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Frontal fluency and memory functioning among multiple sclerosis patients in Hong Kong
Abstract
The frontal fluency and memory functioning among Chinese patients with multiple sclerosis (MS) were investigated in order to identify cross-cultural differences in the impact of MS on cognitive functions. RESEARCH DESIGN, METHODS AND PROCEDURES: Cognitive profiles of 11 Chinese patients with MS were compared to that of their corresponding matched healthy volunteers. Since MS is of low prevalence in Hong Kong, the present sample is considered representative of patients with MS in the Hong Kong Island district. Frontal fluency and memory measures, namely Chinese Rey Auditory Verbal Learning Test, Aggie Figure Learning Test, Word Fluency Test (fruit/vegetable and animal categories), and Design Fluency Test were administered one-on-one to the participants to evaluate their cognitive functions along the verbal-non-verbal axis.
Results indicated that patients with MS performed poorer on non-verbal, but not verbal measures in this study relative to their healthy counterparts. These deficits cannot be explained by clinical or demographic variables.
These findings further support the speculation of a verbal-non-verbal distinction for cognitive deficits in patients with MS in Hong Kong.
... In studies examining verbal fluency, category and letter fluency tended to be impaired compared to healthy controls (e.g., Cerezo García et al., 2015). However, in two studies there was no difference between healthy controls and people with MS on category fluency tasks (Storm- Van 's Gravesande et al., 2019;Tong et al., 2002). Furthermore, some studies reported differences in verbal fluency between people with different subtypes of MS, but no Rook et al. ...
... Impaired verbal fluency may relate to ketamine-induced damage to the left frontal cortex (Liao et al., 2011). Furthermore, given ketamine's unique capacity for disrupting semantic memory by disorganizing semantic store (Morgan, Monaghan, et al., 2004), the impaired performance on the VFT could relate to the selective impairment of semantic memory, rather than a general executive dysfunction because for the latter, users should have been equally impaired on the RFFT (Tong, Yip, Lee, & Li, 2002). ...
... In the verbal fluency test, the subject names as many animals as possible in 1 min. 34 The raw score is the number of different animals correctly named with one point for each correct response. This test measures language and executive function. ...
Several studies have shown that general and specific cognitive dysfunction may be present during the early stages of chronic kidney disease. These studies, however, were conducted in elderly patients with comorbid conditions and used a limited battery of cognitive tests. Here we determined whether 40- to 54-year-old women in a population-based cohort in Taiwan with moderate chronic kidney disease have reduced cognitive performance. In total, 64 women with moderate chronic kidney disease (estimated glomerular filtration rate (eGFR) stage 3) were randomly matched by age and education with 192 control individuals with eGFR stage 2 or better. All patients underwent the Rey Auditory-Verbal Learning Test, visual memory, verbal fluency, Trail Making Test, digit spans, and Hospital Anxiety and Depression Scale neuropsychological tests. Women with moderate chronic kidney disease had significantly worse performance in delayed recalls and backward digit span than controls. Mixed effects modeling showed that women with moderate chronic kidney disease had reduced cognitive performance after controlling for body mass index, menopausal status, and psychosocial distress. Thus, in a population-based sample, we found that midlife women have reduced cognitive performance associated with early-stage chronic kidney disease. If confirmed, routine cognition evaluation of patients with mild chronic kidney disease may help identify this problem earlier because mild cognitive impairment can convert to dementia.
... Generalized, or diffuse, brain damage has a more deleterious effect on fluid abilities than on crystallized abilities (Goldberg & Builder, 1987;Horn, 1982;Russell, 1980). This finding has been demonstrated in several populations with brain damage (individuals with alcoholism, Leber, Jenkins, & Parsons, 1981; patients with multiple sclerosis, Tong, Yip, Lee, & Li, 2002), including patients who have sustained a traumatic brain injury (TBI). In addition to generalized effects of brain damage on fluid abilities, Mattson and Levin (1990) noted, in their summary of the literature on frontal lobe dysfunction following closed head injury, that patients with frontal lesions tend to have intact performance on standard intelligence measures that emphasize overlearned information. ...
G. Tremont, S. Halpert, D. J. Javorsky, and R. A. Stern (2000) found that individuals with executive dysfunction were more impaired on less structured versus more structured verbal memory tasks. In the present study, the authors investigated the relationship between executive functions and memory in patients with a history of traumatic brain injury by examining the effect of executive functioning on more structured and less structured verbal and visual memory tasks at baseline and 1-year follow-up. Matched subgroups controlled for differences in severity of neuropsychological impairment unrelated to specific executive functions. The G. Tremont et al. (2000) findings were not replicated. Results showed that when acuteness and severity of injury were controlled, executive impairment played no significant role in performance on either more or less structured memory tasks. However, regardless of structure, executive functions played a role in visual memory performance, suggesting that visual memory may be a more fluid ability than verbal memory.
... Cross-cultural differences are considered to be an 70 important issue in any research that deals with cognition assessment and neuropsychological evaluation [35][36][37]. In this regard, there are very few data available on cognitive impairment among Brazilian MS population. ...
The cognitive profile of patients with Multiple Sclerosis in the Brazilian population is relatively unknown and no cognitive screening instruments have been developed for this population. The purpose of the present study was to develop a neuropsychological screening instrument battery to identify cognitive impairment in epidemiological research protocols in this country.
Fifty-four patients with Relapsing-Remitting Multiple Sclerosis (RRMS) and 54 controls matched by sex, age and educational level were evaluated through a long and comprehensive neuropsychological test battery.
In comparison to the control group, 51.8% of the patients with RRMS presented some form of cognitive impairment. Three neuropsychological tests - Verbal Fluency, Rey Auditory Verbal Learning and Enhanced Cued Recall - presented an 80.6% sensitivity and 97.2% specificity in differentiating RRMS patients with cognitive deficits from paired control subjects.
These three tests constitute a Brief Battery that represents a first Brazilian MS cognitive screening instrument. However, further validation study is necessary to achieve better normative scores in a larger sample and to establish feasibility of this battery.
Cette thèse propose d'explorer les capacités en mémoire épisodique de patients atteints de sclérose en plaques (sep). A notre connaissance, l'analyse des processus touchés et préservés a fait l'objet de peu de travaux. L'une des raisons historiques semble être la création, dès les années 1980, de batteries d'évaluation rapide destinées aux neurologues. Ainsi, le golden standard de l'évaluation mnésique dans cette affection est le srt (dujardin et al., 2004) qui permet difficilement de contrôler les troubles d'encodage et de récupération. L'objectif de cette thèse sera dans un premier temps de documenter à l'aide d'épreuves permettant une analyse des processus mnésiques, les capacités de mémoire épisodique verbale dans la sep. Les performances de trois groupes de patients (sep, maladies d'Alzheimer et de Parkinson) seront comparées dans l'épreuve rl/ri-16 items. Cette étude sera destinée à vérifier si une majorité de patients sep présente une amélioration du rappel libre après délai contrairement aux deux autres affections testées. Si tel est le cas, l'hypothèse d'un temps de traitement, insuffisamment long pour les patients sep entre les rappels immédiats, mériterait d'être testée. Pour cela, une version parallèle du cvlt sera créée. Ainsi, les performances des patients seront comparées intra-individuellement lors de l'administration de l'épreuve dans sa version originale et lors d'une version où les temps entre les présentations de la liste de courses seront allongés. Un troisième volet sera destiné à tester les capacités de consolidation à long terme (une étude dans ce domaine pour la sep). Une analyse anatomo-fonctionnelle sera conduite en éprouvant l'hypothèse d'un lien entre les performances de rappel à une semaine et la volumétrie hippocampique des patients sep.
Memory impairment, especially verbal episodic memory (VEM), represents a common
ground for cognitive complaint in patients with multiple sclerosis (MS). Beyond
the difficulty caused in daily life, these deficits may impact on occupational activities.Neuropsychological assessment of these patients has to include VEM tests, to describe the
level of dysfunction of the different processes contributing to VEM and, if required, to guide
adapted cognitive rehabilitation. The objective of the present paper is to propose a critique
review of the literature on VEM abilities in MS. This review will present the conceptual
references and the psychometric characteristics of the main VEM tests applied in MS
(isolated tests or included within more general batteries developed specifically for MS).
In a second phase, we propose an inventory of work on MS presented as a function of the
cognitive processes involved. This approach provides an approach to the limitations of each
conception and possible terminological ambiguities. Contributions to knowledge of MS
memory impairments will be clarified, as well as the impact of the disease characteristics
(MS forms, disease duration, EDSS).
Memory impairment, especially verbal episodic memory (VEM), represents a common ground for cognitive complaint in patients with multiple sclerosis (MS). Beyond the difficulty caused in daily life, these deficits may impact on occupational activities. Neuropsychological assessment of these patients has to include VEM tests, to describe the level of dysfunction of the different processes contributing to VEM and, if required, to guide adapted cognitive rehabilitation. The objective of the present paper is to propose a critique review of the literature on VEM abilities in MS. This review will present the conceptual references and the psychometric characteristics of the main VEM tests applied in MS (isolated tests or included within more general batteries developed specifically for MS). In a second phase, we propose an inventory of work on MS presented as a function of the cognitive processes involved. This approach provides an approach to the limitations of each conception and possible terminological ambiguities. Contributions to knowledge of MS memory impairments will be clarified, as well as the impact of the disease characteristics (MS forms, disease duration, EDSS).
Copyright © 2015 Elsevier Masson SAS. All rights reserved.
Cognitive theories of emotional disorders indicate that biases in cognitive processes, such as attention, memory, and interpretation, are common factors that indicate vulnerability to these disorders, although their form varies according to the type of disorder. However, most of the studies have focused on adolescence and adulthood. It is still uncertain whether cognitive biases are risk factors for late-life depression. The present study sought to explore the role of interpretive bias in older adults with depressive symptoms and whether this effect is independent of basic cognitive abilities. Therefore, 18 older adults with depressive symptoms and 21 healthy controls were compared with an ambiguous facial expression identification task, a Mini Mental Status Examination, a Trail Making Test A and B, and a Word Fluency Test. Findings revealed that the depressive group was more likely to identify more ambiguous happy-sad facial expressions as indicative of sadness than were the healthy controls, but the two groups showed no significant differences in the cognitive test scores. These results suggest that interpretive bias indicates vulnerability to late-life depression, but basic cognitive abilities may have no influence in this context.
© 2015 The Institute of Psychology, Chinese Academy of Sciences and Wiley Publishing Asia Pty Ltd.
The primary purpose of this study was to test the hypothesis that multiple sclerosis (MS) patients have impaired acquisition rather than a retrieval deficit. Verbal memory impairment in MS was examined in 53 relapsing-remitting MS patients and 31 healthy controls (HC), and in a meta-analysis of studies that examined memory functioning in MS with list-learning tasks. The MS group demonstrated significantly lower acquisition and delayed recall performance than the HC group, and the meta-analysis revealed that the largest effect sizes were obtained for acquisition measures relative to delayed recall and recognition. Our data argue against a retrieval deficit as the sole explanation for verbal memory impairment in MS, and make a consistent case for the position that deficient acquisition contributes to the memory dysfunction of MS patients. Deficient acquisition may result from demyelination in relevant white matter tracts that reduces encoding efficiency as a result of impaired speed of information processing. (JINS, 2013, 19, 995–1008)
To examine the effect of glucose tolerance status on cognitive performance in early middle-aged women.
We conducted a matched, case-control study from a population-based cohort in Kinmen, Taiwan. Women aged 40-54 years were recruited. Participants were classified into one of three groups: normal, impaired glucose tolerance (IGT) or diabetes mellitus. Cognitive measures used were the Rey Auditory-Verbal Learning Test, visual memory, verbal fluency, Trail Making Test, and digit spans.
Seven hundred and twenty eligible women underwent both the cognitive and oral glucose tolerance tests. The 72 women (10%) who had diabetes mellitus were compared with 68 women with IGT and 144 with normal glucose tolerance. All groups were matched for age and education level. Mean scores on cognitive testing did not differ between the three groups, except for the forward digit spans test. After adjustment for menopausal status, psychological stress scores and other cardiovascular variables, glucose tolerance status was no longer a significant predictor for forward digit span scores.
Glucose tolerance status was not associated with cognitive performance in middle-aged women.
A quantitative review of 35 studies with 3673 participants was conducted to estimate and compare the magnitude of deficits upon tests of phonemic and semantic fluency for participants with multiple sclerosis (MS) relative to healthy controls. Participants with MS were substantially but similarly impaired on tests of phonemic and semantic fluency. These deficits were larger than deficits on measures of verbal intelligence, confrontation naming and another widely used measure of executive functioning, the Wisconsin Card Sorting Test, but were of a comparable or smaller magnitude relative to deficits on the oral version of the Symbol Digit Modalities Test (SDMT). This is consistent with other research suggesting that measures of verbal fluency and the SDMT may be amongst the most sensitive neuropsychological measures to cognitive impairment in MS. Increased neurological disability and a chronic progressive (as opposed to a relapsing remitting) disease course were associated with larger deficits on tests of phonemic and semantic fluency. However, it is suggested that this latter finding is attributable to the distinct clinical features of chronic progressive and relapsing remitting sub-types. Thus, patients who follow a chronic progressive course tend to be older, have an increased duration of illness and experience greater neurological disability. Once these variables were controlled for, differences between the two sub-types were substantially attenuated.
The Rey Auditory Verbal Learning Test [RAVLT; Rey, A. (1941). L'examen psychologique dans les cas d'encéphalopathie traumatique. Archives de Psychologie, 28, 21] is a commonly used neuropsychological measure that assesses verbal learning and memory. Normative data have been compiled [Schmidt, M. (1996). Rey Auditory and Verbal Learning Test: A handbook. Los Angeles, CA: Western Psychological Services]. When assessing an individual suspected of neurological dysfunction, useful comparisons include the extent that the patient deviates from healthy peers and also how closely the subject's performance matches those with known brain injury. This study provides the means and S.D.'s of 392 individuals with documented neurological dysfunction [closed head TBI (n=68), neoplasms (n=57), stroke (n=47), Dementia of the Alzheimer's type (n=158), and presurgical epilepsy left seizure focus (n=28), presurgical epilepsy right seizure focus (n=34)] and 122 patients with no known neurological dysfunction and psychiatric complaints. Patients were stratified into three age groups, 16-35, 36-59, and 60-88. Data were provided for trials I-V, List B, immediate recall, 30-min delayed recall, and recognition. Classification characteristics of the RAVLT using [Schmidt, M. (1996). Rey Auditory and Verbal Learning Test: A handbook. Los Angeles, CA: Western Psychological Services] meta-norms found the RAVLT to best distinguish patients suspected of Alzheimer's disease from the psychiatric comparison group.
Administered the WAIS and an expanded Halstead-Reitan Neuropsychological Test Battery (HRB) to 100 (mean age 37.38 yrs) patients with relapsing-remitting (
n = 57) or chronic-progressive (
n = 43) courses of multiple sclerosis (MS) and to 100 normal controls to assess neuropsychological functioning in MS Ss. Both MS groups were clinically stable at the times of testing. Results indicate that both MS groups showed significant neuropsychological impairment, relative to controls, but chronic-progressive MS was associated with greater impairment in each major ability domain (cognitive, sensory, and motor) than was relapsing-remitting MS. In particular, only minimal cognitive impairment was noted in relapsing-remitting MS Ss, whereas chronic-progressive Ss showed impairment on the majority of cognitive test measures from the expanded HRB. Degree of neuropsychological impairment was significantly correlated with MS duration but was unrelated to medication status. MS subgroup differences on the test battery could not be attributed to duration of illness, indicating that disease course is an important independent determinant of neuropsychological impairment in MS. Disability ratings from clinical neurological examinations were highly correlated with motor and sensory performances on neuropsychologial testing, but clinical exams were inadequate in predicting Ss' cognitive status. (33 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Proposes that the primary objective of intelligence testing be redirected from predicting to improving intellectual performance. In a number of instances, specific behaviors involved in responding to items on intelligence tests have been subjected to experimental analysis in laboratory studies. Results support the concept that different levels of test performance result from different combinations of processes and mechanisms of coding, hierarchical association, memory search, and cybernetic control of intellectual functioning. (20 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Memory disturbance is common in patients with multiple sclerosis (MS), as previously demonstrated on clinical memory tests of explicit learning using effortful retrieval paradigms. To better understand the mechanisms underlying memory failure, the authors compared the performance of 46 MS patients and 47 demographically matched normal controls on experimental tests of working memory, semantic encoding, and implicit memory. On the working memory task, MS patients demonstrated an exaggerated word length effect, which indicates a deficit in the control process of articulatory rehearsal. In contrast, MS patients demonstrated a normal buildup and release from proactive inhibition, which suggests intact semantic encoding. Finally, on priming and procedural memory tasks, MS patients performed without difficulty. The MS patients' test performance was not correlated with illness duration or course, severity of physical disability, or psychoactive medication use. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
One hundred patients with unilateral cortical excisions and 34 normal control subjects were tested for the ability to produce abstract (meaningless) designs under a time constraint. It was predicted that the task, testing fluency in a nonverbal mode, would tap the specialized abilities of anterior parts of the right hemisphere just as certain tests of word fluency tap those of the left frontal lobe. Results showed patients with right frontal and right fronto-central lesions to be the most impaired, with milder deficits being found in left frontal and right temporal groups, thus emphasizing the importance of both side and site of lesion in performance of this task.
Acquisition of scientific information regarding the neuropsychological aspects of multiple sclerosis has been hampered by studies using small, inadequately described patient and control samples and a wide array of cognitive test procedures that hinder multicenter data pooling. Based on a review of key issues of clinical need and experimental interest, research guidelines are proposed for investigations in this burgeoning research area. The guidelines include suggestions for sampling methods, population characterization, and control groups as well as a recommended core battery of neuropsychological tests for use in this population. It is hoped that these guidelines will advance knowledge about the neuropsychology of multiple sclerosis by helping to promote sound experimental design, facilitate cross-study comparison, and encourage multicenter collaborative efforts.
The Wisconsin Card Sorting Test (WCST), a measure of concept formation and set-shifting capacity, was administered to two groups of multiple sclerosis (MS) patients defined by relapsing-remitting (n = 36) or chronic-progressive (n = 33) clinical courses. The performance of each group was compared with an age and education-matched control group of chronic back pain patients. The chronic-progressive patients achieved fewer conceptual categories due to a significantly greater number of perseverative responses than control patients, whereas the relapsing-remitting group was unimpaired on the WCST relative to the control group. A stepwise multiple regression analysis suggested that these performance differences were related to clinical course and not to length of illness or degree of physical disability.
Multiple sclerosis (MS) is a relatively common, chronic progressive neurological illness affecting individuals primarily in the third and fourth decades of life. Autopsy studies indicate that the disease preferentially attacks white matter throughout the CNS, including the cerebral hemispheres. This article reviews the current state of knowledge regarding cognitive dysfunction in MS and relates these findings to neuropathological changes. The view that affective disturbance may also result from cerebral demyelination is presented, along with a brief discussion of MS as a prototype "subcortical" dementia. Finally, methodological problems intrinsic to the study of MS are presented, and suggestions for future research are made.
Forty-seven patients with chronic progressive multiple sclerosis were examined to assess the possible relationship between cerebral atrophy (by computed tomography [CT] ) and performance on neuropsychological tests of memory and verbal intelligence. Nineteen patients were found to have mildly dilated ventricles and another nine patients had moderate to severe ventricular enlargement. Performance on memory and intelligence testing was related to the degree of ventriculomegaly. Three linear CT measurements were also recorded. Using this method, the width of the third ventricle proved to be the best indicator of intellectual and memory dysfunction. Measures of cognition and ventricular size did not correlate with length of illness or overall disability as rated by the Kurtzke Disability Status Score.
Forty-four patients with chronic progressive multiple sclerosis (MS) were compared with age- and education-matched control groups on a battery of clinical and experimental memory measures. Patients with MS performed substantially below the control groups on both immediate learning and delayed recall tasks, particularly in the retrieval of spatial information. The MS sample was subdivided into three groups using a cluster analytic procedure. One group (N = 9) performed well below expectations on memory tasks, exhibited signs of global cognitive disturbance, and had an atypical personality adjustment, characterized by irritability, social withdrawal, and apathy. A second group (N = 19) showed mild memory disturbance, associated with a greater use of psychotropic medications and a higher incidence of reactive depression. A third group (N = 16) performed normally on memory measures. The three groups of patients with MS did not differ in length or overall severity of illness.
The present study was designed to examine whether verbal memory impairment in multiple sclerosis (MS) is attributable to impaired information acquisition or compromised retrieval. Twenty-three MS and 23 control subjects were administered a 10-item verbal list-learning task. Subjects were trained to a specific criterion on the verbal test in order to assure equal information acquisition. Following a 30-min delay, retrieval and recognition performance was evaluated. MS subjects required significantly more trials to reach criterion on the task relative to controls, but the groups did not differ on tests of recall and recognition. Performance was correlated with rate of information processing speed. These results suggest that verbal memory impairment among MS subjects is a consequence of inadequate initial learning and not a function of impaired retrieval.
We examined the equivalence of three matched forms of the Rey Auditory Verbal Learning Test (RAVLT) and three parallel forms of a new nonverbal analog, the Aggie Figures Learning Test (AFLT). One hundred and fourteen healthy subjects, primarily college students, were administered corresponding forms of the two tasks. For both tasks the three forms proved to be well-matched; as well, overall performance on the RAVLT was comparable to that on the AFLT. The two tasks were also administered to 23 patients with anterior resection from the left or right temporal lobe (ATL). Findings showed that right ATL patients were significantly impaired on the learning trials of the AFLT as compared to their learning on the RAVLT; they showed little forgetting of figures or words over a 20-min delay interval. By contrast, left ATL patients showed severe forgetting of words as compared to figures, but their learning curve for the RAVLT did not differ from that on the AFLT.
A detailed exposition of the author's methods of evaluating children with cerebral defects is presented in terms of longitudinal studies of 4 fictional and 3 actual cases and a systematic discussion of the varied techniques and their modifications that can be employed in such evaluations. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Based on the prevalence of multiple sclerosis (MS) in 10 Japanese cities, as studied by the MS Research Committee of Japan since 1972, the relationship between the prevalence ratio and latitude was tested using Armitage's tests for linear trends in proportions and frequencies. Crude prevalence ratios were 0.8–4.0 per 100,000 population. With respect to both crude and age- and sex-adjusted prevalence ratios, a statistically significant north-to-south gradient for MS was found in Japan. This result may be explained by the existence of environmental factor(s), although it does not exclude the participation of immunologic processes as an additional causative or endogenous modifying factor.
Both mortality and morbidity data indicate quite clearly that multiple sclerosis is a geographically-related disease, and thus MS can be thought of as an acquired environmental (exogenous) illness. High frequency parts of the world for MS are Europe between 65° and 45° north latitude, northern United States and southern Canada, New Zealand, and southern Australia. These regions are bounded by medium frequency MS regions: in Europe to the north, east, and south; in America for southern U.S.; and the remainder of Australia. Latin America, Asia and Africa are essentially of low frequency from present data. Latitude is not a sufficient criterion: at 40° north latitude, MS is high in America, medium in Europe, and low in Asia.
All high and medium risk areas therefore are in Europe or European colonies; thus MS is the white man's burden spread from western Europe. Within the U.S., MS is less common among Negroes, Japanese, and possibly Amerindians than in whites regardless of geography. Migration studies among risk areas indicate that migrants keep much of the risk of their birthplace, but also that overall the risk is decreased by high-to-low migration, and probably increased by low-to-high. For the former, it seems that adolescence is the age critical for retention of birthplace risk. Some preliminary data on a possible epidemic of MS are also presented.
All the epidemiologic information would be most easily explained if MS were an infectious (?viral) illness with prolonged latency. The proof of this though must come from the laboratory.
Twenty-four traumatically brain-injured males, of whom eight had sustained right-sided, eight left-sided, and eight bilateral or diffuse closed head injuries, took a battery of neuropsychological tests within the first six months, the second six months, the second year and the third year post injury. Performances on WAIS Digits Forward and Backward and Rey's Auditory-Verbal Learning Test were classified as within or below normal range. Comparisons were made (1) between time periods and tests and (2) between subgroups formed by severity, site of lesion, and age. The findings give an overall picture of wide performance variability with consistent improvement in immediate memory span and learning. Recovery varied with the specific nature of the tested function, task complexity, and severity of injury. Neither age, site of injury, not recency were associated with improvement.
The National Research Council Twin Registry comprises 16,000 pairs of white male twins, both members of which had been in military service, mainly in World War II. All their available military and Veterans Administration records and their responses to a 1965 to 1970 NRC questionnaire have been coded as to disease. Upon review we found 16 cases of multiple sclerosis (MS) among 15 pairs of twins, for an age-specific prevalence rate of 51 per 100,000 veterans aged 43 to 53--about half the expected frequency. Of the 15 sets, three sets refused cooperation and three were unavailable for study. Nine sets were examined and interviewed together with the mother. One of five monozygotic twin pairs was concordant for MS and in another the co-twin of an MS case had had a solitary episode of retrobulbar neuritis; all others were discordant. There were more definable environmental events (as noted below) among the affected twins than among the unaffected co-twins. The greatest excess was within the 20 years before onset. Summing events across the four 5-year periods before onset, among the 10 MS versus the eight not-MS individuals, there were 5:1 instances of trauma, 8:2 or operation, 7:1 of ether anesthesia, 7:1 of allergy, 10:5 of infection, and 9:0 of animal exposure. Summing these same events within each 5-year period, the MS:control ratios were 9:1, 10:2, 12:3, and 15:4, respectively, for 0 to 4, 5 to 9, 10 to 14, and 15 to 19 years before onset.
Compared the neuropsychological performances of 14 patients who had multiple sclerosis (MS) and who received repeated testings spaced over time by at least 1 yr with identical evaluations of 14 patients who had neurological involvement but not MS. Ss in each group were individually matched on CA at first testing (38.0 yrs for MS Ss and 37.0 yrs for controls), length of test-retest interval, sex, and years of formal education. Tests included the WAIS, the Wide Range Achievement Test, the Tactual Performance Test, the Seashore Rhythm Test, the Finger Angosia Test, and the Maze Coordination Test among others. Performance decrements attributable to the demyelination process of MS were primarily manifested on tasks requiring motor proficiency or complex sensory discriminations. Tests of higher order cognitive functions (e.g., abstractions, speech perception) were less adversely affected, except for measures having significant motor components. Preliminary MMPI data are also presented. Results indicate relative preservation or only mild deterioration for most intellectual abilities despite worsened motor-sensory functioning. (15 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
A search for cases of multiple sclerosis (MS) was carried out among the 120,066 Japanese-American residents and the 3,060,366 Caucasian residents native to state of residence in King and Pierce Counties, Washington, and Los Angeles County, California. Although 48 cases would have been expected among Japanese-Americans in both areas (on the basis of the prevalence among Caucasians in these two areas), only eight cases were found who were residents on prevalence day -- all were American-born residents of Los Angeles County. The age-, sex-adjusted prevalence of MS among Japanese-Americans in both areas was 5.9 per 100,000. The lower prevalence of multiple sclerosis among Japanese-Americans than among Caucasians has been interpreted as evidence of a lower susceptibility to factors causing multiple sclerosis.
Twenty-five cases of multiple sclerosis (MS), including 2 autopsy cases, collected during the past 20 years from amongst the Chinese of Taiwan, are reported. These cases fulfilled all the clinical diagnostic criteria of MS. The following observations were made: (1) Multiple sclerosis does exist among Chinese in Taiwan. It is uncommon, but is by no means a very rare disease. The prevalence rate in northern Taiwan near Taipei is estimated as 0.8/100.000 population. (2) Female preponderence was conspicuous (F:M = 3.2.:1) in our MS cases as well as in other demyelinating diseases. (3) On the whole, the onset of the disease was earlier in female patients, and those who had their initial symptoms before the age of 20 years were all females. (4) The optic nerve was most frequently involved at the onset, and it was involved in the majority of patients during the whole clinical course. (5) Involvement of the optic nerve and spinal cord, with or without the brain stem, was the commonest form of our MS cases, especially among female patients. (6) More malignant forms of MS, with acute onset and rapid clinical course leading to severe incapacity or fatality, were more common among female patients. (7) Painful tonic spasms were relatively frequently encountered, and they were usually seen in patients with severe spinal cord involvement. (8) Marked elevation of the CSF total protein and of leukocytes was relatively frequent during severe relapses in patients with spinal cord lesions. (9) Severe and extensive demyelinating lesions, both old and recent, in the optic nerve and spinal cord were seen in 2 autopsy cases. The relationship between MS and NMO in Oriental patients is briefly discussed. (10) It seems likely that cases of MS which are atypical as compared with Western MS are more frequently seen in Oriental countries, and perhaps also in tropical regions where MS is known to be rare.
Previous frequency estimates of cognitive dysfunction in multiple sclerosis have ranged from 54 to 65 percent. These studies may overestimate the frequency in the general MS population, since the patients in these studies were recruited from clinic populations. In the present study, we administered a comprehensive neuropsychological test battery to 100 community-based MS patients and 100 demographically matched healthy controls. Of 31 cognitive test indices examined, 48 MS patients and five controls were impaired on four or more test indices, yielding an overall frequency rate of 43% for the MS group. The pattern of cognitive decline was not uniform: MS patients were more frequently impaired on measures of recent memory, sustained attention, verbal fluency, conceptual reasoning, and visuospatial perception, and less frequently impaired on measures of language and immediate and remote memory. We developed a brief (20-minute) screening battery empirically by selecting the four most sensitive test indices from the comprehensive battery. The brief battery yielded a sensitivity value of 71% and a specificity value of 94% in discriminating cognitively intact from impaired MS patients, as defined by the comprehensive battery. Cognitive impairment was not significantly associated with illness duration, depression, disease course, or medication usage, but was significantly (albeit weakly) correlated with physical disability.
Patients with chronic progressive multiple sclerosis often perform more poorly on cognitive tasks than do patients with the relapsing-remitting form of this disease. Whether these differences reflect an independent influence of disease type on cognitive performance is uncertain. We used multiple regression techniques to determine how well performance on a number of tasks done poorly by groups of patients with multiple sclerosis could be predicted by disease type and its confounds: age, disease duration, and disability status as well as other demographic variables. Disease types were assigned longitudinally, based on serial neurological examinations at 6-month intervals over a minimum of 2 years. None of the demographic or clinical variables predicted cognitive performance with more than minimal accuracy. These findings fail to provide support for the assertion that disease type is an important independent determinant of cognitive impairment in multiple sclerosis.
We compared the performance of 50 multiple sclerosis (MS) patients and 35 normal controls on a variety of memory tasks to determine the nature and severity of memory deficits in the MS patients and the proportion of patients affected. We also determined the relationship between memory and other cognitive functions, demographic factors, disease characteristics, depression, and psychoactive medication. We found significant differences between patients and controls on almost all memory tests. Patterns of learning, effects of interference, and improvement with cuing were similar for both groups. Thirty percent of patients showed severe memory impairment, 30% were moderately impaired, and 40% were mildly or not impaired. Memory dysfunction was related to impairment of other cognitive functions, lower socioeconomic status, chronic progressive type of MS, and use of antianxiety medication, but not to severity of disability, duration of MS symptoms or depression.
In 22 (56%) of 39 quiet-stage multiple sclerosis (MS) patients with at least average intelligence quotients, performances in memory and learning tasks were normal, as compared with those of a control group (24 healthy volunteers). Of the remaining 44% (n = 17), 2 patients were amnesic and 5 had been judged to have suffered cognitive decline. Auditory word learning was particularly vulnerable; however, acquisition rate was not significantly different between MS patients and controls.
A territory-wide investigation of southern Chinese patients with multiple sclerosis (MS) was conducted in Hong Kong. There were 47 patients, 35 of whom were clinically definite (CDMS), 6 laboratory-supported definite (LSDMS) and 6 clinically probable (CPMS). The prevalence rate was 0.88 per 10(5) population, which is of the same order as in other Oriental populations but much lower than in Caucasoid populations. Comparisons with major Oriental and Caucasian series showed essentially the same clinical picture with only minor variations. In one autopsy case, the lesions were found mainly in the optic nerves and spinal cord, with marked softening in addition to the classical demyelination features. In contrast to findings in Caucasians, the detection rate of oligoclonal bands in the cerebrospinal fluid was low (33% in CDMS patients) and there was no association with human leucocyte antigens. The possible implications of these findings on the pathogenesis of MS are discussed.
We have recently proposed that the cognitive deficits of patients with multiple sclerosis (MS) share numerous characteristics associated with the syndrome of subcortical dementia. One such characteristic, slowness of mental processing, was evaluated in the present study. Thirty-six MS patients were compared to 26 normal controls of equivalent age, education, and verbal intelligence on the Sternberg memory scanning test. As anticipated, the motor-involved MS patients had an overall slower reaction time than did controls. Their scanning rate, a measure of pure cognitive speed, was also significantly slower than controls. These results suggest that MS patients exhibit a slowing of mental processing independent of motor involvement.
Thirty-seven patients with multiple sclerosis (MS) were compared to 26 normal controls of equivalent age, education, and verbal intelligence on measures of verbal learning and memory (Digit Span and Supraspan, Brown-Peterson Distractor Task, Selective Reminding Test, Story Recall, and Free Verbal Recall) and verbal fluency (Letter and Animal Fluency). The MS patients exhibited deficits on measures of secondary (long-term) memory and verbal fluency, but performed normally on measures of primary (short-term) memory, recognition memory, and rate of forgetting from secondary memory. These results suggest that the memory disturbance in MS results primarily from an imparied ability to access information from secondary memory, while encoding and storage capacity is intact. Degree of memory impairment was unrelated to length of illness, severity of disability, or self-reported depression.
Previous research has suggested that cerebral lesions observed on magnetic resonance imaging (MRI) of MS patients are clinically "silent." We examined the validity of this assertion by correlating neuropsychological test performance with MRI findings in 53 MS patients. We used a semiautomated quantitation system to measure three MRI variables: total lesion area (TLA), ventricular-brain ratio (VBR), and size of the corpus callosum (SCC). Stepwise multiple regression analyses indicated that TLA was a robust predictor of cognitive dysfunction, particularly for measures of recent memory, abstract/conceptual reasoning, language, and visuospatial problem solving. SCC predicted test performance on measures on mental processing speed and rapid problem solving, while VBR did not independently predict cognitive test findings. These findings suggest that cerebral lesions in MS produce cognitive dysfunction and that MRI may be a useful predictor of cognitive dysfunction.
This study compared the intellectual deficits of patients who had the earliest stages of Huntington's disease (HD) with those of mildly or moderately affected patients suffering from multiple sclerosis; both groups were matched for age, education, and ability to function. Twenty-one HD patients, 30 multiple sclerosis subjects, and 15 matched controls were evaluated neuropsychologically; all were free of psychoactive medications. The two patient groups showed similar overall patterns of impairment, though the HD group had greater verbal and nonverbal memory deficits. The HD patients also demonstrated significant dyscalculia and showed indications of developing problems in language usage and copying. These results are discussed in light of each disorder's neuropathologic substrate.
Forty mildly disabled and clinically stable patients with multiple sclerosis (MS), representative of the corresponding population in Northern Holland, with disability Status Scale scores evenly distributed within the 1 to 4 range, were compared with 40 age-, sex-, and education-matched normal controls on a battery of neuropsychological tests. Apart from impairments in perceptual-motor functioning, generally mild deficiencies in intelligence and, specifically, in memory were displayed in the MS group. Attentional processes appeared uncompromised. Increasing fatigue during testing could not account for poor performance. The memory deficits could be attributed to poor initial learning, although there was also evidence suggesting that accelerated forgetting of what had been learned may appear with the progression of MS. Seven patients (17.5%), as compared with none of the controls, were classified by blind clinical judgement of test performance as definitely impaired.
Environmental factors implicated as affecting world-wide distribution of multiple sclerosis are reviewed. It is suggested that climate may be involved in the etiology of this disease. Diffused solar radiation effects on multiple sclerosis hospital admission rates are demonstrated.
Sixty patients with chronic/progressive MS received a newly assembled neuropsychological screening battery (NSB) and a brain MRI. A neuroradiologist blinded to NSB findings quantified cerebral lesions on MRI. We developed weighted brain area lesion scores according to number and size of cerebral lesions. Patients who were impaired on NSB testing had a significantly higher mean bihemispheric lesion score (X = 26.1) than those who were unimpaired (X = 17.4); this MRI lesion rating score correlated significantly with the cognitive summary score of the NSB (r = 0.35, p less than 0.01). However, we did not find a significant correlation between the Kurtzke Expanded Disability Status Scale and any MRI or NSB summary measures. Compared with the Mini-Mental State Exam (MMSE), the NSB cognitive summary score yielded a prevalence estimate for cognitive impairment that is more consistent with previous findings in chronic/progressive MS. The NSB is a useful screening test for cognitive dysfunction in chronic/progressive MS because of its relationship to cerebral lesions on MRI and its greater sensitivity than the frequently used MMSE.
Sixteen patients with a definitive diagnosis of multiple sclerosis (MS) and an equal number of matched controls were administered tests of memory and information processing speed. Results indicated a significant long-term verbal memory impairment in patients with MS, with spared short-term memory and memory scanning. Speed of information processing was evaluated with the Paced Auditory Serial Addition Test. The results for the two highest rates of presentation revealed significantly impaired processing in the MS group. Performance at the higher rates and retrieval of information from long-term memory were significantly correlated. These results suggest that slowed information processing is a deficit that contributes to long-term memory impairment in patients with MS.
Thirty consecutive patients from peninsular Malaysia with clinically definite multiple sclerosis were studied; 80% were ethnic Chinese, with a female-male ratio of 5:1. The average age at onset was 29.7 years, with one relapse average every 1.9 years. Optic-spinal recurrence was the most common clinical pattern of the disease, accounting for 63.3% (19/30) of the cases. All the patients had spinal cord involvement sometime during the course of the illness. The mortality was high at 36.7% (11/30), with an average duration of symptoms of 7.6 years. There was characteristic severe residual visual and motor disability. At the time of the last examination, 12 patients had bilateral optic atrophy with blindness or severe visual acuity impairment. Sixteen patients were bedridden or confined to a wheelchair. The severe motor disability reflected the severe spinal cord involvement. It was the main factor that accounted for the high mortality. The cerebral, cerebellar, and brain-stem involvements were, however, generally transient. None of the patients' had a family history of similar illness despite the average sibling size of six. There was no example of Devic's disease. The clinical pattern was closest to those patients who presented from Taiwan.
The performance of 38 patients with chronic progressive multiple sclerosis was compared with that of 26 age- and education-matched controls on a battery of tests of information-processing speed, verbal fluency, naming, egocentric perception, and anterograde and remote memory. Although there were marked differences in the extent and severity of cognitive disturbance among individual patients, as a group they were impaired compared with controls on all measures. Deficits were most striking on the Symbol-Digit Modalities Test and the verbal fluency measures, tests that require rapid information processing. More than 75% of the patients scored below the tenth percentile for controls on the Symbol-Digit Modalities Test, while 61% scored below the tenth percentile on verbal fluency. Memory disturbances were also common. More than 45% of the patients scored below the tenth percentile. The proportion of impaired patients was quite similar for anterograde and remote memory tests and for recall and recognition procedures. The pattern of memory disturbance and slowed information processing resembled deficits generally observed in subcortical dementias, such as Huntington's disease, but in addition, the patients with multiple sclerosis showed naming difficulties that are usually associated with cortical dementias, such as Alzheimer's disease.
Some patients with multiple sclerosis (MS) demonstrate impaired memory. A group of 16 patients with MS who were mildly to moderately affected (Kurtzke Expanded Disability Status Scale Score = 3.8) were studied, and they were compared with a matched control group on tests of "working memory." The working memory system was explored by evaluating the amount of information that can temporarily be held in a buffer system during encoding. Results indicated that patients with MS have difficulty in processing information at the level of a hypothesized articulatory loop in working memory. This deficit was correlated with their retrieval of verbal information from long-term memory, as well as how accurately they processed verbal information presented at a rapid rate. There was no significant relationship between ratings of MS severity or number of plaques visualized on magnetic resonance imaging scans and the degree of working memory deficit.
Multiple sclerosis (MS) has its usual onset in early adult life (average age of 30 years), but age at clinical onset varies considerably. The implications of the age of onset on the clinical presentation and course of MS are unclear. This population-based retrospective study presents data from a group of 125 patients with onset of MS before age 16 years and can thus be considered as representative of MS occurring in childhood. It demonstrates that childhood MS is more frequent in girls, that it very often has a relapsing-remitting course, that initial bouts usually involve afferent structures of the central nervous system, that recovery from these is often complete, and that the pace of the disease is slow.
A nation wide Finnish Twin Cohort was linked with sickness insurance and hospital discharge registers on the basis of the unique identification number assigned to each Finnish citizen. The study series consisted of 4,063 monozygotic (MZ) and 9,001 dizygotic (DZ) same-sexed twin pairs born before 1958 and alive in 1981. Altogether, 22 subjects representing 11 MZ pairs and 10 DZ pairs showed clinically definite multiple sclerosis (MS). In one MZ pair both members had the disease. The frequency of MS among DZ twins corresponded to the figure in the Finnish population, but the prevalence was higher in MZ twins than in DZ twins.
Subcortical dementia is a clinical syndrome characterized by slowness of mental processing, forgetfulness, impaired cognition, apathy, and depression. First recognized in progressive supranuclear palsy and Huntington's disease, the concept has been extended to account for the intellectual impairment of Parkinson's disease, Wilson's disease, spinocerebellar degenerations, idiopathic basal ganglia calcification, the lacunar state, and the dementia syndrome of depression. Disorders manifesting subcortical dementia have pathologic changes that involve primarily the thalamus, basal ganglia, and related brain-stem nuclei with relative sparing of the cerebral cortex. Recent studies of neuropsychologic deficits following focal subcortical lesions also support a role for these structures in arousal, attention, mood, motivation, language, memory, abstraction, and visuospatial skills. The clinical characteristics of subcortical dementia differ from those of dementia of Alzheimer's type where prominent cerebral cortical involvement produces aphasia, amnesia, agnosia, and apraxia.
Forty-three patients with multiple sclerosis showed disturbances in short-term memory, learning, and delayed recall which were associated with years of active disease (average was 4.5 years), age, presence of flareup, but not steroid/ACTH treatment. Unrecognised memory loss might be prevalent early in the natural history of multiple sclerosis and deserves neuropsychological assessment.
Two hundred and four consecutive British cases and 60 consecutive Japanese cases of probable (clinically definite) multiple sclerosis, seen at The National Hospital for Nervous Disease, Maida Vale, London and at Kyushu University Hospital, Fukuoka, Japan, respectively, over a defined period of time, were reviewed retrospectively by the same neurologist, using the same diagnostic criteria and the same method of analysis. The clinical pictures in the present 2 series were in many respects similar to each other and to that of other reported series. Some significant differences were found, however: there was (1) a greater incidence of visual loss at the onset of illness, (2) more frequent and severe involvement of spinal cord and brainstem during the course of illness, as judged clinically, and (3) more severe visual disability in the Japanese series as compared with the British series.
To assess the evolution of cognitive dysfunction in early-onset multiple sclerosis, to identify clinical predictors of mental decline, and to determine its impact on a patient's everyday life.
The cognitive performance of 50 patients with multiple sclerosis on a neuropsychological battery was compared with that of 70 control subjects initially and again after a 4-year interval. Clinical predictors of cognitive impairment and its effect on daily life were analyzed by stepwise linear regression.
The research clinic of a university department of neurology.
A consecutive sample of 50 inpatients and outpatients with multiple sclerosis (mean disease duration, 1.58 years) and 70 demographically matched healthy control subjects selected from the patients' relatives and friends.
Mean psychometric test scores of both groups at the initial and follow-up testing. Regression coefficients measuring the relationship between clinical parameters and cognitive capacity and between mental decline and performance of common tasks measured by the Environmental and the Incapacity Status scales.
Multiple sclerosis-related deficits in verbal memory and abstract reasoning on initial testing remained more or less stable on the retest, at which time linguistic disturbances on the Set and Token tests also emerged. A patient's initial disability level predicted decreased performance on only four of 13 cognitive variables, and disease duration did so on only two. Extent of intellectual decline on initial testing, initial disability level, and progressive course were independent determinants of handicap in a patient's work and social activities.
Cognitive and neurological deficits appear not to develop in parallel. Yet cognitive dysfunction proves to be a predictor of handicap in everyday life, even in patients in the incipient phase of multiple sclerosis.
The psychopathological status of 25 inpatients suffering from clinically definite multiple sclerosis (MS) according to Poser criteria was assessed by using standardized methods (Structured Clinical Interview for DSM-III-R, Inpatient Multidimensional Psychiatric Scale, Hamilton and Montgomery-Asberg Depression Rating Scales and the Structured Interview for the Diagnosis of Alzheimer Dementia and Dementias of other Aetiology (SIDAM). Magnetic resonance (MRT) (0.5 T; T2-weighted sequence) of the brain was analysed by measuring the ventricular brain ration (VBR), the area of the corpus callosum (CC) and the extension of hyperintense lesions of the brainstem, the temporal lobes and the brain at all. Six of 25 (24%) of these moderately disabled patients (mean Extended Disability Score (EDSS) 3.3) were diagnosed to suffer from depressive mood disorder (major depression or dysthymia); 2 were demented. In correlation analysis, depression was unrelated to age, gender, duration of illness, status of disability (EDSS) or the results of cognitive assessment. No relationship between the depression scores and the different MRT measures could be identified. The presence or absence of gadolinium enhancement was also uncorrelated to depressive symptoms. Fatigue as measured by the Fatigue Severity Scale was unrelated to depression or subcortical brain atrophy (increased VBR) but significantly correlated to the area of hyperintense MRT changes in brainstem and midbrain. Cognitive impairment (decreased SIDAM scores) was correlated to the total area of hyperintense MRT changes of the brain parenchyma. The type of clinical course (relapsing-remitting vs chronic progredient) was not found to influence the affective or cognitive state in our MS patient's sample.
During a 27-month recruitment period, we identified 146 individuals with multiple sclerosis (MS) who have a twin. A single clinician interviewed and examined 105 pairs of twins, and we confirmed zygosity using minisatellite probes. Including two suspected cases, 11 of 44 (25%) monozygotic twin pairs were concordant compared with two of 61 (3%) dizygotic twin pairs--two of 33 (6%) like-sexed and zero of 28 (0%) opposite-sexed. MRI was performed in 64 of 105 co-twins, and showed abnormalities consistent with demyelination in 13% of monozygotic and 9% of dizygotic co-twins who were clinically unaffected. These findings are similar to the results of most previous studies of MS in twins in which zygosity was not unequivocally established and where the majority of clinically unaffected co-twins were not studied by MRI; the difference in concordance rates in monozygotic and dizygotic twins indicates a significant genetic component in the etiology of MS.
Neurocognitive studies of multiple sclerosis (MS) have identified a robust long-term memory deficit. We hypothesized that this is due in part to the limited representation and use of serial order information. MS patients and controls were studied with a supraspan list learning procedure with post-encoding retrieval and recognition trials. MS patients demonstrated post-encoding negative recency with normal recognition, and word order recall was impaired. These findings appear to be in part to difficulty using temporal order cues in long-term memory. Two dissociable memory deficits were identified, suggesting that there are at least two neurocognitive mechanisms underlying memory impairment in MS.