Multiple Sclerosis Participants Research Articles

Satisfaction with participation in multiple sclerosis and spinal cord injury

Purpose: To validate a single item self-report of satisfaction with participation in two groups with differing patterns of symptoms and disease progress, multiple sclerosis (MS) and spinal cord injury (SCI). Method: Community-dwelling adults with MS (N = 1,271) or SCI (N = 620) completed a battery of self-report questionnaires covering demographic information, disease specific measures, symptoms, psychological distress, social-environmental issues, and overall well-being. They were also asked to rate satisfaction with participation: How satisfied are you with your ability to take part in activities that are important to you: not satisfied, somewhat satisfied, satisfied, or very satisfied. Kendall’s tau rank correlation coefficient and χ2 tests were used to examine the strength and direction of associations between demographic and symptom variables and responses to the participation item. Results: Although the demographics of the MS and SCI differed in predictable ways, younger participants and those employed report more satisfaction with participation. Ratings of satisfaction with participation were also consistently associated with a number of variables including less fatigue, pain, depression, stress, anxiety, as well as higher overall measures of well-being across the two populations. Conclusions: More research is needed to better understand the multiple dimensions that comprise participation and to develop robust and sensitive measurement tools. A global rating of satisfaction with participation using one item has a number of potentially useful applications including description of case mix in clinical trials.Implications for RehabilitationRestrictions in participation are faced by many adults with disability including those with multiple sclerosis or spinal cord injury.These restrictions are associated with an array of biopsychosocial variables.A psychometrically sound indicator of satisfaction with participation could be used to describe the severity of condition, to adjust case mix in clinical trials, or to track global change disability status.

Optical coherence tomography segmentation reveals ganglion cell layer pathology after optic neuritis

Post-mortem ganglion cell dropout has been observed in multiple sclerosis; however, longitudinal in vivo assessment of retinal neuronal layers following acute optic neuritis remains largely unexplored. Peripapillary retinal nerve fibre layer thickness, measured by optical coherence tomography, has been proposed as an outcome measure in studies of neuroprotective agents in multiple sclerosis, yet potential swelling during the acute stages of optic neuritis may confound baseline measurements. The objective of this study was to ascertain whether patients with multiple sclerosis or neuromyelitis optica develop retinal neuronal layer pathology following acute optic neuritis, and to systematically characterize such changes in vivo over time. Spectral domain optical coherence tomography imaging, including automated retinal layer segmentation, was performed serially in 20 participants during the acute phase of optic neuritis, and again 3 and 6 months later. Imaging was performed cross-sectionally in 98 multiple sclerosis participants, 22 neuromyelitis optica participants and 72 healthy controls. Neuronal thinning was observed in the ganglion cell layer of eyes affected by acute optic neuritis 3 and 6 months after onset (P < 0.001). Baseline ganglion cell layer thicknesses did not demonstrate swelling when compared with contralateral unaffected eyes, whereas peripapillary retinal nerve fibre layer oedema was observed in affected eyes (P = 0.008) and subsequently thinned over the course of this study. Ganglion cell layer thickness was lower in both participants with multiple sclerosis and participants with neuromyelitis optica, with and without a history of optic neuritis, when compared with healthy controls (P < 0.001) and correlated with visual function. Of all patient groups investigated, those with neuromyelitis optica and a history of optic neuritis exhibited the greatest reduction in ganglion cell layer thickness. Results from our in vivo longitudinal study demonstrate retinal neuronal layer thinning following acute optic neuritis, corroborating the hypothesis that axonal injury may cause neuronal pathology in multiple sclerosis. Further, these data provide evidence of subclinical disease activity, in both participants with multiple sclerosis and with neuromyelitis optica without a history of optic neuritis, a disease in which subclinical disease activity has not been widely appreciated. No pathology was seen in the inner or outer nuclear layers of eyes with optic neuritis, suggesting that retrograde degeneration after optic neuritis may not extend into the deeper retinal layers. The subsequent thinning of the ganglion cell layer following acute optic neuritis, in the absence of evidence of baseline swelling, suggests the potential utility of quantitative optical coherence tomography retinal layer segmentation to monitor neuroprotective effects of novel agents in therapeutic trials.

Use of the international classification of functioning, disability and health to describe patient-reported disability: A comparison of motor neurone disease, Guillain-Barré syndrome and multiple sclerosis in an Australian cohort

Purpose: To compare patient-reported disability across three long-term neurological conditions [motor neurone disease (MND), Guillain-Barré syndrome (GBS) and multiple sclerosis (MS)] using the International Classification of Functioning, Disability and Health (ICF). Methods: A prospective cross-sectional survey of Australian community-based persons with MND (n = 44). Their MND-related problems were linked with ICF categories (second level) using open-ended questionnaires and ‘linkage rules’ and compared to similar data collected for GBS (n = 77) and MS (n = 101) participants. Results: MND participants were older (mean age 61 years, GBS 55, MS 49) with more males (66%, GBS 59%, MS 29%). Seventy ICF categories in MND were identified (GBS 41, MS 63): “body function” 15 (GBS 7; MS 18); “body structure” 5 (GBS 3, MS 5); “activities and participation” 40 (GBS 25, MS 30); “environmental factors” 10 (GBS 6, MS 10). The main areas linked in “activities and participation” were mobility, self care, general tasks and demands, domestic life, interpersonal interactions and relationships, major life areas and community, social and civic life; environmental factors included products and technology, natural environment, support and relationships, services, systems and policies. Conclusions: Comparison of three long-term neurological conditions will assist with development of a core set of categories to optimise consensus of care and communication amongst treating clinicians.Implications for RehabilitationMotor Neurone Disease causes diverse and challenging symptoms and disability.A set of relevant ICF categories in Motor Neurone Disease would be useful in both clinical and research settings for optimising care given the rare incidence of Motor Neurone Disease.Motor Neurone Disease can be compared to other long-term neurological conditions (Multiple Sclerosis and Guillain-Barré Syndrome) to assist with development of a core set of categories to optimise consensus of care and communication amongst treating clinicians.

Activation patterns in multiple sclerosis on the Computerized Tests of Information Processing

Rationale Multiple sclerosis (MS) patients exhibit cognitive deficits that negatively impact quality of life. The Relative Consequence Model suggests that problems with information processing speed (IPS) may be the basis for many of these cognitive difficulties. Objective To investigate, with functional magnetic resonance imaging (fMRI), if an IPS task (the Computerized Test of Information Processing (CTIP)) would reveal neurophysiological differences between MS patients and matched controls. Methods Performance and neural activation were investigated in twelve cognitively impaired MS patients and 12 matched controls as each performed the CTIP. The CTIP measures reaction time (RT) and errors on three tasks (simple RT, choice RT and semantic search RT) with increasing cognitive demands. Results Participants demonstrated increased RT with increased task complexity. Patients showed longer RTs for the choice RT condition than controls but the pattern of performance across tasks did not vary between groups. Errors were not significantly different between groups. Imaging results for both the choice and the semantic search conditions revealed significant differences between groups involving a compensatory increase in activation in MS participants compared to controls in prefrontal cortex and right temporal gyri. However, there were also areas of decreased activity in MS participants when compared with controls in left temporal gyri. Conclusions Significantly different neural activation patterns between MS patients and controls were associated with IPS, as measured by the CTIP.

The effects of cognitive loading on balance control in patients with multiple sclerosis

The aim of this study was to compare the effects of concurrent cognitive task (silent backward counting) on balance performance between two groups of multiple sclerosis (MS) ( n = 23) and healthy ( n = 23) participates. Three levels of postural difficulty were studied on a force platform, i.e. rigid surface with eyes open, rigid surface with eyes closed, and foam surface with eyes closed. A mixed model analysis of variance showed that under difficult sensory condition of foam surface with eyes closed, execution of concurrent cognitive task caused a significant decrement in variability of sway velocity in anteroposterior direction for the patient group ( P < 0.01) while this was not the case for healthy participants ( P = 0.22). Also, the variability of sway velocity in mediolateral direction was significantly decreased during concurrent execution of cognitive task in patient group ( P < 0.01) and not in healthy participants ( P = 0.39). Furthermore, in contrast to single tasking, dual tasking had the ability to discriminate between the 2 groups in all conditions of postural difficulty. In conclusion, findings of variability in sway velocity seem to confirm the different response to cognitive loading between two groups of MS and healthy participants.

The Computerized Test of Information Processing (CTIP) Offers an Alternative to the PASAT for Assessing Cognitive Processing Speed in Individuals With Multiple Sclerosis

To compare the ability of the Computerized Test of Information Processing (CTIP) to detect impaired cognitive processing speed in patients with multiple sclerosis (MS) with a traditional 3.0 second Paced Auditory Serial Addition Test (PASAT) and the Adjusting-PASAT which allows for calculation of a speed score. A primary cognitive deficit in MS is an impaired ability to process information quickly. Unfortunately, relatively few clinical tests effectively measure information processing speed. Of these, the PASAT is generally acknowledged to be the most sensitive, but use of this test is constrained by several factors. All tests were administered to 30 adults with relapsing-remitting MS and 30 control participants. A series of analysis of variances revealed MS participants performed significantly worse than controls on the CTIP and the 3.0 second PASAT, whereas no significant difference was observed for the Adjusting-PASAT. The results suggest the CTIP can detect deficits in the speed at which people with MS process information. Thus, the CTIP offers an alternative means to the 3.0 second PASAT included in the Multiple Sclerosis Functional Composite for assessing such impairment.

Awareness of executive functioning deficits in multiple sclerosis: Self versus informant ratings of impairment

This study investigates the accuracy of self and informant ratings of executive dysfunction in a multiple sclerosis (MS) and control sample. Participants completed a neuropsychological battery. Participants and informants completed depression measures and the Dysexecutive Questionnaire (DEX). MS participants rated themselves more impaired than controls, while informants' ratings were not statistically different. MS participants' performance on executive tasks was more highly correlated with self than informant DEX ratings. Discrepancies between informant DEX ratings and executive performance were related to executive functioning for the MS participants only. Overall, results indicate that MS patients were able to accurately rate their executive functioning.

Retrieval practice improves memory in multiple sclerosis: Clinical application of the testing effect.

The testing effect is a robust cognitive phenomenon by which memory retrieval on a test improves subsequent recall more than restudying. Also known as retrieval practice, the testing effect has been studied almost exclusively in healthy undergraduates. The current study investigated whether retrieval practice during testing leads to better delayed recall than restudy among persons with multiple sclerosis (MS), a neurologic disease associated with memory dysfunction. In a within-subjects design, 32 persons with MS and 16 demographically matched healthy controls (HC) studied 48 verbal paired associates (VPA) divided across 3 learning conditions: massed restudy (MR), spaced restudy (SR), and spaced testing (ST). Delayed VPA cued recall was measured after 45 min. There was a large main effect of learning condition (etap2 = .54, p < .001) such that both MS and HC participants produced better delayed recall for VPAs learned through ST relative to MR and SR; and SR relative to MR. This same pattern was observed for MS participants with objective memory impairment (n = 16), thereby providing the first evidence that retrieval practice improves memory more than restudy among persons with neurologically based memory impairment.

Multiple Sclerosis and Postural Control: The Role of Spasticity

Sosnoff JJ, Shin S, Motl RW. Multiple sclerosis and postural control: the role of spasticity. Objectives To examine the association between spasticity and postural control in subjects with multiple sclerosis (MS). Design Cross-sectional. Setting Motor control laboratory. Participants Subjects with MS (n=16, 2 male) and age and sex-matched subjects (n=16) participated in the investigation. All subjects with MS had Expanded Disability Status Scale scores between 0 and 4.5 and modified Ashworth scale scores between 1 and 3. Interventions Not applicable. Main Outcome Measures Postural control was measured with a force platform that quantifies ground reaction forces and moments in mediolateral and anteroposterior directions. Postural control was indexed with anterior-posterior sway range, medial-lateral sway range, 95% elliptical area of the deviations of center of pressure (COP), velocity of COP sway, and the frequency at which 95% of spectral profile was contained. Participants with MS further underwent assessment of the soleus Hoffman reflex (H-reflex) as an index of spasticity. Results Cluster analysis on H-reflex data identified groups of MS participants with high spasticity (n=7) and low spasticity (n=9). There were no differences in age, duration of MS, and disease severity between MS groups. There were no differences in anterior-posterior sway range between any of the groups. The high spasticity group had greater COP area, velocity, and mediolateral sway compared with the low spasticity and control group, and the low spasticity group had postural control values between the high spasticity and control groups. Conclusions The pattern of results suggests that spasticity contributes to postural deficits observed in MS.

Velopharyngeal function in adult speakers of Portuguese diagnosed with multiple sclerosis

The primary aim of the present investigation was to obtain the nasalance score in Portuguese speakers with multiple sclerosis (MS) in order to identify velopharyngeal impairments and to enhance clinicians' ability to employ appropriate therapy strategies for speech disorders in MS. Perceptual assessments (speech sample analysis) and instrumental technique (Nasometer) were performed. Two passages were constructed in the Portuguese Language: one similar to the Grandfather Passage for perceptual assessments and the other similar to the Zoo Passage for the nasalance score. Seventy (70) adult Portuguese speakers with MS and seventy five (75) nonneurologically disordered Portuguese speakers were involved in this study. The mean nasalance score of the MS participants was found to be significantly higher than of the control group, confirming velopharyngeal dysfunction in the Portuguese speakers group with MS. The results in this study contrast with a low incidence of velopharyngeal impairment present in English speakers with MS. These findings are discussed with respect to the degree of hypernasality and the potential influence of these impairments on the verbal output of the speakers of Portuguese.

Cognitive–linguistic deficit and speech intelligibility in chronic progressive multiple sclerosis

Multiple sclerosis is a disabling neurological disease with varied symptoms, including dysarthria and cognitive and linguistic impairments. Association between dysarthria and cognitive-linguistic deficit has not been explored in clinical multiple sclerosis studies. In patients with chronic progressive multiple sclerosis, the study aimed to investigate the presence and nature of cognitive-linguistic deficit, the association between levels of cognitive-linguistic ability and speech intelligibility, and of both of these with functional disability and time since onset of multiple sclerosis symptoms. The Arizona Battery for Communication Disorders of Dementia (ABCD) (Bayles and Tomoeda 1993 ), The Assessment of Intelligibility of Dysarthric Speech (AIDS) Sentence Intelligibility Task (Yorkston and Beukelman 1984 ), and the Modified Barthel Activities of Daily Living Index (MBADLI) (Shah 1998 ) were administered to 24 chronic progressive multiple sclerosis participants with dysarthria. A total of 24 non-neurologically impaired participants, matched for gender, age and education, formed a control group. For multiple sclerosis participants, linear regression analysis showed a strong association between ABCD and AIDS (beta = 0.89, p = 0.005), no association between ABCD and either MBADLI or time since onset, a strong association between AIDS and MBADLI (beta = 0.60, p = 0.001), and a trend towards an association between AIDS and time since onset (beta = -0.29, p = 0.08). Correlations between the four included ABCD construct scores and between these and the total ABCD score were significant (r>0.60, p<0.01). For each of the 15 included ABCD measures and for the four construct scores and the overall ABCD score, multiple sclerosis and control group performances were significantly different (p<0.01) and effect sizes were large (d>0.80). The results revealed a strong association between dysarthria, as measured by connected speech intelligibility testing, and cognitive-linguistic deficit, in people with chronic progressive-type multiple sclerosis. While some of the impairments that are associated with multiple sclerosis, including motor speech disorder, may influence performance on the ABCD, the data support the conclusion that marked cognitive-linguistic deficit is present in chronic progressive-type multiple sclerosis patients with dysarthria. Deterioration was global, rather than being indicative of a construct specific deficit, and encompassed language, both expression and comprehension. Episodic memory and linguistic expression were especially affected. Speech and language therapists who work with dysarthric patients with chronic progressive multiple sclerosis should monitor cognitive-linguistic impairment. An awareness of this might influence assessment, intervention and management, including the information and advice given to patients and their relatives.

Aerobic fitness is associated with gray matter volume and white matter integrity in multiple sclerosis

Alterations in gray and white matter have been well documented in individuals with multiple sclerosis. Severity and extent of such brain tissue damage have been associated with cognitive impairment, disease duration and neurological disability, making quantitative indices of tissue damage important markers of disease progression. In this study, we investigated the association between cardiorespiratory fitness and measures of gray matter atrophy and white matter integrity. Employing voxel-based approaches to analysis of gray matter and white matter, we specifically examined whether higher levels of fitness in multiple sclerosis participants were associated with preserved gray matter volume and integrity of white matter. We found a positive association between cardiorespiratory fitness and regional gray matter volumes and higher focal fractional anisotropy values. Statistical mapping revealed that higher levels of fitness were associated with greater gray matter volume in the midline cortical structures including the medial frontal gyrus, anterior cingulate cortex and the precuneus. Further, we also found that increasing levels of fitness were associated with higher fractional anisotropy in the left thalamic radiation and right anterior corona radiata. Both preserved gray matter volume and white matter tract integrity were associated with better performance on measures of processing speed. Taken together, these results suggest that fitness exerts a prophylactic influence on the structural decline observed early on, preserving neuronal integrity in multiple sclerosis, thereby reducing long-term disability.

Driving Behaviors Among Community-Dwelling Persons With Multiple Sclerosis

Schultheis MT, Weisser V, Manning K, Blasco A, Ang J. Driving behaviors among community-dwelling persons with multiple sclerosis. Objective The current study examined driver behaviors and patterns among drivers with multiple sclerosis (MS) as a function of disease severity and in comparison to drivers without MS. Design Between-group comparisons of participants with and without MS and cohorts of MS groups at varying levels of severity. Setting All data were collected in an outpatient research setting. Participants Community-dwelling persons (n=66) with clinically definite MS who were active drivers and healthy controls (n=30) were included. Interventions Not applicable. Main Outcome Measures Driving characteristics' measures included (1) driving frequency defined in days and miles driven per week, (2) self-reports of voluntarily limited driving behaviors, (3) changes in driving since MS diagnosis, and (4) self-rating as a driver. Driving performance was also assessed by using pass/borderline performance on a clinical behind-the-wheel evaluation. Results Mann-Whitney U tests showed a significant difference in driving frequency ( P=.021) with MS participants reporting they drove fewer days per week than healthy control group. This was also seen between cohorts of MS drivers ( P=.014), with high Expanded Disability Status Scale (EDSS) participants driving less frequently than the low EDSS group. Descriptive observations suggested that participants with moderate EDSS scores drove less and engaged in more self-limiting behaviors. Chi-square tests showed that participants with high EDSS scores were more likely to report changing their driving behavior after diagnosis ( P=.01) and were more likely to not pass the behind-the-wheel evaluation ( P<.001). Conclusions The current findings suggest that as disease severity progresses, differences in frequency of driving (days per week) and the use of self-limiting driving behaviors may vary. Furthermore, the findings also raise questions regarding the overall sensitivity of the most commonly used clinical driving assessment method (the behind-the-wheel evaluation) to accurately capture driving capacity in the milder stages of the disease process. The results indicate the need to consider issues related to driving as MS severity progresses, and, given the progressive nature of MS and the concerns of the validity of the most common clinical driving assessment measures (the behind-the-wheel evaluation), repeated assessment of driving ability may be the most effective approach for identifying driving difficulties among persons with MS.

Clinical screening of autonomic dysfunction in multiple sclerosis

Multiple sclerosis (MS) can affect the autonomic nervous system. Although exercise may be beneficial for people with MS, those with autonomic dysfunction may have altered heart rate responses to exercise. We investigated the hypothesis that the pattern of increase in heart rate on commencement of a simple cycle test would be different in those participants with MS who had been shown to have autonomic dysfunction on laboratory testing compared with both control participants and MS participants not exhibiting autonomic involvement. A controlled cohort study with a volunteer sample of 31 adults with MS (26 women, 5 men) with a mean age of 46 +/- 8.00 years (32-60 years), a median Expanded Disability Severity Scale of 3 (1-6) and a mean duration since diagnosis of 10.3 years (0.1-39 years). Thirty-one age-matched, non-disabled, sedentary but healthy adults (26 women, 5 men) with a mean age of 45 +/- 9.5 years (24-57) comprised the control group. Autonomic function was evaluated using continuous heart rate and blood pressure responses to rhythmical deep breathing, the Valsalva manoeuvre, passive postural change and a simple cycle test. There were no significant differences in age, height or weight (p < 0.05) between the two groups or on any of the autonomic test results (p < 0.05). Five participants with MS (16%) had abnormal autonomic function on laboratory testing, two of whom demonstrated an abnormal heart rate response to the cycle test. It is suggested that physiotherapists monitor the heart rate response to a dynamic exercise test in people with MS prior to prescribing an exercise programme to ensure patients' safety. Should the response appear delayed or attenuated, referral for more formal autonomic laboratory testing is recommended.

Effect of Exercise Training on Walking Mobility in Multiple Sclerosis: A Meta-Analysis

Objective. The study used meta-analytic procedures to examine the overall effect of exercise training interventions on walking mobility among individuals with multiple sclerosis. Methods. A search was conducted for published exercise training studies from 1960 to November 2007 using MEDLINE, PsychINFO, CINAHL, and Current Contents Plus. Studies were selected if they measured walking mobility, using instruments identified as acceptable walking mobility constructs and outcome measures for individuals with neurologic disorders, before and after an intervention that included exercise training. Results. Forty-two published articles were located and reviewed, and 22 provided enough data to compute effect sizes expressed as Cohen's d. Sixty-six effect sizes were retrieved from the 22 publications with 600 multiple sclerosis participants and yielded a weighted mean effect size of g = 0.19 (95% confidence interval, 0.09-0.28). There were larger effects associated with supervised exercise training ( g = 0.32), exercise programs that were less than 3 months in duration (g = 0.28), and mixed samples of relapsing-remitting and progressive multiple sclerosis (g = 0.52). Conclusions. The cumulative evidence supports that exercise training is associated with a small improvement in walking mobility among individuals with multiple sclerosis.

Cortical recruitment during selective attention in multiple sclerosis: An fMRI investigation of individual differences

Recent studies with multiple sclerosis (MS) participants have provided evidence for cortical reorganization. Greater recruitment of task-related areas and additional brain regions are thought to play an adaptive role in the performance of cognitive tasks. In this study, we compared cortical circuitry recruited by MS patients and controls during a selective attention task that requires both focusing attention on task-relevant information and ignoring or inhibiting task-irrelevant information. Despite comparable behavioral performance, MS patients demonstrated increased neural recruitment of task-related areas along with additional activation of the prefrontal cortices. However, this additional activation was associated with poor behavioral performance, thereby providing evidence against compensatory brain reorganization. Future studies specifically investigating the nature of additional activation seen in MS patients in a wider variety of cognitive tasks would provide insight into the specific cognitive decline in MS.

Gait Initiation in Multiple Sclerosis

Individuals with multiple sclerosis (MS) often have poor balance control that is especially apparent during dynamic tasks such as gait initiation (GI). The purpose of this study was to investigate how balance symptoms due to MS alter spatiotemporal variables, coordination, and temporal margins within the stability boundary during gait initiation. Twelve women with MS (Expanded Disability Status Scale [EDSS] mean = 4.0, SD = 1.4) and 12 women without MS (control group) initiated gait at their preferred speed. MS participants attained a slower anterior velocity because of smaller anterior center of mass displacements and took longer to complete the initiation of gait than the control group. MS participants exhibited a smaller posterior shift in center of pressure during GI and stepped with a longer dual support time than the control group. However, these changes may be due to differences in initiation velocity. Relative timing analysis showed invariance in postural and locomotor phases of gait initiation between groups. The MS group showed different coordination between anterior-posterior and medio-lateral center of pressure components while increasing temporal margins to the posterior and lateral stability boundaries in comparison with the control group. Overall, during gait initiation at their preferred speed the MS participants adopted a functional strategy that produces lower speed and reduced proximity to the stability boundaries prior to stepping.

Multiple Sclerosis in the UK

Multiple sclerosis (MS) is a chronic condition that affects quality of life (QOL), leads to disability and requires ongoing care inputs. Few studies have examined the impact of QOL, disability and demographic characteristics on treatment costs. To investigate the links between service use, costs, QOL and disability for people with MS. A cross-sectional study was conducted in people with MS who were members of the Multiple Sclerosis Society of Great Britain and Northern Ireland. A questionnaire, consisting of sociodemographic questions, the Client Service Receipt Inventory, EQ-5D and Guy's Neurological Disability Scale (GNDS), was sent to 4000 members of the Society. Service and lost employment costs were calculated. Regression models were developed to identify the participant characteristics that were associated with costs, QOL and disability. All costs are presented in year 2006-7 values. Questionnaires were returned by 1942 members (48.9%). The mean (SD) EQ-5D QOL score was 0.41 (0.34), whilst the GNDS disability score was 20.8 (8.9). The mean (SD) service cost over the preceding 6 months was pound8397 ( pound10,404), and most of this (71.6%) was due to informal care. Only a small amount of cost (8.1%) was due to the use of disease-modifying drugs and drugs for spasticity. Lost employment costs amounted to a mean of pound4240. Higher costs were associated with higher levels of disability and lower levels of health-related QOL. This study showed that MS participants had high levels of service use, and that QOL was low in comparison with other conditions. There were significant associations between costs, QOL and disability.

Prospective memory in multiple sclerosis

There is considerable evidence that multiple sclerosis (MS) is associated with impaired retrospective memory. However, although preliminary evidence suggests that prospective memory is also affected by the disorder, the degree and nature of the impairment remains to be clarified. Twenty participants with MS were compared with 20 matched controls on Virtual Week, a measure of prospective memory that closely represents the types of prospective memory tasks that actually occur in everyday life, and provides an opportunity to investigate the different sorts of prospective memory failures that occur. The results indicated that irrespective of the specific prospective memory task demands, MS participants' performance was significantly impaired relative to controls. MS deficits could not be attributed to problems with retrospective memory because MS participants in the present study did not differ significantly from controls on measures of long- and short-term memory, and significant impairment was observed on a prospective memory task, which imposed only minimal demands on retrospective memory. These results therefore suggest that individuals with MS may experience general difficulties with prospective memory. The practical and theoretical implications of these findings are discussed.

Use of the International Classification of Functioning, Disability and Health (ICF) to identify preliminary comprehensive and brief core sets for multiple sclerosis

Purpose. To identify the preliminary comprehensive and brief core sets for multiple sclerosis (MS), in a Delphi process using the International Classification of Functioning, Disability and Health (ICF).Method. Focus groups and a consensus process were used to identify ICF core sets for MS. This included: preliminary ICF studies; empirical patient data collection for 101 MS participants; review of the evidence base and treatment in MS literature followed by a Delphi exercise with 23 physicians and allied health professionals in Melbourne, Australia.Results. One hundred and forty-four (40%) second level ICF categories were selected by 23 participants in three rounds. The comprehensive MS ICF core set includes 34 (24%) categories from the component ‘body function’, six (4%) categories from ‘body structures’, 68 (47%) from ‘activities and participation’ and 36 (25%) from the component ‘environmental’ factors. Ten categories in ‘personal factors’ in MS were also suggested by the participants after intensive discussions. The brief set comprises 30 categories, 21% of categories in the comprehensive core set.Conclusion. Consensus expert opinion can use ICF categories to identify the core set for MS which reflects disease complexity and care burden for persons' with MS. Further research is needed to identify ICF categories of relevant personal factors to improve our understanding of the large social and cultural variance associated with them.