Perceived Deficits Questionnaire Research Articles

The Perceived Deficits Questionnaire: Perception, Deficit, or Distress?

Cognitive dysfunction affects approximately 43% to 70% of individuals with multiple sclerosis (MS) and is an important determinant of several functional outcomes in MS and quality of life. Brief neuropsychological test batteries have been developed specifically for use in MS and are widely used to aid clinicians in assessing levels of cognitive impairment in MS. Neuropsychologists and neurologists also frequently use briefer screening measures, such as the Perceived Deficits Questionnaire (PDQ), to assist in determining whether a more extensive neuropsychological evaluation is warranted. However, despite the ease of such measures, the relationship between self-report and objective cognitive impairment has been inconsistent, at best. Moreover, factors such as depression, fatigue, anxiety, and personality have been found to be more related to reports of cognitive difficulties. The purpose of the present study was to clarify the relationship between subjective cognitive concerns and objective cognitive impairment while accounting for related symptoms. We examined the association of self-reported cognitive concerns on the PDQ with objective cognitive measures, as well as depression, anxiety, fatigue, and self-efficacy. There was no relationship between self-reported cognitive concerns and objective performance. Rather, reports on the PDQ were more correlated with reports of depression, anxiety, fatigue, and self-efficacy. Depression and poor self-efficacy can contribute to reports of cognitive difficulties. Effective treatment to improve these factors seems warranted given the impact of perceived cognitive impairment on outcomes in MS and the potential for more accurate self-reports.

A Randomized, Placebo-Controlled, Active-Reference, Double-Blind, Flexible-Dose Study of the Efficacy of Vortioxetine on Cognitive Function in Major Depressive Disorder.

This multicenter, randomized, double-blind, placebo-controlled, active-referenced (duloxetine 60 mg), parallel-group study evaluated the short-term efficacy and safety of vortioxetine (10–20 mg) on cognitive function in adults (aged 18–65 years) diagnosed with major depressive disorder (MDD) who self-reported cognitive dysfunction. Efficacy was evaluated using ANCOVA for the change from baseline to week 8 in the digit symbol substitution test (DSST)–number of correct symbols as the prespecified primary end point. The patient-reported perceived deficits questionnaire (PDQ) and physician-assessed clinical global impression (CGI) were analyzed in a prespecified hierarchical testing sequence as key secondary end points. Additional predefined end points included the objective performance-based University of San Diego performance-based skills assessment (UPSA) (ANCOVA) to measure functionality, MADRS (MMRM) to assess efficacy in depression, and a prespecified multiple regression analysis (path analysis) to calculate direct vs indirect effects of vortioxetine on cognitive function. Safety and tolerability were assessed at all visits. Vortioxetine was statistically superior to placebo on the DSST (P<0.05), PDQ (P<0.01), CGI-I (P<0.001), MADRS (P<0.05), and UPSA (P<0.001). Path analysis indicated that vortioxetine's cognitive benefit was primarily a direct treatment effect rather than due to alleviation of depressive symptoms. Duloxetine was not significantly different from placebo on the DSST or UPSA, but was superior to placebo on the PDQ, CGI-I, and MADRS. Common adverse events (incidence ⩾5%) for vortioxetine were nausea, headache, and diarrhea. In this study of MDD adults who self-reported cognitive dysfunction, vortioxetine significantly improved cognitive function, depression, and functionality and was generally well tolerated.

The association of somatic arousal with the symptoms of upper airway resistance syndrome

ObjectivesWe tested the hypothesis that the symptoms of upper airway resistance syndrome (UARS) are manifestations of chronic stress. To accomplish this, we utilized the score on a self-report questionnaire for somatic arousal (a component of stress) to compare somatic arousal between UARS patients and healthy controls and, among all participants, to correlate the level of somatic arousal with the severity of UARS symptoms. MethodsWe administered the Mood and Anxiety Symptom Questionnaire anxious arousal subscale (MASQaas; a 17-item questionnaire with increasing levels of arousal scored 17–85) to 12 UARS patients and 12 healthy controls and compared scores between groups. For all participants, we correlated the MASQaas scores with scores for the Epworth Sleepiness Scale (ESS), Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-Fatigue) scale, Pittsburgh Sleep Quality Index (PSQI), SF-36 Health Survey, and Perceived Deficits Questionnaire (PDQ; assessing cognitive function). ResultsCompared to healthy controls, UARS patients demonstrated increased somatic arousal (MASQaas scores of 18±2 and 28±7, respectively; p<0.0001). For all participants, the MASQaas scores correlated significantly with scores of the ESS (r=0.64; p=0.0008), the FACIT-Fatigue scale (r=−0.89; p<0.0001), the PSQI (r=0.70; p=0.0002), SF-36 Physical component (r=−0.78; p<0.0001), SF-36 Mental component (r=−0.74; p<0.0001), and the PDQ (r=0.89; p<0.0001). ConclusionsOur findings suggest that UARS patients have increased levels of the stress component, somatic arousal, proportionate to the severity of their symptoms.

Options for Evaluating Treatment Benefit in MCI and Prodromal Alzheimer’s Disease: Content Validity of the Perceived Deficits Questionnaire (PDQ) in Patients with Early Symptoms of Cognitive Decline

Background: Many instruments used to assess outcomes of treatment for Alzheimer’s disease (AD) have no published evidence of their relevance and content validity in earlier stages of the disease, i.e., mild cognitive impairment, or prodromal AD (pAD). The objective of this project was to evaluate the applicability and usefulness of the Perceived Deficits Questionnaire (PDQ) as an outcome measure in this population using qualitative methodology to support content validity. Method: Two waves of qualitative interviews were conducted in patients with MCI and pAD. Results: Evidence for content validity and usefulness of the instrument was demonstrated in the patient interviews. Minor modifications to the wording of several items were suggested for the PDQ and the recall period was changed. Conclusion: With these modifications, the PDQ has improved content validity and relevance. It is therefore a potentially useful outcome measure to evaluate therapeutic benefit in interventional studies of patients in the early stages of AD.

Perceived cognitive decline in multiple sclerosis impacts quality of life independently of depression.

Background/Aim. The aim of this study is to examine the effects of perceived cognitive dysfunction and of depression, on self-reported QoL, in a Greek population sample of MS patients. Methods. One hundred outpatients diagnosed with MS completed the Short-Form-36 Health Survey (SF-36), as well as the Perceived Deficits Questionnaire (PDQ) and the Depression subscale of the Mental Health Inventory (MHI), as part of a clinical evaluation which included the Expanded Disability Status Scale (EDSS) estimation. Multiple linear regression was conducted to determine the best linear combination of age, gender, education, EDSS, depression, attention/concentration, retrospective memory, prospective memory, and planning/organization, for predicting QoL scores. Results. In the multivariate regression analysis models, EDSS (P < 0.05), depression (P < 0.001), perceived planning/organization (P < 0.05), and perceived retrospective memory dysfunction (P < 0.05) independently predict quality of life scores. Age, sex, education level, and perceived attention/concentration dysfunction, as well as perceived prospective memory dysfunction, do not independently predict quality of life scores. Conclusions. Perceived planning/organization impairment and perceived retrospective memory impairment in MS patients predict QoL independently of the severity of disease and the severity of depression and therefore should be considered in the assessment of patient health status as well as in the design of treatment interventions and rehabilitation.

Structural correlates of subjective and objective memory performance in multiple sclerosis

Subjective and objective memory deficits represent a frequent and ill-understood aspect of multiple sclerosis (MS), and a significant cause of disability and quality of life reduction. The aim of the study is to verify the role of hippocampal and temporal associative fibers' damage in MS-related memory complaints. To reach this aim, 25 patients with low disability relapsing-remitting MS and 19 healthy controls were included in the study. All subjects underwent 3D T1 structural imaging and Diffusion Tensor Imaging. Additionally, MS patients underwent neuropsychological evaluation of objective (Selective Reminding Test and Spatial Recall Test) and of subjective (Perceived Deficit Questionnaire, Retrospective and Prospective Memory Subscales) memory deficits. Normalized hippocampal volume (NHV) and mean Fractional Anisotropy (FA) for the uncinate fasciculus (UF) and for the ventral division of the cingulum bundle (VCB) were calculated for all subjects. We showed that, compared to controls, MS subjects presented with reduced right NHV and with reduced mean FA bilaterally in the UF and the VCB. In the MS group, verbal memory scores correlated with left NHV, spatial memory scores correlated with right NHV, while perceived retrospective and prospective memory deficits correlated with left VCB and left UF mean FA respectively. Our data confirm an early involvement of memory-related brain structures in MS patients. Our data suggest that verbal and nonverbal memory as well as perceived retrospective and prospective memory deficits are related to alterations of discrete anatomical structures in the low-disability phase of MS.

PRM166 - Using Feedback from Patients in Determining Suitability of the Perceived Deficits Questionnaire (PDQ) and the Resource Utilization in Dementia-Lite (RUD-Lite) for Use in Clinical Trials in Prodromal Alzheimer’s Disease

PRM166 - Using Feedback from Patients in Determining Suitability of the Perceived Deficits Questionnaire (PDQ) and the Resource Utilization in Dementia-Lite (RUD-Lite) for Use in Clinical Trials in Prodromal Alzheimer’s Disease

QL4 - Psychometric Validation of Perceived Deficits Questionnaire – Depression (PDQ-D) in Patients with Major Depressive Disorder (MDD)

QL4 - Psychometric Validation of Perceived Deficits Questionnaire – Depression (PDQ-D) in Patients with Major Depressive Disorder (MDD)

PMH14 - Patient-Reported Cognitive Dysfunction Negatively Impacts Functioning in Patients with Major Depressive Disorder – Preliminary Findings from the Perform Study

Objectives: PERFORM (Prospective Epidemiological Research on Functioning Outcomes Related to Major depressive disorder) is a 2-year prospective observational cohort study conducted in Europe to describe the functioning of patients with major depressive disorder (MDD) and factors associated with functional impairment. Here we report the impact of patient-reported cognitive dysfunction (PRCD) on quality of life (QoL), work and overall functioning at baseline, on a preliminary 1000-patient dataset. Methods: Outpatients were recruited from primary or secondary care. Inclusion criteria were: DSM-IV-TR diagnosis of MDD, 18-65 years old, initiation or first switch to an antidepressant, in monotherapy. Functioning was assessed by the SDS (Sheehan Disability Scale), work productivity by the WPAI-SHP (Work Productivity and Activity Impairment Questionnaire) and QoL by the EQ-5D (EuroQol-5 Dimensions) and SF-12 (12-Item Short-Form Health Survey). PRCD was assessed by the Perceived Deficit Questionnaire 5-item (PDQ-5). Descriptive analyses stratified on PDQ-5 quartiles were complemented with ANCOVA adjusted for severity of depression. Results: At inclusion, over 947 analysable patients, mean PDQ-5 score (ranging from 0 to 20) was 11.5 (SD=4.4). PRCD was associated with impairment of overall functioning, QoL and productivity. SDS total scores were 14.4, 18.5, 20.2, and 23.6 (first to fourth PDQ-5 quartiles, respectively) (p<0.001). Similar patterns were observed for WPAI-SHP presenteeism scores (impairment while working: from 36.9% in first quartile to 64.4% in fourth quartile, p<0.001; overall work impairment: from 41.5% to 71.3%, p<0.001). These associations remained statistically significant after adjustment for baseline depression severity in multivariate analyses. A negative impact of PRCD was also observed on sick-leave length and on QoL. Conclusions: At inclusion, subjective cognitive dysfunction in depressed patients was associated with poorer functioning, work productivity and QoL. This is in addition to any negative impact of the severity of depression on these outcomes. These preliminary results need to be confirmed on the full dataset.

Patient-centered assessment of cognitive symptoms of depression

To identify and explore concepts important to patients with cognitive symptoms of major depressive disorder (MDD) and adapt an existing patient-reported outcome (PRO) measure to assess these symptoms. Four focus groups were conducted with MDD patients (n = 33) to elicit relevant concepts and determine whether one of several PRO scales could be used to assess cognitive symptoms of depression. Following selection and minor modification of the Perceived Deficits Questionnaire (PDQ), cognitive debriefing interviews were conducted with additional patients (n = 17) to further refine and adapt this measure for use in MDD. Minor revisions based on patient input yielded the PDQ for Depression (PDQ-D). Focus group participants reported a variety of cognitive symptoms that were classified into 7 general categories: lack of focus and clear thought, memory problems, difficulty with lexical access, difficulty with divided attention, difficulty with decision making, difficulty thinking quickly, and difficulty learning new things. Limitations in work productivity were the most commonly reported impacts of cognitive symptoms. While suggesting a few modifications, focus group participants reacted positively to the PDQ based on the breadth, specificity, and relevance of the items. Cognitive debriefing participants indicated that the modified PDQ items were generally easy to understand and relevant to their experiences with MDD. Because cognitive symptoms are burdensome to patients with MDD, their assessment is important to optimize treatment outcomes. The PDQ-D has the potential to supplement existing assessment methods, providing unique information important for both comprehensive evaluation of individuals with MDD and evaluation of new treatments.

Association Between Severity of Depression and Self-Perceived Cognitive Difficulties Among Full-Time Employees

To assess the relationship between self-perceived deficits in cognition and severity of depression reported by individuals in full-time employment. Individuals ≥ 18 years of age employed full-time with diagnosed depression excluding bipolar disorder (participants had to be told by a doctor that they had depression based on DSM-IV criteria) completed a 25-minute Web-based survey in February 2010 (study population identified by Harris Interactive, Rochester, New York). The survey used the Perceived Deficits Questionnaire (PDQ) to assess self-perceived cognitive impairment and the 9-item Patient Health Questionnaire (PHQ-9) to assess depression severity. The 20-question PDQ was used to assess self-perceived cognitive difficulties within the domains of prospective memory, retrospective memory, attention/concentration, and planning/organization (range, 0-20: higher scores indicate greater impairment). Subjects answered how often they experienced such difficulties during the previous 4 weeks (0 = never, 1 = rarely, 2 = sometimes, 3 = often, 4 = almost always). The scale ranges from 0-20 for each of the 4 subscales, with higher scores indicating greater cognitive impairment. The impact of depression on PDQ scores was assessed using a trend test based on an analysis of covariance controlling for potential confounders. Subjects (N = 1,051) (58% women) had a mean ± SD age of 47 ± 12 years; 38% held professional employment. PHQ-9 scores indicated that 423 employees (40.3%) had no depressive symptoms at the time of the survey, 319 (30.4%) had mild depression, 166 (15.8%) had moderate depression, 82 (7.8%) had moderately severe depression, and 61 (5.8%) had severe depression. Perceived cognitive functioning worsened with increasing severity of depression symptoms (P < .0001) on the basis of PDQ scores. On the basis of responses to the PDQ, in the current study, most impairment was seen in the attention/concentration and planning/organization subscales in severely depressed subjects (12.2 for both) compared with those with no depressive symptoms (4.4 and 3.5, respectively), indicating more cognitive impairment in the severely depressed subjects compared to the subjects with no depression. In currently employed individuals, self-perceived cognitive dysfunction worsened with increasing severity of depressive symptoms. This association was independent of antidepressant use. The greatest impairment in self-perceived cognition was observed in the planning/organization and attention/concentration subscales.

Work capacity and health-related quality of life among individuals with multiple sclerosis reduced by fatigue: a cross-sectional study.

BackgroundAmong individuals diagnosed with the chronic neurologic disease, multiple sclerosis (MS), a majority suffers from fatigue, which strongly influences their every-day-life. The aim of this study was to investigate work capacity and health-related quality of life (HRQoL) in a group of MS patients and also to investigate if work capacity and HRQoL could be predicted by background factors, fatigue, heat sensitivity, cognitive dysfunction, emotional distress or degree of disability.MethodsA descriptive, cross-sectional, designed survey was undertaken A questionnaire was sent to 323 individuals diagnosed with MS, aged between 20 and 65 years, with physical disability on the expanded disability status score (EDSS) in the interval 0 ≥ EDSS ≤ 6.5, living in Östergötland county in eastern Sweden. Questions on background factors, occupation and work, together with the health-related quality of life short form instrument (SF-36), the fatigue severity scale (FSS), the perceived deficit questionnaire (PDQ) and the hospital anxiety depression scale (HAD) were posed. Associations between variables were analyzed using Pearson’s and Spearman’s correlations. Differences between groups were tested using the Chi-square test, the Mann Whitney U-test, and the Student’s t-test. Predictive factors were analyzed using multiple linear and multiple logistic regression analysis.ResultsOf those who completed the questionnaire (n = 257, 79.6%), 59.8% were working. Work capacity was found significantly more among men (p < 0.005), those with a higher level of education (p < 0.001), those reporting less fatigue (p < 0.001), and those having no heat sensitivity (p = 0.004). For work capacity, significant predictors were low physical disability (EDSS), low fatigue, higher level of education, male sex and lower age. Those with work capacity showed significantly higher HRQoL than those who had no work capacity (p < 0.001). Levels of fatigue, cognition and emotional distress were found to be major contributing factors for HRQoL.ConclusionsWork capacity and HRQoL among individuals diagnosed with MS are highly influenced by fatigue which can be considered as a key symptom. Work capacity was influenced by heat-sensitivity, cognitive difficulties and emotional distress and significant predictive factors besides fatigue, were physical disability (EDSS), age, sex, and level of education. Remaining at work also gives a better HRQoL.

Relationship between perceived cognitive dysfunction and objective neuropsychological performance in persons with rheumatoid arthritis

Research shows a gap between perceived cognitive dysfunction and objective neuropsychological performance in persons with chronic diseases. We explored this relationship in persons with rheumatoid arthritis (RA). Individuals from a longitudinal cohort study of RA participated in a study visit that included physical, psychosocial, cognitive, and biologic metrics. Subjective cognitive dysfunction was assessed using the Perceived Deficits Questionnaire (PDQ; range 0-20, where higher scores = greater perceived impairment). Objective cognitive impairment was assessed using a battery of 12 standardized neuropsychological measures yielding 16 indices. On each test, subjects were classified as impaired if they performed 1 SD below the age-based population norms. Total cognitive function scores were calculated by summing the transformed scores (range 0-16, where higher scores = greater impairment). Multiple linear regression analyses determined the relationship of the total cognitive function score with the PDQ score, controlling for sex, race, marital status, income, education, disease duration, disease severity, depression, and fatigue. One hundred twenty subjects (mean ± SD age 58.5 ± 11.0 years) were included. Mean ± SD scores of total cognitive function and the PDQ were 2.5 ± 2.2 (range 0-10) and 5.8 ± 3.8 (range 0-16), respectively. In multivariate analysis, there was no significant relationship between the total cognitive function score and the PDQ score. However, depression and fatigue (β = 0.32, P < 0.001 and β = 0.31, P = 0.001, respectively) were significantly associated with the PDQ score. The findings emphasize the gap between subjective and objective measures of cognitive impairment and the importance of considering psychological factors within the context of cognitive symptoms in clinical settings.

Validity and Reliability of the Perceived Deficit Questionnaire to Assess Cognitive Symptoms in People With Chronic Whiplash-Associated Disorders

Takasaki H, Chien C-W, Johnston V, Treleaven J, Jull G. Validity and reliability of the Perceived Deficit Questionnaire to assess cognitive symptoms in people with chronic whiplash-associated disorders. ObjectiveTo investigate the validity and reliability of the Perceived Deficit Questionnaire (PDQ) for use in people with chronic whiplash-associated disorders. DesignCross-sectional. SettingTertiary institution. ParticipantsPatients (N=105) with chronic whiplash-associated disorders and asymptomatic controls (n=50). InterventionsNot applicable. Main Outcome MeasuresThe 20-item PDQ inclusive of 4 sections (attention/concentration, retrospective memory, prospective memory, and organization/planning) rated on a 5-point scale. ResultsInternal construct validity of the PDQ was examined by Rasch analysis, confirming the appropriateness of its 5-point scale and the unidimensionality of each section after modification by eliminating 1 item each from the attention/concentration and retrospective memory sections. Preliminary evidence was also gained for external construct validity (convergent validity) of the modified PDQ by demonstrating significant (P<.05) correlations of all sections with a global measure of disability due to neck pain (the Neck Disability Index). The whiplash group demonstrated significantly (P<.05) higher scores in each section of the modified PDQ than did the control group, indicating evidence for discriminant validity. In addition, the modified PDQ demonstrated good internal consistency (Rasch-generated reliability >.8) and acceptable test-retest reliability with 1-month interval (intraclass correlation coefficients >.8). ConclusionsThe modified PDQ appears to be a valid and reliable questionnaire and could be used quickly in clinical practice to gain a basic understanding of perceived cognitive symptoms in people with chronic whiplash-associated disorders.

Cognitive reserve and patient-reported outcomes in multiple sclerosis

Background: Adaptation and compensation in the face of changing pathology may be better understood by considering the concept of cognitive reserve, which may protect against disability in multiple sclerosis (MS). Objectives: The present work investigates the relationship between cognitive reserve and demographic characteristics, health behaviors, and patient-reported outcomes (PROs). Methods: Cross-sectional data (n=1142) were drawn from the North American Research Committee on MS (NARCOMS) Registry, from whom additional survey data were collected. Cognitive reserve was measured using the Stern and Sole-Padulles measures, the O*NET occupational classification system, and the Godin Leisure-Time Exercise Questionnaire. PROs were assessed using generic (SF -12v2, Perceived Deficits Questionnaire, Ryff Psychological Well-Being, Diener Satisfaction with Life Scale) and disease-specific (Patient-Determined Disease Steps, Performance Scales) measures. Psychometric analysis created unidimensional cognitive reserve subscales. Regression models examined relationships between cognitive reserve, demographic characteristics, and PROs. Results: The cognitive reserve measures assessed distinct but related constructs. Individuals with high cognitive reserve were more likely to report lower levels of perceived disability and perceived cognitive deficits, and higher levels of physical health, mental health, and well-being. Both active and passive reserve are associated with better outcomes, independent of demographic factors, and these associations apply to both generic and disease-specific outcomes. Conclusions: This expanded measurement of cognitive reserve captures both the passive and active aspects of the construct, and there is a consistent and substantial relationship with PROs. Individuals with high passive and/or active reserve are healthier and experience higher levels of well-being.

Examining Predictors of the Physical and Mental Components of Quality of Life in the TOP MS Study (P07.103)

Objective: To assess the most effective predictors of the Physical Component Score (PCS) and Mental Component Score (MCS) of the SF-12 used to assess quality of life in the Treatment Optimization in MS (TOP MS) Study. Background Several MS patient characteristics may be associated with the PCS and MCS including patient age, disability status and levels of fatigue, perceived cognitive deficits and depression. Design/Methods: Potential participants for the TOP MS study were identified at specialty pharmacies with medication therapy management programs. Signed informed consent forms were returned to the pharmacies and study enrollment produced log-on instructions for the study website. At baseline and at regular intervals over 24 months, enrolled participants receive reminders to respond to surveys, including the SF-12 Health Survey, self-reported EDSS, Fatigue Severity Scale (FSS), Perceived Deficits Questionnaire (PDQ), and Patient Health Questionnaire (PHQ-depression). Self-reported responses are entered directly into the study database. Multiple regression analyses were used to identify predictors of the PCS and MCS. Results: The array of patient characteristics that was highly effective at predicting the PCS included patient age, self-reported EDSS, and scores on the FSS, PDQ, and PHQ (adjusted R 2 = .620, p 2 = .467, p Conclusions: While the same set of patient characteristics was highly effective at predicting the PCS and MCS, depression was a unique and mediating variable between disability and MCS while the PCS had two independent predictors: disability and fatigue. Supported by: Teva Pharmaceuticals. Disclosure: Dr. Oleen-Burkey has received personal compensation for activities with Teva Neuroscience. Dr. Oleen-Burkey holds stock and/or stock options in Pfizer, Inc and Teva Neuroscience. Dr. Oleen-Burkey has received research support from Teva Neuroscience. Dr. Zwibel has received personal compensation for activities with Serono, Inc., and Teva Neuroscience. Dr. Zwibel has received research support from Teva Neuroscience. Dr. Coyle has received personal compensation for activities with Acorda Therapeutics, Avanir Pharmaceuticals, Bayer Pharmaceuticals Corporation, Biogen Idec, Genzyme Corporation, Novartis, Questcor, Roche Diagnostics Corporation, Sanofi-Aventis Pharmaceuticals, Inc., and Teva Neuroscience. Dr. Coyle has received personal compensation in an editorial capacity for NEURA. Dr. Coyle has received research support from Serono, Inc., Novartis, and Sanofi-Aventis Pharmaceuticals, Inc. Dr. Denney has received personal compensation for activities with Teva Neuroscience Inc. as a consultant.Dr. Denney has received research support from Serono Inc.

Sensitivity to heat in MS patients: a factor strongly influencing symptomology--an explorative survey.

BackgroundMany individuals diagnosed with Multiple Sclerosis (MS) are sensitive to increased body temperature, which has been recognized as correlating with the symptom of fatigue. The need to explore this association has been highlighted. The aim of this study was to investigate the occurrence of heat sensitivity and its relations to disease course, disability, common MS-related symptoms and ongoing immunosuppressive treatments among individuals 65 years of age or younger diagnosed with MS.MethodsA cross-sectional designed survey was undertaken. A questionnaire was sent to MS-patients with an Expanded Disability Status Score (EDSS) in the interval of 0-6.5 and who were between 20 and 65 years of age, living in an eastern region of Sweden (n = 334). Besides occurrence of heat sensitivity (Yes/No) and corresponding questions, the Fatigue Severity Scale (FSS), the MS-related symptom checklist and the Perceived Deficit Questionnaire (PDQ) were included. Data were analysed in relation to data level using Chi-square, Mann Whitney U-test, and Student's t-test. Pearson's and Spearman's correlations were calculated. In the logistic regression analyses (enter) dichotomized MS-symptoms were used as dependent variables, and EDSS, disease-course, time since onset, heat-sensitivity, age and sex (female/male) were independent variables. In the linear regression analyses, enter, mean FSS and summarized PDQ were entered as dependent variables and EDSS, disease-course, time since onset, heat sensitivity, age and sex (female/male) were independent variables.ResultsOf the responding patients (n = 256), 58% reported heat sensitivity. The regression analyses revealed heat sensitivity as a significant factor relating not only to fatigue (p < 0.001), but also to several other common MS symptoms such as pain (p < 0.001), concentration difficulties (p < 0.001), and urination urgency (p = 0.009).ConclusionsHeat sensitivity in MS patients is a key symptom that is highly correlated with disabling symptoms such as fatigue, pain, concentration difficulty and urination urgency.

Do subjective cognitive complaints correlate with cognitive impairment in systemic lupus erythematosus? A Danish outpatient study

This study examined the prevalence of cognitive impairment and its association with depressive symptoms and self-reported cognitive complaints in Danish outpatients with systemic lupus erythematosus (SLE). Fifty-seven consecutive female SLE-outpatients were examined with a comprehensive neuropsychological test-battery, a 20-item self-administered Perceived Deficits Questionnaire (PDQ) and a self-rated depression scale (Major Depression Inventory). Twenty-two patients (38.5%) were classified as cognitively impaired, mostly with deficits in executive functions and attention. Among cognitively impaired patients only 18.2% had significantly higher PDQ scores than the normal range. PDQ scores were highly correlated to depressive symptoms (r = 0.67, p < 0.001). Only two neuropsychological tests were significantly correlated with subjective cognitive complaints. When these variables and self-rated depression score were entered into a regression model both depression score and Symbol Digit Modalities Test performances were significantly associated with the PDQ score. In conclusion, cognitive impairments were common in this group of (mild) SLE outpatients, but the level of significant subjective cognitive complaints was low even among patients with cognitive impairment. Affective status may influence subjective experience of cognitive functions even more than cognitive functioning itself, and absence of subjective cognitive complaints did not exclude the presence of cognitive impairments.

Relationship between depression, fatigue, subjective cognitive impairment, and objective neuropsychological functioning in patients with multiple sclerosis.

This study explored the influence of depression and fatigue on subjective cognitive complaints and objective neuropsychological impairment in patients with multiple sclerosis (MS). Data for this study were taken from a randomized controlled trial, comparing 16 weeks of telephone-administered cognitive-behavioral therapy and telephone-administered supportive emotion focused therapy for the treatment of depression. The sample includes 127 patients with MS. The following self-report measures were collected pre- and posttreatment: Perceived Deficits Questionnaire, Beck Depression Inventory-II, and Modified Fatigue Impact Scale. Measures of objective cognitive functioning and the Hamilton Rating Scale for Depression were administered over the telephone. Our results showed that changes in depression and fatigue significantly predicted changes in subjective cognitive complaints from pre- to posttreatment, with patients perceiving fewer cognitive problems at posttreatment (beta = .36, p < .001 and beta = .61, p < .001, respectively). Changes in depression and fatigue were not significantly related to changes in objective neuropsychological performance. Improvements in depression and fatigue also predicted improved accuracy in perceiving cognitive abilities from pre- to posttreatment (OR = .77, p < .001 and OR = .90, p < .001, respectively). The results of this study suggest that improvements in depression and fatigue through treatment do not influence objective neuropsychological performance in MS patients, but do relate to changes in subjective impairment. Furthermore, these changes improve patients' abilities to accurately perceive their cognitive functioning.

Pilot trial of low‐dose naltrexone and quality of life in multiple sclerosis

To evaluate the efficacy of 4.5mg nightly naltrexone on the quality of life of multiple sclerosis (MS) patients. This single-center, double-masked, placebo-controlled, crossover study evaluated the efficacy of 8 weeks of treatment with 4.5mg nightly naltrexone (low-dose naltrexone, LDN) on self-reported quality of life of MS patients. Eighty subjects with clinically definite MS were enrolled, and 60 subjects completed the trial. Ten withdrew before completing the first trial period: 8 for personal reasons, 1 for a non-MS-related adverse event, and 1 for perceived benefit. Database management errors occurred in 4 other subjects, and quality of life surveys were incomplete in 6 subjects for unknown reasons. The high rate of subject dropout and data management errors substantially reduced the trial's statistical power. LDN was well tolerated, and serious adverse events did not occur. LDN was associated with significant improvement on the following mental health quality of life measures: a 3.3-point improvement on the Mental Component Summary score of the Short Form-36 General Health Survey (p = 0.04), a 6-point improvement on the Mental Health Inventory (p < 0.01), a 1.6-point improvement on the Pain Effects Scale (p =.04), and a 2.4-point improvement on the Perceived Deficits Questionnaire (p = 0.05). LDN significantly improved mental health quality of life indices. Further studies with LDN in MS are warranted.