A recent review by Kessler Foundation researchers explored the relationship between neuropsychological assessment and predictability of performance of everyday life activities among people with multiple sclerosis (MS). The article, “Beyond cognitive dysfunction: Relevance of ecological validity of neuropsychological tests in multiple sclerosis,” was epublished on August 30, 2019 by the Multiple Sclerosis Journal in a special issue on rehabilitation.
The authors are Erica Weber, PhD, and John DeLuca, PhD of Kessler Foundation, and Yael Goverover, PhD, of New York University, who is a visiting scientist at Kessler Foundation. Drs. Weber and Goverover are former Switzer fellows. The Switzer Fellowship is awarded by the National Institute on Disability Independent Living and Rehabilitation Research to postdoctoral fellows with the potential to change the lives of people with disabilities though their research.
Individuals with neurological diseases such as MS often undergo neuropsychological testing to evaluate the influence of cognitive effects on their ability to perform everyday life activities. To be a useful tool for the clinicians who care for these individuals, it is important that their performance on neuropsychological testing parallels their function in everyday life. The Kessler team examined this issue, as well as the broader context for the question: “Are neuropsychological tests ecologically valid?”
The authors examined the literature on the relationships between cognitive and functional domains in the MS population. Cognitive functions included processing speed, executive function, visuospatial function, learning and memory, working memory, and verbal fluency. Functional domains included driving, employment, internet shopping and financial/medical decision-making.
They found that neuropsychological tests do have predictive value for individuals’ behavior in these real life settings, according to Dr. Weber, research scientist in the Center for Traumatic Brain Injury Research. “While neuropsychological tests are ecologically valid in this population, other measures need to be considered in the clinical evaluation of individuals with MS, in order to understand the impact of the disease on everyday function,” she explained. “Everyday life is complex, and there is no single measure for predicting the performance of complex daily activities. This is especially true for MS.”
In summary, to best serve the clinical needs of individuals with MS, neuropsychological testing needs to be viewed in larger context comprising non-cognitive variables, such as motor ability and demographic values, fatigue and depression, and disease activity and level of disability, as well as person-specific factors such as personality and coping styles. “It’s important to note that other types of assessments used to evaluate individuals with MS need to be subjected to the same standards for validity as neuropsychological assessments,” added Dr. Weber.
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