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Comparing cognitive impairment using MACFIMS in patients with multiple sclerosis and healthy controls: a systematic
Amirreza Nasirzadeh1, Mohammad Mohammadi2, Melika Arab Bafrani3
1Department of Medical-Surgical Nursing, Faculty of Nursing, Nursing Research Center, Gonabad University of Medical Sciences, Gonabad, Iran.
Background:
Multiple sclerosis (MS) is a chronic autoimmune disorder affecting the central nervous system, leading to a range of symptoms that impact physical, psychiatric, and cognitive functions. Cognitive dysfunction is prevalent among patients with MS (pwMS), affecting at least 65% of patients, and includes deficits in processing speed, attention, learning, memory, and executive function. Despite the significant impact on daily life, cognitive impairment in MS patients is often underrecognized in clinical settings.
Methods:
This systematic review and meta-analysis aimed to evaluate cognitive function using the Minimal Assessment of Cognitive Function in Multiple Sclerosis (MACFIMS) battery among pwMS patients and healthy controls (HCs). A comprehensive search of the Web of Science, PubMed, Scopus, and Cochrane Library databases was conducted on January 2024 following the PRISMA guidelines. Eligible studies included peer-reviewed research assessing the validity of the MACFIMS in adult MS patients. Data extraction and quality assessment were performed using standardized tools, and statistical analyses were conducted using R4.2.3.
Results:
Eight studies met the inclusion criteria, including a total of 1,481 pwMS and 1,072 HCs. The meta-analysis revealed significant cognitive deficits in pwMS patients compared to HCs across all the MACFIMS subtests, including language, spatial processing, new learning and memory, processing speed, and executive function. Processing speed and working memory were the most affected domains, with 36% of pwMS showing impairment on the Symbol Digit Modalities Test (SDMT). Subgroup analyses indicated that the Expanded Disability Status Scale (EDSS) score significantly influenced cognitive impairment, while disease duration had a limited impact.
Conclusions:
The MACFIMS effectively discriminates between pwMS patients and HCs, demonstrating its validity as a comprehensive cognitive assessment tool for MS. Routine cognitive screening, particularly for processing speed and working memory, is crucial for early detection and intervention. Future research should focus on the sensitivity and specificity of the MACFIMS across diverse MS subtypes and cultural contexts to enhance its global applicability in clinical practice.
Insights
Cognitive impairment is common in multiple sclerosis (MS), affecting processing speed and memory. The Minimal Assessment of Cognitive Function in Multiple Sclerosis (MACFIMS) tool effectively identifies these deficits in patients with MS compared to healthy individuals.
Area of Science:
- Neuroscience
- Clinical Neurology
- Psychology
Background:
- Multiple sclerosis (MS) is a chronic central nervous system autoimmune disorder.
- Cognitive dysfunction affects over 65% of patients with MS, impacting daily life.
- Cognitive impairment in MS is often underrecognized clinically.
Purpose of the Study:
- To evaluate cognitive function in patients with MS (pwMS) versus healthy controls (HCs) using the Minimal Assessment of Cognitive Function in Multiple Sclerosis (MACFIMS) battery.
- To systematically review and meta-analyze existing research on MACFIMS validity in adult MS patients.
Main Methods:
- Systematic review and meta-analysis adhering to PRISMA guidelines.
- Comprehensive database search (Web of Science, PubMed, Scopus, Cochrane Library).
- Inclusion of 8 studies with 1,481 pwMS and 1,072 HCs; data analysis using R4.2.3.
Main Results:
- Significant cognitive deficits in pwMS across all MACFIMS subtests compared to HCs.
- Processing speed and working memory were the most affected domains.
- Higher Expanded Disability Status Scale (EDSS) scores correlated with greater cognitive impairment.
Conclusions:
- The MACFIMS is a valid tool for distinguishing cognitive function between pwMS and HCs.
- Routine cognitive screening, especially for processing speed and working memory, is recommended for early MS intervention.
- Further research is needed to assess MACFIMS sensitivity and specificity across MS subtypes and cultures.
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