Indices of Cognitive Dysfunction in Relapsing-Remitting Multiple Sclerosis: Intra-individual Variability, Processing Speed, and Attention Network Efficiency

Abstract Impairments in attention and information processing speed are common in multiple sclerosis (MS) and may contribute to impairments of other cognitive abilities. This study examined attentional efficiency, information processing speed and intra-individual variability in response speed using the Attention Network Test-Interactions (ANT-I) in mildy-affected patients with MS. Thirty-one patients with relapsing-remitting MS and 30 age, sex, and education-matched controls completed the ANT-I, as well as the Paced Auditory Serial Attention Test (PASAT), as a standard clinical measure of information processing efficiency. As expected, patients with MS were slower in reaction time performance on the ANT-I and had poorer performance on the PASAT compared to controls. Patients with MS also demonstrated poorer efficiency in their executive control of attention on the ANT-I, suggesting difficulties with top-down allocation of attention. In addition, the MS group demonstrated greater intra-individual variability in the responses to the ANT-I even when their slower overall response time and other factors such as practice were accounted for. Intra-individual variability was found to best predict group membership compared to PASAT scores and other ANT-I scores. These results suggest that intra-individual variability may provide sensitive, unique and important information regarding cognitive functioning in early MS. (JINS, 2013, 19, 1–8)

[1]  P. Snyder,et al.  Information processing speed deficits may be better correlated with the extent of white matter sclerotic lesions in multiple sclerosis than previously suspected , 2001, Brain and Cognition.

[2]  S. MacDonald,et al.  Neural underpinnings of within-person variability in cognitive functioning. , 2009, Psychology and aging.

[3]  C. Eriksen,et al.  Effects of noise letters upon the identification of a target letter in a nonsearch task , 1974 .

[4]  J. Kurtzke Rating neurologic impairment in multiple sclerosis , 1983, Neurology.

[5]  J. Correale,et al.  Alerting Network Dysfunction in Early Multiple Sclerosis , 2012, Journal of the International Neuropsychological Society.

[6]  F. Paul,et al.  Poor PASAT performance correlates with MRI contrast enhancement in multiple sclerosis , 2009, Neurology.

[7]  J. Fisk,et al.  Information Processing Efficiency in Patients with Multiple Sclerosis , 2000, Journal of clinical and experimental neuropsychology.

[8]  H. Diener,et al.  Activity of attention related structures in multiple sclerosis patients , 2007, Brain Research.

[9]  Juan Lupiáñez,et al.  The three attentional networks: On their independence and interactions , 2004, Brain and Cognition.

[10]  J. Beaumont,et al.  Modality-specific aspects of sustained and divided attentional performance in multiple sclerosis. , 2005, Archives of clinical neuropsychology : the official journal of the National Academy of Neuropsychologists.

[11]  C H Polman,et al.  The Brief Repeatable Battery of Neuropsychological Tests: normative values allow application in multiple sclerosis clinical practice , 2001, Multiple sclerosis.

[12]  V. Dousset,et al.  Should SDMT substitute for PASAT in MSFC? A 5-year longitudinal study , 2008, Multiple sclerosis.

[13]  P. Arnett,et al.  Cognitive and neurobehavioral features in multiple sclerosis , 2011, Expert review of neurotherapeutics.

[14]  A. Compston,et al.  Recommended diagnostic criteria for multiple sclerosis: Guidelines from the international panel on the diagnosis of multiple sclerosis , 2001, Annals of neurology.

[15]  M Rovaris,et al.  Relation between MR abnormalities and patterns of cognitive impairment in multiple sclerosis , 1998, Neurology.

[16]  R. Heaton,et al.  Neuropsychological findings in relapsing-remitting and chronic-progressive multiple sclerosis. , 1985, Journal of consulting and clinical psychology.

[17]  Roberto Mutani,et al.  Grey Matter Pathology in Multiple Sclerosis , 2005, Journal of neuropathology and experimental neurology.

[18]  P. Sørensen,et al.  The changing demographic pattern of multiple sclerosis epidemiology , 2010, The Lancet Neurology.

[19]  Raymond M. Klein,et al.  Are Individual Differences in Absentmindedness Correlated with Individual Differences in Attention , 2009 .

[20]  J. Fisk,et al.  Limitations of the Paced Auditory Serial Addition Test as a measure of working memory in patients with multiple sclerosis , 2001, Journal of the International Neuropsychological Society.

[21]  Jin Fan,et al.  The activation of attentional networks , 2005, NeuroImage.

[22]  R. Klein,et al.  Information processing and magnetic resonance imaging indices of brain pathology in multiple sclerosis. , 2012, International journal of MS care.

[23]  Hirofumi Ochi,et al.  [Cognitive impairment in multiple sclerosis]. , 2014, Brain and nerve = Shinkei kenkyu no shinpo.

[24]  J. Jakobsen,et al.  Fatigue and processing speed are related in multiple sclerosis , 2010, European journal of neurology.

[25]  J. Fisk,et al.  Intra-individual Variability as a Measure of Information Processing Difficulties in Multiple Sclerosis. , 2012, International journal of MS care.

[26]  S. MacDonald,et al.  Intra-individual variability in behavior: links to brain structure, neurotransmission and neuronal activity , 2006, Trends in Neurosciences.

[27]  S. Reingold,et al.  The Multiple Sclerosis Functional Composite measure (MSFC): an integrated approach to MS clinical outcome assessment , 1999, Multiple sclerosis.

[28]  S. Ludwin,et al.  The Pathogenesis of Multiple Sclerosis: Relating Human Pathology to Experimental Studies , 2006, Journal of neuropathology and experimental neurology.

[29]  M. Posner Attention: the mechanisms of consciousness. , 1994, Proceedings of the National Academy of Sciences of the United States of America.

[30]  Pío Tudela,et al.  Modulations among the alerting, orienting and executive control networks , 2005, Experimental Brain Research.

[31]  J. DeLuca,et al.  Is Speed of Processing or Working Memory the Primary Information Processing Deficit in Multiple Sclerosis? , 2004, Journal of clinical and experimental neuropsychology.

[32]  R. Benedict,et al.  Psychometrics and normative data for the Multiple Sclerosis Functional Composite: replacing the PASAT with the Symbol Digit Modalities Test , 2010, Multiple sclerosis.

[33]  P. Sørensen,et al.  Cognitive impairment in newly diagnosed multiple sclerosis patients: A 4-year follow-up study , 2006, Journal of the Neurological Sciences.

[34]  Stephen M Rao,et al.  Cognitive dysfunction in multiple sclerosis: a review of recent developments. , 2003, Current opinion in neurology.

[35]  S. MacDonald,et al.  Intraindividual variability in cognitive performance in older adults: comparison of adults with mild dementia, adults with arthritis, and healthy adults. , 2000, Neuropsychology.

[36]  R. Klein,et al.  Repeated measurement of the components of attention using two versions of the Attention Network Test (ANT): Stability, isolability, robustness, and reliability , 2010, Journal of Neuroscience Methods.

[37]  Jared M. Bruce,et al.  Response variability is associated with self-reported cognitive fatigue in multiple sclerosis. , 2010, Neuropsychology.

[38]  M. Posner,et al.  Orienting of Attention* , 1980, The Quarterly journal of experimental psychology.

[39]  E. Strauss,et al.  Intraindividual Variability as a Marker of Neurological Dysfunction: A Comparison of Alzheimer's Disease and Parkinson's Disease , 2006, Journal of clinical and experimental neuropsychology.

[40]  D. Altmann,et al.  Clinical and imaging correlates of the multiple sclerosis impact scale in secondary progressive multiple sclerosis , 2012, Journal of Neurology.

[41]  W. Beatty,et al.  Impairments of attention in individuals with Multiple Sclerosis , 1998, Multiple sclerosis.

[42]  M. Posner,et al.  The attention system of the human brain. , 1990, Annual review of neuroscience.

[43]  Hans Forssberg,et al.  Visuo-Spatial Working Memory Span: A Sensitive Measure of Cognitive Deficits in Children With ADHD , 2004, Child neuropsychology : a journal on normal and abnormal development in childhood and adolescence.

[44]  P. O'Connor The Use of Disease-Modifying Agents in Multiple Sclerosis - by the Canadian Network of MS Clinics , 2008, Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques.

[45]  Frauke Zipp,et al.  Attention Network Test reveals alerting network dysfunction in multiple sclerosis , 2010, Multiple sclerosis.

[46]  Individual variability in speed of information processing: an index of cognitive impairment in multiple sclerosis. , 2012, Neuropsychology.

[47]  T. Tombaugh,et al.  A comprehensive review of the Paced Auditory Serial Addition Test (PASAT). , 2006, Archives of clinical neuropsychology : the official journal of the National Academy of Neuropsychologists.

[48]  Stephen M. Rao,et al.  Cognitive dysfunction in multiple sclerosis. , 1991, Neurology.

[49]  Frederik Barkhof,et al.  Grey matter pathology in multiple sclerosis , 2008, The Lancet Neurology.

[50]  Bruce D. McCandliss,et al.  Testing the Efficiency and Independence of Attentional Networks , 2002, Journal of Cognitive Neuroscience.

[51]  C. Pfueller,et al.  Correlation of self-assessed fatigue and alertness in multiple sclerosis , 2010, Multiple sclerosis.