1. Background The Island of Jersey is part of the British Isles but has a Healthcare System independent from the UK. The Neurology Service offers a patient pathway via collaboration between medical, nursing and neuropsychological services. A cohort of the Multiple Sclerosis (MS) patients in a specialist nurse-led service are considered and selected for Natalizumab infusions, and are currently the only MS patients receiving planned cognitive screening. This is often on the basis of self-reported difficulties. The Addenbrooke’s Cognitive Examination – version 3 (ACE-III Hsieh et al, 2013; previously ACE-R) is the usually administered screening. However, despite its focus on memory and visuospatial deficits often observed in MS, it lacks attention to executive functioning, it has a heavy bias on language and was designed for Dementia. It is standardised on participants with a minimum age of 50, which greatly exceeds the average diagnostic age for MS (34; typical range: 20-50) with obvious implications. Follow-up assessments currently provided are often on the basis of patients’ self-reported difficulties. However, depressed patients are likely to over-report cognitive deficits, whilst patients with metamemory deficits may underestimate their cognitive abilities (Langdon et al, 2012). Performance on cognitive screening in MS is also knowingly affected by mood and self-report tends to correlate only with the latter (Bradshaw et al, 2008). Furthermore, there is evidence that patients being treated with Natalizumab maintain better cognitive function than controls, and they report improvements in employment status and fatigue (Stephenson et al, 2012). These variables are not routinely and formally monitored within our patient population. Aims We aim to develop a more coordinated and comprehensive assessment pathway and assessment framework. Method Participants Purposive sample (N=51) of MS patients selected for Natalizumab (14 male, 37 were female; Mean age= 43.2, SD: 9.27). The median number of years since diagnosis for the sample was 7 and Median years on infusions was 3 (Interquartile Range: 2). Discussion (contd.) In addition, an in-depth neuropsychological battery may not be appropriate unless for specialist queries. Current international guidelines exist for more appropriate screening procedures (e.g. Langdon et al, 2012). Furthermore, the service currently records physical aspects of Quality of Life (QoL). However, mood, fatigue and changes in employment status are not routinely or formally assessed. In order to improve the Service Provision of cognitive screening in patients with MS, as well as relevant processes and quality of data, the following areas for improvement have been identified: - Adopting a more appropriate screening battery for the entire MS patient population (the current study considered only natalizumab patients as they have been, to date, the only logistically accessible group), including: fatigue, depression, cognition, employment status, as well as physical function. -Training for the Specialist MS Nurse and the Assistant/Associate Psychologist in the administration of the BICAMS and additionally required questionnaires. -Agreement on explicit timeframes for baseline and follow up assessments. -Development of one overall point of contact and database for data collection and analysis -Development of regular audit review cycles. Method (contd.) Procedure We collected the outcomes of cognitive screening received at baseline and at follow up. The data was summarised and analysed with appropriate database and statistical packages. Analysis Descriptive statistics were completed to establish the utility of the currently utilised screening measures. Differences in patients’ matched baseline and follow-up cognitive scores were analysed using Paired Samples T-tests. Results Descriptive statistics revealed that 71% (n=36) of the sample were not within the age range for the normative data of ACE- III. Of the overall sample, only 31% (n = 16) had received a cognitive screening follow up. Evaluation of the Service Provision of Cognitive Screening for Multiple Sclerosis in a discrete Jersey-based population. S.Kean 1, H.Gibson 1, C. Bree 1, J. Harvey 2, S. Smith 2, A. Agostinis 2, Multiple Sclerosis Service, Overdale Hospital, States of Jersey Health and Social Services Department (H&SSD), St Helier, Jersey, United Kingdom Channel Islands Neuropsychology Service, Psychological Assessment and Therapy Service, Overdale Hospital, States of Jersey H&SSD, St Helier, Jersey, United Kingdom Channel Islands Acknowledgements 2015 CONFERENCE With thanks to all participants 8 - 10 November Contact details: Nr. Windsor s.kean@health.gov.je s.kean@health.gov.je Tel: +44 (0)1534 444524 References 1. Bradshaw, J., Lincoln, N., Manning, C., Mitchel, S., Reeve, D., Rose, A., Ware, J., White, M & Zeman, A. (2008). Cognitive Function in Multiple Sclerosis. Advances in Clinical Neuroscience & Rehabilitation, 8(1), 36-38 2. Hsieh, S., Schubert, S., Hoon, C., Mioshi, E., & Hodges, J. R. (2013). Validation of the Addenbrooke's Cognitive Examination III in frontotemporal dementia and Alzheimer's disease. Dementia and geriatric cognitive disorders, 36(3-4), 242-250. 3. Langdon, D. W., Amato, M. P., Boringa, J., Brochet, B., Foley, F., Fredrikson, S.,... & Benedict, R. H. B. (2012). Recommendations for a brief international cognitive assessment for multiple sclerosis (BICAMS). Multiple Sclerosis Journal, 18(6), 891- 898. 4. Stephenson, J. J., Kern, D. M., Agarwal, S. S., Zeidman, R., Rajagopalan, K., Kamat, S. A., & Foley, J. (2012). Impact of natalizumab on patient-reported outcomes in multiple sclerosis: a longitudinal study. Health Qual Life Outcomes, 10, 155. Table 1 *significant at.05 level Baseline Mean(Std) Follow-up Mean(Std) T (d.f.) p Total Score (N = 15) 91.67 (5.44)92.67 (4.11)0.91 (14).379 MMSE (N = 16) 28.75 (1.39)29.31 (1.09)1.78 (15).095 Attention (N = 12) 17.17 (1.36)17.92 (0.33)2.46 (11).032* Memory (N = 12) 22.89 (2.26)23 (2.55)1.02 (11).328 Fluency (N = 12) 11.33 (1.88)10.17 (1.90)0.30 (11).767 Language (N = 12) 25.17 (1.34)25.08 (1.08)0.43 (11).674 Visuospatial (N = 12) 15.08 (1.56)14.92 (1.31)0.33 (11).748 Discussion The literature and service review process highlighted a number of limitations of the cognitive screening currently utilised. Firstly, the ACE is not standardised for a typical MS age- range group. The data analysed for the proportion of the sample which had completed at least one follow up assessment (Table 1) did not reveal significant differences on the ACE sub-domain, with the exception of attention.