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Helminen J, Jehkonen M. Relationship between neuropsychiatric symptoms and cognition in multiple sclerosis: A systematic review. APPLIED NEUROPSYCHOLOGY. ADULT 2024:1-16. [PMID: 39325074 DOI: 10.1080/23279095.2024.2403764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/27/2024]
Abstract
The results of previous research on the relationship between neuropsychiatric symptoms and cognition in multiple sclerosis (MS) have been mixed. The aim of this systematic review was to examine the evidence on the relationship between neuropsychiatric symptoms and different cognitive domains in adult (≥18 years) MS patients. A literature search was conducted in the Ovid Medline, PsycInfo, Scopus, and Web of Science databases. A total of 4,216 nonduplicate records were identified, and after screening, 37 studies met the inclusion criteria and were included in the systematic review. Higher levels of depressive symptoms were related to deficits in processing speed, verbal memory, executive functions, visuospatial functions, and attention in MS patients. Symptoms of anxiety were not consistently related to any of the cognitive functions, but the relationship to deficits in visual memory received a minimal amount of support. Higher levels of apathy were most clearly associated with impairment in executive functions, but the association with deficits in visuospatial functions, visual memory, working memory, and processing speed was also supported. The results indicate that more neuropsychiatric symptoms, especially depressive symptoms and apathy, are associated with cognitive dysfunction in MS patients. These results can be utilized in the clinical examination and treatment planning of MS patients.
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Affiliation(s)
- Johanna Helminen
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Mervi Jehkonen
- Faculty of Social Sciences, Tampere University, Tampere, Finland
- Tays Research Services, Tampere University Hospital, Tampere, Finland
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O'Keeffe F, Cogley C, McManus C, Davenport L, O'Connor S, Tubridy N, Gaughan M, McGuigan C, Bramham J. Neuropsychology intervention for managing invisible symptoms of MS (NIMIS-MS) group: A pilot effectiveness and acceptability study. Mult Scler Relat Disord 2024; 88:105719. [PMID: 38909526 DOI: 10.1016/j.msard.2024.105719] [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: 02/03/2023] [Revised: 05/18/2024] [Accepted: 06/08/2024] [Indexed: 06/25/2024]
Abstract
BACKGROUND People with MS (pwMS) commonly experience a range of hidden symptoms, including cognitive impairment, anxiety and depression, fatigue, pain, and sensory difficulties. These "invisible" symptoms can significantly impact wellbeing, relationships, employment and life goals. We developed a novel bespoke online group neuropsychological intervention combining psychoeducation and cognitive rehabilitation with an Acceptance and Commitment Therapy (ACT)-informed approach for pwMS in an acute tertiary hospital. This 'Neuropsychological Intervention for Managing Invisible Symptoms' in MS (NIMIS-MS) consisted of 6 sessions, each with a psychoeducation and ACT component. The content included psychoeducation around managing cognitive difficulties, fatigue, pain, sleep and other unpleasant sensations in MS with the general approach of understanding, monitoring, and recognising patterns and potential triggers. Specific cognitive rehabilitation and fatigue management strategies were introduced. The ACT-informed component focussed on three core ACT areas of the 'Triflex' of psychological flexibility (Harris, 2019): Being Present, Opening Up, and Doing What Matters. METHODS 118 pwMS attended the NIMIS-MS group intervention which was delivered 14 times in six-week blocks over an 18-month period. To evaluate the effectiveness and acceptability, participants completed measures of depression and anxiety (HADS), functional impairment (WSAS), Values- Progress (VQ) and Values- Obstruction (VQ), and Acceptance of MS (MSAS) pre and post NIMIs-MS group intervention. Qualitative feedback was obtained during focus groups after the final session and via online feedback questionnaires RESULTS: Pre-post analysis showed that symptoms of depression and anxiety were significantly lower and acceptance of MS was significantly higher following completion of the NIMIS-MS group. Qualitative feedback showed that participants reported that they felt more equipped to manage the "invisible" symptoms of MS following completion of the group, and benefited from using ACT-based strategies and techniques. Participants highly valued the peer support that evolved during the NIMIS-MS groups. The online format was considered more accessible than in-person groups, due to less concerns of travel time, cost, fatigue, and comfort and infection. CONCLUSION Evaluation suggests that our novel NIMIS-MS groups is an acceptable, beneficial and feasible approach for providing neuropsychological interventions to individuals with MS.
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Affiliation(s)
- Fiadhnait O'Keeffe
- University College Dublin, Ireland; St. Vincent's University Hospital, Ireland; University College Cork, Ireland.
| | - Clodagh Cogley
- University College Dublin, Ireland; St. Vincent's University Hospital, Ireland
| | | | | | | | - Niall Tubridy
- University College Dublin, Ireland; St. Vincent's University Hospital, Ireland
| | | | | | - Jessica Bramham
- University College Dublin, Ireland; St. Vincent's University Hospital, Ireland
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Stein C, O'Keeffe F, McManus C, Tubridy N, Gaughan M, McGuigan C, Bramham J. Premorbid cognitive functioning influences differences between self-reported cognitive difficulties and cognitive assessment in multiple sclerosis. J Neuropsychol 2024; 18:47-65. [PMID: 37212461 DOI: 10.1111/jnp.12327] [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: 10/17/2022] [Accepted: 05/05/2023] [Indexed: 05/23/2023]
Abstract
Cognitive difficulties are reported in up to 60% of people with MS (pwMS). There is often a discrepancy between self-reported cognitive difficulties and performance on cognitive assessments. Some of this discrepancy can be explained by depression and fatigue. Pre-MS cognitive abilities may be another important variable in explaining differences between self-reported and assessed cognitive abilities. PwMS with high estimated premorbid cognitive functioning (ePCF) may notice cognitive difficulties in daily life whilst performing within the average range on cognitive assessments. We hypothesised that, taking into account depression and fatigue, ePCF would predict (1) differences between self-reported and assessed cognitive abilities and (2) performance on cognitive assessments. We explored whether ePCF predicted (3) self-reported cognitive difficulties. Eighty-seven pwMS completed the Test of Premorbid Functioning (TOPF), the Brief International Cognitive Assessment for MS (BICAMS), self-report measures of cognitive difficulty (MS Neuropsychological Questionnaire; MSNQ), fatigue (MS Fatigue Impact Scale; MFIS) and depression (Hospital Anxiety and Depression Scale; HADS). Results revealed that, taking into account covariates, ePCF predicted (1) differences between self-reported and assessed cognitive abilities, p < .001 (model explained 29.35% of variance), and (2) performance on cognitive assessments, p < .001 (model explained 46.00% of variance), but not (3) self-reported cognitive difficulties, p = .545 (model explained 35.10% of variance). These results provide new and unique insights into predictors of the frequently observed discrepancy between self-reported and assessed cognitive abilities for pwMS. These findings have important implications for clinical practice, including the importance of exploring premorbid factors in self-reported experience of cognitive difficulties.
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Affiliation(s)
| | - Fiadhnait O'Keeffe
- University College Dublin, Dublin, Ireland
- St. Vincent's University Hospital, Dublin, Ireland
| | - Caoimhe McManus
- University College Dublin, Dublin, Ireland
- St. Vincent's University Hospital, Dublin, Ireland
| | - Niall Tubridy
- University College Dublin, Dublin, Ireland
- St. Vincent's University Hospital, Dublin, Ireland
| | | | - Christopher McGuigan
- University College Dublin, Dublin, Ireland
- St. Vincent's University Hospital, Dublin, Ireland
| | - Jessica Bramham
- University College Dublin, Dublin, Ireland
- St. Vincent's University Hospital, Dublin, Ireland
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Vagias H, Byrne ML, Millist L, White O, Clough M, Fielding J. Visuo-Cognitive Phenotypes in Early Multiple Sclerosis: A Multisystem Model of Visual Processing. J Clin Med 2024; 13:649. [PMID: 38337342 PMCID: PMC10855997 DOI: 10.3390/jcm13030649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 01/15/2024] [Accepted: 01/16/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Cognitive impairment can emerge in the earliest stages of multiple sclerosis (MS), with heterogeneity in cognitive deficits often hindering symptom identification and management. Sensory-motor dysfunction, such as visual processing impairment, is also common in early disease and can impact neuropsychological task performance in MS. However, cognitive phenotype research in MS does not currently consider the relationship between early cognitive changes and visual processing impairment. OBJECTIVES This study explored the relationship between cognition and visual processing in early MS by adopting a three-system model of afferent sensory, central cognitive and efferent ocular motor visual processing to identify distinct visuo-cognitive phenotypes. METHODS Patients with clinically isolated syndrome and relapsing-remitting MS underwent neuro-ophthalmic, ocular motor and neuropsychological evaluation to assess each visual processing system. The factor structure of ocular motor variables was examined using exploratory factor analysis, and phenotypes were identified using latent profile analysis. RESULTS Analyses revealed three ocular-motor constructs (cognitive control, cognitive processing speed and basic visual processing) and four visuo-cognitive phenotypes (early visual changes, efferent-cognitive, cognitive control and afferent-processing speed). While the efferent-cognitive phenotype was present in significantly older patients than was the early visual changes phenotype, there were no other demographic differences between phenotypes. The efferent-cognitive and cognitive control phenotypes had poorer performance on the Symbol Digit Modalities Test compared to that of other phenotypes; however, no other differences in performance were detected. CONCLUSION Our findings suggest that distinct visual processing deficits in early MS may differentially impact cognition, which is not captured using standard neuropsychological evaluation. Further research may facilitate improved symptom identification and intervention in early disease.
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Affiliation(s)
- Hariklia Vagias
- School of Psychological Sciences and the Turner Institute for Brain and Mental Health, Monash University, Melbourne 3800, Australia; (H.V.)
| | - Michelle L. Byrne
- School of Psychological Sciences and the Turner Institute for Brain and Mental Health, Monash University, Melbourne 3800, Australia; (H.V.)
| | - Lyn Millist
- Department of Neuroscience, Alfred Hospital, Melbourne 3004, Australia
| | - Owen White
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne 3004, Australia (J.F.)
| | - Meaghan Clough
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne 3004, Australia (J.F.)
| | - Joanne Fielding
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne 3004, Australia (J.F.)
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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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Margoni M, Preziosa P, Rocca MA, Filippi M. Depressive symptoms, anxiety and cognitive impairment: emerging evidence in multiple sclerosis. Transl Psychiatry 2023; 13:264. [PMID: 37468462 PMCID: PMC10356956 DOI: 10.1038/s41398-023-02555-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 06/28/2023] [Accepted: 06/30/2023] [Indexed: 07/21/2023] Open
Abstract
Neuropsychiatric abnormalities may be broadly divided in two categories: disorders of mood, affect, and behavior and abnormalities affecting cognition. Among these conditions, clinical depression, anxiety and neurocognitive disorders are the most common in multiple sclerosis (MS), with a substantial impact on patients' quality of life and adherence to treatments. Such manifestations may occur from the earliest phases of the disease but become more frequent in MS patients with a progressive disease course and more severe clinical disability. Although the pathogenesis of these neuropsychiatric manifestations has not been fully defined yet, brain structural and functional abnormalities, consistently observed with magnetic resonance imaging (MRI), together with genetic and immunologic factors, have been suggested to be key players. Even though the detrimental clinical impact of such manifestations in MS patients is a matter of crucial importance, at present, they are often overlooked in the clinical setting. Moreover, the efficacy of pharmacologic and non-pharmacologic approaches for their amelioration has been poorly investigated, with the majority of studies showing marginal or no beneficial effect of different therapeutic approaches, possibly due to the presence of multiple and heterogeneous underlying pathological mechanisms and intrinsic methodological limitations. A better evaluation of these manifestations in the clinical setting and improvements in the understanding of their pathophysiology may offer the potential to develop tools for differentiating these mechanisms in individual patients and ultimately provide a principled basis for treatment selection. This review provides an updated overview regarding the pathophysiology of the most common neuropsychiatric symptoms in MS, the clinical and MRI characteristics that have been associated with mood disorders (i.e., depression and anxiety) and cognitive impairment, and the treatment approaches currently available or under investigation.
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Affiliation(s)
- Monica Margoni
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Paolo Preziosa
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Maria A Rocca
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.
- Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
- Vita-Salute San Raffaele University, Milan, Italy.
- Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy.
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Henry A, Stefaniak N, Schmid F, Kwiatkowski A, Hautecoeur P, Lenne B. Assessing cognitive changes in multiple sclerosis: criteria for a reliable decision. J Clin Exp Neuropsychol 2023; 45:321-344. [PMID: 37405367 DOI: 10.1080/13803395.2023.2232122] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 06/16/2023] [Accepted: 06/26/2023] [Indexed: 07/06/2023]
Abstract
INTRODUCTION Quantifying a significant cognitive change on a neuropsychological battery is essential to assess patients' decline or recovery and offer appropriate care. The reliability of change indices is particularly important in multiple sclerosis (MS), as the course of cognitive impairment is quite unpredictable, due at least in part to substantial interindividual variability. The main objective of this study was to compare six different methods for assessing cognitive change in an MS sample: the SD method, two reliable change indices, two standardized regression-based methods (SRB), and the generalized regression-based method (GSRB). METHOD One hundred and twenty-three patients with clinically definite MS and 89 healthy controls underwent a battery of standardized neuropsychological tests assessing cognitive functions that are frequently affected in this disease (i.e., verbal episodic memory, working memory, processing speed and verbal fluency). RESULTS We observed fairly similar proportions of improvement, decline or stability in the control group whatever the method. By contrast, in the MS sample, regression-based methods with one predictor (i.e., score at T1) and four predictors (i.e., score at T1 and demographic factors: age, sex, education level) detected a significant worsening more often than the reliable change indices while the GSRB method was more consistent with the RCI methods in tasks associated with ceiling effects. CONCLUSIONS The interpretation of a patient's cognitive changes depends on which method is used. The (G)SRB methods appear to be relevant indicators for assessing cognitive change in MS. The addition of demographic factors does not seem to play an important role in the prediction of significant worsening in the MS sample, regardless of cognitive domain. For clinicians, an easy-to-use free shiny app is provided.
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Affiliation(s)
- Audrey Henry
- Université de Reims Champagne-Ardenne, Laboratoire Cognition, Santé et Société (C2S), Reims, France
- Department of Psychiatry, Reims University Hospital, EPSMM, Reims, France
| | - Nicolas Stefaniak
- Université de Reims Champagne-Ardenne, Laboratoire Cognition, Santé et Société (C2S), Reims, France
| | - Franca Schmid
- Université de Reims Champagne-Ardenne, Laboratoire Cognition, Santé et Société (C2S), Reims, France
| | - Arnaud Kwiatkowski
- Faculté des Sciences Humaines et Sociales (Institut Catholique de Lille), Groupement des hôpitaux de l'Institut Catholique de Lille - Service de Neurologie - Hôpital St Vincent de Paul, Lille, France
| | - Patrick Hautecoeur
- Faculté des Sciences Humaines et Sociales (Institut Catholique de Lille), Groupement des hôpitaux de l'Institut Catholique de Lille - Service de Neurologie - Hôpital St Vincent de Paul, Lille, France
| | - Bruno Lenne
- Faculté des Sciences Humaines et Sociales (Institut Catholique de Lille), Groupement des hôpitaux de l'Institut Catholique de Lille - Service de Neurologie - Hôpital St Vincent de Paul, Lille, France
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Pless S, Woelfle T, Naegelin Y, Lorscheider J, Wiencierz A, Reyes Ó, Calabrese P, Kappos L. Assessment of cognitive performance in multiple sclerosis using smartphone-based training games: a feasibility study. J Neurol 2023:10.1007/s00415-023-11671-9. [PMID: 36952010 DOI: 10.1007/s00415-023-11671-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 03/14/2023] [Accepted: 03/15/2023] [Indexed: 03/24/2023]
Abstract
BACKGROUND Cognitive impairment occurs in up to 70% of people with MS (pwMS) and has a large impact on quality of life and working capacity. As part of the development of a smartphone-app (dreaMS) for monitoring MS disease activity and progression, we assessed the feasibility and acceptance of using cognitive games as assessment tools for cognitive domains. METHODS We integrated ten cognitive games in the dreaMS app. Participants were asked to play these games twice a week for 5 weeks. All subjects underwent a battery of established neuropsychological tests. User feedback on acceptance was obtained via a five-point Likert-scale questionnaire. We correlated game performance measures with predetermined reference tests (Spearman's rho) and analyzed differences between pwMS and Healthy Controls (rank biserial correlation). RESULTS We included 31 pwMS (mean age 43.4 ± 12.0 years; 68% females; median Expanded Disability Status Scale score 3.0, range 1.0-6.0) and 31 age- and sex-matched HC. All but one game showed moderate-strong correlations with their reference tests, (|rs|= 0.34-0.77). Performance improved in both groups over the 5 weeks. Average ratings for overall impression and meaningfulness were 4.6 (range 4.2-4.9) and 4.7 (range 4.5-4.8), respectively. CONCLUSION Moderate-strong correlations with reference tests suggest that adaptive cognitive games may be used as measures of cognitive domains. The practice effects observed suggest that game-derived measures may capture change over time. All games were perceived as enjoyable and meaningful, features crucial for long-term adherence. Our results encourage further validation of adaptive cognitive games as monitoring tools for cognition in larger studies of longer duration. STUDY REGISTER ClinicalTrials.gov: NCT04413032.
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Affiliation(s)
- Silvan Pless
- Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel, University of Basel, Spitalstrasse 2, 4031, Basel, Switzerland
- Neuropsychology and Behavioral Neurology Unit, Department of Psychology and Interdisciplinary Platform Psychiatry and Psychology, Division of Molecular and Cognitive Neuroscience, University of Basel, Basel, Switzerland
| | - Tim Woelfle
- Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel, University of Basel, Spitalstrasse 2, 4031, Basel, Switzerland
- Department of Neurology, University Hospital Basel, Basel, Switzerland
| | - Yvonne Naegelin
- Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel, University of Basel, Spitalstrasse 2, 4031, Basel, Switzerland
- Department of Neurology, University Hospital Basel, Basel, Switzerland
| | - Johannes Lorscheider
- Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel, University of Basel, Spitalstrasse 2, 4031, Basel, Switzerland
- Department of Neurology, University Hospital Basel, Basel, Switzerland
| | - Andrea Wiencierz
- Clinical Trial Unit, University Hospital Basel, Basel, Switzerland
| | | | - Pasquale Calabrese
- Neuropsychology and Behavioral Neurology Unit, Department of Psychology and Interdisciplinary Platform Psychiatry and Psychology, Division of Molecular and Cognitive Neuroscience, University of Basel, Basel, Switzerland
| | - Ludwig Kappos
- Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel, University of Basel, Spitalstrasse 2, 4031, Basel, Switzerland.
- Department of Neurology, University Hospital Basel, Basel, Switzerland.
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Ashtiani SNM, Behnam H, Daliri MR. Diagnosis of Multiple Sclerosis Using Graph-Theoretic Measures of Cognitive-Task-Based Functional Connectivity Networks. IEEE Trans Cogn Dev Syst 2022. [DOI: 10.1109/tcds.2021.3081605] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Seyedeh Naghmeh Miri Ashtiani
- Biomedical Engineering Department, School of Electrical Engineering, Iran University of Science and Technology, Tehran, Iran
| | - Hamid Behnam
- Biomedical Engineering Department, School of Electrical Engineering, Iran University of Science and Technology, Tehran, Iran
| | - Mohammad Reza Daliri
- Biomedical Engineering Department, School of Electrical Engineering, Iran University of Science and Technology, Tehran, Iran
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Incontri-Abraham D, Esparza-Salazar FJ, Ibarra A. Copolymer-1 as a potential therapy for mild cognitive impairment. Brain Cogn 2022; 162:105892. [PMID: 35841771 DOI: 10.1016/j.bandc.2022.105892] [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: 04/22/2022] [Accepted: 06/28/2022] [Indexed: 11/25/2022]
Abstract
Mild cognitive impairment (MCI) is a prodromal stage of memory impairment that may precede dementia. MCI is classified by the presence or absence of memory impairment into amnestic or non-amnestic MCI, respectively. More than 90% of patients with amnestic MCI who progress towards dementia meet criteria for Alzheimer's disease (AD). A combination of mechanisms promotes MCI, including intracellular neurofibrillary tangle formation, extracellular amyloid deposition, oxidative stress, neuronal loss, synaptodegeneration, cholinergic dysfunction, cerebrovascular disease, and neuroinflammation. However, emerging evidence indicates that neuroinflammation plays an important role in the pathogenesis of cognitive impairment. Unfortunately, there are currently no Food and Drug Administration (FDA)-approved drugs for MCI. Copolymer-1 (Cop-1), also known as glatiramer acetate, is a synthetic polypeptide of four amino acids approved by the FDA for the treatment of relapsing-remitting multiple sclerosis. Cop-1 therapeutic effect is attributed to immunomodulation, promoting a switch from proinflammatory to anti-inflammatory phenotype. In addition to its anti-inflammatory properties, it stimulates brain-derived neurotrophic factor (BDNF) secretion, a neurotrophin involved in neurogenesis and the generation of hippocampal long-term potentials. Moreover, BDNF levels are significantly decreased in patients with cognitive impairment. Therefore, Cop-1 immunization might promote synaptic plasticity and memory consolidation by increasing BDNF production in patients with MCI.
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Affiliation(s)
- Diego Incontri-Abraham
- Centro de Investigación en Ciencias de la Salud (CICSA), FCS, Universidad Anáhuac México Campus Norte, Av. Universidad Anáhuac No. 46, Col. Lomas Anáhuac, Huixquilucan, CP 52786, Edo. de México, Mexico
| | - Felipe J Esparza-Salazar
- Centro de Investigación en Ciencias de la Salud (CICSA), FCS, Universidad Anáhuac México Campus Norte, Av. Universidad Anáhuac No. 46, Col. Lomas Anáhuac, Huixquilucan, CP 52786, Edo. de México, Mexico
| | - Antonio Ibarra
- Centro de Investigación en Ciencias de la Salud (CICSA), FCS, Universidad Anáhuac México Campus Norte, Av. Universidad Anáhuac No. 46, Col. Lomas Anáhuac, Huixquilucan, CP 52786, Edo. de México, Mexico.
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Gaughan M, Monaghan R, O'Connell K, McNicholas N, Yap SM, Tubridy N, O'Keeffe F, McGuigan C. Five-year follow up of the original Irish BICAMS validation cohort. Mult Scler Relat Disord 2021; 56:103257. [PMID: 34619486 DOI: 10.1016/j.msard.2021.103257] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 08/23/2021] [Accepted: 09/05/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Cognitive impairment is common in multiple sclerosis at all stages of the condition. The natural history of cognition in multiple sclerosis has been considered to be deterioration of cognitive functioning over time. The development of the Brief International Cognitive Assessment for Multiple Sclerosis(BICAMS) has allowed standardization of a screening tool for cognitive impairment which can be easily performed in the neurology clinic. Cross-sectional and validation studies using BICAMS have been widely reported, however minimal longitudinal assessment of cognition using BICAMS has taken place to date. OBJECTIVES The objective of this study was to evaluate the prevalence of cognitive impairment at a five-year interval in participants of an original BICAMS validation study. We will also evaluate change of the BICAMS subtests over time. MATERIALS AND METHODS Participants of the original BICAMS validation study were invited to participate in the study. Demographic and clinical details were collected. BICAMS subtests, anxiety, depression and fatigue questionnaires were completed. RESULTS Fifty out of the original 67 participants completed BICAMS five years post original assessment. The prevalence of cognitive impairment in this cohort with a mean age of 49 and a median EDSS of 2.5 (EDSS of 2.0 at initial BICAMS testing) remained stable five years following initial BICAMS screening assessment, X2(1)=0.36, p=.548. There was no significant difference in SDMT scores between 2014 and 2019 t(48) = 1.08, p=.15. There was an improvement in CVLT-II, t(49)=-3.03; p=.004 and BVMT-R, t(49)=-3.38; p=.001. CONCLUSIONS This study demonstrates overall stability in the prevalence of cognitive impairment as assessed by the BICAMS. The interval of five years between assessment reduces the possibility of practice effects, although familiarity with the testing protocol may exert an influence.
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Affiliation(s)
- Maria Gaughan
- Department of Neurology, St Vincent's University Hospital, Dublin 4, Ireland; School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland.
| | - Ruth Monaghan
- Department of Neuropsychology, St Vincent's University Hospital, Dublin 4, Ireland
| | - Karen O'Connell
- Department of Neurology, St Vincent's University Hospital, Dublin 4, Ireland
| | - Nonnie McNicholas
- Department of Neurology, St Vincent's University Hospital, Dublin 4, Ireland
| | - Siew Mei Yap
- Department of Neurology, St Vincent's University Hospital, Dublin 4, Ireland; School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland
| | - Niall Tubridy
- Department of Neurology, St Vincent's University Hospital, Dublin 4, Ireland; School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland
| | - Fiadhnait O'Keeffe
- Department of Neuropsychology, St Vincent's University Hospital, Dublin 4, Ireland
| | - Christopher McGuigan
- Department of Neurology, St Vincent's University Hospital, Dublin 4, Ireland; School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland
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12
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Jandric D, Doshi A, Scott R, Paling D, Rog D, Chataway J, Schoonheim M, Parker G, Muhlert N. A systematic review of resting state functional MRI connectivity changes and cognitive impairment in multiple sclerosis. Brain Connect 2021; 12:112-133. [PMID: 34382408 DOI: 10.1089/brain.2021.0104] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Cognitive impairment in multiple sclerosis (MS) is increasingly being investigated with resting state functional MRI (rs-fMRI) functional connectivity (FC) . However, results remain difficult to interpret, showing both high and low FC associated with cognitive impairment. We conducted a systematic review of rs-fMRI studies in MS to understand whether the direction of FC change relates to cognitive dysfunction, and how this may be influenced by the choice of methodology. METHODS Embase, Medline and PsycINFO were searched for studies assessing cognitive function and rs-fMRI FC in adults with MS. RESULTS Fifty-seven studies were included in a narrative synthesis. Of these, 50 found an association between cognitive impairment and FC abnormalities. Worse cognition was linked to high FC in 18 studies, and to low FC in 17 studies. Nine studies found patterns of both high and low FC related to poor cognitive performance, in different regions or for different MR metrics. There was no clear link to increased FC during early stages of MS and reduced FC in later stages, as predicted by common models of MS pathology. Throughout, we found substantial heterogeneity in study methodology, and carefully consider how this may impact on the observed findings. DISCUSSION These results indicate an urgent need for greater standardisation in the field - in terms of the choice of MRI analysis and the definition of cognitive impairment. This will allow us to use rs-fMRI FC as a biomarker in future clinical studies, and as a tool to understand mechanisms underpinning cognitive symptoms in MS.
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Affiliation(s)
- Danka Jandric
- The University of Manchester, 5292, Oxford Road, Manchester, United Kingdom of Great Britain and Northern Ireland, M13 9PL;
| | - Anisha Doshi
- University College London, 4919, London, London, United Kingdom of Great Britain and Northern Ireland;
| | - Richelle Scott
- The University of Manchester, 5292, Manchester, United Kingdom of Great Britain and Northern Ireland;
| | - David Paling
- Royal Hallamshire Hospital, 105629, Sheffield, Sheffield, United Kingdom of Great Britain and Northern Ireland;
| | - David Rog
- Salford Royal Hospital, 105621, Salford, Salford, United Kingdom of Great Britain and Northern Ireland;
| | - Jeremy Chataway
- University College London, 4919, London, London, United Kingdom of Great Britain and Northern Ireland;
| | - Menno Schoonheim
- Amsterdam UMC Locatie VUmc, 1209, Anatomy & Neurosciences, Amsterdam, Noord-Holland, Netherlands;
| | - Geoff Parker
- University College London, 4919, London, London, United Kingdom of Great Britain and Northern Ireland.,The University of Manchester, 5292, Manchester, United Kingdom of Great Britain and Northern Ireland;
| | - Nils Muhlert
- The University of Manchester, 5292, Manchester, United Kingdom of Great Britain and Northern Ireland;
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13
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Association between symbol digit modalities test and regional cortex thickness in young adults with relapsing-remitting multiple sclerosis. Clin Neurol Neurosurg 2021; 207:106805. [PMID: 34280674 DOI: 10.1016/j.clineuro.2021.106805] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 06/24/2021] [Accepted: 06/25/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Multiple sclerosis (MS) is a demyelinating disease of the central nervous system, predominating within young adults. Cognitive disorders are common in MS and have are associated with several Magnetic Resonance Imaging (MRI) markers, especially brain atrophy. Many have found the symbol digit modalities test (SDMT) to be the most sensitive individual cognitive measure relevant to MS. However, the relationship between SDMT and regional brain cortex thickness in young adults with relapsing-remitting multiple sclerosis (YA-RRMS) has been little explored. The purpose of this study was to investigate the association between the SDMT and regional cortex thickness in YA-RRMS by FreeSurfer, which is an automatic brain structure segmentation method. METHOD Twenty-eight YA-RRMS patients (18-35 years old) were enrolled in the present study. Informed consent and information including gender, age, disease duration, number of relapses, annual relapse rate was collected from all patients. Clinical cognitive evaluations (SDMT and auditory verbal learning test (AVLT)) and daily performance: activities of daily living (ADL) were assessed in the present study. MRI scans were performed at the Institute of Neurosurgery of Tiantan Hospital. Twenty-eight matched healthy controls (HC) MRI data were obtained from Tiantan Hospital database. Data on thirty-four points of bilateral cortical structure thickness using statistically defined brain regions-of-interest from FreeSurfer were obtained from all participants. RESULTS Patients with RRMS exhibited extensively thinner cerebellar cortex compared with HC. SDMT scores were significantly correlated with AVLT subentries (IM, immediate memory; DRM, delayed recall memory; LTRM, long-term recognition memory) in YA-RRMS patients (P < 0.05). SDMT was strongly correlated with regional cortex thickness differences of the right temporal pole (r = 0.68) and bilateral parahippocampal areas (right r = 0.62; left r = 0.60), and moderately correlated with regional cortex thickness differences including the left superior temporal and right insula (r = 0.57 and 0.56, respectively) in YA-RRMS patients. CONCLUSION The present study has shown the SDMT is strongly correlated with selected cortex regions including the bilateral parahippocampal area and the right temporal pole which are involved in geometric structures processing.
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14
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Gromisch ES, Turner AP, Haselkorn JK, Lo AC, Agresta T. Mobile health (mHealth) usage, barriers, and technological considerations in persons with multiple sclerosis: a literature review. JAMIA Open 2021; 4:ooaa067. [PMID: 34514349 PMCID: PMC8423420 DOI: 10.1093/jamiaopen/ooaa067] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 10/01/2020] [Accepted: 11/18/2020] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES Persons with multiple sclerosis (MS) can face a number of potential healthcare-related barriers, for which mobile health (mHealth) technology can be potentially beneficial. This review aimed to understand the frequency, current uses, and potential barriers with mHealth usage among persons with MS. METHODS A query string was used to identify articles on PubMed, MEDLINE, CINAHL, and IEEE Xplore that were published in English between January 2010 and December 2019. Abstracts were reviewed and selected based on a priori inclusion and exclusion criteria. Fifty-nine peer-reviewed research studies related to the study questions are summarized. RESULTS The majority of persons with MS were reported as using smartphones, although rates of mHealth utilization varied widely. mHealth usage was grouped into 3 broad categories: (1) disability and symptom measurement; (2) interventions and symptom management; and (3) tracking and promoting adherence. While there have been an increasing number of mHealth options, certain limitations associated with MS (eg, poor dexterity, memory problems) may affect usage, although including persons with MS in the design process can address some of these issues. DISCUSSION Given the increased attention to mHealth in this population and the current need for telehealth and at home devices, it is important that persons with MS and healthcare providers are involved in the development of new mHealth tools to ensure that the end product meets their needs. Considerations for addressing the potential mHealth use barriers in persons with MS are discussed.
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Affiliation(s)
- Elizabeth S Gromisch
- Mandell Center for Multiple Sclerosis, Mount Sinai Rehabilitation Hospital, Trinity Health Of New England, Hartford, Connecticut, USA
- Department of Rehabilitative Medicine, Frank H. Netter MD School of Medicine at Quinnipiac University, North Haven, Connecticut, USA
- Department of Medical Sciences, Frank H. Netter MD School of Medicine at Quinnipiac University, North Haven, Connecticut, USA
- Department of Neurology, University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Aaron P Turner
- Multiple Sclerosis Center for Excellence West, Veterans Affairs, Seattle, Washington, USA
- Rehabilitation Care Service, VA Puget Sound Health Care System, Seattle, Washington, USA
- Department of Rehabilitative Medicine, University of Washington, Seattle, Washington, USA
| | - Jodie K Haselkorn
- Multiple Sclerosis Center for Excellence West, Veterans Affairs, Seattle, Washington, USA
- Rehabilitation Care Service, VA Puget Sound Health Care System, Seattle, Washington, USA
- Department of Rehabilitative Medicine, University of Washington, Seattle, Washington, USA
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Albert C Lo
- Mandell Center for Multiple Sclerosis, Mount Sinai Rehabilitation Hospital, Trinity Health Of New England, Hartford, Connecticut, USA
| | - Thomas Agresta
- Department of Family Medicine, University of Connecticut Health Center, Farmington, Connecticut, USA
- Center for Quantitative Medicine, University of Connecticut Health Center, Farmington, Connecticut, USA
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15
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Doskas T, Vavougios GD, Karampetsou P, Kormas C, Synadinakis E, Stavrogianni K, Sionidou P, Serdari A, Vorvolakos T, Iliopoulos I, Vadikolias Κ. Neurocognitive impairment and social cognition in multiple sclerosis. Int J Neurosci 2021; 132:1229-1244. [PMID: 33527857 DOI: 10.1080/00207454.2021.1879066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE/AIM OF THE STUDY The impairment of neurocognitive functions occurs in all subtypes of multiple sclerosis, even from the earliest stages of the disease. Commonly reported manifestations of cognitive impairment include deficits in attention, conceptual reasoning, processing efficiency, information processing speed, memory (episodic and working), verbal fluency (language), and executive functions. Multiple sclerosis patients also suffer from social cognition impairment, which affects their social functioning. The objective of the current paper is to assess the effect of neurocognitive impairment and its potential correlation with social cognition performance and impairment in multiple sclerosis patients. MATERIALS AND METHODS An overview of the available-to-date literature on neurocognitive impairment and social cognition performance in multiple sclerosis patients by disease subtype was performed. RESULTS It is not clear if social cognition impairment occurs independently or secondarily to neurocognitive impairment. There are associations of variable strengths between neurocognitive and social cognition deficits and their neural basis is increasingly investigated. CONCLUSIONS The prompt detection of neurocognitive predictors of social cognition impairment that may be applicable to all multiple sclerosis subtypes and intervention are crucial to prevent further neural and social cognition decline in multiple sclerosis patients.
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Affiliation(s)
- Triantafyllos Doskas
- Department of Neurology, Athens Naval Hospital, Athens, Greece.,Department of Neurology, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | | | | | | | | | | | | | - Aspasia Serdari
- Department of Psychiatry, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Theofanis Vorvolakos
- Department of Psychiatry, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Ioannis Iliopoulos
- Department of Neurology, University Hospital of Alexandroupolis, Alexandroupolis, Greece
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16
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Bagnato F, Gauthier SA, Laule C, Moore GRW, Bove R, Cai Z, Cohen-Adad J, Harrison DM, Klawiter EC, Morrow SA, Öz G, Rooney WD, Smith SA, Calabresi PA, Henry RG, Oh J, Ontaneda D, Pelletier D, Reich DS, Shinohara RT, Sicotte NL. Imaging Mechanisms of Disease Progression in Multiple Sclerosis: Beyond Brain Atrophy. J Neuroimaging 2021; 30:251-266. [PMID: 32418324 DOI: 10.1111/jon.12700] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 02/04/2020] [Accepted: 02/18/2020] [Indexed: 12/11/2022] Open
Abstract
Clinicians involved with different aspects of the care of persons with multiple sclerosis (MS) and scientists with expertise on clinical and imaging techniques convened in Dallas, TX, USA on February 27, 2019 at a North American Imaging in Multiple Sclerosis Cooperative workshop meeting. The aim of the workshop was to discuss cardinal pathobiological mechanisms implicated in the progression of MS and novel imaging techniques, beyond brain atrophy, to unravel these pathologies. Indeed, although brain volume assessment demonstrates changes linked to disease progression, identifying the biological mechanisms leading up to that volume loss are key for understanding disease mechanisms. To this end, the workshop focused on the application of advanced magnetic resonance imaging (MRI) and positron emission tomography (PET) imaging techniques to assess and measure disease progression in both the brain and the spinal cord. Clinical translation of quantitative MRI was recognized as of vital importance, although the need to maintain a relatively short acquisition time mandated by most radiology departments remains the major obstacle toward this effort. Regarding PET, the panel agreed upon its utility to identify ongoing pathological processes. However, due to costs, required expertise, and the use of ionizing radiation, PET was not considered to be a viable option for ongoing care of persons with MS. Collaborative efforts fostering robust study designs and imaging technique standardization across scanners and centers are needed to unravel disease mechanisms leading to progression and discovering medications halting neurodegeneration and/or promoting repair.
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Affiliation(s)
- Francesca Bagnato
- Neuroimaging Unit, Neuroimmunology Division, Department of Neurology, Vanderbilt University Medical Center, Nashville, TN
| | - Susan A Gauthier
- Judith Jaffe Multiple Sclerosis Center, Department of Neurology, Feil Family Brain and Mind Institute, and Department of Radiology, Weill Cornell Medicine, New York, NY
| | - Cornelia Laule
- Department of Radiology, Pathology, and Laboratory Medicine, Department of Physics and Astronomy, and International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, British Columbia, Canada
| | - George R Wayne Moore
- Department of Pathology and Laboratory Medicine, and International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, British Columbia, Canada
| | - Riley Bove
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, CA
| | - Zhengxin Cai
- Department of Radiology and Biomedical Imaging, PET Center, Yale University, New Haven, CT
| | - Julien Cohen-Adad
- NeuroPoly Lab, Institute of Biomedical Engineering, Polytechnique Montreal and Functional Neuroimaging Unit, CRIUGM, University of Montreal, Montreal, Quebec, Canada
| | - Daniel M Harrison
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD
| | - Eric C Klawiter
- Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Sarah A Morrow
- Department of Clinical Neurological Sciences, University of Western Ontario, London, Ontario, Canada
| | - Gülin Öz
- Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, MN
| | - William D Rooney
- Advanced Imaging Research Center, Departments of Biomedical Engineering, Neurology, and Behavioral Neuroscience, Oregon Health & Science University, Portland, OR
| | - Seth A Smith
- Radiology and Radiological Sciences and Vanderbilt University Imaging Institute, Vanderbilt University Medical Center, and Biomedical Engineering, Vanderbilt University, Nashville, TN
| | - Peter A Calabresi
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Roland G Henry
- Departments of Neurology, Radiology and Biomedical Imaging, and the UC San Francisco & Berkeley Bioengineering Graduate Group, University of California San Francisco, San Francisco, CA
| | - Jiwon Oh
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD.,Division of Neurology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Daniel Ontaneda
- Mellen Center for Multiple Sclerosis, Neurological Institute, Cleveland Clinic, Cleveland, OH
| | - Daniel Pelletier
- Department of Neurology, University of Southern California Keck School of Medicine, Los Angeles, CA
| | - Daniel S Reich
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, Bethesda, MD
| | - Russell T Shinohara
- Department of Biostatistics, Epidemiology, and Informatics, Penn Statistics in Imaging and Visualization Center, University of Pennsylvania, Philadelphia, PA
| | - Nancy L Sicotte
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA
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- Neuroimaging Unit, Neuroimmunology Division, Department of Neurology, Vanderbilt University Medical Center, Nashville, TN
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17
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Gromisch ES, Kulas JF, Altalib H, Kerns RD, Mattocks KM, Brandt CA, Haskell S. Neuropsychological assessments and psychotherapeutic services in Veterans with multiple sclerosis: Rates of utilization and their associations with socio-demographics and clinical characteristics using Veterans Health Administration-based data. Mult Scler Relat Disord 2020; 43:102220. [PMID: 32480347 DOI: 10.1016/j.msard.2020.102220] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 04/08/2020] [Accepted: 05/19/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND As cognitive, emotional, and health-related behavioral issues are prevalent among persons with multiple sclerosis (MS), mental health services are a valuable component of comprehensive care. However, it is unknown how many participate in neuropsychological and psychotherapeutic services, and whether the presence of certain co-occurring conditions increase service use. This study aimed to examine the frequency and associated factors (e.g., age, gender, education, race/ethnicity, and co-occurring conditions) of neuropsychological and psychotherapeutic service utilization in the Veterans Health Administration (VHA) among Veterans with MS. METHODS Data were extracted from VHA Corporate Data Warehouse as part of the Women Veterans Cohort Study (WVCS), a longitudinal project with Veterans who served during the Iraq and Afghanistan conflicts. Participants (n = 1,686) were Veterans from the overall WVCS dataset who had three or more VHA MS-related encounters (inpatient, outpatient, and/or disease modifying therapy) within one calendar year between fiscal years 2010 and 2015. Neuropsychological assessment participation was identified by procedural codes 96118 and 96119, while psychotherapeutic services were defined using 90804, 90806, 90808, 96150, 96151, and 96152. Bivariate analyses were conducted to identify socio-demographics and clinical characteristics that differed between Veterans who did and did not use these services. Service dates were compared to the diagnosis dates of the co-occurring conditions to determine whether the majority of the diagnoses preceded the service (e.g., a recognized problem) or were coded the day of or after the initial appointment (e.g., a suspected problem), which informed what co-occurring conditions and participants were included in the subsequent logistic regressions. RESULTS Two hundred eighty-one Veterans (16.67%) participated in a neuropsychological assessment. Veterans who had an evaluation had higher rates of several co-occurring conditions (ps <0.01), though no significant relationships emerged with any of the socio-demographic variables and participation. After controlling for age, gender, education, and race/ethnicity, two previously diagnosed co-occurring conditions predicted service utilization: traumatic brain injuries (TBIs; OR: 2.33, 95% CI: 1.60, 3.35) and mood disorders (i.e., depressive and bipolar disorders; OR: 1.71, 95% CI: 1.26, 2.31). Psychotherapeutic service usage was more common, occurring in over 45% (n = 771) of the sample. Service utilization was associated with several co-occurring conditions (ps <0.001), as well as level of education (p = .003). Focusing on participants who were diagnosed the day of or after the initial encounter, five co-occurring conditions were predictors of psychotherapeutic service use: mood disorders (OR: 1.81, 95% CI: 1.34, 2.46), anxiety disorders (OR: 1.38, 95% CI: 1.03, 1.85), sleep disorders (OR: 1.55, 95% CI: 1.19, 2.01), alcohol-related disorders (OR: 3.29, 95% CI: 1.79, 6.21), and cognitive disorders (OR: 3.72, 95% CI: 2.29, 6.16). CONCLUSIONS These findings suggest that these services are being utilized by clinicians and Veterans to address the clinical complexity related to having MS and one or more of these other conditions.
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Affiliation(s)
- Elizabeth S Gromisch
- Mandell Center for Multiple Sclerosis, Mount Sinai Rehabilitation Hospital, Trinity Health Of New England, 490 Blue Hills Avenue, Hartford, CT, 06112, USA; VA Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT, 06516, USA; University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT, 06030, USA; Frank H. Netter School of Medicine at Quinnipiac University, 370 Bassett Road, North Haven, CT, 06473, USA.
| | - Joseph F Kulas
- VA Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT, 06516, USA; Yale University School of Medicine, 333 Cedar Street, New Haven, CT, 06510, USA
| | - Hamada Altalib
- VA Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT, 06516, USA; Yale University School of Medicine, 333 Cedar Street, New Haven, CT, 06510, USA
| | - Robert D Kerns
- VA Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT, 06516, USA; Yale University School of Medicine, 333 Cedar Street, New Haven, CT, 06510, USA; Pain Research, Informatics, Multimorbidities and Education (PRIME) Center, VA Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT, 06516, USA
| | - Kristin M Mattocks
- VA Central Western Massachusetts Healthcare System, 421 North Main Street, Leeds, MA, 01053, USA; University of Massachusetts Medical School, 55 N Lake Avenue, Worcester, MA, 01655, USA
| | - Cynthia A Brandt
- VA Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT, 06516, USA; Yale University School of Medicine, 333 Cedar Street, New Haven, CT, 06510, USA; Pain Research, Informatics, Multimorbidities and Education (PRIME) Center, VA Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT, 06516, USA
| | - Sally Haskell
- VA Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT, 06516, USA; Yale University School of Medicine, 333 Cedar Street, New Haven, CT, 06510, USA; Pain Research, Informatics, Multimorbidities and Education (PRIME) Center, VA Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT, 06516, USA
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Renner A, Baetge SJ, Filser M, Ullrich S, Lassek C, Penner I. Characterizing cognitive deficits and potential predictors in multiple sclerosis: A large nationwide study applying Brief International Cognitive Assessment for Multiple Sclerosis in standard clinical care. J Neuropsychol 2020; 14:347-369. [DOI: 10.1111/jnp.12202] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 01/10/2020] [Indexed: 01/21/2023]
Affiliation(s)
- Alina Renner
- Cogito Center for Applied Neurocognition and Neuropsychological Research Düsseldorf Germany
| | - Sharon J. Baetge
- Cogito Center for Applied Neurocognition and Neuropsychological Research Düsseldorf Germany
| | - Melanie Filser
- Cogito Center for Applied Neurocognition and Neuropsychological Research Düsseldorf Germany
| | | | | | - Iris‐Katharina Penner
- Cogito Center for Applied Neurocognition and Neuropsychological Research Düsseldorf Germany
- Department of Neurology Medical Faculty Heinrich‐Heine University Düsseldorf Düsseldorf Germany
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19
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Katsari M, Kasselimis DS, Giogkaraki E, Breza M, Evangelopoulos ME, Anagnostouli M, Andreadou E, Kilidireas C, Hotary A, Zalonis I, Koutsis G, Potagas C. A longitudinal study of cognitive function in multiple sclerosis: is decline inevitable? J Neurol 2020; 267:1464-1475. [PMID: 32008073 DOI: 10.1007/s00415-020-09720-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Revised: 01/15/2020] [Accepted: 01/20/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Marina Katsari
- 1st Department of Neurology, Eginition Hospital, National and Kapodistrian University of Athens, 74 Vas. Sofias Av., 11528, Athens, Greece
| | - Dimitrios S Kasselimis
- 1st Department of Neurology, Eginition Hospital, National and Kapodistrian University of Athens, 74 Vas. Sofias Av., 11528, Athens, Greece.
- Department of Psychiatry, School of Medicine, University of Crete, Heraklion, Greece.
| | - Erasmia Giogkaraki
- 1st Department of Neurology, Eginition Hospital, National and Kapodistrian University of Athens, 74 Vas. Sofias Av., 11528, Athens, Greece
| | - Marianthi Breza
- 1st Department of Neurology, Eginition Hospital, National and Kapodistrian University of Athens, 74 Vas. Sofias Av., 11528, Athens, Greece
| | - Maria-Eleftheria Evangelopoulos
- 1st Department of Neurology, Eginition Hospital, National and Kapodistrian University of Athens, 74 Vas. Sofias Av., 11528, Athens, Greece
| | - Maria Anagnostouli
- 1st Department of Neurology, Eginition Hospital, National and Kapodistrian University of Athens, 74 Vas. Sofias Av., 11528, Athens, Greece
| | - Elisabeth Andreadou
- 1st Department of Neurology, Eginition Hospital, National and Kapodistrian University of Athens, 74 Vas. Sofias Av., 11528, Athens, Greece
| | - Costas Kilidireas
- 1st Department of Neurology, Eginition Hospital, National and Kapodistrian University of Athens, 74 Vas. Sofias Av., 11528, Athens, Greece
| | - Alia Hotary
- School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis Zalonis
- 1st Department of Neurology, Eginition Hospital, National and Kapodistrian University of Athens, 74 Vas. Sofias Av., 11528, Athens, Greece
| | - Georgios Koutsis
- 1st Department of Neurology, Eginition Hospital, National and Kapodistrian University of Athens, 74 Vas. Sofias Av., 11528, Athens, Greece
| | - Constantin Potagas
- 1st Department of Neurology, Eginition Hospital, National and Kapodistrian University of Athens, 74 Vas. Sofias Av., 11528, Athens, Greece
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20
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Walker LAS, Gardner C, Freedman MS, MacLean H, Rush C, Bowman M. Research-to-Practice Gaps in Multiple Sclerosis Care for Patients with Subjective Cognitive, Mental Health, and Psychosocial Concerns in a Canadian Center. Int J MS Care 2020; 21:243-248. [PMID: 31889928 DOI: 10.7224/1537-2073.2017-090] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background People with multiple sclerosis (MS) are at increased risk for cognitive impairment, mental health concerns, and psychosocial issues, which can negatively affect disease outcomes and quality of life. Current MS care guidelines recommend integrated interdisciplinary services to address these concerns; however, issues can be overlooked during routine care. To date, there is inadequate research on how often these issues are identified and addressed during routine MS care. Methods One hundred medical records were randomly selected and reviewed (55 relapsing-remitting MS, 17 secondary progressive MS, 8 primary progressive MS, and 20 other or subtype not indicated). All visits to, and contacts with (ie, telephone, e-mail), an MS clinic over 1 year were included in the analysis to determine the proportion of patients presenting with cognitive, mental health, and psychosocial concerns and the proportion of patients offered associated services. Results Of the 25 patients with at least one identified concern, treatment recommendations occurred for 13 (52%). Rates of identification of cognitive, mental health, and psychosocial concerns in standard clinical practice were significantly lower than the identified prevalence in epidemiologic studies. Demographic factors had no bearing on who was offered treatment. Patients with concerns access MS clinic services more often than those without. Conclusions Discrepancies between reported and expected frequencies may be due to overreliance on patient self-disclosure and concerns by the health care team that inadequate resources are available to address issues. An interdisciplinary team model may help address these issues.
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Can semantic fluency be used as an alternative or additional measure in the abbreviated Minimal Assessment of Cognitive Function in Multiple Sclerosis (aMACFIMS)? J Neurol Sci 2019; 410:116640. [PMID: 31884353 DOI: 10.1016/j.jns.2019.116640] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 12/17/2019] [Accepted: 12/18/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND The abbreviated Minimal Assessment of Cognitive Function in Multiple Sclerosis (aMACFIMS) was designed using four shortened measures from the MACFIMS. Semantic fluency was suggested as an alternative task; however, its equivalency as part of this battery has yet to be examined. OBJECTIVES 1) To determine the optimal semantic fluency raw score cut-offs; 2) compare the modified aMACFIMS (with semantic fluency) to the standard aMACFIMS (with phonemic fluency); and 3) compare the expanded aMACFIMS (with both verbal fluency measures) to the Brief International Cognitive Assessment in MS (BICAMS). METHODS Receiver-operating-characteristic curves were used to identify the optimal cut-off at -1.5 and - 2.0 standard deviation (SD) impairment criteria (n = 335). The diagnostic accuracies were compared between the different versions of the aMACFIMS and BICAMS (n = 146). RESULTS The raw score cut-offs for semantic fluency (13 and 11 words) had high sensitivity (100%) and specificity (96.6% - 98.6%). The modified aMACFIMS did not significantly differ from the standard aMACFIMS. The expanded aMACFIMS had stronger specificity (84.8%) and positive predictive value (85.9%) than the BICAMS. CONCLUSIONS Semantic fluency can be used as an alternative, though including both measures results in the most effective aMACFIMS version. Using semantic fluency may be especially valuable when evaluating older PwMS.
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22
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Bass AD, Van Wijmeersch B, Mayer L, Mäurer M, Boster A, Mandel M, Mitchell C, Sharrock K, Singer B. Effect of Multiple Sclerosis on Daily Activities, Emotional Well-being, and Relationships: The Global vsMS Survey. Int J MS Care 2019; 22:158-164. [PMID: 32863783 DOI: 10.7224/1537-2073.2018-087] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background The vsMS survey was conducted to better understand the negative effects of fatigue, cognitive impairment, emotional burden, and decreased physical functioning on the personal, professional, and social lives of individuals with multiple sclerosis (MS). Methods The vsMS survey was an online survey conducted in Australia, Canada, France, Italy, Spain, the United Kingdom, and the United States that assessed the impact of MS on individuals' daily activities, emotional well-being, relationships, and employment. Results The survey included 1075 participants with relapsing-remitting MS. Almost 42% of participants reported that their ability to perform and manage daily activities had worsened during the previous 2 years. More than 50% reported limitations in daily activities due to fatigue, physical weakness, problems with balance/coordination, heat/cold sensitivity, memory problems, numbness/tingling, trouble concentrating, impaired movement/muscle stiffness, and impaired sleeping. Participants also reported a negative effect on emotional and social factors, including self-esteem, general outlook, well-being, maintaining/starting relationships, ability to progress in their career/keep their job, and ability to cope with life roles. Conclusions These data highlight the importance of addressing the impact of MS and the social and emotional disease burdens on daily activities when planning the care of patients with MS.
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Abstract
BACKGROUND Cognitive dysfunction affects 40% to 70% of people with multiple sclerosis (MS). Sex may influence a person's cognition. Although a few studies have reported greater cognitive deficits in men than women, it is unclear whether specific cognitive domains are more vulnerable than others to the effects of sex or whether cognition is influenced by neurologic or psychiatric variables. METHODS A chart review was undertaken of 408 people with MS referred to neuropsychological services. Demographic and MS-related variables were extracted from the patients' records. We used the Minimal Assessment of Cognitive Functioning in Multiple Sclerosis for the neuropsychological assessment. Raw test scores were converted to z scores using Canadian regression-based normative means. A general linear model was conducted on the adjusted scores, controlling for age; years of education; disease course; illness duration; and disability, anxiety, and depression scores. RESULTS Men were more likely than women to have primary progressive MS (χ=6.415, P=0.011). There were no other sex differences with respect to demographic, neurologic, or psychiatric data. Women performed significantly better than men on the California Verbal Learning Test-Second Edition Total Learning index (F=7.846, P=0.006). CONCLUSIONS An analysis of a large, consecutive sample of people with MS demonstrated that sex, independent of demographic, neurologic, or psychiatric factors, is an important determinant in cognitive impairment, with men being more impaired than women on tests of verbal learning and memory.
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Turner MP, Hubbard NA, Sivakolundu DK, Himes LM, Hutchison JL, Hart J, Spence JS, Frohman EM, Frohman TC, Okuda DT, Rypma B. Preserved canonicality of the BOLD hemodynamic response reflects healthy cognition: Insights into the healthy brain through the window of Multiple Sclerosis. Neuroimage 2019; 190:46-55. [PMID: 29454932 DOI: 10.1016/j.neuroimage.2017.12.081] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 12/18/2017] [Accepted: 12/22/2017] [Indexed: 10/18/2022] Open
Abstract
The hemodynamic response function (HRF), a model of brain blood-flow changes in response to neural activity, reflects communication between neurons and the vasculature that supplies these neurons in part by means of glial cell intermediaries (e.g., astrocytes). Intact neural-vascular communication might play a central role in optimal cognitive performance. This hypothesis can be tested by comparing healthy individuals to those with known white-matter damage and impaired performance, as seen in Multiple Sclerosis (MS). Glial cell intermediaries facilitate the ability of neurons to adequately convey metabolic needs to cerebral vasculature for sufficient oxygen and nutrient perfusion. In this study, we isolated measurements of the HRF that could quantify the extent to which white-matter affects neural-vascular coupling and cognitive performance. HRFs were modeled from multiple brain regions during multiple cognitive tasks using piecewise cubic spline functions, an approach that minimized assumptions regarding HRF shape that may not be valid for diseased populations, and were characterized using two shape metrics (peak amplitude and time-to-peak). Peak amplitude was reduced, and time-to-peak was longer, in MS patients relative to healthy controls. Faster time-to-peak was predicted by faster reaction time, suggesting an important role for vasodilatory speed in the physiology underlying processing speed. These results support the hypothesis that intact neural-glial-vascular communication underlies optimal neural and cognitive functioning.
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Affiliation(s)
- Monroe P Turner
- School of Behavioral and Brain Sciences, University of Texas at Dallas, Richardson, TX, USA
| | - Nicholas A Hubbard
- McGovern Institute for Brain Research, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Dinesh K Sivakolundu
- School of Behavioral and Brain Sciences, University of Texas at Dallas, Richardson, TX, USA
| | - Lyndahl M Himes
- School of Behavioral and Brain Sciences, University of Texas at Dallas, Richardson, TX, USA
| | - Joanna L Hutchison
- School of Behavioral and Brain Sciences, University of Texas at Dallas, Richardson, TX, USA
| | - John Hart
- School of Behavioral and Brain Sciences, University of Texas at Dallas, Richardson, TX, USA; Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jeffrey S Spence
- School of Behavioral and Brain Sciences, University of Texas at Dallas, Richardson, TX, USA
| | - Elliot M Frohman
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Teresa C Frohman
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Darin T Okuda
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Bart Rypma
- School of Behavioral and Brain Sciences, University of Texas at Dallas, Richardson, TX, USA; Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA.
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Aharoni R, Schottlender N, Bar-Lev DD, Eilam R, Sela M, Tsoory M, Arnon R. Cognitive impairment in an animal model of multiple sclerosis and its amelioration by glatiramer acetate. Sci Rep 2019; 9:4140. [PMID: 30858445 PMCID: PMC6412002 DOI: 10.1038/s41598-019-40713-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 02/21/2019] [Indexed: 01/28/2023] Open
Abstract
The severe motor impairment in the MS animal model experimental autoimmune encephalomyelitis (EAE) obstructs the assessment of cognitive functions. We developed an experimental system that evaluates memory faculties in EAE-affected mice, irrespective of their motor performance, enabling the assessment of cognitive impairments along the disease duration, the associated brain damage, and the consequences of glatiramer acetate (GA) treatment on these manifestations. The delayed-non-matching to sample (DNMS) T-maze task, testing working and long term memory was adapted and utilized. Following the appearance of clinical manifestations task performances of the EAE-untreated mice drastically declined. Cognitive impairments were associated with disease severity, as indicated by a significant correlation between the T-maze performance and the clinical symptoms in EAE-untreated mice. GA-treatment conserved cognitive functions, so that despite their exhibited mild motor impairments, the treated mice performed similarly to naïve controls. The cognitive deficit of EAE-mice coincided with inflammatory and neurodegenerative damage to the frontal cortex and the hippocampus; these damages were alleviated by GA-treatment. These combined findings indicate that in addition to motor impairment, EAE leads to substantial impairment of cognitive functions, starting at the early stages and increasing with disease aggravation. GA-treatment, conserves cognitive capacities and prevents its disease related deterioration.
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Affiliation(s)
- Rina Aharoni
- Department of Immunology, The Weizmann Institute of Science, Rehovot, 761001, Israel.
| | - Nofar Schottlender
- Department of Immunology, The Weizmann Institute of Science, Rehovot, 761001, Israel
| | - Dekel D Bar-Lev
- Department of Immunology, The Weizmann Institute of Science, Rehovot, 761001, Israel
| | - Raya Eilam
- Department of Veterinary Resources, The Weizmann Institute of Science, Rehovot, 761001, Israel
| | - Michael Sela
- Department of Immunology, The Weizmann Institute of Science, Rehovot, 761001, Israel
| | - Michael Tsoory
- Department of Veterinary Resources, The Weizmann Institute of Science, Rehovot, 761001, Israel
| | - Ruth Arnon
- Department of Immunology, The Weizmann Institute of Science, Rehovot, 761001, Israel.
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Raimo S, Spitaleri D, Trojano L, Santangelo G. Apathy as a herald of cognitive changes in multiple sclerosis: A 2-year follow-up study. Mult Scler 2019; 26:363-371. [DOI: 10.1177/1352458519828296] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Behavioral symptoms, such as apathy and depression, are common in multiple sclerosis (MS) but their relationship with cognitive and clinical characteristics often remains underinvestigated and not monitored over time. Objective: The aim of this study was to assess the evolution of cognitive profile of patients affected by MS in relation to apathy and depression using a 2-year follow-up study. Methods: Two years after the first assessment, 100 of 125 MS patients were re-evaluated on a comprehensive neuropsychological battery, and on specific scales for assessment of apathy (Apathy Evaluation Scale—Self-reported) and depression (Hamilton Depression Rating Scale). Results: After 2 years (T1), we found a relatively consistent prevalence of apathy (about 40%) and a reduction in prevalence of depression (from 44% to 30%). Higher level of apathy at baseline predicted the progressive cognitive changes at follow-up; and patients with apathy without depression (“pure” apathy) than patients without apathy had poorer performance on the interference task of the Stroop test assessing inhibitory control. Conclusion: The present results suggested that apathy in MS was associated with more severe executive dysfunctions (in particular cognitive control). Apathy rather than depression predicted cognitive impairment in MS over time.
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Affiliation(s)
- Simona Raimo
- Department of Medical and Surgical Sciences, University “Magna Graecia” of Catanzaro, Catanzaro, Italy/ Department of Psychology, University of Campania “Luigi Vanvitelli,” Caserta, Italy
| | - Daniele Spitaleri
- Neurology Unit “San Giuseppe Moscati,” Hospital Avellino, Avellino, Italy
| | - Luigi Trojano
- Department of Psychology, University of Campania “Luigi Vanvitelli,” Caserta, Italy/ Salvatore Maugeri Foundation, Scientific Institute of Telese Terme, Telese Terme, Italy
| | - Gabriella Santangelo
- Department of Psychology, University of Campania “Luigi Vanvitelli,” Caserta, Italy
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Kalb R, Beier M, Benedict RH, Charvet L, Costello K, Feinstein A, Gingold J, Goverover Y, Halper J, Harris C, Kostich L, Krupp L, Lathi E, LaRocca N, Thrower B, DeLuca J. Recommendations for cognitive screening and management in multiple sclerosis care. Mult Scler 2018; 24:1665-1680. [PMID: 30303036 PMCID: PMC6238181 DOI: 10.1177/1352458518803785] [Citation(s) in RCA: 248] [Impact Index Per Article: 41.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Purpose: To promote understanding of cognitive impairment in multiple sclerosis (MS), recommend optimal screening, monitoring, and treatment strategies, and address barriers to optimal management. Methods: The National MS Society (“Society”) convened experts in cognitive dysfunction (clinicians, researchers, and lay people with MS) to review the published literature, reach consensus on optimal strategies for screening, monitoring, and treating cognitive changes, and propose strategies to address barriers to optimal care. Recommendations: Based on current evidence, the Society makes the following recommendations, endorsed by the Consortium of Multiple Sclerosis Centers and the International Multiple Sclerosis Cognition Society:
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Affiliation(s)
- Rosalind Kalb
- National Multiple Sclerosis Society, New York, NY, USA
| | - Meghan Beier
- Division of Rehabilitation Psychology and Neuropsychology, Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Leigh Charvet
- Department of Neurology, Langone Medical Center, New York University, New York, NY, USA
| | | | - Anthony Feinstein
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | | | | | - June Halper
- The Consortium of Multiple Sclerosis Centers and International Organization of Multiple Sclerosis Nurses, Multiple Sclerosis Nurses International Certification Board, Hackensack, NJ, USA
| | - Colleen Harris
- Multiple Sclerosis Center, University of Calgary, Calgary, AB, Canada
| | - Lori Kostich
- The Mandell Center for Multiple Sclerosis, Mount Sinai Rehabilitation Hospital, Hartford, CT, USA
| | - Lauren Krupp
- Department of Neurology, NYU Langone Health, New York University, New York, NY, USA
| | - Ellen Lathi
- The Elliot Lewis Center for Multiple Sclerosis Care, Wellesley, MA, USA
| | | | - Ben Thrower
- Emory University, Atlanta, GA, USA/Andrew C. Carlos Multiple Sclerosis Institute at Shepherd Center, Atlanta, GA, USA
| | - John DeLuca
- Department of Physical Medicine and Rehabilitation and Department of Neurology, Rutgers New Jersey Medical School, Newark, NJ, USA
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Patel VP, Shen L, Rose J, Feinstein A. Taking the tester out of the SDMT: A proof of concept fully automated approach to assessing processing speed in people with MS. Mult Scler 2018; 25:1506-1513. [DOI: 10.1177/1352458518792772] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: One factor hindering the widespread use of cognitive testing for people with multiple sclerosis (pwMS) is the need for a tester to administer tests. Objective: To undertake a proof of concept study assessing the feasibility of a fully automated speech recognition version of the Symbol Digit Modalities Test (auto-SDMT) in detecting abnormalities in processing speed in pwMS. Methods: A sample of 50 pwMS and 32 matched healthy control (HC) subjects was tested with the auto-SDMT and the Brief International Cognitive Assessment for MS (BICAMS). Results: The percentages of MS participants impaired on the auto-SDMT and the traditional oral SDMT were 34% and 32%, respectively. Excellent convergent validity was found between the two tests (MS: r = −0.806, p < 0.001 and HC: r = −0.629, p < 0.001). The auto-SDMT had a similar sensitivity and specificity to the traditional oral SDMT in predicting overall impairment on the BICAMS. Conclusion: The auto-SDMT is a sensitive measure for detecting processing speed deficits in pwMS. The test, the first entirely computer administrated oral response version of the SDMT, uses speech recognition technology, thereby eliminating the need for a human tester. Replication of the results is required in a larger representative sample of pwMS.
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Affiliation(s)
- Viral Prakash Patel
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Lingkai Shen
- The Edward S. Rogers Sr. Department of Electrical & Computer Engineering, University of Toronto, Toronto, ON, Canada
| | - Jonathan Rose
- The Edward S. Rogers Sr. Department of Electrical & Computer Engineering, University of Toronto, Toronto, ON, Canada
| | - Anthony Feinstein
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada/Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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Gromisch ES, Fiszdon JM, Kurtz MM. The effects of cognitive-focused interventions on cognition and psychological well-being in persons with multiple sclerosis: A meta-analysis. Neuropsychol Rehabil 2018; 30:767-786. [PMID: 29973121 DOI: 10.1080/09602011.2018.1491408] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- Elizabeth S. Gromisch
- Mandell Center for Multiple Sclerosis, Mount Sinai Rehabilitation Hospital, Trinity Health Of New England, Hartford, CT, USA
- Psychology Service, VA Connecticut Healthcare System, West Haven, CT, USA
| | - Joanna M. Fiszdon
- Psychology Service, VA Connecticut Healthcare System, West Haven, CT, USA
- Department of Psychiatry, Yale University, New Haven, CT, USA
| | - Matthew M. Kurtz
- Department of Psychology and Program in Neuroscience and Behavior, Wesleyan University, Middletown, CT, USA
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30
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Roth AK, Denney DR, Burns JM, Lynch SG. Cognition in older patients with multiple sclerosis compared to patients with amnestic mild cognitive impairment and healthy older adults. Neuropsychology 2018; 32:654-663. [PMID: 29939057 PMCID: PMC6126957 DOI: 10.1037/neu0000453] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE Progress in the treatment of multiple sclerosis (MS) has resulted in larger numbers of patients living to an advanced age, but little is known about the cognitive status of these individuals. The primary purpose of this study was to identify differences in the cognitive performance between elderly individuals with MS and those with amnestic mild cognitive impairment (aMCI). METHOD Three groups ranging in age from 60 to 80 were compared: patients with MS (n = 64), patients with aMCI (n = 58), and healthy adults (n = 70). All participants completed a standard neuropsychological test battery that evaluated domains of attention, processing speed, executive function, memory, language, and visual spatial function. RESULTS Compared to age- and gender-matched healthy controls, elderly MS patients exhibited a pattern of cognitive impairment centering on information processing speed and memory that was consistent with the deficits observed in other studies of MS patients regardless of age. Compared to aMCI patients, the MS patients exhibited worse performance on measures of processing speed, but better performance on a measure of memory under cued conditions (Selective Reminding Test), a nonspeeded measure of language (Boston Naming Test), and measures of executive function with processing speed statistically controlled (Trail Making Test, Stroop Test). CONCLUSIONS Differences on neuropsychological measures can serve to distinguish aMCI from MS-related cognitive impairment in older patients, but it is essential that these measures control for the deficit in processing speed that is such a primary feature of MS. (PsycINFO Database Record
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Affiliation(s)
| | | | - Jeffrey M Burns
- Department of Neurology, University of Kansas Medical Center
| | - Sharon G Lynch
- Department of Neurology, University of Kansas Medical Center
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Boa INF, Rimkus CDM, Campanholo KR, Pereira SLA, Junqueira TDF, Machado MDAR, Callegaro D, Otaduy MCG, Leite CDC, Miotto EC. Longitudinal analysis of verbal episodic memory in patients with relapsing-remitting multiple sclerosis. ARQUIVOS DE NEURO-PSIQUIATRIA 2018; 76:302-309. [PMID: 29898076 DOI: 10.1590/0004-282x20180038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 02/22/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE A 4.5-year follow-up study was conducted to characterize baseline verbal episodic memory (VEM) and its behavior and to assess the effects of relapsing-remitting multiple sclerosis (RRMS) on this domain. METHODS Twenty-nine patients with RRMS underwent two neuropsychological assessments performed an average of 4.5 years apart. Twenty-six control participants underwent a single neuropsychological assessment. A significance level of p < 0.005 was adopted to denote a significant difference between the groups on the Mann Whitney and Wilcoxon paired statistical analyses. RESULTS No statistical difference was found in the results of the VEM tests between the first and second neuropsychological assessments of the patients. However, a statistical difference was evident between the patient and control groups in the results of the VEM tests. CONCLUSION The patient group showed changes in the VEM relative to the control group. After approximately 4.5 years of disease, the patient performance on the VEM stabilized or improved.
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Affiliation(s)
- Izadora Nogueira Fonte Boa
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Departamento de Neurologia, São Paulo SP, Brasil
| | - Carolina de Medeiros Rimkus
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Departamento de Neurologia, São Paulo SP, Brasil
| | - Kenia Repiso Campanholo
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Departamento de Neurologia, São Paulo SP, Brasil
| | - Samira Luisa Apóstolos Pereira
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Departamento de Neurologia, São Paulo SP, Brasil
| | - Thiago de Faria Junqueira
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Departamento de Neurologia, São Paulo SP, Brasil
| | | | - Dagoberto Callegaro
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Departamento de Neurologia, São Paulo SP, Brasil
| | - Maria Concepción García Otaduy
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Departamento de Neurologia, São Paulo SP, Brasil
| | - Claudia da Costa Leite
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Departamento de Neurologia, São Paulo SP, Brasil
| | - Eliane Correa Miotto
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Departamento de Neurologia, São Paulo SP, Brasil
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Raggi A, Giovannetti AM, Schiavolin S, Brambilla L, Brenna G, Confalonieri PA, Cortese F, Frangiamore R, Leonardi M, Mantegazza RE, Moscatelli M, Ponzio M, Torri Clerici V, Zaratin P, De Torres L. Older age, higher perceived disability and depressive symptoms predict the amount and severity of work-related difficulties in persons with multiple sclerosis. Disabil Rehabil 2018; 41:2255-2263. [PMID: 29658343 DOI: 10.1080/09638288.2018.1461937] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Purpose: This cross-sectional study aims to identify the predictors of work-related difficulties in a sample of employed persons with multiple sclerosis as addressed with the Multiple Sclerosis Questionnaire for Job Difficulties. Materials and methods: Hierarchical linear regression analysis was conducted to identify predictors of work difficulties: predictors included demographic variables (age, formal education), disease duration and severity, perceived disability and psychological variables (cognitive dysfunction, depression and anxiety). The targets were the questionnaire's overall score and its six subscales. Results: A total of 177 participants (108 females, aged 21-63) were recruited. Age, perceived disability and depression were direct and significant predictors of the questionnaire total score, and the final model explained 43.7% of its variation. The models built on the questionnaire's subscales show that perceived disability and depression were direct and significant predictors of most of its subscales. Conclusions: Our results show that, among patients with multiple sclerosis, those who were older, with higher perceived disability and higher depression symptoms have more and more severe work-related difficulties. The Multiple Sclerosis Questionnaire for Job Difficulties can be fruitfully exploited to plan tailored actions to limit the likelihood of near-future job loss in persons of working age with multiple sclerosis. Implications for rehabilitation Difficulties with work are common among people with multiple sclerosis and are usually addressed in terms of unemployment or job loss. The Multiple Sclerosis Questionnaire for Job Difficulties is a disease-specific questionnaire developed to address the amount and severity of work-related difficulties. We found that work-related difficulties were associated to older age, higher perceived disability and depressive symptoms. Mental health issues and perceived disability should be consistently included in future research targeting work-related difficulties.
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Affiliation(s)
- Alberto Raggi
- a Neurology, Public Health and Disability Unit , Neurological Instiute C. Besta, IRCCS Foundation , Milan , Italy
| | - Ambra Mara Giovannetti
- b Department of Neuroimmunology and Neuromuscular Diseases , Neurological Institute C. Besta, IRCCS Foundation , Milan , Italy.,c Unit of Neuroepidemiology , Neurological Institute C. Besta, IRCCS Foundation , Milan , Italy
| | - Silvia Schiavolin
- a Neurology, Public Health and Disability Unit , Neurological Instiute C. Besta, IRCCS Foundation , Milan , Italy
| | - Laura Brambilla
- b Department of Neuroimmunology and Neuromuscular Diseases , Neurological Institute C. Besta, IRCCS Foundation , Milan , Italy
| | - Greta Brenna
- d Scientific Directorate, Neurological Institute C. Besta, IRCCS Foundation , Milan , Italy
| | - Paolo Agostino Confalonieri
- b Department of Neuroimmunology and Neuromuscular Diseases , Neurological Institute C. Besta, IRCCS Foundation , Milan , Italy
| | - Francesca Cortese
- d Scientific Directorate, Neurological Institute C. Besta, IRCCS Foundation , Milan , Italy
| | - Rita Frangiamore
- b Department of Neuroimmunology and Neuromuscular Diseases , Neurological Institute C. Besta, IRCCS Foundation , Milan , Italy
| | - Matilde Leonardi
- a Neurology, Public Health and Disability Unit , Neurological Instiute C. Besta, IRCCS Foundation , Milan , Italy
| | - Renato Emilio Mantegazza
- b Department of Neuroimmunology and Neuromuscular Diseases , Neurological Institute C. Besta, IRCCS Foundation , Milan , Italy
| | - Marco Moscatelli
- b Department of Neuroimmunology and Neuromuscular Diseases , Neurological Institute C. Besta, IRCCS Foundation , Milan , Italy
| | - Michela Ponzio
- e Scientific Research Area, Italian Foundation of Multiple Sclerosis , Genoa , Italy
| | - Valentina Torri Clerici
- b Department of Neuroimmunology and Neuromuscular Diseases , Neurological Institute C. Besta, IRCCS Foundation , Milan , Italy
| | - Paola Zaratin
- e Scientific Research Area, Italian Foundation of Multiple Sclerosis , Genoa , Italy
| | - Laura De Torres
- a Neurology, Public Health and Disability Unit , Neurological Instiute C. Besta, IRCCS Foundation , Milan , Italy
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Ouellette R, Bergendal Å, Shams S, Martola J, Mainero C, Kristoffersen Wiberg M, Fredrikson S, Granberg T. Lesion accumulation is predictive of long-term cognitive decline in multiple sclerosis. Mult Scler Relat Disord 2018; 21:110-116. [PMID: 29550717 DOI: 10.1016/j.msard.2018.03.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 02/14/2018] [Accepted: 03/01/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To investigate the long-term progression of cognitive dysfunction and its neuroanatomical correlates and predictors in multiple sclerosis (MS). METHODS A cohort of 37 MS patients reflecting five decades of disease duration and all subtypes was followed over 17.5 years. Matched controls were recruited at the last follow-up. Global cognitive functioning was assessed using a principal component cognitive index based on comprehensive neuropsychological testing. During the last 8.5 years of the study, brain MRI was performed to analyze normalized volumetrics of three global tissue compartments (white and gray matter, lesions) and strategic regions (corpus callosum, thalamus, hippocampus). RESULTS Cognitive decline progressed continuously throughout the study paralleled by atrophy and lesion accumulation. The cognitive index partly correlated with Expanded Disability Status Scale (ρ = -0.47, p < 0.001) and was mainly associated with the lesion fraction (β = -0.48, p < 0.001) and callosal fraction (β = 0.39, p = 0.002) in multiple linear regression analysis. The lesion fraction was an independent predictor of the cognitive performance 8.5 years later (β = -0.35, p = 0.008). Symbol Digit Modalities Test was most frequently abnormal (40%), while Rey-Osterrieth Complex Figure Test was more sensitive to detect cognitive decline. CONCLUSIONS Cognitive impairment progresses continuously in MS, associated with atrophy and lesion accumulation, suggesting that interventions targeting these processes could be beneficial at all disease stages. Widespread cognitive functions are more profoundly affected, associated with lesions and corpus callosal atrophy, supporting the idea of an underlying disconnection mechanism for cognitive decline in MS.
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Affiliation(s)
- Russell Ouellette
- Karolinska Institutet, Department of Clinical Neuroscience, Stockholm, Sweden; Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, USA
| | - Åsa Bergendal
- Karolinska Institutet, Department of Clinical Science, Intervention and Technology, Division of Medical Imaging and Technology, Stockholm, Sweden; Karolinska University Hospital, Department of Medical Psychology, Stockholm, Sweden
| | - Sara Shams
- Karolinska Institutet, Department of Clinical Science, Intervention and Technology, Division of Medical Imaging and Technology, Stockholm, Sweden; Karolinska University Hospital, Department of Radiology, Stockholm, Sweden
| | - Juha Martola
- Karolinska Institutet, Department of Clinical Science, Intervention and Technology, Division of Medical Imaging and Technology, Stockholm, Sweden; Karolinska University Hospital, Department of Radiology, Stockholm, Sweden
| | - Caterina Mainero
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Maria Kristoffersen Wiberg
- Karolinska Institutet, Department of Clinical Science, Intervention and Technology, Division of Medical Imaging and Technology, Stockholm, Sweden; Karolinska University Hospital, Department of Radiology, Stockholm, Sweden
| | - Sten Fredrikson
- Karolinska Institutet, Department of Clinical Neuroscience, Stockholm, Sweden; Karolinska University Hospital, Department of Neurology, Stockholm, Sweden
| | - Tobias Granberg
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, USA; Karolinska Institutet, Department of Clinical Science, Intervention and Technology, Division of Medical Imaging and Technology, Stockholm, Sweden; Karolinska University Hospital, Department of Radiology, Stockholm, Sweden; Harvard Medical School, Boston, MA, USA.
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Miri Ashtiani SN, Daliri MR, Behnam H, Hossein-Zadeh GA, Mehrpour M, Motamed MR, Fadaie F. Altered topological properties of brain networks in the early MS patients revealed by cognitive task-related fMRI and graph theory. Biomed Signal Process Control 2018. [DOI: 10.1016/j.bspc.2017.10.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Riccitelli GC, Pagani E, Rodegher M, Colombo B, Preziosa P, Falini A, Comi G, Filippi M, Rocca MA. Imaging patterns of gray and white matter abnormalities associated with PASAT and SDMT performance in relapsing-remitting multiple sclerosis. Mult Scler 2017; 25:204-216. [DOI: 10.1177/1352458517743091] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Objectives: To map the regional patterns of white matter (WM) microstructural abnormalities and gray matter (GM) atrophy exclusively associated with reduced performance in the Symbol Digit Modalities Test (SDMT) and Paced Auditory Serial Addition Test (PASAT) in relapsing-remitting (RR) multiple sclerosis (MS) patients. Methods: In all, 177 RRMS patients and 80 healthy controls (HC) were studied. WM microstructural abnormalities were investigated on diffusion tensor images using tract-based spatial statistics analysis, and regional GM atrophy was estimated on three-dimensional (3D) T1-weighted images using voxel-based morphometry. Results: Compared to HC, RRMS patients showed the expected pattern of cortical–subcortical GM atrophy and WM microstructural abnormalities. In patients, diffusivity abnormalities of supratentorial WM tracts correlated with both SDMT and PASAT scores. Lower SDMT performance was also associated with WM damage in several infratentorial WM tracts. Lower SDMT scores correlated with atrophy of the right anterior cingulate cortex, left postcentral gyrus, and right middle temporal gyrus, whereas lower PASAT scores correlated with atrophy of the deep GM nuclei, bilaterally, and several fronto-temporo-occipital regions. Conclusion: In RRMS patients, regional damage of different neural systems helps explaining reduced performance in SDMT and PASAT. WM microstructural damage typified reduced SDMT performance, whereas atrophy of several GM regions distinguished reduced PASAT performance.
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Affiliation(s)
- Gianna C Riccitelli
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Elisabetta Pagani
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Mariaemma Rodegher
- Department of Neurology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Bruno Colombo
- Department of Neurology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Paolo Preziosa
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy/Department of Neurology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Andrea Falini
- Department of Neuroradiology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Giancarlo Comi
- Department of Neurology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy/Department of Neurology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Maria A Rocca
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy/Department of Neurology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
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Kavaliunas A, Danylaite Karrenbauer V, Gyllensten H, Manouchehrinia A, Glaser A, Olsson T, Alexanderson K, Hillert J. Cognitive function is a major determinant of income among multiple sclerosis patients in Sweden acting independently from physical disability. Mult Scler 2017; 25:104-112. [PMID: 29143553 DOI: 10.1177/1352458517740212] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND In multiple sclerosis (MS), various aspects of cognitive function can be detrimentally affected, thus patients' employment and social functioning is commonly impacted. OBJECTIVE To analyse income among MS patients in relation to cognitive function, assessed with the Symbol Digit Modalities Test (SDMT). METHODS A cross-sectional study including 2080 MS patients was conducted linking national register-based data. Descriptive statistics and a two-part model were used to estimate differences in earnings and social benefits. RESULTS MS patients in the highest SDMT score quartile earned more than twice annually compared to patients in the lowest quartile, whereas patients in the lowest quartile received three times more income through social benefits. The difference in earnings and benefits across the SDMT performance quartiles remained statistically significant after adjusting for various clinical and socio-demographic variables, including physical disability. The corrected prevalence ratios for MS patients in the highest quartile for having income from earnings and benefits were 1.40 (95% confidence interval (CI): 1.29-1.49) and 0.81 (95% CI: 0.71-0.90), respectively, when compared to the patients in the lowest quartile. CONCLUSION Cognitive function affects the financial situation of MS patients negatively and independently of physical disability. This warrants cognitive testing as a routine measure in health care services for MS patients.
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Affiliation(s)
- Andrius Kavaliunas
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Virginija Danylaite Karrenbauer
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden/Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
| | - Hanna Gyllensten
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden/Centre for Person-centred Care (GPCC), Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ali Manouchehrinia
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Anna Glaser
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Tomas Olsson
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden/Centre for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden
| | | | - Jan Hillert
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden/Department of Neurology, Karolinska University Hospital, Stockholm, Sweden/Centre for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden
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Cohan S, Kappos L, Giovannoni G, Wiendl H, Selmaj K, Havrdová EK, Rose J, Greenberg S, Phillips G, Ma W, Wang P, Lima G, Sabatella G. Efficacy of daclizumab beta versus intramuscular interferon beta-1a on disability progression across patient demographic and disease activity subgroups in DECIDE. Mult Scler 2017; 24:1883-1891. [PMID: 28984179 PMCID: PMC6282160 DOI: 10.1177/1352458517735190] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background: Demonstration of clinical benefits on disability progression measures is an
important attribute of effective multiple sclerosis (MS) treatments. Objective: Examine efficacy of daclizumab beta versus intramuscular (IM) interferon
beta-1a on measures of disability progression in patient subgroups from
DECIDE. Methods: Twenty-four-week confirmed disability progression (CDP), 24-week sustained
worsening on a modified Multiple Sclerosis Functional Composite (MSFCS)
where 3-Second Paced Auditory Serial Addition Test was replaced by Symbol
Digit Modalities Test, and proportion of patients with clinically meaningful
worsening in 29-Item Multiple Sclerosis Impact Scale physical impact
subscale (MSIS-29 PHYS) score from baseline to week 96 were examined in the
overall population and subgroups defined by baseline demographic/disease
characteristics. Results: Daclizumab beta significantly reduced risk of 24-week CDP (hazard ratio (HR),
0.73; 95% confidence interval (95% CI), 0.55–0.98), risk of 24-week
sustained MSFCS progression (HR, 0.80; 95% CI, 0.67–0.95), and odds of
clinically meaningful worsening in MSIS-29 PHYS (odds ratio, 0.76; 95% CI,
0.60–0.95) versus IM interferon beta-1a. Point estimates showed trends
favoring daclizumab beta over IM interferon beta-1a across several patient
subgroups for all three outcome measures. Conclusion: Daclizumab beta showed consistent benefit versus IM interferon beta-1a across
measures assessing patient disability/function and across a range of
clinical baseline characteristics in patients with relapsing-remitting
MS.
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Affiliation(s)
- Stanley Cohan
- Providence Multiple Sclerosis Center, Providence Brain and Spine Institute, Providence St. Joseph Health, Portland, OR, USA
| | - Ludwig Kappos
- Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research and Biomedical Engineering, University Hospital and University of Basel, Basel, Switzerland
| | - Gavin Giovannoni
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University London, London, UK
| | - Heinz Wiendl
- Department of Neurology, University of Münster, Münster, Germany
| | - Krzysztof Selmaj
- Department of Neurology, Medical University of Lodz, Lodz, Poland
| | - Eva Kubala Havrdová
- Department of Neurology and Center for Clinical Neuroscience, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - John Rose
- Department of Neurology, University of Utah and Neurovirology Research Laboratory VASLCHCS, Imaging and Neuroscience Center, Salt Lake City, UT, USA
| | | | | | - Wei Ma
- Biogen, Cambridge, MA, USA
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Low E, Crewther SG, Ong B, Perre D, Wijeratne T. Compromised Motor Dexterity Confounds Processing Speed Task Outcomes in Stroke Patients. Front Neurol 2017; 8:484. [PMID: 28983276 PMCID: PMC5613174 DOI: 10.3389/fneur.2017.00484] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 08/30/2017] [Indexed: 11/13/2022] Open
Abstract
Most conventional measures of information processing speed require motor responses to facilitate performance. However, although not often addressed clinically, motor impairment, whether due to age or acquired brain injury, would be expected to confound the outcome measure of such tasks. The current study recruited 29 patients (20 stroke and 9 transient ischemic attack) with documented reduction in dexterity of the dominant hand, and 29 controls, to investigate the extent to which 3 commonly used processing speed measures with varying motor demands (a Visuo-Motor Reaction Time task, and the Wechsler Adult Intelligence Scale-IV Symbol Search and Coding subtests) may be measuring motor-related speed more so than cognitive speed. Analyses include correlations between indices of cognitive and motor speed obtained from two other tasks (Inspection Time and Pegboard task, respectively) with the three speed measures, followed by hierarchical regressions to determine the relative contribution of cognitive and motor speed indices toward task performance. Results revealed that speed outcomes on tasks with relatively high motor demands, such as Coding, were largely reflecting motor speed in individuals with reduced dominant hand dexterity. Thus, findings indicate the importance of employing measures with minimal motor requirements, especially when the assessment of speed is aimed at understanding cognitive rather than physical function.
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Affiliation(s)
- Essie Low
- Department of Neurology, Sunshine Hospital, Western Health, Melbourne, VIC, Australia.,Department of Psychology and Counselling, School of Psychology and Public Health, La Trobe University, Bundoora, VIC, Australia
| | - Sheila Gillard Crewther
- Department of Neurology, Sunshine Hospital, Western Health, Melbourne, VIC, Australia.,Department of Psychology and Counselling, School of Psychology and Public Health, La Trobe University, Bundoora, VIC, Australia
| | - Ben Ong
- Department of Psychology and Counselling, School of Psychology and Public Health, La Trobe University, Bundoora, VIC, Australia
| | - Diana Perre
- Department of Psychology, Sunshine Hospital, Western Health, Melbourne, VIC, Australia
| | - Tissa Wijeratne
- Department of Neurology, Sunshine Hospital, Western Health, Melbourne, VIC, Australia.,Department of Psychology and Counselling, School of Psychology and Public Health, La Trobe University, Bundoora, VIC, Australia.,Department of Medicine, Melbourne Medical School, University of Melbourne, Western Health Sunshine Hospital, St Albans, VIC, Australia.,Department of Medicine, University of Rajarata, Anuradhapura, Sri Lanka
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Kleiter I, Lang M, Jeske J, Norenberg C, Stollfuß B, Schürks M. Adherence, satisfaction and functional health status among patients with multiple sclerosis using the BETACONNECT® autoinjector: a prospective observational cohort study. BMC Neurol 2017; 17:174. [PMID: 28877664 PMCID: PMC5588619 DOI: 10.1186/s12883-017-0953-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 08/24/2017] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Maintaining patient adherence to disease modifying drugs in multiple sclerosis is a challenge, which can be improved by autoinjectors. The BETACONNECT® is a fully electronic autoinjector for the injection of interferon beta-1b (IFN beta-1b) automatically recording injections. METHODS The BETAEVAL study was a prospective, observational, cohort study over 24 weeks among patients with relapsing remitting multiple sclerosis or clinically isolated syndrome treated with IFN beta-1b in Germany using the BETACONNECT®. The primary aim was to investigate treatment adherence, secondary aims included assessing satisfaction and functional health status. Adherence was evaluated from injection data recorded by the device. Patient-related data were obtained from clinical examinations and patient questionnaires. RESULTS Of the 151 patients enrolled, 143 were available for analysis. Thirty-four patients discontinued the study prematurely. 107/143 (74.8%) patients still used the BETACONNECT® at the end of the study. Injection data from the device at any visit was available for 107 patients. Among those, the percentage of adherent patients injecting ≥80% of doses and still participating in the study was 57.9% at week 24. 29% of patients prematurely stopped the study, 13.1% injected <80%. Among patients with BETACONNECT® data at the respective visit, the proportion of adherent patients was high over the entire study period (week 4: 81.1% [N = 95], week 12: 86.7% [N = 83], week 24: 80.5% [N = 77]). Participants (N = 143) indicated high satisfaction with the BETACONNECT®. At week 24, 98.0% of patients who completed the corresponding questionnaire (strongly) agreed that it was user-friendly, 81.2% felt confident in using it compared to their previous way and 85.5% preferred it to their previous way of injection. Injection-related pain was rated as mild to moderate at all follow-up visits. Whereas 17.2% of patients with corresponding questionnaire indicated using analgesics prior to injection at week 4, only 9.1% did at week 24. Outcomes from questionnaires assessing functional health status, depression, fatigue and cognitive function were very similar throughout the study course. CONCLUSIONS The majority of patients continued using the BETACONNECT® for IFN beta-1b treatment during the 24-week study period. Adherence was high among participants still using the BETACONNECT® and patients were highly satisfied with the device. Ongoing studies will evaluate long-term adherence and treatment outcomes in patients using the BETACONNECT®. TRIAL REGISTRATION clinicaltrails.gov NCT02121444 (registered April 22, 2014).
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Affiliation(s)
- Ingo Kleiter
- St. Josef Hospital, University Hospital Bochum, Bochum, Germany
- Present Address: Marianne-Strauß-Klinik, Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke, Berg, Germany
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LaRocca NG, Hudson LD, Rudick R, Amtmann D, Balcer L, Benedict R, Bermel R, Chang I, Chiaravalloti ND, Chin P, Cohen JA, Cutter GR, Davis MD, DeLuca J, Feys P, Francis G, Goldman MD, Hartley E, Kapoor R, Lublin F, Lundstrom G, Matthews PM, Mayo N, Meibach R, Miller DM, Motl RW, Mowry EM, Naismith R, Neville J, Panagoulias J, Panzara M, Phillips G, Robbins A, Sidovar MF, Smith KE, Sperling B, Uitdehaag BM, Weaver J. The MSOAC approach to developing performance outcomes to measure and monitor multiple sclerosis disability. Mult Scler 2017; 24:1469-1484. [PMID: 28799444 PMCID: PMC6174619 DOI: 10.1177/1352458517723718] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: The Multiple Sclerosis Outcome Assessments Consortium (MSOAC) was formed by
the National MS Society to develop improved measures of multiple sclerosis
(MS)-related disability. Objectives: (1) To assess the current literature and available data on functional
performance outcome measures (PerfOs) and (2) to determine suitability of
using PerfOs to quantify MS disability in MS clinical trials. Methods: (1) Identify disability dimensions common in MS; (2) conduct a comprehensive
literature review of measures for those dimensions; (3) develop an MS
Clinical Data Interchange Standards Consortium (CDISC) data standard; (4)
create a database of standardized, pooled clinical trial data; (5) analyze
the pooled data to assess psychometric properties of candidate measures; and
(6) work with regulatory agencies to use the measures as primary or
secondary outcomes in MS clinical trials. Conclusion: Considerable data exist supporting measures of the functional domains
ambulation, manual dexterity, vision, and cognition. A CDISC standard for MS
(http://www.cdisc.org/therapeutic#MS) was published, allowing
pooling of clinical trial data. MSOAC member organizations contributed
clinical data from 16 trials, including 14,370 subjects. Data from
placebo-arm subjects are available to qualified researchers. This
integrated, standardized dataset is being analyzed to support qualification
of disability endpoints by regulatory agencies.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Peter Feys
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | | | | | | | | | - Fred Lublin
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | | | | | | | | | - Robert W Motl
- University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Rob Naismith
- Washington University in St. Louis, St. Louis, MO, USA
| | | | | | | | | | | | - Matthew F Sidovar
- Acorda Therapeutics, Inc., Ardsley, NY, USA; KES Business Consulting LLC, Lyme, CT, USA
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Patel VP, Walker LAS, Feinstein A. Revisiting cognitive reserve and cognition in multiple sclerosis: A closer look at depression. Mult Scler 2017; 24:186-195. [DOI: 10.1177/1352458517692887] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: The protective effect of cognitive reserve (CR) on cognition in people with multiple sclerosis (PwMS) has been well described. Objective: To explore the relationship between aspects of CR, namely, leisure pursuits and depression. Methods: In a cross-sectional study, a sample of 155 PwMS and 115 healthy controls (HC) underwent cognitive testing with the Minimal Assessment of Cognitive Function in Multiple Sclerosis (MACFIMS) battery. Leisure activity was retrospectively recorded using the Leisure Activity Scale (LAS). Depression was assessed using the Hospital Anxiety and Depression Scale. Results: PwMS demonstrated greater decreases in leisure activity over time compared to the HC group, particularly in the past year ( p < 0.001). Here, depression accounted for 17% of the variance in determining the level of leisure activity ( p < 0.001). Premorbid IQ and leisure activity within the past year emerged as significant predictors of information processing speed, learning, memory and executive function. After controlling for depression, the influence of leisure activity on cognition was insignificant. Conclusion: Depression can cause significant changes in behaviour which can influence indices of CR, such as leisure pursuits. Successfully treating depression may lead to a more active lifestyle thereby offsetting in part the cognitive burden of disease.
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Affiliation(s)
- Viral P Patel
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Lisa AS Walker
- Ottawa Hospital Research Institute, Ottawa, ON, Canada/Brain and Mind Research Institute, University of Ottawa, Ottawa, ON, Canada/Carleton University, Ottawa, ON, Canada
| | - Anthony Feinstein
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada/University of Toronto, Toronto, ON, Canada
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Brenner P, Piehl F. Fatigue and depression in multiple sclerosis: pharmacological and non-pharmacological interventions. Acta Neurol Scand 2016; 134 Suppl 200:47-54. [PMID: 27580906 DOI: 10.1111/ane.12648] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2016] [Indexed: 12/18/2022]
Abstract
Multiple sclerosis (MS) is a neuroinflammatory condition with a prominent progressive neurodegenerative facet that typically affects young- or middle-aged adults. Although physical disabilities have been in the foreground by being easier to assess, there is an increasing interest in mental disabilities and psychiatric co-morbidities, which have a disproportionally high impact on important outcome measures such as quality of life and occupational disability. In particular, cognitive impairment, depression and mental fatigue, which mutually interact with each other, seem to be of importance in this context. In recent decades, major efforts have been invested in developing more effective disease modulatory treatments. This has resulted in novel therapeutic options and awareness of the importance of early intervention. In comparison, good quality and adequately powered studies on symptomatic treatments of fatigue and psychiatric co-morbidities in MS are rare, and awareness of treatment options is much lower. We here review the existing evidence base for symptomatic treatment of fatigue and depression in MS patients. With regard to fatigue, off-label prescription of alertness improving drugs is common, in spite of all but absent evidence of efficacy. In contrast, a number of smaller studies suggest that physical exercise and fatigue management courses may have some clinical benefit. Very few studies have addressed the efficacy of antidepressants and non-pharmaceutical interventions specifically in MS patients. Therefore, treatment guidelines largely rely on data from non-MS populations. In the future, there is a strong motive to direct additional resources to the study of these important aspects of MS.
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Affiliation(s)
- P. Brenner
- Centre for Psychiatry Research; Department of Clinical Neuroscience; Karolinska Institutet; Stockholm Sweden
| | - F. Piehl
- Division of Neurology; Department of Clinical Neuroscience; Karolinska Institutet; Stockholm Sweden
- Department of Neurology; Karolinska University Hospital Solna; Stockholm Sweden
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Bora E, Özakbaş S, Velakoulis D, Walterfang M. Social Cognition in Multiple Sclerosis: a Meta-Analysis. Neuropsychol Rev 2016; 26:160-72. [DOI: 10.1007/s11065-016-9320-6] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2015] [Accepted: 05/12/2016] [Indexed: 12/16/2022]
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Roman CAF, Arnett PA. Structural brain indices and executive functioning in multiple sclerosis: A review. J Clin Exp Neuropsychol 2016; 38:261-74. [DOI: 10.1080/13803395.2015.1105199] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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45
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Pereira DR, Costa P, Cerqueira JJ. Repeated Assessment and Practice Effects of the Written Symbol Digit Modalities Test Using a Short Inter-Test Interval. Arch Clin Neuropsychol 2015; 30:424-34. [DOI: 10.1093/arclin/acv028] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2015] [Indexed: 11/13/2022] Open
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