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Morrow SA. Cognitive Impairment in Multiple Sclerosis: Past, Present, and Future. Neuroimaging Clin N Am 2024; 34:469-479. [PMID: 38942528 DOI: 10.1016/j.nic.2024.03.010] [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] [Indexed: 06/30/2024]
Abstract
Cognitive impairment in multiple sclerosis (MS) is common and can have negative effects on quality of life. The clinical presentation can be more subtle and insidious. Thus, cognitive impairment is often underrecognized by both persons with MS (PwMS) and clinicians, leading to underestimation disability due to MS. Recent evidence supports that relapses affect cognition in a similar pattern to other physical relapse symptoms and may be the only symptom of a relapse. Regular screening using validated tests for PwMS will improve the care provided and quality of life of PwMS.
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Affiliation(s)
- Sarah A Morrow
- Department of Clinical Neurosciences, University of Calgary, Hotchkiss Brain Institute, Calgary, Alberta, Canada; Foothills Medical Centre, 907 South Tower, 1403 29th Street NorthWest, Calgary, Alberta T2N 2T9, Canada.
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Morrow SA, Hancock L. Monitoring cognitive functioning in multiple sclerosis will trigger anxiety in patients: Commentary. Mult Scler 2024:13524585241261200. [PMID: 38880941 DOI: 10.1177/13524585241261200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/18/2024]
Affiliation(s)
- Sarah A Morrow
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Laura Hancock
- Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
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Valdivia-Tangarife ER, Morlett-Paredes A, Villaseñor-Cabrera T, Mireles-Ramírez MA, Cortés-Enríquez F, Macías-Islas MÁ. Validation of the Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS) in individuals with multiple sclerosis from Mexico. Mult Scler Relat Disord 2024; 83:105451. [PMID: 38245997 DOI: 10.1016/j.msard.2024.105451] [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: 09/22/2023] [Revised: 12/04/2023] [Accepted: 01/15/2024] [Indexed: 01/23/2024]
Abstract
BACKGROUND Cognitive impairment is observed in 43-70 % of Multiple sclerosis (MS) patients. One of the most widely used batteries for cognitive assessment in this population is the Brief International Cognitive Assessment for MS (BICAMS). The objective of this study was to validate and assess the reliability of the BICAMS in a Mexican population with MS and to obtain and provide regression-based norms. METHODS One hundred healthy controls (HCs) and 100 patients with multiple sclerosis participated in the present study, and groups were matched for age, years of education and sex. Subjects completed all three tests of the BICAMS. Test-retest measures were obtained from 30 patients to test reliability. RESULTS The sample´s average age was 43.39 ± 6.03 years old, and the average years of education was 12.55 ± 2.52 years. Approximately 63 % of the participants were female. The groups did not differ in age, years of education, or sex. The MS group performed significantly worse than the HCs group on all three neuropsychological tests. A significant difference was observed for the SDMT (t = 10.166; p=<0.001), CVLT-II (t = 10.949; p=<0.001), and BVMT-R (t = 2.636; p = 0.009). For all comparisons, the effect size (d) for each test was calculated as follows: SDMT= 0.58 and CVLT-II= 0.61. The test-retest coefficients for each test were as follows: SDMT: r = 0.95; CVLT-II: r = 0.84; and BVMT-R = 0.81. CONCLUSION The BICAMS can provide information on cognitive impairment in MS patients, and this information can be used by neuropsychologists for cognitive rehabilitation in different domains.
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Affiliation(s)
- Edgar R Valdivia-Tangarife
- Departamento de Neurociencias, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, 44340 Guadalajara, Jalisco, México
| | | | - Teresita Villaseñor-Cabrera
- Departamento de Neurociencias, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, 44340 Guadalajara, Jalisco, México; O.P.D Hospital Civil Fray Antonio Alcalde, Guadalajara, México
| | - Mario A Mireles-Ramírez
- Departamento de Neurología, Unidad de Alta Especialidad Médica, Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social. Guadalajara, Jalisco, México
| | - Fernando Cortés-Enríquez
- Departamento de Neurología, Hospital General, No 14 del Instituto Mexicano del Seguro Social. Guadalajara, Jalisco, México
| | - Miguel Ángel Macías-Islas
- Departamento de Neurociencias, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, 44340 Guadalajara, Jalisco, México.
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Filippi M, Grimaldi L, Conte A, Totaro R, Valente MR, Malucchi S, Granella F, Cordioli C, Brescia Morra V, Zanetta C, Perini D, Santoni L. Intravenous or subcutaneous natalizumab in patients with relapsing-remitting multiple sclerosis: investigation on efficiency and savings-the EASIER study. J Neurol 2024; 271:340-354. [PMID: 37715789 PMCID: PMC10769988 DOI: 10.1007/s00415-023-11955-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 08/14/2023] [Accepted: 08/17/2023] [Indexed: 09/18/2023]
Abstract
INTRODUCTION EASIER is a multicenter, observational, cross-sectional study investigating the consumption of healthcare resources, including healthcare professional (HCP) active working time, the costs associated with the current natalizumab intravenous (IV) administration, and the potential impact of the adoption of subcutaneous (SC) route. METHODS The EASIER study has three parts: (1) time and motion study to measure healthcare resources and working time needed for natalizumab IV administration using a digital data collection tool operated directly by HCPs; (2) HCP structured questionnaire-based estimation of the potential impact of natalizumab SC vs. IV administration; and (3) patient survey on the burden of natalizumab administration. RESULTS Nine Italian multiple sclerosis (MS) centers measured 404 IV natalizumab administration procedures and administered 26 HCP questionnaires and 297 patient questionnaires. Patients had a mean of 52 (range 1-176) previous IV administrations and spent a mean (median, IQR) of 152 (130, 94-184) minutes in the center per each IV procedure, with IV infusion covering 50% of the total. Including patient travel time, an average of 5 h was dedicated to each IV administration. Active working time by HCP amounted to 29 min per IV administration procedure, 70% of which by nursing staff. With adoption of the SC route, HCPs estimated a 50% reduction in patient procedure time and 55% lower HCP active working time. This translated into a 63% cost reduction for the MS center per natalizumab administration procedure. CONCLUSIONS SC natalizumab administration will consistently reduce consumption of patient and HCP times per procedure and associated costs.
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Affiliation(s)
- Massimo Filippi
- Neurology Unit, Neurorehabilitation Unit, Neurophysiology Service, and Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy.
- Vita-Salute San Raffaele University, Milan, Italy.
| | - Luigi Grimaldi
- Multiple Sclerosis Center, Institute Foundation G. Giglio, Cefalù, PA, Italy
| | - Antonella Conte
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
- Multiple Sclerosis Center, Policlinico Umberto I Hospital, Rome, Italy
- IRCCS Neuromed, Pozzilli, IS, Italy
| | - Rocco Totaro
- Demyelinating Disease Center, Department of Neurology, San Salvatore Hospital, L'Aquila, Italy
| | - Maria Rosaria Valente
- Clinical Neurology, Santa Maria della Misericordia University Hospital, and Department of Medicine, University of Udine, Udine, Italy
| | - Simona Malucchi
- SCDO Neurologia, S. Luigi Gonzaga University Hospital, Orbassano, TO, Italy
| | - Franco Granella
- Department of Medicine and Surgery, University Hospital of Parma, Parma, Italy
| | - Cinzia Cordioli
- Multiple Sclerosis Center, ASST Spedali Civili di Brescia, Montichiari Hospital (Brescia), Brescia, Italy
| | - Vincenzo Brescia Morra
- Multiple Sclerosis Clinical Care and Research Center, Department of Neuroscience (NSRO), Federico II University Hospital, Naples, Italy
| | - Chiara Zanetta
- Neurology Unit, Neurorehabilitation Unit, Neurophysiology Service, and Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
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Morrow SA, Balusha AAK, Rosehart H, Casserly C, Racosta JM. Does multilingualism act as a protective factor (cognitive reserve) against cognitive impairment in multiple sclerosis?: A retrospective cohort study. Mult Scler Relat Disord 2023; 80:105060. [PMID: 37866025 DOI: 10.1016/j.msard.2023.105060] [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: 03/11/2023] [Revised: 09/09/2023] [Accepted: 10/07/2023] [Indexed: 10/24/2023]
Abstract
BACKGROUND Cognitive impairment (CI) is common in multiple sclerosis (MS), affecting half of persons with MS (PwMS). Cognitive reserve has been associated with delaying the onset and slowing the progression of CI in PwMS. Multilingualism has been demonstrated to be a protective factor against CI in Alzheimer's disease (AD) but has never been studied in PwMS. OBJECTIVE To explore if multilingualism is a protective factor against CI in PwMS. METHODS This is a retrospective cohort study of PwMS aged 18-59, with a confirmed diagnosis of relapsing MS, fluent in English, who completed the Minimal Assessment of Cognitive Function in MS (MACFIMS) at the London (ON) MS Clinic. Any PwMS with a history of dementia or developmental delay, daily marijuana use, a major psychiatric disorder, or less than grade 9 education was excluded. We focused on the Brief Visuospatial Memory Test (BVMTR), immediate recall (-IR) and delayed recall (-DR) as it would be the least affected by language, as well as the Symbol Digit Modalities Test (SDMT), as information processing speed is the most commonly affected domain in PwMS. One-way ANOVA was used to compare raw scores on the BVMTR and SDMT between groups (uni- vs. multillingual), while chi-square was used to compare impairment on BVMTR and SDMT between groups. RESULTS The cohort consisted of 678 subjects. The mean age was 39.7 (± 9.6) years with 501 (73.9 %) females (sex at birth), the mean duration of disease of 5.9 (± 6.9) years, and mean years of education was 13.9 (±2.2). The majority of subjects (563, 83 %) were unilingual and (115, 17 %) were multilingual; 102 subjects were bilingual and 13 subjects fluent in ≥ three languages. English was the first language was in most of subjects (614, 90.6 %). There was no significant difference on the BVMTR-IR scores (p = 0.189) or BVMTR-DR (p = 0.096) between groups. Similarly, there was no difference in the number of subjects impaired on the BVMTR-IR (X2 (1, N = 678) = 3.167, p = 0.057) or BVMT-DR between groups (X2 (1, N = 678) = 2.996, p = 0.083). Further, there was no significant difference on the SDMT (p = 0.506) between groups, or in number of subjects impaired on the SDMT between groups (X2 (1, N = 678) = 1.023, p = 0.312). CONCLUSION This study shows that multilingualism does not have a protective effect against CI in PwMS and does not play a role in enriching the cognitive reserve, in contrast to studies in AD. This difference may be explained by a different underlying pathological mechanism in these diseases and warrants further study.
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Affiliation(s)
- Sarah A Morrow
- Department of Clinical Neurological Sciences, London Health Sciences Centre, University of Western Ontario (Western), London, ON Canada..
| | - Abedallah A K Balusha
- Department of Clinical Neurological Sciences, London Health Sciences Centre, University of Western Ontario (Western), London, ON Canada
| | - Heather Rosehart
- Department of Clinical Neurological Sciences, London Health Sciences Centre, University of Western Ontario (Western), London, ON Canada
| | - Courtney Casserly
- Department of Clinical Neurological Sciences, London Health Sciences Centre, University of Western Ontario (Western), London, ON Canada
| | - Juan M Racosta
- Department of Clinical Neurological Sciences, London Health Sciences Centre, University of Western Ontario (Western), London, ON Canada
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Morrow SA, Weinstock ZL, Mirmosayyeb O, Conway D, Fuchs T, Jaworski MG, Eckert S, Hojnacki DH, Dwyer MG, Zivadinov R, Weinstock-Guttman B, Benedict RHB. Detecting isolated cognitive relapses in persons with MS. Mult Scler 2023; 29:1786-1794. [PMID: 37776097 PMCID: PMC10687840 DOI: 10.1177/13524585231201219] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 08/16/2023] [Accepted: 08/29/2023] [Indexed: 10/01/2023]
Abstract
BACKGROUND The existence of isolated cognitive relapses (ICRs) in persons with MS (PwMS) has been debated. OBJECTIVE To examine relapses with decline on Symbol Digit Modalities Test (SDMT) but no change on Expanded Disability Status Scale (EDSS). METHODS This 3-year prospective cohort study identified PwMS experiencing a relapse with decrease on SDMT. Participants with SDMT decline/stable EDSS were labeled "ICR," while those with a corresponding decrease on EDSS were classified "Relapse with Cognitive Decline (RCD)." Two definitions of SDMT decline were explored: (1) ⩾ 8 points, and (2) ⩾ 4 points. Logistic regression was used to analyze the relationship between ICR and RCD. RESULTS The full cohort had 592 participants: 83 experienced relapses; 22 (26.5%) had an SDMT decrease of ⩾ 8 points; 14 (63.6%) met ICR criteria. Logistic regression (X2(1) = 5.112, p = 0.024) using demographics and disease characteristics explained 28.4% of the variance in ICR versus RCD. Only the MS Neuropsychological Questionnaire was associated with ICR (odds ratio (OR): 8.6; 95% confidence interval (CI): 1.1-16.4) 40 relapsing participants with SDMT decrease of ⩾ 4 points were identified: 26 (65%) had a stable EDSS (ICR). Logistic regression did not find any variable predictive of ICR. CONCLUSION This prospective study demonstrates evidence of ICR in PwMS.
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Affiliation(s)
- Sarah A Morrow
- University Hospital, London Health Sciences Center, Department of Clinical Neurological Sciences, Western University, London, ON, Canada
| | - Zachary L Weinstock
- Jacobs School of Medicine and Biomedical Sciences, Department of Neurology, State University of New York, Buffalo, NY, USA
| | - Omid Mirmosayyeb
- Jacobs School of Medicine and Biomedical Sciences, Department of Neurology, State University of New York, Buffalo, NY, USA
| | - Devon Conway
- Mellen Center for Multiple Sclerosis Treatment, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Tom Fuchs
- Jacobs School of Medicine and Biomedical Sciences and Buffalo Neuroimaging Analysis Center, Department of Neurology, State University of New York, Buffalo, NY, USA
| | - Michael G Jaworski
- Jacobs School of Medicine and Biomedical Sciences, Department of Neurology, State University of New York, Buffalo, NY, USA
| | - Sveltlana Eckert
- Jacobs School of Medicine and Biomedical Sciences, Department of Neurology, State University of New York, Buffalo, NY, USA
| | - David H Hojnacki
- Jacobs School of Medicine and Biomedical Sciences, Department of Neurology, State University of New York, Buffalo, NY, USA
| | - Michael G Dwyer
- Jacobs School of Medicine and Biomedical Sciences and Buffalo Neuroimaging Analysis Center, Department of Neurology, State University of New York, Buffalo, NY, USA
| | - Robert Zivadinov
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, State University of New York, Buffalo, NY, USA
- Center for Biomedical Imaging, Clinical Translational Science Institute, State University of New York, Buffalo, NY, USA
| | - Bianca Weinstock-Guttman
- Jacobs School of Medicine and Biomedical Sciences, Department of Neurology, State University of New York, Buffalo, NY, USA
| | - Ralph H B Benedict
- Jacobs School of Medicine and Biomedical Sciences, Department of Neurology, State University of New York, Buffalo, NY, USA
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Goldman MD, Chen S, Motl R, Pearsall R, Oh U, Brenton JN. Progression risk stratification with six-minute walk gait speed trajectory in multiple sclerosis. Front Neurol 2023; 14:1259413. [PMID: 37859654 PMCID: PMC10582752 DOI: 10.3389/fneur.2023.1259413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 09/13/2023] [Indexed: 10/21/2023] Open
Abstract
Background Multiple Sclerosis (MS) disease progression has notable heterogeneity among patients and over time. There is no available single method to predict the risk of progression, which represents a significant and unmet need in MS. Methods MS and healthy control (HC) participants were recruited for a 2-year observational study. A latent-variable growth mixture model (GMM) was applied to cluster baseline 6-min walk gait speed trajectories (6MWGST). MS patients within different 6 MWGST clusters were identified and stratified. The group membership of these MS patients was compared against 2-year confirmed-disease progression (CDP). Clinical and patient-reported outcome (PRO) measures were compared between HC and MS subgroups over 2 years. Results 62 MS and 41 HC participants completed the 2-year study. Within the MS cohort, 90% were relapsing MS. Two distinct patterns of baseline 6 MWGST emerged, with one cluster displaying a faster gait speed and a typical "U" shape, and the other showing a slower gait speed and a "flattened" 6 MWGST curve. We stratified MS participants in each cluster as low- and high-risk progressors (LRP and HRP, respectively). When compared against 2-year CDP, our 6 MWGST approach had 71% accuracy and 60% positive predictive value. Compared to the LRP group, those MS participants stratified as HRP (15 out of 62 MS participants), were on average 3.8 years older, had longer MS disease duration and poorer baseline performance on clinical outcomes and PROs scores. Over the subsequent 2 years, only the HRP subgroup showed a significant worsened performance on 6 MW, clinical measures and PROs from baseline. Conclusion Baseline 6 MWGST was useful for stratifying MS participants with high or low risks for progression over the subsequent 2 years. Findings represent the first reported single measure to predict MS disease progression with important potential applications in both clinical trials and care in MS.
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Affiliation(s)
- Myla D. Goldman
- Department of Neurology, Virginia Commonwealth University, Richmond, VA, United States
| | - Shanshan Chen
- Department of Biostatistics, Virginia Commonwealth University, Richmond, VA, United States
| | - Robert Motl
- Department of Kinesiology & Nutrition, University of Illinois at Chicago, Chicago, IL, United States
| | - Rylan Pearsall
- College of Arts and Sciences, University of Virginia, Charlottesville, VA, United States
| | - Unsong Oh
- Department of Neurology, Virginia Commonwealth University, Richmond, VA, United States
| | - J. Nicholas Brenton
- Department of Neurology, Division of Pediatric Neurology, University of Virginia, Charlottesville, VA, United States
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Wallin A, Franzén E, Ekman U, Piehl F, Johansson S. A highly challenging balance training intervention for people with multiple sclerosis: a feasibility trial. Pilot Feasibility Stud 2023; 9:41. [PMID: 36922859 PMCID: PMC10015930 DOI: 10.1186/s40814-023-01265-7] [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: 04/29/2022] [Accepted: 02/18/2023] [Indexed: 03/17/2023] Open
Abstract
BACKGROUND Balance training interventions with a gradual progression of difficulty and highly challenging tasks designed specifically for people with multiple sclerosis (MS) are rare. The objective was to adapt a balance training intervention originally developed for Parkinson's disease through a co-design process and then conduct a pilot trial in MS to evaluate the feasibility of a large, full-scale study. METHODS Twelve people with MS with mild to moderate overall MS-disability were included in this single-group feasibility trial. Participants received one-hour training sessions twice or three times weekly for 10 weeks. The assessment included tests of physical and cognitive functioning and patient-reported quality of life-related outcomes. Data on feasibility aspects were collected at baseline and follow-up assessments and three times during the intervention period to inform the recruitment process, as well as to monitor retention and inclusion rates, study procedures, intervention delivery, and dynamic changes in the selected potential outcome measures. Progression criteria were used to determine whether to proceed to a full-scale trial. Descriptive statistics were used to present the data. RESULTS Out of six progression criteria, only retention and attendance at training sessions were not met. Reasons reported for not completing the intervention period mainly depended on external circumstances beyond the control of the study. In contrast, study procedures, intervention delivery, and intervention content (progression, adjustment, and control of challenge level of exercises) were considered feasible for a future, full-scale trial. The Mini-BESTest, which was used for the assessment of balance control, was considered suitable as the primary outcome in a full-scale trial with no ceiling or floor effects. Further, the Mini-BESTest showed a positive trend in outcome response with a median difference of 3.5 points between baseline and follow-up assessments. The power calculation performed suggests a feasible number of participants for recruitment. CONCLUSIONS Overall trial aspects and intervention delivery were deemed feasible for a full-scale trial, but adjustments are needed to increase retention and attendance.
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Affiliation(s)
- A Wallin
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Huddinge, Sweden. .,Rehab Station Stockholm, Research and Development Unit, Solna, Sweden.
| | - E Franzén
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Huddinge, Sweden.,Women's Health and Allied Health Professionals Theme, Medical Unit Occupational Therapy and Physiotherapy, Karolinska University Hospital, Stockholm, Sweden.,Stockholm Sjukhem Foundation, R&D Unit, Stockholm, Sweden
| | - U Ekman
- Department of Neurobiology, Care Sciences and Society, Division of Clinical Geriatrics, Karolinska Institutet, Stockholm, Sweden.,Women's Health and Allied Health Professionals Theme, Medical Unit Medical Psychology, Karolinska University Hospital, Stockholm, Sweden
| | - F Piehl
- Department of Clinical Neuroscience, Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Neurology, Karolinska University Hospital and Neuroimmunology Unit, Stockholm, Sweden
| | - S Johansson
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Huddinge, Sweden.,Women's Health and Allied Health Professionals Theme, Medical Unit Occupational Therapy and Physiotherapy, Karolinska University Hospital, Stockholm, Sweden
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Perumal J, Balabanov R, Su R, Chang R, Balcer LJ, Galetta SL, Avila RL, Rutledge D, Fox RJ. Correction to: Improvements in Cognitive Processing Speed, Disability, and Patient‑Reported Outcomes in Patients with Early Relapsing‑Remitting Multiple Sclerosis Treated with Natalizumab: Results of a 4‑year, Real‑World, Open‑Label Study. CNS Drugs 2023; 37:275-289. [PMID: 36780107 PMCID: PMC10024661 DOI: 10.1007/s40263-022-00982-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
BACKGROUND STRIVE was a prospective, 4-year, multicenter, observational, open-label, single-arm study of natalizumab treatment in anti-JC virus antibody-negative patients with early relapsing-remitting multiple sclerosis (RRMS). OBJECTIVE Study objectives examined the effects of natalizumab on cognitive processing speed, confirmed disability improvement (CDI), and patient-reported outcomes (PROs). METHODS Clinical and PRO secondary endpoints were assessed annually over 4 years in STRIVE. The Symbol Digit Modalities Test (SDMT) was used as a measure of cognitive processing speed. PROs were assessed using the Multiple Sclerosis Impact Score (MSIS-29) and the Work Productivity and Activity Impairment Questionnaire (WPAI). RESULTS At all four annual assessments, the proportion of patients in the intent-to-treat (ITT) population (N = 222) who exhibited clinically meaningful improvement in their SDMT score from baseline (i.e., change ≥ 4 points) ranged from 41.9 to 54.0%. The cumulative probability of CDI at 4 years in patients in the ITT population with a baseline Expanded Disability Status Scale score ≥ 2 (N = 133) was 43.9%. Statistically significant reductions in the mean change from screening in the MSIS-29 physical and psychological scores, indicating improved quality of life, were observed over all 4 years (P ≤ 0.0012 for all). A statistically significant decrease from screening in the impact of MS on regular activities, signifying an improvement in this WPAI measure, was also observed over all 4 years of the study. CONCLUSION These results further extend our knowledge of the effectiveness, specifically regarding improvements in cognitive processing speed, disability and PROs, of long-term natalizumab treatment in early RRMS patients. CLINICALTRIALS GOV: NCT01485003 (5 December 2011).
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Affiliation(s)
- Jai Perumal
- Weill Cornell Medical College, Cornell University, 1305 York Ave #2F, New York, NY, 10065, USA.
| | | | - Ray Su
- Biogen, Cambridge, MA, USA
| | | | - Laura J Balcer
- New York University Grossman School of Medicine, New York, NY, USA
| | - Steven L Galetta
- New York University Grossman School of Medicine, New York, NY, USA
| | | | | | - Robert J Fox
- Mellen Center for Multiple Sclerosis, Cleveland Clinic, Cleveland, OH, USA
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Manouchehrinia A, Larsson H, Karim ME, Lycke J, Olsson T, Kockum I. Comparative effectiveness of natalizumab on cognition in multiple sclerosis: A cohort study. Mult Scler 2023; 29:628-636. [PMID: 36789885 PMCID: PMC10152556 DOI: 10.1177/13524585231153992] [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: 02/16/2023]
Abstract
BACKGROUND Cognitive impairment occurs in 40%-70% of persons with multiple sclerosis (MS). OBJECTIVE To examine the effectiveness of natalizumab compared with other disease-modifying treatments (DMTs) on improving cognition as measured by the Symbol Digit Modalities Test (SDMT). METHODS Data were collected as part of Swedish nationwide phase IV surveillance studies (2007-2020). An increase in SDMT score by ⩾10% of the difference between maximum score possible (110) and the baseline value was defined as cognitive improvement. The likelihood of improvement was compared between natalizumab-treated individuals and individuals treated with other DMTs using mixed effect logistic regression. Trend in odds of improvement was investigated using slope analyses. RESULTS We included 2100 persons with relapsing-remitting MS treated with natalizumab and 2622 persons treated with other DMTs. At 6 months, 45% reached improvement. The natalizumab group showed largest odds of improvement during follow-up (odds ratio: 2.3, 95% confidence interval (CI): 1.5-3.5). The odds of improvement increased by 7% (95% CI: 6-7) per month of natalizumab treatment. The equivalent estimate was 4% (95% CI: 2-5) for other monoclonal antibodies and nonsignificant for oral or platform therapies. CONCLUSION Treatment with natalizumab or other monoclonal antibodies is associated with a significantly faster likelihood of cognitive improvement than platform or oral DMTs.
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Affiliation(s)
- Ali Manouchehrinia
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden/Centre for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden/The Karolinska Neuroimmunology & Multiple Sclerosis Centre, Department of Clinical Neurosciences, Karolinska Institutet, Centre for Molecular Medicine, Stockholm, Sweden
| | - Hanna Larsson
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden/Centre for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Mohammad Ehsanul Karim
- School of Population and Public Health, The University of British Columbia, Vancouver, BC, Canada/Centre for Health Evaluation and Outcome Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Jan Lycke
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden/Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Tomas Olsson
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden/Centre for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Ingrid Kockum
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden/Centre for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden
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Labiano-Fontcuberta A, Monreal E, Benito-León J. Time to rethink the reported disease-modifying treatment effects on cognitive outcomes: Methods and interpretative caveats. Front Neurol 2022; 13:995690. [PMID: 36119690 PMCID: PMC9474887 DOI: 10.3389/fneur.2022.995690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 08/08/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Andrés Labiano-Fontcuberta
- Department of Neurology, University Hospital12 de Octubre, Madrid, Spain
- *Correspondence: Andrés Labiano-Fontcuberta
| | - Enric Monreal
- Department of Neurology, University Hospital Ramón y Cajal, Universidad de Alcalá, Ramón y Cajal Institute for Health Research (IRYCIS), Spanish Network of Multiple Sclerosis (REEM), Madrid, Spain
| | - Julián Benito-León
- Department of Neurology, University Hospital12 de Octubre, Madrid, Spain
- Centro de Investigación Biomédica en Red Sobre Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
- Department of Medicine, Complutense University, Madrid, Spain
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12
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Qiu R, Gu Y, Xie C, Wang Y, Sheng Y, Zhu J, Yue Y, Cao J. Virtual reality-based targeted cognitive training program for Chinese older adults: A feasibility study. Geriatr Nurs 2022; 47:35-41. [PMID: 35839753 DOI: 10.1016/j.gerinurse.2022.06.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 06/11/2022] [Accepted: 06/14/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To investigate the acceptance and tolerance of a targeted cognitive training program with virtual reality (VR) in Chinese older adults. METHODS We developed a VR-based program consisting of five games for cognitive training. Fourteen older adults voluntarily participated in the VR training program from January 1 to 22, 2022. The tolerance of the participants and acceptance of the video-based training were assessed after training. RESULTS Of the participants, 8 (57.1%) had normal cognitive function, and 6 (42.9%) had cognitive impairment. The participants tolerated the program well with a total SSQ (simulated sickness questionnaire) score of 10.42±12.97. Regarding acceptance, 97.6% of subjects found VR equipment to be easy to use, 76.2% said it was a positive experience, and 57.1% thought VR devices were attractive. CONCLUSION This study shows that VR-based cognitive training was well tolerated by Chinese older adults, without major or severe adverse events.
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Affiliation(s)
- Ruxia Qiu
- Shanghai Fifth People's Hospital, Fudan University, Shanghai, China; School of Nursing, Fudan University, Shanghai, China
| | - Yanhong Gu
- Shanghai Fifth People's Hospital, Fudan University, Shanghai, China; School of Nursing, Fudan University, Shanghai, China.
| | - Chuantao Xie
- Shanghai Fifth People's Hospital, Fudan University, Shanghai, China; School of Nursing, Fudan University, Shanghai, China
| | - Yanan Wang
- Shanghai Fifth People's Hospital, Fudan University, Shanghai, China
| | - Ying Sheng
- Shanghai Fifth People's Hospital, Fudan University, Shanghai, China
| | - Jinfen Zhu
- Shanghai Fifth People's Hospital, Fudan University, Shanghai, China
| | - Ying Yue
- Shanghai Fifth People's Hospital, Fudan University, Shanghai, China
| | - Jianmin Cao
- Shanghai Fifth People's Hospital, Fudan University, Shanghai, China
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13
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Advanced diffusion-weighted imaging models better characterize white matter neurodegeneration and clinical outcomes in multiple sclerosis. J Neurol 2022; 269:4729-4741. [DOI: 10.1007/s00415-022-11104-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 03/23/2022] [Accepted: 03/24/2022] [Indexed: 10/18/2022]
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14
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KH L, IG B, Oirschot P V, Graaf F D, H W, EMM S, BMJ U, T H, J K, Groot V D. Towards individualized monitoring of cognition in multiple sclerosis in the digital era: a one-year cohort study. Mult Scler Relat Disord 2022; 60:103692. [DOI: 10.1016/j.msard.2022.103692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 02/04/2022] [Accepted: 02/18/2022] [Indexed: 10/19/2022]
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15
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McKay KA, Bedri SK, Manouchehrinia A, Stawiarz L, Olsson T, Hillert J, Fink K. Reduction in cognitive processing speed surrounding multiple sclerosis relapse. Ann Neurol 2022; 91:417-423. [PMID: 34984719 PMCID: PMC9303402 DOI: 10.1002/ana.26301] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 01/02/2022] [Accepted: 01/03/2022] [Indexed: 11/21/2022]
Abstract
Objective The purpose of this study was to explore the longitudinal relationship between multiple sclerosis (MS) relapses and information processing efficiency among persons with relapsing–remitting MS. Methods We conducted a Swedish nationwide cohort study of persons with incident relapsing–remitting MS (2001–2019). Relapse information and symbol digit modalities test (SDMT) scores were obtained from the Swedish MS Registry. Follow‐up was categorized into 2 periods based on relapse status: “relapse” (90 days pre‐relapse to 730 days post‐relapse, subdivided into 10 periods) and “remission.” Linear mixed models compared SDMT scores during the relapse periods to SDMT scores recorded during remission (reference) with results reported as β‐coefficients and 95% confidence intervals (CIs), adjusted for age, sex, SDMT type (written vs oral), time‐varying, disease‐modifying therapy exposure and sequence of SDMT. Results Over a mean (SD) follow‐up of 10.7 (4.3) years, 31,529 distinct SDMTs were recorded among 3,877 persons with MS. There was a significant decline in information processing efficiency that lasted from 30 days pre‐relapse up to 550 days post‐relapse, with the largest decline occurring 0 to 30 days post‐relapse (β‐coefficient: −4.00 (95% CI = −4.61 to −3.39), relative to the period of remission. Interpretation We found evidence of cognitive change up to 1 month prior to relapse onset. The reduction in SDMT lasted 1.5 years and was clinically significant up to 3 months post‐relapse. These results suggest that the effects of a relapse on cognition are longer than previously thought and highlight the importance of reducing relapse rates as a potential means of preserving cognitive function. ANN NEUROL 2022;91:417–423
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Affiliation(s)
- Kyla A McKay
- Department of Clinical Neuroscience Neuro Division, Karolinska Institutet Stockholm Sweden
- Centre for Molecular Medicine Karolinska University Hospital Stockholm Sweden
| | - Sahl K Bedri
- Department of Clinical Neuroscience Neuro Division, Karolinska Institutet Stockholm Sweden
- Centre for Molecular Medicine Karolinska University Hospital Stockholm Sweden
| | - Ali Manouchehrinia
- Department of Clinical Neuroscience Neuro Division, Karolinska Institutet Stockholm Sweden
- Centre for Molecular Medicine Karolinska University Hospital Stockholm Sweden
| | - Leszek Stawiarz
- Department of Clinical Neuroscience Neuro Division, Karolinska Institutet Stockholm Sweden
| | - Tomas Olsson
- Department of Clinical Neuroscience Neuro Division, Karolinska Institutet Stockholm Sweden
- Centre for Molecular Medicine Karolinska University Hospital Stockholm Sweden
| | - Jan Hillert
- Department of Clinical Neuroscience Neuro Division, Karolinska Institutet Stockholm Sweden
| | - Katharina Fink
- Department of Clinical Neuroscience Neuro Division, Karolinska Institutet Stockholm Sweden
- Centrum for Neurology, Academical Specialist Center Stockholm Sweden
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16
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Improvements in Cognitive Processing Speed, Disability, and Patient-Reported Outcomes in Patients with Early Relapsing-Remitting Multiple Sclerosis Treated with Natalizumab: Results of a 4-year, Real-World, Open-Label Study. CNS Drugs 2022; 36:977-993. [PMID: 36064841 PMCID: PMC9797458 DOI: 10.1007/s40263-022-00950-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/21/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND STRIVE was a prospective, 4-year, multicenter, observational, open-label, single-arm study of natalizumab treatment in anti-JC virus antibody-negative patients with early relapsing-remitting multiple sclerosis (RRMS). OBJECTIVE Study objectives examined the effects of natalizumab on cognitive processing speed, confirmed disability improvement (CDI), and patient-reported outcomes (PROs). METHODS Clinical and PRO secondary endpoints were assessed annually over 4 years in STRIVE. The Symbol Digit Modalities Test (SDMT) was used as a measure of cognitive processing speed. PROs were assessed using the Multiple Sclerosis Impact Score (MSIS-29) and the Work Productivity and Activity Impairment Questionnaire (WPAI). RESULTS At all four annual assessments, the proportion of patients in the intent-to-treat (ITT) population (N = 222) who exhibited clinically meaningful improvement in their SDMT score from baseline (i.e., change ≥ 4 points) ranged from 41.9 to 54.0%. The cumulative probability of CDI at 4 years in patients in the ITT population with a baseline Expanded Disability Status Scale score ≥ 2 (N = 133) was 43.9%. Statistically significant reductions in the mean change from screening in the MSIS-29 physical and psychological scores, indicating improved quality of life, were observed over all 4 years (P ≤ 0.0012 for all). A statistically significant decrease from screening in the impact of MS on regular activities, signifying an improvement in this WPAI measure, was also observed over all 4 years of the study. CONCLUSION These results further extend our knowledge of the effectiveness, specifically regarding improvements in cognitive processing speed, disability and PROs, of long-term natalizumab treatment in early RRMS patients. CLINICALTRIALS GOV: NCT01485003 (5 December 2011).
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17
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Webb KL, Ryan J, Wolfe R, Woods RL, Shah RC, Murray AM, Orchard SG, Storey E. Test-Retest Reliability and Minimal Detectable Change of Four Cognitive Tests in Community-Dwelling Older Adults. J Alzheimers Dis 2022; 87:1683-1693. [PMID: 35491779 PMCID: PMC9588392 DOI: 10.3233/jad-215564] [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: 01/03/2023]
Abstract
BACKGROUND Cognitive test-retest reliability measures can be used to evaluate meaningful changes in scores. OBJECTIVE This analysis aimed to develop a comprehensive set of test-retest reliability values and minimal detectable change (MDC) values for a cognitive battery for community-dwelling older individuals in Australia and the U.S., for use in clinical practice. METHODS Cognitive scores collected at baseline and year 1, in the ASPirin in Reducing Events in the Elderly clinical trial were used to calculate intraclass correlation coefficients (ICC) for four tests: Modified Mini-Mental State examination (3MS), Hopkins Verbal Learning Test-Revised (HVLT-R), single-letter Controlled Oral Word Association Test (COWAT-F), and Symbol Digit Modalities Test (SDMT). 16,956 participants aged 70 years and over (65 years and over for U.S. minorities) were included. ICCs were used to calculate MDC values for eight education and ethno-racial subgroups. RESULTS All four cognitive tests had moderate (ICC > 0.5) to good (ICC > 0.7) test-retest reliability. ICCs ranged from 0.53 to 0.63 (3MS), 0.68 to 0.77 (SDMT), 0.56 to 0.64 (COWAT-F), 0.57 to 0.69 (HVLT-R total recall), and 0.57 to 0.70 (HVLT-R delayed recall) across the subgroups. MDC values ranged from 6.60 to 9.95 (3MS), 12.42 to 15.61 (SDMT), 6.34 to 8.34 (COWAT-F), 8.13 to 10.85 (HVLT-R total recall), and 4.00 to 5.62 (HVLT-R delayed recall). CONCLUSION This large cohort of older individuals provides test-retest reliability and MDC values for four widely employed tests of cognitive function. These results can aid interpretation of cognitive scores and decline instead of relying on cross-sectional normative data alone.
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Affiliation(s)
- Katherine L. Webb
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia,Correspondence to: Katherine L. Webb Monash University, School of Public Health and Preventive Medicine, Address: 553 St Kilda Rd, Melbourne VIC 3004, Australia. Tel.: +61 03 9903 0555;
| | - Joanne Ryan
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Rory Wolfe
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Robyn L. Woods
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Raj C. Shah
- Department of Family Medicine and Rush Alzheimer’s Disease Center; Rush University Medical Center, Chicago, IL, USA
| | - Anne M. Murray
- Berman Center for Outcomes and Clinical Research, Minneapolis Medical Research Foundation, Hennepin Healthcare Research Institute, Minneapolis, MN, USA,Department of Medicine, Division of Geriatrics, Hennepin County Medical Center and University of Minnesota, Minneapolis, MN, USA
| | - Suzanne G. Orchard
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Elsdon Storey
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
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18
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Woelfle T, Pless S, Wiencierz A, Kappos L, Naegelin Y, Lorscheider J. Practice Effects of Mobile Tests of Cognition, Dexterity, and Mobility on Patients With Multiple Sclerosis: Data Analysis of a Smartphone-Based Observational Study. J Med Internet Res 2021; 23:e30394. [PMID: 34792480 PMCID: PMC8663564 DOI: 10.2196/30394] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 08/23/2021] [Accepted: 09/12/2021] [Indexed: 12/23/2022] Open
Abstract
Background Smartphones and their built-in sensors allow for measuring functions in disease-related domains through mobile tests. This could improve disease characterization and monitoring, and could potentially support treatment decisions for multiple sclerosis (MS), a multifaceted chronic neurological disease with highly variable clinical manifestations. Practice effects can complicate the interpretation of both improvement over time by potentially exaggerating treatment effects and stability by masking deterioration. Objective The aim of this study is to identify short-term learning and long-term practice effects in 6 active tests for cognition, dexterity, and mobility in user-scheduled, high-frequency smartphone-based testing. Methods We analyzed data from 264 people with self-declared MS with a minimum of 5 weeks of follow-up and at least 5 repetitions per test in the Floodlight Open study, a self-enrollment study accessible by smartphone owners from 16 countries. The collected data are openly available to scientists. Using regression and bounded growth mixed models, we characterized practice effects for the following tests: electronic Symbol Digit Modalities Test (e-SDMT) for cognition; Finger Pinching and Draw a Shape for dexterity; and Two Minute Walk, U-Turn, and Static Balance for mobility. Results Strong practice effects were found for e-SDMT (n=4824 trials), Finger Pinching (n=19,650), and Draw a Shape (n=19,019) with modeled boundary improvements of 40.8% (39.9%-41.6%), 86.2% (83.6%-88.7%), and 23.1% (20.9%-25.2%) over baseline, respectively. Half of the practice effect was reached after 11 repetitions for e-SDMT, 28 repetitions for Finger Pinching, and 17 repetitions for Draw a Shape; 90% was reached after 35, 94, and 56 repetitions, respectively. Although baseline performance levels were highly variable across participants, no significant differences between the short-term learning effects in low performers (5th and 25th percentile), median performers, and high performers (75th and 95th percentile) were found for e-SDMT up to the fifth trial (β=1.50-2.00). Only small differences were observed for Finger Pinching (β=1.25-2.5). For U-Turn (n=15,051) and Static Balance (n=16,797), only short-term learning effects could be observed, which ceased after a maximum of 5 trials. For Two Minute Walk (n=14,393), neither short-term learning nor long-term practice effects were observed. Conclusions Smartphone-based tests are promising for monitoring the disease trajectories of MS and other chronic neurological diseases. Our findings suggest that strong long-term practice effects in cognitive and dexterity functions have to be accounted for to identify disease-related changes in these domains, especially in the context of personalized health and in studies without a comparator arm. In contrast, changes in mobility may be more easily interpreted because of the absence of long-term practice effects, even though short-term learning effects might have to be considered.
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Affiliation(s)
- Tim Woelfle
- Research Center for Clinical Neuroimmunology and Neuroscience Basel, University of Basel, University Hospital Basel, Basel, Switzerland.,Department of Neurology, University Hospital Basel, Basel, Switzerland
| | - Silvan Pless
- Research Center for Clinical Neuroimmunology and Neuroscience Basel, University of Basel, University Hospital Basel, Basel, Switzerland.,Department of Neurology, University Hospital Basel, Basel, Switzerland
| | - Andrea Wiencierz
- Clinical Trial Unit, Department of Clinical Research, University of Basel, University Hospital Basel, Basel, Switzerland
| | - Ludwig Kappos
- Research Center for Clinical Neuroimmunology and Neuroscience Basel, University of Basel, University Hospital Basel, Basel, Switzerland.,Department of Neurology, University Hospital Basel, Basel, Switzerland
| | - Yvonne Naegelin
- Research Center for Clinical Neuroimmunology and Neuroscience Basel, University of Basel, University Hospital Basel, Basel, Switzerland.,Department of Neurology, University Hospital Basel, Basel, Switzerland
| | - Johannes Lorscheider
- Research Center for Clinical Neuroimmunology and Neuroscience Basel, University of Basel, University Hospital Basel, Basel, Switzerland.,Department of Neurology, University Hospital Basel, Basel, Switzerland
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19
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Mackay L, Johnson AM, Moodie ST, Rosehart H, Morrow SA. Predictors of cognitive fatigue and fatigability in multiple sclerosis. Mult Scler Relat Disord 2021; 56:103316. [PMID: 34638096 DOI: 10.1016/j.msard.2021.103316] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 09/26/2021] [Accepted: 10/04/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Persons with multiple sclerosis (PwMS) commonly experience cognitive fatigue (CF), defined as a decrease in cognitive performance with sustained activity, yet CF remains understudied. Further, the relationship between subjective CF and objective CF, or cognitive fatiguability, has not been fully elucidated in previous studies. Understanding the predictors of cognitive fatigue may scaffold the development of interventions that target this symptom. The objective of this prospective study was to evaluate the extent to which depression, anxiety, information processing speed, and sleep quality predict subjective and objective CF. METHODS PwMS were recruited from one academic MS clinic in London (ON) Canada. Objective CF was measured by the Paced Auditory Serial Addition Test (PASAT), where performance on the last third of the PASAT is compared to performance on the 1st third, a validated measurement of objective CF. Subjective CF was measured by the cognitive component of the Modified Fatigue Impact Scale (MFIS). Additionally, depression, anxiety, information processing speed, and sleep quality data was collected. All assessments took place on the same day. Pearson's r was calculated to examine the relationship among all continuous outcome measures while linear regression analyses were used to examine predictors of subjective and objective CF. RESULTS The sample consisted of 53 subjects who were mostly female (37; 69.8%) with a mean age of 44.2 years; the majority (47; 88.7%) had relapsing MS. Objective CF and subjective CF were not significantly related (r = - 0.16). Further, there was no statistically significant predictors of objective CF noted. In contrast, subjective CF demonstrated a statistically significant relationship with the Symbol Digit Modalities Test (SDMT; r = - 0.29, p = .05), Hospital Anxiety and Depression Scale (HADS), depression subscale (r = 0.61, p < .001), HADS anxiety subscale (r = 0.54, p < .001), and sleep quality (r = 0.33, p = .02). Additionally, all variables predicted subjective CF, R2adj = 0.384 [F (6, 40) = 5.783, p = .0002]. In particular, anxiety significantly predicted subjective CF when controlling for depression, information speed, and sleep quality. CONCLUSION This study demonstrated that subjective CF is significantly predicted by anxiety, and strongly influenced by information processing impairment and depression. Addressing underlying affective factors, such as anxiety or depression, may help alleviate perceived or subjective CF among PwMS, thus improving their function and quality of life. Further studies with a larger sample size or longitudinal follow up may help define predictors of objective CF.
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Affiliation(s)
- Leila Mackay
- Graduate Program in Health and Rehabilitation Sciences, The University of Western Ontario, London, Ontario N6A 5Q5, Canada
| | - Andrew M Johnson
- School of Health Studies, The University of Western Ontario, London, Ontario, Canada
| | - Sheila T Moodie
- School of Communication Sciences and Disorders, The University of Western Ontario, London, Ontario, Canada
| | - Heather Rosehart
- Clinical Neurological Sciences, University Hospital-London Health Sciences Center, 339 Windermere Road, London, Ontario, Canada
| | - Sarah A Morrow
- Clinical Neurological Sciences, University Hospital-London Health Sciences Center, 339 Windermere Road, London, Ontario, Canada.
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20
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Weinstock Z, Morrow S, Conway D, Fuchs T, Wojcik C, Unverdi M, Zivadinov R, Weinstock-Guttman B, Iverson GL, Dwyer M, Benedict RH. Interpreting change on the Symbol Digit Modalities Test in people with relapsing multiple sclerosis using the reliable change methodology. Mult Scler 2021; 28:1101-1111. [PMID: 34612114 DOI: 10.1177/13524585211049397] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The Symbol Digit Modalities Test (SDMT) is increasingly utilized in clinical trials. A SDMT score change of 4 points is considered clinically important, based on association with employment anchors. Optimal thresholds for statistically reliable SDMT changes, accounting for test reliability and measurement error, are yet to be applied to individual cases. OBJECTIVE The aim of this study was to derive a statistically reliable marker of individual change on the SDMT. METHODS This prospective, case-control study enrolled 166 patients with multiple sclerosis (MS). SDMT scores at baseline, relapse, and 3-month follow-up were compared between relapsing and stable patient groups. Using data from the stable group and three previously published studies, candidate thresholds for reliable decline were calculated and validated against other tests and a clinically meaningful anchor-cognitive relapse. RESULTS Candidate thresholds for reliable decline at the 80% confidence level varied between 6 and 11 points. An SDMT change of 8 or more raw score points was deemed to offer the best balance of discriminatory power and external validity for estimating cognitive decline. CONCLUSION This study illustrates the feasibility and usefulness of reliable change methodology for identifying statistically meaningful cognitive decline that could be implemented to identify change in individual patients, for both clinical management and clinical trial outcomes.
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Affiliation(s)
- Zachary Weinstock
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Sarah Morrow
- Department of Clinical Neurological Sciences, Western University and London Health Sciences Center, London, ON, Canada
| | - Devon Conway
- Mellen Center for Multiple Sclerosis Treatment, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Tom Fuchs
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Curtis Wojcik
- Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Mahmut Unverdi
- Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Robert Zivadinov
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, USA/Jacobs MS Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Bianca Weinstock-Guttman
- Jacobs MS Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Grant L Iverson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA/Spaulding Rehabilitation Hospital and Spaulding Research Institute, Charlestown, MA, USA
| | - Michael Dwyer
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, USA/Jacobs MS Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Ralph Hb Benedict
- Jacobs MS Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, USA
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21
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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: 14] [Impact Index Per Article: 4.7] [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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22
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Predictors of Improvement in Quality of Life When Treating Hypothyroidism. J Thyroid Res 2021; 2021:5577217. [PMID: 34194721 PMCID: PMC8214493 DOI: 10.1155/2021/5577217] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 06/05/2021] [Indexed: 11/25/2022] Open
Abstract
Background Primary hypothyroidism is characterized by reduced quality of life (QoL). Although thyrotropin (TSH) is utilized as the primary indicator of thyroid disease and treatment adequacy, no simple correlation between QoL and TSH has been shown. This study aimed to investigate changes in clinically relevant predictors during initiation of levothyroxine (L-T4) therapy and their ability to predict improvement in QoL. Method Quality of life was measured in patients with newly diagnosed hypothyroidism, during the initial 12 months of L-T4 therapy, by the thyroid-related patient-reported outcome questionnaire, ThyPRO-39. The main outcome measures were the Composite QoL scale and the Tiredness and Emotional Susceptibility subscales (0–100, higher scores worse). Clinical variables (resting energy expenditure (REE), body composition, thyroid function, L-T4 dose, and cognitive function tests) were evaluated as predictors of improvement in QoL by univariate and multiple regression analysis. Results Thirty-seven hypothyroid patients with a baseline median TSH of 30 mU/l and a median QoL score of 29 were included. After twelve months of L-T4 treatment, the ThyPRO-39 QoL score had significantly improved to a median score of 14, while REE per kg fat-free mass (FFM) increased significantly from a mean of 26.5 to 28.7 kcal/day/kg (p < 0.001). Change in ThyPRO-39 was not associated with a change in REE/FFM (unstandardized coefficient (USC): 0.09 with confidence interval (CI): −1.93 to 2.11, p=0.93) but was positively predicted by baseline body mass index (BMI) (USC: 1.54 with CI: 0.59 to 2.49, (p=0.002), without association with weight loss (USC: 0.33 with CI: −1.21 to 1.27, p=0.96). Conclusion Improvement in QoL as measured by ThyPRO-39 after initiation of L-T4 therapy for hypothyroidism was not associated with changes in REE. High baseline BMI, but not weight loss during therapy, was associated with improvement in QoL. This trail is registered with www.Clinicaltrials.gov (registration no. https://clinicaltrials.gov/ct2/show/NCT02891668).
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Hämäläinen P, Leo V, Therman S, Ruutiainen J. Validation of the Finnish version of the Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS) and evaluation of the applicability of the Multiple Sclerosis Neuropsychological Questionnaire (MSNQ) and the Fatigue Scale for Motor and Cognitive Functions (FSMC). Brain Behav 2021; 11:e02087. [PMID: 33960700 PMCID: PMC8213644 DOI: 10.1002/brb3.2087] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 01/05/2021] [Accepted: 02/08/2021] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVES Cognitive impairment is frequent in multiple sclerosis (MS) as approximately half of the patients manifest some degree of cognitive impairment. The Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS) has been designed for brief cognitive evaluation. The purpose of the study was to validate the BICAMS along with the Finnish versions of one self-rating questionnaire each for cognition and fatigue. METHODS A total of 65 MS patients and 45 healthy controls (HC) were assessed with the BICAMS, the Multiple Sclerosis Neuropsychological Questionnaire (MSNQ), and the Fatigue Scale for Motor and Cognitive Functions (FSMC) twice, approximately within nine days. RESULTS MS patients scored markedly lower than the HCs on each of the three tests of the BICAMS. Of the patients, 60% scored at least 1.5 SD below the mean of the HCs on at least one test; 49% on the SDMT, 26% on the CVLT-II, and 28% on the BVMT-R. Correlation coefficients for the repeated measurement were between 0.75 and 0.89 for the three tests in the whole study sample. MS patients reported more cognitive symptoms and more fatigue than the HCs. Cronbach's alpha was 0.94 for the MSNQ and 0.98 for the FSMC. Correlation coefficient for the repeated measurement was 0.91 for the MSNQ and between 0.92 and 0.94 for the FSMC scores for the whole study sample. CONCLUSIONS The present study supports the validity of the Finnish version of the BICAMS. The SDMT was the most sensitive of the three BICAMS tests and showed cognitive impairment in half of the patients. The Finnish versions of the MSNQ and the FSMC proved useful tools in approaching concerns related to cognition and fatigue.
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Affiliation(s)
- Päivi Hämäläinen
- Masku Neurological Rehabilitation Centre, The Finnish Neuro Society, Masku, Finland
| | - Vera Leo
- Masku Neurological Rehabilitation Centre, The Finnish Neuro Society, Masku, Finland.,Cognitive Brain Research Unit, Department of Psychology and Logopedics, Faculty of Medicine, Helsinki, Finland
| | - Sebastian Therman
- Mental Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Juhani Ruutiainen
- Masku Neurological Rehabilitation Centre, The Finnish Neuro Society, Masku, Finland.,Department of Neurology, University of Turku, Turku, Finland
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Lu L, Chen L, Wu W, Wang Y, Liu Z, Xu J, Yang Q, Zhao J, Liu L, Yu H. Consistency and applicability of different brief screen instrument of cognitive function in elderly population. BMC Neurol 2021; 21:95. [PMID: 33648444 PMCID: PMC7919302 DOI: 10.1186/s12883-021-02048-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 01/05/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Screening for cognitive impairment (CI) is often hampered by lack of consensus as to which screening instrument to use. The aim is to assess the consistence and applicability of different CI screening tools. METHOD In a cross-sectional study from October 2017 to September 2018 in 7 communities in Shanghai, China, elder (≧60) residential volunteers with no history of major cardiovascular diseases, cancers and other comorbidities known to affect cognitive functions were recruited. The participants underwent tests with 7 cognitive function screening instruments. Multivariate linear regressions were performed to test correlations between demographic characteristics, including gender, age, education, and marital status, with cognitive test scores. Mini-Mental State Examination (MMSE) score adjusted according to the correlation coefficients was used to detect CI with a cutoff of 24. Other cognitive function scores were compared between participants with and without CI. In addition, Pearson's correlation test was used to detect association between different test scores. RESULTS 172 participants with relatively low education levels were included. Age and education showed significant association with cognitive test scores. Using adjusted MMSE, 39.6% of participants were identified with CI, while the percentage was 87.2% when adjusted Montreal Cognitive Assessment (MoCA) with cutoff of 26 was used. Analysis of "abnormal" test scores showed that MMSE had the highest percentage of valid data (98.8%). MoCA and Isaacs test of Verbal Fluency (VF) score had correlation with most the other scores, while MMSE only significantly associated with VF and MoCA. CONCLUSIONS MMSE may still present the most applicable tools for quick screen of cognitive functions, especially when environmental conditions may interfere with participants' attention.
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Affiliation(s)
- Lixia Lu
- Department of Neurology, Qingpu Branch of Zhongshan Hospital, Fudan University, 1158 East of Park Road, Qingpu District, Shanghai, 201700, China
| | - Lin Chen
- Department of Neurology, Qingpu Branch of Zhongshan Hospital, Fudan University, 1158 East of Park Road, Qingpu District, Shanghai, 201700, China
| | - Weiwen Wu
- Department of Neurology, Qingpu Branch of Zhongshan Hospital, Fudan University, 1158 East of Park Road, Qingpu District, Shanghai, 201700, China.
| | - Yang Wang
- Department of Neurology, Qingpu Branch of Zhongshan Hospital, Fudan University, 1158 East of Park Road, Qingpu District, Shanghai, 201700, China
| | - Zhenbao Liu
- Department of Neurology, Qingpu Branch of Zhongshan Hospital, Fudan University, 1158 East of Park Road, Qingpu District, Shanghai, 201700, China
| | - Jun Xu
- Department of Neurology, Qingpu Branch of Zhongshan Hospital, Fudan University, 1158 East of Park Road, Qingpu District, Shanghai, 201700, China
| | - Qianhong Yang
- Department of Neurology, Qingpu Branch of Zhongshan Hospital, Fudan University, 1158 East of Park Road, Qingpu District, Shanghai, 201700, China
| | - Jun Zhao
- Department of Neurology, Qingpu Branch of Zhongshan Hospital, Fudan University, 1158 East of Park Road, Qingpu District, Shanghai, 201700, China
| | - Liangxian Liu
- Department of Neurology, Qingpu Branch of Zhongshan Hospital, Fudan University, 1158 East of Park Road, Qingpu District, Shanghai, 201700, China
| | - Hui Yu
- Department of Neurology, Qingpu Branch of Zhongshan Hospital, Fudan University, 1158 East of Park Road, Qingpu District, Shanghai, 201700, China
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Bagnato F, Gauthier SA, Laule C, Moore GRW, Bove R, Cai Z, Cohen-Adad J, Harrison DM, Klawiter EC, Morrow SA, Öz G, Rooney WD, Smith SA, Calabresi PA, Henry RG, Oh J, Ontaneda D, Pelletier D, Reich DS, Shinohara RT, Sicotte NL. Imaging Mechanisms of Disease Progression in Multiple Sclerosis: Beyond Brain Atrophy. J Neuroimaging 2021; 30:251-266. [PMID: 32418324 DOI: 10.1111/jon.12700] [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: 10/24/2019] [Revised: 02/04/2020] [Accepted: 02/18/2020] [Indexed: 12/11/2022] Open
Abstract
Clinicians involved with different aspects of the care of persons with multiple sclerosis (MS) and scientists with expertise on clinical and imaging techniques convened in Dallas, TX, USA on February 27, 2019 at a North American Imaging in Multiple Sclerosis Cooperative workshop meeting. The aim of the workshop was to discuss cardinal pathobiological mechanisms implicated in the progression of MS and novel imaging techniques, beyond brain atrophy, to unravel these pathologies. Indeed, although brain volume assessment demonstrates changes linked to disease progression, identifying the biological mechanisms leading up to that volume loss are key for understanding disease mechanisms. To this end, the workshop focused on the application of advanced magnetic resonance imaging (MRI) and positron emission tomography (PET) imaging techniques to assess and measure disease progression in both the brain and the spinal cord. Clinical translation of quantitative MRI was recognized as of vital importance, although the need to maintain a relatively short acquisition time mandated by most radiology departments remains the major obstacle toward this effort. Regarding PET, the panel agreed upon its utility to identify ongoing pathological processes. However, due to costs, required expertise, and the use of ionizing radiation, PET was not considered to be a viable option for ongoing care of persons with MS. Collaborative efforts fostering robust study designs and imaging technique standardization across scanners and centers are needed to unravel disease mechanisms leading to progression and discovering medications halting neurodegeneration and/or promoting repair.
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Affiliation(s)
- Francesca Bagnato
- Neuroimaging Unit, Neuroimmunology Division, Department of Neurology, Vanderbilt University Medical Center, Nashville, TN
| | - Susan A Gauthier
- Judith Jaffe Multiple Sclerosis Center, Department of Neurology, Feil Family Brain and Mind Institute, and Department of Radiology, Weill Cornell Medicine, New York, NY
| | - Cornelia Laule
- Department of Radiology, Pathology, and Laboratory Medicine, Department of Physics and Astronomy, and International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, British Columbia, Canada
| | - George R Wayne Moore
- Department of Pathology and Laboratory Medicine, and International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, British Columbia, Canada
| | - Riley Bove
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, CA
| | - Zhengxin Cai
- Department of Radiology and Biomedical Imaging, PET Center, Yale University, New Haven, CT
| | - Julien Cohen-Adad
- NeuroPoly Lab, Institute of Biomedical Engineering, Polytechnique Montreal and Functional Neuroimaging Unit, CRIUGM, University of Montreal, Montreal, Quebec, Canada
| | - Daniel M Harrison
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD
| | - Eric C Klawiter
- Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Sarah A Morrow
- Department of Clinical Neurological Sciences, University of Western Ontario, London, Ontario, Canada
| | - Gülin Öz
- Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, MN
| | - William D Rooney
- Advanced Imaging Research Center, Departments of Biomedical Engineering, Neurology, and Behavioral Neuroscience, Oregon Health & Science University, Portland, OR
| | - Seth A Smith
- Radiology and Radiological Sciences and Vanderbilt University Imaging Institute, Vanderbilt University Medical Center, and Biomedical Engineering, Vanderbilt University, Nashville, TN
| | - Peter A Calabresi
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Roland G Henry
- Departments of Neurology, Radiology and Biomedical Imaging, and the UC San Francisco & Berkeley Bioengineering Graduate Group, University of California San Francisco, San Francisco, CA
| | - Jiwon Oh
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD.,Division of Neurology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Daniel Ontaneda
- Mellen Center for Multiple Sclerosis, Neurological Institute, Cleveland Clinic, Cleveland, OH
| | - Daniel Pelletier
- Department of Neurology, University of Southern California Keck School of Medicine, Los Angeles, CA
| | - Daniel S Reich
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, Bethesda, MD
| | - Russell T Shinohara
- Department of Biostatistics, Epidemiology, and Informatics, Penn Statistics in Imaging and Visualization Center, University of Pennsylvania, Philadelphia, PA
| | - Nancy L Sicotte
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA
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- Neuroimaging Unit, Neuroimmunology Division, Department of Neurology, Vanderbilt University Medical Center, Nashville, TN
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Barois E, Sagawa Y, Yilmaz S, Magnin E, Decavel P. What (more) can verbal fluency tell us about multiple sclerosis? Ann Phys Rehabil Med 2020; 64:101394. [PMID: 32450272 DOI: 10.1016/j.rehab.2020.05.002] [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: 11/28/2019] [Revised: 05/01/2020] [Accepted: 05/02/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Clinical symptoms of multiple sclerosis (MS) are variable and may include cognitive impairment, which can be assessed with the verbal fluency test (VFT). This test is evaluated by counting words spoken during a 2-min period, which is not a functional approach. OBJECTIVE The objectives of this observational study were to: (1) determine new parameters that reflect communication and cognitive functions in persons with multiple sclerosis (PwMS) considering the evaluation of real-time word production in the VFT; (2) compare the results with those of a control group; and (3) evaluate the impact of including errors. METHODS A phonological fluency test ("letter P") and a semantic fluency test ("animals") were used. The real-time word production was recorded. The main variables studied were the total number of words, first word delay, moment of inflection of the curve corresponding to the change in the cognitive process, speed of word production before inflection, and maximum delay between 2 consecutive words. These variables were studied by taking into account or not errors. RESULTS We included 68 PwMS and 33 healthy controls. VFT results were impaired in PwMS. The total number of words, first word delay, speed before inflection, and maximum delay were relevant to the study of phonologic fluency. For studying semantic fluency, the total number of words, first word delay, speed before inflection, and inflection time of the curve seemed relevant. Taking into account errors was significant only for total number of words. CONCLUSION Taking into account errors in evaluating real-time word production in PwMS is of interest only for the total number of words performed but has no impact on the variables studied. These variables should be used to quantitatively evaluate verbal fluency with the objective of evaluating functionally relevant parameters (communication).
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Affiliation(s)
- Elise Barois
- Clinical Functional Exploration Laboratory of the Movement, 25000 Besançon, France; Department of Physical Medicine and Rehabilitation, University Hospital Center of Besançon, 25000 Besançon, France
| | - Yoshimasa Sagawa
- Clinical Functional Exploration Laboratory of the Movement, 25000 Besançon, France; Department of Physical Medicine and Rehabilitation, University Hospital Center of Besançon, 25000 Besançon, France; Integrative and Clinical Neurosciences EA481, Bourgogne Franche-Comte University, Besançon, France
| | - Suveyla Yilmaz
- Clinical Functional Exploration Laboratory of the Movement, 25000 Besançon, France
| | - Eloi Magnin
- Integrative and Clinical Neurosciences EA481, Bourgogne Franche-Comte University, Besançon, France; Regional Memory Centre (CMRR), Department of Neurology, University Hospital of Besançon, 25000, Besançon, France
| | - Pierre Decavel
- Clinical Functional Exploration Laboratory of the Movement, 25000 Besançon, France; Department of Physical Medicine and Rehabilitation, University Hospital Center of Besançon, 25000 Besançon, France; Integrative and Clinical Neurosciences EA481, Bourgogne Franche-Comte University, Besançon, France.
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Bringeland GH, Blaser N, Myhr KM, Vedeler CA, Gavasso S. Wearing-off at the end of natalizumab dosing intervals is associated with low receptor occupancy. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2020; 7:7/3/e678. [PMID: 32019768 PMCID: PMC7051203 DOI: 10.1212/nxi.0000000000000678] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 12/20/2019] [Indexed: 11/15/2022]
Abstract
Objective We aimed to investigate whether wearing-off symptoms at the end of the natalizumab dosing interval were associated with clinical and demographic patient characteristics or natalizumab receptor occupancy (RO) on leukocytes. Methods In this cross-sectional study of 40 patients with relapsing-remitting MS (RRMS) receiving natalizumab at the Department of Neurology, Haukeland University Hospital, we recorded clinical and demographic data including age, body mass index (BMI), working status, smoking habits, disease characteristics, treatment duration, vitamin D levels, and wearing-off symptoms. We quantified neurofilament light chain in serum and measured natalizumab RO in leukocyte subtypes by high-parameter mass cytometry. Associations with wearing-off symptoms were analyzed. Results Eight (20.0%) patients who reported regular occurrence of wearing-off symptoms, 9 (22.5%) who sometimes had wearing-off symptoms, and 23 (57.5%) who did not have wearing-off symptoms were evaluated. Patients who regularly had wearing-off symptoms had lower natalizumab RO than patients who reported having such symptoms sometimes or never. The former group also had higher BMI and higher frequency of sick leave. High BMI was associated with low RO. No other demographic or disease characteristics were associated with the phenomenon. Conclusions Low RO may explain the wearing-off phenomenon observed in some patients with RRMS treated with natalizumab, and high BMI may be the underlying cause.
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Affiliation(s)
- Gerd Haga Bringeland
- From the Neuro-SysMed (G.H.B., K.-M.M., C.A.V., S.G.), Department of Neurology, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine (G.H.B., K.-M.M., C.A.V., S.G.), University of Bergen, Bergen, Norway; and Department of Informatics (N.B.), University of Bergen, Bergen, Norway.
| | - Nello Blaser
- From the Neuro-SysMed (G.H.B., K.-M.M., C.A.V., S.G.), Department of Neurology, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine (G.H.B., K.-M.M., C.A.V., S.G.), University of Bergen, Bergen, Norway; and Department of Informatics (N.B.), University of Bergen, Bergen, Norway
| | - Kjell-Morten Myhr
- From the Neuro-SysMed (G.H.B., K.-M.M., C.A.V., S.G.), Department of Neurology, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine (G.H.B., K.-M.M., C.A.V., S.G.), University of Bergen, Bergen, Norway; and Department of Informatics (N.B.), University of Bergen, Bergen, Norway
| | - Christian Alexander Vedeler
- From the Neuro-SysMed (G.H.B., K.-M.M., C.A.V., S.G.), Department of Neurology, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine (G.H.B., K.-M.M., C.A.V., S.G.), University of Bergen, Bergen, Norway; and Department of Informatics (N.B.), University of Bergen, Bergen, Norway
| | - Sonia Gavasso
- From the Neuro-SysMed (G.H.B., K.-M.M., C.A.V., S.G.), Department of Neurology, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine (G.H.B., K.-M.M., C.A.V., S.G.), University of Bergen, Bergen, Norway; and Department of Informatics (N.B.), University of Bergen, Bergen, Norway
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Treatment Optimization in Multiple Sclerosis: Canadian MS Working Group Recommendations. Can J Neurol Sci 2020; 47:437-455. [DOI: 10.1017/cjn.2020.66] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Abstract:The Canadian Multiple Sclerosis Working Group has updated its treatment optimization recommendations (TORs) on the optimal use of disease-modifying therapies for patients with all forms of multiple sclerosis (MS). Recommendations provide guidance on initiating effective treatment early in the course of disease, monitoring response to therapy, and modifying or switching therapies to optimize disease control. The current TORs also address the treatment of pediatric MS, progressive MS and the identification and treatment of aggressive forms of the disease. Newer therapies offer improved efficacy, but also have potential safety concerns that must be adequately balanced, notably when treatment sequencing is considered. There are added discussions regarding the management of pregnancy, the future potential of biomarkers and consideration as to when it may be prudent to stop therapy. These TORs are meant to be used and interpreted by all neurologists with a special interest in the management of MS.
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Healy BC, Barker L, Bakshi R, Benedict RHB, Gonzalez CT, Chitnis T, Weiner HL, Glanz BI. Trajectories of Symbol Digit Modalities Test performance in individuals with multiple sclerosis. Mult Scler 2020; 27:593-602. [DOI: 10.1177/1352458520913439] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Background: Although cognitive problems have been identified in people with multiple sclerosis (PwMS), few studies have investigated the long-term change in cognitive functioning. Objective: To identify trajectories of change in cognitive functioning for PwMS. Methods: Participants enrolled in the quality-of-life subgroup from the Comprehensive Longitudinal Investigation of Multiple Sclerosis at Brigham and Women’s Hospital (CLIMB) were eligible for our analysis. In 2006, participants in this group began to complete the Symbol Digit Modalities Test (SDMT) annually. Latent trajectory models were used to identify groups of participants with similar longitudinal change in SDMT scores. Linear and quadratic trajectory models were fit, and the models were compared. Latent trajectory models were also fit adjusting for baseline age and disease duration as well as using normalized SDMT scores. The groups identified across the approaches were compared. Results: We found that classes with higher-than-average baseline values improved, classes with average baseline values remained relatively constant, and classes with lower baseline values experienced cognitive worsening. Similar results were observed in the alternative latent trajectory models accounting for other variables. Conclusion: Our models show that subjects with higher SDMT scores at baseline showed improvement, while subjects with lower SDMT scores at baseline showed worsening. Baseline age and disease duration were also associated with SDMT performance.
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Affiliation(s)
- Brian C Healy
- Partners Multiple Sclerosis Center, Brigham and Women’s Hospital, Boston, MA, USA/Department of Neurology, Harvard Medical School, Boston, MA, USA/Biostatistics Center, Massachusetts General Hospital, Boston, MA, USA
| | - Lindsay Barker
- Partners Multiple Sclerosis Center, Brigham and Women’s Hospital, Boston, MA, USA/Department of Neurology, Harvard Medical School, Boston, MA, USA
| | - Rohit Bakshi
- Partners Multiple Sclerosis Center, Brigham and Women’s Hospital, Boston, MA, USA/Department of Neurology, Harvard Medical School, Boston, MA, USA
| | - Ralph H B Benedict
- Department of Neurology, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Cindy T Gonzalez
- Partners Multiple Sclerosis Center, Brigham and Women’s Hospital, Boston, MA, USA
| | - Tanuja Chitnis
- Partners Multiple Sclerosis Center, Brigham and Women’s Hospital, Boston, MA, USA/Department of Neurology, Harvard Medical School, Boston, MA, USA
| | - Howard L Weiner
- Partners Multiple Sclerosis Center, Brigham and Women’s Hospital, Boston, MA, USA/Department of Neurology, Harvard Medical School, Boston, MA, USA
| | - Bonnie I Glanz
- Partners Multiple Sclerosis Center, Brigham and Women’s Hospital, Boston, MA, USA/Department of Neurology, Harvard Medical School, Boston, MA, USA
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Wallach AI, Waltz M, Casper TC, Aaen G, Belman A, Benson L, Chitnis T, Gorman M, Graves J, Harris Y, Lotze TE, Mar S, Moodley M, Ness JM, Rensel M, Rodriguez M, Rose JW, Schreiner T, Tillema JM, Waubant E, Weinstock-Guttman B, Charvet LE, Krupp LB. Cognitive processing speed in pediatric-onset multiple sclerosis: Baseline characteristics of impairment and prediction of decline. Mult Scler 2019; 26:1938-1947. [PMID: 31775571 DOI: 10.1177/1352458519891984] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Cognitive impairment occurs in approximately one-third of pediatric-onset multiple sclerosis (POMS) patients. The Symbol Digit Modalities Test (SDMT), a widely used cognitive screen in adults, has yet to be incorporated early into the standard care of POMS. OBJECTIVE To screen for cognitive impairment early in the course of POMS and analyze predictive factors. METHODS Of the 955 POMS or clinically isolated syndrome (CIS) patients prospectively assessed from March 2014 to July 2018, 500 POMS and 116 CIS patients met inclusion criteria (disease onset before the age of 18, one or more SDMTs, and 8 years or older at the time of testing). Those with relapse were analyzed separately from those who were relapse-free. RESULTS At initial assessment, the mean (interquartile range (IQR)) age at symptom onset was 13.5 years (12.0, 15.9) and the mean (±SD) disease duration was 3.0 ± 2.9 years. Impaired processing speed occurred in 23.4% of POMS and in 16.4% of CIS. On serial testing (n = 383, mean follow-up: 1.8 years), 14.1% had clinically meaningful decline predicted by older age of multiple sclerosis (MS) onset and male gender. Disease relapse or steroid use led to transient worsening on the SDMT. CONCLUSION Early in the disease, some POMS and CIS patients are at risk for cognitive impairment and subsequent decline.
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Affiliation(s)
- Asya I Wallach
- Pediatric Multiple Sclerosis Center, Department of Neurology, NYU Langone Medical Center, New York, NY, USA
| | - Michael Waltz
- Pediatrics, The University of Utah, Salt Lake City, UT, USA
| | | | - Gregory Aaen
- Pediatric Multiple Sclerosis Center, Loma Linda University, Loma Linda, CA, USA
| | - Anita Belman
- Pediatric Multiple Sclerosis Center, Department of Neurology, NYU Langone Medical Center, New York, NY, USA
| | - Leslie Benson
- Partners Multiple Sclerosis Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Tanuja Chitnis
- Partners Multiple Sclerosis Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Jennifer Graves
- Pediatric MS Center, Neurology, University of California, San Diego, San Diego, CA, USA
| | - Yolanda Harris
- Center for Pediatric-Onset Demyelinating Disease, Children's of Alabama, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Timothy E Lotze
- The Blue Bird Circle Clinic for Multiple Sclerosis, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Soe Mar
- Pediatric MS and other Demyelinating Disease Center, Washington University in St Louis, St. Louis, MO, USA
| | - Manikum Moodley
- Mellen Center for Multiple Sclerosis, Cleveland Clinic, Cleveland, OH, USA
| | - Jayne M Ness
- Center for Pediatric-Onset Demyelinating Disease, Children's of Alabama, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Mary Rensel
- Mellen Center for Multiple Sclerosis, Cleveland Clinic, Cleveland, OH, USA
| | - Moses Rodriguez
- Pediatric Multiple Sclerosis Center, Mayo Clinic, Rochester, MN, USA
| | - John W Rose
- Pediatrics, The University of Utah, Salt Lake City, UT, USA
| | - Teri Schreiner
- Department of Neurology, Children's Hospital Colorado, University of Colorado, Aurora, CO, USA
| | | | - Emmanuelle Waubant
- Regional Pediatric MS Center, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Bianca Weinstock-Guttman
- The Pediatric MS Center, Jacobs Neurological Institute, State University of New York at Buffalo, Buffalo, NY, USA
| | - Leigh E Charvet
- Pediatric Multiple Sclerosis Center, Department of Neurology, NYU Langone Medical Center, New York, NY, USA
| | - Lauren B Krupp
- Pediatric Multiple Sclerosis Center, Department of Neurology, NYU Langone Medical Center, New York, NY, USA
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Povolo CA, Blair M, Mehta S, Rosehart H, Morrow SA. Predictors of vocational status among persons with multiple sclerosis. Mult Scler Relat Disord 2019; 36:101411. [PMID: 31586801 DOI: 10.1016/j.msard.2019.101411] [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: 05/22/2019] [Revised: 08/16/2019] [Accepted: 09/23/2019] [Indexed: 11/15/2022]
Abstract
BACKGROUND Multiple Sclerosis (MS) is a common cause of neurological disability in young to middle-aged adults, resulting in physical, psychosocial, and cognitive impairments. Manifestation of these symptoms during crucial work-life years can greatly influence the ability of persons with (PwMS) to retain employment. It is unknown what factors are most important in leading to work disability, and if/how these different factors interact with each other and result in work disability. OBJECTIVE To determine significant predictors of vocational status among PwMS using a structural equation modeling approach. METHODS A retrospective chart review identified PwMS at an academic tertiary care hospital. The following data was collected: demographics and disease characteristics, vocational status, physical disability status (Expanded Disability Status Scale, EDSS), fine motor function (Nine Hole Peg Test, NHPT), generalized fatigue (Fatigue Severity Scale, FSS), mood and anxiety symptoms (Hospital Anxiety and Depression Scale, HADS) and cognitive function (Symbol Digit Modalities Test, SDMT). An exploratory structural equation model (SEM) was developed to examine the predictive utility of clinical and psychosocial variables on vocational status after controlling for demographic and disease characteristics. The fit of the model to the data was examined using the comparative fit index (CFI), normal fit index (NFI), root-mean-squared error of approximation (RMSEA), and standardized root mean residual (SRMR). RESULTS There were 158 PwMS included in the analysis. The final model demonstrated that SDMT (β = 0.16), EDSS (β = -0.33), and HADS-D (β = -0.23) significantly predicted vocational status (ps < 0.05). It explained 37% of the variance and provided a good fit to the data (χ2(11) = 13.01, p > 0.05, SRMR = 0.055, RMSEA = 0.034, NFI = 0.94, CFI = 0.99. CONCLUSIONS Physical disability, depressive symptoms, and reduced information processing affect work-related disability and vocational status among PwMS. Interventions targeting these factors should be prioritized by clinicians.
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Affiliation(s)
| | - Mervin Blair
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Parkwood Institute, Lawson Health Research Institute, University of Western Ontario, 550 Wellington Rd, London, ON, Canada
| | - Swati Mehta
- Lawson Health Research Institute, Department of Physical Medicine and Rehabilitation, Western University, 750 Base Line Rd E, London, ON N6C 2R5, Canada
| | | | - Sarah A Morrow
- London Health Sciences Center, London, Ontario, Canada; University of Western Ontario, Department of Clinical Neurological Sciences, Western University, 339 Windermere Road, London, Ontario, N6A 5A5, Canada.
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Effect of Various OR Noise on Fine Motor Skills, Cognition, and Mood. Surg Res Pract 2019; 2019:5372174. [PMID: 31355326 PMCID: PMC6637681 DOI: 10.1155/2019/5372174] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 05/29/2019] [Accepted: 06/26/2019] [Indexed: 11/18/2022] Open
Abstract
Background The amalgam of noises inherent to the modern-day operating room has the potential of diluting surgeon concentration, which could affect surgeon performance and mood and have implications on quality of care and surgeon resilience. Objective Evaluate the impact of operating room environmental noises on surgeon performance including fine motor dexterity, cognition, and mood. Methods 37 subjects were tested under three different environmental noise conditions including silence, a prerecorded soundtrack of a loud bustling operating room, and with background music of their choosing. We used the Motor Performance Series to test motor dexterity, neuropsychological tests to evaluate cognitive thinking, and Profile of Mood States to test mental well-being. Results Our results showed that typical operating room noise had no impact on motor dexterity but music improved the speed and precision of movements and information processing skills. Neurocognitive testing showed a significant decrement from operating room noise on verbal learning and delayed memory, whereas music improved complex attention and mental flexibility. The Profile of Mood States found that music resulted in a significant decrease in feelings of anger, confusion, fatigue, and tension along with decreased total mood disturbance, which is a measure of psychological distress. Loud operating room noise had a negative impact on feelings of vigor but no increase in total mood disturbance. Conclusion Our results suggest that loud and unnecessary environmental noises can be distracting to a surgeon, so every effort should be taken to minimize these. Music of the surgeons' choosing does not negatively affect fine motor dexterity or cognition and has an overall positive impact on mood and can therefore be safely practiced if desired.
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Perumal J, Fox RJ, Balabanov R, Balcer LJ, Galetta S, Makh S, Santra S, Hotermans C, Lee L. Outcomes of natalizumab treatment within 3 years of relapsing-remitting multiple sclerosis diagnosis: a prespecified 2-year interim analysis of STRIVE. BMC Neurol 2019; 19:116. [PMID: 31176355 PMCID: PMC6555913 DOI: 10.1186/s12883-019-1337-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 05/20/2019] [Indexed: 12/23/2022] Open
Abstract
Background STRIVE is a multicenter, observational, open-label, single-arm study of natalizumab in anti–JC virus (JCV) seronegative patients with early relapsing-remitting multiple sclerosis (RRMS). The objective of this prespecified 2-year interim analysis was to determine the effectiveness of natalizumab in establishing and maintaining no evidence of disease activity (NEDA) in early RRMS. Methods Patients aged 18–65 years had an RRMS diagnosis < 3 years prior to screening, an Expanded Disability Status Scale (EDSS) score ≤ 4.0, and anti-JCV antibody negative status. Magnetic resonance imaging was performed at baseline and yearly thereafter. Cumulative probabilities of 24-week–confirmed EDSS worsening and improvement were evaluated at 2 years. NEDA (no 24-week–confirmed EDSS worsening, no relapses, no gadolinium-enhancing lesions, and no new/newly enlarging T2-hyperintense lesions) was evaluated over 2 years. The Symbol Digit Modalities Test (SDMT) and Multiple Sclerosis Impact Score (MSIS-29) were assessed at baseline and 1 and 2 years. Statistical analysis used summary statistics and frequency distributions. Results The study population (N = 222) had early RRMS, with mean (standard deviation [SD]) time since diagnosis of 1.6 (0.77) years and mean (SD) baseline EDSS score of 2.0 (1.13). NEDA was achieved in 105 of 187 patients (56.1%) during year 1 and 120 of 163 (73.6%) during year 2. Over 2 years, 76 of 171 patients (44.4%) attained overall NEDA. Probabilities of 24-week–confirmed EDSS worsening and improvement were 14.1% and 28.4%, respectively. After 2 years, patients exhibited significant improvements from baseline in SDMT (n = 158; mean [SD]: 4.3 [11.8]; p < 0.001) and MSIS-29 physical (n = 153; mean [SD]: − 3.9 [14.7]; p = 0.001), psychological (n = 152; mean [SD]: − 2.0 [7.9]; p < 0.001), and quality-of-life (n = 153; mean [SD]: − 6.0 [21.3]; p < 0.001) scores. Conclusions These results support natalizumab’s effectiveness over 2 years, during which nearly half of early RRMS patients achieved NEDA. During year 2, nearly 75% of patients exhibited NEDA. Over 2 years, patients continued to experience significant cognitive and quality-of-life benefits. These results are limited by the lack of a comparator group to determine the extent of a placebo effect. Trial registration clinicaltrials.gov, NCT01485003, registered 5 December 2011. Electronic supplementary material The online version of this article (10.1186/s12883-019-1337-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jai Perumal
- Weill Cornell Multiple Sclerosis Center, New York, NY, USA
| | - Robert J Fox
- Mellen Center for Multiple Sclerosis, Cleveland Clinic, Cleveland, OH, USA
| | | | - Laura J Balcer
- New York University School of Medicine, New York, NY, USA
| | - Steven Galetta
- New York University School of Medicine, New York, NY, USA
| | - Shavy Makh
- Biogen, 225 Binney St, Cambridge, MA, 02142, USA
| | | | | | - Lily Lee
- Biogen, 225 Binney St, Cambridge, MA, 02142, USA.
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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: 243] [Impact Index Per Article: 40.5] [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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Estimating Everyday Neuropsychological Functioning in Multiple Sclerosis: Reliability and Validity of the Greek Multiple Sclerosis Neuropsychological Questionnaire. Mult Scler Int 2018; 2018:6301535. [PMID: 30356376 PMCID: PMC6176322 DOI: 10.1155/2018/6301535] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 08/04/2018] [Accepted: 09/04/2018] [Indexed: 11/18/2022] Open
Abstract
The Multiple Sclerosis Neuropsychological Questionnaire is a brief screening questionnaire for the assessment of everyday neuropsychological competence of patients with Multiple Sclerosis. The aim of the present study was to examine psychometric properties of the Greek version of the instrument. One hundred and three MS patients and 60 informants participated in the present study and completed the questionnaire. From the initial patient sample, 51 participants completed broadly used neuropsychological tests and measures estimating cognitive failures and depression. Moreover, after a six-month interval the MSNQ was administered to 58 patients from the initial sample in order to explore test-retest reliability. Cronbach's α was 0.92 and 0.93 for patient and informant forms, respectively. The patient form was correlated significantly with measures of cognitive failures and depression. Low correlations were found between the informant form and performance on cognitive tests. In regard to the patient form, significant correlation was observed between repeated administrations and, psychometrically, the three-factor structure was preferable than the one-factor structure. The present study confirms the already established pattern of correlations among the two MSNQ forms, neuropsychological test performance and depression measurements. Additional research is needed in order to define a cut-off score for the MSNQ-I providing further information about the diagnostic interpretability of the instrument.
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Weinstock-Guttman B, Eckert S, Benedict RHB. A decline in cognitive function should lead to a change in disease-modifying therapy – Yes. Mult Scler 2018; 24:1681-1682. [DOI: 10.1177/1352458518783364] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Bianca Weinstock-Guttman
- Jacobs Comprehensive Center for Treatment and Research, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Svetlana Eckert
- Jacobs Comprehensive Center for Treatment and Research, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Ralph HB Benedict
- Jacobs Comprehensive Center for Treatment and Research, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, USA
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Abstract
Treatment options for progressive multiple sclerosis remain the main unmet need of the field. As the understanding of multiple sclerosis (MS) pathogenesis improves, new pathways and molecules will be tested for potential reparative, remyelinating, or neuroprotective effects. The clinical outcomes used will determine successful demonstration of beneficial treatment effects to regulatory agencies, clinicians, and persons with MS. This review focuses on clinical outcome measures including the Expanded Disability Status Scale, Multiple Sclerosis Functional Composite, and novel composite measures of disability. The paper also covers cognitive outcomes and screening tests for use in clinical trials. The growing importance of patient-reported outcomes and their suitability for clinical trials is also presented. The review aims to create consensus in regard to these topics and suggestions for future research.
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Affiliation(s)
- Daniel Ontaneda
- Mellen Center for Multiple Sclerosis Treatment and Research, Cleveland Clinic, Cleveland, OH, USA
| | - Jeffrey A Cohen
- Mellen Center for Multiple Sclerosis Treatment and Research, Cleveland Clinic, Cleveland, OH, USA
| | - Maria Pia Amato
- Department NEUROFARBA, Section Neurosciences, University of Florence, Florence, Italy
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Kuceyeski A, Monohan E, Morris E, Fujimoto K, Vargas W, Gauthier SA. Baseline biomarkers of connectome disruption and atrophy predict future processing speed in early multiple sclerosis. NEUROIMAGE-CLINICAL 2018; 19:417-424. [PMID: 30013921 PMCID: PMC6019863 DOI: 10.1016/j.nicl.2018.05.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 05/04/2018] [Accepted: 05/06/2018] [Indexed: 12/26/2022]
Abstract
The development of accurate prognoses in multiple sclerosis is difficult, as the disease is characterized by heterogeneous patterns of brain abnormalities that relate in an unclear way to future impairments. Here, we use a statistical modeling approach to determine if the baseline pattern of connectome disruption due to T2-FLAIR lesions could predict a patient's future processing speed, as measured using the Symbol Digits Modality Test scores. Imaging data, demographics and Symbol Digits Modality Test scores were collected from 61 early relapsing remitting multiple sclerosis patients. The Network Modification Tool was used to estimate damage to the connectome by quantifying white matter abnormalities' effects on 1) global network properties, 2) regional connectivity and 3) connectivity between pairs of regions. MS subjects showed significant improvement of processing speed between baseline and follow-up (t = −2.6, p = 0.0096); however, both baseline (t = −4.01, p = 0.00012) and follow-up (t = −2.10, p = 0.038) processing speed were significantly lower than age-matched healthy controls. Partial Least Squares Regression was used to create models that predict future processing speed from between baseline imaging metrics and demographics. The model based on region-pair disconnection and gray matter atrophy had the lowest AIC and highest prediction accuracy (R2 = 0.79) compared to models based on global (R2 = 0.41) or regional (R2 = 0.66) disconnection and gray matter atrophy, overlap with an ROI-based atlas and gray matter atrophy (R2 = 0.73) or gray matter atrophy alone (R2 = 0.71). We found that baseline measures of connectivity disruption in various parietal, temporal, occipital and subcortical regions and atrophy in the putamen were important predictors of future processing speed. We conclude that information about disruptions to pairwise brain connections is more informative of future processing speed than regional or global metrics or gray matter atrophy alone. The combination of quantitative disconnectome metrics, gray matter atrophy and statistical modeling approaches could enable clinicians in developing more accurate, individualized prognoses of future cognitive status in multiple sclerosis patients. Atrophy and structural disconnection estimates via NeMo Tool were collected in MS. Future cognitive functioning in MS patients was predicted by baseline MRI measures. Measures of atrophy and disconnection between region-pairs had best goodness-of-fit. More caudate atrophy was significantly predictive of worse future cognition. Disconnections in parietal/temporal/occipital areas predicted worse future cognition.
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Affiliation(s)
- A Kuceyeski
- Department of Radiology, Weill Cornell Medicine, New York, NY, USA; The Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY, USA.
| | - E Monohan
- Department of Neurology, Weill Cornell Medicine, New York, NY, USA
| | - E Morris
- Department of Neurology, Weill Cornell Medicine, New York, NY, USA
| | - K Fujimoto
- Department of Neurology, Weill Cornell Medicine, New York, NY, USA
| | - W Vargas
- Department of Neurology, Weill Cornell Medicine, New York, NY, USA
| | - S A Gauthier
- Department of Neurology, Weill Cornell Medicine, New York, NY, USA; The Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY, USA
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Benedict RHB, Cohan S, Lynch SG, Riester K, Wang P, Castro-Borrero W, Elkins J, Sabatella G. Improved cognitive outcomes in patients with relapsing-remitting multiple sclerosis treated with daclizumab beta: Results from the DECIDE study. Mult Scler 2018; 24:795-804. [PMID: 28485186 PMCID: PMC5971365 DOI: 10.1177/1352458517707345] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 04/05/2017] [Accepted: 04/07/2017] [Indexed: 12/24/2022]
Abstract
BACKGROUND Cognitive impairment is common in multiple sclerosis (MS), with cognitive processing speed being the most frequently affected domain. OBJECTIVE Examine the effects of daclizumab beta versus intramuscular (IM) interferon (IFN) beta-1a on cognitive processing speed as assessed by Symbol Digit Modalities Test (SDMT). METHODS In DECIDE, patients with relapsing-remitting multiple sclerosis (RRMS) (age: 18-55 years; Expanded Disability Status Scale (EDSS) score 0-5.0) were randomized to daclizumab beta ( n = 919) or IM IFN beta-1a ( n = 922) for 96-144 weeks. SDMT was administered at baseline and at 24-week intervals. RESULTS At week 96, significantly greater mean improvement from baseline in SDMT was observed with daclizumab beta versus IM IFN beta-1a ( p = 0.0274). Significantly more patients treated with daclizumab beta showed clinically meaningful improvement in SDMT (increase from baseline of ⩾3 points ( p = 0.0153) or ⩾4 points ( p = 0.0366)), and significantly fewer patients showed clinically meaningful worsening (decrease from baseline of ⩾3 points ( p = 0.0103)). Odds representing risk of worsening versus stability or improvement on SDMT were significantly smaller for daclizumab beta ( p = 0.0088 (3-point threshold); p = 0.0267 (4-point threshold)). In patients completing 144 weeks of treatment, the effects of daclizumab beta were generally sustained. CONCLUSION These results provide evidence for a benefit of daclizumab beta versus IM IFN beta-1a on cognitive processing speed in RRMS. TRIAL REGISTRATION ClinicalTrials.gov identifier NCT01064401 (Efficacy and Safety of BIIB019 (Daclizumab High Yield Process) Versus Interferon β 1a in Participants With Relapsing-Remitting Multiple Sclerosis (DECIDE)): https://clinicaltrials.gov/ct2/show/NCT01064401 .
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Affiliation(s)
- Ralph HB Benedict
- UBMD Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Stanley Cohan
- Providence Multiple Sclerosis Center, Providence Brain and Spine Institute, Portland, OR, USA
| | - Sharon G Lynch
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS, USA
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Benn BS, Lehman Z, Kidd SA, Miaskowski C, Sunwoo BY, Ho M, Sun S, Ramstein J, Gelfand JM, Koth LL. Sleep disturbance and symptom burden in sarcoidosis. Respir Med 2018; 144S:S35-S40. [PMID: 29628134 DOI: 10.1016/j.rmed.2018.03.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 02/11/2018] [Accepted: 03/19/2018] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Sarcoidosis is a systemic inflammatory disease associated with myriad symptoms, including fatigue. It can affect physiological processes like sleep, leading to poor sleep quality and excessive daytime sleepiness. We hypothesized that sarcoidosis patients would report more severe sleep disturbance than healthy controls and that relationships would be found with sleep disturbance and the severity of other symptoms. METHODS We enrolled 84 sarcoidosis patients and 30 healthy controls and recorded demographic and clinical characteristics. Self-report measures were used to assess sleep disturbance, psychosocial symptoms, and quality of life at enrollment and longitudinally. Relationships between different self-report outcomes were analyzed using correlation statistics. RESULTS Using the General Sleep Disturbance Scale, 54% of sarcoidosis patients reported frequent and occasional sleep disturbance compared to only 17% of healthy controls (p < 0.0001). This significant increase in sleep disturbance found in sarcoidosis patients strongly correlated with multiple psychosocial symptoms, including fatigue, depression, and cognitive dysfunction, and negatively impacted quality of life (p < 0.01). Traditional measures of sarcoidosis disease severity or activity were not associated with sleep disturbance. Sleep disturbance scores remained stable at follow-up (mean time between first and last administration of questionnaire was 17.3 months) in 56 of the sarcoidosis patients. CONCLUSIONS Sarcoidosis patients experienced significant sleep disturbance that correlated with higher levels of fatigue, depression, and cognitive dysfunction, and poorer quality of life. These associations were present regardless of disease severity or activity and result in decrements in quality of life and mental health.
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Affiliation(s)
- Bryan S Benn
- University of California, San Francisco, Division of Pulmonary and Critical Care, 505 Parnassus Ave, San Francisco, CA 94143, USA
| | - Zoe Lehman
- University of California, San Francisco, Division of Pulmonary and Critical Care, 505 Parnassus Ave, San Francisco, CA 94143, USA
| | - Sharon A Kidd
- University of California, San Francisco, Division of Pulmonary and Critical Care, 505 Parnassus Ave, San Francisco, CA 94143, USA
| | - Christine Miaskowski
- University of California, San Francisco, Department of Physiological Nursing, 2 Koret Way, San Francisco, CA 94143, USA
| | - Bernie Y Sunwoo
- University of California, San Francisco, Division of Pulmonary and Critical Care, 505 Parnassus Ave, San Francisco, CA 94143, USA
| | - Melissa Ho
- University of California, San Francisco, Division of Pulmonary and Critical Care, 505 Parnassus Ave, San Francisco, CA 94143, USA
| | - Sara Sun
- University of California, San Francisco, Division of Pulmonary and Critical Care, 505 Parnassus Ave, San Francisco, CA 94143, USA
| | - Joris Ramstein
- University of California, San Francisco, Division of Pulmonary and Critical Care, 505 Parnassus Ave, San Francisco, CA 94143, USA
| | - Jeffrey M Gelfand
- University of California, San Francisco, Department of Neurology, Multiple Sclerosis and Neuroinflammation Center, 1500 Owens Street, San Francisco, CA 94158, USA
| | - Laura L Koth
- University of California, San Francisco, Division of Pulmonary and Critical Care, 505 Parnassus Ave, San Francisco, CA 94143, USA.
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Grzegorski T, Losy J. Cognitive impairment in multiple sclerosis - a review of current knowledge and recent research. Rev Neurosci 2018; 28:845-860. [PMID: 28787275 DOI: 10.1515/revneuro-2017-0011] [Citation(s) in RCA: 95] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 05/19/2017] [Indexed: 11/15/2022]
Abstract
Multiple sclerosis (MS) is a chronic, progressive disease of the central nervous system that is characterised by inflammatory damage to the myelin sheath. Though often neglected, cognitive impairment is a common feature of MS that affects 43-70% of patients. It has a sophisticated neuroanatomic and pathophysiologic background and disturbs such vital cognitive domains as speed of information processing, memory, attention, executive functions and visual perceptual functions. In recent years there has been growing interest in neuroimaging findings with regard to cognitive impairment in MS. The possible options of managing cognitive dysfunction in MS are pharmacologic interventions, cognitive rehabilitation and exercise training; however, not enough evidence has been presented in this field. The aim of our article is to provide current knowledge on cognitive impairment in MS based on the most recent scientific results and conclusions with regard to affected cognitive domains, neuropsychological assessment, underlying mechanisms of this disturbance, neuroimaging findings and therapeutic options.
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Sejbæk T, Blaabjerg M, Sprogøe P, Ravnborg M. Reliability and Validity of a Danish Version of the Multiple Sclerosis Neuropsychological Screening Questionnaire. Int J MS Care 2018; 20:49-54. [PMID: 29507543 DOI: 10.7224/1537-2073.2017-011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background More than half of all patients with multiple sclerosis (MS) acquire cognitive impairment as part of their disease progression. Because cognitive dysfunction adds substantially to disability and coping strategies, a cost-effective screening tool is needed for cognitive impairment. The Multiple Sclerosis Neuropsychological Screening Questionnaire (MSNQ) has previously shown good validity in American, Argentinean, and Dutch MS cohorts. We sought to test reliability and validity of a Danish translation of the MSNQ compared with formal neuropsychological testing, and measures of depression and disability, and to compare self-reported cognition with Symbol Digit Modalities Test (SDMT) results. Methods Of 126 patients with MS and their informants tested with the MSNQ, 77 also underwent formal neuropsychological testing. All patients were tested with the SDMT and assessed clinically using the Expanded Disability Status Scale and MS Impairment Scale. Results The test-retest reliability of the MSNQ-P was significant (R2 = 0.79, P < .0001). R2 of informants (MSNQ-I) and patients (MSNQ-P) was much lower (R2 = 0.22, P < .0001). Compared with formal neuropsychological testing, the MSNQ-P and MSNQ-I performed poorly, with no correlation to individual neuropsychological tests, combined neuropsychological tests, or disability scores (Expanded Disability Status Scale and MS Impairment Scale). Depression/anxiety (Beck Depression Inventory) showed a weak linear relationship (R2 = 0.25, P < .0001), suggesting that the MSNQ-P measures these items more than the cognitive abilities of the patients. Conclusions This study does not support use of the MSNQ as a sensitive or valid screening tool for cognitive impairment in Danish patients with MS.
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Edwards JD, Fausto BA, Tetlow AM, Corona RT, Valdés EG. Systematic review and meta-analyses of useful field of view cognitive training. Neurosci Biobehav Rev 2018; 84:72-91. [DOI: 10.1016/j.neubiorev.2017.11.004] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 11/04/2017] [Accepted: 11/06/2017] [Indexed: 12/30/2022]
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Morrow SA, Rosehart H, Sener A, Welk B. Anti-cholinergic medications for bladder dysfunction worsen cognition in persons with multiple sclerosis. J Neurol Sci 2017; 385:39-44. [PMID: 29406911 DOI: 10.1016/j.jns.2017.11.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 10/26/2017] [Accepted: 11/21/2017] [Indexed: 12/26/2022]
Abstract
Bladder dysfunction is common in persons with MS (PwMS), often due to detrusor muscle overactivity. Anticholinergic medications are considered the first line treatment for bladder dysfunction and are known to worsen cognition in healthy older adults and in persons with dementia. Yet, it is not known if these medications have the same effect on PwMS. Thus, the Objective of this prospective matched-cohort study was to determine if anticholinergic medications affect objective measures of cognition in PwMS. We recruited PwMS starting either oxybutynin or tolterodine (cases). Cases and controls were tested with the Brief International Cognitive Assessment for MS (BiCAMS) battery prior to starting anticholinergic medications and 12weeks later. The primary outcome was change on the Symbol Digit Modalities Test (SDMT) between groups; secondary outcomes were changes on the other BiCAMS measures. Analysis of Covariance with baseline measures as covariates to assess the significance of between group differences was performed at 12weeks. Forty eight PwMS starting anticholinergic medications and 21 matched PwMS controls were recruited. There was a significant difference (p<0.001) in the change on the cognitive measures over 12weeks between groups. The controls demonstrated improvement, consistent with practice effect, while the cases remained unchanged. This study demonstrates that anticholinergic medications may have a negative effect on cognition in PwMS; further confirmatory studies are needed.
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Affiliation(s)
- Sarah A Morrow
- Department of Clinical Neurological Sciences, Western University, London Health Sciences Center, LHSC-UH, 339 Windermere Rd, London N6A 5A5, ON, Canada.
| | - Heather Rosehart
- Department of Clinical Neurological Sciences, London Health Sciences Center, London, ON, Canada
| | - Alp Sener
- Western University, London Health Sciences Center, London, ON, Canada
| | - Blayne Welk
- Department of Epidemiology and Biostatistics, Western University, London Health Sciences Center, London, ON, Canada
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Affiliation(s)
- Iris-Katharina Penner
- Neurology Department, Medical Faculty, Heinrich Heine University, Moorenstrasse 5, 40225 Düsseldorf, Germany
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Cohen M, Brochet B, Clavelou P, Le Page E, Vermersch P, Tourbah A, Moreau T, Joly H, Sakarovitch C, Lebrun C. Cognition and quality of life in clinically isolated syndrome patients starting a disease modifying therapy in the QUALICIS study may not predict treatment response at one year. J Neurol Sci 2017; 382:73-78. [PMID: 29111024 DOI: 10.1016/j.jns.2017.09.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 09/01/2017] [Accepted: 09/20/2017] [Indexed: 11/26/2022]
Abstract
Cognition and health-related quality of life (HRQoL) are early involved in multiple sclerosis (MS). The aim of QUALICIS study was to monitor cognition and HRQoL prospectively in a cohort of clinically isolated syndrome (CIS) patients starting a treatment with subcutaneous beta-1b interferon as a first disease modifying treatment (DMT), and to assess their correlation with the clinical outcome 6years later. Relapse history, EDSS and yearly standardized brain MRI data were also collected. 37 patients were included. Cognition and HRQoL remained stable over treatment period. At baseline, we found that SDMT was moderately correlated to T2 lesion load (r=-0.47, p=0.04). Baseline SDMT was predictive of HRQoL at year 2 (r=0.53, p=0.02). Regarding 6-year outcome, the most specific predictive factor of favorable outcome was achieving "No Evidence of Disease Activity" (NEDA) status at year 1. In this group, all the patients had a stable EDSS score and none switched to a second line therapy. In the "non-NEDA" group, 44% of patients experienced EDSS worsening and 38.9% switched to a second line therapy. The number of gadolinium enhancing lesions on baseline scan was the only predictive factor of poor outcome in this subgroup of patients (2 vs. 0.13, p=0.03). Our results suggest that NEDA at 1year could be used to predict long term outcome after initiation of DMT in CIS. For non-NEDA patients, monitoring SDMT and brain atrophy could be potentially relevant, but this should be confirmed on a larger sample.
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Affiliation(s)
- Mikael Cohen
- Université Côte d'Azur, Hôpital Pasteur 2, Centre Hospitalier Universitaire de Nice, Service de Neurologie, Nice, France.
| | - Bruno Brochet
- Service de Neurologie, CHU de Bordeaux, Bordeaux, France; INSERM U1215-Labex TRAIL-FHU TALISMAN, France; Univ-Bordeaux, France
| | - Pierre Clavelou
- Service de Neurologie, CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | | | - Patrick Vermersch
- Service de Neurologie, Univ Lille, CHU Lille, LIRIC - INSERM U995, FHU Imminent, F-59037 Lille, France
| | - Ayman Tourbah
- Service de Neurologie et Faculté de Médecine de Reims, CHU de Reims, URCA, Reims, France; LPN EA 207, Université Paris 8, Saint-Denis, France
| | | | - Héloïse Joly
- Université Côte d'Azur, Hôpital Pasteur 2, Centre Hospitalier Universitaire de Nice, Service de Neurologie, Nice, France
| | - Charlotte Sakarovitch
- Département de la Recherche Clinique, Université Côte d'Azur, Hôpital de Cimiez, Centre Hospitalier Universitaire de Nice, Nice, France
| | - Christine Lebrun
- Université Côte d'Azur, Hôpital Pasteur 2, Centre Hospitalier Universitaire de Nice, Service de Neurologie, Nice, France
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Shaw MT, Pawlak NO, Frontario A, Sherman K, Krupp LB, Charvet LE. Adverse Childhood Experiences Are Linked to Age of Onset and Reading Recognition in Multiple Sclerosis. Front Neurol 2017. [PMID: 28626445 PMCID: PMC5454080 DOI: 10.3389/fneur.2017.00242] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Adverse childhood experiences (ACEs) exert a psychological and physiological toll that increases risk of chronic conditions, poorer social functioning, and cognitive impairment in adulthood. Objective To investigate the relationship between childhood adversity and clinical disease features in multiple sclerosis (MS). Methods Sixty-seven participants with MS completed the ACE assessment and neuropsychological assessments as part of a larger clinical trial of cognitive remediation. Results Adverse childhood experience scores, a measure of exposure to adverse events in childhood, significantly predicted age of MS onset (r = –0.30, p = 0.04). ACEs were also linked to reading recognition (a proxy for premorbid IQ) (r = –0.25, p = 0.04). ACE scores were not related to age, current disability, or current level of cognitive impairment measured by the Symbol Digit Modalities Test (SDMT). Conclusion Childhood adversity may increase the likelihood of earlier age of onset and poorer estimated premorbid IQ in MS.
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Affiliation(s)
- Michael T Shaw
- Department of Neurology, NYU Langone Medical Center, New York, NY, United States
| | - Natalie O Pawlak
- Department of Neurology, NYU Langone Medical Center, New York, NY, United States
| | - Ariana Frontario
- Lake Erie College of Osteopathic Medicine, Erie, PA, United States
| | - Kathleen Sherman
- Department of Neurology, NYU Langone Medical Center, New York, NY, United States
| | - Lauren B Krupp
- Department of Neurology, NYU Langone Medical Center, New York, NY, United States
| | - Leigh E Charvet
- Department of Neurology, NYU Langone Medical Center, New York, NY, United States
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Benedict RH, DeLuca J, Phillips G, LaRocca N, Hudson LD, Rudick R. Validity of the Symbol Digit Modalities Test as a cognition performance outcome measure for multiple sclerosis. Mult Scler 2017; 23:721-733. [PMID: 28206827 PMCID: PMC5405816 DOI: 10.1177/1352458517690821] [Citation(s) in RCA: 521] [Impact Index Per Article: 74.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Cognitive and motor performance measures are commonly employed in multiple sclerosis (MS) research, particularly when the purpose is to determine the efficacy of treatment. The increasing focus of new therapies on slowing progression or reversing neurological disability makes the utilization of sensitive, reproducible, and valid measures essential. Processing speed is a basic elemental cognitive function that likely influences downstream processes such as memory. The Multiple Sclerosis Outcome Assessments Consortium (MSOAC) includes representatives from advocacy organizations, Food and Drug Administration (FDA), European Medicines Agency (EMA), National Institute of Neurological Disorders and Stroke (NINDS), academic institutions, and industry partners along with persons living with MS. Among the MSOAC goals is acceptance and qualification by regulators of performance outcomes that are highly reliable and valid, practical, cost-effective, and meaningful to persons with MS. A critical step for these neuroperformance metrics is elucidation of clinically relevant benchmarks, well-defined degrees of disability, and gradients of change that are deemed clinically meaningful. This topical review provides an overview of research on one particular cognitive measure, the Symbol Digit Modalities Test (SDMT), recognized as being particularly sensitive to slowed processing of information that is commonly seen in MS. The research in MS clearly supports the reliability and validity of this test and recently has supported a responder definition of SDMT change approximating 4 points or 10% in magnitude.
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Affiliation(s)
- Ralph Hb Benedict
- Department of Neurology and Buffalo General Medical Center, University at Buffalo, Buffalo, NY, USA
| | - John DeLuca
- Kessler Foundation, West Orange, NJ, USA; Rutgers New Jersey Medical School, Newark, NJ, USA
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- Multiple Sclerosis Outcome Assessments Consortium (MSOAC), Critical Path Institute, Tucson, AZ, USA
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Dahdaleh M, Alroughani R, Aljumah M, AlTahan A, Alsharoqi I, Bohlega SA, Daif A, Deleu D, Inshasi J, Karabudak R, Sahraian MA, Taha K, Yammout BI, Zakaria M. Intervening to reduce the risk of future disability from multiple sclerosis: are we there yet? Int J Neurosci 2017; 127:944-951. [PMID: 28029270 DOI: 10.1080/00207454.2016.1277424] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Disease-modifying therapies (DMTs) delay or may prevent the progression of patients with high-risk clinically isolated syndrome (CIS) to clinically definite multiple sclerosis (MS), and from relapsing-remitting MS to secondary progressive MS. Current evidence on the effects of DMT on disability in MS is supported by the use of the Expanded Disability Status Scale (EDSS), which is dominated by ambulation, and usually used as a secondary outcome measure. Less is known about the long-term effects of DMTs on other aspects of functional status, particularly cognition, which is a key determinant of ability to work. The time scale for measurements of disability is at most a few years, with scant data from more than 10 years of observation. Longer prospective follow-up of large numbers of patients with CIS is needed to determine whether early intervention with a DMT influences long-term disease progression. Finally, the emergence of the radiologically isolated syndrome (RIS) as a clinical entity has shifted the debate about when to intervene to an even earlier time frame. Balancing the significant side-effects associated with DMT in general and the expected outcome of pharmacologic intervention is increasingly problematic for managing patients with uncertain prognosis, as many patients may have low-risk CIS, benign MS or patients with RIS only. Preventing long-term disability in MS should be recognised more clearly as an important outcome in its own right, with disability measured more consistently with more sensitive instruments beyond the use of the EDSS.
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Affiliation(s)
- Maurice Dahdaleh
- a Department of Internal Medicine, Neurology Section , Arab Medical Center and Khalidi Hospital , Amman , Jordan
| | - Raed Alroughani
- b Division of Neurology, Amiri Hospital, Kuwait and Division of Neurology , Dasman Diabetes Institute , Kuwait City , Kuwait
| | - Mohammed Aljumah
- c King Abdullah International Medical Research Center , King Saud Ben Abdulaziz University for Health Sciences, NGHA , Riyadh , Saudi Arabia.,d KFMC, Ministry of Health , Riyadh , Saudi Arabia
| | - Abdulrahman AlTahan
- e Neurology Section , King Khalid University Hospital, King Saud University and Dallah Hospital , Riyadh , Saudi Arabia
| | - Issa Alsharoqi
- f Clinical Neurosciences Department , Salmaniya Medical Complex , Manama , Bahrain
| | - Saeed A Bohlega
- g Department of Neurosciences , King Faisal Specialist Hospital and Research Centre , Riyadh , Saudi Arabia
| | - Abdulkader Daif
- h Neurology Division, King Khalid University Hospital , King Saud University , Riyadh , Saudi Arabia
| | - Dirk Deleu
- i Department of Neurology (Medicine) , Hamad Medical Corporation , Doha , Qatar
| | - Jihad Inshasi
- j Neurology Department, Rashid Hospital and Dubai Medical College , Dubai Health Authority , Dubai , United Arab Emirates
| | - Rana Karabudak
- k Department of Neurology, Neuroimmunology Unit , Hacettepe University Hospitals , Ankara , Turkey
| | - Mohammed A Sahraian
- l MS Research Center , Neuroscience Institute, Tehran University of Medical Sciences , Tehran , Iran
| | - Karim Taha
- m Merck Serono Intercontinental Region , Dubai , United Arab Emirates
| | - Bassem I Yammout
- n Multiple Sclerosis Center , American University of Beirut Medical Center , Beirut , Lebanon
| | - Magd Zakaria
- o Neuropsychiatric Department, Faculty of Medicine , Ain Shams University , Egypt
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Rao SM, Losinski G, Mourany L, Schindler D, Mamone B, Reece C, Kemeny D, Narayanan S, Miller DM, Bethoux F, Bermel RA, Rudick R, Alberts J. Processing speed test: Validation of a self-administered, iPad®-based tool for screening cognitive dysfunction in a clinic setting. Mult Scler 2017; 23:1929-1937. [DOI: 10.1177/1352458516688955] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Cognitive dysfunction is common in multiple sclerosis (MS) patients and has important consequences for daily activities, yet, unlike motor function, is not routinely assessed in the clinic setting. We developed the Processing Speed Test (PST), a self-administered iPad®-based tool to measure MS-related deficits in processing speed. Objective: To determine whether the PST is valid for screening cognitive dysfunction by comparing it to the paper-and-pencil Symbol Digit Modalities Test (SDMT). Methods: We assessed PST test–retest reliability, sensitivity of PST and SDMT in discriminating MS patients from healthy controls (HC), convergent validity between PST and SDMT, correlations between T2 lesion load and PST and SDMT, and PST performance with and without technician present during administration. Results: PST had excellent test–retest reliability, was highly correlated with SDMT, was slightly more sensitive than SDMT in discriminating MS from HC groups, and correlated better with cerebral T2 lesion load than did SDMT. Finally, PST performance was no different with or without a technician in the testing environment. Conclusion: PST has advantages over SDMT because of its efficient administration, scoring, and potential for medical record or research database integration. PST is a practical tool for routine screening of processing speed deficits in the MS clinic.
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Affiliation(s)
- Stephen M Rao
- Schey Center for Cognitive Neuroimaging, Lou Ruvo Center for Brain Health, Neurological Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Genna Losinski
- Schey Center for Cognitive Neuroimaging, Lou Ruvo Center for Brain Health, Neurological Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Lyla Mourany
- Schey Center for Cognitive Neuroimaging, Lou Ruvo Center for Brain Health, Neurological Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - David Schindler
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | | | - Christine Reece
- Schey Center for Cognitive Neuroimaging, Lou Ruvo Center for Brain Health, Neurological Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Danielle Kemeny
- Schey Center for Cognitive Neuroimaging, Lou Ruvo Center for Brain Health, Neurological Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Sridar Narayanan
- McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, Montreal, QC, Canada
| | - Deborah M Miller
- Mellen Center for Multiple Sclerosis Treatment and Research, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Francois Bethoux
- Mellen Center for Multiple Sclerosis Treatment and Research, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Robert A Bermel
- Mellen Center for Multiple Sclerosis Treatment and Research, Cleveland Clinic Foundation, Cleveland, OH, USA
| | | | - Jay Alberts
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
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