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Hynes SM, Dwyer CP, Alvarez-Iglesias A, Rogers F, Joyce RA, Oglesby MH, Moses A, Bane E, Counihan TJ, Charamba B. A cluster-randomised controlled feasibility trial evaluating the Cognitive Occupation-Based programme for people with Multiple Sclerosis (COB-MS). Neurol Sci 2024:10.1007/s10072-024-07757-5. [PMID: 39313688 DOI: 10.1007/s10072-024-07757-5] [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: 03/23/2024] [Accepted: 09/02/2024] [Indexed: 09/25/2024]
Abstract
INTRODUCTION There is a high prevalence of cognitive difficulties in MS, but despite this, there are few programmes targeting cognition that focus on the ability to function well in everyday life. The Cognitive Occupation-Based programme for people with Multiple Sclerosis (COB-MS), an occupation-focused cognitive intervention, was developed to address this. It addresses both the functional difficulties and the wide-ranging symptoms that present in MS. OBJECTIVE Here we report on the results of a cluster-randomised controlled feasibility trial (ISRCTN11462710; registered 4th September 2019) evaluating the COB-MS in terms of feasibility and initial efficacy as a cognitive intervention for people with MS. METHOD The eight-session COB-MS intervention was delivered remotely by occupational therapists to participants with MS in the intervention group. Following the end of the trial the COB-MS was delivered to the wait-list control group. Data was collected from people with MS experiencing cognitive difficulties at baseline, post-intervention, 12-weeks, and 6-month follow-up. The primary outcome measure was the Goal Attainment Scaling at 12 weeks. Data was also collected in the domains of cognition, quality of life, and mood. RESULTS One hundred and eighteen people with MS and cognitive difficulties were randomised to either usual care (n = 60) or COB-MS intervention (n = 58). Ninety-four participants were retained at 6-month follow-up. The COB-MS was found to be feasible, including trial procedures and protocol. Data indicates that the COB-MS is accepted by participants and had positive impacts on daily life. Those allocated to the COB-MS group had a significant improvement in the primary outcome compared to the control condition. Progression criteria set for the feasibility trial have been met therefore further testing of the COB-MS at a definitive trial is supported by the results. CONCLUSION The results provide a strong basis for a pathway to a future definitive trial of COB-MS, with respect to both feasibility and preliminary, clinical efficacy. TRIAL REGISTRATION ISRCTN11462710 Date of registration: 4th September 2019.
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Affiliation(s)
- Sinéad M Hynes
- Discipline of Occupational Therapy, School of Health Sciences, College of Medicine, Nursing and Health Sciences, University of Galway, Galway, Ireland
| | - Christopher P Dwyer
- HEA Performance & Department of Teacher Education, Technological University of the Shannon, Athlone, Ireland
| | - Alberto Alvarez-Iglesias
- Health Research Board Clinical Research Facility, University of Galway and School of Medicine, University of Galway, Galway, Ireland
| | - Fionnuala Rogers
- Discipline of Occupational Therapy, School of Health Sciences, College of Medicine, Nursing and Health Sciences, University of Galway, Galway, Ireland.
- Cardiff University Brain Research Imaging Centre (CUBRIC), Cardiff University, Cardiff, Wales, UK.
| | - Robert A Joyce
- Discipline of Occupational Therapy, School of Health Sciences, College of Medicine, Nursing and Health Sciences, University of Galway, Galway, Ireland
| | - Megan H Oglesby
- Discipline of Occupational Therapy, School of Health Sciences, College of Medicine, Nursing and Health Sciences, University of Galway, Galway, Ireland
| | - Anusha Moses
- Discipline of Occupational Therapy, School of Health Sciences, College of Medicine, Nursing and Health Sciences, University of Galway, Galway, Ireland
- Faculty of Science and Technology, University of Twente, Enschede, Netherlands
| | - Eimear Bane
- Discipline of Occupational Therapy, School of Health Sciences, College of Medicine, Nursing and Health Sciences, University of Galway, Galway, Ireland
- School of Psychology, University of Galway, Galway, Ireland
| | | | - Beatrice Charamba
- Discipline of Occupational Therapy, School of Health Sciences, College of Medicine, Nursing and Health Sciences, University of Galway, Galway, Ireland
- Staburo GmbH, Aschauer Str. 26a, 81549, Munich, Bavaria, Germany
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VanNostrand M, Monaghan PG, Daugherty AM, Fritz NE. Study protocol of a randomized controlled trial comparing backward walking to forward walking training on balance in multiple sclerosis: The TRAIN-MS trial. Contemp Clin Trials 2024; 144:107621. [PMID: 38971304 DOI: 10.1016/j.cct.2024.107621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 06/11/2024] [Accepted: 07/03/2024] [Indexed: 07/08/2024]
Abstract
Balance impairment and accidental falls are a pervasive challenge faced by persons with multiple sclerosis (PwMS), significantly impacting their quality of life. While exercise has proven to be an effective intervention for improving mobility and functioning in PwMS, current exercise approaches predominantly emphasize forward walking (FW) and balance training, with variable improvements in balance and fall rates. Backward walking (BW) has emerged as a promising intervention modality for enhancing mobility and strength outcomes; however, significant gaps remain. Specifically, there is limited knowledge about the efficacy of BW interventions on outcomes such as static, anticipatory, and reactive balance, balance confidence, falls, and cognition. This randomized controlled trial aims to determine the feasibility, acceptability, and impact of 8-weeks of backward walking training (TRAIN-BW) as compared to forward walking training (TRAIN-FW). Ninety individuals with MS with self-reported walking dysfunction or ≥ 2 falls in the past 6 months will be randomized in blocks, stratified by sex and disease severity to either the TRAIN-BW or TRAIN-FW intervention groups. Adherence and retention rates will be used to determine feasibility and the Client Satisfaction Questionnaire will be used to assess acceptability. The primary outcomes will be static, anticipatory, and reactive balance. Secondary outcomes include walking velocity, balance confidence, concern about falling, cognition, physical activity, and fall rates measured prospectively for 6 months after post-testing. Additionally, the extent to which cognitive functioning influences response to intervention will be examined. Backward walking training may be an innovative intervention to address balance impairments and falls in persons with MS.
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Affiliation(s)
- Michael VanNostrand
- Neuroimaging and Neurorehabilitation Laboratory, Wayne State University, Detroit, MI, USA; Department of Health Care Sciences, Wayne State University, Detroit, MI, USA.
| | - Patrick G Monaghan
- Neuroimaging and Neurorehabilitation Laboratory, Wayne State University, Detroit, MI, USA; Department of Health Care Sciences, Wayne State University, Detroit, MI, USA
| | - Ana M Daugherty
- Translational Neuroscience Program, Wayne State University, Detroit, MI, USA; Department of Psychology, Wayne State University, Detroit, MI, USA; Institute of Gerontology, Wayne State University, Detroit, MI, USA
| | - Nora E Fritz
- Neuroimaging and Neurorehabilitation Laboratory, Wayne State University, Detroit, MI, USA; Department of Health Care Sciences, Wayne State University, Detroit, MI, USA; Department of Neurology, Wayne State University, Detroit, MI, USA
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Mirmosayyeb O, Nabizadeh F, Moases Ghaffary E, Yazdan Panah M, Zivadinov R, Weinstock-Guttman B, Benedict RHB, Jakimovski D. Cognitive performance and magnetic resonance imaging in people with multiple sclerosis: A systematic review and meta-analysis. Mult Scler Relat Disord 2024; 88:105705. [PMID: 38885600 DOI: 10.1016/j.msard.2024.105705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 06/03/2024] [Accepted: 06/07/2024] [Indexed: 06/20/2024]
Abstract
BACKGROUND Several studies have shown the different relationships between cognitive functions and structural magnetic resonance imaging (MRI) measurements in people with multiple sclerosis (pwMS). However, there is an ongoing debate regarding the magnitude of correlation between MRI measurements and specific cognitive function tests. This systematic review and meta-analysis aimed to synthesize the most consistent correlations between MRI measurements and cognitive function in pwMS. METHODS PubMed/MEDLINE, Embase, Scopus, and Web of Science databases were systematically searched up to February 2023, to find relevant data. The search utilized syntax and medical subject headings (MeSH) relevant to cognitive performance tests and MRI measurements in pwMS. The R software version 4.3.3 with random effect models was used to estimate the pooled effect sizes. RESULTS 13,559 studies were reviewed, of which 136 were included. The meta-analyses showed that thalamic volume had the most significant correlations with Symbol Digit Modalities Test (SDMT) r = 0.47 (95 % CI: 0.39 to 0.56, p < 0.001, I2 = 88 %), Brief Visual Memory Test-Revised-Total Recall (BVMT-TR) r = 0.51 (95 % CI: 0.36 to 0.66, p < 0.001, I2 = 81 %), California Verbal Learning Test-II-Total Recall (CVLT-TR) r = 0.47 (95 % CI: 0.34 to 0.59, p < 0.001, I2 = 69 %,), and Delis-Kaplan Executive Function System (DKEFS) r = 0.48 (95 % CI: 0.34 to 0.63, p < 0.001, I2 = 22 %,). CONCLUSION We conclude that thalamic volume exhibits highest relationships with information processing speed (IPS), visuospatial learning-memory, verbal learning-memory, and executive function in pwMS. A comprehensive understanding of the intricacies of the mechanisms underpinning this association requires additional research.
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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, United States
| | - Fardin Nabizadeh
- School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Elham Moases Ghaffary
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Yazdan Panah
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Robert Zivadinov
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, United States; Center for Biomedical Imaging at the Clinical Translational Science Institute, University at Buffalo, State University of New York, Buffalo, NY, United States
| | - 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, United States
| | - 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, United States
| | - 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, United States; Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, United States.
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Pilloni G, Casper TC, Mar S, Ness J, Schreiner T, Waltz M, Waubant E, Weinstock-Guttman B, Wheeler Y, Krupp L, Charvet L. Increased intraindividual variability (IIV) in reaction time is the earliest indicator of cognitive change in MS: A two-year observational study. Int J Clin Health Psychol 2024; 24:100486. [PMID: 39105175 PMCID: PMC11299566 DOI: 10.1016/j.ijchp.2024.100486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 07/03/2024] [Indexed: 08/07/2024] Open
Abstract
Background Cognitive decline in multiple sclerosis (MS) is common, but unpredictable, and increases with disease duration. As such, early detection of cognitive decline may improve the effectiveness of interventions. To that end, the Symbol Digit Modalities Test (SDMT) is effective in detecting slow processing speed as it relates to cognitive impairment, and intraindividual variability (IIV) observed in trials assessing continuous reaction time (RT) may be a useful indicator of early cognitive changes. Here, we will assess cognitive IIV changes in adults with early MS. Methods Adults with relapsing-remitting MS (RRMS), <11 years since diagnosis, were recruited nationally. Baseline and two-year follow-up assessments included Brief International Cognitive Assessment in MS (BICAMS) and Cogstate computerized tests. Intraindividual variability in RT was calculated from psychomotor tasks and data were age-normalized. Results A total of 44 of the 66 participants completed follow-up (mean age, 34.0 ± 5.5 years; 66 % female; mean disease duration, 4.1 ± 2.9 years; median Expanded Disability Status Scale (EDSS) score, 1.5 [0 to 6.0]). Participants were grouped by SDMT z-score median split. Groups did not differ in demographics or clinical features. The higher baseline SDMT group was faster (p = 0.05) in RT and less variable (lower IIV, p = 0.001). At the two-year follow-up, the higher SDMT group showed increased variability (p = 0.05) compared to the lower SDMT group, with no significant RT or BICAMS changes. Conclusions In early MS, higher SDMT performance at baseline is associated with less cognitive variability but may indicate susceptibility to increased variability over time, highlighting the importance of monitoring IIV for early cognitive changes.
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Affiliation(s)
- Giuseppina Pilloni
- Department of Neurology, NYU Grossman School of Medicine, New York, NY, USA
- Parekh Center for Interdisciplinary Neurology, NYU Grossman School of Medicine, New York, NY, USA
| | | | - Soe Mar
- Washington University, St. Louis, MO, USA
| | - Jayne Ness
- University of Alabama, Birmingham, AL, USA
| | | | | | | | | | | | - Lauren Krupp
- Department of Neurology, NYU Grossman School of Medicine, New York, NY, USA
- Parekh Center for Interdisciplinary Neurology, NYU Grossman School of Medicine, New York, NY, USA
| | - Leigh Charvet
- Department of Neurology, NYU Grossman School of Medicine, New York, NY, USA
- Parekh Center for Interdisciplinary Neurology, NYU Grossman School of Medicine, New York, NY, USA
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Pradeep Kumar D, Zanotto T, Cozart JS, Bruce AS, Befort C, Siengsukon C, Shook R, Lynch S, Mahmoud R, Simon S, Hibbing PR, Drees B, Huebner J, Bradish T, Robichaud J, Sosnoff JJ, Bruce JM. Association between frailty and sleep quality in people living with multiple sclerosis and obesity: An observational cross-sectional study. Mult Scler Relat Disord 2024; 81:105154. [PMID: 38043367 DOI: 10.1016/j.msard.2023.105154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 11/20/2023] [Accepted: 11/23/2023] [Indexed: 12/05/2023]
Abstract
BACKGROUND A majority of the people with multiple sclerosis (pwMS) experience sleep disturbances. Frailty is also common in pwMS. The geriatric literature strongly suggests that frailty is associated with worse sleep outcomes in community-dwelling older adults, but this association has yet to be explored among pwMS. This study focused on examining the association between frailty and sleep quality in pwMS. METHODS Seventy-six people with both MS and obesity (mean age: 47.6 ± 10.9 years, 81.6 % female, mean body mass index (BMI): 37.10 ± 5.5 kg/m2, mean Patient Determined Disease Steps (PDDS): 0.82 ± 1.20) were included in this cross-sectional secondary analysis. A comprehensive frailty index (FI) based on 41 health deficits from various health domains was calculated based on standardized procedures. Sleep quality was determined by the Pittsburgh Sleep Quality Index questionnaire (PSQI). RESULTS Overall, 67.1 % of the participants were identified as non-frail (FI ≤ 0.25), and 32.9 % were identified as frail (FI > 0.25). A significant correlation was observed between FI scores and global PSQI scores (ρ = 0.43, p < 0.05). Cross-tabulation analyses revealed that frail participants had worse subjective sleep quality, sleep latency, habitual sleep efficiency, sleep disturbances, daytime dysfunction, and higher use of sleep medications compared to non-frail participants (p < 0.05). CONCLUSIONS The current study identified a significant association between frailty and sleep quality in people with both MS and obesity with minimal disability. These findings underscore the importance of untangling the relationship between frailty and sleep quality in pwMS. These results could lead to a more targeted approach for rehabilitation interventions aiming to improve frailty in MS.
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Affiliation(s)
- Danya Pradeep Kumar
- Department of Physical Therapy and Rehabilitation Science, School of Health Professions, University of Kansas Medical Center, Kansas City, KS, USA
| | - Tobia Zanotto
- Department of Occupational Therapy Education, School of Health Professions, University of Kansas Medical Center, Kansas City, KS, USA; Mobility Core, University of Kansas Centre for Community Access, Rehabilitation Research, Education and Service, Kansas City, KS, USA; Landon Center on Aging, University of Kansas Medical Center, Kansas City, KS, USA
| | - Julia S Cozart
- Department of Biomedical and Health Informatics, University of Missouri - Kansas City School of Medicine, University of Missouri - Kansas City, Kansas City, MO, USA
| | - Amanda S Bruce
- Center for Children's Healthy Lifestyles and Nutrition, Children's Mercy Hospital, Kansas City, MO, USA; Department of Pediatrics, University of Kansas Medical Center, Kansas City, KS, USA
| | - Christie Befort
- Department of Population Health, University Kansas Medical Center, Kansas City, KS, USA
| | - Catherine Siengsukon
- Department of Physical Therapy and Rehabilitation Science, School of Health Professions, University of Kansas Medical Center, Kansas City, KS, USA
| | - Robin Shook
- Center for Children's Healthy Lifestyles and Nutrition, Children's Mercy Hospital, Kansas City, MO, USA; Department of Pediatrics, University of Kansas Medical Center, Kansas City, KS, USA; School of Medicine, University of Missouri-Kansas City, Kansas City, MO USA
| | - Sharon Lynch
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Rola Mahmoud
- Department of Neurology, University of Missouri, Kansas City, Saint Luke's Hospital, Kansas City, MO, USA
| | - Steve Simon
- Department of Biomedical and Health Informatics, University of Missouri - Kansas City School of Medicine, University of Missouri - Kansas City, Kansas City, MO, USA
| | - Paul R Hibbing
- Department of Kinesiology & Nutrition, University of Illinois Chicago, Chicago, IL, USA
| | - Betty Drees
- Department of Biomedical and Health Informatics, University of Missouri - Kansas City School of Medicine, University of Missouri - Kansas City, Kansas City, MO, USA; Department of Internal Medicine, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA; Graduate School of the Stowers Institute for Medical Research, USA
| | - Joanie Huebner
- UMKC Department of Community and Family Medicine, University Health Lakewood Medical Center, Kansas City, MO, USA
| | - Taylor Bradish
- Department of Biomedical and Health Informatics, University of Missouri - Kansas City School of Medicine, University of Missouri - Kansas City, Kansas City, MO, USA
| | - Jade Robichaud
- Department of Biomedical and Health Informatics, University of Missouri - Kansas City School of Medicine, University of Missouri - Kansas City, Kansas City, MO, USA
| | - Jacob J Sosnoff
- Department of Physical Therapy and Rehabilitation Science, School of Health Professions, University of Kansas Medical Center, Kansas City, KS, USA; Department of Occupational Therapy Education, School of Health Professions, University of Kansas Medical Center, Kansas City, KS, USA; Mobility Core, University of Kansas Centre for Community Access, Rehabilitation Research, Education and Service, Kansas City, KS, USA; Landon Center on Aging, University of Kansas Medical Center, Kansas City, KS, USA
| | - Jared M Bruce
- Department of Biomedical and Health Informatics, University of Missouri - Kansas City School of Medicine, University of Missouri - Kansas City, Kansas City, MO, USA; Departments of Neurology and Psychiatry, University Health, Kansas City, MO, USA.
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Jung SO, Kim JEE, Kim HJ. Assessing objective cognitive impairments in cancer survivors: Features and validity of measures for research and clinical applications. Asia Pac J Oncol Nurs 2023; 10:100309. [PMID: 37928414 PMCID: PMC10622612 DOI: 10.1016/j.apjon.2023.100309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 09/11/2023] [Indexed: 11/07/2023] Open
Abstract
Objective This narrative review aims to (1) identify neuropsychological tests for assessing cognitive function impairment in patients with cancer, specifically in the domains of attention and memory, (2) summarize the characteristics of these tests, including cognitive function domains, test content, readability, and psychometric quality, and (3) evaluate the feasibility of each test in cancer care. Methods Data sources include published test manuals, documents from official web pages, and published journal articles. Results Our study identified eight neuropsychological tests that are most frequently used to assess the attention and memory domains of objective cognitive function in patients with breast cancer. These tests include the California Verbal Learning Test, Hopkins Verbal Learning Test, Rey Auditory Verbal Learning Test, Rey-Osterrieth Complex Figure, CNS Vital Signs, Wechsler Adult Intelligence Scale, Wechsler Memory Scale, and Trail Making Test. They demonstrate acceptable evidence of psychometric quality and varying degrees of feasibility. Test feasibility is influenced by factors such as short testing time, brevity and comprehensiveness, clear cognitive domain distinctions, availability of normative data, minimal practice effects, ease of administration, and limited attention-span requirements. These attributes determine a test's feasibility for use in cancer care. Among the evaluated measures, the California Verbal Learning Test for memory, the Trail Making Test for attention, and the CNS Vital Signs for comprehensive assessment emerge as the most practical choices for cancer care. Conclusions The assessment and management of cognitive function impairment are crucial for enhancing the quality of life in cancer survivors. Nurses should possess knowledge of assessment tools for early detection and the ongoing monitoring of this symptom's progression.
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Affiliation(s)
- Sun Ok Jung
- College of Nursing, Ewha Womans University, Seoul, Republic of Korea
| | | | - Hee-Ju Kim
- College of Nursing, The Catholic University of Korea, Seoul, Republic of Korea
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Kletenik I, Cohen AL, Glanz BI, Ferguson MA, Tauhid S, Li J, Drew W, Polgar-Turcsanyi M, Palotai M, Siddiqi SH, Marshall GA, Chitnis T, Guttmann CRG, Bakshi R, Fox MD. Multiple sclerosis lesions that impair memory map to a connected memory circuit. J Neurol 2023; 270:5211-5222. [PMID: 37532802 PMCID: PMC10592111 DOI: 10.1007/s00415-023-11907-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 07/24/2023] [Accepted: 07/26/2023] [Indexed: 08/04/2023]
Abstract
BACKGROUND Nearly 1 million Americans are living with multiple sclerosis (MS) and 30-50% will experience memory dysfunction. It remains unclear whether this memory dysfunction is due to overall white matter lesion burden or damage to specific neuroanatomical structures. Here we test if MS memory dysfunction is associated with white matter lesions to a specific brain circuit. METHODS We performed a cross-sectional analysis of standard structural images and verbal memory scores as assessed by immediate recall trials from 431 patients with MS (mean age 49.2 years, 71.9% female) enrolled at a large, academic referral center. White matter lesion locations from each patient were mapped using a validated algorithm. First, we tested for associations between memory dysfunction and total MS lesion volume. Second, we tested for associations between memory dysfunction and lesion intersection with an a priori memory circuit derived from stroke lesions. Third, we performed mediation analyses to determine which variable was most associated with memory dysfunction. Finally, we performed a data-driven analysis to derive de-novo brain circuits for MS memory dysfunction using both functional (n = 1000) and structural (n = 178) connectomes. RESULTS Both total lesion volume (r = 0.31, p < 0.001) and lesion damage to our a priori memory circuit (r = 0.34, p < 0.001) were associated with memory dysfunction. However, lesion damage to the memory circuit fully mediated the association of lesion volume with memory performance. Our data-driven analysis identified multiple connections associated with memory dysfunction, including peaks in the hippocampus (T = 6.05, family-wise error p = 0.000008), parahippocampus, fornix and cingulate. Finally, the overall topography of our data-driven MS memory circuit matched our a priori stroke-derived memory circuit. CONCLUSIONS Lesion locations associated with memory dysfunction in MS map onto a specific brain circuit centered on the hippocampus. Lesion damage to this circuit fully mediated associations between lesion volume and memory. A circuit-based approach to mapping MS symptoms based on lesions visible on standard structural imaging may prove useful for localization and prognosis of higher order deficits in MS.
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Affiliation(s)
- Isaiah Kletenik
- Division of Cognitive and Behavioral Neurology, Brigham and Women's Hospital, 60 Fenwood Road, 9016H, Boston, MA, 02115, USA.
- Department of Neurology, Brigham and Women's Hospital, Boston, USA.
- Center for Brain Circuit Therapeutics, Brigham and Women's Hospital, Boston, USA.
- Harvard Medical School, Boston, MA, USA.
| | - Alexander L Cohen
- Center for Brain Circuit Therapeutics, Brigham and Women's Hospital, Boston, USA
- Harvard Medical School, Boston, MA, USA
- Department of Neurology, Boston Children's Hospital, Boston, MA, USA
- Computational Radiology Laboratory, Department of Radiology, Boston Children's Hospital, Boston, MA, USA
| | - Bonnie I Glanz
- Brigham Multiple Sclerosis Center, Brigham and Women's Hospital, Harvard Medical School Boston, Boston, MA, USA
| | - Michael A Ferguson
- Department of Neurology, Brigham and Women's Hospital, Boston, USA
- Center for Brain Circuit Therapeutics, Brigham and Women's Hospital, Boston, USA
- Harvard Medical School, Boston, MA, USA
| | - Shahamat Tauhid
- Department of Neurology, Brigham and Women's Hospital, Boston, USA
| | - Jing Li
- Center for Brain Circuit Therapeutics, Brigham and Women's Hospital, Boston, USA
| | - William Drew
- Center for Brain Circuit Therapeutics, Brigham and Women's Hospital, Boston, USA
| | - Mariann Polgar-Turcsanyi
- Brigham Multiple Sclerosis Center, Brigham and Women's Hospital, Harvard Medical School Boston, Boston, MA, USA
| | - Miklos Palotai
- Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | - Shan H Siddiqi
- Center for Brain Circuit Therapeutics, Brigham and Women's Hospital, Boston, USA
- Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, USA
| | - Gad A Marshall
- Division of Cognitive and Behavioral Neurology, Brigham and Women's Hospital, 60 Fenwood Road, 9016H, Boston, MA, 02115, USA
- Department of Neurology, Brigham and Women's Hospital, Boston, USA
- Harvard Medical School, Boston, MA, USA
- Center for Alzheimer Research and Treatment, Brigham and Women's Hospital, Boston, MA, USA
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Tanuja Chitnis
- Department of Neurology, Brigham and Women's Hospital, Boston, USA
- Harvard Medical School, Boston, MA, USA
- Brigham Multiple Sclerosis Center, Brigham and Women's Hospital, Harvard Medical School Boston, Boston, MA, USA
| | - Charles R G Guttmann
- Harvard Medical School, Boston, MA, USA
- Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
- Center for Neurological Imaging, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Rohit Bakshi
- Department of Neurology, Brigham and Women's Hospital, Boston, USA
- Harvard Medical School, Boston, MA, USA
- Brigham Multiple Sclerosis Center, Brigham and Women's Hospital, Harvard Medical School Boston, Boston, MA, USA
- Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | - Michael D Fox
- Division of Cognitive and Behavioral Neurology, Brigham and Women's Hospital, 60 Fenwood Road, 9016H, Boston, MA, 02115, USA
- Department of Neurology, Brigham and Women's Hospital, Boston, USA
- Center for Brain Circuit Therapeutics, Brigham and Women's Hospital, Boston, USA
- Harvard Medical School, Boston, MA, USA
- Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
- Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, USA
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
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Bair JL, Patrick SD, Noyes ET, Hale AC, Campbell EB, Wilson AM, Ransom MT, Spencer RJ. Semantic clustering on common list-learning tasks: a systematic review of the state of the literature and recommendations for future directions. J Clin Exp Neuropsychol 2023; 45:652-692. [PMID: 37865967 DOI: 10.1080/13803395.2023.2270204] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 10/06/2023] [Indexed: 10/24/2023]
Abstract
INTRODUCTION On some list-learning tasks, such as the California Verbal Learning Test (CVLT) or Hopkins Verbal Learning Test (HVLT), examinees have the opportunity to group words based on semantically related categories (i.e., semantic clustering). Semantic clustering (SC) is often considered the most efficient organizational strategy and adopting SC is presumed to improve learning and memory. In addition, SC is conceptualized as reflecting higher-order executive functioning skills. Although SC measures have intuitive appeal, to date, there are no comprehensive reviews of the SC literature base that summarize its psychometric utility. In this systematic review, we synthesize the literature to judge the validity of SC scores. METHOD We conducted a systematic literature search for empirical articles reporting SC from the CVLT and HVLT. We qualitatively described the relationship of SC with other list-learning and cognitive test scores and clinical diagnoses, contrasting SC with serial clustering and total learning scores when possible. RESULTS SC was inversely correlated with serial clustering. Higher SC was strongly associated with better learning and memory performances. When compared with cognitive tests, SC tended to have the strongest relationships with other memory measures and modest relationships with tests of executive functioning. SC had negligible to small relationships with most other cognitive domains. Traditional memory scores yielded stronger relationships to cognitive test performances than did SC. SC across clinical groups varied widely, but clinical groups tended to use SC less often than healthy comparison groups. CONCLUSION Our comprehensive review of the literature revealed that SC is strongly related to measures of learning and memory on the CVLT and HVLT and is correlated with a wide range of cognitive functions. SC has been understudied in relevant populations and additional research is needed to test the degree to which it adds incremental validity beyond traditional measures of learning and memory.
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Affiliation(s)
- Jessica L Bair
- Mental Health Service, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
- Department of Psychiatry, University of Michigan Health System, Ann Arbor, MI, USA
| | - Sarah D Patrick
- Mental Health Service, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Emily T Noyes
- Mental Health Service, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
| | - Andrew C Hale
- Mental Health Service, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
- Department of Psychiatry, University of Michigan Health System, Ann Arbor, MI, USA
| | - Elizabeth B Campbell
- Mental Health Service, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
- Department of Psychiatry, University of Michigan Health System, Ann Arbor, MI, USA
- Behavioral Health, St. Elizabeth Physicians, Crestview Hills, KY, USA
| | - Addie M Wilson
- Mental Health Service, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Michael T Ransom
- Mental Health Service, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
- Department of Psychiatry, University of Michigan Health System, Ann Arbor, MI, USA
| | - Robert J Spencer
- Mental Health Service, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
- Department of Psychiatry, University of Michigan Health System, Ann Arbor, MI, USA
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9
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Egeland J, Raudeberg R. Patterns of proactive interference in CVLT-II: evidence of a low-organized, disorganized, and highly organized learning style. J Clin Exp Neuropsychol 2023; 45:693-704. [PMID: 37807914 DOI: 10.1080/13803395.2023.2265615] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 09/25/2023] [Indexed: 10/10/2023]
Abstract
OBJECTIVE Previous studies have interpreted proactive interference (PI) either as indicating executive dysfunction or a normal process indicating deep level encoding. We investigated these competing models of PI in a large clinical sample using cluster analyses. We expected to find clusters defined by high PI but otherwise characterized by either EF impairment or of good memory performance. METHOD File records of 731 patients with neurological or psychiatric disorders were analyzed. PI-scores, false positive recognition errors, and semantic organization scores on the California Verbal Learning Test-II (CVLT-II) were subjected to cluster analyses. Clusters were compared regarding buildup and release from PI, memory performance and strategy measures, measures of intelligence, EF, and processing speed. RESULTS The analyses revealed six analyzable clusters. Two clusters showed no buildup of PI and normal release from PI. Discriminability was impaired both in List A and B. Learning acquisition and speeded measures of EF were reduced. One cluster showed both buildup of PI and problems with releasing from PI, and particularly impaired discriminability of List B. Semantic organization was low. Learning consolidation and EF speeded measures were impaired. Two other clusters showed buildup of PI, but no problem with release. Learning was highly organized, and they showed good memory and normal neuropsychological performance. CONCLUSIONS Results shows differentiation between a low organized EF dysfunction pattern with no PI, a disorganized PI pattern also indicating EF dysfunction and a highly organized pattern where PI seems to be the price to pay for high effort put into the learning process.
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Affiliation(s)
- Jens Egeland
- Division of Mental Health and Addiction, Vestfold Hospital Trust, Tønsberg, Norway
- Department of Psychology, University of Oslo, Oslo, Norway
| | - Rune Raudeberg
- Faculty of Psychology, University of Bergen, Bergen, Norway
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10
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Takla TN, Chargo AN, Daugherty AM, Fritz NE. Cognitive Contributors of Backward Walking in Persons with Multiple Sclerosis. Mult Scler Int 2023; 2023:5582242. [PMID: 37600498 PMCID: PMC10438976 DOI: 10.1155/2023/5582242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 07/26/2023] [Accepted: 07/29/2023] [Indexed: 08/22/2023] Open
Abstract
Purpose Individuals with multiple sclerosis (MS) are at an increased fall risk due to motor and cognitive dysfunction. Our past studies suggest that backward walking (BW) velocity predicts fall risk; however, specific cognitive domains associated with BW velocity remain understudied. The goal of this study was to determine the specific contributions of cognitive functioning to BW velocity in persons with MS. We hypothesized that better visuospatial memory, verbal immediate recall, and faster information processing speed would contribute to faster BW velocity, and deficits in these domains would partially account for disease severity-related impairment in BW velocity. Methods Participants completed demographic questionnaires, walking tests, and cognitive assessments. Applied structural equation modeling was used to test our hypothesized model of competing cognitive mediators. Within the model, disease severity was a predictor of BW via three intercorrelated cognitive mediators. Results Participants included 39 individuals with relapsing-remitting MS. Results indicated that 35.3% of the significant total effect of disease severity on BW was accounted for by specific cognitive deficits. Verbal immediate recall had the largest contribution, followed by visuospatial memory and information processing speed. Conclusions When examining the unique effects of cognitive domains on disease severity-related deficits in BW, a meaningful source of impairment related to visuospatial memory and verbal immediate recall was demonstrated. Considering the utility of BW velocity as a predictor of falls, these results highlight the importance of assessing cognition when evaluating fall risk in MS. Cognitive-based intervention studies investigating fall prevention may find BW as a more specific and sensitive predictor of fall risk than forward walking.
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Affiliation(s)
- Taylor N. Takla
- Neuroimaging and Neurorehabilitation Laboratory, Wayne State University, Detroit, MI, USA
- Translational Neuroscience Program, Wayne State University, Detroit, MI, USA
| | - Alexis N. Chargo
- Department of Psychology, Wayne State University, Detroit, MI, USA
- Institute of Gerontology, Wayne State University, Detroit, MI, USA
| | - Ana M. Daugherty
- Translational Neuroscience Program, Wayne State University, Detroit, MI, USA
- Department of Psychology, Wayne State University, Detroit, MI, USA
- Institute of Gerontology, Wayne State University, Detroit, MI, USA
| | - Nora E. Fritz
- Neuroimaging and Neurorehabilitation Laboratory, Wayne State University, Detroit, MI, USA
- Translational Neuroscience Program, Wayne State University, Detroit, MI, USA
- Department of Health Care Sciences, Wayne State University, Detroit, MI, USA
- Department of Neurology, Wayne State University, Detroit, MI, USA
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11
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Hsu WY, Anguera JA, Rizzo A, Campusano R, Chiaravalloti ND, DeLuca J, Gazzaley A, Bove RM. A virtual reality program to assess cognitive function in multiple sclerosis: A pilot study. Front Hum Neurosci 2023; 17:1139316. [PMID: 37007676 PMCID: PMC10060881 DOI: 10.3389/fnhum.2023.1139316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 02/17/2023] [Indexed: 03/18/2023] Open
Abstract
Introduction: Cognitive impairment is a debilitating symptom in people with multiple sclerosis (MS). Most of the neuropsychological tasks have little resemblance to everyday life. There is a need for ecologically valid tools for assessing cognition in real-life functional contexts in MS. One potential solution would involve the use of virtual reality (VR) to exert finer control over the task presentation environment; however, VR studies in the MS population are scarce.Objectives: To explore the utility and feasibility of a VR program for cognitive assessment in MS.Methods: A VR classroom embedded with a continuous performance task (CPT) was assessed in 10 non-MS adults and 10 people with MS with low cognitive functioning. Participants performed the CPT with distractors (i.e., WD) and without distractors (i.e., ND). The Symbol Digit Modalities Test (SDMT), California Verbal Learning Test—II (CVLT-II), and a feedback survey on the VR program was administered.Results: People with MS exhibited greater reaction time variability (RTV) compared to non-MS participants, and greater RTV in both WD and ND conditions was associated with lower SDMT.Conclusions: VR tools warrant further research to determine their value as an ecologically valid platform for assessing cognition and everyday functioning in people with MS.
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Affiliation(s)
- Wan-Yu Hsu
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Joaquin A. Anguera
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
- Neuroscape, University of California, San Francisco, San Francisco, CA, United States
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA, United States
| | - Albert Rizzo
- Institute for Creative Studies, University of Southern California, Los Angeles, CA, United States
| | - Richard Campusano
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
- Neuroscape, University of California, San Francisco, San Francisco, CA, United States
| | - Nancy D. Chiaravalloti
- Kessler Foundation, East Hanover, NJ, United States
- Department of Physical Medicine & Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, United States
| | - John DeLuca
- Kessler Foundation, East Hanover, NJ, United States
- Department of Physical Medicine & Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, United States
| | - Adam Gazzaley
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
- Neuroscape, University of California, San Francisco, San Francisco, CA, United States
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA, United States
- Department of Physiology, University of California, San Francisco, San Francisco, CA, United States
| | - Riley M. Bove
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
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12
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Abdolalizadeh A, Ohadi MAD, Ershadi ASB, Aarabi MH. Graph theoretical approach to brain remodeling in multiple sclerosis. Netw Neurosci 2023; 7:148-159. [PMID: 37334009 PMCID: PMC10270718 DOI: 10.1162/netn_a_00276] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 09/05/2022] [Indexed: 03/21/2024] Open
Abstract
Multiple sclerosis (MS) is a neuroinflammatory disorder damaging structural connectivity. Natural remodeling processes of the nervous system can, to some extent, restore the damage caused. However, there is a lack of biomarkers to evaluate remodeling in MS. Our objective is to evaluate graph theory metrics (especially modularity) as a biomarker of remodeling and cognition in MS. We recruited 60 relapsing-remitting MS and 26 healthy controls. Structural and diffusion MRI, plus cognitive and disability evaluations, were done. We calculated modularity and global efficiency from the tractography-derived connectivity matrices. Association of graph metrics with T2 lesion load, cognition, and disability was evaluated using general linear models adjusting for age, gender, and disease duration wherever applicable. We showed that MS subjects had higher modularity and lower global efficiency compared with controls. In the MS group, modularity was inversely associated with cognitive performance but positively associated with T2 lesion load. Our results indicate that modularity increase is due to the disruption of intermodular connections in MS because of the lesions, with no improvement or preserving of cognitive functions.
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Affiliation(s)
- AmirHussein Abdolalizadeh
- Students’ Scientific Research Program, Tehran University of Medical Sciences, Tehran, Iran
- Interdisciplinary Neuroscience Research Program, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Amin Dabbagh Ohadi
- Students’ Scientific Research Program, Tehran University of Medical Sciences, Tehran, Iran
- Interdisciplinary Neuroscience Research Program, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Sasan Bayani Ershadi
- Students’ Scientific Research Program, Tehran University of Medical Sciences, Tehran, Iran
- Interdisciplinary Neuroscience Research Program, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Hadi Aarabi
- Department of Neuroscience, Padova Neuroscience Center, University of Padova, Padova, Italy
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13
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Lou F, Yang G, Cai L, Yu L, Zhang Y, Shi C, Zhang N. Effects of age, sex, and education on California Verbal Learning Test-II performance in a Chinese-speaking population. Front Psychol 2022; 13:935875. [PMID: 36092060 PMCID: PMC9454604 DOI: 10.3389/fpsyg.2022.935875] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 08/08/2022] [Indexed: 11/13/2022] Open
Abstract
The California Verbal Learning Test-Second Edition (CVLT-II), is a commonly used tool to assess episodic memory. This study analyzed learning and memory characteristics in a cognitively healthy Chinese population, as well as the effects of age, sex and education on CVLT-II factors. In total, 246 healthy people aged 20–80 years and 29 persons with multiple sclerosis (MS) were included in this study and completed the CVLT-II. Factors including total learning, learning strategy, serial position effects, short-delay free and cued recall, long-delay free and cued recall, repetitions and intrusions during recall, hits and false positives of recognition, and total recognition discriminability were calculated. The effects of age, sex and education on these factors were analyzed using ANCOVA or independent two-sample t-tests and further confirmed by multiple regression analysis. The regression-based normative data were then computed by the equivalent scores method. Moreover, differences in learning and memory were compared between persons with MS and age-, sex- and education-matched healthy individuals. Most CVLT-II factors significantly differed between different age and education groups; in particular, better performance in total learning, recall, semantic clustering and recognition was observed in the younger and more educated groups than in the older and less educated groups. Male participants showed higher recency effect scores, more repetitions and fewer hits than female participants. Compared with healthy individuals, persons with MS showed extensive impairments in memory processes, such as learning, recall, learning strategy and recognition (p < 0.05). These findings indicated that verbal learning and memory were highly dependent on age and educational level but not strongly affected by sex. The CVLT-II effectively assesses episodic memory impairment in the Chinese-speaking population.
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Affiliation(s)
- Fanghua Lou
- Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China
- Department of Neurology, Tianjin Huang He Hospital, Tianjin, China
| | - Guotao Yang
- Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China
- Department of Neurology, Cangzhou Central Hospital, Cangzhou, China
| | - Lihui Cai
- School of Electrical and Information Engineering, Tianjin University, Tianjin, China
| | - Lechang Yu
- Department of Geriatrics, Tianjin Medical University General Hospital, Tianjin, China
| | - Ying Zhang
- Department of Neurology, Tianjin TEDA Hospital, Tianjin, China
| | - Chuan Shi
- NHC Key Laboratory of Mental Health, National Clinical Research Center for Mental Disorders, Peking University Sixth Hospital, Peking University Institute of Mental Health, Beijing, China
- *Correspondence: Chuan Shi,
| | - Nan Zhang
- Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China
- Nan Zhang,
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14
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Abou L, Sosnoff JJ, Peterson EW, Backus D, Willingham TB, Rice LA. Prediction of future falls among full-time wheelchair and scooter users with multiple sclerosis: A prospective study. Mult Scler Relat Disord 2022; 64:103962. [PMID: 35716478 DOI: 10.1016/j.msard.2022.103962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 05/23/2022] [Accepted: 06/10/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Seventy-five percent (75%) of full-time wheelchair or scooter users with multiple sclerosis (MS) experience at least one fall in a period of 6 months. Falls are detrimental for the independence, quality of life, and community participation. No previous prospective study has evaluated fall risk factors in this segment of MS community. OBJECTIVE To develop a multivariable falls risk prediction model for people with MS (PwMS) who use a wheelchair or scooter full-time. METHODS This prospective cohort study is a secondary data analysis that recruited PwMS from the community across the US. Forty-eight adults with MS who use a wheelchair or scooter as their main form of mobility were included. Dependent variable was fall incidence over 3-month recorded through diaries. Dependent variable was categorized as fallers (≥ 1 fall) and non-fallers (0 fall). Predictors were demographics, history of falls in the past 6 months, measures of fear of falling, Spinal Cord Injury- Falls Concern Scale, California Verbal Learning Test II, and Multiple Sclerosis Quality of Life- mental health. Multivariable logistic regression analyses were conducted to identity predictors of future falls. RESULTS In total, 63 falls (range 0 - 8) were reported over the 3-month period from a total of 26 fallers (54%). Multivariate logistic regression analyses indicated that the risk factor with the best predictive ability of future falls included history of falls in the past 6 months (sensitivity 77%, specificity 54%, and area under the receiving operating curve statistic = 0.76, 95% CI 0.62 to 0.89). CONCLUSION Findings highlight the importance of asking full-time wheelchair and scooter users with MS if they have fallen in the past 6 months to quickly identify those who are at increased fall risk and in need of follow up assessment and intervention to identify and address modifiable risk factors. More attention to fall risks among full-time wheelchair or scooter users with MS is suggested to increase the understanding among clinicians and researchers of modifiable risk factors.
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Affiliation(s)
- Libak Abou
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, 219 Freer Hall, 906 S. Goodwin Ave., Urbana, IL 61801, USA. https://twitter.com/https://twitter.com/libak9
| | - Jacob J Sosnoff
- Department of Physical Therapy, Rehabilitation Science, and Athletic Training, University of Kansas Medical Center, Kansas City, KS, USA
| | - Elizabeth W Peterson
- Department of Occupational Therapy, College of Applied Health Sciences, University of Illinois Chicago, Chicago, IL, USA
| | - Deborah Backus
- Virginia Crawford Research Institute, Shepherd Center, Atlanta, GA, USA
| | | | - Laura A Rice
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, 219 Freer Hall, 906 S. Goodwin Ave., Urbana, IL 61801, USA; Center on Health, Aging, and Disability, College of Applied Health Sciences, Champaign, IL, USA.
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15
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Costa ACS, Brandão AC, Boada R, Barrionuevo VL, Taylor HG, Roth E, Stasko MR, Johnson MW, Assir FF, Roberto MP, Salmona P, Abreu-Silveira G, Bederman I, Prendergast E, Hüls A, Abrishamcar S, Mustacchi Z, Scheidemantel T, Roizen NJ, Ruedrich S. Safety, efficacy, and tolerability of memantine for cognitive and adaptive outcome measures in adolescents and young adults with Down syndrome: a randomised, double-blind, placebo-controlled phase 2 trial. Lancet Neurol 2021; 21:31-41. [PMID: 34942135 DOI: 10.1016/s1474-4422(21)00369-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 10/02/2021] [Accepted: 10/11/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Down syndrome is a chromosomal disorder with considerable neurodevelopmental impact and neurodegenerative morbidity. In a pilot trial in young adults with Down syndrome, memantine (a drug approved for Alzheimer's disease) showed a significant effect on a secondary measure of episodic memory. We aimed to test whether memantine would improve episodic memory in adolescents and young adults with Down syndrome. METHODS We did a randomised, double-blind, placebo-controlled phase 2 trial with a parallel design, stratified by age and sex. Participants (aged 15-32 years) with either trisomy 21 or complete unbalanced translocation of chromosome 21 and in general good health were recruited from the community at one site in Brazil and another in the USA. Participants were randomly assigned (1:1) to receive either memantine (20 mg/day orally) or placebo for 16 weeks. Computer-generated randomisation tables for both sites (allocating a placebo or drug label to each member of a unique pair of participants) were centrally produced by an independent statistician and were shared only with investigational pharmacists at participating sites until unblinding of the study. Participants and investigators were masked to treatment assignments. Neuropsychological assessments were done at baseline (T1) and week 16 (T2). The primary outcome measure was change from baseline to week 16 in the California Verbal Learning Test-second edition short-form (CVLT-II-sf) total free recall score, assessed in the per-protocol population (ie, participants who completed 16 weeks of treatment and had neuropsychological assessments at T1 and T2). Linear mixed effect models were fit to data from the per-protocol population. Safety and tolerability were monitored and analysed in all participants who started treatment. Steady-state concentrations in plasma of memantine were measured at the end of the trial. This study is registered at ClinicalTrials.gov, number NCT02304302. FINDINGS From May 13, 2015, to July 22, 2020, 185 participants with Down syndrome were assessed for eligibility and 160 (86%) were randomly assigned either memantine (n=81) or placebo (n=79). All participants received their allocated treatment. Linear mixed effect models were fit to data from 149 (81%) participants, 73 in the memantine group and 76 in the placebo group, after 11 people (eight in the memantine group and three in the placebo group) discontinued due to COVID-19 restrictions, illness of their caregiver, adverse events, or low compliance. The primary outcome measure did not differ between groups (CVLT-II-sf total free recall score, change from baseline 0·34 points [95% CI -0·98 to 1·67], p=0·61). Memantine was well tolerated, with infrequent mild-to-moderate adverse events, the most common being viral upper respiratory infection (nine [11%] participants in the memantine group and 12 [15%] in the placebo group) and transient dizziness (eight [10%] in the memantine group and six [8%] in the placebo group). No serious adverse events were observed. Amounts of memantine in plasma were substantially lower than those considered therapeutic for Alzheimer's disease. INTERPRETATION Memantine was well tolerated, but cognition-enhancing effects were not recorded with a 20 mg/day dose in adolescents and young adults with Down syndrome. Exploratory analyses point to a need for future work. FUNDING Alana Foundation. TRANSLATION For the Portuguese translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Alberto C S Costa
- Department of Pediatrics, School of Medicine, Case Western Reserve University, Cleveland, OH, USA; Department of Psychiatry, School of Medicine, Case Western Reserve University, Cleveland, OH, USA.
| | - Ana C Brandão
- Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Richard Boada
- Department of Pediatrics, School of Medicine, University of Colorado Aurora, CO, USA
| | | | - Hudson G Taylor
- Center for Biobehavioral Health, Nationwide Children's Hospital Research Institute, Ohio State University, Columbus, OH, USA
| | - Elizabeth Roth
- Department of Pediatrics, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Melissa R Stasko
- Department of Pediatrics, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Mark W Johnson
- Department of Pediatrics, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | | | | | - Patrícia Salmona
- São Paulo Center for Clinical Studies and Research-CEPEC-SP, São Paulo, Brazil
| | | | - Ilya Bederman
- Department of Genetics and Genome Sciences, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Erin Prendergast
- Department of Genetics and Genome Sciences, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Anke Hüls
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA; Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Sarina Abrishamcar
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Zan Mustacchi
- São Paulo Center for Clinical Studies and Research-CEPEC-SP, São Paulo, Brazil
| | - Thomas Scheidemantel
- Department of Psychiatry, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Nancy J Roizen
- Department of Pediatrics, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Stephen Ruedrich
- Department of Psychiatry, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
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Kallianta MDK, Katsira XE, Tsitsika AK, Vlachakis D, Chrousos G, Darviri C, Bacopoulou F. Stress management intervention to enhance adolescent resilience: a randomized controlled trial. ACTA ACUST UNITED AC 2021; 26. [PMID: 34671547 DOI: 10.14806/ej.26.1.967] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The purpose of this study was to examine the effects of an 8-week stress management intervention to enhance resilience and coping techniques and decrease stress in adolescent students. Teenagers, 11 to 17 years old, recruited from two tertiary Adolescent Medicine Centers of the National and Kapodistrian University of Athens, Greece, were randomly assigned into two groups: the stress management group (n=24) and the control group (n=25). Resilience, stress, anxiety, everyday use of social media, school performance and cognitive skills were measured in adolescents of both groups, pre- and post-intervention. Post-intervention, the stress management group had significantly higher resilience scores and school performance self-evaluation scores, lower scores of stress, anxiety and everyday use of social media and better cognitive skills than the control group. Regarding cognitive skills, the stress management group significantly improved the speed of information processing and memory. Adolescents following stress management experienced significantly reduced stress from interacting with teachers/parents, from peer pressure, from school/leisure conflict as well as compulsive behaviours. With respect to resilience, the intervention improved adolescents' individual skills and resources, relationships with primary caregivers, and environmental factors that facilitated the sense of belonging. Future studies of large adolescent samples are required to evaluate the long-term benefits of stress management techniques on adolescents' health and resilience, as well as the need of continued support to preserve these benefits throughout transition to adulthood.
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Affiliation(s)
- Maria-Despoina K Kallianta
- Postgraduate Course of Science of Stress and Health Promotion, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Xrysoula E Katsira
- Postgraduate Course of Science of Stress and Health Promotion, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Artemis K Tsitsika
- Adolescent Health Unit, Second Department of Pediatrics, «P. & A. Kyriakou» Children's Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Vlachakis
- Laboratory of Genetics, Department of Biotechnology, School of Applied Biology and Biotechnology, Agricultural University of Athens, Athens, Greece.,Lab of Molecular Endocrinology, Center of Clinical, Experimental Surgery and Translational Research, Biomedical Research Foundation of the Academy of Athens, Greece.,University Research Institute of Maternal and Child Health & Precision Medicine, and UNESCO Chair on Adolescent Health Care, National and Kapodistrian University of Athens, Aghia Sophia Children's Hospital, Athens, Greece
| | - George Chrousos
- University Research Institute of Maternal and Child Health & Precision Medicine, and UNESCO Chair on Adolescent Health Care, National and Kapodistrian University of Athens, Aghia Sophia Children's Hospital, Athens, Greece
| | - Christina Darviri
- Postgraduate Course of Science of Stress and Health Promotion, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Flora Bacopoulou
- University Research Institute of Maternal and Child Health & Precision Medicine, and UNESCO Chair on Adolescent Health Care, National and Kapodistrian University of Athens, Aghia Sophia Children's Hospital, Athens, Greece
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Lakin L, Davis BE, Binns CC, Currie KM, Rensel MR. Comprehensive Approach to Management of Multiple Sclerosis: Addressing Invisible Symptoms-A Narrative Review. Neurol Ther 2021; 10:75-98. [PMID: 33877583 PMCID: PMC8057008 DOI: 10.1007/s40120-021-00239-2] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 03/03/2021] [Indexed: 02/06/2023] Open
Abstract
Multiple sclerosis (MS) is a chronic autoimmune inflammatory disease of the central nervous system, leading to neurodegeneration and manifesting as a variety of symptoms. These can include "invisible" symptoms, not externally evident to others, such as fatigue, mood disorders, cognitive impairments, pain, bladder/bowel dysfunction, sexual dysfunction, and vision changes. Invisible symptoms are highly prevalent in people living with MS, with multifactorial etiology and potential to impact the disease course. Patient experiences of these symptoms include both physical and psychosocial elements, which when unaddressed negatively influence many aspects of quality of life and perception of health. Despite the high impact on patient lives, gaps persist in awareness and management of these hidden symptoms. The healthcare provider and patient author experiences brought together here serve to raise the profile of invisible symptoms and review strategies for a team-based approach to comprehensive MS care. We summarize the current literature regarding the prevalence and etiology of invisible symptoms to convey the high likelihood that a person living with MS will contend with one or more of these concerns. We then explore how open communication between people living with MS and their care team, stigma mitigation, and shared decision-making are key to comprehensive management of invisible symptoms. We recommend validated screening tools and technological advancements that may be incorporated into MS care to regularly monitor these symptoms, offering insight into how healthcare providers can both educate and listen to patients, with the goal of improved patient quality of life. By pairing clinical knowledge with an understanding and consideration of the patient perspective, providers will be equipped to foster a patient-centered dialogue that encourages shared decision-making. Invisible symptoms of MS.
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Affiliation(s)
- Lynsey Lakin
- The Neurology Group, 9120 Haven Ave, Rancho Cucamonga, CA, USA
- Comprehensive MS Center, The University of California Riverside, 3390 University Ave, Suite 100, Riverside, CA, USA
| | - Bryan E Davis
- Comprehensive MS Center, The University of California Riverside, 3390 University Ave, Suite 100, Riverside, CA, USA
| | - Cherie C Binns
- Accelerated Cure Project/iConquerMS, 187 Robinson Street, Wakefield, RI, USA
| | - Keisha M Currie
- Currie Consultancy Agency LLC., 11 M. R. Watson Court, Eastover, SC, USA
| | - Mary R Rensel
- Mellen Center for Multiple Sclerosis Treatment and Research, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, USA.
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The Effects of Pythagorean Self-Awareness Intervention on Irritable Bowel Syndrome Patients: A Non-randomized Controlled Trial. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1337:345-354. [DOI: 10.1007/978-3-030-78771-4_39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Benedict RHB, Amato MP, DeLuca J, Geurts JJG. Cognitive impairment in multiple sclerosis: clinical management, MRI, and therapeutic avenues. Lancet Neurol 2020; 19:860-871. [PMID: 32949546 PMCID: PMC10011205 DOI: 10.1016/s1474-4422(20)30277-5] [Citation(s) in RCA: 320] [Impact Index Per Article: 80.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 07/14/2020] [Accepted: 07/21/2020] [Indexed: 12/15/2022]
Abstract
Multiple sclerosis is a chronic, demyelinating disease of the CNS. Cognitive impairment is a sometimes neglected, yet common, sign and symptom with a profound effect on instrumental activities of daily living. The prevalence of cognitive impairment in multiple sclerosis varies across the lifespan and might be difficult to distinguish from other causes in older age. MRI studies show that widespread changes to brain networks contribute to cognitive dysfunction, and grey matter atrophy is an early sign of potential future cognitive decline. Neuropsychological research suggests that cognitive processing speed and episodic memory are the most frequently affected cognitive domains. Narrowing evaluation to these core areas permits brief, routine assessment in the clinical setting. Owing to its brevity, reliability, and sensitivity, the Symbol Digit Modalities Test, or its computer-based analogues, can be used to monitor episodes of acute disease activity. The Symbol Digit Modalities Test can also be used in clinical trials, and data increasingly show that cognitive processing speed and memory are amenable to cognitive training interventions.
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Affiliation(s)
- Ralph H B Benedict
- Department of Neurology and Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA.
| | - Maria Pia Amato
- Department of Neurology, University of Florence, IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | | | - Jeroen J G Geurts
- Department of Anatomy and Neurosciences, Section Clinical Neuroscience, Amsterdam UMC, Location VUmc, Vrije Universiteit, Amsterdam, Netherlands
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Zeinoun P, Farran N, Khoury SJ, Darwish H. Development, psychometric properties, and pilot norms of the first Arabic indigenous memory test: The Verbal Memory Arabic Test (VMAT). J Clin Exp Neuropsychol 2020; 42:505-515. [DOI: 10.1080/13803395.2020.1773408] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Pia Zeinoun
- Department of Psychology, American University of Beirut, Beirut, Lebanon
- Department of Psychiatry, American University of Beirut Medical Center, Beirut, Lebanon
| | - Natali Farran
- Hariri School of Nursing, American University of Beirut, Beirut, Lebanon
| | - Samia J. Khoury
- Nehme and Therese Tohme Multiple Sclerosis Center, American University of Beirut Medical Center, Beirut, Lebanon
- Abu-Haidar Neuroscience Institute, American University of Beirut Medical Center, Beirut, Lebanon
| | - Hala Darwish
- Hariri School of Nursing, American University of Beirut, Beirut, Lebanon
- Nehme and Therese Tohme Multiple Sclerosis Center, American University of Beirut Medical Center, Beirut, Lebanon
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Alessandria G, Meli R, Infante MT, Vestito L, Capello E, Bandini F. Long-term assessment of the cognitive effects of nabiximols in patients with multiple sclerosis: A pilot study. Clin Neurol Neurosurg 2020; 196:105990. [PMID: 32526487 DOI: 10.1016/j.clineuro.2020.105990] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 06/02/2020] [Accepted: 06/03/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Moderate to severe spasticity is commonly reported in Multiple Sclerosis (MS) and its management is still a challenge. Cannabinoids were recently suggested as add-on therapy for the treatment of spasticity and chronic pain in MS but there is no conclusive scientific evidence on their safety, especially on cognition and over long periods. The aim of this prospective pilot study was to assess the long-term effects of a tetrahydrocannabinol-cannabidiol (THC/CBD) oromucosal spray (Sativex®) on cognition, mood and anxiety. PATIENTS AND METHODS An extensive and specific battery of neuropsychological tests (Symbol Digit Modalities Test-SDMT, California Verbal Learning Test-CVLT, Brief Visuospatial Memory Test-BVMT; PASAT-3 and 2; Free and Cued Selective Remind Test-FCSRT, Index of Sensitivity of Cueing-ISC) was applied to longitudinally investigate different domains of cognition in 20 consecutive MS patients receiving Sativex for spasticity. The primary endpoint was to assess any variation in cognitive performance. Secondary outcomes regarding mood and anxiety were investigated by means of Beck Depression Inventory (BDI) and Hamilton Anxiety Rating Scale (HAM-A). Any change in patients' spasticity was evaluated using the 0-10 Numerical Rating Scale (NRS). RESULTS Twenty per protocol patients were followed up and evaluated at baseline, 6 and 12 months. Domains involving processing speed and auditory verbal memory significantly improved within the first 6 months of therapy (SDMT: p < 0.001; CVLT: p = 0.0001). Mood and anxiety did not show any significant variation. Additionally, the NRS score significantly improved since the beginning (p < 0.0001). CONCLUSIONS These results are encouraging in supporting possible long-term benefits of Sativex on cognition and a wider role than symptom alleviator. Further studies on larger groups of patients would be necessary in order to test this intriguing possibility.
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Affiliation(s)
- Giulia Alessandria
- Department of Neurology, S. Paolo Hospital, Via Genova 30, 17100, Savona, Italy
| | - Riccardo Meli
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, IRCCS Ospedale Policlinico San Martino, Largo Daneo 3, 16132, Genova, Italy
| | | | - Lucilla Vestito
- IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genova, Italy
| | - Elisabetta Capello
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, IRCCS Ospedale Policlinico San Martino, Largo Daneo 3, 16132, Genova, Italy
| | - Fabio Bandini
- Department of Neurology, S. Paolo Hospital, Via Genova 30, 17100, Savona, Italy.
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Khaligh-Razavi SM, Sadeghi M, Khanbagi M, Kalafatis C, Nabavi SM. A self-administered, artificial intelligence (AI) platform for cognitive assessment in multiple sclerosis (MS). BMC Neurol 2020; 20:193. [PMID: 32423386 PMCID: PMC7236354 DOI: 10.1186/s12883-020-01736-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 04/20/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cognitive impairment is common in patients with multiple sclerosis (MS). Accurate and repeatable measures of cognition have the potential to be used as markers of disease activity. METHODS We developed a 5-min computerized test to measure cognitive dysfunction in patients with MS. The proposed test - named the Integrated Cognitive Assessment (ICA) - is self-administered and language-independent. Ninety-one MS patients and 83 healthy controls (HC) took part in Substudy 1, in which each participant took the ICA test and the Brief International Cognitive Assessment for MS (BICAMS). We assessed ICA's test-retest reliability, its correlation with BICAMS, its sensitivity to discriminate patients with MS from the HC group, and its accuracy in detecting cognitive dysfunction. In Substudy 2, we recruited 48 MS patients, 38 of which had received an 8-week physical and cognitive rehabilitation programme and 10 MS patients who did not. We examined the association between the level of serum neurofilament light (NfL) in these patients and their ICA scores and Symbol Digit Modalities Test (SDMT) scores pre- and post-rehabilitation. RESULTS The ICA demonstrated excellent test-retest reliability (r = 0.94), with no learning bias, and showed a high level of convergent validity with BICAMS. The ICA was sensitive in discriminating the MS patients from the HC group, and demonstrated high accuracy (AUC = 95%) in discriminating cognitively normal from cognitively impaired participants. Additionally, we found a strong association (r = - 0.79) between ICA score and the level of NfL in MS patients before and after rehabilitation. CONCLUSIONS The ICA has the potential to be used as a digital marker of cognitive impairment and to monitor response to therapeutic interventions. In comparison to standard cognitive tools for MS, the ICA is shorter in duration, does not show a learning bias, and is independent of language.
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Affiliation(s)
- Seyed-Mahdi Khaligh-Razavi
- Cognetivity Ltd, London, UK. .,Department of Brain and Cognitive Sciences, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran.
| | | | - Mahdiyeh Khanbagi
- Department of Brain and Cognitive Sciences, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran
| | - Chris Kalafatis
- Cognetivity Ltd, London, UK.,South London & Maudsley NHS Foundation Trust, London, UK.,Department of Old Age Psychiatry, King's College London, London, UK
| | - Seyed Massood Nabavi
- Department of Brain and Cognitive Sciences, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran
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Matias-Guiu JA, Cortés-Martínez A, Curiel RE, Delgado-Álvarez A, Fernández-Oliveira A, Pytel V, Montero P, Moreno-Ramos T, Loewenstein DA, Matías-Guiu J. Memory Impairment in Relapsing-Remitting Multiple Sclerosis Using a Challenging Semantic Interference Task. Front Neurol 2020; 11:309. [PMID: 32373060 PMCID: PMC7186484 DOI: 10.3389/fneur.2020.00309] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 03/31/2020] [Indexed: 11/13/2022] Open
Abstract
Objective: Episodic memory is frequently impaired in Multiple Sclerosis (MS), but the cognitive characteristics and neuropsychological processes involved remain controversial. Our aim was to study episodic memory dysfunction in MS, using the LASSI-L, a novel memory-based cognitive stress test that uses a new paradigm that capitalizes on semantic interference. Methods: Cross-sectional study in which 93 patients with MS (relapsing-remitting) and 124 healthy controls were included. The LASSI-L test was administered to all participants, as well as a comprehensive neuropsychological battery including a selective reminding test. MS patients were divided into two groups, with cognitive impairment (CI-MS) and cognitively preserved (CP-MS). Results: Reliability of the LASSI-L test was high (Cronbach's alpha 0.892) and there were less ceiling effects. MS patients scored lower than controls on all LASSI-L subtests, except for maximum storage of the initial target items (CRA2). Effect sizes were moderate-large. A delay in learning, difficulties in retroactive semantic interference, failure to recover from proactive semantic interference, and delayed recall were the most frequent findings in MS patients. Scores associated with maximum storage capacity, and retroactive semantic interference were the most strongly associated with cognitive impairment and employment status. Conclusion: We found that deficits in maximum learning, difficulties in recovery from the effects of proactive semantic interference and retroactive semantic interference are three important breakdowns in episodic memory deficits among patients with MS. The LASSI-L showed good psychometric and diagnostic properties. Overall, our study supports the utility of the LASSI-L, as a new cognitive test, useful for neuropsychological assessment in MS in clinical and research settings.
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Affiliation(s)
- Jordi A Matias-Guiu
- Department of Neurology, Hospital Clinico San Carlos, Health Research Institute "San Carlos" (IdISCC), Universidad Complutense de Madrid, Madrid, Spain
| | - Ana Cortés-Martínez
- Department of Neurology, Hospital Clinico San Carlos, Health Research Institute "San Carlos" (IdISCC), Universidad Complutense de Madrid, Madrid, Spain
| | - Rosie E Curiel
- Department of Psychiatry and Behavioral Sciences, Center for Cognitive Neuroscience and Aging, Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Alfonso Delgado-Álvarez
- Department of Neurology, Hospital Clinico San Carlos, Health Research Institute "San Carlos" (IdISCC), Universidad Complutense de Madrid, Madrid, Spain
| | | | - Vanesa Pytel
- Department of Neurology, Hospital Clinico San Carlos, Health Research Institute "San Carlos" (IdISCC), Universidad Complutense de Madrid, Madrid, Spain
| | - Paloma Montero
- Department of Neurology, Hospital Clinico San Carlos, Health Research Institute "San Carlos" (IdISCC), Universidad Complutense de Madrid, Madrid, Spain
| | - Teresa Moreno-Ramos
- Department of Neurology, Hospital Clinico San Carlos, Health Research Institute "San Carlos" (IdISCC), Universidad Complutense de Madrid, Madrid, Spain
| | - David A Loewenstein
- Department of Psychiatry and Behavioral Sciences, Center for Cognitive Neuroscience and Aging, Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Jorge Matías-Guiu
- Department of Neurology, Hospital Clinico San Carlos, Health Research Institute "San Carlos" (IdISCC), Universidad Complutense de Madrid, Madrid, Spain
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Weitzner DS, Pugh EA, Calamia M, Roye S. Examining the factor structure of the Rey auditory verbal learning test in individuals across the life span. J Clin Exp Neuropsychol 2020; 42:406-414. [PMID: 32202202 DOI: 10.1080/13803395.2020.1741517] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Objective: Previous studies analyzing the factor structure of the Rey Auditory Verbal Learning Test (RAVLT) have been limited in the number of scores included in the analysis. Often, they lacked inclusion of process scores that have been shown to add predictive value in identifying future cognitive decline. Therefore, the goal of the current study was to determine the factor structure of the RAVLT utilizing factor scores including serial position effects, repetitions, and intrusion errors, and to examine if the factor structure for older adults is similar to that found in the entire lifespan sample.Method: Exploratory factor analysis (EFA) was conducted on 718 participants (age 16-85 years) from the Nathan Kline Institute (NKI)-Rockland project. Confirmatory factor analyses (CFA) of a reduced model of the EFA was conducted on the entire sample and an older (ages 55-85 years; n = 265) and a younger (less than 55 years of age; n = 453) subsample.Results: EFA indicated three factors: Memory, Attention/Learning, and Inaccurate Memory (i.e., repetitions and intrusions). CFA of a reduced model indicated adequate fit in the entire sample and older subsample, and good fit in the younger subsample.Conclusion: The present study examined the factor structure of the RAVLT in a large lifespan sample utilizing a larger set of RAVLT scores than have been examined in prior studies, including total scores and process scores. The same factors were identified in the entire lifespan sample and the younger and older adult subsamples, although similar to previous studies, measures of model fit were less robust in the older adult subsample. These results provide additional support for the error scores (e.g., intrusions and repetitions) as separable from other aspects of learning and memory.
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Affiliation(s)
- Daniel S Weitzner
- Department of Psychology, Louisiana State University, Baton Rouge, USA
| | - Erika A Pugh
- Department of Psychology, Louisiana State University, Baton Rouge, USA
| | - Matthew Calamia
- Department of Psychology, Louisiana State University, Baton Rouge, USA
| | - Scott Roye
- Department of Psychology, Louisiana State University, Baton Rouge, USA
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25
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Goverover Y, Genova HM, Smith A, Lengenfelder J, Chiaravalloti ND. Changes in Activity Participation After Multiple Sclerosis Diagnosis. Int J MS Care 2020; 22:23-30. [PMID: 32123525 PMCID: PMC7041618 DOI: 10.7224/1537-2073.2018-036] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Multiple sclerosis (MS) results in impairments in cognitive and motor skills, which may reduce the level of activity participation in people with MS. This study compares past and current levels of activity participation in adults with MS and controls. The relationship between retained activity participation (since diagnosis) and cognitive, motor, functional status, and depression symptoms of persons with MS was examined. METHODS Twenty-seven individuals with MS living in the community and 21 controls completed cognitive and motor tests and rated their activity participation (using the Activity Card Sort), depression symptoms, and functional status. RESULTS The MS group reported significantly lower current activity participation than the control group. Percentage of retained activity participation (from prediagnosis to current) in the MS group correlated with time since diagnosis, executive function and motor skill ability, depression symptoms, and current functional status. CONCLUSIONS Persons with MS report negative changes in activity participation in most aspects of life after diagnosis. These findings call attention to changes in activity participation in people with MS that are directly related to disease symptoms. Therefore, using a quantitative measure of activity participation-the Activity Card Sort-can provide important information to aid the clinician in developing individualized treatment goals for people with MS.
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Proschinger S, Joisten N, Rademacher A, Schlagheck ML, Walzik D, Metcalfe AJ, Oberste M, Warnke C, Bloch W, Schenk A, Bansi J, Zimmer P. Influence of combined functional resistance and endurance exercise over 12 weeks on matrix metalloproteinase-2 serum concentration in persons with relapsing-remitting multiple sclerosis - a community-based randomized controlled trial. BMC Neurol 2019; 19:314. [PMID: 31810462 PMCID: PMC6898928 DOI: 10.1186/s12883-019-1544-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 11/26/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The relevance of regular moderate to intense exercise for ameliorating psychomotor symptoms in persons with multiple sclerosis (pwMS) is becoming increasingly evident. Over the last two decades, emerging evidence from clinical studies and animal models indicate immune regulatory mechanisms in both periphery and the central nervous system that may underlie these beneficial effects. The integrity of the blood-brain barrier as the main structural interface between periphery and brain seems to play an important role in MS. Reducing the secretion of proteolytic matrix metalloproteinases (MMP), i.e. MMP-2, as disruptors of blood-brain barrier integrity could have profound implications for MS. METHODS In this two-armed randomized controlled trial 64 participants with relapsing-remitting MS (RRMS) (EDSS 0-4.0) will be allocated to either an intervention group or a passive wait list control group. The intervention group will perform 60 min of combined functional resistance and endurance exercises 3x per week over a period of 12 weeks in a community-based and publicly available setting. Changes in serum concentration of MMP-2 will be the primary outcome. Secondary outcomes are numbers of immune cell subsets, soluble (anti-) inflammatory factors, physical capacity, cognitive performance, physical activity behavior, gait performance, and patient-reported outcomes. All outcome measures will be assessed at baseline and after week 12 with an additional blood sampling before, during and immediately after a single training session in week 6. DISCUSSION To our knowledge, this will be the first RCT to investigate both the acute and chronic effects of a community-based intense functional resistance and endurance exercise regimen in persons with RRMS. Combining analysis of biological and cognitive or psychological outcomes may provide a better understanding of the MS-specific symptomology. TRIAL REGISTRATION DRKS00017091; 05th of April, 2019; International Clinical Trials Registry Platform.
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Affiliation(s)
- Sebastian Proschinger
- Department for Molecular and Cellular Sports Medicine, Institute for Cardiovascular Research and Sports Medicine, German Sport University Cologne, Cologne, Germany
| | - Niklas Joisten
- Department for Molecular and Cellular Sports Medicine, Institute for Cardiovascular Research and Sports Medicine, German Sport University Cologne, Cologne, Germany
| | - Annette Rademacher
- Department for Molecular and Cellular Sports Medicine, Institute for Cardiovascular Research and Sports Medicine, German Sport University Cologne, Cologne, Germany
| | - Marit L Schlagheck
- Department for Molecular and Cellular Sports Medicine, Institute for Cardiovascular Research and Sports Medicine, German Sport University Cologne, Cologne, Germany
| | - David Walzik
- Department for Molecular and Cellular Sports Medicine, Institute for Cardiovascular Research and Sports Medicine, German Sport University Cologne, Cologne, Germany
| | - Alan J Metcalfe
- Department for Molecular and Cellular Sports Medicine, Institute for Cardiovascular Research and Sports Medicine, German Sport University Cologne, Cologne, Germany
| | - Max Oberste
- Department for Molecular and Cellular Sports Medicine, Institute for Cardiovascular Research and Sports Medicine, German Sport University Cologne, Cologne, Germany
| | - Clemens Warnke
- Department of Neurology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Wilhelm Bloch
- Department for Molecular and Cellular Sports Medicine, Institute for Cardiovascular Research and Sports Medicine, German Sport University Cologne, Cologne, Germany
| | - Alexander Schenk
- Department for Molecular and Cellular Sports Medicine, Institute for Cardiovascular Research and Sports Medicine, German Sport University Cologne, Cologne, Germany
| | - Jens Bansi
- Deparment of Neurology, Kliniken-Valens, Rehabilitationsklinik-Valens, Taminaplatz 1, 7317, Valens, Switzerland
| | - Philipp Zimmer
- Department for Molecular and Cellular Sports Medicine, Institute for Cardiovascular Research and Sports Medicine, German Sport University Cologne, Cologne, Germany.
- Department of Exercise and Health, Institute of Sports Science, Leibniz University Hannover, Hannover, Germany.
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The Norwegian translation of the brief international cognitive assessment for multiple sclerosis (BICAMS). Mult Scler Relat Disord 2019; 36:101408. [PMID: 31610403 DOI: 10.1016/j.msard.2019.101408] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 09/17/2019] [Accepted: 09/19/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND Cognitive impairment is a common symptom in all stages of multiple sclerosis (MS), yet it is underreported and not routinely evaluated. The Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS) is a short and easily administered test battery for screening of cognitive impairment in MS that can be completed within 15 min and incorporated into routine clinical practice. The test battery consists of the oral version of the Symbols Digit Modalities Test (SDMT) and the initial learning trials of the California Verbal Learning Test 2nd edition (CVLT-II) and the Brief Visuospatial Memory Test Revised (BVMT-R). OBJECTIVE To investigate if the Norwegian version of the BICAMS could identify cognitive impairment in early stages of MS and be used as part of routine follow-up procedures. METHODS A total of 65 relapsing-remitting MS (RRMS) patients and 68 healthy controls were examined with the BICAMS test battery. A randomly selected subset of 29 controls were retested 1-4 weeks after baseline. All participants were screened for anxiety and depression using the Hospital Anxiety and Depression Scale (HADS). RESULTS There were statistically significant differences between the patients with MS and the healthy controls on all three subtests, and the differences remained significant for the CVLT-II (p = 0.003) and BVMT-R (p = 0.011) after adjusting for education. There were no statistically significant correlations between BICAMS scores and anxiety and depression. SDMT and BVMT-R results in the control group at baseline and re-test were strongly correlated (r ≥ 0.70, p < 0.001), and CVLT-II achieved an adequate value of r = 0.60 (p = 0.001). On the SDMT, there was a statistically significant improvement between the two test-sessions. Cognitive impairment, defined as an abnormal test score on ≥1 subtest, was identified in 46.2% of the patient sample, whereas 15.4% were considered cognitively impaired on ≥2 subtests. CONCLUSION This study supports that the Norwegian version of the BICAMS should be included as a screening procedure for cognitive impairment in Norwegian MS patients.
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The association between executive functioning, coping styles and depressive symptoms in patients with Multiple Sclerosis. Mult Scler Relat Disord 2019; 36:101392. [PMID: 31526983 DOI: 10.1016/j.msard.2019.101392] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Revised: 08/24/2019] [Accepted: 09/07/2019] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To investigate the direct, mediated and moderated relationships between executive functioning, coping and depressive symptoms in patients with multiple sclerosis (MS). METHODS Cross-sectional cohort study of routine follow-up visits, including a standardized (neuro)psychological evaluation of 68 MS patients. Coping was measured with the Coping Inventory for Stressful Situations; Depressive symptoms with the subscale depression of the Hospital Anxiety and Depression Scale. Cognitive tests were reduced to a single 'executive function' factor by means of confirmatory factor analysis. Path analyses tested mediating and moderating effects of coping on the relation between executive functioning and depressive symptoms. RESULTS Consistently, the executive functioning factor was not related to task-oriented and emotion-oriented coping. Better executive functioning, however, and less reliance on avoidance coping, was related to more depressive symptoms. Testing of the mediating path showed that executive dysfunctioning was indeed significantly related to more depressive symptoms by less reliance on avoidance coping. There was no additional direct effect of executive functioning on depressive symptoms and also no moderating effect of any coping style on the association between cognition and depressive symptoms. CONCLUSION Our findings suggest that task-oriented and emotion-oriented coping do not influence the relationship between executive functioning and depression in MS patients, but their mental health might benefit from more reliance on avoidance coping.
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Vissicchio NA, Altaras C, Parker A, Schneider S, Portnoy JG, Archetti R, Stimmel M, Foley FW. Relationship Between Anxiety and Cognition in Multiple Sclerosis: Implications for Treatment. Int J MS Care 2019; 21:151-156. [PMID: 31474807 DOI: 10.7224/1537-2073.2018-027] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background Anxiety, which is very prevalent in multiple sclerosis (MS) but understudied, has been shown to negatively affect cognition in many different populations. Slowed information processing speed underlies most cognitive impairments in MS, including verbal learning. The aim of this study was to look at how anxiety influences cognition-specifically processing speed and verbal learning-in MS. Methods Eligibility criteria were adults (≥18 years) who had a diagnosis of clinically definite MS and had participated in neuropsychological research projects. A retrospective medical record review was conducted on the neuropsychological testing data. Two hierarchical multiple regressions were conducted to determine the unique contributions of processing speed and anxiety on verbal learning in MS, after adjusting for demographic and disability variables. Two separate mediation analyses were conducted to determine the relationship between processing speed, verbal learning, and anxiety. Results Participants (N = 141) ranged in age from 18-91 years. Based on the multiple regression analyses, processing speed (β = 0.55, ΔR 2 = 0.27, P < .001) and anxiety (β = -0.34, ΔR 2 = 0.11, P < .001) were uniquely significant predictors of verbal learning. Based on the mediation analyses, there was a significant indirect effect of anxiety on verbal learning through processing speed (ab = -0.31, 95% CI = -0.60 to -0.09). There was also a significant indirect effect of processing speed on verbal learning through anxiety (ab = -0.05, 95% CI = 0.01 to 0.12). Conclusions Results suggest a bidirectional relationship of anxiety and processing speed on verbal learning in MS. Anxiety has a significant effect on cognition and should not be overlooked. Interventions targeting anxiety may improve cognition in MS.
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Kouvatsou Z, Masoura E, Kiosseoglou G, Kimiskidis VK. Working memory profiles of patients with multiple sclerosis: Where does the impairment lie? J Clin Exp Neuropsychol 2019; 41:832-844. [PMID: 31204607 DOI: 10.1080/13803395.2019.1626805] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Introduction: Previous studies have mostly provided general estimations regarding Working Memory impairment in patients with Multiple Sclerosis. The aim of the present study was to investigate the relative degree of impairment in the four Working Memory components in Multiple Sclerosis. Method: Thirty-eight patients diagnosed with MS and 27 matched controls were assessed using 12 different cognitive tasks of the four components, i.e. phonological loop, visuospatial sketchpad, central executive and episodic buffer. More precisely, Greek translated and adapted versions of the following tasks were administered: Digit recall, Word recall, Non-word recall, Block recall, Mazes recall, Visual Patterns recall, Backward Digit recall, Backward Block recall, Listening recall, Logical Memory I-Immediate Story recall and Greek Verbal Learning Test, which is based on the California Verbal Learning Test. Results: The phonological loop, the central executive and the spatial subcomponent of the visuospatial sketchpad were found to be equally disrupted in MS patients. The episodic buffer was found to be more heavily affected. On the other hand, the visual subcomponent of the visuospatial sketchpad proved to be preserved. Conclusions: WM subcomponents are differentially affected in patients with MS. This novel finding is discussed within the framework of existing knowledge regarding WM impairment in MS.
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Affiliation(s)
- Zoe Kouvatsou
- a School of Psychology, Department of Experimental Cognitive Psychology, Aristotle University of Thessaloniki , Thessaloniki , Greece
| | - Elvira Masoura
- a School of Psychology, Department of Experimental Cognitive Psychology, Aristotle University of Thessaloniki , Thessaloniki , Greece
| | - Grigoris Kiosseoglou
- a School of Psychology, Department of Experimental Cognitive Psychology, Aristotle University of Thessaloniki , Thessaloniki , Greece
| | - Vasilios K Kimiskidis
- b Laboratory of Clinical Neurophysiology, AHEPA Hospital, Aristotle University of Thessaloniki , Thessaloniki , Greece
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The Intersection of Physical Function, Cognitive Performance, Aging, and Multiple Sclerosis: A Cross-sectional Comparative Study. Cogn Behav Neurol 2019; 32:1-10. [PMID: 30896571 DOI: 10.1097/wnn.0000000000000179] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine the associations between physical function (walking speed and endurance and functional mobility) and cognitive function (information processing speed and verbal memory) in older adults with multiple sclerosis (MS) and healthy controls. BACKGROUND Older adults with MS have worse physical and cognitive function than older adults without MS and young and middle-aged adults with MS. To date, little is known about the associations between, or coupling of, physical and cognitive function outcomes in older adults with MS. METHODS We administered physical and cognitive function measures to 40 older adults with MS and 40 demographically matched healthy controls. Pearson product moment correlations were used to examine bivariate linear relationships in the overall sample and in the subsamples of (a) older adults with MS and (b) healthy controls. Linear regression analyses were used to examine the independent associations between demographic characteristics and physical and cognitive function variables in the two subsamples. RESULTS In the overall sample, all physical function variables were significantly correlated with cognitive function, as measured by information processing speed, and these correlations were mainly due to the subsample of older adults with MS. The linear regression analyses further indicated that information processing speed and years of education consistently explained variance in all physical function variables, beyond the influence of demographic variables, in older adults with MS. CONCLUSIONS Physical function and information processing speed are strongly correlated in older adults with MS. Future research should examine underlying neurobehavioral mechanisms associated with physical and cognitive function as well as behavioral strategies for jointly improving these functions in older adults with MS.
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Babicz MA, Sheppard DP, Morgan EE, Paul Woods S. Where have I heard that before? A validity study of source memory indices from the California Verbal Learning Test - Second edition. Clin Neuropsychol 2019; 34:541-560. [PMID: 31084399 DOI: 10.1080/13854046.2019.1613559] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective: We investigated the construct and criterion validity of the source memory (SM) indices within the California Verbal Learning Test-II (CVLT-II).Method: Participants included 77 individuals with HIV-associated neurocognitive disorders (HAND+), 287 HIV + neurocognitively normal individuals (HAND-) and 203 seronegative HIV comparisons (HIV-). CVLT-II SM impairment status (normative scores ≤1 standard deviation) was determined using Total Across-List Intrusions and Source Recognition Discriminability (d'). Participants also completed a comprehensive neuropsychological battery, assessments of everyday functioning and experimental measures of SM.Results: CVLT-II SM impairment was significantly associated with increased errors on experimental SM measures and lower scores on measures of passage recall and executive functions, but not visuospatial skills. In a logistic regression controlling for clinicodemographic factors, CVLT-II SM impairment was a significant independent predictor of HAND, with the HAND + group showing higher rates of SM impairment than both the HAND - and HIV - groups. Finally, CVLT-II SM impairment was significantly related to a composite measure of everyday functioning, but this effect disappeared after adjusting for covariates. Note that, the overall pattern of findings across this study also held when CVLT-3 normative standards were applied to the SM indices.Conclusions: Results provide initial support for the construct and criterion validity of a CVLT-II SM index in the setting of HIV disease. Future studies should examine the validity of CVLT-II SM variables in other neuropsychological populations.
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Affiliation(s)
| | - David P Sheppard
- Department of Psychology, University of Houston, Houston, TX, USA
| | - Erin E Morgan
- Department of Psychiatry, University of California, San Diego, San Diego, CA, USA
| | - Steven Paul Woods
- Department of Psychology, University of Houston, Houston, TX, USA.,Department of Psychiatry, University of California, San Diego, San Diego, CA, USA
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Khaligh-Razavi SM, Habibi S, Sadeghi M, Marefat H, Khanbagi M, Nabavi SM, Sadeghi E, Kalafatis C. Integrated Cognitive Assessment: Speed and Accuracy of Visual Processing as a Reliable Proxy to Cognitive Performance. Sci Rep 2019; 9:1102. [PMID: 30705371 PMCID: PMC6355897 DOI: 10.1038/s41598-018-37709-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 12/11/2018] [Indexed: 12/18/2022] Open
Abstract
Various mental disorders are accompanied by some degree of cognitive impairment. Particularly in neurodegenerative disorders, cognitive impairment is the phenotypical hallmark of the disease. Effective, accurate and timely cognitive assessment is key to early diagnosis of this family of mental disorders. Current standard-of-care techniques for cognitive assessment are primarily paper-based, and need to be administered by a healthcare professional; they are additionally language and education-dependent and typically suffer from a learning bias. These tests are thus not ideal for large-scale pro-active cognitive screening and disease progression monitoring. We developed the Integrated Cognitive Assessment (referred to as CGN_ICA), a 5-minute computerized cognitive assessment tool based on a rapid visual categorization task, in which a series of carefully selected natural images of varied difficulty are presented to participants. Overall 448 participants, across a wide age-range with different levels of education took the CGN_ICA test. We compared participants' CGN_ICA test results with a variety of standard pen-and-paper tests, such as Symbol Digit Modalities Test (SDMT) and Montreal Cognitive Assessment (MoCA), that are routinely used to assess cognitive performance. CGN_ICA had excellent test-retest reliability, showed convergent validity with the standard-of-care cognitive tests used here, and demonstrated to be suitable for micro-monitoring of cognitive performance.
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Affiliation(s)
- Seyed-Mahdi Khaligh-Razavi
- Computer Science and Artificial Intelligence Laboratory, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA.
- Department of Brain and Cognitive Sciences, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran.
- Cognetivity ltd, London, UK.
| | | | | | - Haniye Marefat
- School of Cognitive Sciences (SCS), Institute for Research in Fundamental Sciences (IPM), Tehran, Iran
| | - Mahdiyeh Khanbagi
- Department of Brain and Cognitive Sciences, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran
| | - Seyed Massood Nabavi
- Department of Brain and Cognitive Sciences, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran
| | | | - Chris Kalafatis
- Cognetivity ltd, London, UK
- South London & Maudsley NHS Foundation Trust, London, UK
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Filser M, Schreiber H, Pöttgen J, Ullrich S, Lang M, Penner IK. The Brief International Cognitive Assessment in Multiple Sclerosis (BICAMS): results from the German validation study. J Neurol 2018; 265:2587-2593. [PMID: 30171410 DOI: 10.1007/s00415-018-9034-1] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 08/21/2018] [Accepted: 08/22/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Recent research has convincingly shown that the ability to work mainly depends on the cognitive status in multiple sclerosis (MS). An international committee of experts recommended a brief neuropsychological battery to evaluate cognitive performance in MS. BICAMS comprises three tests, the Symbol Digit Modalities Test (SDMT), the learning trials of the California Verbal Learning Test II (CVLT-II), and the Brief Visuospatial Memory Test-Revised (BVMT-R). OBJECTIVE To validate BICAMS on a sample of German MS patients and healthy controls (HCs). METHODS According to the international guidelines for validation, examiner's instructions were standardized and translated into German. Due to the availability of better normative data for future applications in routine clinical care and classification of individual performance degree, the Rey Auditory Verbal Learning Test (RAVLT) (German version: Verbaler Lern- und Merkfähigkeits-Test, VLMT) was chosen instead of CVLT-II. 172 MS patients and 100 HCs entered the study. BICAMS was administered at baseline and retest (after 3-4 weeks). RESULTS The groups did not differ in age, gender or education. Mean age of MS patients was 43.33 years (SD 11.64); 68% were female and 86.9% had relapsing-remitting MS. Patients performed significantly worse than HCs on the SDMT (p < 0.01) and on BVMT-R (p < 0.05) but not on VLMT. In addition, BICAMS was shown to be reliable over time: r = 0.71 for BVMT-R, r = 0.72 for VLMT and r = 0.85 for SDMT. SDMT z-score proved to be a good predictor for the ability to work in a full-time (p < 0.001) as well as in a part-time job (p < 0.001). VLMT z-score turned out to be a significant predictor only for the ability to work in a part-time job, while BVMT-R z-score showed no significant predictive value. CONCLUSION In this German validation study with the VLMT, the modified BICAMS (BICAMS-M) turned out to reliably detect cognitive problems in MS patients and to monitor cognitive performance over time. SDMT revealed the best predictive value for working ability. Moreover, only the SDMT was able to predict the ability to work in a part-time or full-time job. Following these results, application of the SDMT is recommended for medical statements on working ability of MS patients.
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Affiliation(s)
- M Filser
- Cogito Center for Applied Neurocognition and Neuropsychological Research, Düsseldorf, Germany
| | - H Schreiber
- Neurological Practice and Neuropoint Academy, Ulm, Germany
| | - J Pöttgen
- Institut für Neuroimmunologie und Multiple Sklerose, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - S Ullrich
- .05 Statistikberatung, Düsseldorf, Germany
| | - M Lang
- Neurological Practice and Neuropoint Academy, Ulm, Germany
| | - I K Penner
- Cogito Center for Applied Neurocognition and Neuropsychological Research, Düsseldorf, Germany. .,Department of Neurology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.
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Corfield F, Langdon D. A Systematic Review and Meta-Analysis of the Brief Cognitive Assessment for Multiple Sclerosis (BICAMS). Neurol Ther 2018; 7:287-306. [PMID: 29923070 PMCID: PMC6283796 DOI: 10.1007/s40120-018-0102-3] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Indexed: 12/13/2022] Open
Abstract
Abstract Multiple sclerosis (MS) is a neurological disease of the central nervous system which can lead to a range of severe physical disabilities. A large proportion of those affected will experience cognitive impairment, which is associated with a worse prognosis. Effective assessment of cognition in MS has been problematic due to a lack of suitable scales. The Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS) was developed in 2010 as part of an international endeavour to facilitate cognitive assessment. Aim The aim of this systematic review and meta-analysis was to synthesise the available literature published as part of the BICAMS international validation protocol. Methods A literature search conducted using PubMed, PsycINFO and Google Scholar identified 16 studies for inclusion in the systematic review, 14 of which could be included in a meta-analysis. Results BICAMS has been widely validated across 11 languages and 14 individual cultures and locations. The meta-analysis demonstrated that BICAMS identified significantly reduced cognitive functioning in adults with MS compared to healthy controls. This was true for all three cognitive domains assessed by BICAMS: information processing speed (g = 0.943, 95% CI 0.839, 1.046, g < 0.001), immediate verbal recall memory (g = 0.688, 95% CI 0.554, 0.822, p < 0.001) and immediate visual recall memory (g = 0.635, 95% CI 0.534, 0.736, p < 0.001). Conclusion BICAMS has been widely applied across cultures and languages to assess cognition in MS. BICAMS offers a feasible, cost-effective means of assessing cognition in MS worldwide. Further validation studies are underway to support this project.
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Affiliation(s)
- Freya Corfield
- Psychology Department, Royal Holloway, University of London, Egham, Surrey, UK
| | - Dawn Langdon
- Psychology Department, Royal Holloway, University of London, Egham, Surrey, UK.
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Hansen S, Lautenbacher S. Neuropsychological Assessment in Multiple Sclerosis. ZEITSCHRIFT FUR NEUROPSYCHOLOGIE 2017. [DOI: 10.1024/1016-264x/a000197] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Abstract. Neuropsychological deficits in multiple sclerosis (MS) are common. Over the past decades, many different procedures have been employed in diagnosing these deficits. Even though certain aspects of cognitive performance such as information processing speed and working memory may be affected more frequently than other cognitive functions, no specific deficit profile has been established in MS. This article provides an overview of the neuropsychological diagnostic procedures in MS and allows the reader to reach an informed decision on the applicability of specific procedures and the availability of study data in the context of MS. Additionally, it makes recommendations on the compilation of both screening procedures and extensive test batteries.
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Affiliation(s)
- Sascha Hansen
- Klinikum Bayreuth GmbH, Betriebsstätte Hohe Warte, Department of Neurology, Bayreuth, Germany
- Otto-Friedrich-University, Department of Physiological Psychology, Bamberg, Germany
| | - Stefan Lautenbacher
- Otto-Friedrich-University, Department of Physiological Psychology, Bamberg, Germany
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George MF, Holingue CB, Briggs FBS, Shao X, Bellesis KH, Whitmer RA, Schaefer C, Benedict RH, Barcellos LF. Feasibility study for remote assessment of cognitive function in multiple sclerosis. ACTA ACUST UNITED AC 2016; 1:10-18. [PMID: 28255581 DOI: 10.29245/2572.942x/2016/8.1084] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Cognitive impairment is common in multiple sclerosis (MS), and affects employment and quality of life. Large studies are needed to identify risk factors for cognitive decline. Currently, a MS-validated remote assessment for cognitive function does not exist. Studies to determine feasibility of large remote cognitive function investigations in MS have not been published. OBJECTIVE To determine whether MS patients would participate in remote cognitive studies. We utilized the Modified Telephone Interview for Cognitive Status (TICS-M), a previously validated phone assessment for cognitive function in healthy elderly populations to detect mild cognitive impairment. We identified factors that influenced participation rates. We investigated the relationship between MS risk factors and TICS-M score in cases, and score differences between cases and control individuals. METHODS The TICS-M was administered to MS cases and controls. Linear and logistic regression models were utilized. RESULTS 11.5% of eligible study participants did not participate in cognitive testing. MS cases, females and individuals with lower educational status were more likely to refuse (p<0.001). Cases who did complete testing did not differ in terms of perceived cognitive deficit compared to cases that did participate. More severe disease, smoking, and being male were associated with a lower TICS-M score among cases (p<0.001). The TICS-M score was significantly lower in cases compared to controls (p=0.007). CONCLUSIONS Our results demonstrate convincingly that a remotely administered cognitive assessment is quite feasible for conducting large epidemiologic studies in MS, and lay the much needed foundation for future work that will utilize MS-validated cognitive measures.
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Affiliation(s)
- Michaela F George
- Division of Epidemiology, Genetic Epidemiology and Genomics Laboratory, School of Public Health, University of California, Berkeley, CA, USA
| | - Calliope B Holingue
- Division of Epidemiology, Genetic Epidemiology and Genomics Laboratory, School of Public Health, University of California, Berkeley, CA, USA
| | - Farren B S Briggs
- Department of Epidemiology and Biostatistics, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Xiaorong Shao
- Division of Epidemiology, Genetic Epidemiology and Genomics Laboratory, School of Public Health, University of California, Berkeley, CA, USA
| | | | | | | | | | - Lisa F Barcellos
- Division of Epidemiology, Genetic Epidemiology and Genomics Laboratory, School of Public Health, University of California, Berkeley, CA, USA; Kaiser Permanente Division of Research, Oakland, CA, USA
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Allison DJ, Josse AR, Gabriel DA, Klentrou P, Ditor DS. Targeting inflammation to influence cognitive function following spinal cord injury: a randomized clinical trial. Spinal Cord 2016; 55:26-32. [PMID: 27324320 DOI: 10.1038/sc.2016.96] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Revised: 04/29/2016] [Accepted: 05/17/2016] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN This study was a randomized, parallel-group, controlled clinical trial. OBJECTIVES The purpose of this study was to examine the efficacy of targeting inflammation as a means of improving cognitive function in individuals with spinal cord injury. SETTING Participants were recruited from the Niagara region of Ontario Canada and all testing occurred on-site at Brock University. METHODS Indices of memory and verbal learning were assessed by means of the California Verbal Learning Test (CVLT). Inflammation and concentrations of neuroactive compounds related to the kynurenine pathway were assessed via a number of pro- and anti-inflammatory cytokines, as well as tryptophan, kynurenine and several large neutral amino acids. All assessments were performed at baseline as well as at 1 month and 3 months during a 3-month intervention by means of an anti-inflammatory diet. RESULTS Despite a reduction in inflammation, all measures of the CVLT, including list A, trial 1 (P=0.48), learning slope (P=0.46), long delay free recall (P=0.83), intrusions (P=0.61) and repetitions (P=0.07), showed no significant group × time interaction. CONCLUSION It may be possible that the reduction in inflammation achieved in the current study was insufficient to induce substantial changes in indices of verbal learning and memory. Alternatively, as these participants likely underwent years of previous chronic inflammation, the underlying hippocampal damage may have negated potential improvements induced by acute reductions in inflammation.
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Affiliation(s)
- D J Allison
- Department of Kinesiology, Brock University, St Catharines, Ontario, Canada.,Brock-Niagara Centre for Health and Well-Being, St Catharines, Ontario, Canada
| | - A R Josse
- Department of Kinesiology, Brock University, St Catharines, Ontario, Canada
| | - D A Gabriel
- Department of Kinesiology, Brock University, St Catharines, Ontario, Canada
| | - P Klentrou
- Department of Kinesiology, Brock University, St Catharines, Ontario, Canada
| | - D S Ditor
- Department of Kinesiology, Brock University, St Catharines, Ontario, Canada.,Brock-Niagara Centre for Health and Well-Being, St Catharines, Ontario, Canada
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Darviri C, Zavitsanou C, Delikou A, Giotaki A, Artemiadis A, Anagnostouli M, Varvogli L, Vasdekis S, Chrousos GP. Pythagorean Self-Awareness Serves Successfully as a New Cognitive Behavioral-Based Technique in Multiple Sclerosis Physical and Psychosocial Well-Being and Quality of Life. ACTA ACUST UNITED AC 2016. [DOI: 10.4236/psych.2016.74059] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Moore P, Methley A, Pollard C, Mutch K, Hamid S, Elsone L, Jacob A. Cognitive and psychiatric comorbidities in neuromyelitis optica. J Neurol Sci 2015; 360:4-9. [PMID: 26723962 DOI: 10.1016/j.jns.2015.11.031] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 11/05/2015] [Accepted: 11/16/2015] [Indexed: 01/15/2023]
Abstract
OBJECTIVE Our primary objective was to examine the neuropsychological and psychopathological profile of patients with neuromyelitis optica (NMO) and compare these to multiple sclerosis (MS) and healthy control (HC) groups. We also examined for relationships between cognitive and psychiatric variables and clinical factors including accumulated neurological disability and disease duration. METHODS A neuropsychological test battery was administered along with a structured psychiatric interview and quantitative measures of mood symptoms. RESULTS 42 NMO, 42 MS and 42 HC participants were assessed. Cognitive impairments were observed in 67% of NMO patients. The prevalence and profile of cognitive impairments and lifetime prevalence of depression was similar between NMO and MS groups. However, significantly higher rates of recurrent depression and suicidality were observed in NMO patients. Correlational analyses revealed higher levels of anxiety symptoms were associated with shorter disease duration in NMO, while higher depression symptom levels were associated with higher neurological disability and poorer cognition. CONCLUSIONS Our results demonstrate substantial cognitive and psychiatric comorbidities in NMO patients. Similar rates of lifetime and current depression between NMO and MS appear to mask greater underlying psychiatric burden in NMO and further understandings of the course of neurobehavioural comorbidities is required to better comprehend the additional morbidity in NMO. Our data support a role for cognitive and psychiatric assessments in the comprehensive care of NMO patients.
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Affiliation(s)
- Perry Moore
- The Walton Centre NHS Foundation Trust, Liverpool, UK.
| | | | | | - Kerry Mutch
- The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Shahd Hamid
- The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Liene Elsone
- The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Anu Jacob
- The Walton Centre NHS Foundation Trust, Liverpool, UK
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Atteinte de la mémoire épisodique verbale dans la sclérose en plaques : revue critique des processus cognitifs concernés et de leur exploration. Rev Neurol (Paris) 2015; 171:624-45. [DOI: 10.1016/j.neurol.2015.02.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Revised: 02/01/2015] [Accepted: 02/13/2015] [Indexed: 11/22/2022]
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Argento O, Pisani V, Incerti CC, Magistrale G, Caltagirone C, Nocentini U. The California Verbal Learning Test- II: Normative Data for Two Italian Alternative Forms. Clin Neuropsychol 2014; 28 Suppl 1:S42-54. [DOI: 10.1080/13854046.2014.978381] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Ornella Argento
- Neurology and Neurorehabilitation Unit, IRCCS “Santa Lucia” Foundation , Rome, Italy
| | - Valerio Pisani
- Neurology and Neurorehabilitation Unit, IRCCS “Santa Lucia” Foundation , Rome, Italy
| | - Chiara C. Incerti
- Neurology and Neurorehabilitation Unit, IRCCS “Santa Lucia” Foundation , Rome, Italy
| | - Giuseppe Magistrale
- Neurology and Neurorehabilitation Unit, IRCCS “Santa Lucia” Foundation , Rome, Italy
| | - Carlo Caltagirone
- Neurology and Neurorehabilitation Unit, IRCCS “Santa Lucia” Foundation , Rome, Italy
- Department of Systems Medicine, University of Rome “Tor Vergata” , Rome, Italy
| | - Ugo Nocentini
- Neurology and Neurorehabilitation Unit, IRCCS “Santa Lucia” Foundation , Rome, Italy
- Department of Systems Medicine, University of Rome “Tor Vergata” , Rome, Italy
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Erlanger DM, Kaushik T, Caruso LS, Benedict RHB, Foley FW, Wilken J, Cadavid D, Deluca J. Reliability of a cognitive endpoint for use in a multiple sclerosis pharmaceutical trial. J Neurol Sci 2014; 340:123-9. [PMID: 24656433 DOI: 10.1016/j.jns.2014.03.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2013] [Revised: 03/04/2014] [Accepted: 03/05/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Determine reliability and basic psychometric properties of a composite cognitive endpoint, MS-COG, for monitoring change in cognitive function in MS drug trials. BACKGROUND 50% of MS patients have cognitive impairment that impacts ability to work and quality of life. We selected neuropsychological tests based on sensitivity to MS cognitive impairment, availability of alternate forms, cross-cultural utility, and feasibility for multicenter trials, and assessed the reliability and validity of a composite endpoint, MS-COG. DESIGN/METHODS Administered SRT, BVMT-R, PASAT, and SDMT to 60 MS patients at 4 US centers twice over 45days, along with symptom inventories by patients and informants. RESULTS The MS-COG had test-retest reliability of 0.91. Processing Speed and Memory indices had reliabilities of 0.89 and 0.86, with modest practice effects. Reliability was high for the RR MS and SP MS subgroups as well, with correlations of .90 and .93, respectively for MS-COG. Overall, 42% of subjects obtained MS-COG scores in the impaired range, with SP MS subjects performing 0.8 SD below RR MS subjects. Impairment correlated well (r=0.37 to 0.40) with informant reports but was inconsistent with patient report, with the least reliable assessments by those with greater symptom severity. CONCLUSIONS The MS-COG is a reliable, repeatable measure of MS cognitive functioning that is sensitive to cognitive impairment in SP MS and RR MS patients and feasible for multicenter clinical trials. Further development is warranted.
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Affiliation(s)
- David M Erlanger
- Psychology Department, Rusk Institute of Rehabilitation Medicine.
| | | | | | | | - F W Foley
- Ferkauf Graduate School of Psychology, Yeshiva University
| | - Jeffrey Wilken
- Neuropsychology Associates of Fairfax, Georgetown University Department of Neurology
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The First Order Transfer Function in the Analysis of Agrochemical Data in Honey Bees (Apis Mellifera L.): Proboscis Extension Reflex (PER) Studies. INSECTS 2014; 5:167-98. [PMID: 26462584 PMCID: PMC4592627 DOI: 10.3390/insects5010167] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Revised: 11/04/2013] [Accepted: 12/23/2013] [Indexed: 11/17/2022]
Abstract
This paper describes a mathematical model of the learning process suitable for studies of conditioning using the proboscis extension reflex (PER) in honey bees when bees are exposed to agrochemicals. Although procedural variations exist in the way laboratories use the PER paradigm, proboscis conditioning is widely used to investigate the influence of pesticides and repellents on honey bee learning. Despite the availability of several mathematical models of the learning process, no attempts have been made to apply a mathematical model to the learning curve in honey bees exposed to agrochemicals. Our model is based on the standard transfer function in the form Y = B3e−B2 (X−1) + B4 (1−e−B2 (X−1)) where X is the trial number, Y is the proportion of correct responses, B2 is the learning rate, B3 is readiness to learn, and B4 is ability to learn. We reanalyze previously published data on the effect of several classes of agrochemicals including: (1) those that are considered harmless to bees (e.g., pymetrozine, essential oils, dicofol); (2) sublethal exposure to pesticides known to harm honey bees (e.g., coumaphos, cyfluthrin, fluvalinate, permethrin); and (3) putative repellents of honey bees (e.g., butyric acid, citronella). The model revealed additional effects not detected with standard statistical tests of significance.
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45
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The nature of verbal memory impairment in multiple sclerosis: a list-learning and meta-analytic study. J Int Neuropsychol Soc 2013; 19:995-1008. [PMID: 24059259 DOI: 10.1017/s1355617713000957] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The primary purpose of this study was to test the hypothesis that multiple sclerosis (MS) patients have impaired acquisition rather than a retrieval deficit. Verbal memory impairment in MS was examined in 53 relapsing-remitting MS patients and 31 healthy controls (HC), and in a meta-analysis of studies that examined memory functioning in MS with list-learning tasks. The MS group demonstrated significantly lower acquisition and delayed recall performance than the HC group, and the meta-analysis revealed that the largest effect sizes were obtained for acquisition measures relative to delayed recall and recognition. Our data argue against a retrieval deficit as the sole explanation for verbal memory impairment in MS, and make a consistent case for the position that deficient acquisition contributes to the memory dysfunction of MS patients. Deficient acquisition may result from demyelination in relevant white matter tracts that reduces encoding efficiency as a result of impaired speed of information processing.
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Hur JW, Byun MS, Shin NY, Shin YS, Kim SN, Jang JH, Kwon JS. General intellectual functioning as a buffer against theory-of-mind deficits in individuals at ultra-high risk for psychosis. Schizophr Res 2013; 149:83-7. [PMID: 23810120 DOI: 10.1016/j.schres.2013.06.019] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Revised: 05/16/2013] [Accepted: 06/04/2013] [Indexed: 10/26/2022]
Abstract
The influence of neurocognition, including general intelligence, on theory of mind (ToM) among patients with schizophrenia spectrum disorder is controversial. The purpose of the present study was to identify the influences of the non-ToM cognition and general intelligence on ToM performance in individuals at ultra-high risk (UHR) for psychosis. Fifty-five UHR subjects and 58 healthy controls (HCs) completed neurocognitive, verbal, and nonverbal ToM tasks. UHR individuals showed poorer performance in the two verbal ToM tasks, the false-belief task and the strange-story tasks. Moreover, the UHR subjects displayed poorer recall on the interference list of the verbal learning test. Linear regression analysis revealed that neurocognitive functioning, including executive functioning, working memory, and general intelligence, accounted for significant amounts of the variance in the results for UHR individuals: 20.4% in the false-belief task, 44.0% in the strange-story task, and 49.0% in the nonverbal cartoon task. Neurocognition, including general intelligence, was not a significant contributor to performance on ToM tasks in HCs. ToM deficits were not noted in UHR individuals with above-average IQ scores (≥ 110) compared with UHR subjects with IQ scores less than 110, who displayed significant differences on all ToM tasks compared with HCs. The present results suggest that ToM deficits in UHR individuals are complex and may be influenced by non-ToM cognition. Our findings are discussed in relation to the role of neurocognitive abilities in ToM-related impairments in UHR individuals.
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Affiliation(s)
- Ji-Won Hur
- Department of Brain and Cognitive Sciences, World Class University Program, College of Natural Sciences, Seoul National University, Seoul, Republic of Korea
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47
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Gromisch ES, Zemon V, Benedict RHB, Chiaravalloti ND, DeLuca J, Picone MA, Kim S, Foley FW. Using a highly abbreviated California Verbal Learning Test-II to detect verbal memory deficits. Mult Scler 2012; 19:498-501. [PMID: 22807235 DOI: 10.1177/1352458512454347] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Multiple sclerosis (MS) is frequently accompanied by changes in verbal memory. We hypothesized that administering an abbreviated California Verbal Learning Test-II (CVLT-II) would detect verbal memory problems in MS accurately, thus serving as a potential screening tool. We performed receiver-operating-characteristic (ROC) analyses of three trials (trial 1, trial 2, and trial 1+2 combined) for raw data against standardized total scores. The results showed that at 1.5 standard deviations (SD) from the mean, the first two trials were 96.3% accurate, while at 2 SD from the mean, the first two trials combined were 97.5% accurate. We conclude that this study demonstrates than an abbreviated CVLT-II is a valid screening tool for verbal memory impairments.
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48
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Benedict RHB, Amato MP, Boringa J, Brochet B, Foley F, Fredrikson S, Hamalainen P, Hartung H, Krupp L, Penner I, Reder AT, Langdon D. Brief International Cognitive Assessment for MS (BICAMS): international standards for validation. BMC Neurol 2012; 12:55. [PMID: 22799620 PMCID: PMC3607849 DOI: 10.1186/1471-2377-12-55] [Citation(s) in RCA: 261] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2012] [Accepted: 06/22/2012] [Indexed: 11/22/2022] Open
Abstract
An international expert consensus committee recently recommended a brief battery of tests for cognitive evaluation in multiple sclerosis. The Brief International Cognitive Assessment for MS (BICAMS) battery includes tests of mental processing speed and memory. Recognizing that resources for validation will vary internationally, the committee identified validation priorities, to facilitate international acceptance of BICAMS. Practical matters pertaining to implementation across different languages and countries were discussed. Five steps to achieve optimal psychometric validation were proposed. In Step 1, test stimuli should be standardized for the target culture or language under consideration. In Step 2, examiner instructions must be standardized and translated, including all information from manuals necessary for administration and interpretation. In Step 3, samples of at least 65 healthy persons should be studied for normalization, matched to patients on demographics such as age, gender and education. The objective of Step 4 is test-retest reliability, which can be investigated in a small sample of MS and/or healthy volunteers over 1–3 weeks. Finally, in Step 5, criterion validity should be established by comparing MS and healthy controls. At this time, preliminary studies are underway in a number of countries as we move forward with this international assessment tool for cognition in MS.
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Affiliation(s)
- Ralph H B Benedict
- Buffalo General Medical Center, Department of Neurology, Suite E2, 100 High Street, Buffalo, NY 14203, USA.
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Ryan JJ, Gontkovsky ST, Kreiner DS, Tree HA. Wechsler Adult Intelligence Scale–Fourth Edition performance in relapsing–remitting multiple sclerosis. J Clin Exp Neuropsychol 2012; 34:571-9. [DOI: 10.1080/13803395.2012.666229] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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50
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Stepanov II, Abramson CI, Hoogs M, Benedict RHB. Overall Memory Impairment Identification with Mathematical Modeling of the CVLT-II Learning Curve in Multiple Sclerosis. Mult Scler Int 2012; 2012:312503. [PMID: 22745911 PMCID: PMC3382211 DOI: 10.1155/2012/312503] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2011] [Revised: 03/04/2012] [Accepted: 04/13/2012] [Indexed: 11/17/2022] Open
Abstract
The CVLT-II provides standardized scores for each of the List A five learning trials, so that the clinician can compare the patient's raw trials 1-5 scores with standardized ones. However, frequently, a patient's raw scores fluctuate making a proper interpretation difficult. The CVLT-II does not offer any other methods for classifying a patient's learning and memory status on the background of the learning curve. The main objective of this research is to illustrate that discriminant analysis provides an accurate assessment of the learning curve, if suitable predictor variables are selected. Normal controls were ninety-eight healthy volunteers (78 females and 20 males). A group of MS patients included 365 patients (266 females and 99 males) with clinically defined multiple sclerosis. We show that the best predictor variables are coefficients B3 and B4 of our mathematical model B3 ∗ exp(-B2 ∗ (X - 1)) + B4 ∗ (1 - exp(-B2 ∗ (X - 1))) because discriminant functions, calculated separately for B3 and B4, allow nearly 100% correct classification. These predictors allow identification of separate impairment of readiness to learn or ability to learn, or both.
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Affiliation(s)
- Igor I. Stepanov
- Department of Neuropharmacology, Institute for Experimental Medicine, The Russian Academy of Medical Sciences, Acad. Pavlov Street 12, 197376 St. Petersburg, Russia
| | - Charles I. Abramson
- Department of Psychology, Oklahoma State University, 116 N. Murray, Stillwater, OK 74078, USA
| | - Marietta Hoogs
- The Jacobs Neurological Institute, Buffalo General Hospital, 100 High Street, Buffalo, NY 14203, USA
| | - Ralph H. B. Benedict
- The Jacobs Neurological Institute, Buffalo General Hospital, 100 High Street, Buffalo, NY 14203, USA
- Department of Neurology, State University of New York (SUNY) at Buffalo, Buffalo General Hospital, Suite D6, 100 High Street, Buffalo, NY 14203, USA
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