title: Neurologists׳ accuracy in predicting cognitive impairment in multiple sclerosis.
abstract: Cognitive impairment affects approximately 40-70% of MS patients. As management of MS typically begins with, and is co-ordinated by neurologists, they are often the first to raise concerns about a patient's cognitive functioning. However, it is not known how accurate the neurological examination is in identifying cognitive impairment. To this end, we conducted a retrospective chart review of 97 MS patients referred by neurologists for neuropsychological assessment based on suspected cognitive impairment. Patients were classified as globally-impaired or intact according to failure on 2 or more of 11 cognitive indices comprising the MACFIMS, a recommended neuropsychological battery for MS. Neurologists' accuracy was not significantly different from chance, Χ(2)=1.25, p=0.26, with 44.3% of patients with suspected cognitive impairment showing global impairment on objective testing. Cognitively intact patients when compared to those who were impaired had higher levels of education and were less likely to have mood disturbances. These findings indicate the clinical interview and standard neurological examination are not sufficiently sensitive to detect cognitive impairment in MS, and suggest the need for a brief, accurate cognitive screen to complement routine clinical evaluation.
authors.affiliation: Neuropsychology Consultation Service, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, Canada M4N 3M5; Department of Psychiatry, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, Canada M4N 3M5. Electronic address: Kristoffer.romero@gmail.com.
authors.forename: Kristoffer
authors.initials: K
authors.lastname: Romero
authors.affiliation: Neuropsychology Consultation Service, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, Canada M4N 3M5.
authors.forename: Prathiba
authors.initials: P
authors.lastname: Shammi
authors.affiliation: Department of Psychiatry, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, Canada M4N 3M5.
authors.forename: Anthony
authors.initials: A
authors.lastname: Feinstein
mesh_terms: D000328:Adult; D003072:Cognition Disorders / Q000150:complications* / Q000175:diagnosis*; D004522:Educational Status; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D019964:Mood Disorders / Q000150:complications; D009103:Multiple Sclerosis / Q000150:complications* / Q000523:psychology*; D009460:Neurologic Examination; D009462:Neurology; D009483:Neuropsychological Tests; D010820:Physicians; D011379:Prognosis; D012189:Retrospective Studies
keywords: Cognitive impairment; Multiple sclerosis; Neurological exam; Neuropsychological assessment