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Akbarian F, Rossi C, Costers L, D'hooghe MB, D'haeseleer M, Nagels G, Van Schependom J. Stimulus-related modulation in the 1/f spectral slope suggests an impaired inhibition during a working memory task in people with multiple sclerosis. Mult Scler 2024:13524585241253777. [PMID: 38767227 DOI: 10.1177/13524585241253777] [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: 05/22/2024]
Abstract
BACKGROUND An imbalance of excitatory and inhibitory synaptic transmission in multiple sclerosis (MS) may lead to cognitive impairment, such as impaired working memory. The 1/f slope of electroencephalography/magnetoencephalography (EEG/MEG) power spectra is shown to be a non-invasive proxy of excitation/inhibition balance. A flatter slope is associated with higher excitation/lower inhibition. OBJECTIVES To assess the 1/f slope modulation induced by stimulus and its association with behavioral and cognitive measures. METHODS We analyzed MEG recordings of 38 healthy controls (HCs) and 79 people with multiple sclerosis (pwMS) while performing an n-back task including target and distractor stimuli. Target trials require an answer, while distractor trials do not. We computed the 1/f spectral slope through the fitting oscillations and one over f (FOOOF) algorithm within the time windows 1 second before and after each stimulus presentation. RESULTS We observed a flatter 1/f slope after distractor stimuli in pwMS compared to HCs. The 1/f slope was significantly steeper after stimulus for both HCs and pwMS and was significantly correlated with reaction times. This modulation in 1/f slope was significantly correlated with visuospatial memory assessed by the BVMT-R test. CONCLUSION Our results suggest possible inhibitory mechanism deficits in pwMS during a working memory task.
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Affiliation(s)
- Fahimeh Akbarian
- Department of Electronics and Informatics (ETRO), Vrije Universiteit Brussel, Brussels, Belgium
- AIMS Lab, Center for Neurosciences, Vrije Universiteit Brussel, Brussels, Belgium
| | - Chiara Rossi
- Department of Electronics and Informatics (ETRO), Vrije Universiteit Brussel, Brussels, Belgium
- AIMS Lab, Center for Neurosciences, Vrije Universiteit Brussel, Brussels, Belgium
| | - Lars Costers
- AIMS Lab, Center for Neurosciences, Vrije Universiteit Brussel, Brussels, Belgium; icometrix, Leuven, Belgium
| | | | - Miguel D'haeseleer
- National MS Center Melsbroek, Melsbroek, Belgium; Department of Neurology, UZ Brussel, Brussels, Belgium
| | - Guy Nagels
- AIMS Lab, Center for Neurosciences, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Neurology, UZ Brussel, Brussels, Belgium
- St Edmund Hall, University of Oxford, Oxford, UK
| | - Jeroen Van Schependom
- Department of Electronics and Informatics (ETRO), Vrije Universiteit Brussel, Brussels, Belgium
- AIMS Lab, Center for Neurosciences, Vrije Universiteit Brussel, Brussels, Belgium
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Morrow SA, Baldwin C, Alkabie S. Importance of Identifying Cognitive Impairment in Multiple Sclerosis. Can J Neurol Sci 2023; 50:813-819. [PMID: 36503630 DOI: 10.1017/cjn.2022.334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
This article aims to highlight the impact of cognitive impairment on outcomes and quality of life for people with multiple sclerosis (MS) and to review current evidence for the efficacy of disease-modifying therapies (DMTs) and other interventions. In addition, we provide clinical practice insights regarding screening and management of cognitive impairment in people with MS. Evidence suggests that cognitive deterioration often accompanies magnetic resonance imaging changes. Neocortical volume and deep grey matter atrophy correlate with cognitive impairment. Similarly, cognitive decline is predictive of a higher lesion burden. Cognitive impairment is an important clinical measure of disability and negatively impacts quality of life. Phase 3 studies suggest that DMTs such as natalizumab, ozanimod and fingolimod may provide long-lasting, clinically meaningful effects on cognition in people with MS. Further data are needed to support the use of adjunct cognitive behavioural and exercise interventions for people with MS who have cognitive impairment. More data are needed to define appropriate management strategies for cognitive impairment in people with MS. Baseline and periodic screening for cognitive impairment and inclusion of cognitive impairment as a clinical trial endpoint will help to inform efforts to manage this important aspect of MS.
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Affiliation(s)
- Sarah A Morrow
- London Multiple Sclerosis Clinic, London Health Sciences Centre, University Hospital, Department of Clinical Neurological Sciences, Western University, London, ON, Canada
| | - Chantal Baldwin
- London Multiple Sclerosis Clinic, London Health Sciences Centre, University Hospital, Department of Clinical Neurological Sciences, Western University, London, ON, Canada
| | - Samir Alkabie
- London Multiple Sclerosis Clinic, London Health Sciences Centre, University Hospital, Department of Clinical Neurological Sciences, Western University, London, ON, Canada
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Grigorescu C, Chalah MA, Ayache SS, Palm U. [Alexithymia in Multiple Sclerosis - Narrative Review]. FORTSCHRITTE DER NEUROLOGIE-PSYCHIATRIE 2023; 91:404-413. [PMID: 35948023 DOI: 10.1055/a-1882-6544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Alexithymia is a multidimensional construct of personality implicating difficulties in identifying and describing another's feelings, and externally oriented thinking. It is broadly reported in psychiatric patients but has gained little attention regarding its occurrence and pathophysiology in multiple sclerosis (MS). This narrative review aims to address prevalence, etiology, neurobiological, and clinical findings of alexithymia. The prevalence of alexithymia in MS ranges from 10 to 53%. There seems to be an association with anxiety, depression, fatigue, and some aspects of social cognition, while the relationship with clinical and classical cognitive variables was rarely evaluated. Only a few studies referred to its pathophysiology assuming an aberrant interhemispheric transfer or regional cerebral abnormalities. The prevalence of alexithymia in MS and the potential negative impact on quality of life and interpersonal communication could severely impact clinical MS management and a screnning for these factors should be mandatory. Thus, further evaluation is needed concerning its relationship with clinical, emotional, and cognitive confounders. Large-scale studies employing neuroimaging techniques are needed for a better understanding of the neural underpinnings of this MS feature.
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Affiliation(s)
- Christina Grigorescu
- Klinik für Psychiatrie und Psychotherapie, Klinikum der Universität München, München
| | - Moussa A Chalah
- EA 4391, Excitabilité Nerveuse et Thérapeutique, Université Paris-Est-Créteil, Créteil, France
- Service de Physiologie - Explorations Fonctionnelles, Hôpital Henri Mondor, Assistance Publique - Hôpitaux de Paris, Créteil, France
| | - Samar S Ayache
- EA 4391, Excitabilité Nerveuse et Thérapeutique, Université Paris-Est-Créteil, Créteil, France
- Service de Physiologie - Explorations Fonctionnelles, Hôpital Henri Mondor, Assistance Publique - Hôpitaux de Paris, Créteil, France
| | - Ulrich Palm
- Klinik für Psychiatrie und Psychotherapie, Klinikum der Universität München, München
- Medical Park Chiemseeblick, Bernau a. Chiemsee
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de Villers-Sidani É, Voss P, Bastien N, Cisneros-Franco JM, Hussein S, Mayo NE, Koch NA, Drouin-Picaro A, Blanchette F, Guitton D, Giacomini PS. Oculomotor analysis to assess brain health: preliminary findings from a longitudinal study of multiple sclerosis using novel tablet-based eye-tracking software. Front Neurol 2023; 14:1243594. [PMID: 37745656 PMCID: PMC10516298 DOI: 10.3389/fneur.2023.1243594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 08/07/2023] [Indexed: 09/26/2023] Open
Abstract
A growing body of evidence supports the link between eye movement anomalies and brain health. Indeed, the oculomotor system is composed of a diverse network of cortical and subcortical structures and circuits that are susceptible to a variety of degenerative processes. Here we show preliminary findings from the baseline measurements of an ongoing longitudinal cohort study in MS participants, designed to determine if disease and cognitive status can be estimated and tracked with high accuracy based on eye movement parameters alone. Using a novel gaze-tracking technology that can reliably and accurately track eye movements with good precision without the need for infrared cameras, using only an iPad Pro embedded camera, we show in this cross-sectional study that several eye movement parameters significantly correlated with clinical outcome measures of interest. Eye movement parameters were extracted from fixation, pro-saccade, anti-saccade, and smooth pursuit visual tasks, whereas the clinical outcome measures were the scores of several disease assessment tools and standard cognitive tests such as the Expanded Disability Status Scale (EDSS), Brief International Cognitive Assessment for MS (BICAMS), the Multiple Sclerosis Functional Composite (MSFC) and the Symbol Digit Modalities Test (SDMT). Furthermore, partial least squares regression analyses show that a small set of oculomotor parameters can explain up to 84% of the variance of the clinical outcome measures. Taken together, these findings not only replicate previously known associations between eye movement parameters and clinical scores, this time using a novel mobile-based technology, but also the notion that interrogating the oculomotor system with a novel eye-tracking technology can inform us of disease severity, as well as the cognitive status of MS participants.
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Affiliation(s)
- Étienne de Villers-Sidani
- Innodem Neurosciences, Montreal, QC, Canada
- Montreal Neurological Institute, McGill University, Montreal, QC, Canada
| | - Patrice Voss
- Innodem Neurosciences, Montreal, QC, Canada
- Montreal Neurological Institute, McGill University, Montreal, QC, Canada
| | | | - J. Miguel Cisneros-Franco
- Innodem Neurosciences, Montreal, QC, Canada
- Montreal Neurological Institute, McGill University, Montreal, QC, Canada
| | | | - Nancy E. Mayo
- Faculty of Medicine, School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
| | - Nils A. Koch
- Innodem Neurosciences, Montreal, QC, Canada
- Integrated Program in Neuroscience, McGill University, Montreal, QC, Canada
| | | | | | - Daniel Guitton
- Montreal Neurological Institute, McGill University, Montreal, QC, Canada
| | - Paul S. Giacomini
- Innodem Neurosciences, Montreal, QC, Canada
- Montreal Neurological Institute, McGill University, Montreal, QC, Canada
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Azzimonti M, Preziosa P, Pagani E, Valsasina P, Tedone N, Vizzino C, Rocca MA, Filippi M. Functional and structural brain MRI changes associated with cognitive worsening in multiple sclerosis: a 3-year longitudinal study. J Neurol 2023; 270:4296-4308. [PMID: 37202603 DOI: 10.1007/s00415-023-11778-z] [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: 03/20/2023] [Revised: 05/08/2023] [Accepted: 05/11/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND Heterogeneous processes may contribute to cognitive impairment in multiple sclerosis (MS). OBJECTIVE To apply a longitudinal multiparametric MRI approach to identify mechanisms associated with cognitive worsening in MS patients. METHODS 3 T brain functional and structural MRI scans were acquired at baseline and after a median follow-up of 3.4 years in 35 MS patients and 22 healthy controls (HC). Associations between cognitive worsening (reliable change index score < - 1.25 at the Rao's battery) and longitudinal changes in regional T2-hyperintense white matter (WM) lesions, diffusion tensor microstructural WM damage, gray matter (GM) atrophy and resting state (RS) functional connectivity (FC) were explored. RESULTS At follow-up, HC showed no clusters of significant microstructural WM damage progression, GM atrophy or changes in RS FC. At follow-up, 10 MS patients (29%) showed cognitive worsening. Compared to cognitively stable, cognitively worsened MS patients showed more severe GM atrophy of the right anterior cingulate cortex and bilateral supplementary motor area (p < 0.001). Cognitively worsened vs cognitively stable MS patients showed also decreased RS FC in the right hippocampus of the right working memory network and in the right insula of the default mode network. Increased RS FC in the left insula of the executive control network was found in the opposite comparison (p < 0.001). No significant regional accumulation of focal WM lesions nor microstructural WM abnormalities occurred in both patients' groups. CONCLUSIONS GM atrophy progression in cognitively relevant brain regions combined with functional impoverishment in networks involved in cognitive functions may represent the substrates underlying cognitive worsening in MS.
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Affiliation(s)
- Matteo Azzimonti
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Paolo Preziosa
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Elisabetta Pagani
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
| | - Paola Valsasina
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
| | - Nicolò Tedone
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
| | - Carmen Vizzino
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
| | - Maria A Rocca
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy.
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
- Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
- Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy.
- Vita-Salute San Raffaele University, Milan, Italy.
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De Cock A, Van Ranst A, Costers L, Keytsman E, D'Hooghe MB, D'Haeseleer M, Nagels G, Van Schependom J. Reduced alpha2 power is associated with slowed information processing speed in multiple sclerosis. Eur J Neurol 2023; 30:2793-2800. [PMID: 37326133 DOI: 10.1111/ene.15927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 06/08/2023] [Accepted: 06/12/2023] [Indexed: 06/17/2023]
Abstract
OBJECTIVE Cognitive impairment is common in multiple sclerosis (MS), significantly impacts daily functioning, is time-consuming to assess, and is prone to practice effects. We examined whether the alpha band power measured with magnetoencephalography (MEG) is associated with the different cognitive domains affected by MS. METHODS Sixty-eight MS patients and 47 healthy controls underwent MEG, T1- and FLAIR-weighted magnetic resonance imaging (MRI), and neuropsychological testing. Alpha power in the occipital cortex was quantified in the alpha1 (8-10 Hz) and alpha2 (10-12 Hz) bands. Next, we performed best subset regression to assess the added value of neurophysiological measures to commonly available MRI measures. RESULTS Alpha2 power significantly correlated with information processing speed (p < 0.001) and was always retained in all multilinear models, whereas thalamic volume was retained in 80% of all models. Alpha1 power was correlated with visual memory (p < 0.001) but only retained in 38% of all models. CONCLUSIONS Alpha2 (10-12 Hz) power in rest is associated with IPS, independent of standard MRI parameters. This study stresses that a multimodal assessment, including structural and functional biomarkers, is likely required to characterize cognitive impairment in MS. Resting-state neurophysiology is thus a promising tool to understand and follow up changes in IPS.
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Affiliation(s)
- Alexander De Cock
- Nationaal Multiple Sclerose Centrum, Melsbroek, Belgium
- Center for Neurosciences (C4N), Vrije Universiteit Brussel (VUB), Brussels, Belgium
- AIMS Lab, Center for Neurosciences, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Alexander Van Ranst
- Neurology Department, Universitair Ziekenhuis Brussel, Brussels, Belgium
- Center for Neurosciences, Vrije Universiteit Brussel, Brussels, Belgium
| | - Lars Costers
- AIMS Lab, Center for Neurosciences, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Eva Keytsman
- AIMS Lab, Center for Neurosciences, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Marie B D'Hooghe
- Nationaal Multiple Sclerose Centrum, Melsbroek, Belgium
- Neurology Department, Universitair Ziekenhuis Brussel, Brussels, Belgium
- Center for Neurosciences, Vrije Universiteit Brussel, Brussels, Belgium
| | - Miguel D'Haeseleer
- Nationaal Multiple Sclerose Centrum, Melsbroek, Belgium
- Neurology Department, Universitair Ziekenhuis Brussel, Brussels, Belgium
- Center for Neurosciences, Vrije Universiteit Brussel, Brussels, Belgium
| | - Guy Nagels
- Center for Neurosciences (C4N), Vrije Universiteit Brussel (VUB), Brussels, Belgium
- AIMS Lab, Center for Neurosciences, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium
- Neurology Department, Universitair Ziekenhuis Brussel, Brussels, Belgium
- Center for Neurosciences, Vrije Universiteit Brussel, Brussels, Belgium
- St Edmund Hall, University of Oxford, Oxford, UK
| | - Jeroen Van Schependom
- AIMS Lab, Center for Neurosciences, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Electronics and Informatics (ETRO), Vrije Universiteit Brussel, Brussels, Belgium
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Carlomagno V, Mirabella M, Lucchini M. Current Status of Oral Disease-Modifying Treatment Effects on Cognitive Outcomes in Multiple Sclerosis: A Scoping Review. Bioengineering (Basel) 2023; 10:848. [PMID: 37508875 PMCID: PMC10376579 DOI: 10.3390/bioengineering10070848] [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: 05/10/2023] [Revised: 06/30/2023] [Accepted: 07/10/2023] [Indexed: 07/30/2023] Open
Abstract
INTRODUCTION Cognitive impairment represents one of the most hidden and disabling clinical aspects of multiple sclerosis (MS). In this regard, the major challenges are represented by the need for a comprehensive and standardised cognitive evaluation of each patient, both at disease onset and during follow-up, and by the lack of clear-cut data on the effects of treatments. In the present review, we summarize the current evidence on the effects of the available oral disease-modifying treatments (DMTs) on cognitive outcome measures. MATERIALS AND METHODS In this systematised review, we extract all the studies that reported longitudinally acquired cognitive outcome data on oral DMTs in MS patients. RESULTS We found 29 studies that evaluated at least one oral DMT, including observational studies, randomised controlled trials, and their extension studies. Most of the studies (n = 20) evaluated sphingosine-1-phosphate (S1P) modulators, while we found seven studies on dimethyl fumarate, six on teriflunomide, and one on cladribine. The most frequently used cognitive outcome measures were SDMT and PASAT. Most of the studies reported substantial stability or mild improvement in cognitive outcomes in a short-time follow-up (duration of most studies ≤2 years). A few studies also reported MRI measures of brain atrophy. CONCLUSION Cognitive outcomes were evaluated only in a minority of prospective studies on oral DMTs in MS patients with variable findings. More solid and numerous data are present for the S1P modulators. A standardised cognitive evaluation remains a yet unmet need to better clarify the possible positive effect of oral DMTs on cognition.
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Affiliation(s)
- Vincenzo Carlomagno
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, UOC Neurologia, 00168 Rome, Italy
- Department of Neuroscience, Università Cattolica del Sacro Cuore, Centro di ricerca Sclerosi Multipla (CERSM), 00168 Rome, Italy
| | - Massimiliano Mirabella
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, UOC Neurologia, 00168 Rome, Italy
- Department of Neuroscience, Università Cattolica del Sacro Cuore, Centro di ricerca Sclerosi Multipla (CERSM), 00168 Rome, Italy
| | - Matteo Lucchini
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, UOC Neurologia, 00168 Rome, Italy
- Department of Neuroscience, Università Cattolica del Sacro Cuore, Centro di ricerca Sclerosi Multipla (CERSM), 00168 Rome, Italy
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8
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Niino M, Miyazaki Y, Altincatal A, Belviso N, Kanda M, Chinen I, Edwards M, de Moor C, Williams JR, Rao SM. Processing speed test: Results from a Japanese normative sample of healthy participants compared with a US normative sample. Clin Neurol Neurosurg 2023; 230:107790. [PMID: 37229953 DOI: 10.1016/j.clineuro.2023.107790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 05/09/2023] [Accepted: 05/13/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND The Processing Speed Test (PST), a validated iPad®-based cognitive screening test for MS, has been applied to the cognitive assessment of Japanese MS patients using US normative data. METHODS To develop PST normative data from Japanese healthy volunteers and compare the PST score distribution between Japanese and US healthy volunteers, 254 healthy Japanese-speaking volunteers were enrolled and stratified by age (20-65 years). Potential participants with a Mini-Mental State Examination score < 27 were excluded. PST raw scores (total correct) were from the Japan cohort and compared with age-restricted US normative data and propensity score-matched data created by matching sex, age, and educational level from a published study of 428 healthy participants. PST score distributions and standardized z-scores were compared using t-test and Kolmogorov-Smirnov test statistics. RESULTS The mean age of the Japan cohort was 44.1 years. The PST scores of Japanese volunteers were significantly different from those of the age-restricted (mean ± SD 61.8 ± 10.1 vs 53.7 ± 10.8; p < 0.001) and the propensity score-matched US cohort (62.1 ± 10.1 vs 53.3 ± 10.6; p < 0.001). CONCLUSION Regression analyses centered on US normative data could underestimate disease severity in Japanese MS patients, suggesting that separate normative data should be considered for each population sample.
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Affiliation(s)
- Masaaki Niino
- Department of Clinical Research, National Hospital Organization Hokkaido Medical Center, Sapporo, Japan.
| | - Yusei Miyazaki
- Department of Clinical Research, National Hospital Organization Hokkaido Medical Center, Sapporo, Japan
| | | | | | | | | | | | | | | | - Stephen M Rao
- Schey Center for Cognitive Neuroimaging, Lou Ruvo Center for Brain Health, Neurological Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
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9
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Cerna J, Edwards CG, Martell S, Athari Anaraki NS, Walk ADM, Robbs CM, Adamson BC, Flemming IR, Labriola L, Motl RW, Khan NA. Neuroprotective influence of macular xanthophylls and retinal integrity on cognitive function among persons with multiple sclerosis. Int J Psychophysiol 2023; 188:24-32. [PMID: 36907558 DOI: 10.1016/j.ijpsycho.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 03/02/2023] [Accepted: 03/07/2023] [Indexed: 03/13/2023]
Abstract
BACKGROUND No studies to date have examined if macular xanthophyll accumulation and retinal integrity are independently associated with cognitive function in individuals with multiple sclerosis (MS). This study explored whether macular xanthophyll accumulation and structural morphometry in the retina were associated with behavioral performance and neuroelectric function during a computerized cognitive task among persons with MS and healthy controls (HCs). METHODS 42 HCs and 42 individuals with MS aged 18-64 years were enrolled. Macular pigment optical density (MPOD) was measured using heterochromatic flicker photometry. Optic disc retinal nerve fiber layer (odRNFL), macular retinal nerve fiber layer, and total macular volume were assessed via optical coherence tomography. Attentional inhibition was assessed using an Eriksen flanker task while underlying neuroelectric function was recorded using event-related potentials. RESULTS Persons with MS had a slower reaction time, lower accuracy, and delayed P3 peak latency time during both congruent and incongruent trials compared with HCs. Within the MS group, MPOD explained variance in incongruent P3 peak latency, and odRNFL explained variance in congruent reaction time and congruent P3 peak latency. CONCLUSIONS Persons with MS exhibited poorer attentional inhibition and slower processing speed, yet higher MPOD and odRNFL levels were independently associated with greater attentional inhibition and faster processing speed among persons with MS. Future interventions are necessary to determine if improvements in these metrics may promote cognitive function among persons with MS.
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Affiliation(s)
- Jonathan Cerna
- Neuroscience Program, University of Illinois Urbana-Champaign, United States of America
| | | | - Shelby Martell
- Neuroscience Program, University of Illinois Urbana-Champaign, United States of America
| | | | - Anne D M Walk
- Department of Psychology, Eastern Illinois University, United States of America
| | | | - Brynn C Adamson
- Department of Kinesiology and Community Health, University of Illinois Urbana-Champaign, United States of America; Department of Health Sciences, University of Colorado Colorado Springs, United States of America; Multiple Sclerosis Research Collaborative, University of Illinois, Urbana, IL, United States of America
| | - Isabel R Flemming
- Department of Health Sciences, Central Michigan University, United States of America
| | - Leanne Labriola
- Surgery, University of Illinois College of Medicine, United States of America
| | - Robert W Motl
- Department of Kinesiology and Nutrition, University of Illinois Chicago, United States of America; Multiple Sclerosis Research Collaborative, University of Illinois, Urbana, IL, United States of America
| | - Naiman A Khan
- Neuroscience Program, University of Illinois Urbana-Champaign, United States of America; Department of Kinesiology and Community Health, University of Illinois Urbana-Champaign, United States of America; Division of Nutritional Sciences, University of Illinois Urbana-Champaign, United States of America; Multiple Sclerosis Research Collaborative, University of Illinois, Urbana, IL, United States of America.
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10
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Theodorsdottir A, Nielsen HH, Ravnborg MH, Illes Z. Patient reported outcomes in a secondary progressive MS cohort related to cognition, MRI and physical outcomes. Mult Scler Relat Disord 2023; 71:104550. [PMID: 36842312 DOI: 10.1016/j.msard.2023.104550] [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: 10/20/2022] [Revised: 01/03/2023] [Accepted: 02/02/2023] [Indexed: 02/07/2023]
Abstract
BACKGROUND Patient-reported outcomes (PROs) are increasingly being used as outcomes in secondary progressive multiple sclerosis (SPMS) trials. We examined how PROs reflect disease burden in SPMS. METHODS In this observational prospective study, 65 SPMS patients were examined by five different PROs (Fatigue Scale Motor Cognition (FSMC), Multiple Sclerosis Impact Scale version 2 (MSIS-29v2), 36-Item Short Form Health Survey version 2 (SF-36v2), EQ-5D-5L and Work Productivity and Activity Impairment Questionnaire: Multiple Sclerosis version 2.0 (WPAI:MS)); two different rating scales, Multiple Sclerosis Impairment Scale (MSIS) and Expanded Disability Status Scale (EDSS); functional tests of mobility (Timed-25-Foot Walk (T-25FW), 6-Spot Step Test (6-SST) and (9-Hole Peg Test (9-HPT)); cognitive tests (Symbol Digital Modalities Test (SDMT) and Brief Visuospatial Memory Test-Revised (BVMT-R)); and multimodal Magnetic Resonance Imaging (MRI). RESULTS When the PROs were divided into physical and psychological subscores, the PRO physical subscores of FSMC, MSIS-29v2 and SF-36v2 correlated with physical rating scales (EDSS, MSIS) and physical measures of upper (9-HPT) and lower extremity function (T-25FW and 6-SST)) (p = 0.04-0.0001). 9-HPT correlated the least with physical subscores of PROs but showed the strongest correlation with activity impairment (subscore of WPAI:MS). In contrast, psychological PRO subscores of FSMC, MSIS-29v2 and SF-36v2 did not reflect the cognitive outcomes (SDMT and BVMT-R), although the cognitive scores correlated with disease burden indicated by MRI lesion volumes. The psychological PRO subscores did not correlate with fatigue, physical and MRI outcomes either. CONCLUSION Correlation between PRO physical subscores and physical outcomes supports PROs as potentially useful clinical endpoints in SPMS. The results of this study indicate that patients with SPMS highly perceive their mobility on function of their lower extremities, while they perceive their daily activities highly dependent on function of the upper extremities. Psychological subscores of MS specific PROs may be less suitable as surrogate markers for the cognitive status and should be considered as a mental quality of life measurement independent of disease burden.
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Affiliation(s)
- A Theodorsdottir
- Department of Neurology, Odense University Hospital, J.B. Winsloewsvej 4, 5000 Odense C, Denmark; OPEN, Odense Patient Data Explorative Network, Odense University Hospital, Odense, J.B. Winsloewsvej 4, 5000 Odense C, Denmark.
| | - H H Nielsen
- Department of Neurology, Odense University Hospital, J.B. Winsloewsvej 4, 5000 Odense C, Denmark; Department of Neurobiology Research, Institute of Molecular Medicine, University of Southern Denmark, J.B. Winsloewsvej 21, st., 5000 Odense C, Denmark; BRIDGE - Brain Research - Inter Disciplinary Guided Excellence, Department of Clinical Research, J.B. Winsloewsvej 19, 3., 5000 Odense C, Denmark
| | - M H Ravnborg
- Filadelfia Epilepsy Hospital, Kolonivej 1, 4293 Dianalund, Denmark
| | - Z Illes
- Department of Neurology, Odense University Hospital, J.B. Winsloewsvej 4, 5000 Odense C, Denmark; Department of Neurobiology Research, Institute of Molecular Medicine, University of Southern Denmark, J.B. Winsloewsvej 21, st., 5000 Odense C, Denmark; BRIDGE - Brain Research - Inter Disciplinary Guided Excellence, Department of Clinical Research, J.B. Winsloewsvej 19, 3., 5000 Odense C, Denmark
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11
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Delayed cognitive processing and treatment status quo bias in early-stage multiple sclerosis. Mult Scler Relat Disord 2022; 68:104138. [PMID: 36029707 DOI: 10.1016/j.msard.2022.104138] [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: 04/08/2022] [Revised: 07/27/2022] [Accepted: 08/19/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND The evolving therapeutic landscape requires more participation of patients with relapsing remitting multiple sclerosis (RRMS) in treatment decisions. The aim of this study was to assess the association between patient's self-perception, cognitive impairment and behavioral factors in treatment choices in a cohort of patients at an early stage of RRMS. METHODS We conducted a multicenter, non-interventional study including adult patients with a diagnosis of RRMS, a disease duration ≤18 months and receiving care at one of the 21 participating MS centers from across Spain. We used patient-reported measures to gather information on fatigue, mood, quality of life, and perception of severity of their MS. Functional metrics (Expanded Disability Status Scale [EDSS], cognitive function by the Symbol Digit Modalities Test [SDMT], 25-foot walk test) and clinical and radiological data were provided by the treating neurologist. The primary outcome of the study was status quo (SQ) bias, defined as participant's tendency to continue taking a previously selected but inferior treatment when intensification was warranted. SQ bias was assessed based on participants treatment preference in six simulated RRMS case scenarios with evidence of clinical relapses and radiological disease progression. RESULTS Of 189 participants who met the inclusion criteria, 188 (99.5%) fully completed the study. The mean age was 36.6 ± 9.5 years, 70.7% female, mean disease duration: 1.2 ± 0.8 years, median EDSS score: 1.0 [IQR=0.0-2.0]). Overall, 43.1% patients (n = 81/188) had an abnormal SDMT (≤49 correct answers). SQ bias was observed in at least one case scenario in 72.3% (137/188). Participant's perception of their MS severity was associated with higher SQ bias (β coeff 0.042; 95% CI 0.0074-0.076) among those with delayed cognitive processing. Higher baseline EDSS and number of T2 lesions were predictors of delayed processing speed (OR EDSS=1.57, 95% CI: 1.11-2.21, p = 0.011; OR T2 lesions=1.50, 95% CI: 1.11-2.03, p<0.01). Bayesian multilevel model accounting for clustering showed that delayed cognitive processing (exp coeff 1.06; 95% CI 1.04-1.09) and MS symptoms severity (exp coeff 1.28; 95% CI 1.22-1.33) were associated with SQ bias. CONCLUSION Over 40% of patients in earlier stages of RRMS experience delays in cognitive processing that might affect their decision-making ability. Our findings suggest that patients' self-perception of disease severity combined with a delay in cognitive processing would affect treatment choices leading to status quo bias early in the course of their disease.
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12
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Talebi M, Sadigh-Eteghad S, Talebi M, Naseri A, Zafarani F. Predominant domains and associated demographic and clinical characteristics in multiple sclerosis-related cognitive impairment in mildly disabled patients. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2022. [DOI: 10.1186/s41983-022-00485-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Cognitive impairment (CI) is a common finding in multiple sclerosis (MS); however, there is a limited information about its prevalence in mildly disabled cases. We aimed to determine the most affected domains, and also the relation between the demographic factors and cognitive outcomes in mildly disabled relapsing–remitting MS (RRMS).
Results
Ninety-one mildly disabled RRMS patients with expanded disability status scale (EDSS) < 4 and literacy level above 9 years, were recruited. Based on Minimal Assessment of Cognitive Function in MS (MACFIMS) battery, CI was observed in 19.8% of the patients while 40.60% of the patients had at least one failure in cognitive tests. The most common impaired cognitive domain was information processing speed and working memory (27.5%). There was no significant difference between men and women in terms of CI in our sample (p-values > 0.05). Disease duration (p = 0.01), EDSS (p = 0.01), and education (p < 0.01) were significantly different between CI and non-CI patients, while age (p = 0.72), sex (p = 0.50), diagnostic gap (p = 0.89), and frequency of relapses (p = 0.22), did not differ considerably.
Conclusions
RRMS patients experience some degrees of CI that may present even before the onset of remarkable physical disability; nevertheless, a higher EDSS score and longer disease duration increases the risk of CI. These findings suggest routine cognitive assessment of MS patients.
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13
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Balloff C, Penner IK, Ma M, Georgiades I, Scala L, Troullinakis N, Graf J, Kremer D, Aktas O, Hartung HP, Meuth SG, Schnitzler A, Groiss SJ, Albrecht P. The degree of cortical plasticity correlates with cognitive performance in patients with Multiple Sclerosis. Brain Stimul 2022; 15:403-413. [PMID: 35182811 DOI: 10.1016/j.brs.2022.02.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 02/14/2022] [Accepted: 02/14/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Cortical reorganization and plasticity may compensate for structural damage in Multiple Sclerosis (MS). It is important to establish sensitive methods to measure these compensatory mechanisms, as they may be of prognostic value. OBJECTIVE To investigate the association between the degree of cortical plasticity and cognitive performance and to compare plasticity between MS patients and healthy controls (HCs). METHODS The amplitudes of the motor evoked potential (MEP) pre and post quadripulse stimulation (QPS) applied over the contralateral motor cortex served as measure of the degree of cortical plasticity in 63 patients with relapsing-remitting MS (RRMS) and 55 matched HCs. The main outcomes were the correlation coefficients between the difference of MEP amplitudes post and pre QPS and the Symbol Digit Modalities Test (SDMT) and Brief Visuospatial Memory Test-Revised (BVMT-R), and the QPSxgroup interaction in a mixed model predicting the MEP amplitude. RESULTS SDMT and BVMT-R correlated significantly with QPS-induced cortical plasticity in RRMS patients. Plasticity was significantly reduced in patients with cognitive impairment compared to patients with preserved cognitive function and the degree of plasticity differentiated between both patient groups. Interestingly, the overall RRMS patient cohort did not show reduced plasticity compared to HCs. CONCLUSIONS We provide first evidence that QPS-induced plasticity may inform about the global synaptic plasticity in RRMS which correlates with cognitive performance as well as clinical disability. Larger longitudinal studies on patients with MS are needed to investigate the relevance and prognostic value of this measure for disease progression and recovery.
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Affiliation(s)
- Carolin Balloff
- Department of Neurology, Medical Faculty, Heinrich-Heine University, 40225, Duesseldorf, Germany; Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich-Heine University, 40225, Duesseldorf, Germany
| | - Iris-Katharina Penner
- Department of Neurology, Medical Faculty, Heinrich-Heine University, 40225, Duesseldorf, Germany; Cogito Center for Applied Neurocognition and Neuropsychological Research, 40225, Düsseldorf, Germany; Department of Neurology, Inselspital, University Hospital Bern, 3010, Bern, Switzerland
| | - Meng Ma
- Department of Neurology, Medical Faculty, Heinrich-Heine University, 40225, Duesseldorf, Germany
| | - Iason Georgiades
- Department of Neurology, Medical Faculty, Heinrich-Heine University, 40225, Duesseldorf, Germany
| | - Lina Scala
- Department of Neurology, Medical Faculty, Heinrich-Heine University, 40225, Duesseldorf, Germany
| | - Nina Troullinakis
- Department of Neurology, Medical Faculty, Heinrich-Heine University, 40225, Duesseldorf, Germany
| | - Jonas Graf
- Department of Neurology, Medical Faculty, Heinrich-Heine University, 40225, Duesseldorf, Germany
| | - David Kremer
- Department of Neurology, Medical Faculty, Heinrich-Heine University, 40225, Duesseldorf, Germany
| | - Orhan Aktas
- Department of Neurology, Medical Faculty, Heinrich-Heine University, 40225, Duesseldorf, Germany
| | - Hans-Peter Hartung
- Department of Neurology, Medical Faculty, Heinrich-Heine University, 40225, Duesseldorf, Germany; Brain and Mind Center, University of Sydney, NSW, 2006, Australia; Department of Neurology, Medical University of Vienna, 1090, Vienna, Austria
| | - Sven Günther Meuth
- Department of Neurology, Medical Faculty, Heinrich-Heine University, 40225, Duesseldorf, Germany
| | - Alfons Schnitzler
- Department of Neurology, Medical Faculty, Heinrich-Heine University, 40225, Duesseldorf, Germany; Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich-Heine University, 40225, Duesseldorf, Germany
| | - Stefan Jun Groiss
- Department of Neurology, Medical Faculty, Heinrich-Heine University, 40225, Duesseldorf, Germany; Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich-Heine University, 40225, Duesseldorf, Germany.
| | - Philipp Albrecht
- Department of Neurology, Medical Faculty, Heinrich-Heine University, 40225, Duesseldorf, Germany
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14
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Giurgola S, Casati C, Stampatori C, Perucca L, Mattioli F, Vallar G, Bolognini N. Abnormal multisensory integration in relapsing–remitting multiple sclerosis. Exp Brain Res 2022; 240:953-968. [PMID: 35094114 PMCID: PMC8918188 DOI: 10.1007/s00221-022-06310-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 01/15/2022] [Indexed: 12/22/2022]
Abstract
Temporal Binding Window (TBW) represents a reliable index of efficient multisensory integration process, which allows individuals to infer which sensory inputs from different modalities pertain to the same event. TBW alterations have been reported in some neurological and neuropsychiatric disorders and seem to negatively affects cognition and behavior. So far, it is still unknown whether deficits of multisensory integration, as indexed by an abnormal TBW, are present even in Multiple Sclerosis. We addressed this issue by testing 25 participants affected by relapsing–remitting Multiple Sclerosis (RRMS) and 30 age-matched healthy controls. Participants completed a simultaneity judgment task (SJ2) to assess the audio-visual TBW; two unimodal SJ2 versions were used as control tasks. Individuals with RRMS showed an enlarged audio-visual TBW (width range = from − 166 ms to + 198 ms), as compared to healthy controls (width range = − 177/ + 66 ms), thus showing an increased tendency to integrate temporally asynchronous visual and auditory stimuli. Instead, simultaneity perception of unimodal (visual or auditory) events overall did not differ from that of controls. These results provide first evidence of a selective deficit of multisensory integration in individuals affected by RRMS, besides the well-known motor and cognitive impairments. The reduced multisensory temporal acuity is likely caused by a disruption of the neural interplay between different sensory systems caused by multiple sclerosis.
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Affiliation(s)
- Serena Giurgola
- Department of Psychology and NeuroMI, University of Milano-Bicocca, Piazza dell’Ateneo Nuovo 1, 20126 Milan, Italy
| | - Carlotta Casati
- Neuropsychology Laboratory, IRCCS Istituto Auxologico Italiano, Milan, Italy
- Neurorehabilitation Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | | | - Laura Perucca
- Neurorehabilitation Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Flavia Mattioli
- Neuropsychology Unit, Spedali Civili of Brescia, Brescia, Italy
| | - Giuseppe Vallar
- Department of Psychology and NeuroMI, University of Milano-Bicocca, Piazza dell’Ateneo Nuovo 1, 20126 Milan, Italy
- Neuropsychology Laboratory, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Nadia Bolognini
- Department of Psychology and NeuroMI, University of Milano-Bicocca, Piazza dell’Ateneo Nuovo 1, 20126 Milan, Italy
- Neuropsychology Laboratory, IRCCS Istituto Auxologico Italiano, Milan, Italy
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15
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Information Processing Speed Assessed with Letter Digit Substitution Test in Croatian Sample of Multiple Sclerosis Patients. Diagnostics (Basel) 2022; 12:diagnostics12010111. [PMID: 35054278 PMCID: PMC8774378 DOI: 10.3390/diagnostics12010111] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 12/29/2021] [Accepted: 12/30/2021] [Indexed: 12/12/2022] Open
Abstract
Cognitive impairment is a common complaint in people with multiple sclerosis (pwMS). The study objective was to determine the psychometric properties of the letter digit substitution test (LDST) that measures information processing speed and to investigate the impact of relevant predictors of LDST achievement in pwMS. The design was cross-sectional. The study included 87 pwMS and 154 control subjects. The validity of LDST was examined, and a hierarchical regression model was used to explore relevant predictors of LDST success. The LDST had excellent construct validity, as expressed by differences between pwMS and control subjects. Convergent validity of the LDST was supported by a significant moderate correlation with the expanded disability status scale (EDSS) (ρ = −0.36; p < 0.05) and a significantly strong correlation with the multiple sclerosis impact scale (MSIS-29) physical subscale (r = −0.64; p < 0.01). The LDTS score well differentiated the pwMS considering age, education, EDSS, disease duration, comorbidity, and medication therapy. Using the LDST as a criterion variable in pwMS results showed consistent evidence for the age, education, and EDSS impact on LDST performance. The best cut-off score of ≤35 discriminated the control and MS group. LDST proved to be a valid test for assessing information processing speed in pwMS.
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16
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Larsen JB, Reitan SK, Løberg EM, Rettenbacher M, Bruserud Ø, Larsen TK, Anda L, Bartz-Johannessen C, Johnsen E, Kroken RA. The association between cytokines and psychomotor speed in a spectrum of psychotic disorders: A longitudinal study. Brain Behav Immun Health 2021; 18:100392. [PMID: 34877553 PMCID: PMC8633579 DOI: 10.1016/j.bbih.2021.100392] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 11/18/2021] [Accepted: 11/21/2021] [Indexed: 12/17/2022] Open
Abstract
Background In schizophrenia, impaired psychomotor speed is a common symptom predicting worse functional outcome. Inflammation causes changes in white matter integrity, which may lead to reduced psychomotor speed. Therefore, we wanted to investigate if peripheral inflammation assessed with cytokines affected performance on psychomotor speed in patients with a spectrum of psychotic disorders. Methods The current study is a prospective cohort study, including participants from a pragmatic, randomised controlled trial comparing three atypical antipsychotics in patients with a spectrum of psychotic disorders. For the purposes of this sub-study, we analysed drug treatment groups collectively. Psychomotor speed was assessed at baseline, and at weeks 6, 12, 26 and 52 of follow-up, using the neuropsychological tests trail making test (TMT) A and B, and symbol coding. Serum concentration of the following cytokines were measured: interleukin (IL)-β, IL-2, IL-4, IL-6, IL-10, IL12 p70, IL-17a, interferon (IFN)-γ and tumor necrosis factor (TNF)-α. Blood samples were collected at baseline and after 1, 3, 6, 12, 26, 39 and 52 weeks. We analysed the effect of cytokines levels on psychomotor speed over time in linear mixed effects models. Results In our linear mixed effects models controlling for possible confounders, IFN-γ had a significant negative effect on TMT-A and symbol coding performance. None of the other tests for psychomotor speed were significantly associated with cytokines. Overall psychomotor speed performance increased significantly across the study period while cytokine levels remained stable. Conclusion Our study indicates a negative association between IFN-γ and psychomotor speed, which might be of importance when understanding the mechanisms behind psychomotor deviations in psychotic disorders. The cytokine interferon (IFN) – γ is related to psychomotor speed in patients with psychotic disorders. For majority of cytokines, we found no significant association with psychomotor speed. Cytokines remained stable during the study period of 52 weeks.
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Key Words
- BMI, body mass index
- Cognition
- Cytokines
- IL, interleukin
- Immune markers
- Inflammation
- MRI, magnetic resonance imaging
- MS, multiple sclerosis
- PANSS, Positive and Negative Syndrome Scale
- Psychomotor performance
- Psychomotor speed
- RCT, randomised controlled trial
- SCID-I, Structured Clinical Interview for DSM-IV Axis I Disorders
- Schizophrenia
- TMT, Trail Making Test
- TNF, tumor necrosis factor
- hs-CRP, high-sensitivity C-reactive protein
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Affiliation(s)
- Jeanette Brun Larsen
- Department of Mental Health, St. Olav's University Hospital, Trondheim, Norway.,Department of Mental Health, Faculty of Medicine and Health Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Solveig Klæbo Reitan
- Department of Mental Health, St. Olav's University Hospital, Trondheim, Norway.,Department of Mental Health, Faculty of Medicine and Health Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Else-Marie Løberg
- NORMENT, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway.,Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Psychology, University of Bergen, Bergen, Norway
| | - Maria Rettenbacher
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University Innsbruck, Innsbruck, Austria
| | - Øystein Bruserud
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - Tor Ketil Larsen
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.,Regional Centre for Clinical Research in Psychosis, TIPS, Stavanger University Hospital, Bergen, Norway
| | - Liss Anda
- Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway.,Department of Social Studies, University of Stavanger, Stavanger, Norway
| | | | - Erik Johnsen
- NORMENT, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Rune A Kroken
- NORMENT, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
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17
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Al-Falaki TA, Hamdan FB, Sheaheed NM. Assessment of cognitive functions in patients with multiple sclerosis. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2021. [DOI: 10.1186/s41983-021-00383-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Abstract
Background
About 40–70% of patients with multiple sclerosis (MS) develop cognitive impairment (CI) throughout their life. We aim to study the influence of MS on cognitive changes. This is a case–control study of fifty patients with MS who met the revised 2017 Mc Donald Criteria and fifty age- and sex-matched healthy subjects. The Expanded Disability Status Scale (EDSS) was used to assess the degree of disability, and the Montreal Cognitive Assessment (MoCA) scoring system was used to assess cognitive function.
Results
MS patients show low total MoCA score than the controls. Total MoCA scores were lower in patients with CI versus those with intact cognition. CI was higher in those with a longer duration of illness and a high EDSS. MoCA was positively correlated with education level but negatively with EDSS and disease duration.
Conclusion
MoCA scale has optimal psychometric properties for routine clinical use in patients with MS, even in those with mild functional disability. The longer the disease duration and the higher the EDSS, the lower the MoCA score and the higher the education level, the higher the MoCA score. As for the profile of cognitive dysfunction in patients with MS, the domains most frequently failed by the patients were memory, attention, visuospatial learning, and language.
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18
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Pitteri M, Dapor C, Ziccardi S, Guandalini M, Meggiato R, Calabrese M. A Videogame-Based Approach to Measuring Information Processing Speed in Multiple Sclerosis Patients. Games Health J 2021; 10:115-120. [PMID: 33818136 DOI: 10.1089/g4h.2020.0069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Objective: Slowing information processing speed (IPS) is a biomarker of neuronal damage in patients with multiple sclerosis (pwMS). A focus on IPS might be the ideal solution in the perspective of promptly detecting cognitive changes over time. We developed a tablet-based home-made videogame to test the sensitivity of this device in measuring subclinical IPS in pwMS. Materials and Methods: Forty-three pwMS without cognitive impairment and 20 healthy controls (HCs) were administered the videogame task with a tablet. Response times (RTs) and accuracy were recorded. Results: PwMS (mean RTs = 505.5 ± 73.9 ms) were significantly slower than HCs (mean RTs = 462.3 ± 40.3 ms, P = 0.014) on the videogame task. A moderate but significant correlation (r = -0.35, P = 0.03) between mean RTs and the Symbol Digit Modalities Test was observed. Conclusion: Our videogame showed good sensitivity in measuring IPS in apparently cognitive normal pwMS. Computerized testing might be useful in screening initial cognitive dysfunction that should be monitored as a marker of underlying disease progression. IRB approval Number is 2332CESC.
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Affiliation(s)
- Marco Pitteri
- Neurology Section, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Caterina Dapor
- Neurology Section, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Stefano Ziccardi
- Neurology Section, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Maddalena Guandalini
- Neurology Section, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Riccardo Meggiato
- Neurology Section, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Massimiliano Calabrese
- Neurology Section, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
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19
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Costers L, Van Schependom J, Laton J, Baijot J, Sjøgård M, Wens V, De Tiège X, Goldman S, D'Haeseleer M, D'hooghe MB, Woolrich M, Nagels G. The role of hippocampal theta oscillations in working memory impairment in multiple sclerosis. Hum Brain Mapp 2021; 42:1376-1390. [PMID: 33247542 PMCID: PMC7927306 DOI: 10.1002/hbm.25299] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 11/11/2020] [Accepted: 11/13/2020] [Indexed: 01/04/2023] Open
Abstract
Working memory (WM) problems are frequently present in people with multiple sclerosis (MS). Even though hippocampal damage has been repeatedly shown to play an important role, the underlying neurophysiological mechanisms remain unclear. This study aimed to investigate the neurophysiological underpinnings of WM impairment in MS using magnetoencephalography (MEG) data from a visual-verbal 2-back task. We analysed MEG recordings of 79 MS patients and 38 healthy subjects through event-related fields and theta (4-8 Hz) and alpha (8-13 Hz) oscillatory processes. Data was source reconstructed and parcellated based on previous findings in the healthy subject sample. MS patients showed a smaller maximum theta power increase in the right hippocampus between 0 and 400 ms than healthy subjects (p = .014). This theta power increase value correlated negatively with reaction time on the task in MS (r = -.32, p = .029). Evidence was provided that this relationship could not be explained by a 'common cause' confounding relationship with MS-related neuronal damage. This study provides the first neurophysiological evidence of the influence of hippocampal dysfunction on WM performance in MS.
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Affiliation(s)
- Lars Costers
- AIMS Lab, Center For NeurosciencesUZ Brussel, Vrije Universiteit BrusselBrusselBelgium
| | - Jeroen Van Schependom
- AIMS Lab, Center For NeurosciencesUZ Brussel, Vrije Universiteit BrusselBrusselBelgium
- Departement of Electronics and Informatics (ETRO)Vrije Universiteit BrusselBrusselBelgium
- Departement of RadiologyUZ BrusselBrusselBelgium
| | - Jorne Laton
- AIMS Lab, Center For NeurosciencesUZ Brussel, Vrije Universiteit BrusselBrusselBelgium
- Nuffield Department of Clinical NeurosciencesUniversity of OxfordOxfordUK
| | - Johan Baijot
- AIMS Lab, Center For NeurosciencesUZ Brussel, Vrije Universiteit BrusselBrusselBelgium
| | - Martin Sjøgård
- Laboratoire de Cartographie Fonctionnelle du Cerveau (LCFC)UNI—ULB Neuroscience Institute, Université libre de Bruxelles (ULB)BruxellesBelgium
| | - Vincent Wens
- Laboratoire de Cartographie Fonctionnelle du Cerveau (LCFC)UNI—ULB Neuroscience Institute, Université libre de Bruxelles (ULB)BruxellesBelgium
- Magnetoencephalography Unit, Department of Functional Neuroimaging, Service of Nuclear MedicineCUB‐Hôpital ErasmeBruxellesBelgium
| | - Xavier De Tiège
- Laboratoire de Cartographie Fonctionnelle du Cerveau (LCFC)UNI—ULB Neuroscience Institute, Université libre de Bruxelles (ULB)BruxellesBelgium
- Magnetoencephalography Unit, Department of Functional Neuroimaging, Service of Nuclear MedicineCUB‐Hôpital ErasmeBruxellesBelgium
| | - Serge Goldman
- Laboratoire de Cartographie Fonctionnelle du Cerveau (LCFC)UNI—ULB Neuroscience Institute, Université libre de Bruxelles (ULB)BruxellesBelgium
- Magnetoencephalography Unit, Department of Functional Neuroimaging, Service of Nuclear MedicineCUB‐Hôpital ErasmeBruxellesBelgium
| | - Miguel D'Haeseleer
- Department of NeurologyNational MS Center MelsbroekMelsbroekBelgium
- Department of NeurologyUZ BrusselsBruxellesBelgium
| | - Marie Beatrice D'hooghe
- Department of NeurologyNational MS Center MelsbroekMelsbroekBelgium
- Department of NeurologyUZ BrusselsBruxellesBelgium
| | - Mark Woolrich
- Oxford Centre for Human Brain Activity (OHBA)University of OxfordOxfordUK
- Oxford University Centre for Functional MRI of the Brain (FMRIB)University of OxfordOxfordUK
| | - Guy Nagels
- AIMS Lab, Center For NeurosciencesUZ Brussel, Vrije Universiteit BrusselBrusselBelgium
- Department of NeurologyUZ BrusselsBruxellesBelgium
- St Edmund HallUniversity of OxfordOxfordUK
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20
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Increased brain atrophy and lesion load is associated with stronger lower alpha MEG power in multiple sclerosis patients. NEUROIMAGE-CLINICAL 2021; 30:102632. [PMID: 33770549 PMCID: PMC8022249 DOI: 10.1016/j.nicl.2021.102632] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 02/05/2021] [Accepted: 03/11/2021] [Indexed: 12/30/2022]
Abstract
In multiple sclerosis, the interplay of neurodegeneration, demyelination and inflammation leads to changes in neurophysiological functioning. This study aims to characterize the relation between reduced brain volumes and spectral power in multiple sclerosis patients and matched healthy subjects. During resting-state eyes closed, we collected magnetoencephalographic data in 67 multiple sclerosis patients and 47 healthy subjects, matched for age and gender. Additionally, we quantified different brain volumes through magnetic resonance imaging (MRI). First, a principal component analysis of MRI-derived brain volumes demonstrates that atrophy can be largely described by two components: one overall degenerative component that correlates strongly with different cognitive tests, and one component that mainly captures degeneration of the cortical grey matter that strongly correlates with age. A multimodal correlation analysis indicates that increased brain atrophy and lesion load is accompanied by increased spectral power in the lower alpha (8-10 Hz) in the temporoparietal junction (TPJ). Increased lower alpha power in the TPJ was further associated with worse results on verbal and spatial working memory tests, whereas an increased lower/upper alpha power ratio was associated with slower information processing speed. In conclusion, multiple sclerosis patients with increased brain atrophy, lesion and thalamic volumes demonstrated increased lower alpha power in the TPJ and reduced cognitive abilities.
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Sadigh-Eteghad S, Abbasi Garravnd N, Feizollahi M, Talebi M. The Expanded Disability Status Scale Score and Demographic Indexes Are Correlated with the Severity of Cognitive Impairment in Multiple Sclerosis Patients. J Clin Neurol 2021; 17:113-120. [PMID: 33480206 PMCID: PMC7840333 DOI: 10.3988/jcn.2021.17.1.113] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 10/25/2020] [Accepted: 10/29/2020] [Indexed: 01/25/2023] Open
Abstract
Background and Purpose Cognitive impairment (CI) is a common symptom of multiple sclerosis (MS). Although demographic and clinical factors contribute to MS-dependent CI, previous findings have been inconsistent. This study aimed to identify the cognitive domains that are impaired in MS patients, and to determine the impacts of the Expanded Disability Status Scale (EDSS) score and other clinical and demographic factors on them domains. Methods This study enrolled 115 MS patients. Cognitive performance was assessed using the Minimal Assessment of Cognitive Function in Multiple Sclerosis (MACFIMS) battery. CI severity was assessed based on the number of impaired tasks in the MACFIMS battery, with impairment in two or more tasks defined as CI cases. Correlation analysis was used to determine whether factors including current age, age at disease onset, EDSS score, disease duration, relapse rate, and education level affect the severity of CI. Results The scores on the Paced Auditory Serial Addition Test and Delis-Kaplan Executive Function System were the most and least affected, respectively. EDSS score (r=0.438, p<0.001), current age (r=0.393, p<0.001), and disease duration (r=0.486, p<0.001) were positively correlated with CI severity, whereas education level (r=−0.527, p<0.001) had a negative correlation with CI severity, and age at disease onset and relapse rate were not correlated with CI severity (r=0.150 and p=0.107, and r=0.052 and p=0.530, respectively). However, all variables (except EDSS score) significantly predicted CI severity in a multiple regression model (p<0.001, r=0.668). Conclusions Information processing speed and working memory were the most commonly affected cognitive domains in the present MS patients. CI severity had strong positive correlations with current age, EDSS score, and disease duration, and a negative correlation with education level. The relapse rate and age at disease onset were not correlated with CI severity.
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Affiliation(s)
- Saeed Sadigh-Eteghad
- Neurosciences Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.,Department of Persian Medicine, Faculty of Persian Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Mahsa Feizollahi
- Neurosciences Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mahnaz Talebi
- Neurosciences Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
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DeLuca J, Schippling S, Montalban X, Kappos L, Cree BAC, Comi G, Arnold DL, Hartung HP, Sheffield JK, Liu H, Silva D, Cohen JA. Effect of Ozanimod on Symbol Digit Modalities Test Performance in Relapsing MS. Mult Scler Relat Disord 2020; 48:102673. [PMID: 33454584 DOI: 10.1016/j.msard.2020.102673] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 11/18/2020] [Accepted: 12/02/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Cognitive dysfunction, including slowed cognitive processing speed (CPS), is one of the most disabling symptoms of multiple sclerosis (MS). The Symbol Digit Modalities Test (SDMT) is a preferred measure of CPS for MS trials and routine screening. Based on encouraging SDMT results in the phase 3 SUNBEAM trial, these post hoc, exploratory analyses were conducted to further compare effects of the sphingosine 1-phosphate receptor modulator ozanimod versus intramuscular interferon β-1a on CPS in participants with relapsing multiple sclerosis (RMS). METHODS In the phase 3, double-blind, double-dummy, SUNBEAM study, adults (aged 18‒55 years) with RMS (N=1,346) were randomized to once-daily oral ozanimod 0.92 or 0.46 mg, or weekly intramuscular interferon β-1a 30 µg. The study continued until the last participant was treated for 12 months. CPS was measured as part of a secondary endpoint using the SDMT. Exploratory, post hoc analyses evaluated SDMT change and percentages of participants with clinically meaningful (≥4-point) SDMT improvement or worsening at months 6 and 12, and relationship between SDMT and brain volume on magnetic resonance imaging. RESULTS Ozanimod improved SDMT scores compared with interferon β-1a at months 6 and 12. At month 12, least squares mean difference in SDMT z-scores for ozanimod 0.92 mg versus interferon β-1a was 0.102 (95% CI, 0.031‒0.174, nominal p = 0.0051; standardized mean difference = 0.1376). A greater percentage of ozanimod 0.92 mg‒treated participants had clinically meaningful improvements in SDMT scores versus interferon β-1a at month 6 (30.0% versus 22.2%) and month 12 (35.6% versus 27.9%). Of those with SDMT improvement at month 6, 66.4% of those treated with ozanimod 0.92 mg and 55.9% of those treated with interferon β-1a had sustained improvement at month 12. Brain volume loss was similar for those with SDMT improvement versus worsening at month 12. CONCLUSIONS In these exploratory analyses, ozanimod had modestly beneficial effects on CPS in RMS participants. The effects of ozanimod on SDMT are being further evaluated in an ongoing 3-year clinical trial. SUNBEAM is registered on clinicaltrials.gov (NCT02294058) and the European Clinical Trials Database (EudraCT 2014-002320-27).
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Affiliation(s)
- John DeLuca
- Kessler Foundation, 1199 Pleasant Valley Way, West Orange, NJ 07052 USA and Departments of Physical Medicine and Rehabilitation, and Neurology, Rutgers - New Jersey Medical School, Newark 07103, NJ, USA.
| | - Sven Schippling
- Neuroimmunology and Multiple Sclerosis Research, Department of Neurology, University Hospital and University of Zürich and Neuroscience Center Zürich, University of Zürich, Frauenklinikstrasse 26, 8091 Zurich, Switzerland and Federal Institute of Technology (ETH) Zürich, Rämistrasse 101, 8092 Zürich, Switzerland.
| | - Xavier Montalban
- Department of Neurology-Neuroimmunology, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitario Vall d'Hebron, Pg. Vall d'Hebron, 119-129, 08035 Barcelona, Spain.
| | - Ludwig Kappos
- Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), Departments of Medicine, Clinical Research, Biomedicine, and Biomedical Engineering, University Hospital and University of Basel, Petersgraben 4, CH-4031 Basel, Switzerland.
| | - Bruce A C Cree
- Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco, 675 Nelson Rising Lane, San Francisco, CA 94158 USA.
| | - Giancarlo Comi
- Department of Neurology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, via Olgettina 48, 20132 Milan, Italy.
| | - Douglas L Arnold
- NeuroRx Research and Montréal Neurological Institute, McGill University, 3801 University Street, Montreal, QC H3A 2B4, Canada.
| | - Hans-Peter Hartung
- Department of Neurology, Medical Faculty, Heinrich-Heine University, University Hospital Dusseldorf, Moorenstr. 5 40225 Dusseldorf, Germany.
| | - James K Sheffield
- Bristol Myers Squibb, 3401 Princeton Pike, Lawrenceville, NJ 08648, USA.
| | - Hongjuan Liu
- Bristol Myers Squibb, 3401 Princeton Pike, Lawrenceville, NJ 08648, USA.
| | - Diego Silva
- Bristol Myers Squibb, 3401 Princeton Pike, Lawrenceville, NJ 08648, USA.
| | - Jeffrey A Cohen
- Department of Neurology, Mellen Center for MS Treatment and Research, Neurological Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195 USA.
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Impaired learning from regret and disappointment in alcohol use disorder. Sci Rep 2020; 10:12104. [PMID: 32694573 PMCID: PMC7374698 DOI: 10.1038/s41598-020-68942-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 06/25/2020] [Indexed: 11/09/2022] Open
Abstract
The development of alcohol habits is considered a form of maladaptive reinforced learning, with sustained alcohol use resulting in the strengthening of associative links between consumption and either rewarding, or the lack of aversive, experiences. Despite recent efforts in characterizing decision-making skills in alcohol-use-disorder (AUD), it is still unknown whether impaired behavioural learning in AUD patients reflects a defective processing and anticipation of choice-related, cognitively mediated, emotions such as regret or relief for what might have been under a different choice. We administered a Wheel-of-Fortune (WoF) task to 26 AUD patients and 19 healthy controls, to investigate possible alterations in adjusting choices to the magnitude of experienced regret/relief, and in other facets of decision-making performance such as choice latency. AUD patients displayed both longer deliberation time than healthy controls, and impaired adaptations to previous outcome-related negative emotions. Although further evidence is needed to unveil the cognitive mechanisms underlying AUD patients’ abnormal choice, the present results highlight important implications for the clinical practice, e.g. in terms of cognitive treatments aiming to shape faulty perceptions about negative emotions associated with excessive alcohol exposure.
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Stojanov J, Stojanov A. A cross-sectional study of alexithymia in patients with relapse remitting form of multiple sclerosis. J Postgrad Med 2020; 66:23-27. [PMID: 31929308 PMCID: PMC6970317 DOI: 10.4103/jpgm.jpgm_499_19] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Background: Alexithymia is one's incapacity to identify, comprehend, and describe emotions. There is almost no literature data about the levels of alexithymia among patients with relapse remitting type of multiple sclerosis. Aim: The objective of the present study was to assess the levels of alexithymia in patients with relapse remitting type of multiple sclerosis in relation to their sociodemographic variables and clinical characteristics of the disease. Methods: This cross-sectional study included 106 consecutively assessed patients with relapse remitting type of multiple sclerosis. In addition to the data regarding disease duration, number of demyelinating relapses, and degree of neurological disability, assessed by the expanded disability scale score (EDSS), we used Toronto alexithymia scale (TAS), fatigue severity scale (FSS) and, Hamilton scale for the assessment of anxiety and depression and sociodemographic questionnaire. Results: Study included 74 female and 32 male patients, with a median age of 44 years, median disease duration 90 months, and median EDSS 4. About 29.55% of patients had alexithymia and borderline alexithymia was observed in 31.15% patients. Alexithymia correlated with anxiety and depression (P < 0.01) on all TAS subscales. Higher levels of neurological disability based on EDSS, severe fatigue based on FSS scores, and severe relapse remitting type of multiple sclerosis with more relapses and longer disease duration correlated with alexithymia (P < 0.01), depression (P < 0.01), and anxiety (P < 0.01). Higher rates of alexithymia were noticed in older, unemployed, single patients, and those having fewer children. Conclusions: Alexithymia was found in a relatively high percentage in patients with relapse remitting type of multiple sclerosis.
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Affiliation(s)
- J Stojanov
- Special Hospital for Psychiatric Illness "Gornja Toponica", Gornja Toponica, Serbia
| | - A Stojanov
- Clinic of Neurology, Clinical Center of Nis, Nis, Serbia
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Abstract
Cognitive impairment and related abnormal brain activity are common in people with multiple sclerosis (PwMS). Adaptive training based on working memory (WM) has been shown to ameliorate cognitive symptoms, although the effects at a neural level are unclear. The aim of this study was to expand the existing research on the effects of an adaptive WM rehabilitative intervention on brain functional activity in PwMS. A sample of eighteen PwMS performed an 8-week home-based cognitive rehabilitation treatment based on adaptive WM training. PwMS were assessed before and after treatment using a validated neuropsychological battery and undergoing an fMRI session while carrying out a cognitive task (i.e., Paced Visual Serial Addition Test - PVSAT). fMRI activations were compared to the activation pattern elicited by eighteen matched healthy subjects performing the same task. At baseline, we found abnormal brain activity during PVSAT in PwMS when compared to healthy subjects, with a pattern including several bilateral activation clusters. Following rehabilitation, PwMS improved cognitive performance, as evaluated by the neuropsychological battery, and showed a different activation map with clusters mainly located in the right cerebellum and in the left hemisphere. The only significant cluster in the right hemisphere was located in the inferior parietal lobule, and the BOLD signal extracted in this area significantly correlated with cognitive performance both before and after the treatment. We suggest that WM training can improve the cognitive performance and reduce the abnormal activation of PwMS by partially maintaining or even restoring brain cognitive function.
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26
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Galioto R, Conway DS, Planchon SM, Rao SM. Is Obesity Related to Processing Speed Impairment in Patients with Multiple Sclerosis: Results of a Large-Scale, Multicenter Study. Arch Clin Neuropsychol 2020; 35:506-510. [DOI: 10.1093/arclin/acaa003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 01/06/2020] [Accepted: 01/09/2020] [Indexed: 01/01/2023] Open
Abstract
Abstract
Background
Obesity is linked to greater physical disability and increased comorbidities among patients with multiple sclerosis (MS). Its contribution to cognition in this group is unclear. This observational study examines the link between obesity and processing speed in a large sample of patients with MS (PwMS).
Methods
As part of routine clinical care at our center, PwMS completed the Processing Speed Test (PST), an electronic implementation of the Symbol Digit Modalities Test (SDMT). Height and weight were used to calculate body mass index (BMI). Bivariate correlations were conducted to examine the association between PST and BMI in the group overall and in subgroups based on demographic and clinical variables. A one-way ANOVA examined differences in PST by BMI categories (normal weight, overweight, obese).
Results
The sample included 8,713 patients. No association between PST and BMI was found in the entire sample (r = .01), nor within subgroups based on demographic and disease variables. No difference in PST score was found between BMI categories.
Conclusions
No association between BMI and processing speed was found among PwMS regardless of demographic or disease-specific patient characteristics.
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Affiliation(s)
- Rachel Galioto
- Mellen Center for Multiple Sclerosis, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Devon S Conway
- Mellen Center for Multiple Sclerosis, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Sarah M Planchon
- Mellen Center for Multiple Sclerosis, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Stephen M Rao
- Mellen Center for Multiple Sclerosis, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
- Lou Ruvo Center for Brain Health, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
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Darwish H, Farran N, Hannoun S, Tadros N, Yamout B, El Ayoubi NK, Khoury SJ. Serum vitamin D level is associated with speed of processing in multiple sclerosis patients. J Steroid Biochem Mol Biol 2020; 200:105628. [PMID: 32061642 DOI: 10.1016/j.jsbmb.2020.105628] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 01/16/2020] [Accepted: 02/12/2020] [Indexed: 01/01/2023]
Abstract
Multiple Sclerosis (MS) is often associated with low serum 25(OH)D levels, as well as cognitive dysfunctions. The relationship between 25(OH)D and the most commonly affected cognitive domain in MS; processing speed, is poorly explored. The purpose of this study is to: (1) assess the effect of serum 25(OH)D change on processing speed in MS, and (2) explore the relationship between serum 25(OH)D and brain volume changes in MS. A retrospective chart review was conducted, data from 299 patients were extracted (baseline), of whom 163 had follow-up measurements (after at least a 9-month interval). The Symbol Digits Modalities Test (SDMT) was used as a measure of processing speed. MRI data was available from 78 individuals at baseline, and 70 at follow-up. SDMT scores and brain volumes (Cerebellum (total, grey, and white), intracranial, Grey Matter (GM), and White Matter (WM)) were compared based on 25(OH)D levels and their changes towards follow-up. Results indicated that patients with deficient 25(OH)D levels had lower SDMT scores when compared to those with sufficient levels, and SDMT scores improved as a function of 25(OH)D. For MRI measures, only patients with sufficient 25(OH)D levels during both assessment periods had significant changes in intracranial and total cerebellum volumes. We conclude that 25(OH)D levels seem to have an effect on processing speed in MS, thus the importance of clinical monitoring and supplementation in this regard is reinforced.
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Affiliation(s)
- Hala Darwish
- Hariri School of Nursing, American University of Beirut, PO Box 11 0236, Riad El-Solh 1107 2020 Beirut, Lebanon; Nehme and Therese Tohme Multiple Sclerosis Center, American University of Beirut Medical Center, PO Box 11 0236, Riad El-Solh 1107 2020 Beirut, Lebanon.
| | - Natali Farran
- Hariri School of Nursing, American University of Beirut, PO Box 11 0236, Riad El-Solh 1107 2020 Beirut, Lebanon
| | - Salem Hannoun
- Nehme and Therese Tohme Multiple Sclerosis Center, American University of Beirut Medical Center, PO Box 11 0236, Riad El-Solh 1107 2020 Beirut, Lebanon
| | - Natalie Tadros
- Hariri School of Nursing, American University of Beirut, PO Box 11 0236, Riad El-Solh 1107 2020 Beirut, Lebanon
| | - Bassem Yamout
- Nehme and Therese Tohme Multiple Sclerosis Center, American University of Beirut Medical Center, PO Box 11 0236, Riad El-Solh 1107 2020 Beirut, Lebanon; Neurology Department, Faculty of Medicine, American University of Beirut, PO Box 11 0236, Riad El-Solh 1107 2020 Beirut, Lebanon
| | - Nabil K El Ayoubi
- Nehme and Therese Tohme Multiple Sclerosis Center, American University of Beirut Medical Center, PO Box 11 0236, Riad El-Solh 1107 2020 Beirut, Lebanon; Neurology Department, Faculty of Medicine, American University of Beirut, PO Box 11 0236, Riad El-Solh 1107 2020 Beirut, Lebanon
| | - Samia J Khoury
- Nehme and Therese Tohme Multiple Sclerosis Center, American University of Beirut Medical Center, PO Box 11 0236, Riad El-Solh 1107 2020 Beirut, Lebanon; Neurology Department, Faculty of Medicine, American University of Beirut, PO Box 11 0236, Riad El-Solh 1107 2020 Beirut, Lebanon
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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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Domen CH, Greher MR, Hosokawa PW, Barnes SL, Hoyt BD, Wodushek TR. Are Established Embedded Performance Validity Test Cut-Offs Generalizable to Patients With Multiple Sclerosis? Arch Clin Neuropsychol 2020; 35:511-516. [DOI: 10.1093/arclin/acaa016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 02/20/2019] [Accepted: 02/27/2020] [Indexed: 11/13/2022] Open
Abstract
Abstract
Objective
Data for the use of embedded performance validity tests (ePVTs) with multiple sclerosis (MS) patients are limited. The purpose of the current study was to determine whether ePVTs previously validated in other neurological samples perform similarly in an MS sample.
Methods
In this retrospective study, the prevalence of below-criterion responding at different cut-off scores was calculated for each ePVT of interest among patients with MS who passed a stand-alone PVT.
Results
Previously established PVT cut-offs generally demonstrated acceptable specificity when applied to our sample. However, the overall cognitive burden of the sample was limited relative to that observed in prior large-scale MS studies.
Conclusion
The current study provides initial data regarding the performance of select ePVTs among an MS sample. Results indicate most previously validated cut-offs avoid excessive false positive errors in a predominantly relapsing remitting MS sample. Further validation among MS patients with more advanced disease is warranted.
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Affiliation(s)
- Christopher H Domen
- Department of Neurosurgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Michael R Greher
- Department of Neurosurgery, University of Colorado School of Medicine, Aurora, CO, USA
| | | | - Sierra L Barnes
- Neurosciences, University of Colorado Health, Aurora, CO, USA
| | - Brian D Hoyt
- Department of Neurosurgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Thomas R Wodushek
- Department of Neurosurgery, University of Colorado School of Medicine, Aurora, CO, USA
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Olfactory identification associates with cognitive function and the third ventricle width in patients with relapsing-remitting multiple sclerosis. Mult Scler Relat Disord 2020; 38:101507. [DOI: 10.1016/j.msard.2019.101507] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 10/29/2019] [Accepted: 11/04/2019] [Indexed: 01/26/2023]
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31
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Tommasin S, De Luca F, Ferrante I, Gurreri F, Castelli L, Ruggieri S, Prosperini L, Pantano P, Pozzilli C, De Giglio L. Cognitive fatigability is a quantifiable distinct phenomenon in multiple sclerosis. J Neuropsychol 2019; 14:370-383. [PMID: 31729168 DOI: 10.1111/jnp.12197] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 10/29/2019] [Indexed: 11/28/2022]
Abstract
Cognitive fatigability in multiple sclerosis represents the decrease in cognitive performance over time. It is a frequent symptom that negatively affects quality of life and ability to work. There are no objective measures of cognitive fatigability. This study aimed at quantifying cognitive fatigability despite the learning effect and to clarify whether cognitive fatigability represents a free-standing phenomenon rather than an aspect of cognitive impairment. We measured information processing speed with the Symbol Digit Modalities Test, and the number of right answers was recorded every 30 s for 180 s. We approximated the number of right answers as function of time with two logarithmic models, one including a first-order term alone and the other adding also a second-order term. The coefficient of the latter (B) may quantify performance deflection and may represent cognitive fatigability. We tested 173 patients with multiple sclerosis, including 119 cognitively impaired and 54 cognitively preserved patients, and 35 healthy subjects. The performance of cognitively preserved patients showed a deflection at the end of task that was detected neither in controls nor in cognitively impaired patients and needed a second-order term to be approximated (p < .03, F = 14.02). B was explained neither by depression nor fatigue. We proposed for the first time a method to quantify cognitive fatigue via a second-order least square fit model, easily usable in the clinical practice. By using this novel approach, cognitive fatigability results to be a free-standing phenomenon that is more evident in cognitively preserved than in cognitive impaired patients.
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Affiliation(s)
- Silvia Tommasin
- Department of Human Neurosciences, Sapienza University of Rome, Italy
| | - Francesca De Luca
- MS Centre, Sapienza University Sant'Andrea Hospital, Roma, Italy.,Department of Psychology, Sapienza University of Rome, Italy
| | - Ilaria Ferrante
- MS Centre, Sapienza University Sant'Andrea Hospital, Roma, Italy
| | - Flavia Gurreri
- MS Centre, Sapienza University Sant'Andrea Hospital, Roma, Italy
| | | | - Serena Ruggieri
- Department of Human Neurosciences, Sapienza University of Rome, Italy
| | - Luca Prosperini
- Department of Neurosciences, S. Camillo-Forlanini Hospital, Rome, Italy
| | - Patrizia Pantano
- Department of Human Neurosciences, Sapienza University of Rome, Italy.,IRCCS Neuromed, (Pozzilli [IS], IT), Pozzilli, Italy
| | - Carlo Pozzilli
- Department of Human Neurosciences, Sapienza University of Rome, Italy.,MS Centre, Sapienza University Sant'Andrea Hospital, Roma, Italy
| | - Laura De Giglio
- Medicine Department, Neurology Unit, San Filippo Neri Hospital, Rome, Italy
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Robinson L, Kimpinski K. Neurogenic orthostatic hypotension impairs information processing speed and attention. Physiol Behav 2019; 211:112682. [PMID: 31526820 DOI: 10.1016/j.physbeh.2019.112682] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 09/11/2019] [Accepted: 09/12/2019] [Indexed: 11/15/2022]
Abstract
Neurogenic orthostatic hypotension (NOH) is characterized by a drop in systolic blood pressure (SBP) ≥20 mmHg or diastolic blood pressure (DBP) ≥10 mmHg within three minutes of upright posture. NOH is common in the elderly population. This group of individuals is at an increased risk for deficits in multiple cognitive domains such as information processing speed (IPS) and attention. The objective of the current study was to investigate the change in IPS and attention during head-up tilt (HUT) in patients with NOH compared to controls. Cognitive function was assessed in the supine and HUT positions using the symbol digit modalities test (SDMT) which assesses IPS and the Stroop Test which measures attention. 40 participants completed the study, 20 controls (age 64.50 ± 9.25) and 20 NOH patients (age 69.55 ± 7.43) with associated conditions of Parkinson's disease (n = 11), multiple systems atrophy (n = 3), early Lewy body dementia (n = 1) and idiopathic NOH (n = 5). NOH patients had no difference in IPS between supine (43.20 ± 15.26) and HUT (42.90 ± 14.33; p = .77). Controls had significantly faster IPS in the HUT position (69.90 ± 12.02) compared to supine (63.55 ± 9.96; p < .001). NOH patients had significantly slower IPS in both the supine and HUT position compared to controls (p < .001). Attention in the HUT position was significantly worse in NOH patients (-14.86 ± 8.96) compared to controls (-8.68 ± 7.13; p = .029). During HUT, NOH patients experienced a significant decrease in mean SBP by -64.11 ± 18.96 from baseline, whereas controls only had a mean decrease of -5.69 ± 7.65. It is evident that NOH patients have impaired IPS and attention compared to controls and likely plays an important role in the morbidity of these individuals.
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Affiliation(s)
| | - Kurt Kimpinski
- School of Kinesiology, Western University, London, ON, Canada; Department of Clinical Neurological Sciences, Rm B7-140, University Hospital, London Health Sciences Centre, 339 Windermere Road, London, ON N6A 5A5, Canada; Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
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De Giglio L, De Luca F, Gurreri F, Ferrante I, Prosperini L, Borriello G, Quartuccio E, Gasperini C, Pozzilli C. Effect of dalfampridine on information processing speed impairment in multiple sclerosis. Neurology 2019; 93:e733-e746. [DOI: 10.1212/wnl.0000000000007970] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Accepted: 04/30/2019] [Indexed: 02/02/2023] Open
Abstract
ObjectiveTo test a possible benefit of dalfampridine on information processing speed (IPS), a key function for cognitive impairment (CogIm) in multiple sclerosis (MS).MethodsIn this randomized, double-blind, placebo-controlled trial, we included patients with a score on the Symbol Digit Modalities Test (SDMT) under the 10th percentile of the reference value. Patients were randomized in a 2:1 ratio to receive dalfampridine 10 mg or placebo twice daily for 12 weeks. They underwent a comprehensive neuropsychological evaluation at screening (T0), at the end of treatment (T1), and after a 4-week follow-up (T2). The primary endpoint was improvement in SDMT.ResultsOut of 208 patients screened, 120 were randomized to receive either dalfampridine (n = 80) or placebo (n = 40). At T1, the dalfampridine group presented an increase of SDMT scores vs placebo group (mean change 9.9 [95% confidence interval (CI) 8.5–11.4] vs 5.2 [95% CI 2.8–7.6], p = 0.0018; d = 0.60 for raw score; and 0.8 [95% CI 0.6–1] vs 0.3 [95% CI 0.0–0.5], p = 0.0013; d = 0.61 for z scores; by linear mixed model with robust standard error). The improvement was not sustained at T2. A beneficial effect of dalfampridine was observed in the Paced Auditory Serial Addition Test and in cognitive fatigue.ConclusionDalfampridine could be considered as an effective treatment option for IPS impairment in MS.Trial registration2013-002558-64 EU Clinical Trials Register.Classification of evidenceThis study provides Class I evidence that for patients with MS with low scores on the SDMT, dalfampridine improves IPS.
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Oreja-Guevara C, Ayuso Blanco T, Brieva Ruiz L, Hernández Pérez MÁ, Meca-Lallana V, Ramió-Torrentà L. Cognitive Dysfunctions and Assessments in Multiple Sclerosis. Front Neurol 2019; 10:581. [PMID: 31214113 PMCID: PMC6558141 DOI: 10.3389/fneur.2019.00581] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 05/16/2019] [Indexed: 12/22/2022] Open
Abstract
Cognitive impairment has been reported at all phases and all subtypes of multiple sclerosis. It remains a major cause of neurological disability in young and middle-aged adults suffering from the disease. The severity and type of cognitive impairment varies considerably among individuals and can be observed both in early and in later stages. The areas which have commonly shown more deficits are: information processing speed, complex attention, memory, and executive function. Even though an alteration in both the white matter and in the gray matter has been found in patients with multiple sclerosis and cognitive impairment, the underlying process still remains unknown. Standardized neurological examinations fail to detect emerging cognitive deficits and self-reported cognitive complaints by the patients can be confounded by other subjective symptoms. This review is a comprehensive and short update of the literature on cognitive dysfunctions, the possible confounders and the impact of quality of life in patients with multiple sclerosis.
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Affiliation(s)
- Celia Oreja-Guevara
- Servicio de Neurología, Hospital Clínico San Carlos, IdISSC, Departamento de Medicina, Universidad Complutense, Madrid, Spain
| | | | | | - Miguel Ángel Hernández Pérez
- Servicio de Neurología, Hospital Universitario Nuestra Señora de Candelaria, Universidad de La Laguna, Santa Cruz de Tenerife, Spain
| | - Virginia Meca-Lallana
- Unidad de Esclerosis Múltiple, Servicio de Neurología, Fundación de Investigación Biomédica, Hospital Universitario de la Princesa, Madrid, Spain
| | - Lluís Ramió-Torrentà
- Unidad de Esclerosis Múltiple y Neuroinmunología de Girona, Servicio de Neurología, IDIBGI, Hospital Universitario Dr. Josep Trueta, Girona, Spain
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35
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Jakimovski D, Weinstock-Guttman B, Roy S, Jaworski M, Hancock L, Nizinski A, Srinivasan P, Fuchs TA, Szigeti K, Zivadinov R, Benedict RHB. Cognitive Profiles of Aging in Multiple Sclerosis. Front Aging Neurosci 2019; 11:105. [PMID: 31133845 PMCID: PMC6524468 DOI: 10.3389/fnagi.2019.00105] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 04/18/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Increasingly favorable mortality prognosis in multiple sclerosis (MS) raises questions regarding MS-specific cognitive aging and the presence of comorbidities such as Alzheimer's disease (AD). OBJECTIVE To assess elderly with MS (EwMS) and age-matched healthy controls (HCs) using both MS- and AD-specific psychometrics. METHODS EwMS (n = 104) and 56 HCs were assessed on a broad spectrum of language, visual-spatial processing, memory, processing speed, and executive function tests. Using logistic regression analysis, we examined cognitive performance differences between the EwMS and HC groups. Cognitive impairment (CI) was defined using a -1.5 SD threshold relative to age and education years-matched HCs, in two cognitive domains. RESULTS CI was observed in 47.1% of EwMS with differences most often seen on tests emphasizing cognitive processing speed as measured by Symbol Digit Modalities Test (SDMT) (d = 0.9, p < 0.001) and verbal fluency (both category-based d = 0.87, p < 0.001; letter-based d = 0.67, p < 0.001). After adjusting for age, sex and years of education, MS/HC diagnosis was best predicted (R 2 = 0.27) by differences in category-based verbal fluency (Wald = 9.935, p = 0.002) and SDMT (Wald = 13.937, p < 0.001). CONCLUSION This study confirms the common hallmark of slowed cognitive processing speed in MS among elderly patients. Defective verbal fluency, less often observed in younger cohorts, may represent emerging cognitive pathology due to other etiologies.
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Affiliation(s)
- Dejan Jakimovski
- Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo – The State University of New York, Buffalo, NY, United States
- 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, United States
| | - Bianca Weinstock-Guttman
- Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo – The State University of New York, Buffalo, NY, United States
| | - Shumita Roy
- Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo – The State University of New York, Buffalo, NY, United States
| | - Michael Jaworski
- Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo – The State University of New York, Buffalo, NY, United States
| | - Laura Hancock
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
| | - Alissa Nizinski
- Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo – The State University of New York, Buffalo, NY, United States
| | - Pavitra Srinivasan
- Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo – The State University of New York, Buffalo, NY, United States
| | - Tom A. Fuchs
- Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo – The State University of New York, Buffalo, NY, United States
- 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, United States
| | - Kinga Szigeti
- Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo – The State University of New York, Buffalo, NY, United States
| | - Robert Zivadinov
- Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo – The State University of New York, Buffalo, NY, United States
- 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, United States
- Clinical Translational Science Institute, Center for Biomedical Imaging, University at Buffalo – The State University of New York, Buffalo, NY, United States
| | - Ralph H. B. Benedict
- Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo – The State University of New York, Buffalo, NY, United States
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Macías Islas MÁ, Ciampi E. Assessment and Impact of Cognitive Impairment in Multiple Sclerosis: An Overview. Biomedicines 2019; 7:E22. [PMID: 30893874 PMCID: PMC6466345 DOI: 10.3390/biomedicines7010022] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 03/13/2019] [Accepted: 03/14/2019] [Indexed: 12/30/2022] Open
Abstract
Cognitive impairment affects 40⁻60% of patients with multiple sclerosis. It may be present early in the course of the disease and has an impact on a patient's employability, social interactions, and quality of life. In the last three decades, an increasing interest in diagnosis and management of cognitive impairment has arisen. Neuropsychological assessment and neuroimaging studies focusing on cognitive impairment are now being incorporated as primary outcomes in clinical trials. However, there are still key uncertainties concerning the underlying mechanisms of damage, neural basis, sensitivity and validity of neuropsychological tests, and efficacy of pharmacological and non-pharmacological interventions. The present article aimed to present an overview of the assessment, neural correlates, and impact of cognitive impairment in multiple sclerosis.
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Affiliation(s)
| | - Ethel Ciampi
- Neurology, Pontificia Universidad Católica de Chile, Neurology, Hospital Dr. Sótero del Río, Santiago 8320000, Chile.
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Kavaliunas A, Tinghög P, Friberg E, Olsson T, Alexanderson K, Hillert J, Karrenbauer VD. Cognitive function predicts work disability among multiple sclerosis patients. Mult Scler J Exp Transl Clin 2019; 5:2055217318822134. [PMID: 30729025 PMCID: PMC6350142 DOI: 10.1177/2055217318822134] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 11/08/2018] [Accepted: 11/22/2018] [Indexed: 11/16/2022] Open
Abstract
Background In multiple sclerosis various aspects of cognitive function can be detrimentally affected. More than that, patients´ employment and social functioning is likely to be impacted. Objective To determine whether work disability among multiple sclerosis patients could be predicted by the symbol digit modalities test. Methods A register-based cohort study was conducted. Individual data on work disability, operationalised as annual net days of sickness absence and/or disability pension were retrieved at baseline, when the symbol digit modalities test was performed, after one-year and 3-year follow-up for 903 multiple sclerosis patients. The incidence rate ratios for work disability were calculated with general estimating equations using a negative binomial distribution and were adjusted for gender, age, educational level, family composition, type of living area and physical disability. Results After one year of follow-up, the patients in the lowest symbol digit modalities test quartile were estimated to have a 73% higher rate of work disability when compared to the patients in the highest symbol digit modalities test quartile (incidence rate ratio 1.73, 95% confidence interval 1.42‒2.10). This estimate after 3-year follow-up was similar (incidence rate ratio 1.68, 95% confidence interval 1.40‒2.02). Conclusion Cognitive function is to a high extent associated with multiple sclerosis patients' future work disability, even after adjusting for other factors.
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Affiliation(s)
| | - Petter Tinghög
- Department of Clinical Neuroscience, Karolinska Institutet, Sweden.,Red Cross University College, Sweden
| | - Emilie Friberg
- Department of Clinical Neuroscience, Karolinska Institutet, Sweden
| | - Tomas Olsson
- Department of Clinical Neuroscience, Karolinska Institutet, Sweden.,Center for Molecular Medicine, Karolinska University Hospital, Sweden
| | | | - Jan Hillert
- Department of Clinical Neuroscience, Karolinska Institutet, Sweden.,Center for Molecular Medicine, Karolinska University Hospital, Sweden.,Department of Neurology, Karolinska University Hospital, Sweden
| | - Virginija Danylaite Karrenbauer
- Department of Clinical Neuroscience, Karolinska Institutet, Sweden.,Department of Neurology, Karolinska University Hospital, Sweden
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D'hooghe MB, Gielen J, Van Remoortel A, D'haeseleer M, Peeters E, Cambron M, De Keyser J, Nagels G. Single MRI-Based Volumetric Assessment in Clinical Practice Is Associated With MS-Related Disability. J Magn Reson Imaging 2018; 49:1312-1321. [DOI: 10.1002/jmri.26303] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 07/30/2018] [Accepted: 07/31/2018] [Indexed: 11/11/2022] Open
Affiliation(s)
- Marie B. D'hooghe
- National MS Center, Neurology; Melsbroek Belgium
- Vrije Universiteit Brussel (VUB), Center for Neurosciences; Brussels Belgium
| | - Jeroen Gielen
- National MS Center, Neurology; Melsbroek Belgium
- Vrije Universiteit Brussel (VUB), Center for Neurosciences; Brussels Belgium
| | | | | | | | - Melissa Cambron
- National MS Center, Neurology; Melsbroek Belgium
- University Hospital Brussels, Vrije Universiteit Brussels (VUB), Neurology; Brussels Belgium
| | - Jacques De Keyser
- University Hospital Brussels, Vrije Universiteit Brussels (VUB), Neurology; Brussels Belgium
- University of Groningen, University Medical Center Groningen, Department of Neurology, Groningen, Neurology; Groningen Netherlands
| | - Guy Nagels
- National MS Center, Neurology; Melsbroek Belgium
- Vrije Universiteit Brussel (VUB), Center for Neurosciences; Brussels Belgium
- Vrije Universiteit Brussel (VUB), ETRO, Faculty of Engineering; Brussels Belgium
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Kalb R, Beier M, Benedict RH, Charvet L, Costello K, Feinstein A, Gingold J, Goverover Y, Halper J, Harris C, Kostich L, Krupp L, Lathi E, LaRocca N, Thrower B, DeLuca J. Recommendations for cognitive screening and management in multiple sclerosis care. Mult Scler 2018; 24:1665-1680. [PMID: 30303036 PMCID: PMC6238181 DOI: 10.1177/1352458518803785] [Citation(s) in RCA: 229] [Impact Index Per Article: 38.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Purpose: To promote understanding of cognitive impairment in multiple sclerosis (MS), recommend optimal screening, monitoring, and treatment strategies, and address barriers to optimal management. Methods: The National MS Society (“Society”) convened experts in cognitive dysfunction (clinicians, researchers, and lay people with MS) to review the published literature, reach consensus on optimal strategies for screening, monitoring, and treating cognitive changes, and propose strategies to address barriers to optimal care. Recommendations: Based on current evidence, the Society makes the following recommendations, endorsed by the Consortium of Multiple Sclerosis Centers and the International Multiple Sclerosis Cognition Society:
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Affiliation(s)
- Rosalind Kalb
- National Multiple Sclerosis Society, New York, NY, USA
| | - Meghan Beier
- Division of Rehabilitation Psychology and Neuropsychology, Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Leigh Charvet
- Department of Neurology, Langone Medical Center, New York University, New York, NY, USA
| | | | - Anthony Feinstein
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | | | | | - June Halper
- The Consortium of Multiple Sclerosis Centers and International Organization of Multiple Sclerosis Nurses, Multiple Sclerosis Nurses International Certification Board, Hackensack, NJ, USA
| | - Colleen Harris
- Multiple Sclerosis Center, University of Calgary, Calgary, AB, Canada
| | - Lori Kostich
- The Mandell Center for Multiple Sclerosis, Mount Sinai Rehabilitation Hospital, Hartford, CT, USA
| | - Lauren Krupp
- Department of Neurology, NYU Langone Health, New York University, New York, NY, USA
| | - Ellen Lathi
- The Elliot Lewis Center for Multiple Sclerosis Care, Wellesley, MA, USA
| | | | - Ben Thrower
- Emory University, Atlanta, GA, USA/Andrew C. Carlos Multiple Sclerosis Institute at Shepherd Center, Atlanta, GA, USA
| | - John DeLuca
- Department of Physical Medicine and Rehabilitation and Department of Neurology, Rutgers New Jersey Medical School, Newark, NJ, USA
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McNicholas N, O'Connell K, Yap SM, Killeen RP, Hutchinson M, McGuigan C. Cognitive dysfunction in early multiple sclerosis: a review. QJM 2018; 111:359-364. [PMID: 28371862 DOI: 10.1093/qjmed/hcx070] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Indexed: 11/14/2022] Open
Abstract
Cognitive impairment is a common and disabling feature of Multiple Sclerosis (MS), including early MS, and may even pre-date any physical symptoms. It contributes even more to withdrawal from work than physical disability. Here, we provide an overview of cognitive impairment in MS, particularly in early MS where it is most commonly under-reported and under-treated. We address the presenting features of CI, its impact on quality of life, and its validated assessments (in particular the use of Brief International Cognitive Assessment in MS for use in a clinical setting). We review the insights radiology has given us into the pathogenesis of cognitive impairment in MS, particularly in early CI and in cognitively preserved MS patients. We review current treatments for cognitive impairment, primarily cognitive rehabilitation. We address the evidence for its associated co-morbidities, which may exacerbate or trigger CI, and should therefore be addressed early in the disease course (smoking, alcohol, mood, fatigue and potential co-existing sleep disorders, exercise, and vitamin D). The article supports the importance for early recognition and management of cognitive impairment in MS, before it becomes an established and irreversible entity.
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Affiliation(s)
- N McNicholas
- Department of Neurology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - K O'Connell
- Department of Neurology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - S M Yap
- Department of Neurology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - R P Killeen
- Department of Neuroradiology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - M Hutchinson
- Department of Neurology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - C McGuigan
- Department of Neurology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
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Willekens B, Perrotta G, Cras P, Cools N. Into the Moment: Does Mindfulness Affect Biological Pathways in Multiple Sclerosis? Front Behav Neurosci 2018; 12:103. [PMID: 29872382 PMCID: PMC5972188 DOI: 10.3389/fnbeh.2018.00103] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 04/30/2018] [Indexed: 01/01/2023] Open
Abstract
Mindfulness was introduced in the Western world by Jon Kabat-Zinn in 1979. He defined it as "awareness that arises through paying attention, on purpose, in the present moment, non-judgmentally." Since then, research on mindfulness-based interventions (MBIs) has increased exponentially both in health and disease, including in patients with neurodegenerative diseases such as dementia and Parkinson's disease. Research on the effect of mindfulness and multiple sclerosis (MS) only recently gained interest. Several studies completed since 2010 provided evidence that mindfulness improves quality of life (QoL), depression and fatigue in MS patients. In addition to patient-reported outcome measures, potential effects on cognitive function have been investigated only to a very limited extent. However, research on laboratory biomarkers and neuroimaging, capable to deliver proof-of-concept of this behavioral treatment in MS, is mainly lacking. In this perspective, we illustrate possible neurobiological mechanisms, including the tripartite interaction between the brain, the immune system and neuroendocrine regulation, through which this treatment might affect multiple sclerosis symptoms. We propose to (1) include immunological and/or neuroimaging biomarkers as standard outcome measures in future research dedicated to mindfulness and MS to help explain the clinical improvements seen in fatigue and depression; (2) to investigate effects on enhancing cognitive reserve and cognitive function; and (3) to investigate the effects of mindfulness on the disease course in MS.
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Affiliation(s)
- Barbara Willekens
- Department of Neurology, Antwerp University Hospital, Antwerp, Belgium.,Laboratory of Experimental Hematology, Faculty of Medicine and Health Sciences, Vaccine & Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | | | - Patrick Cras
- Department of Neurology, Antwerp University Hospital, Antwerp, Belgium.,Department of Neurology, Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Department of Neurology, Laboratory for Neurobiology, Born-Bunge Institute, University of Antwerp, Antwerp, Belgium
| | - Nathalie Cools
- Laboratory of Experimental Hematology, Faculty of Medicine and Health Sciences, Vaccine & Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
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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: 89] [Impact Index Per Article: 14.8] [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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Manca R, Sharrack B, Paling D, Wilkinson ID, Venneri A. Brain connectivity and cognitive processing speed in multiple sclerosis: A systematic review. J Neurol Sci 2018; 388:115-127. [PMID: 29627004 DOI: 10.1016/j.jns.2018.03.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 02/06/2018] [Accepted: 03/01/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Processing speed (PS) decline is the most commonly observed cognitive deficit in people with multiple sclerosis (MS) resulting in a significant impact on quality of life. Despite its importance, knowledge of the underlying neural substrates is lacking. OBJECTIVE As MS is increasingly recognised as a disconnection syndrome, our aim was to carry out a systematic literature review to clarify the relationship between PS performance and MRI measures of structural and functional brain connectivity in people with MS. SEARCH METHODS A literature search was carried out on PubMed and Web of Science that included publications predating September 2017. Additional articles were added after inspection of the reference lists of all selected papers. DATA EXTRACTION All selected papers were categorised in three sections according to the MRI measures investigated, independently or both. Quality assessment was carried out using a customised set of criteria. RESULTS Thirty-two articles met the inclusion criteria and were included in the review. Microstructural integrity of the anterior corpus callosum and functional connectivity of frontal areas were more consistently found to correlate with PS performance, though high variability of findings was observed across studies. Several methodological flaws emerged from the reviewed literature. CONCLUSIONS Despite the observed trends, no definite conclusions can be drawn on the relationship between brain connectivity and PS decline in MS given the limitations of the current literature. Future investigations may benefit from theoretical and methodological advances to clarify how MS-related brain damage affects patients' cognition.
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Affiliation(s)
- Riccardo Manca
- Department of Neurosciences, University of Sheffield, Sheffield, UK
| | - Basil Sharrack
- Department of Neurosciences, University of Sheffield, Sheffield, UK; Department of Neurology, Sheffield Teaching Hospital NHS Trust, Sheffield, UK
| | - David Paling
- Department of Neurosciences, University of Sheffield, Sheffield, UK; Department of Neurology, Sheffield Teaching Hospital NHS Trust, Sheffield, UK
| | - Iain D Wilkinson
- Academic Unit of Radiology, University of Sheffield, Sheffield, UK
| | - Annalena Venneri
- Department of Neurosciences, University of Sheffield, Sheffield, UK.
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The kinematics of handwriting movements as expression of cognitive and sensorimotor impairments in people with multiple sclerosis. Sci Rep 2017; 7:17730. [PMID: 29255220 PMCID: PMC5735165 DOI: 10.1038/s41598-017-18066-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 12/02/2017] [Indexed: 11/23/2022] Open
Abstract
Handwriting is an important activity of daily living, which requires sensorimotor and cognitive skills that could deteriorate in presence of neurological diseases. Handwriting impairments are common in people with multiple sclerosis (PwMS). Aims of the present study were to characterize handwriting movement features of PwMS in comparison with those of healthy adults, and to evaluate the relationship between kinematic parameters of handwriting movements and the results of the assessment of cognitive and motor domains. A new handwriting evaluation methodology was applied to quantify handwriting features of 19 PwMS and 22 age-matched healthy controls who were required to write a sentence on a digitizing tablet. Kinematic parameters of the sentence and of the strokes were used to evaluate handwriting performance. PwMS showed an altered handwriting kinematics with respect to healthy controls: higher movement duration, fragmented velocity profile and higher jerk. Furthermore, motor abilities and cognitive status of PwMS were related to handwriting parameters in accordance with the evidence that MS is a multifactorial disease affecting different domains. These results suggested that the proposed methodology might be a valuable tool to quantitatively assess handwriting impairments and the efficacy of handwriting treatments in PwMS.
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Matias-Guiu JA, Cortés-Martínez A, Valles-Salgado M, Oreja-Guevara C, Pytel V, Montero P, Moreno-Ramos T, Matias-Guiu J. Functional Components of Cognitive Impairment in Multiple Sclerosis: A Cross-Sectional Investigation. Front Neurol 2017; 8:643. [PMID: 29234305 PMCID: PMC5712315 DOI: 10.3389/fneur.2017.00643] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 11/16/2017] [Indexed: 12/14/2022] Open
Abstract
Background Cognitive impairment is frequent and disabling in multiple sclerosis (MS). Changes in information processing speed constitute the most important cognitive deficit in MS. However, given the clinical and topographical variability of the disease, cognitive impairment may vary greatly and appear in other forms in addition to slower information processing speed. Our aim was to determine the frequency of cognitive impairment, the principal cognitive domains, and components involved in MS and to identify factors associated with presence of cognitive impairment in these patients in a large series of patients. Methods Cross-sectional study of 311 patients with MS [236 with relapsing-remitting MS (RRMS), 52 with secondary progressive MS (SPMS), and 23 with primary progressive MS (PPMS)]. Patients' cognitive function was assessed with a comprehensive neuropsychological assessment protocol. Patients displaying deficits in 2 or more cognitive domains were considered to have cognitive impairment associated with MS. We conducted a principal component analysis to detect different cognitive patterns by identifying clusters of tests highly correlated to one another. Results Cognitive impairment was detected in 41.5% of the sample, and it was more frequent in patients with SPMS and PPMS (P = 0.002). Expanded Disability Status Scale scores and education were independent predictors of cognitive impairment. Principal component analysis identified seven clusters: attention and basic executive function (including information processing speed), planning and high-level executive function, verbal memory and language, executive and visuospatial performance time, fatigue-depression, visuospatial function, and basic attention and verbal/visual working memory. Mean scoring of components 2 (high-order executive functioning) and 3 (verbal memory-language) was higher in patients with RRMS than in those with PPMS (component 2) and SPMS (component 3). Conclusion MS is linked to multiple cognitive profiles and disturbances in different domains. This suggests that cognitive alterations in MS are heterogeneous and affect other domains in addition to information processing speed.
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Affiliation(s)
- Jordi A Matias-Guiu
- Department of Neurology, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Universidad Complutense de Madrid, Madrid, Spain
| | - Ana Cortés-Martínez
- Department of Neurology, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Universidad Complutense de Madrid, Madrid, Spain
| | - María Valles-Salgado
- Department of Neurology, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Universidad Complutense de Madrid, Madrid, Spain
| | - Celia Oreja-Guevara
- Department of Neurology, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Universidad Complutense de Madrid, Madrid, Spain
| | - Vanesa Pytel
- Department of Neurology, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Universidad Complutense de Madrid, Madrid, Spain
| | - Paloma Montero
- Department of Neurology, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Universidad Complutense de Madrid, Madrid, Spain
| | - Teresa Moreno-Ramos
- Department of Neurology, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Universidad Complutense de Madrid, Madrid, Spain
| | - Jorge Matias-Guiu
- Department of Neurology, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Universidad Complutense de Madrid, Madrid, Spain
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Chalah MA, Ayache SS. Alexithymia in multiple sclerosis: A systematic review of literature. Neuropsychologia 2017; 104:31-47. [DOI: 10.1016/j.neuropsychologia.2017.07.034] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 07/28/2017] [Accepted: 07/29/2017] [Indexed: 02/07/2023]
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The Relationship between Psychosocial Factors and Cognition in Multiple Sclerosis. Behav Neurol 2017; 2017:6847070. [PMID: 28584406 PMCID: PMC5451874 DOI: 10.1155/2017/6847070] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 04/06/2017] [Accepted: 04/12/2017] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Multiple sclerosis (MS) is a common disorder in some regions of the world, with over 2.3 million people diagnosed worldwide. Cognitive impairment is one of the earliest symptoms to present in the course of the disease and can cause significant morbidity. We proposed a study to explore the psychosocial predictors of cognitive impairment in MS patients in Saudi Arabia, a previously unexplored patient population. METHODS Demographic data, depression scale (PHQ9), symptom burden (PHQ15), anxiety (GAD7), disease duration, and Montreal Cognitive Assessment (MOCA) scores were collected from 195 patients in a neurology clinic in Ryiadh, Saudi Arabia. Univariate and multiple regression analyses were conducted to identify variables that are significantly associated with cognitive impairment. RESULTS Variables that were identified to be significantly associated with cognition, p < 0.05, were education level, disease duration, and family history. DISCUSSION Both education level and disease duration were variables identified in previous studies. We showed family history to be a significant variable, and no association was found with depression or anxiety, which is unique to our study population. CONCLUSIONS We identified several psychosocial predictors that are associated with cognition in our patient population. It was also noted that a difference exists between patient populations, highlighting the need for further studies in specific geographical regions.
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Lubrini G, Ríos Lago M, Periañez JA, Tallón Barranco A, De Dios C, Fernández-Fournier M, Diez Tejedor E, Frank García A. The contribution of depressive symptoms to slowness of information processing in relapsing remitting multiple sclerosis. Mult Scler 2016; 22:1607-1615. [DOI: 10.1177/1352458516661047] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Accepted: 07/03/2016] [Indexed: 11/16/2022]
Abstract
Background: Slowness of information processing has been suggested as a fundamental factor modulating cognitive impairment in multiple sclerosis (MS). However, the contribution of depressive symptoms (DS) to slowness remains unclear. One of the most accepted hypotheses on the impact of depression on the general population suggests that depression interferes only with tasks requiring high cognitive demands. However, no studies have investigated if the same pattern occurs in MS. Objective: The aim of this study was to determine the profile of the contribution of DS to slowness. Methods: Four Reaction Time (RT) tasks requiring an increasing level of cognitive demands were administered to 35 relapsing remitting MS patients with DS, 33 MS patients without DS, 17 depressed non-MS patients and 27 controls. Results: MS patients without DS obtained longer RTs than controls in all the tasks. On the contrary, depressed non-MS patients were slower than controls only in the most demanding task. Finally, MS patients with DS were slower than MS patients without DS not only in the most demanding task but also in the task requiring a lower level of cognitive demands. Conclusion: The contribution of DS to slowness depends on the level of cognitive demands. However, its impact on MS is more deleterious than on the general population.
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Affiliation(s)
- Genny Lubrini
- Department of Neurology, La Paz University Hospital, IdiPAZ Health Research Institute, Autónoma University of Madrid, Madrid, Spain
| | - Marcos Ríos Lago
- Brain Damage Service, Hospital Beata Maria Ana, Madrid, Spain; Department of Basic Psychology II, UNED, Madrid, Spain
| | - Jose A Periañez
- Department of Basic Psychology II, Complutense University of Madrid, Madrid, Spain
| | - Antonio Tallón Barranco
- Department of Neurology, La Paz University Hospital, IdiPAZ Health Research Institute, Autónoma University of Madrid, Madrid, Spain
| | - Consuelo De Dios
- Department of Psychiatry, La Paz University Hospital, IdiPAZ Health Research Institute, Autónoma University of Madrid, Madrid, Spain
| | - Mireya Fernández-Fournier
- Department of Neurology, La Paz University Hospital, IdiPAZ Health Research Institute, Autónoma University of Madrid, Madrid, Spain
| | - Exuperio Diez Tejedor
- Department of Neurology, La Paz University Hospital, IdiPAZ Health Research Institute, Autónoma University of Madrid, Madrid, Spain
| | - Ana Frank García
- Department of Neurology, La Paz University Hospital, IdiPAZ Health Research Institute, Autónoma University of Madrid, Madrid, Spain
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Pedullà L, Brichetto G, Tacchino A, Vassallo C, Zaratin P, Battaglia MA, Bonzano L, Bove M. Adaptive vs. non-adaptive cognitive training by means of a personalized App: a randomized trial in people with multiple sclerosis. J Neuroeng Rehabil 2016; 13:88. [PMID: 27716336 PMCID: PMC5050994 DOI: 10.1186/s12984-016-0193-y] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 09/17/2016] [Indexed: 11/26/2022] Open
Abstract
Background Cognitive impairment is common in multiple sclerosis (MS), but the definition of the best cognitive rehabilitation tools and features is still an open issue among researchers. The aims of the present study were to evaluate the effectiveness of COGNI-TRAcK (a customized application software delivering personalized working memory-based exercises) on cognitively impaired people with MS and to investigate the effects of an adaptive vs. a non-adaptive cognitive training administered by means of COGNI-TRAcK. Methods Twenty eight patients (20 women, age 47.5 ± 9.3 years, Expanded Disability Status Scale score 3.8 ± 1.9) were randomized in two homogeneous groups, both performing a 8-week home-based cognitive rehabilitation treatment by means of COGNI-TRAcK. The study group (ADAPT-gr) underwent an adaptive training given by the automatic adjustment of tasks difficulty to the subjects’ performance, whilst the control group (CONST-gr) was trained at constant difficulty levels. Before and after the treatment, patients’ cognitive status was assessed using a gold standard neuropsychological evaluation. Moreover, the mostly affected cognitive domains in MS (i.e., attention, concentration and information processing speed) were also assessed 6 months after the end of the treatment. Results The analysis of variance showed a significant Group*Time interaction in six out of ten tests of the cognitive evaluation. Post-hoc analysis revealed a significant improvement between the performances before and after the intervention only in the ADAPT-gr in tests evaluating verbal memory acquisition (p <0.05) and delayed recall (p = 0.001), verbal fluency (p = 0.01), sustained attention, concentration and information processing speed (p < 0.01). This last effect was maintained also after 6 months (p < 0.05). Conclusions We concluded that COGNI-TRAcK represents a suitable tool to administer a personalized training to cognitively impaired subjects and that an adaptive working load is a crucial feature determining the effectiveness of cognitive treatment, allowing transfer effects to several cognitive domains and long-term maintenance of results.
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Affiliation(s)
- Ludovico Pedullà
- Department of Experimental Medicine, Section of Human Physiology, University of Genoa, Genoa, Italy.,Italian Multiple Sclerosis Foundation, Scientific Research Area, Genoa, Italy
| | - Giampaolo Brichetto
- Italian Multiple Sclerosis Foundation, Scientific Research Area, Genoa, Italy.
| | - Andrea Tacchino
- Italian Multiple Sclerosis Foundation, Scientific Research Area, Genoa, Italy
| | - Claudio Vassallo
- Italian Multiple Sclerosis Foundation, Scientific Research Area, Genoa, Italy
| | - Paola Zaratin
- Italian Multiple Sclerosis Foundation, Scientific Research Area, Genoa, Italy
| | | | - Laura Bonzano
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Marco Bove
- Department of Experimental Medicine, Section of Human Physiology, University of Genoa, Genoa, Italy.
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van Ettinger-Veenstra H. Cumulative evidence for MS as a neural network disconnection syndrome consistent with cognitive impairment mechanisms and the confounding role of fatigue and depression-outlook from the Fourth Nordic MS symposium. Acta Neurol Scand 2016; 134 Suppl 200:4-7. [PMID: 27580899 DOI: 10.1111/ane.12655] [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] [Accepted: 07/07/2016] [Indexed: 12/14/2022]
Abstract
The Fourth Nordic MS symposium served as a platform to present an overview over the rise and impact of cognitive impairment in people with MS, from early stages on, impairing their quality of life. After discussing MS and cognitive impairment symptoms, a review on the pathophysiology underlying cognitive impairment was given, followed by a talk on neuroimaging highlighting cortical reorganization in MS-affected brains. As a conclusion, therapy and treatment options were discussed. The symposium presented several cutting-edge research studies providing or testing working models that appear successful in predicting and explaining cognitive impairment in MS, such as the disconnection syndrome.
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Affiliation(s)
- H. van Ettinger-Veenstra
- Department of Clinical and Experimental Medicine; Linköping University; Linköping Sweden
- Center for Medical Image Science and Visualization (CMIV); Linköping University; Linköping Sweden
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