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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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Snow NJ, Landine J, Chaves AR, Ploughman M. Age and asymmetry of corticospinal excitability, but not cardiorespiratory fitness, predict cognitive impairments in multiple sclerosis. IBRO Neurosci Rep 2023; 15:131-142. [PMID: 37577407 PMCID: PMC10412844 DOI: 10.1016/j.ibneur.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 07/11/2023] [Accepted: 07/15/2023] [Indexed: 08/15/2023] Open
Abstract
Background Cognitive impairment is a disabling and underestimated consequence of multiple sclerosis (MS), with multiple determinants that are poorly understood. Objectives We explored predictors of MS-related processing speed impairment (PSI) and age-related mild cognitive impairment (MCI) and hypothesized that cardiorespiratory fitness and corticospinal excitability would predict these impairments. Methods We screened 73 adults with MS (53 females; median [range]: Age 48 [21-70] years, EDSS 2.0 [0.0-6.5]) for PSI and MCI using the Symbol Digit Modalities Test and Montréal Cognitive Assessment, respectively. We identified six persons with PSI (No PSI, n = 67) and 13 with MCI (No MCI, n = 60). We obtained clinical data from medical records and self-reports; used transcranial magnetic stimulation to test corticospinal excitability; and assessed cardiorespiratory fitness using a graded maximal exercise test. We used receiver operator characteristic (ROC) curves to discern predictors of PSI and MCI. Results Interhemispheric asymmetry of corticospinal excitability was specific for PSI, while age was both sensitive and specific for MCI. MS-related PSI was also associated with statin prescriptions, while age-related MCI was related to progressive MS and GABA agonist prescriptions. Cardiorespiratory fitness was associated with neither PSI nor MCI. Discussion Corticospinal excitability is a potential marker of neurodegeneration in MS-related PSI, independent of age-related effects on global cognitive function. Age is a key predictor of mild global cognitive impairment. Cardiorespiratory fitness did not predict cognitive impairments in this clinic-based sample of persons with MS.
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Affiliation(s)
- Nicholas J. Snow
- Recovery and Performance Laboratory, Faculty of Medicine, Memorial University of Newfoundland and Labrador, St. John's, Newfoundland and Labrador, Canada
| | - Josef Landine
- Recovery and Performance Laboratory, Faculty of Medicine, Memorial University of Newfoundland and Labrador, St. John's, Newfoundland and Labrador, Canada
| | - Arthur R. Chaves
- Recovery and Performance Laboratory, Faculty of Medicine, Memorial University of Newfoundland and Labrador, St. John's, Newfoundland and Labrador, Canada
| | - Michelle Ploughman
- Recovery and Performance Laboratory, Faculty of Medicine, Memorial University of Newfoundland and Labrador, St. John's, Newfoundland and Labrador, Canada
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Rainka MM, Aladeen TS, Mattle AG, Lewandowski E, Vanini D, McCormack K, Mechtler L. Multiple Sclerosis and Use of Medical Cannabis: A Retrospective Review of a Neurology Outpatient Population. Int J MS Care 2023; 25:111-117. [PMID: 37250194 PMCID: PMC10211357 DOI: 10.7224/1537-2073.2022-006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
BACKGROUND Patients diagnosed as having multiple sclerosis (MS) experience a wide range of symptoms requiring pharmacologic management, and many do not achieve adequate symptom control. The purpose of this study was to evaluate the role of medical cannabis (MC) as part of a comprehensive treatment plan for patients with MS. METHODS A retrospective medical record review of 141 patients with MS receiving MC for symptom management was conducted. Data were collected for up to 4 follow-up appointments after initiation of MC. Outcomes included changes in MS symptoms, medication changes, adverse events, and changes in cognition and mobility. RESULTS Patients experienced extensive MS symptom improvement after initiation of MC, with alleviation of pain (72% of patients) and spasticity (48% of patients) and improvement in sleep (40% of patients) the most common. There was a significant reduction in concomitant opioid use after initiating MC as evidenced by a significant decrease in daily morphine milligram equivalents among patients prescribed opioid analgesics (P = .01). Decreases in muscle relaxant use and benzodiazepine use did not reach significance (P > .05). The most common adverse reaction to MC was fatigue (11% of patients). CONCLUSIONS In many patients with MS, MC was well tolerated, eased pain and spasticity, improved sleep and other symptoms, and reduced use of concomitant opioid analgesics. Prospective studies are needed to further investigate the role of MC in the treatment of patients with MS.
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Affiliation(s)
- Michelle M. Rainka
- From the Dent Neurologic Institute, Buffalo, NY, USA (MMR, TSA, AGM, KM, LM)
- The University at Buffalo School of Pharmacy and Pharmaceutical Sciences, Buffalo, NY, USA (MMR, TSA, AGM, EL, DV)
| | - Traci S. Aladeen
- From the Dent Neurologic Institute, Buffalo, NY, USA (MMR, TSA, AGM, KM, LM)
- The University at Buffalo School of Pharmacy and Pharmaceutical Sciences, Buffalo, NY, USA (MMR, TSA, AGM, EL, DV)
| | - Anna G. Mattle
- From the Dent Neurologic Institute, Buffalo, NY, USA (MMR, TSA, AGM, KM, LM)
- The University at Buffalo School of Pharmacy and Pharmaceutical Sciences, Buffalo, NY, USA (MMR, TSA, AGM, EL, DV)
| | - Emily Lewandowski
- The University at Buffalo School of Pharmacy and Pharmaceutical Sciences, Buffalo, NY, USA (MMR, TSA, AGM, EL, DV)
| | - Denis Vanini
- The University at Buffalo School of Pharmacy and Pharmaceutical Sciences, Buffalo, NY, USA (MMR, TSA, AGM, EL, DV)
| | - Katelyn McCormack
- From the Dent Neurologic Institute, Buffalo, NY, USA (MMR, TSA, AGM, KM, LM)
| | - Laszlo Mechtler
- From the Dent Neurologic Institute, Buffalo, NY, USA (MMR, TSA, AGM, KM, LM)
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Chang MC, Lee BJ, Yang D, Kim CR, Park D, Kim S. The association between cognition and gait disturbance in central nervous system demyelinating disorder with mild disability. BMC Neurol 2023; 23:177. [PMID: 37120584 PMCID: PMC10148385 DOI: 10.1186/s12883-023-03210-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 04/14/2023] [Indexed: 05/01/2023] Open
Abstract
INTRODUCTION Gait disturbance in central nervous system (CNS) demyelinating disorders, including multiple sclerosis (MS) and neuromyelitis optica (NMO) is one of the most troublesome problems that has a direct impact on the quality of life. However, the associations between gait disturbance and other clinical variables of these two diseases have not been fully elucidated. OBJECTIVE This study aimed to evaluate gait disturbance using a computerized gait analysis system and its association with various clinical variables in patients with MS and NMO. METHODS A total of 33 patients (14 with MS and 19 with NMO) with minor disabilities, who were able to walk independently and had passed their acute phase, were enrolled in the study. Gait analysis were performed using a computer-based instrumented walkway system. (Walk-way MG-1000, Anima, Japan) Clinical variables, such as disease duration, medication, body mass index (BMI), hand grip power, and muscle mass were recorded. The Montreal Cognitive Assessment (MOCA), Beck Depression Inventory score-II (BDI), and fatigue scale were measured using the Functional Assessment of Chronic Illness Therapy-fatigue scale (FACIT-fatigue) scale. A trained neurologist scored the Expanded Disability Status Scale (EDSS). RESULTS Gait speed was the single parameter that showed a significant positive correlation with MOCA (p < 0.001). The stance phase time was the single parameter that showed a significant negative correlation with EDSS (p < 0.001). Hand grip strength showed a significant positive correlation with skeletal muscle mass as assessed by bioimpedance analysis (p < 0.05). The FACIT-fatigue scale score showed a significant negative correlation with the BDI (p < 0.001). CONCLUSION In our patients with MS/NMO with mild disability, cognitive impairment was significantly correlated with gait speed, and the degree of disability was significantly correlated with stance phase time. Our findings may imply that early detection of a decrease in gait speed and an increase in stance phase time can predict the progression of cognitive impairment in patients with MS/NMO with mild disability.
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Affiliation(s)
- Min Cheol Chang
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Daegu, Republic of Korea
| | - Byung Joo Lee
- Department of Physical Medicine and Rehabilitation, Daegu Fatima Hospital, Ayang-Ro 99 Gil, Dong-Gu, Daegu, 41199, Republic of Korea
| | - Dongseok Yang
- Department of Physical Medicine and Rehabilitation, Ulsan University Hospital, Ulsan University College of Medicine, Ulsan, Korea
| | - Chung Reen Kim
- Department of Physical Medicine and Rehabilitation, Ulsan University Hospital, Ulsan University College of Medicine, Ulsan, Korea
| | - Donghwi Park
- Department of Physical Medicine and Rehabilitation, Daegu Fatima Hospital, Ayang-Ro 99 Gil, Dong-Gu, Daegu, 41199, Republic of Korea.
| | - Sunyoung Kim
- Department of Neurology, Ulsan University Hospital, Ulsan University College of Medicine, 877 Bangeojin sunhwando-ro, Dong-gu, 44033, Ulsan, Korea.
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Goffredo M, Pagliari C, Turolla A, Tassorelli C, Di Tella S, Federico S, Pournajaf S, Jonsdottir J, De Icco R, Pellicciari L, Calabrò RS, Baglio F, Franceschini M. Non-Immersive Virtual Reality Telerehabilitation System Improves Postural Balance in People with Chronic Neurological Diseases. J Clin Med 2023; 12:jcm12093178. [PMID: 37176618 PMCID: PMC10179507 DOI: 10.3390/jcm12093178] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 04/19/2023] [Accepted: 04/21/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND People with chronic neurological diseases, such as Parkinson's Disease (PD) and Multiple Sclerosis (MS), often present postural disorders and a high risk of falling. When difficulties in achieving outpatient rehabilitation services occur, a solution to guarantee the continuity of care may be telerehabilitation. This study intends to expand the scope of our previously published research on the impact of telerehabilitation on quality of life in an MS sample, testing the impact of this type of intervention in a larger sample of neurological patients also including PD individuals on postural balance. METHODS We included 60 participants with MS and 72 with PD. All enrolled subjects were randomized into two groups: 65 in the intervention group and 67 in the control group. Both treatments lasted 30-40 sessions (5 days/week, 6-8 weeks). Motor, cognitive, and participation outcomes were registered before and after the treatments. RESULTS All participants improved the outcomes at the end of the treatments. The study's primary outcome (Mini-BESTest) registered a greater significant improvement in the telerehabilitation group than in the control group. CONCLUSIONS Our results demonstrated that non-immersive virtual reality telerehabilitation is well tolerated and positively affects static and dynamic balance and gait in people with PD and MS.
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Affiliation(s)
- Michela Goffredo
- Neurorehabilitation Research Laboratory, Department of Neurological and Rehabilitation Sciences, IRCCS San Raffaele Roma, 00163 Rome, Italy
| | - Chiara Pagliari
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, 20148 Milan, Italy
| | - Andrea Turolla
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater University of Bologna, 40138 Bologna, Italy
- Unit of Occupational Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Cristina Tassorelli
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy
- Headache Science & Neurorehabilitation Center, IRCCS Mondino Foundation, 27100 Pavia, Italy
| | - Sonia Di Tella
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, 20148 Milan, Italy
| | - Sara Federico
- Laboratory of Healthcare Innovation Technology, IRCCS San Camillo Hospital, 30126 Venice, Italy
| | - Sanaz Pournajaf
- Neurorehabilitation Research Laboratory, Department of Neurological and Rehabilitation Sciences, IRCCS San Raffaele Roma, 00163 Rome, Italy
| | | | - Roberto De Icco
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy
- Headache Science & Neurorehabilitation Center, IRCCS Mondino Foundation, 27100 Pavia, Italy
| | | | | | | | - Marco Franceschini
- Neurorehabilitation Research Laboratory, Department of Neurological and Rehabilitation Sciences, IRCCS San Raffaele Roma, 00163 Rome, Italy
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele University, 00166 Rome, Italy
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Kupjetz M, Joisten N, Rademacher A, Gonzenbach R, Bansi J, Zimmer P. Cycling in primary progressive multiple sclerosis (CYPRO): study protocol for a randomized controlled superiority trial evaluating the effects of high-intensity interval training in persons with primary progressive multiple sclerosis. BMC Neurol 2023; 23:162. [PMID: 37087424 PMCID: PMC10122389 DOI: 10.1186/s12883-023-03187-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 03/27/2023] [Indexed: 04/24/2023] Open
Abstract
BACKGROUND Primary progressive multiple sclerosis (PPMS) is the least prevalent multiple sclerosis (MS) phenotype. For persons with PPMS (pwPPMS), pharmacological treatment options are limited. As a complementary non-pharmacological treatment, endurance training improves the health-related quality of life (HRQoL), numerous MS symptoms, and MS-related performance impediments. High-intensity interval training (HIIT) has been shown to induce superior effects compared to moderate-intensity continuous training (MCT). As current evidence is based on MS samples with mixed phenotypes, generalizability to pwPPMS remains unclear. METHODS CYPRO is a parallel-group, single-center, and single-blind randomized controlled superiority trial evaluating the effects of HIIT compared to MCT in pwPPMS. Sixty-one pwPPMS are randomized (1:1) to perform volume-matched HIIT or MCT sessions on bicycle ergometers two to three times per week in addition to standard rehabilitative care during their three-week inpatient stay at Valens rehabilitation clinic, Switzerland. Standard rehabilitative care comprises endurance and strength training, physiotherapy, and occupational therapy. HIIT sessions include six 90-second intervals at 95% peak heart rate (HRpeak), interspersed by 90-second active breaks with unloaded pedaling, aimed to reach 60%HRpeak. MCT represents the standard treatment at Valens rehabilitation clinic and is performed as continuous cycling at 60%HRpeak for the duration of 26 minutes. The primary outcome is cardiorespiratory fitness, assessed as peak oxygen consumption (V̇O2peak) during cardiopulmonary exercise testing (CPET). Secondary outcomes include peak power output during CPET, walking capacity, cognitive performance, HRQoL, fatigue, anxiety and depressive symptoms, and blood-derived biomarkers (e.g., serum neurofilament light chain, glial fibrillary acidic protein, kynurenine pathway metabolites) related to MS pathophysiology. All outcomes are assessed at baseline and discharge after three weeks. Venous blood sampling is additionally performed immediately and two hours after the first HIIT or MCT session. DISCUSSION CYPRO will expand current knowledge on symptom management and rehabilitation in MS to the subpopulation of pwPPMS, and will contribute to the exploration of potential disease-modifying effects of endurance training in MS. The superiority design of CYPRO will allow deriving explicit recommendations on endurance training design in pwPPMS that can be readily translated into clinical practice. TRIAL REGISTRATION CYPRO has been prospectively registered at ClinicalTrials.gov on 8 February 2022 (NCT05229861).
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Affiliation(s)
- Marie Kupjetz
- Department of Performance and Health (Sports Medicine), Institute of Sport and Sport Science, TU Dortmund University, Otto-Hahn-Straße 3, 44227, Dortmund, Germany
| | - Niklas Joisten
- Department of Performance and Health (Sports Medicine), Institute of Sport and Sport Science, TU Dortmund University, Otto-Hahn-Straße 3, 44227, Dortmund, Germany
| | - Annette Rademacher
- Marianne-Strauß-Klinik, Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke gGmbH, Milchberg 21, 82335, Berg, Germany
| | - Roman Gonzenbach
- Department of Neurology, Clinics of Valens, Rehabilitation Centre Valens, Taminaplatz 1, 7317, Valens, Switzerland
| | - Jens Bansi
- Department of Neurology, Clinics of Valens, Rehabilitation Centre Valens, Taminaplatz 1, 7317, Valens, Switzerland
- Department of Health, OST - Eastern Switzerland University of Applied Sciences, Rosenbergstrasse 59, 9001, Sankt Gallen, Switzerland
| | - Philipp Zimmer
- Department of Performance and Health (Sports Medicine), Institute of Sport and Sport Science, TU Dortmund University, Otto-Hahn-Straße 3, 44227, Dortmund, Germany.
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Giannopapas V, Stavrogianni K, Christouli N, Kitsos D, Sideri E, Bakalidou D, Voumvourakis K, Papagiannopoulou G, Tzartos J, Paraskevas G, Tsivgoulis G, Giannopoulos S. Do cardiovascular disease comorbidities affect the cognitive function of Multiple Sclerosis patients? J Clin Neurosci 2023; 112:20-24. [PMID: 37031630 DOI: 10.1016/j.jocn.2023.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/30/2023] [Accepted: 04/03/2023] [Indexed: 04/11/2023]
Abstract
INTRODUCTION Cognitive impairment is a core symptom of multiple sclerosis, leading to disability in 40-70% of patients. The most common cognitive domains affected by MS are information processing speed, complex attention, executive functions and less frequently, episodic declarative memory. Cardiovascular disease comorbidities have been shown to increase the decline rate in many neurological conditions. Our study aims to examine the possible impact of CVD risk factors in the cognitive decline rate of PwMS. METHODS Over the course of a year, 248 PwMS with and without Cardiovascular comorbidity were cognitively evaluated using the written version of SDMT and the MoCA. RESULTS Compared to control, MS patients with comorbid CVD had greater general cognitive decline and decreased processing speed. Patients with comorbid diabetes and dyslipidemia had the highest impairment, followed by those with hypertension, compared to the control group and those patients with a high BMI. CONCLUSION The presence of cardiovascular comorbidities and especially dyslipidemia increases the rate of cognitive decline in MS patients. In such cases, patients should be evaluated every 6 months instead of a year and the use of the SDMT is advised since it's time efficient,it requires minimal training and correlates with MRI findings.
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Affiliation(s)
- Vasileios Giannopapas
- Department of Neurology, Attikon University Hospital Greece, School of Medicine, National and Kapodistrian University of Athens, Greece; Department of Physical Therapy, University of West Attica, Greece; Laboratory of Neuromuscular and Cardiovascular Study of Motion-LANECASM, University of West Attica, Greece
| | - Konstantina Stavrogianni
- Department of Neurology, Attikon University Hospital Greece, School of Medicine, National and Kapodistrian University of Athens, Greece
| | - Niki Christouli
- Department of Neurology, Attikon University Hospital Greece, School of Medicine, National and Kapodistrian University of Athens, Greece
| | - Dimitrios Kitsos
- Department of Neurology, Attikon University Hospital Greece, School of Medicine, National and Kapodistrian University of Athens, Greece
| | - Eleni Sideri
- Department of Neurology, Attikon University Hospital Greece, School of Medicine, National and Kapodistrian University of Athens, Greece
| | - Daphne Bakalidou
- Department of Physical Therapy, University of West Attica, Greece; Laboratory of Neuromuscular and Cardiovascular Study of Motion-LANECASM, University of West Attica, Greece
| | - Konstantinos Voumvourakis
- Department of Neurology, Attikon University Hospital Greece, School of Medicine, National and Kapodistrian University of Athens, Greece
| | - Georgia Papagiannopoulou
- Department of Neurology, Attikon University Hospital Greece, School of Medicine, National and Kapodistrian University of Athens, Greece
| | - John Tzartos
- Department of Neurology, Attikon University Hospital Greece, School of Medicine, National and Kapodistrian University of Athens, Greece
| | - Georgios Paraskevas
- Department of Neurology, Attikon University Hospital Greece, School of Medicine, National and Kapodistrian University of Athens, Greece
| | - Georgios Tsivgoulis
- Department of Neurology, Attikon University Hospital Greece, School of Medicine, National and Kapodistrian University of Athens, Greece
| | - Sotirios Giannopoulos
- Department of Neurology, Attikon University Hospital Greece, School of Medicine, National and Kapodistrian University of Athens, Greece.
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Cornea A, Lata I, Simu M, Rosca EC. Assessment and Diagnosis of HIV-Associated Dementia. Viruses 2023; 15:v15020378. [PMID: 36851592 PMCID: PMC9966987 DOI: 10.3390/v15020378] [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: 11/27/2022] [Revised: 01/11/2023] [Accepted: 01/27/2023] [Indexed: 01/31/2023] Open
Abstract
The modern combined antiretroviral treatment (cART) for human immunodeficiency virus (HIV) infection has substantially lowered the incidence of HIV-associated dementia (HAD). The dominant clinical features include deficits in cognitive processing speed, concentration, attention, and memory. As people living with HIV become older, with high rates of comorbidities and concomitant treatments, the prevalence and complexity of cognitive impairment are expected to increase. Currently, the management of HAD and milder forms of HAND is grounded on the best clinical practice, as there is no specific, evidence-based, proven intervention for managing cognitive impairment. The present article acknowledges the multifactorial nature of the cognitive impairments found in HIV patients, outlining the current concepts in the field of HAD. Major areas of interest include neuropsychological testing and neuroimaging to evaluate CNS status, focusing on greater reliability in the exclusion of associated diseases and allowing for earlier diagnosis. Additionally, we considered the evidence for neurological involvement in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and the impact of the coronavirus (COVID-19) pandemic, with wider consequences to population health than can be attributed to the virus itself. The indirect effects of COVID-19, including the increased adoption of telehealth, decreased access to community resources, and social isolation, represent a significant health burden, disproportionately affecting older adults with dementia who have limited social networks and increased functional dependence on the community and health system. This synopsis reviews these aspects in greater detail, identifying key gaps and opportunities for researchers and clinicians; we provide an overview of the current concepts in the field of HAD, with suggestions for diagnosing and managing this important neurological complication, which is intended to be applicable across diverse populations, in line with clinical observations, and closely representative of HIV brain pathology.
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Affiliation(s)
- Amalia Cornea
- Department of Neurology, Victor Babes University of Medicine and Pharmacy Timisoara, Eftimie Murgu Sq. No. 2, 300041 Timisoara, Romania
- Department of Neurology, Clinical Emergency County Hospital Timisoara, Bd. Iosif Bulbuca No. 10, 300736 Timisoara, Romania
| | - Irina Lata
- Department of Neurology, Clinical Emergency County Hospital Timisoara, Bd. Iosif Bulbuca No. 10, 300736 Timisoara, Romania
| | - Mihaela Simu
- Department of Neurology, Victor Babes University of Medicine and Pharmacy Timisoara, Eftimie Murgu Sq. No. 2, 300041 Timisoara, Romania
- Department of Neurology, Clinical Emergency County Hospital Timisoara, Bd. Iosif Bulbuca No. 10, 300736 Timisoara, Romania
| | - Elena Cecilia Rosca
- Department of Neurology, Victor Babes University of Medicine and Pharmacy Timisoara, Eftimie Murgu Sq. No. 2, 300041 Timisoara, Romania
- Department of Neurology, Clinical Emergency County Hospital Timisoara, Bd. Iosif Bulbuca No. 10, 300736 Timisoara, Romania
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Delgado-Álvarez A, Díez-Cirarda M, Delgado-Alonso C, Hernández-Lorenzo L, Cuevas C, Valles-Salgado M, Montero-Escribano P, Gil-Moreno MJ, Matías-Guiu J, García-Ramos R, Matias-Guiu JA. Multi-Disease Validation of the RUDAS for Cognitive Screening in Alzheimer's Disease, Parkinson's Disease, and Multiple Sclerosis. J Alzheimers Dis 2023; 91:705-717. [PMID: 36502332 DOI: 10.3233/jad-220907] [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: 12/12/2022]
Abstract
BACKGROUND The Rowland Universal Dementia Assessment Scale (RUDAS) is a cognitive test with favorable diagnostic properties for detecting dementia and a low influence of education and cultural biases. OBJECTIVE We aimed to validate the RUDAS in people with Alzheimer's disease (AD), Parkinson's disease (PD), and multiple sclerosis (MS). METHODS We enrolled one hundred and fifty participants (60 with AD, 30 with PD, 60 with MS, and 120 healthy controls (HC)). All clinical groups completed a comprehensive neuropsychological battery, RUDAS, and standard cognitive tests of each disorder: MMSE, SCOPA-COG, and Symbol Digit Modalities Test. Intergroup comparisons between clinical groups and HC and ROC curves were estimated. Random Forest algorithms were trained and validated to detect cognitive impairment using RUDAS and rank the most relevant scores. RESULTS The RUDAS scores were lower in patients with AD, and patients with PD and MS showed cognitive impairment compared to healthy controls. Effect sizes were generally large. The total score was the most discriminative, followed by the memory score. Correlations with standardized neuropsychological tests were moderate to high. Random Forest algorithms obtained accuracies over 80-90% using the RUDAS for diagnosing AD and cognitive impairment associated with PD and MS. CONCLUSION Our results suggest the RUDAS is a valid test candidate for multi-disease cognitive screening tool in AD, PD, and MS.
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Affiliation(s)
- Alfonso Delgado-Álvarez
- Department of Neurology, Hospital Clinico San Carlos, San Carlos Institute for Health Research (IdiSSC), Universidad Complutense, Madrid, Spain.,Faculty of Psychology, Universidad Autónoma de Madrid, Madrid, Spain
| | - María Díez-Cirarda
- Department of Neurology, Hospital Clinico San Carlos, San Carlos Institute for Health Research (IdiSSC), Universidad Complutense, Madrid, Spain
| | - Cristina Delgado-Alonso
- Department of Neurology, Hospital Clinico San Carlos, San Carlos Institute for Health Research (IdiSSC), Universidad Complutense, Madrid, Spain
| | - Laura Hernández-Lorenzo
- Department of Neurology, Hospital Clinico San Carlos, San Carlos Institute for Health Research (IdiSSC), Universidad Complutense, Madrid, Spain.,Faculty of Psychology, Universidad Autónoma de Madrid, Madrid, Spain
| | - Constanza Cuevas
- Department of Neurology, Hospital Clinico San Carlos, San Carlos Institute for Health Research (IdiSSC), Universidad Complutense, Madrid, Spain
| | - María Valles-Salgado
- Department of Neurology, Hospital Clinico San Carlos, San Carlos Institute for Health Research (IdiSSC), Universidad Complutense, Madrid, Spain
| | - Paloma Montero-Escribano
- Department of Neurology, Hospital Clinico San Carlos, San Carlos Institute for Health Research (IdiSSC), Universidad Complutense, Madrid, Spain
| | - María José Gil-Moreno
- Department of Neurology, Hospital Clinico San Carlos, San Carlos Institute for Health Research (IdiSSC), Universidad Complutense, Madrid, Spain
| | - Jorge Matías-Guiu
- Department of Neurology, Hospital Clinico San Carlos, San Carlos Institute for Health Research (IdiSSC), Universidad Complutense, Madrid, Spain
| | - Rocío García-Ramos
- Department of Neurology, Hospital Clinico San Carlos, San Carlos Institute for Health Research (IdiSSC), Universidad Complutense, Madrid, Spain
| | - Jordi A Matias-Guiu
- Department of Neurology, Hospital Clinico San Carlos, San Carlos Institute for Health Research (IdiSSC), Universidad Complutense, Madrid, Spain
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10
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Murphy HM, Fetter CM, Snow NJ, Chaves AR, Downer MB, Ploughman M. Lower corticospinal excitability and greater fatigue among people with multiple sclerosis experiencing pain. Mult Scler J Exp Transl Clin 2023; 9:20552173221143398. [PMID: 36636581 PMCID: PMC9830099 DOI: 10.1177/20552173221143398] [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: 09/14/2022] [Accepted: 11/17/2022] [Indexed: 01/08/2023] Open
Abstract
Introduction Persons with multiple sclerosis (MS) frequently report pain that negatively affects their quality of life. Evidence linking pain and corticospinal excitability in MS is sparse. We aimed to (1) examine differences in corticospinal excitability in MS participants with and without pain and (2) explore predictors of pain. Methods Sixty-four participants rated their pain severity on a visual analog scale (VAS). Transcranial magnetic stimulation (TMS) and validated clinical instruments characterized corticospinal excitability and subjective disease features like mood and fatigue. We retrieved information on participants' prescriptions and disability status from their clinical records. Results Fifty-five percent of participants reported pain that affected their daily functioning. Persons with pain had significantly greater fatigue and lower area under the excitatory motor evoked potential (MEP) recruitment curve (eREC AUC), a measure of total corticospinal excitability. After controlling for age, disability status, and pain medications, increased fatigue and decreased eREC AUC together explained 40% of the variance in pain. Discussion Pain in MS is multifactorial and relates to both greater fatigue and lesser corticospinal excitability. Future work should better characterize relationships between these outcomes to develop targeted pain interventions such as neuromodulation. Summary We examined pain in MS. Individuals with pain had higher fatigue and lower corticospinal excitability than those without pain. These outcomes significantly predicted self-reported pain.
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Affiliation(s)
- Hannah M. Murphy
- Recovery & Performance Laboratory, Faculty of
Medicine, Memorial University of Newfoundland, St John's, Newfoundland and
Labrador, Canada
| | - Christopher M. Fetter
- Recovery & Performance Laboratory, Faculty of
Medicine, Memorial University of Newfoundland, St John's, Newfoundland and
Labrador, Canada
| | - Nicholas J. Snow
- Recovery & Performance Laboratory, Faculty of
Medicine, Memorial University of Newfoundland, St John's, Newfoundland and
Labrador, Canada
| | - Arthur R. Chaves
- Recovery & Performance Laboratory, Faculty of
Medicine, Memorial University of Newfoundland, St John's, Newfoundland and
Labrador, Canada
| | - Matthew B. Downer
- Recovery & Performance Laboratory, Faculty of
Medicine, Memorial University of Newfoundland, St John's, Newfoundland and
Labrador, Canada
| | - Michelle Ploughman
- Recovery & Performance Laboratory, Faculty of
Medicine, Memorial University of Newfoundland, St John's, Newfoundland and
Labrador, Canada,Michelle Ploughman, Recovery
& Performance Laboratory, Faculty of Medicine, Memorial University of
Newfoundland, LA Miller Centre, 100 Forest Road, St. John's, NL, A1A1E5, Canada.
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11
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Taranu D, Tumani H, Holbrook J, Tumani V, Uttner I, Fissler P. The TRACK-MS Test Battery: A Very Brief Tool to Track Multiple Sclerosis-Related Cognitive Impairment. Biomedicines 2022; 10:biomedicines10112975. [PMID: 36428543 PMCID: PMC9687502 DOI: 10.3390/biomedicines10112975] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 11/12/2022] [Accepted: 11/16/2022] [Indexed: 11/22/2022] Open
Abstract
Tracking cognition in patients with multiple sclerosis (MS) is important for detection of disease progression but it is often not performed in routine settings due to time constraints. This exploratory cohort study aims to develop a very brief repeatable tracking tool with comparable test quality criteria to the current gold standard, the Brief International Cognitive Assessment for MS (BICAMS). The study included 88 participants (22 healthy controls, 66 MS patients) who were examined at baseline and at one-year follow-up. As a validity criterion for the six administered cognitive tests, we assessed the difference between MS patients and HC, and the correlation with MS-related disability. Combining the two tests with the highest validity-the Controlled Oral Word Association Test and Symbol Digit Modalities Test-yielded an administration time of 5 min. Comparing this new TRACK-MS test battery with the 15 min BICAMS indicated that TRACK-MS showed larger differences between MS patients and healthy controls, a higher correlation with MS-related disability, smaller practice effects, and a good test-retest reliability. We provide evidence that TRACK-MS, although faster to administer, showed at least comparable quality criteria as the BICAMS. As the study was exploratory, replication of these results is necessary.
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Affiliation(s)
- Daniela Taranu
- Department of Neurology, Faculty of Medicine, Ulm University, D-89071 Ulm, Germany
- Correspondence: (D.T.); (H.T.)
| | - Hayrettin Tumani
- Department of Neurology, Faculty of Medicine, Ulm University, D-89071 Ulm, Germany
- Correspondence: (D.T.); (H.T.)
| | - Jill Holbrook
- Department of Neurology, Faculty of Medicine, Ulm University, D-89071 Ulm, Germany
| | - Visal Tumani
- Department of Psychiatry, Faculty of Medicine, Ulm University, D-89071 Ulm, Germany
| | - Ingo Uttner
- Department of Neurology, Faculty of Medicine, Ulm University, D-89071 Ulm, Germany
| | - Patrick Fissler
- Department of Neurology, Faculty of Medicine, Ulm University, D-89071 Ulm, Germany
- Psychiatric Services Thurgau, CH-8596 Münsterlingen, Switzerland
- University Hospital for Psychiatry and Psychotherapy, Paracelsus Medical University, A-5020 Salzburg, Austria
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12
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Cornea A, Simu M, Rosca EC. Montreal Cognitive Assessment for Evaluating Cognitive Impairment in Subarachnoid Hemorrhage: A Systematic Review. J Clin Med 2022; 11:jcm11164679. [PMID: 36012917 PMCID: PMC9409824 DOI: 10.3390/jcm11164679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 08/08/2022] [Accepted: 08/09/2022] [Indexed: 11/20/2022] Open
Abstract
Subarachnoid hemorrhage (SAH) is a severe condition with high mortality and extensive long-term morbidity. Although research has focused mainly on physical signs and disability for decades, in recent years, it has been increasingly recognized that cognitive and psychological impairments may be present in many patients with SAH, negatively impacting their quality of life. We performed a systematic review aiming to provide a comprehensive report on the diagnostic accuracy of the Montreal Cognitive Assessment (MoCA) test for evaluating the presence of cognitive impairment in patients with SAH. Using appropriate search terms, we searched five databases (PubMed, Scopus, PsychINFO, Web of Sciences, and Latin American and Caribbean Health Sciences Literature) up to January 2022. Two cross-sectional studies investigated the accuracy of MoCA in SAH patients in the subacute and chronic phase. We appraised the quality of the included studies using the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) criteria. The MoCA test provides information about general cognitive functioning disturbances. However, a lower threshold than the original cutoff might be needed as it improves diagnostic accuracy, lowering the false positive rates. Further research is necessary for an evidence-based decision to use the MoCA in SAH patients.
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Affiliation(s)
- Amalia Cornea
- Department of Neurology, Victor Babes University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square No. 2, 300041 Timisoara, Romania
- Department of Neurology, Clinical Emergency County Hospital Timisoara, Boulevard Iosif Bulbuca No. 10, 300736 Timisoara, Romania
| | - Mihaela Simu
- Department of Neurology, Victor Babes University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square No. 2, 300041 Timisoara, Romania
- Department of Neurology, Clinical Emergency County Hospital Timisoara, Boulevard Iosif Bulbuca No. 10, 300736 Timisoara, Romania
| | - Elena Cecilia Rosca
- Department of Neurology, Victor Babes University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square No. 2, 300041 Timisoara, Romania
- Department of Neurology, Clinical Emergency County Hospital Timisoara, Boulevard Iosif Bulbuca No. 10, 300736 Timisoara, Romania
- Correspondence: ; Tel.: +40-746173794
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13
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Delgado-Álvarez A, Delgado-Alonso C, Goudsmit M, Gil MJ, Díez-Cirarda M, Valles-Salgado M, Montero-Escribano P, Hernández-Lorenzo L, Matías-Guiu J, Matias-Guiu JA. Validation of a brief cross-cultural cognitive screening test in Multiple Sclerosis. Mult Scler Relat Disord 2022; 67:104091. [DOI: 10.1016/j.msard.2022.104091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 07/12/2022] [Accepted: 08/05/2022] [Indexed: 11/16/2022]
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14
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Kessels RPC, de Vent NR, Bruijnen CJWH, Jansen MG, de Jonghe JFM, Dijkstra BAG, Oosterman JM. Regression-Based Normative Data for the Montreal Cognitive Assessment (MoCA) and Its Memory Index Score (MoCA-MIS) for Individuals Aged 18–91. J Clin Med 2022; 11:jcm11144059. [PMID: 35887823 PMCID: PMC9318507 DOI: 10.3390/jcm11144059] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 07/07/2022] [Accepted: 07/12/2022] [Indexed: 01/07/2023] Open
Abstract
(1) Background: There is a need for a brief assessment of cognitive function, both in patient care and scientific research, for which the Montreal Cognitive Assessment (MoCA) is a psychometrically reliable and valid tool. However, fine-grained normative data allowing for adjustment for age, education, and/or sex are lacking, especially for its Memory Index Score (MIS). (2) Methods: A total of 820 healthy individuals aged 18–91 (366 men) completed the Dutch MoCA (version 7.1), of whom 182 also completed the cued recall and recognition memory subtests enabling calculation of the MIS. Regression-based normative data were computed for the MoCA Total Score and MIS, following the data-handling procedure of the Advanced Neuropsychological Diagnostics Infrastructure (ANDI). (3) Results: Age, education level, and sex were significant predictors of the MoCA Total Score (Conditional R2 = 0.4, Marginal R2 = 0.12, restricted maximum likelihood (REML) criterion at convergence: 3470.1) and MIS (Marginal R2 = 0.14, REML criterion at convergence: 682.8). Percentile distributions are presented that allow for age, education and sex adjustment for the MoCA Total Score and the MIS. (4) Conclusions: We present normative data covering the full adult life span that can be used for the screening for overall cognitive deficits and memory impairment, not only in older people with or people at risk of neurodegenerative disease, but also in younger individuals with acquired brain injury, neurological disease, or non-neurological medical conditions.
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Affiliation(s)
- Roy P. C. Kessels
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, 6525 GD Nijmegen, The Netherlands; (M.G.J.); (J.M.O.)
- Vincent van Gogh Institute for Psychiatry, Center of Excellence for Korsakoff and Alcohol-Related Cognitive Disorders, 5803 DN Venray, The Netherlands;
- Klimmendaal Rehabilitation Specialists, 6813 GG Arnhem, The Netherlands
- Tactus Addiction Care, 7400 AD Deventer, The Netherlands
- Department of Medical Psychology and Radboudumc Alzheimer Center, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands
- Correspondence: ; Tel.: +31-24-3612-541
| | - Nathalie R. de Vent
- Department of Psychology, University of Amsterdam, 1018 WS Amsterdam, The Netherlands;
| | - Carolien J. W. H. Bruijnen
- Vincent van Gogh Institute for Psychiatry, Center of Excellence for Korsakoff and Alcohol-Related Cognitive Disorders, 5803 DN Venray, The Netherlands;
- Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA), Radboud University, 6525 GD Nijmegen, The Netherlands;
| | - Michelle G. Jansen
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, 6525 GD Nijmegen, The Netherlands; (M.G.J.); (J.M.O.)
| | | | - Boukje A. G. Dijkstra
- Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA), Radboud University, 6525 GD Nijmegen, The Netherlands;
- Novadic-Kentron, Addiction Care Center, 5261 LX Vught, The Netherlands
| | - Joukje M. Oosterman
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, 6525 GD Nijmegen, The Netherlands; (M.G.J.); (J.M.O.)
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Significance of the Diagnosis of Executive Functions in Patients with Relapsing-Remitting Multiple Sclerosis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910527. [PMID: 34639827 PMCID: PMC8507634 DOI: 10.3390/ijerph181910527] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 09/28/2021] [Accepted: 10/06/2021] [Indexed: 12/02/2022]
Abstract
Multiple sclerosis (MS) is a progressive chronic disease of the Central Nervous System (CNS). Cognitive decline occurs rather rarely in relapsing–remitting multiple sclerosis (RRMS) compared to other types. The present study aimed to assess executive functions (EF) in relation to clinical and demographic variables in patients with RRMS. The study involved 22 individuals with RRMS (aged 23 to 49 years) and 22 matching controls. All the individuals with RRMS were in the remission phase. The assessments were carried out using MoCA, BDI-II, Halstead Category Test, Porteus Maze Test, verbal fluency tasks and Stroop Colour-Word Interference Test. The findings show that the two groups differed significantly in all the tests. All patients with RRMS in the remission phase presented at least one cognitive deficit, observed in general cognitive functioning, abstract reasoning or other executive functions, i.e., fluency, interference suppression, planning, or ability to modify activity in response to feedback. The deficits in most cases (except for those measured with the MoCA, Category Tests and phonemic fluency), are not related to intensity of depression and duration of the disease. Findings suggest that the diagnostic process in the case of patients with RRMS may include psychological assessment focusing on potentially existing cognitive, mainly executive, deficits and their severity.
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