1
|
Kim YJ, Park I, Choi HC, Ahn ME, Ryu OH, Jang D, Lee U, Lee SK. Relationship of Neural Correlates of Gait Characteristics and Cognitive Dysfunction in Patients with Mild Cognitive Impairment. J Clin Med 2023; 12:5347. [PMID: 37629389 PMCID: PMC10455461 DOI: 10.3390/jcm12165347] [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: 06/14/2023] [Revised: 08/09/2023] [Accepted: 08/12/2023] [Indexed: 08/27/2023] Open
Abstract
Background: Some patients with mild cognitive impairment (MCI) experience gait disturbances. However, there are few reports on the relationship between gait disturbance and cognitive function in patients with MCI. Therefore, we investigated the neural correlates of gait characteristics related to cognitive dysfunction. Methods: Eighty patients diagnosed with MCI from three dementia centers in Gangwon-do, Korea, were recruited for this study. We defined MCI as a Clinical Dementia Rating global score of 0.5 or higher, with a memory domain score of 0.5 or greater. The patients were classified as having either higher or lower MMSE and the groups were based on their Mini Mental Status Examination z-scores. Multiple logistic regression analysis was performed to examine the association between the gait characteristics and cognitive impairment. Analyses included variables such as age, sex, years of education, number of comorbidities, body mass index, and height. Results: Gait velocity, step count, step length, heel-to-heel base support, swing and stance phase duration, and support time were associated with cognitive function. A decrease in gray matter volume in the right pericalcarine area was associated with gait characteristics related to cognitive dysfunction. An increase in the curvature of gray matter in the right entorhinal, right lateral orbitofrontal, right cuneus, and right and left pars opercularis areas was also associated with gait characteristics related to cognitive dysfunction. Conclusion: Since gait impairment is an important factor in determining activities of daily living in patients with mild cognitive impairment, the evaluation of gait and cognitive functions in patients with mild cognitive impairment is important.
Collapse
Affiliation(s)
- Yeo Jin Kim
- Department of Neurology, Kangdong Sacred Heart Hospital, Seoul 05355, Republic of Korea;
| | - Ingyu Park
- Department of Electronic Engineering, Hallym University, Chuncheon 24252, Republic of Korea; (I.P.); (D.J.)
| | - Hui-Chul Choi
- Department of Neurology, Hallym University-Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon 24253, Republic of Korea;
| | - Moo-Eob Ahn
- Department of Emergency Medicine, Hallym University-Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon 24253, Republic of Korea;
| | - Ohk-Hyun Ryu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Hallym University-Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon 24253, Republic of Korea;
| | - Daehun Jang
- Department of Electronic Engineering, Hallym University, Chuncheon 24252, Republic of Korea; (I.P.); (D.J.)
| | - Unjoo Lee
- Division of Software, School of Information Science, Hallym University, Chuncheon 24252, Republic of Korea
| | - Sang-Kyu Lee
- Department of Psychiatry, Hallym University-Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon 24253, Republic of Korea
| |
Collapse
|
2
|
Sandroff BM, Rafizadeh CM, Motl RW. Neuroimaging Technology in Exercise Neurorehabilitation Research in Persons with MS: A Scoping Review. SENSORS (BASEL, SWITZERLAND) 2023; 23:s23094530. [PMID: 37177732 PMCID: PMC10181711 DOI: 10.3390/s23094530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 04/28/2023] [Accepted: 05/03/2023] [Indexed: 05/15/2023]
Abstract
There is increasing interest in the application of neuroimaging technology in exercise neurorehabilitation research among persons with multiple sclerosis (MS). The inclusion and focus on neuroimaging outcomes in MS exercise training research is critical for establishing a biological basis for improvements in functioning and elevating exercise within the neurologist's clinical armamentarium alongside disease modifying therapies as an approach for treating the disease and its consequences. Indeed, the inclusion of selective neuroimaging approaches and sensor-based technology among physical activity, mobility, and balance outcomes in such MS research might further allow for detecting specific links between the brain and real-world behavior. This paper provided a scoping review on the application of neuroimaging in exercise training research among persons with MS based on searches conducted in PubMed, Web of Science, and Scopus. We identified 60 studies on neuroimaging-technology-based (primarily MRI, which involved a variety of sequences and approaches) correlates of functions, based on multiple sensor-based measures, which are typically targets for exercise training trials in MS. We further identified 12 randomized controlled trials of exercise training effects on neuroimaging outcomes in MS. Overall, there was a large degree of heterogeneity whereby we could not identify definitive conclusions regarding a consistent neuroimaging biomarker of MS-related dysfunction or singular sensor-based measure, or consistent neural adaptation for exercise training in MS. Nevertheless, the present review provides a first step for better linking correlational and randomized controlled trial research for the development of high-quality exercise training studies on the brain in persons with MS, and this is timely given the substantial interest in exercise as a potential disease-modifying and/or neuroplasticity-inducing behavior in this population.
Collapse
Affiliation(s)
- Brian M Sandroff
- Center for Neuropsychology and Neuroscience Research, Kessler Foundation, 1199 Pleasant Valley Way, West Orange, NJ 07052, USA
- Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ 07103, USA
| | - Caroline M Rafizadeh
- Center for Neuropsychology and Neuroscience Research, Kessler Foundation, 1199 Pleasant Valley Way, West Orange, NJ 07052, USA
| | - Robert W Motl
- Department of Kinesiology and Nutrition, University of Illinois Chicago, Chicago, IL 60607, USA
| |
Collapse
|
3
|
Gan C, Cao X, Wang L, Sun H, Ji M, Zhang H, Yuan Y, Zhang K. Cholinergic basal forebrain atrophy in Parkinson's disease with freezing of gait. Ann Clin Transl Neurol 2023; 10:814-824. [PMID: 37000969 DOI: 10.1002/acn3.51769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 02/21/2023] [Accepted: 03/19/2023] [Indexed: 04/03/2023] Open
Abstract
BACKGROUND Mounting research support that cholinergic dysfunction plays a prominent role in freezing of gait (FOG), which commonly occurs in Parkinson's disease (PD). Basal forebrain (BF), especially the cholinergic nuclei 4 (Ch4), provides the primary source of the brain cholinergic input. However, whether the degeneration of BF and its innervated cortex contribute to the pathogenesis of FOG is unknown. OBJECTIVE To explore the role of structural alterations of BF and its innervated cortical brain regions in the pathogenesis of PD patients with freezing. METHODS Magnetic resonance imaging assessments and neurological assessments were performed on 20 PD patients with FOG (PD-FOG), 20 without FOG (PD-NFOG), and 21 healthy participants. Subregion volumes of the BF were compared among groups. Local gyrification index (LGI) was computed to reveal the cortical alternations. Relationships among subregional BF volumes, LGI, and the severity of FOG were evaluated by multiple linear regression. RESULTS Our study discovered that, compared to PD-NFOG, PD-FOG exhibited significant Ch4 atrophy (p = 4.6 × 10-5 ), accompanied by decreased LGI values in the left entorhinal cortex (p = 3.00 × 10-5 ) and parahippocampal gyrus (p = 2.90 × 10-5 ). Based on the regression analysis, Ch4 volume was negatively associated with FOG severity in PD-FOG group (β = -12.224, T = -2.556, p = 0.031). INTERPRETATION Our results imply that Ch4 degeneration and microstructural disorganization of its innervated cortical brain regions may play important roles in PD-FOG.
Collapse
|
4
|
Nair G, Nair SS, Arun KM, Camacho P, Bava E, Ajayaghosh P, Menon RN, Nair M, Kesavadas C, Anteraper SA. Resting-State Functional Connectivity in Relapsing-Remitting Multiple Sclerosis with Mild Disability: A Data-Driven, Whole-Brain Multivoxel Pattern Analysis Study. Brain Connect 2023; 13:89-96. [PMID: 36006365 DOI: 10.1089/brain.2021.0182] [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] [Indexed: 11/12/2022] Open
Abstract
Background: Multivoxel pattern analysis (MVPA) has emerged as a powerful unbiased approach for generating seed regions of interest (ROIs) in resting-state functional connectivity (RSFC) analysis in a data-driven manner. Studies exploring RSFC in multiple sclerosis have produced diverse and often incongruent results. Objectives: The aim of the present study was to investigate RSFC differences between people with relapsing-remitting multiple sclerosis (RRMS) and healthy controls (HC). Methods: We performed a whole-brain connectome-wide MVPA in 50 RRMS patients with expanded disability status scale ≤4 and 50 age and gender-matched HCs. Results: Significant group differences were noted in RSFC in three clusters distributed in the following regions: anterior cingulate gyrus, right middle frontal gyrus, and frontal medial cortex. Whole-brain seed-to-voxel RSFC characterization of these clusters as seed ROIs revealed network-specific abnormalities, specifically in the anterior cingulate cortex and the default mode network. Conclusions: The network-wide RSFC abnormalities we report agree with the previous findings in RRMS, the cognitive and clinical implications of which are discussed herein. Impact statement This study investigated resting-state functional connectivity (RSFC) in relapsing-remitting multiple sclerosis (RRMS) people with mild disability (expanded disability status scale ≤4). Whole-brain connectome-wide multivoxel pattern analysis was used for assessing RSFC. Compared with healthy controls, we were able to identify three regions of interest for significant differences in connectivity patterns, which were then extracted as a mask for whole-brain seed-to-voxel analysis. A reduced connectivity was noted in the RRMS group, particularly in the anterior cingulate cortex and the default mode network regions, providing insights into the RSFC abnormalities in RRMS.
Collapse
Affiliation(s)
- Gowthami Nair
- Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | - Sruthi S Nair
- Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | - Karumattu Manattu Arun
- Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | - Paul Camacho
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
- Neuroscience Program, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
- Department of Bioengineering, Interdisciplinary Health Science Institute, Urbana, Illinois, USA
| | - Elshal Bava
- Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | - Priya Ajayaghosh
- Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | - Ramshekhar N Menon
- Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | - Muralidharan Nair
- Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | - Chandrasekharan Kesavadas
- Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | | |
Collapse
|
5
|
Yang L, Qin Y, Chen K, Xu C, Peng M, Tan S, Liu T, Yao D. The role of basal ganglia network in neural plasticity in neuromyelitis optica spectrum disorder with myelitis. Mult Scler Relat Disord 2022; 68:104170. [PMID: 36113277 DOI: 10.1016/j.msard.2022.104170] [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: 06/09/2022] [Revised: 09/02/2022] [Accepted: 09/08/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVES To explore the alternation of the brain baseline activity in neuromyelitis optica spectrum disorder (NMOSD) patients after myelitis, and characterize the representation of the neural plasticity process. METHODS Clinical evaluation and resting-state fMRI were obtained from 20 NMOSD patients with myelitis and 20 healthy controls, matched in gender and age. Resting-state networks (RSNs) were identified through independent component analysis (ICA), and functional connectivity (FC) intra-RSNs and between region-of-interest (ROI) seed to whole-brain voxels were analyzed. Between-group comparisons and correlations with motor performance were also assessed. RESULTS A total of 14 main functional RSNs were identified. Group comparison of intra-network FCs revealed that FC strengths increased in basal ganglia network (BGN) and left frontoparietal network, decreased in sensorimotor network and default mode network in NMOSD. Better motor performance was found closely correlated with higher FC of BGN. Additionally, remarkably increased FC between caudate in BGN with cerebellum, frontal lobe and parietal lobe was discovered in further ROI-based whole-brain voxels FC analysis. CONCLUSIONS NMOSD patients presented wide brain resting-state functional connectivity alterations after myelitis, and BGN might be highly active in the process of neural plasticity in chronic stage of NMOSD. Besides, understanding neural plasticity representation, especially that in NMOSD patients after myelitis, might have important applications in monitoring and designing rehabilitative approaches.
Collapse
Affiliation(s)
- Lili Yang
- Department of Neurology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, 32 West Second Section of First Ring Road, Chengdu 611731, China
| | - Yun Qin
- Key Laboratory for NeuroInformation of Ministry of Education, School of Life Science and Technology, University of Electronic Science and Technology of China, No. 2006, Xiyuan Ave., West Hi-Tech Zone, Chengdu, Sichuan 611731, China
| | - Kai Chen
- Department of Neurology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, 32 West Second Section of First Ring Road, Chengdu 611731, China
| | - Congyu Xu
- Key Laboratory for NeuroInformation of Ministry of Education, School of Life Science and Technology, University of Electronic Science and Technology of China, No. 2006, Xiyuan Ave., West Hi-Tech Zone, Chengdu, Sichuan 611731, China
| | - Maoqing Peng
- Key Laboratory for NeuroInformation of Ministry of Education, School of Life Science and Technology, University of Electronic Science and Technology of China, No. 2006, Xiyuan Ave., West Hi-Tech Zone, Chengdu, Sichuan 611731, China
| | - Song Tan
- Department of Neurology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, 32 West Second Section of First Ring Road, Chengdu 611731, China.
| | - Tiejun Liu
- Key Laboratory for NeuroInformation of Ministry of Education, School of Life Science and Technology, University of Electronic Science and Technology of China, No. 2006, Xiyuan Ave., West Hi-Tech Zone, Chengdu, Sichuan 611731, China.
| | - Dezhong Yao
- Key Laboratory for NeuroInformation of Ministry of Education, School of Life Science and Technology, University of Electronic Science and Technology of China, No. 2006, Xiyuan Ave., West Hi-Tech Zone, Chengdu, Sichuan 611731, China.
| |
Collapse
|
6
|
Rocca MA, Schoonheim MM, Valsasina P, Geurts JJG, Filippi M. Task- and resting-state fMRI studies in multiple sclerosis: From regions to systems and time-varying analysis. Current status and future perspective. Neuroimage Clin 2022; 35:103076. [PMID: 35691253 PMCID: PMC9194954 DOI: 10.1016/j.nicl.2022.103076] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 06/01/2022] [Accepted: 06/02/2022] [Indexed: 01/12/2023]
Abstract
Functional MRI is able to detect adaptive and maladaptive abnormalities at different MS stages. Increased fMRI activity is a feature of early MS, while progressive exhaustion of adaptive mechanisms is detected later on in the disease. Collapse of long-range connections and impaired hub integration characterize MS network reorganization. Time-varying connectivity analysis provides useful and complementary pieces of information to static functional connectivity. New perspectives might be the use of multimodal MRI and artificial intelligence.
Multiple sclerosis (MS) is a neurological disorder affecting the central nervous system and features extensive functional brain changes that are poorly understood but relate strongly to clinical impairments. Functional magnetic resonance imaging (fMRI) is a non-invasive, powerful technique able to map activity of brain regions and to assess how such regions interact for an efficient brain network. FMRI has been widely applied to study functional brain changes in MS, allowing to investigate functional plasticity consequent to disease-related structural injury. The first studies in MS using active fMRI tasks mainly aimed to study such plastic changes by identifying abnormal activity in salient brain regions (or systems) involved by the task. In later studies the focus shifted towards resting state (RS) functional connectivity (FC) studies, which aimed to map large-scale functional networks of the brain and to establish how MS pathology impairs functional integration, eventually leading to the hypothesized network collapse as patients clinically progress. This review provides a summary of the main findings from studies using task-based and RS fMRI and illustrates how functional brain alterations relate to clinical disability and cognitive deficits in this condition. We also give an overview of longitudinal studies that used task-based and RS fMRI to monitor disease evolution and effects of motor and cognitive rehabilitation. In addition, we discuss the results of studies using newer technologies involving time-varying FC to investigate abnormal dynamism and flexibility of network configurations in MS. Finally, we show some preliminary results from two recent topics (i.e., multimodal MRI analysis and artificial intelligence) that are receiving increasing attention. Together, these functional studies could provide new (conceptual) insights into disease stage-specific mechanisms underlying progression in MS, with recommendations for future research.
Collapse
Affiliation(s)
- 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.
| | - Menno M Schoonheim
- Department of Anatomy and Neurosciences, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Paola Valsasina
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Jeroen J G Geurts
- Department of Anatomy and Neurosciences, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy; Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy; Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| |
Collapse
|
7
|
Srinivasan SS, Tuckute G, Zou J, Gutierrez-Arango S, Song H, Barry RL, Herr HM. Agonist-antagonist myoneural interface amputation preserves proprioceptive sensorimotor neurophysiology in lower limbs. Sci Transl Med 2021; 12:12/573/eabc5926. [PMID: 33298564 DOI: 10.1126/scitranslmed.abc5926] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 07/22/2020] [Accepted: 10/06/2020] [Indexed: 12/12/2022]
Abstract
The brain undergoes marked changes in function and functional connectivity after limb amputation. The agonist-antagonist myoneural interface (AMI) amputation is a procedure that restores physiological agonist-antagonist muscle relationships responsible for proprioceptive sensory feedback to enable greater motor control. We compared results from the functional neuroimaging of individuals (n = 29) with AMI amputation, traditional amputation, and no amputation. Individuals with traditional amputation demonstrated a significant decrease in proprioceptive activity, measured by activation of Brodmann area 3a, whereas functional activation in individuals with AMIs was not significantly different from controls with no amputation (P < 0.05). The degree of proprioceptive activity in the brain strongly correlated with fascicle activity in the peripheral muscles and performance on motor tasks (P < 0.05), supporting the mechanistic basis of the AMI procedure. These results suggest that surgical techniques designed to restore proprioceptive peripheral neuromuscular constructs result in desirable central sensorimotor plasticity.
Collapse
Affiliation(s)
- Shriya S Srinivasan
- Harvard-MIT Program in Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA 02139, USA. .,MIT Center for Extreme Bionics, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA 02129, USA
| | - Greta Tuckute
- MIT Center for Extreme Bionics, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Jasmine Zou
- MIT Center for Extreme Bionics, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Samantha Gutierrez-Arango
- MIT Center for Extreme Bionics, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA 02129, USA
| | - Hyungeun Song
- Harvard-MIT Program in Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,MIT Center for Extreme Bionics, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA 02129, USA
| | - Robert L Barry
- Harvard-MIT Program in Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA 02139, USA. .,Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA 02129, USA.,Department of Radiology, Harvard Medical School, Boston, MA 02115, USA
| | - Hugh M Herr
- MIT Center for Extreme Bionics, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.
| |
Collapse
|
8
|
Androwis GJ, Sandroff BM, Niewrzol P, Fakhoury F, Wylie GR, Yue G, DeLuca J. A pilot randomized controlled trial of robotic exoskeleton-assisted exercise rehabilitation in multiple sclerosis. Mult Scler Relat Disord 2021; 51:102936. [PMID: 33878619 DOI: 10.1016/j.msard.2021.102936] [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: 11/21/2020] [Revised: 02/21/2021] [Accepted: 03/29/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Co-occurring mobility and cognitive impairments are common, debilitating, and poorly-managed with pharmacological therapies in persons with multiple sclerosis (MS). Exercise rehabilitation (ER), particularly walking ER, has been suggested as one of the best approaches for managing these manifestations of MS. However, there is a focal lack of efficacy of ER on mobility and cognitive outcomes in persons with MS who present with substantial neurological disability. Such severe neurological disability oftentimes precludes the ability for participation in highly-intensive and repetitive ER that is necessary for eliciting adaptations in mobility and cognition. To address such a concern, robotic exoskeleton-assisted ER (REAER) might represent a promising intervention approach for managing co-occurring mobility and cognitive impairments in those with substantial MS disability who might not benefit from traditional ER. METHODS The current pilot single-blind, randomized controlled trial (RCT) compared the effects of 4-weeks of REAER with 4-weeks of conventional gait training (CGT) as a standard-of-care control condition on functional mobility (timed up-and-go; TUG), walking endurance (six-minute walk test; 6MWT), cognitive processing speed (CPS; Symbol Digit Modalities Test; SDMT), and brain connectivity (thalamocortical resting-state functional connectivity (RSFC) based on fMRI) outcomes in 10 persons with substantial MS-related neurological disability. RESULTS Overall, compared with CGT, 4-weeks of REAER was associated with large improvements in functional mobility (ηp2=.38), CPS (ηp2=.53), and RSFC between the thalamus and ventromedial prefrontal cortex (ηp2=.72), but not walking endurance (ηp2=.01). Further, changes in RSFC were moderately associated with changes in TUG, 6MWT, and SDMT performance, respectively, whereby increased thalamocortical RSFC was associated with improved functional mobility, walking endurance, and CPS (|ρ|>.36). CONCLUSION The current pilot RCT provides initial support for REAER as an approach for improving functional mobility and CPS, perhaps based on adaptive and integrative central nervous system plasticity, namely increases in RSFC between the thalamus and ventromedial prefrontal cortex, in a small sample of persons with substantial MS disability. Such a pilot trial provides proof-of-concept data for the design and implementation of an appropriately-powered RCT of REAER in a larger sample of persons with MS who present with co-occurring impairments in both mobility and cognitive functioning.
Collapse
Affiliation(s)
- Ghaith J Androwis
- Kessler Foundation, West Orange, New Jersey, USA; Department of Physical Medicine and Rehabilitation, Rutgers, New Jersey Medical School, Newark, New Jersey, USA.
| | - Brian M Sandroff
- Kessler Foundation, West Orange, New Jersey, USA; Department of Physical Medicine and Rehabilitation, Rutgers, New Jersey Medical School, Newark, New Jersey, USA
| | | | | | - Glenn R Wylie
- Kessler Foundation, West Orange, New Jersey, USA; Department of Physical Medicine and Rehabilitation, Rutgers, New Jersey Medical School, Newark, New Jersey, USA
| | - Guang Yue
- Kessler Foundation, West Orange, New Jersey, USA; Department of Physical Medicine and Rehabilitation, Rutgers, New Jersey Medical School, Newark, New Jersey, USA
| | - John DeLuca
- Kessler Foundation, West Orange, New Jersey, USA; Department of Physical Medicine and Rehabilitation, Rutgers, New Jersey Medical School, Newark, New Jersey, USA
| |
Collapse
|
9
|
Yalachkov Y, Bergmann HJ, Soydaş D, Buschenlange C, Fadai Motlagh LY, Naumer MJ, Kaiser J, Frisch S, Behrens M, Foerch C, Gehrig J. Cognitive Impairment in Multiple Sclerosis Is Reflected by Increased Susceptibility to the Sound-Induced Flash Illusion. Front Neurol 2019; 10:373. [PMID: 31031699 PMCID: PMC6474182 DOI: 10.3389/fneur.2019.00373] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 03/26/2019] [Indexed: 11/16/2022] Open
Abstract
Objective: To determine whether the performance of multiple sclerosis (MS) patients in the sound-induced flash illusion (SiFi), a multisensory perceptual illusion, would reflect their cognitive impairment. Methods: We performed the SiFi task as well as an extensive neuropsychological testing in 95 subjects [39 patients with relapse-remitting MS (RRMS), 16 subjects with progressive multiple sclerosis (PMS) and 40 healthy control subjects (HC)]. Results: MS patients reported more frequently the multisensory SiFi than HC. In contrast, there were no group differences in the control conditions. Essentially, patients with progressive type of MS continued to perceive the illusion at stimulus onset asynchronies (SOA) that were more than three times longer than the SOA at which the illusion was already disrupted for healthy controls. Furthermore, MS patients' degree of cognitive impairment measured with a broad neuropsychological battery encompassing tests for memory, attention, executive functions, and fluency was predicted by their performance in the SiFi task for the longest SOA of 500 ms. Conclusions: These findings support the notion that MS patients exhibit an altered multisensory perception in the SiFi task and that their susceptibility to the perceptual illusion is negatively correlated with their neuropsychological test performance. Since MS lesions affect white matter tracts and cortical regions which seem to be involved in the transfer and processing of both crossmodal and cognitive information, this might be one possible explanation for our findings. SiFi might be considered as a brief, non-expensive, language- and education-independent screening test for cognitive deficits in MS patients.
Collapse
Affiliation(s)
- Yavor Yalachkov
- Department of Neurology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | | | - Dilara Soydaş
- Department of Neurology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | | | | | - Marcus J Naumer
- Institute of Medical Psychology, Goethe-University, Frankfurt am Main, Germany
| | - Jochen Kaiser
- Institute of Medical Psychology, Goethe-University, Frankfurt am Main, Germany
| | - Stefan Frisch
- Department of Neurology, University Hospital Frankfurt, Frankfurt am Main, Germany.,Institute of Psychology, Goethe-University, Frankfurt am Main, Germany
| | - Marion Behrens
- Department of Neurology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Christian Foerch
- Department of Neurology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Johannes Gehrig
- Department of Neurology, University Hospital Frankfurt, Frankfurt am Main, Germany
| |
Collapse
|
10
|
Cordani C, Meani A, Esposito F, Valsasina P, Colombo B, Pagani E, Preziosa P, Comi G, Filippi M, Rocca MA. Imaging correlates of hand motor performance in multiple sclerosis: A multiparametric structural and functional MRI study. Mult Scler 2019; 26:233-244. [PMID: 30657011 DOI: 10.1177/1352458518822145] [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: 01/18/2023]
Abstract
BACKGROUND Hand motor impairment has considerable effects on daily-life activities of patients with multiple sclerosis (pwMS). Understanding its anatomo-functional substrates is relevant to provide more specific therapeutic interventions. OBJECTIVES To investigate the association between hand motor performance and anatomo-functional magnetic resonance imaging (MRI) abnormalities in pwMS. METHODS A total of 134 healthy controls (HC) and 366 pwMS underwent the Nine-Hole-Peg-Test (9HPT), structural and resting state (RS) functional MRI. Multivariate analyses identified the independent predictors of hand motor performance. RESULTS PwMS versus HC showed widespread gray matter atrophy, microstructural white matter abnormalities, and decreased RS functional connectivity in motor and cognitive networks. Predictors of worse right-9HPT (R2 = 0.52) were decreased right superior cerebellar peduncle and right lemniscus fractional anisotropy (FA) (p ⩽ 0.02), left angular gyrus atrophy (p < 0.003), decreased RS connectivity in left superior frontal gyrus, and left posterior cerebellum (p < 0.001). Worse left 9HPT (R2 = 0.56) was predicted by decreased right corticospinal FA (p = 0.003), atrophy of left anterior cingulum and left cerebellum (p ⩽ 0.02), decreased RS connectivity of left lingual gyrus and right posterior cerebellum in cerebellar and executive networks (p ⩽ 0.02). CONCLUSION Structural and functional abnormalities of regions involved in motor functions contribute to explain motor disability in pwMS. The integration of clinical and advanced MRI measures contributes to improve our understanding of multiple sclerosis clinical manifestations.
Collapse
Affiliation(s)
- Claudio Cordani
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Alessandro Meani
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Federica Esposito
- Department of Neurology, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Paola Valsasina
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Bruno Colombo
- Department of Neurology, 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
| | - Paolo Preziosa
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Giancarlo Comi
- Department of Neurology, Institute of Experimental Neurology, Division of Neuroscience, 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, Institute of Experimental Neurology, Division of Neuroscience, 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, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| |
Collapse
|