Diagnostic value of simple and selective Reaction Time in discriminating patients with multiple sclerosis from normal people

Document Type : Research Paper


1 Ph.D Student of Psychology, Faculty of Education and Psychology, University of Isfahan, Isfahan, Iran.

2 Associate professor of Psychopharmacology, Faculty of Education and Psychology, University of Isfahan, Isfahan, Iran.(Corresponding Author)

3 Assistant Professor, Department of Psychology, University of Guilan, Rasht. Iran.

4 Professor, Department of Neurology, Guilan University of Medical Science, Rasht, Iran.


Cognitive dysfunctions may be brought about following the diseases which have destructive effects on the central nervous system. One way of studying the relationship among brain, behavior and thought, is examining and investigating the brain damaged people, among them Multiple sclerosis is one of the most prevalent diseases of CNS.
Material and Method
The aim of present study was to investigate the diagnostic value of simple and selective reaction time in discriminating patients with multiple sclerosis (MS) from normal people. For that purpose, two groups of patient with MS (n=44), a group of normal people (n=48) were selected as the control group. Their reaction time in simple and selective modes were measured by reaction timer, then demographic information of all subjects were collected and their inability was evaluated by EDSS.
Mann-Withney U test and logistic regression were used to analyze the data. Results:Following analysis of data, it was revealed that both simple (z= -2.566, p=0.011) and selective (z=6.348, p<0.001) modes of reaction time in patients with MS, were significantly more than control group. Selective reaction time was statistically able to predict health and illness (χ2= 51.067, df= 2, p<0.0001).
Both simple and selective reaction times were significantly longer in the patient group, and it was able to differentiate the MS patients from normal people.
According to the findings of the research, reaction time in both simple and selective modes is appropriate in differentiating the patient with MS, from normal people, and hence it is worthy to be utilized in clinical situations including clinics and neurology wards of hospitals.


  1. Bjornevik K, Cortese M, Healy B C, Kuhle  J, Mina  M J, Leng Y, S Elledge S J, Niebuhr  D W, Ann I Scher  A I, Kassandra L Munger # K M,   Ascherio   . Longitudinal analysis reveals high prevalence of Epstein-Barr virus associated with multiple sclerosis. Science  2022؛21 (375), PP. 296-301.  DOI: 10.1126/science.abj8222
  2. Benedict RHB, Amato MP, DeLuca J, Geurts JJG. Cognitive impairment in multiple sclerosis: clinical management, MRI, and therapeutic avenues. National library of Medicine 2020؛ 19(10), pp 860-871.  DOI: 1016/S1474-4422(20)30277-5
  3. Trapp BD, Ransohoff R, Rudick R. Axonal pathology in multiple sclerosis: relationship to neurologic disability. Current Opinion in Neurology 1999؛ 12(3), pp. 295–302. DOI: 1097/00019052-199906000-00008
  4. Manchery N, Henry JD, Swayne A, Beer R, Blum S, Nangle MR.
    Cognitive function and oral health in relapsing-remitting multiple sclerosis. Clin oral investing 2022؛  26(3), pp. 2899-2907. DOI: 1007/s00784-021-04272-1
  5. Wojcik C, Fuchs TA, Tran H, Dwyer MG, Jakimovski D, Unverdi M, Weinstock-Guttman B, Zivadinov R, Eshaghi A, Benedict RH.   Staging and stratifying cognitive dysfunction in multiple sclerosis. National library of Medicine 2022؛ 28 (3), pp. 463-471.

DOI: 10.1177/13524585211011390

  1. Lisak M, Špiljak B, Pašić H, Trkanjec Z. Cognitive Aspects in Multiple Sclerosis Psychiatr Danub 2021؛ 33(13), PP. 177-182.
  2. Meo E, Portaccio E, Giorgio A, Ruano L, Goretti B, Niccolai C, Patti F, Chisari CG, Gallo P, Grossi P, Ghezzi A, Roscio M, Mattioli F, Stampatori C, Simone M, Viterbo RG, Bonacchi R, Rocca MA, De Stefano N, Filippi M, Amato MP. Identifying the Distinct Cognitive Phenotypes in Multiple Sclerosis. JAMA Neurol 2021؛  78 (4), Pp. 414-425.  DOI: 
  3. J Clin Exp Neuropsychol. 37(5), pp. 518-29.DOI: 1080/13803395.2015.1037252
  4. Batista S, Zivadinov R, Hoogs M, et al. Basal ganglia, thalamus and neocortical atrophy predicting slowed cognitive processing in multiple sclerosis. Journal of Neurology 2012؛ 259(1), pp. 139–146. DOI: 1007/s00415-011-6147-1
  5. Khodadadi M, Amani H. Selective Reaction Timer Software. 1393؛ Tehran: Behavioral-Cognitive Research Institute SINA. [Persian].
  6. Kurtzke JF. Rating neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS). Neurology 1983؛ . 33(11), pp.1444–52. DOI: 1212/wnl.33.11.1444
  7. Charalambous D, Pantzaris M, Theodosis-Nobelos P, Triantis C. The prevalence of sexual dysfunction in patients with multiple sclerosis in cyprus: a cross-sectional study. J Neurosci Nurs 2020؛ . 52(6):302– 7.
  8. Meyer-Moock S, Feng Y-S, Maeurer M, Dippel F-W, Kohlmann T. Systematic literature review and validity evaluation of the Expanded Disability Status Scale (EDSS) and the Multiple Sclerosis Functional Composite (MSFC) in patients with multiple sclerosis. BMC Neurol 2014؛ 14(58). DOI: 1186/1471-2377-14-58
  9. Sharrack B, R A Hughes RA,  ­ S,  Dunn The psychometric properties of clinical rating scales used in multiple sclerosis. Brain 1999؛ 122 (1), PP. 141-59. DOI: 
  10. Asghari E, Rashedi I. Study of disability (based on EDSS) and other variables in 100 patients with clinically definite multiple sclerosis referring to hospitals of Tehran Medical Sciences University and private centers [MSc. thesis]: [Tehran] 1999؛. Tehran Medical Sciences University. [Persian].
  11. Rezaeimanesh S,Norouzi E,Parsaei S, Shetab Boushehri N, Norouzi S, Hossieni R, Gonzalez Vega Narciso. Effect Of Foreperiod Duration And Handedness On Simple And Choice Auditory Reaction Time Among The Older People. IRANIAN JOURNAL OF AGEING  2017؛ 11(4), PP. 528-537. [Persian].
  12. Chamanian R, Rafei Boroujeni M, Nezakat-Alhoseini M, Salehi H. Effect of PETTLEP Mental Imagery and Physical Practice on Pre-motor and Motor Parts of Simple and Choice Reaction Time. Motor Behavior 2016؛ 31(10), PP. 17-38. [Persian].doi: 22089/mbj.2018.1186
  13. Amato MP, Portaccio E, Goretti B, et al. Association of neocortical volume changes with cognitive deterioration in relapsing-remitting multiple sclerosis. Archives of Neurology 2007؛ 64(8), pp. 1157–1161. DOI: 1001/archneur.64.8.1157
  14. Lazeron RH, De Sonneville LMJ, Scheltens p. et al. Cognitive slowing in multiple sclerosis is strongly associated with brain volume. Multiple Sclerosis Journal 2006؛ 12(6), pp. 760-800. DOI: 1177/1352458506070924
  15. Calabrese M, Rinaldi F, Mattisi I, et al. Widespread cortical thinning characterizes patients with MS with mild cognitive impairment. Neurology 2010؛ 74(4), pp. 321–328. DOI: 1212/WNL.0b013e3181cbcd03
  16. Fisniku LK, Chard DT, Jackson JS, et alGray matter atrophy is related to long-term disability in multiple sclerosis. Annals of Neurology 2008؛ 64(3):247–254. 
  17. Feuillet L, Reuter F, Audoin B, et al. Early cognitive impairment in patients with clinically isolated syndrome suggestive of multiple sclerosis. Multiple Sclerosis 2007؛ 13(1), pp.124–127. DOI: 1177/1352458506071196
  18. hemati R, yadolahpour N, bakhshi E, abdolahi I. Investigation and comparison of Information processing speed between three different subtypes of multiple sclerosis and healthy control subjects. RJMS 2018; 24 (163):12-18
    URL: http://rjms.iums.ac.ir/article-1-3761-fa.html.

24. Hassanshahi E, Asadollahi Z, Azin H,  Hassanshahi J and at al. Cognitive Function in Multiple Sclerosis Patients Based on Age, Gender, and Education Level. Acta Medica Iranica 2020؛  .58(10): 86-91.

  1. Martola JStawiarz LFredrikson SHillert JBergstrom JFlodmark OAspelin PKristoffersen Wiberg M. Rate of ventricular enlargement in multiple sclerosis: a nine-year magnetic resonance imaging follow-up study. Acta Radiol 2008؛  Jun; 49(5): 570-9.

26.  Luerding R,  Gebel S,  Eva-Maria Gebel Schwab-Malek S, and Robert Weissert R. Influence of Formal Education on Cognitive Reserve in Patients with Multiple Sclerosis. Frontier in neurology 2016؛.   7: 46.

  1. Chiaravalloti ND, DeLuca J. Cognitive impairment in multiple sclerosis. The Lancet Neurology 2008؛ 7(12):1139–1151.
  2. Lynch SG, Parmenter BA, Denney DR. (2005). The association between cognitive impairment and physical disability in multiple sclerosis. Multiple Sclerosis. 11(4):469–476. 
  3. A Tsao, SA Yousefzadeh, WH Meck, MB Moser, EI Moser (2022). The neural bases for timing of durations Nature reviews neuroscience 23 (11), 646-665. DOI: 10.1038/s41583-022-00623-3
  4. Z Shi, BM Gu, S Glasauer, WH Meck (2022). Beyond scalar timing theory: integrating neural oscillators with computational accessibility in memory. Timing & Time Perception 11 (1-4), 198-219. DOI: 10.1163/22134468-bja10059.
  5. B Yin, Z Shi, Y Wang, WH Meck. (2022). Oscillation/coincidence-detection models of reward-related timing in corticostriatal Timing and Time Perception 11 (1-4), 124-166. DOI: doi.org/10.1163/22134468-bja10057.
  6. N Lusk, WH Meck, HH Yin. (2020). Mediodorsal thalamus contributes to the timing of instrumental actions. Journal of Neuroscience 40 (33), 6379-6388. DOI: doi.org/10.1523/JNEUROSCI.0695-20.2020
  7. Martin Bareš, Richard Apps, Laura Avanzino, Assaf Breska, Egidio D’Angelo, Pavel Filip, Marcus Gerwig, Richard B Ivry, Charlotte L Lawrenson, Elan D Louis, Nicholas A Lusk, Mario Manto, Warren H Meck, Hiroshi Mitoma, Elijah A Petter. (2019). Consensus paper: decoding the contributions of the cerebellum as a time machine. From neurons to clinical applications. The Cerebellum 18, 266-286. DOI: 10.1007/s12311-018-0979-5.
  8. Amato MP, Zipoli V, Portaccio E. Multiple sclerosis-related cognitive changes: a review of cross-sectional and longitudinal studies. Journal of the Neurological Sciences 2006؛ . 245(1-2), pp. 41–46. DOI: 1016/j.jns.2005.08.019
  9. K Asgari, S Body, Z Zhang, KCF Fone, CM Bradshaw, E Szabadi. (2006). Effects of 5-HT1A and 5-HT2A receptor stimulation on temporal differentiation performance in the fixed-interval peak procedure. Behavioural processes 71 (2-3), 250-257. https://doi.org/10.1016/j.beproc.2005.06.007.
  10. K Asgari, S Body, VK Bak, Z Zhang, JF Rickard, JC Glennon, KCF Fone. (2006). Effects of 5-HT2A receptor stimulation on the discrimination of durations by rats. Behavioural pharmacology 17 (1), 51-59. DOI: 10.1097/01.fbp.0000189810.69425.89.
  11. Amato MP, Ponziani G, Siracusa G, Sorbi S. Cognitive dysfunction in early-onset multiple sclerosis: a reappraisal after 10 years. Archives of Neurology 2001؛ 58(10), pp. 1602–1606. DOI: 1001/archneur.58.10.1602
  12. Hernan Nicolas Lemus, MD, Arthur E.Warrington, PhD, Moses Rodriguez, MD. Multiple Sclerosis mechanisms of disease and strategies for Myelin and Axonal repair. Neurol clin 2018؛ 36: 1-11.
  13. Asgari-Mobaraké, Karim (2006) An investigation of the psychopharmacology of timing behavior in the rat. PhD thesis, University of Nottingham.