title: Low contrast visual acuity testing is associated with cognitive performance in multiple sclerosis: a cross-sectional pilot study.
abstract: BACKGROUND
  Cognitive impairment and visual deterioration are two key clinical symptoms in MS and affect 50 to 80% of patients. Little is known about the influence of cognitive impairment on visual tests recommended for MS such as low contrast sensitivity testing. Our objective was to investigate whether low contrast sensitivity testing is influenced by cognitive impairment in multiple sclerosis (MS) patients.
  
  
  METHODS
  Cross-sectional study including 89 patients with relapsing-remitting MS. All patients received cognitive evaluation using Rao's Brief Repeatable Battery of Neuropsychological Testing (BRB-N). Visual assessments included low contrast sensitivity (CS) by functional acuity contrast testing and high contrast visual acuity (VA) using ETDRS charts. Retinal morphology as visual impairment correlate was measured using retinal nerve fiber layer (RNFL) thickness by optical coherence tomography.
  
  
  RESULTS
  In combined analyses using generalized estimating equation models, Paced Auditory Serial Addition Test (PASAT) and RNFL as well as and the Symbol Digit Modalities Test (SDMT) and RNFL predicted CS. To further control for a potential influence of the anterior visual system we performed partial correlation analyses between visual function and cognitive function test results but controlling for RNFL. Even when controlling for RNFL, CS was associated with PASAT performance and SDMT performance.
  
  
  CONCLUSIONS
  Our data show that: a) cognitive impairment and performance in visual function tests such as low contrast sensitivity testing are associated; b) the main cognitive domains correlating with visual test performance are information processing speed and, to a lesser degree, memory; This preliminary data needs to be substantiated in further studies investigating patients with a higher cognitive burden, healthy controls and in longitudinal settings.
authors.forename: Laura
authors.initials: L
authors.lastname: Wieder
authors.forename: Gunnar
authors.initials: G
authors.lastname: Gäde
authors.forename: Luisa M
authors.initials: LM
authors.lastname: Pech
authors.forename: Hanna
authors.initials: H
authors.lastname: Zimmermann
authors.forename: Klaus-Dieter
authors.initials: KD
authors.lastname: Wernecke
authors.forename: Jan-Markus
authors.initials: JM
authors.lastname: Dörr
authors.forename: Judith
authors.initials: J
authors.lastname: Bellmann-Strobl
authors.forename: Friedemann
authors.initials: F
authors.lastname: Paul
authors.affiliation: NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Berlin, Germany. alexander.brandt@charite.de.
authors.forename: Alexander U
authors.initials: AU
authors.lastname: Brandt
mesh_terms: D000328:Adult; D003072:Cognition Disorders / Q000175:diagnosis* / Q000453:epidemiology* / Q000503:physiopathology; D015331:Cohort Studies; D015350:Contrast Sensitivity / Q000502:physiology*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000175:diagnosis* / Q000453:epidemiology* / Q000503:physiopathology; D010865:Pilot Projects; D014787:Vision Tests / Q000379:methods; D014792:Visual Acuity / Q000502:physiology