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Cognitive processing speed in pediatric-onset multiple sclerosis: Baseline characteristics of impairment and
Asya I Wallach1, Michael Waltz2, T Charles Casper2
1Pediatric Multiple Sclerosis Center, Department of Neurology, NYU Langone Medical Center, New York, NY, USA.
Insights
Pediatric multiple sclerosis (MS) patients can experience cognitive impairment early. The Symbol Digit Modalities Test (SDMT) can identify risks for cognitive decline in these young patients.
Area of Science:
- Neurology
- Pediatrics
- Cognitive Science
Background:
- Cognitive impairment affects about one-third of pediatric-onset multiple sclerosis (POMS) patients.
- The Symbol Digit Modalities Test (SDMT) is a standard cognitive screen for adults but is underutilized in POMS care.
- Early identification of cognitive issues in POMS is crucial for management.
Purpose of the Study:
- To implement early cognitive screening in POMS using the SDMT.
- To identify factors that predict cognitive impairment and decline in POMS patients.
- To analyze the impact of disease activity on cognitive function.
Main Methods:
- Prospective assessment of 955 pediatric-onset multiple sclerosis (POMS) or clinically isolated syndrome (CIS) patients.
- Inclusion criteria: disease onset before 18 years, at least one SDMT, and age 8+ at testing.
- Analysis of cognitive decline based on disease relapse and steroid use.
Main Results:
- Impaired processing speed was observed in 23.4% of POMS and 16.4% of CIS patients at initial assessment.
- A clinically meaningful cognitive decline was noted in 14.1% of patients during follow-up.
- Older age at MS onset and male gender predicted decline, while relapses and steroid use caused transient worsening.
Conclusions:
- Early in the disease course, POMS and CIS patients are susceptible to cognitive impairment.
- The SDMT is a valuable tool for early detection of cognitive deficits in pediatric MS.
- Identifying at-risk individuals allows for timely intervention to mitigate cognitive decline.
Background:
Cognitive impairment occurs in approximately one-third of pediatric-onset multiple sclerosis (POMS) patients. The Symbol Digit Modalities Test (SDMT), a widely used cognitive screen in adults, has yet to be incorporated early into the standard care of POMS.
Objective:
To screen for cognitive impairment early in the course of POMS and analyze predictive factors.
Methods:
Of the 955 POMS or clinically isolated syndrome (CIS) patients prospectively assessed from March 2014 to July 2018, 500 POMS and 116 CIS patients met inclusion criteria (disease onset before the age of 18, one or more SDMTs, and 8 years or older at the time of testing). Those with relapse were analyzed separately from those who were relapse-free.
Results:
At initial assessment, the mean (interquartile range (IQR)) age at symptom onset was 13.5 years (12.0, 15.9) and the mean (±SD) disease duration was 3.0 ± 2.9 years. Impaired processing speed occurred in 23.4% of POMS and in 16.4% of CIS. On serial testing (n = 383, mean follow-up: 1.8 years), 14.1% had clinically meaningful decline predicted by older age of multiple sclerosis (MS) onset and male gender. Disease relapse or steroid use led to transient worsening on the SDMT.
Conclusion:
Early in the disease, some POMS and CIS patients are at risk for cognitive impairment and subsequent decline.
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