Relationship between global cognitive decline and depressive symptoms in multiple sclerosis

Relationship between neuropsychiatric symptoms and cognition in multiple sclerosis: A systematic review

The results of previous research on the relationship between neuropsychiatric symptoms and cognition in multiple sclerosis (MS) have been mixed. The aim of this systematic review was to examine the evidence on the relationship between neuropsychiatric symptoms and different cognitive domains in adult (≥18 years) MS patients. A literature search was conducted in the Ovid Medline, PsycInfo, Scopus, and Web of Science databases. A total of 4,216 nonduplicate records were identified, and after screening, 37 studies met the inclusion criteria and were included in the systematic review. Higher levels of depressive symptoms were related to deficits in processing speed, verbal memory, executive functions, visuospatial functions, and attention in MS patients. Symptoms of anxiety were not consistently related to any of the cognitive functions, but the relationship to deficits in visual memory received a minimal amount of support. Higher levels of apathy were most clearly associated with impairment in executive functions, but the association with deficits in visuospatial functions, visual memory, working memory, and processing speed was also supported. The results indicate that more neuropsychiatric symptoms, especially depressive symptoms and apathy, are associated with cognitive dysfunction in MS patients. These results can be utilized in the clinical examination and treatment planning of MS patients.

Perceived cognitive decline in multiple sclerosis impacts quality of life independently of depression

Background/Aim. The aim of this study is to examine the effects of perceived cognitive dysfunction and of depression, on self-reported QoL, in a Greek population sample of MS patients. Methods. One hundred outpatients diagnosed with MS completed the Short-Form-36 Health Survey (SF-36), as well as the Perceived Deficits Questionnaire (PDQ) and the Depression subscale of the Mental Health Inventory (MHI), as part of a clinical evaluation which included the Expanded Disability Status Scale (EDSS) estimation. Multiple linear regression was conducted to determine the best linear combination of age, gender, education, EDSS, depression, attention/concentration, retrospective memory, prospective memory, and planning/organization, for predicting QoL scores. Results. In the multivariate regression analysis models, EDSS (P < 0.05), depression (P < 0.001), perceived planning/organization (P < 0.05), and perceived retrospective memory dysfunction (P < 0.05) independently predict quality of life scores. Age, sex, education level, and perceived attention/concentration dysfunction, as well as perceived prospective memory dysfunction, do not independently predict quality of life scores. Conclusions. Perceived planning/organization impairment and perceived retrospective memory impairment in MS patients predict QoL independently of the severity of disease and the severity of depression and therefore should be considered in the assessment of patient health status as well as in the design of treatment interventions and rehabilitation.

Reliability and Validity of PROMIS Cognitive Abilities and Cognitive Concerns Scales Among People with Multiple Sclerosis

BACKGROUND

Cognitive impairment is among the most debilitating outcomes of multiple sclerosis (MS). Although several neuropsychological tests and self-report cognitive measures have been used to assess cognitive impairment, they may not be sensitive to change over time, or may not be feasible to administer in a clinical setting. The purpose of this study was to assess the reliability and validity of the 8-item PROMIS Cognitive Abilities and Cognitive Concerns Scales in a large community-based sample of people with MS. The PROMIS Cognitive Abilities and Cognitive Concerns Scales derive from the National Institutes of Health-funded Patient Reported Outcomes Measurement Information System (PROMIS), an item repository that capitalizes on recent psychometric advances to produce short, psychometrically sound health measures.

METHODS

Mailed survey data were collected from 322 individuals recruited from two National Multiple Sclerosis Society chapters in a southwestern state.

RESULTS

Both cognitive scales demonstrated high internal consistency reliability and were moderately correlated with self-reported depressive symptoms, self-efficacy, barriers to health promotion, health, and functional status (all correlation coefficients >0.35). In hierarchical regression analysis, the PROMIS Cognitive Concerns score added significant unique variance to the prediction of MS Incapacity Status after controlling for self-reported depressive symptoms, exercise, spiritual growth, and global health. Those who were unemployed owing to their disabilities had significantly lower PROMIS Cognitive Abilities scores and higher Cognitive Concerns scores than those who were working or those who were retired or not working for other reasons.

CONCLUSIONS

The PROMIS Cognitive Abilities and Cognitive Concerns Scales are short, psychometrically sound measures that assess an important dimension of functioning and health for people with MS.

Does fatigue complaint reflect memory impairment in multiple sclerosis?

Background and Purpose. Fatigue and memory impairment are common symptoms in multiple sclerosis (MS) and both may interact with cognition. This can contribute to making a complaint misrepresentative of the objective disorder. We sought to determine whether fatigue complaint in MS reflects memory impairment and investigated whether patients' subjective fatigue is associated with memory complaint. Methods. Fifty MS patients complaining of fatigue underwent subjective assessment of fatigue and memory complaint measured using self-assessment scales. Cognitive functions were assessed using a battery of neuropsychological tests, including a test of verbal episodic memory, the selective reminding test (SRT). Correlations were studied between subjective fatigue, memory complaint, and performance in verbal episodic memory. Results. Depression score, psychotropic and/or antiepileptic drug use, Expanded Disability Status Scale (EDSS) score, and MS form were confounding factors. After adjusting for these confounding factors, neither fatigue complaint nor memory complaint was correlated with SRT performance. Subjective fatigue was significantly associated with memory complaint. Conclusion. Although complaint of fatigue in MS was correlated with memory complaint, subjective fatigue was not the expression of memory impairment.

Influence of anxiety on memory performance in temporal lobe epilepsy

This study examined the degree to which anxiety contributed to inconsistent material-specific memory difficulties among 243 patients with temporal lobe epilepsy from the Multisite Epilepsy Study. Visual memory performance on the Rey Complex Figure Test (RCFT) was poorer for those with high versus low levels of anxiety but was not found to be related to the TLE side. The verbal memory score on the California Verbal Learning Test (CVLT) was significantly lower for patients with left-sided TLE than for patients with right-sided TLE with low anxiety levels but equally impaired for those with high anxiety levels. These results suggest that we can place more confidence in the ability of verbal memory tests like the CVLT to lateralize to left-sided TLE for those with low anxiety levels, but that verbal memory will be less likely to produce lateralizing information for those with high anxiety levels. This suggests that more caution is needed when interpreting verbal memory tests for those with high anxiety levels. These results indicated that RCFT performance was significantly affected by anxiety and did not lateralize to either side, regardless of anxiety levels. This study adds to the existing literature which suggests that drawing-based visual memory tests do not lateralize among patients with TLE, regardless of anxiety levels.

Ask the Experts: Managing depression in multiple sclerosis: prevalence, pathology and progress

Dr Arnett received his PhD in Psychology (Clinical) from the University of Wisconsin – Madison (WI, USA), and completed a postdoctoral fellowship in Clinical Neuropsychology at the Medical College of Wisconsin. He is currently a psychology professor and Director of Clinical Training at Penn State University (PA, USA). Dr Arnett’s research focuses on clinical neuropsychology, with an emphasis on secondary influences on cognitive functioning in persons with multiple sclerosis and mild traumatic brain injury. He is the director of the Neuropsychology of Sports-Related Concussion and Multiple Sclerosis programs at Penn State University, a fellow of the National Academy of Neuropsychology (NAN), past winner of NAN’s Nelson Butters Award for Research Contributions to Clinical Neuropsychology, and was Program Co-Chair for the 2010 Mid-Year Meeting of the International Neuropsychological Society (INS). He has authored over 90 research articles and book chapters, as well as over 160 conference presentations. He is an editorial board member of several journals, including Neuropsychology, Journal of the International Neuropsychological Society and Archives of Clinical Neuropsychology.

Dede Ukueberuwa received her bachelor’s degree from Princeton University (NJ, USA) and earned a master’s degree in Psychology at Penn State University (PA, USA), where she is currently a PhD student in Clinical Psychology. She is also the coordinator of the Penn State University Multiple Sclerosis Project. Her work uses neuropsychological testing and neuroimaging to understand cognitive and biological factors relating to emotional difficulties in multiple sclerosis. She is the author of several publications pertaining to multiple sclerosis and has also presented her work at numerous conferences.

Psychiatric manifestations in cerebrotendinous xanthomatosis

Cerebrotendinous xanthomatosis (CTX) is a rare and severe, but treatable, inborn disorder of bile acid biosynthesis and sterol storage with autosomal recessive inheritance and variable clinical presentation. CTX treatment consists of chenodeoxycholic acid and must be started as early as possible to prevent permanent disability. Psychiatric manifestations are rare and non-specific, and often lead to significant diagnostic and treatment delay. Therefore, better recognition of the gamut of psychiatric manifestations in CTX can diminish the risk of misdiagnosis and irreversible neurological deterioration. We hereby describe the psychiatric features in CTX. A complete review of all published cases of CTX in the medical literature was undertaken and the case reports with psychiatric presentation were collected and analyzed. We also describe the psychiatric features in relation to the neurological semeiology in six patients with CTX diagnosed at the La Salpêtrière Hospital. We conclude that psychiatric manifestations in CTX follow a bimodal/bitemporal pattern, appearing early in the disease course in the form of a behavioral/personality disorder associated with learning difficulties or mental retardation, or manifesting in advanced disease in the setting of dementia as rich neuropsychiatric syndromes, such as frontal, orbitofrontal or frontotemporal syndromes of cortico-subcortical dementia encompassing behavioral/personality disturbance, affective/mood disorders or psychotic disorders. Behavioral/personality disturbance in childhood or adolescence, especially when accompanied by learning difficulties, should therefore lead to further investigation to exclude CTX, as early diagnosis and treatment is critical for prognosis.

Cognitive impairment has a strong relation to nonsomatic symptoms of depression in relapsing-remitting multiple sclerosis

It is unclear how cognitive impairment in multiple sclerosis (MS) is influenced by physical disability, fatigue, and depression. Our aim was to identify the strongest clinical predictors for cognitive impairment in relapsing-remitting MS (RRMS) patients. The clinical risk factors included in the analysis were physical disability (EDSS), fatigue (FSS), the somatic and nonsomatic components of depression (BDI), disease progression rate [Multiple Sclerosis Severity Score (MSSS)], and psychotropic medication. Cognitive impairment had a prevalence of 30.5% in patients affecting preferentially attention, executive functions, processing speed and visual perception/organization. MSSS was not associated with cognitive impairment, depression, or fatigue. In regression models, cognitive performance was best predicted by the nonsomatic symptoms of depression alone or in combination with physical disability. Exclusion of patients with any psychotropic medication did not influence the results. Our results underscore the importance of evaluating depressive symptoms when suspecting cognitive impairment in patients with RRMS.