BackgroundThe heterogeneous nature of cognitive impairment in people with multiple sclerosis (PwMS) hampers understanding of the underlying mechanisms and developing patient-tailored interventions.... Show moreBackgroundThe heterogeneous nature of cognitive impairment in people with multiple sclerosis (PwMS) hampers understanding of the underlying mechanisms and developing patient-tailored interventions. We aim to identify and classify cognitive profiles in PwMS, comparing these to cognitive status (preserved versus impaired).MethodsWe included 1213 PwMS (72% female, age 45.4 ± 10.7 years, 83% relapsing–remitting MS). Cognitive test scores were converted to Z-scores compared to healthy controls for the functions: attention, inhibition, information processing speed (IPS), verbal fluency and verbal/visuospatial memory. Concerning cognitive status, impaired cognition (CI) was defined as performing at Z ≤ − 1.5 SD on ≥ 2 functions. Cognitive profiles were constructed using latent profile analysis on all cognitive functions. Cognitive profiles or status was classified using gradient boosting decision trees, providing the importance of each feature (demographics, clinical, cognitive and psychological functioning) for the overall classification.ResultsSix profiles were identified, showing variations in overall performance and specific deficits (attention, inhibition, IPS, verbal fluency, verbal memory and visuospatial memory). Across the profiles, IPS was the most impaired function (%CI most preserved profile, Profile 1 = 22.4%; %CI most impaired profile, Profile 6 = 76.6%). Cognitive impairment varied from 11.8% in Profile 1 to 95.3% in Profile 6. Of all cognitive functions, visuospatial memory was most important in classifying profiles and IPS the least (area under the curve (AUC) = 0.910). For cognitive status, IPS was the most important classifier (AUC = 0.997).ConclusionsThis study demonstrated that cognitive heterogeneity in MS reflects a continuum of cognitive severity, distinguishable by distinct cognitive profiles, primarily explained by variations in visuospatial memory functioning. Show less
Dam, M. van; Jong, B.A. de; Willemse, E.A.J.; Nauta, I.M.; Huiskamp, M.; Klein, M.; ... ; Hulst, H.E. 2023
In the area of financial services, lawmakers and regulators increasingly promote theuse of plain language in business-to-consumer contracts. Although such efforts are undoubtedlywelcomed by... Show moreIn the area of financial services, lawmakers and regulators increasingly promote theuse of plain language in business-to-consumer contracts. Although such efforts are undoubtedlywelcomed by consumers, as they promote better comprehension, not much is knownabout the actual effects of improved readability on consumer attitudes and cognitive processes.Does improved readability in general contract terms have an impact on the consumer’sperception of their contractual position? Do contracts that are easier to read influence the stepsor actions taken by consumers in the wake of conflict? In response to these questions, wepresent data from an experiment that investigates the relationship between the reading ease ofgeneral contract terms on the one hand and consumer expectations and willingness to engagein conflict on the other. Our findings suggest that readability increases the trust and confidenceof the consumer in the sense that it increases their expectations of the claim. Moreover, wehave found partial evidence to suggest that reading ease also increases the consumer’swillingness to engage in legal action in the case of subsequent claim denial. Show less
