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Ocular motor measures of cognitive dysfunction in multiple sclerosis II: working memory

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Abstract

Our companion paper documents pervasive inhibitory deficits in multiple sclerosis (MS) using ocular motor (OM) measures. Here we investigated the utility of an OM working memory (WMem) task in characterising WMem deficits in these patients as a function of disease status and disease duration. 22 patients with CIS, 22 early clinically definite MS patients (CDMS: <7 years of diagnosis), 22 late CDMS patients (>7 years from diagnosis), and 22 healthy controls participated. All participants completed the ocular motor WMem task, the paced auditory serial addition test (PASAT), and the symbol digit modalities test (SDMT). Clinical disability was characterised in CDMS patients using the Expanded Disability Severity Scale (EDSS). WMem performance was measured as proportion of errors (WMem errors), saccade latency, and relative sensitivity to WMem loading (WMem effect), an indicator of WMem capacity. All patient groups performed more WMem errors than controls with proportion of WMem errors, and degree of WMem effect increasing with increasing disease duration. A larger WMem effect, reflecting poorer WMem capacity, corresponded to poorer performance on neuropsychological measures, and a higher disability score for CDMS patients with the longest disease duration; an observation that suggests wider implication of WMem executive processes with advancing disease. Conspicuously, performance decrements on standard neuropsychological testing did not similarly increase commensurate with disease duration. The ocular motor WMem task appears to meaningfully dissociate WMem deficit from healthy individuals as well as a function of increasing disease duration. Potentially, this task represents a highly informative and objective method by which to ascertain progressive WMem changes from the earliest inception of MS.

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Acknowledgments

We would like to thank all the participants who gave up their time and conscientiously completed each task. We would also like to thank Bayer, Australia for providing the financial support for this study. The authors are deeply grateful to Mr. Jason Thean Kit Ooi, for his patience, dedication, perseverance, and hard work on the creation of the medical illustrations contained within this two-part series on cognitive abnormalities in MS.

Conflicts of interest

Meaghan Clough, Nathaniel Lizak and Lynette Millist declare that they have no conflicts of interest. Dr. Owen White reports grants from Bayer, Australia, during the conduct of the study; personal fees from Bayer, Australia, grants from Biogen, grants and personal fees from Novartis, personal fees from Genzyme, outside the submitted work. Dr. Joanne Fielding reports grants from Bayer, Australia, during the conduct of the study; grants from Biogen, grants from Novartis, outside the submitted work. Teresa Frohman has received speaker and consulting fees from Novartis, Genzyme, and Acorda. Dr. Elliot Frohman has received speaker and consulting fees from Novartis, Genzyme, and Acorda.

Ethical standard

All human studies have been approved by the appropriate ethics committee and have, therefore, been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. All persons involved in this study gave their informed consent prior to their inclusion in the study.

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Authors and Affiliations

  1. School of Psychological Sciences, Monash University, Clayton, 3800, Australia

    Meaghan Clough, Laura Mitchell, Nathaniel Lizak & Joanne Fielding

  2. Department of Neurology, Royal Melbourne Hospital, Parkville, 3050, Australia

    Lynette Millist, Nathaniel Lizak & Owen B. White

  3. Department of Medicine, University of Melbourne, Parkville, 3010, Australia

    Lynette Millist, Owen B. White & Joanne Fielding

  4. Department of Neurology and Neurotherapeutics, University of Texas Southwestern School of Medicine, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA

    Shin Beh & Teresa C. Frohman

  5. Department of Neurology and Neurotherapeutics and Ophthalmology, University of Texas Southwestern School of Medicine, Dallas, 75390, USA

    Elliot M. Frohman

Authors
  1. Meaghan Clough
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  2. Laura Mitchell
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Corresponding author

Correspondence to Elliot M. Frohman.

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Clough, M., Mitchell, L., Millist, L. et al. Ocular motor measures of cognitive dysfunction in multiple sclerosis II: working memory. J Neurol 262, 1138–1147 (2015). https://doi.org/10.1007/s00415-015-7644-4

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  • DOI: https://doi.org/10.1007/s00415-015-7644-4

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