Benchmarks of Cognitive Performance in a Large, Representative Patient Population (S44.007)

Objective: Identify and validate benchmarks of cognitive performance in multiple sclerosis (MS).

Background: Cognitive impairment occurs in half of MS patients, but benchmarks of cognitive performance for socioeconomic outcomes have not been reported.

Design/Methods: Patients were enrolled in MS PATHS, a network of 10 healthcare institutions in the United States (7) and Europe (3). During routine visits, patients used the Multiple Sclerosis Performance Test (MSPT) to complete a standardized MS history and the Processing Speed Test (PST), an electronic adaptation of the Symbol Digit Modalities Test. Working age patients (18 to 65 y.o.) were randomly divided (2:1) into a training set (n=3059) or a test set (n=1514). PST benchmarks predicting unemployment, Living with Assistance, or Medicare/Medicaid insurance were identified as PST scores with the minimum p-value in logistic regression models adjusting for age, sex and education. The benchmarks were validated in the test set.

Results: In the training set, the PST benchmarks were: unemployment (≤41); Living with Assistance (≤39) and Medicare/Medicaid (≤42). In the n=1514 test set, the prevalence rates below and above the benchmarks were 65.3% vs 24.5% for unemployment, 34.3% vs 9.3% for Living With Assistance, and 41.9% vs 17.9% for Medicare/Medicaid Insurance. After adjusting for age, sex, education, Patient Determined Disease Steps, timed 25-foot walk, and 9-hole peg test, the PST odds ratios (ORs) [OR (95% CI; p-value)] were: 1.85 (1.25, 2.73; p=.002) for predicting unemployment, 1.96 (1.16, 3.33; p=.001) for Living with Assistance, and 1.58 (2.05, 2.37; p=.029) for Medicare/Medicaid insurance.

Conclusions: Clinically meaningful benchmarks of cognitive performance were identified in a large training sample and validated in a separate cohort. The PST benchmark scores correlated with socioeconomic outcomes even after adjusting for physical disability, emphasizing the relevance of cognition for meaningful MS outcomes.

Study Supported by:

This study was supported by Biogen (Cambridge, MA, USA).

Disclosure: Dr. DeMoor has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Employee of Biogen. Dr. DeMoor holds stock and/or stock options in Holds stock/stock options in Biogen. Dr. Rudick has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Employee of Biogen. Dr. Rudick holds stock and/or stock options in Holds stock/stock options in Biogen. Dr. Williams has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Employee of Biogen. Dr. Williams holds stock and/or stock options in Holds stock/stock options in Biogen. Dr. Krupp has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with as a speaker, consultant and/or participant on an advisory board from Biogen Idec, Novartis, Teva Neurosciences and Multicell; grant support from the National Multiple Sclerosis Society, National Institutes of Health and the Department of Defense. Dr. Krupp has received research support from research support from Novartis, Biogen Idec, Celgene Corporation and Genentech and support from the Lourie Foundation, Slomo and Cindy Silvian Foundation and the Multiple Sclerosis Foundation. Dr. Hersh has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Biogen Idec, Novartis, Teva, and Genzyme. Dr. Rao has received personal compensation in an editorial capacity for Journal of the International Neuropsychological Society; American Psychologist. Dr. Rao has received research support from Biogen.