function and depression severity in MS patients, as well as sensitivity and specificity characteristics of the BRBNT (The Brief Repeatable Battery of Neuropsychological Tests). We investigated 41 MS patients and 52 healthy people.Forty-one controls were selected from fifty-two healthy subjects and were individually matched with MS subjects for age, gender and education. BRBNT (Rao and Peyser, 1986) was designed for measuring verbal learning, visuospatial learning, sustained attention and concentration, information processing speed and verbal fluency cognitive functions. The B version of the BRBNT was translated and used in our study. Beck Depression Inventory-Second Edition (BDI-II) (Beck, 1996) was used for the evaluation of depression severity.Results of our study confirmed that depression severity was associated with verbal learning: Consistent Long Term Retrieval and the Delayed Recall significantly negatively related to depression severity. The relationship between information processing speed and depression severity was also negative, but not statistically significant. The five individual BRBNT tests separately did not significantly discriminate healthy controls from MS patients; however, when all the five BRBNT tests put together we found 100% sensitivity of and 100% specificity.Our findings lead to the conclusion that neuropsychological testing is important in organizing help strategies for MS patients. BRBNT is a sensitive measure of cognitive function in MS, and may assist with differential diagnosis. Similarly, BRBNT could well be applied to other groups of patients, whose illness results in physical and/or cognitive functional limitations.

Computer-aided retraining of memory and attention in people with multiple sclerosis: a randomized, double-blind controlled trial

Context: Cognitive compromise is one of the main contributing factors to activity and participation restrictions in people with multiple sclerosis (MS). Computer-aided programs are used for retraining memory and attention, but data on the efficacy of these interventions are scarce. Objective: To assess the efficacy of computer-aided retraining of memory and attention in people with MS impaired in these abilities. Design and setting: Randomized, double-blind, controlled trial. Participants: Outpatients ( n=82) with subjective complaints of poor attention or memory, confirmed by a score <80th percentile in at least two tests of the Brief Repeatable Battery of Neuropsychological Tests (BRBNT). Interventions: Participants were randomized to two computer-assisted retraining interventions: memory and attention (study arm), and visuo-constructional and visuo-motor coordination (control arm). Both groups received 16 training sessions over 8 weeks. Outcome measures: Improvement of 20% or more in at least two BRBNT test scores at 8 weeks compared to baseline (primary end point). Changes in depression and health-related quality of life. Results: An improvement occurred in 45% of study patients vs. 43% of control patients (odds ratio 1.07, 95% confidence interval 0.44–2.64). The study treatment was better than the control treatment only on the word list generation test ( p=0.016). Conclusions: This trial does not support the efficacy of specific memory and attention retraining in MS.