Leavenworth Robert C, Wagshul Mark E, Motl Robert W, Foley Frederick W, Holtzer Roee
Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA.
Department of Radiology, Gruss Magnetic Resonance Research Center, Albert Einstein College of Medicine, Bronx, NY, USA; Department of Physiology and Biophysics, Albert Einstein College of Medicine, Bronx, NY, USA.
Mult Scler Relat Disord. 2025 May;97:106391. doi: 10.1016/j.msard.2025.106391. Epub 2025 Mar 15.
Multiple sclerosis (MS) is increasingly prevalent among older adults, and this results in the cumulative effects of aging and MS on mobility disability. The Patient-Determined Disease Steps (PDDS) is a patient-reported outcome measure of mobility disability in adults with MS, but its validity has not been established in older adults. This study validated the PDDS in older adults with MS by examining correlations with conceptually-relevant objective and subjective measures, including neuroimaging markers.
The sample included older adults with MS (N = 87, mean age = 64.67 ± 4.24yrs, percent female = 65.5). Primary outcome measures for validation included the Timed 25-foot Walk (T25FW), Short Physical Performance Battery (SPPB), University of Alabama at Birmingham Life-Space-Assessment scale (UAB-LSA), Nine-Hole Peg Test (9HPT), oral Symbol-Digit Modalities Test (Oral SDMT), and Fatigue Severity Scale (FSS). Structural measures of brain integrity, evaluated via 3T MRI, included grey matter volumes (thalamus, caudate, putamen, globus pallidus, hippocampus), and total white matter lesion load (WMLL). Spearman correlations were used for analyses based on non-normality of the data.
Higher PDDS scores were significantly correlated with slower walking speed (T25FW time: ρ= 0.664, p < .001), worse lower extremity functioning (SPPB: ρ= -0.540, p < .001), poor fine motor dexterity (9HPT time) bilaterally (dominant hand: ρ= 0.367, p < .001; non-dominant hand: ρ= 0.263, p= .014), worse fatigue (FSS: ρ= 0.383, p < .001), and lower community mobility (UAB-LSA: ρ= -0.586, p < .001). Higher PDDS scores were also associated with lower grey matter volume in the caudate (ρ= -0.218, p= .042), putamen (ρ= -0.226, p= .036), and hippocampus (ρ= -0.213, p= .047). There were no significant correlations with WMLL, Oral SDMT, or socio-demographic covariates.
The PDDS is a valid self-report measure of MS-related disability in ambulatory older adults with MS.
多发性硬化症（MS）在老年人中越来越普遍，这导致衰老和MS对行动能力残疾产生累积影响。患者确定疾病阶段（PDDS）是一种由患者报告的MS成年患者行动能力残疾的结局指标，但尚未在老年人中验证其有效性。本研究通过检查与概念相关的客观和主观指标（包括神经影像标记物）的相关性，验证了PDDS在老年MS患者中的有效性。
样本包括老年MS患者（N = 87，平均年龄 = 64.67 ± 4.24岁，女性比例 = 65.5%）。验证的主要结局指标包括25英尺计时步行（T25FW）、简短身体功能测试电池（SPPB）、阿拉巴马大学伯明翰分校生活空间评估量表（UAB-LSA）、九孔插板测试（9HPT）、口头符号数字模态测试（口头SDMT）和疲劳严重程度量表（FSS）。通过3T MRI评估的脑完整性结构指标包括灰质体积（丘脑、尾状核、壳核、苍白球、海马体）和总白质病变负荷（WMLL）。基于数据的非正态性，采用Spearman相关性进行分析。
较高的PDDS评分与较慢的步行速度（T25FW时间：ρ = 0.664，p <.001）、较差的下肢功能（SPPB：ρ = -0.540，p <.001）、双侧精细运动灵活性差（9HPT时间）（优势手：ρ = 0.367，p <.001；非优势手：ρ = 0.263，p =.014）、更严重的疲劳（FSS：ρ = 0.383，p <.001）和较低的社区活动能力（UAB-LSA：ρ = -0.586，p <.001）显著相关。较高的PDDS评分还与尾状核（ρ = -0.218，p =.042）、壳核（ρ = -0.226，p =.036）和海马体（ρ = -0.213，p =.047）的灰质体积较低有关。与WMLL、口头SDMT或社会人口统计学协变量无显著相关性。
PDDS是一种有效的自我报告指标，可用于评估能行走的老年MS患者中与MS相关的残疾情况。
