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Alıyev NO, Kara B, Güneş AS, Anık Y, Efendi H, Çoskun A. Evaluation of mental performance and cognitive functions of children and adolescents diagnosed with radiologically isolated syndrome. Mult Scler Relat Disord 2024; 88:105735. [PMID: 38981312 DOI: 10.1016/j.msard.2024.105735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 05/14/2024] [Accepted: 06/19/2024] [Indexed: 07/11/2024]
Abstract
BACKGROUND Radiologically isolated syndrome (RIS) is a condition characterized by asymptomatic, incidentally detected demyelinating plaques in the CNS in a patient without typical clinical findings of multiple sclerosis (MS). This study aimed to compare the mental status and cognitive functions of child and adolescent RIS cases with healthy controls and to investigate the relationship between psychometric test results and the demyelinating lesion characteristics. METHODS The mental status and cognitive functions of 12 RIS cases and 12 healthy controls were compared. Semi-structured interviews, behavioral evaluations, depression and anxiety scales, neuropsychological test battery, and an intelligence test were applied for the evaluation of mental state and cognitive functions. These results were compared with the number and localization of demyelinating lesions. RESULTS Sustained attention, visual-motor coordination, short-term memory skills, and ability to use visual-spatial information were found worse in the RIS group. There was no correlation between mental state and cognitive functions, and the number and localization of demyelinating lesions. CONCLUSION Our study showed that pediatric RIS cases may have worse cognitive performance than healthy controls, but no correlation was found between the number and location of demyelinating lesions and psychiatric findings. Although it is controversial whether psychiatric disorders and cognitive disabilities have predictive value in terms of MS conversion in pediatric RIS cases, these subjects were not included in the scope of this study.
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Affiliation(s)
- Nilüfer Okumuş Alıyev
- Bolu İzzet Baysal Mental Health and Diseases Hospital, Department of Child and Adolescent Psychiatry, Bolu, Turkey.
| | - Bülent Kara
- Kocaeli University Faculty of Medicine, Department of Pediatrics, Division of Child Neurology, Kocaeli, Turkey
| | - Ayfer Sakarya Güneş
- Kocaeli University Faculty of Medicine, Department of Pediatrics, Division of Child Neurology, Kocaeli, Turkey
| | - Yonca Anık
- Kocaeli University Faculty of Medicine, Department of Radiology, Division of Neuroradiology, Kocaeli, Turkey
| | - Hüsnü Efendi
- Kocaeli University Faculty of Medicine, Department of Neurology, Kocaeli, Turkey
| | - Ayşen Çoskun
- Kocaeli University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Kocaeli, Turkey
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Conte F, Rinaldi L, Gerosa T, Mondini S, Costantini G, Girelli L. Cognitive Reserve Potential: Capturing Cognitive Resilience Capability in Adolescence. Assessment 2024; 31:812-826. [PMID: 37394752 DOI: 10.1177/10731911231183363] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
Cognitive reserve (CR) represents the adaptive response of the cognitive system responsible for preserving normal functioning in the face of brain damage. Experiential factors such as education, occupation, and leisure activities influence the development of CR. Theoretically, such factors build up from childhood and across adulthood. Thus, appropriate tools to define and measure CR as early as adolescence are essential to understand its developmental processes. To this aim, we introduce the construct of "Cognitive Reserve Potential" (CRP) and its corresponding index of experiential factors tailored to youth. We investigated prototypical youth exposures potentially associated with the lifelong development of CR (e.g., sport practice, musical experiences, cultural activities, and relationships with peers and family). Principal component analysis and confirmatory factor analysis identified and replicated the CRP factor structure on two independent samples of Italian students: N = 585 (295 F) and N = 351 (201 F), ages 11 to 20. CRP was associated mainly with family socio-cultural status (i.e., socioeconomic status [SES], Home Possessions, and Books at Home). Results confirmed the strength of the factorial model and warranted the proposal of the CRP-questionnaire as an innovative tool for understanding CR evolutionary dynamics.
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Affiliation(s)
| | - Luca Rinaldi
- University of Pavia, Italy
- IRCCS Mondino Foundation, Pavia, Italy
| | | | | | | | - Luisa Girelli
- University of Milano-Bicocca, Italy
- Milan Center for Neuroscience, Milano, Italy
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3
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Jellinger KA. Cognitive impairment in multiple sclerosis: from phenomenology to neurobiological mechanisms. J Neural Transm (Vienna) 2024:10.1007/s00702-024-02786-y. [PMID: 38761183 DOI: 10.1007/s00702-024-02786-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 05/08/2024] [Indexed: 05/20/2024]
Abstract
Multiple sclerosis (MS) is an autoimmune-mediated disease of the central nervous system characterized by inflammation, demyelination and chronic progressive neurodegeneration. Among its broad and unpredictable range of clinical symptoms, cognitive impairment (CI) is a common and disabling feature greatly affecting the patients' quality of life. Its prevalence is 20% up to 88% with a wide variety depending on the phenotype of MS, with highest frequency and severity in primary progressive MS. Involving different cognitive domains, CI is often associated with depression and other neuropsychiatric symptoms, but usually not correlated with motor and other deficits, suggesting different pathophysiological mechanisms. While no specific neuropathological data for CI in MS are available, modern research has provided evidence that it arises from the disease-specific brain alterations. Multimodal neuroimaging, besides structural changes of cortical and deep subcortical gray and white matter, exhibited dysfunction of fronto-parietal, thalamo-hippocampal, default mode and cognition-related networks, disruption of inter-network connections and involvement of the γ-aminobutyric acid (GABA) system. This provided a conceptual framework to explain how aberrant pathophysiological processes, including oxidative stress, mitochondrial dysfunction, autoimmune reactions and disruption of essential signaling pathways predict/cause specific disorders of cognition. CI in MS is related to multi-regional patterns of cerebral disturbances, although its complex pathogenic mechanisms await further elucidation. This article, based on systematic analysis of PubMed, Google Scholar and Cochrane Library, reviews current epidemiological, clinical, neuroimaging and pathogenetic evidence that could aid early identification of CI in MS and inform about new therapeutic targets and strategies.
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Affiliation(s)
- Kurt A Jellinger
- Institute of Clinical Neurobiology, Alberichgasse 5/13, Vienna, A-1150, Austria.
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Aloni R, Kalron A, Goodman A, Ben-Ari A, Yoeli-Shalom T, Menascu S. Attention Deficit/Hyperactivity Disorder in Children with Multiple Sclerosis. J Atten Disord 2024; 28:1105-1113. [PMID: 38385203 DOI: 10.1177/10870547241232710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
BACKGROUND Multiple sclerosis (MS) is a chronic neurological autoimmune disease; pediatric-onset multiple sclerosis (POMS) represents 5% to 10% of total MS population. Children with POMS may experience attention difficulties due to the disease's impact on the central nervous system. However, little is known regarding Attention Deficit Hyperactivity Disorder (ADHD) in POMS, and its relation to cognitive performance. METHODS A retrospective case review was conducted using medical records of 66 children and adolescent patients diagnosed with POMS between 2012 and 2021 in a MS center of a tertiary medical center. All patients had undergone routine clinical neurological examinations and had been assessed for a diagnosis of ADHD by a department pediatric neurologist. In addition, sociodemographic data, disease-related variables, and cognitive performance were collected. RESULTS Of the 66 patients, 31 (47%) had a diagnosis of ADHD; 29 (44%) had cognitive impairment. Moreover, we identified four different profiles of POMS: those with only ADHD (17, 26%); only cognitive impairment (15, 23%), ADHD and cognitive impairment (14, 21%), and only POMS (20, 30%). A significant difference in disease duration was found among the four profiles [F(3,65) = 8.17, p < .001, η² = 0.29], indicating that patients with ADHD and cognitive impairment were characterized by longer disease duration. CONCLUSIONS ADHD may be prominently involved in POMS, even during the early stages of the disease and early diagnosis is crucial in order to provide appropriate interventions and support.
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Affiliation(s)
- Roy Aloni
- Department of Psychology, Ariel University, Israel
- Multiple Sclerosis Center, Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel
| | - Alon Kalron
- Multiple Sclerosis Center, Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel
- Department of Physical Therapy, School of Health Professions, Tel-Aviv Faculty of Medicine, Tel-Aviv University, Israel
| | - Assaf Goodman
- Department of Behavioral Sciences, Ruppin Academic Center, Emek Hefer, Israel
| | | | - Talya Yoeli-Shalom
- Multiple Sclerosis Center, Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel
| | - Shay Menascu
- Multiple Sclerosis Center, Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel
- Tel-Aviv School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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5
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Barker MM, Beresford B, Fraser LK. Incidence of anxiety and depression in children and young people with life-limiting conditions. Pediatr Res 2022:10.1038/s41390-022-02370-8. [PMID: 36369475 DOI: 10.1038/s41390-022-02370-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 05/30/2022] [Accepted: 06/06/2022] [Indexed: 11/13/2022]
Abstract
BACKGROUND The aim of this study was to investigate the incidence of anxiety and depression in children and young people with life-limiting conditions. METHODS A comparative cohort study was conducted, using primary and secondary care data from the Clinical Practice Research Datalink (CPRD) in England. Anxiety and depression codes were identified using diagnostic, symptom and prescription codes. Incidence rates of anxiety and depression were compared across condition groups using Poisson regression, adjusting for sex, age, ethnicity, and deprivation status. RESULTS A total of 25,313 children and young people were included in the study: 5527 with life-limiting conditions, 6729 with chronic conditions, and 13,057 with no long-term conditions. The incidence of anxiety (IRRadj: 1.39, 95% CI: 1.09-1.77) and depression (IRRadj: 1.41, 95% CI: 1.08-1.83) was significantly higher in children and young people with life-limiting conditions, compared to children and young people with no long-term conditions. CONCLUSIONS The higher incidence of anxiety and depression observed among children and young people with life-limiting conditions highlights the need for psychological support in this population, including further efforts to prevent, identify, and treat anxiety and depression. IMPACT The analysis of primary and secondary healthcare data from England revealed that the incidence of anxiety and depression was higher among children and young people with life-limiting conditions, compared to those with no long-term conditions. This is the first study to investigate the incidence of anxiety and depression in children and young people with a wide range of life-limiting conditions. The higher incidence of anxiety and depression observed in children and young people with life-limiting conditions highlights the need for psychological support aiming to prevent, identify, and treat anxiety and depression in this population group.
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Affiliation(s)
- Mary M Barker
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Gwendolen Road, Leicester, UK. .,Martin House Research Centre, Department of Health Sciences, University of York, York, UK.
| | - Bryony Beresford
- Martin House Research Centre, Department of Health Sciences, University of York, York, UK.,Social Policy Research Unit, University of York, York, UK
| | - Lorna K Fraser
- Martin House Research Centre, Department of Health Sciences, University of York, York, UK
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Kesselring J, Boyko A, Laroni A, Bharadia T, van Galen P, Alexandri N. Caregiver Involvement in MS: Duty or Disruption? Neurol Ther 2022; 11:9-20. [PMID: 34792783 PMCID: PMC8857341 DOI: 10.1007/s40120-021-00299-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 11/01/2021] [Indexed: 11/06/2022] Open
Abstract
Multiple sclerosis (MS) is a complex condition with numerous physical, cognitive and emotional symptoms. These may necessitate significant, permanent lifestyle changes for people with multiple sclerosis (PwMS) and their caregivers and families, meaning it is important in contemporary neurological practice to consider including families and/or caregivers in the management of MS. However, existing evidence suggests that family involvement is not always beneficial; for example, it can exert either a strong positive or negative influence on the ability of PwMS to achieve optimal outcomes from their treatment and disease management. This paper, based on a live debate between neurologists and PwMS, examines the current perceptions on constructive involvement of families and caregivers in consultations for and management of MS, and reveals several areas where additional studies are warranted. Shared decision-making in MS has historically been a collaboration solely between healthcare professionals (HCPs) and PwMS, but PwMS are now more frequently being accompanied to appointments by a support person. This paper encourages HCPs to understand the dynamics between PwMS and their support person, and to individualize consultations and information accordingly. Family and caregiver involvement in the provision of care for PwMS needs to be for the benefit of, and at the discretion of, the PwMS. Support for families of PwMS, although important, may be more effectively and appropriately delivered through other channels outside of the clinical setting. Educating HCPs on the current patient experience to enable them to provide improved personalized care will ensure a mutualistic, patient-centred relationship with PwMS, which will help to optimize outcomes. Communication tools may also facilitate these interactions.
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Affiliation(s)
- Jürg Kesselring
- Department of Neurology and Neurorehabilitation, Kliniken Valens, Valens, Switzerland.
| | - Alexey Boyko
- Institute of Clinical Neurology and Department of Neuroimmunology of the Federal Centre of Brain Research and Neurotechnologies, Pirogov's Russian National Research Scientific Medical University, Moscow, Russia
| | - Alice Laroni
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Trishna Bharadia
- Patient Author, Member of the MS in the 21st Century Steering Group, Buckinghamshire, UK
| | - Pieter van Galen
- Patient Author, Member of the MS in the 21st Century Steering Group, Overijse, Belgium
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Wang J, Li Y, Geng X, Zhang X, Xiao Y, Wang W. Associations of Epstein-Barr Virus Infection with Attention Deficit Hyperactivity Disorder, Learning Disability, and Special Education in US Children. Int J Gen Med 2022; 15:2187-2195. [PMID: 35241933 PMCID: PMC8887610 DOI: 10.2147/ijgm.s355263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 02/16/2022] [Indexed: 11/24/2022] Open
Abstract
Background Most infections of Epstein-Barr virus (EBV), which is potentially neurotropic, occur in childhood, but little is known about its association with child neurodevelopmental outcomes. Patients and Methods We investigated whether EBV seropositivity was associated with parent-reported attention deficit hyperactivity disorder (ADHD), learning disability, or special education utilization among children, using data from the National Health and Nutrition Examination Survey (NHANES) 2003–2004. Potential confounding factors were adjusted using survey logistic regression models. Results EBV seroprevalence was 69.6% (95% CI, 67.1–72.1%) for US children aged 6–19. The prevalence was 8.86% (95% CI, 7.47–10.47%) for ADHD among 6–19 year olds, 11.70% (95% CI, 9.84–13.87%) for learning disability among 6–15 year olds, and 10.18% (95% CI, 8.58–12.05%) for special education among 6–17 year olds. Children with positive anti-EBV had higher crude prevalence rates of learning disability and special education but not ADHD compared with those with negative anti-EBV. The adjusted odds ratios were 2.76 (95% CI, 1.53–4.96) for learning disability, 3.58 (95% CI, 1.92–6.55) for special education, and 0.77 (95% CI, 0.42–1.38) for ADHD, when comparing children with positive and negative anti-EBV. Conclusion EBV seropositivity was associated with learning disability and special education among US children. Future studies that longitudinally examine the associations are warranted.
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Affiliation(s)
- Jingjing Wang
- Department of Pediatrics, Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, People’s Republic of China
| | - Yaping Li
- Department of Infectious Diseases, Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, People’s Republic of China
| | - Xiaozhen Geng
- Department of Infectious Diseases, Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, People’s Republic of China
| | - Xin Zhang
- Department of Infectious Diseases, Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, People’s Republic of China
| | - Yanfeng Xiao
- Department of Pediatrics, Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, People’s Republic of China
- Yanfeng Xiao, Department of Pediatrics, Second Affiliated Hospital of Xi’an Jiaotong University, 157 Xiwu Road, Xi’an, Shaanxi, People’s Republic of China, Tel +8602987679273, Email
| | - Wenjun Wang
- Department of Infectious Diseases, Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, People’s Republic of China
- Correspondence: Wenjun Wang, Department of Infectious Diseases, Second Affiliated Hospital of Xi’an Jiaotong University, 157 Xiwu Road, Xi’an, Shaanxi, People’s Republic of China, Tel +8615091052402, Email
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Ayele BA, Wuhib MZ, Zenebe BG, Zewde YZ, Wolde YT, Metaferia GZ. Neuroimaging Features and Associated Factors in Multiple Sclerosis Patients: A Perspective from a Private Care Center in Addis Ababa, Ethiopia. Ethiop J Health Sci 2021; 31:1043-1052. [PMID: 35221622 PMCID: PMC8843137 DOI: 10.4314/ejhs.v31i5.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 04/22/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Brain and spine magnetic resonance image (MRI) have an invaluable importance in diagnosing multiple sclerosis (MS) in low prevalence countries such as Ethiopia. The objective of our study was to characterize the neuroimaging features and associated factors in Multiple sclerosis patients in Addis Ababa, Ethiopia. METHOD A cross-sectional observational study was conducted in 30 multiple sclerosis patients at Yehuleshet Specialty Clinic, Addis Ababa, Ethiopia. Both descriptive and analytical statistics were used to analyze the data. RESULTS We have enrolled 30 patients with confirmed multiple sclerosis and clinically isolate syndrome. The mean age was 34.7 years (1SD=8.9). Female accounted 86.7%. The mean duration of illness was 3.4 years (1SD=3.1) (range: 1 - 11 years). Relapsing and remitting variant was the commonest sub type (66.7%). Alcohol use and head injury were the commonest identified risk factors reported by the patients. Classical radiological features of MS such as white matter lesions involving juxtacortical, U-fiber, corpus callosum (CC), and Dawson's finger projections pattern were observed in 46.7%, 23.3%, 70%, and 40% respectively. Cervical and thoracic cords were affected in 40% and 6.7% respectively. Global cortical and CC atrophy was observed in 16.7% and 6.7% respectively. Advanced age was associated with lesions of corpus callosum when adjusted for duration of illness and history of head injury (AOR 1.13, 95% CI 1.01-1.28, p=0.04). CONCLUSION Typical neuroimaging features of MS were prevalent among Ethiopian MS patients. Age was an independent predictor of lesions involving corpus callosum. Global cortical atrophy was common among Ethiopian MS patients.
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Affiliation(s)
- Biniyam A Ayele
- Assistant Professor of Neurology, Department of Neurology College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Mehila Z Wuhib
- Yehuleshet Specialty Clinic, Honorary Assistant Professor of Neurology
| | | | - Yared Z Zewde
- Assistant Professor of Neurology, Department of Neurology College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Yonas T Wolde
- Assistant Professor of Radiology, Neuroradiologist Department of Radiology, St.Paul Millennium Medical College, Addis Ababa, Ethiopia
| | - Guta Z Metaferia
- Assistant Professor of Neurology, Department of Neurology College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Fabri TL, Datta R, O'Mahony J, Barlow-Krelina E, De Somma E, Longoni G, Gur RE, Gur RC, Bacchus M, Ann Yeh E, Banwell BL, Till C. Memory, processing of emotional stimuli, and volume of limbic structures in pediatric-onset multiple sclerosis. Neuroimage Clin 2021; 31:102753. [PMID: 34273791 PMCID: PMC8319518 DOI: 10.1016/j.nicl.2021.102753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 06/22/2021] [Accepted: 06/29/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The limbic system is involved in memory and in processing of emotional stimuli. We measured volume of the hippocampus, amygdala, and thalamus, and assessed their relative contribution to episodic memory and emotion identification in POMS. METHOD Sixty-five POMS participants (Mage = 18.3 ± 3.9 years; 48 female (73.8%)), average disease duration = 3.8 ± 3.8 years) and 76 age- and sex-matched controls (Mage = 18.1 ± 4.6 years; 49 female (64.5%)) completed the Penn Computerized Neurocognitive Battery (PCNB); 59 of 65 POMS participants and 69 out of 76 controls underwent 3 T MRI scanning. We derived age-adjusted Z-scores on accuracy and response time (RT) measures of episodic memory and emotion identification of the PCNB. Magnetic resonance imaging (MRI) volumetrics were normalized using the scaling factor computed by SIENAx. On PCNB tests that differed between groups, we used multiple linear regression to assess relationships between regional brain volumes and either episodic memory or emotion identification outcomes controlling for age, sex, accuracy/RT, and parental education. RESULTS POMS participants were slower and less accurate than controls on the episodic memory domain but did not differ from controls on emotion outcomes. At the subtest level, POMS participants showed reduced accuracy on Word Memory (p = .002) and slower performance on Face Memory (p = .04) subtests. POMS participants had smaller total and regional brain volumes of the hippocampus, amygdala, and thalamus (p values ≤ 0.01). Collapsing across groups, both hippocampal and thalamic volume were significant predictors of Word Memory accuracy; hippocampal volume (B = 0.24, SE = 0.10, p = .02) was more strongly associated with Word Memory performance than thalamic volume (B = 0.16, SE = 0.05, p = .003), though the estimate with was less precise. CONCLUSIONS POMS participants showed reduced episodic memory performance compared to controls. Aspects of episodic memory performance were associated with hippocampal and thalamic volume. Emotion identification was intact, despite volume loss in the amygdala.
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Affiliation(s)
| | - Ritobrato Datta
- Division of Neurology, Children's Hospital of Philadelphia, United States
| | - Julia O'Mahony
- Departments of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada
| | | | | | - Giulia Longoni
- Department of Paediatrics, Division of Neurology, The Hospital for Sick Children, University of Toronto, Canada
| | - Raquel E Gur
- Penn-CHOP Lifespan Brain Institute, Departments of Psychiatry, Neurology, and Radiology, University of Pennsylvania School of Medicine, United States
| | - Ruben C Gur
- Penn-CHOP Lifespan Brain Institute, Departments of Psychiatry, Neurology, and Radiology, University of Pennsylvania School of Medicine, United States
| | - Micky Bacchus
- Division of Neurology, Children's Hospital of Philadelphia, United States
| | - E Ann Yeh
- Department of Paediatrics, Division of Neurology, The Hospital for Sick Children, University of Toronto, Canada
| | - Brenda L Banwell
- Division of Neurology, Children's Hospital of Philadelphia, United States; Perelman School of Medicine, University of Pennsylvania, United States
| | - Christine Till
- Department of Psychology, York University, Canada; Department of Paediatrics, Division of Neurology, The Hospital for Sick Children, University of Toronto, Canada.
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Simone M, Viterbo RG, Margari L, Iaffaldano P. A Randomized Computer-Assisted Rehabilitation Trial of Attention in Pediatric Multiple Sclerosis: A Post Hoc Analysis. Brain Sci 2021; 11:brainsci11050637. [PMID: 34069276 PMCID: PMC8156276 DOI: 10.3390/brainsci11050637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 05/05/2021] [Accepted: 05/10/2021] [Indexed: 11/25/2022] Open
Abstract
Cognitive impairment (CI) is a remarkable feature in pediatric-onset multiple sclerosis (POMS). The Symbol Digit Modalities Test (SDMT) is increasingly used to explore CI in MS. Recently, a four-point worsening on the SDMT score has been demonstrated to correlate with a clinically meaningful cognitive worsening in adult MS. We conducted a post hoc analysis of a randomized computer-assisted rehabilitation trial for attention impairment in POMS to test the clinical meaningfulness of the changes in SDMT scores at the end of the trial (delta SDMT). A four-point SDMT cut-off was applied. POMS patients exposed to specific computer training (ST) and non-specific training (nST) were compared. Data of 16 POMS (9 females, age 15.75 ± 1.74 years) patients were analyzed. At the end of the trial, 25% of patients reported no clinically significant changes (−3 to 3), 12.5% a clinically significant worsening (≤−4) and 62.5% a clinically significant improvement (≥4) in the delta SDMT. The proportion of patients reporting a clinically meaningful improvement was significantly (p = 0.008) higher (100%) in patients exposed to ST in comparison to those (25%) exposed to nST. The use of the four-point SDMT cut-off may be useful to assess the clinical meaningfulness of results from cognitive rehabilitation trials.
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Affiliation(s)
- Marta Simone
- Child Neuropsychiatry Unit, Department of Biomedical Sciences and Oncology, University of Bari “Aldo Moro”, 70121 Bari, Italy;
- Correspondence:
| | - Rosa Gemma Viterbo
- MS Centre, Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari “Aldo Moro”, Piazza G. Cesare, 11, 70121 Bari, Italy; (R.G.V.); (P.I.)
| | - Lucia Margari
- Child Neuropsychiatry Unit, Department of Biomedical Sciences and Oncology, University of Bari “Aldo Moro”, 70121 Bari, Italy;
| | - Pietro Iaffaldano
- MS Centre, Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari “Aldo Moro”, Piazza G. Cesare, 11, 70121 Bari, Italy; (R.G.V.); (P.I.)
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Doskas T, Vavougios GD, Karampetsou P, Kormas C, Synadinakis E, Stavrogianni K, Sionidou P, Serdari A, Vorvolakos T, Iliopoulos I, Vadikolias Κ. Neurocognitive impairment and social cognition in multiple sclerosis. Int J Neurosci 2021; 132:1229-1244. [PMID: 33527857 DOI: 10.1080/00207454.2021.1879066] [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: 10/22/2022]
Abstract
PURPOSE/AIM OF THE STUDY The impairment of neurocognitive functions occurs in all subtypes of multiple sclerosis, even from the earliest stages of the disease. Commonly reported manifestations of cognitive impairment include deficits in attention, conceptual reasoning, processing efficiency, information processing speed, memory (episodic and working), verbal fluency (language), and executive functions. Multiple sclerosis patients also suffer from social cognition impairment, which affects their social functioning. The objective of the current paper is to assess the effect of neurocognitive impairment and its potential correlation with social cognition performance and impairment in multiple sclerosis patients. MATERIALS AND METHODS An overview of the available-to-date literature on neurocognitive impairment and social cognition performance in multiple sclerosis patients by disease subtype was performed. RESULTS It is not clear if social cognition impairment occurs independently or secondarily to neurocognitive impairment. There are associations of variable strengths between neurocognitive and social cognition deficits and their neural basis is increasingly investigated. CONCLUSIONS The prompt detection of neurocognitive predictors of social cognition impairment that may be applicable to all multiple sclerosis subtypes and intervention are crucial to prevent further neural and social cognition decline in multiple sclerosis patients.
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Affiliation(s)
- Triantafyllos Doskas
- Department of Neurology, Athens Naval Hospital, Athens, Greece.,Department of Neurology, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | | | | | | | | | | | | | - Aspasia Serdari
- Department of Psychiatry, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Theofanis Vorvolakos
- Department of Psychiatry, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Ioannis Iliopoulos
- Department of Neurology, University Hospital of Alexandroupolis, Alexandroupolis, Greece
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Troche SJ, Kapanci T, Rammsayer TH, Kesseler CPA, Häusler MG, Geis T, Schimmel M, Elpers C, Kreth JH, Thiels C, Rostásy K. Interval Timing in Pediatric Multiple Sclerosis: Impaired in the Subsecond Range but Unimpaired in the One-Second Range. Front Neurol 2020; 11:575780. [PMID: 33193026 PMCID: PMC7606509 DOI: 10.3389/fneur.2020.575780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 08/26/2020] [Indexed: 11/13/2022] Open
Abstract
Background: For adult multiple sclerosis (MS) patients, impaired temporal processing of simultaneity/successiveness has been frequently reported although interval timing has been investigated in neither adult nor pediatric MS patients. We aim to extend previous research in two ways. First, we focus on interval timing (instead of simultaneity/successiveness) and differentiate between sensory-automatic processing of intervals in the subsecond range and cognitive processing of intervals in the one-second range. Second, we investigate whether impaired temporal information processing would also be observable in pediatric MS patients' interval timing in the subsecond and one-second ranges. Methods: Participants were 22 pediatric MS patients and 22 healthy controls, matched for age, gender, and psychometric intelligence as measured by the Culture Fair Test 20-R. They completed two auditory interval-timing tasks with stimuli in the subsecond and one-second ranges, respectively, as well as a frequency discrimination task. Results: Pediatric MS patients showed impaired interval timing in the subsecond range compared to healthy controls with a mean difference of the difference limen (DL) of 6.3 ms, 95% CI [1.7, 10.9 ms] and an effect size of Cohen's d = 0.830. The two groups did not differ significantly in interval timing in the one-second range (mean difference of the DL = 26.9 ms, 95% CI [−14.2, 67.9 ms], Cohen's d = 0.399) or in frequency discrimination (mean difference of the DL = 0.4 Hz, 95% CI [−1.1, 1.9 Hz], Cohen's d = 0.158). Conclusion: The results indicate that, in particular, the sensory-automatic processing of intervals in the subsecond range but not the cognitive processing of longer intervals is impaired in pediatric MS patients. This differential pattern of results is unlikely to be explained by general deficits of auditory information processing. A tentative explanation, to be tested in future studies, points to subcortical deficits in pediatric MS patients, which might also underlie deficits in speech and visuomotor coordination typically reported in pediatric MS patients.
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Affiliation(s)
- Stefan J Troche
- Institute of Psychology, University of Bern, Bern, Switzerland
| | - Tugba Kapanci
- Department of Psychology and Psychotherapy, University of Witten/Herdecke, Witten, Germany
| | | | - Carl P A Kesseler
- Department of Psychology and Psychotherapy, University of Witten/Herdecke, Witten, Germany
| | - Martin Georg Häusler
- Division of Neuropediatrics and Social Pediatrics, Department of Pediatrics, University Hospital, Rheinisch-Westfälische Technische Hochschule Aachen, Aachen, Germany
| | - Tobias Geis
- Department of Pediatric Neurology, Klinik St. Hedwig, University Children's Hospital Regensburg (Kinder-Universitätsklinik Ostbayern KUNO), Regensburg, Germany
| | - Mareike Schimmel
- Pediatric Neurology, Children's Hospital, University Hospital Augsburg, Augsburg, Germany
| | - Christiane Elpers
- Neuropediatric Department, Children's University Hospital Muenster, Muenster, Germany
| | - Jonas H Kreth
- Department of Pediatric Neurology, Hospital for Children and Adolescents, Klinikum Leverkusen, Leverkusen, Germany
| | - Charlotte Thiels
- Department of Pediatrics and Pediatric Neurology, Ruhr University Bochum, Bochum, Germany
| | - Kevin Rostásy
- Pediatric Neurology, University of Witten/Herdecke, Children's Hospital Datteln, Datteln, Germany
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13
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Varma-Doyle AV, Lukiw WJ, Zhao Y, Lovera J, Devier D. A hypothesis-generating scoping review of miRs identified in both multiple sclerosis and dementia, their protein targets, and miR signaling pathways. J Neurol Sci 2020; 420:117202. [PMID: 33183778 DOI: 10.1016/j.jns.2020.117202] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 09/26/2020] [Accepted: 10/19/2020] [Indexed: 12/11/2022]
Abstract
Cognitive impairment (CI) is a frequent complication affecting people with multiple sclerosis (MS). The causes of CI in MS are not fully understood. Besides MRI measures, few other biomarkers exist to help us predict the development of CI and understand its biology. MicroRNAs (miRs) are relatively stable, non-coding RNA molecules about 22 nucleotides in length that can serve as biomarkers and possible therapeutic targets in several autoimmune and neurodegenerative diseases, including the dementias. In this review, we identify dysregulated miRs in MS that overlap with dysregulated miRs in cognitive disorders and dementia and explore how these overlapping miRs play a role in CI in MS. MiR-15, miR-21, miR-128, miR-132, miR-138, miR-142, miR-146a, miR-155, miR-181, miR-572, and let-7 are known to contribute to various forms of dementia and show abnormal expression in MS. These overlapping miRs are involved in pathways related to apoptosis, neuroinflammation, glutamate toxicity, astrocyte activation, microglial burst activity, synaptic dysfunction, and remyelination. The mechanisms of action suggest that these miRs may be related to CI in MS. From our review, we also delineated miRs that could be neuroprotective in MS, namely miR-23a, miR-219, miR-214, and miR-22. Further studies can help clarify if these miRs are responsible for CI in MS, leading to potential therapeutic targets.
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Affiliation(s)
- Aditi Vian Varma-Doyle
- Louisiana State University Health Sciences Center -New Orleans School of Medicine, Department of Neurology, New Orleans, United States of America
| | - Walter J Lukiw
- Louisiana State University Health Sciences Center -New Orleans School of Medicine, Department of Neurology, New Orleans, United States of America; Louisiana State University Health Sciences Center - New Orleans Neuroscience Center, United States of America; Louisiana State University Health Sciences Center - New Orleans Department of Ophthalmology, United States of America
| | - Yuhai Zhao
- Louisiana State University Health Sciences Center - New Orleans Department of Cell Biology and Anatomy, United States of America; Louisiana State University Health Sciences Center - New Orleans Neuroscience Center, United States of America
| | - Jesus Lovera
- Louisiana State University Health Sciences Center -New Orleans School of Medicine, Department of Neurology, New Orleans, United States of America.
| | - Deidre Devier
- Louisiana State University Health Sciences Center -New Orleans School of Medicine, Department of Neurology, New Orleans, United States of America; Louisiana State University Health Sciences Center - New Orleans Department of Cell Biology and Anatomy, United States of America.
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14
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Lin WS, Lin SJ, Hsu TR. Cognitive Assessment and Rehabilitation for Pediatric-Onset Multiple Sclerosis: A Scoping Review. CHILDREN-BASEL 2020; 7:children7100183. [PMID: 33076220 PMCID: PMC7602453 DOI: 10.3390/children7100183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 10/08/2020] [Accepted: 10/10/2020] [Indexed: 02/07/2023]
Abstract
Cognitive impairment is increasingly recognized as an important clinical issue in pediatric multiple sclerosis (MS). However, variations regarding its assessment and remediation are noted in clinical arena. This scoping review aims to collate available evidence concerning cognitive assessment tool and cognitive rehabilitation for pediatric MS. We performed a systematic search of electronic databases (MEDLINE, PubMed, CINAHL Plus, and Web of Science) from inception to February 2020. Reference lists of included articles and trial registers were also searched. We included original studies published in English that addressed cognitive assessment tools or cognitive rehabilitation for pediatric-onset MS. Fourteen studies fulfilled our inclusion criteria. Among them, 11 studies evaluated the psychometric aspects of various cognitive assessment tools in the context of pediatric MS, and different neuro-cognitive domains were emphasized across studies. There were only three pilot studies reporting cognitive rehabilitation for pediatric-onset MS, all of which used home-based computerized programs targeting working memory and attention, respectively. Overall, more systematic research on cognitive assessment tools and rehabilitation for pediatric MS is needed to inform evidence-based practice. Computer-assisted cognitive assessment and rehabilitation appear feasible and deserve further studies.
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Affiliation(s)
- Wei-Sheng Lin
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei 11217, Taiwan;
- Correspondence:
| | - Shan-Ju Lin
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital Yunlin Branch, Yunlin 640, Taiwan;
| | - Ting-Rong Hsu
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei 11217, Taiwan;
- Institute of Clinical Medicine, National Yang-Ming University, Taipei 112, Taiwan
- Faculty of Medicine, National Yang-Ming University, Taipei 112, Taiwan
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15
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Ivanchuk EV, Boyko EA, Boyko AN, Klimov YA, Troitskaya LA, Batysheva TT. [The efficacy of active physical exercises in comprehensive cognitive rehabilitation of pediatric and adult patients with multiple sclerosis]. Zh Nevrol Psikhiatr Im S S Korsakova 2020; 120:38-42. [PMID: 32844628 DOI: 10.17116/jnevro202012007238] [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: 11/17/2022]
Abstract
Cognitive dysfunction in multiple sclerosis (MS) is a disabling factor and extends to the processes of memory, attention, verbal and logical thinking, visual-spatial, and motor skills. 40-70% of patients have a decrease in the rate of information processing, dysfunction of executive functions, and decrease in the quality of training. Cognitive dysfunction is also often reduced quality of life with MS. The most common methods of non-drug cognitive function correction are cognitive rehabilitation and exercise. This article reviews current research on the positive effects of regular physical activity on the cognitive functions of adults and children with MS.
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Affiliation(s)
- E V Ivanchuk
- Scientific Practical Center of Pediatric Psychoneurology of the Department of Heath Care of Moscow, Moscow, Russia
| | - E A Boyko
- Scientific Practical Center of Pediatric Psychoneurology of the Department of Heath Care of Moscow, Moscow, Russia
| | - A N Boyko
- Scientific Practical Center of Pediatric Psychoneurology of the Department of Heath Care of Moscow, Moscow, Russia.,Pirogov Russian National Research Medical University, Moscow, Russia.,Federal Center of Brain Rresearch and Neurotechnologies» of FMBA, Moscow, Russia
| | - Yu A Klimov
- Scientific Practical Center of Pediatric Psychoneurology of the Department of Heath Care of Moscow, Moscow, Russia.,Pirogov Russian National Research Medical University, Moscow, Russia
| | - L A Troitskaya
- Scientific Practical Center of Pediatric Psychoneurology of the Department of Heath Care of Moscow, Moscow, Russia
| | - T T Batysheva
- Scientific Practical Center of Pediatric Psychoneurology of the Department of Heath Care of Moscow, Moscow, Russia
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16
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Evolving Cognitive Dysfunction in Children with Neurologically Stable Opsoclonus-Myoclonus Syndrome. CHILDREN-BASEL 2020; 7:children7090103. [PMID: 32824925 PMCID: PMC7552772 DOI: 10.3390/children7090103] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 08/09/2020] [Accepted: 08/13/2020] [Indexed: 11/16/2022]
Abstract
Cognitive and acquired neurodevelopmental deficits have been reported in children with opsoclonus-myoclonus syndrome (OMS) and are known to be associated with more severe and relapsing disease course. However, there is a paucity of data regarding cognitive dysfunction in children with stable neurological disease. We report three children with OMS and evolving cognitive dysfunction in the context of a mild disease course. The children's ages at disease onset were between 17 and 35 months and they were followed up for 4-10 years. Neuroblastoma was identified in one child. OMS severity scores ranged between 8 and 12/15 at presentation. They underwent immunotherapy and all were in remission by 7 months (range 4-13 months), with treatment maintained for 1 year. One child remained relapse-free, while two others had one clinical relapse each and were immunotherapy-responsive again. In all cases, evolving cognitive dysfunction was reported despite being in remission and stable off treatment for a median of 20 months (range of 12-31 months; two OMS scores of 0/15 and one of 2/15). In children with OMS who have completed treatment and have made full or near full neurological recovery, concerns remain regarding long-term outcome in terms of future learning and cognitive development.
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17
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Current Advances in Pediatric Onset Multiple Sclerosis. Biomedicines 2020; 8:biomedicines8040071. [PMID: 32231060 PMCID: PMC7235875 DOI: 10.3390/biomedicines8040071] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 03/25/2020] [Accepted: 03/26/2020] [Indexed: 01/01/2023] Open
Abstract
Multiple sclerosis (MS) is an autoimmune inflammatory disease affecting the central nervous system leading to demyelination. MS in the pediatric population is rare, but has been shown to lead to significant disability over the duration of the disease. As we have learned more about pediatric MS, there has been a development of improved diagnostic criteria leading to earlier diagnosis, earlier initiation of disease-modifying therapies (DMT), and an increasing number of DMT used in the treatment of pediatric MS. Over time, treatment with DMT has trended towards the initiation of higher efficacy treatment at time of diagnosis to help prevent further disease progression and accrual of disability over time, and there is evidence in current literature that supports this change in treatment patterns. In this review, we discuss the current knowledge in diagnosis, treatment, and clinical outcomes in pediatric MS.
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18
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Kapanci T, Rostásy K, Häusler MG, Geis T, Schimmel M, Elpers C, Kreth JH, Thiels C, Troche SJ. Evaluating the relationship between psychometric intelligence and cognitive functions in paediatric multiple sclerosis. Mult Scler J Exp Transl Clin 2019; 5:2055217319894365. [PMID: 31853370 PMCID: PMC6906347 DOI: 10.1177/2055217319894365] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 11/09/2019] [Accepted: 11/21/2019] [Indexed: 01/19/2023] Open
Abstract
Background Processing speed is frequently reduced in patients suffering from multiple sclerosis (MS). Reduced processing speed can also lead to impaired working memory capacity (WMC) in adult MS patients. Less is known about the interplay of cognitive deficits in paediatric MS patients. Objectives In the present study, we investigated whether processing speed and WMC are reduced in paediatric MS patients compared with healthy controls and whether reduced processing speed and WMC might explain potential differences in psychometric intelligence between MS patients and healthy controls. Methods Twenty-one paediatric MS patients and 21 healthy controls completed a reaction time (RT) task, a working memory task, and Cattell's Culture Fair Test (CFT20-R). Results Patients with MS had slower RT and lower intelligence scores than healthy controls. We could find no significant differences for WMC. An analysis of covariance revealed that group differences in intelligence could be partially explained by processing speed differences. Conclusion The results indicate that processing speed is a good marker for MS-related impaired efficiency and increased error-proneness of the central nervous system in higher-order cognition as required by Cattell's CFT20-R.
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Affiliation(s)
- Tugba Kapanci
- Department of Psychology and Psychotherapy, University of Witten/Herdecke, Witten, Germany
| | - Kevin Rostásy
- Pediatric Neurology, University of Witten/Herdecke, Children's Hospital Datteln, Datteln, Germany
| | - Martin Georg Häusler
- Division of Neuropediatrics and Social Pediatrics, Department of Pediatrics, University Hospital RWTH Aachen, Aachen, Germany
| | - Tobias Geis
- Department of Pediatric Neurology, Klinik St. Hedwig, University Children's Hospital Regensburg (KUNO), Regensburg, Germany
| | - Mareike Schimmel
- Pediatric Neurology, University Children's Hospital Augsburg, Augsburg, Germany
| | - Christiane Elpers
- Children's Hospital of the University Medical Center, University of Münster, Münster, Germany
| | - Jonas H Kreth
- Pediatric Neurology, Hospital for Children and Adolescents, gGmbH Klinikum Leverkusen, Leverkusen, Germany
| | - Charlotte Thiels
- Department of Pediatrics and Pediatric Neurology, Ruhr University Bochum, Bochum, Germany
| | - Stefan J Troche
- Department of Psychology, University of Bern, Bern, Switzerland
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19
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Associations between cognitive impairment at onset and disability accrual in young people with multiple sclerosis. Sci Rep 2019; 9:18074. [PMID: 31792347 PMCID: PMC6889418 DOI: 10.1038/s41598-019-54153-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Accepted: 11/10/2019] [Indexed: 12/12/2022] Open
Abstract
Differently from the adult multiple sclerosis (MS) population, the predictive value of cognitive impairment in early-onset MS is still unknown. We aim to evaluate whether cognitive performances at disease onset predict disease progression in young people with MS. This is a retrospective study on early onset (<25 years) MS patients, who had a baseline cognitive evaluation at disease onset. Demographic and longitudinal clinical data were collected up to 7 years follow up. Cognitive abilities were assessed at baseline through the Brief Repeatable Battery. Associations between cognitive abilities and clinical outcomes (occurrence of a relapse, and 1-point EDSS progression) were evaluated with stepwise logistic and Cox regression models. We included 51 patients (26 females), with a mean age at MS onset of 17.2 ± 3.9 years, and an EDSS of 2.5 (1.0–6.0). Over the follow-up, twenty-five patients had at least one relapse, and 7 patients had 1-point EDSS progression. Relapse occurrence was associated with lower 10/36 SPART scores (HR = 0.92; p = 0.002) and higher WLG scores (HR = 1.05; p = 0.01). EDSS progression was associated with lower SDMT score (OR: 0.70; p = 0.04). Worse visual memory and attention/information processing were associated with relapses and with increased motor disability after up to 7-years follow-up. Therefor, specific cognitive subdomains might better predict clinical outcomes than the overall cognitive impairment in early-onset MS.
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20
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Johnen A, Elpers C, Riepl E, Landmeyer NC, Krämer J, Polzer P, Lohmann H, Omran H, Wiendl H, Göbel K, Meuth SG. Early effective treatment may protect from cognitive decline in paediatric multiple sclerosis. Eur J Paediatr Neurol 2019; 23:783-791. [PMID: 31540711 DOI: 10.1016/j.ejpn.2019.08.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 08/01/2019] [Accepted: 08/28/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Cognitive impairment (CI) is a critical feature for patients with childhood or juvenile multiple sclerosis (MS). OBJECTIVE To promote the understanding of CI and to address the impact of different pharmacological treatment strategies on cognitive performance in this patient group. METHODS A cohort of 19 patients with therapy-naïve or ß-Interferon-treated juvenile MS completed a comprehensive neuropsychological assessment at initial presentation (baseline) and on average 2.5 years later (follow-up). The assessments were complemented with a neuropaediatric examination and conventional cerebral magnetic resonance imaging (MRI). RESULTS 9 patients (47%) were impaired in at least one test at baseline (z-score <-1.645 compared with age-adjusted normative data), with the highest impairment frequency in the domains processing speed and attention & executive functions. At follow-up a higher impairment frequency was prominent in those patients whose therapy had not been escalated (N = 13, 69% impaired in at least one test), while cognition was preserved or ameliorated in patients whose treatment had been escalated to highly effective drugs (N = 6, 0% impaired) during the observational period. These group differences at follow-up were not attributable to differences regarding demographics, MRI metrics or cognitive performance at baseline. CONCLUSION Our findings confirm that paediatric MS is associated with considerable CI already in early disease stages. Early administration of highly effective treatment may protect from cognitive decline or alleviate CI in juvenile MS, but larger controlled trials are warranted to confirm these preliminary results.
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Affiliation(s)
- A Johnen
- University of Münster, Department of Neurology with Institute of Translational Neurology, Germany.
| | - C Elpers
- University of Münster, University Children's Hospital Münster, General Pediatrics - Neuropediatric Department, Germany
| | - E Riepl
- University of Münster, Department of Neurology with Institute of Translational Neurology, Germany
| | - N C Landmeyer
- University of Münster, Department of Neurology with Institute of Translational Neurology, Germany
| | - J Krämer
- University of Münster, Department of Neurology with Institute of Translational Neurology, Germany
| | - P Polzer
- University of Münster, Institute of Clinical Radiology, Germany
| | - H Lohmann
- Herz-Jesu-Hospital, Münster-Hiltrup, Germany
| | - H Omran
- University of Münster, University Children's Hospital Münster, General Pediatrics - Neuropediatric Department, Germany
| | - H Wiendl
- University of Münster, Department of Neurology with Institute of Translational Neurology, Germany
| | - K Göbel
- University of Münster, Department of Neurology with Institute of Translational Neurology, Germany
| | - S G Meuth
- University of Münster, Department of Neurology with Institute of Translational Neurology, Germany
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21
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Reen GK, Muirhead L, Langdon DW. Usability of Health Information Websites Designed for Adolescents: Systematic Review, Neurodevelopmental Model, and Design Brief. J Med Internet Res 2019; 21:e11584. [PMID: 31012856 PMCID: PMC6658246 DOI: 10.2196/11584] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 12/12/2018] [Accepted: 02/11/2019] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Adolescence is a unique developmental period characterized by biological, social, and cognitive changes, as well as an interest in managing one's own health care. Many adolescents use the internet to seek health care information. However, young people face barriers before they can understand and apply the health information that they access on the web. It is essential that usability of adolescent health websites on the internet is improved to help adolescents overcome these barriers and allow them to engage successfully with web-based health care content. OBJECTIVE The aim of this review was to synthesize the usability of specific health information websites. These findings were mapped onto the adolescent neurodevelopmental profile, and a design brief based on the findings was developed to tailor future websites for specific adolescent requirements. METHODS A systematic search conducted using PubMed, PsycINFO, and Education Resources Information Center (ERIC) identified 25 studies that assessed the usability of health information websites. Adolescent feedback was collected by a mixture of surveys, focus groups, interviews, and think-aloud procedures. RESULTS A majority of the information websites were developed for specific health issues that may be relevant to adolescents. The most preferred website features were interactive content such as games and quizzes, as well as videos, images, audio clips, and animations. Participants also preferred communicating with other adolescents with similar conditions or learning about their experience through real stories and testimonials. Adolescents found it difficult to use health information websites if they contained too much text, were too cluttered, or had features that made it difficult to access. The findings are considered in the context of adolescent social processes, low tolerance of delayed gratification, and attraction to novelty and mapped onto a neurodevelopmental model of adolescence. CONCLUSIONS Young people's feedback can determine usability and content that make a health information website easy or informative to use. Neurodevelopmental profiles and the users' specific preferences and skills should be addressed in future development of health information websites for adolescents.
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Affiliation(s)
- Gurpreet Kaur Reen
- Royal Holloway, University of London, Egham, United Kingdom.,University of Oxford, Oxford, United Kingdom
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22
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Falco F, Moccia M, Chiodi A, Carotenuto A, D'Amelio A, Rosa L, Piscopo K, Falco A, Costabile T, Lauro F, Brescia Morra V, Lanzillo R. Normative values of the Rao's Brief Repeatable Battery in an Italian young adolescent population: the influence of age, gender, and education. Neurol Sci 2019; 40:713-717. [PMID: 30645750 DOI: 10.1007/s10072-019-3712-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 01/09/2019] [Indexed: 10/27/2022]
Abstract
AIM The Brief Repeatable Battery of Neuropsychological Tests (BRB) is frequently used to estimate cognitive function in adults with multiple sclerosis (MS), while it has been included in few studies on young MS, also because of the absence of normative values. We aim to evaluate the impact of age, gender, and education on BRB scores in a young adolescent population. METHODS We administered the BRB to 76, 14-to-17-year-old, healthy subjects. Linear regression models were used to assess the impact of age, gender, and education on sub-test scores. When statistically significant (p < 0.05), we used the regression coefficient to correct the raw scores. RESULTS Younger age was associated with better performance on SPART (β = - 2.54; p < 0.05) and SPART-D (β = - 1.06; p < 0.05). Male gender was associated with better performance on SPART (β = 3.40; p < 0.05), SPART-D (β = 1.41; p < 0.05), PASAT-3 (β = 5.58; p < 0.05), and PASAT-2 (β = 5.07; p < 0.05). Educational attainments were associated with better performance on SPART (β = 3.23; p < 0.05) and SPART-D (β = 1.28; p < 0.05). Cut-off points were suggested at the 5th lowest percentile. INTERPRETATION Age, gender, and education must be accounted for when applying the BRB to young population. Present results can prove useful for future clinical and research applications in adolescent MS patients.
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Affiliation(s)
- Fabrizia Falco
- Multiple Sclerosis Clinical Care and Research Centre, Department of Neuroscience, Reproductive Science and Odontostomatology, Federico II University, Via Sergio Pansini, 5 - Building 17, Ground floor, Naples, Italy
| | - Marcello Moccia
- Multiple Sclerosis Clinical Care and Research Centre, Department of Neuroscience, Reproductive Science and Odontostomatology, Federico II University, Via Sergio Pansini, 5 - Building 17, Ground floor, Naples, Italy.
| | - Alessandro Chiodi
- Clinical Psychology Unit, Department of Neuroscience, Reproductive Science and Odontostomatology, Federico II University, Naples, Italy
| | - Antonio Carotenuto
- Multiple Sclerosis Clinical Care and Research Centre, Department of Neuroscience, Reproductive Science and Odontostomatology, Federico II University, Via Sergio Pansini, 5 - Building 17, Ground floor, Naples, Italy
| | - Angelo D'Amelio
- Clinical Psychology Unit, Department of Neuroscience, Reproductive Science and Odontostomatology, Federico II University, Naples, Italy
| | - Laura Rosa
- Active Inclusion and Student Participation Service, Federico II University of Naples, Naples, Italy
| | - Kyrie Piscopo
- Active Inclusion and Student Participation Service, Federico II University of Naples, Naples, Italy
| | - Andrea Falco
- Multiple Sclerosis Clinical Care and Research Centre, Department of Neuroscience, Reproductive Science and Odontostomatology, Federico II University, Via Sergio Pansini, 5 - Building 17, Ground floor, Naples, Italy
| | - Teresa Costabile
- Multiple Sclerosis Clinical Care and Research Centre, Department of Neuroscience, Reproductive Science and Odontostomatology, Federico II University, Via Sergio Pansini, 5 - Building 17, Ground floor, Naples, Italy
| | - Francesca Lauro
- Multiple Sclerosis Clinical Care and Research Centre, Department of Neuroscience, Reproductive Science and Odontostomatology, Federico II University, Via Sergio Pansini, 5 - Building 17, Ground floor, Naples, Italy
| | - Vincenzo Brescia Morra
- Multiple Sclerosis Clinical Care and Research Centre, Department of Neuroscience, Reproductive Science and Odontostomatology, Federico II University, Via Sergio Pansini, 5 - Building 17, Ground floor, Naples, Italy
| | - Roberta Lanzillo
- Multiple Sclerosis Clinical Care and Research Centre, Department of Neuroscience, Reproductive Science and Odontostomatology, Federico II University, Via Sergio Pansini, 5 - Building 17, Ground floor, Naples, Italy
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