Interpreting change on the Symbol Digit Modalities Test in people with relapsing multiple sclerosis using the reliable change methodology-Reference-Cited by-同舟云学术

Interpreting change on the Symbol Digit Modalities Test in people with relapsing multiple sclerosis using the reliable change methodology

Published:2021-10-06 Issue: Volume: Page:135245852110493
ISSN:1352-4585
Container-title:Multiple Sclerosis Journal
language:en
Short-container-title:Mult Scler

Author:

Weinstock Zachary¹^ORCID,Morrow Sarah²,Conway Devon³^ORCID,Fuchs Tom¹^ORCID,Wojcik Curtis⁴,Unverdi Mahmut⁴^ORCID,Zivadinov Robert⁵^ORCID,Weinstock-Guttman Bianca⁶^ORCID,Iverson Grant L⁷,Dwyer Michael⁵,Benedict Ralph HB⁶

Affiliation:

1. Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, USA

2. Department of Clinical Neurological Sciences, Western University and London Health Sciences Center, London, ON, Canada

3. Mellen Center for Multiple Sclerosis Treatment, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA

4. Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, USA

5. Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, USA/Jacobs MS Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, USA

6. Jacobs MS Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, USA

7. Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA/Spaulding Rehabilitation Hospital and Spaulding Research Institute, Charlestown, MA, USA

Abstract

Background: The Symbol Digit Modalities Test (SDMT) is increasingly utilized in clinical trials. A SDMT score change of 4 points is considered clinically important, based on association with employment anchors. Optimal thresholds for statistically reliable SDMT changes, accounting for test reliability and measurement error, are yet to be applied to individual cases. Objective: The aim of this study was to derive a statistically reliable marker of individual change on the SDMT. Methods: This prospective, case–control study enrolled 166 patients with multiple sclerosis (MS). SDMT scores at baseline, relapse, and 3-month follow-up were compared between relapsing and stable patient groups. Using data from the stable group and three previously published studies, candidate thresholds for reliable decline were calculated and validated against other tests and a clinically meaningful anchor—cognitive relapse. Results: Candidate thresholds for reliable decline at the 80% confidence level varied between 6 and 11 points. An SDMT change of 8 or more raw score points was deemed to offer the best balance of discriminatory power and external validity for estimating cognitive decline. Conclusion: This study illustrates the feasibility and usefulness of reliable change methodology for identifying statistically meaningful cognitive decline that could be implemented to identify change in individual patients, for both clinical management and clinical trial outcomes.

Funder

National Multiple Sclerosis Society

Publisher

SAGE Publications

Subject

Neurology (clinical),Neurology

Link

http://journals.sagepub.com/doi/pdf/10.1177/13524585211049397

Reference32 articles.

1. Diagnosis and treatment of multiple sclerosis

2. Characterizing cognitive function during relapse in multiple sclerosis

3. Recovery of cognitive function after relapse in multiple sclerosis