Testing cognitive abilities — like learning and memory, processing speed, and verbal fluency — can give valuable clues as to how well people with multiple sclerosis (MS) are able to go about their daily lives, according to a review study led by Kessler Foundation researchers.
Neuropsychological tests are of “significant predictive value regarding everyday life activity,” the team wrote, but they need to be paired with other measures of disease status and progression to fully understand the “impact of MS disease on everyday functioning.”
The review study, “Beyond cognitive dysfunction: Relevance of ecological validity of neuropsychological tests in multiple sclerosis,” was published in the Multiple Sclerosis Journal.
An estimated 43% to 70% of MS patients experience cognitive difficulties in addition to the physical challenges that characterize this disease.
Changes in cognitive skills can greatly affect a patient’s ability to perform common tasks, such as cooking, driving, managing money, and finding or holding a job. Neuropsychological testing and close monitoring of patients’ neuropsychological changes are, for these reasons, critical steps in adequate patient care and in improving overall outcome.
The role of neuropsychological tests has evolved significantly with the development and refinement of neuroimaging techniques (like an MRI), which also now allow clinicians to link these cognitive changes with visualized physical changes or areas of damage in the brain.
Increasing evidence suggests that neuropsychological tests are useful in assessing real-world behaviors and performance, with several studies showing an association between test results and driving ability or employment.
However, these findings are controversial, as other studies could not replicate their associations. This failure raises questions as the validity of neuropsychological tests, and their ability to predict patient outcomes.
Kessler Foundation researchers reviewed literature on the use of neuropsychological tests to assess functioning in MS patients.
The cognitive functions analyzed included processing speed, working memory, learning and memory, executive function, verbal fluency, and visuospatial function. The daily life (functional) domains assessed included employment, driving, internet shopping, and financial/medical decision-making.
Results showed that neuropsychological tests indeed have high predictive value for individuals’ behavior in real-life settings.
Neuropsychological tests “play an important role in understanding cognition, and provide significant information regarding everyday life predictability in persons with MS,” the researchers wrote. “However, as with any test, NP [neuropsychological] tests alone cannot provide absolute clinical predictability.”
Other measures need to be evaluated in conjunction with these tests.
“While neuropsychological tests are ecologically valid in this population, other measures need to be considered in the clinical evaluation of individuals with MS, in order to understand the impact of the disease on everyday function,” Erica Weber, PhD, the study’s lead author, said in a news release.
“Everyday life is complex, and there is no single measure for predicting the performance of complex daily activities. This is especially true for MS,” Weber added.
Increasing evidence suggests that the predictive value of neuropsychological tests in MS improve when used together with measures that include physical disability scoring, mental health, and disease activity.
But “it’s important to note that other types of assessments used to evaluate individuals with MS need to be subjected to the same standards for validity as neuropsychological assessments,” Weber said.
Specifically, the team suggested that neuropsychological tests be interpreted together with non-cognitive variables, such as motor ability, fatigue and depression, disease activity, and level of disability.
The value of neuropsychological tests relies on how they are used in the clinic to help physicians “understand the impact of MS disease on everyday functioning,” the researchers concluded. These tests play “an invaluable role in the real-world assessment of the patient with MS.”