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Vidorreta-Ballesteros L, Matias-Guiu JA, Delgado-Álvarez A, Delgado-Alonso C, Valles-Salgado M, Cuevas C, Gil-Moreno MJ, García-Ramos R, Montero-Escribano P, Matias-Guiu J. Cognitive dysfunction characteristics of multiple sclerosis with aging. Mult Scler Relat Disord 2024; 87:105678. [PMID: 38728960 DOI: 10.1016/j.msard.2024.105678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 12/30/2023] [Accepted: 05/06/2024] [Indexed: 05/12/2024]
Abstract
BACKGROUND We aimed to investigate the characteristics of cognitive impairment in older people with multiple sclerosis (MS). METHODS Cross-sectional study that included participants that were examined with a common and comprehensive neuropsychological protocol. The subjects were matched by sociodemographic variables and the following groups were generated for comparisons: young MS versus healthy controls (HC) (n = 246), old MS versus HC (n = 198), young MS vs old MS (n = 226), MS vs Alzheimer's disease (AD)(n = 70), and MS vs Parkinson's disease (PD) (n = 62). The ICCoDiMS criteria were used to define cognitive impairment in MS. RESULTS Cognitive impairment was more frequent in young than old patients (70.8 % vs 52.2 %). Attention and speed processing is the most frequent cognitive domain impaired in MS (54.9 % of young MS vs 32.7 % of old MS). The frequency of impairment in attention/processing speed (54.9 % vs 32.7 %) and episodic memory (27.9 % vs 14.3) was higher in the young group than in the old group. There were no statistically significant differences in the distribution of impairment in executive function (46.0 % vs 35.3 %), visuospatial (17.9 % vs 9.5 %), and language (12.4 % vs 17.7 %). In those patients meeting the criteria for cognitive impairment, young MS patients showed lower performance in attention/processing speed tests. Conversely, old MS patients showed lower performance in episodic memory, verbal fluency, and planning. There were no differences in the correlations between SDMT and other neuropsychological tests in young and old patients, which suggests similar cognitive processes underlying SDMT performance in both groups. There were differences between old MS and prodromal AD, especially in episodic memory, while the cognitive profile of old MS was largely shared with PD. CONCLUSIONS Our study found that the cognitive profile of MS is defined by a characteristic impairment in attention and processing speed, which is present during the lifespan. The impairment in processing speed is less prominent in old age, whereas the impairment of other cognitive functions becomes more relevant. These findings suggest potential differences in the pathophysiological processes associated with cognitive impairment between young and old ages that warrant further investigation.
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Affiliation(s)
- Lucía Vidorreta-Ballesteros
- Department of Neurology. Hospital Clínico San Carlos. San Carlos Health Research Institute (IdISCC). Universidad Complutense de Madrid. Madrid, Spain
| | - Jordi A Matias-Guiu
- Department of Neurology. Hospital Clínico San Carlos. San Carlos Health Research Institute (IdISCC). Universidad Complutense de Madrid. Madrid, Spain.
| | - Alfonso Delgado-Álvarez
- Department of Neurology. Hospital Clínico San Carlos. San Carlos Health Research Institute (IdISCC). Universidad Complutense de Madrid. Madrid, Spain
| | - Cristina Delgado-Alonso
- Department of Neurology. Hospital Clínico San Carlos. San Carlos Health Research Institute (IdISCC). Universidad Complutense de Madrid. Madrid, Spain
| | - María Valles-Salgado
- Department of Neurology. Hospital Clínico San Carlos. San Carlos Health Research Institute (IdISCC). Universidad Complutense de Madrid. Madrid, Spain
| | - Constanza Cuevas
- Department of Neurology. Hospital Clínico San Carlos. San Carlos Health Research Institute (IdISCC). Universidad Complutense de Madrid. Madrid, Spain
| | - María José Gil-Moreno
- Department of Neurology. Hospital Clínico San Carlos. San Carlos Health Research Institute (IdISCC). Universidad Complutense de Madrid. Madrid, Spain
| | - Rocío García-Ramos
- Department of Neurology. Hospital Clínico San Carlos. San Carlos Health Research Institute (IdISCC). Universidad Complutense de Madrid. Madrid, Spain
| | - Paloma Montero-Escribano
- Department of Neurology. Hospital Clínico San Carlos. San Carlos Health Research Institute (IdISCC). Universidad Complutense de Madrid. Madrid, Spain
| | - Jorge Matias-Guiu
- Department of Neurology. Hospital Clínico San Carlos. San Carlos Health Research Institute (IdISCC). Universidad Complutense de Madrid. Madrid, Spain
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Sawan H, Li C, Buch S, Bernitsas E, Haacke EM, Ge Y, Chen Y. Reduced oxygen extraction fraction in deep cerebral veins associated with cognitive impairment in multiple sclerosis. J Cereb Blood Flow Metab 2024:271678X241259551. [PMID: 38820447 DOI: 10.1177/0271678x241259551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/02/2024]
Abstract
Studying the relationship between cerebral oxygen utilization and cognitive impairment is essential to understanding neuronal functional changes in the disease progression of multiple sclerosis (MS). This study explores the potential of using venous susceptibility in internal cerebral veins (ICVs) as an imaging biomarker for cognitive impairment in relapsing-remitting MS (RRMS) patients. Quantitative susceptibility mapping derived from fully flow-compensated MRI phase data was employed to directly measure venous blood oxygen saturation levels (SvO2) in the ICVs. Results revealed a significant reduction in the susceptibility of ICVs (212.4 ± 30.8 ppb vs 239.4 ± 25.9 ppb) and a significant increase of SvO2 (74.5 ± 1.89% vs 72.4 ± 2.23%) in patients with RRMS compared with age- and sex-matched healthy controls. Both the susceptibility of ICVs (r = 0.508, p = 0.031) and the SvO2 (r = -0.498, p = 0.036) exhibited a moderate correlation with cognitive decline in these patients assessed by the Paced Auditory Serial Addition Test, while no significant correlation was observed with clinical disability measured by the Expanded Disability Status Scale. The findings suggest that venous susceptibility in ICVs has the potential to serve as a specific indicator of oxygen metabolism and cognitive function in RRMS. .
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Affiliation(s)
- Hasan Sawan
- Department of Neurology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Chenyang Li
- Department of Radiology, New York University School of Medicine, New York, NY, USA
| | - Sagar Buch
- Department of Neurology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Evanthia Bernitsas
- Department of Neurology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - E Mark Haacke
- Department of Radiology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Yulin Ge
- Department of Radiology, New York University School of Medicine, New York, NY, USA
| | - Yongsheng Chen
- Department of Neurology, Wayne State University School of Medicine, Detroit, Michigan, USA
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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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Tekin A, Rende B, Efendi H, Bunul SD, Çakır Ö, Çolak T, Balcı S. Volumetric and Asymmetric Index Analysis of Subcortical Structures in Multiple Sclerosis Patients: A Retrospective Study Using volBrain Software. Cureus 2024; 16:e55799. [PMID: 38590495 PMCID: PMC10999780 DOI: 10.7759/cureus.55799] [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] [Accepted: 03/08/2024] [Indexed: 04/10/2024] Open
Abstract
Introduction Multiple sclerosis (MS) is a chronic and autoimmune disease that has a significant influence on the central nervous system, such as the brain and spinal cord, affecting millions of individuals globally. Understanding the connection between subcortical brain regions and MS is crucial for effective diagnostic and therapeutic approaches for treating this disabling disease. This study explores the relationship between volume and contours of asymmetry index of subcortical brain regions in individuals with MS using volBrain software (https://www.volbrain.net; developed by José V. Manjón (Valencia Polytechnic University, Valencia, Spain) and Pierrick Coupé (University of Bordeaux, Bordeaux, France)). Methods In our retrospective investigation, we admitted 100 Turkish individuals, comprising 50 patients diagnosed with relapsing-remitting MS (RRMS) (24 (48%) males and 26 (52%) females) and 50 healthy controls (23 (46%) males and 27 (54%) females), registered between October 2017 and February 2022 for five years and underwent assessment in the radiology department at the Teaching and Research Hospital of Kocaeli University; 1,150 Turkish patients were excluded from our study based on our exclusion criteria. We used magnetic resonance imaging with a 3-Tesla (3T) scanner and volBrain software to assess volumes (cm3) and asymmetry indexes due to asymmetry for different levels of atrophy of total intracranial, total brain, gray matter, white matter, and subcortical regions, the most affected regions in MS patients for both patient and control cohorts. Results Statistical analysis revealed a significant difference between patient and control groups (p < 0.001), with patient group mean age at 38.32 years and control group mean age at 32.88 years. Patient group exhibited lower values for total intracranial, total brain, gray matter, white matter, and cerebrospinal fluid volume compared to control group (p < 0.05). The results indicated a statistically significant decrease (p < 0.05) in the values for total intracranial and total brain volume, whereas all other values remained unchanged. We compared volumes of subcortical structures on the right and left sides and found that the putamen, thalamus, and globus pallidus had statistically lower values in the patient group than in the control group (p < 0.001), apart from the lateral ventricle. Furthermore, our retrospective investigation demonstrated a statistically significant difference in the globus pallidus asymmetry index, indicating a preference for the patient group (p < 0.05). A lower asymmetry index value signifies a larger volume for the right side of the subcortical regions of the brain when compared to the left side. Conclusion Brain atrophy, although characterized by irreversible tissue damage, is targeted by therapeutic interventions to prevent progression. It is, therefore, imperative to develop a universally accepted measurement standard for subcortical structures that also considers the inherent variability present within each structure. Our findings serve as an important basis and indicator for the determination of subcortical atrophy and asymmetry in MS, the prognosis of the disease, and the etiology of clinical symptoms. Subsequent research may benefit by adopting the novel approach of considering brain atrophy as an outcome rather than a predictor, thereby facilitating the elucidation of the intricate biological mechanisms that give rise to volume loss.
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Affiliation(s)
- Ayla Tekin
- Anatomy, Kocaeli University, Kocaeli, TUR
| | - Buket Rende
- Anatomy, European Vocational School, Kocaeli Health and Technology University, Kocaeli, TUR
| | | | | | | | - Tuncay Çolak
- Anatomy, Faculty of Medicine, Kocaeli University, Kocaeli, TUR
| | - Sibel Balcı
- Biostatistics and Medical Informatics, Kocaeli University, Kocaeli, TUR
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Sawan H, Li C, Buch S, Bernitsas E, Haacke EM, Ge Y, Chen Y. Reduced Oxygen Extraction Fraction in Deep Cerebral Veins Associated with Cognitive Impairment in Multiple Sclerosis. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.01.10.24301049. [PMID: 38260542 PMCID: PMC10802653 DOI: 10.1101/2024.01.10.24301049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
Studying the relationship between cerebral oxygen utilization and cognitive impairment is essential to understanding neuronal functional changes in the disease progression of multiple sclerosis (MS). This study explores the potential of using venous susceptibility in internal cerebral veins (ICVs) as an imaging biomarker for cognitive impairment in relapsing-remitting MS (RRMS) patients. Quantitative susceptibility mapping derived from fully flow-compensated MRI phase data was employed to directly measure venous blood oxygen saturation levels (SvO2) in the ICVs. Results revealed a significant reduction in the susceptibility of ICVs (212.4 ± 30.8 ppb vs 239.4 ± 25.9 ppb) and a significant increase of SvO2 (74.5 ± 1.89 % vs 72.4 ± 2.23 %) in patients with RRMS compared with age- and sex-matched healthy controls. Both the susceptibility of ICVs (r = 0.646, p = 0.004) and the SvO2 (r = -0.603, p = 0.008) exhibited a strong correlation with cognitive decline in these patients assessed by the Paced Auditory Serial Addition Test, while no significant correlation was observed with clinical disability measured by the Expanded Disability Status Scale. The findings suggest that venous susceptibility in ICVs has the potential to serve as a specific indicator of oxygen metabolism and cognitive function in RRMS.
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Affiliation(s)
- Hasan Sawan
- Department of Neurology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Chenyang Li
- Department of Radiology, New York University School of Medicine, New York, New York, USA
| | - Sagar Buch
- Department of Neurology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Evanthia Bernitsas
- Department of Neurology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - E. Mark Haacke
- Department of Radiology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Yulin Ge
- Department of Radiology, New York University School of Medicine, New York, New York, USA
| | - Yongsheng Chen
- Department of Neurology, Wayne State University School of Medicine, Detroit, Michigan, USA
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Tahedl M, Wiltgen T, Voon CC, Berthele A, Kirschke JS, Hemmer B, Mühlau M, Zimmer C, Wiestler B. Cortical Thin Patch Fraction Reflects Disease Burden in MS: The Mosaic Approach. AJNR Am J Neuroradiol 2023; 45:82-89. [PMID: 38164526 PMCID: PMC10756581 DOI: 10.3174/ajnr.a8064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 10/18/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND AND PURPOSE GM pathology plays an essential role in MS disability progression, emphasizing the importance of neuroradiologic biomarkers to capture the heterogeneity of cortical disease burden. This study aimed to assess the validity of a patch-wise, individual interpretation of cortical thickness data to identify GM pathology, the "mosaic approach," which was previously suggested as a biomarker for assessing and localizing atrophy. MATERIALS AND METHODS We investigated the mosaic approach in a cohort of 501 patients with MS with respect to 89 internal and 651 external controls. The resulting metric of the mosaic approach is the so-called thin patch fraction, which is an estimate of overall cortical disease burden per patient. We evaluated the mosaic approach with respect to the following: 1) discrimination between patients with MS and controls, 2) classification between different MS phenotypes, and 3) association with established biomarkers reflecting MS disease burden, using general linear modeling. RESULTS The thin patch fraction varied significantly between patients with MS and healthy controls and discriminated among MS phenotypes. Furthermore, the thin patch fraction was associated with disease burden, including the Expanded Disability Status Scale, cognitive and fatigue scores, and lesion volume. CONCLUSIONS This study demonstrates the validity of the mosaic approach as a neuroradiologic biomarker in MS. The output of the mosaic approach, namely the thin patch fraction, is a candidate biomarker for assessing and localizing cortical GM pathology. The mosaic approach can furthermore enhance the development of a personalized cortical MS biomarker, given that the thin patch fraction provides a feature on which artificial intelligence methods can be trained. Most important, we showed the validity of the mosaic approach when referencing data with respect to external control MR imaging repositories.
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Affiliation(s)
- Marlene Tahedl
- From the Department of Neuroradiology (M.T., J.S.K., C.Z., B.W.), School of Medicine, Technical University of Munich, Munich, Germany
| | - Tun Wiltgen
- Department of Neurology (T.W., C.C.V., A.B., B.H., M.M.), School of Medicine, Technical University of Munich, Munich, Germany
| | - Cui Ci Voon
- Department of Neurology (T.W., C.C.V., A.B., B.H., M.M.), School of Medicine, Technical University of Munich, Munich, Germany
| | - Achim Berthele
- Department of Neurology (T.W., C.C.V., A.B., B.H., M.M.), School of Medicine, Technical University of Munich, Munich, Germany
| | - Jan S Kirschke
- From the Department of Neuroradiology (M.T., J.S.K., C.Z., B.W.), School of Medicine, Technical University of Munich, Munich, Germany
| | - Bernhard Hemmer
- Department of Neurology (T.W., C.C.V., A.B., B.H., M.M.), School of Medicine, Technical University of Munich, Munich, Germany
- Munich Cluster for Systems Neurology (B.H.), Munich, Germany
| | - Mark Mühlau
- Department of Neurology (T.W., C.C.V., A.B., B.H., M.M.), School of Medicine, Technical University of Munich, Munich, Germany
| | - Claus Zimmer
- From the Department of Neuroradiology (M.T., J.S.K., C.Z., B.W.), School of Medicine, Technical University of Munich, Munich, Germany
| | - Benedikt Wiestler
- From the Department of Neuroradiology (M.T., J.S.K., C.Z., B.W.), School of Medicine, Technical University of Munich, Munich, Germany
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Kletenik I, Cohen AL, Glanz BI, Ferguson MA, Tauhid S, Li J, Drew W, Polgar-Turcsanyi M, Palotai M, Siddiqi SH, Marshall GA, Chitnis T, Guttmann CRG, Bakshi R, Fox MD. Multiple sclerosis lesions that impair memory map to a connected memory circuit. J Neurol 2023; 270:5211-5222. [PMID: 37532802 PMCID: PMC10592111 DOI: 10.1007/s00415-023-11907-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 07/24/2023] [Accepted: 07/26/2023] [Indexed: 08/04/2023]
Abstract
BACKGROUND Nearly 1 million Americans are living with multiple sclerosis (MS) and 30-50% will experience memory dysfunction. It remains unclear whether this memory dysfunction is due to overall white matter lesion burden or damage to specific neuroanatomical structures. Here we test if MS memory dysfunction is associated with white matter lesions to a specific brain circuit. METHODS We performed a cross-sectional analysis of standard structural images and verbal memory scores as assessed by immediate recall trials from 431 patients with MS (mean age 49.2 years, 71.9% female) enrolled at a large, academic referral center. White matter lesion locations from each patient were mapped using a validated algorithm. First, we tested for associations between memory dysfunction and total MS lesion volume. Second, we tested for associations between memory dysfunction and lesion intersection with an a priori memory circuit derived from stroke lesions. Third, we performed mediation analyses to determine which variable was most associated with memory dysfunction. Finally, we performed a data-driven analysis to derive de-novo brain circuits for MS memory dysfunction using both functional (n = 1000) and structural (n = 178) connectomes. RESULTS Both total lesion volume (r = 0.31, p < 0.001) and lesion damage to our a priori memory circuit (r = 0.34, p < 0.001) were associated with memory dysfunction. However, lesion damage to the memory circuit fully mediated the association of lesion volume with memory performance. Our data-driven analysis identified multiple connections associated with memory dysfunction, including peaks in the hippocampus (T = 6.05, family-wise error p = 0.000008), parahippocampus, fornix and cingulate. Finally, the overall topography of our data-driven MS memory circuit matched our a priori stroke-derived memory circuit. CONCLUSIONS Lesion locations associated with memory dysfunction in MS map onto a specific brain circuit centered on the hippocampus. Lesion damage to this circuit fully mediated associations between lesion volume and memory. A circuit-based approach to mapping MS symptoms based on lesions visible on standard structural imaging may prove useful for localization and prognosis of higher order deficits in MS.
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Affiliation(s)
- Isaiah Kletenik
- Division of Cognitive and Behavioral Neurology, Brigham and Women's Hospital, 60 Fenwood Road, 9016H, Boston, MA, 02115, USA.
- Department of Neurology, Brigham and Women's Hospital, Boston, USA.
- Center for Brain Circuit Therapeutics, Brigham and Women's Hospital, Boston, USA.
- Harvard Medical School, Boston, MA, USA.
| | - Alexander L Cohen
- Center for Brain Circuit Therapeutics, Brigham and Women's Hospital, Boston, USA
- Harvard Medical School, Boston, MA, USA
- Department of Neurology, Boston Children's Hospital, Boston, MA, USA
- Computational Radiology Laboratory, Department of Radiology, Boston Children's Hospital, Boston, MA, USA
| | - Bonnie I Glanz
- Brigham Multiple Sclerosis Center, Brigham and Women's Hospital, Harvard Medical School Boston, Boston, MA, USA
| | - Michael A Ferguson
- Department of Neurology, Brigham and Women's Hospital, Boston, USA
- Center for Brain Circuit Therapeutics, Brigham and Women's Hospital, Boston, USA
- Harvard Medical School, Boston, MA, USA
| | - Shahamat Tauhid
- Department of Neurology, Brigham and Women's Hospital, Boston, USA
| | - Jing Li
- Center for Brain Circuit Therapeutics, Brigham and Women's Hospital, Boston, USA
| | - William Drew
- Center for Brain Circuit Therapeutics, Brigham and Women's Hospital, Boston, USA
| | - Mariann Polgar-Turcsanyi
- Brigham Multiple Sclerosis Center, Brigham and Women's Hospital, Harvard Medical School Boston, Boston, MA, USA
| | - Miklos Palotai
- Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | - Shan H Siddiqi
- Center for Brain Circuit Therapeutics, Brigham and Women's Hospital, Boston, USA
- Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, USA
| | - Gad A Marshall
- Division of Cognitive and Behavioral Neurology, Brigham and Women's Hospital, 60 Fenwood Road, 9016H, Boston, MA, 02115, USA
- Department of Neurology, Brigham and Women's Hospital, Boston, USA
- Harvard Medical School, Boston, MA, USA
- Center for Alzheimer Research and Treatment, Brigham and Women's Hospital, Boston, MA, USA
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Tanuja Chitnis
- Department of Neurology, Brigham and Women's Hospital, Boston, USA
- Harvard Medical School, Boston, MA, USA
- Brigham Multiple Sclerosis Center, Brigham and Women's Hospital, Harvard Medical School Boston, Boston, MA, USA
| | - Charles R G Guttmann
- Harvard Medical School, Boston, MA, USA
- Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
- Center for Neurological Imaging, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Rohit Bakshi
- Department of Neurology, Brigham and Women's Hospital, Boston, USA
- Harvard Medical School, Boston, MA, USA
- Brigham Multiple Sclerosis Center, Brigham and Women's Hospital, Harvard Medical School Boston, Boston, MA, USA
- Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | - Michael D Fox
- Division of Cognitive and Behavioral Neurology, Brigham and Women's Hospital, 60 Fenwood Road, 9016H, Boston, MA, 02115, USA
- Department of Neurology, Brigham and Women's Hospital, Boston, USA
- Center for Brain Circuit Therapeutics, Brigham and Women's Hospital, Boston, USA
- Harvard Medical School, Boston, MA, USA
- Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
- Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, USA
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
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8
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Morrow SA, Baldwin C, Alkabie S. Importance of Identifying Cognitive Impairment in Multiple Sclerosis. Can J Neurol Sci 2023; 50:813-819. [PMID: 36503630 DOI: 10.1017/cjn.2022.334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
This article aims to highlight the impact of cognitive impairment on outcomes and quality of life for people with multiple sclerosis (MS) and to review current evidence for the efficacy of disease-modifying therapies (DMTs) and other interventions. In addition, we provide clinical practice insights regarding screening and management of cognitive impairment in people with MS. Evidence suggests that cognitive deterioration often accompanies magnetic resonance imaging changes. Neocortical volume and deep grey matter atrophy correlate with cognitive impairment. Similarly, cognitive decline is predictive of a higher lesion burden. Cognitive impairment is an important clinical measure of disability and negatively impacts quality of life. Phase 3 studies suggest that DMTs such as natalizumab, ozanimod and fingolimod may provide long-lasting, clinically meaningful effects on cognition in people with MS. Further data are needed to support the use of adjunct cognitive behavioural and exercise interventions for people with MS who have cognitive impairment. More data are needed to define appropriate management strategies for cognitive impairment in people with MS. Baseline and periodic screening for cognitive impairment and inclusion of cognitive impairment as a clinical trial endpoint will help to inform efforts to manage this important aspect of MS.
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Affiliation(s)
- Sarah A Morrow
- London Multiple Sclerosis Clinic, London Health Sciences Centre, University Hospital, Department of Clinical Neurological Sciences, Western University, London, ON, Canada
| | - Chantal Baldwin
- London Multiple Sclerosis Clinic, London Health Sciences Centre, University Hospital, Department of Clinical Neurological Sciences, Western University, London, ON, Canada
| | - Samir Alkabie
- London Multiple Sclerosis Clinic, London Health Sciences Centre, University Hospital, Department of Clinical Neurological Sciences, Western University, London, ON, Canada
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9
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Pansieri J, Hadley G, Lockhart A, Pisa M, DeLuca GC. Regional contribution of vascular dysfunction in white matter dementia: clinical and neuropathological insights. Front Neurol 2023; 14:1199491. [PMID: 37396778 PMCID: PMC10313211 DOI: 10.3389/fneur.2023.1199491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 05/25/2023] [Indexed: 07/04/2023] Open
Abstract
The maintenance of adequate blood supply and vascular integrity is fundamental to ensure cerebral function. A wide range of studies report vascular dysfunction in white matter dementias, a group of cerebral disorders characterized by substantial white matter damage in the brain leading to cognitive impairment. Despite recent advances in imaging, the contribution of vascular-specific regional alterations in white matter dementia has been not extensively reviewed. First, we present an overview of the main components of the vascular system involved in the maintenance of brain function, modulation of cerebral blood flow and integrity of the blood-brain barrier in the healthy brain and during aging. Second, we review the regional contribution of cerebral blood flow and blood-brain barrier disturbances in the pathogenesis of three distinct conditions: the archetypal white matter predominant neurocognitive dementia that is vascular dementia, a neuroinflammatory predominant disease (multiple sclerosis) and a neurodegenerative predominant disease (Alzheimer's). Finally, we then examine the shared landscape of vascular dysfunction in white matter dementia. By emphasizing the involvement of vascular dysfunction in the white matter, we put forward a hypothetical map of vascular dysfunction during disease-specific progression to guide future research aimed to improve diagnostics and facilitate the development of tailored therapies.
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Sadek MA, Kandil EA, El Sayed NS, Sayed HM, Rabie MA. Semaglutide, a novel glucagon-like peptide-1 agonist, amends experimental autoimmune encephalomyelitis-induced multiple sclerosis in mice: Involvement of the PI3K/Akt/GSK-3β pathway. Int Immunopharmacol 2023; 115:109647. [PMID: 36584570 DOI: 10.1016/j.intimp.2022.109647] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 12/17/2022] [Accepted: 12/24/2022] [Indexed: 12/29/2022]
Abstract
Multiple sclerosis (MS) is a disabling neurodegenerative disease that causes demyelination and axonal degeneration of the central nervous system. Current treatments are partially effective in managing MS relapses and have a negligible impact on treating MS cognitive deficits and cannot enhance neuronal remyelination, imposing a need for a new MS remedy. Semaglutide, a novel glucagon-like peptide-1 agonist, has recently displayed a neuroprotective effect on several neurodegenerative diseases, suggesting that it may have a protective effect in MS. Therefore, this study was conducted to investigate the influence of semaglutide on experimental autoimmune encephalomyelitis (EAE)-induced MS in mice. Here, EAE was induced in mice using spinal cord homogenate, which eventually altered the mice's cognitive and motor functions, similar to what is observed in MS. Interestingly, intraperitoneally administered semaglutide (25 nmol/kg/day) amended EAE-induced cognitive and motor deficits observed in novel object recognition, open field, rotarod, and grip strength tests. Moreover, histological examination revealed that semaglutide treatment attenuated hippocampal damage and corpus callosum demyelination caused by EAE. Additionally, biochemical testing revealed that semaglutide activates the PI3K/Akt axis, which eventually hampers GSK-3β activity. GSK-3β activity inhibition attenuates demyelination and triggers remyelination through CREB/BDNF; furthermore, it boosts Nrf2 and SOD levels, protecting the mice from EAE-induced oxidative stress. Additionally, GSK-3β inhibition minimizes neuroinflammation, as reflected by decreased NF-kβ and TNF-α levels. In conclusion, semaglutide has a neuroprotective effect in EAE-induced MS in mice, which is mediated by activating the ramified PI3K/Akt/GSK-3β pathway.
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Affiliation(s)
- Mohamed A Sadek
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Cairo University, Cairo, Egypt
| | - Esraa A Kandil
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Cairo University, Cairo, Egypt
| | - Nesrine S El Sayed
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Cairo University, Cairo, Egypt
| | - Helmy M Sayed
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Cairo University, Cairo, Egypt
| | - Mostafa A Rabie
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Cairo University, Cairo, Egypt.
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11
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Ziccardi S, Pisani AI, Schiavi GM, Guandalini M, Crescenzo F, Colombi A, Peloso A, Tamanti A, Bertolazzo M, Marastoni D, Calabrese M. Cortical lesions at diagnosis predict long-term cognitive impairment in multiple sclerosis: A 20-year study. Eur J Neurol 2023; 30:1378-1388. [PMID: 36692863 DOI: 10.1111/ene.15697] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 12/05/2022] [Accepted: 01/18/2023] [Indexed: 01/25/2023]
Abstract
BACKGROUND AND PURPOSE Although cognitive impairment (CI) is frequent in multiple sclerosis (MS) patients, few studies (and with conflicting results) have evaluated early predictors of CI in the long term. We aimed at determining associations between early clinical/neuroradiological variables with reference to CI after 20 years of MS. METHODS We investigated in 170 MS patients the relationship between clinical/magnetic resonance imaging (MRI) data at diagnosis and cognitive status almost 20 years after MS onset. Among others, number and volume of both white matter lesions (WMLs) and cortical lesions (CLs) were evaluated at diagnosis and after 2 years. All MS patients were followed over time and underwent a comprehensive neuropsychological assessment at the end of study. Advanced statistical methods (unsupervised cluster analysis and random forest model) were conducted. RESULTS CI patients showed higher focal cortical pathology at diagnosis compared to cognitively normal subjects (p < 0.001). Volumes of both WMLs and CLs emerged as the MRI metrics most associated with long-term CI. Moreover, number of CLs (especially ≥3) was also strongly associated with long-term CI (≥3 CLs: odds ratio [OR] = 3.7, 95% confidence interval = 1.8-7.5, p < 0.001), more than number of WMLs; the optimal cutoff of three CLs (area under the curve = 0.67, specificity = 75%, sensitivity = 55%) was estimated according to the risk of developing CI. CONCLUSIONS These results highlight the impact of considering both white and gray matter focal damage from early MS stages. Given the low predictive value of WML number and the poor clinical applicability of lesion volume estimation in the daily clinical context, the evaluation of number of CLs could represent a reliable prognostic marker of CI.
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Affiliation(s)
- Stefano Ziccardi
- Neurology Section, Department of Neuroscience, Biomedicine, and Movement Sciences, University of Verona, Verona, Italy
| | - Anna Isabella Pisani
- Neurology Section, Department of Neuroscience, Biomedicine, and Movement Sciences, University of Verona, Verona, Italy
| | - Gian Marco Schiavi
- Neurology Section, Department of Neuroscience, Biomedicine, and Movement Sciences, University of Verona, Verona, Italy
| | - Maddalena Guandalini
- Neurology Section, Department of Neuroscience, Biomedicine, and Movement Sciences, University of Verona, Verona, Italy
| | | | - Annalisa Colombi
- Neurology Section, Department of Neuroscience, Biomedicine, and Movement Sciences, University of Verona, Verona, Italy
| | - Angela Peloso
- Neurology Section, Department of Neuroscience, Biomedicine, and Movement Sciences, University of Verona, Verona, Italy
| | - Agnese Tamanti
- Neurology Section, Department of Neuroscience, Biomedicine, and Movement Sciences, University of Verona, Verona, Italy
| | - Maddalena Bertolazzo
- Neurology Section, Department of Neuroscience, Biomedicine, and Movement Sciences, University of Verona, Verona, Italy
| | - Damiano Marastoni
- Neurology Section, Department of Neuroscience, Biomedicine, and Movement Sciences, University of Verona, Verona, Italy
| | - Massimiliano Calabrese
- Neurology Section, Department of Neuroscience, Biomedicine, and Movement Sciences, University of Verona, Verona, Italy
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12
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Skorve E, Lundervold AJ, Torkildsen Ø, Riemer F, Grüner R, Myhr KM. Brief international cognitive assessment for MS (BICAMS) and global brain volumes in early stages of MS - A longitudinal correlation study. Mult Scler Relat Disord 2023; 69:104398. [PMID: 36462469 DOI: 10.1016/j.msard.2022.104398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 08/04/2022] [Accepted: 11/03/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Cognitive impairment is common in patients with multiple sclerosis, even in the early stages of the disease. The Brief International Cognitive Assessment for multiple sclerosis (BICAMS) is a short screening tool developed to assess cognitive function in everyday clinical practice. OBJECTIVE To investigate associations between volumetric brain measures derived from a magnetic resonance imaging (MRI) examination and performance on BICAMS subtests in early stages of multiple sclerosis (MS). METHODS BICAMS was used to assess cognitive function in 49 MS patients at baseline and after one and two years. The patients were separated into two groups (with or without cognitive impairment) based on their performances on BICAMSs subtests. MRI data were analysed by a software tool (MSMetrix), yielding normalized measures of global brain volumes and lesion volumes. Associations between cognitive tests and brain MRI measures were analysed by running correlation analyses, and differences between subgroups and changes over time with independent and paired samples tests, respectively. RESULTS The strongest baseline correlations were found between the BICAMS subtests and normalized whole brain volume (NBV) and grey matter volume (NGV); processing speed r = 0.54/r = 0.48, verbal memory r = 0.49/ r = 0.42, visual memory r = 0.48 /r = 0.39. Only the verbal memory test had significant correlations with T2 and T1 lesion volumes (LV) at both time points; T2LV r = 0.39, T1LV r = 0.38. There were significant loss of grey matter and white matter volume overall (NGV p<0.001, NWV p = 0.003), as well as an increase in T1LV (p = 0.013). The longitudinally defined confirmed cognitively impaired (CCI) and preserved (CCP) patients showed significant group differences on all MRI volume measures at both time points, except for NWV. Only the CCI subgroup showed significant white matter atrophy (p = 0.006) and increase in T2LV (p = 0.029). CONCLUSIONS The present study found strong correlations between whole brain and grey matter volumes and performance on the BICAMS subtests as well as significant changes in global volumes from baseline to follow-up with clear differences between patients defined as cognitively impaired and preserved at both baseline and follow-up.
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Affiliation(s)
- Ellen Skorve
- Neuro-SysMed, Department of Neurology, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway.
| | - Astri J Lundervold
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
| | - Øivind Torkildsen
- Neuro-SysMed, Department of Neurology, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Frank Riemer
- Neuro-SysMed, Department of Neurology, Haukeland University Hospital, Bergen, Norway; Mohn Medical Imaging and Visualization Centre (MMIV), Department of Radiology, Haukeland University Hospital, Bergen, Norway
| | - Renate Grüner
- Mohn Medical Imaging and Visualization Centre (MMIV), Department of Radiology, Haukeland University Hospital, Bergen, Norway; Department of Physics and Technology, University of Bergen, N-5007 Bergen, Norway
| | - Kjell-Morten Myhr
- Neuro-SysMed, Department of Neurology, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway
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13
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Petracca M, Palladino R, Droby A, Kurz D, Graziano N, Wang K, Riley C, Howard J, Klineova S, Lublin F, Inglese M. Disability outcomes in early-stage African American and White people with multiple sclerosis. Mult Scler Relat Disord 2023; 69:104413. [PMID: 36399964 PMCID: PMC9892256 DOI: 10.1016/j.msard.2022.104413] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 09/28/2022] [Accepted: 11/11/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND Factors driving differences in disease burden between African American and White people with multiple sclerosis (pwMS) remain unclear. Here, we explored whether differences in disability outcomes could be observed after controlling for major sociodemographic factors and comorbidities, and assessed the presence of a possible interaction between MS and race. METHODS In this cross-sectional study, 120 pwMS within 6 years from disease onset and 82 healthy controls between 18 and 70 years of age, self-identified as either African American or White, were prospectively enrolled. Inclusion criteria for pwMS were: diagnosis of MS according to the revised McDonald criteria, relapsing-remitting phenotype and Expanded Disability Status Scale (EDSS) < 6.5. Study outcomes included: (i) global disability (EDSS); (ii) quantitative mobility and leg function (Timed 25 Foot Walk Test-T25FWT); (iii) quantitative finger dexterity (9-Hole Peg Test-9HPT); (iv) cognitive efficiency and speed performance (Symbol Digit Modalities Test-SDMT). Differences in disability outcomes were assessed employing multivariable linear regression models. Based on their association with MS or disability, covariates included age, gender, race, years of education, total income, body mass index, comorbidities. The interaction between MS and race on disability outcomes was estimated via relative excess risk of interaction and attributable proportion. RESULTS Accounting for age, gender, total income, education, body mass index and comorbidities, African American pwMS showed significantly worse performances in manual dexterity and cognition than White pwMS (White pwMS coeff. 3.24, 95% CI 1.55, 4.92 vs African American pwMS coeff. 5.52, 95% CI 3.55, 7.48 and White pwMS coeff. -5.87, 95% CI -8.86, -2.87 vs African American pwMS coeff. -7.99, 95% CI -11.58,-4.38). MS and race independently contributed to the observed gradient in disability severity. CONCLUSIONS Complex social disparities and systemic racism might contribute to clinical heterogeneity in MS.
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Affiliation(s)
- Maria Petracca
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Human Neurosciences, Sapienza University, Rome, Italy
| | - Raffaele Palladino
- Department of Public Health, University of Naples "Federico II", Naples, Italy
| | - Amgad Droby
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Daniel Kurz
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Nicole Graziano
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Katherine Wang
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Claire Riley
- Department of Neurology, Columbia University Medical Center, New York, NY, USA
| | - Jonathan Howard
- Department of Neurology, New York University School of Medicine, New York, NY, USA
| | - Sylvia Klineova
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Fred Lublin
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Matilde Inglese
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA; DINOGMI, University of Genoa, Genoa, Italy; Ospedale Policlinico San Martino-IRCSS, Genoa, Italy.
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14
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Ganzetti M, Graves JS, Holm SP, Dondelinger F, Midaglia L, Gaetano L, Craveiro L, Lipsmeier F, Bernasconi C, Montalban X, Hauser SL, Lindemann M. Neural correlates of digital measures shown by structural MRI: a post-hoc analysis of a smartphone-based remote assessment feasibility study in multiple sclerosis. J Neurol 2023; 270:1624-1636. [PMID: 36469103 PMCID: PMC9970954 DOI: 10.1007/s00415-022-11494-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 11/15/2022] [Accepted: 11/17/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND A study was undertaken to evaluate remote monitoring via smartphone sensor-based tests in people with multiple sclerosis (PwMS). This analysis aimed to explore regional neural correlates of digital measures derived from these tests. METHODS In a 24-week, non-randomized, interventional, feasibility study (NCT02952911), sensor-based tests on the Floodlight Proof-of-Concept app were used to assess cognition (smartphone-based electronic Symbol Digit Modalities Test), upper extremity function (Draw a Shape Test, Pinching Test), and gait and balance (Static Balance Test, Two-Minute Walk Test, U-Turn Test). In this post-hoc analysis, digital measures and standard clinical measures (e.g., Nine-Hole Peg Test [9HPT]) were correlated against regional structural magnetic resonance imaging outcomes. Seventy-six PwMS aged 18-55 years with an Expanded Disability Status Scale score of 0.0-5.5 were enrolled from two different sites (USA and Spain). Sixty-two PwMS were included in this analysis. RESULTS Worse performance on digital and clinical measures was associated with smaller regional brain volumes and larger ventricular volumes. Whereas digital and clinical measures had many neural correlates in common (e.g., putamen, globus pallidus, caudate nucleus, lateral occipital cortex), some were observed only for digital measures. For example, Draw a Shape Test and Pinching Test measures, but not 9HPT score, correlated with volume of the hippocampus (r = 0.37 [drawing accuracy over time on the Draw a Shape Test]/ - 0.45 [touching asynchrony on the Pinching Test]), thalamus (r = 0.38/ - 0.41), and pons (r = 0.35/ - 0.35). CONCLUSIONS Multiple neural correlates were identified for the digital measures in a cohort of people with early MS. Digital measures showed associations with brain regions that clinical measures were unable to demonstrate, thus providing potential novel information on functional ability compared with standard clinical assessments.
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Affiliation(s)
- Marco Ganzetti
- grid.417570.00000 0004 0374 1269F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | - Jennifer S. Graves
- grid.266100.30000 0001 2107 4242Department of Neurosciences, University of California San Diego, San Diego, CA USA
| | - Sven P. Holm
- grid.417570.00000 0004 0374 1269F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | - Frank Dondelinger
- grid.417570.00000 0004 0374 1269F. Hoffmann-La Roche Ltd, Basel, Switzerland ,grid.419481.10000 0001 1515 9979Present Address: Novartis Institutes for Biomedical Research, Basel, Switzerland
| | - Luciana Midaglia
- grid.411083.f0000 0001 0675 8654Department of Neurology-Neuroimmunology, Centre d’Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d’Hebron, Barcelona, Spain ,grid.7080.f0000 0001 2296 0625Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | - Laura Gaetano
- grid.417570.00000 0004 0374 1269F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | - Licinio Craveiro
- grid.417570.00000 0004 0374 1269F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | | | - Corrado Bernasconi
- grid.417570.00000 0004 0374 1269F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | - Xavier Montalban
- grid.411083.f0000 0001 0675 8654Department of Neurology-Neuroimmunology, Centre d’Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d’Hebron, Barcelona, Spain ,grid.7080.f0000 0001 2296 0625Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | - Stephen L. Hauser
- grid.266102.10000 0001 2297 6811Department of Neurology, University of California San Francisco, San Francisco, CA USA
| | - Michael Lindemann
- grid.417570.00000 0004 0374 1269F. Hoffmann-La Roche Ltd, Basel, Switzerland
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15
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Buyukturkoglu K, Dworkin JD, Leiva V, Provenzano FA, Guevara P, De Jager PL, Leavitt VM, Riley CS. Brain volumetric correlates of remotely versus in-person administered symbol digit modalities test in multiple sclerosis. Mult Scler Relat Disord 2022; 68:104247. [PMID: 36274283 DOI: 10.1016/j.msard.2022.104247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 09/25/2022] [Accepted: 10/15/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Prior studies in multiple sclerosis (MS) support reliability of telehealth-delivered cognitive batteries, although, to date, none have reported relationships of cognitive test performance to neural correlates across administration modalities. In this study we aimed to compare brain-behavior relationships, using the Symbol Digit Modalities Test (SDMT), the most reliable and sensitive cognitive measure in MS, measured from patients seen via telehealth versus in-person. METHODS SDMT was administered to individuals with MS either in-person (N=60, mean age=39.7) or remotely via video conference (N=51, mean age=47.4). Magnetic resonance imaging (MRI) data was collected in 3-Tesla scanners. Using 3-dimensional T1 images cerebral, cortical, deep gray, cerebral white matter and thalamic nuclei volumes were calculated. Using a meta-analysis approach with an interaction term for participant group, individual regression models were run for each MRI measure having SDMT scores as the outcome variable in each model. In addition, the correlation and average difference between In-person and Remote group associations across the MRI measures were calculated. Finally, for each MRI variable I2 score was quantified to test the heterogeneity between the groups. RESULTS Administration modality did not affect the association of SDMT performance with MRI measures. Brain tissue volumes showing high associations with the SDMT scores in one group also showed high associations in the other (r = 0.83; 95% CI = [0.07, 0.86]). The average difference between the In-person and the Remote group associations was not significant (βRemote - βIn-person = 0.14, 95% CI = [-0.04, 0.34]). Across MRI measures, the average I2 value was 14%, reflecting very little heterogeneity in the relationship of SDMT performance to brain volume. CONCLUSION We found consistent relationships to neural correlates across in-person and remote SDMT administration modalities. Hence, our study extended the findings of the previous studies demonstrating the feasibility of remote administration of the SDMT.
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Affiliation(s)
- Korhan Buyukturkoglu
- Department of Neurology, Columbia University Irving Medical Center, 630 W. 168th Street, PH 18-324, New York, NY 10032, USA; The Center for Translational and Computational Neuroimmunology, NY, USA; Columbia University MS Center, NY, USA.
| | - Jordan D Dworkin
- Department of Psychiatry, Columbia University and the New York State Psychiatric Institute, NY, USA
| | - Victor Leiva
- Department of Biomedical Engineering, Universidad de Concepción, Santiago, Chile
| | - Frank A Provenzano
- Department of Neurology, Columbia University Irving Medical Center, 630 W. 168th Street, PH 18-324, New York, NY 10032, USA
| | - Pamela Guevara
- Department of Biomedical Engineering, Universidad de Concepción, Santiago, Chile
| | - Philip L De Jager
- Department of Neurology, Columbia University Irving Medical Center, 630 W. 168th Street, PH 18-324, New York, NY 10032, USA; The Center for Translational and Computational Neuroimmunology, NY, USA; Columbia University MS Center, NY, USA
| | - Victoria M Leavitt
- Department of Neurology, Columbia University Irving Medical Center, 630 W. 168th Street, PH 18-324, New York, NY 10032, USA
| | - Claire S Riley
- Department of Neurology, Columbia University Irving Medical Center, 630 W. 168th Street, PH 18-324, New York, NY 10032, USA; The Center for Translational and Computational Neuroimmunology, NY, USA; Columbia University MS Center, NY, USA
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16
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Zhang JJ, Yang YL, Hu J, Zhao CF, He XH, Yang QY, Qi XS, Lu H, He C, Liu H. Development and validation of a novel model based on hand knob score and white matter injury on MRI to predict hand function in children with cerebral palsy. ANNALS OF TRANSLATIONAL MEDICINE 2022; 10:1102. [PMID: 36388818 PMCID: PMC9652546 DOI: 10.21037/atm-22-4112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 09/30/2022] [Indexed: 08/30/2023]
Abstract
BACKGROUND Childhood hand function is considered to be one of the strongest predictors of the ability to participate in daily activities as children with cerebral palsy (CP) reach adulthood. The manual ability classification system (MACS) is currently the most widely used for grading hand function in children with CP. However, the MACS method is subjective and may be affected by the raters' experience. Hand knob is an important control center for hand movement. Therefor this study aimed to develop and validate an objective model for hand function estimation in children with CP and visualize it as a nomogram. METHODS A total of 70 Children (2-12 years old) with CP underwent magnetic resonance imaging (MRI) scanning, MACS assessment. According to MACS, children with CP were divided into mild impairment group (grade I-III) and severe impairment group (grade IV-V). Hand function prediction models based on (I) hand knob score, (II) clinical features, and (III) the combination of clinical features and hand knob score were developed and validated separately. The models were subjected to stepwise regression according to the maximum likelihood method, and the Akaike information criterion was used to select the best model. Model discrimination was assessed using receiver operating characteristic (ROC) and calibration curves. The nomogram was finally built according to the best model. RESULTS The area under the curve (AUC) of the hand knob score model in the training set was 0.752, the clinical features model was 0.819, and the hand knob score and clinical features combined model was 0.880. The AUC of the hand knob score model in the validation set was 0.765, the clinical features model was 0.782, and the combined model was 0.894. The best model was the hand knob score-clinical features combined model, and the nomogram finally incorporated two assessment items: the hand knob score and white matter injury. The estimated probability of hand function injury degree of the combined model displayed good agreement with the actual occurrence probability. CONCLUSIONS The hand knob score-clinical features combined model can be used to preliminarily assess the degree of hand impairment in children with CP, with good calibration.
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Affiliation(s)
- Jing-Jing Zhang
- Department of Radiology, The Affiliated Hospital of Zunyi Medical University, Zunyi, China
- Department of Radiology, Mianyang Hospital of T.C.M, Mianyang, China
| | - Yan-Li Yang
- Department of Radiology, The Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Jie Hu
- Department of Radiology, The Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Chun-Feng Zhao
- Department of Radiology, The Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Xing-Hong He
- Department of Radiology, The Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Qian-Yu Yang
- Department of Radiology, The Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Xiao-Shan Qi
- Department of Radiology, The Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Hong Lu
- Department of Radiology, The Seventh People’s Hospital of Chongqing, The Central Hospital Affiliated to Chongqing University of Technology, Chongqing, China
| | - Cheng He
- Medical Imaging Department, Chongqing University Central Hospital, Chongqing, China
| | - Heng Liu
- Department of Radiology, The Affiliated Hospital of Zunyi Medical University, Zunyi, China
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17
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van Schaik PEM, Zuhorn IS, Baron W. Targeting Fibronectin to Overcome Remyelination Failure in Multiple Sclerosis: The Need for Brain- and Lesion-Targeted Drug Delivery. Int J Mol Sci 2022; 23:ijms23158418. [PMID: 35955549 PMCID: PMC9368816 DOI: 10.3390/ijms23158418] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 07/22/2022] [Accepted: 07/23/2022] [Indexed: 11/16/2022] Open
Abstract
Multiple sclerosis (MS) is a neuroinflammatory and neurodegenerative disease with unknown etiology that can be characterized by the presence of demyelinated lesions. Prevailing treatment protocols in MS rely on the modulation of the inflammatory process but do not impact disease progression. Remyelination is an essential factor for both axonal survival and functional neurological recovery but is often insufficient. The extracellular matrix protein fibronectin contributes to the inhibitory environment created in MS lesions and likely plays a causative role in remyelination failure. The presence of the blood–brain barrier (BBB) hinders the delivery of remyelination therapeutics to lesions. Therefore, therapeutic interventions to normalize the pathogenic MS lesion environment need to be able to cross the BBB. In this review, we outline the multifaceted roles of fibronectin in MS pathogenesis and discuss promising therapeutic targets and agents to overcome fibronectin-mediated inhibition of remyelination. In addition, to pave the way for clinical use, we reflect on opportunities to deliver MS therapeutics to lesions through the utilization of nanomedicine and discuss strategies to deliver fibronectin-directed therapeutics across the BBB. The use of well-designed nanocarriers with appropriate surface functionalization to cross the BBB and target the lesion sites is recommended.
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Affiliation(s)
- Pauline E. M. van Schaik
- Section Molecular Neurobiology, Department of Biomedical Sciences of Cells & Systems, University of Groningen, University Medical Center Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands;
| | - Inge S. Zuhorn
- Department of Biomedical Engineering, University of Groningen, University Medical Center Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands
- Correspondence: (I.S.Z.); (W.B.); Tel.: +31-50-3616178 (I.S.Z.); +31-503611652 (W.B.); Fax: +31-503616190 (W.B.)
| | - Wia Baron
- Section Molecular Neurobiology, Department of Biomedical Sciences of Cells & Systems, University of Groningen, University Medical Center Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands;
- Correspondence: (I.S.Z.); (W.B.); Tel.: +31-50-3616178 (I.S.Z.); +31-503611652 (W.B.); Fax: +31-503616190 (W.B.)
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18
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Silva R, Coelho P, Seabra M, Laranjinha I, Vieira D, Costa O, Jesus J, Fonseca AC, Costa S, Ferreira I, Lemos J, Sousa C, Vale J, Sá MJ, Ruano L. Cognitive impairment and markers of optical neurodegeneration in early multiple sclerosis. Neurol Sci 2022; 43:4381-4386. [DOI: 10.1007/s10072-022-05945-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 02/09/2022] [Indexed: 10/19/2022]
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19
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Wu H, Sun C, Huang X, Wei R, Li Z, Ke D, Bai R, Liang H. Short-Range Structural Connections Are More Severely Damaged in Early-Stage MS. AJNR Am J Neuroradiol 2022; 43:361-367. [PMID: 35177546 PMCID: PMC8910797 DOI: 10.3174/ajnr.a7425] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 12/11/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Long-range connections are more severely damaged and relevant for cognition in long-standing MS. However, the evolution of such coordinated network damage in patients with MS is unclear. We investigated whether short- and long-range structural connections sustained equal damage in early-stage MS. MATERIALS AND METHODS Sixteen patients with early-stage MS and 17 healthy controls were scanned by high-resolution, multishell diffusion imaging on 7T MR imaging and assessed cognitively. We investigated macrostructural properties in short- and long-range fibers and of microstructural metrics derived from 2 quantitative diffusion MR imaging models: DTI and neurite orientation dispersion and density imaging. RESULTS Patients had significant WM integrity damage-that is, higher radial diffusivity and a lower intracellular volume fraction in the focal WM lesions. Compared with the healthy controls, the patients had noticeable microstructure changes in both short- and long-range fibers, including increased radial diffusivity, mean diffusivity, and axial diffusivity. Z scores further indicated greater damage in the short-range fibers than in the long-range fibers. CONCLUSIONS Our findings demonstrate that more severe demyelination preceding axonal degeneration occurs in short-range connections but not in long-range connections in early-stage MS, suggesting the possibility that there are cortical lesions that are undetectable by current MR imaging.
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Affiliation(s)
- H. Wu
- Frpm the Department of Neurology (H.W., X.H., R.W., D.K., H.L.), First Affiliated Hospital
| | - C. Sun
- Key Laboratory of Biomedical Engineering of Ministry of Education (C.S., Z.L.), College of Biomedical Engineering and Instrument Science
| | - X. Huang
- Frpm the Department of Neurology (H.W., X.H., R.W., D.K., H.L.), First Affiliated Hospital
| | - R. Wei
- Frpm the Department of Neurology (H.W., X.H., R.W., D.K., H.L.), First Affiliated Hospital
| | - Z. Li
- Key Laboratory of Biomedical Engineering of Ministry of Education (C.S., Z.L.), College of Biomedical Engineering and Instrument Science
| | - D. Ke
- Frpm the Department of Neurology (H.W., X.H., R.W., D.K., H.L.), First Affiliated Hospital
| | - R. Bai
- Department of Physical Medicine and Rehabilitation of the Affiliated Sir Run Run Shaw Hospital and Interdisciplinary Institute of Neuroscience and Technology (R.B.), School of Medicine, Zhejiang University, Hangzhou, China
| | - H. Liang
- Frpm the Department of Neurology (H.W., X.H., R.W., D.K., H.L.), First Affiliated Hospital
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20
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Giovannoni G, Popescu V, Wuerfel J, Hellwig K, Iacobaeus E, Jensen MB, García-Domínguez JM, Sousa L, De Rossi N, Hupperts R, Fenu G, Bodini B, Kuusisto HM, Stankoff B, Lycke J, Airas L, Granziera C, Scalfari A. Smouldering multiple sclerosis: the ‘real MS’. Ther Adv Neurol Disord 2022; 15:17562864211066751. [PMID: 35096143 PMCID: PMC8793117 DOI: 10.1177/17562864211066751] [Citation(s) in RCA: 72] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 11/28/2021] [Indexed: 12/25/2022] Open
Abstract
Using a philosophical approach or deductive reasoning, we challenge the dominant
clinico-radiological worldview that defines multiple sclerosis (MS) as a focal
inflammatory disease of the central nervous system (CNS). We provide a range of
evidence to argue that the ‘real MS’ is in fact driven primarily by a
smouldering pathological disease process. In natural history studies and
clinical trials, relapses and focal activity revealed by magnetic resonance
imaging (MRI) in MS patients on placebo or on disease-modifying therapies (DMTs)
were found to be poor predictors of long-term disease evolution and were
dissociated from disability outcomes. In addition, the progressive accumulation
of disability in MS can occur independently of relapse activity from early in
the disease course. This scenario is underpinned by a more diffuse smouldering
pathological process that may affect the entire CNS. Many putative pathological
drivers of smouldering MS can be potentially modified by specific therapeutic
strategies, an approach that may have major implications for the management of
MS patients. We hypothesise that therapeutically targeting a state of ‘no
evident inflammatory disease activity’ (NEIDA) cannot sufficiently prevent
disability accumulation in MS, meaning that treatment should also focus on other
brain and spinal cord pathological processes contributing to the slow loss of
neurological function. This should also be complemented with a holistic approach
to the management of other systemic disease processes that have been shown to
worsen MS outcomes.
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Affiliation(s)
| | - Veronica Popescu
- Universitair MS Centrum, Hasselt, Belgium;
Noorderhart Hospital, Pelt, Belgium; Hasselt University, Hasselt,
Belgium
| | - Jens Wuerfel
- MIAC AG, Department of Biomedical Engineering,
University of Basel, Basel, Switzerland; Charité – University Medicine
Berlin, Berlin, Germany
| | - Kerstin Hellwig
- Katholisches Klinikum Bochum, Klinikum der
Ruhr-Universität, Bochum, Germany
| | | | | | | | - Livia Sousa
- Centro Hospitalar e Universitário de Coimbra,
Faculdade de Medicina, Universidade de Coimbra, Coimbra, Portugal
| | | | - Raymond Hupperts
- Zuyderland Medisch Centrum, Sittard-Geleen,
The Netherlands; Maastricht University Medical Center, Maastricht, The
Netherlands
| | - Giuseppe Fenu
- Department of Neurology, Brotzu Hospital,
Cagliari, Italy
| | - Benedetta Bodini
- Paris Brain Institute, Sorbonne University,
Paris, France; Department of Neurology, APHP, Saint-Antoine Hospital, Paris,
France
| | - Hanna-Maija Kuusisto
- Department of Neurology, Tampere University
Hospital, Tampere, Finland; Department of Customer and Patient Safety,
University of Eastern Finland, Kuopio, Finland
| | - Bruno Stankoff
- Paris Brain Institute, Sorbonne University,
ICM, CNRS, Inserm, Paris, France; APHP, Saint-Antoine Hospital, Paris,
France
| | - Jan Lycke
- Institute of Neuroscience and Physiology,
University of Gothenburg, Gothenburg, Sweden
| | | | - Cristina Granziera
- Neurologic Clinic and Policlinic, Departments
of Medicine, Clinical Research and Biomedical Engineering, University
Hospital Basel and University of Basel, Basel, Switzerland
- Translational Imaging in Neurology (ThINk)
Basel, Department of Biomedical Engineering, University Hospital Basel and
University of Basel, Basel, Switzerland
- Research Center for Clinical Neuroimmunology
and Neuroscience Basel (RC2NB), University Hospital Basel and University of
Basel, Basel, Switzerland
| | - Antonio Scalfari
- Centre for Neuroscience, Department of
Medicine, Charing Cross Hospital, Imperial College London, London, UK
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21
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Dal-Bianco A, Schranzer R, Grabner G, Lanzinger M, Kolbrink S, Pusswald G, Altmann P, Ponleitner M, Weber M, Kornek B, Zebenholzer K, Schmied C, Berger T, Lassmann H, Trattnig S, Hametner S, Leutmezer F, Rommer P. Iron Rims in Patients With Multiple Sclerosis as Neurodegenerative Marker? A 7-Tesla Magnetic Resonance Study. Front Neurol 2022; 12:632749. [PMID: 34992573 PMCID: PMC8724313 DOI: 10.3389/fneur.2021.632749] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 11/12/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Multiple sclerosis (MS) is a demyelinating and neurodegenerative disease of the central nervous system, characterized by inflammatory-driven demyelination. Symptoms in MS manifest as both physical and neuropsychological deficits. With time, inflammation is accompanied by neurodegeneration, indicated by brain volume loss on an MRI. Here, we combined clinical, imaging, and serum biomarkers in patients with iron rim lesions (IRLs), which lead to severe tissue destruction and thus contribute to the accumulation of clinical disability. Objectives: Subcortical atrophy and ventricular enlargement using an automatic segmentation pipeline for 7 Tesla (T) MRI, serum neurofilament light chain (sNfL) levels, and neuropsychological performance in patients with MS with IRLs and non-IRLs were assessed. Methods: In total 29 patients with MS [15 women, 24 relapsing-remitting multiple sclerosis (RRMS), and five secondary-progressive multiple sclerosis (SPMS)] aged 38 (22–69) years with an Expanded Disability Status Score of 2 (0–8) and a disease duration of 11 (5–40) years underwent neurological and neuropsychological examinations. Volumes of lesions, subcortical structures, and lateral ventricles on 7-T MRI (SWI, FLAIR, and MP2RAGE, 3D Segmentation Software) and sNfL concentrations using the Simoa SR-X Analyzer in IRL and non-IRL patients were assessed. Results: (1) Iron rim lesions patients had a higher FLAIR lesion count (p = 0.047). Patients with higher MP2Rage lesion volume exhibited more IRLs (p <0.014) and showed poorer performance in the information processing speed tested within 1 year using the Symbol Digit Modalities Test (SDMT) (p <0.047). (2) Within 3 years, patients showed atrophy of the thalamus (p = 0.021) and putamen (p = 0.043) and enlargement of the lateral ventricles (p = 0.012). At baseline and after 3 years, thalamic volumes were lower in IRLs than in non-IRL patients (p = 0.045). (3) At baseline, IRL patients had higher sNfL concentrations (p = 0.028). Higher sNfL concentrations were associated with poorer SDMT (p = 0.004), regardless of IRL presence. (4) IRL and non-IRL patients showed no significant difference in the neuropsychological performance within 1 year. Conclusions: Compared with non-IRL patients, IRL patients had higher FLAIR lesion counts, smaller thalamic volumes, and higher sNfL concentrations. Our pilot study combines IRL and sNfL, two biomarkers considered indicative for neurodegenerative processes. Our preliminary data underscore the reported destructive nature of IRLs.
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Affiliation(s)
| | - R Schranzer
- Department of Neurology, Vienna, Austria.,Department of Medical Engineering, Carinthia University of Applied Sciences, Klagenfurt, Austria
| | - G Grabner
- Department of Neurology, Vienna, Austria.,Department of Medical Engineering, Carinthia University of Applied Sciences, Klagenfurt, Austria
| | | | - S Kolbrink
- Department of Neurology, Vienna, Austria
| | - G Pusswald
- Department of Neurology, Vienna, Austria
| | - P Altmann
- Department of Neurology, Vienna, Austria
| | | | - M Weber
- Department of Biomedical Imaging and Image-Guided Therapy, High Field Magnetic Resonance Centre, Vienna, Austria
| | - B Kornek
- Department of Neurology, Vienna, Austria
| | | | - C Schmied
- Department of Neurology, Vienna, Austria
| | - T Berger
- Department of Neurology, Vienna, Austria
| | - H Lassmann
- Department of Neuroimmunology, Center for Brain Research, Vienna, Austria
| | - S Trattnig
- Department of Biomedical Imaging and Image-Guided Therapy, High Field Magnetic Resonance Centre, Vienna, Austria
| | - S Hametner
- Department of Neurology, Vienna, Austria.,Institute of Neurology, Medical University of Vienna, Vienna, Austria
| | | | - P Rommer
- Department of Neurology, Vienna, Austria
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22
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Microstructural White Matter Alterations in Cognitively Impaired Patients at Early Stages of Multiple Sclerosis. Clin Neuroradiol 2021; 31:993-1003. [PMID: 33787958 PMCID: PMC8648694 DOI: 10.1007/s00062-021-01010-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 02/26/2021] [Indexed: 10/28/2022]
Abstract
PURPOSE As conventional quantitative magnetic resonance imaging (MRI) parameters are weakly associated with cognitive impairment (CI) in early multiple sclerosis (MS), we explored microstructural white matter alterations in early MS or clinically isolated syndrome (CIS) comparing patients with or without CI. METHODS Based on a preceding tract-based spatial statistics analysis (3 Tesla MRI) which contrasted 106 patients with early MS or CIS and 49 healthy controls, diffusion metrics (fractional anisotropy, FA, mean diffusivity, MD) were extracted from significant clusters using an atlas-based approach. The FA and MD were compared between patients with (Ci_P n = 14) and without (Cp_P n = 81) cognitive impairment in a subset of patients who underwent CI screening. RESULTS The FA was reduced in Ci_P compared to Cp_P in the splenium of corpus callosum (p = 0.001), right parahippocampal cingulum (p = 0.002) and fornix cres./stria terminalis (0.042), left posterior corona radiata (p = 0.012), bilateral cerebral peduncles, medial lemniscus and in cerebellar tracts. Increased MD was detected in the splenium of corpus callosum (p = 0.01). The CI-related localizations overlapped only partially with MS lesions. CONCLUSION Microstructural white matter alterations at disease onset were detectable in Ci_P compared to Cp_P in known cognitively relevant fiber tracts, indicating the relevance of early treatment initiation in MS and CIS.
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23
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Petracca M, Pontillo G, Moccia M, Carotenuto A, Cocozza S, Lanzillo R, Brunetti A, Brescia Morra V. Neuroimaging Correlates of Cognitive Dysfunction in Adults with Multiple Sclerosis. Brain Sci 2021; 11:346. [PMID: 33803287 PMCID: PMC8000635 DOI: 10.3390/brainsci11030346] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 03/02/2021] [Accepted: 03/04/2021] [Indexed: 02/06/2023] Open
Abstract
Cognitive impairment is a frequent and meaningful symptom in multiple sclerosis (MS), caused by the accrual of brain structural damage only partially counteracted by effective functional reorganization. As both these aspects can be successfully investigated through the application of advanced neuroimaging, here, we offer an up-to-date overview of the latest findings on structural, functional and metabolic correlates of cognitive impairment in adults with MS, focusing on the mechanisms sustaining damage accrual and on the identification of useful imaging markers of cognitive decline.
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Affiliation(s)
- Maria Petracca
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, 80131 Naples, Italy; (M.P.); (M.M.); (A.C.); (V.B.M.)
| | - Giuseppe Pontillo
- Department of Advanced Biomedical Sciences, University of Naples “Federico II”, 80131 Naples, Italy; (G.P.); (S.C.); (A.B.)
- Department of Electrical Engineering and Information Technology, University of Naples “Federico II”, 80125 Naples, Italy
| | - Marcello Moccia
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, 80131 Naples, Italy; (M.P.); (M.M.); (A.C.); (V.B.M.)
| | - Antonio Carotenuto
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, 80131 Naples, Italy; (M.P.); (M.M.); (A.C.); (V.B.M.)
| | - Sirio Cocozza
- Department of Advanced Biomedical Sciences, University of Naples “Federico II”, 80131 Naples, Italy; (G.P.); (S.C.); (A.B.)
| | - Roberta Lanzillo
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, 80131 Naples, Italy; (M.P.); (M.M.); (A.C.); (V.B.M.)
| | - Arturo Brunetti
- Department of Advanced Biomedical Sciences, University of Naples “Federico II”, 80131 Naples, Italy; (G.P.); (S.C.); (A.B.)
| | - Vincenzo Brescia Morra
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, 80131 Naples, Italy; (M.P.); (M.M.); (A.C.); (V.B.M.)
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24
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Beutel T, Dzimiera J, Kapell H, Engelhardt M, Gass A, Schirmer L. Cortical projection neurons as a therapeutic target in multiple sclerosis. Expert Opin Ther Targets 2020; 24:1211-1224. [PMID: 33103501 DOI: 10.1080/14728222.2020.1842358] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Multiple sclerosis (MS) is a chronic inflammatory-demyelinating disease of the central nervous system associated with lesions of the cortical gray matter and subcortical white matter. Recently, cortical lesions have become a major focus of research because cortical pathology and neuronal damage are critical determinants of irreversible clinical progression. Recent transcriptomic studies point toward cell type-specific changes in cortical neurons in MS with a selective vulnerability of excitatory projection neuron subtypes. AREAS COVERED We discuss the cortical mapping and the molecular properties of excitatory projection neurons and their role in MS lesion pathology while placing an emphasis on their subtype-specific transcriptomic changes and levels of vulnerability. We also examine the latest magnetic resonance imaging techniques to study cortical MS pathology as a key tool for monitoring disease progression and treatment efficacy. Finally, we consider possible therapeutic avenues and novel strategies to protect excitatory cortical projection neurons. Literature search methodology: PubMed articles from 2000-2020. EXPERT OPINION Excitatory cortical projection neurons are an emerging therapeutic target in the treatment of progressive MS. Understanding neuron subtype-specific molecular pathologies and their exact spatial mapping will help establish starting points for the development of novel cell type-specific therapies and biomarkers in MS.
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Affiliation(s)
- Tatjana Beutel
- Department of Neurology, Medical Faculty Mannheim, MCTN, Heidelberg University , Mannheim, Germany
| | - Julia Dzimiera
- Department of Neurology, Medical Faculty Mannheim, MCTN, Heidelberg University , Mannheim, Germany
| | - Hannah Kapell
- Department of Neurology, Medical Faculty Mannheim, MCTN, Heidelberg University , Mannheim, Germany
| | - Maren Engelhardt
- Institute of Neuroanatomy, Medical Faculty Mannheim, MCTN, Heidelberg University , Mannheim, Germany.,Interdisciplinary Center for Neurosciences, Heidelberg University , Heidelberg, Germany
| | - Achim Gass
- Department of Neurology, Medical Faculty Mannheim, MCTN, Heidelberg University , Mannheim, Germany
| | - Lucas Schirmer
- Department of Neurology, Medical Faculty Mannheim, MCTN, Heidelberg University , Mannheim, Germany.,Interdisciplinary Center for Neurosciences, Heidelberg University , Heidelberg, Germany
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