Lapshin H, Audet B, Feinstein A
Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; University of Toronto, Toronto, ON, Canada.
Eur J Neurol. 2014 Feb;21(2):281-6. doi: 10.1111/ene.12292. Epub 2013 Nov 7.
This study aims to explore the effectiveness of a brief, computerized battery of tests in detecting cognitive differences between clinically isolated syndromes (CIS), relapsing-remitting multiple sclerosis (RRMS), primary progressive multiple sclerosis (PPMS) and secondary progressive multiple sclerosis (SPMS) patients.
Four groups of patients between the ages of 18 and 63 were enrolled from two hospital-based multiple sclerosis clinics: CIS (n = 42), RRMS (n = 44), PPMS (n = 15) and SPMS (n = 37). All subjects were administered a validated battery of five computerized cognitive tests: the STROOP Color-Word Test, the Computerized Symbol Digit Modalities Test, the Paced Visual Serial Addition Test (PVSAT) 4 s and 2 s trials, and a speed of cognition index obtained by subtracting simple reaction time from choice reaction time. Results were recorded by the test administrator.
Significant between-group differences in cognition were evident on all tests (P < 0.01) with the exception of the PVSAT 2 s trial. CIS patients were the least impaired, SPMS the most. RRMS and PPMS patients generally had a similar cognitive profile, more impaired than the CIS patients but less so than the SPMS patients. These differences persisted after controlling for the effects of age and education.
The ability of this computerized cognitive battery to distinguish the progression of cognitive deficits across the entire multiple sclerosis disease spectrum from CIS through to SPMS enhances its construct validity. This finding, coupled with the battery's brevity (20 min) and ease of administration, highlights its potential utility in a busy clinic setting.
本研究旨在探讨一套简短的计算机化测试组合在检测临床孤立综合征（CIS）、复发缓解型多发性硬化症（RRMS）、原发进展型多发性硬化症（PPMS）和继发进展型多发性硬化症（SPMS）患者认知差异方面的有效性。
从两家医院的多发性硬化症诊所招募了四组年龄在18至63岁之间的患者：CIS组（n = 42）、RRMS组（n = 44）、PPMS组（n = 15）和SPMS组（n = 37）。所有受试者均接受了一套经验证有效的五项计算机化认知测试：斯特鲁普颜色-文字测试、计算机化符号数字模态测试、4秒和2秒试验的定速视觉序列加法测试（PVSAT），以及通过从选择反应时间中减去简单反应时间获得的认知速度指数。测试结果由测试管理员记录。
除PVSAT 2秒试验外，所有测试在组间认知差异均显著（P < 0.01）。CIS患者受损最轻，SPMS患者受损最重。RRMS和PPMS患者的认知概况通常相似，比CIS患者受损更严重，但比SPMS患者轻。在控制年龄和教育程度的影响后，这些差异仍然存在。
这套计算机化认知测试组合能够区分从CIS到SPMS的整个多发性硬化症疾病谱中认知缺陷的进展，增强了其结构效度。这一发现，再加上该测试组合的简短性（20分钟）和易于实施，凸显了其在繁忙诊所环境中的潜在效用。
