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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 B 1 , Dueñas M 1 , Salazar A 1 , Torres LM 2 , Micó JA 3 , Failde I 1 . 1 Preventive Medicine and Public Health Department, University of Cádiz, 2 Anesthesiology-Critical Care and Pain Management, University Hospital, Cádiz, 3 NeuroScience Department, University of Cádiz, Spain. External Chair of Pain Grünenthal Foundation-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 Conclusion University Hospital, Cádiz, NeuroScience 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 sheet CP 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 MMSE TYM properties compared to MMSE TYM properties compared to MMSE TYM properties compared to MMSE considering the good properties of the new TYM new TYM new TYM new TYM instrument instrument instrument instrument 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 sided sheet Includes different tasks to assess 10 cognitive domains Original structure (Brown, 2009) No. of Score TYM TYM TYM TYM Mean (SD) Mean (SD) Mean (SD) Mean (SD) IC (95%) IC (95%) IC (95%) IC (95%) Minimum Minimum Minimum Minimum Maximum Maximum Maximum Maximum Floor (%) Floor (%) Floor (%) Floor (%) 40.5 (5.5) 40.5 (5.5) 40.5 (5.5) 40.5 (5.5) 39.8 39.8 39.8 39.8- - -41.2 41.2 41.2 41.2 21 21 21 21 50 50 50 50 0.4 0.4 0.4 0.4 43.9 (4.1) 43.9 (4.1) 43.9 (4.1) 43.9 (4.1) 43 43 43 43- - -44.9 44.9 44.9 44.9 31 31 31 31 50 50 50 50 1.4 1.4 1.4 1.4 40.5 (6.2) 40.5 (6.2) 40.5 (6.2) 40.5 (6.2) 39.3 39.3 39.3 39.3- - -41.7 41.7 41.7 41.7 21 21 21 21 50 50 50 50 1 1 1 40.7 (5.4) 40.7 (5.4) 40.7 (5.4) 40.7 (5.4) 39.6 39.6 39.6 39.6- - -41.8 41.8 41.8 41.8 26 26 26 26 49 49 49 49 3 3 3 40.2 (4.4) 40.2 (4.4) 40.2 (4.4) 40.2 (4.4) 38.9 38.9 38.9 38.9- - -41.45 41.45 41.45 41.45 31 31 31 31 50 50 50 50 2 2 2 • 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 origins from three different origins from three different origins from three different origins . Original structure (Brown, 2009) No. of items Score 1. 1. 1. 1. Orientation Orientation Orientation Orientation 2. 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. 9 1 2 4 10 2 3 4 Method Method Method Method Floor (%) Floor (%) Floor (%) Floor (%) Ceiling (%) Ceiling (%) Ceiling (%) Ceiling (%) 0.4 0.4 0.4 0.4 1.2 1.2 1.2 1.2 1.4 1.4 1.4 1.4 5.6 5.6 5.6 5.6 1 1 1 1.9 1.9 1.9 1.9 3 3 3 1 1 1 2 2 2 2 2 2 MMSE Mean (SD) IC (95%) Minimum Maximum 26.9 (2.2) 26.7-27.2 17 30 29.1 (1.4) 28.8-29.4 24 30 26.9 (2.2) 26.5-27.4 17 30 27 (2.3) 26.5-27.4 20 30 26.8 (2.3) 26.2-27.5 19 30 evaluate cognitive function. • TYM test shows Instruments Cognitive 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. Vi Vi Vi Visuospatial suospatial suospatial suospatial ability ability ability ability 1 & 2 ( 1 & 2 ( 1 & 2 ( 1 & 2 (clock clock clock clock). ). ). ). 9. 9. 9. 9. Anterograde Anterograde Anterograde Anterograde memory memory memory memory. . . 4 1 2 5 2 1 4 4 4 5 7 6 Method Method Method Method Internal consistency Internal consistency Internal consistency Internal consistency Maximum Floor (%) Ceiling (%) 30 0.4 9.4 30 1.4 58.3 30 1 8.7 30 1 11.1 30 2 7.8 • TYM test shows good psychometric properties in Factor Factor Factor Factor 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. Anterograde Anterograde Anterograde Anterograde memory memory memory memory. . . 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). 1 1 6 5 28 50 Range of item correlations Domains Domains Domains Domains No. of items Item Item Item Item- - -internal internal internal internal consistency consistency consistency consistency a a a Item-discriminant consistency b (Cronbach’s alpha was 0.66) properties in chronic pain patients. Factor Factor Factor Factor analyses analyses analyses analyses : 8 factors identified Eigenvalues ranging from 3,5 to1,1. Percentage of total variance acconted for 53%. Anxiety and depression scale (HADs) Sleep: Medical Outcome Study Sleep 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) Orientation Orientation Orientation Orientation Semantic knowledge Semantic knowledge Semantic knowledge Semantic knowledge Calculation Calculation Calculation Calculation Similarities Similarities Similarities Similarities 9 2 4 2 .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 validity Hypothesis: 1. TYM positively correlated with the Health Quality of life: SF-12 v1 of pain. n=104 104 104 104 Musculoskeletal pain Musculoskeletal pain Musculoskeletal pain Musculoskeletal pain (MSK) n=99 99 99 99 Internal consistency Naming Naming Naming Naming Visuospatial Visuospatial Visuospatial Visuospatial 5 2 .12 .12 .12 .12- - -.74 .74 .74 .74 .76 .76 .76 .76- - -.76 .76 .76 .76 .00-.11 .04-.16 a Minimum-maximum correlation of the item with its own scale b Minimum-maximum correlation of the items with other scales Studies Studies Studies Studies : 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 43,78 44 - Cronbach’s alpha coefficient. - Item-internal consistency/Item- discriminant Construct validity Construct validity Construct validity Construct validity Pain duration Pain duration Pain duration Pain duration Mean MONTHS: 108.5 108.5 108.5 108.5 Pain intensity Pain intensity Pain intensity Pain intensity Significant 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 Fibromyalgia Fibromyalgia Fibromyalgia Fibromyalgia (FM) n=51 51 51 51 43,78 41,7 41,53 42,54 42 43 core discriminant consistency. Structure of the TYM Mean MONTHS: 108.5 108.5 108.5 108.5 (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 40,53 40,32 40,68 40,66 41,22 39,05 41,53 40,24 40,55 40,27 40,84 40,04 40,63 40,62 40,53 40 41 TYM sc the TYM - Exploratory Factor Analysis (EFA) after Varimax rotation. Anxiety & Depression (HADs 0 Anxiety & Depression (HADs 0 Anxiety & Depression (HADs 0 Anxiety & Depression (HADs 0- - -21) 21) 21) 21) duration of pain. 38,94 39,05 38 39 Varimax rotation. Printed by HRQoL HRQoL HRQoL HRQoL: Higher scores=Better QoL QoSleep QoSleep QoSleep QoSleep: Higher scores=Worst QoSleep Pain duration
