Highlights
- •We validated the Neuronorma battery for cognitive assessment in multiple sclerosis.
- •Most tests showed medium or large effect sizes between MS patients and controls.
- •The best strategy to define cognitive impairment was based on cognitive domains.
- •Neuronorma battery provides a comprehensive neuropsychological assessment.
- •This battery is available in several countries with reliable normative data.
Abstract
Background
Cognitive dysfunction is prevalent among patients with multiple sclerosis (MS). In
recent years, several (generally brief) neuropsychological batteries have been proposed
for cognitive assessment. There is a need for comprehensive batteries providing complete
cognitive assessment of patients with MS. The Neuronorma battery includes several
standardised neuropsychological tests examining the main cognitive domains, and is
available in several countries. The aim of this study was to validate the battery
for cognitive assessment in a sample of patients with MS and healthy controls, and
to find the most appropriate criteria for defining cognitive impairment using this
battery.
Methods
Five hundred and sixty participants (280 with MS and 280 controls matched for age,
sex, and years of education) were included. Inter-group differences were calculated
using the Mann-Whitney U test and effect sizes with Cohen's d. Several criteria for definition of cognitive impairment were evaluated, according
to different cut-off points, and the number of tests and cognitive domains impaired.
Receiver operating characteristic curves with 95% confidence intervals were estimated
and they were compared using the DeLong method.
Results
Patients with MS showed poorer performance in almost all cognitive tests, with large
effect sizes for the Symbol Digit Modalities Test and Judgement of Line Orientation,
and moderate effects for Digit Span Backward, the Corsi test, Trail Making Test, Free
and Cued Selective Reminding Test, Rey-Osterrieth Complex Figure (recall), verbal
fluency (P words), and the Stroop Color-Word Interference Test. The area under the
curve was superior for classification by cognitive domain than for the mean scaled
score of the tests or the number of tests showing impairment according to different
cut-off points for the adjusted scaled scores.
Conclusions
Our study validates the Neuronorma battery for cognitive assessment of patients with
MS. The battery is currently available in several countries with reliable normative
data, and may be useful in both the clinical and the research settings when comprehensive
neuropsychological examination is warranted.
Keywords
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Article info
Publication history
Published online: April 17, 2020
Accepted:
March 23,
2020
Received in revised form:
March 22,
2020
Received:
February 26,
2020
Identification
Copyright
© 2020 Elsevier B.V. All rights reserved.
