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Nyári A, Kokas Z, Szamosi S, Fricska-Nagy Z, Füvesi J, Kincses ZT, Biernacki T, Vécsei L, Klivényi P, Bencsik K, Sandi D. The 7-year follow-up of the Hungarian BICAMS validation cohort implies that cognitive performance may improve in multiple sclerosis patients. Neurol Sci 2024; 45:3369-3378. [PMID: 38280085 DOI: 10.1007/s10072-024-07347-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 01/22/2024] [Indexed: 01/29/2024]
Abstract
BACKGROUND Cognitive impairment (CI) is a frequent symptom of multiple sclerosis (MS) and has a great impact on the patients' quality of life, so screening is essential. The brief international cognitive assessment for multiple sclerosis (BICAMS) was developed for this purpose. However, longitudinal data is lacking with the use of the battery. OBJECTIVE This study is to assess the performance of patients after 5 and 7 years of the original BICAMS validation study and to identify any influencing factors. METHODS BICAMS was used to measure cognitive function of 52 relapsing-remitting MS patients (RRMS) from the original validation study after 5 years (n = 43) and again, after 7 years (n = 42). Patients filled out the fatigue impact scale (FIS) and multiple sclerosis quality of life-54 (MSQoL-54) questionnaire, and we evaluated expanded disability status scale (EDSS). RESULTS There was an improvement in the BVMT-R and the CVLT-II assessments at both the 5-year (p<0.001 and p=0.025) and the 7-year retest (p<0.001 and p=0.002). The prevalence of CI significantly decreased at the 5-year mark (p=0.021) but remained stable after that. There was no deterioration in MSQoL scores during the study. The basic cognitive performance is the most important influencing factor, but the duration of the disease, the EDSS score, and the escalation of the therapy also affect the cognitive scores. CONCLUSION This is the longest longitudinal study utilizing the BICAMS battery, reinforcing its feasibility as a clinical screening tool. It seems that cognitive performance may improve in the long term and early initiation of effective therapy may influence this outcome.
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Affiliation(s)
- Aliz Nyári
- Department of Neurology, Albert Szent-Györgyi Faculty of Medicine and Clinical Center, University of Szeged, Szeged, Hungary
| | - Zsófia Kokas
- Department of Neurology, Albert Szent-Györgyi Faculty of Medicine and Clinical Center, University of Szeged, Szeged, Hungary
| | - Szabolcs Szamosi
- Department of Neurology, Albert Szent-Györgyi Faculty of Medicine and Clinical Center, University of Szeged, Szeged, Hungary
| | - Zsanett Fricska-Nagy
- Department of Neurology, Albert Szent-Györgyi Faculty of Medicine and Clinical Center, University of Szeged, Szeged, Hungary
| | - Judit Füvesi
- Department of Neurology, Albert Szent-Györgyi Faculty of Medicine and Clinical Center, University of Szeged, Szeged, Hungary
| | - Zsigmond Tamás Kincses
- Department of Neurology, Albert Szent-Györgyi Faculty of Medicine and Clinical Center, University of Szeged, Szeged, Hungary
- Department of Radiology, Albert Szent-Györgyi Faculty of Medicine and Clinical Center, University of Szeged, Szeged, Hungary
| | - Tamás Biernacki
- Department of Neurology, Albert Szent-Györgyi Faculty of Medicine and Clinical Center, University of Szeged, Szeged, Hungary
| | - László Vécsei
- Department of Neurology, Albert Szent-Györgyi Faculty of Medicine and Clinical Center, University of Szeged, Szeged, Hungary
- ELKH - SZTE Neuroscience Research Group, Szeged, Hungary
| | - Péter Klivényi
- Department of Neurology, Albert Szent-Györgyi Faculty of Medicine and Clinical Center, University of Szeged, Szeged, Hungary
| | - Krisztina Bencsik
- Department of Neurology, Albert Szent-Györgyi Faculty of Medicine and Clinical Center, University of Szeged, Szeged, Hungary
| | - Dániel Sandi
- Department of Neurology, Albert Szent-Györgyi Faculty of Medicine and Clinical Center, University of Szeged, Szeged, Hungary.
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2
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Scaramozza M, Chiesa PA, Zajac L, Sun Z, Tang M, Juraver A, Bartholomé E, Charré-Morin J, Saubusse A, Johnson SC, Brochet B, Carment L, Ruiz M, Campbell N, Ruet A. Konectom™ cognitive processing speed test enables reliable remote, unsupervised cognitive assessment in people with multiple sclerosis: Exploring the use of substitution time as a novel digital outcome measure. Mult Scler 2024:13524585241259650. [PMID: 38912764 DOI: 10.1177/13524585241259650] [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: 06/25/2024]
Abstract
BACKGROUND The Konectom™ smartphone-based cognitive processing speed (CPS) test is designed to assess processing speed and account for impact of visuomotor function on performance. OBJECTIVE Evaluate reliability and validity of Konectom CPS Test, performed in clinic and remotely. METHODS Data were collected from people with multiple sclerosis (PwMS) aged 18-64 years and healthy control participants (HC) matched for age, sex, and education. Remote test-retest reliability (intraclass correlation coefficients, ICC); correlation with established clinical measures (Spearman correlation coefficients); group analyses between cognitively impaired/unimpaired PwMS; and influence of age, sex, education, and upper limb motor function on CPS Test measures were assessed. RESULTS Eighty PwMS and 66 HC participated. CPS Test measures from remote tests had good test-retest reliability (ICC of 0.67-0.87) and correlated with symbol digit modalities test (highest |ρ| = 0.80, p < 0.0001). Remote measures were stable (change from baseline < 5%) and correlated with MS disability (highest |ρ| = 0.39, p = 0.0004) measured by Expanded Disability Status Scale. CPS Test measures displayed sensitivity to cognitive impairment (highest d = 1.47). Demographics and motor function had the lowest impact on CPS Test substitution time, a measure accounting for visuomotor function. CONCLUSION Konectom CPS Test measures provide valid, reliable remote measurements of cognitive processing speed in PwMS.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Sterling C Johnson
- Department of Medicine-Geriatrics, University of Wisconsin-Madison, Madison, WI, USA
| | - Bruno Brochet
- U1215 INSERM, University of Bordeaux, Bordeaux, France
| | | | | | | | - Aurélie Ruet
- Neurology Department, CHU de Bordeaux, Bordeaux, France; U1215 INSERM, University of Bordeaux, Bordeaux, France
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Longinetti E, Englund S, Burman J, Fink K, Fogdell-Hahn A, Gunnarsson M, Hillert J, Langer-Gould AM, Lycke J, Nilsson P, Salzer J, Svenningsson A, Mellergård J, Olsson T, Piehl F, Frisell T. Trajectories of cognitive processing speed and physical disability over 11 years following initiation of a first multiple sclerosis disease-modulating therapy. J Neurol Neurosurg Psychiatry 2024; 95:134-141. [PMID: 37558400 PMCID: PMC10850621 DOI: 10.1136/jnnp-2023-331784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 07/30/2023] [Indexed: 08/11/2023]
Abstract
BACKGROUND We analysed the COMparison Between All immunoTherapies for Multiple Sclerosis (NCT03193866), a Swedish nationwide observational study in relapsing-remitting multiple sclerosis (RRMS), to identify trajectories of processing speed and physical disability after disease-modulating therapy (DMT) start. METHODS Using a group-modelling approach, we assessed trajectories of processing speed with oral Symbol Digit Modalities Test (SDMT) and physical disability with Expanded Disability Status Scale, from first DMT start among 1645 patients with RRMS followed during 2011-2022. We investigated predictors of trajectories using group membership as a multinomial outcome and calculated conditional probabilities linking membership across the trajectories. RESULTS We identified 5 stable trajectories of processing speed: low SDMT scores (mean starting values=29.9; 5.4% of population), low/medium (44.3; 25.3%), medium (52.6; 37.9%), medium/high (63.1; 25.8%) and high (72.4; 5.6%). We identified 3 physical disability trajectories: no disability/stable (0.8; 26.8%), minimal disability/stable (1.6; 58.1%) and moderate disability (3.2; 15.1%), which increased to severe disability. Older patients starting interferons were more likely than younger patients starting rituximab to be on low processing speed trajectories. Older patients starting teriflunomide, with more than one comorbidity, and a history of pain treatment were more likely to belong to the moderate/severe physical disability trajectory, relative to the no disability one. There was a strong association between processing speed and physical disability trajectories. CONCLUSIONS In this cohort of actively treated RRMS, patients' processing speed remained stable over the years following DMT start, whereas patients with moderate physical disability deteriorated in physical function. Nevertheless, there was a strong link between processing speed and disability after DMT start.
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Affiliation(s)
- Elisa Longinetti
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Simon Englund
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Joachim Burman
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Katharina Fink
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Anna Fogdell-Hahn
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | | | - Jan Hillert
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | | | - Jan Lycke
- Department of Clinical Neuroscience, University of Gothenburg, Goteborg, Sweden
| | - Petra Nilsson
- Department of Clinical Sciences, Division of Neurology, Lund University, Lund, Sweden
| | - Jonatan Salzer
- Department of Clinical Sciences, Neurosciences, Umeå University, Umeå, Sweden
| | - Anders Svenningsson
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Johan Mellergård
- Department of Neurology, Linköping University, Linkoping, Östergötland, Sweden
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Tomas Olsson
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Fredrik Piehl
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Thomas Frisell
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
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Wishart M, Everest MR, Morrow SA, Rose J, Shen L, Feinstein A. Establishing the consistency of a voice recognition symbol digit modalities test analogue. Mult Scler 2023; 29:1676-1679. [PMID: 37842762 PMCID: PMC10637108 DOI: 10.1177/13524585231199321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 06/09/2023] [Accepted: 06/17/2023] [Indexed: 10/17/2023]
Abstract
BACKGROUND We previously demonstrated the convergent validity of a fully automated voice recognition analogue of the Symbol Digit Modalities Test (VR-SDMT) for evaluating processing speed in people with multiple sclerosis (pwMS). OBJECTIVE/METHODS We aimed to replicate these results in 54 pwMS and 18 healthy controls (HCs), demonstrating the VR-SDMT's reliability. RESULTS Significant correlations were found between the VR-SDMT and the traditional oral SDMT in the multiple sclerosis (MS) (r = -0.771, p < 0.001) and HC (r = -0.785, p < 0.001) groups. CONCLUSION Taken collectively, our two studies demonstrate the reliability and validity of the VR-SDMT for assessing processing speed in pwMS.
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Affiliation(s)
- Margaret Wishart
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Marina R. Everest
- Department of Clinical Neurological Sciences, University of Western Ontario, London, ON, Canada
- London Health Sciences Centre, London, ON, Canada
| | - Sarah A. Morrow
- Department of Clinical Neurological Sciences, University of Western Ontario, London, ON, Canada
- London Health Sciences Centre, London, ON, Canada
| | - Jonathan Rose
- The Edward S. Rogers Sr. Department of Electrical & Computer Engineering, University of Toronto, Toronto, ON, Canada
| | - Lingkai Shen
- The Edward S. Rogers Sr. Department of Electrical & Computer Engineering, University of Toronto, Toronto, ON, Canada
| | - Anthony Feinstein
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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5
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Lechner-Scott J, Agland S, Allan M, Darby D, Diamond K, Merlo D, van der Walt A. Managing cognitive impairment and its impact in multiple sclerosis: An Australian multidisciplinary perspective. Mult Scler Relat Disord 2023; 79:104952. [PMID: 37683558 DOI: 10.1016/j.msard.2023.104952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 07/10/2023] [Accepted: 08/20/2023] [Indexed: 09/10/2023]
Abstract
Cognitive impairment in multiple sclerosis (MS) affects approximately 40-70% of patients and can have varying degrees of severity. Even mild cognitive impairment can impact on quality of life and productivity. Despite this, patients are not routinely screened or monitored for cognitive impairment in Australia due to a range of issues, with time and space being the main limiting factors. This Australian multidisciplinary perspective provides recommendations on cognition management in Australia. It gives a broad overview of cognition in MS, advice on the screening and monitoring tools available to clinicians, and strategies that can be implemented in clinics to help monitor for cognitive impairment in patients with MS. We suggest a routine baseline assessment and multidomain cognitive battery in regular intervals; a change should trigger a thorough investigation of the cause.
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Affiliation(s)
- Jeannette Lechner-Scott
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia; Department of Neurology, John Hunter Hospital, New Lambton Heights, Australia; Hunter Medical Research Institute, New Lambton, NSW, Australia.
| | - Susan Agland
- MSSN John Hunter Hospital, Hunter New England Health, Australia
| | - Michelle Allan
- Multiple Sclerosis Nurse Consultant, Monash Health, Australia
| | - David Darby
- Department of Neurology, Alfred Hospital, Melbourne, Australia; Department of Neurology, Royal Melbourne Hospital, Parkville, Australia; Florey Institute of Neuroscience and Mental Health, Melbourne, Australia
| | - Keri Diamond
- Clinical Research Unit, Brain & Mind Research Institute, University of Sydney, Sydney, Australia
| | - Daniel Merlo
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia
| | - Anneke van der Walt
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia; Department of Neurology, MSNI Service, Alfred Health, Melbourne, Australia
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Morrow SA, Baldwin C, Alkabie S. Importance of Identifying Cognitive Impairment in Multiple Sclerosis. Can J Neurol Sci 2023; 50:813-819. [PMID: 36503630 DOI: 10.1017/cjn.2022.334] [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: 12/14/2022]
Abstract
This article aims to highlight the impact of cognitive impairment on outcomes and quality of life for people with multiple sclerosis (MS) and to review current evidence for the efficacy of disease-modifying therapies (DMTs) and other interventions. In addition, we provide clinical practice insights regarding screening and management of cognitive impairment in people with MS. Evidence suggests that cognitive deterioration often accompanies magnetic resonance imaging changes. Neocortical volume and deep grey matter atrophy correlate with cognitive impairment. Similarly, cognitive decline is predictive of a higher lesion burden. Cognitive impairment is an important clinical measure of disability and negatively impacts quality of life. Phase 3 studies suggest that DMTs such as natalizumab, ozanimod and fingolimod may provide long-lasting, clinically meaningful effects on cognition in people with MS. Further data are needed to support the use of adjunct cognitive behavioural and exercise interventions for people with MS who have cognitive impairment. More data are needed to define appropriate management strategies for cognitive impairment in people with MS. Baseline and periodic screening for cognitive impairment and inclusion of cognitive impairment as a clinical trial endpoint will help to inform efforts to manage this important aspect of MS.
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Affiliation(s)
- Sarah A Morrow
- London Multiple Sclerosis Clinic, London Health Sciences Centre, University Hospital, Department of Clinical Neurological Sciences, Western University, London, ON, Canada
| | - Chantal Baldwin
- London Multiple Sclerosis Clinic, London Health Sciences Centre, University Hospital, Department of Clinical Neurological Sciences, Western University, London, ON, Canada
| | - Samir Alkabie
- London Multiple Sclerosis Clinic, London Health Sciences Centre, University Hospital, Department of Clinical Neurological Sciences, Western University, London, ON, Canada
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Mariottini A, Muraro PA, Saccardi R. Should autologous hematopoietic stem cell transplantation be offered as a first-line disease modifying therapy to patients with multiple sclerosis? Mult Scler Relat Disord 2023; 78:104932. [PMID: 37572554 DOI: 10.1016/j.msard.2023.104932] [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: 07/13/2023] [Accepted: 08/04/2023] [Indexed: 08/14/2023]
Abstract
In multiple sclerosis (MS), progression independent of new focal inflammation may commence shortly after disease onset, and it is increasingly revealed that the risk of disability accrual is reduced by early use of high-efficacy disease-modifying therapies (HE-DMTs). People with aggressive MS may therefore benefit from early treatment with autologous haematopoietic stem cell transplantation (AHSCT), a procedure inducing maximal immunosuppression followed by immune reconstitution, demonstrated to be superior to DMTs in one randomized clinical trial. However, in current practice prior failure to HE-DMTs is typically required to establish the indication for AHSCT. In the present article, the available evidence on the potential role of AHSCT as first-line treatment in aggressive MS and the rationale for its early use will be summarized. Proposed definitions of aggressive MS that could help identifying MS patients eligible for early treatment with AHSCT will also be discussed.
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Affiliation(s)
- Alice Mariottini
- Department of Brain Sciences, Imperial College London, London, United Kingdom; Department of Neurosciences, Drug and Child Health, University of Florence, Florence, Italy
| | - Paolo A Muraro
- Department of Brain Sciences, Imperial College London, London, United Kingdom
| | - Riccardo Saccardi
- Cell Therapy and Transfusion Medicine Unit, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy.
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Sabanagic-Hajric S, Memic-Serdarevic A, Sulejmanpasic G, Salihovic-Besirovic D, Kurtovic A, Bajramagic N, Mehmedika-Suljic E. Cognitive Imapirment in Multiple Sclerosis: Relation to Dysability, Duration and Type of Disease. Mater Sociomed 2023; 35:23-27. [PMID: 37095882 PMCID: PMC10122534 DOI: 10.5455/msm.2023.35.23-27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 03/02/2023] [Indexed: 04/26/2023] Open
Abstract
Background Cognitive dysfunctions are often presented as a symptom in multiple sclerosis which is associated with both structural and functional imapirments of neuronal networks in the brain. Objective The aim of the study was to evaluate the influence of dysability, duration and type of disesase on cognitive functions in multiple sclerosis patients. Methods This study included 60 MS patients treated at the Department of Neurology, Clinical Center University of Sarajevo. Inclusion criteria were clinically definite diagnosis of multiple sclerosis, 18 years of age or older and were able to give written informed consent. Cognitive function was evaluated by the Montreal Cognitive Assessment (MoCa) screening test. Mann-Whitney and Kruskal-Wallis test were used for comparisons between clinical characteristics and MoCa test scores. Results Out of 63.33% of patients had EDSS <=4.5. Disease lasted longer than 10 years in 30% of patients. 80% had relapsing-remitting MS and 20% had secondary progressive MS. 84,2 % of patients with EDSS ≤ 4.5 had cognitive dysfunction. Higher disability (rho=0,306, p<0,05), progressive type of disease (rho=0,377, p< 0,01) and longer disease duration (rho=0,282, p<0,05) were associated with worse overall cognitive functions. Level of disability showed statistical significant correlation with the executive functions and language domains of cognition (p<0.01). Longer disease duration was significant correlated with executive functions (p<0,01) and language domains (p<0,01), while progressive type of disease was signifacant correlated only with executive functions domain (p<0,01). MoCa score variables did not show a statistically significant difference in relation to the number of relapses per year and the use of imunoterapy. Statistically significant negative correlation was obtained between executive functions domain and level of disability, disease duration and progressive type of disease, while language domain significantly correlated only with disability level and progressive type of disease. Conclusion High percentage of MS patients has cognitive impairment. Patients with higher disability were presented with lower cognitive abilities, especially in executive functions and language domains. Higher frequency of cognitive impairment were presented in progessive forms of disaese and longer disease duration with strong influence on executive functions domains of cognition.
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Affiliation(s)
- Selma Sabanagic-Hajric
- Department of Neurology, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Amra Memic-Serdarevic
- Department of Psychiatry, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Gorana Sulejmanpasic
- Department of Psychiatry, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
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9
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Grant JG, Rapport LJ, Darling R, Waldron-Perrine B, Bernitsas E. Incremental validity of brief and abbreviated neuropsychological tests toward predicting functional outcomes in multiple sclerosis. APPLIED NEUROPSYCHOLOGY. ADULT 2023:1-11. [PMID: 36773023 DOI: 10.1080/23279095.2023.2176766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
OBJECTIVE This study examined the relationships among functional outcomes and performance on standard-length and abbreviated cognitive screening measures for multiple sclerosis (MS). METHOD 72 adults with MS underwent neurological examination and cognitive screening. They completed standard-length and abbreviated versions of tests from the Minimal Assessment of Cognitive Function in MS (MACFIMS), the abbreviated aMACFIMS, and the Brief International Cognitive Assessment for MS (BICAMS). Functional outcomes included neurological disability, physical and psychological dysfunction, and employment status. RESULTS Concordance of impairment classifications was examined between standard-length and abbreviated tests using logistic regression and ROC curve analyses. Overall, the abbreviated test versions showed a broad range of concordance with impairment classifications made using the full-length tests. Processing speed was the strongest correlate of neurological disability and employment status; immediate recall was the strongest predictor of subjective physical dysfunction. Test performance provided unique value toward predicting neurological disability and employment status, but not physical and psychological dysfunction. CONCLUSIONS The findings replicate some support for abbreviated tests in MS assessment, although caveats regarding loss of validity associated with abbreviation remain. The findings extend prior research showing that abbreviated tests of processing speed and immediate recall can provide unique predictive information regarding objective functional outcomes.
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Affiliation(s)
- Jeremy G Grant
- Department of Psychology, Wayne State University, Detroit, MI, USA
| | - Lisa J Rapport
- Department of Psychology, Wayne State University, Detroit, MI, USA
| | - Rachel Darling
- Department of Neurology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Brigid Waldron-Perrine
- Department of Physical Medicine & Rehabilitation, Wayne State University School of Medicine, Detroit, MI, USA
| | - Eva Bernitsas
- Department of Neurology, Wayne State University School of Medicine, Detroit, MI, USA
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10
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Tremblay A, Charest K, Brando E, Roger E, Duquette P, Rouleau I. Cognitive reserve as a moderating factor between EDSS and cognition in multiple sclerosis. Mult Scler Relat Disord 2023; 70:104482. [PMID: 36603291 DOI: 10.1016/j.msard.2022.104482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 12/13/2022] [Accepted: 12/22/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVES It is now well recognized that brain damage and/or atrophy apparent on MRI is only moderately correlated to cognitive functioning. The cognitive reserve (CR) hypothesis has been proposed to explain this functional heterogeneity, but it has only been addressed recently in the MS literature and has not yet been thoroughly investigated. The objective of this study is to examine the protective role of CR in cognition using a standardized CR tool in a population with a wide age range. METHODS A neuropsychological evaluation was performed on 84 pwMS aged between 27 and 78 years old and the CR Index questionnaire (CRIq) was used to estimate CR. The EDSS scale was used to assess the degree of neurologic impairment and estimate the disease burden. RESULTS A moderating effect of CR was observed in the relationship between EDSS score and specific cognitive domains: processing efficiency, visuospatial learning and memory, as well as a tendency for verbal memory. In pwMS with a high level of CR, there was no negative relationship between these cognitive domains and EDSS. CONCLUSION The results support the protective role of CR in a sample of pwMS with a wide age range. This role seems to be limited to specific cognitive tasks that pose a greater challenge and therefore require greater adaptability.
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Affiliation(s)
- Alexandra Tremblay
- Department of Psychology, Université du Québec à Montréal, CP 8888, succ. Centre-ville, QC, Montreal H3C 3P8, Canada
| | - Kim Charest
- Department of Psychology, Université du Québec à Montréal, CP 8888, succ. Centre-ville, QC, Montreal H3C 3P8, Canada
| | - Estefan Brando
- Department of Psychology, Université du Québec à Montréal, CP 8888, succ. Centre-ville, QC, Montreal H3C 3P8, Canada
| | - Elaine Roger
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, 900 Rue Saint-Denis, QC H2 X 3H8, Montréal, Canada
| | - Pierre Duquette
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, 900 Rue Saint-Denis, QC H2 X 3H8, Montréal, Canada
| | - Isabelle Rouleau
- Department of Psychology, Université du Québec à Montréal, CP 8888, succ. Centre-ville, QC, Montreal H3C 3P8, Canada; Centre de Recherche du Centre Hospitalier de l'Université de Montréal, 900 Rue Saint-Denis, QC H2 X 3H8, Montréal, Canada.
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11
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Valadkevičienė D, Žukauskaitė I, Karrenbauer VD, Bileviciute-Ljungar I. Can fatigue predict the worsening of multiple sclerosis one year later? An explorative study with participants referred to assess their ability to work. Mult Scler Relat Disord 2022; 68:104393. [PMID: 36544323 DOI: 10.1016/j.msard.2022.104393] [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: 08/28/2022] [Revised: 10/18/2022] [Accepted: 10/31/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Multiple sclerosis (MS) is an inflammatory and degenerative disease of the central nervous system and is triggered by several environmental factors in genetically predisposed people. OBJECTIVES To explore which evaluation battery items used for evaluation of work capacity at baseline can best predict MS progression at 1 year follow-up. METHODS In this prospective single-centre study, participants with MS were recruited consecutively when visiting a neurologist for referral for the determination work capacity status at the Disability and Working Capacity Assessment Office. At baseline, a neurologist assessed patients using the following evaluation scales: Fatigue self-assessment, Fatigue Descriptive Scale (FDS), Memory self-assessment, Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS), Short Form 36 (SF-36), and the Brief International Classification of Functioning and Disability (ICF) core set for MS. The Expanded Disability Status Scale (EDSS) was evaluated by neurologists at baseline and one year later. An increase in EDSS by 0.5 points after one year was defined as MS progression. RESULTS During the one year period among 72 participants, 21 fulfilled the criteria for MS progression. In more than 75% of these participants, impairments were found in the following ICF subitems at baseline: "energy and drive functions", "muscle and power functions", and "moving around". Greater impairments were identified in progressing participants. Progressing participants scored higher on the FDS and scored lower on the BICAMS and SF-36. Regression analysis indicated that the FDS sum score predicted MS progression one year later. CONCLUSIONS Increased fatigue might indicate worsening in MS one year later.
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Affiliation(s)
- Daiva Valadkevičienė
- Clinic of Neurology and Neurosurgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania; Disability and Working Capacity Assessment Office under the Ministry of Social Security and Labour of the Republic of Lithuania, Vilnius, Lithuania
| | - Irena Žukauskaitė
- Institute of Psychology, Faculty of Philosophy, Vilnius University, Vilnius, Lithuania
| | - Virginija Danylaitė Karrenbauer
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Medical Unit Neuro, Karolinska University Hospital, Stockholm, Sweden
| | - Indre Bileviciute-Ljungar
- Department of Clinical Sciences, Karolinska Institutet, Stockholm, Sweden; Multidisciplinary Pain Clinic, St. Göran Hospital, Stockholm, Sweden.
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12
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Van Wijmeersch B, Hartung HP, Vermersch P, Pugliatti M, Pozzilli C, Grigoriadis N, Alkhawajah M, Airas L, Linker R, Oreja-Guevara C. Using personalized prognosis in the treatment of relapsing multiple sclerosis: A practical guide. Front Immunol 2022; 13:991291. [PMID: 36238285 PMCID: PMC9551305 DOI: 10.3389/fimmu.2022.991291] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 07/28/2022] [Indexed: 11/13/2022] Open
Abstract
The clinical course of multiple sclerosis (MS) is highly variable among patients, thus creating important challenges for the neurologist to appropriately treat and monitor patient progress. Despite some patients having apparently similar symptom severity at MS disease onset, their prognoses may differ greatly. To this end, we believe that a proactive disposition on the part of the neurologist to identify prognostic “red flags” early in the disease course can lead to much better long-term outcomes for the patient in terms of reduced disability and improved quality of life. Here, we present a prognosis tool in the form of a checklist of clinical, imaging and biomarker parameters which, based on consensus in the literature and on our own clinical experiences, we have established to be associated with poorer or improved clinical outcomes. The neurologist is encouraged to use this tool to identify the presence or absence of specific variables in individual patients at disease onset and thereby implement sufficiently effective treatment strategies that appropriately address the likely prognosis for each patient.
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Affiliation(s)
- Bart Van Wijmeersch
- Universitair Multiple Sclerosis (MS) Centrum, Hasselt-Pelt, Belgium
- Noorderhart, Revalidatie & Multiple Sclerosis (MS), Pelt, Belgium
- REVAL & BIOMED, Hasselt University, Hasselt, Belgium
- *Correspondence: Bart Van Wijmeersch,
| | - Hans-Peter Hartung
- Department of Neurology, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
- Brain and Mind Center, University of Sydney, Sydney, NSW, Australia
- Department of Neurology, Palacky University Olomouc, Olomouc, Czechia
| | - Patrick Vermersch
- University Lille, Inserm U1172 LilNCog, Centre Hospitalier Universitaire (CHU) Lille, Fédératif Hospitalo-Universitaire (FHU) Precise, Lille, France
| | - Maura Pugliatti
- Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
- Unit of Clinical Neurology, San Anna University Hospital, Ferrara, Italy
| | - Carlo Pozzilli
- Department of Human Neuroscience, Sapienza University, Rome, Italy
| | - Nikolaos Grigoriadis
- B’ Department of Neurology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Mona Alkhawajah
- Neuroscience Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Laura Airas
- Turku University Hospital and University of Turku, Turku, Finland
| | - Ralf Linker
- Department of Neurology, University Hospital Regensburg, Regensburg, Germany
| | - Celia Oreja-Guevara
- Department of Neurology, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Cliínico San Carlos (IDISSC), Madrid, Spain
- Department of Medicine, Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain
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13
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van Ballegooijen H, van der Hiele K, Enzinger C, de Voer G, Visser LH. The longitudinal relationship between fatigue, depression, anxiety, disability, and adherence with cognitive status in patients with early multiple sclerosis treated with interferon beta-1a. eNeurologicalSci 2022; 28:100409. [PMID: 35733640 PMCID: PMC9207145 DOI: 10.1016/j.ensci.2022.100409] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 05/24/2022] [Accepted: 06/07/2022] [Indexed: 11/30/2022] Open
Abstract
Background Cognitive dysfunction is common in multiple sclerosis and may worsen with reduced treatment adherence. We examined longitudinal relationships between anxiety, depression, fatigue, disability and adherence with cognitive status in patients with relapsing-remitting multiple sclerosis (MS) treated with interferon beta-1a in four countries. Methods The Confidence study is a prospective study in 165 people with MS with four visits (baseline/12/24/36 months). Physical and psychological symptoms were assessed using standardized questionnaires. Adherence was calculated as the number of injections divided by number of expected injections. Cognitive status was assessed by the Brief Repeatable Battery of Neuropsychological Tests and converted to a global Z-score. Results At baseline, mean age was 35.7 ± 11 years and 66% were female (n = 109). Adherence to treatment was very high throughout the study (>99%). A depression score ≥ 8 was significantly associated with a higher risk of low cognitive status compared with a lower score (0–7): relative risk 1.79 (1.14–2.83) adjusted for education and time since diagnosis. The P-value-for-time was not significant (P = 0.304) meaning that associations existed since baseline and remained stable during follow-up. Conclusion Our findings provide evidence for a longitudinal association between depression and low cognitive status in patients treated with interferon beta-1a in routine medical practice. Long-term effects of adherence to treatment and MS symptoms with cognition are largely unknown. Depression was longitudinally associated with a higher risk of low cognitive status in a real-world population. Clinical consideration and additional investigation in the treatment of depression for cognitive benefits should be considered.
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Affiliation(s)
| | - Karin van der Hiele
- Department of Psychology, Health, Medical and Neuropsychology Unit, Leiden University, Leiden, Netherlands
| | | | - Gert de Voer
- Merck BV, Schiphol-Rijk, The Netherlands, an affiliate of Merck KGaA, Germany
| | - Leo H Visser
- St Elisabeth Tweesteden Hospital, Tilburg, the Netherlands
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14
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Validation of the Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS) in the Russian Population. J Int Neuropsychol Soc 2022; 28:503-510. [PMID: 34132190 DOI: 10.1017/s1355617721000722] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Cognitive dysfunction is common in multiple sclerosis (MS). The Brief International Cognitive Assessment for MS (BICAMS) battery of tests has been suggested as a measure for the evaluation of the cognitive status of MS patients. This study aims to validate the BICAMS battery in the Russian population of MS patients. METHODS Age- and sex-matched MS patients (n = 98) and healthy individuals (n = 86) were included in the study. Symbol Digit Modalities Test (SDMT), California Verbal Learning Test, 2nd edition (CVLT-II) and the Brief Visuospatial Memory Test - Revised (BVMT-R) were administered to all participants. The battery was readministered 1 month later to 44 MS patients to investigate the test-retest reliability. RESULTS MS patients exhibited a significantly lower performance in testing with BICAMS than the control group in all three neuropsychological tests. Test-retest reliability was good for SDMT and CVLT-II (r = .82 and r = .85, respectively) and adequate for BVMT-R (r = .70). Based on the proposed criterion for impairment as z score below 1.5 SD the mean of the control group, we found that 34/98 (35%) of MS patients were found impaired at least in one cognitive domain. Patients with Expanded Disability Status Scale score ≥3.5 performed significantly worse than controls (SDMT, p < .0001; CVLT-II, p = .03; BVMT-R, p = .0004), while those with ≤3.0 scores did not. CONCLUSION This study demonstrates that the BICAMS battery is a valid instrument to identify cognitive impairment in MS patients and it can be recommended for routine use in the Russian Federation.
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15
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Maltby VE, Lea RA, Reeves P, Saugbjerg B, Lechner-Scott J. Reduced cognitive function contributes to economic burden of multiple sclerosis. Mult Scler Relat Disord 2022; 60:103707. [DOI: 10.1016/j.msard.2022.103707] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 02/14/2022] [Accepted: 02/19/2022] [Indexed: 11/28/2022]
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16
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Hechenberger S, Helmlinger B, Ropele S, Pirpamer L, Bachmaier G, Damulina A, Pichler A, Khalil M, Enzinger C, Pinter D. Information processing speed as a prognostic marker of physical impairment and progression in patients with multiple sclerosis. Mult Scler Relat Disord 2022; 57:103353. [PMID: 35158430 DOI: 10.1016/j.msard.2021.103353] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 10/22/2021] [Accepted: 10/25/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND Prediction of disability progression in patients with MS (pwMS) is challenging. So far, scarce evidence exists suggesting knowledge about how cognitive performance may potentially improve prediction of physical impairment and disability progression in MS. Therefore, we wanted to assess the prognostic value of cognitive performance regarding physical impairment and disability progression in pwMS. METHODS 85 patients (64% female; 60% relapse-remitting MS; mean age=36.78 ± 9.63 years) underwent clinical, neuropsychological (Brief Repeatable Battery for Neuropsychological Test (BRB-N)) and brain MRI (T1-weighted and T2-weighted FLAIR images) assessment at baseline and after an average of 7 years (SD=3.75) at follow-up. We assessed physical impairment and annualized disability progression (disability progression divided by follow-up duration) using the Expanded Disability Status Scale (EDSS). To compare patients with no or mild physical impairment (EDSS≤2.5) and patients with moderate to severe physical impairment (EDSS≥3.0), we used an EDSS score ≥3.0 as cut-off. Silent progression was defined by an EDSS worsening of at least 0.5 in the absence of relapses and inflammation in relapsing-remitting MS. RESULTS In hierarchical regression models (method "STEPWISE", forward) performance in information processing speed was a significant and independent predictor of physical impairment (EDSS≥3.0) at follow-up (model R²=0.671, b=-1.46, OR=0.23, p=0.001) and annualized disability progression (adjusted model R²=0.257, β=-0.26, 95% CI: -0.066, -0.008, p=0.012), in addition to demographics (age, education, individual follow-up time), clinical (EDSS, disease duration, clinical phenotype, annualized-relapse-rate) and MRI measures (brain volumes and T2-lesion load). In a MANCOVA controlled for age, disease duration and individual follow-up time, worse baseline performance in information processing speed was found in patients with higher EDSS at follow-up (m=-1.91, SD=1.18, p<0.001) and silent progression (m=-2.19, SD=1.01, p=0.038). CONCLUSION Performance in information processing speed might help to identify patients at risk for physical impairment. Therefore, neuropsychological assessment should be integrated in clinical standard care to support disease management in pwMS.
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Affiliation(s)
- Stefanie Hechenberger
- Medical University of Graz, Department of Neurology, Research Unit for Neuronal Plasticity and Repair, Graz, Austria
| | - Birgit Helmlinger
- Medical University of Graz, Department of Neurology, Research Unit for Neuronal Plasticity and Repair, Graz, Austria
| | - Stefan Ropele
- Medical University of Graz, Department of Neurology, Graz, Austria
| | - Lukas Pirpamer
- Medical University of Graz, Department of Neurology, Graz, Austria
| | - Gerhard Bachmaier
- Medical University of Graz, Institute for Medical Informatics, Statistics and Documentation, Graz, Austria
| | - Anna Damulina
- Medical University of Graz, Department of Neurology, Graz, Austria
| | | | - Michael Khalil
- Medical University of Graz, Department of Neurology, Graz, Austria
| | - Christian Enzinger
- Medical University of Graz, Department of Neurology, Research Unit for Neuronal Plasticity and Repair, Graz, Austria; Medical University of Graz, Department of Neurology, Graz, Austria; Medical University of Graz, Division of Neuroradiology, Vascular And Interventional Radiology, Department of Radiology, Graz, Austria
| | - Daniela Pinter
- Medical University of Graz, Department of Neurology, Research Unit for Neuronal Plasticity and Repair, Graz, Austria.
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17
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Cavaco S, Ferreira I, Moreira I, Santos E, Samões R, Sousa AP, Pinheiro J, Teixeira-Pinto A, Martins da Silva A. Cognitive dysfunction and mortality in multiple sclerosis: Long-term retrospective review. Mult Scler 2021; 28:1382-1391. [PMID: 34965761 DOI: 10.1177/13524585211066598] [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: 11/16/2022]
Abstract
BACKGROUND Cognitive dysfunction as a predictor of clinical progression and mortality in multiple sclerosis (MS) is still a matter of debate. OBJECTIVE The aim of this study was to explore the long-term outcome associated with neuropsychological performance in a cohort of patients with MS. METHODS A series of 408 MS patients had previously undergone a comprehensive neuropsychological assessment and a contemporaneous neurological evaluation (T1). A retrospective review of the clinical records was conducted 102-192 months after T1. Demographic and clinical data regarding the last clinical appointment with EDSS measurement (T2) were collected and the date of the last clinical contact or death (TS) was recorded. RESULTS This review revealed that cognitive dysfunction (T1) was associated with higher odds of transitioning from relapsing-remitting course to a progressive disease course (adjusted odds ratio (OR) = 2.29, p = 0.043) and higher hazard of death in the total sample (adjusted hazard ratio (HR) = 3.07, p = 0.006) and the progressive disease course subgroup (adjusted HR = 3.68, p = 0.007), even when adjusting for other covariates. DISCUSSION The study results demonstrate that cognitive dysfunction in MS is predictive of poorer prognosis and mortality.
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Affiliation(s)
- Sara Cavaco
- Neurology Department, Centro Hospitalar Universitário do Porto, Porto, Portugal/Neuropsychology Unit, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Inês Ferreira
- Neurology Department, Centro Hospitalar Universitário do Porto, Porto, Portugal/Neuropsychology Unit, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Inês Moreira
- Neurology Department, Centro Hospitalar Universitário do Porto, Porto, Portugal/Neuropsychology Unit, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Ernestina Santos
- Neurology Department, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Raquel Samões
- Neurology Department, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Ana Paula Sousa
- Neurophysiology Department, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Joaquim Pinheiro
- Neurology Department, Centro Hospitalar de Vila Nova de Gaia, Vila Nova de Gaia, Portugal
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18
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Maltby VE, Lea RA, Monif M, Fabis-Pedrini MJ, Buzzard K, Kalincik T, Kermode AG, Taylor B, Hodgkinson S, McCombe P, Butzkueven H, Barnett M, Lechner-Scott J. Efficacy of Cladribine Tablets as a Treatment for People With Multiple Sclerosis: Protocol for the CLOBAS Study (Cladribine, a Multicenter, Long-term Efficacy and Biomarker Australian Study). JMIR Res Protoc 2021; 10:e24969. [PMID: 34665152 PMCID: PMC8564661 DOI: 10.2196/24969] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 05/04/2021] [Accepted: 05/28/2021] [Indexed: 01/26/2023] Open
Abstract
Background Cladribine tablets (marketed as Mavenclad) are a new oral therapy, which has recently been listed on the pharmaceutical benefits scheme in Australia for the treatment of relapsing multiple sclerosis (MS). The current dosing schedule is for 2 courses given a year apart, which has been shown to be effective for treatment of MS for up to 4 years in 75% of patients (based on annualized relapse rate). However, the reinitiation of therapy after year 4 has not been studied. Objective This study aims to evaluate the safety and efficacy of cladribine tablets over a 6-year period, according to no evidence of disease activity 3. Methods This will be a multicenter, 6-year, phase IV, low interventional, observational study that incorporates clinical, hematological, biochemical, epigenetic, radiological and cognitive biomarkers of disease. Participants considered for treatment with cladribine as part of their routine clinical care will be consented to take part in the study. They will be monitored at regular intervals during the initial course of medication administration in years 1 and 2. After year 3, patients will have the option of redosing, if clinically indicated, or to switch to another disease-modifying therapy. Throughout the duration of the study, we will assess blood-based biomarkers including lymphocyte subsets, serum neurofilament light chain, DNA methylation, and RNA analysis as well as magnetic resonance imaging findings (brain volume and/or lesion load) and cognitive performance. Results This study has been approved by the Hunter New England Local Health District Human Research Ethics Committee. Recruitment began in March of 2019 and was completed by June 2021. Conclusions This will be the first long-term efficacy trial of cladribine, which offers reinitiation of therapy in the 3rd year, based on disease activity, after the initial 2 courses. We expect that this study will indicate whether any of the assessed biomarkers can be used to predict treatment efficacy or the need for future reinitiation of cladribine in people with MS. Trial Registration This study is registered with the Australian and New Zealand Clinical Trials Registry (ACTRN12619000257167) with Universal Trial Number (U1111-1228-2165). International Registered Report Identifier (IRRID) DERR1-10.2196/24969
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Affiliation(s)
- Vicki E Maltby
- Department of Neurology, John Hunter Hospital, New Lambton Heights, Australia.,School for Medicine and Public Health, University of Newcastle, Callaghan, Australia.,Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Rodney A Lea
- School for Medicine and Public Health, University of Newcastle, Callaghan, Australia.,Hunter Medical Research Institute, New Lambton Heights, Australia.,Institute of Health and Biomedical Innovations, Genomics Research Centre, Queensland University of Technology, Kelvin Grove, Australia
| | - Mastura Monif
- Department of Neurosciences, Eastern Health Clinical School, Monash University, Box Hill Hospital, Melbourne, Australia.,Department of Neurology, Alfred Health, Melbourne, Australia.,Department of Neurology, Melbourne Multiple Sclerosis Centre, Melbourne Health, Melbourne, Australia
| | - Marzena J Fabis-Pedrini
- Centre for Neuromuscular and Neurological Disorders, Perron Institute for Neurological and Translational Science, University of Western Australia, Perth, Australia
| | - Katherine Buzzard
- Department of Neurosciences, Eastern Health Clinical School, Monash University, Box Hill Hospital, Melbourne, Australia.,Department of Neurology, Melbourne Multiple Sclerosis Centre, Melbourne Health, Melbourne, Australia
| | - Tomas Kalincik
- Department of Neurology, Melbourne Multiple Sclerosis Centre, Melbourne Health, Melbourne, Australia.,Clinical Outcomes Research (CORe) Unit, Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Allan G Kermode
- Centre for Neuromuscular and Neurological Disorders, Perron Institute for Neurological and Translational Science, University of Western Australia, Perth, Australia.,Institute for Immunology and Infectious Disease, Murdoch University, Perth, Australia
| | - Bruce Taylor
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Suzanne Hodgkinson
- Department of Medicine, University of New South Wales, Sydney, Australia.,Department of Neurology, Liverpool Hospital, Sydney, Australia.,Immune Tolerance Laboratory, Ingham Institute, Sydney, Australia
| | - Pamela McCombe
- Centre for Clinical Research, University of Queensland, Brisbane, Australia
| | - Helmut Butzkueven
- Department of Neurology, Alfred Health, Melbourne, Australia.,Clinical Outcomes Research (CORe) Unit, Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Michael Barnett
- Brain and Mind Centre, University of Sydney, Sydney, Australia.,Sydney Neuroimaging Analysis Centre, Sydney, Australia
| | - Jeannette Lechner-Scott
- Department of Neurology, John Hunter Hospital, New Lambton Heights, Australia.,School for Medicine and Public Health, University of Newcastle, Callaghan, Australia.,Hunter Medical Research Institute, New Lambton Heights, Australia
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19
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Langdon DW, Tomic D, Penner IK, Calabrese P, Cutter G, Häring DA, Dahlke F, Kappos L. Baseline characteristics and effects of fingolimod on cognitive performance in patients with relapsing-remitting multiple sclerosis. Eur J Neurol 2021; 28:4135-4145. [PMID: 34431170 PMCID: PMC9292292 DOI: 10.1111/ene.15081] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 08/04/2021] [Accepted: 08/07/2021] [Indexed: 11/28/2022]
Abstract
Background and purpose Studies reporting the baseline determinants of cognitive performance and treatment effect on cognition in patients with multiple sclerosis (MS) are limited. We investigated the baseline correlates of cognition and the long‐term treatment effects of fingolimod 0.5 mg once daily on cognitive processing speed and attention in patients with relapsing‐remitting MS. Methods This post hoc analysis pooled data from the phase 3 FREEDOMS and FREEDOMS II trials (N = 1556). We assessed the correlation between baseline patient demographic and disease characteristics and baseline 3‐second Paced Auditory Serial Addition Test (PASAT‐3) scores (Spearman's rank test) and the changes from baseline in PASAT‐3 (mixed model repeated measures model) in the fingolimod and placebo (up to 24 months) or placebo‐fingolimod switched (from Month 24 up to 120 months) groups. Additionally, the predictive value of PASAT‐3 score for future disease outcomes was assessed (Cox or logistic regression models). Results Among the variables assessed, lower PASAT‐3 score at baseline correlated with higher disease burden (total brain volume, T2 lesion volume, and Expanded Disability Status Scale score), longer disease duration and older age (p < 0.0001 for all). Fingolimod significantly improved PASAT‐3 scores from baseline versus placebo at 6 (1.3; p = 0.0007), 12 (1.1; p = 0.0044) and 24 months (1.1; p = 0.0028), with a sustained effect (overall treatment effect p = 0.0012) up to 120 months. Improvements were seen regardless of baseline cognitive status (PASAT quartile). Baseline PASAT‐3 score was predictive of both clinical and magnetic resonance imaging measures of disease activity at Month 24 (p < 0.001 for all). Conclusion Early fingolimod treatment may offer long‐term cognitive benefit in patients with relapsing‐remitting MS.
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Affiliation(s)
- Dawn W Langdon
- Department of Psychology, Royal Holloway, University of London, Egham, UK
| | | | - Iris-Katharina Penner
- Medical Faculty, Department of Neurology, Heinrich Heine University, Düsseldorf, Germany.,COGITO Center for Applied Neurocognition and Neuropsychological Research, Düsseldorf, Germany
| | - Pasquale Calabrese
- Neuropsychology and Behavioral Neurology Unit, Division of Cognitive and Molecular Neuroscience, University of Basel, Switzerland
| | - Gary Cutter
- Department of Biostatistics, University of Alabama, Birmingham, AL, USA
| | | | | | - Ludwig Kappos
- Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB) and MS Center, Neurology, Departments of Head, Spine and Neuromedicine and Clinical Research, University Hospital and University of Basel, Spitalstrasse 2, Basel, Schweiz, 4031, Switzerland
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20
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A Greek Validation Study of the Multiple Sclerosis Work Difficulties Questionnaire-23. Healthcare (Basel) 2021; 9:healthcare9070897. [PMID: 34356274 PMCID: PMC8306802 DOI: 10.3390/healthcare9070897] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 07/02/2021] [Accepted: 07/13/2021] [Indexed: 11/17/2022] Open
Abstract
The Multiple Sclerosis Work Difficulties Questionnaire-23 (MSWDQ-23) is a self-report instrument developed to assess barriers faced by People with Multiple Sclerosis (PwMS) in the workplace. The aim of this study was to explore the psychometric properties of the Greek version of the MSWDQ-23. The study sample consisted of 196 PwMS, all currently working in part- or full-time jobs. Participants underwent clinical examination and cognitive screening with the Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS) and completed self-report measures of fatigue, psychological functioning, and quality of life, along with the MSWDQ-23 questionnaire. Confirmatory Factor Analysis (CFA) was performed, and goodness-of-fit measures were used to evaluate construct validity. Convergent validity was checked by correlating MSWDQ-23 scores with study measures. Cronbach's alpha value was produced to assess internal consistency. CFA yielded a model with a fair fit confirming the three-factor structure of the instrument. Higher work difficulties were associated with higher Expanded Disability Status Scale (EDSS) scores, poorer cognitive function, more fatigue, stress, anxiety, and depression, and poorer health status, supporting the convergent validity of MSWDQ-23. Internal consistency (Cronbach's alpha = 0.94) and test-retest reliability (ICC = 0.996, 95%, CI = 0.990-0.998) were excellent. The Greek MSWDQ-23 can be considered a valid patient-reported outcome measure and can be used in interventions aiming to improve the vocational status of PwMS.
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21
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Simpson A, Mowry EM, Newsome SD. Early Aggressive Treatment Approaches for Multiple Sclerosis. Curr Treat Options Neurol 2021; 23:19. [PMID: 34025110 PMCID: PMC8121641 DOI: 10.1007/s11940-021-00677-1] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2021] [Indexed: 12/19/2022]
Abstract
Purpose of review This review presents a comprehensive analysis of the current high-efficacy disease-modifying therapies (DMTs) available for treatment of multiple sclerosis (MS). We discuss the existing approved and emerging therapeutics in patients with relapsing and progressive forms of MS using data from clinical trials and observational studies. Treatment considerations in pediatric and pregnant populations are also reviewed. Finally, we discuss the treatment paradigms of the escalation and early aggressive approaches to treatment of MS, with review of ongoing clinical trials to compare these approaches. Recent findings Natalizumab has shown promising data on efficacy in not only randomized trials but also observational studies when compared with placebo, the injectable DMTs, and fingolimod. The anti-CD20 B cell depleting therapies (rituximab, ocrelizumab, and ofatumumab) have also demonstrated superiority in randomized clinical trials compared to their comparator group (placebo, interferon, and teriflunomide, respectively) and rituximab has shown in observational studies to be more effective than older injectable therapies and some of the oral therapies. Alemtuzumab has shown good efficacy in randomized controlled trials and observational studies yet has several potentially severe side effects limiting its use. Mitoxantrone has similarly demonstrated significant reduction in new disease activity compared to placebo but is rarely used due to its severe side effects. Cladribine is an oral DMT often grouped in discussion with other higher efficacy DMTs but may be slightly less effective than the other therapies described in this review. Many emerging targets for therapeutic intervention are currently under investigation that may prove to be beneficial in early aggressive MS, including autologous hematopoietic stem cell transplantation. Summary Traditionally, MS has been treated with an escalation approach, starting patients on a modestly effective DMT and subsequently escalating to a higher efficacy DMT when there is evidence of clinical and/or radiologic breakthrough activity. With the development of higher efficacy therapies and emerging data showing the potential positive long-term impact of these therapies when started earlier in the disease course, many clinicians have shifted to an early aggressive treatment approach in which patients are initially started on a higher efficacy DMT. Two clinical trials, the TRaditional versus Early Aggressive Therapy for MS (TREAT-MS) trial and the Determining the Effectiveness of earLy Intensive Versus Escalation approaches for the treatment of Relapsing-remitting MS (DELIVER-MS) trial, aim to directly compare these treatment strategies and their impact on clinical and radiologic outcomes.
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Affiliation(s)
- Alexandra Simpson
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD USA
| | - Ellen M Mowry
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD USA
| | - Scott D Newsome
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD USA.,Division of Neuroimmunology and Neurological Infections, Johns Hopkins Hospital, 600 North Wolfe St., Pathology 627, Baltimore, MD 21287 USA
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22
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Meca-Lallana V, Berenguer-Ruiz L, Carreres-Polo J, Eichau-Madueño S, Ferrer-Lozano J, Forero L, Higueras Y, Téllez Lara N, Vidal-Jordana A, Pérez-Miralles FC. Deciphering Multiple Sclerosis Progression. Front Neurol 2021; 12:608491. [PMID: 33897583 PMCID: PMC8058428 DOI: 10.3389/fneur.2021.608491] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 03/11/2021] [Indexed: 12/12/2022] Open
Abstract
Multiple sclerosis (MS) is primarily an inflammatory and degenerative disease of the central nervous system, triggered by unknown environmental factors in patients with predisposing genetic risk profiles. The prevention of neurological disability is one of the essential goals to be achieved in a patient with MS. However, the pathogenic mechanisms driving the progressive phase of the disease remain unknown. It was described that the pathophysiological mechanisms associated with disease progression are present from disease onset. In daily practice, there is a lack of clinical, radiological, or biological markers that favor an early detection of the disease's progression. Different definitions of disability progression were used in clinical trials. According to the most descriptive, progression was defined as a minimum increase in the Expanded Disability Status Scale (EDSS) of 1.5, 1.0, or 0.5 from a baseline level of 0, 1.0–5.0, and 5.5, respectively. Nevertheless, the EDSS is not the most sensitive scale to assess progression, and there is no consensus regarding any specific diagnostic criteria for disability progression. This review document discusses the current pathophysiological concepts associated with MS progression, the different measurement strategies, the biomarkers associated with disability progression, and the available pharmacologic therapeutic approaches.
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Affiliation(s)
- Virginia Meca-Lallana
- Multiple Sclerosis Unit, Neurology Department, Fundación de Investigación Biomédica, Hospital Universitario de la Princesa, Madrid, Spain
| | | | - Joan Carreres-Polo
- Neuroradiology Section, Radiology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Sara Eichau-Madueño
- Multiple Sclerosis CSUR Unit, Neurology Department, Hospital Universitario Virgen Macarena, Seville, Spain
| | - Jaime Ferrer-Lozano
- Department of Pathology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Lucía Forero
- Neurology Department, Hospital Puerta del Mar, Cádiz, Spain
| | - Yolanda Higueras
- Neurology Department, Instituto de Investigación Sanitaria Gregorio Marañón (IISGM), Hospital Universitario Gregorio Marañón, Madrid, Spain.,Department of Experimental Psychology, Cognitive Processes and Speech Therapy, Universidad Complutense, Madrid, Spain
| | - Nieves Téllez Lara
- Neurology Department, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Angela Vidal-Jordana
- Neurology/Neuroimmunology Department, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Francisco Carlos Pérez-Miralles
- Neuroimmunology Unit, Neurology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain.,Department of Medicine, University of València, Valencia, Spain
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23
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Meca-Lallana V, Gascón-Giménez F, Ginestal-López RC, Higueras Y, Téllez-Lara N, Carreres-Polo J, Eichau-Madueño S, Romero-Imbroda J, Vidal-Jordana Á, Pérez-Miralles F. Cognitive impairment in multiple sclerosis: diagnosis and monitoring. Neurol Sci 2021; 42:5183-5193. [PMID: 33796947 PMCID: PMC8642331 DOI: 10.1007/s10072-021-05165-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 03/04/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Cognitive impairment (CI) has a prevalence of 45-70% in people with multiple sclerosis (MS), producing a negative impact on their quality of life, personal life, and work. Early detection of CI has become an important aspect to be considered for an adequate follow-up, to optimize social adaptation and to implement specific cognitive rehabilitation strategies. The aim of this work is to propose a suitable cognitive evaluation of patients with MS based on available and efficient tools for diagnosis and monitoring purposes well supported by literature review and clinical experience. METHODS A multidisciplinary panel of professionals from the field of neurology, neuropsychology, and neuroimaging performed a literature review of the topic of cognitive impairment assessment. This was combined and completed with their clinical experience to produce a set of recommendations. RESULTS Some limitations to cognitive evaluation are described: shortage of time and resources during the neurology consultation, scarceness or absence of specialized professionals' availability, importance of tests adaptation, and doubts about its use to define therapeutic efficiency. We recommend a baseline and annual screening evaluation, and we suggest a baseline and periodic neuropsychological assessment. The latter ought to change to a recommendation with the presence of either positive screening test, or subjective to cognitive complaints, screening-test results and patient or family report mismatch, or in specific social/work situations. CONCLUSIONS Cognitive evaluation should be performed on all patients diagnosed with MS and throughout follow-up. It is necessary to support the creation of multidisciplinary MS teams to optimize the evaluation and follow-up of MS patients.
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Affiliation(s)
- Virginia Meca-Lallana
- Unidad de Enfermedades Desmielinizantes, Servicio de Neurología, Hospital Universitario de La Princesa, Madrid, Spain.
| | - Francisco Gascón-Giménez
- Unidad de Esclerosis Múltiple, Servicio de Neurología, Hospital Clínico Universitario, Valencia, Spain
| | | | - Yolanda Higueras
- Instituto de Investigación Sanitaria del Gregorio Marañón, Hospital Gregorio Marañón, Madrid, Spain
| | - Nieves Téllez-Lara
- Servicio de Neurología, Hospital Clínico Universitario, Valladolid, Spain
| | - Joan Carreres-Polo
- Servicio de Radiología, Hospital Universitari i Politècnic La Fe de Valencia, Valencia, Spain
| | - Sara Eichau-Madueño
- Servicio de Neurología, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - Jesús Romero-Imbroda
- Servicio de Neurología, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Ángela Vidal-Jordana
- Servicio de Neurología-Neuroinmunología, Centro de Esclerosis Múltiple de Cataluña (Cemcat), Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Francisco Pérez-Miralles
- Unitat de Neuroimmunología - CSUR Servicio de Neurología Hospital Universitari i Politècnic La Fe de Valencia, Valencia, Spain
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24
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Dogru-Huzmeli E, Duman T. There is an impairment in time perception of patients with multiple sclerosis. Somatosens Mot Res 2021; 38:140-145. [PMID: 33719839 DOI: 10.1080/08990220.2021.1879777] [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: 10/21/2022]
Abstract
OBJECTIVE The objective of this study is to examine time perception impairment in multiple sclerosis (MS) patients. METHOD The study was performed with 60 MS patients and 60 age-matched healthy people. Estimation and Production Tests were carried out with a standard personal laptop computer and participants were aware to count the seconds by the 'start' command and to stop by the 'stop' command. The outcome measure was the ratio between the estimated duration and the target (7 s, 32 s, or 58 s) one for the Estimation Test and the Produced duration and the target (7 s, 32 s, or 58 s) one for the Production Test; and each time duration was repeated three times both for Production and Estimation Tests. RESULTS We found a significant difference in the Estimation Test (7 s, 32 s, 58 s), and the Production Test (7 s, 32 s, 58 s) between the MS group and healthy control group (p < .05). It was observed that patients with MS had a higher deviation from the target time compared to the control group. It was found that this difference was statistically significant (p < .05). There was a high and negative correlation between the Estimation and Production Tests in MS patients. CONCLUSION In conclusion, our data suggests that time estimation and production are disturbed in MS patients, and cognitive rehabilitation is required for most of them.
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Affiliation(s)
- Esra Dogru-Huzmeli
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Hatay Mustafa Kemal University, Hatay, Turkey
| | - Taskin Duman
- Department of Neurology, Faculty of Medicine, Hatay Mustafa Kemal University, Hatay, Turkey
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25
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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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26
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Gromisch ES, Dhari Z. Identifying Early Neuropsychological Indicators of Cognitive Involvement in Multiple Sclerosis. Neuropsychiatr Dis Treat 2021; 17:323-337. [PMID: 33574669 PMCID: PMC7872925 DOI: 10.2147/ndt.s256689] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 01/22/2021] [Indexed: 12/19/2022] Open
Abstract
Multiple sclerosis (MS) is a debilitating disease of the central nervous system that is most commonly seen in early to middle adulthood, although it can be diagnosed during childhood or later in life. While cognitive impairment can become more prevalent and severe as the disease progresses, signs of cognitive involvement can be apparent in the early stages of the disease. In this review, we discuss the prevalence and types of cognitive impairment seen in early MS, including the specific measures used to identify them, as well as the challenges in characterizing their frequency and progression. In addition to examining the progression of early cognitive involvement over time, we explore the clinical factors associated with early cognitive involvement, including demographics, level of physical disability, disease modifying therapy use, vocational status, and psychological and physical symptoms. Given the prevalence and functional impact these impairments can have for persons with MS, considerations for clinicians are provided, such as the role of early cognitive screenings and the importance of comprehensive neuropsychological assessments.
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Affiliation(s)
- Elizabeth S Gromisch
- Mandell Center for Multiple Sclerosis, Mount Sinai Rehabilitation Hospital, Trinity Health Of New England, Hartford, CT, USA
- Department of Rehabilitative Medicine, Frank H. Netter MD School of Medicine at Quinnipiac University, North Haven, CT, USA
- Department of Medical Sciences, Frank H. Netter MD School of Medicine at Quinnipiac University, North Haven, CT, USA
- Department of Neurology, University of Connecticut School of Medicine, Farmington, CT, USA
| | - Zaenab Dhari
- Mandell Center for Multiple Sclerosis, Mount Sinai Rehabilitation Hospital, Trinity Health Of New England, Hartford, CT, USA
- Department of Rehabilitative Medicine, Frank H. Netter MD School of Medicine at Quinnipiac University, North Haven, CT, USA
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27
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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: 24] [Impact Index Per Article: 8.0] [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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28
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Maubeuge N, Deloire MSA, Brochet B, Ehrlé N, Charré-Morin J, Saubusse A, Ruet A. Validation of the French version of the minimal assessment of cognitive function in multiple sclerosis (MACFIMS). Mult Scler Relat Disord 2020; 48:102692. [PMID: 33352358 DOI: 10.1016/j.msard.2020.102692] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 11/18/2020] [Accepted: 12/13/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND The Minimal Assessment of Cognitive Function in Multiple sclerosis (MACFIMS) is an internationally recognised battery of neuropsychological tests for patients with multiple sclerosis (MS). OBJECTIVES To establish regression-based norms for the MACFIMS in French-speaking healthy subjects (HS) and validate its use in persons with multiple sclerosis (PwMS). METHODS 136 PwMS, including 43 with relapsing-remitting MS, 46 with secondary progressive MS and 45 with primary progressive MS, as well as 276 HS were enrolled. Regression-based norms and validity were established for the seven tests of the MACIMS: the Symbol Digit Modalities Test (SDMT), the Paced Auditory Serial Addition Test (PASAT), the French learning test (FLT) a French-adapted memory test (or the California Verbal Learning Test (CVLT) at re-testing), the Judgment of Line Orientation Test (JLO), the 'épreuve de classement de cartes de Champagne' (ECCC), a French adaptation of the DKEF-sorting test, the Brief Visuospatial Memory Test (BVMT-R) and the Controlled Oral Word Association Test (COWAT). RESULTS Regression-based norms of MACFIMS tests were established in the HS population. The MACFIMS battery was able to identify cognitive impairment (CI) (at least two abnormal tests in different domains) in 32.7% of PwMS. The domains with more frequent impairment were (in descending order): learning followed by IPS, delayed memory, verbal fluency and working memory. CONCLUSION This study established the regression-based norms for French subjects of the French adaptation of the MACFIMS and its validity in PwMS.
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Affiliation(s)
| | | | - Bruno Brochet
- CHU de Bordeaux, F-33000 Bordeaux, France; Inserm U1215 - Neurocentre Magendie, F-33000 Bordeaux, France; Univ. Bordeaux, F-33076 Bordeaux, France.
| | | | | | | | - Aurélie Ruet
- CHU de Bordeaux, F-33000 Bordeaux, France; Inserm U1215 - Neurocentre Magendie, F-33000 Bordeaux, France; Univ. Bordeaux, F-33076 Bordeaux, France
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29
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Sá MJ, Soares Dos Reis R, Altintas A, Celius EG, Chien C, Comi G, Graus F, Hillert J, Hobart J, Khan G, Kissani N, Langdon D, Leite MI, Okuda DT, Palace J, Papais-Alvarenga RM, Mendes-Pinto I, Shi FD. State of the Art and Future Challenges in Multiple Sclerosis Research and Medical Management: An Insight into the 5th International Porto Congress of Multiple Sclerosis. Neurol Ther 2020; 9:281-300. [PMID: 32666470 PMCID: PMC7606370 DOI: 10.1007/s40120-020-00202-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Indexed: 02/07/2023] Open
Abstract
The 5th International Porto Congress of Multiple Sclerosis took place between the 14th and 16th of February 2019 in Porto, Portugal. Its intensive programme covered a wide-range of themes-including many of the hot topics, challenges, pitfalls and yet unmet needs in the field of multiple sclerosis (MS)-led by a number of well-acknowledged world experts. This meeting review summarizes the talks that took place during the congress, which focussed on issues in MS as diverse as the development and challenges of progressive MS, epidemiology, differential diagnosis, medical management, molecular research and imaging tools.
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Affiliation(s)
- María José Sá
- Department of Neurology, Centro Hospitalar Universitário de São João, Alameda Prof. Hernáni Monteiro, Porto, Portugal.
- Faculty of Health Sciences, University Fernando Pessoa, Rua Carlos da Maia, Porto, Portugal.
| | - Ricardo Soares Dos Reis
- Department of Neurology, Centro Hospitalar Universitário de São João, Alameda Prof. Hernáni Monteiro, Porto, Portugal.
- Department of Clinical Neurosciences and Mental Health, Faculty of Medicine, University of Porto, Porto, Portugal.
| | - Ayse Altintas
- Department of Neurology, School of Medicine, Koç University, Istanbul, Turkey
| | - Elisabeth Gulowsen Celius
- Department of Neurology, Oslo University Hospital, Ullevål, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Claudia Chien
- NeuroCure Clinical Research Center, NeuroCure Cluster of Excellence, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Giancarlo Comi
- Department of Neurology, University Vita-Salute San Raffaele, Milan, Italy
| | - Francesc Graus
- Department of Neurology, August Pi i Sunyer Biomedical Research Institute (IDIBAPS) Hospital Clínic, Barcelona, Spain
| | - Jan Hillert
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Jeremy Hobart
- Department of Neurology, University Hospitals Plymouth, Plymouth, UK
- Peninsula Schools of Medicine and Dentistry, University of Plymouth, Plymouth, UK
| | - Gulfaraz Khan
- Department of Microbiology and Immunology, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Najib Kissani
- Neurology Department, Marrakech University Hospital Mohammed VI, Marrakech, Morocco
- Neuroscience Research Laboratory, Marrakesh Medical School, Cadi Ayyad University, Marrakech, Morocco
| | - Dawn Langdon
- Department of Psychology, Royal Holloway, University of London, London, UK
| | - Maria Isabel Leite
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Darin T Okuda
- Department of Neurology and Neurotherapeutics, UT Southwestern Medical Center, Dallas, TX, USA
| | - Jacqueline Palace
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | | | | | - Fu-Dong Shi
- Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
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30
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Buyukturkoglu K, Zeng D, Bharadwaj S, Tozlu C, Mormina E, Igwe KC, Lee S, Habeck C, Brickman AM, Riley CS, De Jager PL, Sumowski JF, Leavitt VM. Classifying multiple sclerosis patients on the basis of SDMT performance using machine learning. Mult Scler 2020; 27:107-116. [DOI: 10.1177/1352458520958362] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Objective: To build a model to predict cognitive status reflecting structural, functional, and white matter integrity changes in early multiple sclerosis (MS). Methods: Based on Symbol Digit Modalities Test (SDMT) performance, 183 early MS patients were assigned “lower” or “higher” performance groups. Three-dimensional (3D)-T2, T1, diffusion weighted, and resting-state magnetic resonance imaging (MRI) data were acquired in 3T. Using Random Forest, five models were trained to classify patients into two groups based on 1—demographic/clinical, 2—lesion volume/location, 3—local/global tissue volume, 4—local/global diffusion tensor imaging, and 5—whole-brain resting-state-functional-connectivity measures. In a final model, all important features from previous models were concatenated. Area under the receiver operating characteristic curve (AUC) values were calculated to evaluate classifier performance. Results: The highest AUC value (0.90) was achieved by concatenating all important features from neuroimaging models. The top 10 contributing variables included volumes of bilateral nucleus accumbens and right thalamus, mean diffusivity of left cingulum-angular bundle, and functional connectivity among hubs of seven large-scale networks. Conclusion: These results provide an indication of a non-random brain pattern mostly compromising areas involved in attentional processes specific to patients who perform worse in SDMT. High accuracy of the final model supports this pattern as a potential neuroimaging biomarker of subtle cognitive changes in early MS.
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Affiliation(s)
- Korhan Buyukturkoglu
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
| | - Dana Zeng
- Department of Biostatistics, Columbia University, New York, NY, USA
| | - Srinidhi Bharadwaj
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
| | - Ceren Tozlu
- Department of Radiology, Weill Cornell Medicine, New York, NY, USA
| | - Enricomaria Mormina
- Department of Clinical and Experimental Medicine, Policlinico Universitario “G. Martino,” University of Messina, Messina, Italy/Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Kay C Igwe
- Department of Neurology, Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, G.H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Seonjoo Lee
- Department of Biostatistics, Columbia University, New York, NY, USA/Mental Health Data Science, Research Foundation for Mental Hygiene, Inc, New York State Psychiatric Institute, New York, NY, USA
| | - Christian Habeck
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
| | - Adam M Brickman
- Department of Neurology, Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, G.H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Claire S Riley
- Multiple Sclerosis Center, Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
| | - Philip L De Jager
- Multiple Sclerosis Center, Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA/Center for Translational & Computational Neuroimmunology, Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
| | - James F Sumowski
- Corinne Goldsmith Dickinson Center for Multiple Sclerosis, Mount Sinai Hospital, New York, NY, USA
| | - Victoria M Leavitt
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
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31
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Lamargue D, Koubiyr I, Deloire M, Saubusse A, Charre-Morin J, Moroso A, Coupé P, Brochet B, Ruet A. Effect of cognitive rehabilitation on neuropsychological and semiecological testing and on daily cognitive functioning in multiple sclerosis: The REACTIV randomized controlled study. J Neurol Sci 2020; 415:116929. [PMID: 32460145 DOI: 10.1016/j.jns.2020.116929] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 04/22/2020] [Accepted: 05/15/2020] [Indexed: 01/05/2023]
Abstract
BACKGROUND Specific cognitive rehabilitation (SCR) has been suggested for multiple sclerosis (MS). A randomized controlled trial (RCT) evaluating the therapeutic effects of SCR is necessary. OBJECTIVE To demonstrate the superiority of a SCR program (REACTIV) over nonspecific intervention (NSI) for neuropsychological (NP) assessment, virtual reality (VR) cognitive testing and daily cognitive functioning. METHODS A single-blind RCT compared SCR and NSI in patients with MS with cognitive complaint. Both programs included 50 individual sessions, 3 times a week for 17 weeks in a real-world setting. The primary end-point was NP assessment. Secondary end-points included semiecological VR tasks (Urban Daily Cog®) and daily cognitive functioning assessment. Maintenance of the effects at 8 months was studied. RESULTS Of the 35 patients, 18 completed the SCR, and 17 completed the NSI. Several NP and semiecological scores improved significantly more after SCR than after NSI. More NP scores improved significantly after SCR than after NSI. SCR improved daily cognitive functioning. Most improvements were maintained at 8 months. CONCLUSION SCR performed in a real-world setting is superior to NSI for improving performance in specific cognitive domains and information processing speed, and for improving cognitive functioning, as evaluated by ecological tools close to daily life and a daily cognitive functioning questionnaire.
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Affiliation(s)
- D Lamargue
- Univ. Bordeaux, F-33000 Bordeaux, France; Inserm U1215 - Neurocentre Magendie, F-33000 Bordeaux, France
| | - I Koubiyr
- Univ. Bordeaux, F-33000 Bordeaux, France; Inserm U1215 - Neurocentre Magendie, F-33000 Bordeaux, France
| | - M Deloire
- CHU de Bordeaux, F-33000 Bordeaux, France
| | - A Saubusse
- CHU de Bordeaux, F-33000 Bordeaux, France
| | | | - A Moroso
- CHU de Bordeaux, F-33000 Bordeaux, France
| | - P Coupé
- Laboratoire Bordelais de Recherche en Informatique, UMR CNRS 5800, PICTURA, F-33405 Talence, France
| | - B Brochet
- Univ. Bordeaux, F-33000 Bordeaux, France; Inserm U1215 - Neurocentre Magendie, F-33000 Bordeaux, France; CHU de Bordeaux, F-33000 Bordeaux, France.
| | - A Ruet
- Univ. Bordeaux, F-33000 Bordeaux, France; Inserm U1215 - Neurocentre Magendie, F-33000 Bordeaux, France; CHU de Bordeaux, F-33000 Bordeaux, France
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32
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French validation of the Brief International Cognitive Assessment for Multiple Sclerosis. Rev Neurol (Paris) 2020; 177:73-79. [PMID: 32713736 DOI: 10.1016/j.neurol.2020.04.028] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 04/23/2020] [Accepted: 04/24/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Cognitive impairment is important to consider in the assessment of multiple sclerosis (MS) patients. A short battery of cognitive assessment, the Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS), has been developed to address the need for rapid assessment by combining 3 tests assessing the main cognitive spheres reached in MS. OBJECTIVES To establish regression-based norms of the BICAMS in French speaking healthy subjects (HS) and validate its use in persons with multiple sclerosis (PwMS). METHODS In all, 123 PwMS including 40 with relapsing-remitting MS, 41 patients with secondary progressive MS and 42 with primary progressive MS and 276 HS were evaluated by the BICAMS including 3 tests, the Symbol Digit Modalities Test (SDMT), the French Verbal learning test (FVLT) a French-adapted memory test, (or the California Verbal Learning Test (CVLT) at retesting) and the Brief Visuo-Spatial Memory Test (BVMT-R). The standards for these tests were established in the healthy population using a multiple regression technique. Validity in MS was measured. RESULTS Regression-based norms of BICAMS tests have been established in the HS population. 50.4% of PwMS have impairment for at least one BICAMS test (-1.5SD on the Z-score). The most common pathological test was the FVLT altered in 36.6% of patients, followed by the SDMT and the BVMT-R. The re-test reliability was good for the various BICAMS tests, 0.891 for SDMT, 0.781 for FVLT/CVLT and 0.669 for BVMT-R. CONCLUSION This study establishes the validity of the BICAMS as a short and easy to apply battery for a brief assessment of the speed of information processing and episodic memory in MS.
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Pinter D, Khalil M, Pirpamer L, Damulina A, Pichler A, Fruhwirth V, Ropele S, Schmidt R, Fuchs S, Enzinger C. Long-term course and morphological MRI correlates of cognitive function in multiple sclerosis. Mult Scler 2020; 27:954-963. [PMID: 32662720 DOI: 10.1177/1352458520941474] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Cognitive impairment frequently occurs in patients with MS (pwMS). Magnetic resonance imaging (MRI) markers could help to identify patients at risk for decline. OBJECTIVE To characterize the long-term course and morphological MRI correlates of cognitive function in pwMS. METHODS We invited 116 pwMS who had undergone clinical, cognitive, and MRI evaluations between 2006 and 2012 (baseline, BL) to attend follow-up (FU) testing between 2016 and 2018. Disability (expanded disability status scale (EDSS)), cognition (brief repeatable battery of neuropsychological test (BRB-N)), global and regional T2-lesion load (T2-LL), brain volumes, and cortical thickness were assessed. RESULTS Sixty-three pwMS were willing to attend the FU (54%; median EDSS = 2, interquartile range (IQR) = 2) and did not differ from non-participating pwMS regarding BL characteristics. At BL, half of the participants showed cognitive deficits in at least one domain. Across the entire group, we observed no relevant changes in physical disability and cognition over 10 years. BL thalamic volume best predicted cognitive function at FU, in addition to age and BL cognition, explaining 67% of variance. Cognitive decliners (23.8%) were older, had longer disease duration, and a tendency for lower thalamic volume at BL. CONCLUSION Thalamic volume predicted FU cognitive function and distinguished declining from stable pwMS, underlining the potential of MRI to define risk groups.
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Affiliation(s)
- Daniela Pinter
- Research Unit for Neuronal Plasticity and Repair, Medical University of Graz, Graz, Austria/Department of Neurology, Medical University of Graz, Graz, Austria
| | - Michael Khalil
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - Lukas Pirpamer
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - Anna Damulina
- Department of Neurology, Medical University of Graz, Graz, Austria
| | | | - Viktoria Fruhwirth
- Research Unit for Neuronal Plasticity and Repair, Medical University of Graz, Graz, Austria/Department of Neurology, Medical University of Graz, Graz, Austria
| | - Stefan Ropele
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - Reinhold Schmidt
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - Siegrid Fuchs
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - Christian Enzinger
- Research Unit for Neuronal Plasticity and Repair, Medical University of Graz, Graz, Austria/Department of Neurology, Medical University of Graz, Graz, Austria/Division of Neuroradiology, Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
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Oset M, Stasiolek M, Matysiak M. Cognitive Dysfunction in the Early Stages of Multiple Sclerosis-How Much and How Important? Curr Neurol Neurosci Rep 2020; 20:22. [PMID: 32444997 PMCID: PMC7244611 DOI: 10.1007/s11910-020-01045-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Purpose of Review Multiple sclerosis (MS) is a demyelinating disease of the central nervous system that mainly affects young adults and that is one of the leading causes of disability in this age group, with cognitive impairment occurring early in the course of the disease. This article summarizes the current knowledge about cognitive dysfunction in the early phase of MS, including biomarkers, MRI correlates, and its value as a prognostic marker. Recent Findings New sets of neuropsychological tests have been established to screen for cognitive dysfunction more easily and accurately. Moreover, structural changes detected by brain MRI and several biomarkers found in cerebrospinal fluid and blood serum have been recently correlated with decreased cognitive performance. Additionally, factors influencing cognition in MS, such as disease-modifying therapy, mood disorders, and lifestyle, are better described. Summary Cognitive impairment early in the course of MS is suggested as a prognostic factor for disease progression. However, clear-cut definitions of the early stage of MS as well as unified criteria for the diagnosis of cognitive impairment are still lacking. New and more reliable tools for evaluating cognition in MS patients should be developed and introduced into everyday practice to facilitate the implementation of effective disease-modifying therapy, cognitive rehabilitation, and lifestyle management.
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Affiliation(s)
- Magdalena Oset
- Department of Neurology, Medical University of Lodz, Kopcinskiego 22, 90-153, Lodz, Poland
| | - Mariusz Stasiolek
- Department of Neurology, Medical University of Lodz, Kopcinskiego 22, 90-153, Lodz, Poland.
| | - Mariola Matysiak
- Department of Neurology, Medical University of Lodz, Kopcinskiego 22, 90-153, Lodz, Poland
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Dwyer CP, Alvarez-Iglesias A, Joyce R, Counihan TJ, Casey D, Hynes SM. Evaluating the feasibility and preliminary efficacy of a Cognitive Occupation-Based programme for people with Multiple Sclerosis (COB-MS): protocol for a feasibility cluster-randomised controlled trial. Trials 2020; 21:269. [PMID: 32183874 PMCID: PMC7077165 DOI: 10.1186/s13063-020-4179-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 02/18/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Cognitive difficulties experienced by people with multiple sclerosis (MS) impact their quality of life and daily functioning, from childcare and work, to social and self-care activities. Despite the high prevalence of cognitive difficulties seen in MS, there is a lack of developed programmes that target cognition, while also supporting patients by helping them to function well in everyday life. The Cognitive Occupation-Based programme for people with MS (COB-MS) was developed as a holistic, individualised cognitive rehabilitation intervention. It addresses the wide-ranging symptoms and functional difficulties that present in MS, including the ability to maintain employment, social activities, home management and self-care. The aim of the current research is to evaluate the feasibility and preliminary efficacy of COB-MS for people with MS. The focus is on feasibility outcomes as well as functioning associated with cognitive difficulty and secondary outcomes related to cognition, fatigue and quality of life. METHODS One hundred and twenty people with MS will be assigned to participate in either the COB-MS programme or a treatment as usual, wait-list control group as part of this single-blind, cluster-randomised controlled feasibility and preliminary efficacy trial of the COB-MS programme. The COB-MS group will participate in an eight-session occupational-based cognitive rehabilitation programme over 9 weeks. The primary outcome measure is the goal attainment scaling at 12 weeks. Participants will be assessed pre-intervention, post-intervention and at 12 weeks post-intervention and 6 months post-intervention. Qualitative evaluations of participants' perspectives will also be examined as part of the feasibility study. DISCUSSION Results will provide recommendations for a future definitive trial of COB-MS, with respect to both feasibility and preliminary, clinical efficacy. In the event that results indicate efficacy, study findings will suggest that COB-MS requires consideration as a means of enhancing cognitive and daily functioning in people living with MS. TRIAL REGISTRATION ISRCTN: ISRCTN11462710. Registered on 9 September 2019.
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Affiliation(s)
- Christopher P. Dwyer
- grid.6142.10000 0004 0488 0789Discipline of Occupational Therapy, School of Health Sciences, National University of Ireland Galway, Galway, Ireland
| | - Alberto Alvarez-Iglesias
- grid.6142.10000 0004 0488 0789Health Research Board Clinical Research Facility, National University of Ireland Galway, Galway, Ireland
| | - Robert Joyce
- grid.6142.10000 0004 0488 0789Discipline of Occupational Therapy, School of Health Sciences, National University of Ireland Galway, Galway, Ireland
| | - Timothy J. Counihan
- grid.412440.70000 0004 0617 9371Department of Neurology, University Hospital Galway, Galway, Ireland
| | - Dympna Casey
- grid.6142.10000 0004 0488 0789Qualitative Research Trials Centre (QUESTS), School of Nursing & Midwifery, National University of Ireland Galway, Galway, Ireland
| | - Sinéad M. Hynes
- grid.6142.10000 0004 0488 0789Discipline of Occupational Therapy, School of Health Sciences, National University of Ireland Galway, Galway, Ireland
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Arroyo-Anlló EM, Sánchez JC, Ventola ARM, Ingrand P, Neau JP, Gil R. Procedural Learning Improves Cognition in Multiple Sclerosis. J Alzheimers Dis 2020; 74:913-924. [PMID: 32116252 PMCID: PMC7242853 DOI: 10.3233/jad-191083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Multiple sclerosis (MS) is considered a neurodegenerative disease and an inflammatory demyelinating neuropathology in young population. Procedural memory has been poorly investigated in MS. Objective: We assessed whether the MS group was able to develop a motor-cognitive skill, using a procedural task (PLSC) developed in our laboratory, applying a manual and serial reaction time (RT) paradigm to semantic categorization. Methods: We evaluated 26 MS patients and 26 socio-demographic matched control participants using the PLSC task. Results: Using non-parametric statistical analyses, we observed a significant improvement of semantic categorization RTs with practice (p = 0.002), even with new verbal material to categorize in MS patients (p = 0.006), despite their motor and executive moderate deficits. This same profile of semantic procedural learning in MS was observed in previous studies carried out with Alzheimer’s and Parkinson’s diseases. Moreover, the visual-motor RTs remained stable or slightly improved over the five blocks in both groups, as well as in the AD groups of previous studies. The MS group showed longer visual-motor reaction times than those of the control group (p < 0.042), except in motor initiation aspect (p = 0.064). Both groups showed no significant differences for any type of error. Additionally, disability level and cognitive performances were not associated with the ratio of semantic procedural learning. Conclusion: The present results support the notion that MS patients may be capable of acquiring semantic skill, despite their motor disabilities and executive troubles. This work also addresses the possibilities to improve motor-cognitive skill RTs in neurodegenerative diseases.
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Affiliation(s)
- Eva M Arroyo-Anlló
- Department of Psychobiology, University of Salamanca, Neuroscience Institute of Castilla-León, Spain
| | | | | | - Pierre Ingrand
- Department of Biostatistics, University of Poitiers, Poitiers, France
| | - Jean-Philippe Neau
- Department of Neurology, University Hospital, CHU La Milétrie, Poitiers, France
| | - Roger Gil
- Emeriti Professor of Neurology, University Hospital, Poitiers, France
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Karavasilis E, Christidi F, Velonakis G, Tzanetakos D, Zalonis I, Potagas C, Andreadou E, Efstathopoulos E, Kilidireas C, Kelekis N, Evdokimidis I. Hippocampal structural and functional integrity in multiple sclerosis patients with or without memory impairment: a multimodal neuroimaging study. Brain Imaging Behav 2020; 13:1049-1059. [PMID: 29971687 DOI: 10.1007/s11682-018-9924-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The increasing evidence for a pure amnestic-like profile in multiple sclerosis (MS) introduces the role of hippocampal formation in MS episodic memory function. The aim of the present study was to investigate structural and functional hippocampal changes in mildly-disabled MS patients with and without memory impairment. Thirty-one MS patients with or without memory impairment and 16 healthy controls (HC) underwent MRI in a 3.0 T MRI scanner. Patients were categorized as memory preserved (MP) and memory impaired (MI) based on verbal and visual memory scores extracted from the Brief Repeatable Neuropsychological Battery. The acquisition protocol included high-resolution 3D-T1-weighted, diffusion weighted imaging and echo-planar imaging sequences for the analysis of hippocampal gray matter (GM) density, perforant pathway area (PPA) tractography, and hippocampal functional connectivity (FC), respectively. Compared to HC, we found decreased left and bilateral hippocampal GM density in MP and MI patients, respectively, decreased fractional anisotropy and increased radial diffusivity on left PPA in MI patients, and reduced FC in MI between left hippocampus and left superior frontal gyrus, precuneus/posterior cingulated cortex and lateral occipital gyrus/angular gyrus. The only differences between MP and MI were found in FC. Specifically, MP patients showed FC changes between left hippocampus and right temporo-occipital fusiform/lingual gyrus (increased FC) as well as supramarginal gyrus (decreased FC). In conclusion, we highlight the early detection of structural hippocampal changes in MS without neuropsychologically-detected memory deficits and decreased hippocampal FC in MS patients with impaired memory performance, when both GM density and PPA integrity are affected.
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Affiliation(s)
- Efstratios Karavasilis
- 2nd Department of Radiology, Medical School, National and Kapodistrian University of Athens, 19 Papadiamantopoulou Street, 11528, Athens, Greece.
| | - Foteini Christidi
- 1st Department of Neurology, Aeginition Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgios Velonakis
- 2nd Department of Radiology, Medical School, National and Kapodistrian University of Athens, 19 Papadiamantopoulou Street, 11528, Athens, Greece
| | - Dimitrios Tzanetakos
- 1st Department of Neurology, Aeginition Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis Zalonis
- 1st Department of Neurology, Aeginition Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Constantin Potagas
- 1st Department of Neurology, Aeginition Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Elisabeth Andreadou
- 1st Department of Neurology, Aeginition Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Efstathios Efstathopoulos
- 2nd Department of Radiology, Medical School, National and Kapodistrian University of Athens, 19 Papadiamantopoulou Street, 11528, Athens, Greece
| | - Constantinos Kilidireas
- 1st Department of Neurology, Aeginition Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Kelekis
- 2nd Department of Radiology, Medical School, National and Kapodistrian University of Athens, 19 Papadiamantopoulou Street, 11528, Athens, Greece
| | - Ioannis Evdokimidis
- 1st Department of Neurology, Aeginition Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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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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Lost in Classification: Lower Cognitive Functioning in Apparently Cognitive Normal Newly Diagnosed RRMS Patients. Brain Sci 2019; 9:brainsci9110321. [PMID: 31766124 PMCID: PMC6895881 DOI: 10.3390/brainsci9110321] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 11/08/2019] [Accepted: 11/11/2019] [Indexed: 01/26/2023] Open
Abstract
Cognitive functioning in multiple sclerosis (MS) patients is usually related to the classic, dichotomic classification of impaired vs. unimpaired cognition. However, this approach is far from mirroring the real efficiency of cognitive functioning. Applying a different approach in which cognitive functioning is considered as a continuous variable, we aimed at showing that even newly diagnosed relapsing–remitting MS (RRMS) patients might suffer from reduced cognitive functioning with respect to a matched group of neurologically healthy controls (HCs), even if they were classified as having no cognitive impairment (CI). Fifty newly diagnosed RRMS patients and 36 HCs were tested with an extensive battery of neuropsychological tests. By using Z-scores applied to the whole group of RRMS and HCs together, a measure of cognitive functioning (Z-score index) was calculated. Among the 50 RRMS patients tested, 36 were classified as cognitively normal (CN). Even though classified as CN, RRMS patients performed worse than HCs at a global level (p = 0.004) and, more specifically, in the domains of memory (p = 0.005) and executive functioning (p = 0.006). These results highlight that reduced cognitive functioning can be present early in the disease course, even in patients without an evident CI. The current classification criteria of CI in MS should be considered with caution.
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Damasceno A, Pimentel-Silva LR, Damasceno BP, Cendes F. Cognitive trajectories in relapsing-remitting multiple sclerosis: A longitudinal 6-year study. Mult Scler 2019; 26:1740-1751. [PMID: 31603042 DOI: 10.1177/1352458519878685] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Information concerning longitudinal cognitive trajectories in multiple sclerosis (MS) is relatively scarce. Moreover, it is unclear which factors are associated with cognitive decline and what is the clinical impact of cognitive impairment (CI) in the long run. OBJECTIVE To investigate cognitive trajectories in relapsing-remitting multiple sclerosis (RRMS) patients, analyzing clinical and magnetic resonance imaging (MRI) predictors of cognitive decline. METHODS We enrolled 42 patients and 30 controls. They underwent brain MRI and clinical/neuropsychological evaluation at baseline and after 1, 2, and 6 years. We evaluated cognitive domains with principal component analysis and performed multivariable regression analyzing predictors of clinical/cognitive deterioration. We also performed repeated measures analysis to assess whether clinical progression was different according to CI at baseline. RESULTS A total of 23 (62.2%) patients deteriorated in combined cognitive domains after 6 years, most in processing speed and memory. The number of baseline impaired cognitive domains was strongly associated with 6-year cognitive (R2 = 0.452; p < 0.001) and Expanded Disability Status Scale (EDSS) deterioration (R2 = 0.263; p < 0.001). Patients with baseline CI in combined domains had worse clinical progression. CONCLUSION Isolated CI tends to become more widespread, affecting memory and processing speed alongside. The extent of baseline CI was the best predictor of both clinical and cognitive deterioration after 6 years.
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Affiliation(s)
- Alfredo Damasceno
- Department of Neurology, Faculdade de Ciências Médicas (FCM), University of Campinas (UNICAMP), Campinas, Brazil/Neuroimaging Laboratory, University of Campinas (UNICAMP), Campinas, Brazil
| | | | - Benito Pereira Damasceno
- Department of Neurology, Faculdade de Ciências Médicas (FCM), University of Campinas (UNICAMP), Campinas, Brazil
| | - Fernando Cendes
- Department of Neurology, Faculdade de Ciências Médicas (FCM), University of Campinas (UNICAMP), Campinas, Brazil/Neuroimaging Laboratory, University of Campinas (UNICAMP), Campinas, Brazil
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Joly H, Cohen M, Bresch S, Lebrun-Frenay C. Impact of executive dysfunction on naming ability in multiple sclerosis. Rev Neurol (Paris) 2019; 175:552-559. [DOI: 10.1016/j.neurol.2019.02.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 02/01/2019] [Accepted: 02/19/2019] [Indexed: 10/26/2022]
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Abstract
Cognitive impairment is increasingly recognized to be a core feature of multiple sclerosis (MS), with important implications for the everyday life of individuals with MS and for disease management. Unfortunately, the exact mechanisms that underlie this cognitive impairment are poorly understood and there are no effective therapeutic options for this aspect of the disease. During MS, focal brain inflammatory lesions, together with pathological changes of both CNS grey matter and normal-appearing white matter, can interfere with cognitive functions. Moreover, inflammation may alter the crosstalk between the immune and the nervous systems, modulating the induction of synaptic plasticity and neurotransmission. In this Review, we examine the CNS structures and cognitive domains that are affected by the disease, with a specific focus on hippocampal involvement in MS and experimental autoimmune encephalomyelitis, an experimental model of MS. We also discuss the hypothesis that, during MS, immune-mediated alterations of synapses' ability to express long-term plastic changes may contribute to the pathogenesis of cognitive impairment by interfering with the dynamics of neuronal networks.
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Heled E, Aloni R, Achiron A. Cognitive functions and disability progression in relapsing-remitting multiple sclerosis: A longitudinal study. APPLIED NEUROPSYCHOLOGY-ADULT 2019; 28:210-219. [PMID: 31204507 DOI: 10.1080/23279095.2019.1624260] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Longitudinal studies have shown inconsistent findings regarding the association between cognition, demographic characteristics, and clinical decline in relapsing-remitting multiple sclerosis (RRMS). Our objective was to further explore these relations, over time, while also considering age and sex. A total of 183 patients with RRMS were assessed at two time points, using a neuropsychological battery and the Expanded Disability Status Scale (EDSS). For the first assessment, participants were divided by age (<29, 30-39, 40-49, 50-60) and sex. Next, they were divided according to their participation in one of three interval assessment points: 2-3, 4-5, and 6-8 years. Cognitive function was not correlated with disease duration but was negatively correlated with EDSS score. Men under 29 and women under 39 showed negative correlations between cognitive and clinical impairment. Executive functions, attention, and information processing speed (IPS) showed cognitive decline between the first and second assessments. Furthermore, at the 4-5 year interval IPS predicted EDSS scores, while at the 6-8 year interval it was IPS and visuo-spatial ability. Therefore, relation between clinical status and cognition is not consistent across different age and sex groups. Additionally, cognitive deterioration is only partially evident longitudinally; however, IPS appears to be the most sensitive in predicting one's future clinical condition.
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Affiliation(s)
- Eyal Heled
- Department of Psychology, Ariel University, Ariel, Israel.,Neurological Rehabilitation Department, Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel
| | - Roy Aloni
- Department of Psychology, Ariel University, Ariel, Israel.,Multiple Sclerosis Center, Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel
| | - Anat Achiron
- Multiple Sclerosis Center, Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
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Abstract
BACKGROUND Cognitive dysfunction affects 40% to 70% of people with multiple sclerosis (MS). Sex may influence a person's cognition. Although a few studies have reported greater cognitive deficits in men than women, it is unclear whether specific cognitive domains are more vulnerable than others to the effects of sex or whether cognition is influenced by neurologic or psychiatric variables. METHODS A chart review was undertaken of 408 people with MS referred to neuropsychological services. Demographic and MS-related variables were extracted from the patients' records. We used the Minimal Assessment of Cognitive Functioning in Multiple Sclerosis for the neuropsychological assessment. Raw test scores were converted to z scores using Canadian regression-based normative means. A general linear model was conducted on the adjusted scores, controlling for age; years of education; disease course; illness duration; and disability, anxiety, and depression scores. RESULTS Men were more likely than women to have primary progressive MS (χ=6.415, P=0.011). There were no other sex differences with respect to demographic, neurologic, or psychiatric data. Women performed significantly better than men on the California Verbal Learning Test-Second Edition Total Learning index (F=7.846, P=0.006). CONCLUSIONS An analysis of a large, consecutive sample of people with MS demonstrated that sex, independent of demographic, neurologic, or psychiatric factors, is an important determinant in cognitive impairment, with men being more impaired than women on tests of verbal learning and memory.
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Does cognitive reserve play any role in multiple sclerosis? A meta-analytic study. Mult Scler Relat Disord 2019; 30:265-276. [DOI: 10.1016/j.msard.2019.02.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 02/07/2019] [Accepted: 02/11/2019] [Indexed: 12/12/2022]
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Assessing cognitive performance in radiologically isolated syndrome. Mult Scler Relat Disord 2019; 32:70-73. [PMID: 31054500 DOI: 10.1016/j.msard.2019.04.030] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Revised: 01/23/2019] [Accepted: 04/26/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND Radiologically isolated syndrome (RIS) is defined as the occurrence of incidental brain MRI lesions suggestive of multiple sclerosis (MS) in otherwise healthy subjects without any signs or symptoms that could indicate to the disease. We evaluated cognitive performance in a cohort of RIS patients. METHODS A retrospective analysis of prospectively collected data from a population-based registry documenting demographic, clinical and imaging data of MS patients followed at our institution. Cognitive performance of subjects diagnosed with RIS according to Okuda's criteria was evaluated. Cognitive assessment was performed using MindStreams Global Assessment Battery to evaluate memory, executive function, visual spatial perception, verbal function, attention, information processing speed and motor skills, and compared to that of age- and education-matched healthy population. RESULTS Thirty patients diagnosed with RIS, mean age at first MRI, 34.3 ± 1.9 years, and disease follow up ranging from 1 to 15 years, were included in the study. Eight patients (26.6%) converted to MS within 4.2 ± 1.4 years. Cognitive performance was relatively preserved with a mean global cognitive score of 98.4 ± 1.6 (median, 100), but all cognitive measurements were below the mean performance for age- and education-matched healthy population. Similar to MS patients, information processing speed was the most impaired cognitive function, mean 94.7 ± 2.04, median 94. Cognitive performance did not differ between RIS patients who converted to MS and those who remained with sustained RIS. CONCLUSIONS Cognitive performance in RIS subjects was below average for age- and education-matched norms. Information processing speed was the most impaired cognitive test. Cognitive performance of RIS subjects should be followed closely in order to identify any changes that may indicate conversion to MS.
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Eriksson J, Kobelt G, Gannedahl M, Berg J. Association between Disability, Cognition, Fatigue, EQ-5D-3L Domains, and Utilities Estimated with Different Western European Value Sets in Patients with Multiple Sclerosis. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2019; 22:231-238. [PMID: 30711069 DOI: 10.1016/j.jval.2018.08.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 04/27/2018] [Accepted: 08/07/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVES To assess the association between fatigue, cognition, domains of the EuroQol five-dimensional questionnaire (EQ-5D-3L), disability, and utilities estimated with several Western European value sets in patients with multiple sclerosis (MS). METHODS Data from a multinational, cross-sectional, observational study of patients with MS (N = 16,808) conducted in 16 European countries were used. Health-related quality of life data were collected through the EQ-5D-3L, and fatigue and cognitive difficulties were self-assessed on a 10-point visual analogue scale. Associations were assessed using Pearson correlation and multivariate regression model. RESULTS Symptoms of fatigue and cognitive difficulties were present in 90% and 70% of patients at all levels of disability, respectively, and thus only weakly correlated to disability. Problems in the EQ-5D-3L domains were common even at mild disability levels. Mobility, usual activities, and pain issues were experienced by 80% to 90% of patients with moderate and high levels of disability. Mobility, usual activities, and self-care were strongly correlated to disability. Disability, MS type, fatigue, and cognition were associated with utility in regression models, although the coefficients of fatigue and cognition were small. CONCLUSIONS The strong relationship of disability with utility was confirmed. Despite this, fatigue and cognitive difficulties were associated with utility estimated with different European value sets.
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Sormani MP, De Stefano N, Giovannoni G, Langdon D, Piani-Meier D, Haering DA, Kappos L, Tomic D. Learning ability correlates with brain atrophy and disability progression in RRMS. J Neurol Neurosurg Psychiatry 2019; 90:38-43. [PMID: 30322898 PMCID: PMC6327865 DOI: 10.1136/jnnp-2018-319129] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 09/10/2018] [Accepted: 09/17/2018] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To assess the prognostic value of practice effect on Paced Auditory Serial Addition Test (PASAT) in multiple sclerosis. METHODS We compared screening (day -14) and baseline (day 0) PASAT scores of 1009 patients from the FTY720 Research Evaluating Effects of Daily Oral therapy in Multiple Sclerosis (FREEDOMS) trial. We grouped patients into high and low learners if their PASAT score change was above or below the median change in their screening PASAT quartile group. We used Wilcoxon test to compare baseline disease characteristics between high and low learners, and multiple regression models to assess the respective impact of learning ability, baseline normalised brain volume and treatment on brain volume loss and 6-month confirmed disability progression over 2 years. RESULTS The mean PASAT score at screening was 45.38, increasing on average by 3.18 from day -14 to day 0. High learners were younger (p=0.003), had lower Expanded Disability Status Scale score (p=0.031), higher brain volume (p<0.001) and lower T2 lesion volume (p=0.009) at baseline. Learning status was not significantly associated with disability progression (HR=0.953, p=0.779), when adjusting for baseline normalised brain volume, screening PASAT score and treatment arm. However, the effect of fingolimod on disability progression was more pronounced in high learners (HR=0.396, p<0.001) than in low learners (HR=0.798, p=0.351; p for interaction=0.05). Brain volume loss at month 24 tended to be higher in low learners (0.17%, p=0.058), after adjusting for the same covariates. CONCLUSIONS Short-term practice effects on PASAT are related to brain volume, disease severity and age and have clinically meaningful prognostic implications. High learners benefited more from fingolimod treatment.
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Affiliation(s)
- Maria Pia Sormani
- Biostatistics Unit, Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Nicola De Stefano
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Gavin Giovannoni
- Barts and The London School of Medicine and Dentistry, Blizard Institute, Queen Mary University of London, London, UK
| | - Dawn Langdon
- Department of Psychology, Royal Holloway, University of London, Egham, UK
| | | | | | - Ludwig Kappos
- Neurological Clinic and Polyclinic, Departments of Medicine, Clinical Research, Biomedicine and Biomedical Engineering, University Hospital Basel, University of Basel, Basel, Switzerland
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Kalb R, Beier M, Benedict RH, Charvet L, Costello K, Feinstein A, Gingold J, Goverover Y, Halper J, Harris C, Kostich L, Krupp L, Lathi E, LaRocca N, Thrower B, DeLuca J. Recommendations for cognitive screening and management in multiple sclerosis care. Mult Scler 2018; 24:1665-1680. [PMID: 30303036 PMCID: PMC6238181 DOI: 10.1177/1352458518803785] [Citation(s) in RCA: 229] [Impact Index Per Article: 38.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Purpose: To promote understanding of cognitive impairment in multiple sclerosis (MS), recommend optimal screening, monitoring, and treatment strategies, and address barriers to optimal management. Methods: The National MS Society (“Society”) convened experts in cognitive dysfunction (clinicians, researchers, and lay people with MS) to review the published literature, reach consensus on optimal strategies for screening, monitoring, and treating cognitive changes, and propose strategies to address barriers to optimal care. Recommendations: Based on current evidence, the Society makes the following recommendations, endorsed by the Consortium of Multiple Sclerosis Centers and the International Multiple Sclerosis Cognition Society:
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Affiliation(s)
- Rosalind Kalb
- National Multiple Sclerosis Society, New York, 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
| | | | - Leigh Charvet
- Department of Neurology, Langone Medical Center, New York University, New York, NY, USA
| | | | - Anthony Feinstein
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | | | | | - June Halper
- The Consortium of Multiple Sclerosis Centers and International Organization of Multiple Sclerosis Nurses, Multiple Sclerosis Nurses International Certification Board, Hackensack, NJ, USA
| | - Colleen Harris
- Multiple Sclerosis Center, University of Calgary, Calgary, AB, Canada
| | - Lori Kostich
- The Mandell Center for Multiple Sclerosis, Mount Sinai Rehabilitation Hospital, Hartford, CT, USA
| | - Lauren Krupp
- Department of Neurology, NYU Langone Health, New York University, New York, NY, USA
| | - Ellen Lathi
- The Elliot Lewis Center for Multiple Sclerosis Care, Wellesley, MA, USA
| | | | - Ben Thrower
- Emory University, Atlanta, GA, USA/Andrew C. Carlos Multiple Sclerosis Institute at Shepherd Center, Atlanta, GA, USA
| | - John DeLuca
- Department of Physical Medicine and Rehabilitation and Department of Neurology, Rutgers New Jersey Medical School, Newark, NJ, USA
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Tremblay A, Jobin C, Demers M, Dagenais E, Narayanan S, Araújo D, Douglas AL, Roger E, Chamelian L, Duquette P, Rouleau I. Thalamic and hippocampal volume associated with memory functions in multiple sclerosis. Brain Cogn 2018; 125:61-68. [DOI: 10.1016/j.bandc.2018.05.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Revised: 05/28/2018] [Accepted: 05/29/2018] [Indexed: 11/28/2022]
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