Achille Motta

Computer-aided retraining of memory and attention in people with multiple sclerosis: A randomized, double-blind controlled trial

CONTEXT Cognitive compromise is one of the main contributing factors to activity and participation restrictions in people with multiple sclerosis (MS). Computer-aided programs are used for retraining memory and attention, but data on the efficacy of these interventions are scarce. OBJECTIVE To assess the efficacy of computer-aided retraining of memory and attention in people with MS impaired in these abilities. DESIGN AND SETTING Randomized, double-blind, controlled trial. PARTICIPANTS Outpatients (n=82) with subjective complaints of poor attention or memory, confirmed by a score <80th percentile in at least two tests of the Brief Repeatable Battery of Neuropsychological Tests (BRBNT). INTERVENTIONS Participants were randomized to two computer-assisted retraining interventions: memory and attention (study arm), and visuo-constructional and visuo-motor coordination (control arm). Both groups received 16 training sessions over 8 weeks. OUTCOME MEASURES Improvement of 20% or more in at least two BRBNT test scores at 8 weeks compared to baseline (primary end point). Changes in depression and health-related quality of life. RESULTS An improvement occurred in 45% of study patients vs. 43% of control patients (odds ratio 1.07, 95% confidence interval 0.44-2.64). The study treatment was better than the control treatment only on the word list generation test (p=0.016). CONCLUSIONS This trial does not support the efficacy of specific memory and attention retraining in MS.

Evaluation and retraining of adults' cognitive impairments : which role for virtual reality technology ?

Immersive virtual reality (IVR) is a technology already developed to assist cognitive psychologists and therapists in their clinical work with brain-damaged patients. The rationale, the software and the hardware of the first application (ARCANA 1) based on affordable technology are discussed here, in order to provide a concrete example of what the authors think may be the role of IVR as a clinical tool. Although prospects are exciting, extensive research is needed to validate this new approach and reveal its limitations and advantages.

Probing Memory and Executive Functions with Virtual Reality: Past and Present Studies

The technology of virtual reality (VR) has been used to develop interactive programs that simulate everyday life environments, where healthy subjects and patients with central nervous system dysfunctions are asked to carry out tasks that probe incidental memory and executive functions. The results of three studies support previous claims that VR-based tests overcome several limitations of traditional paper-and-pencil tests, are at least as sensitive to target cognitive impairments, while providing a richer range of opportunities for measuring behavior. Preliminary analyses also suggest that results of VR-based memory tests are replicable across laboratories and subjects samples and that the technology is well-accepted and tolerated by both healthy and impaired subjects.

Italian version of the Chicago multiscale depression inventory: translation, adaptation and testing in people with multiple sclerosis.

Abstract.Depression is the commonest psychiatric disturbance in people with multiple sclerosis (MS), with prevalence higher than in the general population and other chronic diseases. However, accurate assessment of depressive symptoms can be biased by somatic symptoms which are part of both MS and depression. We translated and adapted into Italian the Chicago multiscale depression inventory (CMDI) and assessed its acceptability, internal consistency and test-retest reliability in 213 MS outpatients and 213 individually matched healthy controls. The questionnaire was also tested in 32 people with major depression. Acceptability, internal consistency, and test-retest reliability were good overall. We found greater odds for depressive symptoms in people with MS than healthy controls, with highest odds ratio for somatic symptoms (vegetative subscale). The Italian CMDI is characterized by good acceptability, internal consistency, and testretest reliability. These findings support the use of the CMDI in Italian subjects with MS to screen for and follow depressive symptoms.

Comparison of two brief neuropsychological batteries in people with multiple sclerosis

Background: We compared two brief neuropsychological batteries devised to assess people with multiple sclerosis (MS) and used them to assess the relationship between cognitive impairment and clinical characteristics. Methods: We administered either the Brief Repeatable Battery of Neuropsychological Tests (BRBNT) or the Screening Examination for Cognitive Impairment (SEFCI) to 213 consecutive MS outpatients and 213 individually matched controls. Results: Administration times were longer for BRBNT than SEFCI, for MS and controls (p=0.001). People with MS had lower scores in all individual tests than controls (p<0.001, BRBNT and SEFCI). By the criterion of poor performance on one or more tests, the sensitivity of BRBNT was 41.9% and that of SEFCI 31.5%. The corresponding figures by poor performance on two or more tests were 16.2% for BRBNT and 18.5% for SEFCI. The Buschke Selective Reminding and Paced Auditory Serial Addition were the tests best discriminating between people with MS and controls for BRBNT, and the Symbol Digit Modalities test for SEFCI. The only clinical variable independently associated with impaired performance on these batteries was EDSS. Conclusions: Both cognitive batteries were well accepted and easy to administer. Administration time for SEFCI was significantly shorter than for BRBNT; however, alternative forms for serial evaluation are available only for BRBNT. The BRBNT was slightly more sensitive in detecting impairment by the criterion of poor performance on one or more tests. EDSS score was the only clinical variable independently associated with cognitive impairment.

The application of virtual reality to document coping deficits after a stroke: Report of a case

An immersive virtual reality (IVR) paradigm to assess cognitive flexibility and problem solving was used to document everyday life-coping failures in a patient with cognitive sequelae of an anterior left thalamic stroke. Three years after the ischemie event, the patient was showing clear signs of frontal lobe dysfunction when left unsupervised in real-life settings, yet his performance on traditional neuropsychological tests tapping frontal functions was unremarkable. We speculated, and provided evidence, that his conduct was influenced by the setting and the presence of an examiner who would strengthen his impaired ability to self-generate control over a number of higher order cognitive activities. Thanks to the immersive effect and nonverbal aspects of the interaction provided by IVR, we could document our patients cognitive difficulties on two separate occasions. The reasons why IVR was superior to traditional tests are analyzed with reference to well-known cognitive models of the way frontal networks...

Frontal lobe dysfunction in multiple sclerosis as assessed by means of Lurian tasks : effect of age at onset

We investigated frontal cognitive function in a group of 153 patients with multiple sclerosis and 100 healthy controls using a global scale composed by a set of items from the Luria-Nebraska Neuropsychological Battery (LNNB) which has been validated by Malloy and colleagues on frontally damaged patients. A second scale was built with LNNB items tapping parietal lobes function. Patients who were specifically impaired on the frontal scale (12%) had a shorter disease duration and were less physically disabled than those failing on the parietal tasks (8.5%) or those showing combined deficits (21.5%). Sixty-four patients were also tested on the Wisconsin Card Sorting Test (WCST). Twenty-seven (37.5%) patients were found to be impaired on the WCST, but the latter could not predict reliably their performance on the LNNB frontal scale. We also examined whether age of onset and disease duration could have had any effect on the cognitive performance of selected groups of patients. We found that relative to normals, deficits on the frontal scale were more severe in patients with a clinical onset around age 20 than in patients with a later onset (i.e., around 35), the two groups being comparable for duration and degree of disability. Furthermore, patients with a longstanding illness (> 10 years) were more affected on visuospatial processing and frontal control of language than those with a short duration (1.5 yrs). We propose that a greater disease activity interacting with contingent (developmental?) factors is responsible for the appearance of transient frontal deficits in several young MS patients.(ABSTRACT TRUNCATED AT 250 WORDS)

VR experience with neurological patients: Basic cost/benefit issues

The future of VR applications for mental health is currently regarded as depending on the rational development of ideas and systems. Criteria to guide this development have been suggested that are both clear and agreeable. Their application, however, may not be easy at this stage. While we may already be able to predict costs of specific VR applications, a period of more extensive clinical research is needed in order to assess adequately any benefit. In our still limited experience, the development of VR applications to increase the diagnostic sensitivity of traditional tests to strategy application disorders is worthwhile, but the uniqueness of VR assets may make the adherence to some of the proposed criteria somewhat problematic.

MRI and cognitive patterns in relapsing-remitting multiple sclerosis

We studied the relationships between magnetic resonance imaging (MRI) and the Luria-Nebraska Neuropsychological Battery (LNNB) in 64 patients with relapsing-remitting multiple sclerosis (MS). MRI films were scored according to arbitrary descriptive criteria designed to emphasize patterns of alterations. Five groups were created: group 1 and 2 had typical discrete white matter lesions, group 3 had confluent lesions, group 4 had large discrete lesions and group 5 had only few small lesions. In addition, groups 2 and 3 had evidence of parenchymal atrophy. Groups 2 and 3 were the most impaired on the LNNB, but none of these patients was actually demented. Groups 1 and 5 were globally intact in spite of very different mean age and MRI pattern. Group 4 was composed of younger subjects with a shorter disease duration; they showed mild loss of attentive and abstracting abilities. We suggest that since their MRI was showing greater signs of local biological activity their mental deficits may be a transitory condition capable of two distinct outcomes: a favorable one as in groups 1 and 5, and a slowly progressive one associated with loss of brain tissue as in groups 2 and 3.

A shortened version of PASAT-3 is feasible

The Paced Auditory Serial Addition Test (PASAT), most used neuropsychological test in people with multiple sclerosis (pwMS), is available as PASAT-3 and more difficult PASAT-2. We determined PASAT performance in 105 pwMS and 105 matched controls and assessed the utility of a shortened PASAT-3 version. Qualitative and quantitative analyses were performed, the latter involving assessment of dyads (two consecutive correct responses) and singles (correct response between two omitted responses). Based on provisional results we then calculated the sensitivity of the first 20 items of PASAT-3 in relation to the full version. Mean PASAT-2 and 3 total score, dyads and singles differed significantly (P ≤ 0.0002) in pwMS and controls, due to more omissions in pwMS, number and type of incorrect answers did not differ. Differences between pwMS and controls were highly significant for the first 50, 40, 30 and 20 responses of the PASAT-3. The sensitivity of the first 20 items of PASAT-3 was 87% (95% CI 0.70—1.00). PASAT-3 and PASAT-2 effectively discriminate pwMS from controls. Use of the first 20 items of PASAT-3 appears as a highly useful PASAT-3 version as it retains the discriminative value and sensitivity of the full version yet is quicker to administer and less demanding. Multiple Sclerosis 2007; 13: 1020—1025. http://msj.sagepub.com