Using comprehensive neuropsychological assessment to assist with pharmaceutical decision making in relapsing-remitting multiple sclerosis

714 Abstracts /Archives of Clinical Neuropsychologv 15 (2000) 653-850 demyelinating lesions were assigned neuroanatomic locations and volumed. Patients completed a neuropsychological screening battery which included the HAM-D, BDI, Digit Span, Symbol Digit, 724, Animal Naming, COWAT, Stroop, RAVLT, and 15Item BNT. Factor analysis of the neuropsychological battery revealed 4 factors: Attention, Visual-Spatial Memory, Verbal Memory, and Language. A third of the patients (1 l/3 1) scored at or below - 2 SD on 4 or more specific tests or subtests. Only 5 patients’ scores were above - 1.5 SD on all testskubtests. Impaired patients, who scored below - 1.5 SD (n= 12) on 4 or more tests, had significantly greater total lesion volume (x = 20.63 cc) than unimpaired patients, who scored below - 1.5 SD on 3 or fewer tests (x = 4.20 cc) (F = 23.9 1, p = 0.000). Significant correlations were found between 3 tests (Symbol Digit, 7/24 Delay, and RAVLT Delay) and lesions in specific neuroanatomic lesions in the impaired patients. Scores on Symbol Digit correlated with total lesion volume, as well as specific lesion volume in the supraventricular frontal lobes, the let? periventricular occipital and parietal areas, the deep white matter of the occipital and temporal lobes, and the right side of the internal capsule. Scores on 7/24 Delay correlated with lesion volume in the deep white matter of the lefl occipital lobe and the right side of the internal capsule. Scores on the RAVLT Delay correlated with lesion volume in the corpus callosum. The correlations with lesions in the internal capsule may be spurious, as the lesion volume in this area is quite small. Development and validation of a screening battery for multiple sclerosis Romero M, Lebby e Gandolfo R, Tanner D, Hammon C. This study examined the classification ability of the MS Screening Battery, which was compared to the classification results obtained with the Mini-Mental State Examination and the Cognistat/ Neurobehavioral Cognitive Status Examination among multiple sclerosis, neurological, and normal control subjects. Descriminant function analysis found MS Screening Battery to be most sensitive to MS-specific deficits by correctly identifying 61.7% of the MS subjects in comparison to 0% of MS subjects identified by either MMSE or NCSE. The MS Screening Battery correctly classified 71% of the original cases, while MMSE and NCSE classified 47% and 57%, respectively. It was concluded that the MS Screening Battery may be a useful measure for an initial screening of multiple sclerosis patients. Using comprehensive neuropsycbological assessment making in relapsing-remitting multiple sclerosis Partridge K, Lewandowski A, Cole J. to assist with pharmaceutical decision Multiple sclerosis (MS) is a devastating neurologic illness affecting concept formation (Beatty, et al., 1995) memory, processing speed, executive functioning, and quality of life (Rao, 1993, 1996, 1997). While it is known that long-term changes in cognitive status associated with MS can be monitored through neuropsychological evaluation (Reitan, 197 I), repeated neuropsychological assessment can also be used to monitor drug efficacy over time in the treatment of this disease (Weinstein et al., 1999). A longitudinal case study of an ambulatory 46-year-old right-handed male with 18 years of education diagnosed with relapsing-remitting MS was conducted over the course of 5 years during which the patient received separate treatments of interferon beta (Avonex@) and glatiramer acetate (Copaxone@). Neuropsychological functioning was assessed using the Halstead-Reitan Neuropsychological Battery (HRNB), its allied procedures, and supplemental achievement and memory Abstracts 1 Archives of Clinical Nemopsychology 15 (2000) 653-850 715 measures. A series of 3 comprehensive neuropsychological evaluations separated by 2 years were completed, the first as a baseline, and the second and third assessments following different medication treatments. An analysis of longitudinal findings revealed a steady decline in cognitive ability over a 2-year period after baseline despite interferon beta treatment, prompting neurological and neuropsychological re-evaluation and subsequent medication change. Comprehensive neurometric assessment revealed significant improvement in cognitive functioning after glatiramer acetate treatment that was consistent with MRI and neurologic observations. These findings effectively illustrate the sensitivity of repeated neuropsychological evaluation in monitoring drug efftcacy and its utility as an important clinical tool in medical decision making. Process analysis of verbal fluency production following nucleus stimulation Trepanier LL, Saint-Cyr JA, Lang AE, Lozano AM. pallidal lesions and subthalamic There has been a renewed interest in neurosurgical interventions for Parkinson’s disease (PD), namely unilateral posteroventral pallidotomy (U-PVP) and chronic bilateral deep brain stimulation of the subthalamic nuclei (SIN-DBS). Recent cognitive outcome studies have indicated that measures of phonemic and/or semantic verbal fluency, already compromised in PD due to frontal-striatal dysfunction, appear to be the most consistently affected neurocognitive functions following these procedures. In order to understand the underlying cognitive processes involved in verbal fluency and hence, the possible nature of these post-operative verbal fluency deficits, a process analysis of pre- and posttest protocols was undertaken in 39 U-PVP patients and in 11 SIN-DBS patients over a l-year follow-up period. Fluency productions were re-analyzed for 2 components: clustering (i.e. the production of words within semantic or phonemic subcategories) and switching (i.e. the ability to shift between clusters). It is thought that clustering and semantic fluency are more related to temporallobe function while switching and phonemic fluency are more related to frontal-lobe function. As expected, post-operative declines were more consistently observed on switching for both surgical procedures, with no recovery of function over 1 year. Lateral&y effects were also noted following UPVP lesions. Left-sided lesions led to declines in switching on phonemic fluency but either side of lesion led to switching difficulties on semantic fluency. Verbal fluency has not recovered in any study published to date and this was found in the present study as well. It can be concluded that neurosurgical interventions for PD further disrupt the functional integrity of frontal-striatal circuitry. Attentional processing in Parkinson’s disease: hyperkentic and akenetic type Kraus CD, Iacono Rp: Burley r Freier K, Raggs M, Jenkins L. Parkinson’s disease (PD) is an idiopathic, progressive, neurologic disorder. This neurologic disorder affects approximately 1 in 100 people over age 60 in the United States (Bondi and Troster, 1997). This disease is a progressive degeneration of the monoaminergic dop (...truncated)