Cognitive Performance in Pediatric Multiple Sclerosis


Kimberly O’Neill, MD, pediatric neuroimmunology fellow at NYU Langone, discussed her presentation at the 2023 AAN Annual Meeting focused on cognitive similarities between pediatric and adult MS.

Kimberly O’Neill, MD

Kimberly O’Neill, MD

Research has shown that cognition can be impacted in patients with multiple sclerosis (MS) over time; however, the onset of this decline is not clear. Studies of cognition in pediatrics have produced mixed results, prompting a group of investigators, led by Kimberly O’Neill, MD, to examine longitudinal cognitive performance.

Presented at the 2023 American Academy of Neurology (AAN) Annual Meeting, April 22-27, in Boston, Massachusetts, the study included a group of pediatric patients with MS (n = 71), pediatric healthy peers (n = 99), and adults with MS (n = 66). Each individual completed the Brief International Cognitive Assessment for MS (BICAMS) and Cogstate Brief Battery (CBB), with findings measured using z-scores based on available normative data.

Most of the cohort returned for a follow-up after a mean of 2.15 years, with cognitive performance that remained relatively stable between groups. Between pediatric patients with MS and controls, no significant differences were seen on z-scores for Symbol Digit Modalities Test (­–0.4 vs 0.1; P = .020), Rey Auditory Verbal Learning Test (–0.6 vs –0.6; P = .90), and Brief Visuospatial Memory Test-Revised (­–0.0 vs 0.1; P = .52). Pediatric vs adult cases only differed in regard to RAVLT, where both pediatric MS and pediatric controls declined to a greater degree than adults with MS (P = .007).

O’Neill, a pediatric neuroimmunology fellow at NYU Langone, sat down at the meeting to provide more context on the research, and the reassuring feeling of unimpaired cognition in pediatric MS in those early in their short-term disease course.

NeurologyLive®: Can you provide an overview of your research and why you chose this specific topic?

Kimberly O’Neill, MD: This is an exciting project, it was a comprehensive study across the US Network of Pediatric MS Centers, which includes 10 clinical centers across the country. It's a nationally representative sample, and we were able to include 3 different groups: pediatric participants with MS, pediatric healthy controls, and adult with MS. We gave them a brief cognitive battery at baseline, followed them up 2 years later, and repeated those brief cognitive batteries.

We were excited about our results, specifically, that at baseline, our pediatric MS cohort were very similar to our pediatric healthy controls [in cognition function], and they didn't change much over the two-year period. At follow up, we observed similar findings, our pediatric MS participants did very similar to our pediatric healthy control. We were thrilled to share these results at this year’s AAN Annual Meeting.

Are there ways to combat potential early changes in cognition?

It’s a great question. In pediatrics in general, these are young people. They are in school, they're taking tests, so I think as a physician or provider, talking to the families, seeing how they're doing in school, and making sure if they need help, that they're getting an entire neuropsychological evaluation. If they need help in school, getting the resources they need. That goes for patients with MS or not. There are rates of cognitive impairment in general population, and so anyone would need those resources. It might not even be specific to pediatric MS, but just further emphasizing working with the families to get any patients or children help they need.

Do you believe the tools available to assess cognition in pediatrics are sufficient?

In nature, in our study, we did a brief cognitive battery. It’s brief, it's not a full day of testing. But at NYU [Langone], we're lucky to have a brilliant neuropsychologist, Leigh Charvet, Phd, who's published [research] on this question. Both in an article in 2018 and in the multiple sclerosis journal, she showed how sensitive both the BICAMS and cogstate are in a pediatric MS population. Brief cognitive batteries are not perfect, but so far the research we’ve showed indicates they're very sensitive and applicable to our pediatric MS Population.

Are there periods in a patient’s life in which they may be more susceptible to cognitive changes?

Generally, patients with lifelong relapsing remitting [MS] cognitively do very well. It's later in life, our aging population and those with progressive MS features, that we worry a little bit more about their cognition. That would be when we're paying a little bit more attention to that age range.

Click here for more coverage of AAN 2023.

O’Neill K, Charvet L, Waltz M, et al. Longitudinal cognitive screening findings in pediatric MS vs pediatric controls and adult MS in a multicenter cohort. Presented at: 2023 AAN Annual Meeting; April 22-27; Boston, MA.
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