RESEARCH REPORT POSTER DISPLAY

RAPIE COGNITIVE SCREENING IN MULTIPLE SCLEROSIS ACCOMPLISHED BY THE FREE RECALL AND RECOGNITION TEST. Claesson I¹, Ytterberg C², Johansson S², Almkvist O³, von Koch L²; ¹Department of Physical Therapy, Karolinska University Hospital, Stockholm, Sweden. ²Department of Clinical Neuroscience, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden. ³Neruotec Department, Karolinska Institutet, Stockholm, Sweden

PURPOSE: This study sought to investigate the feasibility of the Free Recall and Recognition Test (FRRT) as a practical screening tool for cognitive impairment in multiple sclerosis (MS). RELEVANCE: Detailed assessment of cognitive function is generally not routinely performed in MS, since using a battery of neuropsychological tests is time-consuming and requires expert skills. Yet, rehabilitation outcome is negatively affected by cognitive impairment, and therefore, should be taken into account. Thus, work is ongoing to find a screening tool for cognitive impairment in MS, for use in clinics by personnel with proper training and knowledge in neuropsychological testing. This tool should be rapid and easily administered, have good reliability, validity and sensitivity for different severities of MS, and be accepted by the patients. PARTICIPANTS: Persons with MS (n=227), outpatients at the Neurological Department in Karolinska University Hospital. METHODS: Persons with MS were consecutively recruited and assessed with four cognitive tests; FRRT, Symbol Digit Modalities Test (SDMT), Paced Auditory Serial Addition Test (PASAT), and the Mini-Mental State Examination (MMSE). Disease severity was assessed by the Expanded Disability Status Scale (EDSS)and grouped into mild, moderate and severe MS. ANALYSIS: The Spearman Rank Correlation Coefficient was used. One-way analysis of variance with Scheffe’s post-hoc was used to assess differences in cognitive performance between the EDSS groups. Sensitivity, specificity and optimum cut-offs for the FRRT were calculated using Receiver Operator Curves. Statistical analyses were conducted using SPSS 13.0. RESULTS: The FRRT, which was completed by 99% of the cohort in approximately 5 minutes per assessment, correlated significantly with the other cognitive tests, as well as with the disease severity rating. A cut-off of 4 for the FRRT recall rendered 90% sensitivity and 25% specificity, and a cut-off of 4.2 for the FRRT recognition resulted in 70% sensitivity and 51% specificity. CONCLUSIONS: We conclude that the FRRT proved feasible as a practical screening tool for cognitive impairment in MS within a clinical setting. IMPLICATIONS: Rehabilitation personnel with proper training and knowledge in neuropsychology may use the FRRT as a simple and rapid screening tool for cognitive impairment in MS. The result of the FRRT might serve as an indicator of when special concern is appropriate and when a more detailed cognitive assessment is necessary. KEYWORDS: assessment; cognition; multiple sclerosis; neuropsychological tests; validity. FUNDING ACKNOWLEDGEMENTS: This study was supported by grants from the Swedish Research Council, Karolinska University Hospital, and The Swedish Association of Persons with Neurological Disabilities. CONTACT: ingrid.claesson@karolinska.se

ETHICS COMMITTEE: The ethical committee att Karolinska University Hospital