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US Network Longitudinal Study of Cognitive Functioning in Pediatric MS, AAN, 2014

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Presentation on study to assess longitudinal changes in cognitive function among individuals with pediatric MS evaluated within the US Network of Pediatric MS Centers.

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US Network Longitudinal Study of Cognitive Functioning in Pediatric MS, AAN, 2014

  1. 1. Objective To assess longitudinal changes in cognitive function among individuals with pediatric MS evaluated within the US Network of Pediatric MS Centers
  2. 2. Background MS onset prior to age18 years has an estimated incidence of: 0.2-0.6/100,000 Cognitive impairment occurs in approximately 1/3 of those with pediatric MS McAllister et al. 2005 (n=37) 35% Amato et al. 2008 (n=63) 31% Till et al. 2011(n= 35) 29% Julian et al. 2012, (n=231) 32%
  3. 3. Longitudinal studies are few Amato et al. 2010: Two-year f/u (n=56), compared to controls  75% worsened on a Cognitive Change Index Till et al. 2013: One-year f/u (n=28) compared to controls  Groups differed in rate of improvement  MS improved on 18% of measures vs Controls on 86%  Using RCI, decline occurred in 23% MS vs 4% of Controls
  4. 4. Methods The US Network consists of 9 pediatric MS centers sharing a common database Baseline and f/u cognitive testing 18 months later was administered across 6 sites Participants had MS or CIS and be were 30 or more days free of a relapse and last steroid dose
  5. 5. Cognitive Test Battery General Intelligence (WASI)  2 subtest IQ Simple Attention (Digit Span)  Digits Forward  Digits back Visuo-motor skill Beery (Visual-Motor Integration Test) Language (Expressive One-Word Vocabulary)
  6. 6. Cognitive Test Battery WIAT-II Pseudoword decoding Verbal Memory California Verbal Learning Test (CVLT- C/CVLT-II ) Total learning across trials Total long-delay free recall D-KEFS Trail Making Test Visual Scanning Number Sequence Letter Sequence Letter-Number Sequence Motor Speed
  7. 7. Study Cohort 53 MS, 7CIS Age at first evaluation (NP1)  Mean = 14.36±1.95 years range (8.11 to 17.77 years) Time between baseline (NP1) and follow-up testing (NP2)  Mean = 1.54 years ± 0.56 (0.75 to 2.99 years)
  8. 8. Cohort Demographic Features  N = 60; 21 male (35%), 39 female (65%)  Race  White n=46 (76.7%)  African-American n=12 (20%)  Asian n=1 (1/7%)  Other n=1 (1.7%)  Ethnicity:  Hispanic=18 (30%)  Non-Hispanic 28 (70%)  Maternal years of education:  Mean =13.8 ±2.2 years (7 - 18 yrs)
  9. 9. Cohort Clinical Features Symptom duration at NP1 Mean =1.36 ± 1.66 years (.09 to 8.32 years) EDSS at NP1 Mean=1.48 ±1.21 (0 to 6) EDSS at NP2 Mean = 1.19 ± 1.40 (0 to 4.5) EDSS NP1 vs. EDSS NP2 ns (p=0.35)
  10. 10. Performances on individual measures at NP1 and NP2 -1 -0.8 -0.6 -0.4 -0.2 0 0.2 0.4 0.6 Meanzscore,n=60 Baseline Follow-Up WASI 2 DSFWD DSBACK EOW PWD LIST A TOT LD FREE VISSCAN NUM SCAN LETTER SEQ LETTER NUMBER MOTOR SPEED VMI
  11. 11. Average percentage of impaired tests per subject Percent of test scores <1 SD published norm/patient NP1: 27% ±21% (range 0 - 86%) NP2: 26% ±21% (range 0-78%)
  12. 12. Number of impaired tests Sum of impaired tests at baseline Mean 4.23 ±-2.99 (0 to 12 Sum of impaired tests at follow-up Mean 4.00 ±-3.00 (0 to 11) Change in sum of impaired tests -4.00 to 5, mean -.017 ± 1.95
  13. 13. Change in total number of impaired tests
  14. 14. Cognitive Change Index (CCI)
  15. 15. Most patients showed no change Declined on 2 or more tasks n=8 (13.3%) Improved on 2 or more tasks n=12 (20%) No clear pattern of improvement or decline on any test, in any area Change was not related to any clinical or demographic features
  16. 16. Comparisons with other studies Amato et al. (2010):  Greater proportion of low IQs 28% vs. only 1 patient in this cohort  20-40% had language problems (with more language measures in battery)  No indication of language impairment or decline in this cohort  More time between testing (18 months vs. 24 months)
  17. 17. Other studies Till et al. (2013) Lower rate of decline consistent with findings from our cohort Absence of expected age-related gains Natural history control group is needed,
  18. 18. Conclusions Cognitive impairment remains relatively stable for most children Relative cognitive stability is present over similar intervals in adult MS Nonetheless, pediatric MS patients may not be achieving age-expected cognitive gains

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