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"Latar Belakang: Gangguan kognitif dapat terjadi pada multipel sklerosis (MS) dan berdampak menurunnya kualitas hidup. Brief International Cognitive Assessment for MS (BICAMS) merupakan instrumen untuk mendeteksi gangguan kognitif penyandang MS. Penelitian ini bertujuan untuk memvalidasi instrumen BICAMS versi bahasa Indonesia (BICAMS-INA). Metode: Penelitian potong lintang ini dilakukan di Rumah Sakit Umum Pusat Nasional Cipto Mangunkusumo Jakarta periode Mei-Juni 2018 pada kelompok MS dan kontrol. Pemeriksaan BICAMS yang terdiri dari; Symbol Digit Modalities Test (SDMT), California Verbal Learning Test-II (CVLT-II), dan Brief Visuospatial Memory Test Revised (BVMTR) dilakukan pada 23 kelompok MS dan 66 kelompok kontrol. Kemudian dilakukan retest pada 13 kelompok MS dan 23 kelompok kontrol. Hasil: Rerata (±SD) hasil pemeriksaan BICAMS pada kelompok MS dan kontrol sebagai berikut: SDMT kelompok MS 41,4±15,1; kelompok kontrol 64,9+16,2 (p<0,001, r=0,55 dan cohen's d 1,50); CVLT-II kelompok kontrol MS 52,2+11,6; kelompok kontrol 61,5+9,7 (p=0,001, r=0,36 dan cohen's d 0,87); BVMTR kelompok MS 23,4+7,0; kontrol kontrol 29,3+5,6, (p<0,001, r=0,40 dan cohen's d 0,93). Didapatkan perbedaan yang bermakna antara kelompok MS dan kontrol pada semua pemeriksaan. Kesimpulan: Didapatkan suatu kuesioner BICAMS-INA yang valid dan reliabel dalam menilai fungsi kognitif penyandang MS.

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Background: Cognitive impairment can occur in multiple sclerosis (MS) and impact on decreased quality of life. Brief International Cognitive Assessment for MS (BICAMS) is an instrument to detect cognitive impairment in MS. This study aimed to validate the Indonesian version of BICAMS (BICAMS-INA). Methods: This cross-sectional study was performed in Cipto Mangunkusumo National General Hospital, Jakarta, from May to June 2018 on MS and control group. Consisted of Symbol Digit Modalities Test (SDMT), California Verbal Learning Test-II (CVLTII), and Brief Visuospatial Memory Test Revised (BVMTR), this instrument was administered to 23 patients with MS and 66 healthy controls. Retest was performed on 13 patients with MS and 23 healthy controls. Result: The mean (±SD) score of BICAMS in MS and control groups were as follows: SDMT in MS vs control group 41.4±15.1 vs 64.9+16.2 (p<0.001, r=0.55 and cohen's d 1.50); CVLT-II in MS vs control group 52.2+11.6 vs 61.5+9.7 (p=0.001, r=0.36 and cohen's d 0.87); BVMTR in MS vs control group 23.4+7.0 vs 29.3+5.6 (p<0.001, r=0.40 and cohen's d 0.93). There were significant difference in all test scores between MS and control group. Conclusion: The BICAMS-INA questionnaire is valid and reliable in assessing cognitive function of MS patients."

"Latar Belakang. Gangguan kognitif dapat terjadi pada multipel sklerosis MS dan berdampak menurunnya kualitas hidup. Brief International Cognitive Assessment for MS BICAMS merupakan instrumen untuk mendeteksi gangguan kognitif penyandang MS. Penelitian ini bertujuan untuk memvalidasi instrumen BICAMS versi bahasa Indonesia BICAMS-INA .Metode. Penelitian potong lintang ini dilakukan di Rumah Sakit Umum Pusat Nasional Cipto Mangunkusumo Jakarta periode Mei-Juni 2018 pada kelompok MS dan kontrol. Pemeriksaan BICAMS yang terdiri dari; Symbol Digit Modalities Test SDMT , California Verbal Learning Test-II CVLT-II , dan Brief Visuospatial Memory Test Revised BVMTR dilakukan pada 23 kelompok MS dan 66 kelompok kontrol. Kemudian dilakukan retest pada 13 kelompok MS dan 23 kelompok kontrol.Hasil. Rerata SD hasil pemeriksaan BICAMS pada kelompok MS dan kontrol sebagai berikut: SDMT kelompok MS 41,4 15,1; kelompok kontrol 64,9 16,2 p

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Background. Cognitive impairment can occur in multiple sclerosis MS and impact on decreased quality of life. Brief International Cognitive Assessment for MS BICAMS is an instrument to detect cognitive impairment in MS. This study aimed to validate the Indonesian version of BICAMS BICAMS INA .Methods. This cross sectional study was performed in Cipto Mangunkusumo National General Hospital, Jakarta, from May to June 2018 on MS and control group. Consisted of Symbol Digit Modalities Test SDMT , California Verbal Learning Test II CVLT II , and Brief Visuospatial Memory Test Revised BVMTR , this instrument was administered to 23 patients with MS and 66 healthy controls. Retest was performed on 13 patients with MS and 23 healthy controls.Result. The mean SD score of BICAMS in MS and control groups were as follows SDMT in MS vs control group 41.4 15.1 vs 64.9 16.2 p"

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ABSTRAK

Latar belakang: Penilaian kualitas hidup pasien multipel sclerosis (MS) belum rutin digunakan di Indonesia karena belum terdapatnya kuesioner spesifik berbahasa indonesia yang valid. Tujuan dari penelitian ini adalah untuk adaptasi lintas budaya dan validasi kuesioner kuesioner MSQOL-54 versi Indonesia (MSQOL-54 INA).

Metode:  Adaptasi lintas budaya dilakukan sesuai dengan metode forward-backward terstandar. Uji psikometri dilakukan dengan menilai reliabilitas (α Cronbach), validitas interna (item internal consistency,  item discriminant validity dan analisis fakorial) dan validitas eksterna dengan menilai korelasi dengan faktor klinis EDSS dan faktor demografis lainnya.

Hasil: Uji reliabilitas α Cronbach menunjukkan konsistensi internal yang baik (>0,7) di setiap domain kecuali domain persepsi kesehatan (0,665) dan fungsi sosial (0,433). Validitas bentuk dengan komputasi koefisien korelasi menunjukkan konsistensi konsistensi internal yang sesuai dengan dimensi MSQOL-54 asli. Berdasarkan analisis faktorial domain energi,  keterbatasan peran akibat masalah emosional, fungsi sosial dan persepsi kesehatan tidak sesuai dengan dimensi asli. Validitas eksternal dengan EDSS menunjukkan korelasi negatif pada semua domain kecuali fungsi seksual, kemaknaan yang signifikan secara statistik ditemukan pada kedua skor komposit.

Kesimpulan: Kuesioner MSQOL-54 INA memilki reliabilitas yang baik dan terbukti valid serta dapat diterima dengan baik oleh pasien MS di Indonesia. Selanjutnya kuesioner ini dapat digunakan oleh klinisi indonesia untuk tata laksana MS yang lebih komprehensif.

 

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ABSTRACT

Background: Quality of life assessment of patients with multiple sclerosis (MS) is not routinely performed in Indonesia due to the unavailability of the validated Indonesian version of a specific instrument. The objective of this study was to transculturally adapt and validate the Indonesian version of the MSQOL-54 (MSQOL-54 INA) questionnaire.

Methods: The transcultural adaptation was conducted by performing a standardized forward-backward method. Psychometric analysis was performed by assessing the reliability (Cronbach α), internal validation (item internal consistency, item discriminant validity and factorial analysis) and external validation by measuring the correlation with a clinical factor such as EDSS and other demographic factors.

Results: Reliability test with Cronbach α showed good internal consistency (>0.7) at each domain, except for health perception (0.665) and social function (0.433). Construct validity using computation of correlation coefficient showed internal consistency in accordance with the original MSQOL-54 standard dimension. Factorial analysis showed that energy, role limitation due to emotional problems, social function and health perception is not in accordance with the original version. External validation with EDSS showed negative correlation on almost all components, except for sexual function, but both composite scores were statistically significant.

Conclusion: MSQOL-54 INA questionnaire has good internal reliability and is proven to be valid and well-accepted by Indonesian MS patients. Therefore, it can be used by Indonesian clinicians for more comprehensive MS management.

 

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"ABSTRAKLatar belakang: Multipel sklerosis (MS) merupakan penyakit autoimun yang menyebabkan inflamasi dan demielinasi pada sistem saraf pusat dimana sering melibatkan nervus optikus (94-99%). Namun hanya sekitar 20% yang mengalami neuritis optik (NO). Penelitian ini bertujuan untuk mengetahui perbedaan struktur dan fungsi nervus optikus antara pasien MS dengan kontrol normal, perbedaan pada kelompok MS selama pengamatan satu tahun, serta hubungannya dengan durasi penyakit, jumlah relaps, derajat disabilitas, dan subtipe MS.Metode: Penelitian ini merupakan studi kohort prospektif yang melibatkan 58 mata pasien MS. Fungsi nervus optikus dinilai dengan visus, sensitivitas kontras, dan latensi P100. Sedangkan struktur nervus optikus dinilai dengan melihat ketebalan GCIPL, RNFL melalui pemeriksaan Optical Coherence Tomography (OCT), dan gambaran fundus.Hasil: Struktur dan fungsi nervus optikus kelompok MS lebih buruk dibandingkan dengan kontrol normal. Selama pengamatan 6 dan 12 bulan, lapisan GCIPL dan RNFL pada kelompok MS mengalami penipisan. Durasi penyakit dan jumlah relaps berkorelasi dengan pemanjangan latensi P100 (r=-0,61, p<0,001 dan r=-0,46, p=0,02). Lapisan GCIPL dan RNFL lebih tipis pada subtipe SPMS dibandingkan RRMS.Kesimpulan: Struktur dan fungsi nervus optikus pasien MS lebih buruk dibandingkan orang normal. Terjadi penipisan GCIPL dan RNFL dalam 6 dan 12 bulan namun tidak berkorelasi dengan durasi penyakit, jumlah relaps, dan derajat disabilitas.

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ABSTRACTBackground: Multipel sclerosis (MS) is an autoimmune disease that causes inflammation and demyelination of central nervous system which often involves the optic nerve (94-99%). However, only about 20% patients experience optic neuritis (ON). This study aims to determinate the optic nerve structure and function differences between MS patients and healthy controls (HC), the optic nerve changes in MS group over 1-year follow up, and its correlations with the disease duration, number of relapses, degree of disability, and MS subtype.Methods: This is a prospective cohort study involving 58 eyes of MS patients. Optic nerve function was evaluated by visual acuity, contrast sensitivity, and P100 latency. While the optic nerve structure was assessed by looking at GCIPL and RNFL thickness through Optical Coherence Tomography (OCT), also fundus appearance.Results: Optic nerve structure and function of MS group were worse than HC. During 6 and 12 months observations, GCIPL and RNFL in MS group were depleting. The disease duration and number of relapses correlated with delayed P100 latency (r=-0,61, p<0,001 and r=-0,46, p=0,02). GCIPL and RNFL in SPMS subtype were thinner than in RRMS."

"This book provides comprehensive and up-to-date information on the neuropsychiatric disturbances that may be experienced by patients with multiple sclerosis. The first section is designed primarily to describe the general clinical aspects of multiple sclerosis, from epidemiology to assessment tools. The role of neuroimaging and especially MRI is then explained, and treatment approaches and rehabilitation strategies are described. The core section of the volume is the second, in which the various forms of neuropsychiatric dysfunction are considered in depth. Especially, detailed attention is devoted to depression, but the other main categories of disturbance are also described and discussed. The final section addresses cognitive dysfunctions since they represent some of the worst events that patients with multiple sclerosis can suffer and are intimately related to neuropsychiatric dysfunction."

"Latar belakang. OCS merupakan instrumen yang dapat digunakan untuk penapisan ganguan fungsi kognitif. Instrumen ringkas, domain spesifik, dan mampu untuk penapisan afasia dan pengabaian. Penelitian ini bertujuan melakukan uji validitas dan reliabilitas OCS-INA.Metode. Proses adaptasi dan translasi OCS sesuai kaidah WHO, kemudian dilakukan uji validitas dan reliabilitas OCS-INA. Populasi penelitian subjek berumur > 18 tahun dengan fungsi kognitif normal menggunakan Moca-INA. Penelitian dilakukan di panti sosial dan fasilitas kesehatan yang memenuhi kriteria inklusi.Hasil. 104 subjek memenuhi kriteria inklusi. Sebagian besar laki-laki (51,92%). Usia berkisar antara 20 sampai 87 tahun dengan prevalensi usia tertinggi > 60 tahun (60%), tingkat pendidikan Sekolah Menengah Atas (35,58%) dan kebanyakan tidak bekerja (62,5%). Uji validitas menggunakan rumus koefisien korelasi spearman, nilai valid pada hampir semua domain yaitu nilai r hitung > r tabel (0,1927). Uji reliabilitas Kappa p didapatkan interpretasi kesepakatan dominan sangat baik pada 6 tugas pemeriksaan, yaitu tugas semantik (0,874), orientasi (0,842) memori verbal (0,822), memori episodik (0,870) dan tes lapang pandang (1,000). Nilai baik didapatkan pada tes penamaan gambar (0,774), membaca (0,726) dan kalkulasi (0,774).Kesimpulan. OCS-INA valid dan reliabel sebagai instrumen untuk penapisan gangguan kognitif dan bisa melengkapi instrumen yang sudah digunakan sebelumnya.

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Background. OCS is an instrument that can be used to screen impaired cognitive function. This is a compact, domain specific and capable instrument for aphasia and neglect screening. This study aims to test the validity and reliability of OCS-INA.

Method. The process of adaptation and translation of OCS according to WHO rules, then tested the validity and reliability of OCS-INA. The study population was subjects > 18 years old with normal cognitive function using Moca-INA. The study was conducted in social institutions and health facilities that met the inclusion criteria.

Results. 104 subjects met the inclusion criteria. Most of the subjects were men (51.92%). Age of subjects ranged from 20 to 87 years with the highest age prevalence > 60 years (60%), high school education level (35.58%) and most of them were not working (62.5%). The validity test uses the Spearman correlation coefficient formula, the valid value in almost all domains is the calculated r value > r table (0.1927). Kappa p reliability test showed that the dominant agreement interpretation was very good on 6 examination tasks: semantic (0.874), orientation (0.842) verbal memory (0.822), episodic memory (0.870) and visual field test (1,000). Good scores were obtained in the picture naming test (0.774), sentence reading (0.726) and calculation (0.774).

Conclusion. OCS-INA is valid and reliable instrument for cognitive impairment screening and can complement the instruments that have been used previously."

"Latar Belakang: Multipel sklerosis (MS) merupakan penyakit autoimun yang menyebabkan inflamasi dan demielinasi pada sistem saraf pusat. Proses tersebut mengakibatkan penurunan volume, tidak hanya di substansia alba namun juga di substansia grisea. Laju atrofi tersebut berlangsung lebih cepat 0,5-1,3% per tahun dibandingkan orang normal 0,1-0,4% per tahun. Proses inflamasi dan atrofi tersebut menyebabkan semakin beratnya disabilitas pada pasien dan nantinya memengaruhi kualitas hidup pasien. Penelitian ini bertujuan untuk menilai hubungan antara atrofi baik di substansia alba dan grisea dengan derajat disabilitasnya serta mencari faktor-faktor yang memengaruhi atrofi.Metode: Penelitian ini dilakukan dengan desain deskriptif potong lintang yang melibatkan 28 pasien MS. Seluruh pasien MS dilakukan anamnesis, pemeriksaan fisik dan EDSS, pemeriksaan laboratorium fungsi ginjal, dan MRI kepala kontras. Gambaran MRI potongan 3DT1 diambil dan dilakukan penghitungan volume otak dengan piranti lunak freesurfer 6.0.Hasil: Volume substansia alba maupun grisea pasien MS lebih rendah signifikan dibandingkan kontrol sehat (p<0,001 dan p=0,001). Untuk proporsi atrofi juga lebih banyak dibandingkan kontrol sehat. EDSS pasien dengan atrofi substansia alba berbeda bermakna dibandingkan dengan yang tidak atrofi (p=0,009). Faktor-faktor yang berhubungan dengan atrofi substansia alba adalah usia, usia onset, jenis kelamin, pendidikan, tipe MS, dan jumlah lokasi lesi. Faktor-faktor yang berhubungan dengan atrofi substansia grisea adalah jumlah lokasi lesi.Kesimpulan: Volume substansia alba dan grisea pasien MS lebih rendah dibandingkan kontrol sehat. Atrofi substansia alba memengaruhi disabilitas pasien.

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Background : Multiple sclerosis (MS) is an autoimmune disease that causes inflammation and demyelination in the central nervous system. The process resulted in a decrease in volume, not only in the white matter but also in the gray matter. The rate of atrophy is 0.5-1.3% per year faster than normal people 0.1-0.4% per year. These inflammatory and atrophic processes cause more severe disability in patients and later affect the quality of life of patients. This study aims to assess the relationship between atrophy both in gray and white matter with the degree of disability and to look for factors that influence atrophy.

Methods : This research was a cross-sectional descriptive study involving 28 MS patients. All patients underwent history taking, physical examination and EDSS examination, laboratory tests of kidney function, and contrast head MRI. MRI images of 3DT1 pieces were taken and the brain volume was calculated using freesurfer 6.0 software.

Results : The volume of white and gray matter of MS patients was significantly lower than healthy controls (p <0.001 and p = 0.001). For the proportion of atrophy also more than healthy controls. EDSS of patients with white matter atrophy was significantly different compared to those without atrophy (p = 0.009). Factors related to white matter atrophy are age, age of onset, sex, education, type of MS, and number of lesion locations. Factors associated with gray matter atrophy are the number of lesion sites.

Conclusions:

The volume of white and gray matter of MS patients is lower than that of healthy controls. Atrophy of the substance of the alba affects the disability of the patient."

"Penelitian mengenai penggunaan instrumen penapis kognitif berbasis informan pada pasien usia lanjut masih jarang hingga saat ini. Penelitian ini ditujukan untuk mengetahui korelasi Montreal Cogntive Assessment Indonesia (MoCA-Ina) yang sudah lazim digunakan sebagai instrumen penapis langsung dengan Short Form of Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE-S) Indonesia dari pasien usia lanjut, baik di rawat jalan maupun inap. Penelitian ini merupakan studi potong-lintang dengan teknik pengambilan sampel secara konsekutif. Kriteria inklusi pasien usia lanjut di antaranya subyek berusia di atas 60 tahun dan mengerti Bahasa Indonesia dengan baik. Kriteria inklusi informan yaitu subyek berusia 25-60 tahun, mengenal pasien usia lanjut minimal selama 10 tahun terakhir, mengerti Bahasa Indonesia dengan baik dan memiliki fungsi kognitif baik. Subyek pasien usia lanjut dengan gangguan kesadaran, depresi, masalah audtorik dan visual serta buta huruf dieksklusi. Subyek penelitian meliputi 32 pasang pasien usia lanjut dan informan. Hasil studi ini mendapatkan nilai tengah usia pasien usia lanjut yaitu 66 (61-80) tahun, skor MoCA-Ina 25 (7-29), skor rerata IQCODE-S 3.13 (2.69-4.38) dan skor total IQCODE-S 50 (43-70). Dari analisis bivariat, didapatkan korelasi kuat antara skor kedua instrumen penapisan kogntif tersebut (r= –0.738, p<0.001). Uji regresi linear menunjukkan skor MoCA-Ina dan IQCODE-S tetap menunjukkan hubungan bermakna tanpa dipengaruhi faktor demografik pasien usia lanjut.

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Studies on the use of informant-based cognitive screening instrument for elderly patients are still rare until now. This study aims to investigate correlation of Montreal Cognitive Assessment Indonesia (MoCA-Ina), which has been used commonly as a direct cognitive screening instrument with Short Form of Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE-S) Indonesia of elderly patients, both inpatient and outpatient settings. This research is a cross-sectional study with consecutive sampling method. Inclusion criteria of elderly patients are subjects aged above 60 years old who understand Indonesian well. Inclusion criteria of informants are subjects aged 25-60 years old who the elderly patients at least the past 10 years, understand Indonesian well and have good cognitive. Subject elderly patients with impaired consciousness, depression, auditory and visual problems, as well as illiteracy are excluded. The study subjects include 32 pairs of elderly patients with their informants. Results of this study obtain median of age of elderly patients is 66 (61-80) years old, MoCA-Ina score 25 (7-29), IQCODE-S average score 3.13 (2.69-4.38) and IQCODE-S total score 50 (43-70). Bivariate analysis shows strong correlation between both cognitive screening instruments (r= –0.738, p<0.001). Linear regression test reveals that MoCA-Ina and IQCODE-S scores still show significant relationship with no influence of demographic factors of elderly patients."