Neurology Department, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.
Iranian Center of Neurological Research, Neuroscience Institute, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.
Arch Clin Neuropsychol. 2023 Jan 21;38(1):37-48. doi: 10.1093/arclin/acac059.
Cognitive impairment (CI) and executive dysfunction (ED) are prevalent in patients with multiple sclerosis (PwMS). The Minimal Assessment of Cognitive Function in Multiple Sclerosis (MACFIMS) is the gold standard neuropsychological battery (NPB) for detecting CI. Delis-Kaplan Executive Function System (DKEFS) NPB evaluates ED. We aimed to find practical test(s) from DKEFS with acceptable diagnostic utility for early detection of impairment in cognitive and executive domains.
Cognitive and executive tasks, physical disability, and depression scores of 30 PwMS were assessed (17 women, age: 38.1). Symbol Digit Modalities Test (SDMT), Paced Auditory Serial Addition Test (PASAT), and Controlled Oral Word Association Test (COWAT) from MACFIMS and Trail Making Test (TMT), Design Fluency Test (DFT), and Verbal Fluency Test (VFT) from DKEFS were selected. The association between patients' characteristics and performance in tests, and diagnostic accuracy of DKEFS tests in detecting impairment in cognitive tasks were evaluated, using Pearson correlation and receiver operator characteristic curve analyses, respectively.
A significant correlation was found between disease duration and SDMT and TMT subtests. Expanded Disability Status Scale was significantly related to SDMT, VFT-switching, and TMT subtests. Beck Depression Inventory was significantly related to DFT. TMT-switching detected abnormalities in SDMT and PASAT with 100% sensitivity, 93.3% (for SDMT), and 85.7% specificity (for PASAT). TMT-letter showed 100% sensitivity and 90% specificity in identifying abnormalities in COWAT.
TMT, particularly the switching condition, is a practical paper-based test that could predict impairment in cognitive tasks. Clinicians may use TMT as a screening tool among PwMS.
认知障碍（CI）和执行功能障碍（ED）在多发性硬化症患者（PwMS）中很常见。认知功能评估在多发性硬化症中的最小评估（MACFIMS）是检测 CI 的金标准神经心理学测试包（NPB）。德利斯-卡普兰执行功能系统（DKEFS）NPB 评估 ED。我们旨在从 DKEFS 中找到实用的测试，这些测试具有可接受的诊断效用，可早期发现认知和执行领域的障碍。
评估了 30 名 PwMS 的认知和执行任务、身体残疾和抑郁评分（17 名女性，年龄：38.1 岁）。从 MACFIMS 中选择符号数字模态测试（SDMT）、 pacedAuditorySerialAdditionTest（PASAT）和受控口头单词联想测试（COWAT），从 DKEFS 中选择连线测试（TMT）、设计流畅性测试（DFT）和言语流畅性测试（VFT）。使用 Pearson 相关分析和受试者工作特征曲线分析评估了患者特征与测试表现之间的关系，以及 DKEFS 测试在检测认知任务障碍方面的诊断准确性。
发现疾病持续时间与 SDMT 和 TMT 子测试之间存在显著相关性。扩展残疾状态量表与 SDMT、VFT 转换和 TMT 子测试显著相关。贝克抑郁量表与 DFT 显著相关。TMT 转换检测到 SDMT 和 PASAT 异常，敏感性为 100%，特异性为 93.3%（SDMT）和 85.7%（PASAT）。TMT-字母在识别 COWAT 异常方面具有 100%的敏感性和 90%的特异性。
TMT，特别是转换条件，是一种实用的纸质测试，可以预测认知任务的障碍。临床医生可以在 PwMS 中使用 TMT 作为筛查工具。
