CHU Clermont-Ferrand

Author Of 2 Presentations

Neuropsychology and Cognition Poster Presentation

P0832 - XO as a new screening test of cognitive impairment in multiple sclerosis (ID 310)

Speakers
Presentation Number
P0832
Presentation Topic
Neuropsychology and Cognition

Abstract

Background

Up to 70% of patients with multiple sclerosis (pwMS) suffer from cognitive impairment. Both patients with remittent-recurrent (RR-MS) and progressive (P-MS) MS courses are concerned, especially regarding information processing speed (IPS) alteration. Among IPS tests, Symbol Digit Modalities Test (SDMT), Computerized Speed Cognitive Test (CSCT) and Weschler Adult Intelligence Scale Symbol Subtest (WAIS-IV-S) are used despite several inconveniences.

Objectives

This study aimed to approve the XO (test administered in 30 seconds only) as a new screening test of cognitive impairment in MS patients.

Methods

During a unique appointment, pwMS and healthy volunteers (HV) were assessed. The set of tests consisted in oral and written XO test, oral SDMT, CSCT, WAIS-IV-S, Go/No-Go and Trail Making Test (TMT) in a random order. The questionnaires included Hospital Anxiety and Depression Scale (HADS) and Fatigue Severity Scale (FSS). The primary endpoint was a comparison between two groups of pwMS, with or without altered IPS defined as at least one test with a result below -1.5 standard deviation.

Results

From November 2nd 2019 to March 13th 2020, 140 pwMS (89 RR-MS and 51 P-MS), and 117 HV were recruited. Thirty-six percent (50/140) of pwMS and 6% (7/117) of HV showed an IPS alteration (p<0.001). Twenty-six percent (37/140) of pwMS and 13% (15/117) of HV have an executive dysfunction (ED) (p=0.007). The Spearman’s rho between written XO test and IPS alteration was -0.54. Regarding the test-retest experiment (n=59), the Lin’s concordance correlation coefficient was 0.88 [0.83-0.94] for written XO. ROC area of written XO was 0.87 [0.80-0.93]. The threshold of 25.5 is the value beyond which there is an IPS alteration. Assuming 36% of pwMS have an IPS alteration, written XO sensibility is 84%, specificity is 65.6%, likelihood ratio (+) is 2.44, likelihood ratio (-) is 0.244, positive predictive value is 57.5%, and negative predictive value is 88.1%.

Conclusions

A correlation between written XO and IPS alteration was observed. The oral XO test was less relevant. There was neither correlation between XO score and ED, nor correlation between XO mistakes and ED. In 59 MS patients, XO did not show any test-retest effect which is very interesting and distinguishes it from other IPS tests used until now.

We have demonstrated that written XO can be a new useful IPS test for pwMS, without test-retest effect and independent of executive dysfunction. The written XO test is now being standardized using a healthy population of 400 individuals.

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Observational Studies Poster Presentation

P0876 - High and low efficacy therapy in secondary progressive multiple sclerosis after accounting for therapeutic lag. (ID 760)

Abstract

Background

In secondary progressive multiple sclerosis (SPMS), reduction in the rates of disability accrual after starting disease modifying therapy (DMT) has largely been limited to patients with ongoing inflammatory activity. A delayed treatment effect, termed therapeutic lag, may obscure therapeutic benefits in SPMS.

Objectives

To compare the effect of high and low efficacy DMT on disability outcomes in patients with recently active and inactive SPMS after accounting for therapeutic lag.

Methods

Using data from MSBase, a multinational MS registry, and OFSEP, the French MS registry, we identified patients with SPMS as per a previously validated objective definition. We identified patients treated with high- (natalizumab, alemtuzumab, mitoxantrone, ocrelizumab, rituximab, cladribine, fingolimod) or low-efficacy (interferons, glatiramer acetate, teriflunomide) DMT after SPMS onset. Based on our previous work, an individualised estimate of duration of therapeutic lag was calculated for each patient. Only events that occurred after the estimated therapeutic lag period were included in the analysis. Propensity score matching was used to select groups with comparable baseline characteristics. Disability and relapse outcomes were compared in paired, pairwise-censored analyses adjusted for visit density.

Results

Of 7359 patients with SPMS, 1000 patients fulfilled the criteria for study inclusion (510 active SPMS, 490 inactive SPMS). For the relapse outcomes, patients with active SPMS treated with high-efficacy DMTs experienced lower probabilities of relapses than low-efficacy DMTs (hazard ratio [HR] 0.7 [95%CI 0.5-0.9], p=0.006). Patients with inactive SPMS had similar probabilities of relapses in the high and low efficacy DMT groups (0.8 [0.6-1.2], p=0.39). No difference in the risk of 6-month sustained disability accumulation, or proportion of patients reaching EDSS>=7, was observed between groups when accounting for therapeutic lag.

Conclusions

The risk of disability accumulation in SPMS seems to be comparable in patients treated with high- and low- efficacy DMT. High efficacy DMT is superior to low efficacy therapy in reducing relapse activity in patients with active SPMS, but not those with inactive SPMS. Pre-treatment inflammatory activity, clinical or radiological, is a treatable target in SPMS which may benefit from higher-efficacy anti-inflammatory therapies.

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Presenter Of 1 Presentation

Neuropsychology and Cognition Poster Presentation

P0832 - XO as a new screening test of cognitive impairment in multiple sclerosis (ID 310)

Speakers
Presentation Number
P0832
Presentation Topic
Neuropsychology and Cognition

Abstract

Background

Up to 70% of patients with multiple sclerosis (pwMS) suffer from cognitive impairment. Both patients with remittent-recurrent (RR-MS) and progressive (P-MS) MS courses are concerned, especially regarding information processing speed (IPS) alteration. Among IPS tests, Symbol Digit Modalities Test (SDMT), Computerized Speed Cognitive Test (CSCT) and Weschler Adult Intelligence Scale Symbol Subtest (WAIS-IV-S) are used despite several inconveniences.

Objectives

This study aimed to approve the XO (test administered in 30 seconds only) as a new screening test of cognitive impairment in MS patients.

Methods

During a unique appointment, pwMS and healthy volunteers (HV) were assessed. The set of tests consisted in oral and written XO test, oral SDMT, CSCT, WAIS-IV-S, Go/No-Go and Trail Making Test (TMT) in a random order. The questionnaires included Hospital Anxiety and Depression Scale (HADS) and Fatigue Severity Scale (FSS). The primary endpoint was a comparison between two groups of pwMS, with or without altered IPS defined as at least one test with a result below -1.5 standard deviation.

Results

From November 2nd 2019 to March 13th 2020, 140 pwMS (89 RR-MS and 51 P-MS), and 117 HV were recruited. Thirty-six percent (50/140) of pwMS and 6% (7/117) of HV showed an IPS alteration (p<0.001). Twenty-six percent (37/140) of pwMS and 13% (15/117) of HV have an executive dysfunction (ED) (p=0.007). The Spearman’s rho between written XO test and IPS alteration was -0.54. Regarding the test-retest experiment (n=59), the Lin’s concordance correlation coefficient was 0.88 [0.83-0.94] for written XO. ROC area of written XO was 0.87 [0.80-0.93]. The threshold of 25.5 is the value beyond which there is an IPS alteration. Assuming 36% of pwMS have an IPS alteration, written XO sensibility is 84%, specificity is 65.6%, likelihood ratio (+) is 2.44, likelihood ratio (-) is 0.244, positive predictive value is 57.5%, and negative predictive value is 88.1%.

Conclusions

A correlation between written XO and IPS alteration was observed. The oral XO test was less relevant. There was neither correlation between XO score and ED, nor correlation between XO mistakes and ED. In 59 MS patients, XO did not show any test-retest effect which is very interesting and distinguishes it from other IPS tests used until now.

We have demonstrated that written XO can be a new useful IPS test for pwMS, without test-retest effect and independent of executive dysfunction. The written XO test is now being standardized using a healthy population of 400 individuals.

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