000131826 001__ 131826
000131826 005__ 20240319081023.0
000131826 0247_ $$2doi$$a10.1016/j.msard.2022.104138
000131826 0248_ $$2sideral$$a137004
000131826 037__ $$aART-2022-137004
000131826 041__ $$aeng
000131826 100__ $$aSaposnik, Gustavo
000131826 245__ $$aDelayed cognitive processing and treatment status quo bias in early-stage multiple sclerosis
000131826 260__ $$c2022
000131826 5203_ $$aBackground
The evolving therapeutic landscape requires more participation of patients with relapsing remitting multiple sclerosis (RRMS) in treatment decisions. The aim of this study was to assess the association between patient's self-perception, cognitive impairment and behavioral factors in treatment choices in a cohort of patients at an early stage of RRMS.
Methods
We conducted a multicenter, non-interventional study including adult patients with a diagnosis of RRMS, a disease duration ≤18 months and receiving care at one of the 21 participating MS centers from across Spain. We used patient-reported measures to gather information on fatigue, mood, quality of life, and perception of severity of their MS. Functional metrics (Expanded Disability Status Scale [EDSS], cognitive function by the Symbol Digit Modalities Test [SDMT], 25-foot walk test) and clinical and radiological data were provided by the treating neurologist. The primary outcome of the study was status quo (SQ) bias, defined as participant's tendency to continue taking a previously selected but inferior treatment when intensification was warranted. SQ bias was assessed based on participants treatment preference in six simulated RRMS case scenarios with evidence of clinical relapses and radiological disease progression.
Results
Of 189 participants who met the inclusion criteria, 188 (99.5%) fully completed the study. The mean age was 36.6 ± 9.5 years, 70.7% female, mean disease duration: 1.2 ± 0.8 years, median EDSS score: 1.0 [IQR=0.0–2.0]). Overall, 43.1% patients (n = 81/188) had an abnormal SDMT (≤49 correct answers). SQ bias was observed in at least one case scenario in 72.3% (137/188). Participant's perception of their MS severity was associated with higher SQ bias (β coeff 0.042; 95% CI 0.0074–0.076) among those with delayed cognitive processing. Higher baseline EDSS and number of T2 lesions were predictors of delayed processing speed (OR EDSS=1.57, 95% CI: 1.11–2.21, p = 0.011; OR T2 lesions=1.50, 95% CI: 1.11–2.03, p<0.01). Bayesian multilevel model accounting for clustering showed that delayed cognitive processing (exp coeff 1.06; 95% CI 1.04–1.09) and MS symptoms severity (exp coeff 1.28; 95% CI 1.22–1.33) were associated with SQ bias.
Conclusion
Over 40% of patients in earlier stages of RRMS experience delays in cognitive processing that might affect their decision-making ability. Our findings suggest that patients' self-perception of disease severity combined with a delay in cognitive processing would affect treatment choices leading to status quo bias early in the course of their disease.
000131826 540__ $$9info:eu-repo/semantics/openAccess$$aAll rights reserved$$uhttp://www.europeana.eu/rights/rr-f/
000131826 590__ $$a4.0$$b2022
000131826 591__ $$aCLINICAL NEUROLOGY$$b69 / 212 = 0.325$$c2022$$dQ2$$eT1
000131826 592__ $$a0.92$$b2022
000131826 593__ $$aMedicine (miscellaneous)$$c2022$$dQ1
000131826 593__ $$aNeurology (clinical)$$c2022$$dQ2
000131826 593__ $$aNeurology$$c2022$$dQ2
000131826 594__ $$a5.6$$b2022
000131826 655_4 $$ainfo:eu-repo/semantics/article$$vinfo:eu-repo/semantics/publishedVersion
000131826 700__ $$aAndhavarapu, Sanketh
000131826 700__ $$aSainz de la Maza, Susana
000131826 700__ $$aCastillo-Triviño, Tamara
000131826 700__ $$aBorges, Mónica
000131826 700__ $$aPardiñas Barón, Beatriz$$uUniversidad de Zaragoza
000131826 700__ $$aSotoca, Javier
000131826 700__ $$aAlonso, Ana
000131826 700__ $$aCaminero, Ana B.
000131826 700__ $$aBorrega, Laura
000131826 700__ $$aSánchez-Menoyo, José L.
000131826 700__ $$aBarrero-Hernández, Francisco J.
000131826 700__ $$aCalles, Carmen
000131826 700__ $$aBrieva, Luis
000131826 700__ $$aBlasco, María R.
000131826 700__ $$aDotor García-Soto, Julio
000131826 700__ $$adel Campo-Amigo, María
000131826 700__ $$aNavarro-Cantó, Laura
000131826 700__ $$aAgüera, Eduardo
000131826 700__ $$0(orcid)0000-0002-1756-5492$$aGarcés, Moisés$$uUniversidad de Zaragoza
000131826 700__ $$aCarmona, Olga
000131826 700__ $$aGabaldón-Torres, Laura
000131826 700__ $$aForero, Lucía
000131826 700__ $$aHervás, Mariona
000131826 700__ $$aGarcía-Arcelay, Elena
000131826 700__ $$aTerzaghi, María
000131826 700__ $$aGómez-Ballesteros, Rocío
000131826 700__ $$aMaurino, Jorge
000131826 7102_ $$11007$$2610$$aUniversidad de Zaragoza$$bDpto. Medicina, Psiqu. y Derm.$$cArea Medicina
000131826 773__ $$g68 (2022), 104138 [9 pp.]$$pMult. scler. relat. disord.$$tMultiple Sclerosis and Related Disorders$$x2211-0348
000131826 8564_ $$s953250$$uhttps://zaguan.unizar.es/record/131826/files/texto_completo.pdf$$yVersión publicada
000131826 8564_ $$s2230203$$uhttps://zaguan.unizar.es/record/131826/files/texto_completo.jpg?subformat=icon$$xicon$$yVersión publicada
000131826 909CO $$ooai:zaguan.unizar.es:131826$$particulos$$pdriver
000131826 951__ $$a2024-03-18-16:27:56
000131826 980__ $$aARTICLE