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Najafi M, Farahmand G, Balali P, Behkar A, Shahbazi M, Moradian N, Pouyanmanouchehri S, Harirchian MH, Ranji S. The Effect of Rituximab on the Cognitive Function of Patients with Relapsing-Remitting Multiple Sclerosis. Clin Ther 2024:S0149-2918(24)00210-8. [PMID: 39214713 DOI: 10.1016/j.clinthera.2024.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 02/25/2024] [Accepted: 07/23/2024] [Indexed: 09/04/2024]
Abstract
PURPOSE Cognitive impairment can begin in the early stages of multiple sclerosis (MS). No medicine has been approved for treating cognitive impairment in MS patients. There is a lack of data on the role of rituximab in managing cognitive impairment in MS patients. Using minimal assessment of cognitive function in MS (MACFIMS), this study aims to investigate the effect of rituximab on the cognitive status of relapsing-remitting MS (RRMS) patients. METHODS In this pre-post interventional trial, 28 eligible RRMS patients participated. They were administered rituximab for a year. Cognitive tests (MACFIMS), MS neuropsychological questionnaire (MSNQ), and Beck depression inventory-fast screen (BDI-FS) scores were evaluated at baseline, six, and 12 months following rituximab administration. FINDINGS Eighteen participants with a mean age of 40.5 ± 12.91, 7 men, completed all three follow-ups. There was no statistically significant change in BDI-FS, MSNQ, Paced Auditory Serial Addition Test (P: 0.743), Symbol Digit Modalities Test (P: 0.711), Brief Visual Memory Test (BVMT) (P: 0.426), learning BVMT (P: 0.268), and delayed recall BVMT (P: 0.394) scores. However, the California Verbal Learning Test (CVLT), CVLT learning, and Controlled Oral Word Association Test scores significantly improved by 45.2% (P < 0.001), 12.3% (P: 0.013), and 26.7% (P: 0.011), respectively, 6-month follow-up rituximab treatment. There was a significant improvement in CVLT (+55.7%, P < 0.001), CVLT learning (+15.9%, P: 0.011), and delayed recall CVLT (+28%, P: 0.022) scores 12-month follow-up rituximab treatment. IMPLICATIONS Rituximab prevents cognitive deterioration and improves some cognitive functions. Further investigations with a larger sample size, longer follow-ups, and inclusion of a placebo or another treatment arm are recommended.
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Affiliation(s)
- Masood Najafi
- Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ghasem Farahmand
- Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Pargol Balali
- Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Atefeh Behkar
- Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran; Occupational Sleep Research Center, Baharloo Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mojtaba Shahbazi
- Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Negar Moradian
- Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Sara Pouyanmanouchehri
- Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Hossein Harirchian
- Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Sara Ranji
- Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran.
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Miscioscia A, Mainero C, Treaba CA, Silvestri E, Scialpi G, Berardi A, Causin F, Anglani MG, Rinaldi F, Perini P, Puthenparampil M, Bertoldo A, Gallo P. The contribution of paramagnetic rim and cortical lesions to physical and cognitive disability at multiple sclerosis clinical onset: evaluating the power of MRI and OCT biomarkers. J Neurol 2024:10.1007/s00415-024-12622-8. [PMID: 39155316 DOI: 10.1007/s00415-024-12622-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2024] [Revised: 07/31/2024] [Accepted: 08/02/2024] [Indexed: 08/20/2024]
Abstract
BACKGROUND In multiple sclerosis (MS), imaging biomarkers play a crucial role in characterizing the disease at the time of diagnosis. MRI and optical coherence tomography (OCT) provide readily available biomarkers that may help to define the patient's clinical profile. However, the evaluation of cortical and paramagnetic rim lesions (CL, PRL), as well as retinal atrophy, is not routinely performed in clinic. OBJECTIVE To identify the most significant MRI and OCT biomarkers associated with early clinical disability in MS. METHODS Brain, spinal cord (SC) MRI, and OCT scans were acquired from 45 patients at MS diagnosis to obtain: brain PRL and non-PRL, CL, SC lesion volumes and counts, brain volumetric metrics, SC C2-C3 cross-sectional area, and retinal layer thickness. Regression models assessed relationships with physical disability (Expanded Disability Status Scale [EDSS]) and cognitive performance (Brief International Cognitive Assessment for Multiple Sclerosis [BICAMS]). RESULTS In a stepwise regression (R2 = 0.526), PRL (β = 0.001, p = 0.023) and SC lesion volumes (β = 0.001, p = 0.017) were the most significant predictors of EDSS, while CL volume and age were strongly associated with BICAMS scores. Moreover, in a model where PRL and non-PRL were pooled, only the contribution of SC lesion volume was retained in EDSS prediction. OCT measures did not show associations with disability at the onset. CONCLUSION At MS onset, PRL and SC lesions exhibit the strongest association with physical disability, while CL strongly contribute to cognitive performance. Incorporating the evaluation of PRL and CL into the initial MS patient assessment could help define their clinical profile, thus supporting the treatment choice.
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Affiliation(s)
- Alessandro Miscioscia
- A. A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Bldg 149, 13th Street, Charlestown, MA, 02129, USA.
- Department of Neuroscience, University of Padua, Padua, Italy.
- Multiple Sclerosis Centre of the Veneto Region (CeSMuV), Padua University Hospital, Padua, Italy.
| | - Caterina Mainero
- A. A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Bldg 149, 13th Street, Charlestown, MA, 02129, USA
- Harvard Medical School, Boston, MA, USA
| | - Constantina A Treaba
- A. A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Bldg 149, 13th Street, Charlestown, MA, 02129, USA
- Harvard Medical School, Boston, MA, USA
| | - Erica Silvestri
- Department of Information Engineering, University of Padua, Padua, Italy
| | - Graziana Scialpi
- Multiple Sclerosis Centre of the Veneto Region (CeSMuV), Padua University Hospital, Padua, Italy
| | - Angela Berardi
- Multiple Sclerosis Centre of the Veneto Region (CeSMuV), Padua University Hospital, Padua, Italy
| | | | | | - Francesca Rinaldi
- Multiple Sclerosis Centre of the Veneto Region (CeSMuV), Padua University Hospital, Padua, Italy
| | - Paola Perini
- Multiple Sclerosis Centre of the Veneto Region (CeSMuV), Padua University Hospital, Padua, Italy
| | - Marco Puthenparampil
- Department of Neuroscience, University of Padua, Padua, Italy
- Multiple Sclerosis Centre of the Veneto Region (CeSMuV), Padua University Hospital, Padua, Italy
| | | | - Paolo Gallo
- Department of Neuroscience, University of Padua, Padua, Italy
- Multiple Sclerosis Centre of the Veneto Region (CeSMuV), Padua University Hospital, Padua, Italy
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Skarlis C, Markoglou N, Artemiadis A, Gontika M, Koutsis G, Chrousos G, Anagnostouli M. Implication of Apolipoprotein E gene variants in pediatric-onset multiple sclerosis: Possible association with disease susceptibility and its clinical characteristics, in a Hellenic cohort. Mult Scler Relat Disord 2024; 90:105797. [PMID: 39146895 DOI: 10.1016/j.msard.2024.105797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 05/08/2024] [Accepted: 08/01/2024] [Indexed: 08/17/2024]
Abstract
BACKGROUND Apolipoprotein E (ApoE) plays a major role in lipid homeostasis and myelination in the central nervous system. Although ApoE gene variants have been linked with cognitive impairment in the setting of Multiple sclerosis (MS), no association with disease susceptibility was found, while similar studies in pediatric-onset MS (POMS) are limited. OBJECTIVE This study aims to explore the role of ApoE gene variants in the POMS susceptibility of a Hellenic cohort and any association with disease features. METHODS 112 POMS, fulfilling the revised IPMSSG 2013 criteria, 391 adult-onset MS (AOMS) and 200 healthy controls (HCs), were enrolled. After DNA extraction, ApoE genotyping was performed by a polymerase chain reaction and sequence-specific-oligonucleotide technique. RESULTS ApoE2/E3 genotype and ApoE2 allele were found to be significantly more frequent among POMS patients compared to HCs [(20.5% vs 11 %, OR [95 %]: 2.1 (1.1-4.0), p = 0.03)], and [(11% vs 5.3 %, OR [95 %]: 2.3 (1.2-4.1), p = 0.01)], respectively. Additionally, significantly lower frequencies of the ApoE3/E3 genotype and the ApoE3 allele were observed in POMS patients compared to HCs (59.8% vs 79 %, OR [95 %]:0.40 (0.24-0.65), p = 0.0005 and 79% vs 89 % 0.46, OR [95 %]: (0.30-0.73), p = 0.001)], respectively. CONCLUSIONS The ApoE2 allele may represent a novel risk factor for POMS development.
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Affiliation(s)
- Charalampos Skarlis
- Research Immunogenetics Laboratory, First Department of Neurology, School of Medicine, National and Kapodistrian University of Athens, Aeginition University Hospital, Vas. Sofias 72-74, 11528, Athens, Greece
| | - Nikolaos Markoglou
- Research Immunogenetics Laboratory, First Department of Neurology, School of Medicine, National and Kapodistrian University of Athens, Aeginition University Hospital, Vas. Sofias 72-74, 11528, Athens, Greece
| | - Artemios Artemiadis
- Neurology Department, Medical School, University of Cyprus, Nicosia 1678, Cyprus
| | - Maria Gontika
- Research Immunogenetics Laboratory, First Department of Neurology, School of Medicine, National and Kapodistrian University of Athens, Aeginition University Hospital, Vas. Sofias 72-74, 11528, Athens, Greece
| | - Georgios Koutsis
- Neurogenetics Unit, First Department of Neurology, School of Medicine, National and Kapodistrian University of Athens, Aeginition University Hospital, Vas. Sofias 72-74, 11528, Athens, Greece
| | - George Chrousos
- University Research Institute of Maternal, Child and Child Health Precision Medicine, Clinical and Translational Research Unit in Endocrinology, National and Kapodistrian University of Athens, , UNESCO Chair in Adolescent Health and Medicine, Greece
| | - Maria Anagnostouli
- Research Immunogenetics Laboratory, First Department of Neurology, School of Medicine, National and Kapodistrian University of Athens, Aeginition University Hospital, Vas. Sofias 72-74, 11528, Athens, Greece; Multiple Sclerosis and Demyelinating Diseases Unit, Center of Expertise for Rare Demyelinating and Autoimmune Diseases of CNS, First Department of Neurology, School of Medicine, National and Kapodistrian University of Athens, NKUA, Aeginition University Hospital, Athens, Greece.
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Cortese R, Battaglini M, Stromillo ML, Luchetti L, Leoncini M, Gentile G, Gasparini D, Plantone D, Altieri M, D'Ambrosio A, Gallo A, Giannì C, Piervincenzi C, Pantano P, Pagani E, Valsasina P, Preziosa P, Tedone N, Rocca MA, Filippi M, De Stefano N. Regional hippocampal atrophy reflects memory impairment in patients with early relapsing remitting multiple sclerosis. J Neurol 2024; 271:4897-4908. [PMID: 38743090 PMCID: PMC11319433 DOI: 10.1007/s00415-024-12290-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 02/28/2024] [Accepted: 02/29/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND Research work has shown that hippocampal subfields are atrophic to varying extents in multiple sclerosis (MS) patients. However, studies examining the functional implications of subfield-specific hippocampal damage in early MS are limited. We aim to gain insights into the relationship between hippocampal atrophy and memory function by investigating the correlation between global and regional hippocampal atrophy and memory performance in early MS patients. METHODS From the Italian Neuroimaging Network Initiative (INNI) dataset, we selected 3D-T1-weighted brain MRIs of 219 early relapsing remitting (RR)MS and 246 healthy controls (HC) to identify hippocampal atrophic areas. At the time of MRI, patients underwent Selective-Reminding-Test (SRT) and Spatial-Recall-Test (SPART) and were classified as mildly (MMI-MS: n.110) or severely (SMI-MS: n:109) memory impaired, according to recently proposed cognitive phenotypes. RESULTS Early RRMS showed lower hippocampal volumes compared to HC (p < 0.001), while these did not differ between MMI-MS and SMI-MS. In MMI-MS, lower hippocampal volumes correlated with worse memory tests (r = 0.23-0.37, p ≤ 0.01). Atrophic voxels were diffuse in the hippocampus but more prevalent in cornu ammonis (CA, 79%) than in tail (21%). In MMI-MS, decreased subfield volumes correlated with decreases in memory, particularly in the right CA1 (SRT-recall: r = 0.38; SPART: r = 0.34, p < 0.01). No correlations were found in the SMI-MS group. CONCLUSION Hippocampal atrophy spreads from CA to tail from early disease stages. Subfield hippocampal atrophy is associated with memory impairment in MMI-MS, while this correlation is lost in SMI-MS. This plays in favor of a limited capacity for an adaptive functional reorganization of the hippocampi in MS patients.
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Affiliation(s)
- Rosa Cortese
- Department of Medicine, Surgery and Neuroscience, University of Siena, Viale Bracci 2, 53100, Siena, Italy
| | - Marco Battaglini
- Department of Medicine, Surgery and Neuroscience, University of Siena, Viale Bracci 2, 53100, Siena, Italy
- SIENA Imaging SRL, 53100, Siena, Italy
| | - Maria Laura Stromillo
- Department of Medicine, Surgery and Neuroscience, University of Siena, Viale Bracci 2, 53100, Siena, Italy
| | - Ludovico Luchetti
- Department of Medicine, Surgery and Neuroscience, University of Siena, Viale Bracci 2, 53100, Siena, Italy
- SIENA Imaging SRL, 53100, Siena, Italy
| | - Matteo Leoncini
- Department of Medicine, Surgery and Neuroscience, University of Siena, Viale Bracci 2, 53100, Siena, Italy
- SIENA Imaging SRL, 53100, Siena, Italy
| | - Giordano Gentile
- Department of Medicine, Surgery and Neuroscience, University of Siena, Viale Bracci 2, 53100, Siena, Italy
- SIENA Imaging SRL, 53100, Siena, Italy
| | - Daniele Gasparini
- Department of Medicine, Surgery and Neuroscience, University of Siena, Viale Bracci 2, 53100, Siena, Italy
| | - Domenico Plantone
- Department of Medicine, Surgery and Neuroscience, University of Siena, Viale Bracci 2, 53100, Siena, Italy
| | - Manuela Altieri
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Piazza Luigi Miraglia, 2, 80138, Naples, Italy
| | - Alessandro D'Ambrosio
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Piazza Luigi Miraglia, 2, 80138, Naples, Italy
| | - Antonio Gallo
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Piazza Luigi Miraglia, 2, 80138, Naples, Italy
| | - Costanza Giannì
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
- IRCCS Neuromed, Pozzilli, IS, Italy
| | | | - Patrizia Pantano
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
- IRCCS Neuromed, Pozzilli, IS, Italy
| | - Elisabetta Pagani
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Paola Valsasina
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Paolo Preziosa
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Nicolo' Tedone
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maria Assunta Rocca
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Nicola De Stefano
- Department of Medicine, Surgery and Neuroscience, University of Siena, Viale Bracci 2, 53100, Siena, Italy.
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Al-Ameri M, Abu-Shaikh H, Mansour M, Al-Habahbeh S, Weshah F, Ennab W, Binsaleh AY, Shilbayeh SAR, Gammoh O. Attention-Deficit Hyperactivity Disorder Symptoms in Adults Diagnosed with Multiple Sclerosis: Prevalence and Correlates. J Clin Med 2024; 13:3844. [PMID: 38999410 PMCID: PMC11242620 DOI: 10.3390/jcm13133844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2024] [Revised: 06/27/2024] [Accepted: 06/28/2024] [Indexed: 07/14/2024] Open
Abstract
Background: The relationship between adult ADHD symptoms in People with Multiple Sclerosis (PwMS) is understudied. This study aimed to answer two questions: are PwMS more likely to experience higher ADHD symptoms versus healthy subjects? And what are the correlates of severe ADHD symptoms in PwMS? Methods: This study followed a cross-sectional design with predefined inclusion criteria. The Adult ADHD Self-Report Scale-V1.1 (ASRS) was used to assess the ADHD symptoms severity. Results: Data were analyzed from 171 PwMS and 200 controls. Regression analysis revealed that PwMS were at a significantly (B = 3.05, t = 2.24, 95% CI = 0.37-5.73, p = 0.02) higher risk to report higher ADHD scores versus controls. In addition, PwMS with relapses in the last 6 months and PwMS reporting smartphone addiction were at a significantly higher risk for severe ADHD (B = 7.19, t = 269, 95% CI = 1.91-12.48, p = 0.008) and (B = 9.18, t = 3.47, 95% CI = 3.97-14.41, p = 0.001), respectively. In conclusion, diagnosis with MS in our study was identified as a risk for higher ADHD symptoms. Conclusions: Further research is required to establish this relationship, and holistic medical and psychological interventions are required to improve the cognitive status of PwMS.
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Affiliation(s)
- Mariam Al-Ameri
- Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy, Yarmouk University, Irbid 21163, Jordan;
| | | | - Mohammad Mansour
- Department of Neurology, Al-Bashir Hospital, Amman 11151, Jordan; (M.M.); (S.A.-H.); (F.W.); (W.E.)
| | - Suha Al-Habahbeh
- Department of Neurology, Al-Bashir Hospital, Amman 11151, Jordan; (M.M.); (S.A.-H.); (F.W.); (W.E.)
| | - Feras Weshah
- Department of Neurology, Al-Bashir Hospital, Amman 11151, Jordan; (M.M.); (S.A.-H.); (F.W.); (W.E.)
| | - Wail Ennab
- Department of Neurology, Al-Bashir Hospital, Amman 11151, Jordan; (M.M.); (S.A.-H.); (F.W.); (W.E.)
| | - Ammena Y. Binsaleh
- Department of Pharmacy Practice, College of Pharmacy, Princess Nourah bint Abdulrahman University, P.O. Box 84428, Riyadh 11671, Saudi Arabia; (A.Y.B.); (S.A.R.S.)
| | - Sireen Abdul Rahim Shilbayeh
- Department of Pharmacy Practice, College of Pharmacy, Princess Nourah bint Abdulrahman University, P.O. Box 84428, Riyadh 11671, Saudi Arabia; (A.Y.B.); (S.A.R.S.)
| | - Omar Gammoh
- Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy, Yarmouk University, Irbid 21163, Jordan;
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Epstein SE, Longbrake EE. Shifting our attention earlier in the multiple sclerosis disease course. Curr Opin Neurol 2024; 37:212-219. [PMID: 38546031 DOI: 10.1097/wco.0000000000001268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2024]
Abstract
PURPOSE OF REVIEW Revisions of multiple sclerosis (MS) diagnostic criteria enable clinicians to diagnose patients earlier in the biologic disease course. Prompt initiation of therapy correlates with improved clinical outcomes. This has led to increased attention on the earliest stages of MS, including the MS prodrome and radiologically isolated syndrome (RIS). Here, we review current understanding and approach to patients with preclinical MS. RECENT FINDINGS MS disease biology often begins well before the onset of typical MS symptoms, and we are increasingly able to recognize preclinical and prodromal stages of MS. RIS represents the best characterized aspect of preclinical MS, and its diagnostic criteria were recently revised to better capture patients at highest risk of conversion to clinical MS. The first two randomized control trials evaluating disease modifying therapy use in RIS also found that treatment could delay or prevent onset of clinical disease. SUMMARY Despite progress in our understanding of the earliest stages of the MS disease course, additional research is needed to systematically identify patients with preclinical MS as well as capture those at risk for developing clinical disease. Recent data suggests that preventive immunomodulatory therapies may be beneficial for high-risk patients with RIS; though management remains controversial.
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Aloni R, Kalron A, Goodman A, Ben-Ari A, Yoeli-Shalom T, Menascu S. Attention Deficit/Hyperactivity Disorder in Children with Multiple Sclerosis. J Atten Disord 2024; 28:1105-1113. [PMID: 38385203 DOI: 10.1177/10870547241232710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
BACKGROUND Multiple sclerosis (MS) is a chronic neurological autoimmune disease; pediatric-onset multiple sclerosis (POMS) represents 5% to 10% of total MS population. Children with POMS may experience attention difficulties due to the disease's impact on the central nervous system. However, little is known regarding Attention Deficit Hyperactivity Disorder (ADHD) in POMS, and its relation to cognitive performance. METHODS A retrospective case review was conducted using medical records of 66 children and adolescent patients diagnosed with POMS between 2012 and 2021 in a MS center of a tertiary medical center. All patients had undergone routine clinical neurological examinations and had been assessed for a diagnosis of ADHD by a department pediatric neurologist. In addition, sociodemographic data, disease-related variables, and cognitive performance were collected. RESULTS Of the 66 patients, 31 (47%) had a diagnosis of ADHD; 29 (44%) had cognitive impairment. Moreover, we identified four different profiles of POMS: those with only ADHD (17, 26%); only cognitive impairment (15, 23%), ADHD and cognitive impairment (14, 21%), and only POMS (20, 30%). A significant difference in disease duration was found among the four profiles [F(3,65) = 8.17, p < .001, η² = 0.29], indicating that patients with ADHD and cognitive impairment were characterized by longer disease duration. CONCLUSIONS ADHD may be prominently involved in POMS, even during the early stages of the disease and early diagnosis is crucial in order to provide appropriate interventions and support.
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Affiliation(s)
- Roy Aloni
- Department of Psychology, Ariel University, Israel
- Multiple Sclerosis Center, Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel
| | - Alon Kalron
- Multiple Sclerosis Center, Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel
- Department of Physical Therapy, School of Health Professions, Tel-Aviv Faculty of Medicine, Tel-Aviv University, Israel
| | - Assaf Goodman
- Department of Behavioral Sciences, Ruppin Academic Center, Emek Hefer, Israel
| | | | - Talya Yoeli-Shalom
- Multiple Sclerosis Center, Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel
| | - Shay Menascu
- Multiple Sclerosis Center, Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel
- Tel-Aviv School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Mistri D, Tedone N, Biondi D, Vizzino C, Pagani E, Rocca MA, Filippi M. Cognitive phenotypes in multiple sclerosis: mapping the spectrum of impairment. J Neurol 2024; 271:1571-1583. [PMID: 38007408 DOI: 10.1007/s00415-023-12102-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 10/30/2023] [Accepted: 11/05/2023] [Indexed: 11/27/2023]
Abstract
BACKGROUND Available criteria for cognitive phenotypes in multiple sclerosis (MS) do not consider the severity of impairment. OBJECTIVES To identify cognitive phenotypes with varying degrees of impairment in MS patients and describe their demographic, clinical and MRI characteristics. METHODS Two hundred and forty-three MS patients and 158 healthy controls underwent neuropsychological tests to assess memory, attention, and executive function. For each domain, mild impairment was defined as performing 1.5 standard deviations below the normative mean on two tests, while the threshold for significant impairment was 2 standard deviations. Patients were classified into cognitive phenotypes based on severity of the impairment (mild/significant) and number of domains affected (one/more). RESULTS Five cognitive phenotypes emerged: Preserved cognition (PC; 56%), Mild Single-Domain Impairment (MSD; 15%), Mild Multi-Domain Impairment (MMD; 9%), Significant Single-Domain Impairment (SSD; 12%), Significant Multi-Domain Impairment (SMD; 8%). Compared with PC, MSD patients were older, had longer disease duration (DD) and higher T2-hyperintense lesion volume (LV; all p ≤ 0.02); MMD patients were older, had longer DD, higher disability, higher T2 LV and lower thalamic volume (all p ≤ 0.01); SSD patients had longer DD and lower gray matter cortical volume, thalamic, caudate, putamen and accumbens volumes (all p ≤ 0.04); and SMD patients were older, had longer DD, higher disability and more extensive structural damage in all brain regions explored (all p ≤ 0.03), except white matter and amygdala volumes. CONCLUSIONS We identified five cognitive phenotypes with graded levels of impairment. These phenotypes were characterized by distinct demographic, clinical and MRI features, indicating potential variations in the neural substrates of dysfunction throughout disease stages.
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Affiliation(s)
- Damiano Mistri
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
| | - Nicolò Tedone
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
| | - Diana Biondi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
| | - Carmen Vizzino
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
| | - Elisabetta Pagani
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
| | - Maria A Rocca
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy.
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
- Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
- Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy.
- Vita-Salute San Raffaele University, Milan, Italy.
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9
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Stavrogianni K, Kitsos DK, Giannopapas V, Chasiotis AK, Christouli N, Paraskevas PG, Zompola C, Tsivgoulis G, Paraskevas GP, Giannopoulos S. Neuropsychological profiles comparison between Multiple Sclerosis patients and Multiple Sclerosis patients with overlapping features of Systemic Lupus Erythematosus. J Neuroimmunol 2024; 387:578270. [PMID: 38176314 DOI: 10.1016/j.jneuroim.2023.578270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 11/30/2023] [Accepted: 12/18/2023] [Indexed: 01/06/2024]
Abstract
AIM Multiple sclerosis (MS) and Systemic Lupus Erythematosus (SLE) are autoimmune disorders that may lead to cognitive impairment. This study aimed to compare the neuropsychological profiles of patients with MS, and MS and coexisting SLE features. METHODS We included a total of 90 participants, divided into 3 groups: 30 patients with clinically definite relapsing remitting MS, 30 with coexisting MS and incomplete SLE (overlap group) and 30 healthy controls (HC). All participants underwent neuropsychological assessment with the Montreal Cognitive Assessment (MoCA), Symbol Digit Modalities Test (SDMT), Paced Auditory Serial Addition Test (PASAT), and Selective Reminding Test (SRT). RESULTS Both groups scored lower on the MoCA compared to the HC (p < .001). The overlap group showed the lowest performance on the SDMT and PASAT compared to the other two groups (p < .01), while the MS group scored similarly to the HC in the PASAT (p > .05). Regarding the learning rate and long-term recall, the overlap group had lower scores compared to both the MS and HC (p < .001), but it outperformed both groups in the retention efficacy score (p < .001). The MS group did not differ significantly from the HC in these memory domains (p > .05). CONCLUSION The overlap group exhibited a broader range of impairments, including slower processing speed, decreased working memory, reduced learning rate, and long-term retrieval deficits. Their retention ability remained intact. The coexistence of MS with SLE pathology had additive impacts on cognitive function.
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Affiliation(s)
- Konstantina Stavrogianni
- Second Department of Neurology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece; Department of Physiology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Dimitrios K Kitsos
- Second Department of Neurology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Vasileios Giannopapas
- Second Department of Neurology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece; Department of Physical Therapy, University of West Attica, Attica, Greece; Laboratory of Neuromuscular and Cardiovascular Study of Motion-LANECASM, University of West Attica, Attica, Greece
| | - Athanasios K Chasiotis
- Second Department of Neurology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece; Department of Physical Therapy, University of West Attica, Attica, Greece; Laboratory of Neuromuscular and Cardiovascular Study of Motion-LANECASM, University of West Attica, Attica, Greece
| | - Niki Christouli
- Second Department of Neurology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Panagiotis G Paraskevas
- Second Department of Neurology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Christina Zompola
- Second Department of Neurology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgios Tsivgoulis
- Second Department of Neurology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - George P Paraskevas
- Second Department of Neurology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Sotirios Giannopoulos
- Second Department of Neurology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
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10
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Elosúa MR, Villadangos N. Executive functions in relapsing-remitting multiple sclerosis. APPLIED NEUROPSYCHOLOGY. ADULT 2023:1-9. [PMID: 37930795 DOI: 10.1080/23279095.2023.2252125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Abstract
Some studies suggest that patients with relapsing-remitting multiple sclerosis have problems in the functioning of working memory, and more specifically in executive functions, but the available results are still inconsistent. The aim of the present study was to examine executive functioning in multiple sclerosis using classical and representative tasks for divided attention, updating, attentional shifting, and inhibition. The sample was composed of 48 participants aged between 18 and 59 years (24 persons living with multiple sclerosis and 24 healthy participants matched in age and education level). The executive functions of divided attention, updating, attentional shifting, and inhibition were analyzed through the Dual-Task Paradigm, the N-Back task, the Trail Making Test (TMT), and the Stroop test, respectively. The analyses of the data showed that the functioning of working memory was impaired in multiple sclerosis in the executive functions of divided attention and updating when the group of persons living with MS and the control group were compared. In addition, the performance in the four executive functions analyzed did not show the same profile across the persons living with MS in the sample, as no deficit in attentional shifting or inhibition was observed. It can be concluded that the presence of deficits was observed only in the executive functions of divided attention and updating under the condition of greater cognitive demand. The clinical implications of these results are underlined due to their impact on daily life.
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Affiliation(s)
- M Rosa Elosúa
- Departamento de Psicología Básica I, UNED, Madrid, Spain
| | - Noelia Villadangos
- Departamento de Psicología Básica I, UNED, Madrid, Spain
- Fundación de Esclerosis Múltiple de Madrid, Madrid, Spain
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11
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Pitteri M, Vannucci M, Dapor C, Guandalini M, Daffinà A, Marastoni D, Calabrese M. Prominent role of executive functioning on the Phonemic Fluency Test in people with multiple sclerosis. J Int Neuropsychol Soc 2023; 29:902-906. [PMID: 36781412 DOI: 10.1017/s1355617723000139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
OBJECTIVE Executive functioning (EF) can be one of the earliest, despite under-detected, impaired cognitive domains in patients with multiple sclerosis (pwMS). However, it is still not clear the role of EF on verbal fluency tests given the presence of information processing speed (IPS) deficits in pwMS. METHOD Performance of a group of 43 pwMS without IPS impairment as measured with the Symbol Digit Modalities Test (SDMT) and a group of 32 healthy controls (HC) was compared on the Phonemic and Semantic Fluency Tests. For each group, we scored the number of words generated (i) in the early time interval (i.e., first 15 sec, semi-automatic process) and (ii) in the late time interval (i.e., from 15 to 60 sec, controlled process). RESULTS Globally, pwMS produced significantly fewer words than HC on the Phonemic but not on the Semantic Fluency Test. Crucially, in the Phonemic Fluency Test pwMS generated significantly fewer words than HC in the late time interval, whereas no significant difference between the two groups emerged in the early time interval. CONCLUSIONS These findings suggest that executive dysfunction is the core element on the Phonemic Fluency Test also in pwMS and it deserves attention in both research and clinical practice.
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Affiliation(s)
- Marco Pitteri
- Department of Neuropsychology, National Hospital for Neurology and Neurosurgery, London, UK
| | - Manila Vannucci
- Department of NEUROFARBA, Section of Psychology, University of Florence, Florence, Italy
| | - Caterina Dapor
- Department of General Psychology, University of Padua, Padua, Italy
| | - Maddalena Guandalini
- Neurology section, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Angelica Daffinà
- Psychology Area, Salesian University Institution of Venice and Verona (IUSVE), Venice-Mestre, Italy
| | - Damiano Marastoni
- Neurology section, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Massimiliano Calabrese
- Neurology section, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
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12
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Bilgin YOU, Koskderelioglu A, Gedizlioglu M. Fall risk is related to cognitive functioning in ambulatory multiple sclerosis patients. Neurol Sci 2023; 44:3233-3242. [PMID: 36997775 DOI: 10.1007/s10072-023-06770-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 03/20/2023] [Indexed: 04/01/2023]
Abstract
BACKGROUND AND AIMS Patients with multiple sclerosis (PwMS) may suffer severely from falling and gait disturbance. Cognitive dysfunction, a common condition in MS patients, may also increase falling rates, regardless of physical disability. We planned this study to determine the fall rate and risk factors in MS patients, follow patients for falls, and reveal the relationship between falls and cognitive dysfunction. METHODS The study was conducted on 124 patients who have RRMS diagnoses. Patients' gait speed, simultaneous gait speed during other tasks, functions of the upper extremity, balance rating, and fear of falling were evaluated with dual-task Timed-Up-and-Go-3 versions (TUG, TUG-C, TUG-M), Timed 25 Foot Walk (T25WFT), Nine Hole Peg Test (9HPT), Berg Balance Scale (BBS) and Falls Efficacy Scale-International (FES-I) tests. Cognitive functions, fatigue levels, and quality of life were measured with the Symbol Digit Modalities Test (SDMT), Fatigue Severity Scale (FSS), and Multiple Sclerosis Quality of Life (MSQoL) test. Two groups were formed as "fallers" and "non-faller patients". We monitored the patients in six months period. RESULTS Forty-six patients fell at least once in the last one year before the study began. Fallers were older, less educated, had lower SDMT scores and higher disability scores. Non-faller patients scored lower in FES-I, TUG, and FSS tests. SDMT scores showed statistically significant, linear, positive, and moderate correlation with BBS and 9HPT scores (r = 0.307, p = 0.038, and r = 0.320, p = 0.030, respectively). CONCLUSION We determined that advanced age, lower education level, and cognitive dysfunction adversely affect gait speed and balance. Among the fallers, those with lower SDMT and MoCA scores had higher falling rates. We determined that EDSS and BBS scores are predictive factors for falls in patients with MS. In conclusion, patients with cognitive impairment should be closely monitored for the risk of falling. Consideration of falls during follow-up examinations might be predictive of cognitive deterioration in patients with MS.
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Affiliation(s)
- Yaprak Ozum Unsal Bilgin
- Department of Neurology, University of Health Sciences, Izmir Bozyaka Education and Research Hospital, Izmir, Turkey.
| | - Asli Koskderelioglu
- Department of Neurology, University of Health Sciences, Izmir Bozyaka Education and Research Hospital, Izmir, Turkey
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13
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Kania K, Ambrosius W, Kozubski W, Kalinowska-Łyszczarz A. The impact of disease modifying therapies on cognitive functions typically impaired in multiple sclerosis patients: a clinician's review. Front Neurol 2023; 14:1222574. [PMID: 37503514 PMCID: PMC10368887 DOI: 10.3389/fneur.2023.1222574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 06/28/2023] [Indexed: 07/29/2023] Open
Abstract
Objective Over the last few decades clinicians have become aware that cognitive impairment might be a major cause of disability, loss of employment and poor quality of life in patients suffering from multiple sclerosis [MS].The impact of disease modifying therapies [DMTs] on cognition is still a matter of debate. Theoretically, DMTs could exert a substantial beneficial effect by means of reducing neuroinflammation and brain atrophy, which are established correlates of cognitive dysfunction. The aim of the study was to review the evidence concerning the effect of DMTs on cognitive functions. Methods PubMed, Scopus, and the European Committee for Treatment and Research in Multiple Sclerosis [ECTRIMS] Library were searched for articles concerning the pediatric and adult populations of patients with multiple sclerosis, including clinical trials and RWD, where psychometric results were analyzed as secondary or exploratory endpoints. Results We reviewed a total of 44 studies that were found by our search strategy, analyzed the psychological tests that were applied, the length of the follow-up, and possible limitations. We pointed out the difficulties associated with assessing of DMTs' effects on cognitive functions, and pitfalls in cognitive tools used for evaluating of MS patients. Conclusion There is a need to highlight this aspect of MS therapies, and to collect adequate data to make informed therapeutic decisions, to improve our understanding of MS-related cognitive dysfunction and provide new therapeutic targets.
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Affiliation(s)
- Karolina Kania
- Department of Neurology, Poznan University of Medical Sciences, Poznań, Poland
| | - Wojciech Ambrosius
- Department of Neurology, Poznan University of Medical Sciences, Poznań, Poland
| | - Wojciech Kozubski
- Department of Neurology, Poznan University of Medical Sciences, Poznań, Poland
| | - Alicja Kalinowska-Łyszczarz
- Department of Neurology, Division of Neurochemistry and Neuropathology, Poznan University of Medical Sciences, Poznań, Poland
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14
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Hernandez CI, Kargarnovin S, Hejazi S, Karwowski W. Examining electroencephalogram signatures of people with multiple sclerosis using a nonlinear dynamics approach: a systematic review and bibliographic analysis. Front Comput Neurosci 2023; 17:1207067. [PMID: 37457899 PMCID: PMC10344458 DOI: 10.3389/fncom.2023.1207067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 06/14/2023] [Indexed: 07/18/2023] Open
Abstract
Background Considering that brain activity involves communication between millions of neurons in a complex network, nonlinear analysis is a viable tool for studying electroencephalography (EEG). The main objective of this review was to collate studies that utilized chaotic measures and nonlinear dynamical analysis in EEG of multiple sclerosis (MS) patients and to discuss the contributions of chaos theory techniques to understanding, diagnosing, and treating MS. Methods Using the preferred reporting items for systematic reviews and meta-analysis (PRISMA), the databases EbscoHost, IEEE, ProQuest, PubMed, Science Direct, Web of Science, and Google Scholar were searched for publications that applied chaos theory in EEG analysis of MS patients. Results A bibliographic analysis was performed using VOSviewer software keyword co-occurrence analysis indicated that MS was the focus of the research and that research on MS diagnosis has shifted from conventional methods, such as magnetic resonance imaging, to EEG techniques in recent years. A total of 17 studies were included in this review. Among the included articles, nine studies examined resting-state, and eight examined task-based conditions. Conclusion Although nonlinear EEG analysis of MS is a relatively novel area of research, the findings have been demonstrated to be informative and effective. The most frequently used nonlinear dynamics analyses were fractal dimension, recurrence quantification analysis, mutual information, and coherence. Each analysis selected provided a unique assessment to fulfill the objective of this review. While considering the limitations discussed, there is a promising path forward using nonlinear analyses with MS data.
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15
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Marinetto S, Riccardi A, Barbadoro F, Pucci V, Selini E, Pavan A, Rinaldi F, Perini P, Puthenparampil M, Gallo P, Mondini S. Sexual Dysfunction in Multiple Sclerosis: The Role of Executive Function. Behav Sci (Basel) 2023; 13:bs13050369. [PMID: 37232606 DOI: 10.3390/bs13050369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 04/21/2023] [Accepted: 04/26/2023] [Indexed: 05/27/2023] Open
Abstract
Cognitive impairment and sexual dysfunction are common symptoms in persons with Multiple Sclerosis (MS). The present study focuses on the relationship between these two dimensions by means of a specific assessment commonly used in clinical practice with this population. Fifty-five persons with a diagnosis of MS underwent specific cognitive tests and answered clinical questionnaires. Two cognitive tests, one for memory (the Selective Reminding Test), and one for attention (the Symbol Digit Modalities Test), were administered together with two tests for executive functions (the D-KEFS Sorting Test and Stroop Test). Two self-report questionnaires to investigate clinical, psychological and sexual features (the Beck Depression Inventory-II and Self-perception of Cognition in Multiple Sclerosis and Multiple Sclerosis Intimacy and Sexuality Questionnaire-19), were also administered. The main result highlights that sexual difficulties are associated with cognitive deficits, particularly with executive disorders, but not with memory and attention. Furthermore, sexual difficulties are better explained when depression symptoms are also taken into account. This study disentangles the interaction between sexual dysfunction, cognitive impairment and depression in persons with MS by emphasising the role of very high cognitive processing (i.e., executive functioning) in determining human behaviour.
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Affiliation(s)
- Silvia Marinetto
- Department of Philosophy, Sociology, Education and Applied Psychology, University of Padua, 35133 Padua, Italy
| | - Alice Riccardi
- Multiple Sclerosis Centre, Department of Neuroscience, University-Hospital of Padua, 35128 Padua, Italy
| | - Filippo Barbadoro
- Department of Philosophy, Sociology, Education and Applied Psychology, University of Padua, 35133 Padua, Italy
| | - Veronica Pucci
- Department of Philosophy, Sociology, Education and Applied Psychology, University of Padua, 35133 Padua, Italy
- Human Inspired Technology Centre (HIT), University of Padua, 35121 Padua, Italy
| | - Enrico Selini
- Department of Philosophy, Sociology, Education and Applied Psychology, University of Padua, 35133 Padua, Italy
| | - Aghite Pavan
- Department of Philosophy, Sociology, Education and Applied Psychology, University of Padua, 35133 Padua, Italy
| | - Francesca Rinaldi
- Multiple Sclerosis Centre, University-Hospital of Padua, 35128 Padua, Italy
| | - Paola Perini
- Multiple Sclerosis Centre, University-Hospital of Padua, 35128 Padua, Italy
| | - Marco Puthenparampil
- Multiple Sclerosis Centre, Department of Neuroscience, University-Hospital of Padua, 35128 Padua, Italy
| | - Paolo Gallo
- Multiple Sclerosis Centre, Department of Neuroscience, University-Hospital of Padua, 35128 Padua, Italy
| | - Sara Mondini
- Department of Philosophy, Sociology, Education and Applied Psychology, University of Padua, 35133 Padua, Italy
- Human Inspired Technology Centre (HIT), University of Padua, 35121 Padua, Italy
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16
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Grant JG, Rapport LJ, Darling R, Waldron-Perrine B, Bernitsas E. Incremental validity of brief and abbreviated neuropsychological tests toward predicting functional outcomes in multiple sclerosis. APPLIED NEUROPSYCHOLOGY. ADULT 2023:1-11. [PMID: 36773023 DOI: 10.1080/23279095.2023.2176766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
OBJECTIVE This study examined the relationships among functional outcomes and performance on standard-length and abbreviated cognitive screening measures for multiple sclerosis (MS). METHOD 72 adults with MS underwent neurological examination and cognitive screening. They completed standard-length and abbreviated versions of tests from the Minimal Assessment of Cognitive Function in MS (MACFIMS), the abbreviated aMACFIMS, and the Brief International Cognitive Assessment for MS (BICAMS). Functional outcomes included neurological disability, physical and psychological dysfunction, and employment status. RESULTS Concordance of impairment classifications was examined between standard-length and abbreviated tests using logistic regression and ROC curve analyses. Overall, the abbreviated test versions showed a broad range of concordance with impairment classifications made using the full-length tests. Processing speed was the strongest correlate of neurological disability and employment status; immediate recall was the strongest predictor of subjective physical dysfunction. Test performance provided unique value toward predicting neurological disability and employment status, but not physical and psychological dysfunction. CONCLUSIONS The findings replicate some support for abbreviated tests in MS assessment, although caveats regarding loss of validity associated with abbreviation remain. The findings extend prior research showing that abbreviated tests of processing speed and immediate recall can provide unique predictive information regarding objective functional outcomes.
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Affiliation(s)
- Jeremy G Grant
- Department of Psychology, Wayne State University, Detroit, MI, USA
| | - Lisa J Rapport
- Department of Psychology, Wayne State University, Detroit, MI, USA
| | - Rachel Darling
- Department of Neurology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Brigid Waldron-Perrine
- Department of Physical Medicine & Rehabilitation, Wayne State University School of Medicine, Detroit, MI, USA
| | - Eva Bernitsas
- Department of Neurology, Wayne State University School of Medicine, Detroit, MI, USA
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17
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Hoeijmakers A, Licitra G, Meijer K, Lam KH, Molenaar P, Strijbis E, Killestein J. Disease severity classification using passively collected smartphone-based keystroke dynamics within multiple sclerosis. Sci Rep 2023; 13:1871. [PMID: 36725975 PMCID: PMC9892592 DOI: 10.1038/s41598-023-28990-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 01/27/2023] [Indexed: 02/03/2023] Open
Abstract
Multiple Sclerosis (MS) is a progressive demyelinating disease of the central nervous system characterised by a wide range of motor and non-motor symptoms. The level of disability of people with MS (pwMS) is based on a wide range of clinical measures, though their frequency of evaluation and inaccuracies coming from objective and self-reported evaluations limits these assessments. Alternatively, remote health monitoring through devices can offer a cost-efficient solution to gather more reliable, objective measures continuously. Measuring smartphone keyboard interactions is a promising tool since typing and, thus, keystroke dynamics are likely influenced by symptoms that pwMS can experience. Therefore, this paper aims to investigate whether keyboard interactions gathered on a person's smartphone can provide insight into the clinical status of pwMS leveraging machine learning techniques. In total, 24 Healthy Controls (HC) and 102 pwMS were followed for one year. Next to continuous data generated via smartphone interactions, clinical outcome measures were collected and used as targets to train four independent multivariate binary classification pipelines in discerning pwMS versus HC and estimating the level of disease severity, manual dexterity and cognitive capabilities. The final models yielded an AUC-ROC in the hold-out set above 0.7, with the highest performance obtained in estimating the level of fine motor skills (AUC-ROC=0.753). These findings show that keyboard interactions combined with machine learning techniques can be used as an unobtrusive monitoring tool to estimate various levels of clinical disability in pwMS from daily activities and with a high frequency of sampling without increasing patient burden.
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Affiliation(s)
| | | | - Kim Meijer
- Neurocast B.V., Amsterdam, The Netherlands
| | - Ka-Hoo Lam
- Department of Neurology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Pam Molenaar
- Department of Neurology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Eva Strijbis
- Department of Neurology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Joep Killestein
- Department of Neurology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
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18
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Iva P, Martin R, Fielding J, Clough M, White O, Godic B, van der Walt A, Rajan R. Discriminating spatialised speech in complex environments in multiple sclerosis. Cortex 2023; 159:217-232. [PMID: 36640621 DOI: 10.1016/j.cortex.2022.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 06/13/2022] [Accepted: 11/09/2022] [Indexed: 12/25/2022]
Abstract
People with multiple sclerosis (pwMS) frequently present with deficits in binaural processing used for sound localization. This study examined spatial release from speech-on-speech masking in pwMS, which involves binaural processing and additional higher level mechanisms underlying streaming, such as spatial attention. 26 pwMS with mild severity (Expanded Disability Status Scale score <3) and 20 age-matched controls listened via headphones to pre-recorded sentences from a standard list presented simultaneously with eight-talker babble. Virtual acoustic techniques were used to simulate sentences originating from 0°, 20°, or 50° on the interaural horizontal plane around the listener whilst babble was presented continuously at 0° azimuth, and participants verbally repeated the target sentence. In a separate task, two simultaneous sentences both containing a colour and number were presented, and participants were required to report the target colour and number. Both competing sentences could originate from 0°, 20°, or 50° on the azimuthal plane. Participants also completed a series of neuropsychological assessments, an auditory questionnaire, and a three-alternative forced-choice task that involved the detection of interaural time differences (ITDs) in noise bursts. Spatial release from masking was observed in both pwMS and controls, as response accuracy in the two speech discrimination tasks improved in the spatially separated conditions (20° and 50°) compared with the co-localised condition. However, pwMS demonstrated significantly less spatial release (18%) than controls (28%) when discriminating colour/number coordinates. At 50° separation, pwMS discriminated significantly fewer coordinates (77%) than controls (89%). In contrast, pwMS had similar performances to controls when sentences were presented in babble, and for the basic ITD discrimination task. Significant correlations between speech discrimination performance and standardized neuropsychological scores were observed across all spatial conditions. Our findings suggest that spatial hearing is likely to be implicated in pwMS, thereby affecting the perception of competing speech originating from various locations.
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Affiliation(s)
- Pippa Iva
- Department of Physiology, Biomedicine Discovery Institute, Monash University, Melbourne, VIC, Australia.
| | - Russell Martin
- Department of Physiology, Biomedicine Discovery Institute, Monash University, Melbourne, VIC, Australia
| | - Joanne Fielding
- Department of Neurosciences, Central Clinical School, Alfred Hospital, Monash University, Melbourne, VIC, Australia
| | - Meaghan Clough
- Department of Neurosciences, Central Clinical School, Alfred Hospital, Monash University, Melbourne, VIC, Australia
| | - Owen White
- Department of Neurosciences, Central Clinical School, Alfred Hospital, Monash University, Melbourne, VIC, Australia
| | - Branislava Godic
- Department of Physiology, Biomedicine Discovery Institute, Monash University, Melbourne, VIC, Australia
| | - Anneke van der Walt
- Department of Neurosciences, Central Clinical School, Alfred Hospital, Monash University, Melbourne, VIC, Australia
| | - Ramesh Rajan
- Department of Physiology, Biomedicine Discovery Institute, Monash University, Melbourne, VIC, Australia
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19
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Majdinasab N, Orakifar N, Kouti L, Shamsaei G, Seyedtabib M, Jafari M. Solifenacin versus posterior tibial nerve stimulation for overactive bladder in patients with multiple sclerosis. Front Neurosci 2023; 17:1107886. [PMID: 36895417 PMCID: PMC9989311 DOI: 10.3389/fnins.2023.1107886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 01/31/2023] [Indexed: 02/25/2023] Open
Abstract
Introduction Overactive bladder (OAB) is one of the most common complications in patients with multiple sclerosis (MS). Choosing the effective treatment is very important in improving their quality of life (QOL). Therefore, the aim of this study was to compare solifenacin (SS) and posterior tibial nerve stimulation (PTNS) treatment effects in the MS Patients with OAB. Materials and methods In total, 70 MS patients suffering from OAB enrolled in this clinical trial study. Patients with a score of at least 3 according to the OAB questionnaire were randomly divided into two groups (35 patients in each group). In one group, patients received SS (5 mg daily for 4 weeks and 10 mg/day for another 8 weeks) and in a second group, patients were treated by PTNS (12 weekly session, 30 min). Results The mean (SD) age of patients participating in this study was 39.82 (9.088) and 42.41 (9.175) years for the SS group and the PTNS group, respectively. Patients in both groups showed statistically significant improvements in urinary incontinence, micturition, and daytime frequency (p < 0.001). Patients in the SS group had a better response for urinary incontinence after 12 weeks compared to the PTNS group. Also, patients in the SS group reported higher satisfaction and less daytime frequency compared to the PTNS group. Conclusion SS and PTNS were effective for improving the OAB symptoms in patients with MS. However, patients demonstrated a better experience with SS in terms of daytime frequency, urinary incontinence, and treatment satisfaction rate.
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Affiliation(s)
- Nastaran Majdinasab
- Member of Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Neda Orakifar
- Department of Physiotherapy, School of Rehabilitation Sciences, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.,Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Leila Kouti
- Faculty of Pharmacy, Clinical Pharmacy Department, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Gholamreza Shamsaei
- Department of Neurology, Golestan Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Maryam Seyedtabib
- Department of Biostatistics and Epidemiology, School of Public Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mohammad Jafari
- Department of Neurology, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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20
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Iodice R, Aceto G, Ruggiero L, Cassano E, Manganelli F, Dubbioso R. A review of current rehabilitation practices and their benefits in patients with multiple sclerosis. Mult Scler Relat Disord 2023; 69:104460. [PMID: 36535234 DOI: 10.1016/j.msard.2022.104460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 11/18/2022] [Accepted: 12/07/2022] [Indexed: 12/13/2022]
Abstract
Multiple sclerosis (MS) is a chronic, debilitating disease characterised by demyelination of the nerves of the central nervous system that results in patients progressively losing the ability to perform daily tasks. As there is no cure for this disease, rehabilitation therapy is an important aspect of care; assisting patients to regain or retain function and improve their physical, mental and social wellbeing. At present there is no current consistent model of care for MS, likely due to the variable symptom presentation. Various forms of rehabilitation therapy are available, and these include physical rehabilitation methods, such as balance and gait therapy, speech and respiration rehabilitation, and occupational therapy. Contrary to previous understanding, exercise-based therapies have shown various benefits for patients with MS, and in addition to improving MS-related physical symptoms, have been shown to reduce the risk of developing cardiovascular disease and can improve cognitive function. Cognition rehabilitation therapy specifically focuses on behavioural tasks and is divided into two main forms: compensatory rehabilitation, which offers cognitive functioning benefits, and restorative rehabilitation, which offers memory benefits. Excitation therapies include cranial stimulation and other stimulation rehabilitation methods such as focal muscle vibration therapy and these non-invasive techniques may improve patient's physical ability. Additionally, more novel rehabilitation methods include robot-assisted gait therapy and telerehabilitation, both of which are expected to play progressively more prominent roles in the future of rehabilitation therapy. The structure of the care team has been found to impact patient outcomes, and both in- and out-patient care settings have been found to be beneficial, dependant on the patient's circumstances, with certain patients better suited to a particular setting. While a single point of care is recommended for patients, a multidisciplinary care team and regular reassessment is recommended to manage changing symptoms and ensure continuity of care. The importance of the critical components of rehabilitation have been identified, and these are of vital importance in achieving beneficial outcomes. These components include the patients' participation in the treatment, goal setting with a multidisciplinary care team, a guiding-light purpose for the patient, which focusses on recognizing their personal potential and obtaining improvements through a tailored plan. The final critical component of rehabilitation is the results measurement, which highlights the need for a quantifiable reduction in impairment and improvement in activity and participation. Overall, a lack of standardisation in outcome measurements makes comparison challenging. This is particularly important when comparing standard methods of care with more novel rehabilitation techniques. However, within the broad area of rehabilitation therapies, it is clear that patients with MS can benefit from rehabilitation practices; physically, mentally and socially.
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Affiliation(s)
- Rosa Iodice
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Napoli, Italy.
| | - Gabriella Aceto
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Napoli, Italy
| | - Lucia Ruggiero
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Napoli, Italy
| | - Emanuele Cassano
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Napoli, Italy
| | - Fiore Manganelli
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Napoli, Italy
| | - Raffaele Dubbioso
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Napoli, Italy
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Raimo S, Giorgini R, Gaita M, Costanzo A, Spitaleri D, Palermo L, Liuzza MT, Santangelo G. Sensitivity of conventional cognitive tests in multiple sclerosis: Application of item response theory. Mult Scler Relat Disord 2023; 69:104440. [PMID: 36495845 DOI: 10.1016/j.msard.2022.104440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 11/17/2022] [Accepted: 12/01/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Cognitive impairment (CI) is common in Multiple Sclerosis (MS), and its prevalence rate ranges between 22% and 70%. Because CI significantly impacts vocational status, caregiver burden, and quality of life, an accurate neuropsychological assessment is required. Three widely used and validated batteries for MS-associated CI are the Brief Repeatable Neuropsychological Battery (BRN-B), the Minimal Assessment of Cognitive Function (MACFIMS), and the Brief International Cognitive Assessment (BICAMS). Although similar, these batteries differ in time-consuming and in specific tests employed. This study aims to assess the sensitivity of cognitive tests included in these batteries through an Item Response Theory approach. METHODS Ninety-seven patients with MS and 91 demographically matched controls (HC) were consecutively assessed using the three neuropsychological batteries (i.e., BRN-B, MACFIMS, and BICAMS). Continuous Response Model (CRM) was used to identify the cognitive test(s) that best discriminate patients with MS from HC. Receiver Operating Characteristic (ROC) curve analysis was used to determine the accuracy of the CRM results. RESULTS Cognitive tests loaded on two different latent variables: the 'higher-order executive functioning,' consisting of tests assessing concept formation, problem-solving, and inhibitory control, and the 'memory and information processing speed,' comprising tests assessing long-term, working memory, and information processing speed. The Delis Kaplan Executive Functioning System-Sorting Test and the Stroop Test were the most sensitive tests in differentiating cognitive functioning between MS and HC. CONCLUSIONS This study confirms the importance of including a more extensive executive assessment in MS clinical practice since higher-order executive functions (e.g., abstraction and inhibitory control) significantly impact patients' quality of life and functional autonomy. Clinical implications of careful dissection of executive functioning in MS neuropsychological assessment are discussed.
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Affiliation(s)
- Simona Raimo
- Department of Medical and Surgical Sciences, University "Magna Graecia" of Catanzaro, Viale Europa, Catanzaro 88100, Italy.
| | - Roberto Giorgini
- Department of Medical and Surgical Sciences, University "Magna Graecia" of Catanzaro, Viale Europa, Catanzaro 88100, Italy
| | - Mariachiara Gaita
- Department of Medical and Surgical Sciences, University "Magna Graecia" of Catanzaro, Viale Europa, Catanzaro 88100, Italy
| | - Antonio Costanzo
- Department of Psychology, University of Campania "Luigi Vanvitelli", Caserta, Italy
| | - Daniele Spitaleri
- Neurology Unit "San Giuseppe Moscati", Hospital Avellino, Avellino, Italy
| | - Liana Palermo
- Department of Medical and Surgical Sciences, University "Magna Graecia" of Catanzaro, Viale Europa, Catanzaro 88100, Italy
| | - Marco Tullio Liuzza
- Department of Medical and Surgical Sciences, University "Magna Graecia" of Catanzaro, Viale Europa, Catanzaro 88100, Italy
| | - Gabriella Santangelo
- Department of Psychology, University of Campania "Luigi Vanvitelli", Caserta, Italy
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22
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Argento O, Piacentini C, Bossa M, Caltagirone C, Santamato A, Saraceni V, Nocentini U. Motor, cognitive, and combined rehabilitation approaches on MS patients' cognitive impairment. Neurol Sci 2023; 44:1109-1118. [PMID: 36542204 PMCID: PMC9769485 DOI: 10.1007/s10072-022-06552-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 12/08/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND At the moment, the possible options for the management of cognitive dysfunctions in patients with MS (pMS) are pharmacological interventions, cognitive rehabilitation (CR), and physical exercise. However, worldwide, multimodal programs are infrequently applied in pMS and CR is not easily accessible through the National Health System as MR. OBJECTIVE The aim of the study is to explore if the combination of motor and cognitive rehabilitation may favor better outcomes on cognitive efficiency compared to separate trainings. METHODS Forty-eight pMS were submitted to detailed neuropsychological and motor assessments, before (T0) and after (T1) having performed one of three rehabilitation conditions (two cognitive trainings/week-Reha1; one cognitive and one motor training/week-Reha2; two motor trainings/week-Reha3, for 12 weeks); they were randomly assigned to one condition or another. The CR was focused on memory functioning and performed with the Rehacom program. RESULTS No significant differences in age, sex, education, and disease course were found between the three groups (sig. > .05). Reha1 patients increased only their cognitive performance, and Reha3 only increased their motor performance, while Reha2 increased both cognitive and motor performances. This benefit was also confirmed by the cognitive efficiency expressed by the Cognitive Impairment Index. CONCLUSIONS These data confirm that to include cognitive training within rehabilitation programs may induce important benefits in pMS. Furthermore, pMS seem to benefit from a combined approach (cognitive and motor) more than from CR and motor rehabilitation separately (ClinicalTrial.gov ID: NCT05462678; 14 July 2022, retrospectively registered).
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Affiliation(s)
- Ornella Argento
- Behavioral Neuropsychology Unit, I.R.C.C.S. "Santa Lucia" Foundation, Via Ardeatina, 306, 00179, Rome, Italy.
| | - Chiara Piacentini
- Behavioral Neuropsychology Unit, I.R.C.C.S. “Santa Lucia” Foundation, Via Ardeatina, 306, 00179 Rome, Italy
| | - Michela Bossa
- Behavioral Neuropsychology Unit, I.R.C.C.S. “Santa Lucia” Foundation, Via Ardeatina, 306, 00179 Rome, Italy
| | - Carlo Caltagirone
- Scientific Direction, I.R.C.C.S. “Santa Lucia” Foundation, Rome, Italy
| | - Andrea Santamato
- Rehabilitation Centre-Physical Medicine and Rehabilitation Section, OORR-Hospital-University of Foggia, Foggia, Italy
| | - Vincenzo Saraceni
- Scientific Direction, “Filippo Turati” Foundation, Rehabilitation Centre, Pistoia, Italy
| | - Ugo Nocentini
- Behavioral Neuropsychology Unit, I.R.C.C.S. “Santa Lucia” Foundation, Via Ardeatina, 306, 00179 Rome, Italy ,Department of Clinical Sciences and Translational Medicine, University of Rome “Tor Vergata”, Rome, Italy
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23
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Zhang W, Chen Y, Pei H. C1q and central nervous system disorders. Front Immunol 2023; 14:1145649. [PMID: 37033981 PMCID: PMC10076750 DOI: 10.3389/fimmu.2023.1145649] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 03/07/2023] [Indexed: 04/11/2023] Open
Abstract
C1q is a crucial component of the complement system, which is activated through the classical pathway to perform non-specific immune functions, serving as the first line of defense against pathogens. C1q can also bind to specific receptors to carry out immune and other functions, playing a vital role in maintaining immune homeostasis and normal physiological functions. In the developing central nervous system (CNS), C1q functions in synapse formation and pruning, serving as a key player in the development and homeostasis of neuronal networks in the CNS. C1q has a close relationship with microglia and astrocytes, and under their influence, C1q may contribute to the development of CNS disorders. Furthermore, C1q can also have independent effects on neurological disorders, producing either beneficial or detrimental outcomes. Most of the evidence for these functions comes from animal models, with some also from human specimen studies. C1q is now emerging as a promising target for the treatment of a variety of diseases, and clinical trials are already underway for CNS disorders. This article highlights the role of C1q in CNS diseases, offering new directions for the diagnosis and treatment of these conditions.
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Affiliation(s)
- Wenjie Zhang
- Department of Emergency Intensive Care Unit, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Department of General Practice, Xingyang Sishui Central Health Center, Zhengzhou, China
| | - Yuan Chen
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Hui Pei
- Department of Emergency Intensive Care Unit, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- *Correspondence: Hui Pei,
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24
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Sexual Dimorphism in Neurodegenerative Diseases and in Brain Ischemia. Biomolecules 2022; 13:biom13010026. [PMID: 36671411 PMCID: PMC9855831 DOI: 10.3390/biom13010026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 12/20/2022] [Accepted: 12/21/2022] [Indexed: 12/25/2022] Open
Abstract
Epidemiological studies and clinical observations show evidence of sexual dimorphism in brain responses to several neurological conditions. It is suggested that sex-related differences between men and women may have profound effects on disease susceptibility, pathophysiology, and progression. Sexual differences of the brain are achieved through the complex interplay of several factors contributing to this phenomenon, such as sex hormones, as well as genetic and epigenetic differences. Despite recent advances, the precise link between these factors and brain disorders is incompletely understood. This review aims to briefly outline the most relevant aspects that differ between men and women in ischemia and neurodegenerative disorders (AD, PD, HD, ALS, and SM). Recognition of disparities between both sexes could aid the development of individual approaches to ameliorate or slow the progression of intractable disorders.
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25
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Neural precursor cells tune striatal connectivity through the release of IGFBPL1. Nat Commun 2022; 13:7579. [PMID: 36482070 PMCID: PMC9731988 DOI: 10.1038/s41467-022-35341-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 11/30/2022] [Indexed: 12/13/2022] Open
Abstract
The adult brain retains over life endogenous neural stem/precursor cells (eNPCs) within the subventricular zone (SVZ). Whether or not these cells exert physiological functions is still unclear. In the present work, we provide evidence that SVZ-eNPCs tune structural, electrophysiological, and behavioural aspects of striatal function via secretion of insulin-like growth factor binding protein-like 1 (IGFBPL1). In mice, selective ablation of SVZ-eNPCs or selective abrogation of IGFBPL1 determined an impairment of striatal medium spiny neuron morphology, a higher failure rate in GABAergic transmission mediated by fast-spiking interneurons, and striatum-related behavioural dysfunctions. We also found IGFBPL1 expression in the human SVZ, foetal and induced-pluripotent stem cell-derived NPCs. Finally, we found a significant correlation between SVZ damage, reduction of striatum volume, and impairment of information processing speed in neurological patients. Our results highlight the physiological role of adult SVZ-eNPCs in supporting cognitive functions by regulating striatal neuronal activity.
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26
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Siems M, Tünnerhoff J, Ziemann U, Siegel M. Multistage classification identifies altered cortical phase- and amplitude-coupling in Multiple Sclerosis. Neuroimage 2022; 264:119752. [PMID: 36400377 PMCID: PMC9771829 DOI: 10.1016/j.neuroimage.2022.119752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 10/28/2022] [Accepted: 11/14/2022] [Indexed: 11/16/2022] Open
Abstract
Distinguishing groups of subjects or experimental conditions in a high-dimensional feature space is a common goal in modern neuroimaging studies. Successful classification depends on the selection of relevant features as not every neuronal signal component or parameter is informative about the research question at hand. Here, we developed a novel unsupervised multistage analysis approach that combines dimensionality reduction, bootstrap aggregating and multivariate classification to select relevant neuronal features. We tested the approach by identifying changes of brain-wide electrophysiological coupling in Multiple Sclerosis. Multiple Sclerosis is a demyelinating disease of the central nervous system that can result in cognitive decline and physical disability. However, related changes in large-scale brain interactions remain poorly understood and corresponding non-invasive biomarkers are sparse. We thus compared brain-wide phase- and amplitude-coupling of frequency specific neuronal activity in relapsing-remitting Multiple Sclerosis patients (n = 17) and healthy controls (n = 17) using magnetoencephalography. Changes in this dataset included both, increased and decreased phase- and amplitude-coupling in wide-spread, bilateral neuronal networks across a broad range of frequencies. These changes allowed to successfully classify patients and controls with an accuracy of 84%. Furthermore, classification confidence predicted behavioral scores of disease severity. In sum, our results unravel systematic changes of large-scale phase- and amplitude coupling in Multiple Sclerosis. Furthermore, our results establish a new analysis approach to efficiently contrast high-dimensional neuroimaging data between experimental groups or conditions.
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Affiliation(s)
- Marcus Siems
- Department of Neural Dynamics and Magnetoencephalography, Hertie Institute for Clinical Brain Research, University of Tübingen, Germany,Centre for Integrative Neuroscience, University of Tübingen, Germany,MEG Center, University of Tübingen, Germany,Department of Neurophysiology and Pathophysiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany,Correspondence author at: Department of Neural Dynamics and Magnetoencephalography, Hertie Institute for Clinical Brain Research, University of Tübingen, Germany.
| | - Johannes Tünnerhoff
- Department of Neurology & Stroke, Hertie Institute for Clinical Brain Research, University of Tübingen, Germany
| | - Ulf Ziemann
- Department of Neurology & Stroke, Hertie Institute for Clinical Brain Research, University of Tübingen, Germany
| | - Markus Siegel
- Department of Neural Dynamics and Magnetoencephalography, Hertie Institute for Clinical Brain Research, University of Tübingen, Germany,Centre for Integrative Neuroscience, University of Tübingen, Germany,MEG Center, University of Tübingen, Germany,Correspondence author at: Department of Neural Dynamics and Magnetoencephalography, Hertie Institute for Clinical Brain Research, University of Tübingen, Germany.
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27
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Tiu VE, Popescu BO, Enache II, Tiu C, Terecoasa E, Panea CA. Serum and CSF Biomarkers Predict Active Early Cognitive Decline Rather Than Established Cognitive Impairment at the Moment of RRMS Diagnosis. Diagnostics (Basel) 2022; 12:diagnostics12112571. [PMID: 36359416 PMCID: PMC9689215 DOI: 10.3390/diagnostics12112571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 10/19/2022] [Accepted: 10/20/2022] [Indexed: 11/16/2022] Open
Abstract
(1) Background: Cognitive impairment (CI) begins early in the evolution of multiple sclerosis (MS) but may only become obvious in the later stages of the disease. Little data is available regarding predictive biomarkers for early, active cognitive decline in relapse remitting MS (RRMS) patients. (2) Methods: 50 RRMS patients in the first 6 months following diagnosis were included. The minimum follow-up was one year. Biomarker samples were collected at baseline, 3-, 6- and 12-month follow-up. Cognitive performance was assessed at baseline and 12-month follow-up; (3) Results: Statistically significant differences were found for patients undergoing active cognitive decline for sNfL z-scores at baseline and 3 months, CSF NfL baseline values, CSF Aβ42 and the Bremso score as well. The logistic regression model based on these 5 variables was statistically significant, χ2(4) = 22.335, p < 0.0001, R2 = 0.671, with a sensitivity of 57.1%, specificity of 97.4%, a positive predictive value of 80% and a negative predictive value of 92.6%. (4) Conclusions: Our study shows that serum biomarkers (adjusted sNfL z-scores at baseline and 3 months) and CSF biomarkers (CSF NfL baseline values, CSF Aβ42), combined with a clinical score (BREMSO), can accurately predict an early cognitive decline for RRMS patients at the moment of diagnosis.
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Affiliation(s)
- Vlad Eugen Tiu
- Neurology Department, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Neurology Department, Elias University Emergency Hospital, 011461 Bucharest, Romania
| | - Bogdan Ovidiu Popescu
- Neurology Department, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Neurology Department, Colentina Clinical Hospital, 020125 Bucharest, Romania
- Correspondence:
| | - Iulian Ion Enache
- Neurology Department, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Neurology Department, University Emergency Hospital of Bucharest, 050098 Bucharest, Romania
| | - Cristina Tiu
- Neurology Department, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Neurology Department, University Emergency Hospital of Bucharest, 050098 Bucharest, Romania
| | - Elena Terecoasa
- Neurology Department, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Neurology Department, University Emergency Hospital of Bucharest, 050098 Bucharest, Romania
| | - Cristina Aura Panea
- Neurology Department, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Neurology Department, Elias University Emergency Hospital, 011461 Bucharest, Romania
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28
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Lysenko ES, Bogdanova MD, Arsalidou M. Quantitative Meta-analyses of Cognitive Abilities in Children With Pediatric-onset Multiple Sclerosis. Neuropsychol Rev 2022; 33:459-473. [PMID: 35802297 DOI: 10.1007/s11065-022-09546-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 05/24/2022] [Indexed: 11/27/2022]
Abstract
Pediatric-onset multiple sclerosis (POMS), is the manifestation of multiple sclerosis in individuals before 18 years of age. About a third of children with POMS show some form of lower cognitive performance. The purpose of this study is to examine using quantitative meta-analyses the effect size of altered performance between children with and without POMS on overall intelligence quotient (IQ), information processing speed, and language functions. We searched the literature for studies that reported scores on cognitive tests administered to children with and without POMS. Studies were systematically reviewed using PRISMA guidelines. We analyzed data from 14 studies that examined 1283 children with and without POMS when cognitive categories consisted of five or more studies. Effect sizes, publication bias and potential confounds were considered. Significant cognitive differences are revealed for all categories with the strongest effect observed for overall IQ. A moderate effect is observed for information processing speed, and small effects for verbal fluency and verbal memory. Cognitive abilities present differently in children with POMS and a better understanding of this manifestation will inform intervention and remediation tools that can improve clinical and educational practice for the benefit of children with POMS.
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Affiliation(s)
- Elena S Lysenko
- Neurobiological Foundations of Cognitive Development - Neuropsy Lab, HSE University, 101000, Myasnitskaya st.-20, Moscow, Russian Federation
| | - Mariia D Bogdanova
- I.M. Sechenov First Moscow State Medical University (Sechenov University), 119991, Trubetskaya st.-8/2, Moscow, Russian Federation.
- Scientific Research and Practical Center of Pediatric Psychoneurology, Michurinskiy pr.-74, 119602, Moscow, Russian Federation.
| | - Marie Arsalidou
- Neurobiological Foundations of Cognitive Development - Neuropsy Lab, HSE University, 101000, Myasnitskaya st.-20, Moscow, Russian Federation
- York University, 4700 Keele St, Toronto, ON, M3J 1P3, Canada
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29
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Guenter W, Betscher E, Bonek R. Predictive Value of the Third Ventricle Width for Neurological Status in Multiple Sclerosis. J Clin Med 2022; 11:jcm11102841. [PMID: 35628967 PMCID: PMC9145351 DOI: 10.3390/jcm11102841] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 05/04/2022] [Accepted: 05/11/2022] [Indexed: 01/27/2023] Open
Abstract
The third ventricle width (3VW) is an easily calculated measure of brain atrophy. The aim of this study was to evaluate the relation of 3VW to cognitive impairment with adjustment for demographic and clinical confounders, including depression, anxiety, and fatigue, as well as to disability in patients with multiple sclerosis (MS). Symbol Digit Modalities Test, California Verbal Learning Test, Brief Visuospatial Memory Test-Revised, Expanded Disability Status Scale (EDSS), Hospital Anxiety and Depression Scale, and Modified Fatigue Impact Scale (MFIS) were analysed in 93 patients with MS. Neuropsychological performance was compared to that of 150 healthy controls. Axial images from 3D FLAIR were used to measure 3VW. In total, 25% of MS patients were impaired in at least two neuropsychological tests. Cognitive impairment and EDSS were associated with 3VW. Age and 3VW were the strongest predictors of cognitive impairment. The multiple regression model including age, 3VW, education, EDSS, and MFIS explained 63% of the variance of neuropsychological tests results, whereas 3VW, age and duration of the disease were significant predictors of EDSS. This study confirms the predictive value of 3VW for neurological status of patients with MS, especially for cognitive impairment after adjustment for demographic and clinical confounders.
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Affiliation(s)
- Wojciech Guenter
- Department of Clinical Neuropsychology, Nicolaus Copernicus University, 87-100 Toruń, Poland, and Collegium Medicum, 85-094 Bydgoszcz, Poland
- Division of Neurology and Clinical Neuroimmunology, Regional Specialized Hospital in Grudziądz, 86-300 Grudziądz, Poland; (E.B.); (R.B.)
- Correspondence: ; Tel./Fax: +00-48-(0)52-585-37-03
| | - Ewa Betscher
- Division of Neurology and Clinical Neuroimmunology, Regional Specialized Hospital in Grudziądz, 86-300 Grudziądz, Poland; (E.B.); (R.B.)
| | - Robert Bonek
- Division of Neurology and Clinical Neuroimmunology, Regional Specialized Hospital in Grudziądz, 86-300 Grudziądz, Poland; (E.B.); (R.B.)
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30
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Portaccio E, Bellinvia A, Razzolini L, Pastò L, Goretti B, Niccolai C, Fonderico M, Zaffaroni M, Pippolo L, Moiola L, Falautano M, Celico C, Viterbo R, Patti F, Chisari C, Gallo P, Riccardi A, Borghi M, Bertolotto A, Simone M, Pozzilli C, Bianchi V, Roscio M, Martinelli V, Comi G, Filippi M, Trojano M, Ghezzi A, Amato MP. Long-term Cognitive Outcomes and Socioprofessional Attainment in People With Multiple Sclerosis With Childhood Onset. Neurology 2022; 98:e1626-e1636. [DOI: 10.1212/wnl.0000000000200115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 01/11/2022] [Indexed: 11/15/2022] Open
Abstract
Background and ObjectivesPatients with pediatric-onset multiple sclerosis (MS) can be especially vulnerable to cognitive impairment (CI) due to the onset of MS during a critical period for CNS development and maturation. The objective of this longitudinal study was to assess long-term cognitive functioning and socioprofessional attainment in the Italian pediatric MS cohort, previously assessed at baseline and 2 and 5 years.MethodsThe 48 patients evaluated at the 5-year assessment were screened for inclusion. All participants were assessed with a cognitive test battery exploring 4 different cognitive abilities. Depression, fatigue, and socioprofessional attainment were also assessed. Mean cognitive z scores were calculated for the whole cohort, and their evolution over time was analyzed with an analysis of variance for repeated measurements test. Predictors of cognitive worsening or improvement were assessed with a linear mixed-model analysis.ResultsThirty-three participants were included (mean follow-up 12.8 ± 0.8 years). The global cognitive performance worsened at year 2 and improved at year 5, although the z score remained significantly lower than at baseline (−0.9 ± 1.2 vs −0.3 ± 0.9, p = 0.002). There was no significant variation between years 5 and 12 (−0.7 ± 1.1, p = 0.452). Higher IQ (>90) at baseline (effect 0.3, 95% CI 0.1–0.5, p = 0.017) and lower number of relapses in the 2 years before baseline (effect −0.1, 95% CI −0.1 to 0.1, p = 0.025) predicted better cognitive performances. Eighteen (54.5%) patients failed at least 2 tests compared with healthy controls and were defined as cognitively impaired. The presence of CI predicted worse socioprofessional attainment (β = 4.8, 95% CI 1.4–8.2, p = 0.008).DiscussionThe longitudinal cognitive trajectory in pediatric-onset MS has a heterogeneous course over time, with a decline in the first years followed by a partial recovery over the long term. However, at the last follow-up evaluation, the proportion of impaired patients was more than double compared with baseline, with a negative impact on the individual’s socioprofessional attainment in adulthood. This study underscores how cognitive reserve may partially mitigate the negative effects of brain damage, highlighting the critical importance of intellectual enrichment early during the disease course.
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31
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Reliability and validity of the modified Walking and Remembering Test in persons with multiple sclerosis. Int J Rehabil Res 2021; 44:323-329. [PMID: 34483289 DOI: 10.1097/mrr.0000000000000493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Cognitive dysfunction can adversely impact the walking ability of people with multiple sclerosis. However, valid and reliable standardized clinical tools to measure cognitive-motor interference or dual-tasking in people with multiple sclerosis remain lacking. This study evaluated the validity and reliability of the modified Walking and Remembering Test (mWART) in people with multiple sclerosis. Eleven adults (mean ± SD age, 51.1 ± 13.4 years) with multiple sclerosis (Expanded Disability Status Score, 2.0-6.0) and six adults (mean ± SD age, 41.5 ± 17.2 years) without multiple sclerosis were administered the mWART twice over a 2-week period. Participants were tested on gait and digit span length under single-task and dual-task conditions according to the mWART procedures over a 10-m walkway. intraclass correlation coefficient2,k were 0.961 for single-task gait velocity (P < 0.001), 0.968 for dual-task gait velocity (P < 0.001), 0.829 for single-task digit span (P = 0.004), and 0.439 for dual-task digit span (P = 0.154). Single-task gait velocity (P = 0.001) and dual-task gait velocity (P = 0.002) were able to discriminate between groups but dual-task costs were similar between participants with and without multiple sclerosis. Those with severe disability demonstrated the greater dual-task cost of gait velocity (P = 0.030). This study provides preliminary evidence of the mWART's validity and reliability in measuring dual-task performance in patients with multiple sclerosis with mild to severe disability. More research is required in more heterogeneous samples of persons with multiple sclerosis.
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Correlation of the symbol digit modalities test with the quality of life and depression in Japanese patients with multiple sclerosis. Mult Scler Relat Disord 2021; 57:103427. [PMID: 34861614 DOI: 10.1016/j.msard.2021.103427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 11/16/2021] [Accepted: 11/21/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND This study aimed to evaluate the association between cognitive impairment and health-related quality of life (HRQOL), fatigue, and depression in Japanese patients with multiple sclerosis (MS). METHODS The Brief International Cognitive Assessment for MS (BICAMS) was performed in 184 Japanese patients with MS. The Functional Assessment of MS (FAMS), Fatigue Severity Scale (FSS), and Beck Depression Inventory-Second Edition (BDI-II) were used to evaluate HRQOL, fatigue, and depression, respectively. RESULTS Multiple linear regression analysis demonstrated positive correlations of the Symbol Digit Modalities Test (SDMT) with the scores on the FAMS subscales of mobility, symptoms, emotional well-being, and additional concerns and with the total FAMS score even after controlling for the Expanded Disability Status Scale score, age at examination, and duration of education. The SDMT score in the BICAMS battery had negative correlations with the BDI-II score, as revealed by multiple linear regression analysis. None of the three tests in the BICAMS had any correlation with the FSS score. CONCLUSION The SDMT has a significant relationship with HRQOL and depression in Japanese patients with MS.
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Validation of the Spanish-language version of the Montreal Cognitive Assessment as a screening test for cognitive impairment in multiple sclerosis. NEUROLOGÍA (ENGLISH EDITION) 2021; 37:726-734. [PMID: 34836843 DOI: 10.1016/j.nrleng.2019.11.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 11/04/2019] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The neuropsychological batteries traditionally used for the assessment of cognitive impairment (CI) in patients with multiple sclerosis are complex tests requiring a long time to administer. Simpler tests are needed to detect cognitive impairment in daily clinical practice. OBJECTIVE We aimed to evaluate the diagnostic validity and reliability of the Montreal Cognitive Assessment (MoCA) test as a screening tool for CI in patients with multiple sclerosis, as compared against the Brief Neuropsychological Battery. MATERIAL AND METHODS We recruited 52 patients with multiple sclerosis (61.5% women; mean age [standard deviation]: 41.7 [11.5] years). We analysed the reliability (internal consistency, interobserver reliability, and test-retest reliability), construct validity (factor analysis, Pearson correlation coefficient, and coefficient of determination), and criterion validity (ROC curve, sensitivity, specificity, total agreement, positive and negative predictive values, positive and negative likelihood ratios, and Fagan nomogram) of the MoCA test in this population. RESULTS The prevalence of CI was 21.2% according to findings from the Brief Neuropsychological Battery, and 25% according to the MoCA test. The MoCA test showed good internal consistency (Cronbach alpha, 0.822) and interobserver and test-retest reliability (intraclass correlation coefficient 0.80 and 0.96, respectively). The correlation coefficient between total Brief Neuropsychological Battery and MoCA test scores was 0.82. The optimal cut-off point on the ROC curve was 25-26, yielding 91% sensitivity and 93% specificity. CONCLUSION The MoCA test is a valid and reliable tool for screening for CI in patients with multiple sclerosis.
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Lees S, Dicker M, Ku JE, Chaganti V, Mew-Sum M, Wang N, Smith A, Oldmeadow C, Goon WL, Bevan M, Lang D, Hinwood M. Impact of disease-modifying therapies on MRI and neurocognitive outcomes in relapsing-remitting multiple sclerosis: a protocol for a systematic review and network meta-analysis. BMJ Open 2021; 11:e051509. [PMID: 34728450 PMCID: PMC8565566 DOI: 10.1136/bmjopen-2021-051509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Disease-modifying therapies (DMTs) are the mainstay of treatment for relapsing-remitting multiple sclerosis (RRMS). There is established evidence that DMTs are effective at reducing relapse rate and disease progression in RRMS, but there has been less consideration to the synthesis of MRI and neurocognitive outcomes, which play an increasingly important role in treatment decisions. The aim of this systematic review and network meta-analysis is to examine the relative efficacy, acceptability and tolerability of DMTs for RRMS, using MRI and neurocognitive outcomes. METHODS AND ANALYSIS We will search electronic databases, including MEDLINE, Embase and the Cochrane Central Register of Controlled Trials, with no date restrictions. We will also search the websites of international regulatory bodies for pharmaceuticals and international trial registries. We will include parallel group randomised controlled trials of DMTs including interferon beta-1a intramuscular, interferon beta-1a subcutaneous, interferon beta-1b, peginterferon beta-1a, glatiramer acetate, natalizumab, ocrelizumab, alemtuzumab, dimethyl fumarate, teriflunomide, fingolimod, cladribine, ozanimod, mitoxantrone and rituximab, either head-to-head or against placebo in adults with RRMS. Primary outcomes include efficacy (MRI outcomes including new T1/hypointense lesions and T2/hyperintense lesions) and acceptability (all-cause dropouts). Secondary outcomes include gadolinium-enhancing lesions, cerebral atrophy and tolerability (dropouts due to adverse events). Neurocognitive measures across three domains including processing speed, working memory and verbal learning will be included as exploratory outcomes. Data will be analysed using a random-effects pairwise meta-analysis and a Bayesian hierarchical random effects network meta-analysis to evaluate the efficacy, acceptability and tolerability of the included DMTs. Subgroup and sensitivity analyses will be conducted to assess the robustness of the findings. The review will be reported using the Preferred Reporting Items for Systematic Reviews incorporating Network Meta-Analyses statement. ETHICS AND DISSEMINATION This protocol does not require ethics approval. Results will be disseminated in a peer-reviewed academic journal. PROSPERO REGISTRATION NUMBER CRD42021239630.
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Affiliation(s)
- Samuel Lees
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Mathew Dicker
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Jie En Ku
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Varun Chaganti
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Matthew Mew-Sum
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Nick Wang
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Angela Smith
- HNEHealth Libraries, Hunter New England Local Health District, New Lambton, New South Wales, Australia
| | | | - Wooi Lynn Goon
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Marc Bevan
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Danielle Lang
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Madeleine Hinwood
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
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Lopez-Soley E, Martinez-Heras E, Andorra M, Solanes A, Radua J, Montejo C, Alba-Arbalat S, Sola-Valls N, Pulido-Valdeolivas I, Sepulveda M, Romero-Pinel L, Munteis E, Martínez-Rodríguez JE, Blanco Y, Martinez-Lapiscina EH, Villoslada P, Saiz A, Solana E, Llufriu S. Dynamics and Predictors of Cognitive Impairment along the Disease Course in Multiple Sclerosis. J Pers Med 2021; 11:jpm11111107. [PMID: 34834459 PMCID: PMC8624684 DOI: 10.3390/jpm11111107] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 10/22/2021] [Accepted: 10/26/2021] [Indexed: 12/15/2022] Open
Abstract
(1) Background: The evolution and predictors of cognitive impairment (CI) in multiple sclerosis (MS) are poorly understood. We aimed to define the temporal dynamics of cognition throughout the disease course and identify clinical and neuroimaging measures that predict CI. (2) Methods: This paper features a longitudinal study with 212 patients who underwent several cognitive examinations at different time points. Dynamics of cognition were assessed using mixed-effects linear spline models. Machine learning techniques were used to identify which baseline demographic, clinical, and neuroimaging measures best predicted CI. (3) Results: In the first 5 years of MS, we detected an increase in the z-scores of global cognition, verbal memory, and information processing speed, which was followed by a decline in global cognition and memory (p < 0.05) between years 5 and 15. From 15 to 30 years of disease onset, cognitive decline continued, affecting global cognition and verbal memory. The baseline measures that best predicted CI were education, disease severity, lesion burden, and hippocampus and anterior cingulate cortex volume. (4) Conclusions: In MS, cognition deteriorates 5 years after disease onset, declining steadily over the next 25 years and more markedly affecting verbal memory. Education, disease severity, lesion burden, and volume of limbic structures predict future CI and may be helpful when identifying at-risk patients.
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Affiliation(s)
- Elisabet Lopez-Soley
- Center of Neuroimmunology, Laboratory of Advanced Imaging in Neuroimmunological Diseases, Hospital Clinic Barcelona, Institut d’Investigacions Biomediques August Pi i Sunyer (IDIBAPS) and Universitat de Barcelona, 08036 Barcelona, Spain; (E.L.-S.); (E.M.-H.); (M.A.); (C.M.); (S.A.-A.); (N.S.-V.); (I.P.-V.); (M.S.); (Y.B.); (E.H.M.-L.); (P.V.); (A.S.)
| | - Eloy Martinez-Heras
- Center of Neuroimmunology, Laboratory of Advanced Imaging in Neuroimmunological Diseases, Hospital Clinic Barcelona, Institut d’Investigacions Biomediques August Pi i Sunyer (IDIBAPS) and Universitat de Barcelona, 08036 Barcelona, Spain; (E.L.-S.); (E.M.-H.); (M.A.); (C.M.); (S.A.-A.); (N.S.-V.); (I.P.-V.); (M.S.); (Y.B.); (E.H.M.-L.); (P.V.); (A.S.)
| | - Magi Andorra
- Center of Neuroimmunology, Laboratory of Advanced Imaging in Neuroimmunological Diseases, Hospital Clinic Barcelona, Institut d’Investigacions Biomediques August Pi i Sunyer (IDIBAPS) and Universitat de Barcelona, 08036 Barcelona, Spain; (E.L.-S.); (E.M.-H.); (M.A.); (C.M.); (S.A.-A.); (N.S.-V.); (I.P.-V.); (M.S.); (Y.B.); (E.H.M.-L.); (P.V.); (A.S.)
| | - Aleix Solanes
- Imaging of Mood- and Anxiety-Related Disorders (IMARD) Group, IDIBAPS and CIBERSAM, 08036 Barcelona, Spain; (A.S.); (J.R.)
| | - Joaquim Radua
- Imaging of Mood- and Anxiety-Related Disorders (IMARD) Group, IDIBAPS and CIBERSAM, 08036 Barcelona, Spain; (A.S.); (J.R.)
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Solna, 171 77 Stockholm, Sweden
- Early Psychosis: Interventions and Clinical-Detection (EPIC) Laboratory, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London WC2R 2LS, UK
| | - Carmen Montejo
- Center of Neuroimmunology, Laboratory of Advanced Imaging in Neuroimmunological Diseases, Hospital Clinic Barcelona, Institut d’Investigacions Biomediques August Pi i Sunyer (IDIBAPS) and Universitat de Barcelona, 08036 Barcelona, Spain; (E.L.-S.); (E.M.-H.); (M.A.); (C.M.); (S.A.-A.); (N.S.-V.); (I.P.-V.); (M.S.); (Y.B.); (E.H.M.-L.); (P.V.); (A.S.)
| | - Salut Alba-Arbalat
- Center of Neuroimmunology, Laboratory of Advanced Imaging in Neuroimmunological Diseases, Hospital Clinic Barcelona, Institut d’Investigacions Biomediques August Pi i Sunyer (IDIBAPS) and Universitat de Barcelona, 08036 Barcelona, Spain; (E.L.-S.); (E.M.-H.); (M.A.); (C.M.); (S.A.-A.); (N.S.-V.); (I.P.-V.); (M.S.); (Y.B.); (E.H.M.-L.); (P.V.); (A.S.)
| | - Nuria Sola-Valls
- Center of Neuroimmunology, Laboratory of Advanced Imaging in Neuroimmunological Diseases, Hospital Clinic Barcelona, Institut d’Investigacions Biomediques August Pi i Sunyer (IDIBAPS) and Universitat de Barcelona, 08036 Barcelona, Spain; (E.L.-S.); (E.M.-H.); (M.A.); (C.M.); (S.A.-A.); (N.S.-V.); (I.P.-V.); (M.S.); (Y.B.); (E.H.M.-L.); (P.V.); (A.S.)
| | - Irene Pulido-Valdeolivas
- Center of Neuroimmunology, Laboratory of Advanced Imaging in Neuroimmunological Diseases, Hospital Clinic Barcelona, Institut d’Investigacions Biomediques August Pi i Sunyer (IDIBAPS) and Universitat de Barcelona, 08036 Barcelona, Spain; (E.L.-S.); (E.M.-H.); (M.A.); (C.M.); (S.A.-A.); (N.S.-V.); (I.P.-V.); (M.S.); (Y.B.); (E.H.M.-L.); (P.V.); (A.S.)
| | - Maria Sepulveda
- Center of Neuroimmunology, Laboratory of Advanced Imaging in Neuroimmunological Diseases, Hospital Clinic Barcelona, Institut d’Investigacions Biomediques August Pi i Sunyer (IDIBAPS) and Universitat de Barcelona, 08036 Barcelona, Spain; (E.L.-S.); (E.M.-H.); (M.A.); (C.M.); (S.A.-A.); (N.S.-V.); (I.P.-V.); (M.S.); (Y.B.); (E.H.M.-L.); (P.V.); (A.S.)
| | - Lucia Romero-Pinel
- Multiple Sclerosis Unit, Neurology Department, Hospital Universitari de Bellvitge, IDIBELL, 08907 Barcelona, Spain;
| | - Elvira Munteis
- Neurology Department: Hospital del Mar Medical Research Institute (IMIM), 08003 Barcelona, Spain; (E.M.); (J.E.M.-R.)
| | - Jose E. Martínez-Rodríguez
- Neurology Department: Hospital del Mar Medical Research Institute (IMIM), 08003 Barcelona, Spain; (E.M.); (J.E.M.-R.)
| | - Yolanda Blanco
- Center of Neuroimmunology, Laboratory of Advanced Imaging in Neuroimmunological Diseases, Hospital Clinic Barcelona, Institut d’Investigacions Biomediques August Pi i Sunyer (IDIBAPS) and Universitat de Barcelona, 08036 Barcelona, Spain; (E.L.-S.); (E.M.-H.); (M.A.); (C.M.); (S.A.-A.); (N.S.-V.); (I.P.-V.); (M.S.); (Y.B.); (E.H.M.-L.); (P.V.); (A.S.)
| | - Elena H. Martinez-Lapiscina
- Center of Neuroimmunology, Laboratory of Advanced Imaging in Neuroimmunological Diseases, Hospital Clinic Barcelona, Institut d’Investigacions Biomediques August Pi i Sunyer (IDIBAPS) and Universitat de Barcelona, 08036 Barcelona, Spain; (E.L.-S.); (E.M.-H.); (M.A.); (C.M.); (S.A.-A.); (N.S.-V.); (I.P.-V.); (M.S.); (Y.B.); (E.H.M.-L.); (P.V.); (A.S.)
| | - Pablo Villoslada
- Center of Neuroimmunology, Laboratory of Advanced Imaging in Neuroimmunological Diseases, Hospital Clinic Barcelona, Institut d’Investigacions Biomediques August Pi i Sunyer (IDIBAPS) and Universitat de Barcelona, 08036 Barcelona, Spain; (E.L.-S.); (E.M.-H.); (M.A.); (C.M.); (S.A.-A.); (N.S.-V.); (I.P.-V.); (M.S.); (Y.B.); (E.H.M.-L.); (P.V.); (A.S.)
| | - Albert Saiz
- Center of Neuroimmunology, Laboratory of Advanced Imaging in Neuroimmunological Diseases, Hospital Clinic Barcelona, Institut d’Investigacions Biomediques August Pi i Sunyer (IDIBAPS) and Universitat de Barcelona, 08036 Barcelona, Spain; (E.L.-S.); (E.M.-H.); (M.A.); (C.M.); (S.A.-A.); (N.S.-V.); (I.P.-V.); (M.S.); (Y.B.); (E.H.M.-L.); (P.V.); (A.S.)
| | - Elisabeth Solana
- Center of Neuroimmunology, Laboratory of Advanced Imaging in Neuroimmunological Diseases, Hospital Clinic Barcelona, Institut d’Investigacions Biomediques August Pi i Sunyer (IDIBAPS) and Universitat de Barcelona, 08036 Barcelona, Spain; (E.L.-S.); (E.M.-H.); (M.A.); (C.M.); (S.A.-A.); (N.S.-V.); (I.P.-V.); (M.S.); (Y.B.); (E.H.M.-L.); (P.V.); (A.S.)
- Correspondence: (E.S.); (S.L.); Tel.: +34-932275414 (E.S. & S.L.); Fax: +34-932275783 (E.S. & S.L.)
| | - Sara Llufriu
- Center of Neuroimmunology, Laboratory of Advanced Imaging in Neuroimmunological Diseases, Hospital Clinic Barcelona, Institut d’Investigacions Biomediques August Pi i Sunyer (IDIBAPS) and Universitat de Barcelona, 08036 Barcelona, Spain; (E.L.-S.); (E.M.-H.); (M.A.); (C.M.); (S.A.-A.); (N.S.-V.); (I.P.-V.); (M.S.); (Y.B.); (E.H.M.-L.); (P.V.); (A.S.)
- Correspondence: (E.S.); (S.L.); Tel.: +34-932275414 (E.S. & S.L.); Fax: +34-932275783 (E.S. & S.L.)
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Significance of the Diagnosis of Executive Functions in Patients with Relapsing-Remitting Multiple Sclerosis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910527. [PMID: 34639827 PMCID: PMC8507634 DOI: 10.3390/ijerph181910527] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 09/28/2021] [Accepted: 10/06/2021] [Indexed: 12/02/2022]
Abstract
Multiple sclerosis (MS) is a progressive chronic disease of the Central Nervous System (CNS). Cognitive decline occurs rather rarely in relapsing–remitting multiple sclerosis (RRMS) compared to other types. The present study aimed to assess executive functions (EF) in relation to clinical and demographic variables in patients with RRMS. The study involved 22 individuals with RRMS (aged 23 to 49 years) and 22 matching controls. All the individuals with RRMS were in the remission phase. The assessments were carried out using MoCA, BDI-II, Halstead Category Test, Porteus Maze Test, verbal fluency tasks and Stroop Colour-Word Interference Test. The findings show that the two groups differed significantly in all the tests. All patients with RRMS in the remission phase presented at least one cognitive deficit, observed in general cognitive functioning, abstract reasoning or other executive functions, i.e., fluency, interference suppression, planning, or ability to modify activity in response to feedback. The deficits in most cases (except for those measured with the MoCA, Category Tests and phonemic fluency), are not related to intensity of depression and duration of the disease. Findings suggest that the diagnostic process in the case of patients with RRMS may include psychological assessment focusing on potentially existing cognitive, mainly executive, deficits and their severity.
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van der Walt A, Butzkueven H, Shin RK, Midaglia L, Capezzuto L, Lindemann M, Davies G, Butler LM, Costantino C, Montalban X. Developing a Digital Solution for Remote Assessment in Multiple Sclerosis: From Concept to Software as a Medical Device. Brain Sci 2021; 11:brainsci11091247. [PMID: 34573267 PMCID: PMC8471038 DOI: 10.3390/brainsci11091247] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 09/10/2021] [Accepted: 09/16/2021] [Indexed: 01/02/2023] Open
Abstract
There is increasing interest in the development and deployment of digital solutions to improve patient care and facilitate monitoring in medical practice, e.g., by remote observation of disease symptoms in the patients’ home environment. Digital health solutions today range from non-regulated wellness applications and research-grade exploratory instruments to regulated software as a medical device (SaMD). This paper discusses the considerations and complexities in developing innovative, effective, and validated SaMD for multiple sclerosis (MS). The development of SaMD requires a formalised approach (design control), inclusive of technical verification and analytical validation to ensure reliability. SaMD must be clinically evaluated, characterised for benefit and risk, and must conform to regulatory requirements associated with device classification. Cybersecurity and data privacy are also critical. Careful consideration of patient and provider needs throughout the design and testing process help developers overcome challenges of adoption in medical practice. Here, we explore the development pathway for SaMD in MS, leveraging experiences from the development of Floodlight™ MS, a continually evolving bundled solution of SaMD for remote functional assessment of MS. The development process will be charted while reflecting on common challenges in the digital space, with a view to providing insights for future developers.
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Affiliation(s)
- Anneke van der Walt
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC 3004, Australia;
- The Alfred, Melbourne, VIC 3004, Australia
- Correspondence: ; Tel.: +61-3-99030555
| | - Helmut Butzkueven
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC 3004, Australia;
| | - Robert K. Shin
- MedStar Georgetown University Hospital, Washington, DC 20007, USA;
| | - Luciana Midaglia
- Servei de Neurologia-Neuroimmunologia, Centre d’Esclerosi Múltiple de Catalunya (Cemcat), Institut de Recerca Vall d’Hebron (VHIR), Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain;
| | - Luca Capezzuto
- F. Hoffmann-La Roche Ltd., 4070 Basel, Switzerland; (L.C.); (M.L.); (G.D.); (L.M.B.); (C.C.)
| | - Michael Lindemann
- F. Hoffmann-La Roche Ltd., 4070 Basel, Switzerland; (L.C.); (M.L.); (G.D.); (L.M.B.); (C.C.)
| | - Geraint Davies
- F. Hoffmann-La Roche Ltd., 4070 Basel, Switzerland; (L.C.); (M.L.); (G.D.); (L.M.B.); (C.C.)
| | - Lesley M. Butler
- F. Hoffmann-La Roche Ltd., 4070 Basel, Switzerland; (L.C.); (M.L.); (G.D.); (L.M.B.); (C.C.)
| | - Cristina Costantino
- F. Hoffmann-La Roche Ltd., 4070 Basel, Switzerland; (L.C.); (M.L.); (G.D.); (L.M.B.); (C.C.)
| | - Xavier Montalban
- Multiple Sclerosis Centre of Catalonia (Cemcat), Department of Neurology/Neuroimmunology, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain;
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Pitteri M, Dapor C, Ziccardi S, Guandalini M, Meggiato R, Calabrese M. A Videogame-Based Approach to Measuring Information Processing Speed in Multiple Sclerosis Patients. Games Health J 2021; 10:115-120. [PMID: 33818136 DOI: 10.1089/g4h.2020.0069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Objective: Slowing information processing speed (IPS) is a biomarker of neuronal damage in patients with multiple sclerosis (pwMS). A focus on IPS might be the ideal solution in the perspective of promptly detecting cognitive changes over time. We developed a tablet-based home-made videogame to test the sensitivity of this device in measuring subclinical IPS in pwMS. Materials and Methods: Forty-three pwMS without cognitive impairment and 20 healthy controls (HCs) were administered the videogame task with a tablet. Response times (RTs) and accuracy were recorded. Results: PwMS (mean RTs = 505.5 ± 73.9 ms) were significantly slower than HCs (mean RTs = 462.3 ± 40.3 ms, P = 0.014) on the videogame task. A moderate but significant correlation (r = -0.35, P = 0.03) between mean RTs and the Symbol Digit Modalities Test was observed. Conclusion: Our videogame showed good sensitivity in measuring IPS in apparently cognitive normal pwMS. Computerized testing might be useful in screening initial cognitive dysfunction that should be monitored as a marker of underlying disease progression. IRB approval Number is 2332CESC.
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Affiliation(s)
- Marco Pitteri
- Neurology Section, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Caterina Dapor
- Neurology Section, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Stefano Ziccardi
- Neurology Section, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Maddalena Guandalini
- Neurology Section, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Riccardo Meggiato
- Neurology Section, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Massimiliano Calabrese
- Neurology Section, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
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Gontkovsky ST. Understanding visual-spatial perceptual deficits in individuals with multiple sclerosis: an analysis of patient performance on the Hooper Visual Organization Test and Visual Form Discrimination. Int J Neurosci 2021; 133:636-641. [PMID: 34253124 DOI: 10.1080/00207454.2021.1954642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Purpose: Although the cognitive sequelae of multiple sclerosis have been recognized for more than four decades, the focus of research has been on studying the more common deficits of the disease, including those involving memory and information processing speed. Less understood and investigated are the visual-spatial perceptual disturbances of multiple sclerosis, which can be difficult to assess and interpret given the potential confounds associated with the physical problems and other cognitive disturbances of the disorder.Materials and methods: This study examined the visual-spatial perceptual deficits of multiple sclerosis in 40 participants diagnosed with this condition using two measures generally unaffected by the aforementioned confounds, the Hooper Visual Organization Test and Visual Form Discrimination.Results: Results revealed both measures to be sensitive to the impairments of multiple sclerosis but suggested that they are assessing somewhat different aspects of visual-spatial perception in this population, given their relationship with one another and with disease-related variables.Conclusions: In this light, findings indicate that a complete and accurate understanding of the visual-spatial perceptual sequelae of multiple sclerosis requires the administration of more than a single measure.
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Riccardi A, Ognibene F, Mondini S, Nucci M, Margoni M, Meglioranzi I, Carta E, Zywicki S, Miante S, Perini P, Rinaldi F, Puthenparampil M, Gallo P. Designing a Self-Perception Cognitive Questionnaire for Italian Multiple Sclerosis Patients (Sclerosi Multipla Autovalutazione Cognitiva, SMAC). A Preliminary Exploratory Pilot Study. Front Neurol 2021; 12:668933. [PMID: 34262521 PMCID: PMC8273489 DOI: 10.3389/fneur.2021.668933] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 05/19/2021] [Indexed: 11/23/2022] Open
Abstract
Background: Although cognition in multiple sclerosis (MS) is assessed by means of several neuropsychological tests, only a few tools exist to investigate patients' perspectives on cognitive functioning. Objective: To develop a new questionnaire aimed at exploring patients' self-perception with respect to cognition in Italian MS patients. Methods: A total of 120 relapsing-remitting MS (RRMS) patients and 120 matched healthy controls (HC) completed a 25-item questionnaire called the Sclerosi Multipla Autovalutazione Cognitiva (SMAC). The Symbol Digit Modalities Test (SDMT), the Delis-Kaplan Executive Function System Sorting Test (D-KEFS ST), the Beck Depression Inventory (BDI-II), and the Fatigue Scale (FSS) were also administered to the patients. Results: Significantly higher SMAC scores were displayed by RRMS patients compared with HC (30.1 ± 16.9 vs. 23.4 ± 10.4, p = 0.003). SMAC inversely correlated with SDMT (r = −0.31, p < 0.001), D-KEFS ST FSC (r = −0.21, p = 0.017), D-KEFS ST FSD (r = −0.22, p = 0.015) and D-KEFS ST SR (r = −0.19, p = 0.035) and positively correlated with FSS (r = 0.42, p < 0.001) and BDI-II (r = 0.59, p < 0.001). Cronbach's alpha coefficient for the questionnaire was 0.94. Conclusion: Preliminary findings suggest that SMAC is a promising patient-reported outcome to be included in MS neuropsychological evaluation and thus warrants being further tested and developed.
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Affiliation(s)
- Alice Riccardi
- Department of Neuroscience, Multiple Sclerosis Center, University of Padua, Padua, Italy
| | - Francesca Ognibene
- Department of Neuroscience, Multiple Sclerosis Center, University of Padua, Padua, Italy
| | - Sara Mondini
- Department of Philosophy, Sociology, Education and Applied Psychology, Human Inspired Technology Research Centre- HIT, University of Padua, Padua, Italy
| | - Massimo Nucci
- Department of General Psychology, Human Inspired Technology Research Centre- HIT, University of Padua, Padua, Italy
| | - Monica Margoni
- Department of Neuroscience, Multiple Sclerosis Center, University of Padua, Padua, Italy
| | - Ilaria Meglioranzi
- Department of Neuroscience, Multiple Sclerosis Center, University of Padua, Padua, Italy
| | - Elisa Carta
- Department of Neuroscience, Multiple Sclerosis Center, University of Padua, Padua, Italy
| | - Sofia Zywicki
- Department of Neuroscience, Multiple Sclerosis Center, University of Padua, Padua, Italy
| | - Silvia Miante
- Department of Neuroscience, Multiple Sclerosis Center, University of Padua, Padua, Italy
| | - Paola Perini
- Multiple Sclerosis Center, University Hospital of Padua, Padua, Italy
| | - Francesca Rinaldi
- Multiple Sclerosis Center, University Hospital of Padua, Padua, Italy
| | - Marco Puthenparampil
- Department of Neuroscience, Multiple Sclerosis Center, University of Padua, Padua, Italy
| | - Paolo Gallo
- Department of Neuroscience, Multiple Sclerosis Center, University of Padua, Padua, Italy
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Microstructural MRI Correlates of Cognitive Impairment in Multiple Sclerosis: The Role of Deep Gray Matter. Diagnostics (Basel) 2021; 11:diagnostics11061103. [PMID: 34208650 PMCID: PMC8234586 DOI: 10.3390/diagnostics11061103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 06/07/2021] [Accepted: 06/10/2021] [Indexed: 11/24/2022] Open
Abstract
Although cognitive impairment (CI) is frequently observed in people with multiple sclerosis (pwMS), its pathogenesis is still controversial. Conflicting results emerged concerning the role of microstructural gray matter (GM) damage especially when involving the deep GM structures. In this study, we aimed at evaluating whether differences in cortical and deep GM structures between apparently cognitively normal (ACN) and CI pwMS (36 subjects in total) are present, using an extensive set of diffusion MRI (dMRI) indices and conventional morphometry measures. The results revealed increased anisotropy and restriction over several deep GM structures in CI compared with ACN pwMS, while no changes in volume were present in the same areas. Conversely, reduced anisotropy/restriction values were detected in cortical regions, mostly the pericalcarine cortex and precuneus, combined with reduced thickness of the superior frontal gyrus and insula. Most of the dMRI metrics but none of the morphometric indices correlated with the Symbol Digit Modality Test. These results suggest that deep GM microstructural damage can be a strong anatomical substrate of CI in pwMS and might allow identifying pwMS at higher risk of developing CI.
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Ziabska K, Ziemka-Nalecz M, Pawelec P, Sypecka J, Zalewska T. Aberrant Complement System Activation in Neurological Disorders. Int J Mol Sci 2021; 22:4675. [PMID: 33925147 PMCID: PMC8125564 DOI: 10.3390/ijms22094675] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 04/22/2021] [Accepted: 04/26/2021] [Indexed: 12/13/2022] Open
Abstract
The complement system is an assembly of proteins that collectively participate in the functions of the healthy and diseased brain. The complement system plays an important role in the maintenance of uninjured (healthy) brain homeostasis, contributing to the clearance of invading pathogens and apoptotic cells, and limiting the inflammatory immune response. However, overactivation or underregulation of the entire complement cascade within the brain may lead to neuronal damage and disturbances in brain function. During the last decade, there has been a growing interest in the role that this cascading pathway plays in the neuropathology of a diverse array of brain disorders (e.g., acute neurotraumatic insult, chronic neurodegenerative diseases, and psychiatric disturbances) in which interruption of neuronal homeostasis triggers complement activation. Dysfunction of the complement promotes a disease-specific response that may have either beneficial or detrimental effects. Despite recent advances, the explicit link between complement component regulation and brain disorders remains unclear. Therefore, a comprehensible understanding of such relationships at different stages of diseases could provide new insight into potential therapeutic targets to ameliorate or slow progression of currently intractable disorders in the nervous system. Hence, the aim of this review is to provide a summary of the literature on the emerging role of the complement system in certain brain disorders.
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Affiliation(s)
| | | | | | | | - Teresa Zalewska
- Mossakowski Medical Research Centre, NeuroRepair Department, Polish Academy of Sciences, 5 Pawinskiego Street, 02-106 Warsaw, Poland; (K.Z.); (M.Z.-N.); (P.P.); (J.S.)
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43
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Winter M, Tallantyre EC, Brice TAW, Robertson NP, Jones DK, Chamberland M. Tract-specific MRI measures explain learning and recall differences in multiple sclerosis. Brain Commun 2021; 3:fcab065. [PMID: 33959710 PMCID: PMC8088789 DOI: 10.1093/braincomms/fcab065] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 02/07/2021] [Accepted: 03/01/2021] [Indexed: 12/19/2022] Open
Abstract
Cognitive difficulties are common and a key concern for people with multiple sclerosis. Advancing knowledge of the role of white matter pathology in multiple sclerosis-related cognitive impairment is essential as both occur early in the disease with implications for early intervention. Consequently, this cross-sectional study asked whether quantifying the relationships between lesions and specific white matter structures could better explain co-existing cognitive differences than whole brain imaging measures. Forty participants with relapse-onset multiple sclerosis underwent cognitive testing and MRI at 3 Tesla. They were classified as cognitively impaired (n = 24) or unimpaired (n = 16) and differed across verbal fluency, learning and recall tasks corrected for intelligence and education (corrected P-values = 0.007-0.04). The relationships between lesions and white matter were characterized across six measures: conventional voxel-based T2 lesion load, whole brain tractogram load (lesioned volume/whole tractogram volume), whole bundle volume, bundle load (lesioned volume/whole bundle volume), Tractometry (diffusion-tensor and high angular resolution diffusion measures sampled from all bundle streamlines) and lesionometry (diffusion measures sampled from streamlines traversing lesions only). The tract-specific measures were extracted from corpus callosum segments (genu and isthmus), striato-prefrontal and -parietal pathways, and the superior longitudinal fasciculi (sections I, II and III). White matter measure-task associations demonstrating at least moderate evidence against the null hypothesis (Bayes Factor threshold < 0.2) were examined using independent t-tests and covariate analyses (significance level P < 0.05). Tract-specific measures were significant predictors (all P-values < 0.05) of task-specific clinical scores and diminished the significant effect of group as a categorical predictor in Story Recall (isthmus bundle load), Figure Recall (right striato-parietal lesionometry) and Design Learning (left superior longitudinal fasciculus III volume). Lesion load explained the difference in List Learning, whereas Letter Fluency was not associated with any of the imaging measures. Overall, tract-specific measures outperformed the global lesion and tractogram load measures. Variation in regional lesion burden translated to group differences in tract-specific measures, which in turn, attenuated differences in individual cognitive tasks. The structural differences converged in temporo-parietal regions with particular influence on tasks requiring visuospatial-constructional processing. We highlight that measures quantifying the relationships between tract-specific structure and multiple sclerosis lesions uncovered associations with cognition masked by overall tract volumes and global lesion and tractogram loads. These tract-specific white matter quantifications show promise for elucidating the relationships between neuropathology and cognition in multiple sclerosis.
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Affiliation(s)
- Mia Winter
- Department of Clinical Neuropsychology, University Hospital of Wales, Cardiff, CF14 4XW, UK
- Cardiff University Brain Research Imaging Centre, Cardiff University, Cardiff, CF24 4HQ, UK
| | - Emma C Tallantyre
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Cardiff, CF14 4XN, UK
- Helen Durham Centre for Neuroinflammation, University Hospital of Wales, Cardiff, CF14 4XW, UK
| | - Thomas A W Brice
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Cardiff, CF14 4XN, UK
| | - Neil P Robertson
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Cardiff, CF14 4XN, UK
- Helen Durham Centre for Neuroinflammation, University Hospital of Wales, Cardiff, CF14 4XW, UK
| | - Derek K Jones
- Cardiff University Brain Research Imaging Centre, Cardiff University, Cardiff, CF24 4HQ, UK
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria 3000, Australia
| | - Maxime Chamberland
- Cardiff University Brain Research Imaging Centre, Cardiff University, Cardiff, CF24 4HQ, UK
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Doskas T, Vavougios GD, Karampetsou P, Kormas C, Synadinakis E, Stavrogianni K, Sionidou P, Serdari A, Vorvolakos T, Iliopoulos I, Vadikolias Κ. Neurocognitive impairment and social cognition in multiple sclerosis. Int J Neurosci 2021; 132:1229-1244. [PMID: 33527857 DOI: 10.1080/00207454.2021.1879066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE/AIM OF THE STUDY The impairment of neurocognitive functions occurs in all subtypes of multiple sclerosis, even from the earliest stages of the disease. Commonly reported manifestations of cognitive impairment include deficits in attention, conceptual reasoning, processing efficiency, information processing speed, memory (episodic and working), verbal fluency (language), and executive functions. Multiple sclerosis patients also suffer from social cognition impairment, which affects their social functioning. The objective of the current paper is to assess the effect of neurocognitive impairment and its potential correlation with social cognition performance and impairment in multiple sclerosis patients. MATERIALS AND METHODS An overview of the available-to-date literature on neurocognitive impairment and social cognition performance in multiple sclerosis patients by disease subtype was performed. RESULTS It is not clear if social cognition impairment occurs independently or secondarily to neurocognitive impairment. There are associations of variable strengths between neurocognitive and social cognition deficits and their neural basis is increasingly investigated. CONCLUSIONS The prompt detection of neurocognitive predictors of social cognition impairment that may be applicable to all multiple sclerosis subtypes and intervention are crucial to prevent further neural and social cognition decline in multiple sclerosis patients.
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Affiliation(s)
- Triantafyllos Doskas
- Department of Neurology, Athens Naval Hospital, Athens, Greece.,Department of Neurology, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | | | | | | | | | | | | | - Aspasia Serdari
- Department of Psychiatry, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Theofanis Vorvolakos
- Department of Psychiatry, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Ioannis Iliopoulos
- Department of Neurology, University Hospital of Alexandroupolis, Alexandroupolis, Greece
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Taherian N, Vaezi G, Neamati A, Etemad L, Hojjati V, Gorji-Valokola M. Vitamin B12 and estradiol benzoate improve memory retrieval through activation of the hippocampal AKT, BDNF, and CREB proteins in a rat model of multiple sclerosis. IRANIAN JOURNAL OF BASIC MEDICAL SCIENCES 2021; 24:256-263. [PMID: 33953866 PMCID: PMC8061324 DOI: 10.22038/ijbms.2021.51469.11681] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 12/14/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Multiple sclerosis (MS) causes extensive damage in the hippocampus. Vitamin B12 (vit B12) and estradiol benzoate (EB) have anti-inflammatory and re-myelination properties that make them proper in improvement of cognitive impairment. This study aimed to evaluate the effects of these compounds on learning and memory disturbances. MATERIALS AND METHODS 77 adult male rats were implanted with stainless steel guide cannula bilaterally into the hippocampal area. The animals received 3 μl intrahippocampal EtB 0.01% and were randomly divided into eleven groups (7 rats/group). The groups included control, peanut oil (sham1), distilled water (sham 2), vit B12 (0.25, 0.5, 1 mg/kg), EB (25 and 50 mg/kg), vit B12 (0.25 mg/kg) plus EB (25 mg/kg), vit B12 (0.5 mg/kg) plus EB (25 mg/kg), and vit B12 (1 mg/kg) plus EB (50 mg/kg). The control group received intrahippocampal saline (as solvent). The locomotor activity and learning and memory functions were evaluated by open-field and shuttle-box tests, respectively. AKT, CREB, and BDNF levels were analyzed by Western blotting. RESULTS This study has found significant deficit in passive avoidance learning, locomotor activity, as well as decrease in the levels of phosphorylated AKT, BDNF, and CREB in groups that received EtB. Vit B12 (1 mg/kg), EB (50 mg/kg), and their combination markedly improved these side effects. CONCLUSION This study demonstrated that vit B12 and estradiol benzoate, especially in combination therapy, can be helpful in treatment of memory problems and MS-induced dysfunction through activation of the hippocampal AKT, BDNF, and CREB proteins.
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Affiliation(s)
- Narjes Taherian
- Department of Biology, Damghan Branch, Islamic Azad University, Damghan, Iran
| | - Gholamhassan Vaezi
- Department of Biology, Damghan Branch, Islamic Azad University, Damghan, Iran
| | - Ali Neamati
- Department of Biology, Mashhad Branch, Islamic Azad University, Mashhad, Iran
| | - Leila Etemad
- Medical Toxicology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Vida Hojjati
- Department of Biology, Damghan Branch, Islamic Azad University, Damghan, Iran
| | - Mahmoud Gorji-Valokola
- Department of Pharmacodynamics and Toxicology, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
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Cattaneo D, Gervasoni E, Anastasi D, Di Giovanni R, Brichetto G, Carpinella I, Cavalla P, Confalonieri P, Groppo E, Prosperini L, Tacchino A, Rovaris M, Solaro C. Prevalence and patterns of subclinical motor and cognitive impairments in non-disabled individuals with early multiple sclerosis: a multicenter cross-sectional study. Ann Phys Rehabil Med 2021; 65:101491. [PMID: 33454397 DOI: 10.1016/j.rehab.2021.101491] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 11/10/2020] [Accepted: 11/12/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Motor and cognitive disorders appear early in the course of multiple sclerosis (MS) and develop gradually over time. OBJECTIVE To study the frequency and pattern of subtle functional disorders in people with MS (PwMS) with no overt signs of disability in an early phase of the disease and their association with walking impairments in daily activities. METHODS In this cross-sectional study, we recruited PwMS with an Expanded Disability Status Scale (EDSS) score ≤ 2.5 and disease duration ≤ 5 years. Participants were assessed with functional scales rating walking endurance (6-Min Walk Test), perceived walking ability (Twelve-item Multiple Sclerosis Walking Scale), balance (Fullerton Advanced Balance scale_short), manual dexterity (Nine Hole Peg Test), fatigue (Fatigue Severity Scale), and cognitive impairments (Brief International Cognitive Assessment). RESULTS About 90% of the 82 PwMS (mean [SD] EDSS score 1.5 [0.7] and disease duration 2.2 [1.7] years) showed endurance values below the expected score; almost 30% showed impairment, and for 57%, perceived walking ability score was abnormal. Balance was impaired in 48% of participants, as was manual dexterity (29%) and fatigue (24%), but only a few showed cognitive impairments. Only 11% of PwMS had no abnormal score on the scales used in the assessment. As compared with EDSS score 0 to 1.5, with EDSS score 2 to 2.5, performance was worse for endurance (difference ±61.0 m, p=0.016), perceived walking ability (-11 points, p=0.002), balance (+1.9 points, p=0.005), manual dexterity (-2.8 sec, p=0.004), and fatigue (-1.3 points, p=0.013). Factors that predicted perceived walking ability were balance (B = -1.37, p<0.001) and fatigue (B = 5.11, p<0.001) rather than endurance (B = -0.01, p=048). CONCLUSION Even PwMS with no clinical disability and classified as having "no problem walking" present walking and other functional deficits when assessed with specific functional tests. The addition of specific tools could better identify subtle motor and cognitive deficits. Finally, the assessment of balance disorders and fatigue is important to understand individuals' perceived walking impairments in daily activities.
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Affiliation(s)
- Davide Cattaneo
- IRCSS Fondazione Don Carlo Gnocchi, Via Capecelatro 66, 20148 Milano, Italy
| | - Elisa Gervasoni
- IRCSS Fondazione Don Carlo Gnocchi, Via Capecelatro 66, 20148 Milano, Italy.
| | - Denise Anastasi
- IRCSS Fondazione Don Carlo Gnocchi, Via Capecelatro 66, 20148 Milano, Italy
| | - Rachele Di Giovanni
- Rehabilitation Department, CRRF Mons L Novarese, 13040 Loc. Trompone, Moncrivello (VC), Italy
| | - Giampaolo Brichetto
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), via Operai 40, 16149 Genoa, Italy
| | - Ilaria Carpinella
- IRCSS Fondazione Don Carlo Gnocchi, Via Capecelatro 66, 20148 Milano, Italy
| | - Paola Cavalla
- MS Center, Department of Neuroscience and Mental Health, City of Health and Science, University Hospital of Torino, via Cherasco 15, Turin, Italy
| | - Paolo Confalonieri
- Multiple Sclerosis Center, IRCCS Foundation "Carlo Besta" Neurological Institute, Milan, Italy
| | - Elisabetta Groppo
- IRCSS Fondazione Don Carlo Gnocchi, Via Capecelatro 66, 20148 Milano, Italy; Clinica Neurologica III, Università degli Studi di Milano, Polo Universitario San Paolo, ASST Santi Paolo e Carlo, Via Antonio di Rudinì, 820142 Milano, Italy
| | - Luca Prosperini
- Department of Neurosciences, S. Camillo-Forlanini Hospital, c.ne Gianicolense 87, 00152 Rome, Italy
| | - Andrea Tacchino
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), via Operai 40, 16149 Genoa, Italy
| | - Marco Rovaris
- IRCSS Fondazione Don Carlo Gnocchi, Via Capecelatro 66, 20148 Milano, Italy
| | - Claudio Solaro
- Rehabilitation Department, CRRF Mons L Novarese, 13040 Loc. Trompone, Moncrivello (VC), Italy
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Iva P, Fielding J, Clough M, White O, Godic B, Martin R, Rajan R. Speech Discrimination Tasks: A Sensitive Sensory and Cognitive Measure in Early and Mild Multiple Sclerosis. Front Neurosci 2021; 14:604991. [PMID: 33424540 PMCID: PMC7786116 DOI: 10.3389/fnins.2020.604991] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 11/30/2020] [Indexed: 11/13/2022] Open
Abstract
There is a need for reliable and objective measures of early and mild symptomology in multiple sclerosis (MS), as deficits can be subtle and difficult to quantify objectively in patients without overt physical deficits. We hypothesized that a speech-in-noise (SiN) task would be sensitive to demyelinating effects on precise neural timing and diffuse higher-level networks required for speech intelligibility, and therefore be a useful tool for monitoring sensory and cognitive changes in early MS. The objective of this study was to develop a SiN task for clinical use that sensitively monitors disease activity in early (<5 years) and late (>10 years) stages of MS subjects with mild severity [Expanded Disability Status Scale (EDSS) score < 3]. Pre-recorded Bamford-Kowal-Bench sentences and isolated keywords were presented at five signal-to-noise ratios (SNR) in one of two background noises: speech-weighted noise and eight-talker babble. All speech and noise were presented via headphones to controls (n = 38), early MS (n = 23), and late MS (n = 12) who were required to verbally repeat the target speech. MS subjects also completed extensive neuropsychological testing which included: Paced Auditory Serial Addition Test, Digit Span Test, and California Verbal Learning Test. Despite normal hearing thresholds, subjects with early and late mild MS displayed speech discrimination deficits when sentences and words were presented in babble - but not speech-weighted noise. Significant correlations between SiN performance and standardized neuropsychological assessments indicated that MS subjects with lower functional scores also had poorer speech discrimination. Furthermore, a quick 5-min task with words and keywords presented in multi-talker babble at an SNR of -1 dB was 82% accurate in discriminating mildly impaired MS individuals (median EDSS = 0) from healthy controls. Quantifying functional deficits in mild MS will help clinicians to maximize the opportunities to preserve neurological reserve in patients with appropriate therapeutic management, particularly in the earliest stages. Given that physical assessments are not informative in this fully ambulatory cohort, a quick 5-min task with words and keywords presented in multi-talker babble at a single SNR could serve as a complementary test for clinical use due to its ease of use and speed.
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Affiliation(s)
- Pippa Iva
- Department of Physiology, Biomedicine Discovery Institute, Monash University, Melbourne, VIC, Australia
| | - Joanne Fielding
- Department of Neuroscience, Central Clinical School, Monash University, Alfred Centre, Melbourne, VIC, Australia
| | - Meaghan Clough
- Department of Neuroscience, Central Clinical School, Monash University, Alfred Centre, Melbourne, VIC, Australia
| | - Owen White
- Department of Neuroscience, Central Clinical School, Monash University, Alfred Centre, Melbourne, VIC, Australia
| | - Branislava Godic
- Department of Physiology, Biomedicine Discovery Institute, Monash University, Melbourne, VIC, Australia
| | - Russell Martin
- Department of Physiology, Biomedicine Discovery Institute, Monash University, Melbourne, VIC, Australia
| | - Ramesh Rajan
- Department of Physiology, Biomedicine Discovery Institute, Monash University, Melbourne, VIC, Australia
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Burggraaff J, Liu Y, Prieto JC, Simoes J, de Sitter A, Ruggieri S, Brouwer I, Lissenberg-Witte BI, Rocca MA, Valsasina P, Ropele S, Gasperini C, Gallo A, Pareto D, Sastre-Garriga J, Enzinger C, Filippi M, De Stefano N, Ciccarelli O, Hulst HE, Wattjes MP, Barkhof F, Uitdehaag BMJ, Vrenken H, Guttmann CRG. Manual and automated tissue segmentation confirm the impact of thalamus atrophy on cognition in multiple sclerosis: A multicenter study. NEUROIMAGE-CLINICAL 2020; 29:102549. [PMID: 33401136 PMCID: PMC7787946 DOI: 10.1016/j.nicl.2020.102549] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 12/09/2020] [Accepted: 12/20/2020] [Indexed: 01/05/2023]
Abstract
BACKGROUND AND RATIONALE Thalamus atrophy has been linked to cognitive decline in multiple sclerosis (MS) using various segmentation methods. We investigated the consistency of the association between thalamus volume and cognition in MS for two common automated segmentation approaches, as well as fully manual outlining. METHODS Standardized neuropsychological assessment and 3-Tesla 3D-T1-weighted brain MRI were collected (multi-center) from 57 MS patients and 17 healthy controls. Thalamus segmentations were generated manually and using five automated methods. Agreement between the algorithms and manual outlines was assessed with Bland-Altman plots; linear regression assessed the presence of proportional bias. The effect of segmentation method on the separation of cognitively impaired (CI) and preserved (CP) patients was investigated through Generalized Estimating Equations; associations with cognitive measures were investigated using linear mixed models, for each method and vendor. RESULTS In smaller thalami, automated methods systematically overestimated volumes compared to manual segmentations [ρ=(-0.42)-(-0.76); p-values < 0.001). All methods significantly distinguished CI from CP MS patients, except manual outlines of the left thalamus (p = 0.23). Poorer global neuropsychological test performance was significantly associated with smaller thalamus volumes bilaterally using all methods. Vendor significantly affected the findings. CONCLUSION Automated and manual thalamus segmentation consistently demonstrated an association between thalamus atrophy and cognitive impairment in MS. However, a proportional bias in smaller thalami and choice of MRI acquisition system might impact the effect size of these findings.
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Affiliation(s)
- Jessica Burggraaff
- Department of Neurology, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, Location VUmc, De Boelelaan 1117, 1118, 1081 HV Amsterdam, The Netherlands.
| | - Yao Liu
- Department of Radiology and Nuclear Medicine, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, Location VUmc, De Boelelaan 1117, 1118, 1081 HV Amsterdam, The Netherlands.
| | - Juan C Prieto
- Center for Neurological Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 1249 Boylston Street, Boston, MA 02215, USA.
| | - Jorge Simoes
- Department of Neurology, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, Location VUmc, De Boelelaan 1117, 1118, 1081 HV Amsterdam, The Netherlands.
| | - Alexandra de Sitter
- Department of Radiology and Nuclear Medicine, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, Location VUmc, De Boelelaan 1117, 1118, 1081 HV Amsterdam, The Netherlands.
| | - Serena Ruggieri
- Department of Human Neurosciences, "Sapienza" University of Rome, Piazzale Aldo Moro, 5, 00185 Roma RM, Italy; Department of Neurosciences, San Camillo Forlanini Hospital, Circonvallazione Gianicolense, 87, 00152 Roma RM, Italy.
| | - Iman Brouwer
- Department of Radiology and Nuclear Medicine, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, Location VUmc, De Boelelaan 1117, 1118, 1081 HV Amsterdam, The Netherlands.
| | - Birgit I Lissenberg-Witte
- Department of Epidemiology and Biostatistics, Amsterdam UMC, Location VUmc, De Boelelaan 1089a, 1081 HV Amsterdam, the Netherlands.
| | - Mara A Rocca
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, and Neurology Unit, San Raffaele Scientific Institute, Via Olgettina, 58, 20132 Milano MI, Italy; Neurology Unit, San Raffaele Scientific Institute, Via Olgettina, 58, 20132 Milano MI, Italy.
| | - Paola Valsasina
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, and Neurology Unit, San Raffaele Scientific Institute, Via Olgettina, 58, 20132 Milano MI, Italy.
| | - Stefan Ropele
- Department of Neurology, Medical University of Graz, Auenbruggerplatz 22, 8036 Graz, Austria.
| | - Claudio Gasperini
- Department of Neurosciences, San Camillo Forlanini Hospital, Circonvallazione Gianicolense, 87, 00152 Roma RM, Italy.
| | - Antonio Gallo
- Division of Neurology and 3T MRI Research Center, Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Viale Abramo Lincoln, 5, 81100 Caserta, CE, Napoli, Italy.
| | - Deborah Pareto
- Section of Neuroradiology and MRI Unit, Department of Radiology, University Hospital iValld'Hebron, Autonomous University of Barcelona, Passeig de la Vall d'Hebron 119-129, 08035 Barcelona, Spain.
| | - Jaume Sastre-Garriga
- Department of Neurology, University Hospital iValld'Hebron, Autonomous University of Barcelona, Passeig de la Vall d'Hebron 119-129, 08035 Barcelona, Spain.
| | - Christian Enzinger
- Division of Neuroradiology, Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz, Auenbruggerplatz 22, 8036 Graz, Austria.
| | - Massimo Filippi
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, and Neurology Unit, San Raffaele Scientific Institute, Via Olgettina, 58, 20132 Milano MI, Italy; Neurology Unit, San Raffaele Scientific Institute, Via Olgettina, 58, 20132 Milano MI, Italy; Neurophysiology Unit, San Raffaele Scientific Institute, and (14)Vita-Salute San Raffaele University, Via Olgettina, 58, 20132 Milano, MI, Italy; Department of Neurological and Behavioural Sciences, University of Siena, 53100 Siena SI, Italy.
| | - Nicola De Stefano
- Department of Neurological and Behavioural Sciences, University of Siena, 53100 Siena SI, Italy.
| | - Olga Ciccarelli
- Department of Neuroinflammation UCL, Queen Square Institute of Neurology UCL, Queen Square, London WC1N 3BG, United Kingdom.
| | - Hanneke E Hulst
- Department of Anatomy and Neurosciences, Amsterdam Neuroscience, MS Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1108, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands.
| | - Mike P Wattjes
- Department of Radiology and Nuclear Medicine, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, Location VUmc, De Boelelaan 1117, 1118, 1081 HV Amsterdam, The Netherlands; Department of Diagnostic and Interventional Neuroradiology, Hannover Medical School, Hannover, Carl-Neuberg-Straße, 30625 Hannover, Germany.
| | - Frederik Barkhof
- Department of Radiology and Nuclear Medicine, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, Location VUmc, De Boelelaan 1117, 1118, 1081 HV Amsterdam, The Netherlands; Institutes of Neurology & Healthcare Engineering, UCL, 235 Euston Rd, Bloomsbury, London NW1 2BU, United Kingdom.
| | - Bernard M J Uitdehaag
- Department of Neurology, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, Location VUmc, De Boelelaan 1117, 1118, 1081 HV Amsterdam, The Netherlands.
| | - Hugo Vrenken
- Department of Radiology and Nuclear Medicine, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, Location VUmc, De Boelelaan 1117, 1118, 1081 HV Amsterdam, The Netherlands.
| | - Charles R G Guttmann
- Center for Neurological Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 1249 Boylston Street, Boston, MA 02215, USA.
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Barros C, Fernandes A. Linking Cognitive Impairment to Neuroinflammation in Multiple Sclerosis using neuroimaging tools. Mult Scler Relat Disord 2020; 47:102622. [PMID: 33227630 DOI: 10.1016/j.msard.2020.102622] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 11/08/2020] [Accepted: 11/09/2020] [Indexed: 12/24/2022]
Abstract
Multiple sclerosis (MS) is a complex chronic immune disease in the central nervous system, causing neurological disability among young and middle-aged adults. Impaired cognition is now emerging as a major clinical symptom being present in more than 50% of MS patients. Recent data support that neuroinflammation mediated by glial cells plays a key part in MS course and, particularly, microglia is responsible for the pruning of synapses possibly impacting on vital neural networks maintenance. However, the knowledge of microglia-mediated mechanisms underlying cognitive impairment in MS is poor and unfortunately, there are no medicines to overcome this "invisible" symptom. Interestingly, the use of powerful diagnostic imaging tools as structural and functional MRI as well as PET brought new insights into some biological mechanisms, but no link between the possibility to use early visible alterations to predict cognitive deficits was clarified yet. In this review, we focus on the interplay between MS-related cognitive structures and neuroinflammation, specifically the presence of microglia and their reactivity. Moreover, we also discuss new imaging tools to assess cognitive impairment and to track microglia activation. Understanding the role of microglia in cognitive impairment and how it can be prevented may be a promising contribution to innovative therapeutic strategies that culminate in the improvement of MS patients' life quality.
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Affiliation(s)
- Catarina Barros
- Neuron-Glia Biology in Health and Disease, Research Institute for Medicines (iMed.ULisboa), Faculty of Pharmacy, Universidade de Lisboa, Portugal
| | - Adelaide Fernandes
- Neuron-Glia Biology in Health and Disease, Research Institute for Medicines (iMed.ULisboa), Faculty of Pharmacy, Universidade de Lisboa, Portugal; Department of Biochemistry and Human Biology, Faculty of Pharmacy, Universidade de Lisboa, Portugal.
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50
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Alboudi A, Hadid A, Ali AR, Alshaikh F, Aqleh H. Normative values of the Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS) in an Arab population: Corrected for age, sex and education. Mult Scler Relat Disord 2020; 44:102305. [PMID: 32570183 DOI: 10.1016/j.msard.2020.102305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 06/01/2020] [Accepted: 06/12/2020] [Indexed: 11/30/2022]
Abstract
Background Cognitive impairment is common in multiple sclerosis (MS) patients with 43-70% of patients being affected. The international cognitive assessment for MS BICAMS is a new battery for cognitive assessment in MS patients. It was suggested in 2012 that international validation efforts be undertaken. Objective To utilize regression to provide normative values for the BICAMS while correcting for age, gender and education, as well as assess test-retest reliability, in an Arab population. Methods Healthy subjects were recruited from different areas in Dubai. Corrections for demographics were calculated using multiple linear regression. Test-retest reliability was assessed using the Pearson correlation coefficient. Results Two hundred eighty-one healthy subjects were enrolled (174 women, mean age 30±10.3 years, mean education 17.8±3.7 years). Test re-test results showed significant correlation between baseline and retest scores. Regression-based equations were derived for the BICAMS. Conclusion This large-scale validation study provides evidence to support the facilitation of international implementation of the BICAMS assessment by focusing on the Arab population. Next steps include validation efforts in an Arab MS patient population to further support the use of the BICAMS in day to day practice and for longitudinal patient assessment.
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Affiliation(s)
- Ayman Alboudi
- Mercy Health Saint Mary, Grand Rapids, Michgan, US; Rashid hospital, Dubai, UAE.
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