Nicholas G. LaRocca

Minimal Neuropsychological Assessment of MS Patients: A Consensus Approach

Cognitive impairment is common in multiple sclerosis (MS), yet patients seen in MS clinics and neurologic practices are not routinely assessed neuropsychologically. In part, poor utilization of NP services may be attributed to a lack of consensus among neuropsychologists regarding the optimal approach for evaluating MS patients. An expert panel composed of neuropsychologists and psychologists from the United States, Canada, United Kingdom, and Australia was convened by the Consortium of MS Centers (CMSC) in April, 2001. Our objectives were to: (a) propose a minimal neuropsychological (NP) examination for clinical monitoring of MS patients and research, and (b) identify strategies for improving NP assessment of MS patients in the future. The panel reviewed pertinent literature on MS-related cognitive dysfunction, considered psychometric factors relevant to NP assessment, defined the purpose and optimal characteristics of a minimal NP examination in MS, and rated the psychometric and practical properties of 36 candidate NP measures based on available literature. A 90-minute NP battery, the Minimal Assessment of Cognitive Function in MS (MACFIMS), emerged from this discussion. The MACFIMS is composed of seven neuropsychological tests, covering five cognitive domains commonly impaired in MS (processing speed/working memory, learning and memory, executive function, visual-spatial processing, and word retrieval). It is supplemented by a measure of estimated premorbid cognitive ability. Recommendations for assessing other factors that may potentially confound interpretation of NP data (e.g., visual/sensory/motor impairment, fatigue, and depression) are offered, as well as strategies for improving NP assessment of MS patients in the future.

Recent developments in the assessment of quality of life in Multiple Sclerosis (MS)

Multiple sclerosis (MS) and its treatment have broad-ranging effects on quality of life. This article reviews recent efforts to assess the impact of MS on activities of daily living (ADLs) and health-related quality of life (HRQL), and describes the development of the Multiple Sclerosis Quality of Life Inventory (MSQLI). The MSQLI is a modular MS-specific HRQL instrument consisting of a widely-used generic measure, the Health Status Questionnaire (SF-36), supplemented by nine symptom-specific measures (covering fatigue, pain, bladder function, bowel function, emotional status, perceived cognitive function, visual function, sexual satisfaction, and social relationships). Content validation consisted of evaluating its adherence to a conceptual model of the impact of MS, and review by MS specialists (neurologists and allied health professionals), HRQL experts, patients, and caregivers. The reliability and construct validity of the MSQLI were rigorously evaluated in a field test with 300 North American patients (198 female, 102 male) with definite MS (Poser criteria) and a broad range of physical impairment (EDSS=0.0-8.5). This article concludes by comparing the MSQLI with two other MS-specific HRQL measures (MS Quality of Life-54 (QOL-54) and Functional Assessment of Multiple Sclerosis (FAMS)) and discussing key issues to consider in selecting an HRQL instrument for a collaborative database.

The Goldman Consensus statement on depression in multiple sclerosis

Background. In January 2002 the New York City Chapter of the National Multiple Sclerosis Society convened a panel of experts to review the issue of depressive affective disorders associated with multiple sclerosis (MS). This Consensus Conference was supported by a grant from the Goldman family of New York City. Results. The panel reviewed summaries of current epidemiologic, neurobiologic, and therapeutic studies having to do with depressive disorders among MS patient populations. Depressive disorders occur at high rates among patients with MS, and there is reason to believe that the immunopathology of the disease is involved in the clinical expression of affective disorders. The depressive syndromes of MS have a major, negative impact on quality of life for MS sufferers, but are treatable. At the present time, most MS patients with depression do not receive adequate recognition and treatment. Conclusions. The Goldman Consensus Conference Study Group provides recommendations for improved screening, diagnosis, and clinical management for depressive affective disorders among patients suffering from MS.

Impact of Walking Impairment in Multiple Sclerosis Perspectives of Patients and Care Partners

AbstractBackground: Multiple sclerosis (MS) is a chronic neurologic disease associated with gait impairment that adversely affects quality of life (QOL). Data are lacking on the impact of these impairments from the perspectives of people with MS and care partners of a person with MS, defined as individuals caring for a friend or family member with MS. Methods: In January and February 2008, online surveys were conducted by Harris Interactive® (HI) on behalf of Acorda Therapeutics, Inc. and the National MS Society (USA) to explore the impact of difficulty walking (defined as trouble walking at least twice a week and/or an inability to walk at least twice a week due to MS) from the perspectives of people with MS and care partners of a person with MS. The study population was drawn from pre-existing panels, generated by HI and eRewards market research, of self-reported people with MS, care partners of a person with MS, or adults living in the same household as a person with MS. Panel members were invited to participate by e-mail, and their status/eligibility was verified with screening questions. Survey results were weighted for demographic factors and propensity to be online. Percentages were adjusted to account for acceptance of multiple responses and exclusion of non-responses. Results: The respondents included 1011 people with MS and 317 care partners. Demographic and MS disease characteristics in the people with MS sample were similar to those of people with MS in the general population. Among people with MS, 41% reported having difficulty walking, including 13% with inability to walk at least twice a week. Of those with difficulty walking, 70% said it was the most challenging aspect of having MS. Of those with inability to walk at least twice a week, 74% said it disrupted their daily lives. Only 34% of people with MS with difficulty walking were employed. Communication between people with MS and physicians regarding difficulty walking was suboptimal; 39% of all people with MS said they never or rarely discussed it with their doctor. Significant percentages of all care partners experienced reduced QOL and socioeconomic status in association with caring for a person with MS. Conclusions: Difficulty walking is a common impairment in people with MS, with adverse effects on the QOL of people with MS and care partners of a person with MS.

Helplessness, self-efficacy, cognitive distortions, and depression in multiple sclerosis and spinal cord injury

The aim of this study was to determine if learned helplessness, self-efficacy, and cognitive distortions would predict depression in a sample of 80 individuals with multiple sclerosis (MS) and 80 individuals with a spinal cord injury (SCI). As MS and SCI usually present with disparate disease courses and etiologies, a secondary objective was to determine if individuals with MS would exhibit greater levels of helplessness, cognitive distortions, and depression and lower levels of self-efficacy than those with SCI. Results indicated that helplessness and self-efficacy significantly predicted depression for both the MS and SCI groups after controlling for confounding variables. Cognitive distortions had no independent effect, indicating that cognitive distortions may have caused feelings of helplessness and low self-efficacy and, in this way, had indirect effects on depression. The MS group exhibited significantly greater levels of depression and helplessness and significantly lower levels of self-efficacy than the SCI group. It was hypothesized that it may have been the combination of an unpredictable course of disease activity and the possibility of being affected by MS in many different ways that produced greater feelings of depression, helplessness, and low self-efficacy in the MS group.

Utilization of unconventional treatments by persons with MS: Is it alternative or complementary?

Article abstract This cross-sectional mail survey evaluated the prevalence and predictors of unconventional therapy (UT) utilization among 569 community-based people with MS. One-third reported having visited a UT practitioner in the last 6 months. Utilizers tended to report at least one medical comorbidity, earn at least

Rehabilitation of intimacy and sexual dysfunction in couples with multiple sclerosis

50,000 a year, and engage in preventive health behaviors; they also used more outpatient services and reported higher levels of interpersonal quality of care with their allopathic MS care provider than did nonutilizers. We conclude that UT is complementary to allopathic medicine for people with MS.

The Multiple Sclerosis Intimacy and Sexuality Questionnaire-19 (MSISQ-19)

Sexual dysfunction is a highly prevalent symptom of multiple sclerosis (MS), with little published research on effective treatments. This pilot study tested the efficacy of a counseling intervention in nine couples utilizing a quasi-experimental research design. The intervention consisted of 12 counseling sessions, communication with the MS medical treatment team, education, and tailoring symptomatic treatments so they interfere less with sexual function. Repeated measures analysis of variance indicated significant improvements in affective and problem-solving communication, marital satisfaction, and sexual satisfaction during the treatment vs. the waiting list phase of the study (F=1.7, P5.001). MS patients and their spouses reported similar levels of improvement.

High‐dose oral baclofen Experience in patients with multiple sclerosis

The purpose of the present study was to develop a reliable and valid self-report questionnaire to assess the perceived influence of Multiple Sclerosis (MS) symptoms on sexual activity and satisfaction and the perceived influence of MS symptoms on the overall quality of intimate relationships. This instrument was called the Multiple Sclerosis Intimacy and Sexuality Questionnaire (MSISQ). The initial item pool consisted of 72 items reflecting primary, secondary, and tertiary sexual dysfunction. The MSISQ was revised by eliminating items assessing the impact of MS symptoms on the overall quality of intimate relationships because they were redundant with items assessing the impact of MS symptoms on sexual activity and satisfaction. Factor analysis, reliability analysis, and item analysis demonstrated that the MSISQ could be further shortened without diminishing the statistical integrity of the instrument. Hence, it was shortened to a 19-item questionnaire (MSISQ-19), with primary, secondary, and tertiary sexual dysfunction subscales. Reliability analyses provided evidence for high internal consistency for the total MSISQ-19 (α = .91) and for the primary(α = .82), secondary (α = .85) and tertiary (α = .87) subscales. The MSISQ-19 demonstrated concurrent validity with measures of: (1) marital satisfaction, specifically satisfaction with affective communication, problem solving communication, and sexual dissatisfaction, (2) neurological impairment and level of disability in MS, (3) psychological distress and well-being, and (4) global sexual dysfunction in MS. In addition, a comparison of the distribution of scores of the MSISQ-19 and the Sexual Function Scale (SFS) of the Minimal Record of Disability (MRD) in MS demonstrated that the MSISQ-19 was more sensitive to moderate and high levels of sexual difficulty. Study limitations, theoretical, clinical, and research implications, and directions for further research are discussed.

Validity of the Symbol Digit Modalities Test as a cognition performance outcome measure for multiple sclerosis.

We reviewed a 10% random sample of charts from an outpatient clinic for multiple sclerosis to determine the frequency with which baclofen was prescribed for spasticity in high doses (>80 mg/d). About 20% of patients had taken high-dose baclofen, and 15% were still receiving a high dose. Taking a high dose was not associated with discontinuing treatment.