TEST YOUR MEMORY (TYM): A NEW TOOL TO EVALUATE THE COGNITIVE FUNCTION

IN CHRONIC PAIN PATIENTS.External Chair of Pain Grünenthal @observadolor

Conclusion

IN CHRONIC PAIN PATIENTS.Ojeda B1, Dueñas M1, Salazar A1, Torres LM2, Micó JA3, Failde I1.

1Preventive Medicine and Public Health Department, University of Cádiz, 2Anesthesiology-Critical Care and Pain Management,

University Hospital, Cádiz, 3NeuroScience Department, University of Cádiz, Spain.

External Chair of Pain GrünenthalFoundation-University of Cádiz. @observadolor

Background & Aims

Taking into account the need for an instrument to assess cognitive function in chronic pain patients in routine clinical practice, and

considering the good properties of the new TYM new TYM new TYM new TYM

ConclusionUniversity Hospital, Cádiz, 3NeuroScience Department, University of Cádiz, Spain.

What and how is the TYM What and how is the TYM What and how is the TYM What and how is the TYM test?test?test?test? Double

sided sheetCP CP CP CP (254)(254)(254)(254) Controls (72)Controls (72)Controls (72)Controls (72) NP (104)NP (104)NP (104)NP (104) MSK (99)MSK (99)MSK (99)MSK (99) FM (51)FM (51)FM (51)FM (51)

TYM properties compared to MMSETYM properties compared to MMSETYM properties compared to MMSETYM properties compared to MMSE

considering the good properties of the new TYM new TYM new TYM new TYM instrumentinstrumentinstrumentinstrument to assess cognitive function, in

this study we proposed to analyze the validity we proposed to analyze the validity we proposed to analyze the validity we proposed to analyze the validity and reliability of the Spanish version of this and reliability of the Spanish version of this and reliability of the Spanish version of this and reliability of the Spanish version of this

test?test?test?test?sided sheet

Includes different tasks to assess 10 cognitive domains

Original structure (Brown, 2009) No. of Score

TYMTYMTYMTYM Mean (SD)Mean (SD)Mean (SD)Mean (SD)IC (95%)IC (95%)IC (95%)IC (95%)MinimumMinimumMinimumMinimumMaximumMaximumMaximumMaximumFloor (%)Floor (%)Floor (%)Floor (%)

40.5 (5.5)40.5 (5.5)40.5 (5.5)40.5 (5.5)39.839.839.839.8----41.241.241.241.2

21212121505050500.40.40.40.4

43.9 (4.1)43.9 (4.1)43.9 (4.1)43.9 (4.1)43434343----44.944.944.944.9

31313131505050501.41.41.41.4

40.5 (6.2)40.5 (6.2)40.5 (6.2)40.5 (6.2)39.339.339.339.3----41.741.741.741.7

21212121505050501111

40.7 (5.4)40.7 (5.4)40.7 (5.4)40.7 (5.4)39.639.639.639.6----41.841.841.841.8

26262626494949493333

40.2 (4.4)40.2 (4.4)40.2 (4.4)40.2 (4.4)38.938.938.938.9----41.4541.4541.4541.45

31313131505050502222

• Test Your Memory

is a quick and

easy tool to questionnaire in patients with chronic pain questionnaire in patients with chronic pain questionnaire in patients with chronic pain questionnaire in patients with chronic pain

from three different originsfrom three different originsfrom three different originsfrom three different origins.

Original structure (Brown, 2009) No. of items

Score

1.1.1.1. OrientationOrientationOrientationOrientation2.2.2.2. Copying.Copying.Copying.Copying.3.3.3.3. Retrograde memory (semantic knowledge).Retrograde memory (semantic knowledge).Retrograde memory (semantic knowledge).Retrograde memory (semantic knowledge).4.4.4.4. Calculation.Calculation.Calculation.Calculation.

9124

10234

MethodMethodMethodMethod

Floor (%)Floor (%)Floor (%)Floor (%)Ceiling (%)Ceiling (%)Ceiling (%)Ceiling (%)

0.40.40.40.41.21.21.21.2

1.41.41.41.45.65.65.65.6

11111.91.91.91.9

33331111

22222222

MMSE Mean (SD)IC (95%)MinimumMaximum

26.9 (2.2)26.7-27.2

1730

29.1 (1.4)28.8-29.4

2430

26.9 (2.2)26.5-27.4

1730

27 (2.3)26.5-27.4

2030

26.8 (2.3)26.2-27.5

1930

easy tool to

evaluate cognitive

function.

• TYM test shows

InstrumentsCognitive function:Test Your

Subjects

4.4.4.4. Calculation.Calculation.Calculation.Calculation.5.5.5.5. Verbal fluency.Verbal fluency.Verbal fluency.Verbal fluency.6.6.6.6. Similarities.Similarities.Similarities.Similarities.7.7.7.7. Naming.Naming.Naming.Naming.8.8.8.8. ViViViVisuospatialsuospatialsuospatialsuospatial abilityabilityabilityability 1 & 2 (1 & 2 (1 & 2 (1 & 2 (clockclockclockclock).).).).9.9.9.9. AnterogradeAnterogradeAnterogradeAnterograde memorymemorymemorymemory....

412521

444576

MethodMethodMethodMethod

Internal consistencyInternal consistencyInternal consistencyInternal consistency

MaximumFloor (%)Ceiling (%)

300.49.4

301.458.3

3018.7

301

11.1

3027.8

• TYM test shows

good

psychometric

properties in FactorFactorFactorFactor 8 factors identified

The higher scores represent better cognitive function.

Cognitive function:Test Your Memory test (TYM) and Mini Mental State Examination (MMSE).Psychiatric disorders: Hospital Anxiety and depression scale

254 chronic pain (CP) patients (pain ≥3 months):

104 neuropathic (NP) 99 Musculoskeletal

9.9.9.9. AnterogradeAnterogradeAnterogradeAnterograde memorymemorymemorymemory....10.10.10.10. Executive (ability to complete the test).Executive (ability to complete the test).Executive (ability to complete the test).Executive (ability to complete the test).

11

65

28 50

Range of item correlationsDomainsDomainsDomainsDomains No. of

itemsItemItemItemItem----internal internal internal internal consistencyconsistencyconsistencyconsistencyaaaa

Item-discriminant consistencyb

(Cronbach’s alpha was 0.66) properties in

chronic pain

patients.

FactorFactorFactorFactoranalysesanalysesanalysesanalyses:

8 factors identified

Eigenvalues ranging from 3,5 to1,1.

Percentage of total varianceacconted for 53%.

Anxiety and depression scale(HADs)Sleep: Medical Outcome StudySleep scale (MOS-Sleep scale).Quality of life: SF-12 v1

99 Musculoskeletal (MSK)

52 fibromyalgia (FM)

72 control subjects free Neuropatic pain Neuropatic pain Neuropatic pain Neuropatic pain (NP)

Demographic and clinical characteristics (CP patients: n= 254)Demographic and clinical characteristics (CP patients: n= 254)Demographic and clinical characteristics (CP patients: n= 254)Demographic and clinical characteristics (CP patients: n= 254)

OrientationOrientationOrientationOrientationSemantic knowledgeSemantic knowledgeSemantic knowledgeSemantic knowledgeCalculationCalculationCalculationCalculationSimilaritiesSimilaritiesSimilaritiesSimilarities

9242

.20.20.20.20----.50.50.50.50

.76.76.76.76----.77.77.77.77

.51.51.51.51----.77.77.77.77

.72.72.72.72----.80.80.80.80

.00-.31

.06-.21

.02-.19

.03-.16

• TYM test will be

of particular value

in clinical setting.

Construct validityHypothesis:

1. TYM positively correlated with the Health

Quality of life: SF-12 v1of pain. n=104104104104

Musculoskeletal pain Musculoskeletal pain Musculoskeletal pain Musculoskeletal pain (MSK) n=99999999Internal

consistency

SimilaritiesSimilaritiesSimilaritiesSimilaritiesNamingNamingNamingNamingVisuospatialVisuospatialVisuospatialVisuospatial

252

.72.72.72.72----.80.80.80.80

.12.12.12.12----.74.74.74.74

.76.76.76.76----.76.76.76.76

.03-.16

.00-.11

.04-.16aMinimum-maximum correlation of the item with its own scalebMinimum-maximum correlation of the items with other scales

StudiesStudiesStudiesStudies: No study 12%

Primary 39%

Secundary 41%

Universitary 8%

Women 64%36% Men

in clinical setting.

1. TYM positively correlated with the Health Related Quality of Life (mental/physical component from SF-12) and with the Mini-Mental State Examination (MMSE).

2. 2. 2. 2. TYM negatively correlated with anxiety 43,7844

- Cronbach’s alphacoefficient.

- Item-internal consistency/Item-discriminant

Construct validityConstruct validityConstruct validityConstruct validityPain durationPain durationPain durationPain durationMean MONTHS: 108.5108.5108.5108.5

Pain intensityPain intensityPain intensityPain intensitySignificant differences

(p<0,005)

2. 2. 2. 2. TYM negatively correlated with anxiety and/or depression (HADs test scores), sleep quality (Index-9 from MOS-sleep), duration and intensity of pain (VAS).

3. 3. 3. 3. Differences in the mean scores of the TYM

FibromyalgiaFibromyalgiaFibromyalgiaFibromyalgia (FM) n=51515151

43,78

41,7 41,53

42,54

42

43

TY

M s

core

discriminant consistency.

Structure of the TYM

Mean MONTHS: 108.5108.5108.5108.5(SD:97.6)

Mean VAS= 6.6 6.6 6.6 6.6 (SD:1.9)

3. 3. 3. 3. Differences in the mean scores of the TYM test between groups of pain/no pain, type of pain, optimal/no optimal sleep (MOS-sleep), anxiety (HADs-A>10) and depression (HADs-D >10), and categories of intensity and

40,5340,32

40,6840,66

41,22

39,05

41,53

40,24

40,55

40,27

40,84

40,04

40,63

40,6240,53

40

41

TY

M s

core

the TYM

- ExploratoryFactor Analysis(EFA) afterVarimax rotation.

Anxiety & Depression (HADs 0Anxiety & Depression (HADs 0Anxiety & Depression (HADs 0Anxiety & Depression (HADs 0----21)21)21)21)

duration of pain. 38,94 39,05

38

39Varimax rotation.

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HRQoLHRQoLHRQoLHRQoL: Higher scores=Better QoL

QoSleepQoSleepQoSleepQoSleep: Higher scores=Worst QoSleep Pain duration