Comparisons of patient self-report, neurologic examination, and functionalimpairment in MS

Objective: To compare the recently developed Guy's Neurologic Disability Sc ale (GNDS), based on patient self-report, with both neurologist rating of n eurologic examination abnormalities using the Expanded Disability Status Sc ale (EDSS) and observations of functional impairment on the Multiple Sclero sis Functional Composite (MSFC) in the assessment of disease impact in MS. Method: Two hundred ninety RIS patients were recruited at an outpatient cli nic. Impairment and disability were assessed using GNDS, EDSS, and MSFC. Co rrelations between GNDS, EDSS, MSFC, and their corresponding components wer e studied for the total population, NS phenotypes, and three disability str ata. Results: Mean scores were 4.6 (SD, 2.0) for EDSS, 0.0 (SD, 0.8) for MS FC, and 14.6 (SD, 7.9) for GNDS. Good correlations were found between GNDS and EDSS (r = 0.73), between GNDS and MSFC (r = -0.68), and between differe nt subcategories of the GNDS and EDSS, MSFC, and their corresponding compon ents. Remarkably good correlations were found between lower limb function a nd all three scales. Poor correlations were also found, especially between different measurements focusing on cognitive function. Conclusion: The good correlations between GNDS and both EDSS and MSFC were mainly due to the im portance of spinal-cord-related neurologic functions in all three scoring s ystems. A marked discrepancy was found for the assessment of cognition betw een objective measurements and subjective complaints. Because patients' sel f-reporting correlates well with results of physical examination, GNDS can offer a valuable way to measure disease impact in RIS. However, GNDS is not an adequate screen of cognitive dysfunction.