Publication Details
Delphine Van Laethem, Alexander De Cock, Jeroen Van Schependom, Ralph H B Benedict, Nagels, Guy, Marie D'hooghe

Contribution To Conference


Background: Even though there is substantial clinical heterogeneity, more than half of the patients with multiple sclerosis face cognitive impairment. The Multiple Sclerosis Neuropsychological Questionnaire (MSNQ), a survey of perceived cognitive performance with a self- and informant-report version, was developed as a screening measure of cognitive impairment (CI). The self-report version shows a strong correlation with depression, whereas the informant-report version correlates with objective cognitive tests. Perceived cognitive impairment has been associated with reduced quality of life, unemployment, comorbidities as well as with reduced gray matter volumes. The MSNQ has been used in patients with a broad range of Expanded Disability Status Scale (EDSS) scores, but it was developed as a screening measure in patients with a relatively low EDSS score. Due to the association between depression and disability progression and the higher prevalence of severe cognitive issues in higher EDSS ranges, patients with a higher EDSS-score are at higher risk of under- and overestimating their cognition. Objectives: To assess whether the correlation between MSNQ and SDMT scores differs according to EDSS range. We hypothesize that the self-reported MSNQ could be an acceptable screening measure of cognition in patients with a low EDSS scores, since this is the population for which it was originally validated. Methods: Patients completed a postal survey, including the self-report MSNQ and a two-question screening tool for depression in MS. Information processing speed was assessed through the Symbol Digit Modalities Test (SDMT) within the last six months before or after the survey and EDSS scores were collected. The cohort was then divided into three groups based on EDSS scores: EDSS Low (EDSS 0.0 - 3.0): 81 samples, EDSS Mid (EDSS 3.5 - 6.0): 123 samples and EDSS High (EDSS 6.5 - 9.5): 84 samples. Results: We observe a negative correlation between the MSNQ and SDMT in the low EDSS group (r = -.225, p = .044), which is not present in the mid and high EDSS groups and the total population, as well as a positive correlation between EDSS and MSNQ in the high EDSS group (r = .220, p = .044) . There is also a correlation between SDMT and EDSS in the low (r = -.357, p = .001) and mid (r = -.322, p < .001) EDSS groups and the total population (r = -.507, p < .001). Furthermore, a correlation between MSNQ and depression was found in the total population (r = .329, p < .001) and all EDSS subgroups (low: r = .360, p = .001, mid: r = .376 p < .001, high: r = .242, p = .027). Conclusions: Our data suggest that the self-report MSNQ has an added value as a measure of cognition in patients with low EDSS-scores, not in the mid and high EDSS ranges. The weak and often inconsistent correlations between the self-report MSNQ and objective cognitive tests in the literature could be explained by its association with depression and its use in a broad ranges of EDSS-scores.