Sandra Vanotti

Epidemiological characteristics of cognitive impairment of multiple sclerosis patients in a Latin American country

We assessed cognitive performance and physical disability in 111 multiple sclerosis (MS) patients and 222 healthy controls in a multicenter study in Argentina to obtain the prevalence of cognitive impairment (CI) in a population of MS outpatients in Argentina. MS patients presented significantly lower scores in all Brief Repeatable Battery of Neuropsychology (BRB-N) tests than did the control group. The prevalence of CI was 43.2%. This study allowed us to obtain actual figures on the number of MS patients with CI in a Latin American sample. This validation is a very useful tool for clinical practice and for research studies to assess cognition in MS.

A new assessment tool for patients with multiple sclerosis from Spanish-speaking countries: validation of the Brief International Cognitive Assessment for MS (BICAMS) in Argentina

Abstract Background: The Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS) is an international assessment tool for monitoring cognitive function in multiple sclerosis (MS) patients. BICAMS comprises the Symbol Digit Modalities Test (SDMT), the California Verbal Learning Test – Second Edition (CVLT II) and the Brief Visuospatial Memory Test – Revised (BVMT-R). Our objective was to validate and assess the reliability of BICAMS as applied in Argentina and to obtain normative data in Spanish for this population. Method: The sample composed of 50 MS patients and 100 healthy controls (HC). In order to test its reliability, BICAMS was re-administered in a subset of 25 patients. Results: The sample’s average age was 43.42 ± 10.17 years old, and average years of schooling were 14.86 ± 2.78. About 74% of the participants were women. The groups did not differ in age, years of schooling, or gender. The MS group performed significantly worse than the HC group across the three neuropsychological tests, yielding the following Cohen’s d values: SDMT: .85; CVLT I: .87; and BVMT-R: .40. The mean raw scores for Argentina normative data were as follows: SDMT: 56.71 ± 10.85; CVLT I: 60.88 ± 10.46; and BVMT-R: 23.44 ± 5.84. Finally, test–retest reliability coefficients for each test were as follows: SDMT: r = .95; CVLT I: r = .87; and BVMT-R: r = .82. Conclusion: This BICAMS version is reliable and useful as a monitoring tool for identifying MS patients with cognitive impairment.

The Effect of Culture on Two Information-Processing Speed Tests.

The Symbol Digit Modalities Test (SDMT) has been proposed to replace the Paced Auditory Serial Addition Test-3 (PASAT-3) in the Multiple Sclerosis Functional Composite because it has the same validity but easy and shorter administration. However, among the two tests, the one that is most affected by culture is still unknown. The purpose of this study was to compare the performance of Argentinian and North American populations on the SDMT and PASAT-3. The SDMT and PASAT-3 were administered to 137 healthy volunteers from Buffalo, NY, and 137 healthy participants from Buenos Aires, Argentina. Participants were matched by gender, age (±2), and education (±1). Significant differences were found on the SDMT but not on the PASAT-3. Significant and low correlations were found between the tests and years of education. The SDMT is more affected by culture than is the PASAT-3. Possible interpretations of this result are presented.

Normatization of the Symbol Digit Modalities Test-Oral Version in a Latin American Country

The aim of this study was to standardize the Symbol Digit Modalities Test (SDMT)-Oral version in a healthy population living in Argentina and to analyze the influence that age, gender, and education have on the SDMT. Secondarily, it is intended to analyze the performance of patients with multiple sclerosis (MS) on this test. Two hundred ninety-seven healthy participants were evaluated; they had an average age of 39.28 years and 13.87 years of schooling; 77.8% were women. The sample was segmented according to age in three groups: younger than 35 years old, 36 to 50 years old, and 51 to 70 years old. The sample was also segmented according to years of schooling in three groups: 11 years or less, 12 to 16 years, and more than 16 years. All participants were evaluated with the oral version of the SDMT. A clinical sample of 111 patients with MS was also assessed. The mean on the SDMT for the total sample was 51.34 (SD = 12.76). The differences were significant between all groups, p < .05, according to age. The participants with a higher level of education performed better than did those with moderate education and those with less schooling, p < .05. There was a significant difference between patients with MS and healthy controls, p < .01. The SDMT is influenced by age as well as by schooling, although not by gender. The norms displayed here will be useful to accurately evaluate the yield of the patients in the neuropsychological clinic when comparing them with their group of reference. It was also demonstrated that the SDMT can discriminate between patients with MS and healthy people.

Validation of the PASAT in Argentina

ABSTRACT The Paced Auditory Serial Addition Test (PASAT) is one of the most used neuropsychological tests to assess information processing speed and working memory in brain injured patients. This study was carried out with the purpose of obtaining normative data for the PASAT-3″ in a healthy Argentinean population, which would result in a reference control population. The PASAT-3″ was administered in a sample of 296 healthy voluntary subjects, born and living in Argentina. The age range went from 20 to 70 years-old. The level of education was 0 to 13 or more years of schooling. The sample obtained a mean of 44.60 (SD = 10.72) in the PASAT-3″. It was found that the score obtained in the PASAT-3″ was related to the age and the level of instruction of the participants. Their performance diminished as age increased and, conversely, it increased as the level of instruction was higher. Normative data was obtained for a Latin American population from Argentina. Percentile distributions obtained by decades of age and different levels of education should be considered as useful reference values for clinicians and investigators when applying the PASAT-3″ to assess cognitive function in different pathologies.

BICAMS in the Argentine population: Relationship with clinical and sociodemographic variables

ABSTRACT The Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS) was developed to provide valid assessment of cognitive impairment in multiple sclerosis (MS). The relationship between clinical and social variables and cognitive disorders has been extensively studied, but primarily in developed countries with a focus on other cognitive measures or batteries. The objectives of this study were to analyze the relationship between the BICAMS data and key clinical and sociodemographic variables in the Argentine MS population. A total of 50 MS patients were administered the Argentinean BICAMS Battery, comprised of the Symbol Digit Modalities Test (SDMT), the California Verbal Learning Test I (CVLT I), and the Brief Visuospatial Memory Test Revised (BVMTR). Disease progression, fatigue, depression, self-reported and informant report cognitive status, and employment status were assessed. Disease progression and employment status were most strongly associated with overall BICAMS performance (η2 effect size values ranging from .302 to .624, all comparisons statistically significant). Informant rating of patient cognition, age, depression, disease duration, fatigue, and work hours were significantly associated as well. Gender, years of education, and patient-reported cognitive status were nonpredictive. A similar pattern was seen at the individual test level, with more variables related to the SDMT and CVLT I than BVMTR. BICAMS is strongly associated with overall disease progression and employment status.

Estimulación y rehabilitación cognitiva en un centro ambulatorio: descripción y análisis de las variables iniciales

Resumen Introduccion La rehabilitacion cognitiva es una practica prescrita cada vez con mayor asiduidad en pacientes neurologicos con trastornos en sus funciones mentales superiores. Objetivo Describir las caracteristicas principales y efectuar un analisis comparativo de los puntajes obtenidos en diferentes escalas en pacientes que iniciaron tratamiento de estimulacion/rehabilitacion cognitiva en INEBA. Materiales y metodos Bateria de pruebas que incluyeron memoria episodica verbal, memoria subjetiva, actividades de la vida diaria, calidad de vida y rasgos depresivos. Descripcion y comparacion entre diferentes grupos etiologicos. Resultados Se analizaron los datos de 73 pacientes (38 varones y 35 mujeres; edad media: 59,89 anos [SD 19,42], educacion formal: media 13 anos [SD 3,74]). Dentro de la poblacion predominaron las causas vasculares (20 casos, 27%), los traumatismos encefalocraneanos (9 casos, 12%) y el deterioro cognitivo leve de causa no vascular (8 casos, 11%). En el analisis de los resultados de la bateria administrada se observo una diferencia significativa entre la percepcion subjetiva de memoria de los pacientes vasculares, con traumatismos y con deterioro cognitivo leve en algunas de las dimensiones estudiadas, entre ellas recuerdo de libros y peliculas, conversaciones y acciones a realizar. Conclusiones Se encontraron diferencias en la percepcion subjetiva de memoria entre los grupos considerados. Resulta importante dentro de los programas de rehabilitacion cognitiva considerar junto a la evaluacion del desempeno objetivo, aspectos metacognitivos y de creencias de memoria para asi conocer las fortalezas y debilidades del paciente de manera integral. Esto permitira el empleo de estrategias compensatorias que apunten a mejorar el desempeno funcional del paciente.

Cognitive and neuropsychiatric disorders among MS patients from Latin America

Cognitive and neuropsychiatric disorders in patients with multiple sclerosis have been extensively documented. The focus of this review will be on cognitive and neuropsychiatric disorders in multiple sclerosis patients from Latin America, in the context of international literature. Multicentre studies carried out in Latin America have shown that 43% of the patients have cognitive impairment and 34.5% in early stages of the disease, 29% depression and 20.9% neuropsychiatric disorders. The profile of cognitive impairment corresponds to alterations in visual and verbal memory, in attention, in information processing speed and in verbal fluency. The neuropsychiatric profile showed disorders in anxiety, depression, apathy and irritability domains. In the region, there exist validations of the multiple sclerosis neuropsychological screening questionnaire (MSNQ), the brief repeatable battery of neuropsychological tests (BRB-N) and the brief international cognitive assessment for multiple sclerosis (BICAMS), as well as of the paced auditory serial addition test (PASAT) and the symbol digit modalities test (SDMT). A study showed that 53% of the patients who met the NEDA3 condition had cognitive impairment. This finding highlights the need for taking cognitive assessment into account when determining therapeutic efficacy.

Estudios de la memoria prospectiva en pacientes con lesión cerebral

Resumen Introduccion La capacidad de recordar realizar una accion en el futuro o de evocar intenciones demoradas, tambien llamada memoria prospectiva (MP), ha sido objeto de estudio de numerosas investigaciones dentro del marco de la neuropsicologia en los ultimos anos debido a la importancia de la indemnidad de esta habilidad para desarrollar una vida independiente. Estas investigaciones han dado el resultado de un gran avance en el conocimiento del rendimiento de MP de los pacientes con distintas enfermedades neurologicas: traumatismo craneoencefalico, enfermedad de Parkinson, demencia de tipo Alzheimer, esclerosis multiple, epilepsia, sindrome de inmunodeficiencia adquirida, sindrome de Korsakoff, encefalitis herpetica y accidente cerebrovascular. A su vez, estos estudios realizan sus aportes al desarrollo de modelos teoricos de MP. Objetivos En este articulo se revisan estudios neuropsicologicos en MP de los ultimos diez anos y su implicancia sobre los modelos teoricos de MP, asi como la utilidad de los descubrimientos en el desarrollo de estrategias terapeuticas de neurorrehabilitacion cognitiva. Desarrollo Se describen las investigaciones dentro de cada patologia, resaltando el aspecto de la MP analizado y tratando de integrar los distintos desarrollos. Conclusiones Se sacan conclusiones acerca del estado de avance en este campo, se exponen las limitaciones de un estudio de revision en esta area y se sugieren direcciones futuras de la investigacion.