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Abstract Number: 281

The Pediatric Automated Neuropsychological Assessment Metrics – Reproducibility and Responsive to Change in Cognition in Childhood-Onset Lupus

Patricia Vega-Fernandez1, Marisa S. Klein-Gitelman2, Jessica Hummel3, Erin C. Thomas4, Jennifer L. Huggins5, Frank Zelko6, Tresa Roebuck-Spencer7, Jun Ying8 and Hermine Brunner5, 1Division of Rheumatology, Cincinanti Children's Hospital Medical Center, Cincinnati, OH, 2Division of Rheumatology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, 3Rheumatology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, 4Division of Rheumatology, Anne & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, 5Pediatric Rheumatology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, 6Pediatric Neuropsychology Service, Children's Memorial Hospital, Chicago, IL, 7Center for the Study of Human Operator Performance, University of Oklahoma, Norman, OK, 8Medicine-Internal Medicine-General Medicine, University of Cincinnati, Cincinnati, OH

Meeting: 2012 ACR/ARHP Annual Meeting

Keywords: Cognitive dysfunction, Pediatric rheumatology and systemic lupus erythematosus (SLE)

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Session Information

Title: Pediatric Rheumatology - Clinical and Therapeutic Aspects: Pediatric Systemic Lupus Erythematosus, Pediatric Vasculitis and Pediatric Myositis

Session Type: Abstract Submissions (ACR)

Background/Purpose: The Childhood-onset Systemic Lupus Erythematosus (cSLE) Neuropsychological Battery (AC&R 2010; 62: 1029-33) was introduced to standardize neuropsychological testing (NPT), specifically probing the domains Attention, Working Memory, Psychomotor Speed, Visuoconstructural Ability (VCA). The Pediatric Automated Neuropsychological Assessment Metrics (PedANAM) software was developed to measure cognition in children ³ 10 years. Performance on the PedANAM subtests is assessed by accuracy (AC = % of correct answers), mean reaction time for correct responses (MNc), & throughput (TP), the number of correct responses per minute. The purpose of this study was to (1) assess the reproducibility & (2) investigate the criterion validity of the PedANAM, using the cSLE Neuropsychological Battery as external standard.

Methods: cSLE patients and best-friend controls completed the PedANAM twice at baseline and then every 6 months. NPT was done at baseline and repeated after 18 month; Performance on Formal Neurocognitive Testing was standardized to age/gender/race-specific z-scores (mean 0, standard deviation 1) and then used to measure overall and domain-specific cognition (attention, processing-speed, working memory, VCA). Neurocognitive dysfunction (NCD) was graded as: no-NCD: all z-scores > -1; mild/moderate NCD: at most two z-scores < -1 but > -2 or one z-score < -2; moderate/severe: at least three z-scores < -1 or two z-scores < -2]. Intraclass and Spearman correlation coefficients were done to assess reproducibility and responsiveness to change.

Results: Among 40 cSLE & 40 controls (85% females), 13 (16.25%) had NCD at baseline and 18-month follow-up data were available for 24 cSLE and 16 control patients.  Most subtests had good reproducibility in mean reaction time (MNc) and fair-good reproducibility in accuracy (AC) and consistency (CVc) (Table 1). Changes of AC scores were found positively related to changes of NCD domain scores. In particular, improved (worsening) NCD attention was found positively related to improved (or worsening) AC scores in Matching to Sample, Procedural Reaction Time, and Spatial Processing (r’s >0.3, p’s<0.05) over 18 months. Positive and negative relationships were also found between NCD domain scores and PedANAM MNc and CVc scores respectively (Table2).

 

Conclusion: The PedANAM has good reproducibility especially for MNc measures. Changes cognitive domain scores were found significantly related to changes of performance scores of several PedANAM subtests over 18 months of follow up. These results are in line with our earlier research.

 

 

 

 

 

Table 1: Test-Retest reliability of the PedANAM of the PedANAM Scores  

PedANAM Subtests

Mean reaction time for correct response  (MNc)

Percentage of correct responses (AC)

Consistency

(CVc = SD of MNc/MNc)

Code Substitution Delayed

0.58 (0.44, 0.71)

0.38 (0.21, 0.55)

0.21 (0.02, 0.40)

Code Substitution

0.80 (0.73, 0.88)

0.44 (0.27, 0.61)

0.43 (0.27, 0.60)

Continuous Performance Test

0.71 (0.61, 0.81)

0.78 (0.70, 0.86)

0.68 (0.57, 0.79)

Logical Relations

0.77 (0.69, 0.86)

0.23 (0.03, 0.43)

0.15 (0.00, 0.35)

Matching to Sample

0.64 (0.52, 0.76)

0.52 (0.37, 0.67)

0.57 (0.42, 0.72)

Matching Grids

0.77 (0.68, 0.85)

0.43 (0.25, 0.60)

0.38 (0.21, 0.56)

Mathematical Processing

0.91 (0.87, 0.95)

0.25 (0.05, 0.45)

0.62 (0.49, 0.75)

Procedural Reaction Time

0.47 (0.32, 0.62)

0.10 (0.00, 0.31)

0.16 (0.00, 0.38)

Spatial Processing

0.71 (0.61, 0.82)

0.26 (0.03, 0.49)

0.34 (0.17, 0.51)

Sternberg Memory Search

0.52 (0.38, 0.67)

0.55 (0.41, 0.69)

0.27 (0.10, 0.45)

Simple Reaction Time

0.68 (0.57, 0.79)

not estimable

not estimable

  Values are intraclass correlation coefficients and 95% confidence intervals (in brackets).

 


 

Table 2:  Relationship between changes of PedANAM score & changes of NCD domain scores*

 

PedANAM parameter

PedANAM
Subtest*

ALL study participants (N=40)

Working Memory

Psychomotor Speed

Attention

Visuoconstructional Ability

All Domains

Percentage of correct responses (AC)

Code Substitution Delayed

 

 

 

 

 

Code Substitution

 

 

 

 

 

Continuous Performance Test

 

 

 

 

 

Logical Relations

 

 

 

 

 

Matching to Sample

 

 

0.35

 

0.30

Matching Grids

 

 

 

 

 

Mathematical Processing

 

 

 

 

 

Procedural Reaction Time

 

0.36

0.34

 

0.39

Spatial Processing

 

 

0.33

0.33

0.52

Sternberg Memory Search

 

 

 

 

 

Consistency
(CVc = SD of MNc/MNc)

Code Substitution Delayed

 

 

 

 

 

Code Substitution

 

 

 

 

 

Continuous Performance Test

 

 

-0.32

 

 

Logical Relations

 

 

 

 

 

Matching to Sample

 

-0.35

 

-0.33

-0.41

Matching Grids

 

 

 

 

 

Mathematical Processing

 

 

 

 

 

Procedural Reaction Time

 

 

-0.44

 

-0.38

Spatial Processing

 

 

 

 

 

Sternberg Memory Search

 

 

 

 

 

Mean reaction time for correct response  (MNc)

Code Substitution Delayed

 

 

 

0.31

 

Code Substitution

 

 

 

0.40

 

Continuous Performance Test

0.31

 

 

 

 

Logical Relations

 

 

 

 

 

Matching to Sample

 

-0.36

 

 

 

Matching Grids

 

 

 

 

 

Mathematical Processing

 

 

 

0.39

 

Procedural Reaction Time

 

 

 

0.37

 

Spatial Processing

 

 

 

0.33

 

Sternberg Memory Search

 

 

 

 

 

 

 

 

 


Disclosure:

P. Vega-Fernandez,
None;

M. S. Klein-Gitelman,
None;

J. Hummel,
None;

E. C. Thomas,
None;

J. L. Huggins,
None;

F. Zelko,
None;

T. Roebuck-Spencer,

University of Oklahoma,

3;

J. Ying,
None;

H. Brunner,
None.

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