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Sanaie S, Koohi N, Mosaddeghi-Heris R, Rezai S, Movagharnia E, Karimi H, Moghaddamziabari S, Hamzehzadeh S, Gholipour-Khalili E, Talebi M, Naseri A. Serum lipids and cognitive outcomes in multiple sclerosis; a systematic review and meta-analysis. Mult Scler Relat Disord 2024; 85:105530. [PMID: 38522226 DOI: 10.1016/j.msard.2024.105530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 11/19/2023] [Accepted: 02/28/2024] [Indexed: 03/26/2024]
Abstract
BACKGROUND Cognitive impairment is highly prevalent in multiple sclerosis (MS) with poorly understood underlying mechanisms. Lipids are considered to be associated with MS progression through the inflammatory and oxidative stress pathways, brain atrophy, cellular signaling, and tissue physiology. In addition, serum lipids are proposed as a modifiable factor affecting the neuropsychiatric condition; therefore, this study aims to assess the association between serum lipid levels and cognitive outcomes in MS. METHODS This study was carried out following the PRISMA 2020 statement. A systematic search was conducted in PubMed, Scopus, Web of Science, and Embase in March 2023, and the Joanna Briggs Institute (JBI)'s critical appraisal tools were utilized for risk of bias (RoB) assessments in the included studies. The quantitative synthesis was performed with the comprehensive meta-analysis (CMA3) software. RESULTS Out of 508 screened records, 7 studies were eventually found to meet our inclusion criteria. In two studies, the course of MS in the sample of the study was only Relapsing-Remitting MS (RRMS), whereas the other five studies' sample was a combination of different phenotypes. Studies utilized different scales such as Minimal Assessment of Cognitive Function in MS (MACFIMS), Brief International Cognitive Assessment for MS (BICAMS), Montreal Cognitive Assessment (MoCA), Brief Repeatable Battery of Neuropsychological Tests (BRB-N) for cognitive evaluations. Dealing with possible confounders such as age, disease duration and level of disability was the most common possible source of bias in the included studies. One study revealed an inverse relationship between serum levels of apolipoproteins (including ApoA-I, ApoB, and ApoB/ApoA-I) and Symbol Digit Modalities Test (SDMT) scores. Also, a correlation between 24S-hydroxycholesterol (24OHC) serum concentrations and SDMT score was reported in one study. The association between serum total cholesterol (TC) and low-density lipoprotein cholesterol (LDL) and different aspects of cognitive function was reported in the studies; however, serum levels of high-density lipoprotein cholesterol (HDL) were not found to be associated. The quantitative synthesis revealed a significant correlation between TC and the MoCA scores (r =-0.238; 95 %CI: -0.366 to -0.100; p-value = 0.001); however, the correlation between TG levels and MoCA were not statistically significant (r:-0.070; 95 %CI: -0.209 to 0.072; p-value: 0.334). In addition, the mata-analyses were not associated with significant findings regarding the correlation between lipid profiles (including HDL, LDL, TG, and TC) and other cognitive assessment scales including SDMT, Brief Visuospatial Memory Test (BVMT), and California Verbal Learning Test (CVLT) (p-values>0.05). DISCUSSION Available evidence suggested a link between TC and LDL with cognitive outcomes of MS patients which was not evident in our quantitative synthesis. The limited number of studies, high RoB, different cognitive assessment scales and reporting methods, and the cross-sectional design of the included studies, were the main limitations that alleviate the clinical significance of the findings of this study and suggested further investigations on this topic. FUNDING AND REGISTRATION The research protocol was approved and supported by the Student Research Committee, Tabriz University of Medical Sciences (grant number: 71,909). This study is registered in the international prospective register of systematic reviews (PROSPERO ID: CRD42023441625).
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Affiliation(s)
- Sarvin Sanaie
- Neurosciences Research Center (NSRC), Tabriz University of Medical Sciences, Tabriz 5166614756, Iran
| | - Narges Koohi
- Student Research Committee, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Reza Mosaddeghi-Heris
- Neurosciences Research Center (NSRC), Tabriz University of Medical Sciences, Tabriz 5166614756, Iran
| | - Shirin Rezai
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Elahe Movagharnia
- Research Center for Evidence-Based Medicine, Iranian EBM Centre: A Joanna Briggs Institute (JBI) Center of Excellence, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hanie Karimi
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Sina Hamzehzadeh
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Mahnaz Talebi
- Neurosciences Research Center (NSRC), Tabriz University of Medical Sciences, Tabriz 5166614756, Iran.
| | - Amirreza Naseri
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran; Research Center for Evidence-Based Medicine, Iranian EBM Centre: A Joanna Briggs Institute (JBI) Center of Excellence, Tabriz University of Medical Sciences, Tabriz, Iran; Tabriz USERN Office, Universal Scientific Education and Research Network (USERN), Tabriz, Iran.
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Rosenstein I, Axelsson M, Novakova L, Rasch S, Blennow K, Zetterberg H, Lycke J. High levels of kappa free light chain synthesis predict cognitive decline in relapsing-remitting multiple sclerosis. Front Immunol 2023; 14:1106028. [PMID: 36742305 PMCID: PMC9896185 DOI: 10.3389/fimmu.2023.1106028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 01/04/2023] [Indexed: 01/21/2023] Open
Abstract
Background Evolving evidence suggests that measurement of cerebrospinal fluid (CSF) kappa free light chain (KFLC) synthesis has high diagnostic sensitivity and specificity for multiple sclerosis (MS), but its prognostic ability is less investigated. The usefulness of KFLC in predicting cognitive impairment (CI) is still unknown. Methods In a monocentric longitudinal retrospecitve cohort study, KFLC-index ([CSF KFLC/serum KFLC]/[CSF albumin/serum albumin]) measured by latex-enhanced immunonephelometry was prospectively determined as part of the diagnostic workup in patients with early relapsing-remitting MS (RRMS, n=77). The ability of KFLC-index to predict information processing speed (IPS) worsening as assessed with the symbol digit modalities test (SDMT) was investigated in univariable and multivariable models. Results In patients with KFLC-index>100 (n=31), 11 subjects (35.5%) showed reduced SDMT scores by ≥8 points at follow-up (mean follow-up time 7.3 ± 2.6 years), compared with their baseline scores (p=0.01). Baseline KFLC-index>100 was strongly associated with a higher hazard of SDMT score reduction at follow-up (adjusted hazard ratio 10.5, 95% confidence interval 2.2-50.8, p=0.003; median time to SDMT reduction 7 years). Conclusion Intrathecal KFLC synthesis has become an attractive diagnostic tool for MS. We show for the first time that in a real-world setting of early RRMS, KFLC-index predicted cognitive decline. Whether this predictive ability of KFLC-index also concerns other cognitive domains than IPS, warrants further investigations.
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Affiliation(s)
- Igal Rosenstein
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden,*Correspondence: Igal Rosenstein,
| | - Markus Axelsson
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Lenka Novakova
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Sofia Rasch
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Kaj Blennow
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden,Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, University of Gothenburg, Mölndal, Sweden
| | - Henrik Zetterberg
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden,Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, University of Gothenburg, Mölndal, Sweden,United Kingdom (UK) Dementia Research Institute at University College London (UCL), London, United Kingdom,Department of Neurodegenerative Disease, University College London (UCL) Queen Square Institute of Neurology, London, United Kingdom,Hong Kong Centre for Neurodegenerative Diseases, Hong Kong SAR, China,Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States
| | - Jan Lycke
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Coll-Martinez C, Quintana E, Salavedra-Pont J, Buxó M, González-Del-Rio M, Gómez I, Muñoz-San Martín M, Villar LM, Álvarez-Bravo G, Robles-Cedeño R, Ramió-Torrentà L, Gich J. Assessing the presence of oligoclonal IgM bands as a prognostic biomarker of cognitive decline in the early stages of multiple sclerosis. Brain Behav 2021; 11:e2405. [PMID: 34796675 PMCID: PMC8671794 DOI: 10.1002/brb3.2405] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 09/09/2021] [Accepted: 10/12/2021] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND An association has been found between the presence of lipid-specific oligoclonal IgM bands (LS-OCMB) in cerebrospinal fluid and a more severe clinical multiple sclerosis course. OBJECTIVE To investigate lipid-specific oligoclonal IgM bands as a prognostic biomarker of cognitive impairment in the early stages of multiple sclerosis. METHODS Forty-four patients underwent neuropsychological assessment at baseline and 4 years. Cognitive performance at follow-up was compared adjusting by age, education, anxiety-depression, and baseline performance. RESULTS LS-OCMB+ patients only performed worse for Long-Term Storage in the Selective Reminding Test (p = .018). CONCLUSION There are no remarkable cognitive differences between LS-OCMB- and LS-OCMB+ patients in the early stages of MS.
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Affiliation(s)
- Clàudia Coll-Martinez
- Girona Neuroimmumology and Multiple Sclerosis Unit, Neurology Department, Dr. Josep Trueta University Hospital and Santa Caterina Hospital, Girona/Salt, Spain.,Neurodegeneration and Neuroimflammation Research Group, Institut d'Investigació Biomèdica de Girona Dr. Josep Trueta, Salt, Spain
| | - Ester Quintana
- Neurodegeneration and Neuroimflammation Research Group, Institut d'Investigació Biomèdica de Girona Dr. Josep Trueta, Salt, Spain.,Medical Sciences Department, University of Girona, Girona, Spain.,REEM, Multiple Sclerosis Spanish Network, Instituo de Salud Carlos III, Madrid, Spain
| | - Judit Salavedra-Pont
- Girona Neuroimmumology and Multiple Sclerosis Unit, Neurology Department, Dr. Josep Trueta University Hospital and Santa Caterina Hospital, Girona/Salt, Spain.,Neurodegeneration and Neuroimflammation Research Group, Institut d'Investigació Biomèdica de Girona Dr. Josep Trueta, Salt, Spain
| | - Maria Buxó
- Institut d'Investigació Biomèdica de Girona Dr. Josep Trueta, Salt, Spain
| | - Marina González-Del-Rio
- Girona Neuroimmumology and Multiple Sclerosis Unit, Neurology Department, Dr. Josep Trueta University Hospital and Santa Caterina Hospital, Girona/Salt, Spain.,Neurodegeneration and Neuroimflammation Research Group, Institut d'Investigació Biomèdica de Girona Dr. Josep Trueta, Salt, Spain
| | - Immaculada Gómez
- Neurodegeneration and Neuroimflammation Research Group, Institut d'Investigació Biomèdica de Girona Dr. Josep Trueta, Salt, Spain
| | - María Muñoz-San Martín
- Neurodegeneration and Neuroimflammation Research Group, Institut d'Investigació Biomèdica de Girona Dr. Josep Trueta, Salt, Spain
| | - Luisa María Villar
- REEM, Multiple Sclerosis Spanish Network, Instituo de Salud Carlos III, Madrid, Spain.,Immunology Department, Ramon y Cajal University Hospital, IRYCIS, Madrid, Spain
| | - Gary Álvarez-Bravo
- Girona Neuroimmumology and Multiple Sclerosis Unit, Neurology Department, Dr. Josep Trueta University Hospital and Santa Caterina Hospital, Girona/Salt, Spain.,Neurodegeneration and Neuroimflammation Research Group, Institut d'Investigació Biomèdica de Girona Dr. Josep Trueta, Salt, Spain
| | - René Robles-Cedeño
- Girona Neuroimmumology and Multiple Sclerosis Unit, Neurology Department, Dr. Josep Trueta University Hospital and Santa Caterina Hospital, Girona/Salt, Spain.,Neurodegeneration and Neuroimflammation Research Group, Institut d'Investigació Biomèdica de Girona Dr. Josep Trueta, Salt, Spain.,Medical Sciences Department, University of Girona, Girona, Spain.,REEM, Multiple Sclerosis Spanish Network, Instituo de Salud Carlos III, Madrid, Spain
| | - Lluís Ramió-Torrentà
- Girona Neuroimmumology and Multiple Sclerosis Unit, Neurology Department, Dr. Josep Trueta University Hospital and Santa Caterina Hospital, Girona/Salt, Spain.,Neurodegeneration and Neuroimflammation Research Group, Institut d'Investigació Biomèdica de Girona Dr. Josep Trueta, Salt, Spain.,Medical Sciences Department, University of Girona, Girona, Spain.,REEM, Multiple Sclerosis Spanish Network, Instituo de Salud Carlos III, Madrid, Spain
| | - Jordi Gich
- Girona Neuroimmumology and Multiple Sclerosis Unit, Neurology Department, Dr. Josep Trueta University Hospital and Santa Caterina Hospital, Girona/Salt, Spain.,Neurodegeneration and Neuroimflammation Research Group, Institut d'Investigació Biomèdica de Girona Dr. Josep Trueta, Salt, Spain.,Medical Sciences Department, University of Girona, Girona, Spain
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