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Aloni R, Kalron A, Goodman A, Ben-Ari A, Yoeli-Shalom T, Menascu S. Attention Deficit/Hyperactivity Disorder in Children with Multiple Sclerosis. J Atten Disord 2024; 28:1105-1113. [PMID: 38385203 DOI: 10.1177/10870547241232710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
BACKGROUND Multiple sclerosis (MS) is a chronic neurological autoimmune disease; pediatric-onset multiple sclerosis (POMS) represents 5% to 10% of total MS population. Children with POMS may experience attention difficulties due to the disease's impact on the central nervous system. However, little is known regarding Attention Deficit Hyperactivity Disorder (ADHD) in POMS, and its relation to cognitive performance. METHODS A retrospective case review was conducted using medical records of 66 children and adolescent patients diagnosed with POMS between 2012 and 2021 in a MS center of a tertiary medical center. All patients had undergone routine clinical neurological examinations and had been assessed for a diagnosis of ADHD by a department pediatric neurologist. In addition, sociodemographic data, disease-related variables, and cognitive performance were collected. RESULTS Of the 66 patients, 31 (47%) had a diagnosis of ADHD; 29 (44%) had cognitive impairment. Moreover, we identified four different profiles of POMS: those with only ADHD (17, 26%); only cognitive impairment (15, 23%), ADHD and cognitive impairment (14, 21%), and only POMS (20, 30%). A significant difference in disease duration was found among the four profiles [F(3,65) = 8.17, p < .001, η² = 0.29], indicating that patients with ADHD and cognitive impairment were characterized by longer disease duration. CONCLUSIONS ADHD may be prominently involved in POMS, even during the early stages of the disease and early diagnosis is crucial in order to provide appropriate interventions and support.
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Affiliation(s)
- Roy Aloni
- Department of Psychology, Ariel University, Israel
- Multiple Sclerosis Center, Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel
| | - Alon Kalron
- Multiple Sclerosis Center, Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel
- Department of Physical Therapy, School of Health Professions, Tel-Aviv Faculty of Medicine, Tel-Aviv University, Israel
| | - Assaf Goodman
- Department of Behavioral Sciences, Ruppin Academic Center, Emek Hefer, Israel
| | | | - Talya Yoeli-Shalom
- Multiple Sclerosis Center, Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel
| | - Shay Menascu
- Multiple Sclerosis Center, Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel
- Tel-Aviv School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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2
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Boschetti A, Maida E, Dini M, Tacchini M, Gamberini G, Comi G, Leocani L. A Review on the Feasibility and Efficacy of Home-Based Cognitive Remediation in People with Multiple Sclerosis. J Clin Med 2024; 13:1916. [PMID: 38610681 PMCID: PMC11012426 DOI: 10.3390/jcm13071916] [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: 02/21/2024] [Revised: 03/15/2024] [Accepted: 03/20/2024] [Indexed: 04/14/2024] Open
Abstract
Cognitive impairment affects 34-65% of People with Multiple Sclerosis (PwMS), significantly impacting their quality of life. Clinicians routinely address cognitive deficits with in-clinic neuro-behavioural interventions, but accessibility issues exist. Given these challenges, coupled with the lifelong need for continuous assistance in PwMS, researchers have underscored the advantageous role of telerehabilitation in addressing these requirements. Nonetheless, the feasibility and efficacy of home-based cognitive remediation remain to be firmly established. In this narrative review, we aimed to investigate the feasibility and efficacy of digital telerehabilitation for cognition in PwMS. Thirteen relevant studies were identified and carefully assessed. Regarding the feasibility of cognitive telerehabilitation, evidence shows adherence rates are generally good, although, surprisingly, not all studies reported measures of compliance with the cognitive training explored. Considering the efficacy of rehabilitative techniques on cognitive performance in PwMS, findings are generally inconsistent, with only one study reporting uniformly positive results. A range of methodological limitations are reported as potential factors contributing to the variable results. Future research must address these challenges, as more rigorous studies are required to draw definitive conclusions regarding the efficacy of home-based cognitive remediation in PwMS. Researchers must prioritise identifying optimal intervention approaches and exploring the long-term effects of telerehabilitation.
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Affiliation(s)
- Angela Boschetti
- Experimental Neurophysiology Unit, Institute of Experimental Neurology—INSPE, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (A.B.); (M.T.)
- San Raffaele Vita-Salute University, 20132 Milan, Italy
| | - Elisabetta Maida
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
| | - Michelangelo Dini
- Experimental Neurophysiology Unit, Institute of Experimental Neurology—INSPE, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (A.B.); (M.T.)
- San Raffaele Vita-Salute University, 20132 Milan, Italy
| | - Marta Tacchini
- Experimental Neurophysiology Unit, Institute of Experimental Neurology—INSPE, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (A.B.); (M.T.)
- San Raffaele Vita-Salute University, 20132 Milan, Italy
| | - Giulia Gamberini
- Department of Neurorehabilitation Sciences, Casa di Cura Igea, 20144 Milan, Italy
| | - Giancarlo Comi
- Department of Neurorehabilitation Sciences, Casa di Cura Igea, 20144 Milan, Italy
| | - Letizia Leocani
- Experimental Neurophysiology Unit, Institute of Experimental Neurology—INSPE, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (A.B.); (M.T.)
- San Raffaele Vita-Salute University, 20132 Milan, Italy
- Department of Neurorehabilitation Sciences, Casa di Cura Igea, 20144 Milan, Italy
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3
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Hsu WY, Zanto T, Park JE, Gazzaley A, Bove RM. Effects of transcranial alternating current stimulation on cognitive function in people with multiple sclerosis: A randomized controlled trial. Mult Scler Relat Disord 2023; 80:105090. [PMID: 37925960 DOI: 10.1016/j.msard.2023.105090] [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: 05/16/2023] [Revised: 09/14/2023] [Accepted: 10/18/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND Cognitive impairment is a core symptom that profoundly impacts the lives of people with multiple sclerosis (PwMS). Since the existing disease modifying therapies can only stabilize, but not actively treat, cognition in PwMS, there is an unmet need to expand approaches to treat these cognitive symptoms. Transcranial alternating current stimulation (tACS) permits frequency-specific entrainment of neural oscillations intrinsic to cognitive activity. However, the effects of the tACS on cognitive function in PwMS have not yet been assessed. We aimed to evaluate the potential efficacy of applying frontal theta-tACS to improve information processing speed in PwMS. METHODS 60 PwMS with cognitive complaints were enrolled in a double-blinded, randomized, controlled trial with three stimulation groups: 2 mA, 1 mA, or sham control. A single session of theta-tACS was applied while participants were engaged in a cognitive program which has shown to improve processing speed in PwMS. tACS effects were examined by the Symbol Digit Modalities Test (SDMT). Tolerability, side effects and acceptability were measured. RESULTS 1 mA groups had a significantly higher SDMT score after stimulation compared to their pre-stimulation score, 2 mA group showed a marginally significant improvement of their SDMT score, while the SDMT score in the sham group did not change. Overall, 49% of the stimulation group participants showed a clinically meaningful SDMT improvement (4+-point increase). CONCLUSION tACS is a well-tolerated, non-pharmacological intervention. Based on the positive effects observed in the current study of a single session of tACS applied during cognitive engagement, the effects of repeated tACS on cognitive function in PwMS merit further research. TRIAL REGISTRATION ClinicalTrials.gov NCT04466228.
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Affiliation(s)
- Wan-Yu Hsu
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, 1651 4th St, San Francisco, CA 94158, USA.
| | - Theodore Zanto
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, 1651 4th St, San Francisco, CA 94158, USA; Neuroscape, University of California San Francisco, San Francisco, CA, USA
| | - Jee Eun Park
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, 1651 4th St, San Francisco, CA 94158, USA; Neuroscape, University of California San Francisco, San Francisco, CA, USA; Department of Psychiatry, Seoul National University College of Medicine and Seoul National University Hospital, Seoul, South Korea
| | - Adam Gazzaley
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, 1651 4th St, San Francisco, CA 94158, USA; Neuroscape, University of California San Francisco, San Francisco, CA, USA
| | - Riley M Bove
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, 1651 4th St, San Francisco, CA 94158, USA
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Yue H, Shah SB, Modzelewski KL, Knobel M, Copeli F, Kao L. A Grave Set of Diagnoses: A Case of Mania with Comorbid Autoimmune Thyroiditis Precipitated by Multiple Sclerosis Treatment. Harv Rev Psychiatry 2023; 31:242-247. [PMID: 37615524 DOI: 10.1097/hrp.0000000000000378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
Affiliation(s)
- Han Yue
- From Department of Psychiatry, Tufts Medical Center, Boston, MA (Dr. Yue); Harvard Medical School (Dr. Shah); Section of Endocrinology, Diabetes, Nutrition & Weight Management, Boston Medical Center, Boston, MA (Dr. Modzelewski); Department of Endocrinology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA (Dr. Modzelewski); Department of Psychiatry, Veteran Affairs Boston Healthcare System, Boston, MA (Drs. Knobel and Kao); BrightView Health, Boston, MA (Dr. Copeli); Power of Recovery, Revere, MA (Dr. Copeli); Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, MA (Dr. Kao)
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Jiang Q, Wang W, Chen W, Xu Y. The impact of cognitive impairment on disease burden in Chinese patients with multiple sclerosis: A model simulation study. Mult Scler Relat Disord 2023; 73:104626. [DOI: 10.1016/j.msard.2023.104626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 02/02/2023] [Accepted: 03/18/2023] [Indexed: 03/28/2023]
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6
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Simani L, Roozbeh M, Shojaei M, Rostami M, Roozbeh M, Sahraian MA. Cognitive deficits in multiple sclerosis: Auditory and visual attention and inhibitory control. APPLIED NEUROPSYCHOLOGY. ADULT 2023:1-8. [PMID: 36972606 DOI: 10.1080/23279095.2023.2192408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
BACKGROUND A growing body of evidence has been paid to the cognitive impairment in patients with multiple sclerosis (MS). However, studies concerning cognitive functions in MS have also yielded conflicting results. This study investigates the attention and inhibitory control functions in patients with MS and their relationship with other clinical features, such as depression and fatigue in these patients. METHODS Participants included 80 patients with MS and 60 healthy controls. The attention and inhibitory control, fatigue, and psychiatric screening in all subjects were studied, respectively with the Integrated Visual and Auditory Continuous Performance Test (IVA-CPT), Fatigue Severity Scale (FSS), and the Hospital Anxiety and Depression Scale (HADS). RESULTS Patients with MS performed the IVA-CPT task more poorly than the healthy control group (p < 0.001). However, multiple regression analysis did not show any significant relationship between disease duration, FSS, and HADS on attention and inhibitory control. CONCLUSION Inhibitory control and attention are significantly impaired in patients with MS. Finding the basics of cognitive deficits in MS have potentially important clinical implications for developing better cognitive rehabilitation strategies.
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Affiliation(s)
- Leila Simani
- Skull Base Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- College of Pharmacy, University of Kentucky, Lexington, KY, USA
| | - Mahrooz Roozbeh
- Department of Cognitive Neuroscience, Institute for Cognitive Sciences Studies, Tehran, Iran
| | - Maziyar Shojaei
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Rostami
- Cognitive Sciences Lab, Allameh Tabataba'i University, Tehran, Iran
| | - Mehrdad Roozbeh
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Sahraian
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
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Sabanagic-Hajric S, Memic-Serdarevic A, Sulejmanpasic G, Salihovic-Besirovic D, Kurtovic A, Bajramagic N, Mehmedika-Suljic E. Cognitive Imapirment in Multiple Sclerosis: Relation to Dysability, Duration and Type of Disease. Mater Sociomed 2023; 35:23-27. [PMID: 37095882 PMCID: PMC10122534 DOI: 10.5455/msm.2023.35.23-27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 03/02/2023] [Indexed: 04/26/2023] Open
Abstract
Background Cognitive dysfunctions are often presented as a symptom in multiple sclerosis which is associated with both structural and functional imapirments of neuronal networks in the brain. Objective The aim of the study was to evaluate the influence of dysability, duration and type of disesase on cognitive functions in multiple sclerosis patients. Methods This study included 60 MS patients treated at the Department of Neurology, Clinical Center University of Sarajevo. Inclusion criteria were clinically definite diagnosis of multiple sclerosis, 18 years of age or older and were able to give written informed consent. Cognitive function was evaluated by the Montreal Cognitive Assessment (MoCa) screening test. Mann-Whitney and Kruskal-Wallis test were used for comparisons between clinical characteristics and MoCa test scores. Results Out of 63.33% of patients had EDSS <=4.5. Disease lasted longer than 10 years in 30% of patients. 80% had relapsing-remitting MS and 20% had secondary progressive MS. 84,2 % of patients with EDSS ≤ 4.5 had cognitive dysfunction. Higher disability (rho=0,306, p<0,05), progressive type of disease (rho=0,377, p< 0,01) and longer disease duration (rho=0,282, p<0,05) were associated with worse overall cognitive functions. Level of disability showed statistical significant correlation with the executive functions and language domains of cognition (p<0.01). Longer disease duration was significant correlated with executive functions (p<0,01) and language domains (p<0,01), while progressive type of disease was signifacant correlated only with executive functions domain (p<0,01). MoCa score variables did not show a statistically significant difference in relation to the number of relapses per year and the use of imunoterapy. Statistically significant negative correlation was obtained between executive functions domain and level of disability, disease duration and progressive type of disease, while language domain significantly correlated only with disability level and progressive type of disease. Conclusion High percentage of MS patients has cognitive impairment. Patients with higher disability were presented with lower cognitive abilities, especially in executive functions and language domains. Higher frequency of cognitive impairment were presented in progessive forms of disaese and longer disease duration with strong influence on executive functions domains of cognition.
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Affiliation(s)
- Selma Sabanagic-Hajric
- Department of Neurology, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Amra Memic-Serdarevic
- Department of Psychiatry, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Gorana Sulejmanpasic
- Department of Psychiatry, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
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Capturing cognitive changes in multiple sclerosis by performance-based functional and virtual reality assessments. Ann Phys Rehabil Med 2022; 66:101677. [PMID: 35667625 DOI: 10.1016/j.rehab.2022.101677] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 04/25/2022] [Accepted: 05/07/2022] [Indexed: 12/03/2022]
Abstract
Cognitive impairment (CI) has been recognized as one of the core multiple sclerosis (MS) symptoms that profoundly impact lives of people with MS (PwMS). Clinical trials have begun to focus on cognition as a primary or secondary outcome, but translating improvements in cognitive testing scores to functioning in the real world is difficult. Performance-based functional assessments and virtual reality (VR) assessments, which incorporate real-world challenges, have been proposed as a way to better assess functional cognition (i.e., cognitive performance and its impact on real-life cognitive functioning of PwMS) and could address the difficulty in evaluating the impact of a treatment on real-world functioning. In this narrative review, we identify and summarize some of the promising recent research applications of performance-based functional assessments and VR tools to assess functional cognition in MS. Overall, most of the studies suggest that functional and VR assessments can detect cognitive differences between people with and without MS and between PwMS with and without CI. Furthermore, performance on some of the functional and VR assessments was associated with performance on standard cognitive assessments. However, developing any guidelines on how to implement these assessments in clinical practice is difficult because of the relatively small sample size across these studies. Performance-based functional and VR assessments represent an innovative approach to increasing sensitivity of how cognitive impairments/abilities present in the daily life of PwMS. More studies, with a larger sample size, robust research methods, and pre- and post-treatment assessments, are warranted to validate relevant, accessible functional and VR assessments before implementing these assessment approaches in clinical practice.
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DİKER S, EKER A, KAYMAKAMZADE DDB, EREM A, BALYEMEZ U. Association of spinal cord lesions with cognition in multiple sclerosis. CUKUROVA MEDICAL JOURNAL 2022. [DOI: 10.17826/cumj.1096925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Purpose: The effect of spinal cord involvement, which is closely related to physical disability and prognosis, on cognitive functions in multiple sclerosis.
Materials and Methods: Twenty nine MS patients (2 clinically isolated syndrome, 23 relapsing and remitting MS, 2 secondary progressive MS, 2 primary progressive MS) were included in the study. Demographic characteristics, expanded disability status scale (EDSS) score, cognition assessed by brief repeatable battery of neuropsychological tests, brain and spinal cord T2 lesion number were evaluated.
Results: Older age, later age of disease onset, education duration are the features affecting cognitive test results. Brain and spinal cord lesion numbers did not have any effect on cognitive tests. Patients with spinal cord lesions had higher EDSS compared to patients without, however there was no difference regarding cognitive test results between groups.
Conclusion: Spinal cord lesions are associated with physical disability quantified by EDSS. Longitudinal studies with larger samples are needed to investigate the effect of presence and number of cord lesions as well as cervical cord atrophy on cognitive test results.
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10
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Silva R, Coelho P, Seabra M, Laranjinha I, Vieira D, Costa O, Jesus J, Fonseca AC, Costa S, Ferreira I, Lemos J, Sousa C, Vale J, Sá MJ, Ruano L. Cognitive impairment and markers of optical neurodegeneration in early multiple sclerosis. Neurol Sci 2022; 43:4381-4386. [DOI: 10.1007/s10072-022-05945-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 02/09/2022] [Indexed: 10/19/2022]
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Hsu WY, Rowles W, Anguera JA, Anderson A, Younger JW, Friedman S, Gazzaley A, Bove R. Assessing Cognitive Function in Multiple Sclerosis With Digital Tools: Observational Study. J Med Internet Res 2021; 23:e25748. [PMID: 34967751 PMCID: PMC8759021 DOI: 10.2196/25748] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 01/29/2021] [Accepted: 11/16/2021] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Cognitive impairment (CI) is one of the most prevalent symptoms of multiple sclerosis (MS). However, it is difficult to include cognitive assessment as part of MS standard care since the comprehensive neuropsychological examinations are usually time-consuming and extensive. OBJECTIVE To improve access to CI assessment, we evaluated the feasibility and potential assessment sensitivity of a tablet-based cognitive battery in patients with MS. METHODS In total, 53 participants with MS (24 [45%] with CI and 29 [55%] without CI) and 24 non-MS participants were assessed with a tablet-based cognitive battery (Adaptive Cognitive Evaluation [ACE]) and standard cognitive measures, including the Symbol Digit Modalities Test (SDMT) and the Paced Auditory Serial Addition Test (PASAT). Associations between performance in ACE and the SDMT/PASAT were explored, with group comparisons to evaluate whether ACE modules can capture group-level differences. RESULTS Correlations between performance in ACE and the SDMT (R=-0.57, P<.001), as well as PASAT (R=-0.39, P=.01), were observed. Compared to non-MS and non-CI MS groups, the CI MS group showed a slower reaction time (CI MS vs non-MS: P<.001; CI MS vs non-CI MS: P=.004) and a higher attention cost (CI MS vs non-MS: P=.02; CI MS vs non-CI MS: P<.001). CONCLUSIONS These results provide preliminary evidence that ACE, a tablet-based cognitive assessment battery, provides modules that could potentially serve as a digital cognitive assessment for people with MS. TRIAL REGISTRATION ClinicalTrials.gov NCT03569618; https://clinicaltrials.gov/ct2/show/NCT03569618.
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Affiliation(s)
- Wan-Yu Hsu
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, CA, United States
| | - William Rowles
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, CA, United States
| | - Joaquin A Anguera
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, CA, United States
- Neuroscape, University of California, San Francisco, CA, United States
- Department of Psychiatry, University of California, San Francisco, CA, United States
| | - Annika Anderson
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, CA, United States
| | - Jessica W Younger
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, CA, United States
- Neuroscape, University of California, San Francisco, CA, United States
| | - Samuel Friedman
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, CA, United States
| | - Adam Gazzaley
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, CA, United States
- Neuroscape, University of California, San Francisco, CA, United States
- Department of Psychiatry, University of California, San Francisco, CA, United States
- Department of Physiology, University of California, San Francisco, CA, United States
| | - Riley Bove
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, CA, United States
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Screening of Cognitive Impairment in Patients with Multiple Sclerosis: A Cross-Sectional Study in Georgia. Neurol Res Int 2021; 2021:5591078. [PMID: 34136283 PMCID: PMC8178012 DOI: 10.1155/2021/5591078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 05/13/2021] [Indexed: 11/17/2022] Open
Abstract
Cognitive impairment (CI) is a common symptom of multiple sclerosis (MS), with a significant negative impact on the occupational and social functioning of patients. This study aimed to estimate the prevalence and characteristics of CI among MS patients in Georgia. Sixty-eight patients with MS attending a neurology outpatient clinic in Tbilisi, Georgia, were enrolled in the study. Cognitive status was evaluated using two screening tools: the Brief International Cognitive Assessment for MS and the Montreal Cognitive Assessment. The overall prevalence of CI in our MS patients was 47%. We found negative associations between cognitive test results and patients' age, disability status, and depression. Lower education, higher scores on the Expanded Disability Status Scale, and the progressive course of MS were the main predictors of CI in the logistic regression analysis. This is the first study in Georgia to evaluate CI in patients with MS. The prevalence of CI in our study was comparable with those reported in other countries; however, we found greater impairment of the executive system compared to other cognitive domains. In our study, patients who were on continuous DMT showed significantly better performance on the cognitive tests used, indicating possible favorable effect of immunomodulatory drugs on cognition.
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Abdel Hafeez MA, Zamzam DA, Swelam MS, Steit AA, Masoud J, Nasser AA, Hazzou A, Hamid E, Aref H, Zakaria MF, Fouad MM. Telephone-based assessment of multiple sclerosis patients at Ain Shams University Hospital in the coronavirus disease 2019 pandemic. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2021; 57:66. [PMID: 34093002 PMCID: PMC8164886 DOI: 10.1186/s41983-021-00316-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 05/07/2021] [Indexed: 11/30/2022] Open
Abstract
Background Assessment of multiple sclerosis (MS) patients during the era of the coronavirus disease 2019 (COVID-19) pandemic was confronted with the overwhelmed healthcare facilities in Egypt and fear of the patients to get infected while attending the follow-up visits. This study aimed to assess the value of telephone-based assessments in the follow-up of MS patients. It includes one hundred and five patients who participated in the study and completed 3 telephone-based assessments which are the Hauser Ambulation index, Multiple Sclerosis Neuropsychology Questionnaire (MSNQ), and Symptoms of Multiple Sclerosis Scale (SMSS). Results The Hauser Ambulation index was significantly correlated with the latest Expanded Disability Status Scale (EDSS) score done within 1 month from the telephone call (r=0.738, P<0.001). The analysis of MSNQ scores showed that one-third of the study population had evidence of cognitive and/or neuropsychological impairment. Post hoc analysis regarding the cognitive and psychological impairment component of SMSS revealed that the patients who answered “Never” had significantly lower MSNQ scores compared to those who answered “Sometimes” (P=0.016), “Often” (P=0.022), and “Always” (P=0.001). The comparison of the EDSS scores of the patients regarding the sensory-motor impairment component of SMSS showed a non-significant difference. Conclusion The Hauser Ambulation index may be a reliable telephone-based tool for the assessment of physical disability. The MSNQ and the cognitive and psychological impairment component of SMSS can be used for the assessment of cognitive and psychological impairment among patients with MS.
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Affiliation(s)
| | - Dina A Zamzam
- Neurology Department, Ain Shams University, Cairo, Egypt
| | | | - Alaa Abo Steit
- Neurology Department, Ain Shams University, Cairo, Egypt
| | - Janet Masoud
- Neurology Department, Ain Shams University, Cairo, Egypt
| | | | - Ahmed Hazzou
- Neurology Department, Ain Shams University, Cairo, Egypt
| | - Eman Hamid
- Neurology Department, Ain Shams University, Cairo, Egypt
| | - Hany Aref
- Neurology Department, Ain Shams University, Cairo, Egypt
| | - Magd F Zakaria
- Neurology Department, Ain Shams University, Cairo, Egypt
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14
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Hsu WY, Cheng CH, Zanto TP, Gazzaley A, Bove RM. Effects of Transcranial Direct Current Stimulation on Cognition, Mood, Pain, and Fatigue in Multiple Sclerosis: A Systematic Review and Meta-Analysis. Front Neurol 2021; 12:626113. [PMID: 33763014 PMCID: PMC7982804 DOI: 10.3389/fneur.2021.626113] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 02/10/2021] [Indexed: 12/29/2022] Open
Abstract
Background: The study aimed to evaluate the effects of transcranial direct current stimulation (tDCS) on cognition, mood disturbance, pain, and fatigue in people with multiple sclerosis (PwMS). Methods: A literature search was performed on articles published between January 1990 and May 2020 in Pubmed, Medline, and Web of Science using the following keywords and their abbreviation in combinations: multiple sclerosis and transcranial direct current stimulation. Mean effect size (ES) and 95% confidence interval were calculated for each domain of interest. Results: Seventeen articles with a total of 383 PwMS were included in this analysis. For cognition, a strong effect size was found for the trial administering the Symbol Digit Modalities Test (ES: 1.15), whereas trials applying the Attention Network Test showed a negative effect size of −0.49. Moderate to strong effect sizes were observed for mood disturbance (mean ES: 0.92), pain (mean ES: 0.59), and fatigue (mean ES: 0.60). Further subgroup analyses for MS-related fatigue showed that both high and low intensities of stimulation lead to nearly the same degree of favorable effects. More pronounced effects were observed in studies administering the Fatigue Severity Scale compared with studies using other fatigue measures such as the Modified Fatigue Impact Scale. Conclusion: These results provide preliminary evidence that tDCS has a favorable effect on cognitive processing speed, mood disturbance, pain, and fatigue in MS. However, the effects on cognition and fatigue vary based on the specific assessment used.
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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
| | - Chia-Hsiung Cheng
- Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, Chang Gung University, Taoyuan, Taiwan.,Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan.,Laboratory of Brain Imaging and Neural Dynamics (BIND Lab), Chang Gung University, Taoyuan, Taiwan.,Department of Psychiatry, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Theodore P Zanto
- 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
| | - 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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15
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Gromisch ES, Dhari Z. Identifying Early Neuropsychological Indicators of Cognitive Involvement in Multiple Sclerosis. Neuropsychiatr Dis Treat 2021; 17:323-337. [PMID: 33574669 PMCID: PMC7872925 DOI: 10.2147/ndt.s256689] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 01/22/2021] [Indexed: 12/19/2022] Open
Abstract
Multiple sclerosis (MS) is a debilitating disease of the central nervous system that is most commonly seen in early to middle adulthood, although it can be diagnosed during childhood or later in life. While cognitive impairment can become more prevalent and severe as the disease progresses, signs of cognitive involvement can be apparent in the early stages of the disease. In this review, we discuss the prevalence and types of cognitive impairment seen in early MS, including the specific measures used to identify them, as well as the challenges in characterizing their frequency and progression. In addition to examining the progression of early cognitive involvement over time, we explore the clinical factors associated with early cognitive involvement, including demographics, level of physical disability, disease modifying therapy use, vocational status, and psychological and physical symptoms. Given the prevalence and functional impact these impairments can have for persons with MS, considerations for clinicians are provided, such as the role of early cognitive screenings and the importance of comprehensive neuropsychological assessments.
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Affiliation(s)
- Elizabeth S Gromisch
- Mandell Center for Multiple Sclerosis, Mount Sinai Rehabilitation Hospital, Trinity Health Of New England, Hartford, CT, USA
- Department of Rehabilitative Medicine, Frank H. Netter MD School of Medicine at Quinnipiac University, North Haven, CT, USA
- Department of Medical Sciences, Frank H. Netter MD School of Medicine at Quinnipiac University, North Haven, CT, USA
- Department of Neurology, University of Connecticut School of Medicine, Farmington, CT, USA
| | - Zaenab Dhari
- Mandell Center for Multiple Sclerosis, Mount Sinai Rehabilitation Hospital, Trinity Health Of New England, Hartford, CT, USA
- Department of Rehabilitative Medicine, Frank H. Netter MD School of Medicine at Quinnipiac University, North Haven, CT, USA
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16
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Hsu WY, Rowles W, Anguera J, Zhao C, Anderson A, Alexander A, Sacco S, Henry R, Gazzaley A, Bove R. Application of an Adaptive, Digital, Game-Based Approach for Cognitive Assessment in Multiple Sclerosis: Observational Study. J Med Internet Res 2021; 23:e24356. [PMID: 33470940 PMCID: PMC7840186 DOI: 10.2196/24356] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 10/14/2020] [Accepted: 10/28/2020] [Indexed: 01/19/2023] Open
Abstract
Background Cognitive impairment is one of the most debilitating manifestations of multiple sclerosis. Currently, the assessment of cognition relies on a time-consuming and extensive neuropsychological examination, which is only available in some centers. Objective To enable simpler, more accessible cognitive screening, we sought to determine the feasibility and potential assessment sensitivity of an unsupervised, adaptive, video game–based digital therapeutic to assess cognition in multiple sclerosis. Methods A total of 100 people with multiple sclerosis (33 with cognitive impairment and 67 without cognitive impairment) and 24 adults without multiple sclerosis were tested with the tablet game (EVO Monitor) and standard measures, including the Brief International Cognitive Assessment for Multiple Sclerosis (which included the Symbol Digit Modalities Test [SDMT]) and Multiple Sclerosis Functional Composite 4 (which included the Timed 25-Foot Walk test). Patients with multiple sclerosis also underwent neurological evaluations and contributed recent structural magnetic resonance imaging scans. Group differences in EVO Monitor performance and the association between EVO Monitor performance and standard measures were investigated. Results Participants with multiple sclerosis and cognitive impairment showed worse performance in EVO Monitor compared with participants without multiple sclerosis (P=.01) and participants with multiple sclerosis without cognitive impairment (all P<.002). Regression analyses indicated that participants with a lower SDMT score showed lower performance in EVO Monitor (r=0.52, P<.001). Further exploratory analyses revealed associations between performance in EVO Monitor and walking speed (r=–0.45, P<.001) as well as brain volumetric data (left thalamic volume: r=0.47, P<.001; right thalamic volume: r=0.39, P=.002; left rostral middle frontal volume: r=0.28, P=.03; right rostral middle frontal volume: r=0.27, P=.03). Conclusions These findings suggest that EVO Monitor, an unsupervised, video game–based digital program integrated with adaptive mechanics, is a clinically valuable approach to measuring cognitive performance in patients with multiple sclerosis. Trial Registration ClinicalTrials.gov NCT03569618; https://clinicaltrials.gov/ct2/show/NCT03569618
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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
| | - William Rowles
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Joaquin 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
| | - Chao Zhao
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Annika Anderson
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Amber Alexander
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Simone Sacco
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Roland Henry
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, 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 Bove
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
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17
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Measures of Thalamic Integrity are Associated with Cognitive Functioning in Fingolimod-treated Multiple Sclerosis Patients. Mult Scler Relat Disord 2020; 47:102635. [PMID: 33260053 DOI: 10.1016/j.msard.2020.102635] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 10/25/2020] [Accepted: 11/18/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Cognitive impairment is common in relapsing-remitting multiple sclerosis (RRMS) and multiple domains are affected, including information processing speed, episodic memory, and executive function. Damage to the thalamus appears to be related to cognitive functioning in MS. Fingolimod is a disease-modifying therapy for RRMS, which has been shown to have a protective effect on thalamic volume. OBJECTIVE To determine the relationship between cognitive measures and the thalamus in fingolimod-treated RRMS patients and healthy controls using ultra high-field magnetic resonance imaging (MRI). METHODS Fingolimod-treated RRMS and healthy participants were recruited from a single center to undergo neuropsychological testing and 7 tesla MRI. These assessments were performed at baseline, 6 months, and 12 months. The neuropsychological testing included the Brief Visuospatial Memory Test-Revised (BVMTR), the Symbol Digit Modalities Test (SDMT), the Selective Reminding Test (SRT), and the Delis-Kaplan Executive Function System (DKEFS). MRI metrics included thalamic volume, thalamic myelin density, thalamic axon density, T2 lesion volume, brain parenchymal fraction, and cortical thickness. Mixed-effects linear regression was used to determine the relationship between MRI parameters and neuropsychological test performance over time. Rates of change in patients and controls were compared using two-sample t-tests. RESULTS We enrolled 15 RRMS patients and 5 healthy controls. Controls performed better than patients at baseline, but this difference was only significant for the letter fluency subtest of the DKEFS and for long-term storage as assessed by the SRT. Thalamic volume and thalamic myelin density were significantly associated with visuospatial (BVMTR) and verbal memory (SRT). Thalamic volume alone was also associated with inhibitory control (Color word interference subtest of the DKEFS) and cognitive flexibility (Number letter switching subtest of the DKEFS), whereas thalamic myelin density alone was associated with semantic knowledge (Verbal fluency subtest of the DKEFS). There were no significant changes in the rates of change in neurometric test performance or MRI metrics between patients and controls from baseline to 6 months and baseline to 12 months. CONCLUSIONS Thalamic injury is associated with cognitive performance in several domains. Fingolimod-treated RRMS patients evolved similarly to healthy controls over one year with regards to neuropsychological test performance and changes on MRI.
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18
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Clinical features and physical performance in multiple sclerosis patients with and without cognitive impairment: a cross-sectional study. Int J Rehabil Res 2020; 43:316-323. [PMID: 32804701 DOI: 10.1097/mrr.0000000000000428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The factors associated with cognitive functions in patients with multiple sclerosis (PwMS) are not yet clear. The aims of this study were (1) to compare clinical features and physical performance in healthy controls, and PwMS with and without cognitive impairment, and (2) to determine the relationship between cognitive domains and demographics characteristics, clinical features and physical performance in PwMS. A total of 112 PwMS and 25 healthy controls participated in this study. Cognitive functions were evaluated by Brief Repeatable Battery of Neuropsychological Tests (BRB-N). Based on cognitive performances by BRB-N, PwMS were divided into two groups as MS patients with impaired (MS-I, n: 57) and with normal (MS-N, n: 55) cognitive functions. For clinical features, fatigue, mood and sleep quality were evaluated by the Fatigue Impact Scale, Beck's Depression Inventory, Pittsburgh Sleep Quality Index, respectively. For physical performances, balance and walking capacity were evaluated by posturography and Six-Minute Walking Test, respectively. The results showed that the education years, postural stability and walking capacity in MS-N and healthy controls were higher than in MS-I (P < 0.05). In addition, visuospatial memory was correlated with both postural stability under all sensory conditions and walking capacity; verbal memory was correlated with education years, postural stability on eyes closed-foam surface and walking capacity; verbal fluency was correlated with only walking capacity; information processing speed was correlated with education years, postural stability under all sensory conditions and walking capacity (P < 0.001). This study suggests that the interventions that aim to improve physical performance might protect and even improve cognitive functions in PwMS.
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19
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Ozkul C, Guclu-Gunduz A, Eldemir K, Apaydin Y, Yazici G, Irkec C. Combined exercise training improves cognitive functions in multiple sclerosis patients with cognitive impairment: A single-blinded randomized controlled trial. Mult Scler Relat Disord 2020; 45:102419. [PMID: 32736216 DOI: 10.1016/j.msard.2020.102419] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 07/03/2020] [Accepted: 07/22/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Cognitive impairment is common in patients with multiple sclerosis (MS). The effects of different exercise trainings on cognitive functions in patients with MS are promising. However, the effects are not yet clear in MS patients with cognitive impairment. This study aimed to investigate the effect of combined exercise training on different cognitive functions in MS patients with cognitive impairment. METHODS Relapsing-remitting and mild disabled MS patients with cognitive impairment were randomly assigned to two groups: Exercise Group (EG, n:17) and the Control Group (CG, n:17). The EG received a combined exercise training consisting of aerobic and Pilates training in three sessions per week for 8 weeks while the CG performed the relaxation exercises at home. Cognitive functions, walking capacity, fatigue, mood, and quality of life were assessed at baseline and after eight weeks using the Brief Repeatable Battery of Neuropsychological Tests (BRB-N), Six-Minute Walk Test (6-MWT), Fatigue Impact Scale (FIS), Beck's Depression Inventory (BDI) and MS Quality of Life-54 (MSQoL-54), respectively. RESULTS This study showed significant group-by-time interactions on long-term verbal memory, walking capacity, cognitive fatigue, and physical quality of life in favor of the EG (p<0.003). Moreover, verbal memory, visuospatial memory, verbal fluency, information processing speed, walking capacity, fatigue, and quality of life improved in the EG (p<0.05) while only verbal memory increased in the CG (p<0.05). Furthermore, the change in visuospatial memory was associated with the change in mental quality of life (r:0.352, p: 0.041) while the change in verbal fluency (r: -0.362, p:0.035) and processing speed (r: -0.356, p:0.039) were associated with the change in mood. CONCLUSION Combined exercise training has beneficial effects on different cognitive functions in mild disabled RRMS patients with cognitive impairment. In addition, there is a mutual relationship in improvements in cognitive functions, mood, and quality of life after exercise.
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Affiliation(s)
- Cagla Ozkul
- Gazi University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Ankara, Turkey.
| | - Arzu Guclu-Gunduz
- Gazi University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Ankara, Turkey
| | - Kader Eldemir
- Gazi University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Ankara, Turkey
| | - Yasemin Apaydin
- Gazi University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Ankara, Turkey
| | - Gokhan Yazici
- Gazi University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Ankara, Turkey
| | - Ceyla Irkec
- Gazi University, Faculty of Medicine, Department of Neurology, Ankara, Turkey
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20
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Amato MP, Goretti B, Brescia Morra V, Gallo P, Zaffaroni M, Onofrj M, Cocco E, Borriello G, Zipoli V, Trojano M. Effects of 2-year treatment with dimethyl fumarate on cognition and functional impairment in patients with relapsing remitting multiple sclerosis. Neurol Sci 2020; 41:3185-3193. [DOI: 10.1007/s10072-020-04320-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 02/28/2020] [Indexed: 11/28/2022]
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21
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Yalachkov Y, Uhlmann V, Bergmann J, Soydaş D, Frisch S, Behrens M, Foerch C, Gehrig J. Patients with chronic autoimmune demyelinating polyneuropathies exhibit cognitive deficits which might be associated with CSF evidence of blood-brain barrier disturbance. PLoS One 2020; 15:e0228679. [PMID: 32017808 PMCID: PMC6999893 DOI: 10.1371/journal.pone.0228679] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 01/20/2020] [Indexed: 12/31/2022] Open
Abstract
Background Chronic autoimmune demyelinating polyneuropathies (CADP) result in impaired sensorimotor function. However, anecdotal clinical observations suggest the development of cognitive deficits during the course of disease. Methods We tested 16 patients with CADP (11 patients with chronic inflammatory demyelinating polyneuropathy, 4 patients with multifocal motor neuropathy and 1 patient with multifocal acquired demyelinating sensory and motor neuropathy) and 40 healthy controls (HC) with a neuropsychological test battery. Blood-brain-barrier dysfunction (BBBd) in patients was assessed retrospectively by analysing the cerebral spinal fluid (CSF) status at the time the diagnosis of CAPD was established. Results CADP patients failed on average in 1.7 out of 9 neuropsychological tests (SD ± 1.25, min. 0, max. 5). 50% of the CADP patients failed in at least two neuropsychological tests and 44.3% of the patients failed in at least two different cognitive domains. CADP patients exhibiting BBBd at the time of first diagnosis failed in more neuropsychological tests than patients with intact integrity of the BBB (p < 0.05). When compared directly with the HC group, CADP patients performed worse than HC in tests measuring information processing ability and speed as well as phonemic verbal fluency after adjusting for confounding covariates. Conclusions Our results suggest that mild to moderate cognitive deficits might be present in patients with CAPD. One possible tentative explanation, albeit strong evidence is still lacking for this pathophysiological mechanism, refers to the effect of autoimmune antibodies entering the CNS via the dysfunctional blood-brain barrier typically seen in some of the CADP patients.
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Affiliation(s)
- Yavor Yalachkov
- University Hospital Frankfurt, Department of Neurology, Frankfurt am Main, Germany
- * E-mail:
| | - Valerie Uhlmann
- University Hospital Frankfurt, Department of Neurology, Frankfurt am Main, Germany
| | - Johannes Bergmann
- University Hospital Frankfurt, Department of Neurology, Frankfurt am Main, Germany
| | - Dilara Soydaş
- University Hospital Frankfurt, Department of Neurology, Frankfurt am Main, Germany
| | - Stefan Frisch
- University Hospital Frankfurt, Department of Neurology, Frankfurt am Main, Germany
- Institute of Psychology, Goethe-University, Frankfurt am Main, Germany
| | - Marion Behrens
- University Hospital Frankfurt, Department of Neurology, Frankfurt am Main, Germany
| | - Christian Foerch
- University Hospital Frankfurt, Department of Neurology, Frankfurt am Main, Germany
| | - Johannes Gehrig
- University Hospital Frankfurt, Department of Neurology, Frankfurt am Main, Germany
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22
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Bogdanova MD, Mikadze YV, Bembeeva RT, Volkova EY. [Methodological issues of cognitive impairment studies in pediatric multiple sclerosis patients]. Zh Nevrol Psikhiatr Im S S Korsakova 2020; 119:105-111. [PMID: 31626226 DOI: 10.17116/jnevro2019119091105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The article provides a review of the characteristics of cognitive impairment in multiple sclerosis (MS) and methods for its assessment in children. The features of the most frequently used neuropsychological batteries, with consideration of specifics of cognitive impairment in MS, and data on assessment of a state of cognitive functions obtained using neuropsychological tests are presented. The authors also discuss the issue of a long-term impact of the disease on a state of cognitive functions. Clinical factors, which can lead to cognitive impairment (type of multiple sclerosis, age at manifestation, number of relapses), are described.
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Affiliation(s)
- M D Bogdanova
- Lomonosov Moscow State University, Moscow, Russia; Sechenov First Moscow State Medical University, Moscow, Russia
| | - Yu V Mikadze
- Lomonosov Moscow State University, Moscow, Russia; Pirogov Russian National Research Medical University, Moscow, Russia
| | - R Ts Bembeeva
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - E Yu Volkova
- Russian Pediatric Clinical Hospital, Pirogov Russian National Research Medical University, Moscow, Russia
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23
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Karavasilis E, Christidi F, Velonakis G, Tzanetakos D, Zalonis I, Potagas C, Andreadou E, Efstathopoulos E, Kilidireas C, Kelekis N, Evdokimidis I. Hippocampal structural and functional integrity in multiple sclerosis patients with or without memory impairment: a multimodal neuroimaging study. Brain Imaging Behav 2020; 13:1049-1059. [PMID: 29971687 DOI: 10.1007/s11682-018-9924-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The increasing evidence for a pure amnestic-like profile in multiple sclerosis (MS) introduces the role of hippocampal formation in MS episodic memory function. The aim of the present study was to investigate structural and functional hippocampal changes in mildly-disabled MS patients with and without memory impairment. Thirty-one MS patients with or without memory impairment and 16 healthy controls (HC) underwent MRI in a 3.0 T MRI scanner. Patients were categorized as memory preserved (MP) and memory impaired (MI) based on verbal and visual memory scores extracted from the Brief Repeatable Neuropsychological Battery. The acquisition protocol included high-resolution 3D-T1-weighted, diffusion weighted imaging and echo-planar imaging sequences for the analysis of hippocampal gray matter (GM) density, perforant pathway area (PPA) tractography, and hippocampal functional connectivity (FC), respectively. Compared to HC, we found decreased left and bilateral hippocampal GM density in MP and MI patients, respectively, decreased fractional anisotropy and increased radial diffusivity on left PPA in MI patients, and reduced FC in MI between left hippocampus and left superior frontal gyrus, precuneus/posterior cingulated cortex and lateral occipital gyrus/angular gyrus. The only differences between MP and MI were found in FC. Specifically, MP patients showed FC changes between left hippocampus and right temporo-occipital fusiform/lingual gyrus (increased FC) as well as supramarginal gyrus (decreased FC). In conclusion, we highlight the early detection of structural hippocampal changes in MS without neuropsychologically-detected memory deficits and decreased hippocampal FC in MS patients with impaired memory performance, when both GM density and PPA integrity are affected.
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Affiliation(s)
- Efstratios Karavasilis
- 2nd Department of Radiology, Medical School, National and Kapodistrian University of Athens, 19 Papadiamantopoulou Street, 11528, Athens, Greece.
| | - Foteini Christidi
- 1st Department of Neurology, Aeginition Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgios Velonakis
- 2nd Department of Radiology, Medical School, National and Kapodistrian University of Athens, 19 Papadiamantopoulou Street, 11528, Athens, Greece
| | - Dimitrios Tzanetakos
- 1st Department of Neurology, Aeginition Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis Zalonis
- 1st Department of Neurology, Aeginition Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Constantin Potagas
- 1st Department of Neurology, Aeginition Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Elisabeth Andreadou
- 1st Department of Neurology, Aeginition Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Efstathios Efstathopoulos
- 2nd Department of Radiology, Medical School, National and Kapodistrian University of Athens, 19 Papadiamantopoulou Street, 11528, Athens, Greece
| | - Constantinos Kilidireas
- 1st Department of Neurology, Aeginition Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Kelekis
- 2nd Department of Radiology, Medical School, National and Kapodistrian University of Athens, 19 Papadiamantopoulou Street, 11528, Athens, Greece
| | - Ioannis Evdokimidis
- 1st Department of Neurology, Aeginition Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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24
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Postigo-Alonso B, Galvao-Carmona A, Conde-Gavilán C, Jover A, Molina S, Peña-Toledo MA, Valverde-Moyano R, Agüera E. The effect of prioritization over cognitive-motor interference in people with relapsing-remitting multiple sclerosis and healthy controls. PLoS One 2019; 14:e0226775. [PMID: 31869375 PMCID: PMC6927625 DOI: 10.1371/journal.pone.0226775] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 12/03/2019] [Indexed: 01/20/2023] Open
Abstract
The cognitive-motor interference (CMI) produced by simultaneous performance of a cognitive and a motor task has been proposed as a marker of real-life impairment of people with Multiple Sclerosis (pwMS), yet there is no consensus on the dual task (DT) procedure. This study aimed to compare DT performance of pwMS and healthy controls (HC) under different instructions and to examine its association with neuropsychological and clinical variables. PwMS (N = 23; relapsing-remitting course) and HC (N = 24) completed the cognitive (Verbal Fluency) and motor (walking) tasks under three conditions: independently or as single task (ST), both tasks simultaneously at best capacity or double prioritization (DT-DP), and only the cognitive task at best capacity while walking at preferred speed or cognitive prioritization (DT-CP). Compared to HC, pwMS walked significantly slower and produced less correct words under all conditions. The distance walked by pwMS and HC significantly differed between conditions (DT-CP< DT-DP< ST). PwMS produced more words during ST respective to DT-DP and DT-CP, with no difference between both DT conditions. HC showed no differences in cognitive performance between conditions. Motor and cognitive dual-task costs (DTC) were similar between groups. Only in pwMS, the cognitive DTC of DT-DP was different from zero. CMI measures correlated with neuropsychological, symptomatic, physiological (cognitive event-related potentials) and clinical variables. These results suggest that cognitive performance while walking is impaired in pwMS, but not in HC. CMI over cognitive performance might be a potential early marker of cognitive decline in pwMS, which may be enhanced by the instruction to prioritize both tasks in DT.
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Affiliation(s)
- Barbara Postigo-Alonso
- Department of Psychology, Universidad Loyola Andalucía. Seville, Spain
- Human Neuroscience Lab (HNL), Universidad Loyola Andalucía, Seville, Spain
- * E-mail:
| | - Alejandro Galvao-Carmona
- Department of Psychology, Universidad Loyola Andalucía. Seville, Spain
- Human Neuroscience Lab (HNL), Universidad Loyola Andalucía, Seville, Spain
| | - Cristina Conde-Gavilán
- Neurology Service, Reina Sofía University Hospital, Cordoba, Spain
- Maimonides Institute for Research in Biomedicine of Cordoba, (IMIBIC), Cordoba, Spain
| | - Ana Jover
- Neurology Service, Reina Sofía University Hospital, Cordoba, Spain
- Maimonides Institute for Research in Biomedicine of Cordoba, (IMIBIC), Cordoba, Spain
| | - Silvia Molina
- Neurology Service, Reina Sofía University Hospital, Cordoba, Spain
- Maimonides Institute for Research in Biomedicine of Cordoba, (IMIBIC), Cordoba, Spain
| | - María A. Peña-Toledo
- Neurology Service, Reina Sofía University Hospital, Cordoba, Spain
- Maimonides Institute for Research in Biomedicine of Cordoba, (IMIBIC), Cordoba, Spain
| | - Roberto Valverde-Moyano
- Neurology Service, Reina Sofía University Hospital, Cordoba, Spain
- Maimonides Institute for Research in Biomedicine of Cordoba, (IMIBIC), Cordoba, Spain
| | - Eduardo Agüera
- Neurology Service, Reina Sofía University Hospital, Cordoba, Spain
- Maimonides Institute for Research in Biomedicine of Cordoba, (IMIBIC), Cordoba, Spain
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Blecher T, Miron S, Schneider GG, Achiron A, Ben-Shachar M. Association Between White Matter Microstructure and Verbal Fluency in Patients With Multiple Sclerosis. Front Psychol 2019; 10:1607. [PMID: 31379663 PMCID: PMC6657651 DOI: 10.3389/fpsyg.2019.01607] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 06/26/2019] [Indexed: 12/14/2022] Open
Abstract
Verbal fluency refers to the ability to generate words quickly and efficiently according to predefined phonological or semantic criteria. Deficits in verbal fluency limit patients' ability to communicate effectively and to function well in social setups. Multiple sclerosis (MS) patients suffer from various cognitive impairments, and some of them experience language deficits as well. The goal of this study is to examine the contribution of the dorsal and ventral language pathways to verbal fluency in MS patients. All patients (N = 33) underwent diffusion MRI (dMRI) and fluency measurements. Diffusion parameters were calculated along dorsal and ventral language-related pathways and their right-hemispheric homologs, identified individually in each patient. Significant correlations were found between fluency measures and mean fractional anisotropy (FA) in several pathways, including the left fronto-temporal arcuate fasciculus (AFft), bilateral inferior fronto-occipital fasciculus (IFOF), and bilateral frontal aslant tract. Along-tract correlations revealed a more selective pattern of associations: letter-based fluency was associated with FA in a segment of the left AFft (dorsal pathway), while category-based fluency was associated with FA in a segment of the right IFOF (ventral pathway). The observed pattern of associations, mapping letter-based fluency to the dorsal stream and category-based fluency to the ventral stream, fits well within the dual stream framework of language processing. Further studies will be necessary to assess whether these associations generalize to the typical adult population or whether they are tied to the clinical state.
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Affiliation(s)
- Tal Blecher
- Gonda Multidisciplinary Brain Research Center, Bar-Ilan University, Ramat Gan, Israel
| | - Shmuel Miron
- Multiple Sclerosis Center, Sheba Medical Center, Tel Hashomer, Israel
| | | | - Anat Achiron
- Multiple Sclerosis Center, Sheba Medical Center, Tel Hashomer, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michal Ben-Shachar
- Gonda Multidisciplinary Brain Research Center, Bar-Ilan University, Ramat Gan, Israel
- Department of English Literature and Linguistics, Bar-Ilan University, Ramat Gan, Israel
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A Pilot Study to Assess At-Home Speed of Processing Training for Individuals with Multiple Sclerosis. Mult Scler Int 2019; 2019:3584259. [PMID: 31275652 PMCID: PMC6582794 DOI: 10.1155/2019/3584259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 05/19/2019] [Indexed: 11/17/2022] Open
Abstract
Objective Cognitive impairment is a common symptom of multiple sclerosis (MS), yet treatment is currently limited. The primary goal of this pilot study was to assess the feasibility and acceptability of an at-home, five-week computerized speed of processing (SOP) training intervention for MS patients. In addition, we examined the utility of the intervention to improve speed of information processing, memory, executive function, and health-related quality of life (HRQOL). Method Fifteen subjects were assigned five weeks of SOP training, two times per week, for a total of ten sessions. Subjects were trained on five computerized SOP tasks that required processing of increasingly complex visual stimuli in successively shorter presentation times. Subjects were given a neuropsychological test battery that included measures of speed of information processing, verbal memory, visual spatial memory, and executive function. Subjects were also administered patient-reported outcome (PRO) measures to assess HRQOL, depression, and work productivity. Neuropsychological and PRO batteries were completed at baseline and after five weeks. Results Eighty percent of subjects completed the five-week intervention (n = 12). Significant improvements were observed on some, but not all, measures of speed of information processing, verbal memory, and executive function. There were no significant changes in HRQOL. Conclusion This pilot study supports the feasibility of an at-home SOP training intervention for individuals with MS. SOP training was associated with improvements in several cognitive domains. Larger, randomized controlled trials are warranted.
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Nickel M, Eid F, Jukkola P, Gu C. Copper chelation and autoimmunity differentially impact myelin in the hippocampal-prefrontal circuit. J Neuroimmunol 2019; 334:576998. [PMID: 31254928 DOI: 10.1016/j.jneuroim.2019.576998] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 06/18/2019] [Accepted: 06/19/2019] [Indexed: 01/19/2023]
Abstract
Multiple sclerosis (MS) is an inflammatory demyelinating disease of the central nervous system. About 50% of MS patients develop deficits in learning, memory and executive function, which are accompanied by demyelinating lesions in the hippocampus and/or prefrontal cortex (PFC). Why demyelination in these regions occurs in some patients but not in others and what is the underlying mechanism remain unclear. Here we report that myelin density in the hippocampus and PFC is markedly reduced in the cuprizone model, but not in the chronic experimental autoimmune encephalomyelitis. These two models can be used for studying different neuropathophysiological aspects of demyelinating diseases.
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Affiliation(s)
- Mara Nickel
- Department of Biological Chemistry and Pharmacology, The Ohio State University, Columbus, OH 43210, USA
| | - Farida Eid
- College of Arts and Sciences, The Ohio State University, Columbus, OH 43210, USA
| | - Peter Jukkola
- Biomedical Sciences Graduate Program, The Ohio State University, Columbus, OH 43210, USA
| | - Chen Gu
- Department of Biological Chemistry and Pharmacology, The Ohio State University, Columbus, OH 43210, USA; Biomedical Sciences Graduate Program, The Ohio State University, Columbus, OH 43210, USA.
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Visual but not verbal working memory interferes with balance in patients after optic neuritis suggestive of multiple sclerosis. Neurosci Lett 2019; 707:134288. [PMID: 31163227 DOI: 10.1016/j.neulet.2019.134288] [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] [Received: 01/13/2019] [Revised: 05/05/2019] [Accepted: 05/21/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND Subtle cognitive deficits are present in almost half of the patients with clinically isolated syndrome (CIS) suggestive of multiple sclerosis (MS). Similarly, subtle balance deficits can be detected at the earliest stages of the disease. To assess cognitive-motor interference (CMI) in nondisabled CIS patients, we studied postural performance using dual task paradigm in CIS patients presenting with optic neuritis. METHODS We prospectively included 20 patients with visual acuity of 0.8 or more within the 3 months from unilateral ON. We also included 20 age, weight, height and education matched healthy subjects. Baseline cognitive performance of the patients was assessed using neuropsychological tests. Balance was studied by posturography (Po) and center of pressure (CoP) measures (maximal medio-lateral, maximal antero-posterior amplitudes, maximal CoP velocity and total CoP path. CMI between static balance and WM was investigated using a dual-task paradigm in three conditions: Po alone, Po+Brooks' visual working memory (WM) task and Po+2-back verbal WM task. RESULTS The two most commonly affected cognitive domains in the patients were attention (52% of the patients) and executive functions (45% of the patients). Static balance as measured by higher maximal CoP velocity while standing alone (p = 0.02) was impaired in patients. Significantly lower maximal m-l CoP amplitude (p = 0.01) and total CoP path (p = 0.004) in the Po + Brooks' task condition compared to Po alone were observed in the group of ON patients but not in healthy subjects. The cost of dualtasking was highest in the ON patients under Po + Brooks' task (p = 0.04 for the total CoP path parameter). CONCLUSION Static balance and cognition are impaired in the earliest MS. CMI between static balance and working memory is higher in the patients and while loading visual working memory. Dual-task paradigms should be used in rehabilitation programmes for patients at the very beginning of the disease.
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The relationship between amplitude of low frequency fluctuations and gray matter volume of the mirror neuron system: Differences between low disability multiple sclerosis patients and healthy controls. IBRO Rep 2018; 5:60-66. [PMID: 30310873 PMCID: PMC6176553 DOI: 10.1016/j.ibror.2018.09.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 09/24/2018] [Indexed: 11/21/2022] Open
Abstract
The study of the relationship between function and structure of the brain is interesting in multiple sclerosis patients. Different relationship between amplitude of low frequency fluctuations (ALFF) and gray matter volume has been detected. This difference may be associated with the presence of white matter lesions involving specific tracts.
The study of the relationship between function and structure of the brain could be particularly interesting in neurodegenerative diseases like multiple sclerosis (MS). The aim of the present work is to identify differences of the amplitude of low frequency fluctuations (ALFF) in the mirror neuron system (MNS) between MS patients and healthy controls and to study the relationship between ALFF and the gray matter volume (GMV) of the regions that belong to the MNS. Relapsing-remitting MS patients with minor disability were compared to healthy controls (HC) using resting-state functional magnetic resonance imaging (fMRI), anatomic T1 weighted images and diffusion tensor imaging (DTI). Region of interest (ROI) analyses was performed in the MNS regions. A decrease of ALFF in MS patients was observed in the left inferior frontal gyrus (IFG). Furthermore, a correlation between ALFF in the IFG and the GMV of the left inferior parietal lobule (IPL) was identified. This relationship was different for MS patients than for HC, which may be associated with changes in diffusivity measures which were impaired in MS patients. MS patients with low disability may show ALFF differences in the MNS without clinical correspondence. This functional difference may be associated with cortical and subcortical changes related to the disease.
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Postigo-Alonso B, Galvao-Carmona A, Benítez I, Conde-Gavilán C, Jover A, Molina S, Peña-Toledo MA, Agüera E. Cognitive-motor interference during gait in patients with Multiple Sclerosis: a mixed methods Systematic Review. Neurosci Biobehav Rev 2018; 94:126-148. [PMID: 30189226 DOI: 10.1016/j.neubiorev.2018.08.016] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 06/28/2018] [Accepted: 08/28/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Cognitive-motor interference (CMI) has been proposed as a valid marker of daily life impairment in Multiple Sclerosis (MS). The heterogeneity and scarce number of studies regarding CMI in MS has hampered the synthesis of the existing evidence. The present systematic review employed a mixed methods approach with the aim of identifying and describing variables under which CMI is particularly useful to assess patients with MS. RESULTS MS patients showed significant CMI. The motor variables that were most sensitive in detecting significant CMI were velocity (m/s), cadence (steps/min), and double support (% gait cycle), which was also specific for MS. Among the cognitive tasks, Alternate Alphabet and Serial Subtracting 7 s were sensitive, whereas Verbal Fluency were both sensitive and specific to CMI in MS. CONCLUSIONS CMI should be assessed in MS with a standardised dual task such as the Verbal Fluency task while walking, with measurements of the double support time and the effect on the cognitive task. The clinical usefulness of CMI in the assessment of patients with MS is discussed.
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Affiliation(s)
- B Postigo-Alonso
- Department of Psychology, Universidad Loyola Andalucía, Seville, Spain; Human Neuroscience Lab (HNL), Universidad Loyola Andalucía, Seville, Spain.
| | - A Galvao-Carmona
- Department of Psychology, Universidad Loyola Andalucía, Seville, Spain; Human Neuroscience Lab (HNL), Universidad Loyola Andalucía, Seville, Spain; Institute of Biomedical Sciences, Universidad Autónoma de Chile, Santiago, Chile
| | - I Benítez
- Department of Psychology, Universidad Loyola Andalucía, Seville, Spain
| | - C Conde-Gavilán
- Dementia and Multiple Sclerosis Unit, Neurology Service, Reina Sofía University Hospital, Córdoba, Spain
| | - A Jover
- Dementia and Multiple Sclerosis Unit, Neurology Service, Reina Sofía University Hospital, Córdoba, Spain
| | - S Molina
- Dementia and Multiple Sclerosis Unit, Neurology Service, Reina Sofía University Hospital, Córdoba, Spain
| | - M A Peña-Toledo
- Dementia and Multiple Sclerosis Unit, Neurology Service, Reina Sofía University Hospital, Córdoba, Spain
| | - E Agüera
- Dementia and Multiple Sclerosis Unit, Neurology Service, Reina Sofía University Hospital, Córdoba, Spain
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Togrol RE, Demir S. Reliability, validity and validation of the CNS emotional lability scale for pseudobulbar affect on multiple sclerosis in Turkish patients. PSYCHIAT CLIN PSYCH 2018. [DOI: 10.1080/24750573.2018.1472905] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
- Rıfat Erdem Togrol
- Department of Neurology, Sultan Abdulhamid Han Training and Research Hospital, Istanbul, Turkey
| | - Serkan Demir
- Department of Neurology, Sultan Abdulhamid Han Training and Research Hospital, Istanbul, Turkey
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Zeydan B, Lowe VJ, Schwarz CG, Przybelski SA, Tosakulwong N, Zuk SM, Senjem ML, Gunter JL, Roberts RO, Mielke MM, Benarroch EE, Rodriguez M, Machulda MM, Lesnick TG, Knopman DS, Petersen RC, Jack CR, Kantarci K, Kantarci OH. Pittsburgh compound-B PET white matter imaging and cognitive function in late multiple sclerosis. Mult Scler 2018; 24:739-749. [PMID: 28474977 PMCID: PMC5665724 DOI: 10.1177/1352458517707346] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND There is growing interest in white matter (WM) imaging with positron emission tomography (PET). OBJECTIVES We studied the association of cognitive function in late multiple sclerosis (MS) with cortical and WM Pittsburgh compound-B PET (PiB-PET) binding. METHODS In the population-based Mayo Clinic Study of Aging, 24 of 4869 participants had MS (12 underwent PiB-PET). Controls were age and sex matched (5:1). We used automated or semi-automated processing for quantitative image analyses and conditional logistic regression for group differences. RESULTS MS patients had lower memory ( p = 0.03) and language ( p = 0.02) performance; smaller thalamic volumes ( p = 0.003); and thinner temporal ( p = 0.001) and frontal ( p = 0.045) cortices on magnetic resonance imaging (MRI) than controls. There was no difference in global cortical PiB standardized uptake value ratios between MS and controls ( p = 0.35). PiB uptake was lower in areas of WM hyperintensities compared to normal-appearing white matter (NAWM) in MS ( p = 0.0002). Reduced PiB uptake in both the areas of WM hyperintensities ( r = 0.65; p = 0.02) and NAWM ( r = 0.69; p = 0.01) was associated with decreased visuospatial performance in MS. CONCLUSION PiB uptake in the cortex in late MS is not different from normal age-matched controls. PiB uptake in the WM in late MS may be a marker of the large network structures' integrity such as those involved in visuospatial performance.
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Affiliation(s)
- Burcu Zeydan
- Mayo Clinic College of Medicine, Department of Neurology, Rochester, Minnesota, United States of America
- Mayo Clinic College of Medicine, Department of Radiology, Rochester, Minnesota, United States of America
| | - Val J. Lowe
- Mayo Clinic College of Medicine, Department of Radiology, Rochester, Minnesota, United States of America
| | - Christopher G. Schwarz
- Mayo Clinic College of Medicine, Department of Radiology, Rochester, Minnesota, United States of America
| | - Scott A. Przybelski
- Mayo Clinic College of Medicine, Department of Health Sciences Research, Rochester, Minnesota, United States of America
| | - Nirubol Tosakulwong
- Mayo Clinic College of Medicine, Department of Health Sciences Research, Rochester, Minnesota, United States of America
| | - Samantha M. Zuk
- Mayo Clinic College of Medicine, Department of Radiology, Rochester, Minnesota, United States of America
| | - Matthew L. Senjem
- Mayo Clinic College of Medicine, Department of Radiology, Rochester, Minnesota, United States of America
- Mayo Clinic College of Medicine, Department of Information Technology, Rochester, Minnesota, United States of America
| | - Jeffrey L. Gunter
- Mayo Clinic College of Medicine, Department of Information Technology, Rochester, Minnesota, United States of America
| | - Rosebud O. Roberts
- Mayo Clinic College of Medicine, Department of Neurology, Rochester, Minnesota, United States of America
- Mayo Clinic College of Medicine, Department of Health Sciences Research, Rochester, Minnesota, United States of America
| | - Michelle M. Mielke
- Mayo Clinic College of Medicine, Department of Neurology, Rochester, Minnesota, United States of America
- Mayo Clinic College of Medicine, Department of Health Sciences Research, Rochester, Minnesota, United States of America
| | - Eduardo E. Benarroch
- Mayo Clinic College of Medicine, Department of Neurology, Rochester, Minnesota, United States of America
| | - Moses Rodriguez
- Mayo Clinic College of Medicine, Department of Neurology, Rochester, Minnesota, United States of America
| | - Mary M. Machulda
- Mayo Clinic College of Medicine, Department of Psychiatry and Psychology, Rochester, Minnesota, United States of America
| | - Timothy G. Lesnick
- Mayo Clinic College of Medicine, Department of Health Sciences Research, Rochester, Minnesota, United States of America
| | - David S. Knopman
- Mayo Clinic College of Medicine, Department of Neurology, Rochester, Minnesota, United States of America
| | - Ronald C. Petersen
- Mayo Clinic College of Medicine, Department of Neurology, Rochester, Minnesota, United States of America
| | - Clifford R. Jack
- Mayo Clinic College of Medicine, Department of Radiology, Rochester, Minnesota, United States of America
| | - Kejal Kantarci
- Mayo Clinic College of Medicine, Department of Radiology, Rochester, Minnesota, United States of America
| | - Orhun H. Kantarci
- Mayo Clinic College of Medicine, Department of Neurology, Rochester, Minnesota, United States of America
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Yurtoğulları Ş, Taşkapılıoğlu Ö, Öztürk B, Bilgiç B, Hakyemez B, Türkeş N, Gelişken Ö, Turan ÖF, Bakar M. Comparison of Brain Atrophy, Cognition and Optical Coherence Tomography Results Between Multiple Sclerosis Patients and Healthy Controls. NORO PSIKIYATRI ARSIVI 2018; 55:3-8. [PMID: 30042634 DOI: 10.29399/npa.12534] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 05/10/2016] [Indexed: 11/07/2022]
Abstract
Introduction Cognitive impairment is also an important cause of disability in MS in addition to motor, sensory, visual, and cerebellar affections. The aim of this study is to show the relation between the cognitive disability in MS with brain atrophy and retinal nerve fiber layer (RNFL). Methods Forty-three multiple sclerosis (MS) patients, and 15 healthy individuals as controls were included in the study. MS patients were divided into three groups as relapsing-remitting MS (RRMS), relapsing-remitting with optic neuritis (RRMS+ON), and secondary-progressive MS (SPMS). An experienced psychologist performed modified Wechsler Memory Scale Revised form (WMS-R), Lines Orientation test, Stroop Color Word Interference test (STROOP), Standard Raven Progressive Matrices (SRPM), Benton Facial Recognition Test, verbal fluency test, and Paced Auditory Serial Addition tests in all cases. Optic coherence tomographies (OCT) were done. Cranial subcortical volumes of all subjects were measured using 3-dimensonal T1A imagines obtained by the cranial subcortical 1.5 tesla MR device (fully automatic Freesurfer program). Brain parenchymal fractions were calculated by proportioning the obtained volume measurements to the total intracranial volume. Results Fifty-eight subjects (65.5% female, 34.5% male) were enrolled in the study. There were significant differences among the groups in terms of parenchymal thickness, volumes of third ventricle, and white matter. There was a significant correlation between the volumes of the deep gray matter, mesial temporal structures and lateral ventricular volumes, and the test results of the WMS-R. OCT scores of all MS patients, whether or not they experienced optic neuritis, had increased, being worse especially in the SPMS group. Correlation between RNFL and the brain parenchymal fractions of the patients were statistically significant. Conclusion Manual methods instead of automatic segmentation method are being more commonly used in the studies with brain atrophy and MS in our country. A significant correlation between OCT scores and brain atrophy is shown with our present study, and this is followed as a reflection of decrease in cognitive tests that provides valuable and reliable knowledge for the literature.
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Affiliation(s)
| | | | - Burkay Öztürk
- Department of Radiology, Çorum İskilip State Hospital, Çorum, Turkey
| | - Başar Bilgiç
- Clinic of Neurology, İstanbul University Medical Faculty, İstanbul, Turkey
| | - Bahattin Hakyemez
- Clinic of Neurology, Uludağ University Medical Faculty, Bursa, Turkey
| | - Nevin Türkeş
- Clinic of Neurology, Uludağ University Medical Faculty, Bursa, Turkey
| | - Öner Gelişken
- Department of Ophthalmology, Uludağ University Medical Faculty, Bursa, Turkey
| | - Ömer Faruk Turan
- Clinic of Neurology, Uludağ University Medical Faculty, Bursa, Turkey
| | - Mustafa Bakar
- Clinic of Neurology, Uludağ University Medical Faculty, Bursa, Turkey
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Shiri V, Emami M, Shiri E. Investigating the Relationship Between Selective Attention and Cognitive Flexibility With Balance in Patients With Relapsing-Remitting Multiple Sclerosis. JOURNAL OF REHABILITATION 2018. [DOI: 10.21859/jrehab.18.4.4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Estudio del estatus laboral y el nivel socioeconómico en personas con esclerosis múltiple en 2 centros de Buenos Aires. ACTA ACUST UNITED AC 2018. [DOI: 10.1016/j.neuarg.2017.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Uher T, Krasensky J, Sobisek L, Blahova Dusankova J, Seidl Z, Kubala Havrdova E, Sormani MP, Horakova D, Kalincik T, Vaneckova M. Cognitive clinico-radiological paradox in early stages of multiple sclerosis. Ann Clin Transl Neurol 2017; 5:81-91. [PMID: 29376094 PMCID: PMC5771324 DOI: 10.1002/acn3.512] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 11/03/2017] [Accepted: 11/15/2017] [Indexed: 01/10/2023] Open
Abstract
Objective To investigate whether the strength of the association between magnetic resonance imaging (MRI) metrics and cognitive outcomes differs between various multiple sclerosis subpopulations. Methods A total of 1052 patients were included in this large cross‐sectional study. Brain MRI (T1 and T2 lesion volume and brain parenchymal fraction) and neuropsychological assessment (Brief International Cognitive Assessment for Multiple Sclerosis and Paced Auditory Serial Addition Test) were performed. Results Weak correlations between cognitive domains and MRI measures were observed in younger patients (age≤30 years; absolute Spearman's rho = 0.05–0.21), with short disease duration (<2 years; rho = 0.01–0.21), low Expanded Disability Status Scale [EDSS] (≤1.5; rho = 0.08–0.18), low T2 lesion volume (lowest quartile; <0.59 mL; rho = 0.01–0.20), and high brain parenchymal fraction (highest quartile; >86.66; rho = 0.01–0.16). Stronger correlations between cognitive domains and MRI measures were observed in older patients (age>50 years; rho = 0.24–0.50), with longer disease duration (>15 years; rho = 0.26–0.53), higher EDSS (≥5.0; rho = 0.23–0.39), greater T2 lesion volume (highest quartile; >5.33 mL; rho = 0.16–0.32), and lower brain parenchymal fraction (lowest quartile; <83.71; rho = 0.13–0.46). The majority of these observed results were confirmed by significant interactions (P ≤ 0.01) using continuous variables. Interpretation The association between structural brain damage and functional cognitive impairment is substantially weaker in multiple sclerosis patients with a low disease burden. Therefore, disease stage should be taken into consideration when interpreting associations between structural and cognitive measures in clinical trials, research studies, and clinical practice.
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Affiliation(s)
- Tomas Uher
- Department of Neurology and Center of Clinical Neuroscience First Faculty of Medicine Charles University and General University Hospital in Prague Prague Czech Republic
| | - Jan Krasensky
- Department of Radiodiagnostic First Faculty of Medicine Charles University and General University Hospital in Prague Prague Czech Republic
| | - Lukas Sobisek
- Department of Statistics and Probability University of Economics in Prague Prague Czech Republic
| | - Jana Blahova Dusankova
- Department of Neurology and Center of Clinical Neuroscience First Faculty of Medicine Charles University and General University Hospital in Prague Prague Czech Republic
| | - Zdenek Seidl
- Department of Radiodiagnostic First Faculty of Medicine Charles University and General University Hospital in Prague Prague Czech Republic
| | - Eva Kubala Havrdova
- Department of Neurology and Center of Clinical Neuroscience First Faculty of Medicine Charles University and General University Hospital in Prague Prague Czech Republic
| | | | - Dana Horakova
- Department of Neurology and Center of Clinical Neuroscience First Faculty of Medicine Charles University and General University Hospital in Prague Prague Czech Republic
| | - Tomas Kalincik
- CORe Department of Medicine University of Melbourne Melbourne Australia.,Department of Neurology Royal Melbourne Hospital Melbourne Australia
| | - Manuela Vaneckova
- Department of Radiodiagnostic First Faculty of Medicine Charles University and General University Hospital in Prague Prague Czech Republic
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Wybrecht D, Reuter F, Pariollaud F, Zaaraoui W, Le Troter A, Rico A, Confort-Gouny S, Soulier E, Guye M, Maarouf A, Ranjeva JP, Pelletier J, Audoin B. New brain lesions with no impact on physical disability can impact cognition in early multiple sclerosis: A ten-year longitudinal study. PLoS One 2017; 12:e0184650. [PMID: 29149177 PMCID: PMC5693435 DOI: 10.1371/journal.pone.0184650] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 08/28/2017] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE In early multiple sclerosis, although brain T2 lesions accrual are hallmark of the disease, only weak correlations were found between T2 lesions accrual and EDSS progression, the disability scale commonly used in multiple sclerosis studies. This may be related to the very poor sensitivity of EDSS to cognitive dysfunctions that may occur and progress from the first stage of the disease. In the present study, we aimed to demonstrate that cognitive deficits progress during the first ten years of MS and are significantly impacted by new T2 lesions. METHODS EDSS and extensive neuropsychological battery (22 measures) exploring memory, attention/speed of information processing and executive functions were assessed at baseline, Year 1 and Year 10 in 26 patients enrolled after their first clinical attack. To limit the bias of test-retest effect, only measures obtained at Year 1 and Year 10 were reported in the analysis. Raw scores of patients were transformed into z-scores using published normative data when available or scores of matched controls. Lesion probability mapping was used to assess the potential relationships between T2 lesions accumulation, cognitive decline and EDSS progression (P<0.05, FWE-corrected). RESULTS At Year 1, 27% of patients showed attention/speed of information processing deficits, 11.5% executive dysfunction and 11.5% memory impairment. During the follow-up, frequency and severity of executive dysfunction increased (from 11.5% of patients at Year 1 to 42% at Year 10, p<0.01) while no significant changes were evidenced for the other cognitive domains. Median EDSS increased from 0.5 [range: 0-3] at Year 1 to 2.5 [range: 0-6.5] at Year 10 (p<0.001). During the ten-year follow-up, lesions accumulation in the left cerebellum and semi-ovale centers was associated with EDSS progression. In contrast, most lesions accumulation in the frontal, parietal and temporal lobes were associated with cognitive decline but had no effect on EDSS progression. CONCLUSION The present study provides strong evidence that clinically silent T2 lesions impact cognition in early MS. In daily practice, early prevention of T2 lesions accrual may be useful to limit cognitive decline.
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Affiliation(s)
- D. Wybrecht
- Aix-Marseille Université, CNRS, CRMBM UMR 7339, Marseille, France
- Hôpital d’Instruction des Armées Sainte Anne, Toulon, France
- * E-mail:
| | - F. Reuter
- Aix-Marseille Université, CNRS, CRMBM UMR 7339, Marseille, France
- APHM, Hôpital de la Timone, Pôle de Neurosciences Cliniques, Service de Neurologie, Marseille, France
| | - F. Pariollaud
- Aix-Marseille Université, CNRS, CRMBM UMR 7339, Marseille, France
- APHM, Hôpital de la Timone, Pôle de Neurosciences Cliniques, Service de Neurologie, Marseille, France
| | - W. Zaaraoui
- Aix-Marseille Université, CNRS, CRMBM UMR 7339, Marseille, France
| | - A. Le Troter
- Aix-Marseille Université, CNRS, CRMBM UMR 7339, Marseille, France
| | - A. Rico
- Aix-Marseille Université, CNRS, CRMBM UMR 7339, Marseille, France
- APHM, Hôpital de la Timone, Pôle de Neurosciences Cliniques, Service de Neurologie, Marseille, France
| | - S. Confort-Gouny
- Aix-Marseille Université, CNRS, CRMBM UMR 7339, Marseille, France
| | - E. Soulier
- Aix-Marseille Université, CNRS, CRMBM UMR 7339, Marseille, France
| | - M. Guye
- Aix-Marseille Université, CNRS, CRMBM UMR 7339, Marseille, France
- APHM, Hôpital de la Timone, Pôle d’Imagerie Médicale, CEMEREM, Marseille, France
| | - A. Maarouf
- Aix-Marseille Université, CNRS, CRMBM UMR 7339, Marseille, France
- APHM, Hôpital de la Timone, Pôle de Neurosciences Cliniques, Service de Neurologie, Marseille, France
| | - J-P. Ranjeva
- Aix-Marseille Université, CNRS, CRMBM UMR 7339, Marseille, France
| | - J. Pelletier
- Aix-Marseille Université, CNRS, CRMBM UMR 7339, Marseille, France
- APHM, Hôpital de la Timone, Pôle de Neurosciences Cliniques, Service de Neurologie, Marseille, France
| | - B. Audoin
- Aix-Marseille Université, CNRS, CRMBM UMR 7339, Marseille, France
- APHM, Hôpital de la Timone, Pôle de Neurosciences Cliniques, Service de Neurologie, Marseille, France
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38
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Vanotti S, Caceres FJ. Cognitive and neuropsychiatric disorders among MS patients from Latin America. Mult Scler J Exp Transl Clin 2017; 3:2055217317717508. [PMID: 28979791 PMCID: PMC5617097 DOI: 10.1177/2055217317717508] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 06/04/2017] [Indexed: 11/20/2022] Open
Abstract
Cognitive and neuropsychiatric disorders in patients with multiple sclerosis have been extensively documented. The focus of this review will be on cognitive and neuropsychiatric disorders in multiple sclerosis patients from Latin America, in the context of international literature. Multicentre studies carried out in Latin America have shown that 43% of the patients have cognitive impairment and 34.5% in early stages of the disease, 29% depression and 20.9% neuropsychiatric disorders. The profile of cognitive impairment corresponds to alterations in visual and verbal memory, in attention, in information processing speed and in verbal fluency. The neuropsychiatric profile showed disorders in anxiety, depression, apathy and irritability domains. In the region, there exist validations of the multiple sclerosis neuropsychological screening questionnaire (MSNQ), the brief repeatable battery of neuropsychological tests (BRB-N) and the brief international cognitive assessment for multiple sclerosis (BICAMS), as well as of the paced auditory serial addition test (PASAT) and the symbol digit modalities test (SDMT). A study showed that 53% of the patients who met the NEDA3 condition had cognitive impairment. This finding highlights the need for taking cognitive assessment into account when determining therapeutic efficacy.
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Affiliation(s)
| | - Fernando J Caceres
- Multiple Sclerosis Clinic, INEBA - Neurosciences Institute of Buenos Aires, Argentina
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39
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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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40
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Mousavi Majd A, Ebrahim Tabar F, Afghani A, Ashrafpour S, Dehghan S, Gol M, Ashrafpour M, Pourabdolhossein F. Inhibition of GABA A receptor improved spatial memory impairment in the local model of demyelination in rat hippocampus. Behav Brain Res 2017; 336:111-121. [PMID: 28866129 DOI: 10.1016/j.bbr.2017.08.046] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 08/20/2017] [Accepted: 08/29/2017] [Indexed: 12/15/2022]
Abstract
Cognitive impairment and memory deficit are common features in multiple Sclerosis patients. The mechanism of memory impairment in MS is unknown, but neuroimaging studies suggest that hippocampal demyelination is involved. Here, we investigate the role of GABA A receptor on spatial memory in the local model of hippocampal demyelination. Demyelination was induced in male Wistar rats by bilaterally injection of lysophosphatidylcholine (LPC) 1% into the CA1 region of the hippocampus. The treatment groups were received daily intraventricular injection of bicuculline (0.025, 0.05μg/2μl/animal) or muscimol (0.1, 0.2μg/2μl/animal) 5days after LPC injection. Morris Water Maze was used to evaluate learning and memory in rats. We used Luxol fast blue staining and qPCR to assess demyelination extention and MBP expression level respectively. Immunohistochemistry (IHC) for CD45 and H&E staining were performed to assess inflammatory cells infiltration. Behavioral study revealed that LPC injection in the hippocampus impaired learning and memory function. Animals treated with both doses of bicuculline improved spatial learning and memory function; however, muscimol treatment had no effect. Histological and MBP expression studies confirmed that demylination in LPC group was maximal. Bicuculline treatment significantly reduced demyelination extension and increased the level of MBP expression. H&E and IHC results showed that bicuculline reduced inflammatory cell infiltration in the lesion site. Bicuculline improved learning and memory and decreased demyelination extention in the LPC-induced hippocampal demyelination model. We conclude that disruption of GABAergic homeostasis in hippocampal demyelination context may be involved in memory impairment with the implications for both pathophysiology and therapy.
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Affiliation(s)
- Alireza Mousavi Majd
- Student Research Committee, Babol University of Medical Sciences, Babol, Iran; Neuroscience Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Forough Ebrahim Tabar
- Student Research Committee, Babol University of Medical Sciences, Babol, Iran; Neuroscience Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Arghavan Afghani
- Student Research Committee, Babol University of Medical Sciences, Babol, Iran; Neuroscience Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Sahand Ashrafpour
- Student Research Committee, Babol University of Medical Sciences, Babol, Iran; Neuroscience Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Samaneh Dehghan
- Physiology Departments, Faculty of Medicine, Tarbiat Modares University, Tehran, Iran
| | - Mohammad Gol
- Student Research Committee, Babol University of Medical Sciences, Babol, Iran
| | - Manouchehr Ashrafpour
- Neuroscience Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran; Physiology Departments, Faculty of Medicine, Babol University of Medical Sciences, Babol, Iran
| | - Fereshteh Pourabdolhossein
- Cellular and Molecular Biology Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran; Neuroscience Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran; Physiology Departments, Faculty of Medicine, Babol University of Medical Sciences, Babol, Iran.
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41
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Cognitive Impairment in Relapsing-Remitting Multiple Sclerosis Patients with Very Mild Clinical Disability. Behav Neurol 2017; 2017:7404289. [PMID: 28912625 PMCID: PMC5574272 DOI: 10.1155/2017/7404289] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 05/24/2017] [Accepted: 06/12/2017] [Indexed: 01/23/2023] Open
Abstract
Cognitive dysfunction affects 40–65% of multiple sclerosis (MS) patients and can occur in the early stages of the disease. This study aimed to explore cognitive functions by means of the Italian version of the minimal assessment of cognitive function in MS (MACFIMS) in relapsing-remitting MS (RRMS) patients with very mild clinical disability to identify the primarily involved cognitive functions. Ninety-two consecutive RRMS patients with Expanded Disability Status Scale (EDSS) scores ≤ 2.5 and forty-two healthy controls (HC) were investigated. Our results show that 51.1% of MS patients have cognitive dysfunction compared to HC. An impairment of verbal and visual memory, working memory, and executive functions was found in the RRMS group. After subgrouping RRMS by EDSS, group 1 (EDSS ≤ 1.5) showed involvement of verbal memory and executive functions; moreover, group 2 (2 ≤ EDSS ≤ 2.5) patients were also impaired in information processing speed and visual memory. Our results show that utilizing a comprehensive neuropsychological assessment, approximately half of MS patients with very mild physical disability exhibit cognitive impairment with a primary involvement of prefrontal cognitive functions. Detecting impairment of executive functions at an early clinical stage of disease could be useful to promptly enroll MS patients in targeted rehabilitation.
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Cortese M, Riise T, Bjørnevik K, Bhan A, Farbu E, Grytten N, Hogenesch I, Midgard R, Smith Simonsen C, Telstad W, Ascherio A, Myhr KM. Preclinical disease activity in multiple sclerosis: A prospective study of cognitive performance prior to first symptom. Ann Neurol 2017; 80:616-24. [PMID: 27554176 DOI: 10.1002/ana.24769] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 08/16/2016] [Accepted: 08/17/2016] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To prospectively investigate potential signs of preclinical multiple sclerosis (MS) activity and when they are present prior to first symptom using data from a historical cohort. METHODS We linked the cognitive performance of all Norwegian men born 1950-1995 who underwent conscription examination at age 18 to 19 years to the Norwegian MS registry to identify those later developing MS, and randomly selected controls frequency-matched on year of birth from the Norwegian Conscript Service database. In this nested case-control study, cognitive test scores were available for 924 male cases and 19,530 male controls. We estimated mean score differences among cases and controls (Student t test) and the risk of developing MS comparing lower to higher scores (Cox regression) in strata of years to clinical onset. RESULTS Men developing first clinical MS symptoms up to 2 years after the examination scored significantly lower than controls (Δ = 0.80, p = 0.0095), corresponding to a 6 intelligence quotient (IQ)-point difference. Those scoring lowest, that is, >1 standard deviation below the controls' mean, had an increased MS risk during the 2 following years (relative risk = 2.81, 95% confidence interval = 1.52-5.20). Whereas results were similar for relapsing-remitting MS cases (RRMS), those developing primary-progressive MS (PPMS) scored a significant 4.6 to 6.9 IQ points lower than controls up to 20 years prior to first progressive symptoms. INTERPRETATION RRMS may start years prior to clinical presentation, and disease processes in PPMS could start decades prior to first apparent progressive symptoms. Cognitive problems could be present in both MS forms before apparent symptoms. Apart from potential implications for clinical practice and research, these findings challenge our thinking about the disease. Ann Neurol 2016;80:616-624.
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Affiliation(s)
- Marianna Cortese
- Department of Clinical Medicine, University of Bergen, Bergen, Norway. .,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway. .,Norwegian MS Competence Center, Haukeland University Hospital, Bergen, Norway.
| | - Trond Riise
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Norwegian MS Competence Center, Haukeland University Hospital, Bergen, Norway
| | - Kjetil Bjørnevik
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Norwegian MS Competence Center, Haukeland University Hospital, Bergen, Norway
| | - Alok Bhan
- Department of Neurology, Stavanger University Hospital, Stavanger, Norway
| | - Elisabeth Farbu
- Department of Neurology, Stavanger University Hospital, Stavanger, Norway
| | - Nina Grytten
- Norwegian MS Competence Center, Haukeland University Hospital, Bergen, Norway.,Kristian Gerhard Jebsen Center for MS Research, Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Ineke Hogenesch
- Department of Neurology, Haugesund Hospital, Haugesund, Norway
| | - Rune Midgard
- Department of Neurology, Molde Hospital, Molde, Norway.,Unit for Applied Clinical Research, Norwegian University of Science and Technology, Trondheim, Norway
| | | | | | - Alberto Ascherio
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA.,Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA.,Channing Division of Network Medicine of the Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Kjell-Morten Myhr
- Norwegian MS Competence Center, Haukeland University Hospital, Bergen, Norway.,Kristian Gerhard Jebsen Center for MS Research, Department of Clinical Medicine, University of Bergen, Bergen, Norway.,Norwegian MS Registry and Biobank, Haukeland University Hospital, Bergen, Norway
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43
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The Mirror Neuron System in Relapsing Remitting Multiple Sclerosis Patients with Low Disability. Brain Topogr 2017; 30:548-559. [DOI: 10.1007/s10548-017-0558-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 03/07/2017] [Indexed: 10/19/2022]
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44
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Cognitive impairment and structural brain changes in patients with clinically isolated syndrome at high risk for multiple sclerosis. J Neurol 2016; 264:482-493. [DOI: 10.1007/s00415-016-8368-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Revised: 12/10/2016] [Accepted: 12/16/2016] [Indexed: 10/20/2022]
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45
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Cinar BP, Kösehasanoğulları G, Yigit P, Ozakbas S. Cognitive dysfunction in patients with multiple sclerosis treated with first-line disease-modifying therapy: a multi-center, controlled study using the BICAMS battery. Neurol Sci 2016; 38:337-342. [DOI: 10.1007/s10072-016-2775-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Accepted: 11/18/2016] [Indexed: 10/20/2022]
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46
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The association of cognitive impairment with gray matter atrophy and cortical lesion load in clinically isolated syndrome. Mult Scler Relat Disord 2016; 10:14-21. [DOI: 10.1016/j.msard.2016.08.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2016] [Revised: 08/03/2016] [Accepted: 08/12/2016] [Indexed: 11/19/2022]
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47
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Giannakopoulou A, Lyras GA, Grigoriadis N. Long-term effects of autoimmune CNS inflammation on adult hippocampal neurogenesis. J Neurosci Res 2016; 95:1446-1458. [PMID: 27781303 DOI: 10.1002/jnr.23982] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 10/09/2016] [Accepted: 10/10/2016] [Indexed: 01/03/2023]
Abstract
Neurogenesis is a well-characterized phenomenon within the dentate gyrus (DG) of the adult hippocampus. Aging and chronic degenerative disorders have been shown to impair hippocampal neurogenesis, but the consequence of chronic inflammation remains controversial. In this study the chronic experimental autoimmune encephalomyelitis (EAE) mouse model of multiple sclerosis was used to investigate the long-term effects of T cell-mediated central nervous system inflammation on hippocampal neurogenesis. 5-Bromodeoxyuridine (BrdU)-labeled subpopulations of hippocampal cells in EAE and control mice (coexpressing GFAP, doublecortin, NeuN, calretinin, and S100) were quantified at the recovery phase, 21 days after BrdU administration, to estimate alterations on the rate and differentiation pattern of the neurogenesis process. The core features of EAE mice DG are (i) elevated number of newborn (BrdU+) cells indicating vigorous proliferation, which in the long term subsided; (ii) enhanced migration of newborn cells into the granule cell layer; (iii) increased level of immature neuronal markers (including calretinin and doublecortin); (iv) trending decrease in the percentage of newborn mature neurons; and (v) augmented gliogenesis and differentiation of newborn neural precursor cells (NPCs) to mature astrocytes (BrdU+/S100+). Although the inflammatory environment in the brain of EAE mice enhances the proliferation of hippocampal NPCs, in the long term neurogenesis is progressively depleted, giving prominence to gliogenesis. The discrepancy between the high number of immature cells and the low number of mature newborn cells could be the result of a caused defect in the maturation pathway. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Aggeliki Giannakopoulou
- Laboratory of Anatomy, Histology and Embryology, Faculty of Veterinary Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - George A Lyras
- Department of Historical Geology and Palaeontology, Faculty of Geology and Geoenvironment, University of Athens, Athens, Greece
| | - Nikolaos Grigoriadis
- Laboratory of Experimental Neurology and Neuroimmunology, 2nd Department of Neurology, AHEPA University Hospital, Thessaloniki, Greece
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48
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Planche V, Ruet A, Coupé P, Lamargue-Hamel D, Deloire M, Pereira B, Manjon JV, Munsch F, Moscufo N, Meier DS, Guttmann CR, Dousset V, Brochet B, Tourdias T. Hippocampal microstructural damage correlates with memory impairment in clinically isolated syndrome suggestive of multiple sclerosis. Mult Scler 2016; 23:1214-1224. [PMID: 27780913 DOI: 10.1177/1352458516675750] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE We investigated whether diffusion tensor imaging (DTI) could reveal early hippocampal damage and clinically relevant correlates of memory impairment in persons with clinically isolated syndrome (CIS) suggestive of multiple sclerosis (MS). METHODS A total of 37 persons with CIS, 32 with MS and 36 controls prospectively included from 2011 to 2014 were tested for cognitive performances and scanned with 3T-magnetic resonance imaging (MRI) to assess volumetric and DTI changes within the hippocampus, whole brain volume and T2-lesion load. RESULTS While there was no hippocampal atrophy in the CIS group, hippocampal fractional anisotropy (FA) was significantly decreased compared to controls. Decrease in hippocampal FA together with increased mean diffusivity (MD) was even more prominent in MS patients. In CIS, hippocampal MD was correlated with episodic verbal memory performance ( r = -0.57, p = 0.0002 and odds ratio (OR) = 0.058, 95% confidence interval (CI) = 0.0057-0.59, p = 0.016 adjusted for age, gender, depression and T2-lesion load), but not with cognitive tasks unrelated to hippocampal functions. Hippocampal MD was the only variable discriminating memory-impaired from memory-preserved persons with CIS (area under the curve (AUC) = 0.77, sensitivity = 90.0%, specificity = 70.3%, positive predictive value (PPV) = 52.9%, negative predictive value (NPV) = 95.0%). CONCLUSION DTI alterations within the hippocampus might reflect early neurodegenerative processes that are correlated with episodic memory performance, discriminating persons with CIS according to their memory status.
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Affiliation(s)
- Vincent Planche
- Universite de Bordeaux, Bordeaux, France/Inserm U1215, Neurocentre Magendie, Bordeaux, France/Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - Aurélie Ruet
- Universite de Bordeaux, Bordeaux, France/Inserm U1215, Neurocentre Magendie, Bordeaux, France/Centre Hospitalier Universitaire (CHU) de Bordeaux, Bordeaux, France
| | - Pierrick Coupé
- Laboratoire Bordelais de Recherche en Informatique (LaBRI), Talence, France
| | - Delphine Lamargue-Hamel
- Universite de Bordeaux, Bordeaux, France/Inserm U1215, Neurocentre Magendie, Bordeaux, France
| | - Mathilde Deloire
- Centre Hospitalier Universitaire (CHU) de Bordeaux, Bordeaux, France
| | - Bruno Pereira
- Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - José V Manjon
- Universitat Politècnica de València, Valencia, Spain
| | - Fanny Munsch
- Universite de Bordeaux, Bordeaux, France/Inserm U1215, Neurocentre Magendie, Bordeaux, France
| | - Nicola Moscufo
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Dominik S Meier
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Charles Rg Guttmann
- Universite de Bordeaux, Bordeaux, France/Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Vincent Dousset
- Universite de Bordeaux, Bordeaux, France/Inserm U1215, Neurocentre Magendie, Bordeaux, France/Centre Hospitalier Universitaire (CHU) de Bordeaux, Bordeaux, France
| | - Bruno Brochet
- Universite de Bordeaux, Bordeaux, France/Inserm U1215, Neurocentre Magendie, Bordeaux, France/Centre Hospitalier Universitaire (CHU) de Bordeaux, Bordeaux, France
| | - Thomas Tourdias
- Universite de Bordeaux, Bordeaux, France/Inserm U1215, Neurocentre Magendie, Bordeaux, France/Centre Hospitalier Universitaire (CHU) de Bordeaux, Bordeaux, France
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Roar M, Illes Z, Sejbaek T. Practice effect in Symbol Digit Modalities Test in multiple sclerosis patients treated with natalizumab. Mult Scler Relat Disord 2016; 10:116-122. [PMID: 27919477 DOI: 10.1016/j.msard.2016.09.009] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 09/19/2016] [Accepted: 09/26/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVES How practice effect influences cognitive testing measured by monthly Symbol Digit Modalities Test (SDMT) during natalizumab treatment, and what factors confound such effect. METHODS Eighty patients were examined monthly with SDMT for 26.2±8.4 months. After 26.0±8.1 months, SDMT was also performed with a rearranged key in 59 cases. Results of SDMTs with the rearranged and previous regular key were compared. We examined if gender, age, Extended Disability Status Scale (EDSS), relapses, and disability progression/improvement influence SDMT performed with the regular and the rearranged key, respectively. We also explored if natalizumab applied before regular monthly SDMT may influence practice effect and cognition. RESULTS SDMT performance improved by 1.2 points/test during the first six months and by 0.4 points/test thereafter. Rearranging the symbols of the key after 26.0±8.1 months returned SDMT scores to baseline indicating a practice effect. Such practice effect was more significant after longer testing period, but was not influenced by gender, age, relapses, disability progression and prior natalizumab treatment. Although the change from baseline to 2.5 years was significant in subgroups with EDSS 0-3, 3.5-5.5 and 6-7.5, this was higher in patients with EDSS 0-3 compared to 6-7.5. CONCLUSIONS Practice effect significantly contributes to continuous improvement in SDMT performance during natalizumab treatment: to test cognition, a change in key is required. Practice effect is less pronounced in patients with advanced disease. Cognition remains stable even in patients with progressive disease during more than 2 years of natalizumab treatment indicated by scores corresponding to baseline after changing the key.
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Affiliation(s)
- Malte Roar
- Department of Neurology, Odense University Hospital, Sdr. Boulevard 29, Odense 5000, Denmark
| | - Zsolt Illes
- Department of Neurology, Odense University Hospital, Sdr. Boulevard 29, Odense 5000, Denmark; Institute of Clinical Research, University of Southern Denmark, Denmark.
| | - Tobias Sejbaek
- Department of Neurology, Odense University Hospital, Sdr. Boulevard 29, Odense 5000, Denmark
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50
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Trenova AG, Slavov GS, Manova MG, Aksentieva JB, Miteva LD, Stanilova SA. Cognitive Impairment in Multiple Sclerosis. Folia Med (Plovdiv) 2016; 58:157-163. [DOI: 10.1515/folmed-2016-0029] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 06/20/2016] [Indexed: 11/15/2022] Open
Abstract
Abstract
Multiple sclerosis (MS) is a socially significant immune-mediated disease, characterized by demyelination, axonal transection and oligodendropathy in the central nervous system. Inflammatory demyelination and neurodegeneration lead to brain atrophy and cognitive deficit in up to 75% of the patients. Cognitive dysfunctions impact significantly patients’ quality of life, independently from the course and phase of the disease.
The relationship between pathological brain findings and cognitive impairment is a subject of intensive research.
Summarizing recent data about prevalence, clinical specificity and treatment of cognitive disorders in MS, this review aims to motivate the necessity of early diagnosis and complex therapeutic approach to these disturbances in order to reduce the social burden of the disease.
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