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Low contrast visual acuity testing is associated with cognitive performance in multiple sclerosis: a cross-sectional pilot study.

Wieder L, Gäde G, Pech LM, Zimmermann H, Wernecke KD, Dörr JM, Bellmann-Strobl J, Paul F, Brandt AU - BMC Neurol (2013)

Bottom Line: In combined analyses using generalized estimating equation models, Paced Auditory Serial Addition Test (PASAT) and RNFL as well as and the Symbol Digit Modalities Test (SDMT) and RNFL predicted CS.To further control for a potential influence of the anterior visual system we performed partial correlation analyses between visual function and cognitive function test results but controlling for RNFL.Even when controlling for RNFL, CS was associated with PASAT performance and SDMT performance.

View Article: PubMed Central - HTML - PubMed

Affiliation: NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Berlin, Germany. alexander.brandt@charite.de.

ABSTRACT

Background: Cognitive impairment and visual deterioration are two key clinical symptoms in MS and affect 50 to 80% of patients. Little is known about the influence of cognitive impairment on visual tests recommended for MS such as low contrast sensitivity testing. Our objective was to investigate whether low contrast sensitivity testing is influenced by cognitive impairment in multiple sclerosis (MS) patients.

Methods: Cross-sectional study including 89 patients with relapsing-remitting MS. All patients received cognitive evaluation using Rao's Brief Repeatable Battery of Neuropsychological Testing (BRB-N). Visual assessments included low contrast sensitivity (CS) by functional acuity contrast testing and high contrast visual acuity (VA) using ETDRS charts. Retinal morphology as visual impairment correlate was measured using retinal nerve fiber layer (RNFL) thickness by optical coherence tomography.

Results: In combined analyses using generalized estimating equation models, Paced Auditory Serial Addition Test (PASAT) and RNFL as well as and the Symbol Digit Modalities Test (SDMT) and RNFL predicted CS. To further control for a potential influence of the anterior visual system we performed partial correlation analyses between visual function and cognitive function test results but controlling for RNFL. Even when controlling for RNFL, CS was associated with PASAT performance and SDMT performance.

Conclusion: Our data show that: a) cognitive impairment and performance in visual function tests such as low contrast sensitivity testing are associated; b) the main cognitive domains correlating with visual test performance are information processing speed and, to a lesser degree, memory; This preliminary data needs to be substantiated in further studies investigating patients with a higher cognitive burden, healthy controls and in longitudinal settings.

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Local regression analysis of cognitive influence on low contrast sensitivity testing. A) Correlation between PASAT and CS, B) Correlation between SDMT and CS. Grey lines are from LOESS analysis. Horizontal LOESS lines represent areas with low or no correlation; rising LOESS lines represent areas with correlation between cognitive function and visual function test performance. For better visibility dotted lines separate the areas with an influence (left sides) and without influence (right sides). Data from partial correlations controlling for retinal nerve fibre layer thickness show a similar result (not shown). Abbreviations: LOESS, local regression analysis; CS, low contrast sensitivity; PASAT, paced auditory serial addition test three second version; SDMT, symbol digit modalities test; FACT, functional acuity contrast testing; AUC, area under the log contrast sensitivity function.
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Figure 1: Local regression analysis of cognitive influence on low contrast sensitivity testing. A) Correlation between PASAT and CS, B) Correlation between SDMT and CS. Grey lines are from LOESS analysis. Horizontal LOESS lines represent areas with low or no correlation; rising LOESS lines represent areas with correlation between cognitive function and visual function test performance. For better visibility dotted lines separate the areas with an influence (left sides) and without influence (right sides). Data from partial correlations controlling for retinal nerve fibre layer thickness show a similar result (not shown). Abbreviations: LOESS, local regression analysis; CS, low contrast sensitivity; PASAT, paced auditory serial addition test three second version; SDMT, symbol digit modalities test; FACT, functional acuity contrast testing; AUC, area under the log contrast sensitivity function.

Mentions: To determine whether the anterior visual system (i.e. retinal damage) influences the correlations discussed above, we performed partial correlation analyses between visual function and cognitive function tests but controlling for RNFL. This way, an influence of actual retinal damage to the performance on visual tests should be eliminated. When controlling for RNFL, a clear correlation was determined between VA and SRT-D, SPART, SDMT and PASAT3. Likewise, CS correlated with the latter cognitive tests, as well as with PASAT2 and WLG (Table 2). In the involved domains, coefficients were moderate and roughly twice as high for cognitive influence on CS as for cognitive influence on VA with the exception of SDMT, a visually dependent cognitive test. SDMT correlation with visual function testing was highest among all tests with r = 0.34 both in CS and VA testing (Figure 1).


Low contrast visual acuity testing is associated with cognitive performance in multiple sclerosis: a cross-sectional pilot study.

Wieder L, Gäde G, Pech LM, Zimmermann H, Wernecke KD, Dörr JM, Bellmann-Strobl J, Paul F, Brandt AU - BMC Neurol (2013)

Local regression analysis of cognitive influence on low contrast sensitivity testing. A) Correlation between PASAT and CS, B) Correlation between SDMT and CS. Grey lines are from LOESS analysis. Horizontal LOESS lines represent areas with low or no correlation; rising LOESS lines represent areas with correlation between cognitive function and visual function test performance. For better visibility dotted lines separate the areas with an influence (left sides) and without influence (right sides). Data from partial correlations controlling for retinal nerve fibre layer thickness show a similar result (not shown). Abbreviations: LOESS, local regression analysis; CS, low contrast sensitivity; PASAT, paced auditory serial addition test three second version; SDMT, symbol digit modalities test; FACT, functional acuity contrast testing; AUC, area under the log contrast sensitivity function.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4226200&req=5

Figure 1: Local regression analysis of cognitive influence on low contrast sensitivity testing. A) Correlation between PASAT and CS, B) Correlation between SDMT and CS. Grey lines are from LOESS analysis. Horizontal LOESS lines represent areas with low or no correlation; rising LOESS lines represent areas with correlation between cognitive function and visual function test performance. For better visibility dotted lines separate the areas with an influence (left sides) and without influence (right sides). Data from partial correlations controlling for retinal nerve fibre layer thickness show a similar result (not shown). Abbreviations: LOESS, local regression analysis; CS, low contrast sensitivity; PASAT, paced auditory serial addition test three second version; SDMT, symbol digit modalities test; FACT, functional acuity contrast testing; AUC, area under the log contrast sensitivity function.
Mentions: To determine whether the anterior visual system (i.e. retinal damage) influences the correlations discussed above, we performed partial correlation analyses between visual function and cognitive function tests but controlling for RNFL. This way, an influence of actual retinal damage to the performance on visual tests should be eliminated. When controlling for RNFL, a clear correlation was determined between VA and SRT-D, SPART, SDMT and PASAT3. Likewise, CS correlated with the latter cognitive tests, as well as with PASAT2 and WLG (Table 2). In the involved domains, coefficients were moderate and roughly twice as high for cognitive influence on CS as for cognitive influence on VA with the exception of SDMT, a visually dependent cognitive test. SDMT correlation with visual function testing was highest among all tests with r = 0.34 both in CS and VA testing (Figure 1).

Bottom Line: In combined analyses using generalized estimating equation models, Paced Auditory Serial Addition Test (PASAT) and RNFL as well as and the Symbol Digit Modalities Test (SDMT) and RNFL predicted CS.To further control for a potential influence of the anterior visual system we performed partial correlation analyses between visual function and cognitive function test results but controlling for RNFL.Even when controlling for RNFL, CS was associated with PASAT performance and SDMT performance.

View Article: PubMed Central - HTML - PubMed

Affiliation: NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Berlin, Germany. alexander.brandt@charite.de.

ABSTRACT

Background: Cognitive impairment and visual deterioration are two key clinical symptoms in MS and affect 50 to 80% of patients. Little is known about the influence of cognitive impairment on visual tests recommended for MS such as low contrast sensitivity testing. Our objective was to investigate whether low contrast sensitivity testing is influenced by cognitive impairment in multiple sclerosis (MS) patients.

Methods: Cross-sectional study including 89 patients with relapsing-remitting MS. All patients received cognitive evaluation using Rao's Brief Repeatable Battery of Neuropsychological Testing (BRB-N). Visual assessments included low contrast sensitivity (CS) by functional acuity contrast testing and high contrast visual acuity (VA) using ETDRS charts. Retinal morphology as visual impairment correlate was measured using retinal nerve fiber layer (RNFL) thickness by optical coherence tomography.

Results: In combined analyses using generalized estimating equation models, Paced Auditory Serial Addition Test (PASAT) and RNFL as well as and the Symbol Digit Modalities Test (SDMT) and RNFL predicted CS. To further control for a potential influence of the anterior visual system we performed partial correlation analyses between visual function and cognitive function test results but controlling for RNFL. Even when controlling for RNFL, CS was associated with PASAT performance and SDMT performance.

Conclusion: Our data show that: a) cognitive impairment and performance in visual function tests such as low contrast sensitivity testing are associated; b) the main cognitive domains correlating with visual test performance are information processing speed and, to a lesser degree, memory; This preliminary data needs to be substantiated in further studies investigating patients with a higher cognitive burden, healthy controls and in longitudinal settings.

Show MeSH
Related in: MedlinePlus