Beginner's Guide to MS: Cognitive Function, Multiple Sclerosis, and Neuropsychology

Patient Expert

In reading Mandy's recent posts on Word Salads and Fears and the comments which followed, I got to thinking (which is sometimes a dangerous thing, hehe).   How many of us know what is involved in the first steps to determine whether or not MS has affected our cognitive function?

I've had times during this disease at which my brain was heavy, slow, and disorganized.   And for someone who once could...

(1) call home from graduate school,

(2) ask my mom to go to my bookcase

(3) to locate a specific book which I had used in undergrad school years before,

(4) tell her it was located on the 2nd shelf from the bottom, near the right side of the shelf,

(5) ask her to open it up to a specific chapter, and

_(6) read to me what it said under a specific subtitle.  _

...and now who could not keep her schedule straight any longer and got confused much too easily... cognitive function became an important topic to discuss with the neurologist which is exactly what I did two years ago.

He referred me to the neuropsychology department to undergo a battery of tests called the Minimal Assessment of Cognitive Function in Multiple Sclerosis (MACFMS)  which is a battery of neuropsych tests which focus on processing speech/working memory, learning/memory, executive functions, visual perception/spatial processing, and language.

Tests which focus on processing speech and working memory include the Paced Auditory Serial Addition Test (PASAT) and the Symbol Digit Modalities Test (SDMT).** PASAT** is a test of sustained attention where subjects listen to a series of numbers and are requested to add consecutive pairs of the numbers as they listen.   The test requires a high level of attention, especially if the numbers are presented quickly.   In the slower version, the numbers are space 3 seconds apart and in the faster version, they are only 2 seconds apart.   This is a hard one (for me anyways).

SDMT involves a simple substitution task that normal children and adults can easily perform. Using a reference key, the examinee has 90 seconds to pair specific numbers with given geometric figures. Responses can be written or oral, and for either response mode, administration time is just 5 minutes.   Individuals with cerebral dysfunction perform poorly on the SDMT, in spite of normal or above average intelligence.

Tests which focus on learning and memory include the California Verbal Learning Test-II (CVLT-II) and the Brief Visuospatial Memory Test-Rev. (BVRT-R).** CVLT-II** is a test of verbal learning and recall, also known as the the popular "Monday's shopping list" test.   The list will contain sixteen common words, each of which belongs to one of four categories: thus, there are four fruits, four herbs and spices, etc. The subject is then asked to recall as many of these items as possible.   There are several components to this test. First, the tester records how many items the subject remembers over several repeated trials. Additionally, the tester records whether or not the subject is making use of category information.

Next, the tester may give a second list ("Tuesday's shopping list"), and see if the subject is able to keep the items from each list separate, or if the two lists become confused.   Finally, there is a short delay of 20 minutes, during which the subject is given other tasks to perform, and then the tester again asks the subject to recall Monday's list.   Patients with different kinds of brain damage or disorder also show reliable patterns of performance.

BVMT-R is a test of visual learning and recall.   The examinee is presented with six geometric figures each on a separate page of the Recall Stimulus Booklet. In three Learning Trials, the respondent views the Recall Stimulus page for ten seconds and then is asked to draw as many of the figures as possible in their correct location on a blank page.

After a 25-minute delay which includes primarily verbal activities, the task is repeated. Then, the respondent is asked to identify which of the 12 figures in the Recognition Stimulus Booklet were included in the six geometric figures on the original Recall Stimulus page. As a final step, an optional Copy trial may be administered to screen for severe visuoconstructive deficits and to help in scoring recall responses.

Tests which focus on executive functions include the California Card Sorting Test (CST).** CST** is a test used to determine problem-solving skills, or executive functions, which are interrelated sets of abilities that include cognitive flexibility, concept formation, and self-monitoring.   The examinee is presented three sets of six stimulus cards and asked to sort the cards, first in a free sort followed by a directed sort (ie. by color, by symbol, by number of symbols, etc.)   The test is useful in identifying impaired executive functions caused by lesions in the frontal lobe.

NOTE: Patients with impaired executive function need not have impaired memory.

Tests which focus on visual perception and spatial processing include the Judgment of Line Orientation Test (JLO).** JLO** is a test which measures pure spatial judgment and requires the examinee to determine the location and directionality of a series of lines.   It tests one's ability to judge angular relationships.

Tests which focus on language and word retrieval include the Controlled Oral Word Association Test (COWAT).** COWAT** is a measure of a person's ability to make verbal associations to specified letters (i.e., C, F, and L). This measure is a useful component of a neuropsychological battery as it is able to detect changes in word association fluency often found with various disorders.   This is the test where you will be asked to name as many words as possible beginning with a single letter.   Information regarding total numbers of words produced as well as frequency of perseverations, breaking set, using the same word stem, and using a proper noun is provided.

The United Spinal Organization published a Multiple Sclerosis Quarterly Report which featured Cognitive Issues in Multiple Scelorsis.  I highly recommend that you read this report if you are interested in the topic of cognition and multiple sclerosis.

So what was the final result of my neuropsychology test?

"You passed the test with flying colors.   However, it did reveal that you are depressed."

No kidding!

I could of told the doc that and saved an afternoon and mild frustration in answering the addition test.   All it shows is that not everything is cut and dried.

When we are talking about the brain, so much is possible.