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Reliable screening for neuropsychological impairment in multiple sclerosis

Department of Neurology, State University of New York (SUNY) at Buffalo, School of Medicine, Buffalo, New York, NY, USA, Jacobs Neurological Institute, Buffalo, New York, NY, USA, benedict{at}buffalo.edu

Darcy Cox

Department of Neurology, University of California at San Francisco, San Francisco, CA, USA

Laetitia L Thompson

Department of Neurology, University of Colorado Health Sciences Center, Denver CO, USA

Fred Foley

Bernard Gimbel Comprehensive Multiple Sclerosis Center of Holy Name Hospital, Teaneck, NJ, USA

Bianca Weinstock-Guttman

Department of Neurology, State University of New York (SUNY) at Buffalo, School of Medicine, Buffalo, New York, NY, USA, Jacobs Neurological Institute, Buffalo, New York, NY, USA

Frederick Munschauer

Department of Neurology, State University of New York (SUNY) at Buffalo, School of Medicine, Buffalo, New York, NY, USA, Jacobs Neurological Institute, Buffalo, New York, NY, USA

In an earlier study, we developed the Multiple Sclerosis Neuropsychological Screening Questionnaire (MSNQ) to assist in the screening for neuropsychological (NP) impairments. Self-report MSNQ scores correlated significantly with measures of depression, whereas informant-report MSNQ scores correlated with cognitive performance, but not depression. This study was criticized for use of a small sample and lack of data regarding normal performance and test -retest reliability. The present study was designed to replicate the earlier work with a larger sample of patients and normal controls obtained from multiple sites. We also evaluated the test -retest reliability and predictive validity of the MSNQ. The sample included 85 multiple sclerosis (MS) patients and 40 normal controls, matched on demographic variables. All participants completed the MSNQ and underwent NP testing. Thirty-four patients were re-examined at one week. Pearson and ANOVA techniques were utilized for univariate comparisons. Bayesian statistics were calculated to assess predictive validity. Patient self- and informant-report MSNQ scores differed from normal and test -retest reliability indices were high. Both self- and informant-reports were correlated with cognitive dysfunction and depression scales. Self-report MSNQ scores correlated more strongly with depression than cognitive performance, whereas the opposite pattern was observed with informant-report scores. Bayesian statistics showed that informant-report MSNQ scores predict cognitive impairment and patient self-report scores identify patients with cognitive impairment or depression. It is concluded that the MSNQ is useful, although patient self-reports may be exaggerated in depressed patients or reduced in patients with severe cognitive impairment.

Key Words: cognitive impairment • depression • multiple sclerosis • neuropsychological testing • screening

Multiple Sclerosis, Vol. 10, No. 6, 675-678 (2004)
DOI: 10.1191/1352458504ms1098oa


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