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Toscano S, Chisari CG, Biondi A, Patti F. Early reduction of retinal thickness predicts physical and cognitive disability in newly diagnosed multiple sclerosis patients: results from a cross-sectional study. Neurol Sci 2024:10.1007/s10072-024-07664-9. [PMID: 38951431 DOI: 10.1007/s10072-024-07664-9] [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: 10/18/2023] [Accepted: 06/18/2024] [Indexed: 07/03/2024]
Abstract
INTRODUCTION Retinal nerve fiber layer (RNFL) thickness is a promising biomarker of axonal loss and a potential outcome predictor in Multiple Sclerosis (MS). Cognitive impairment (CoI) exhibits a high prevalence in patients with MS (pwMS), even in the early phases of the disease. Our aim was to explore the role of RNFL thickness as a predictor of physical and cognitive disability in pwMS. METHODS All newly diagnosed pwMS referred to the MS centre of the University-Hospital "Policlinico-San Marco" between 2015-2019 were evaluated at baseline and at 3 years. RNFL and ganglion cell layer (GCL) thickness for right (r.e.) and left eyes (l.e.) were measured with Optical Coherence Tomography (OCT). Disability level and cognitive profile were assessed, using the Expanded Disability Status Scale (EDSS) and the Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS) battery, respectively. RESULTS We consecutively enrolled 487 pwMS, including 68 (14.0%) with primary progressive MS (PPMS). At baseline, RNFL and GCL were bilaterally thinner in PPMS (r.e. 90.4 ± 12.7; l.e. 90.2 ± 13.5, and r.e. 80.1 ± 11.2; l.e. 80.3 ± 12.6, respectively) compared to relapsing-remitting MS (RRMS) (r.e. 94.6 ± 13.1; l.e. 94.3 ± 14.8, and r.e. 85.1 ± 9.5; l.e. 84.9 ± 9.3, respectively) (p < 0.01). Both groups exhibited reduced RNFL and GCL thickness, worse cognitive performance and higher EDSS scores at 3-years follow-up compared with baseline. RNFL thickness ≤ 88.0 μm was an independent predictor of CoI (OR = 5.32; 95% CI = 1.84-9.12; p = 0.02) and disability worsening (OR = 3.18; 95% CI = 1.21-10.33; p = 0.05). DISCUSSION RNFL thickness, as a biomarker of neurodegeneration, could be considered a predictive biomarker of cognitive degeneration and physical disability in MS.
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Affiliation(s)
- Simona Toscano
- Department "GF Ingrassia", Section of Neurosciences, Neurology Clinic, University of Catania, 9126, Catania, Italy
- Department of Biomedical and Biotechnological Sciences (BIOMETEC), University of Catania, Catania, Italy
| | - Clara Grazia Chisari
- Department "GF Ingrassia", Section of Neurosciences, Neurology Clinic, University of Catania, 9126, Catania, Italy
| | - Alice Biondi
- Department "GF Ingrassia", Section of Neurosciences, Neurology Clinic, University of Catania, 9126, Catania, Italy
| | - Francesco Patti
- Department "GF Ingrassia", Section of Neurosciences, Neurology Clinic, University of Catania, 9126, Catania, Italy.
- Department "GF Ingrassia", Section of Neurosciences, Multiple Sclerosis Center, Neurology Clinic, University of Catania, Via Santa Sofia 78, 95123, Catania, Italy.
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van der Feen FE, de Haan GA, van der Lijn I, Heersema DJ, Meilof JF, Heutink J. Neurovisual rehabilitation in multiple sclerosis: Why a close integration of low-vision rehabilitation and neuropsychological rehabilitation may be effective for visual complaints. Clin Rehabil 2024; 38:393-402. [PMID: 37921016 PMCID: PMC10829419 DOI: 10.1177/02692155231210968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 10/12/2023] [Indexed: 11/04/2023]
Abstract
OBJECTIVE The quality of life of people with multiple sclerosis (MS) is often affected by visual complaints. A previous study suggested that visual complaints are not likely to be related to specific visual functions, but by a global decline of cognitive and visual functioning. In this study, we further explore this hypothesis, by investigating the relation between visual functions and global cognitive functioning, aiming to provide recommendations for rehabilitation for visual complaints. DESIGN Cross-sectional study. SETTING A rehabilitation centre for partially sighted and blind people and a MS centre at a university hospital. PARTICIPANTS 102 people with MS. MAIN MEASURE Correlations between assessments of visual functions (acuity, contrast sensitivity, visual field, smooth pursuit and saccades) and composite scores of a neuropsychological assessment (tests with a visual component and without a visual component). RESULTS All composite scores correlated with visual acuity, contrast sensitivity and the sensitivity of the monocular field, but not with smooth pursuit and saccades. Similar patterns were found in various subgroups. Results showed that visual functions that related to visual complaints correlated with a diffuse decline of global cognitive functioning and that visual and cognitive functioning may decline concurrently in people with MS. CONCLUSIONS Visual complaints may occur as a result of a diffuse decline of the integrity of a cerebral network involved in vision and cognition. People with MS with visual complaints may benefit from neurovisual rehabilitation, in which low-vision rehabilitation and neuropsychological rehabilitation are closely intertwined.
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Affiliation(s)
- FE van der Feen
- Clinical and Developmental Neuropsychology, University of Groningen, Groningen, The Netherlands
- Royal Dutch Visio, Centre of Expertise for Blind and Partially Sighted People, Huizen, The Netherlands
| | - GA de Haan
- Clinical and Developmental Neuropsychology, University of Groningen, Groningen, The Netherlands
- Royal Dutch Visio, Centre of Expertise for Blind and Partially Sighted People, Huizen, The Netherlands
| | - I van der Lijn
- Clinical and Developmental Neuropsychology, University of Groningen, Groningen, The Netherlands
- Royal Dutch Visio, Centre of Expertise for Blind and Partially Sighted People, Huizen, The Netherlands
| | - DJ Heersema
- Department of Neurology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
- MS Centrum Noord Nederland, Groningen, The Netherlands
| | - JF Meilof
- MS Centrum Noord Nederland, Groningen, The Netherlands
- Department of Neurology, Martini Hospital Groningen, Groningen, The Netherlands
| | - J Heutink
- Clinical and Developmental Neuropsychology, University of Groningen, Groningen, The Netherlands
- Royal Dutch Visio, Centre of Expertise for Blind and Partially Sighted People, Huizen, The Netherlands
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Mirmosayyeb O, Zivadinov R, Weinstock-Guttman B, Benedict RHB, Jakimovski D. Optical coherence tomography (OCT) measurements and cognitive performance in multiple sclerosis: a systematic review and meta-analysis. J Neurol 2023; 270:1266-1285. [PMID: 36396812 DOI: 10.1007/s00415-022-11449-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 10/21/2022] [Accepted: 10/22/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Several studies report mixed associations between the retinal nerve fiber layer (RNFL) thickness with cognitive and physical disability in persons with multiple sclerosis (PwMS). Systematic synthesis of these findings is crucial in deriving credible conclusions. METHODS Five databases were searched from their inception to March 2022. The inclusion criteria for studies were MS-specific and required RNFL and cognitive performance data in order to be analyzed. The selection processes followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. RESULTS The systematic review yielded 31 studies that investigated the association between RNFL thickness and cognitive performance. Twenty-two studies reported positive associations, and nine did not. The meta-analysis included 11 studies with a total of 782 PwMS with mean age of 40.5 years, mean Expanded Disability Status Scale (EDSS) of 2.7, and disease duration of 11.3 years. RNFL thickness was significantly associated Symbol Digit Modalities Test (pooled r = 0.306, p < 0.001), Paced Auditory Serial Addition Test (pooled r = 0.374, p < 0.001) and Word List Generation (WLG, pooled r = 0.177, p < 0.001). RNFL was also significantly correlated with visuospatial learning and memory tests (pooled r = 0.148, p = 0.042) and verbal learning and memory tests (pooled r = 0.245, p = 0.005). Within three eligible studies, no significant association between ganglion cell inner-plexiform layer and SDMT 0.083 (95% CI - 0.186, 0.352) was noted. The heterogeneity was high in all correlation studies (I2 > 63% and p < 0.008) except for the WLG and visuospatial memory findings. CONCLUSION RNFL thickness is associated with cognitive processing speed, verbal learning and memory, visual learning and memory, as well as verbal fluency in PwMS. The number of studies included in the meta-analyses were limited due to non-standardized reporting.
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Affiliation(s)
- Omid Mirmosayyeb
- Department of Neurology, Jacobs Comprehensive MS Treatment and Research Center, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Robert Zivadinov
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, 100 High Street, Buffalo, NY, 14203, USA
- Center for Biomedical Imaging at the Clinical Translational Science Institute, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Bianca Weinstock-Guttman
- Department of Neurology, Jacobs Comprehensive MS Treatment and Research Center, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Ralph H B Benedict
- Department of Neurology, Jacobs Comprehensive MS Treatment and Research Center, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Dejan Jakimovski
- Department of Neurology, Jacobs Comprehensive MS Treatment and Research Center, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA.
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, 100 High Street, Buffalo, NY, 14203, USA.
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Javitt DC, Martinez A, Sehatpour P, Beloborodova A, Habeck C, Gazes Y, Bermudez D, Razlighi QR, Devanand DP, Stern Y. Disruption of early visual processing in amyloid-positive healthy individuals and mild cognitive impairment. Alzheimers Res Ther 2023; 15:42. [PMID: 36855162 PMCID: PMC9972790 DOI: 10.1186/s13195-023-01189-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 02/12/2023] [Indexed: 03/02/2023]
Abstract
BACKGROUND Amyloid deposition is a primary predictor of Alzheimer's disease (AD) and related neurodegenerative disorders. Retinal changes involving the structure and function of the ganglion cell layer are increasingly documented in both established and prodromal AD. Visual event-related potentials (vERP) are sensitive to dysfunction in the magno- and parvocellular visual systems, which originate within the retinal ganglion cell layer. The present study evaluates vERP as a function of amyloid deposition in aging, and in mild cognitive impairment (MCI). METHODS vERP to stimulus-onset, motion-onset, and alpha-frequency steady-state (ssVEP) stimuli were obtained from 16 amyloid-positive and 41 amyloid-negative healthy elders and 15 MCI individuals and analyzed using time-frequency approaches. Social cognition was assessed in a subset of individuals using The Awareness of Social Inference Test (TASIT). RESULTS Neurocognitively intact but amyloid-positive participants and MCI individuals showed significant deficits in stimulus-onset (theta) and motion-onset (delta) vERP generation relative to amyloid-negative participants (all p < .01). Across healthy elders, a composite index of these measures correlated highly (r = - .52, p < .001) with amyloid standardized uptake value ratios (SUVR) and TASIT performance. A composite index composed of vERP measures significant differentiated amyloid-positive and amyloid-negative groups with an overall classification accuracy of > 70%. DISCUSSION vERP may assist in the early detection of amyloid deposition among older individuals without observable neurocognitive impairments and in linking previously documented retinal deficits in both prodromal AD and MCI to behavioral impairments in social cognition.
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Affiliation(s)
- Daniel C Javitt
- Division of Experimental Therapeutics, Department of Psychiatry, Columbia University Irving Medical Center, 1051 Riverside Drive, Unit 21, New York, NY, 10032, USA.
- Division of Schizophrenia Research, Nathan Kline Institute for Psychiatric Research, Orangeburg, NY, 10962, USA.
| | - Antigona Martinez
- Division of Experimental Therapeutics, Department of Psychiatry, Columbia University Irving Medical Center, 1051 Riverside Drive, Unit 21, New York, NY, 10032, USA
- Division of Schizophrenia Research, Nathan Kline Institute for Psychiatric Research, Orangeburg, NY, 10962, USA
| | - Pejman Sehatpour
- Division of Experimental Therapeutics, Department of Psychiatry, Columbia University Irving Medical Center, 1051 Riverside Drive, Unit 21, New York, NY, 10032, USA
- Division of Schizophrenia Research, Nathan Kline Institute for Psychiatric Research, Orangeburg, NY, 10962, USA
| | - Anna Beloborodova
- Division of Experimental Therapeutics, Department of Psychiatry, Columbia University Irving Medical Center, 1051 Riverside Drive, Unit 21, New York, NY, 10032, USA
| | - Christian Habeck
- Cognitive Neuroscience Division, Department of Neurology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, 10032, USA
| | - Yunglin Gazes
- Cognitive Neuroscience Division, Department of Neurology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, 10032, USA
| | - Dalton Bermudez
- Division of Schizophrenia Research, Nathan Kline Institute for Psychiatric Research, Orangeburg, NY, 10962, USA
| | - Qolamreza R Razlighi
- Quantitative Neuroimaging Laboratory, Department of Radiology, Weill Cornell Medicine, Brain Health Image Institute, New York, NY, 10065, USA
| | - D P Devanand
- Area Brain Aging and Mental Health, Columbia University Irving Medical Center/New York State Psychiatric Institute, New York, NY, 10032, USA
| | - Yaakov Stern
- Cognitive Neuroscience Division, Department of Neurology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, 10032, USA
- Area Brain Aging and Mental Health, Columbia University Irving Medical Center/New York State Psychiatric Institute, New York, NY, 10032, USA
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Moghadasi AN, Mirmosayyeb O, Ebrahimi N, Sahraian MA, Mohammadi A, Ghajarzadeh M. The relationship between retinal layer thickness and cognition in patients with multiple sclerosis: A systematic review of current literature. CURRENT JOURNAL OF NEUROLOGY 2023; 22:50-57. [PMID: 38011353 PMCID: PMC10444597 DOI: 10.18502/cjn.v22i1.12617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 11/02/2022] [Indexed: 11/29/2023]
Abstract
Background: This study was conducted to evaluate the relationship between retinal layer thickness (RLT) and cognition in patients with multiple sclerosis (MS). Methods: We searched PubMed, Scopus, Embase, Web of Science, and Google Scholar. The search strategy included the MeSH and text words as ["ora serrata" OR "retina" OR ("coherence tomography" AND "optical") OR "OCT tomography" OR (tomography AND OCT) OR "optical coherence tomography" OR "OCT" OR "retinal thickness" OR "inner plexiform layer" OR "nerve fiber layer" OR "ganglion cell layer" OR "inner nuclear layer" OR "outer plexiform layer" OR "outer nuclear layer" OR "external limiting membrane" OR "inner segment layer" OR "outer segment layer" OR "retinal pigment epithelium"] AND ["cognition"* OR "cognitive function"* OR (function* AND cognitive)] AND [(sclerosis AND multiple) OR (sclerosis AND disseminated) OR "disseminated sclerosis" OR "multiple sclerosis" OR "acute fulminating"]. Results: The literature search revealed 1090 articles; after deleting duplicates, 980 remained. Finally, 14 studies were included. Totally, 1081 patients were evaluated. Mean age ranged from 31 to 55 years. In some studies, there was a correlation between cognition and retinal thickness, while others did not confirm this finding. Some authors found cognitive impairment (CI) in patients with MS with RLT. Conclusion: The results of this systematic review show that there are discrepancies between the results of studies regarding the relationship between RLT and cognition status in patients with MS. Further studies with more included original studies and meta-analysis are recommended.
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Affiliation(s)
- Abdorreza Naser Moghadasi
- Multiple Sclerosis Research Center, Neuroscience institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Omid Mirmosayyeb
- Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Narges Ebrahimi
- School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Ali Sahraian
- Multiple Sclerosis Research Center, Neuroscience institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Aida Mohammadi
- Universal Council of Epidemiology, Universal Scientific Education and Research Network, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahsa Ghajarzadeh
- Multiple Sclerosis Research Center, Neuroscience institute, Tehran University of Medical Sciences, Tehran, Iran
- Universal Council of Epidemiology, Universal Scientific Education and Research Network, Tehran University of Medical Sciences, Tehran, Iran
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Cai Y, Yang T, Yu X, Han X, Chen G, Shi C. The alternate-form reliability study of six variants of the Brief Visual-Spatial Memory Test-Revised and the Hopkins Verbal Learning Test-Revised. Front Public Health 2023; 11:1096397. [PMID: 37033023 PMCID: PMC10073731 DOI: 10.3389/fpubh.2023.1096397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 02/22/2023] [Indexed: 04/11/2023] Open
Abstract
Introduction The revised Hopkins Verbal Learning Test-Revised (HVLT-R) and the Brief Visual-Spatial Memory Test-Revised (BVMT-R) are two widely used test involving verbal and visual learning and memory. In the two tests, six different versions are assembled, respectively, to prevent learning effects. Currently, no researchers have compared the six versions of the two tests. Thus, their usefulness in clinical studies requiring multiple follow-ups is limited. In this work, we confirm the equivalence of six HVLT-R and BVMT-R versions. Methods 20 people completed all six HVLT-R and BVMT-R versions, while 120 people were randomly assigned to complete one of the six versions of each test. The Intelligence Quotient (IQ) level is measured using the short version of the Wechsler Adult Intelligence test. R4.2.0 is used for statistical analysis. The K-Related sample test (a non-parametric test) is used to observe the differences in test scores among the 20 subjects. The one-way Analysis of Variance (ANOVA) test is utilized to analyze the differences in test scores among the 120 subjects. The scores on different versions are compared using two similar sample tests. The HVLT-R Total Learning, the HVLT-R Delayed Recall, the BVMT-R Total Learning, and the BVMT-R Delayed Recall are indexes for comparison. Version and test scores are used as research factors, while different versions are used as research levels. Results The results suggest that HVLT-R and BVMT-R versions 3, 5 and 6 are equally difficult, and relatively easy compared to versions 1, 2 and 4. HVLT-R versions 3, 5, and 6 show good reliability and can be used interchangeably when testing word learning ability or short-term memory; BVMT-R Versions 3, 5, and 6 show acceptable reliability and can be can be used interchangeably. Discussion In the study of multiple follow-ups, it is a must to avoid discrepant versions and choose other equivalent versions. The results from this study could be used as a guide for upcoming studies and clinical applications in China.
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Affiliation(s)
- Yumei Cai
- Peking University Institute of Population Research, Beijing, China
| | | | - Xin Yu
- Peking University Institute of Mental Health (Sixth Hospital), Beijing, China
- National Clinical Research Center for Mental Disorders, Peking University Sixth Hospital, Beijing, China
- Key Laboratory of Mental Health, Ministry of Health, Peking University, Beijing, China
| | - Xue Han
- Peking University Institute of Mental Health (Sixth Hospital), Beijing, China
- National Clinical Research Center for Mental Disorders, Peking University Sixth Hospital, Beijing, China
- Key Laboratory of Mental Health, Ministry of Health, Peking University, Beijing, China
- *Correspondence: Xue Han
| | - Gong Chen
- Peking University Institute of Population Research, Beijing, China
- Gong Chen
| | - Chuan Shi
- Peking University Institute of Mental Health (Sixth Hospital), Beijing, China
- National Clinical Research Center for Mental Disorders, Peking University Sixth Hospital, Beijing, China
- Key Laboratory of Mental Health, Ministry of Health, Peking University, Beijing, China
- Chuan Shi
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Davion JB, Jougleux C, Lopes R, Leclerc X, Outteryck O. Relation between retina, cognition and brain volumes in MS: a consequence of asymptomatic optic nerve lesions. J Neurol 2023; 270:240-249. [PMID: 36018381 DOI: 10.1007/s00415-022-11348-9] [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: 07/05/2022] [Revised: 08/16/2022] [Accepted: 08/17/2022] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Asymptomatic optic nerve lesions are frequent in multiple sclerosis (MS) and their impact on cognition and/or brain volume has never been taken into account. PATIENTS AND METHODS We used the data from the cross-sectional Visual Ways in MS (VWIMS) study including relapsing remitting MS. All patients underwent brain and optic nerve Magnetic Resonance Imaging (MRI) including Double Inversion Recuperation (DIR) sequence, retinal OCT, and cognitive evaluation with the Brief International Cognitive Assessment in MS (BICAMS). We measured the association between OCT findings (thickness/volume of retinal layers) and extra-visual parameters (cerebral volumes and BICAMS scores) in optic nerves with and/or without the presence of DIR asymptomatic optic nerve hypersignal. RESULTS Between March and December 2017, we included 98 patients. Two patients were excluded. Over the 192 eyes, 73 had at least one clinical history of optic neuritis (ON-eyes) whereas 119 were asymptomatic (NON-eyes). Among the 119 NON-eyes, 58 had 3D-DIR optic nerve hypersignal (48.7%). We confirmed significant associations between some retinal OCT measures and some extra-visual parameters (cerebral volumes, cognitive scores) in NON-eyes. Unexpectedly, these associations were found when an asymptomatic optic nerve DIR-hypersignal was present on MRI, but not when it was absent. CONCLUSION Our study showed a relation between OCT measures and extra-visual parameters in NON-eyes MS patients. As a confusion factor, asymptomatic optic nerve lesions may be the explanation of the relation between OCT measures and extra-visual parameters. Retinal OCT seems to be far more a "window over the optic nerve" than a "window over the brain".
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Affiliation(s)
- Jean-Baptiste Davion
- Department of Neuroradiology, Univ. Lille, INSERM, CHU Lille, U1172, Degenerative and Vascular Cognitive Disorders, 59000, Lille, France
| | - Caroline Jougleux
- Department of Neurology, Multiple Sclerosis Center of Lille, Univ. Lille, 59000, Lille, France
| | - Renaud Lopes
- Department of Neuroradiology, Univ. Lille, INSERM, CHU Lille, U1172, Degenerative and Vascular Cognitive Disorders, 59000, Lille, France
| | - Xavier Leclerc
- Department of Neuroradiology, Univ. Lille, INSERM, CHU Lille, U1172, Degenerative and Vascular Cognitive Disorders, 59000, Lille, France
| | - Olivier Outteryck
- Department of Neuroradiology, Univ. Lille, INSERM, CHU Lille, U1172, Degenerative and Vascular Cognitive Disorders, 59000, Lille, France.
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Integrated Approaches to Identify miRNA Biomarkers Associated with Cognitive Dysfunction in Multiple Sclerosis Using Text Mining, Gene Expression, Pathways, and GWAS. Diagnostics (Basel) 2022; 12:diagnostics12081914. [PMID: 36010264 PMCID: PMC9406323 DOI: 10.3390/diagnostics12081914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 08/03/2022] [Accepted: 08/03/2022] [Indexed: 11/16/2022] Open
Abstract
Multiple sclerosis (MS), a chronic autoimmune disorder, affects the central nervous system of many young adults. More than half of MS patients develop cognition problems. Although several genomic and transcriptomic studies are currently reported in MS cognitive impairment, a comprehensive repository dealing with all the experimental data is still underdeveloped. In this study, we combined text mining, gene regulation, pathway analysis, and genome-wide association studies (GWAS) to identify miRNA biomarkers to explore the cognitive dysfunction in MS, and to understand the genomic etiology of the disease. We first identified the dysregulated miRNAs associated with MS and cognitive dysfunction using PubTator (text mining), HMDD (experimental associations), miR2Disease, and PhenomiR database (differentially expressed miRNAs). Our results suggest that miRNAs such as hsa-mir-148b-3p, hsa-mir-7b-5p, and hsa-mir-7a-5p are commonly associated with MS and cognitive dysfunction. Next, we retrieved GWAS signals from GWAS Catalog, and analyzed the enrichment analysis of association signals in genes/miRNAs and their association networks. Then, we identified susceptible genetic loci, rs17119 (chromosome 6; p = 1 × 10−10), rs1843938 (chromosome 7; p = 1 × 10−10), and rs11637611 (chromosome 15; p = 1.00 × 10−15), associated with significant genetic risk. Lastly, we conducted a pathway analysis for the susceptible genetic variants and identified novel risk pathways. The ECM receptor signaling pathway (p = 3.98 × 10−8) and PI3K/Akt signaling pathway (p = 5.98 × 10−5) were found to be associated with differentially expressed miRNA biomarkers.
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Collorone S, Kanber B, Hashem L, Cawley N, Prados F, Davagnanam I, Barkhof F, Ciccarelli O, Toosy A. Visual Function and Brief Cognitive Assessment for Multiple Sclerosis in Optic Neuritis Clinically Isolated Syndrome Patients. J Neuroophthalmol 2022; 42:e22-e31. [PMID: 34561401 PMCID: PMC8834161 DOI: 10.1097/wno.0000000000001280] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND In this study, we hypothesized that clinically isolated syndrome-optic neuritis patients may have disturbances in neuropsychological functions related to visual processes. METHODS Forty-two patients with optic neuritis within 3 months from onset and 13 healthy controls were assessed at baseline and 6 months with MRI (brain volumes, lesion load, and optic radiation lesion volume) and optical coherence tomography (OCT) (peripapillary retinal nerve fiber layer [RNFL], ganglion cell and inner plexiform layers [GCIPLs], and inner nuclear layer). Patients underwent the brief cognitive assessment for multiple sclerosis, high-contrast and low-contrast letter acuity, and color vision. RESULTS At baseline, patients had impaired visual function, had GCIPL thinning in both eyes, and performed below the normative average in the visual-related tests: Symbol Digit Modalities Test and Brief Visuospatial Memory Test-Revised (BVMT-R). Over time, improvement in visual function in the affected eye was predicted by baseline GCIPL (P = 0.015), RNFL decreased, and the BVMT-R improved (P = 0.001). Improvement in BVMT-R was associated with improvement in the high-contrast letter acuity of the affected eye (P = 0.03), independently of OCT and MRI metrics. CONCLUSION Cognitive testing, assessed binocularly, of visuospatial processing is affected after unilateral optic neuritis and improves over time with visual recovery. This is not related to structural markers of the visual or central nervous system.
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Affiliation(s)
- Sara Collorone
- NMR Research Unit (SC, BK, LH, NC, FP, OC, and AT), Queen Square MS Centre, Department of Neuroinflammation, Queen Square Institute of Neurology, Faculty of Brain Sciences, UCL, London, United Kingdom; Department of Medical Physics and Biomedical Engineering (BK, FP, and FB), Centre for Medical Image Computing (CMIC), University College London, London, United Kingdom; Universitat Oberta de Catalunya (FP), Barcelona, Spain; Department of Brain Repair and Rehabilitation (ID and FB), University College London Institute of Neurology, Faculty of Brain Sciences, UCL, London, United Kingdom; National Institute for Health Research (FB and OC), University College London Hospitals, Biomedical Research Centre, London, United Kingdom; and Department of Radiology and Nuclear Medicine (FB), Amsterdam University Medical Centers, Vrije Universiteit, the Netherlands
| | - Baris Kanber
- NMR Research Unit (SC, BK, LH, NC, FP, OC, and AT), Queen Square MS Centre, Department of Neuroinflammation, Queen Square Institute of Neurology, Faculty of Brain Sciences, UCL, London, United Kingdom; Department of Medical Physics and Biomedical Engineering (BK, FP, and FB), Centre for Medical Image Computing (CMIC), University College London, London, United Kingdom; Universitat Oberta de Catalunya (FP), Barcelona, Spain; Department of Brain Repair and Rehabilitation (ID and FB), University College London Institute of Neurology, Faculty of Brain Sciences, UCL, London, United Kingdom; National Institute for Health Research (FB and OC), University College London Hospitals, Biomedical Research Centre, London, United Kingdom; and Department of Radiology and Nuclear Medicine (FB), Amsterdam University Medical Centers, Vrije Universiteit, the Netherlands
| | - Leen Hashem
- NMR Research Unit (SC, BK, LH, NC, FP, OC, and AT), Queen Square MS Centre, Department of Neuroinflammation, Queen Square Institute of Neurology, Faculty of Brain Sciences, UCL, London, United Kingdom; Department of Medical Physics and Biomedical Engineering (BK, FP, and FB), Centre for Medical Image Computing (CMIC), University College London, London, United Kingdom; Universitat Oberta de Catalunya (FP), Barcelona, Spain; Department of Brain Repair and Rehabilitation (ID and FB), University College London Institute of Neurology, Faculty of Brain Sciences, UCL, London, United Kingdom; National Institute for Health Research (FB and OC), University College London Hospitals, Biomedical Research Centre, London, United Kingdom; and Department of Radiology and Nuclear Medicine (FB), Amsterdam University Medical Centers, Vrije Universiteit, the Netherlands
| | - Niamh Cawley
- NMR Research Unit (SC, BK, LH, NC, FP, OC, and AT), Queen Square MS Centre, Department of Neuroinflammation, Queen Square Institute of Neurology, Faculty of Brain Sciences, UCL, London, United Kingdom; Department of Medical Physics and Biomedical Engineering (BK, FP, and FB), Centre for Medical Image Computing (CMIC), University College London, London, United Kingdom; Universitat Oberta de Catalunya (FP), Barcelona, Spain; Department of Brain Repair and Rehabilitation (ID and FB), University College London Institute of Neurology, Faculty of Brain Sciences, UCL, London, United Kingdom; National Institute for Health Research (FB and OC), University College London Hospitals, Biomedical Research Centre, London, United Kingdom; and Department of Radiology and Nuclear Medicine (FB), Amsterdam University Medical Centers, Vrije Universiteit, the Netherlands
| | - Ferran Prados
- NMR Research Unit (SC, BK, LH, NC, FP, OC, and AT), Queen Square MS Centre, Department of Neuroinflammation, Queen Square Institute of Neurology, Faculty of Brain Sciences, UCL, London, United Kingdom; Department of Medical Physics and Biomedical Engineering (BK, FP, and FB), Centre for Medical Image Computing (CMIC), University College London, London, United Kingdom; Universitat Oberta de Catalunya (FP), Barcelona, Spain; Department of Brain Repair and Rehabilitation (ID and FB), University College London Institute of Neurology, Faculty of Brain Sciences, UCL, London, United Kingdom; National Institute for Health Research (FB and OC), University College London Hospitals, Biomedical Research Centre, London, United Kingdom; and Department of Radiology and Nuclear Medicine (FB), Amsterdam University Medical Centers, Vrije Universiteit, the Netherlands
| | - Indran Davagnanam
- NMR Research Unit (SC, BK, LH, NC, FP, OC, and AT), Queen Square MS Centre, Department of Neuroinflammation, Queen Square Institute of Neurology, Faculty of Brain Sciences, UCL, London, United Kingdom; Department of Medical Physics and Biomedical Engineering (BK, FP, and FB), Centre for Medical Image Computing (CMIC), University College London, London, United Kingdom; Universitat Oberta de Catalunya (FP), Barcelona, Spain; Department of Brain Repair and Rehabilitation (ID and FB), University College London Institute of Neurology, Faculty of Brain Sciences, UCL, London, United Kingdom; National Institute for Health Research (FB and OC), University College London Hospitals, Biomedical Research Centre, London, United Kingdom; and Department of Radiology and Nuclear Medicine (FB), Amsterdam University Medical Centers, Vrije Universiteit, the Netherlands
| | - Frederik Barkhof
- NMR Research Unit (SC, BK, LH, NC, FP, OC, and AT), Queen Square MS Centre, Department of Neuroinflammation, Queen Square Institute of Neurology, Faculty of Brain Sciences, UCL, London, United Kingdom; Department of Medical Physics and Biomedical Engineering (BK, FP, and FB), Centre for Medical Image Computing (CMIC), University College London, London, United Kingdom; Universitat Oberta de Catalunya (FP), Barcelona, Spain; Department of Brain Repair and Rehabilitation (ID and FB), University College London Institute of Neurology, Faculty of Brain Sciences, UCL, London, United Kingdom; National Institute for Health Research (FB and OC), University College London Hospitals, Biomedical Research Centre, London, United Kingdom; and Department of Radiology and Nuclear Medicine (FB), Amsterdam University Medical Centers, Vrije Universiteit, the Netherlands
| | - Olga Ciccarelli
- NMR Research Unit (SC, BK, LH, NC, FP, OC, and AT), Queen Square MS Centre, Department of Neuroinflammation, Queen Square Institute of Neurology, Faculty of Brain Sciences, UCL, London, United Kingdom; Department of Medical Physics and Biomedical Engineering (BK, FP, and FB), Centre for Medical Image Computing (CMIC), University College London, London, United Kingdom; Universitat Oberta de Catalunya (FP), Barcelona, Spain; Department of Brain Repair and Rehabilitation (ID and FB), University College London Institute of Neurology, Faculty of Brain Sciences, UCL, London, United Kingdom; National Institute for Health Research (FB and OC), University College London Hospitals, Biomedical Research Centre, London, United Kingdom; and Department of Radiology and Nuclear Medicine (FB), Amsterdam University Medical Centers, Vrije Universiteit, the Netherlands
| | - Ahmed Toosy
- NMR Research Unit (SC, BK, LH, NC, FP, OC, and AT), Queen Square MS Centre, Department of Neuroinflammation, Queen Square Institute of Neurology, Faculty of Brain Sciences, UCL, London, United Kingdom; Department of Medical Physics and Biomedical Engineering (BK, FP, and FB), Centre for Medical Image Computing (CMIC), University College London, London, United Kingdom; Universitat Oberta de Catalunya (FP), Barcelona, Spain; Department of Brain Repair and Rehabilitation (ID and FB), University College London Institute of Neurology, Faculty of Brain Sciences, UCL, London, United Kingdom; National Institute for Health Research (FB and OC), University College London Hospitals, Biomedical Research Centre, London, United Kingdom; and Department of Radiology and Nuclear Medicine (FB), Amsterdam University Medical Centers, Vrije Universiteit, the Netherlands
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10
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Baetge SJ, Dietrich M, Filser M, Renner A, Stute N, Gasis M, Weise M, Lepka K, Graf J, Goebels N, Hartung HP, Aktas O, Meuth S, Albrecht P, Penner IK. Association of Retinal Layer Thickness With Cognition in Patients With Multiple Sclerosis. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2021; 8:8/4/e1018. [PMID: 34045307 PMCID: PMC8161541 DOI: 10.1212/nxi.0000000000001018] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 04/13/2021] [Indexed: 01/04/2023]
Abstract
Objective Retinal layer thickness (RLT) measured by optical coherence tomography (OCT) is considered a noninvasive, cost-efficient marker of neurodegeneration in multiple sclerosis (MS). We aimed to investigate associations of RLT with cognitive performance and its potential as indicator of cognitive status in patients with MS by performing generalized estimating equation (GEE) analyses. Methods In this cross-sectional study, patients with at least mild signs of cognitive impairment were examined by OCT as well as by the Brief International Cognitive Assessment for MS and tests assessing attention and executive functions (Trail Making Test [TMT] A and B). Associations of these factors were investigated using GEE models controlling for demographic and disease-related factors and correcting for multiple testing. Results A total of 64 patients entered the study. In the final sample (n = 50 [n = 14 excluded due to missing data or drop-outs]; n = 44 relapsing-remitting MS and n = 6 secondary progressive MS, mean Expanded Disability Status Scale score = 2.59 [SD = 1.17], disease duration [median] = 7.34 [interquartile range = 12.1]), 36.0% were cognitively impaired. RLT of the macular retinal nerve fiber layer was associated with performance in TMT-B (β = −0.259). Analyses focusing on the upper and lower tertile of RLT additionally revealed associations between macular ganglion cell-inner plexiform layer and TMT-B and verbal short-term memory and learning, respectively. Conclusion In patients with MS, at less advanced disease stages, RLT was especially associated with cognitive flexibility promoting OCT as a potential marker advocating further extensive neuropsychological examination.
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Affiliation(s)
- Sharon Jean Baetge
- From the Cogito Center for Applied Neurocognition and Neuropsychological Research (S.J.B., M.F., A.R., N.S., I.-K.P.); Department of Neurology (M.D., M.G., M.W., K.L., J.G., N.G., H.-P.H., O.A., S.M., P.A., I.-K.P.), Medical Faculty, Heinrich Heine University, Düsseldorf, Germany; Brain and Mind Centre (H.-P.H.), Department of Neurology, University of Sydney; and Department of Neurology (H.-P.H.), Medical University of Vienna, Austria
| | - Michael Dietrich
- From the Cogito Center for Applied Neurocognition and Neuropsychological Research (S.J.B., M.F., A.R., N.S., I.-K.P.); Department of Neurology (M.D., M.G., M.W., K.L., J.G., N.G., H.-P.H., O.A., S.M., P.A., I.-K.P.), Medical Faculty, Heinrich Heine University, Düsseldorf, Germany; Brain and Mind Centre (H.-P.H.), Department of Neurology, University of Sydney; and Department of Neurology (H.-P.H.), Medical University of Vienna, Austria
| | - Melanie Filser
- From the Cogito Center for Applied Neurocognition and Neuropsychological Research (S.J.B., M.F., A.R., N.S., I.-K.P.); Department of Neurology (M.D., M.G., M.W., K.L., J.G., N.G., H.-P.H., O.A., S.M., P.A., I.-K.P.), Medical Faculty, Heinrich Heine University, Düsseldorf, Germany; Brain and Mind Centre (H.-P.H.), Department of Neurology, University of Sydney; and Department of Neurology (H.-P.H.), Medical University of Vienna, Austria
| | - Alina Renner
- From the Cogito Center for Applied Neurocognition and Neuropsychological Research (S.J.B., M.F., A.R., N.S., I.-K.P.); Department of Neurology (M.D., M.G., M.W., K.L., J.G., N.G., H.-P.H., O.A., S.M., P.A., I.-K.P.), Medical Faculty, Heinrich Heine University, Düsseldorf, Germany; Brain and Mind Centre (H.-P.H.), Department of Neurology, University of Sydney; and Department of Neurology (H.-P.H.), Medical University of Vienna, Austria
| | - Nathalie Stute
- From the Cogito Center for Applied Neurocognition and Neuropsychological Research (S.J.B., M.F., A.R., N.S., I.-K.P.); Department of Neurology (M.D., M.G., M.W., K.L., J.G., N.G., H.-P.H., O.A., S.M., P.A., I.-K.P.), Medical Faculty, Heinrich Heine University, Düsseldorf, Germany; Brain and Mind Centre (H.-P.H.), Department of Neurology, University of Sydney; and Department of Neurology (H.-P.H.), Medical University of Vienna, Austria
| | - Marcia Gasis
- From the Cogito Center for Applied Neurocognition and Neuropsychological Research (S.J.B., M.F., A.R., N.S., I.-K.P.); Department of Neurology (M.D., M.G., M.W., K.L., J.G., N.G., H.-P.H., O.A., S.M., P.A., I.-K.P.), Medical Faculty, Heinrich Heine University, Düsseldorf, Germany; Brain and Mind Centre (H.-P.H.), Department of Neurology, University of Sydney; and Department of Neurology (H.-P.H.), Medical University of Vienna, Austria
| | - Margit Weise
- From the Cogito Center for Applied Neurocognition and Neuropsychological Research (S.J.B., M.F., A.R., N.S., I.-K.P.); Department of Neurology (M.D., M.G., M.W., K.L., J.G., N.G., H.-P.H., O.A., S.M., P.A., I.-K.P.), Medical Faculty, Heinrich Heine University, Düsseldorf, Germany; Brain and Mind Centre (H.-P.H.), Department of Neurology, University of Sydney; and Department of Neurology (H.-P.H.), Medical University of Vienna, Austria
| | - Klaudia Lepka
- From the Cogito Center for Applied Neurocognition and Neuropsychological Research (S.J.B., M.F., A.R., N.S., I.-K.P.); Department of Neurology (M.D., M.G., M.W., K.L., J.G., N.G., H.-P.H., O.A., S.M., P.A., I.-K.P.), Medical Faculty, Heinrich Heine University, Düsseldorf, Germany; Brain and Mind Centre (H.-P.H.), Department of Neurology, University of Sydney; and Department of Neurology (H.-P.H.), Medical University of Vienna, Austria
| | - Jonas Graf
- From the Cogito Center for Applied Neurocognition and Neuropsychological Research (S.J.B., M.F., A.R., N.S., I.-K.P.); Department of Neurology (M.D., M.G., M.W., K.L., J.G., N.G., H.-P.H., O.A., S.M., P.A., I.-K.P.), Medical Faculty, Heinrich Heine University, Düsseldorf, Germany; Brain and Mind Centre (H.-P.H.), Department of Neurology, University of Sydney; and Department of Neurology (H.-P.H.), Medical University of Vienna, Austria
| | - Norbert Goebels
- From the Cogito Center for Applied Neurocognition and Neuropsychological Research (S.J.B., M.F., A.R., N.S., I.-K.P.); Department of Neurology (M.D., M.G., M.W., K.L., J.G., N.G., H.-P.H., O.A., S.M., P.A., I.-K.P.), Medical Faculty, Heinrich Heine University, Düsseldorf, Germany; Brain and Mind Centre (H.-P.H.), Department of Neurology, University of Sydney; and Department of Neurology (H.-P.H.), Medical University of Vienna, Austria
| | - Hans-Peter Hartung
- From the Cogito Center for Applied Neurocognition and Neuropsychological Research (S.J.B., M.F., A.R., N.S., I.-K.P.); Department of Neurology (M.D., M.G., M.W., K.L., J.G., N.G., H.-P.H., O.A., S.M., P.A., I.-K.P.), Medical Faculty, Heinrich Heine University, Düsseldorf, Germany; Brain and Mind Centre (H.-P.H.), Department of Neurology, University of Sydney; and Department of Neurology (H.-P.H.), Medical University of Vienna, Austria
| | - Orhan Aktas
- From the Cogito Center for Applied Neurocognition and Neuropsychological Research (S.J.B., M.F., A.R., N.S., I.-K.P.); Department of Neurology (M.D., M.G., M.W., K.L., J.G., N.G., H.-P.H., O.A., S.M., P.A., I.-K.P.), Medical Faculty, Heinrich Heine University, Düsseldorf, Germany; Brain and Mind Centre (H.-P.H.), Department of Neurology, University of Sydney; and Department of Neurology (H.-P.H.), Medical University of Vienna, Austria
| | - Sven Meuth
- From the Cogito Center for Applied Neurocognition and Neuropsychological Research (S.J.B., M.F., A.R., N.S., I.-K.P.); Department of Neurology (M.D., M.G., M.W., K.L., J.G., N.G., H.-P.H., O.A., S.M., P.A., I.-K.P.), Medical Faculty, Heinrich Heine University, Düsseldorf, Germany; Brain and Mind Centre (H.-P.H.), Department of Neurology, University of Sydney; and Department of Neurology (H.-P.H.), Medical University of Vienna, Austria
| | - Philipp Albrecht
- From the Cogito Center for Applied Neurocognition and Neuropsychological Research (S.J.B., M.F., A.R., N.S., I.-K.P.); Department of Neurology (M.D., M.G., M.W., K.L., J.G., N.G., H.-P.H., O.A., S.M., P.A., I.-K.P.), Medical Faculty, Heinrich Heine University, Düsseldorf, Germany; Brain and Mind Centre (H.-P.H.), Department of Neurology, University of Sydney; and Department of Neurology (H.-P.H.), Medical University of Vienna, Austria
| | - Iris-Katharina Penner
- From the Cogito Center for Applied Neurocognition and Neuropsychological Research (S.J.B., M.F., A.R., N.S., I.-K.P.); Department of Neurology (M.D., M.G., M.W., K.L., J.G., N.G., H.-P.H., O.A., S.M., P.A., I.-K.P.), Medical Faculty, Heinrich Heine University, Düsseldorf, Germany; Brain and Mind Centre (H.-P.H.), Department of Neurology, University of Sydney; and Department of Neurology (H.-P.H.), Medical University of Vienna, Austria.
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11
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Has Silemek AC, Ranjeva J, Audoin B, Heesen C, Gold SM, Kühn S, Weygandt M, Stellmann J. Delayed access to conscious processing in multiple sclerosis: Reduced cortical activation and impaired structural connectivity. Hum Brain Mapp 2021; 42:3379-3395. [PMID: 33826184 PMCID: PMC8249884 DOI: 10.1002/hbm.25440] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 03/26/2021] [Accepted: 03/28/2021] [Indexed: 01/24/2023] Open
Abstract
Although multiple sclerosis (MS) is frequently accompanied by visuo‐cognitive impairment, especially functional brain mechanisms underlying this impairment are still not well understood. Consequently, we used a functional MRI (fMRI) backward masking task to study visual information processing stratifying unconscious and conscious in MS. Specifically, 30 persons with MS (pwMS) and 34 healthy controls (HC) were shown target stimuli followed by a mask presented 8–150 ms later and had to compare the target to a reference stimulus. Retinal integrity (via optical coherence tomography), optic tract integrity (visual evoked potential; VEP) and whole brain structural connectivity (probabilistic tractography) were assessed as complementary structural brain integrity markers. On a psychophysical level, pwMS reached conscious access later than HC (50 vs. 16 ms, p < .001). The delay increased with disease duration (p < .001, β = .37) and disability (p < .001, β = .24), but did not correlate with conscious information processing speed (Symbol digit modality test, β = .07, p = .817). No association was found for VEP and retinal integrity markers. Moreover, pwMS were characterized by decreased brain activation during unconscious processing compared with HC. No group differences were found during conscious processing. Finally, a complementary structural brain integrity analysis showed that a reduced fractional anisotropy in corpus callosum and an impaired connection between right insula and primary visual areas was related to delayed conscious access in pwMS. Our study revealed slowed conscious access to visual stimulus material in MS and a complex pattern of functional and structural alterations coupled to unconscious processing of/delayed conscious access to visual stimulus material in MS.
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Affiliation(s)
- Arzu C. Has Silemek
- Institut für Neuroimmunologie und Multiple Sklerose (INIMS)Universitätsklinikum Hamburg‐Eppendorf (UKE)HamburgGermany
| | - Jean‐Philippe Ranjeva
- Aix‐Marseille UniversityCNRS, CRMBMMarseille CedexFrance
- APHMHopital de la Timone, CEMEREMMarseilleFrance
| | - Bertrand Audoin
- Aix‐Marseille UniversityCNRS, CRMBMMarseille CedexFrance
- APHMHopital de la Timone, CEMEREMMarseilleFrance
| | - Christoph Heesen
- Institut für Neuroimmunologie und Multiple Sklerose (INIMS)Universitätsklinikum Hamburg‐Eppendorf (UKE)HamburgGermany
- Klinik und Poliklinik für NeurologieUniversitätsklinikum Hamburg‐EppendorfHamburgGermany
| | - Stefan M. Gold
- Institut für Neuroimmunologie und Multiple Sklerose (INIMS)Universitätsklinikum Hamburg‐Eppendorf (UKE)HamburgGermany
- Charité ‐ Universitätsmedizin Berlin, Freie Universität BerlinHumboldt Universität zu Berlin, and Berlin Institute of Health (BIH), Klinik für Psychiatrie & Psychotherapie und Medizinische Klinik m.S. Psychosomatik, Campus Benjamin Franklin (CBF)BerlinGermany
| | - Simone Kühn
- Clinic for Psychiatry and PsychotherapyUniversity Medical Center Hamburg‐EppendorfHamburgGermany
- Lise Meitner Group for Environmental NeuroscienceMax Planck Institute for Human DevelopmentBerlinGermany
| | - Martin Weygandt
- Max Delbrück Center for Molecular Medicine and Charité – Universitätsmedizin Berlin, corporate member of Freie Universität BerlinHumboldt‐Universität zu Berlin, and Berlin Institute of Health, Experimental and Clinical Research CenterBerlinGermany
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität BerlinHumboldt‐Universität zu Berlin, and Berlin Institute of Health, NeuroCure Clinical Research CenterBerlinGermany
| | - Jan‐Patrick Stellmann
- Institut für Neuroimmunologie und Multiple Sklerose (INIMS)Universitätsklinikum Hamburg‐Eppendorf (UKE)HamburgGermany
- Aix‐Marseille UniversityCNRS, CRMBMMarseille CedexFrance
- APHMHopital de la Timone, CEMEREMMarseilleFrance
- Klinik und Poliklinik für NeurologieUniversitätsklinikum Hamburg‐EppendorfHamburgGermany
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12
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Sguigna PV, McCreary MC, Conger DL, Graves JS, Benson LA, Waldman AT, Greenberg BM. Utilization of Visual Acuity Retroilluminated Charts for the Assessment of Afferent Visual System Dysfunction in a Pediatric Neuroimmunology Population. J Neuroophthalmol 2021; 41:19-23. [PMID: 32868561 DOI: 10.1097/wno.0000000000001001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Visual acuity has been a significant outcome measure in clinical trials for patients suffering from neuro-ophthalmological diseases and multiple sclerosis; however, there are limited data on the comparison of various testing strategies in pediatric patients with these disorders. Clinical trials using vision as an outcome could include a variety of tools to assess the acuity, including 2-m and 4-m standardized retroilluminated charts. METHODS We investigated the difference in Early Treatment Diabetic Retinopathy Study (ETDRS) scores obtained using 2-m and 4-m charts, as well as the impact of optic neuritis, use of vision correction, age, and gender on visual acuity data from 71 patients with pediatric neuroimmunological conditions in a cross-sectional study. RESULTS We determine that the ETDRS letter scores obtained using 4-m charts are on average 3.43 points less (P = 0.0034) when testing monocular ETDRS letter scores and on average 4.14 points less (P = 0.0008) when testing binocular ETDRS letter scores, relative to that obtained using the 2-m charts. However, we find that when performing monocular testing, optic neuritis in the eye being tested did not result in a statistically significant difference between 2-m and 4-m ETDRS letter scores. CONCLUSIONS Although visual acuity charts are formatted by the distance, there are significant differences in the number of letters correctly identified between 2-m and 4-m charts. Although the differences may not impact the clinical acuity, research protocols should consider these differences before collapsing data across disparate studies.
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Affiliation(s)
- Peter V Sguigna
- Multiple Sclerosis Division (PVS, MM, DC, BMG), Department of Neurology and Neurotherapeutics, University of Texas Southwestern, Dallas, Texas; Department of Neurology (JG), University of California San Diego, San Diego, California; Department of Neurology and Pediatrics (LB), Boston Children's Hospital, Boston, Massachusetts; Division of Neurology (ATW), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and Departments of Neurology and Pediatrics (ATW), Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
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13
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Jakimovski D, Benedict RHB, Weinstock-Guttman B, Ozel O, Fuchs TA, Lincoff N, Bergsland N, Dwyer MG, Zivadinov R. Visual deficits and cognitive assessment of multiple sclerosis: confounder, correlate, or both? J Neurol 2021; 268:2578-2588. [PMID: 33590339 DOI: 10.1007/s00415-021-10437-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 01/29/2021] [Accepted: 01/30/2021] [Indexed: 01/07/2023]
Abstract
BACKGROUND The relationship between visual impairment and cognitive performance in multiple sclerosis (MS) remains poorly understood. OBJECTIVE To determine associations between visual acuity and optical coherence tomography (OCT) measures with cognitive performance of MS patients and healthy controls (HCs). METHODS 141 MS patients (with and without MS optic neuritis; MSON) and 50 HCs underwent neuropsychological, visual, and OCT testing. California Verbal Learning Test (CVLT-II), Brief Visuospatial Memory Test (BVMT-R), and Symbol Digit Modalities Test (SDMT) were used. Patients with test performance below - 1.5 standard deviations of the mean HCs scores were labeled as cognitive impairment. Visual ability was assessed with 100%, 2.5%, and 1.25% low-contrast letter acuity (LCLA) charts. OCT-derived peripapillary retinal nerve fiber layer (pRNFL) thickness, macular volume (MV), macular ganglion cell inner plexiform (mGCIP) thickness (as a sum of GC and IP layers), and macular inner nuclear layer (mINL) were computed. RESULTS 100% and 2.5% LCLA associated with SDMT in MS and HCs (p < 0.001; and p < 0.012, respectively). In MSON patients, visually demanding tests were explained by pRNFL and macular volume for SDMT (β = 0.172, p = 0.039 and β = 0.27, p = 0.001) and MV for BVMT-R (β = 0.21, p = 0.012). In non-MSON, only mINL was predictor of CVLT-II. pRNFL and MV predicted cognitive impairment with an accuracy of 72.2% (Negelkerke R2 = 0.234). These findings were driven by associations within the progressive MS subgroup. HC's SDMT performance was explained by mGCIP (β = 0.316, p = 0.001). CONCLUSIONS Both LCLA and OCT-based measures (pRNFL and macular volume) were associated with MS cognitive performance. OCT-based measures were also significant predictors of cognitive status in MS patients. mGCIP associated with cognitive performance in HCs.
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Affiliation(s)
- Dejan Jakimovski
- Department of Neurology, Buffalo Neuroimaging Analysis Center (BNAC), Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, 100 High Street, Buffalo, NY, 14203, USA. .,Department of Neurology, Jacobs Comprehensive MS Treatment and Research Center, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA.
| | - Ralph H B Benedict
- Department of Neurology, Jacobs Comprehensive MS Treatment and Research Center, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Bianca Weinstock-Guttman
- Department of Neurology, Jacobs Comprehensive MS Treatment and Research Center, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Osman Ozel
- Department of Neurology, Jacobs Comprehensive MS Treatment and Research Center, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Tom A Fuchs
- Department of Neurology, Buffalo Neuroimaging Analysis Center (BNAC), Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, 100 High Street, Buffalo, NY, 14203, USA.,Department of Neurology, Jacobs Comprehensive MS Treatment and Research Center, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Norah Lincoff
- Department of Neurology, Jacobs Comprehensive MS Treatment and Research Center, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Niels Bergsland
- Department of Neurology, Buffalo Neuroimaging Analysis Center (BNAC), Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, 100 High Street, Buffalo, NY, 14203, USA.,Department of Neurology, Jacobs Comprehensive MS Treatment and Research Center, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA.,IRCCS, Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
| | - Michael G Dwyer
- Department of Neurology, Buffalo Neuroimaging Analysis Center (BNAC), Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, 100 High Street, Buffalo, NY, 14203, USA.,Department of Neurology, Jacobs Comprehensive MS Treatment and Research Center, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Robert Zivadinov
- Department of Neurology, Buffalo Neuroimaging Analysis Center (BNAC), Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, 100 High Street, Buffalo, NY, 14203, USA.,Department of Neurology, Jacobs Comprehensive MS Treatment and Research Center, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA.,Center for Biomedical Imaging at Clinical Translational Science Institute, University at Buffalo, State University of New York, Buffalo, NY, USA
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14
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Nguyen J, Rothman A, Gonzalez N, Avornu A, Ogbuokiri E, Balcer LJ, Galetta SL, Frohman EM, Frohman T, Crainiceanu C, Calabresi PA, Saidha S. Macular Ganglion Cell and Inner Plexiform Layer Thickness Is More Strongly Associated With Visual Function in Multiple Sclerosis Than Bruch Membrane Opening-Minimum Rim Width or Peripapillary Retinal Nerve Fiber Layer Thicknesses. J Neuroophthalmol 2020; 39:444-450. [PMID: 30921169 DOI: 10.1097/wno.0000000000000768] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Optical coherence tomography (OCT) measurements of ganglion cell + inner plexiform layer (GCIPL) and peripapillary retinal nerve fiber layer (pRNFL) thicknesses are associated with visual function (VF) and disability in multiple sclerosis (MS). However, the value of measuring Bruch membrane opening-minimum rim width (BMO-MRW) thickness in MS remains unclear. METHODS Sixty-eight patients with MS and 22 healthy controls (HCs) underwent spectral domain OCT, 100%-contrast visual acuity (VA), 2.5%- and 1.25%-contrast letter acuity (LA), and Expanded Disability Status Scale (EDSS) testing. Mixed-effects linear regression models, accounting for within-subject, intereye correlations, were used to assess relationships. RESULTS The MS cohort exhibited significantly lower BMO-MRW (P = 0.01), pRNFL at 3.7-, 4.1-, and 4.7-mm diameters surrounding the optic disc (P < 0.001 for all), and GCIPL (P < 0.001) thicknesses than HCs. BMO-MRW thickness was associated with 100%-VA (P < 0.001, R = 0.08), 2.5%-LA (P < 0.001; R = 0.13), and 1.25%-LA (P = 0.002; R = 0.11). All measured pRNFL thicknesses were associated with high- and low-contrast VF (all: P < 0.001). GCIPL thickness was more strongly associated with 100%-VA (P < 0.001; R = 0.23), 2.5%-LA (P < 0.001; R = 0.27), and 1.25%-LA (P < 0.001; R = 0.21) than the other OCT measures assessed. All OCT measures were significantly, but weakly, associated with EDSS scores. CONCLUSIONS BMO-MRW and pRNFL thicknesses are reduced and associated with VF and disability in MS, but GCIPL thickness is a stronger marker of visual impairment. Our findings corroborate the utility of OCT in providing valuable information regarding the MS disease process.
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Affiliation(s)
- James Nguyen
- Department of Neurology (JN, AR, NG, AA, EO, PAC, and SS), Johns Hopkins University School of Medicine, Baltimore, Maryland; Departments of Neurology (LJB and SLG), Population Health (LJB and SLG), and Ophthalmology (LJB and SLG), New York University School of Medicine, New York, New York; Departments of Neurology (EMF and TF) and Ophthalmology (EMF and TF), Dell Medical School, University of Texas at Austin, Austin, Texas; and Department of Biostatistics (CC), Johns Hopkins University, Baltimore, Maryland
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15
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Murphy OC, Kwakyi O, Iftikhar M, Zafar S, Lambe J, Pellegrini N, Sotirchos ES, Gonzalez-Caldito N, Ogbuokiri E, Filippatou A, Risher H, Cowley N, Feldman S, Fioravante N, Frohman EM, Frohman TC, Balcer LJ, Prince JL, Channa R, Calabresi PA, Saidha S. Alterations in the retinal vasculature occur in multiple sclerosis and exhibit novel correlations with disability and visual function measures. Mult Scler 2020; 26:815-828. [PMID: 31094280 PMCID: PMC6858526 DOI: 10.1177/1352458519845116] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND The retinal vasculature may be altered in multiple sclerosis (MS), potentially acting as a biomarker of disease processes. OBJECTIVE To compare retinal vascular plexus densities in people with MS (PwMS) and healthy controls (HCs), and examine correlations with visual function and global disability. METHODS In this cross-sectional study, 111 PwMS (201 eyes) and 50 HCs (97 eyes) underwent optical coherence tomography angiography (OCTA). Macular superficial vascular plexus (SVP) and deep vascular plexus (DVP) densities were quantified, and poor quality images were excluded according to an artifact-rating protocol. RESULTS Mean SVP density was 24.1% (SD = 5.5) in MS eyes (26.0% (SD = 4.7) in non-optic neuritis (ON) eyes vs. 21.7% (SD = 5.5) in ON eyes, p < 0.001), as compared to 29.2% (SD = 3.3) in HC eyes (p < 0.001 for all MS eyes and multiple sclerosis optic neuritis (MSON) eyes vs. HC eyes, p = 0.03 for MS non-ON eyes vs. HC eyes). DVP density did not differ between groups. In PwMS, lower SVP density was associated with higher levels of disability (expanded disability status scale (EDSS): R2 = 0.26, p = 0.004; multiple sclerosis functional composite (MSFC): R2 = 0.27, p = 0.03) and lower letter acuity scores (100% contrast: R2 = 0.29; 2.5% contrast: R2 = 0.40; 1.25% contrast: R2 = 0.31; p < 0.001 for all). CONCLUSIONS Retinal SVP density measured by OCTA is reduced across MS eyes, and correlates with visual function, EDSS, and MSFC scores.
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Affiliation(s)
- Olwen C. Murphy
- Division of Neuroimmunology and Neurological Infections,
Department of Neurology, Johns Hopkins Hospital, Baltimore, MD, United States
| | - Ohemaa Kwakyi
- Division of Neuroimmunology and Neurological Infections,
Department of Neurology, Johns Hopkins Hospital, Baltimore, MD, United States
| | - Mustafa Iftikhar
- Wilmer Eye Institute, Johns Hopkins University School of
Medicine, Baltimore, MD, United States
| | - Sidra Zafar
- Wilmer Eye Institute, Johns Hopkins University School of
Medicine, Baltimore, MD, United States
| | - Jeffrey Lambe
- Division of Neuroimmunology and Neurological Infections,
Department of Neurology, Johns Hopkins Hospital, Baltimore, MD, United States
| | - Nicole Pellegrini
- Division of Neuroimmunology and Neurological Infections,
Department of Neurology, Johns Hopkins Hospital, Baltimore, MD, United States
| | - Elias S. Sotirchos
- Division of Neuroimmunology and Neurological Infections,
Department of Neurology, Johns Hopkins Hospital, Baltimore, MD, United States
| | - Natalia Gonzalez-Caldito
- Division of Neuroimmunology and Neurological Infections,
Department of Neurology, Johns Hopkins Hospital, Baltimore, MD, United States
| | - Esther Ogbuokiri
- Division of Neuroimmunology and Neurological Infections,
Department of Neurology, Johns Hopkins Hospital, Baltimore, MD, United States
| | - Angeliki Filippatou
- Division of Neuroimmunology and Neurological Infections,
Department of Neurology, Johns Hopkins Hospital, Baltimore, MD, United States
| | - Hunter Risher
- Division of Neuroimmunology and Neurological Infections,
Department of Neurology, Johns Hopkins Hospital, Baltimore, MD, United States
| | - Norah Cowley
- Division of Neuroimmunology and Neurological Infections,
Department of Neurology, Johns Hopkins Hospital, Baltimore, MD, United States
| | - Sydney Feldman
- Division of Neuroimmunology and Neurological Infections,
Department of Neurology, Johns Hopkins Hospital, Baltimore, MD, United States
| | - Nicholas Fioravante
- Division of Neuroimmunology and Neurological Infections,
Department of Neurology, Johns Hopkins Hospital, Baltimore, MD, United States
| | - Elliot M. Frohman
- Department of Neurology and Ophthalmology, University of
Texas Austin Dell Medical School, Austin, TX, United States
| | - Teresa C. Frohman
- Department of Neurology and Ophthalmology, University of
Texas Austin Dell Medical School, Austin, TX, United States
| | - Laura J. Balcer
- Department of Neurology, New York University Langone
Medical Center, New York, NY, United States
| | - Jerry L. Prince
- Department of Electrical and Computer Engineering, Johns
Hopkins University, Baltimore, MD, United States
| | - Roomasa Channa
- Wilmer Eye Institute, Johns Hopkins University School of
Medicine, Baltimore, MD, United States
- Department of Ophthalmology, Baylor College of Medicine,
Houston, TX, United States
| | - Peter A. Calabresi
- Division of Neuroimmunology and Neurological Infections,
Department of Neurology, Johns Hopkins Hospital, Baltimore, MD, United States
| | - Shiv Saidha
- Division of Neuroimmunology and Neurological Infections,
Department of Neurology, Johns Hopkins Hospital, Baltimore, MD, United States
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Phase-synchrony evaluation of EEG signals for Multiple Sclerosis diagnosis based on bivariate empirical mode decomposition during a visual task. Comput Biol Med 2019; 117:103596. [PMID: 32072973 DOI: 10.1016/j.compbiomed.2019.103596] [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] [Received: 09/25/2019] [Revised: 12/29/2019] [Accepted: 12/29/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND OBJECTIVE Despite the widespread prevalence of Multiple Sclerosis (MS), the study of brain interactions is still poorly understood. Moreover, there has always been a great need to automate the MS diagnosis procedure to eliminate the evaluation errors thereby improving its consistency and reliability. To address these issues, in this work, we proposed a robust pattern recognition algorithm as a computer-aided diagnosis system. This method is based on calculating the pairwise phase-synchrony of EEG recordings during a visual task. Initially, the bivariate empirical mode decomposition (BEMD) was applied to extract the intrinsic mode functions (IMFs). The phases of these IMFs were then obtained using the Hilbert transform to be utilized in the mean phase coherence (MPC), a measure for phase-synchrony calculation. After the construction of the feature space using MPC values, the ReliefF algorithm was applied for dimension reduction. Finally, the best distinguishing features were input to a k-nearest neighbor (KNN) classifier. The results revealed a higher level of network synchronization in the posterior regions of the brain and desynchronization in the anterior regions among the MS group as compared with the normal subjects. In the validation phase, the leave-one-subject-out cross-validation (LOOCV) method was used to assess the validity of the proposed algorithm. We achieved an accuracy, sensitivity, and specificity of 93.09%, 91.07%, and 95.24% for red-green, 90.44%, 88.39%, and 92.62% for luminance, and 87.44%, 87.05%, and 87.86% for blue-yellow tasks, respectively. The experimental results demonstrated the reliability of the presented method to be generalized in the field of automated MS diagnosis systems.
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17
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Fischer M, Köhler W, Faiss JH, Hoffmann F, Kunkel A, Sailer M, Schwab M, Zettl UK, Bublak P. A smart peek: Processing of rapid visual displays is disturbed in newly diagnosed, cognitively intact MS patients and refers to cognitive performance and disease progression in late stages. J Neurol Sci 2019; 401:118-124. [DOI: 10.1016/j.jns.2019.04.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 04/18/2019] [Accepted: 04/22/2019] [Indexed: 10/27/2022]
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