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Elosúa MR, Villadangos N. Executive functions in relapsing-remitting multiple sclerosis. APPLIED NEUROPSYCHOLOGY. ADULT 2023:1-9. [PMID: 37930795 DOI: 10.1080/23279095.2023.2252125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Abstract
Some studies suggest that patients with relapsing-remitting multiple sclerosis have problems in the functioning of working memory, and more specifically in executive functions, but the available results are still inconsistent. The aim of the present study was to examine executive functioning in multiple sclerosis using classical and representative tasks for divided attention, updating, attentional shifting, and inhibition. The sample was composed of 48 participants aged between 18 and 59 years (24 persons living with multiple sclerosis and 24 healthy participants matched in age and education level). The executive functions of divided attention, updating, attentional shifting, and inhibition were analyzed through the Dual-Task Paradigm, the N-Back task, the Trail Making Test (TMT), and the Stroop test, respectively. The analyses of the data showed that the functioning of working memory was impaired in multiple sclerosis in the executive functions of divided attention and updating when the group of persons living with MS and the control group were compared. In addition, the performance in the four executive functions analyzed did not show the same profile across the persons living with MS in the sample, as no deficit in attentional shifting or inhibition was observed. It can be concluded that the presence of deficits was observed only in the executive functions of divided attention and updating under the condition of greater cognitive demand. The clinical implications of these results are underlined due to their impact on daily life.
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Affiliation(s)
- M Rosa Elosúa
- Departamento de Psicología Básica I, UNED, Madrid, Spain
| | - Noelia Villadangos
- Departamento de Psicología Básica I, UNED, Madrid, Spain
- Fundación de Esclerosis Múltiple de Madrid, Madrid, Spain
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2
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Rook J, Llufriu S, de Kok D, Rofes A. Language impairments in people with autoimmune neurological diseases: A scoping review. JOURNAL OF COMMUNICATION DISORDERS 2023; 106:106368. [PMID: 37717472 DOI: 10.1016/j.jcomdis.2023.106368] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 08/02/2023] [Accepted: 08/16/2023] [Indexed: 09/19/2023]
Abstract
INTRODUCTION Autoimmune neurological diseases (ANDs) are a specific type of autoimmune disease that affect cells within the central and peripheral nervous system. ANDs trigger various physical/neuropsychiatric symptoms. However, language impairments in people with ANDs are not well characterized. Here we aimed to determine the kinds of language impairment that most commonly emerge in 10 ANDs, the characteristics of the patients (demographic, neurological damage), and the assessment methods used. METHODS We followed the PRISMA Extension for Scoping Reviews (PRISMA-ScR). PubMed and Google Scholar were searched. We used a list of search terms containing 10 types of ANDs (e.g., multiple sclerosis, acute disseminated encephalomyelitis) in combination with the terms aphasia, dysphasia, fluency, language, listening, morphology, phonology, pragmatics, reading, semantics, speaking, syntax, writing. The reference lists and citations of the relevant papers were also investigated. The type of AND, patient characteristics, neurological damage and examination technique, language tests administered, and main findings were noted for each study meeting the inclusion criteria. RESULTS We found 171 studies meeting our inclusion criteria. These comprised group studies and case studies. Language impairments differed largely among types of ANDs. Neurological findings were mentioned in most of the papers, but specific language tests were rarely used. CONCLUSIONS Language symptoms in people with ANDs are commonly reported. These are often not full descriptions or only focus on specific time points in the course of the disease. Future research needs to assess specific language functions in people with ANDs and relate their language impairments to brain damage at different stages of disease evolution.
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Affiliation(s)
- Janine Rook
- Center for Language and Cognition, University of Groningen, Groningen, The Netherlands; Research School of Behavioural and Cognitive Neurosciences, University of Groningen, Groningen, The Netherlands
| | - Sara Llufriu
- Center of Neuroimmunology, Laboratory of Advanced Imaging in Neuroimmunological Diseases, Hospital Clinic Barcelona, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Dörte de Kok
- Center for Language and Cognition, University of Groningen, Groningen, The Netherlands
| | - Adrià Rofes
- Center for Language and Cognition, University of Groningen, Groningen, The Netherlands.
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3
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Weigel M, Hutchinson B, Magee WL, Leong K, Sweitzer T, Weiss JL, Su W, Fleming R. Orchestrating a New Path for Multiple Sclerosis: Achieving Physical, Cognitive, and Emotional Rehabilitation Goals Through Physical and Music Therapy. Int J MS Care 2023; 25:168-175. [PMID: 37469330 PMCID: PMC10353696 DOI: 10.7224/1537-2073.2021-144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]
Abstract
BACKGROUND Interdisciplinary therapies for the management of people with multiple sclerosis (MS) are underappreciated. There is an urgent need to introduce music therapy (MT), either alone or in combination with physical therapy (PT), into clinical practice to achieve synergy with disease-modifying therapies. A holistic approach to rehabilitation for people with MS may mitigate symptoms and reduce polypharmacy, potentially lowering health care costs. RESULTS As MS progresses, patients experience a range of worsening symptoms, and many develop psychosocial comorbidities. As disease-modifying therapies delay disability progression, nonpharmacologic treatments become increasingly important. The main aim of PT is to improve or maintain patients' functional mobility, strength, and flexibility. Because it targets multiple functions, MT can help improve functional and psychosocial domains and may be a valuable intervention to help patients achieve the physical, cognitive, and emotional goals of PT. Exploratory studies showed that MT, alone or in combination with PT, can lead to functional improvements in mobility, balance, gait, and fatigue. Similar to PT, MT also has benefits in improving fine motor skills, cognition, learning, and memory and in providing emotional support. CONCLUSIONS Both MT and PT have the potential to improve overall well-being and health-related quality of life in physically active patients with MS, and MT can provide added emotional support for those who are less able to engage in physical activity. However, MT is not typically a part of standard of care, and PT visits are limited. Nevertheless, interdisciplinary therapies should be incorporated into clinical practice.
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Affiliation(s)
- Megan Weigel
- From First Coast Integrative Medicine, Jacksonville Beach, FL, USA (MW)
| | | | - Wendy L. Magee
- Boyer College of Music and Dance, Temple University, Philadelphia, PA, USA (WLM)
| | | | | | - Jamie L. Weiss
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA (JLW, WS)
| | - Wendy Su
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA (JLW, WS)
| | - Renée Fleming
- John F. Kennedy Center for the Performing Arts, Washington, DC, USA (RF)
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4
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Ostellino S, Benso A, Politano G. The integration of clinical data in the assessment of multiple sclerosis - A review. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2022; 221:106900. [PMID: 35623208 DOI: 10.1016/j.cmpb.2022.106900] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 05/18/2022] [Accepted: 05/18/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND AND OBJECTIVES Multiple Sclerosis (MS) is a neurological disease associated with various and heterogeneous clinical characteristics. Given its complex nature and its unpredictable evolution over time, there isn't an established and exhaustive clinical protocol (or tool) for its diagnosis nor for monitoring its progression. Instead, different clinical exams and physical/psychological evaluations need to be taken into account. The Expanded Disability Status Scale (EDSS) is the most used clinical scale, but it suffers from several limitations. Developing computational solutions for the identification of bio-markers of disease progression that overcome the downsides of currently used scales is crucial and is gaining interest in current literature and research. METHODS This Review focuses on the importance of approaching MS diagnosis and monitoring by investigating correlations between cognitive impairment and clinical data that refer to different MS domains. We review papers that integrate heterogeneous data and analyse them with statistical methods to understand their applicability into more advanced computational tools. Particular attention is paid to the impact that computational approaches can have on personalized-medicine. RESULTS Personalized medicine for neuro-degenerative diseases is an unmet clinical need which can be addressed using computational approaches able to efficiently integrate heterogeneous clinical data extracted from both private and publicly available electronic health databases. CONCLUSIONS Reliable and explainable Artificial Intelligence are computational approaches required to understand the complex and demonstrated interactions between MS manifestations as well as to provide reliable predictions on the disease evolution, representing a promising research field.
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Affiliation(s)
- Sofia Ostellino
- Department of Control and Computer Engineering, Politecnico di Torino, Italy.
| | - Alfredo Benso
- Department of Control and Computer Engineering, Politecnico di Torino, Italy.
| | - Gianfranco Politano
- Department of Control and Computer Engineering, Politecnico di Torino, Italy.
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Langensee L, Mårtensson J, Jönsen A, Zervides K, Bengtsson A, Nystedt J, Cannerfelt B, Nilsson P, Mannfolk P, Lätt J, Rumetshofer T, Sundgren PC. Cognitive performance in systemic lupus erythematosus patients: a cross-sectional and longitudinal study. BMC Rheumatol 2022; 6:22. [PMID: 35440096 PMCID: PMC9019974 DOI: 10.1186/s41927-022-00253-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 02/16/2022] [Indexed: 12/02/2022] Open
Abstract
Background Previous research has provided evidence for cognitive dysfunction as a common symptom of systemic lupus erythematosus (SLE). In light of this, the primary goal of this study was to investigate how cognitive impairment in this patient group develops over time. In addition, the present dataset contributes to delineating the specific abilities that are impaired in SLE patients as well as answering the question whether the disease affects the cognition of SLE patients with neuropsychiatric manifestations (NPSLE) and without (non-NPSLE) in distinct ways. Methods 91 female participants (33 NPSLE, 29 non-NPSLE, 29 healthy controls (HC)) underwent standardized neurocognitive testing. A total of ten different cognitive abilities were assessed, among others executive function, memory, and attention. Some of the participants (30 NPSLE patients, 22 non-NPSLE, 13 HC) were tested twice (mean time between testing sessions: 50 months) to enable longitudinal tracking of cognitive abilities. Analyses of Variance (ANOVA) were conducted to determine whether cognitive performance differed cross-sectionally between the groups. Linear mixed effects models were fit to investigate performance differences between the groups over time. Results Cross-sectional analysis at follow-up demonstrated that the cognitive performance of both NPSLE and non-NPSLE was significantly lower than that of HC for the motor speed and the psychomotor speed domain. Additionally, NPSLE patients performed significantly weaker than HC in the complex attention domain. At the same time, the cross-sectional data did not yield any support for performance differences between NPSLE and non-NPSLE patients. Weak positive correlations between disease duration and psychomotor speed, motor speed and reaction time emerged. A temporal progression of cognitive dysfunction in SLE patients was not confirmed. Conclusions Cognitive performance is affected in both non-NPSLE and NPSLE patients. However, a linear decline in performance over time could not be verified. More in-depth longitudinal assessments of cognition in SLE patients are needed to establish how cognitive abilities in this patient population develop over time. Supplementary Information The online version contains supplementary material available at 10.1186/s41927-022-00253-3.
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Affiliation(s)
- L Langensee
- Department of Clinical Sciences Lund, Logopedics, Phoniatrics and Audiology, Faculty of Medicine, Lund University, 22185, Lund, Sweden
| | - J Mårtensson
- Department of Clinical Sciences Lund, Logopedics, Phoniatrics and Audiology, Faculty of Medicine, Lund University, 22185, Lund, Sweden
| | - A Jönsen
- Department of Clinical Sciences Lund, Rheumatology, Faculty of Medicine, Lund University, 22185, Lund, Sweden
| | - K Zervides
- Department of Clinical Sciences Lund, Rheumatology, Faculty of Medicine, Lund University, 22185, Lund, Sweden.,Department of Clinical Sciences Lund, Neurology, Faculty of Medicine, Lund University, 22185, Lund, Sweden
| | - A Bengtsson
- Department of Clinical Sciences Lund, Rheumatology, Faculty of Medicine, Lund University, 22185, Lund, Sweden
| | - J Nystedt
- Department of Clinical Sciences Lund, Radiology, Faculty of Medicine, Lund University, 22185, Lund, Sweden
| | - B Cannerfelt
- Department of Medical Imaging and Physiology, Skåne University Hospital, 221 85, Lund, Sweden
| | - P Nilsson
- Department of Clinical Sciences Lund, Neurology, Faculty of Medicine, Lund University, 22185, Lund, Sweden
| | - P Mannfolk
- Department of Medical Imaging and Physiology, Skåne University Hospital, 221 85, Lund, Sweden
| | - J Lätt
- Department of Medical Imaging and Physiology, Skåne University Hospital, 221 85, Lund, Sweden
| | - T Rumetshofer
- Department of Clinical Sciences Lund, Logopedics, Phoniatrics and Audiology, Faculty of Medicine, Lund University, 22185, Lund, Sweden
| | - P C Sundgren
- Department of Clinical Sciences Lund, Radiology, Faculty of Medicine, Lund University, 22185, Lund, Sweden. .,Department of Medical Imaging and Physiology, Skåne University Hospital, 221 85, Lund, Sweden. .,Lund University BioImaging Center (LBIC), Lund University, 22185, Lund, Sweden.
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6
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Pilipenko P, Ivanova AA, Kotsiubinskaya YV, Feigin V, Majdan M, Grigoryeva VN, Khrulev AY. Randomised, double-blind, placebo-controlled study investigating Safety and efficAcy of MLC901 in post-traUmatic bRAin Injury: the SAMURAI study protocol. BMJ Open 2022; 12:e059167. [PMID: 35418437 PMCID: PMC9014072 DOI: 10.1136/bmjopen-2021-059167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Traumatic brain injury (TBI) is a leading cause of death in young adults globally and 90% of cases are mild TBI. Treatment to facilitate recovery after TBI is needed. Traditional medicine MLC901 (NeuroAiD II) with neuroprotective and neuroproliferative properties in cellular and animal models of brain injury showed TBI-associated cognitive improvement in mild or moderate TBI. METHODS AND ANALYSIS This is a randomised placebo-controlled trial, with 6-month treatment and 9-month follow-up, to determine the safety and efficacy of MLC901 in improving cognitive function in patients with cognitive impairment following mild TBI. This multicentre trial is conducted at the research centres of six hospitals/institutions in Russia. The primary outcome is to determine the effect of MLC901 on complex attention using the CNS Vital Signs (CNS-VS) online neurological test after 6-month treatment in patients receiving MLC901 compared with placebo. Secondary outcomes include other cognitive domains of CNS-VS and Rivermead Post Concussion Symptoms Questionnaire. The exploratory endpoints include Quality of Life after Brain Injury, Hospital Anxiety and Depression Scale and evaluation of improved neurological parameters 3 months after treatment completion. In addition, treatment compliance, concomitant therapies and adverse events will be collected. Investigators will use a secured online system for data entry. ETHICS AND DISSEMINATION The study has been approved by the ethic committee of Ministry of Health of the Russian Federation (No: 58074). The results of this study will be published in a peer-review journal and presented at international conferences as poster presentations. TRIAL REGISTRATION NUMBER NCT04861688.
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Affiliation(s)
- Pavel Pilipenko
- Department of Clinical Neurology and Neurogeriatrics, Novosibirsk State Medical University, Novosibirsk, Russian Federation
| | - Anna Andreevna Ivanova
- Adult Polyclinic Department N 124, State Budgetary Institution of Public Health City Polyclinic N 106, St. Petersburg, Russian Federation
| | | | - Valery Feigin
- National institute for Stroke & Applied Neurosciences, Auckland University of Technology, Auckland, New Zealand
| | - Marek Majdan
- Department of Public Health, Trnava University in Trnava, Trnava, Slovakia
| | - Vera Naumovna Grigoryeva
- Department of Nervous Diseases, Privolzhsky Research Medical University, Niznij Novgorod, Russian Federation
| | - Alexey Yevgenievich Khrulev
- Department of Nervous Diseases, Privolzhsky Research Medical University, Niznij Novgorod, Russian Federation
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Cohan SL, Benedict RHB, Cree BAC, DeLuca J, Hua LH, Chun J. The Two Sides of Siponimod: Evidence for Brain and Immune Mechanisms in Multiple Sclerosis. CNS Drugs 2022; 36:703-719. [PMID: 35725892 PMCID: PMC9259525 DOI: 10.1007/s40263-022-00927-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/12/2022] [Indexed: 12/13/2022]
Abstract
Siponimod is a selective sphingosine 1-phosphate receptor subtype 1 (S1P1) and 5 (S1P5) modulator approved in the United States and the European Union as an oral treatment for adults with relapsing forms of multiple sclerosis (RMS), including active secondary progressive multiple sclerosis (SPMS). Preclinical and clinical studies provide support for a dual mechanism of action of siponimod, targeting peripherally mediated inflammation and exerting direct central effects. As an S1P1 receptor modulator, siponimod reduces lymphocyte egress from lymph nodes, thus inhibiting their migration from the periphery to the central nervous system. As a result of its peripheral immunomodulatory effects, siponimod reduces both magnetic resonance imaging (MRI) lesion (gadolinium-enhancing and new/enlarging T2 hyperintense) and relapse activity compared with placebo. Independent of these effects, siponimod can penetrate the blood-brain barrier and, by binding to S1P1 and S1P5 receptors on a variety of brain cells, including astrocytes, oligodendrocytes, neurons, and microglia, exert effects to modulate neural inflammation and neurodegeneration. Clinical data in patients with SPMS have shown that, compared with placebo, siponimod treatment is associated with reductions in levels of neurofilament light chain (a marker of neuroaxonal damage) and thalamic and cortical gray matter atrophy, with smaller reductions in MRI magnetization transfer ratio and reduced confirmed disability progression. This review examines the preclinical and clinical data supporting the dual mechanism of action of siponimod in RMS.
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Affiliation(s)
- Stanley L Cohan
- Providence Multiple Sclerosis Center, Providence Brain Institute, 9135 SW Barnes Rd Suite 461, Portland, OR, 97225, USA.
| | | | - Bruce A C Cree
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | | | - Le H Hua
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, USA
| | - Jerold Chun
- Sanford Burnham Prebys Medical Discovery Institute, La Jolla, CA, USA
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8
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Lozano-Soto E, Cruz-López ÁJ, Gutiérrez R, González M, Sanmartino F, Rashid-Lopez R, Espinosa-Rosso R, Forero L, González-Rosa JJ. Predicting Neuropsychological Impairment in Relapsing Remitting Multiple Sclerosis: The Role of Clinical Measures, Treatment, and Neuropsychiatry Symptoms. Arch Clin Neuropsychol 2021; 36:475-484. [PMID: 33067616 DOI: 10.1093/arclin/acaa088] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2020] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE This retrospective observational study aimed to define neuropsychological impairment (NI) profiles and determine the influence of clinical, demographic, and neuropsychiatric measures in specific cognitive domains in a cohort of relapsing-remitting multiple sclerosis (RRMS) patients. METHODS Ninety-one RRMS patients underwent a neurological examination and a brief neuropsychological assessment. Patients were classified according to the disease-modifying therapies (DMTs) received (platform or high-efficacy). Differences between groups and multiple regression analyses were performed to determine the predictive value of the assessed measures in cognitive performance. RESULTS More than two-thirds of the patients showed NI. Specifically, mild to moderate NI was presented in approximately half of the participants. Paced Auditory Serial Addition Test (PASAT-3) and Symbol Digit Modalities Test (SDMT) were the most frequently impaired cognitive tests (45.3% and 41.3%, respectively) followed by phonemic verbal fluency (PVF) (27.8%). Expanded Disability Status Scale (EDSS), age, depressive symptoms, and disease duration were the best predictors of SDMT (R2 = .34; p < .01), whereas disease duration, EDSS, and anxiety-state levels predicted PASAT-3 (R2 = .33, p < .01). Educational level, age, EDSS, and depressive symptoms demonstrated the strongest association with PVF (R2 = .31, p < .01). CONCLUSIONS Our results indicated a significant prevalence of NI in RRMS patients that was not dependent on the DMT type. In addition to the meaningful working memory (PASAT-3) and information processing speed (SDMT) impairments found, PVF deficits may also be an important marker of cognitive impairment in RRMS patients. This study supports the relevance of standard clinical measures and reinforces the importance of quantifying clinical and neuropsychiatric symptoms to predict subsequent cognitive performance on a similar multiple sclerosis phenotype and disease stage.
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Affiliation(s)
- Elena Lozano-Soto
- Psychophysiology and Neuroimaging Group, Institute of Biomedical Research and Innovation of Cádiz (INiBICA), Cádiz, Spain
| | | | - Rafael Gutiérrez
- Neurology Department, Puerta del Mar University Hospital, Cádiz, Spain
| | - Macarena González
- Neurology Department, Puerta del Mar University Hospital, Cádiz, Spain
| | - Florencia Sanmartino
- Psychophysiology and Neuroimaging Group, Institute of Biomedical Research and Innovation of Cádiz (INiBICA), Cádiz, Spain
| | - Raúl Rashid-Lopez
- Neurology Department, Puerta del Mar University Hospital, Cádiz, Spain
| | | | - Lucía Forero
- Neurology Department, Puerta del Mar University Hospital, Cádiz, Spain
| | - Javier J González-Rosa
- Psychophysiology and Neuroimaging Group, Institute of Biomedical Research and Innovation of Cádiz (INiBICA), Cádiz, Spain.,Institute of Biomedical Research and Innovation of Cádiz (INiBICA), Cádiz, Spain
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9
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Ostolaza A, Corroza J, Ayuso T. Multiple sclerosis and aging: comorbidity and treatment challenges. Mult Scler Relat Disord 2021; 50:102815. [PMID: 33581613 DOI: 10.1016/j.msard.2021.102815] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 01/27/2021] [Accepted: 02/01/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND The prevalence of elderly patients with MS is increasing, in conjunction with the ageing general population. This review will examine the principal characteristics of elderly patients with MS and how the concomitant pathologies affect them. Finally, it will assess the impact of the medications on these patients and whether it would be safe to discontinue the disease-modifying treatment. METHODS Searches using PubMed were conducted in October 2020 to collect studies assessing the impact of age and comorbidities on patients with MS. RESULTS Several studies showed that aged patients develop concomitant pathologies that could worsen the disease's prognosis. Also, MS itself may be closely related to cognitive impairment, even though the exact etiopathogenic mechanism of it is still unclear. To date, safety and efficacy of currently available drugs remain unassessed in elderly populations. These treatments may not be beneficial in preventing the progression of disability in ageing people with no signs of inflammatory activity, and discontinuation of treatment is often discussed in this subgroup of patients. CONCLUSIONS The presence of cardiovascular pathology, psychiatric disorders, diabetes or cancer is further associated with increased mortality in MS patients. The diagnosis and treatment of the disease is challenged by both age-related comorbidities and clinical variations compared to younger patients. It may be safe to discontinue treatment in elderly patients with no clinico-radiological activity.
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Affiliation(s)
- Aiora Ostolaza
- Department of Neurology, Complejo Hospitalario de Navarra-IdiSNA (Navarra Institute for Health Research), Pamplona, Navarra, 31008, Spain.
| | - Jon Corroza
- Department of Neurology, Complejo Hospitalario de Navarra-IdiSNA (Navarra Institute for Health Research), Pamplona, Navarra, 31008, Spain
| | - Teresa Ayuso
- Department of Neurology, Complejo Hospitalario de Navarra-IdiSNA (Navarra Institute for Health Research), Pamplona, Navarra, 31008, Spain
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10
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Inojosa H, Proschmann U, Akgün K, Ziemssen T. Should We Use Clinical Tools to Identify Disease Progression? Front Neurol 2021; 11:628542. [PMID: 33551982 PMCID: PMC7859270 DOI: 10.3389/fneur.2020.628542] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 12/18/2020] [Indexed: 01/02/2023] Open
Abstract
The presence of disability progression in multiple sclerosis (MS) is an important hallmark for MS patients in the course of their disease. The transition from relapsing remitting (RRMS) to secondary progressive forms of the disease (SPMS) represents a significant change in their quality of life and perception of the disease. It could also be a therapeutic key for opportunities, where approaches different from those in the initial phases of the disease can be adopted. The characterization of structural biomarkers (e.g., magnetic resonance imaging or neurofilament light chain) has been proposed to differentiate between both phenotypes. However, there is no definite threshold between them. Whether the risk of clinical progression can be predicted by structural markers at early disease phases is still a focus of clinical research. However, several theories and pathological evidence suggest that both disease phenotypes are part of a continuum with common pathophysiological mechanisms. In this case, the clinical evaluation of the patients would play a preponderant role above destruction biomarkers for the early identification of disability progression and SPMS. For this purpose, the use of clinical tools beyond the Expanded Disability Status Scale (EDSS) should be considered. Besides established functional tests such as the Multiple Sclerosis Functional Composite (MSFC), patient's neurological history or digital resources may help neurologists in the decision-taking. In this article, we discuss arguments for the use of clinical markers in the detection of secondary progressive MS and the characterization of progressive disease activity.
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Affiliation(s)
- Hernan Inojosa
- Multiple Sclerosis Center, Center of Clinical Neuroscience, Department of Neurology, University Hospital Carl Gustav Carus, Dresden University of Technology, Dresden, Germany
| | - Undine Proschmann
- Multiple Sclerosis Center, Center of Clinical Neuroscience, Department of Neurology, University Hospital Carl Gustav Carus, Dresden University of Technology, Dresden, Germany
| | - Katja Akgün
- Multiple Sclerosis Center, Center of Clinical Neuroscience, Department of Neurology, University Hospital Carl Gustav Carus, Dresden University of Technology, Dresden, Germany
| | - Tjalf Ziemssen
- Multiple Sclerosis Center, Center of Clinical Neuroscience, Department of Neurology, University Hospital Carl Gustav Carus, Dresden University of Technology, Dresden, Germany
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Sehanovic A, Smajlovic D, Tupkovic E, Ibrahimagic OC, Kunic S, Dostovic Z, Zoletic E, Pasic Z. Cognitive Disorders in Patients with Multiple Sclerosis. Mater Sociomed 2021; 32:191-195. [PMID: 33424448 PMCID: PMC7780783 DOI: 10.5455/msm.2020.32.191-195] [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] [Indexed: 11/16/2022] Open
Abstract
Introduction: Multiple sclerosis (MS) is a chronic, inflammatory, (auto) immune disease of the central nervous system (CNS). Cognitive disorders are found in over 50% of patients. Aim: The aim of the study was to determine the distribution of cognitive disorders in people with MS. Methods: The prospective study included 135 respondents with MS and 50 healthy respondents. The respondents were divided into three groups: the first group consisted of 85 respondents where the disease lasted longer than one year, the second group consisted of 50 respondents with newly diagnosed MS, the third group consisted of 50 healthy respondents. Clinical assessment instruments were: Extended Disability Score in Multiple Sclerosis Patients, Mini Mental Status, Battery of Tests to Assess Cognitive Functions: Wechsler Intelligence Scale, Revised Beta Test, Raven Colored Progressive Matrices, Wechsler Memory Scale, Rey Audio Verbal Learning Test -Osterriecht’s complex character test, verbal fluency test. Results: Cognitive disorders were present in 40-60% of respondents with MS. Visuospatial, visuoconstructive and visuoperceptive functions are worse in the first group. Mnestic functions (learning process, short-term and long-term memory, recollection, verbal-logical memory) were most affected in both groups of respondents, ranging from 30-60%. Poorer cognitive domains are in the first groups of respondents. Immediate working process memory (current learning), memory, attention, short-term and logical memory is worse in the examinees of the first group. At the beginning of the disease, 16% had verbal fluency difficulties, and as the disease progresses, the difficulties become more pronounced. Conclusion: Cognitive disorders are heterogeneous, they can be noticed in the early stages of the disease. They refer to impairments of working memory, executive functions and attention, while global intellectual efficiency is later reduced.
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Affiliation(s)
- Aida Sehanovic
- Clinic of Neurology, University Medical Center Tuzla, Tuzla, Bosnia and Herzegovina.,Faculty of Medicine, University of Tuzla, Tuzla, Bosnia and Herzegovina
| | - Dzevdet Smajlovic
- Clinic of Neurology, University Medical Center Tuzla, Tuzla, Bosnia and Herzegovina.,Faculty of Medicine, University of Tuzla, Tuzla, Bosnia and Herzegovina
| | - Emir Tupkovic
- Faculty of Medicine, University of Tuzla, Tuzla, Bosnia and Herzegovina.,Center for Neurology, Health Center Tuzla, Tuzla, Bosnia and Herzegovina
| | - Omer C Ibrahimagic
- Faculty of Medicine, University of Tuzla, Tuzla, Bosnia and Herzegovina.,Center for Neurology, Health Center Tuzla, Tuzla, Bosnia and Herzegovina
| | - Suljo Kunic
- Faculty of Medicine, University of Tuzla, Tuzla, Bosnia and Herzegovina.,Center for Neurology, Health Center Tuzla, Tuzla, Bosnia and Herzegovina
| | - Zikrija Dostovic
- Clinic of Neurology, University Medical Center Tuzla, Tuzla, Bosnia and Herzegovina.,Faculty of Medicine, University of Tuzla, Tuzla, Bosnia and Herzegovina
| | - Emina Zoletic
- Clinic of Neurology, Medical Center of University in Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Zejneba Pasic
- Clinic of Neurology, University Medical Center Tuzla, Tuzla, Bosnia and Herzegovina.,Faculty of Medicine, University of Tuzla, Tuzla, Bosnia and Herzegovina
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12
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Rydelius A, Lätt J, Kinhult S, Engelholm S, Van Westen D, Pihlsgård M, Bengzon J, Sundgren PC, Lilja Å. Longitudinal study of cognitive function in glioma patients treated with modern radiotherapy techniques and standard chemotherapy. Acta Oncol 2020; 59:1091-1097. [PMID: 32847475 DOI: 10.1080/0284186x.2020.1778181] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Introduction: Cognitive function is an important outcome measure in patients with brain tumor, providing information about the patient's clinical situation, treatment effects and possible progressive disease. The aim of this longitudinal study was to evaluate effects of the currently used radiation and chemotherapy treatment on cognitive function and to investigate associations between cognitive function at baseline and progression as well as overall survival.Methods: 32 patients newly diagnosed with malignant glioma were evaluated at baseline with CNS Vital Signs (CNS-VS), a computerized standardized neuropsychological test battery, prior to arc-based radiotherapy and concomitant chemotherapy with Temozolomide. CNS-VS measures the cognitive functions known to be affected in patients with brain tumor, covering nine cognitive domains. Follow-up cognitive evaluations were performed in 26 patients after 3.5 months and in 13 patients 1 year after treatment start.Results: Overall cognitive scores were lower in the studied patient cohort at baseline compared to standardized domain scores. At 3.5 months follow-up cognitive functioning was slightly decreased, but only in 1/9 cognitive domains - visual memory - where significant changes were found compared to baseline test results. Similarly, at 12 months follow-up no significant changes in cognitive test results were seen compared to baseline examination, except for a decrease in the visual memory domain. In relation to early progression, the most significant cognitive deficits were dysfunctional visual memory and low executive functioning at baseline. Low executive function at baseline correlated most significantly with shorter overall survival.Conclusion: The present study suggests that the currently used arc-based radiotherapy and chemotherapy might affect cognitive function less negatively than previously described during treatment and in the first year after treatment in malignant glioma patients. In general, a high cognitive test score at baseline was associated with longer time to progression and with longer survival.
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Affiliation(s)
- Anna Rydelius
- Department of Clinical Sciences, Division of Neurology, Lund University, Lund, Sweden
| | - Jimmy Lätt
- Department of Medical Imaging and Physiology, Skåne University hospital Lund University, Lund, Sweden
| | - Sara Kinhult
- Department of Clinical Sciences, Division of Oncology, Lund University, Lund, Sweden
| | - Silke Engelholm
- Department of Clinical Sciences, Division of Oncology, Lund University, Lund, Sweden
| | - Danielle Van Westen
- Department of Medical Imaging and Physiology, Skåne University hospital Lund University, Lund, Sweden
- Department of Clinical Sciences, Division of Radiology, Lund University, Lund, Sweden
| | - Mats Pihlsgård
- Department of Clinical Sciences, Division of Geriatrics, Lund University, Malmö, Sweden
| | - Johan Bengzon
- Department of Clinical Sciences, Division of Neurosurgery, Lund University, Lund, Sweden
- Stem Cell Center, BMC B10, Lund University, Lund, Sweden
| | - Pia C. Sundgren
- Department of Medical Imaging and Physiology, Skåne University hospital Lund University, Lund, Sweden
- Department of Clinical Sciences, Division of Radiology, Lund University, Lund, Sweden
- Lund University BioImaging Center, Lund University, Lund, Sweden
- Department of Radiology, University of Michigan, Ann Arbor, MI, USA
| | - Åsa Lilja
- Department of Clinical Sciences, Division of Radiology, Lund University, Lund, Sweden
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13
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Kouvatsou Z, Masoura E, Kiosseoglou G, Kimiskidis VK. Evaluating the relationship between working memory and information processing speed in multiple sclerosis. APPLIED NEUROPSYCHOLOGY-ADULT 2020; 29:695-702. [PMID: 32813544 DOI: 10.1080/23279095.2020.1804911] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The aim of the present study was to evaluate the effect of information processing speed on the functioning of specific working memory components, i.e. phonological loop, visuospatial sketchpad, central executive and episodic buffer. Cognitive tasks that assess working memory ("word lists recall" for the phonological loop, "block recall" for the spatial component of visuospatial sketchpad, "listening recall" for the central executive and "immediate story recall" for the episodic buffer) and information processing speed (symbol digit modalities test- oral form) were administered to 38 patients with multiple sclerosis. Results showed that the central executive and episodic buffer components were significantly related to information processing speed. However, when age was included in the regression model, information processing speed significantly predicted only the episodic buffer scores. Further research on the relationship between the episodic buffer and information processing speed is recommended.
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Affiliation(s)
- Zoe Kouvatsou
- School of Psychology, Department of Experimental Cognitive Psychology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Elvira Masoura
- School of Psychology, Department of Experimental Cognitive Psychology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Grigoris Kiosseoglou
- School of Psychology, Department of Experimental Cognitive Psychology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Vasilios K Kimiskidis
- Laboratory of Clinical Neurophysiology, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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14
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Piperine ameliorated memory impairment and myelin damage in lysolecethin induced hippocampal demyelination. Life Sci 2020; 253:117671. [PMID: 32335165 DOI: 10.1016/j.lfs.2020.117671] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 04/02/2020] [Accepted: 04/11/2020] [Indexed: 12/14/2022]
Abstract
AIMS We still do not have effective treatment for hippocampal demyelination and memory deficit, the two common comorbidities in multiple sclerosis (MS). This study aimed to assess the therapeutic effect of Piperine (the main alkaloid of black pepper) in an experimental model of demyelination. MAIN METHODS Demyelination was induced in male Wistar rats by bilateral injection of lysolecithin (LPC) into the CA1 region of the hippocampus. Piperine (5, 10, 20 mg/kg) was daily injected intraperitoneally three days post LPC injection for ten days. The spatial memory was examined by the Morris water maze task. Demyelination and astrocyte activation were assessed by an immunohistological study. The gene expression analysis of TNF-α, IL1-β, NF-κB, IL-10, Foxp3, iNOS, Nrf2, HO1, MBP, and BDNF was done using qPCR. The total antioxidant capacity of hippocampal tissue was measured using FRAP assay. KEY FINDINGS Our results showed that piperine improved the memory performance and myelin repair in the hippocampal demyelination model. Piperine inhibited iNOS expression concomitant with enhanced expression levels of Nrf2, HO1 and the total antioxidant capacity in the hippocampal tissue. Piperine treatment significantly reduced the gene expression level of TNF-α, IL1-β, NF-κB, and glial activation in the injured area; however, the mRNA level of IL-10, Foxp3, BDNF and MBP were significantly increased. SIGNIFICANCE We found piperine to be an effective treatment for spatial memory impairment and myelin repair in the hippocampal demyelination model. However, further experimental evidence is needed to investigate the precise mechanisms underlying piperine as a promising therapeutic target in MS patients.
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15
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Nasios G, Bakirtzis C, Messinis L. Cognitive Impairment and Brain Reorganization in MS: Underlying Mechanisms and the Role of Neurorehabilitation. Front Neurol 2020; 11:147. [PMID: 32210905 PMCID: PMC7068711 DOI: 10.3389/fneur.2020.00147] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 02/14/2020] [Indexed: 12/29/2022] Open
Abstract
Multiple sclerosis (MS) is a chronic, immune-mediated, inflammatory, and degenerative disease of the central nervous system (CNS) that affects both white and gray matter. Various mechanisms throughout its course, mainly regarding gray matter lesions and brain atrophy, result in cognitive network dysfunction and can cause clinically significant cognitive impairment in roughly half the persons living with MS. Altered cognition is responsible for many negative aspects of patients' lives, independently of physical disability, such as higher unemployment and divorce rates, reduced social activities, and an overall decrease in quality of life. Despite its devastating impact it is not included in clinical ratings and decision making in the way it should be. It is interesting that only half the persons with MS exhibit cognitive dysfunction, as this implies that the other half remain cognitively intact. It appears that a dynamic balance between brain destruction and brain reorganization is taking place. This balance acts in favor of keeping brain systems functioning effectively, but this is not so in all cases, and the effect does not last forever. When these systems collapse, functional brain reorganization is not effective anymore, and clinically apparent impairments are evident. It is therefore important to reveal which factors could make provision for the subpopulation of patients in whom cognitive impairment occurs. Even if we manage to detect this subpopulation earlier, effective pharmaceutical treatments will still be lacking. Nevertheless, recent evidence shows that cognitive rehabilitation and neuromodulation, using non-invasive techniques such as transcranial magnetic or direct current stimulation, could be effective in cognitively impaired patients with MS. In this Mini Review, we discuss the mechanisms underlying cognitive impairment in MS. We also focus on mechanisms of reorganization of cognitive networks, which occur throughout the disease course. Finally, we review theoretical and practical issues of neurorehabilitation and neuromodulation for cognition in MS as well as factors that influence them and prevent them from being widely applied in clinical settings.
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Affiliation(s)
- Grigorios Nasios
- Department of Speech and Language Therapy, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Christos Bakirtzis
- Department of Neurology, The Multiple Sclerosis Center, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Lambros Messinis
- Neuropsychology Section, Departments of Neurology and Psychiatry, University of Patras Medical School, Patras, Greece
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16
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Messinis L, Kosmidis MH, Nasios G, Konitsiotis S, Ntoskou A, Bakirtzis C, Grigoriadis N, Patrikelis P, Panagiotopoulos E, Gourzis P, Malefaki S, Papathanasopoulos P. Do Secondary Progressive Multiple Sclerosis patients benefit from Computer- based cognitive neurorehabilitation? A randomized sham controlled trial. Mult Scler Relat Disord 2020; 39:101932. [PMID: 31927200 DOI: 10.1016/j.msard.2020.101932] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 12/21/2019] [Accepted: 01/02/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Cognitive impairment is common in multiple sclerosis (MS), but deficits tend to be more pronounced in progressive MS, negatively impacting daily functional capacity. Despite this, most cognitive rehabilitation (CR) interventions to date have focused on relapsing-remitting MS (RRMS). Moreover, information on the efficacy of CR in progressive MS is limited and controversial. The present study investigated the efficacy of a home based, computer assisted cognitive rehabilitation (HBCACR) intervention (RehaComTM software) exclusively in a Secondary Progressive Multiple Sclerosis (SPMS) sample. METHODS This was a randomized, multi site, sham controlled trial. Thirty six (36) individuals with SPMS, naïve to the RehaCom software, with cognitive deficits were randomized to the treatment (IG; n= 19) or control group condition (CG; n=17). Treatment with the RehaCom modules consisted of 24 domain and task specific, 45 minute session's over an 8-week period, three sessions per week, applied by each patient at home. The CG completed non specific computer based activities at home with the same frequency and duration. Primary cognitive outcome measures included the Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS) battery, and secondary outcome measures for depression (BDI-FS), fatigue (MFIS), and quality of life (EuroQol EQ-5D) visual analogue scale (VAS). RESULTS The two groups were well matched on demographic and clinical characteristics, cognitive reserve and severity of cognitive deficits at baseline assessment. At post treatment assessment the IG group showed significant improvements with large effect sizes; in verbal learning [z = -4.759, p <.0005, g = 2.898], visuospatial memory [z = -3.940, p <.0005, g = 1.699] and information processing speed [z= -4.792, p <.0005, g = 2.980], compared with the sham control group. We also found significant between group differences on physical [z=-3.308, p = .001, g= -.604], cognitive [z = -4.011, p <.0005, g = -1.654], psychosocial [z= 3.308, p = .010, g = -.940], and general fatigue impact [z= -2.623, p = .008, g = -.519], depression severity [z = -2.730, p = .006, g = -.519], and quality of life [z= -4.239, p <.0005, g = -1.885] in favor of the treated group. CONCLUSION These data provide the first evidence supporting the efficacy of computer based restorative cognitive rehabilitation applied at home exclusively in SPMS patients, suggesting that adaptive neuroplasticity may occur after functional cognitive training in progressive MS. Improved cognitive functioning in combination with mood augmentation appear to have ameliorated fatigue, which impacted daily functioning activity and culminated in improved health related quality of life.
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Affiliation(s)
- Lambros Messinis
- Neuropsychology Section, Departments of Neurology and Psychiatry, University Hospital of Patras and University of Patras Medical School.
| | - Mary H Kosmidis
- Lab of Cognitive Neuroscience, School of Psychology, Aristotle University of Thessaloniki, Greece
| | - Grigorios Nasios
- Department of Speech and Language Therapy, School of Health Sciences, University of Ioannina
| | | | - Aikaterini Ntoskou
- Rehabilitation Unit for patients with Spinal Cord Injury, "Demetrios and Vera Sfikas" Department of Medicine, University of Patras Medical School
| | - Christos Bakirtzis
- B'Department of Neurology and the MS Center, AHEPA University Hospital, Central Macedonia, Thessaloniki, Greece
| | - Nikolaos Grigoriadis
- B'Department of Neurology and the MS Center, AHEPA University Hospital, Central Macedonia, Thessaloniki, Greece
| | - Panayiotis Patrikelis
- First Department of Neurosurgery, Medical School, National and Kapodistrian University of Athens, Greece
| | - Elias Panagiotopoulos
- Rehabilitation Unit for patients with Spinal Cord Injury, "Demetrios and Vera Sfikas" Department of Medicine, University of Patras Medical School
| | | | - Sonia Malefaki
- Department of Mechanical Engineering & Aeronautics, University of Patras (statistics)
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17
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Pavisian B, Patel VP, Feinstein A. Cognitive mediated eye movements during the SDMT reveal the challenges with processing speed faced by people with MS. BMC Neurol 2019; 19:340. [PMID: 31878918 PMCID: PMC6933713 DOI: 10.1186/s12883-019-1543-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 11/26/2019] [Indexed: 11/10/2022] Open
Abstract
Background The Symbol Digit Modalities Test (SDMT) is regarded as the cognitive test of choice for people with MS (pwMS). While deficits are linked to impaired processing speed, the mechanisms by which they arise are unclear. Cognitive-mediated eye movements offer one putative explanation. The objective of this study was to determine the association between eye movements and performance on the SDMT. Methods Thirty-three people with confirmed MS and 25 matched healthy control subjects (HC) were administered the oral SDMT while eye movements were recorded. Results Mean SDMT scores were significantly lower in pwMS (p < 0.038). Shorter mean saccade distance in the key area (p = 0.007), more visits to the key area per response (p = 0.014), and more total number of fixations in the test area (p = 0.045) differentiated pwMS from HCs. A hierarchical regression analysis revealed that the number of visits to the key area per response (p < 0.001; ΔR2 = 0.549) and total number of fixations in the test area (p < 0.001; ΔR2 = 0.782) were the most robust predictors of SDMT scores. Conclusion Cognitive-mediated eye movements help elucidate the processing speed challenges confronted by people with MS. Mechanistic insights such as these can potentially help inform new cognitive rehabilitation strategies.
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Affiliation(s)
- Bennis Pavisian
- Department of Psychiatry, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, Ontario, M4N 3M5, Canada
| | - Viral P Patel
- Department of Psychiatry, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, Ontario, M4N 3M5, Canada
| | - Anthony Feinstein
- Department of Psychiatry, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, Ontario, M4N 3M5, Canada. .,Department of Psychiatry, University of Toronto, 2075 Bayview Avenue, Toronto, Ontario, M4N 3M5, Canada.
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18
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Jang JH, Kim J, Park G, Kim H, Jung ES, Cha JY, Kim CY, Kim S, Lee JH, Yoo H. Beta wave enhancement neurofeedback improves cognitive functions in patients with mild cognitive impairment: A preliminary pilot study. Medicine (Baltimore) 2019; 98:e18357. [PMID: 31852140 PMCID: PMC6922450 DOI: 10.1097/md.0000000000018357] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Mild cognitive impairment (MCI) is a symptom characterizing cognitive decline and a transitional state between normal aging and dementia; however, there is no definitive diagnosis and treatment for MCI. Neurofeedback (NF), which is a training mechanism that employs operant conditioning to regulate brain activity, has been increasingly investigated concerning its beneficial effects for dementia and MCI. METHODS This study investigated cognitive improvement and hemodynamic changes in the prefrontal cortex (PFC) following NF training in patients with MCI. Five patients with MCI received NF training for enhanced beta band activity in the dorsolateral PFC-16 sessions for 8 weeks-with each session divided into 9 5-minute trials. The primary outcome measure was a cognitive assessment tool: the Korean version of the Montreal Cognitive Assessment. The secondary outcome measures were the Central Nervous System Vital Signs for neurocognitive testing, hemodynamic changes using functional near-infrared spectroscopy in the PFC during a working-memory task, and Beck Depression Inventory scores. RESULTS After completing the training, patients' cognitive function significantly improved in domains such as composite memory, cognitive flexibility, complex attention, reaction time, and executive function. Increased electroencephalogram beta power was observed over NF training sessions (Spearman rank correlation test: r = 0.746, P = .001). The threshold value for gaining positive feedback from pre-NF baseline on beta power significantly increased (Spearman rank correlation test: r = 0.805, P = .001). Hemodynamic response in PFC changed after NF training, and individual differences were identified. Specifically, hypoactivation of the hemodynamic response by emotional distraction recovered following NF training. CONCLUSION We suggest that patients' cognitive processing efficiency was improved by the NF training. These beneficial results suggest that NF training may have potential therapeutic applications to prevent the progression from MCI to dementia. TRIAL REGISTRATION NUMBER Clinical Research Information Service (KCT0003433).
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Affiliation(s)
- Jung-Hee Jang
- Department of Neurologic Disorders & Aging Brain Constitution, Dunsan Korean Medicine Hospital, Daejeon University
| | - Jieun Kim
- Clinical Medicine Division, Korea Institute of Oriental Medicine
| | - Gunhyuk Park
- Herbal Medicine Resources Research Center, Korea Institute of Oriental Medicine, Naju-si, Jeollanam-do, Republic of Korea
| | - Haesook Kim
- Department of Neurologic Disorders & Aging Brain Constitution, Dunsan Korean Medicine Hospital, Daejeon University
| | - Eun-Sun Jung
- Department of Neurologic Disorders & Aging Brain Constitution, Dunsan Korean Medicine Hospital, Daejeon University
| | - Ji-yun Cha
- Department of Neurologic Disorders & Aging Brain Constitution, Dunsan Korean Medicine Hospital, Daejeon University
| | - Chan-young Kim
- Department of Neurologic Disorders & Aging Brain Constitution, Dunsan Korean Medicine Hospital, Daejeon University
| | - Siyeon Kim
- Department of Neurologic Disorders & Aging Brain Constitution, Dunsan Korean Medicine Hospital, Daejeon University
| | - Jun-Hwan Lee
- Clinical Medicine Division, Korea Institute of Oriental Medicine
| | - Horyong Yoo
- Department of Neurologic Disorders & Aging Brain Constitution, Dunsan Korean Medicine Hospital, Daejeon University
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19
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Wojcik CM, Beier M, Costello K, DeLuca J, Feinstein A, Goverover Y, Gudesblatt M, Jaworski M, Kalb R, Kostich L, LaRocca NG, Rodgers JD, Benedict RH. Computerized neuropsychological assessment devices in multiple sclerosis: A systematic review. Mult Scler 2019; 25:1848-1869. [PMID: 31637963 PMCID: PMC6875828 DOI: 10.1177/1352458519879094] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background: The proliferation of computerized neuropsychological assessment devices (CNADs) for screening and monitoring cognitive impairment is increasing exponentially. Previous reviews of computerized tests for multiple sclerosis (MS) were primarily qualitative and did not rigorously compare CNADs on psychometric properties. Objective: We aimed to systematically review the literature on the use of CNADs in MS and identify test batteries and single tests with good evidence for reliability and validity. Method: A search of four major online databases was conducted for publications related to computerized testing and MS. Test–retest reliability and validity coefficients and effect sizes were recorded for each CNAD test, along with administration characteristics. Results: We identified 11 batteries and 33 individual tests from 120 peer-reviewed articles meeting the inclusion criteria. CNADs with the strongest psychometric support include the CogState Brief Battery, Cognitive Drug Research Battery, NeuroTrax, CNS-Vital Signs, and computer-based administrations of the Symbol Digit Modalities Test. Conclusion: We identified several CNADs that are valid to screen for MS-related cognitive impairment, or to supplement full, conventional neuropsychological assessment. The necessity of testing with a technician, and in a controlled clinic/laboratory environment, remains uncertain.
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Affiliation(s)
- Curtis M Wojcik
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Meghan Beier
- Division of Rehabilitation Psychology and Neuropsychology, Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - John DeLuca
- Department of Physical Medicine and Rehabilitation and Department of Neurology, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Anthony Feinstein
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Yael Goverover
- New York University, New York, NY, USA/South Shore Neurologic Associates, New York, NY, USA
| | | | - Michael Jaworski
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Rosalind Kalb
- National Multiple Sclerosis Society, New York, NY, USA
| | - Lori Kostich
- The Mandell MS Center, Mount Sinai Rehabilitation Hospital, Hartford, CT, USA
| | | | - Jonathan D Rodgers
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA/Jacobs Neurological Institute, Buffalo, NY, USA/Canisius College, Buffalo, NY, USA
| | - Ralph Hb Benedict
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA/Jacobs Neurological Institute, Buffalo, NY, USA
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20
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Ruano L, Branco M, Severo M, Sousa A, Castelo J, Araújo I, Pais J, Cerqueira J, Amato MP, Lunet N, Cruz VT. Tracking cognitive impairment in multiple sclerosis using the Brain on Track test: a validation study. Neurol Sci 2019; 41:183-191. [PMID: 31631230 DOI: 10.1007/s10072-019-04088-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Accepted: 09/24/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND The accurate and regular monitoring cognitive performance in multiple sclerosis (MS) patients is critical to develop new prevention and management strategies for cognitive impairment (CI). The Brain on Track (BoT) test is a self-administered web-based tool developed for cognitive screening and monitoring. The objective of this study was to validate the use of the BoT in MS, by assessing its ability to distinguish between MS patients and matched controls, as well as detect CI among MS patients, by analysing its correlation with standard cognitive tests and its reliability and learning effects in repeatable use. METHODS The BoT was applied in 30 patients with MS consecutively selected and 30 age- and education-matched controls, first in a hospital clinic, under supervision, and then 1 week later from home. After these first two trials, MS patients repeated the test from home every 4 weeks for 3 months. A standard neuropsychological battery was also applied to MS patients at baseline. RESULTS The Cronbach's alpha was 0.89. Test scores were significantly different between MS patients and controls (Cohen's d = 0.87; p < 0.01). Among MS patients, scores were significantly lower in those with CI documented in the standard neuropsychological battery than in their cognitively preserved counterparts (Cohen's d = 2.0; p < 0.001). The BoT scores presented a good correlation with standard neuropsychological tests, particularly for information processing speed. Regarding test-retest reliability, 10/11 subtests presented two-way mixed single intraclass consistency correlation coefficients > 0.70. CONCLUSION The BoT showed good neuropsychological parameters in MS patients, endorsing the use of self-administered computerized tests in this setting.
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Affiliation(s)
- Luis Ruano
- Neurology Department, Centro Hospitalar de Entre Douro e Vouga, Santa Maria da Feira, Portugal. .,Departamento de Ciências da Saúde Pública e Forenses e Educação Médica Faculdade de Medicina da Universidade do Porto, Porto, Portugal. .,EPIUnit, Institute of Public Health, University of Porto, Rua das Taipas 135-139, 4050-600, Porto, Portugal.
| | - Mariana Branco
- Neurology Department, Centro Hospitalar de Entre Douro e Vouga, Santa Maria da Feira, Portugal.,Departamento de Ciências da Saúde Pública e Forenses e Educação Médica Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Milton Severo
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica Faculdade de Medicina da Universidade do Porto, Porto, Portugal.,EPIUnit, Institute of Public Health, University of Porto, Rua das Taipas 135-139, 4050-600, Porto, Portugal
| | - Andreia Sousa
- Neurology Department, Centro Hospitalar de Entre Douro e Vouga, Santa Maria da Feira, Portugal
| | - Juliana Castelo
- Neurology Department, Centro Hospitalar de Entre Douro e Vouga, Santa Maria da Feira, Portugal
| | - Isabel Araújo
- Neurology Department, Centro Hospitalar de Entre Douro e Vouga, Santa Maria da Feira, Portugal
| | - Joana Pais
- EPIUnit, Institute of Public Health, University of Porto, Rua das Taipas 135-139, 4050-600, Porto, Portugal
| | - João Cerqueira
- 2CA Braga, Braga, Portugal.,Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal.,ICVS/3B's - PT Government Associate Laboratory, Braga, Guimarães, Portugal
| | - Maria Pia Amato
- Department NEUROFARBA, Section Neurosciences, University of Florence, Florence, Italy
| | - Nuno Lunet
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica Faculdade de Medicina da Universidade do Porto, Porto, Portugal.,EPIUnit, Institute of Public Health, University of Porto, Rua das Taipas 135-139, 4050-600, Porto, Portugal
| | - Vítor Tedim Cruz
- Neurology Department, Centro Hospitalar de Entre Douro e Vouga, Santa Maria da Feira, Portugal.,IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy.,Neurology Department, Hospital Pedro Hispano, Unidade Local de Saúde de Matosinhos, Sra. da Hora, Portugal
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21
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Manca R, Mitolo M, Stabile MR, Bevilacqua F, Sharrack B, Venneri A. Multiple brain networks support processing speed abilities of patients with multiple sclerosis. Postgrad Med 2019; 131:523-532. [PMID: 31478421 DOI: 10.1080/00325481.2019.1663706] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objectives: Many people affected by multiple sclerosis (MS) experience cognitive impairment, especially decreases in information processing speed (PS). Neural disconnection is thought to represent the neural marker of this symptom, although the role played by alterations of specific functional brain networks still remains unclear. The aim is to investigate and compare patterns of association between PS-demanding cognitive performance and functional connectivity across two MS phenotypes. Methods: Forty patients with relapsing-remitting MS (RRMS) and 25 with secondary progressive MS (SPMS) had neuropsychological and MRI assessments. Multiple regression models were used to investigate the relationship between performance on tests of visuomotor and verbal PS, and on the verbal fluency tests, and functional connectivity of four cognitive networks, i.e. left and right frontoparietal, salience and default-mode, and two control networks, i.e. visual and sensorimotor. Results: Patients with SPMS were older and had longer disease history than patients with RRMS and presented with worse overall clinical conditions: higher disease severity, total lesion volume, and cognitive impairment rates. However, in both patient samples, cognitive performance across tests was negatively correlated with functional connectivity of the salience and default-mode networks, and positively with connectivity of the left frontoparietal network. Only the visuomotor PS scores of the RRMS group were also associated with connectivity of the sensorimotor network. Conclusions: PS-demanding cognitive performance in patients with MS appears mainly associated with strength of functional connectivity of frontal networks involved in the evaluation and manipulation of information, as well as the default mode network. These results are in line with the hypothesis that multiple neural networks are needed to support normal cognitive performance across MS phenotypes. However, different PS measures showed partially different patterns of association with functional connectivity. Therefore, further investigations are needed to clarify the contribution of inter-network communication to specific cognitive deficits due to MS.
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Affiliation(s)
- Riccardo Manca
- Department of Neuroscience, University of Sheffield , Sheffield , UK
| | - Micaela Mitolo
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Diagnostica Funzionale Neuroradiologica , Bologna , Italy
| | | | | | - Basil Sharrack
- Academic Department of Neuroscience, Sheffield Teaching Hospital, NHS Foundation Trust , Sheffield , UK
| | - Annalena Venneri
- Department of Neuroscience, University of Sheffield , Sheffield , UK
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Kouvatsou Z, Masoura E, Kiosseoglou G, Kimiskidis VK. Working memory profiles of patients with multiple sclerosis: Where does the impairment lie? J Clin Exp Neuropsychol 2019; 41:832-844. [PMID: 31204607 DOI: 10.1080/13803395.2019.1626805] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Introduction: Previous studies have mostly provided general estimations regarding Working Memory impairment in patients with Multiple Sclerosis. The aim of the present study was to investigate the relative degree of impairment in the four Working Memory components in Multiple Sclerosis. Method: Thirty-eight patients diagnosed with MS and 27 matched controls were assessed using 12 different cognitive tasks of the four components, i.e. phonological loop, visuospatial sketchpad, central executive and episodic buffer. More precisely, Greek translated and adapted versions of the following tasks were administered: Digit recall, Word recall, Non-word recall, Block recall, Mazes recall, Visual Patterns recall, Backward Digit recall, Backward Block recall, Listening recall, Logical Memory I-Immediate Story recall and Greek Verbal Learning Test, which is based on the California Verbal Learning Test. Results: The phonological loop, the central executive and the spatial subcomponent of the visuospatial sketchpad were found to be equally disrupted in MS patients. The episodic buffer was found to be more heavily affected. On the other hand, the visual subcomponent of the visuospatial sketchpad proved to be preserved. Conclusions: WM subcomponents are differentially affected in patients with MS. This novel finding is discussed within the framework of existing knowledge regarding WM impairment in MS.
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Affiliation(s)
- Zoe Kouvatsou
- a School of Psychology, Department of Experimental Cognitive Psychology, Aristotle University of Thessaloniki , Thessaloniki , Greece
| | - Elvira Masoura
- a School of Psychology, Department of Experimental Cognitive Psychology, Aristotle University of Thessaloniki , Thessaloniki , Greece
| | - Grigoris Kiosseoglou
- a School of Psychology, Department of Experimental Cognitive Psychology, Aristotle University of Thessaloniki , Thessaloniki , Greece
| | - Vasilios K Kimiskidis
- b Laboratory of Clinical Neurophysiology, AHEPA Hospital, Aristotle University of Thessaloniki , Thessaloniki , Greece
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Golan D, Wilken J, Doniger GM, Fratto T, Kane R, Srinivasan J, Zarif M, Bumstead B, Buhse M, Fafard L, Topalli I, Gudesblatt M. Validity of a multi-domain computerized cognitive assessment battery for patients with multiple sclerosis. Mult Scler Relat Disord 2019; 30:154-162. [DOI: 10.1016/j.msard.2019.01.051] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 01/04/2019] [Accepted: 01/29/2019] [Indexed: 11/25/2022]
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Brochet B, Ruet A. Cognitive Impairment in Multiple Sclerosis With Regards to Disease Duration and Clinical Phenotypes. Front Neurol 2019; 10:261. [PMID: 30949122 PMCID: PMC6435517 DOI: 10.3389/fneur.2019.00261] [Citation(s) in RCA: 116] [Impact Index Per Article: 23.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 02/27/2019] [Indexed: 12/26/2022] Open
Abstract
The relationships between cognitive impairment that exist during the clinical course of multiple sclerosis (MS) remain poorly described. The effect of disease duration has been studied in a few longitudinal cohorts and some cross-sectional studies that suggest that cognitive deficits tend to extend with disease duration. However, the effect of disease duration seems to be confounded by the effect of age. At the pre-clinical stage, cognitive deficits have been observed in patients with radiologically isolated syndromes, and their profile is similar than in clinically isolated syndromes (CIS) and relapsing-remitting MS (RRMS). The frequency of cognitive impairment tends to be higher in RRMS than in CIS. In these phenotypes, slowness of information processing speed (IPS) and episodic verbal and visuo-spatial memory deficits are frequently observed, but executive functions, and in particular verbal fluency, could also be impaired. More frequent and severe deficits are reported in SPMS than in RRMS with more severe deficits for memory tests, working memory and IPS. Similarly to what is observed in SPMS, patients with primary progressive MS (PPMS) present with a wide range of cognitive deficits in IPS, attention, working memory, executive functions, and verbal episodic memory with more tests and domains impaired than RRMS patients. Altogether these data suggested that not only the duration of the disease and age play an important role in the cognitive profile of patients, but also the phenotype itself, probably because of its specific pathological mechanism.
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Affiliation(s)
- Bruno Brochet
- Service de Neurologie, CHU de Bordeaux, Bordeaux, France.,Team Glia-Neuron Interactions, Neurocentre Magendie, INSERM U1215, Université de Bordeaux, Bordeaux, France
| | - Aurélie Ruet
- Service de Neurologie, CHU de Bordeaux, Bordeaux, France.,Team Glia-Neuron Interactions, Neurocentre Magendie, INSERM U1215, Université de Bordeaux, Bordeaux, France
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Bogosian A, Morgan M, Moss-Morris R. Multiple challenges for people after transitioning to secondary progressive multiple sclerosis: a qualitative study. BMJ Open 2019; 9:e026421. [PMID: 30852548 PMCID: PMC6429969 DOI: 10.1136/bmjopen-2018-026421] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Transitioning to secondary progressive multiple sclerosis (SPMS) is demanding for both patients and healthcare professionals. The particular challenges and the ways patients cope are poorly understood. The present study examines what challenges people face when diagnosed with SPMS by exploring experiences of people who have transitioned recently (up to 5 years). DESIGN Semistructured qualitative interviews at two time points a year apart. Interviews were analysed using inductive thematic analysis. SETTING UK. PARTICIPANTS We interviewed 21 people at baseline and 17 participated in the follow-up interviews. RESULTS The majority of participants reported expecting to transition to SPMS, and the diagnosis did not make much difference to them. Participants described increasing emotional and physical challenges after transitioning to SPMS and between the first and second interviews. Planning, using distractions and maintaining social roles helped participants cope with the increased challenges. The same coping strategies were used between the two interviews. Participants felt there was not much left to do regarding the management of their symptoms. A key theme was the sense of abandonment from healthcare services after transitioning to SPMS. CONCLUSIONS After transitioning to SPMS, people are faced with multiple challenges. Participants described a lack of directions for symptoms management and lack of support from the healthcare system. An integrated multidisciplinary healthcare approach is crucial at the progressive stage of the disease to alleviate feelings of helplessness and promote symptom management.
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Affiliation(s)
| | - Myfanwy Morgan
- Institute of Pharmaceutical Science, King’s College London, London, UK
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Functional connectivity changes in core resting state networks are associated with cognitive performance in systemic lupus erythematosus. J Comp Neurol 2019; 527:1837-1856. [DOI: 10.1002/cne.24656] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 12/29/2018] [Accepted: 01/17/2019] [Indexed: 12/23/2022]
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Cui C, Wang J, Mullin AP, Caggiano AO, Parry TJ, Colburn RW, Pavlopoulos E. The antibody rHIgM22 facilitates hippocampal remyelination and ameliorates memory deficits in the cuprizone mouse model of demyelination. Brain Res 2018; 1694:73-86. [DOI: 10.1016/j.brainres.2018.05.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 05/13/2018] [Accepted: 05/14/2018] [Indexed: 12/26/2022]
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Ntoskou K, Messinis L, Nasios G, Martzoukou M, Makris G, Panagiotopoulos E, Papathanasopoulos P. Cognitive and Language Deficits in Multiple Sclerosis: Comparison of Relapsing Remitting and Secondary Progressive Subtypes. Open Neurol J 2018; 12:19-30. [PMID: 29576812 PMCID: PMC5850485 DOI: 10.2174/1874205x01812010019] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 01/24/2018] [Accepted: 02/22/2018] [Indexed: 11/22/2022] Open
Abstract
Objective: The objective of this study was to investigate the pattern and severity of cognitive and language impairment in Greek patients with Relapsing-remitting (RRMS) and Secondary Progressive Multiple Sclerosis (SPMS), relative to control participants. Method: A prospective study was conducted in 27 patients with multiple sclerosis (PwMS), (N= 15) with RRMS, (N= 12) with SPMS, and (N= 12) healthy controls. All participants were assessed with a flexible comprehensive neuropsychological – language battery of tests that have been standardized in Greece and validated in Greek MS patients. They were also assessed on measures of disability (Expanded Disability Status Scale; EDSS), fatigue (Fatigue Severity Scale; FSS) and depression (Beck Depression Inventory - fast screen; BDI-FS). Results: Our results revealed that groups were well matched on baseline demographic and clinical characteristics. The two clinical groups (RRMS; SPMS) did not differ on overall global cognitive impairment but differed in the initial encoding of verbal material, mental processing speed, response inhibition and set-shifting. RRMS patients differed from controls in the initial encoding of verbal material, learning curve, delayed recall of verbal information, processing speed, and response inhibition. SPMS patients differed in all utilized measures compared to controls. Moreover, we noted increased impairment frequency on individualized measures in the progressive SPMS group. Conclusion: We conclude that MS patients, irrespective of clinical subtype, have cognitive deficits compared to healthy participants, which become increasingly worse when they convert from RRMS to SPMS.On the contrary,the pattern of impairment remains relatively stable.
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Affiliation(s)
- Katerina Ntoskou
- Rehabilitation unit for Patients with Spinal Cord Injury, "Demetrios and Vera Sfikas", Department of Medicine, University of Patras, 26504 Patras, Greece
| | - Lambros Messinis
- Neuropsychology Section, Department of Neurology, University of Patras Medical School, 26504 Patras, Greece
| | - Grigorios Nasios
- Higher Educational Institute of Epirus, Department of Speech and Language Therapy, Ioannina, Greece
| | - Maria Martzoukou
- Higher Educational Institute of Epirus, Department of Speech and Language Therapy, Ioannina, Greece
| | - Giorgos Makris
- Higher Educational Institute of Peloponnese, Department of Speech and Language Therapy, Patras, Greece
| | - Elias Panagiotopoulos
- Rehabilitation unit for Patients with Spinal Cord Injury, "Demetrios and Vera Sfikas", Department of Medicine, University of Patras, 26504 Patras, Greece
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Neuropsychological Features of Multiple Sclerosis: Impact and Rehabilitation. Behav Neurol 2018; 2018:4831647. [PMID: 29576817 PMCID: PMC5848101 DOI: 10.1155/2018/4831647] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 01/16/2018] [Indexed: 12/26/2022] Open
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Altered white matter microstructure in lupus patients: a diffusion tensor imaging study. Arthritis Res Ther 2018; 20:21. [PMID: 29415762 PMCID: PMC5803933 DOI: 10.1186/s13075-018-1516-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 01/10/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The purpose of this study was to investigate whether white matter microstructure is altered in patients suffering from systemic lupus erythematosus (SLE), and if so, whether such alterations differed between patients with and without neuropsychiatric symptoms. METHODS Structural MRI and diffusion tensor imaging (DTI) were performed in 64 female SLE patients (mean age 36.9 years, range 18.2-52.2 years) and 21 healthy controls (mean age 36.7 years, range 23.3-51.2 years) in conjunction with clinical examination, laboratory tests, cognitive evaluation, and self-assessment questionnaires. The patients were subgrouped according to the American College of Rheumatology Neuropsychiatric Systemic Lupus Erythematosus case definitions into non-neuropsychiatric SLE (nonNPSLE) and neuropsychiatric SLE (NPSLE). RESULTS Comparisons between the SLE group and healthy controls showed that the mean fractional anisotropy (FA) was significantly reduced in the right rostral cingulum (p = 0.038), the mid-sagittal corpus callosum (CC) (p = 0.050), and the forceps minor of the CC (p = 0.015). The mean diffusivity (MD) was significantly increased in the left hippocampal cingulum (p = 0.017). No significant differences in MD or FA values were identified between NPSLE and nonNPSLE patients. Disease duration among all SLE patients correlated significantly with reduced FA in the CC (p < 0.05). No correlations were found between DTI parameters and white matter hyperintensities, SLE Disease Activity Index-2000, Systemic Lupus International Collaborating Clinical/ACR Organ Damage Index, or Montgomery Asberg Depression Rate Score Self-report. CONCLUSIONS We found alterations of white matter microstructure in SLE patients that were related to disease duration and fatigue. Our results indicate that cerebral involvement in SLE is not isolated to the NPSLE subgroup.
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Trenova AG, Slavov GS, Draganova-Filipova MN, Mateva NG, Manova MG, Miteva LD, Stanilova SA. Circulating levels of interleukin-17A, tumor necrosis factor-alpha, interleukin-18, interleukin-10, and cognitive performance of patients with relapsing-remitting multiple sclerosis. Neurol Res 2018; 40:153-159. [DOI: 10.1080/01616412.2017.1420522] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
| | - Georgi S. Slavov
- Department of Neurology, Medical University of Plovdiv, Plovdiv, Bulgaria
| | | | - Nonka G. Mateva
- Department of Medical Informatics, Biostatistics and Electronic Education, Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Mariya G. Manova
- Department of Neurology, Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Lyuba D. Miteva
- Department of Molecular Biology, Immunology and Medical Genetics, Trakia University, Stara Zagora, Bulgaria
| | - Spaska A. Stanilova
- Department of Molecular Biology, Immunology and Medical Genetics, Trakia University, Stara Zagora, Bulgaria
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Efficacy of a Computer-Assisted Cognitive Rehabilitation Intervention in Relapsing-Remitting Multiple Sclerosis Patients: A Multicenter Randomized Controlled Trial. Behav Neurol 2017; 2017:5919841. [PMID: 29463950 PMCID: PMC5804109 DOI: 10.1155/2017/5919841] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Revised: 09/25/2017] [Accepted: 10/04/2017] [Indexed: 11/17/2022] Open
Abstract
Cognitive impairment is frequently encountered in multiple sclerosis (MS) affecting between 40-65% of individuals, irrespective of disease duration and severity of physical disability. In the present multicenter randomized controlled trial, fifty-eight clinically stable RRMS patients with mild to moderate cognitive impairment and relatively low disability status were randomized to receive either computer-assisted (RehaCom) functional cognitive training with an emphasis on episodic memory, information processing speed/attention, and executive functions for 10 weeks (IG; n = 32) or standard clinical care (CG; n = 26). Outcome measures included a flexible comprehensive neuropsychological battery of tests sensitive to MS patient deficits and feedback regarding personal benefit gained from the intervention on four verbal questions. Only the IG group showed significant improvements in verbal and visuospatial episodic memory, processing speed/attention, and executive functioning from pre - to postassessment. Moreover, the improvement obtained on attention was retained over 6 months providing evidence on the long-term benefits of this intervention. Group by time interactions revealed significant improvements in composite cognitive domain scores in the IG relative to the demographically and clinically matched CG for verbal episodic memory, processing speed, verbal fluency, and attention. Treated patients rated the intervention positively and were more confident about their cognitive abilities following treatment.
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33
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Braga DM, Prado GFD, Bichueti DB, Oliveira EMLD. Positive correlation between functional disability, excessive daytime sleepiness, and fatigue in relapsing-remitting multiple sclerosis. ARQUIVOS DE NEURO-PSIQUIATRIA 2017; 74:433-8. [PMID: 27332066 DOI: 10.1590/0004-282x20160069] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Accepted: 03/28/2016] [Indexed: 11/22/2022]
Abstract
METHOD Retrospective review of medical records from patients with multiple sclerosis to collect data on severity of fatigue, disability, daytime sleepiness, and depression. From 912 medical records reviewed, 122 reported daytime sleepiness: 67% had relapsing remitting, 12% had primary progressive, and 21% had secondary progressive. RESULTS In 95% of the patients with relapsing remitting who complained of daytime sleepiness and fatigue, association was found between these symptoms and neurological disability. Patients with relapsing remitting who complained of daytime sleepiness and fatigue also experienced depression (p = 0.001). No association between fatigue, excessive daytime sleepiness, depression, and disability was found in patients with progressive disease. CONCLUSION In relapsing remitting, there is correlation between functional disability, excessive daytime sleepiness and fatigue, a finding not confirmed in primary progressive and secondary progressive form.
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Affiliation(s)
- Douglas Martins Braga
- Universidade Federal de São Paulo, Universidade Federal de São Paulo, Departamento de Neurologia e Neurocirurgia, São Paulo SP , Brasil, Universidade Federal de São Paulo, Departamento de Neurologia e Neurocirurgia, Setor de Doenças Desmielizantes e Neuro-sono, São Paulo SP, Brasil
| | - Gilmar Fernandes do Prado
- Universidade Federal de São Paulo, Universidade Federal de São Paulo, Departamento de Neurologia e Neurocirurgia, São Paulo SP , Brasil, Universidade Federal de São Paulo, Departamento de Neurologia e Neurocirurgia, Setor de Doenças Desmielizantes e Neuro-sono, São Paulo SP, Brasil
| | - Denis Bernardi Bichueti
- Universidade Federal de São Paulo, Universidade Federal de São Paulo, Departamento de Neurologia e Neurocirurgia, São Paulo SP , Brasil, Universidade Federal de São Paulo, Departamento de Neurologia e Neurocirurgia, Setor de Doenças Desmielizantes e Neuro-sono, São Paulo SP, Brasil
| | - Enedina Maria Lobato de Oliveira
- Universidade Federal de São Paulo, Universidade Federal de São Paulo, Departamento de Neurologia e Neurocirurgia, São Paulo SP , Brasil, Universidade Federal de São Paulo, Departamento de Neurologia e Neurocirurgia, Setor de Doenças Desmielizantes e Neuro-sono, São Paulo SP, Brasil
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Bogosian A, Morgan M, Bishop FL, Day F, Moss-Morris R. Adjustment modes in the trajectory of progressive multiple sclerosis: a qualitative study and conceptual model. Psychol Health 2016; 32:343-360. [DOI: 10.1080/08870446.2016.1268691] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Angeliki Bogosian
- School of Health Sciences, City, University of London, London, UK
- Psychology Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Myfanwy Morgan
- Institute of Pharmaceutical Science, King’s College London, London, UK
| | | | - Fern Day
- School of Health Sciences, City, University of London, London, UK
| | - Rona Moss-Morris
- Psychology Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
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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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Polychroniadou E, Bakirtzis C, Langdon D, Lagoudaki R, Kesidou E, Theotokis P, Tsalikakis D, Poulatsidou K, Kyriazis O, Boziki M, Papadopoulos G, Boura E, Sintila L, Hatzigeorgiou S, Ziamos C, Ioannidis P, Karacostas D, Grigoriadis N. Validation of the Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS) in Greek population with multiple sclerosis. Mult Scler Relat Disord 2016; 9:68-72. [DOI: 10.1016/j.msard.2016.06.011] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 06/21/2016] [Accepted: 06/25/2016] [Indexed: 10/21/2022]
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Katsari M, Kasselimis D, Gasparinatos G, Antonellou R, Voumvourakis K. Neuropsychological and psychiatric aspects of multiple sclerosis: preliminary investigation of discrete profiles across neurological subtypes. Neurol Sci 2016; 37:969-72. [DOI: 10.1007/s10072-015-2463-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 12/22/2015] [Indexed: 10/22/2022]
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de Bruin NMWJ, Schmitz K, Schiffmann S, Tafferner N, Schmidt M, Jordan H, Häußler A, Tegeder I, Geisslinger G, Parnham MJ. Multiple rodent models and behavioral measures reveal unexpected responses to FTY720 and DMF in experimental autoimmune encephalomyelitis. Behav Brain Res 2015; 300:160-74. [PMID: 26692368 DOI: 10.1016/j.bbr.2015.12.006] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 11/30/2015] [Accepted: 12/09/2015] [Indexed: 10/22/2022]
Abstract
Experimental autoimmune encephalomyelitis (EAE) is a widely-used rodent model for multiple sclerosis (MS), but a single model can hardly capture all features of MS. We investigated whether behavioral parameters in addition to clinical motor function scores could be used to assess treatment efficacy during score-free intervals in the relapsing-remitting EAE model in SJL/J mice. We studied the effects of the clinical reference compounds FTY720 (fingolimod, 0.5mg/kg/day) and dimethyl fumarate (DMF, 20-30 mg/kg/day) on clinical scores in several rodent EAE models in order to generate efficacy profiles. SJL/J mice with relapsing-remitting EAE were studied using behavioral tests, including rotarod, gait analysis, locomotor activity and grip strength. SJL/J mice were also examined according to Crawley's sociability and preference for social novelty test. Prophylactic treatment with FTY720 prevented clinical scores in three of the four EAE rodent models: Dark Agouti (DA) and Lewis rats and C57BL/6J mice. Neither prophylactic nor late-therapeutic treatment with FTY720 reduced clinical scores or reversed deficits in the rotarod test in SJL/J mice, but we observed effects on motor functions and sociability in the absence of clinical scores. Prophylactic treatment with FTY720 improved the gait of SJL/J mice whereas late-therapeutic treatment improved manifestations of reduced social (re)cognition or preference for social novelty. DMF was tested in three EAE models and did not improve clinical scores at the dose used. These data indicate that improvements in behavioral deficits can occur in absence of clinical scores, which indicate subtle drug effects and may have translational value for human MS.
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Affiliation(s)
- N M W J de Bruin
- Fraunhofer Institute for Molecular Biology and Applied Ecology IME, Project Group Translational Medicine & Pharmacology TMP, Theodor-Stern-Kai 7, 60596 Frankfurt am Main, Germany.
| | - K Schmitz
- Pharmazentrum Frankfurt/ZAFES, Institute of Clinical Pharmacology, Goethe-University Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - S Schiffmann
- Fraunhofer Institute for Molecular Biology and Applied Ecology IME, Project Group Translational Medicine & Pharmacology TMP, Theodor-Stern-Kai 7, 60596 Frankfurt am Main, Germany
| | - N Tafferner
- Fraunhofer Institute for Molecular Biology and Applied Ecology IME, Project Group Translational Medicine & Pharmacology TMP, Theodor-Stern-Kai 7, 60596 Frankfurt am Main, Germany
| | - M Schmidt
- Fraunhofer Institute for Molecular Biology and Applied Ecology IME, Project Group Translational Medicine & Pharmacology TMP, Theodor-Stern-Kai 7, 60596 Frankfurt am Main, Germany
| | - H Jordan
- Fraunhofer Institute for Molecular Biology and Applied Ecology IME, Project Group Translational Medicine & Pharmacology TMP, Theodor-Stern-Kai 7, 60596 Frankfurt am Main, Germany
| | - A Häußler
- Pharmazentrum Frankfurt/ZAFES, Institute of Clinical Pharmacology, Goethe-University Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - I Tegeder
- Pharmazentrum Frankfurt/ZAFES, Institute of Clinical Pharmacology, Goethe-University Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - G Geisslinger
- Fraunhofer Institute for Molecular Biology and Applied Ecology IME, Project Group Translational Medicine & Pharmacology TMP, Theodor-Stern-Kai 7, 60596 Frankfurt am Main, Germany; Pharmazentrum Frankfurt/ZAFES, Institute of Clinical Pharmacology, Goethe-University Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - M J Parnham
- Fraunhofer Institute for Molecular Biology and Applied Ecology IME, Project Group Translational Medicine & Pharmacology TMP, Theodor-Stern-Kai 7, 60596 Frankfurt am Main, Germany
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Messinis L, Nasios G, Mougias A, Politis A, Zampakis P, Tsiamaki E, Malefaki S, Gourzis P, Papathanasopoulos P. Age and education adjusted normative data and discriminative validity for Rey’s Auditory Verbal Learning Test in the elderly Greek population. J Clin Exp Neuropsychol 2015; 38:23-39. [DOI: 10.1080/13803395.2015.1085496] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Beadnall HN, Kuppanda KE, O'Connell A, Hardy TA, Reddel SW, Barnett MH. Tablet-based screening improves continence management in multiple sclerosis. Ann Clin Transl Neurol 2015; 2:679-87. [PMID: 26125042 PMCID: PMC4479527 DOI: 10.1002/acn3.205] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 03/17/2015] [Indexed: 11/12/2022] Open
Abstract
Objective To investigate whether electronic continence questionnaires aid early identification and optimizes management of sphincter dysfunction in a multiple sclerosis clinic. Methods A custom designed, tablet-based cross-platform software tool was designed to capture validated multiple sclerosis (MS) patient-reported outcomes. An unselected cohort of MS patients from a tertiary referral clinic completed electronic tablet-based versions of the Bladder Control Scale (BLCS) and the Bowel Control Scale in the waiting room. Data were captured wirelessly “on-the-fly” and stored in a deidentified, secure database; and individual questionnaire results were immediately available to the treating neurologist in the electronic medical record. Scores of ≥2 on either questionnaire generated an automated electronic referral to the clinic MS continence nurse (MS CN). Results One hundred and fifty-seven MS patients completed a total of 184 electronic continence test sets and on two occasions only the BLCS was completed. An automatic electronic referral for formal continence review was generated 128 times in 108 patients. Fifty-seven formal continence assessments were undertaken by the MS CN following automated referral. All reviews resulted in at least one clinical intervention being made. Interpretation Tablet-based data capture and automated continence referral using this software tool is an efficient, sensitive, and feasible method of screening MS patients for bladder and bowel dysfunction. Concordance with the results of formal continence assessment in this pilot study validates the use of this technology as a screening tool.
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Affiliation(s)
- Heidi N Beadnall
- Brain and Mind Research Institute, University of Sydney Sydney, New South Wales, Australia ; Multiple Sclerosis Clinic, Brain and Mind Research Institute, University of Sydney Sydney, New South Wales, Australia ; Department of Neurology, Royal Prince Alfred Hospital Sydney, New South Wales, Australia
| | - Kushi E Kuppanda
- Multiple Sclerosis Clinic, Brain and Mind Research Institute, University of Sydney Sydney, New South Wales, Australia ; Multiple Sclerosis Australia Sydney, New South Wales, Australia
| | - Annmaree O'Connell
- Multiple Sclerosis Clinic, Brain and Mind Research Institute, University of Sydney Sydney, New South Wales, Australia ; Multiple Sclerosis Australia Sydney, New South Wales, Australia
| | - Todd A Hardy
- Multiple Sclerosis Clinic, Brain and Mind Research Institute, University of Sydney Sydney, New South Wales, Australia ; Neuroimmunology Clinic, Concord Hospital and University of Sydney Sydney, New South Wales, Australia
| | - Stephen W Reddel
- Brain and Mind Research Institute, University of Sydney Sydney, New South Wales, Australia ; Department of Neurology, Concord Repatriation General Hospital Sydney, New South Wales, Australia ; Concord Clinical School, University of Sydney Sydney, New South Wales, Australia
| | - Michael H Barnett
- Brain and Mind Research Institute, University of Sydney Sydney, New South Wales, Australia ; Multiple Sclerosis Clinic, Brain and Mind Research Institute, University of Sydney Sydney, New South Wales, Australia ; Department of Neurology, Royal Prince Alfred Hospital Sydney, New South Wales, Australia
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