Comparison of Cognitive Screening of MS Patients Using the MOCA, SDMT, and MSNQ

Background:

Multiple Sclerosis (MS) is a disease which can affect cognitive, motor, and neuropsychiatric functioning, with an unclear etiology.  Cognitive impairment can occur in 43% to 70% of patients with MS, including attention, information processing efficiency, executive functioning, processing speed, and long term memory. Specific and subtle cognitive deficits, rather than obvious dementia, are the more common presentations in MS. Quality of life may be impacted due to these deficits; therefore it is important that patients be screened for them early on in order to ensure appropriate therapies are initiated.

Comprehensive assessment of cognitive impairment is time consuming and expensive, requiring specialist materials and expertise, and is not suitable for screening. Although widely used, the Mini Mental State Examination and the Expanded Disability Status Scale do not give appropriate measures of cognitive impairment in MS.

Two brief tests which have shown reliable information about mental status of MS patients include the Symbol Digit Modalities Test (SDMT) and the MS Neuropsychological Screening Questionnaire (MSNQ). The SDMT emphasizes processing speed and visual working memory while the MSNQ is a self report questionnaire which shows cognitive impairment and emotional status, and by using them together a patient's neuropsychological status can be effectively screened.

Objectives:

To determine if the MoCA correlates with the SDMT and MSNQ in screening for mild cognitive impairment in patients with multiple sclerosis. The aim is to provide evidence for supporting the use of MoCA regularly in screening for cognitive impairment in MS clinics and primary care providers' offices.

Methods:

Patients' cognitive status will be assessed using the Montreal Cognitive Assessment, Symbol Digit Modalities Test, and the MS Neuropsychological Screening Questionnaire. Data collection will be through the use of these questionnaires.

Results:

Data collection is to be completed, with results presented at the 2013 CMSC conference.

Conclusions:

The SDMT is currently is test of choice for brief cognitive screening, yet the Montreal Cognitive assessment (MoCA) has been shown to be a sensitive tool for use in mild cognitive impairment. The MoCA has been shown useful in screening for cognitive impairment in Parkinson's Disease, Post-Stroke, and Alzheimer's Disease. It will be determined if the MOCA correlates with the MSNQ and the SDMT.