The EDSS integration with the Brief International Cognitive Assessment for Multiple Sclerosis and orientation tests.
OBJECTIVE
Despite cognitive tests have been validated in multiple sclerosis (MS), a neuropsychological evaluation is not implemented in the Expanded Disability Status Scale (EDSS) scoring.


METHODS
We used the Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS) and orientation tests (OTs) to measure the cerebral functional system (CFS) score and to evaluate its impact on the EDSS. We compared EDSS calculated as usual (Native-EDSS) and after the use of the BICAMS and OT (NPS-EDSS).


RESULTS
We tested 604 MS patients with BICAMS, OTs, and EDSS. In all, 384 patients (63.6%) had at least one altered test at the BICAMS. Older age, lower education, higher Native-EDSS, and male gender were independently associated with at least one impaired BICAMS test. Native-EDSS was different from NPS-EDSS (-0.112; p < 0.001) in 99 patients (16%). When considering patients with a Native-EDSS ⩽ 4.0, the proportion of miscalculated EDSS was 25%.


CONCLUSIONS
The use of brief neuropsychological tests leads to a more accurate CFS assessment in two-thirds of MS patients, and a more accurate EDSS calculation in 25% of patients with a score ⩽4.0. This may help clinicians to better recognize cognitive impairment in everyday clinical practice, especially in the case of isolated cognitive worsening.
Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Napoli, Italy.
Francesco
F
Saccà
Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Napoli, Italy.
Teresa
T
Costabile
Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Napoli, Italy.
Antonio
A
Carotenuto
Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Napoli, Italy.
Roberta
R
Lanzillo
Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Napoli, Italy.
Marcello
M
Moccia
Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Napoli, Italy.
Chiara
C
Pane
Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Napoli, Italy.
Cinzia Valeria
CV
Russo
Department of Clinical and Experimental Medicine, Second University of Naples, Napoli, Italy.
Anna Maria
AM
Barbarulo
Department of Clinical and Experimental Medicine, Second University of Naples, Napoli, Italy.
Sara
S
Casertano
Department of Clinical and Experimental Medicine, Second University of Naples, Napoli, Italy.
Fabiana
F
Rossi
Department of Clinical and Experimental Medicine, Second University of Naples, Napoli, Italy.
Elisabetta
E
Signoriello
Department of Clinical and Experimental Medicine, Second University of Naples, Napoli, Italy.
Giacomo
G
Lus
Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Napoli, Italy.
Vincenzo
V
Brescia Morra
D000293:Adolescent; D000328:Adult; D000368:Aged; D060825:Cognitive Dysfunction / Q000175:diagnosis* / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000150:complications / Q000175:diagnosis*; D009460:Neurologic Examination / Q000379:methods* / Q000592:standards; D009483:Neuropsychological Tests; D009949:Orientation / Q000502:physiology*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D055815:Young Adult
BICAMS; EDSS; cerebral functional score; cognitive