Cognitive involvement in pediatric multiple sclerosis (MS) relative to adult MS is less defined. This study advances our understanding by measuring cognitive performances in pediatric MS, adult MS, and pediatric healthy controls.
Methods:
Consecutive relapsing pediatric MS participants from the United States Network of Pediatric MS Centers were compared with pediatric healthy controls and adults with relapsing MS. Participants were compared on two screening batteries: the Brief International Cognitive Assessment for MS and the Cogstate Brief Battery. Results were transformed to age-normative z scores.
Results:
The pediatric groups (MS vs. Healthy Controls) did not differ on either battery’s composite mean score or individual test scores (ps > 0.32), nor in the proportions impaired on either battery, Brief International Cognitive Assessment for MS (26% vs. 24%, p = 0.83); Cogstate Brief Battery (26% vs. 32%, p = 0.41). The pediatric versus adult MS group even after controlling for differences in disease duration performed better on the Brief International Cognition Assessment for MS composite (p = 0.03), Symbol Digit Modalities Test (p = 0.02), Rey Auditory Verbal Learning Test (p = 0.01), and Cogstate choice reaction time (p < 0.001).
Conclusion:
Pediatric MS patients do not differ from healthy pediatric controls on cognitive screens but perform better than adults with MS.
KalbRBeierMBenedictRH, et al. Recommendations for cognitive screening and management in multiple sclerosis care. Mult Scler2018; 24: 1665–1680.
2.
KruppLBCharvetLE.Long-term cognitive consequences for patients with pediatric-onset multiple sclerosis. JAMA Neurol2019; 76: 1008–1009.
3.
MikaeloffYCaridadeGBillardC, et al. School performance in a cohort of children with CNS inflammatory demyelination. Eur J Paediatr Neurol2010; 14: 418–424.
4.
AmatoMPGorettiBGhezziA, et al. Cognitive and psychosocial features in childhood and juvenile MS: Two-year follow-up. Neurology2010; 75: 1134–1140.
5.
AmatoMPGorettiBGhezziA, et al. Cognitive and psychosocial features of childhood and juvenile MS. Neurology2008; 70: 1891–1897.
6.
TillCRacineNAraujoD, et al. Changes in cognitive performance over a 1-year period in children and adolescents with multiple sclerosis. Neuropsychology2013; 27: 210–219.
7.
MacAllisterWSBelmanALMilazzoM, et al. Cognitive functioning in children and adolescents with multiple sclerosis. Neurology2005; 64: 1422–1425.
8.
JulianLSerafinDCharvetL, et al. Cognitive impairment occurs in children and adolescents with multiple sclerosis: Results from a United States network. J Child Neurol2013; 28: 102–107.
9.
CharvetLEShawMFrontarioA, et al. Cognitive impairment in pediatric-onset multiple sclerosis is detected by the Brief International Cognitive Assessment for Multiple Sclerosis and computerized cognitive testing. Mult Scler2018; 24: 512–519.
10.
CasperTCRoseJWRoalstadS, et al. The US network of pediatric multiple sclerosis centers: Development, progress, and next steps. J Child Neurol2015; 30: 1381–1387.
11.
KruppLBTardieuMAmatoMP, et al. International Pediatric Multiple Sclerosis Study Group criteria for pediatric multiple sclerosis and immune-mediated central nervous system demyelinating disorders: Revisions to the 2007 definitions. Mult Scler2013; 19: 1261–1267.
12.
PolmanCHReingoldSCBanwellB, et al. Diagnostic criteria for multiple sclerosis: 2010 revisions to the McDonald criteria. Ann Neurol2011; 69: 292–302.
13.
KurtzkeJF.Rating neurologic impairment in multiple sclerosis: An expanded disability status scale (EDSS). Neurology1983; 33: 1444–1452.
14.
WilkinsonGSRobertsonGJ.WRAT 4: Wide range achievement test; Professional manual. Lutz, FL: Psychological Assessment Resources, Inc., 2006.
15.
SmithGEBohacDLIvnikRJ, et al. Using word recognition tests to estimate premorbid IQ in early dementia: Longitudinal data. J Int Neuropsychol Soc1997; 3: 528–533.
LangdonDWAmatoMPBoringaJ, et al. Recommendations for a brief international cognitive assessment for multiple sclerosis (BICAMS). Mult Scler2012; 18: 891–898.
18.
StroberLBBruceJMArnettPA, et al. A new look at an old test: Normative data of the symbol digit modalities test—Oral version. Mult Scler Relat Disord2020; 43: 102154.
19.
BeanJ.Rey auditory verbal learning test (Rey AVLT). In: KreutzerJSDelucaJCaplanB (eds) Encyclopedia of clinical neuropsychology. Berlin: Springer, 2011, pp. 2174–2175.
SmerbeckAMParrishJYehEA, et al. Regression-based pediatric norms for the brief visuospatial memory test—Revised and the symbol digit modalities test. Clin Neuropsychol2011; 25: 402–412.
22.
Eilam-StockTShawMTKruppLB, et al. Early neuropsychological markers of cognitive involvement in multiple sclerosis. J Neurol Sci2021; 423: 117349.
23.
BartlettEShawMTSchwarzC, et al. Brief computer-based information processing measures are linked to white matter integrity in pediatric-onset multiple sclerosis. J Neuroimaging2019; 29: 140–150.
24.
BaronciniDSimoneMIaffaldanoP, et al. Risk of persistent disability in patients with pediatric-onset multiple sclerosis. JAMA Neurol2021; 78: 726–735.
25.
WallachAIWaltzMCasperTC, et al. Cognitive processing speed in pediatric-onset multiple sclerosis: Baseline characteristics of impairment and prediction of decline. Mult Scler2020; 26: 1938–1947.
26.
BaruchNFO’DonnellEHGlanzBI, et al. Cognitive and patient-reported outcomes in adults with pediatric-onset multiple sclerosis. Mult Scler2016; 22: 354–361.
27.
ChitnisTAaenGBelmanA, et al. Improved relapse recovery in paediatric compared to adult multiple sclerosis. Brain2020; 143: 2733–2741.
28.
RenouxCVukusicSConfavreuxC.The natural history of multiple sclerosis with childhood onset. Clin Neurol Neurosurg2008; 110: 897–904.
29.
WeisbrotDCharvetLSerafinD, et al. Psychiatric diagnoses and cognitive impairment in pediatric multiple sclerosis. Mult Scler2014; 20: 588–593.
30.
RuanoLBrancoMPortaccioE, et al. Patients with paediatric-onset multiple sclerosis are at higher risk of cognitive impairment in adulthood: An Italian collaborative study. Mult Scler2018; 24: 1234–1242.
31.
McKayKAManouchehriniaABerriganL, et al. Long-term cognitive outcomes in patients with pediatric-onset vs adult-onset multiple sclerosis. JAMA Neurol2019; 76: 1028–1034.
