TY - JOUR
T1 - Comparing diagnostic criteria for the diagnosis of neurocognitive disorders in multiple sclerosis
AU - Hancock, Laura M.
AU - Hermann, Bruce
AU - Schoonheim, Menno M.
AU - Hetzel, Scott J.
AU - Brochet, Bruno
AU - DeLuca, John
N1 - Funding Information: The authors would like to acknowledge both Beatrice Lee, PhD and Kaitlin Maxa, BS for their help with data entry. The authors would also like to thank the people living with MS who receive their clinical care from the University of Wisconsin Hospital and Clinics for providing valuable lessons and insights about the issues they face every day. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Funding Information: Dr. Hancock has received honoraria from Can Do MS, the MS Association of America, and the National MS Society of America. She has also received grant funding from BMS, NIH, and Clinical & Translational Science Institute and Advancing a Healthier Wisconsin Research and Education Program.Dr. Hermann serves on a Medtronics DSMB and receives support from the NIH.Dr. Schoonheim serves on the editorial board of Frontiers of Neurology and has received research support, compensation for consulting services or speaker honoraria from the Dutch MS Research Foundation, ARSEP, Eurostars-EUREKA, ZonMW, ExceMed, Amsterdam Neuroscience, Atara, Biogen, Celgene/BMS, Merck, MedDay and Sanofi-Genzyme.Mr. Hetzel has no declarations of interest.Dr. Brochet has received honoraria or consulting fees from Novartis, BMS, Sanofi, Janssen, Roche, Biogen, and Merck. Dr. DeLuca has received honoraria or consulting fees from Novartis, BMS, Sanofi-Genzyme, Roche, Biogen, MedRhythms and Merck. He has also received grant funding from Biogen, EMD Serono, Roche, CMSC, NIH, NMSS and MS Society of Canada. Publisher Copyright: © 2022
PY - 2022/2/1
Y1 - 2022/2/1
N2 - Background: People with multiple sclerosis (MS) commonly experience cognitive impairment associated with the disease, but there is currently no agreed-upon operational definition for identifying the presence of that impairment, in either research or clinic contexts. The International MS Cognition Society (IMSCOGS) established a task force to begin to examine this issue and this paper represents the results of an initial pilot investigation. The aim of this paper was to compare two criterion sets to determine how to identify cognitive impairment among people with MS: the general Diagnostic and Statistical Manual (DSM-5) Criteria for neurocognitive disorders and criteria derived from existing MS research (scores in two domains fall 1.5 standard deviations below normative controls). Methods: Two hundred and ten people with MS presented for a brief cognitive evaluation in an MS Multidisciplinary Clinic at a midwestern academic medical center in the United States. Participants were generally middle aged (average 51.5 years), female (73.8%), and white (93.3%). McNemar's test was computed to compare the number of individuals whose cognitive test score performance was deemed cognitively normal, mildly impaired, or more significantly impaired. Results: DSM-5 criteria classified 87.2% of the sample as cognitively impaired, where 66.7% were more mildly impaired and 20.5% more significantly impaired. By contrast, research-based criteria classified 63.3% of the sample as cognitively impaired, with 49.5% as mildly impaired and 13.8% as more significantly impaired. Conclusions: These findings indicate that compared to research criteria, the DSM-5 criteria classified far more people with MS as having cognitive impairment secondary to the disease. The paper discusses the potential benefits and drawbacks of the two diagnostic methods, highlighting that more work will be needed in order to establish a standardized and validated method for characterizing these impairments.
AB - Background: People with multiple sclerosis (MS) commonly experience cognitive impairment associated with the disease, but there is currently no agreed-upon operational definition for identifying the presence of that impairment, in either research or clinic contexts. The International MS Cognition Society (IMSCOGS) established a task force to begin to examine this issue and this paper represents the results of an initial pilot investigation. The aim of this paper was to compare two criterion sets to determine how to identify cognitive impairment among people with MS: the general Diagnostic and Statistical Manual (DSM-5) Criteria for neurocognitive disorders and criteria derived from existing MS research (scores in two domains fall 1.5 standard deviations below normative controls). Methods: Two hundred and ten people with MS presented for a brief cognitive evaluation in an MS Multidisciplinary Clinic at a midwestern academic medical center in the United States. Participants were generally middle aged (average 51.5 years), female (73.8%), and white (93.3%). McNemar's test was computed to compare the number of individuals whose cognitive test score performance was deemed cognitively normal, mildly impaired, or more significantly impaired. Results: DSM-5 criteria classified 87.2% of the sample as cognitively impaired, where 66.7% were more mildly impaired and 20.5% more significantly impaired. By contrast, research-based criteria classified 63.3% of the sample as cognitively impaired, with 49.5% as mildly impaired and 13.8% as more significantly impaired. Conclusions: These findings indicate that compared to research criteria, the DSM-5 criteria classified far more people with MS as having cognitive impairment secondary to the disease. The paper discusses the potential benefits and drawbacks of the two diagnostic methods, highlighting that more work will be needed in order to establish a standardized and validated method for characterizing these impairments.
KW - Cognitive impairment
KW - Dementia
KW - Diagnosis of cognitive impairment
UR - http://www.scopus.com/inward/record.url?scp=85122633088&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.msard.2021.103479
DO - https://doi.org/10.1016/j.msard.2021.103479
M3 - Article
C2 - 35033839
SN - 2211-0348
VL - 58
JO - Multiple Sclerosis and Related Disorders
JF - Multiple Sclerosis and Related Disorders
M1 - 103479
ER -