title: Distraction adds to the cognitive burden in multiple sclerosis.
abstract: Cognitive dysfunction in multiple sclerosis (MS) causes numerous limitations in activities of daily living.
  
  
  
  To develop an improved method of cognitive assessment in people with MS using novel real-world distracters.
  
  
  
  A sample of 99 people with MS and 55 demographically matched healthy controls underwent testing with the Minimal Assessment of Cognitive Functioning in Multiple Sclerosis (MACFIMS) and a modified version of the computerized Symbol Digit Modalities Test (c-SDMT). Half of the subjects completed the c-SDMT with built-in real-world distracters and half without.
  
  
  
  The mean time on the c-SDMT was significantly greater in MS subjects than healthy controls for both distracter ( p = 0.001) and non-distracter ( p < 0.001) versions. Significantly more MS subjects were impaired on the c-SDMT with distracters than the traditional SDMT (47.1% vs 30.3%, p = 0.04). There were no differences in impairment between the c-SDMT with and without distracters (47.1% vs 37.5%, p = 0.34). The distracter version had a sensitivity of 81% and specificity of 88% in detecting global cognitive impairment.
  
  
  
  The incorporation of distracters improves the sensitivity of a validated computerized version of the SDMT relative to the non-distracter and traditional versions and offers a quick and easy means of detecting cognitive impairment in people with MS.
authors.affiliation: Sunnybrook Health Sciences Centre, Department of Psychiatry, University of Toronto, Toronto, ON, Canada/University of Toronto, Toronto, ON, Canada.
authors.forename: Viral P
authors.initials: VP
authors.lastname: Patel
authors.affiliation: Ottawa Hospital Research Institute, Ottawa, ON, Canada.
authors.forename: Aaron
authors.initials: A
authors.lastname: Zambrana
authors.affiliation: Ottawa Hospital Research Institute, Ottawa, ON, Canada/University of Ottawa, Ottawa, ON, Canada/Carleton University, Ottawa, ON, Canada.
authors.forename: Lisa As
authors.initials: LA
authors.lastname: Walker
authors.affiliation: Sunnybrook Health Sciences Centre, Department of Psychiatry, University of Toronto, Toronto, ON, Canada/University of Toronto, Toronto, ON, Canada.
authors.forename: Nathan
authors.initials: N
authors.lastname: Herrmann
authors.affiliation: Sunnybrook Health Sciences Centre, Department of Psychiatry, University of Toronto, Toronto, ON, Canada/University of Toronto, Toronto, ON, Canada.
authors.forename: Anthony
authors.initials: A
authors.lastname: Feinstein
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D003071:Cognition / Q000502:physiology*; D003072:Cognition Disorders / Q000209:etiology / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology*; D009483:Neuropsychological Tests; D055815:Young Adult
keywords: Multiple sclerosis; cognitive assessment; cognitive reserve; computerized testing; information processing speed; neuropsychology