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Meaningful Change in Cognition in Multiple Sclerosis: Method Matters

  • L. A. S. Walker (a1) (a2) (a3), P. D. Mendella (a1) (a4) (a3), A. Stewart (a5) (a6), M. S. Freedman (a7) (a2) and A. M. Smith (a3)...

Abstract

Objective:

To determine if different methods of evaluating cognitive change over time yield measurably different outcomes.

Methods:

Twelve cognitively impaired patients with clinically definite Multiple sclerosis (10 relapsing-remitting, 2 secondary progressive) underwent neuropsychological testing (baseline, 6, 12 months). Data was analysed using: t-tests evaluating group differences on individual tests, group differences in composite scores, reliable change analyses at the level of the individual, and comparisons regarding number of tests failed at each time point.

Results:

Group t-tests on individual tests yielded no change. When tests were grouped according to theoretical constructs, analyses revealed change in processing speed. Reliable change estimates revealed that 16% of the sample deteriorated. When change was measured with respect to the number of domains affected at each time point, 58% of the sample deteriorated on at least one subtest.

Conclusions:

Methodology has a significant impact on interpretation of longitudinal data. In the same group of subjects, traditional group analyses documented no change in individual test scores or change on a single composite score. Analyses of individual results documented change from 16 to 58% of the sample. Advantages and disadvantages of each method were discussed. Findings have implications for interpretation of longitudinal studies.

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Copyright

Corresponding author

The Ottawa Hospital, Psychology, 737 Parkdale Avenue, Main Floor, Room 49, Ottawa, Ontario, K1Y 1J8, Canada

References

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1Rao, SM, Leo, GJ, Bernardin, L, Unverzagt, F.Cognitive dysfunction in multiple sclerosis. I. Frequency, patterns, and prediction. Neurology. 1991; 41(5): 68591.
2Achiron, A, Barak, Y.Cognitive impairment in probable multiple sclerosis. J Neurol Neurosurg Psychiatry. 2003; 74: 4436.
3Olivares, T, Nieto, A, Sánchez, MP, Wollmann, T, Hernández, MA, Barroso, J.Pattern of neuropsychological impairment in the early phase of relapsing-remitting multiple sclerosis. Mult Scler. 2005; 11: 1917.
4Arnett, PA, Higginson, CI, Voss, WD, Wright, B, Bender, WI, Wurst, JM.Depressed mood in multiple sclerosis: relationship to capacity-demanding memory and attentional functioning. Neuropsychology. 1999; 13: 43446.
5Mitchell, AJ, Benito-León, J, Morales González, J-M, Rivera-Navarro, J.Quality of life and its assessment in multiple sclerosis: integrating physical and psychological components of wellbeing. Lancet Neurol. 2005; 4: 55666.
6Jennekins-Schinkel, A, Laboyrie, PM, Lanser, JB, van der Velde, EA.Cognition in patients with multiple sclerosis after four years. J Neurol Sci. 1990; 99(2-3): 22947.
7Kujala, P, Portin, R, Ruutiainen, J.The progress of cognitive decline in multiple sclerosis. A controlled 3-year follow-up. Brain. 1997; 120 (Pt 2): 28997.
8Amato, MP, Zipoli, V, Portaccio, E.Multiple sclerosis-related cognitive changes: a review of cross-sectional and longitudinal studies. J Neurol Sci. 2006; 245: 416.
9Amato, MP, Portaccio, E, Goretti, B, et al.Association of neocortical volume changes with cognitive deterioration in relapsing-remitting multiple sclerosis. Arch Neurol. 2007: 64(8): 115761.
10Abramson, IS.Reliable change formula query: a statistician’s comments. J Int Neuropsychol Soc. 2000; 6: 365.
11Chelune, GJ.Assessing reliable neuropsychological change. In: Franklin, RD, editor. Prediction in forensic and neuropsychology: sound statistical practices. Mahwah, NJ: Lawrence Erlbaum Associates; 2003. p. 12347.
12Heaton, RK, Temkin, N, Dikmen, S, et al.Detecting change: a comparison of three neuropsychological methods using normal and clinical samples. Arch Clin Neuropsychol. 2001; 16: 7591.
13Hinton-Bayre, A.Reliable change formula query. J Int Neuropsychol Soc. 2000; 6: 3623.
14Sawrie, SM, Chelune, GJ, Naugle, RI, Lüders, HO.Empirical methods for assessing meaningful neuropsychological change following epilepsy surgery. J Int Neuropsychol Soc. 1996; 2: 55664.
15Sawrie, SM.Analysis of cognitive change: a commentary on Keith et al. Neuropsychol. 2002; 16: 42931.
16Temkin, NR, Heaton, RK, Grant, I, Dikmen, SS.Detecting significant change in neuropsychological test performance: a comparison of four models. J Int Neuropsychol Soc. 1999; 5: 35769.
17Temkin, NR, Heaton, RK, Grant, I, Dikmen, SS.Reliable change formula query: Temkin et al. Reply. J Int Neuropsychol Soc. 2000; 6: 364.
18Schilling, V, Jenkins, V, Morris, R, Deutsch, G, Bloomfield, D.The effects of adjuvant chemotherapy on cognition in women with breast cancer-preliminary results of an observational longitudinal study. The Breast. 2005; 14: 14250.
19Collie, A, Maruff, P, McStephen, M, Darby, D.Are reliable change (RC) calculations appropriate for determining the extent of cognitive change in concussed athletes? Br J Sports Med. 2003; 37: 3706.
20Iverson, G.Interpreting change on the WAIS-III/WMS-III following traumatic brain injury. J Cog Rehab. 1999; July/August (17): 1620.
21Chelune, GJ, Naugle, RI, Lüders, H, Sedlak, J, Awad, IA.Individual change after epilepsy surgery: practice effects and base-rate information. Neuropsychol. 1993; 7: 4152.
22Frerichs, RJ, Tuokko, HA.A comparison of methods for measuring cognitive change in older adults. Arch Clin Neuropsychol. 2005; 20: 32133.
23Jacobson, NS, Truax, P.Clinical significance: a statistical approach to defining meaningful change in psychotherapy research. J Consult Clin Psychol. 1991; 59: 129.
24Chelune, GJ, Sands, K, Barrett, J, Naugle, RI, Ledbetter, M, Tulsky, D.Test-retest characteristics and measures of meaningful change for the Wechsler Memory Scale-III. J Int Neuropsychol Soc. 1999; 5: 109.
25McSweeny, AJ, Naugle, RI, Chelune, GJ, Lüders, H.“T scores for change”: An illustration of a regression approach to depicting change in clinical neuropsychology. Clin Neuropsychologist. 1993; 7: 30012.
26Rapport, LJ, Axelrod, BN, Theisen, ME, Brines, DB, Kalechstein, AD.Relationship of IQ to verbal learning and memory: test and retest. J Clin Esp Neuropsychol. 1997; 19: 65566.
27Smith, AM, Walker, LAS, Freedman, MS, DeMeuleemeester, C, Hogan, MJ, Cameron, I.fMRI investigation of disinhibition in cognitively impaired patients with multiple sclerosis. J Neurol Sci. 2009; 281: 5863.
28Ammons, RB, Ammons, CH.The Quick Test (QT): Provisional Manual. Psychol Rep; 1962.
29Wechsler, D.Wechsler Adult Intelligence Scale-III: Administration and Scoring Manual. San Antonio, TX: The Psychological Corporation; 1997.
30Wechsler, D.Wechsler Memory Scale- III: Administration and Scoring Manual. San Antonio, TX: The Psychological Corporation; 1997.
31Gordon, M, McClure, FD, Post, EM.Gordon Diagnostic System. New York: Gordon Systems; 1986.
32Army Individual Test Battery. Manual of Directions and Scoring. Washington, DC: War Department, Adjutant General’s Office 1944.
33Brown, J.Some tests of the decay of immediate memory. Q J Exp Psychol. 1958; 10: 1221.
34Peterson, LR, Peterson, MJ.Short-term retention of individual verbal items. J Exp Psychol. 1959; 58: 1938.
35Spreen, O, Benton, AL.Neurosensory Center Comprehensive Examination for Aphasia (NCCEA). Victoria, BC: University of Victoria Neuropsychology Laboratory; 1969, 1977.
36Berg, EA.A simple objective technique for measuring flexibility in thinking. J Gen Psychol. 1948; 39: 1522.
37Grant, DA, Berg, EA.A behavioural analysis of degree of impairment and ease of shifting to new responses in a Weigl-type card sorting problem. J Exp Psychol. 1948; 39: 40411.
38Bohnen, N, Jolles, J, Twijnstra, A.Modification of the Stroop Color Word Test improves differentiation between patients with mild head injury and matched controls. Clin Neuropsychol. 1992; 6: 197884.
39Delis, DC, Kramer, JH, Kaplan, E, Ober, BA.California Verbal Learning Test-Second Edition, Short Form. San Antonio, TX: The Psychological Corporation; 2000.
40Camp, SJ, Stevenson, VL, Thompson, AJ, et al.A longitudinal study of cognition in primary progressive multiple sclerosis. Brain. 2005; 128: 28918.
41Iverson, GL, Lovell, MR, Collins, MW.Interpreting change on ImPACT following sport concussion. Clin Neuropsychol. 2003; 17: 4607.
42Woods, SP, Childers, M, Ellis, RJ, Guaman, S, Grant, I, Heaton, RK.A battery approach for measuring neuropsychological change. Arch Clin Neuropsychol. 2006; 21: 839.
43Rao, SM.A manual for the Brief, Repeatable Battery of Neuropsychological Tests in Multiple Sclerosis. New York, NY: National Multiple Sclerosis Society; 1991.
44Benedict, RHB, Fischer, JS, Archibald, CJ, et al.Minimal neuropsychological assessment of MS patients. A consensus approach. Clin Neuropsychol. 2002; 16: 38197.
45Benedict, RHB, Cookfair, D, Gavett, R, et al.Validation of the minimal assessment of cognitive function in multiple sclerosis (MACFIMS). J Int Neuropsychol Soc. 2006; 12: 54958.
46Ingraham, LJ, Aiken, CB.An empirical approach to determining criteria for abnormality in test batteries with multiple measures. Neuropsychol. 1996; 10: 1204.

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