Course of Cognitive Functioning in Institutionalized Persons With Moderate to Severe Dementia: Evidence From the Severe Impairment Battery Short Version.

OBJECTIVES: To adequately monitor the course of cognitive functioning in persons with moderate to severe dementia, relevant cognitive tests for the advanced dementia stages are needed. We examined the ability of a test developed for the advanced dementia stages, the Severe Impairment Battery Short version (SIB-S), to measure cognitive change over time. Second, we examined type of memory impairment measured with the SIB-S in different dementia stages. METHODS: Participants were institutionalized persons with moderate to severe dementia (N = 217). The SIB-S was administered at 6-month intervals during a 2-year period. Dementia severity at baseline was classified according to Global Deterioration Scale criteria. We used mixed models to evaluate the course of SIB-S total and domain scores, and whether dementia stage at baseline affected these courses. RESULTS: SIB-S total scores declined significantly over time, and the course of decline differed significantly between dementia stages at baseline. Persons with moderately severe dementia declined faster in mean SIB-S total scores than persons with moderate or severe dementia. Between persons with moderate and moderately severe dementia, there was only a difference in the rate of decline of semantic items, but not episodic and non-semantic items. CONCLUSIONS: Although modest floor and slight ceiling effects were noted in severe and milder cases, respectively, the SIB-S proved to be one of few available adequate measures of cognitive change in institutionalized persons with moderate to severe dementia. (JINS, 2019, 25, 204-214).

Sensory Function and Chronic Pain in Multiple Sclerosis.

Objective: To examine whether hypoesthesia and chronic pain are related in patients with MS. Methods: Sixty-seven MS patients with pain and 80 persons without MS were included. Sensory functioning was tested by bedside neurological examination. Touch, joint position (dorsal column-medial lemniscus pathway), temperature sense, and pain (spinothalamic tract) were tested. Pain intensity was measured by the Colored Analogue Scale (CAS Intensity) and the Faces Pain Scale (FPS); pain affect was also measured by CAS Affect and Number of Words Chosen-Affective (NWC-A). Mood was assessed with the SCL-90 anxiety and depression subscales and the Beck Depression Inventory (BDI). Results: A significant negative relationship was found between pain intensity and the function of the dorsal column-medial lemniscal pathway, but not with the spinothalamic tract. Conclusion: In addition to the already known relation between hyperesthesia and pain, hypoesthesia for touch and joint position also seems to be related to chronic pain in MS patients.

Psychiatric and physical comorbidities and pain in patients with multiple sclerosis.

BACKGROUND: It has been observed that patients with multiple sclerosis (MS), who have psychiatric and physical comorbidities such as depression and COPD, have an increased risk of experiencing more pain. In this study, we have distinguished between pain intensity and pain affect, as the latter, particularly, requires treatment. Furthermore, while pain and comorbidities have been assessed using questionnaires, this is possibly a less reliable method for those who are cognitively vulnerable. OBJECTIVE: The aim of this study was to determine whether psychiatric and physical comorbidities can predict pain intensity and pain affect in MS patients, susceptible to cognitive impairment. METHODS: Ninety-four patients with MS and 80 control participants participated in this cross-sectional study. Besides depression and anxiety, 47 additional comorbidities were extracted from patients' medical records. Depression and anxiety were assessed using the Beck Depression Inventory and the Symptom Check List-90. Pain was assessed using the Number of Words Chosen Affective, Coloured Analog Scale, and the Faces Pain Scale. Cognitive functions, for example, memory and executive functions, were assessed using several neuropsychological tests. RESULTS: The main findings indicate that psychiatric comorbidities (depression and anxiety) predict both pain intensity and pain affect and that total physical comorbidity predicts only pain affect in MS patients, susceptible to cognitive impairment. CONCLUSION: Both psychiatric and physical comorbidities predict pain affect. All three clinical outcomes enhance MS patients' suffering.