Neurocognitive and Psychosocial Profiles of Pediatric Multiple Sclerosis and Transverse Myelitis

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2018-07-30

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Tan, Alexander

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Abstract

Research shows that youth with multiple sclerosis (MS) are at risk for neuropsychological deficits due to cerebral involvement, but establishing a clear profile remains difficult due to disease complexity. Emerging evidence also shows neuropsychological deficits and the possibility of brain-based involvement in youth with transverse myelitis (TM) despite absence of obvious cerebral pathology. The present objective is to further investigate neuropsychological sequelae associated with pediatric MS and TM by characterizing and comparing neurocognitive and psychosocial profiles using profile analysis, a method which has not been utilized to investigate neuropsychological functioning in pediatric demyelinating diseases. Sixty-two pediatric MS and 46 pediatric idiopathic TM participants were administered brief neuropsychological screening evaluations during routine clinical care. Separate profile analyses were conducted on performance-based neurocognitive and parent-rated psychosocial variables of interest. Results of the neurocognitive profile analysis revealed significantly (p < .05) poorer overall performance in MS, with measures of cognitive flexibility, visual-motor integration, and fine-motor speed and dexterity found to be significant (p < .05) contributors to combined profiles. However, no significant difference was found in profile patterns between MS and TM groups. Results of the psychosocial profile analysis revealed no significant difference in overall levels of psychosocial problems between groups, with no individual measures found to be significant contributors to combined profiles. However, a significant (p < .05) difference in profile patterns was found between MS and TM groups, characterized by increased elevations in working memory and attention difficulties in MS and physical and social quality of life difficulties in TM. These findings elucidate the neurocognitive and psychosocial sequelae of pediatric MS and TM. While it is established that pediatric patients with MS often present with wide-ranging neuropsychological deficits consistent with brain-based pathology, the present study shows that pediatric patients with TM are also considered to be at risk for neuropsychological difficulties, suggesting that disease mechanisms may impact brain function despite the lack of obvious cerebral involvement. Findings of the current study indicate neuropsychologists play an important role in assessment and treatment planning for these populations, and youth with TM may also benefit from interventions to address cognitive and psychosocial problems.

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