An investigation of cognitive impairments in Relapsing Remitting Multiple Sclerosis using an ecologically valid test of executive functioning

Abstract

Background
Multiple Sclerosis (MS) is a multi-faceted condition which is characterised primarily by demyelination of white matter in the central nervous system. MS is associated with physical, cognitive and emotional impairments, which can have a significant impact on daily functioning. Cognitive impairments are observed in multiple domains, including processing speed, verbal memory and executive functioning. However, previous studies have reported mixed findings in relation to the ability of neuropsychological tasks to detect difficulties in everyday functioning, particularly in terms of executive functioning.

Aims
This study aimed to investigate cognitive abilities in relapsing remitting MS (RRMS) using a novel modification of the Hotel Task, designed to be a more ecologically valid test of executive functioning. In particular, performance of participants with RRMS was compared on high and low executive demand conditions of this task, and was also compared to performance on traditional neuropsychological assessments.

Method
Nineteen participants with RRMS and 19 matched healthy controls completed the Standard and Structured conditions of the Hotel Task, alongside a battery of traditional neuropsychological tasks and questionnaires measuring non-cognitive symptoms and everyday cognitive functioning.

Results
Participants with RRMS performed similarly to healthy controls on the executive functioning variables of the Hotel Task, although with a significant deficit on the prospective memory task. Participants with RRMS displayed significantly less efficient performance on both conditions of the Hotel Task compared to controls, and performance did not differ significantly between conditions.

Conclusions
These results were interpreted as evidence that RRMS is not associated with a disproportionate impairment in planning and multitasking, although specific impairments in prospective memory may be present. The Hotel Task holds some promise as a sensitive measure of cognitive difficulties in people with RRMS. Implications and suggestions for future research are discussed.

Date of Award	2014
Original language	English
Awarding Institution	King's College London
Supervisor	Robin Morris (Supervisor) & Richard Brown (Supervisor)