CHICAGO—Many of the neuropsychologic tests that target cognitive domains affected in patients with multiple sclerosis (MS) do not appear to be predictive of neuropsychiatric symptoms in these patients, as has been previously hypothesized, reported Jesus Lovera, PhD, and colleagues. Neuropsychiatric symptoms occur in 80% of patients with MS, and depression is the most common of these symptoms, the researchers stated at the 60th Annual Meeting of the American Academy of Neurology.
The investigators studied 109 patients (mean age, 51) who were enrolled in clinical trials of memantine for cognitive impairment in MS. Among the inclusion criteria were significant cognitive complaints, a score 1 SD below the normal population average on the Paced Auditory Serial Addition Test (PASAT) or the California Verbal Learning Test-II (CVLT-II), and a Beck Depression Inventory–IA score of less than 19.
Neuropsychologic tests included a three-second version of the PASAT, the CVLT-II, the Symbol Digits Modalities Test, the Delis-Kaplan Executive Function System (D-KEFS) sorting test, the Controlled Oral Word Association Test (COWAT), and the Victoria version of the Stroop test. Neuropsychiatric symptoms were assessed using the Modified Neuropsychiatric Inventory.
According to Dr. Lovera, who is an Instructor in the Department of Neurology at Oregon Health and Science University in Portland, and colleagues, 55 patients had one or more neuropsychiatric symptoms: 42 had irritability, 31 anxiety, 24 agitation/aggression, 23 apathy, 18 disinhibition, and 11 euphoria. Tests of attention and processing speed (PASAT), verbal fluency (COWAT), sorting (D-KEFS), and verbal learning and recall (CVLT-II) were not predictive of neuropsychiatric symptoms.
Perseveration and intrusions, as measured by the Stroop test and the CVLT-II, were highly predictive of neuropsychiatric symptoms.
Physicians should consider screening for neuropsychiatric symptoms in patients with MS, particularly in those with cognitive complaints, commented the researchers. They also advised that patients with MS who have impairment on the Stroop test or intrusions or repetitions on the CVLT-II be screened for neuropsychiatric symptoms.