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September 11, 2012; 79 (11) Articles

Looking anew at cognitive dysfunction in multiple sclerosis

The gorilla in the room

Anthony Feinstein, Helen Lapshin, Paul O'Connor
First published August 29, 2012, DOI: https://doi.org/10.1212/WNL.0b013e3182698da3
Anthony Feinstein
From the Sunnybrook Health Sciences Centre (A.F., H.L.), Toronto, Canada; University of Toronto (A.F., H.L., P.O.), Toronto, Canada; and St. Michael's Hospital (P.O.), Toronto, Canada.
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Helen Lapshin
From the Sunnybrook Health Sciences Centre (A.F., H.L.), Toronto, Canada; University of Toronto (A.F., H.L., P.O.), Toronto, Canada; and St. Michael's Hospital (P.O.), Toronto, Canada.
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Paul O'Connor
From the Sunnybrook Health Sciences Centre (A.F., H.L.), Toronto, Canada; University of Toronto (A.F., H.L., P.O.), Toronto, Canada; and St. Michael's Hospital (P.O.), Toronto, Canada.
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Citation
Looking anew at cognitive dysfunction in multiple sclerosis
The gorilla in the room
Anthony Feinstein, Helen Lapshin, Paul O'Connor
Neurology Sep 2012, 79 (11) 1124-1129; DOI: 10.1212/WNL.0b013e3182698da3

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Abstract

Objective: Inattentional blindness refers to a phenomenon in which individuals fail to notice an object in plain sight. Present in healthy, cognitively intact individuals, it has not been studied in patients with MS in whom it could theoretically act as a marker for real-world cognitive difficulties in those deemed cognitively intact on conventional neuropsychological batteries. Our hypothesis was that difficulty sustaining attention in patients with MS would paradoxically be associated with less inattentional blindness.

Methods: A cross-sectional study was undertaken in which a consecutive sample of 68 patients with MS completed neuropsychological testing with the Minimal Assessment of Cognitive Function in Multiple Sclerosis (MACFIMS) battery. Two additional tests were administered, the Stroop Test and a measure of inattentional blindness, i.e., the gorilla in the room paradigm. The gorilla test elicited 2 variables: the ability to detect the gorilla and the number of times a ball was passed between members of one team.

Results: Cognitive dysfunction by MACFIMS criteria was present in 36.8 of subjects. There were no differences between patients with MS and healthy control subjects on the gorilla indices. Similarly, no inattentional differences were present between cognitively intact and impaired patients with MS. However, patients with MS who were impaired on the Stroop and 2-second Paced Auditory Serial Addition Test were more likely than their intact counterparts to detect the gorilla (p = 0.038 and 0.014, respectively), with Stroop-impaired patients detecting fewer ball passes (p = 0.002).

Conclusions: The results support our hypothesis that less inattentional blindness is associated with heightened distractibility. This may explain why some patients with MS deemed cognitively intact on a battery of tests such as the MACFIMS still struggle with real-world challenges such as multitasking and filtering distracting stimuli.

GLOSSARY

ANART=
American National Adult Reading Test;
CVLT-II=
California Verbal Learning Test–II;;
HADS=
Hospital Anxiety and Depression Scale;
MACFIMS=
Minimal Assessment of Cognitive Function in Multiple Sclerosis;
MS=
multiple sclerosis;
PASAT=
Paced Auditory Serial Addition Test;
SDMT=
Symbol Digit Modalities Test

Footnotes

  • Study funding: Supported by the Multiple Sclerosis Society of Canada.

  • Received February 27, 2012.
  • Accepted April 19, 2012.
  • Copyright © 2012 by AAN Enterprises, Inc.
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