151
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Distinct cognitive impairments in different disease courses of multiple sclerosis—A systematic review and meta-analysis. Neurosci Biobehav Rev 2017; 83:568-578. [DOI: 10.1016/j.neubiorev.2017.09.005] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 09/02/2017] [Accepted: 09/04/2017] [Indexed: 12/13/2022]
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152
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Kavaliunas A, Danylaite Karrenbauer V, Gyllensten H, Manouchehrinia A, Glaser A, Olsson T, Alexanderson K, Hillert J. Cognitive function is a major determinant of income among multiple sclerosis patients in Sweden acting independently from physical disability. Mult Scler 2017; 25:104-112. [PMID: 29143553 DOI: 10.1177/1352458517740212] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND In multiple sclerosis (MS), various aspects of cognitive function can be detrimentally affected, thus patients' employment and social functioning is commonly impacted. OBJECTIVE To analyse income among MS patients in relation to cognitive function, assessed with the Symbol Digit Modalities Test (SDMT). METHODS A cross-sectional study including 2080 MS patients was conducted linking national register-based data. Descriptive statistics and a two-part model were used to estimate differences in earnings and social benefits. RESULTS MS patients in the highest SDMT score quartile earned more than twice annually compared to patients in the lowest quartile, whereas patients in the lowest quartile received three times more income through social benefits. The difference in earnings and benefits across the SDMT performance quartiles remained statistically significant after adjusting for various clinical and socio-demographic variables, including physical disability. The corrected prevalence ratios for MS patients in the highest quartile for having income from earnings and benefits were 1.40 (95% confidence interval (CI): 1.29-1.49) and 0.81 (95% CI: 0.71-0.90), respectively, when compared to the patients in the lowest quartile. CONCLUSION Cognitive function affects the financial situation of MS patients negatively and independently of physical disability. This warrants cognitive testing as a routine measure in health care services for MS patients.
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Affiliation(s)
- Andrius Kavaliunas
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Virginija Danylaite Karrenbauer
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden/Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
| | - Hanna Gyllensten
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden/Centre for Person-centred Care (GPCC), Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ali Manouchehrinia
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Anna Glaser
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Tomas Olsson
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden/Centre for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden
| | | | - Jan Hillert
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden/Department of Neurology, Karolinska University Hospital, Stockholm, Sweden/Centre for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden
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153
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Vanotti S, Caceres FJ. Cognitive and neuropsychiatric disorders among MS patients from Latin America. Mult Scler J Exp Transl Clin 2017; 3:2055217317717508. [PMID: 28979791 PMCID: PMC5617097 DOI: 10.1177/2055217317717508] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 06/04/2017] [Indexed: 11/20/2022] Open
Abstract
Cognitive and neuropsychiatric disorders in patients with multiple sclerosis have been extensively documented. The focus of this review will be on cognitive and neuropsychiatric disorders in multiple sclerosis patients from Latin America, in the context of international literature. Multicentre studies carried out in Latin America have shown that 43% of the patients have cognitive impairment and 34.5% in early stages of the disease, 29% depression and 20.9% neuropsychiatric disorders. The profile of cognitive impairment corresponds to alterations in visual and verbal memory, in attention, in information processing speed and in verbal fluency. The neuropsychiatric profile showed disorders in anxiety, depression, apathy and irritability domains. In the region, there exist validations of the multiple sclerosis neuropsychological screening questionnaire (MSNQ), the brief repeatable battery of neuropsychological tests (BRB-N) and the brief international cognitive assessment for multiple sclerosis (BICAMS), as well as of the paced auditory serial addition test (PASAT) and the symbol digit modalities test (SDMT). A study showed that 53% of the patients who met the NEDA3 condition had cognitive impairment. This finding highlights the need for taking cognitive assessment into account when determining therapeutic efficacy.
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Affiliation(s)
| | - Fernando J Caceres
- Multiple Sclerosis Clinic, INEBA - Neurosciences Institute of Buenos Aires, Argentina
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154
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Cognitive-motor interference in multiple sclerosis: What happens when the gait speed is fixed? Gait Posture 2017; 57:211-216. [PMID: 28667902 DOI: 10.1016/j.gaitpost.2017.06.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 04/18/2017] [Accepted: 06/22/2017] [Indexed: 02/02/2023]
Abstract
During the last decade, numerous studies have confirmed a coupling between walking performance and cognition in people with multiple sclerosis (PwMS). Our aim was to provide new insights into a walking-cognitive dual-task (DT) in PwMS. We tested the DT phenomenon by controlling the walking speed using an instrumented treadmill. Thirty PwMS (20 women) with a mean age 40.1 (SD=12.0) participated in the study. Twenty-one healthy subjects served as controls. Each subject completed a sequence of tests: a) Normal walking (ST) - the participant walked on the instrumented treadmill at a comfortable walking speed for 1min; b) Cognitive evaluation (ST) - subjects performed two cognitive tests while seated; c) DT cognitive tests performed while walking on the treadmill at the identical speed performed during normal walking. Outcome measures were spatio-temporal parameters of gait (mean and variability), the Word List Generation Test (WLG) and the Serial-3 Subtraction Test. MS participants significantly decreased their cadence while increasing their stride length during the DT condition compared to the ST condition. Non-significant differences were observed for the WLG and Serial-3 Subtraction Cognitive Tests between the ST condition and the DT condition in both the MS and healthy groups. In terms of gait variability parameters, MS subjects demonstrated a 2 to 3-fold greater gait variability compared to the healthy controls. Non-significant differences in gait variability parameters were observed between the ST and DT conditions in both the MS and control groups. This study provides new insights into the DT phenomenon in the MS population.
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155
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Chalah MA, Kauv P, Lefaucheur JP, Hodel J, Créange A, Ayache SS. Theory of mind in multiple sclerosis: A neuropsychological and MRI study. Neurosci Lett 2017; 658:108-113. [PMID: 28855125 DOI: 10.1016/j.neulet.2017.08.055] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Revised: 08/17/2017] [Accepted: 08/23/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Social cognition stands among the most frequently affected yet the least studied cognitive domains in multiple sclerosis (MS). Theory of mind (ToM) is a social cognitive facet that implies the one's ability to predict others' mental states. The objective of this study was to assess the relationship between ToM and neuropsychological and neuroimaging data. METHODS Thirty-eight consecutive MS patients completed the Reading the Mind in the Eyes test (RMET). They underwent a neuropsychological evaluation and a 3T T1-weighted brain MRI. A fully automated volume-based morphometry algorithm (MorphoBox) was applied to calculate regional brain volumes. Correlation analysis was performed using Spearman's test. RESULTS Among the sociodemographic and clinical data, significant correlations were found between RMET scores and each of years of education (r=0.54; p<0.01) and the duration of the disease progressive phase (r=-0.46; p<0.01). Regarding neuropsychological measures, RMET scores were directly correlated with information processing speed (r=0.58; p<0.01) and empathy (r=0.46; p<0.01) scores. As for brain volumes, RMET scores were directly correlated with parietal (left: r=0.39; right: r=0.46; p<0.05) and temporal (left: r=0.36; right: r=0.40; p<0.05) white matter volumes, as well as with cingulate (left: r=0.32; right: r=0.44; p<0.05) gray matter volumes. CONCLUSION These results highlight the relationship between ToM and some of the disease characteristics and cognitive domains. Importantly, ToM performance in MS is associated with brain volumes of key areas in social cognitive networks. Further works are needed to enhance the current knowledge on the underlying mechanisms of ToM deficits in this population.
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Affiliation(s)
- Moussa A Chalah
- EA 4391, Excitabilité Nerveuse et Thérapeutique, Université Paris-Est-Créteil, Créteil, France; Service de Physiologie-Explorations Fonctionnelles, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, Créteil, France
| | - Paul Kauv
- EA 4391, Excitabilité Nerveuse et Thérapeutique, Université Paris-Est-Créteil, Créteil, France; Service de Neuroradiologie, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, Créteil, France
| | - Jean-Pascal Lefaucheur
- EA 4391, Excitabilité Nerveuse et Thérapeutique, Université Paris-Est-Créteil, Créteil, France; Service de Physiologie-Explorations Fonctionnelles, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, Créteil, France
| | - Jérôme Hodel
- EA 4391, Excitabilité Nerveuse et Thérapeutique, Université Paris-Est-Créteil, Créteil, France; Service de Neuroradiologie, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, Créteil, France
| | - Alain Créange
- EA 4391, Excitabilité Nerveuse et Thérapeutique, Université Paris-Est-Créteil, Créteil, France; Service de Neurologie, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, Créteil, France
| | - Samar S Ayache
- EA 4391, Excitabilité Nerveuse et Thérapeutique, Université Paris-Est-Créteil, Créteil, France; Service de Physiologie-Explorations Fonctionnelles, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, Créteil, France; Neurology Division, Lebanese American University Medical Center Rizk Hospital, Beirut, Lebanon.
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156
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Cognitive Impairment in Relapsing-Remitting Multiple Sclerosis Patients with Very Mild Clinical Disability. Behav Neurol 2017; 2017:7404289. [PMID: 28912625 PMCID: PMC5574272 DOI: 10.1155/2017/7404289] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 05/24/2017] [Accepted: 06/12/2017] [Indexed: 01/23/2023] Open
Abstract
Cognitive dysfunction affects 40–65% of multiple sclerosis (MS) patients and can occur in the early stages of the disease. This study aimed to explore cognitive functions by means of the Italian version of the minimal assessment of cognitive function in MS (MACFIMS) in relapsing-remitting MS (RRMS) patients with very mild clinical disability to identify the primarily involved cognitive functions. Ninety-two consecutive RRMS patients with Expanded Disability Status Scale (EDSS) scores ≤ 2.5 and forty-two healthy controls (HC) were investigated. Our results show that 51.1% of MS patients have cognitive dysfunction compared to HC. An impairment of verbal and visual memory, working memory, and executive functions was found in the RRMS group. After subgrouping RRMS by EDSS, group 1 (EDSS ≤ 1.5) showed involvement of verbal memory and executive functions; moreover, group 2 (2 ≤ EDSS ≤ 2.5) patients were also impaired in information processing speed and visual memory. Our results show that utilizing a comprehensive neuropsychological assessment, approximately half of MS patients with very mild physical disability exhibit cognitive impairment with a primary involvement of prefrontal cognitive functions. Detecting impairment of executive functions at an early clinical stage of disease could be useful to promptly enroll MS patients in targeted rehabilitation.
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157
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Sandi D, Biernacki T, Szekeres D, Füvesi J, Kincses ZT, Rózsa C, Mátyás K, Kása K, Matolcsi J, Zboznovits D, Burány Z, Langane É, Vécsei L, Bencsik K. Prevalence of cognitive impairment among Hungarian patients with relapsing-remitting multiple sclerosis and clinically isolated syndrome. Mult Scler Relat Disord 2017; 17:57-62. [PMID: 29055476 DOI: 10.1016/j.msard.2017.06.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 06/12/2017] [Accepted: 06/30/2017] [Indexed: 12/16/2022]
Abstract
BACKGROUND Cognitive impairment (CI) is a frequent symptom of multiple sclerosis (MS); its prevalence is reported to be 43-70%. It is one of the most important determinants of MS patients' quality of life, as it is one of the main factors for MS patients becoming unemployed. AIM We aimed to determine the prevalence of CI among the relapsing-remitting MS (RRMS) and clinically isolated syndrome (CIS) patients in Hungary, to evaluate the predicting factors of CI and to assess the differences between sexes and patients with different educational levels. PATIENTS AND METHODS Five-hundred and fifty-three CIS and RRMS patients were enrolled to our study from three Hungarian MS centers. Age at screening, age at disease onset, disease duration, EDSS score, sex and educational levels were analyzed as socio-demographic factors. The BICAMS battery was used to assess their cognitive state, the BDI-II battery to assess depression. For statistical analysis, we utilized logistical regression, and used Fisher exact tests, chi-square tests and one-way ANOVA. RESULTS The mean age of our patients was 44.93 ± 11.69 years, mean age at disease onset was 31.95 ± 10.01 years, the mean disease duration was 13.05 ± 8.05 years and the median EDSS score 2.0 (Range: 6.5, IQR:2.0) points. Three-hundred and sixteen (57.1%) patients had CI. Sex, educational level and EDSS score proved to be significant predictors of CI (OR: 2.71, p < 0.001; OR: 1.94, p = 0.023; OR: 0.47, p = 0.003 respectively). CI was significantly (p < 0.001) more frequent among men (70.1%) than women (52.0%). We found, that educational level and EDSS score were only a significant predicting factor among women. Thus, the prevalence of CI among women with college or university degree was significantly (p < 0.001) less common (39.4%) than women with 12-15 years of education (57.4%) and women without a high school degree (66.7%). Also, we found that among women with higher EDSS score than 2 points, the prevalence of CI is 69.9% as compared to women with EDSS score between 0 and 2 points, where the prevalence is 42.8% (p < 0.001). No such differences were observed among man. DISCUSSION Our prevalence data is similar to those reported in the literature (43-70%), and almost identical to the one assessment using the BICAMS battery. We found that men are more vulnerable to CI than women in MS, as was reported recently. We are the first to report however, that higher educational level and lower EDSS scores are only associated with better cognitive performance in women.
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Affiliation(s)
- Dániel Sandi
- Department of Neurology, Faculty of General Medicine, Albert Szent-Györgyi Clinical Centre, University of Szeged, Semmelweis u 6., H-6725 Szeged, Hungary
| | - Tamás Biernacki
- Department of Neurology, Faculty of General Medicine, Albert Szent-Györgyi Clinical Centre, University of Szeged, Semmelweis u 6., H-6725 Szeged, Hungary
| | - Dóra Szekeres
- Department of Neurology, Faculty of General Medicine, Albert Szent-Györgyi Clinical Centre, University of Szeged, Semmelweis u 6., H-6725 Szeged, Hungary
| | - Judit Füvesi
- Department of Neurology, Faculty of General Medicine, Albert Szent-Györgyi Clinical Centre, University of Szeged, Semmelweis u 6., H-6725 Szeged, Hungary
| | - Zsigmond Tamás Kincses
- Department of Neurology, Faculty of General Medicine, Albert Szent-Györgyi Clinical Centre, University of Szeged, Semmelweis u 6., H-6725 Szeged, Hungary
| | - Csilla Rózsa
- Jahn Ferenc Dél-Pest Hospital, Köves út, H-1204 Budapest, Hungary
| | - Klotild Mátyás
- Markhot Ferenc Teaching Hospital, Széchenyi u 27-29, H-3300 Eger, Hungary
| | - Krisztián Kása
- Jahn Ferenc Dél-Pest Hospital, Köves út, H-1204 Budapest, Hungary
| | - Judit Matolcsi
- Jahn Ferenc Dél-Pest Hospital, Köves út, H-1204 Budapest, Hungary
| | - Dóra Zboznovits
- Jahn Ferenc Dél-Pest Hospital, Köves út, H-1204 Budapest, Hungary
| | - Zita Burány
- Jahn Ferenc Dél-Pest Hospital, Köves út, H-1204 Budapest, Hungary
| | - Éva Langane
- Department of Neurology, Faculty of General Medicine, Albert Szent-Györgyi Clinical Centre, University of Szeged, Semmelweis u 6., H-6725 Szeged, Hungary
| | - László Vécsei
- Department of Neurology, Faculty of General Medicine, Albert Szent-Györgyi Clinical Centre, University of Szeged, Semmelweis u 6., H-6725 Szeged, Hungary; MTA - SZTE Neuroscience Research Group, Semmelweis u 6., H-6725 Szeged, Hungary
| | - Krisztina Bencsik
- Department of Neurology, Faculty of General Medicine, Albert Szent-Györgyi Clinical Centre, University of Szeged, Semmelweis u 6., H-6725 Szeged, Hungary.
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158
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Van Schependom J, Nagels G. Targeting Cognitive Impairment in Multiple Sclerosis-The Road toward an Imaging-based Biomarker. Front Neurosci 2017; 11:380. [PMID: 28713238 PMCID: PMC5491975 DOI: 10.3389/fnins.2017.00380] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 06/19/2017] [Indexed: 12/26/2022] Open
Abstract
Multiple Sclerosis (MS) is a neuro-degenerative and -inflammatory disease leading to physical and cognitive impairment, pathological fatigue and depression, and affecting patients' quality of life and employment status. The combination of inflammation, demyelination, and neurodegeneration leads to the emergence of MS lesions, reduced white and gray matter brain volumes, a reduced conduction velocity and microstructural changes in the so-called Normal Appearing White Matter (NAWM). Currently, there are very limited options to treat cognitive impairment and its origin is only poorly understood. Therefore, several studies have attempted to relate clinical scores with features calculated either using T1- and/or FLAIR weighted MR images or using neurophysiology. The aim of those studies is not only to provide an improved understanding of the processes that underlie the different symptoms, but also to develop a biomarker—sensitive to therapy induced change—that could be used to speed up therapeutic developments (e.g., cognitive training/drug discovery/…). Here, we provide an overview of studies that have established relationships between either neuro-anatomical or neurophysiological measures and cognitive outcome scores. We discuss different avenues that may help to improve the prediction of cognitive impairment, and how well we can expect them to predict cognitive scores.
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Affiliation(s)
- Jeroen Van Schependom
- Center for Neurosciences, Universitair Ziekenhuis Brussel, Vrije Universiteit BrusselBrussels, Belgium.,Radiology, Universitair Ziekenhuis Brussel, Vrije Universiteit BrusselBrussels, Belgium
| | - Guy Nagels
- Center for Neurosciences, Universitair Ziekenhuis Brussel, Vrije Universiteit BrusselBrussels, Belgium.,Neurology, National MS Center MelsbroekMelsbroek, Belgium
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159
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Papathanasiou A, Messinis L, Zampakis P, Papathanasopoulos P. Corpus callosum atrophy as a marker of clinically meaningful cognitive decline in secondary progressive multiple sclerosis. Impact on employment status. J Clin Neurosci 2017; 43:170-175. [PMID: 28601572 DOI: 10.1016/j.jocn.2017.05.032] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Accepted: 05/22/2017] [Indexed: 11/16/2022]
Abstract
Cognitive impairment in Multiple Sclerosis (MS) is more frequent and pronounced in secondary progressive MS (SPMS). Cognitive decline is an important predictor of employment status in patients with MS. Magnetic Resonance Imaging (MRI) markers have been used to associate tissue damage with cognitive dysfunction. The aim of the study was to designate the MRI marker that predicts cognitive decline in SPMS and explore its effect on employment status. 30 SPMS patients and 30 healthy participants underwent neuropsychological assessment using the Trail Making Test (TMT) parts A and B, semantic and phonological verbal fluency task and a computerized cognitive screening battery (Central Nervous System Vital Signs). Employment status was obtained as a quality of life measure. Brain MRI was performed in all participants. We measured total lesion volume, third ventricle width, thalamic and corpus callosum atrophy. The frequency of cognitive decline for our SPMS patients was 80%. SPMS patients differed significantly from controls in all neuropsychological measures. Corpus callosum area was correlated with cognitive flexibility, processing speed, composite memory, executive functions, psychomotor speed, reaction time and phonological verbal fluency task. Processing speed and composite memory were the most sensitive markers for predicting employment status. Corpus callosum area was the most sensitive MRI marker for memory and processing speed. Corpus callosum atrophy predicts a clinically meaningful cognitive decline, affecting employment status in our SPMS patients.
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Affiliation(s)
- Athanasios Papathanasiou
- Department of Neurology, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham NG7 2UH, UK; Neuropsychology Section, Department of Neurology, University of Patras Medical School, Patras 265 04, Greece.
| | - Lambros Messinis
- Neuropsychology Section, Department of Neurology, University of Patras Medical School, Patras 265 04, Greece
| | - Petros Zampakis
- Department of Radiology, University of Patras Medical School, Patras 265 04, Greece
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160
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Reen GK, Silber E, Langdon DW. Interventions to support risk and benefit understanding of disease-modifying drugs in Multiple Sclerosis patients: A systematic review. PATIENT EDUCATION AND COUNSELING 2017; 100:1031-1048. [PMID: 28108125 DOI: 10.1016/j.pec.2016.12.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 11/29/2016] [Accepted: 12/25/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE The present review evaluates interventions that have been designed to improve understanding of the complex risk-benefit profiles of disease-modifying drugs (DMDs) in patients with Multiple Sclerosis (MS). METHODS A systematic search conducted using PubMed, Embase, Google Scholar and PsycINFO identified 15 studies. Interventions which provided treatment information were present across a range of study designs. A narrative synthesis was conducted due to heterogeneity of research findings. RESULTS Interventions providing treatment information ranged from comprehensive education programmes to booklets of a few pages. MS patients favoured the interventions they received. Understanding of overall treatment information and treatment risks specifically, generally improved following interventions. Yet overestimation of treatment benefits persisted. There was no conclusive effect on DMD decisions. No superior intervention was identified. CONCLUSION Interventions designed to improve understanding of DMD risk and benefit information are moderately successful. PRACTICE IMPLICATIONS Additional support provided to MS patients beyond routine healthcare can generally improve understanding of the complex risk-benefit profiles of DMDs. Future interventions need to ensure that patients with symptoms that may confound understanding can also benefit from this additional information.
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Affiliation(s)
- Gurpreet K Reen
- Department of Psychology, Royal Holloway, University of London, Egham, UK.
| | - Eli Silber
- Department of Neurology, King's College Hospital NHS Foundation Trust, Denmark Hill, London, UK
| | - Dawn W Langdon
- Department of Psychology, Royal Holloway, University of London, Egham, UK
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161
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De Looze C, Moreau N, Renié L, Kelly F, Ghio A, Rico A, Audoin B, Viallet F, Pelletier J, Petrone C. Effects of cognitive impairment on prosodic parameters of speech production planning in multiple sclerosis. J Neuropsychol 2017; 13:22-45. [PMID: 28544439 DOI: 10.1111/jnp.12127] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 03/17/2017] [Indexed: 12/14/2022]
Abstract
Cognitive impairment (CI) affects 40-65% of patients with multiple sclerosis (MS). CI can have a negative impact on a patient's everyday activities, such as engaging in conversations. Speech production planning ability is crucial for successful verbal interactions and thus for preserving social and occupational skills. This study investigates the effect of cognitive-linguistic demand and CI on speech production planning in MS, as reflected in speech prosody. A secondary aim is to explore the clinical potential of prosodic features for the prediction of an individual's cognitive status in MS. A total of 45 subjects, that is 22 healthy controls (HC) and 23 patients in early stages of relapsing-remitting MS, underwent neuropsychological tests probing specific cognitive processes involved in speech production planning. All subjects also performed a read speech task, in which they had to read isolated sentences manipulated as for phonological length. Results show that the speech of MS patients with CI is mainly affected at the temporal level (articulation and speech rate, pause duration). Regression analyses further indicate that rate measures are correlated with working memory scores. In addition, linear discriminant analysis shows the ROC AUC of identifying MS patients with CI is 0.70 (95% confidence interval: 0.68-0.73). Our findings indicate that prosodic planning is deficient in patients with MS-CI and that the scope of planning depends on patients' cognitive abilities. We discuss how speech-based approaches could be used as an ecological method for the assessment and monitoring of CI in MS.
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Affiliation(s)
- Céline De Looze
- Laboratoire Parole et Langage, UMR 7309, Aix-Marseille University, Aix-en-Provence, France.,Trinity Centre for Bioengineering, TBSI, Trinity College Dublin, Ireland
| | - Noémie Moreau
- Laboratoire Parole et Langage, UMR 7309, Aix-Marseille University, Aix-en-Provence, France.,Neurology Department, Aix en Provence Hospital, Aix-en-Provence, France
| | - Laurent Renié
- Neurology Department, Aix en Provence Hospital, Aix-en-Provence, France
| | - Finnian Kelly
- Trinity Centre for Bioengineering, TBSI, Trinity College Dublin, Ireland
| | - Alain Ghio
- Laboratoire Parole et Langage, UMR 7309, Aix-Marseille University, Aix-en-Provence, France
| | - Audrey Rico
- Department of Neurology, CHU Timone, APHM, Aix-Marseille University, Marseille, France
| | - Bertrand Audoin
- Department of Neurology, CHU Timone, APHM, Aix-Marseille University, Marseille, France
| | - François Viallet
- Laboratoire Parole et Langage, UMR 7309, Aix-Marseille University, Aix-en-Provence, France.,Neurology Department, Aix en Provence Hospital, Aix-en-Provence, France
| | - Jean Pelletier
- Department of Neurology, CHU Timone, APHM, Aix-Marseille University, Marseille, France
| | - Caterina Petrone
- Laboratoire Parole et Langage, UMR 7309, Aix-Marseille University, Aix-en-Provence, France
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162
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Vanotti S, Smerbeck A, Eizaguirre MB, Saladino ML, Benedict RRH, Caceres FJ. BICAMS in the Argentine population: Relationship with clinical and sociodemographic variables. APPLIED NEUROPSYCHOLOGY-ADULT 2017; 25:424-433. [PMID: 28534643 DOI: 10.1080/23279095.2017.1323751] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS) was developed to provide valid assessment of cognitive impairment in multiple sclerosis (MS). The relationship between clinical and social variables and cognitive disorders has been extensively studied, but primarily in developed countries with a focus on other cognitive measures or batteries. The objectives of this study were to analyze the relationship between the BICAMS data and key clinical and sociodemographic variables in the Argentine MS population. A total of 50 MS patients were administered the Argentinean BICAMS Battery, comprised of the Symbol Digit Modalities Test (SDMT), the California Verbal Learning Test I (CVLT I), and the Brief Visuospatial Memory Test Revised (BVMTR). Disease progression, fatigue, depression, self-reported and informant report cognitive status, and employment status were assessed. Disease progression and employment status were most strongly associated with overall BICAMS performance (η2 effect size values ranging from .302 to .624, all comparisons statistically significant). Informant rating of patient cognition, age, depression, disease duration, fatigue, and work hours were significantly associated as well. Gender, years of education, and patient-reported cognitive status were nonpredictive. A similar pattern was seen at the individual test level, with more variables related to the SDMT and CVLT I than BVMTR. BICAMS is strongly associated with overall disease progression and employment status.
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Affiliation(s)
- Sandra Vanotti
- a Multiple Sclerosis Clinic , INEBA - Neurosciences Institute of Buenos Aires , Buenos Aires , Argentina
| | - A Smerbeck
- b Department of Psychology , Rochester Institute of Technology , Rochester , New York , USA
| | - María B Eizaguirre
- a Multiple Sclerosis Clinic , INEBA - Neurosciences Institute of Buenos Aires , Buenos Aires , Argentina
| | - Maria L Saladino
- a Multiple Sclerosis Clinic , INEBA - Neurosciences Institute of Buenos Aires , Buenos Aires , Argentina
| | - Ralph R H Benedict
- c SUNY at Buffalo School of Medicine, Neurology , Buffalo , New York , USA
| | - Fernando J Caceres
- a Multiple Sclerosis Clinic , INEBA - Neurosciences Institute of Buenos Aires , Buenos Aires , Argentina
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163
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Multiple sclerosis patients' understanding and preferences for risks and benefits of disease-modifying drugs: A systematic review. J Neurol Sci 2017; 375:107-122. [DOI: 10.1016/j.jns.2016.12.038] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 11/28/2016] [Accepted: 12/21/2016] [Indexed: 11/17/2022]
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164
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Abstract
BACKGROUND AND OBJECTIVES Multiple sclerosis (MS) is a chronic progressive inflammatory disease of the central nervous system, representing the primary cause of non-traumatic disability in young adults. Cognitive dysfunction can affect patients at any time during the disease process and might alter the six core functional domains. Social cognition is a multi-component construct that includes the theory of mind, empathy and social perception of emotions from facial, bodily and vocal cues. Deficits in this cognitive faculty might have a drastic impact on interpersonal relationships and quality of life (QoL). Although exhaustive data exist for non-social cognitive functions in MS, only a little attention has been paid for social cognition. The objectives of the present work are to reappraise the definition and anatomy of social cognition and evaluate the integrity of this domain across MS studies. We will put special emphasis on neuropsychological and neuroimaging studies concerning social cognitive performance in MS. METHODS Studies were selected in conformity with PRISMA guidelines. We looked for computerized databases (PubMed, Medline, and Scopus) that index peer-reviewed journals to identify published reports in English and French languages that mention social cognition and multiple sclerosis, regardless of publication year. We combined keywords as follows: (facial emotion or facial expression or emotional facial expressions or theory of mind or social cognition or empathy or affective prosody) AND multiple sclerosis AND (MRI or functional MRI or positron emission tomography or functional imaging or structural imaging). We also scanned references from articles aiming to get additional relevant studies. RESULTS In total, 26 studies matched the abovementioned criteria (26 neuropsychological studies including five neuroimaging studies). Available data support the presence of social cognitive deficits even at early stages of MS. The increase in disease burden along with the "multiple disconnection syndrome" resulting from gray and white matters pathology might exceed the "threshold for cerebral tolerance" and can manifest as deficits in social cognition. Admitting the impact of the latter on patients' social functioning, a thorough screening for such deficits is crucial to improving patients' QoL. (JINS, 2017, 23, 266-286).
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165
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Benedict RH, DeLuca J, Phillips G, LaRocca N, Hudson LD, Rudick R. Validity of the Symbol Digit Modalities Test as a cognition performance outcome measure for multiple sclerosis. Mult Scler 2017; 23:721-733. [PMID: 28206827 PMCID: PMC5405816 DOI: 10.1177/1352458517690821] [Citation(s) in RCA: 544] [Impact Index Per Article: 77.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Cognitive and motor performance measures are commonly employed in multiple sclerosis (MS) research, particularly when the purpose is to determine the efficacy of treatment. The increasing focus of new therapies on slowing progression or reversing neurological disability makes the utilization of sensitive, reproducible, and valid measures essential. Processing speed is a basic elemental cognitive function that likely influences downstream processes such as memory. The Multiple Sclerosis Outcome Assessments Consortium (MSOAC) includes representatives from advocacy organizations, Food and Drug Administration (FDA), European Medicines Agency (EMA), National Institute of Neurological Disorders and Stroke (NINDS), academic institutions, and industry partners along with persons living with MS. Among the MSOAC goals is acceptance and qualification by regulators of performance outcomes that are highly reliable and valid, practical, cost-effective, and meaningful to persons with MS. A critical step for these neuroperformance metrics is elucidation of clinically relevant benchmarks, well-defined degrees of disability, and gradients of change that are deemed clinically meaningful. This topical review provides an overview of research on one particular cognitive measure, the Symbol Digit Modalities Test (SDMT), recognized as being particularly sensitive to slowed processing of information that is commonly seen in MS. The research in MS clearly supports the reliability and validity of this test and recently has supported a responder definition of SDMT change approximating 4 points or 10% in magnitude.
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Affiliation(s)
- Ralph Hb Benedict
- Department of Neurology and Buffalo General Medical Center, University at Buffalo, Buffalo, NY, USA
| | - John DeLuca
- Kessler Foundation, West Orange, NJ, USA; Rutgers New Jersey Medical School, Newark, NJ, USA
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- Multiple Sclerosis Outcome Assessments Consortium (MSOAC), Critical Path Institute, Tucson, AZ, USA
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166
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Karhula ME, Salminen AL, Hämäläinen PI, Ruutiainen J, Era P, Tolvanen A. Psychometric evaluation of the Finnish version of the impact on participation and autonomy questionnaire in persons with multiple sclerosis. Scand J Occup Ther 2017; 24:410-420. [PMID: 28049364 DOI: 10.1080/11038128.2016.1272630] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate the psychometric properties of the impact on participation and autonomy (IPA) questionnaire. The Finnish version of IPA (IPAFin) was translated into Finnish using the protocol for linguistic validation for patient-reported outcomes instruments. METHODS A total of 194 persons with multiple sclerosis (MS) (mean age 50 years SD 9, 72% female) with moderate to severe disability participated in this study. A confirmatory factor analysis (CFA) was used to confirm the four factor structure of the IPAFin. The work and educational opportunities domain was excluded from analysis, because it was only applicable to 51 persons. Internal consistency was investigated by calculating Cronbach's alpha. RESULTS CFA confirmed the construct validity of the IPA (standardized root mean square residual (SRMR) = 0.06, comparative fit index (CFI) = 0.93, Tucker-Lewis index =0.93, root mean square error of approximation (RMSEA) = 0.06), indicating a good fit to the model. There was no difference in the models for females and males. Cronbach's alpha for the domains ranged between 0.80 and 0.91, indicating good homogeneity. CONCLUSIONS The construct validity and reliability of the IPAFin is acceptable. IPAFin is a suitable measure of participation in persons with MS.
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Affiliation(s)
- Maarit E Karhula
- a Department of Social and Health Care , Mikkeli University of Applied Sciences , Mikkeli , Finland.,b Department of Health Sciences , University of Jyväskylä , Jyväskylä , Finland.,c GeroCenter Foundation for Aging Research & Development , Jyväskylä , Finland
| | | | - Päivi I Hämäläinen
- e Masku Neurological Rehabilitation Centre , Masku , Finland.,f Finnish Neuro Society , Masku , Finland
| | | | - Pertti Era
- b Department of Health Sciences , University of Jyväskylä , Jyväskylä , Finland
| | - Asko Tolvanen
- g Department of Psychology , University of Jyväskylä , Jyväskylä , Finland
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167
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Brown JWL, Pardini M, Brownlee WJ, Fernando K, Samson RS, Prados Carrasco F, Ourselin S, Gandini Wheeler-Kingshott CAM, Miller DH, Chard DT. An abnormal periventricular magnetization transfer ratio gradient occurs early in multiple sclerosis. Brain 2017; 140:387-398. [PMID: 28043954 DOI: 10.1093/brain/aww296] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 08/16/2016] [Accepted: 09/28/2016] [Indexed: 11/13/2022] Open
Abstract
In established multiple sclerosis, tissue abnormality-as assessed using magnetization transfer ratio-increases close to the lateral ventricles. We aimed to determine whether or not (i) these changes are present from the earliest clinical stages of multiple sclerosis; (ii) they occur independent of white matter lesions; and (iii) they are associated with subsequent conversion to clinically definite multiple sclerosis and disability. Seventy-one subjects had MRI scanning a median of 4.6 months after a clinically isolated optic neuritis (49 females, mean age 33.5 years) and were followed up clinically 2 and 5 years later. Thirty-seven healthy controls (25 females, mean age 34.4 years) were also scanned. In normal-appearing white matter, magnetization transfer ratio gradients were measured 1-5 mm and 6-10 mm from the lateral ventricles. In control subjects, magnetization transfer ratio was highest adjacent to the ventricles and decreased with distance from them; in optic neuritis, normal-appearing white matter magnetization transfer ratio was lowest adjacent to the ventricles, increased over the first 5 mm, and then paralleled control values. The magnetization transfer ratio gradient over 1-5 mm differed significantly between the optic neuritis and control groups [+0.059 percentage units/mm (pu/mm) versus -0.033 pu/mm, P = 0.010], and was significantly steeper in those developing clinically definite multiple sclerosis within 2 years compared to those who did not (0.132 pu/mm versus 0.016 pu/mm, P = 0.020). In multivariate binary logistic regression the magnetization transfer ratio gradient was independently associated with the development of clinically definite multiple sclerosis within 2 years (magnetization transfer ratio gradient odds ratio 61.708, P = 0.023; presence of T2 lesions odds ratio 8.500, P = 0.071). At 5 years, lesional measures overtook magnetization transfer ratio gradients as significant predictors of conversion to multiple sclerosis. The magnetization transfer ratio gradient was not significantly affected by the presence of brain lesions [T2 lesions (P = 0.918), periventricular T2 lesions (P = 0.580) or gadolinium-enhancing T1 lesions (P = 0.724)]. The magnetization transfer ratio gradient also correlated with Expanded Disability Status Scale score 5 years later (Spearman r = 0.313, P = 0.027). An abnormal periventricular magnetization transfer ratio gradient occurs early in multiple sclerosis, is clinically relevant, and may arise from one or more mechanisms that are at least partly independent of lesion formation.
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Affiliation(s)
- J William L Brown
- NMR Research Unit, Queen Square Multiple Sclerosis Centre, University College London (UCL) Institute of Neurology, London, UK.,Department of Clinical Neurosciences, University of Cambridge, Box 165, Cambridge Biomedical Campus, Cambridge, UK
| | - Matteo Pardini
- NMR Research Unit, Queen Square Multiple Sclerosis Centre, University College London (UCL) Institute of Neurology, London, UK.,Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, and IRCCS AOU San Martino-IST, Genoa, Italy
| | - Wallace J Brownlee
- NMR Research Unit, Queen Square Multiple Sclerosis Centre, University College London (UCL) Institute of Neurology, London, UK
| | - Kryshani Fernando
- Department of Neurology, Royal Free Hospital, Pond Street, London, UK
| | - Rebecca S Samson
- NMR Research Unit, Queen Square Multiple Sclerosis Centre, University College London (UCL) Institute of Neurology, London, UK
| | - Ferran Prados Carrasco
- NMR Research Unit, Queen Square Multiple Sclerosis Centre, University College London (UCL) Institute of Neurology, London, UK.,Translational Imaging Group, Centre for Medical Image Computing (CMIC), Department of Medical Physics and Bioengineering, University College London, London, UK.,National Institute for Health Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre, UK
| | - Sebastien Ourselin
- Translational Imaging Group, Centre for Medical Image Computing (CMIC), Department of Medical Physics and Bioengineering, University College London, London, UK.,National Institute for Health Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre, UK.,Dementia Research Centre, Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London, UK
| | - Claudia A M Gandini Wheeler-Kingshott
- NMR Research Unit, Queen Square Multiple Sclerosis Centre, University College London (UCL) Institute of Neurology, London, UK.,Brain MRI 3T Center, C. Mondino National Neurological Institute, Pavia, Italy.,Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
| | - David H Miller
- NMR Research Unit, Queen Square Multiple Sclerosis Centre, University College London (UCL) Institute of Neurology, London, UK.,National Institute for Health Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre, UK
| | - Declan T Chard
- NMR Research Unit, Queen Square Multiple Sclerosis Centre, University College London (UCL) Institute of Neurology, London, UK .,National Institute for Health Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre, UK
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168
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Stratton ME, Pilutti LA, Crowell JA, Kaczmarski H, Motl RW. Virtual street-crossing performance in persons with multiple sclerosis: Feasibility and task performance characteristics. TRAFFIC INJURY PREVENTION 2017; 18:47-55. [PMID: 27602598 DOI: 10.1080/15389588.2016.1195494] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Accepted: 05/25/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES Multiple sclerosis (MS) is a neurological disease that commonly results in physical and cognitive dysfunction. Accordingly, MS might impact the ability to safely cross the street. The purpose of this study was to examine the feasibility of a simulated street-crossing task in persons with MS and to determine differences in street-crossing performance between persons with MS and non-MS controls. METHODS 26 participants with MS (median Expanded Disability Status Scale [EDSS] score = 3.5) and 19 controls completed 40 trials of a virtual street-crossing task. There were 2 crossing conditions (i.e., no distraction and phone conversation), and participants performed 20 trials per condition. Participants were instructed that the goal of the task was to cross the street successfully (i.e., without being hit be a vehicle). The primary outcome was task feasibility, assessed as completion and adverse events. Secondary outcomes were measures of street-crossing performance. RESULTS Overall, the simulated street-crossing task was feasible (i.e., 90% completion, no adverse events) in participants with MS. Participants with MS waited longer and were less attentive to traffic before entering the street compared with controls (all P < .05). Participants with MS also took longer to cross the street and were closer to oncoming vehicles when exiting the street compared to controls (all P < .05). When distracted, all participants took longer to initiate crossing, took longer to cross the street, and made more head turns while crossing (all P < .05). There were no significant group by condition interaction effects (all P > .05). CONCLUSIONS A virtual street-crossing task is feasible for studying street-crossing behavior in persons with mild MS and most individuals with moderate MS. Virtual street-crossing performance is impaired in persons with MS compared to controls; however, persons with MS do not appear to be more vulnerable to a distracting condition. The virtual reality environment presents a safe and useful setting for understanding pedestrian behavior in persons with MS.
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Affiliation(s)
- M E Stratton
- a Department of Kinesiology and Community Health , University of Illinois at Urbana-Champaign , Urbana , Illinois
| | - L A Pilutti
- a Department of Kinesiology and Community Health , University of Illinois at Urbana-Champaign , Urbana , Illinois
| | - J A Crowell
- b Beckman Institute for Advanced Science and Technology , University of Illinois at Urbana-Champaign , Urbana , Illinois
| | - H Kaczmarski
- b Beckman Institute for Advanced Science and Technology , University of Illinois at Urbana-Champaign , Urbana , Illinois
| | - R W Motl
- a Department of Kinesiology and Community Health , University of Illinois at Urbana-Champaign , Urbana , Illinois
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169
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Benešová Y, Tvaroh A. Cognition and fatigue in patients with relapsing multiple sclerosis treated by subcutaneous interferon β-1a: an observational study SKORE. Ther Adv Neurol Disord 2017; 10:18-32. [PMID: 28450892 PMCID: PMC5400153 DOI: 10.1177/1756285616671882] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Multiple sclerosis (MS) is a chronic autoimmune disease of the central nervous system, which often causes progressive neurological disability. In addition to motor and sensory dysfunction, cognitive decline and fatigue are frequent manifestations of the disease. Fatigue is probably the most common symptom, with up to 90% of MS individuals reporting fatigue at some point. Cognitive impairment affects about 50% of patients and may be present at all MS stages. The aim of this observational study was to evaluate changes in cognition, fatigue, and disability status in 300 relapsing-remitting MS (RRMS) patients, treated with subcutaneous (sc) interferon (IFN) β-1a over 2 years. METHODS The study was designed as an observational, multicentre, prospective, single-arm, phase IV study carried out in 13 MS centres in the Czech Republic. Cognition status was assessed using the Paced Auditory Serial Addition Task (PASAT), fatigue using the Fatigue Descriptive Scale (FDS), and disability using the Expanded Disability Status Scale (EDSS), at baseline, and after 6, 12 and 24 months. The percentage of patients with changed versus stable cognition, fatigue status and disability was calculated at each time point and the changes in these scores were evaluated. RESULTS The proportion of patients with cognitive improvement was higher compared with those with a stable or decreased PASAT scores at all time points, and the average cognitive performance improved during the follow-up period. Also the proportion of patients with stable or improved fatigue and EDSS scores was higher compared with those in which FDS or EDSS scores declined, this was found at all time points of the analysed sample. However, the direct effect of IFN β-1a on cognition and fatigue cannot be concluded from this study. CONCLUSIONS The results of this observational study have demonstrated a stable or improved cognitive performance, fatigue status, and disability level in the majority of RRMS patients treated with sc IFN β-1a over a two-year follow-up period, in a real life setting, in the Czech Republic.
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Affiliation(s)
- Yvonne Benešová
- Department of Neurology, University Hospital Brno and Faculty of Medicine, Masaryk University, Jihlavská 20, Brno 625 00, Czech Republic
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170
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Abstract
Multiple sclerosis (MS) is a chronic disease of the central nervous system (CNS) characterized by loss of motor and sensory function that results from immune-mediated inflammation, demyelination, and subsequent axonal damage. Clinically, most MS patients experience recurrent episodes (relapses) of neurological impairment, but in most cases (60–80%) the course of the disease eventually becomes chronic and progressive, leading to cumulative motor, sensory, and visual disability, and cognitive deficits. The course of the disease is largely unpredictable and its clinical presentation is variable, but its predilection for certain parts of the CNS, which includes the optic nerves, the brain stem, cerebellum, and cervical spinal cord, provides a characteristic constellation of signs and symptoms. Several variants of MS have been nowadays defined with variable immunopathogenesis, course and prognosis. Many new treatments targeting the immune system have shown efficacy in preventing the relapses of MS and have been introduced to its management during the last decade.
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171
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A Randomised Controlled Trial of Efficacy of Cognitive Rehabilitation in Multiple Sclerosis: A Cognitive, Behavioural, and MRI Study. Neural Plast 2016; 2016:4292585. [PMID: 28116167 PMCID: PMC5223046 DOI: 10.1155/2016/4292585] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Revised: 10/29/2016] [Accepted: 11/17/2016] [Indexed: 12/18/2022] Open
Abstract
Aim. To explore the efficacy of home-based, computerised, cognitive rehabilitation in patients with multiple sclerosis using neuropsychological assessment and advanced structural and functional magnetic resonance imaging (fMRI). Methods. 38 patients with MS and cognitive impairment on the Brief International Cognitive Assessment for MS (BICAMS) were enrolled. Patients were randomised to undergo 45 minutes of computerised cognitive rehabilitation using RehaCom software (n = 19) three times weekly for six weeks or to a control condition (n = 19). Neuropsychological and MRI data were obtained at baseline (time 1), following the 6-week intervention (time 2), and after a further twelve weeks (time 3). Cortical activations were explored using fMRI and microstructural changes were explored using quantitative magnetisation transfer (QMT) imaging. Results. The treatment group showed a greater improvement in SDMT gain scores between baseline and time 2 compared to the control group (p = 0.005). The treatment group exhibited increased activation in the bilateral prefrontal cortex and right temporoparietal regions relative to control group at time 3 (p < 0.05FWE corrected). No significant changes were observed on QMT. Conclusion. This study supports the hypothesis that home-based, computerised, cognitive rehabilitation may be effective in improving cognitive performance in patients with MS. Clinical trials registration is ISRCTN54901925.
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172
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Uher T, Vaneckova M, Sormani MP, Krasensky J, Sobisek L, Dusankova JB, Seidl Z, Havrdova E, Kalincik T, Benedict RHB, Horakova D. Identification of multiple sclerosis patients at highest risk of cognitive impairment using an integrated brain magnetic resonance imaging assessment approach. Eur J Neurol 2016; 24:292-301. [PMID: 27873386 DOI: 10.1111/ene.13200] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 09/25/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE While impaired cognitive performance is common in multiple sclerosis (MS), it has been largely underdiagnosed. Here a magnetic resonance imaging (MRI) screening algorithm is proposed to identify patients at highest risk of cognitive impairment. The objective was to examine whether assessment of lesion burden together with whole brain atrophy on MRI improves our ability to identify cognitively impaired MS patients. METHODS Of the 1253 patients enrolled in the study, 1052 patients with all cognitive, volumetric MRI and clinical data available were included in the analysis. Brain MRI and neuropsychological assessment with the Brief International Cognitive Assessment for Multiple Sclerosis were performed. Multivariable logistic regression and individual prediction analysis were used to investigate the associations between MRI markers and cognitive impairment. The results of the primary analysis were validated at two subsequent time points (months 12 and 24). RESULTS The prevalence of cognitive impairment was greater in patients with low brain parenchymal fraction (BPF) (<0.85) and high T2 lesion volume (T2-LV) (>3.5 ml) than in patients with high BPF (>0.85) and low T2-LV (<3.5 ml), with an odds ratio (OR) of 6.5 (95% CI 4.4-9.5). Low BPF together with high T2-LV identified in 270 (25.7%) patients predicted cognitive impairment with 83% specificity, 82% negative predictive value, 51% sensitivity and 75% overall accuracy. The risk of confirmed cognitive decline over the follow-up was greater in patients with high T2-LV (OR 2.1; 95% CI 1.1-3.8) and low BPF (OR 2.6; 95% CI 1.4-4.7). CONCLUSIONS The integrated MRI assessment of lesion burden and brain atrophy may improve the stratification of MS patients who may benefit from cognitive assessment.
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Affiliation(s)
- T Uher
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - M Vaneckova
- Department of Radiology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - M P Sormani
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - J Krasensky
- Department of Radiology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - L Sobisek
- Department of Statistics and Probability, University of Economics in Prague, Prague, Czech Republic
| | - J Blahova Dusankova
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Z Seidl
- Department of Radiology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - E Havrdova
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - T Kalincik
- Department of Medicine, University of Melbourne, Melbourne, Vic., Australia.,Department of Neurology, Royal Melbourne Hospital, Melbourne, Vic., Australia
| | - R H B Benedict
- Department of Neurology, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - D Horakova
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
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173
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George MF, Holingue CB, Briggs FBS, Shao X, Bellesis KH, Whitmer RA, Schaefer C, Benedict RH, Barcellos LF. Feasibility study for remote assessment of cognitive function in multiple sclerosis. ACTA ACUST UNITED AC 2016; 1:10-18. [PMID: 28255581 DOI: 10.29245/2572.942x/2016/8.1084] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Cognitive impairment is common in multiple sclerosis (MS), and affects employment and quality of life. Large studies are needed to identify risk factors for cognitive decline. Currently, a MS-validated remote assessment for cognitive function does not exist. Studies to determine feasibility of large remote cognitive function investigations in MS have not been published. OBJECTIVE To determine whether MS patients would participate in remote cognitive studies. We utilized the Modified Telephone Interview for Cognitive Status (TICS-M), a previously validated phone assessment for cognitive function in healthy elderly populations to detect mild cognitive impairment. We identified factors that influenced participation rates. We investigated the relationship between MS risk factors and TICS-M score in cases, and score differences between cases and control individuals. METHODS The TICS-M was administered to MS cases and controls. Linear and logistic regression models were utilized. RESULTS 11.5% of eligible study participants did not participate in cognitive testing. MS cases, females and individuals with lower educational status were more likely to refuse (p<0.001). Cases who did complete testing did not differ in terms of perceived cognitive deficit compared to cases that did participate. More severe disease, smoking, and being male were associated with a lower TICS-M score among cases (p<0.001). The TICS-M score was significantly lower in cases compared to controls (p=0.007). CONCLUSIONS Our results demonstrate convincingly that a remotely administered cognitive assessment is quite feasible for conducting large epidemiologic studies in MS, and lay the much needed foundation for future work that will utilize MS-validated cognitive measures.
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Affiliation(s)
- Michaela F George
- Division of Epidemiology, Genetic Epidemiology and Genomics Laboratory, School of Public Health, University of California, Berkeley, CA, USA
| | - Calliope B Holingue
- Division of Epidemiology, Genetic Epidemiology and Genomics Laboratory, School of Public Health, University of California, Berkeley, CA, USA
| | - Farren B S Briggs
- Department of Epidemiology and Biostatistics, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Xiaorong Shao
- Division of Epidemiology, Genetic Epidemiology and Genomics Laboratory, School of Public Health, University of California, Berkeley, CA, USA
| | | | | | | | | | - Lisa F Barcellos
- Division of Epidemiology, Genetic Epidemiology and Genomics Laboratory, School of Public Health, University of California, Berkeley, CA, USA; Kaiser Permanente Division of Research, Oakland, CA, USA
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174
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Sundgren M, Piehl F, Wahlin Å, Brismar T. Cognitive function did not improve after initiation of natalizumab treatment in relapsing-remitting multiple sclerosis. A prospective one-year dual control group study. Mult Scler Relat Disord 2016; 10:36-43. [DOI: 10.1016/j.msard.2016.08.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 07/28/2016] [Accepted: 08/23/2016] [Indexed: 01/25/2023]
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175
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Freitas S, Batista S, Afonso AC, Simões MR, de Sousa L, Cunha L, Santana I. The Montreal Cognitive Assessment (MoCA) as a screening test for cognitive dysfunction in multiple sclerosis. APPLIED NEUROPSYCHOLOGY-ADULT 2016; 25:57-70. [DOI: 10.1080/23279095.2016.1243108] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Sandra Freitas
- Centre for Neuroscience and Cell Biology (CNC), University of Coimbra, Coimbra, Portugal
- Centro de Investigação do Núcleo de Estudos e Intervenção Cognitivo Comportamental (CINEICC), University of Coimbra, Coimbra, Portugal
- PsyAssessmentLab, Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
| | - Sónia Batista
- Neurology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | | | - Mário R. Simões
- Centro de Investigação do Núcleo de Estudos e Intervenção Cognitivo Comportamental (CINEICC), University of Coimbra, Coimbra, Portugal
- PsyAssessmentLab, Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
| | - Lívia de Sousa
- Neurology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Luís Cunha
- Neurology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Isabel Santana
- Centre for Neuroscience and Cell Biology (CNC), University of Coimbra, Coimbra, Portugal
- Neurology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
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176
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Morrison JD, Mayer L. Physical activity and cognitive function in adults with multiple sclerosis: an integrative review. Disabil Rehabil 2016; 39:1909-1920. [PMID: 27764974 DOI: 10.1080/09638288.2016.1213900] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
PURPOSE To identify and synthesize the research evidence concerning (1) the relationship between physical activity and cognitive performance in persons with multiple sclerosis (MS) and (2) to review the reported effects of physical activity interventions on neurocognitive performance conducted in this population. METHODS Relevant peer-reviewed journal articles were identified by searching PubMed, PsychINFO, and SPORTDiscus through May 2016. Full-text articles meeting the inclusion criteria were evaluated for quality using tools developed by the National Institutes of Health. Studies deemed to be of poor quality were excluded from the review. RESULTS Nineteen studies meeting the inclusion/exclusion criteria were analyzed. Nine studies reported significant relationships between higher levels of physical activity or cardiorespiratory fitness and measures of cognitive function. Data extracted from 10 physical activity intervention studies reported mixed results on the effectiveness of physical activity to improve selected domains of cognitive function in persons with MS. CONCLUSION Although correlational studies provide evidence to support a linkage between physical activity and cognitive function in persons with MS, this linkage is confounded by factors that may have influenced the studies' results. Evidence derived from intervention studies that could support a positive effect of physical activity on cognition in persons with MS is equivocal. Implications for Rehabilitation Physical activity has numerous benefits for persons with multiple sclerosis (MS) including improvements in balance, ambulation, depression, fatigue, and quality of life. Structured physical activity programs may contribute to cognitive function stability or improvement in persons with MS.
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Affiliation(s)
- Janet D Morrison
- a School of Nursing , the University of Texas at Austin , Austin , TX , USA
| | - Lori Mayer
- b Central Texas Neurology Consultants , MS Clinic of Central Texas , Round Rock , TX , USA
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177
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Cotter J, Firth J, Enzinger C, Kontopantelis E, Yung AR, Elliott R, Drake RJ. Social cognition in multiple sclerosis: A systematic review and meta-analysis. Neurology 2016; 87:1727-1736. [PMID: 27655736 DOI: 10.1212/wnl.0000000000003236] [Citation(s) in RCA: 100] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 07/05/2016] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE To quantify the magnitude of deficits in theory of mind (ToM) and facial emotion recognition among patients with multiple sclerosis (MS) relative to healthy controls. METHODS An electronic database search of Ovid MEDLINE, PsycINFO, and Embase was conducted from inception to April 1, 2016. Eligible studies were original research articles published in peer-reviewed journals that examined ToM or facial emotion recognition among patients with a diagnosis of MS and a healthy control comparison group. Data were independently extracted by 2 authors. Effect sizes were calculated using Hedges g. RESULTS Twenty-one eligible studies were identified assessing ToM (12 studies) and/or facial emotion recognition (13 studies) among 722 patients with MS and 635 controls. Deficits in both ToM (g = -0.71, 95% confidence interval [CI] -0.88 to -0.55, p < 0.001) and facial emotion recognition (g = -0.64, 95% CI -0.81 to -0.47, p < 0.001) were identified among patients with MS relative to healthy controls. The largest deficits were observed for visual ToM tasks and for the recognition of negative facial emotional expressions. Older age predicted larger emotion recognition deficits. Other cognitive domains were inconsistently associated with social cognitive performance. CONCLUSIONS Social cognitive deficits are an overlooked but potentially important aspect of cognitive impairment in MS with potential prognostic significance for social functioning and quality of life. Further research is required to clarify the longitudinal course of social cognitive dysfunction, its association with MS disease characteristics and neurocognitive impairment, and the MS-specific neurologic damage underlying these deficits.
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Affiliation(s)
- Jack Cotter
- From the Institute of Brain, Behaviour and Mental Health (J.C., J.F., A.R.Y., R.E., R.J.D.) and Farr Institute for Health Informatics Research (E.K.), University of Manchester, UK; and Research Unit for Neuronal Repair and Plasticity (C.E.), Department of Neurology, Medical University of Graz, Austria.
| | - Joseph Firth
- From the Institute of Brain, Behaviour and Mental Health (J.C., J.F., A.R.Y., R.E., R.J.D.) and Farr Institute for Health Informatics Research (E.K.), University of Manchester, UK; and Research Unit for Neuronal Repair and Plasticity (C.E.), Department of Neurology, Medical University of Graz, Austria
| | - Christian Enzinger
- From the Institute of Brain, Behaviour and Mental Health (J.C., J.F., A.R.Y., R.E., R.J.D.) and Farr Institute for Health Informatics Research (E.K.), University of Manchester, UK; and Research Unit for Neuronal Repair and Plasticity (C.E.), Department of Neurology, Medical University of Graz, Austria
| | - Evangelos Kontopantelis
- From the Institute of Brain, Behaviour and Mental Health (J.C., J.F., A.R.Y., R.E., R.J.D.) and Farr Institute for Health Informatics Research (E.K.), University of Manchester, UK; and Research Unit for Neuronal Repair and Plasticity (C.E.), Department of Neurology, Medical University of Graz, Austria
| | - Alison R Yung
- From the Institute of Brain, Behaviour and Mental Health (J.C., J.F., A.R.Y., R.E., R.J.D.) and Farr Institute for Health Informatics Research (E.K.), University of Manchester, UK; and Research Unit for Neuronal Repair and Plasticity (C.E.), Department of Neurology, Medical University of Graz, Austria
| | - Rebecca Elliott
- From the Institute of Brain, Behaviour and Mental Health (J.C., J.F., A.R.Y., R.E., R.J.D.) and Farr Institute for Health Informatics Research (E.K.), University of Manchester, UK; and Research Unit for Neuronal Repair and Plasticity (C.E.), Department of Neurology, Medical University of Graz, Austria
| | - Richard J Drake
- From the Institute of Brain, Behaviour and Mental Health (J.C., J.F., A.R.Y., R.E., R.J.D.) and Farr Institute for Health Informatics Research (E.K.), University of Manchester, UK; and Research Unit for Neuronal Repair and Plasticity (C.E.), Department of Neurology, Medical University of Graz, Austria
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178
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Affiliation(s)
- Dawn Langdon
- Royal Holloway, University of London, Egham, Surrey, TW20 0EX, UK
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179
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Polychroniadou E, Bakirtzis C, Langdon D, Lagoudaki R, Kesidou E, Theotokis P, Tsalikakis D, Poulatsidou K, Kyriazis O, Boziki M, Papadopoulos G, Boura E, Sintila L, Hatzigeorgiou S, Ziamos C, Ioannidis P, Karacostas D, Grigoriadis N. Validation of the Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS) in Greek population with multiple sclerosis. Mult Scler Relat Disord 2016; 9:68-72. [DOI: 10.1016/j.msard.2016.06.011] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 06/21/2016] [Accepted: 06/25/2016] [Indexed: 10/21/2022]
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180
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Hämäläinen P, Rosti-Otajärvi E. Cognitive impairment in MS: rehabilitation approaches. Acta Neurol Scand 2016; 134 Suppl 200:8-13. [PMID: 27580900 DOI: 10.1111/ane.12650] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2016] [Indexed: 11/29/2022]
Abstract
Cognitive deficits have been reported in 45%-70% of patients with multiple sclerosis (MS). Like other symptoms of MS, cognitive deficits are highly variable. Slowed information processing and memory and learning dysfunction are regarded as the most frequent cognitive deficits in MS. Both white and gray matter damages have been suggested to contribute to cognitive impairments in MS. There is no direct relationship between cognitive deficits and physical disability, disease duration or course of the disease. In addition to cognitive impairments, neuropsychiatric symptoms are observed in MS, the most common being alterations in mood state. Neurobehavioral deficits have multidimensional effects on the activities of daily living and quality of life. Consequently, attention should be paid to early diagnosis and treatment. Based on studies on cognitive retraining and more multimodal neuropsychological rehabilitation, both approaches show promise in the treatment of cognitive impairments and their harmful effects. This review introduces the frequency and characteristics of cognitive impairments, as well as main findings on the effects of neuropsychological rehabilitation in MS.
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Affiliation(s)
- P. Hämäläinen
- Masku Neurological Rehabilitation Centre; Masku Finland
| | - E. Rosti-Otajärvi
- Department of Neurology and Rehabilitation; Tampere University Hospital; Tampere Finland
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181
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Portaccio E. Differential diagnosis, discerning depression from cognition. Acta Neurol Scand 2016; 134 Suppl 200:14-8. [PMID: 27580901 DOI: 10.1111/ane.12652] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2016] [Indexed: 02/02/2023]
Abstract
Cognitive impairment is common in multiple sclerosis (MS), affecting up to 70% of patients. One of the most important possible confounders to cognitive assessment is the occurrence of depression, a common consequence of MS. Cognition and depression have been linked in recent neuropsychiatric research that proposed a number of neurocognitive models of mood disorders. According to these models, primary failure of key brain regions of emotional processing and regulation or abnormal connectivity between them contributes to the adoption of maladaptive cognitive strategies and the development of mood disorders. In MS, a similar interplay between cognitive function and depression has been reported. In particular, depression seems to alter attentional capacity in terms of deficits in working memory and, more specifically, deficits in the executive control. However, cognitive impairment in MS does exist also in the absence of depression and it is more likely that depression exacerbates existing cognitive difficulties rather than cause them per se. On the other hand, it is possible that a dysexecutive syndrome secondary to MS might in turn precipitate depression.
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Affiliation(s)
- E. Portaccio
- Department of NEUROFARBA; University of Florence; Florence Italy
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182
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Penner IK. Evaluation of cognition and fatigue in multiple sclerosis: daily practice and future directions. Acta Neurol Scand 2016; 134 Suppl 200:19-23. [PMID: 27580902 DOI: 10.1111/ane.12651] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2016] [Indexed: 12/27/2022]
Abstract
The so-called hidden symptoms or soft signs of multiple sclerosis comprise cognitive dysfunction, fatigue, depression and anxiety. From a patient's perspective, these symptoms are rated as exerting much more negative impact on quality of life and daily functioning than their physical symptoms. Despite this knowledge, the symptoms remain disregarded by many neurologists in clinical practice. This missing awareness can be attributed to several reasons. First, the underlying pathophysiological mechanisms determining occurrence and severity of the different symptoms are still unclear. Second, there is uncertainty in how to reliably assess them. It is undeniable that assessment can be difficult as the hidden symptoms seldom appear isolated but more often highly interact. Third, if standardized, fast and cost-effective assessment to quantify and monitor the evolution of the hidden symptoms would be feasible, the question still remains how to treat these aspects. The present article will give an overview on symptom background and assessment strategies for clinical practice.
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Affiliation(s)
- I.-K. Penner
- COGITO Center for Applied Neurocognition and Neuropsychological Research; University Hospital Düsseldorf, Cognitive Neuroscience; Düsseldorf Germany
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183
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Pitteri M, Romualdi C, Magliozzi R, Monaco S, Calabrese M. Cognitive impairment predicts disability progression and cortical thinning in MS: An 8-year study. Mult Scler 2016; 23:848-854. [PMID: 27527906 DOI: 10.1177/1352458516665496] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Multiple sclerosis (MS) is a chronic immune-mediated disease of the central nervous system (CNS). Although cognitive impairment (CI) affects a large proportion of MS patients, only few data are available about its prognostic value associated with advanced magnetic resonance imaging (MRI) metrics. OBJECTIVES We aimed at investigating the relationship between the early CI and the disease progression over 8-year follow-up in MS patients. METHODS We conducted a retrospective 8-year longitudinal study involving 78 patients with relapsing-remitting MS, who completed neuropsychological examination and structural MRI at the time of diagnosis. Each patient was clinically evaluated every 6 months, and cortical thickness was quantified at baseline and at the end of the follow-up. Patients were classified as having normal cognition and mild or severe CI. RESULTS The results show that CI at the time of diagnosis is a good predictor of conversion to definite MS ( p < 0.001), disability progression ( p < 0.001), as well as of transition to secondary progressive phase ( p < 0.001) and of cortical thinning ( p < 0.001). CONCLUSION We confirmed and extended the evidence that early CI might be helpful in the identification of MS patients at high risk of disability progression and poor clinical outcome and should be considered as a marker of most aggressive pathology.
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Affiliation(s)
- Marco Pitteri
- Neurology B, Department of Neurosciences, Biomedicine and Movement, University of Verona, Verona, Italy
| | | | - Roberta Magliozzi
- Neurology B, Department of Neurosciences, Biomedicine and Movement, University of Verona, Verona, Italy/Division of Brain Sciences, Imperial College Faculty of Medicine, Hammersmith Hospital, London, UK
| | - Salvatore Monaco
- Neurology B, Department of Neurosciences, Biomedicine and Movement, University of Verona, Verona, Italy
| | - Massimiliano Calabrese
- Neurology B, Department of Neurosciences, Biomedicine and Movement, University of Verona, Policlinico "G.B. Rossi" Borgo Roma, Piazzale L.A. Scuro, 10, 37134 Verona, Italy
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184
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Campbell J, Rashid W, Cercignani M, Langdon D. Cognitive impairment among patients with multiple sclerosis: associations with employment and quality of life. Postgrad Med J 2016; 93:143-147. [PMID: 27512050 DOI: 10.1136/postgradmedj-2016-134071] [Citation(s) in RCA: 89] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Revised: 07/05/2016] [Accepted: 07/13/2016] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To explore the relationship between cognitive impairment and conventional measures of disability in multiple sclerosis (MS), quality of life (QOL) and employment status using the brief international cognitive assessment for multiple sclerosis (BICAMS) in the routine outpatient clinic. METHODS 62 patients with MS were assessed on the BICAMS test battery for cognitive impairment. Data were obtained on employment status and a number of questionnaires completed including fatigue severity score, multiple sclerosis neuropsychological questionnaire, hospital anxiety and depression scale, the functional assessment of multiple sclerosis (FAMS) as well as on the EuroQOL five dimension questionnaire (EQ-5D). Other assessments include the patient activation measure and unidimensional self-efficacy scale for multiple sclerosis. RESULTS Cognitive assessment revealed 44 subjects (65%) had evidence of cognitive impairment on formal testing. In comparison with patients without evidence of cognitive impairment, cognitively impaired patients exhibited significantly higher rates of unemployment (p=0.009). The symbol digits modalities test was the most significant predictor of unemployment. Cognitive impairment was associated with lower QOL scores on the FAMS (p=0.001) and EQ-5D (p<0.001). CONCLUSIONS BICAMS provides a sensitive and easy to administer screening test for cognitive impairment within the outpatient setting. Cognitive impairment is common in our cohort of patients with MS attending outpatients and appears to be associated with increased rates of unemployment and lower measures of QOL.
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Affiliation(s)
- J Campbell
- Clinical Imaging Sciences Centre, Brighton and Sussex Medical School, Falmer, UK
| | - W Rashid
- Department of Neurology, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - M Cercignani
- Clinical Imaging Sciences Centre, Brighton and Sussex Medical School, Falmer, UK
| | - D Langdon
- Department of Neuropsychology, Royal Holloway, University of London, Egham, Surrey, UK
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185
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Bora E, Özakbaş S, Velakoulis D, Walterfang M. Social Cognition in Multiple Sclerosis: a Meta-Analysis. Neuropsychol Rev 2016; 26:160-72. [DOI: 10.1007/s11065-016-9320-6] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2015] [Accepted: 05/12/2016] [Indexed: 12/16/2022]
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186
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Bhargav P, Bhargav H, Raghuram N, Garner C. Immediate effect of two yoga-based relaxation techniques on cognitive functions in patients suffering from relapsing remitting multiple sclerosis: A comparative study. Int Rev Psychiatry 2016; 28:299-308. [PMID: 27299568 DOI: 10.1080/09540261.2016.1191447] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Cognitive impairment (CI) is an important feature of relapsing remitting multiple sclerosis (RRMS). Yogic relaxation techniques have been found useful in improving various cognitive domains in health and disease. Eighteen subjects (13 females) in the age range of 51.5 ± 12.72 years with the diagnosis of RRMS by a neurologist (McDonald Criteria 2010) since last 18.16 ± 12.59 years were recruited into the study from a neuro-rehabilitation centre in Germany. Assessments were done before and immediately after two randomly allocated 30-min sessions of yogic relaxation: Cyclic Meditation (CM) and SR (supine rest or shavasana). Assessments were done for attention, psychomotor performance, information processing speed, executive functions, and immediate and delayed recall using standard psychometric tools. RMANOVA was applied to analyse the data using SPSS version 10. Both CM and SR sessions improved scores on Digit Symbol Substitution Test (DSST) (p < 0.01) and Auditory Verbal Learning Test (AVLT) (p < 0.05). There was a significantly better performance in Trail Making Test (TMT)-A and forward digit span (FDS) after CM as compared to SR (p < 0.01). Yogic relaxation techniques may have an immediate enhancing effect on processing speed, psychomotor performance, and recall of RRMS patients. CM is better than SR in improving processing speed, short-term memory, and verbal working memory.
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Affiliation(s)
- Praerna Bhargav
- a School of Yoga and Life Sciences , S-VYASA Yoga University , Bangalore , India
| | - Hemant Bhargav
- a School of Yoga and Life Sciences , S-VYASA Yoga University , Bangalore , India
| | | | - Christoph Garner
- c KWA-Klinik für Neurologische und Geriatrische Rehabilitation Stift Rottal , Bad Griesbach , Germany
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187
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Kuusisto H, Vahvelainen T, Hämäläinen P, Luukkaala T, Elovaara I. Asymptomatic subjects differ less from their twin siblings with MS than from healthy controls in cognitive functioning. A Finnish Twin Cohort study. J Neurol Sci 2016; 365:50-3. [DOI: 10.1016/j.jns.2016.03.046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Revised: 03/27/2016] [Accepted: 03/28/2016] [Indexed: 11/24/2022]
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188
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Dackovic J, Pekmezovic T, Mesaros S, Dujmovic I, Stojsavljevic N, Martinovic V, Drulovic J. The Rao's Brief Repeatable Battery in the study of cognition in different multiple sclerosis phenotypes: application of normative data in a Serbian population. Neurol Sci 2016; 37:1475-81. [PMID: 27207679 DOI: 10.1007/s10072-016-2610-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2015] [Accepted: 05/12/2016] [Indexed: 11/25/2022]
Abstract
Cognitive impairment is prevalent in multiple sclerosis (MS) occurring in 43-72 % of patients with all MS phenotypes. The aim of our study was to assess cognitive performance in different MS subtypes in Serbian population. Rao's Brief Repeatable Battery of neuropsychological tests (BRB-N) was administered to 168 MS patients [37 patients with clinically isolated syndrome (CIS) suggestive of MS, 65 with relapsing-remitting MS (RRMS), 31 with secondary progressive MS (SPMS) and 35 patients with primary progressive MS (PPMS)]. The percentage of cognitively impaired patients in our total MS cohort was 58.9 %. Prevalence of cognitive dysfunction was 40.5 % in CIS group, 36.9 % in RRMS, 96.8 % in SPMS, and 85.7 % in PPMS group. Patients in CIS and RRMS groups performed consistently better all tests of the Rao's battery than patients in SPMS and PPMS cohort. CIS and RRMS groups performed consistently better in all tests of the Rao's battery than SPMS and PPMS cohort. Additionally, difference in the performance of any of the BRB-N tests was not found between CIS and RRMS. However, there was a significant difference between SPMS and PPMS patients in the performance on five tests of Rao's battery. Statistical significance (p < 0.05) in favor of PPMS patients was demonstrated for the following tasks: SRT_lts, SRT_cltr, SDMT, SRT_D, SPART_D. Our study demonstrates that cognitive impairment is frequent in all MS phenotypes. Furthermore, we have found that cognitive deficit is most severe and most frequent in SPMS patients, followed by PPMS subjects and then CIS and RRMS patients.
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Affiliation(s)
- Jelena Dackovic
- Clinic of Neurology, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Dr Subotica 6, Belgrade, 11000, Serbia.
| | - Tatjana Pekmezovic
- Institute of Epidemiology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Sarlota Mesaros
- Clinic of Neurology, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Dr Subotica 6, Belgrade, 11000, Serbia
| | - Irena Dujmovic
- Clinic of Neurology, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Dr Subotica 6, Belgrade, 11000, Serbia
| | - Nebojsa Stojsavljevic
- Clinic of Neurology, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Dr Subotica 6, Belgrade, 11000, Serbia
| | - Vanja Martinovic
- Clinic of Neurology, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Dr Subotica 6, Belgrade, 11000, Serbia
| | - Jelena Drulovic
- Clinic of Neurology, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Dr Subotica 6, Belgrade, 11000, Serbia
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189
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Vanotti S, Smerbeck A, Benedict RHB, Caceres F. A new assessment tool for patients with multiple sclerosis from Spanish-speaking countries: validation of the Brief International Cognitive Assessment for MS (BICAMS) in Argentina. Clin Neuropsychol 2016; 30:1023-31. [PMID: 27668977 DOI: 10.1080/13854046.2016.1184317] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND The Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS) is an international assessment tool for monitoring cognitive function in multiple sclerosis (MS) patients. BICAMS comprises the Symbol Digit Modalities Test (SDMT), the California Verbal Learning Test - Second Edition (CVLT II) and the Brief Visuospatial Memory Test - Revised (BVMT-R). Our objective was to validate and assess the reliability of BICAMS as applied in Argentina and to obtain normative data in Spanish for this population. METHOD The sample composed of 50 MS patients and 100 healthy controls (HC). In order to test its reliability, BICAMS was re-administered in a subset of 25 patients. RESULTS The sample's average age was 43.42 ± 10.17 years old, and average years of schooling were 14.86 ± 2.78. About 74% of the participants were women. The groups did not differ in age, years of schooling, or gender. The MS group performed significantly worse than the HC group across the three neuropsychological tests, yielding the following Cohen's d values: SDMT: .85; CVLT I: .87; and BVMT-R: .40. The mean raw scores for Argentina normative data were as follows: SDMT: 56.71 ± 10.85; CVLT I: 60.88 ± 10.46; and BVMT-R: 23.44 ± 5.84. Finally, test-retest reliability coefficients for each test were as follows: SDMT: r = .95; CVLT I: r = .87; and BVMT-R: r = .82. CONCLUSION This BICAMS version is reliable and useful as a monitoring tool for identifying MS patients with cognitive impairment.
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Affiliation(s)
- Sandra Vanotti
- a Multiple Sclerosis Clinic , INEBA - Neurosciencies Institute of Buenos Aires , Buenos Aires , Argentina
| | - Audrey Smerbeck
- b Department of Psychology , Rochester Institute of Technology , Rochester , NY , USA
| | | | - Fernando Caceres
- a Multiple Sclerosis Clinic , INEBA - Neurosciencies Institute of Buenos Aires , Buenos Aires , Argentina
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190
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Pinter D, Beckmann C, Koini M, Pirker E, Filippini N, Pichler A, Fuchs S, Fazekas F, Enzinger C. Reproducibility of Resting State Connectivity in Patients with Stable Multiple Sclerosis. PLoS One 2016; 11:e0152158. [PMID: 27007237 PMCID: PMC4805264 DOI: 10.1371/journal.pone.0152158] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 03/09/2016] [Indexed: 01/05/2023] Open
Abstract
Given increasing efforts to use resting-state fMRI (rfMRI) as a biomarker of disease progression in multiple sclerosis (MS) we here explored the reproducibility of longitudinal rfMRI over three months in patients with clinically and radiologically stable MS. To pursue this aim, two approaches were applied in nine rfMRI networks: First, the intraclass correlation coefficient (ICC 3,1) was assessed for the mean functional connectivity maps across the entire network and a region of interest (ROI). Second, the ratio of overlap between Z-thresholded connectivity maps for each network was assessed. We quantified between-session functional reproducibility of rfMRI for 20 patients with stable MS and 14 healthy controls (HC). Nine rfMRI networks (RSNs) were examined at baseline and after 3 months of follow-up: three visual RSNs, the default-mode network, sensorimotor-, auditory-, executive control, and the left and right fronto-parietal RSN. ROI analyses were constrained to thresholded overlap masks for each individual (Z>0) at baseline and follow-up.In both stable MS and HC mean functional connectivity across the entire network did not reach acceptable ICCs for several networks (ICC<0.40) but we found a high reproducibility of ROI ICCs and of the ratio of overlap. ROI ICCs of all nine networks were between 0.98 and 0.99 for HC and ranged from 0.88 to 0.99 in patients with MS, respectively. The ratio of overlap for all networks was similar for both groups, ranging from 0.60 to 0.75.Our findings attest to a high reproducibility of rfMRI networks not only in HC but also in patients with stable MS when applying ROI analysis. This supports the utility of rfMRI to monitor functional changes related to disease progression or therapeutic interventions in MS.
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Affiliation(s)
- Daniela Pinter
- Department of Neurology, Medical University of Graz, Graz, Austria
- * E-mail:
| | - Christian Beckmann
- Donders Institute, Cognitive Neuroscience Department and Centre for Cognitive Neuroimaging, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Marisa Koini
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - Eva Pirker
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - Nicola Filippini
- The Oxford Centre for Functional MRI of the Brain, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | | | - Siegrid Fuchs
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - Franz Fazekas
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - Christian Enzinger
- Department of Neurology, Medical University of Graz, Graz, Austria
- Division of Neuroradiology, Department of Radiology, Medical University of Graz, Graz, Austria
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191
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Roy S, Benedict RHB, Drake AS, Weinstock-Guttman B. Impact of Pharmacotherapy on Cognitive Dysfunction in Patients with Multiple Sclerosis. CNS Drugs 2016; 30:209-25. [PMID: 26884145 DOI: 10.1007/s40263-016-0319-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Cognitive impairment is a common symptom of multiple sclerosis (MS), adversely impacting many spheres of daily functioning. Yet the effectiveness of pharmacological interventions for cognitive impairment in MS is unclear. Clinicians and patients alike would benefit from formal guidelines regarding effective management of cognitive symptoms. We reviewed the background on the measurement, pathophysiology and risk factors for cognitive dysfunction in MS, and then examined the published clinical trials of pharmacotherapy, including both disease-modifying treatments (DMTs) and symptom-management therapies (SMTs). Our review of DMTs revealed only a single well-designed, randomized, controlled trial where intramuscular interferon (IFN)-β1a, administered once weekly, was compared with placebo. The results showed significant benefits in terms of cognitive processing speed and memory. Less convincing but promising data have shown the potential benefits of IFN-β1b and natalizumab. The literature on SMTs is replete with placebo-controlled, single-centre studies, with a failure to replicate initially promising results. The results for SMTs such as acetylcholinesterase inhibitors and psychostimulants are mixed. Some encouraging data show promise but not to a threshold of indication for standard clinical use. Numerous methodological factors hamper research in this area. Acknowledging the lack of firm conclusions, we argue that all DMTs are likely to benefit cognition and that, if otherwise safe, SMTs with some empirical support may be attempted at the discretion of the treating clinician. We offer some guidance on the assessment and monitoring of cognitive function to inform off-license treatment of cognitive impairment in MS patients.
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Affiliation(s)
- Shumita Roy
- Department of Neurology, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York (SUNY), Buffalo, NY, USA
| | - Ralph H B Benedict
- Department of Neurology, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York (SUNY), Buffalo, NY, USA.
| | - Allison S Drake
- Department of Neurology, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York (SUNY), Buffalo, NY, USA
| | - Bianca Weinstock-Guttman
- Department of Neurology, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York (SUNY), Buffalo, NY, USA
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192
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D'Amico E, Leone C, Hayrettin T, Patti F. Can we define a rehabilitation strategy for cognitive impairment in progressive multiple sclerosis? A critical appraisal. Mult Scler 2016; 22:581-9. [PMID: 26920381 DOI: 10.1177/1352458516632066] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 01/17/2016] [Indexed: 01/25/2023]
Abstract
Cognitive impairment (CI) has been shown to be severe in patients with progressive forms of multiple sclerosis (MS), and the most frequently impaired domains are sustained attention, information processing speed, memory, and executive functions. In contrast to relapsing forms of MS, where studies have shown favorable results from cognitive rehabilitation, there is a lack of data on cognitive rehabilitation in progressive forms of MS. A specific approach in assessing CI and in designing and administering rehabilitation training for patients with progressive forms of MS is needed.
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Affiliation(s)
| | | | - Tumani Hayrettin
- Klinik und PoliklinikfürNeurologie der Universität Ulm, Ulm, Germany
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193
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Pérez-Martín MY, Eguia-Del Río P, González-Platas M, Jiménez-Sosa A. Cognitive status in patients with multiple sclerosis in Lanzarote. Neuropsychiatr Dis Treat 2016; 12:1553-9. [PMID: 27418825 PMCID: PMC4935002 DOI: 10.2147/ndt.s105805] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES Cognitive impairment is a common feature in multiple sclerosis affecting ~43%-72% of patients, which involves cognitive functions such as memory, processing speed, attention, and executive function. The aim of this study was to describe the extent and pattern of the involvement of cognitive impairment and psychological status in all patients with multiple sclerosis on a small Spanish island. PATIENTS AND METHODS In all, 70 patients and 56 healthy controls were included in the study between February 2013 and May 2013. All participants were assessed using the Brief Repeatable Battery of Neuropsychological Test. The patients also completed instruments to evaluate the presence of fatigue, perceived cognitive dysfunction, and symptoms of anxiety and depression. All procedures were performed in a single session. RESULTS Cognitive impairment, defined as a score <1.5 standard deviation on two subtests of the battery, was present in 35% of the participants. The most frequently affected domain was working memory, followed by verbal memory and processing speed. Disease duration showed a moderate correlation with visuospatial memory and processing speed. The Expanded Disability Status Scale score correlated with verbal and processing speed. Verbal memory was correlated with depression symptoms and fatigue. CONCLUSION Cognitive impairment was present in 35% of the study population. The most affected domains were working memory and verbal memory. Working memory and verbal fluency deficit are independent factors of disease evolution. Cognitive decline is related to clinical variables and psychological measures such as fatigue or depression but not to anxiety.
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Affiliation(s)
| | - Pablo Eguia-Del Río
- Service of Neurology, Doctor José Molina Orosa Hospital, Arrecife, Lanzarote
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194
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Jongen PJ, Lemmens WA, Hupperts R, Hoogervorst ELJ, Schrijver HM, Slettenaar A, de Schryver EL, Boringa J, van Noort E, Donders R. Persistence and adherence in multiple sclerosis patients starting glatiramer acetate treatment: assessment of relationship with care received from multiple disciplines. Patient Prefer Adherence 2016; 10:909-17. [PMID: 27307711 PMCID: PMC4889087 DOI: 10.2147/ppa.s108121] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND In multiple sclerosis patients, the persistence of, and adherence to, disease-modifying treatment are often insufficient. The degree of persistence and adherence may relate to the care received from various disciplines. METHODS In an observational study of 203 patients treated with glatiramer acetate 20 mg subcutaneous daily, we assess the persistence and adherence in relation to the amount of care received in various disciplines. The frequencies and durations of care per discipline were reported by patients online, as were missed doses and eventual treatment discontinuation. The associations between the care provided by neurologists, nurses, psychologists, pharmacists, and rehabilitative doctors and persistence and adherence were the primary outcomes; the associations between care received from general practitioners, occupational therapists, physiotherapists, social workers, dieticians, home caregivers, informal caregivers, other medical specialists, and other caregivers and persistence and adherence were secondary outcomes. RESULTS It was found that the 12-month persistence rate was 62% and that 85% of the persistent patients were 95% adherent (missed <5% of doses). Patients who discontinued treatment in the fourth quarter (Q) had received less-frequent and shorter psychological care in Q3 than persistent patients (P=0.0018 and P=0.0022). Adherent patients had received more frequent home care and informal care than nonadherent patients (P=0.0074 and P=0.0198), as well as longer home care and informal care (P=0.0074 and P=0.0318). Associations between care in other disciplines and persistence or adherence were not observed. As to the relationship between adherence and persistence, nonadherence in Q2 was related to discontinuation after Q2 (P=0.0001). CONCLUSION We obtained no evidence that, in multiple sclerosis patients, persistence of and adherence to disease-modifying treatment are associated with the amount of neurological, nursing, pharmaceutical, or rehabilitative care. However, findings suggest that the treatment of psychological problems in Q3 may relate to persistence and that home care and informal care may relate to adherence.
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Affiliation(s)
- Peter Joseph Jongen
- Department of Community and Occupational Medicine, University Medical Centre Groningen, University Groningen, Groningen, the Netherlands
- MS4 Research Institute, Radboud university medical center, Nijmegen, the Netherlands
- Correspondence: Peter Joseph Jongen, Department of Community and Occupational Medicine, University Medical Centre Groningen, University Groningen, Antonius Deusinglaan 1, 9713 AV, Groningen, the Netherlands, Tel +31 24 323 9146, Email
| | - Wim A Lemmens
- Department for Health Evidence, Radboud university medical center, Nijmegen, the Netherlands
| | - Raymond Hupperts
- Department of Neurology, Zuijderland Medisch Centrum Sittard, Sittard, the Netherlands
| | | | - Hans M Schrijver
- Department of Neurology, Multiple Sclerosis Centre, Westfries Gasthuis, Hoorn, the Netherlands
| | - Astrid Slettenaar
- Department of Neurology, Medisch Spectrum Twente, Enschede, the Netherlands
| | - Els L de Schryver
- Department of Neurology, Alrijne Ziekenhuis, Leiderdorp, the Netherlands
| | - Jan Boringa
- Department of Neurology, Meander Medisch Centrum, Amersfoort, the Netherlands
| | | | - Rogier Donders
- Department for Health Evidence, Radboud university medical center, Nijmegen, the Netherlands
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195
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Giedraitienė N, Kizlaitienė R, Kaubrys G. The BICAMS Battery for Assessment of Lithuanian-Speaking Multiple Sclerosis Patients: Relationship with Age, Education, Disease Disability, and Duration. Med Sci Monit 2015; 21:3853-9. [PMID: 26655632 PMCID: PMC4678925 DOI: 10.12659/msm.896571] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background Assessment of cognitive impairment (CI) in multiple sclerosis (MS) patients is very useful, but it requires time-consuming expert evaluation with specialized materials. The Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS) was created as a brief and specific instrument for the evaluation of CI. The aims of this study were to assess the cognitive status of MS patients by using the Lithuanian version of BICAMS, to evaluate the test-retest reliability of the Lithuanian version of BICAMS, and to measure the impact of CI on disability and duration of MS. Material/Methods We enrolled 50 MS patients and 20 cognitively normal control subjects, matched for age, gender, and level of education. Cognitive functions were assessed by the BICAMS tests, which include the Symbol Digit Modalities Test, the Brief Visuospatial Memory Test Revised, and the California Verbal Learning Test, 2nd edition. Results MS patients performed significantly worse than controls on the 3 neuropsychological tests of BICAMS (p<0.001). Younger and intellectually employed persons performed significantly better on these tests than older persons, manual workers, or unemployed persons (p<0.05). MS patients with higher disability scores tended to perform worse on the tests (p<0.05), but we found no relationship between BICAMS test scores and the duration of the disease or relapse rate (p>0.05). Test-retest reliability was excellent for all 3 subtests (r>0.8, p<0.05). Conclusions Our study shows that BICAMS is a valid and acceptable cognitive assessment tool that can be recommended for routine use in Lithuania for assessing patients with MS.
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Affiliation(s)
- Nataša Giedraitienė
- Clinic of Neurology and Neurosurgery, Faculty of Medicine, Vilnius University, Center of Neurology, Vilnius University Hospital Santariskiu Clinics, Vilnius, Lithuania
| | - Rasa Kizlaitienė
- Clinic of Neurology and Neurosurgery, Faculty of Medicine, Vilnius University, Center of Neurology, Vilnius University Hospital Santariskiu Clinics, Vilnius, Lithuania
| | - Gintaras Kaubrys
- Clinic of Neurology and Neurosurgery, Faculty of Medicine, Vilnius University, Center of Neurology, Vilnius University Hospital Santariskiu Clinics, Vilnius, Lithuania
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196
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Hansen S, Muenssinger J, Kronhofmann S, Lautenbacher S, Oschmann P, Keune PM. Cognitive screening tools in multiple sclerosis revisited: sensitivity and specificity of a short version of Rao's Brief Repeatable Battery. BMC Neurol 2015; 15:246. [PMID: 26612613 PMCID: PMC4660646 DOI: 10.1186/s12883-015-0497-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 11/17/2015] [Indexed: 11/17/2022] Open
Abstract
Background Cognitive deficits are common in multiple sclerosis (MS) and require continuous monitoring. In routine examinations, screening instruments such as the Brief Repeatable Battery (BRB) may serve this purpose. It was suggested that even a shortened version of the BRB, comprising the Symbol Digit Modalities Test (SDMT), Paced Auditory Serial Addition Test (PASAT) and Selective Reminding Test (SRT), may be feasible. However, an evaluation of sensitivity and specificity of the short BRB in comparison to an independent battery of established tests has not yet occurred. Therefore in the current study, this short version of the BRB was matched against the gold standard of an extensive test battery comprehensively assessing neuropsychological functions. Methods 127 MS-patients were tested with a short version of the BRB and an extensive procedure. The latter served as the gold standard for defining sensitivity and specificity. Results For subtests of the short BRB, estimates of sensitivity (38-44 %) and specificity (81-94 %) were obtained. Combining subtests into a single indicator of cognitive deficits yielded increased sensitivity (78 %), while reducing specificity (65 %). Conclusion The short BRB is reasonably sensitive and specific in detecting cognitive deficits. However, these qualities only emerge, if the short BRB is administered as a whole, whereas sensitivity is considerably lower than suggested by previous work, when relying on subtests separately (SDMT, PASAT, SRT). While the short BRB may not be regarded as conclusive as an extensive test battery, it represents a valid and economic screening instrument. Electronic supplementary material The online version of this article (doi:10.1186/s12883-015-0497-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sascha Hansen
- Department of Neurology, Klinikum Bayreuth GmbH, Betriebsstätte Hohe Warte, Neurologische Klinik, Sekretariat Prof. Dr. Oschmann, z.Hd. Sascha Hansen, Hohe Warte 8, DE-95445, Bayreuth, Germany. .,Department of Physiological Psychology, Otto-Friedrich-University Bamberg, Bamberg, Germany.
| | - Jana Muenssinger
- Department of Neurology, Klinikum Bayreuth GmbH, Betriebsstätte Hohe Warte, Neurologische Klinik, Sekretariat Prof. Dr. Oschmann, z.Hd. Sascha Hansen, Hohe Warte 8, DE-95445, Bayreuth, Germany.
| | - Simona Kronhofmann
- Department of Neurology, Klinikum Bayreuth GmbH, Betriebsstätte Hohe Warte, Neurologische Klinik, Sekretariat Prof. Dr. Oschmann, z.Hd. Sascha Hansen, Hohe Warte 8, DE-95445, Bayreuth, Germany.
| | - Stefan Lautenbacher
- Department of Physiological Psychology, Otto-Friedrich-University Bamberg, Bamberg, Germany.
| | - Patrick Oschmann
- Department of Neurology, Klinikum Bayreuth GmbH, Betriebsstätte Hohe Warte, Neurologische Klinik, Sekretariat Prof. Dr. Oschmann, z.Hd. Sascha Hansen, Hohe Warte 8, DE-95445, Bayreuth, Germany.
| | - Philipp M Keune
- Department of Neurology, Klinikum Bayreuth GmbH, Betriebsstätte Hohe Warte, Neurologische Klinik, Sekretariat Prof. Dr. Oschmann, z.Hd. Sascha Hansen, Hohe Warte 8, DE-95445, Bayreuth, Germany. .,Department of Physiological Psychology, Otto-Friedrich-University Bamberg, Bamberg, Germany.
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197
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Bergsland N, Zivadinov R, Dwyer MG, Weinstock-Guttman B, Benedict RH. Localized atrophy of the thalamus and slowed cognitive processing speed in MS patients. Mult Scler 2015; 22:1327-36. [PMID: 26541795 DOI: 10.1177/1352458515616204] [Citation(s) in RCA: 82] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 10/13/2015] [Indexed: 12/18/2022]
Abstract
BACKGROUND Deep gray matter (DGM) atrophy is common in multiple sclerosis (MS), but no studies have investigated surface-based structure changes over time with respect to healthy controls (HCs). Moreover, the relationship between cognition and the spatio-temporal evolution of DGM atrophy is poorly understood. OBJECTIVES To explore DGM structural differences between MS and HCs over time in relation to neuropsychological (NP) outcomes. METHODS The participants were 44 relapsing-remitting and 20 secondary progressive MS patients and 22 HCs. All were scanned using 3T magnetic resonance imaging (MRI) at baseline and 3-year follow-up. NP examination emphasized consensus standard tests of processing speed and memory. We performed both volumetric and shape analysis of DGM structures and assessed their relationships with cognition. RESULTS Compared to HCs, MS patients presented with significantly smaller DGM volumes. For the thalamus and caudate, differences in shape were mostly localized along the lateral ventricles. NP outcomes were related to both volume and shape of the DGM structures. Over 3 years, decreased cognitive processing speed was related to localized atrophy on the anterior and superior surface of the left thalamus. CONCLUSIONS These findings highlight the role of atrophy in the anterior nucleus of the thalamus and its relation to cognitive decline in MS.
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Affiliation(s)
- Niels Bergsland
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, USA/IRCCS "S.Maria Nascente," Don Gnocchi Foundation, Milan, Italy/Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Robert Zivadinov
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, USA/MR Imaging Clinical Translational Research Center, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Michael G Dwyer
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Bianca Weinstock-Guttman
- Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Ralph Hb Benedict
- Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, USA
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O’Connell K, Langdon D, Tubridy N, Hutchinson M, McGuigan C. A preliminary validation of the brief international cognitive assessment for multiple sclerosis (BICAMS) tool in an Irish population with multiple sclerosis (MS). Mult Scler Relat Disord 2015; 4:521-5. [DOI: 10.1016/j.msard.2015.07.012] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Revised: 06/25/2015] [Accepted: 07/22/2015] [Indexed: 11/16/2022]
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199
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Multimodal neurophysiological evaluation of primary progressive multiple sclerosis – An increasingly valid biomarker, with limits. Mult Scler Relat Disord 2015; 4:607-13. [DOI: 10.1016/j.msard.2015.07.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Revised: 06/17/2015] [Accepted: 07/19/2015] [Indexed: 11/18/2022]
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200
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Papathanasiou A, Messinis L, Zampakis P, Panagiotakis G, Gourzis P, Georgiou V, Papathanasopoulos P. Thalamic atrophy predicts cognitive impairment in relapsing remitting multiple sclerosis. Effect on instrumental activities of daily living and employment status. J Neurol Sci 2015; 358:236-42. [DOI: 10.1016/j.jns.2015.09.001] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2015] [Revised: 08/31/2015] [Accepted: 09/01/2015] [Indexed: 11/30/2022]
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