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Bastos A, Soares M, Guimarães J. Markers of secondary progression in multiple sclerosis. Mult Scler Relat Disord 2024; 91:105881. [PMID: 39277977 DOI: 10.1016/j.msard.2024.105881] [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: 05/30/2024] [Revised: 09/02/2024] [Accepted: 09/06/2024] [Indexed: 09/17/2024]
Abstract
INTRODUCTION There is no globally accepted definition of Secondary Progressive Multiple Sclerosis (SPMS) or set of unambiguous clinical, radiological, or other criteria that can accurately identify patients who transition to SPMS. Thus, the SPMS diagnosis is almost always a retrospective and frequently delayed process. OBJECTIVE The aim of this study was to elucidate the current understanding of phenotypic changes throughout MS course and provide insights into the detection of SPMS from the available literature on this diagnostic landscape. METHODS Comprehensive literature review aiming at detecting the transition from RRMS to SPMS. A search for relevant publications was conducted across different databases, scrutinizing studies that investigated tools and biomarkers for an accurate diagnosis of SPMS. RESULTS 62 studies from the past two decades were included. The EDSS-plus was shown to be more sensitive than the EDSS alone in identifying disability progression. We found some helpful indicators for diagnosing SPMS, including cognitive impairment, particularly on working memory, information processing speed, and verbal fluency; presence of slowly expanding lesions on MRI; thinning of retinal layers on OCT. Also, glial markers as Glial Fibrillary Acidic Protein and Chitinase-3-like protein 1 might be more suitable to identify the conversion to progressive disease than Neurofilament light chain. Certain subjective symptoms seem to be more prevalent in the SPMS phase, although further studies are needed to understand whether patient reported outcomes' measures (PROMs) and which ones could be useful in detecting the transition to a progressive phenotype. CONCLUSION Our review highlights the emergence of useful biomarkers in early detection of progression of MS, such as cognitive impairment, MRI, and glial markers. We are getting closer to revolutionising the SPMS diagnosis and clinical management as we get a deeper understanding of these biomarkers.
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Affiliation(s)
- André Bastos
- Faculty of Medicine of University of Porto, Porto, Portugal.
| | - Mafalda Soares
- Faculty of Medicine of University of Porto, Porto, Portugal; Department of Neurology, Saint Joseph's Local Health Unit, Lisbon, Portugal
| | - Joana Guimarães
- Faculty of Medicine of University of Porto, Porto, Portugal; Department of Neurology, Saint John's Local Health Unit, Porto, Portugal
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França M, Sousa C, Campos P, Rigueiro-Neves M, Ferreira A, Passos AM, Sá MJ. Assessment of phonemic verbal fluency in Portuguese patients with multiple sclerosis. J Clin Exp Neuropsychol 2024; 46:570-578. [PMID: 38980264 DOI: 10.1080/13803395.2024.2376295] [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: 01/15/2024] [Accepted: 06/28/2024] [Indexed: 07/10/2024]
Abstract
BACKGROUND Executive dysfunction occurs in 15% to 20% of multiple sclerosis (MS) patients and verbal fluency tests are frequently used to assess this deficit. The Word List Generation (WLG) is one of the most used measures in MS. This study aims to compare the performance of WLG of MS patients and healthy controls and to analyze the influence of clinical and demographic factors on the performance of MS patients. METHODS One hundred and nine MS patients and an age- and gender-matched group of 138 healthy controls were evaluated with WLG Portuguese version, as well as other tests from the Brief Repeatable Battery of Neuropsychological Tests (BRBN-T), subtests from WAIS, a phonemic fluency test (M, R, and P), and measures of psychological symptomatology and cognitive fatigue. The MS group (70.6% females) was mainly diagnosed with RRMS (89.2%). RESULTS The MS group performed significantly lower than healthy controls on the WLG. In the MS group, this performance was significantly correlated with the level of education. Significant differences were found between the two groups regarding cognitive fatigue, with MS patients reporting higher levels than healthy controls. However, this variable was not related to the performance on the WLG for MS patients. CONCLUSIONS This study suggests that MS is associated with large levels of cognitive decline on the phonemic verbal fluency tests. These results are consistent with other studies and highlight the importance of verbal fluency and cognitive speed measures in the neuropsychological assessment of MS. Deficits on this task seem to be highly related to the level of education of the patient rather than other demographic and clinical factors.
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Affiliation(s)
- Márcia França
- Neuropsychology Unit of Department of Psychology, Centro Hospitalar Universitário São João Porto, Porto, Portugal
| | - Cláudia Sousa
- Neuropsychology Unit of Department of Psychology, Centro Hospitalar Universitário São João Porto, Porto, Portugal
- Department of Neurology, Centro Hospitalar Universitário São João Porto, Porto, Portugal
| | - Patricia Campos
- Neuropsychology Unit of Department of Psychology, Centro Hospitalar Universitário São João Porto, Porto, Portugal
| | - Mariana Rigueiro-Neves
- Business Research Unit (BRU-IUL), University Institute of Lisbon (ISCTE-IUL), Lisboa, Portugal
- Psychology Unit, PIN - Em todas as fases da vida, Lisboa, Portugal
| | - Aristides Ferreira
- Business Research Unit (BRU-IUL), University Institute of Lisbon (ISCTE-IUL), Lisboa, Portugal
| | - Ana Margarida Passos
- Business Research Unit (BRU-IUL), University Institute of Lisbon (ISCTE-IUL), Lisboa, Portugal
| | - Maria José Sá
- Department of Neurology, Centro Hospitalar Universitário São João Porto, Porto, Portugal
- Faculty of Health Sciences, University Fernando Pessoa, Porto, Portugal
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Altun MB, Öge-Daşdöğen Ö, Tütüncü M. Microstructural analysis of verbal fluency performance in relapsing-remitting multiple sclerosis based on the impact of disability level. APPLIED NEUROPSYCHOLOGY. ADULT 2024:1-11. [PMID: 38574394 DOI: 10.1080/23279095.2024.2335534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
Verbal fluency (VF) evaluates language and cognitive abilities. This study compared VF in Relapsing-Remitting Multiple Sclerosis (RRMS) and healthy controls (HC), examining variables including correct responses (CR), mean cluster size (MCS), switches (S), and fluency difference score (FDS). RRMS participants were subgrouped by Expanded Disability Status Scale (EDSS), to explore the relationship between MS severity and VF. Twenty-four RRMS participants and matched HCs underwent Mini-Mental State Exam and VF Test. Statistical analysis compared VF between RRMS subgroups based on severity levels, and in HC. RRMS significantly impacted the CR, and S (CRSF p = 0.01, SSF p = 0.002; CRPF=0.002, SPF p = 0.002), while there was no significant difference in FDS between RRMS groups (p = 0.9). No significant relationship was found between EDSS scores, and VF subtests (CRSF p = 0.061, MCSSF p = 0.46, SSF p = 0.051, CRPF p = 0.521, MCSPF p = 0.966, SPF p = 0.599). In RRMS, our results demonstrate impairments in all VF parameters except the MCSSF+PF, and FDS. This study suggests that intact MCSSF+PF may reflect preserved verbal memory and word recall, while significant switching differences may indicate impaired cognitive flexibility. Similar FDS to those of HC suggest that no performance discrepancy in subtests in RRMS. Intact MCS might be a distinctive pattern in the early clinical stage of MS.
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Affiliation(s)
- Melis Buse Altun
- Department of Speech and Language Therapy, Faculty of Health Sciences, Istanbul Atlas University, Istanbul, Turkey
| | - Özlem Öge-Daşdöğen
- Department of Speech and Language Therapy, Faculty of Health Sciences, Istanbul Atlas University, Istanbul, Turkey
| | - Melih Tütüncü
- Department of Neurology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
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Ontaneda D, Chitnis T, Rammohan K, Obeidat AZ. Identification and management of subclinical disease activity in early multiple sclerosis: a review. J Neurol 2024; 271:1497-1514. [PMID: 37864717 PMCID: PMC10972995 DOI: 10.1007/s00415-023-12021-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 09/22/2023] [Accepted: 09/24/2023] [Indexed: 10/23/2023]
Abstract
IMPORTANCE Early treatment initiation in multiple sclerosis (MS) is crucial in preventing irreversible neurological damage and disability progression. The current assessment of disease activity relies on relapse rates and magnetic resonance imaging (MRI) lesion activity, but inclusion of other early, often "hidden," indicators of disease activity may describe a more comprehensive picture of MS. OBSERVATIONS Early indicators of MS disease activity other than relapses and MRI activity, such as cognitive impairment, brain atrophy, and fatigue, are not typically captured by routine disease monitoring. Furthermore, silent progression (neurological decline not clearly captured by standard methods) may occur undetected by relapse and MRI lesion activity monitoring. Consequently, patients considered to have no disease activity actually may have worsening disease, suggesting a need to revise MS management strategies with respect to timely initiation and escalation of disease-modifying therapy (DMT). Traditionally, first-line MS treatment starts with low- or moderate-efficacy therapies, before escalating to high-efficacy therapies (HETs) after evidence of breakthrough disease activity. However, multiple observational studies have shown that early initiation of HETs can prevent or reduce disability progression. Ongoing randomized clinical trials are comparing escalation and early HET approaches. CONCLUSIONS AND RELEVANCE There is an urgent need to reassess how MS disease activity and worsening are measured. A greater awareness of "hidden" indicators, potentially combined with biomarkers to reveal silent disease activity and neurodegeneration underlying MS, would provide a more complete picture of MS and allow for timely therapeutic intervention with HET or switching DMTs to address suboptimal treatment responses.
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Affiliation(s)
- Daniel Ontaneda
- Mellen Center for Multiple Sclerosis, Department of Neurology, Cleveland Clinic, Cleveland, OH, USA.
| | - Tanuja Chitnis
- Brigham Multiple Sclerosis Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Kottil Rammohan
- Division of Multiple Sclerosis, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Ahmed Z Obeidat
- Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, USA
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Pitteri M, Vannucci M, Dapor C, Guandalini M, Daffinà A, Marastoni D, Calabrese M. Prominent role of executive functioning on the Phonemic Fluency Test in people with multiple sclerosis. J Int Neuropsychol Soc 2023; 29:902-906. [PMID: 36781412 DOI: 10.1017/s1355617723000139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
OBJECTIVE Executive functioning (EF) can be one of the earliest, despite under-detected, impaired cognitive domains in patients with multiple sclerosis (pwMS). However, it is still not clear the role of EF on verbal fluency tests given the presence of information processing speed (IPS) deficits in pwMS. METHOD Performance of a group of 43 pwMS without IPS impairment as measured with the Symbol Digit Modalities Test (SDMT) and a group of 32 healthy controls (HC) was compared on the Phonemic and Semantic Fluency Tests. For each group, we scored the number of words generated (i) in the early time interval (i.e., first 15 sec, semi-automatic process) and (ii) in the late time interval (i.e., from 15 to 60 sec, controlled process). RESULTS Globally, pwMS produced significantly fewer words than HC on the Phonemic but not on the Semantic Fluency Test. Crucially, in the Phonemic Fluency Test pwMS generated significantly fewer words than HC in the late time interval, whereas no significant difference between the two groups emerged in the early time interval. CONCLUSIONS These findings suggest that executive dysfunction is the core element on the Phonemic Fluency Test also in pwMS and it deserves attention in both research and clinical practice.
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Affiliation(s)
- Marco Pitteri
- Department of Neuropsychology, National Hospital for Neurology and Neurosurgery, London, UK
| | - Manila Vannucci
- Department of NEUROFARBA, Section of Psychology, University of Florence, Florence, Italy
| | - Caterina Dapor
- Department of General Psychology, University of Padua, Padua, Italy
| | - Maddalena Guandalini
- Neurology section, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Angelica Daffinà
- Psychology Area, Salesian University Institution of Venice and Verona (IUSVE), Venice-Mestre, Italy
| | - Damiano Marastoni
- 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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Rook J, Llufriu S, de Kok D, Rofes A. Language impairments in people with autoimmune neurological diseases: A scoping review. JOURNAL OF COMMUNICATION DISORDERS 2023; 106:106368. [PMID: 37717472 DOI: 10.1016/j.jcomdis.2023.106368] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 08/02/2023] [Accepted: 08/16/2023] [Indexed: 09/19/2023]
Abstract
INTRODUCTION Autoimmune neurological diseases (ANDs) are a specific type of autoimmune disease that affect cells within the central and peripheral nervous system. ANDs trigger various physical/neuropsychiatric symptoms. However, language impairments in people with ANDs are not well characterized. Here we aimed to determine the kinds of language impairment that most commonly emerge in 10 ANDs, the characteristics of the patients (demographic, neurological damage), and the assessment methods used. METHODS We followed the PRISMA Extension for Scoping Reviews (PRISMA-ScR). PubMed and Google Scholar were searched. We used a list of search terms containing 10 types of ANDs (e.g., multiple sclerosis, acute disseminated encephalomyelitis) in combination with the terms aphasia, dysphasia, fluency, language, listening, morphology, phonology, pragmatics, reading, semantics, speaking, syntax, writing. The reference lists and citations of the relevant papers were also investigated. The type of AND, patient characteristics, neurological damage and examination technique, language tests administered, and main findings were noted for each study meeting the inclusion criteria. RESULTS We found 171 studies meeting our inclusion criteria. These comprised group studies and case studies. Language impairments differed largely among types of ANDs. Neurological findings were mentioned in most of the papers, but specific language tests were rarely used. CONCLUSIONS Language symptoms in people with ANDs are commonly reported. These are often not full descriptions or only focus on specific time points in the course of the disease. Future research needs to assess specific language functions in people with ANDs and relate their language impairments to brain damage at different stages of disease evolution.
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Affiliation(s)
- Janine Rook
- Center for Language and Cognition, University of Groningen, Groningen, The Netherlands; Research School of Behavioural and Cognitive Neurosciences, University of Groningen, Groningen, The Netherlands
| | - Sara Llufriu
- Center of Neuroimmunology, Laboratory of Advanced Imaging in Neuroimmunological Diseases, Hospital Clinic Barcelona, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Dörte de Kok
- Center for Language and Cognition, University of Groningen, Groningen, The Netherlands
| | - Adrià Rofes
- Center for Language and Cognition, University of Groningen, Groningen, The Netherlands.
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Kundu P, Yasuhara K, Brandes MS, Zweig JA, Neff CJ, Holden S, Kessler K, Matsumoto S, Offner H, Waslo CS, Vandenbark A, Soumyanath A, Sherman LS, Raber J, Gray NE, Spain RI. Centella asiatica promotes antioxidant gene expression and mitochondrial oxidative respiration in experimental autoimmune encephalomyelitis. RESEARCH SQUARE 2023:rs.3.rs-3393042. [PMID: 37886497 PMCID: PMC10602085 DOI: 10.21203/rs.3.rs-3393042/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
Centella asiatica (Centella) is a traditional botanical medicine that shows promise in treating dementia based on behavioral alterations seen in animal models of aging and cognitive dysfunction. In order to determine if Centella could similarly improve cognitive function and reduce disease burden in multiple sclerosis (MS), we tested its effects in the neuroinflammatory experimental autoimmune encephalomyelitis (EAE) model of MS. In two independent experiments, C57BL/6J mice were treated following induction of EAE with either a standardized water extract of Centella (CAW) or placebo for 2 weeks. At the dosing schedule and concentrations tested, CAW did not improve behavioral performance, EAE motor disability, or degrees of demyelination. However, CAW-treated mice demonstrated increases in nuclear factor (erythroid-derived 2)-like 2 and other antioxidant response element genes, and increases in mitochondrial respiratory activity. Caw also decreased spinal cord inflammation. Our findings indicate that CAW can increase antioxidant gene expression and mitochondrial respiratory activity in mice with EAE, supporting investigation of the clinical effects of CAW in people with MS.
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Spain RI, Hildebrand A, Waslo CS, Rooney WD, Emmons J, Schwartz DL, Freedman MS, Paz Soldan MM, Repovic P, Solomon AJ, Rinker J, Wallin M, Haselkorn JK, Stuve O, Gross RH, Turner AP. Processing speed and memory test performance are associated with different brain region volumes in Veterans and others with progressive multiple sclerosis. Front Neurol 2023; 14:1188124. [PMID: 37360346 PMCID: PMC10285490 DOI: 10.3389/fneur.2023.1188124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 05/09/2023] [Indexed: 06/28/2023] Open
Abstract
Background Cognitive dysfunction and brain atrophy are both common in progressive multiple sclerosis (MS) but are seldom examined comprehensively in clinical trials. Antioxidant treatment may affect the neurodegeneration characteristic of progressive MS and slow its symptomatic and radiographic correlates. Objectives This study aims to evaluate cross-sectional associations between cognitive battery components of the Brief International Cognitive Assessment for Multiple Sclerosis with whole and segmented brain volumes and to determine if associations differ between secondary progressive (SPMS) and primary progressive (PPMS) MS subtypes. Design The study was based on a baseline analysis from a multi-site randomized controlled trial of the antioxidant lipoic acid in veterans and other people with progressive MS (NCT03161028). Methods Cognitive batteries were conducted by trained research personnel. MRIs were processed at a central processing site for maximum harmonization. Semi-partial Pearson's adjustments evaluated associations between cognitive tests and MRI volumes. Regression analyses evaluated differences in association patterns between SPMS and PPMS cohorts. Results Of the 114 participants, 70% had SPMS. Veterans with MS made up 26% (n = 30) of the total sample and 73% had SPMS. Participants had a mean age of 59.2 and sd 8.5 years, and 54% of them were women, had a disease duration of 22.4 (sd 11.3) years, and had a median Expanded Disability Status Scale of 6.0 (with an interquartile range of 4.0-6.0, moderate disability). The Symbol Digit Modalities Test (processing speed) correlated with whole brain volume (R = 0.29, p = 0.01) and total white matter volume (R = 0.33, p < 0.01). Both the California Verbal Learning Test (verbal memory) and Brief Visuospatial Memory Test-Revised (visual memory) correlated with mean cortical thickness (R = 0.27, p = 0.02 and R = 0.35, p < 0.01, respectively). Correlation patterns were similar in subgroup analyses. Conclusion Brain volumes showed differing patterns of correlation across cognitive tasks in progressive MS. Similar results between SPMS and PPMS cohorts suggest combining progressive MS subtypes in studies involving cognition and brain atrophy in these populations. Longitudinal assessment will determine the therapeutic effects of lipoic acid on cognitive tasks, brain atrophy, and their associations.
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Affiliation(s)
- Rebecca I. Spain
- Department of Veterans Affairs Portland Health Care System, Portland, OR, United States
- Neurology, Oregon Health & Science University, Portland, OR, United States
| | - Andrea Hildebrand
- Biostatistics and Design Program, Oregon Health & Science University/Portland State University School of Public Health, Portland, OR, United States
| | - Carin S. Waslo
- Department of Veterans Affairs Portland Health Care System, Portland, OR, United States
| | - William D. Rooney
- Advanced Imaging Research Center, Oregon Health & Science University, Portland, OR, United States
| | - Joshua Emmons
- Advanced Imaging Research Center, Oregon Health & Science University, Portland, OR, United States
| | - Daniel L. Schwartz
- Neurology, Oregon Health & Science University, Portland, OR, United States
- Advanced Imaging Research Center, Oregon Health & Science University, Portland, OR, United States
| | - Mark S. Freedman
- Department of Medicine, University of Ottawa and the Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - M. Mateo Paz Soldan
- Department of Veterans Affairs, Salt Lake City Health Care System, Salt Lake City, UT, United States
- Neurology, University of Utah, Salt Lake City, UT, United States
| | - Pavle Repovic
- Neurology, Swedish Medical Center, Seattle, WA, United States
| | - Andrew J. Solomon
- Lerner College of Medicine at the University of Vermont, Burlington, VT, United States
| | - John Rinker
- Neurology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Mitchell Wallin
- Department of Veterans Affairs Washington DC Medical Center, Washington, DC, United States
- University of Maryland School of Medicine, Baltimore, MD, United States
| | - Jodie K. Haselkorn
- Department of Veterans Affairs, Puget Sound Health Care System, Seattle, WA, United States
- Rehabilitation Medicine & Epidemiology, University of Washington, Seattle, WA, United States
| | - Olaf Stuve
- Department of Veterans Affairs North Texas Health Care System-Dallas, Dallas, TX, United States
- Neurology, University of Texas Southwestern Medical Center, Dallas, TX, United States
- Peter O'Donnell Brain Institute, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Robert H. Gross
- Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Aaron P. Turner
- Department of Veterans Affairs, Puget Sound Health Care System, Seattle, WA, United States
- Rehabilitation Medicine & Epidemiology, University of Washington, Seattle, WA, United States
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Barateiro A, Barros C, Pinto MV, Ribeiro AR, Alberro A, Fernandes A. Women in the field of multiple sclerosis: How they contributed to paradigm shifts. Front Mol Neurosci 2023; 16:1087745. [PMID: 36818652 PMCID: PMC9937661 DOI: 10.3389/fnmol.2023.1087745] [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: 11/02/2022] [Accepted: 01/13/2023] [Indexed: 02/05/2023] Open
Abstract
History is full of women who made enormous contributions to science. While there is little to no imbalance at the early career stage, a decreasing proportion of women is found as seniority increases. In the multiple sclerosis (MS) field, 44% of first authors and only 35% of senior authors were female. So, in this review, we highlight ground-breaking research done by women in the field of MS, focusing mostly on their work as principal investigators. MS is an autoimmune disorder of the central nervous system (CNS), with evident paradigm shifts in the understating of its pathophysiology. It is known that the immune system becomes overactivated and attacks myelin sheath surrounding axons. The resulting demyelination disrupts the communication signals to and from the CNS, which causes unpredictable symptoms, depending on the neurons that are affected. Classically, MS was reported to cause mostly physical and motor disabilities. However, it is now recognized that cognitive impairment affects more than 50% of the MS patients. Another shifting paradigm was the involvement of gray matter in MS pathology, formerly considered to be a white matter disease. Additionally, the identification of different T cell immune subsets and the mechanisms underlying the involvement of B cells and peripheral macrophages provided a better understanding of the immunopathophysiological processes present in MS. Relevantly, the gut-brain axis, recognized as a bi-directional communication system between the CNS and the gut, was found to be crucial in MS. Indeed, gut microbiota influences not only different susceptibilities to MS pathology, but it can also be modulated in order to positively act in MS course. Also, after the identification of the first microRNA in 1993, the role of microRNAs has been investigated in MS, either as potential biomarkers or therapeutic agents. Finally, concerning MS therapeutical approaches, remyelination-based studies have arisen on the spotlight aiming to repair myelin loss/neuronal connectivity. Altogether, here we emphasize the new insights of remarkable women that have voiced the impact of cognitive impairment, white and gray matter pathology, immune response, and that of the CNS-peripheral interplay on MS diagnosis, progression, and/or therapy efficacy, leading to huge breakthroughs in the MS field.
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Affiliation(s)
- Andreia Barateiro
- Central Nervous System, Blood and Peripheral Inflammation Lab, Research Institute for Medicines (iMed.ULisboa), Faculty of Pharmacy, Universidade de Lisboa, Lisbon, Portugal,Department of Pharmaceutical Sciences and Medicines, Faculty of Pharmacy, Universidade de Lisboa, Lisbon, Portugal,Andreia Barateiro,
| | - Catarina Barros
- Central Nervous System, Blood and Peripheral Inflammation Lab, Research Institute for Medicines (iMed.ULisboa), Faculty of Pharmacy, Universidade de Lisboa, Lisbon, Portugal
| | - Maria V. Pinto
- Central Nervous System, Blood and Peripheral Inflammation Lab, Research Institute for Medicines (iMed.ULisboa), Faculty of Pharmacy, Universidade de Lisboa, Lisbon, Portugal
| | - Ana Rita Ribeiro
- Central Nervous System, Blood and Peripheral Inflammation Lab, Research Institute for Medicines (iMed.ULisboa), Faculty of Pharmacy, Universidade de Lisboa, Lisbon, Portugal
| | - Ainhoa Alberro
- Central Nervous System, Blood and Peripheral Inflammation Lab, Research Institute for Medicines (iMed.ULisboa), Faculty of Pharmacy, Universidade de Lisboa, Lisbon, Portugal,Multiple Sclerosis Group, Biodonostia Health Research Institute, Donostia-San Sebastian, Spain
| | - Adelaide Fernandes
- Central Nervous System, Blood and Peripheral Inflammation Lab, Research Institute for Medicines (iMed.ULisboa), Faculty of Pharmacy, Universidade de Lisboa, Lisbon, Portugal,Department of Pharmaceutical Sciences and Medicines, Faculty of Pharmacy, Universidade de Lisboa, Lisbon, Portugal,*Correspondence: Adelaide Fernandes,
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Pourmohammadi A, Motahharynia A, Shaygannejad V, Ashtari F, Adibi I, Sanayei M. Working memory dysfunction differs between secondary progressive and relapsing multiple sclerosis: Effects of clinical phenotype, age, disease duration, and disability. Mult Scler Relat Disord 2023; 69:104411. [PMID: 36436396 DOI: 10.1016/j.msard.2022.104411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 10/24/2022] [Accepted: 11/11/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND Cognitive dysfunction is relatively common in patients with multiple sclerosis (MS). Although it occurs in all stages and all phenotypes of MS, it is more prevalent in secondary progressive MS (SPMS) compared to relapsing MS (RMS). It is unclear whether the higher frequency of cognitive impairment in SPMS is linked to the progressive phenotype or other clinical factors. In this study, we compared working memory in patients with RMS, SPMS, and healthy subjects. We also investigated the effects of age, disease duration, and disability on working memory performance. METHODS This case-control study enrolled 134 MS patients, 69 patients were diagnosed with RMS and 65 patients with SPMS, and 77 healthy control subjects. We designed two working memory tasks with different sets of stimuli (face vs. checkerboard) and different instructions (same or different vs. which one is the same). RESULTS Accuracy was significantly more impaired in SPMS patients than in RMS patients and both groups were worse than healthy subjects. This finding was similar between both tasks. Age and overall cognitive functions (measured with MoCA) also affected accuracy, but disease duration and disability only affected accuracy in working memory task with checkerboard stimuli. CONCLUSION MS patients are impaired in keeping the information in the visual working memory for a few seconds. Progressive phenotype significantly affected working memory accuracy, and this effect did not explain out with other demographic or clinical factors. Future studies are needed to reveal underlying mechanisms of working memory dysfunction in SPMS and working memory dysfunction as a biomarker of disease progression.
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Affiliation(s)
- Ahmad Pourmohammadi
- School of Cognitive Sciences, Institute for Research in Fundamental Sciences (IPM), Tehran, Iran; Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran; Center for Translational Neuroscience, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ali Motahharynia
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran; Center for Translational Neuroscience, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Vahid Shaygannejad
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran; Center for Translational Neuroscience, Isfahan University of Medical Sciences, Isfahan, Iran; Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fereshteh Ashtari
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran; Center for Translational Neuroscience, Isfahan University of Medical Sciences, Isfahan, Iran; Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Iman Adibi
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran; Center for Translational Neuroscience, Isfahan University of Medical Sciences, Isfahan, Iran; Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Mehdi Sanayei
- School of Cognitive Sciences, Institute for Research in Fundamental Sciences (IPM), Tehran, Iran; Center for Translational Neuroscience, Isfahan University of Medical Sciences, Isfahan, Iran.
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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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12
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Brochet B, Clavelou P, Defer G, De Seze J, Louapre C, Magnin E, Ruet A, Thomas-Anterion C, Vermersch P. Cognitive Impairment in Secondary Progressive Multiple Sclerosis: Effect of Disease Duration, Age, and Progressive Phenotype. Brain Sci 2022; 12:brainsci12020183. [PMID: 35203948 PMCID: PMC8870031 DOI: 10.3390/brainsci12020183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 01/21/2022] [Accepted: 01/24/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Cognitive deficits are common in multiple sclerosis (MS) and affect patients at all stages of the disease, regardless of phenotype. Aims: This literature review focuses the cognitive deficits observed in secondary progressive MS (SPMS). It is mainly based on studies that compared the frequency and main characteristics of cognitive deficits in SPMS with other phenotypes. Methods: A bibliographic search was carried out using the PubMed database with the following keywords: multiple sclerosis, secondary-progressive, cognition. Results: Thirteen studies were initially selected that were published in English, reporting the neuropsychological data of a sample of at least 30 patients with SPMS, comparing them with patients with other phenotypes. Studies suggest that there is an association between the duration of the disease and the frequency and extent of the cognitive disorders. Studies also showed that the SP form is associated with an increased frequency of cognitive impairment and with an increased severity as compared to relapsing-remitting MS (RRMS). Compared to RRMS, progressive forms of MS are associated with more severe impairment in certain cognitive areas, such as episodic verbal memory, information processing speed, working memory, or verbal fluency. Two studies showed that cognitive performances decline overtime in SPMS. Conclusion: Cognitive disorders are more frequent and more severe in the SP form than in relapsing course of MS. The profile of cognitive impairment encountered in the SP form also appears to be different from those found in the other phenotypes.
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Affiliation(s)
- Bruno Brochet
- Neurocentre Magendie Inserm U 1215, Université de Bordeaux, 146 rue de Léo Saignat, 33077 Bordeaux, France
- Correspondence:
| | - Pierre Clavelou
- CRC-SEP, Hôpital Gabriel Montpied, CHU de Clermont-Ferrand, 58 Rue Montalembert, 63003 Clermont-Ferrand, France;
| | - Gilles Defer
- CRC-SEP, Service de Neurologie, CHU de Caen, Avenue de la côte de Nacre, 14033 Caen, France;
| | - Jérôme De Seze
- CRC-SEP, CHU Strasbourg, Hôpital Hautepierre, 1 Avenue Molière, 67098 Strasbourg, France;
| | - Céline Louapre
- Sorbonne University, Paris Brain Institute—ICM, Assistance Publique Hôpitaux de Paris, Inserm, CNRS, Hôpital de la Pitié Salpêtrière, CIC Neurosciences, 75013, Paris, France;
| | - Eloi Magnin
- Service de Neurologie, Hôpital Jean Minoz, 1-3 Boulevard Alexandre Fleming, 25000 Besançon, France;
| | - Aurélie Ruet
- Neurocentre Magendie, INSERM U 1215, Université de Bordeaux, Service de Neurologie, CHU de Bordeaux, Hôpital Pellegrin, Place Amélie Raba Léon, 33076 Bordeaux, France;
| | | | - Patrick Vermersch
- Inserm U1172—Lille Neuroscience et Cognition, Université de Lille, CRCR SEP, CHU Lille, FHU Precise, 59000 Lille, France;
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13
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Leonardi S, Maggio MG, Russo M, Bramanti A, Arcadi FA, Naro A, Calabrò RS, De Luca R. Cognitive recovery in people with relapsing/remitting multiple sclerosis: A randomized clinical trial on virtual reality-based neurorehabilitation. Clin Neurol Neurosurg 2021; 208:106828. [PMID: 34332269 DOI: 10.1016/j.clineuro.2021.106828] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 07/12/2021] [Accepted: 07/13/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Multiple sclerosis (MS) can adversely affect several domains of cognitive function, including attention, information processing, memory and learning, executive functions and visuospatial skills. In recent years, technological innovations have proven effective in improving motor and cognitive impairment in neurological patients, including those affected by MS. OBJECTIVE The study aims to evaluate cognitive outcomes after rehabilitation training with the Virtual Reality rehabilitation system (VRRS) in patients suffering from MS. METHODS All patients were randomized into either the control group (CG: 15 patients) receiving conventional cognitive rehab or the experimental group (EG) using virtual reality (VR) (15 patients). Both groups underwent the same amount of cognitive training, 3 times a week for 8 weeks. They were submitted to neuropsychological assessment before (T0) and after the rehabilitation treatment (T1). RESULTS Our data showed that both conventional and VR cognitive rehabilitation approaches improved mood (p < 0.001) and visuospatial skills. However, only in the EG a significant improvement in specific cognitive domains (p < 0.001), including learning ability, short-term verbal memory, lexical access ability, as well as quality of life related to mental states, was found. CONCLUSIONS The present study demonstrated that VR can be a motivational and effective tool for cognitive recovery in MS patients.
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Affiliation(s)
| | - Maria Grazia Maggio
- University of Catania, Department of Biomedical and Biotechnological Science, Italy
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14
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Eilam-Stock T, Best P, Sherman K, Shaw MT, Ventura J, Krupp LB, Charvet LE. An Interview-Based Assessment of the Experience of Cognitive Impairment in Multiple Sclerosis: The Cognitive Assessment Interview (CAI). Front Neurol 2021; 12:637895. [PMID: 33643211 PMCID: PMC7905222 DOI: 10.3389/fneur.2021.637895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 01/06/2021] [Indexed: 11/25/2022] Open
Abstract
Background: Cognitive impairment is a common feature of multiple sclerosis (MS). A semi-structured interview, including informant input, can characterize the experience of individuals living with MS and cognitive involvement. Objective: We administered the Cognitive Assessment Interview (CAI), a patient- and informant-based semi-structured interview, to characterize the experience of cognitive impairments in those living with MS. Methods: Trained raters administered the CAI to a sample of MS participants and their informants enrolled for a trial of cognitive remediation. Cognitive impairments on the CAI were characterized and compared to those captured by neuropsychological and self-report measures. Results: A total of n = 109 MS participants (mean age = 50.3 ± 12.2) and their available informants (n = 71) were interviewed. Participants reported experiencing processing speed (90/106, 85%), working memory (87/109, 80%), and learning and memory (79/109, 72%) problems most commonly. CAI-based ratings were moderately correlated with a self-report measure (Multiple Sclerosis Neuropsychological Screening Questionnaire, rs = 0.52, p < 0.001) and only mildly correlated with objective neuropsychological measures specific to executive functions (rs = 0.21, p = 0.029). For those with informant interviews, ratings were overall consistent, suggesting that the CAI is valid even in cases in which an informant is unavailable and the interview is conducted with the patient alone (as is often the case in clinical and research settings). Conclusions: The CAI provides a semi-structured interview to characterize the experience of cognitive impairment in MS, with findings representing real-world functioning, adding valuable information to both self-report measures and neuropsychological assessment.
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Affiliation(s)
- Tehila Eilam-Stock
- Department of Neurology, New York University Grossman School of Medicine, New York, NY, United States
| | - Pamela Best
- Department of Neurology, New York University Grossman School of Medicine, New York, NY, United States
| | - Kathleen Sherman
- Department of Neurology, New York University Grossman School of Medicine, New York, NY, United States
| | - Michael T Shaw
- Department of Psychology, Binghamton University, Binghamton, NY, United States
| | - Joseph Ventura
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, United States
| | - Lauren B Krupp
- Department of Neurology, New York University Grossman School of Medicine, New York, NY, United States
| | - Leigh E Charvet
- Department of Neurology, New York University Grossman School of Medicine, New York, NY, United States
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15
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Gromisch ES, Dhari Z. Identifying Early Neuropsychological Indicators of Cognitive Involvement in Multiple Sclerosis. Neuropsychiatr Dis Treat 2021; 17:323-337. [PMID: 33574669 PMCID: PMC7872925 DOI: 10.2147/ndt.s256689] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 01/22/2021] [Indexed: 12/19/2022] Open
Abstract
Multiple sclerosis (MS) is a debilitating disease of the central nervous system that is most commonly seen in early to middle adulthood, although it can be diagnosed during childhood or later in life. While cognitive impairment can become more prevalent and severe as the disease progresses, signs of cognitive involvement can be apparent in the early stages of the disease. In this review, we discuss the prevalence and types of cognitive impairment seen in early MS, including the specific measures used to identify them, as well as the challenges in characterizing their frequency and progression. In addition to examining the progression of early cognitive involvement over time, we explore the clinical factors associated with early cognitive involvement, including demographics, level of physical disability, disease modifying therapy use, vocational status, and psychological and physical symptoms. Given the prevalence and functional impact these impairments can have for persons with MS, considerations for clinicians are provided, such as the role of early cognitive screenings and the importance of comprehensive neuropsychological assessments.
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Affiliation(s)
- Elizabeth S Gromisch
- Mandell Center for Multiple Sclerosis, Mount Sinai Rehabilitation Hospital, Trinity Health Of New England, Hartford, CT, USA
- Department of Rehabilitative Medicine, Frank H. Netter MD School of Medicine at Quinnipiac University, North Haven, CT, USA
- Department of Medical Sciences, Frank H. Netter MD School of Medicine at Quinnipiac University, North Haven, CT, USA
- Department of Neurology, University of Connecticut School of Medicine, Farmington, CT, USA
| | - Zaenab Dhari
- Mandell Center for Multiple Sclerosis, Mount Sinai Rehabilitation Hospital, Trinity Health Of New England, Hartford, CT, USA
- Department of Rehabilitative Medicine, Frank H. Netter MD School of Medicine at Quinnipiac University, North Haven, CT, USA
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16
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Iva P, Fielding J, Clough M, White O, Godic B, Martin R, Rajan R. Speech Discrimination Tasks: A Sensitive Sensory and Cognitive Measure in Early and Mild Multiple Sclerosis. Front Neurosci 2021; 14:604991. [PMID: 33424540 PMCID: PMC7786116 DOI: 10.3389/fnins.2020.604991] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 11/30/2020] [Indexed: 11/13/2022] Open
Abstract
There is a need for reliable and objective measures of early and mild symptomology in multiple sclerosis (MS), as deficits can be subtle and difficult to quantify objectively in patients without overt physical deficits. We hypothesized that a speech-in-noise (SiN) task would be sensitive to demyelinating effects on precise neural timing and diffuse higher-level networks required for speech intelligibility, and therefore be a useful tool for monitoring sensory and cognitive changes in early MS. The objective of this study was to develop a SiN task for clinical use that sensitively monitors disease activity in early (<5 years) and late (>10 years) stages of MS subjects with mild severity [Expanded Disability Status Scale (EDSS) score < 3]. Pre-recorded Bamford-Kowal-Bench sentences and isolated keywords were presented at five signal-to-noise ratios (SNR) in one of two background noises: speech-weighted noise and eight-talker babble. All speech and noise were presented via headphones to controls (n = 38), early MS (n = 23), and late MS (n = 12) who were required to verbally repeat the target speech. MS subjects also completed extensive neuropsychological testing which included: Paced Auditory Serial Addition Test, Digit Span Test, and California Verbal Learning Test. Despite normal hearing thresholds, subjects with early and late mild MS displayed speech discrimination deficits when sentences and words were presented in babble - but not speech-weighted noise. Significant correlations between SiN performance and standardized neuropsychological assessments indicated that MS subjects with lower functional scores also had poorer speech discrimination. Furthermore, a quick 5-min task with words and keywords presented in multi-talker babble at an SNR of -1 dB was 82% accurate in discriminating mildly impaired MS individuals (median EDSS = 0) from healthy controls. Quantifying functional deficits in mild MS will help clinicians to maximize the opportunities to preserve neurological reserve in patients with appropriate therapeutic management, particularly in the earliest stages. Given that physical assessments are not informative in this fully ambulatory cohort, a quick 5-min task with words and keywords presented in multi-talker babble at a single SNR could serve as a complementary test for clinical use due to its ease of use and speed.
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Affiliation(s)
- Pippa Iva
- Department of Physiology, Biomedicine Discovery Institute, Monash University, Melbourne, VIC, Australia
| | - Joanne Fielding
- Department of Neuroscience, Central Clinical School, Monash University, Alfred Centre, Melbourne, VIC, Australia
| | - Meaghan Clough
- Department of Neuroscience, Central Clinical School, Monash University, Alfred Centre, Melbourne, VIC, Australia
| | - Owen White
- Department of Neuroscience, Central Clinical School, Monash University, Alfred Centre, Melbourne, VIC, Australia
| | - Branislava Godic
- Department of Physiology, Biomedicine Discovery Institute, Monash University, Melbourne, VIC, Australia
| | - Russell Martin
- Department of Physiology, Biomedicine Discovery Institute, Monash University, Melbourne, VIC, Australia
| | - Ramesh Rajan
- Department of Physiology, Biomedicine Discovery Institute, Monash University, Melbourne, VIC, Australia
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17
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Evolving relationship between respiratory functions & impairment in sleep and cognition in patients with multiple sclerosis. Mult Scler Relat Disord 2020; 46:102514. [PMID: 32992131 DOI: 10.1016/j.msard.2020.102514] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 09/03/2020] [Accepted: 09/05/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND The most apparent source of disability in patients with multiple sclerosis (MS) is the physical and mental impact. The pathophysiological mechanisms of cognitive dysfunction are multifactorial although hypoventilation secondary to respiratory dysfunction may contribute to cognitive decline. METHODS This study was conducted on 146 MS patients with baseline clinical assessments including the Epworth sleepiness scale (ESS) and physical disability was assessed using the Expanded Disability Status Scale (EDSS). Cognitive testing was performed utilizing the Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS) and the Perceived Deficits Questionnaire (PDQ). Respiratory functions were assessed by spirometry and the respiratory muscle functional assessment was done by maximal mouth pressure measurement. RESULTS The respiratory muscle function test had a significant negative correlation with the score of ESS and PDQ scale and a significant positive correlation with the BICAMS scale score (p < 0.001). The ESS and PDQ scores were significantly negatively correlated with forced expiratory volume in the first second (FEV1)/ forced vital capacity (FVC) (p = 0.03, 0.02), FVC supine (p = 0.03, 0.01), FVC upright- FVC supine (ΔFVC) (p < 0.001, <0.001) FEV1 (p < 0.001) and FVC (L) (p < 0.001), respectively. While the BICAMS showed a significant positive correlation with spirometry results except FVC upright. ESS scores were significantly correlated with the BICAMS and PDQ scale score (p < 0.001). CONCLUSION Among MS patients, impaired respiratory functions are significantly associated with sleep disturbance and cognitive impairment. Thus the spirometry and respiratory muscle strength assessment are necessary from the early phase of MS.
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18
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Magnin E, Sagawa Y, Moulin T, Decavel P. What Are the Minimal Detectable Changes in SDMT and Verbal Fluency Tests for Assessing Changes in Cognitive Performance in Persons with Multiple Sclerosis and Non-Multiple Sclerosis Controls? Eur Neurol 2020; 83:263-270. [PMID: 32634812 DOI: 10.1159/000508607] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 05/08/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Cognitive impairment is frequent in persons with multiple sclerosis (PwMS) and can impact on activities of daily living. The capacity to differentiate real changes from background statistical noise induced by human, instrumentational, and environmental variations inherent to the evaluation would improve cognitive assessments. OBJECTIVE To assess the short-term reproducibility of cognitive tests in non-multiple sclerosis (non-MS) persons and PwMS. METHODS Sixty-two PwMS and 19 non-MS persons performed 2 measurements, 1 week apart, of the Symbol Digit Modalities Test (SDMT) and phonological and semantic verbal fluency. Test-retest reliability was evaluated by the intraclass correlation coefficients (ICC) and agreement by standard error of measurement (SEM) and minimum detectable change (MDC). RESULTS The reliability of the cognitive variables studied had moderate to high ICC values (ICC > 0.8) in both populations. The threshold to consider a significant cognitive modification evaluated by SEM and MDC was lower in PwMS compared with non-MS persons. CONCLUSIONS SDMT and verbal fluency have good short-term reproducibility in PwMS. Specific SEM and MDC cutoffs based on the same design of evaluation (especially retest timing) and to the targeted pathological population (MS vs. healthy) should systematically be used to consider cognitive modification as significant in research protocol as well as in clinical practice.
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Affiliation(s)
- Eloi Magnin
- Integrative and Clinical Neurosciences EA481, Bourgogne Franche-Comte University, Besançon, France.,Regional Memory Centre, Department of Neurology, University Hospital of Besançon, Besançon, France.,Department of Neurology, University Hospital of Besançon, Besançon, France
| | - Yoshimasa Sagawa
- Integrative and Clinical Neurosciences EA481, Bourgogne Franche-Comte University, Besançon, France, .,Laboratory of Clinical Functional Exploration of Movement, University Hospital of Besançon, Besançon, France,
| | - Thierry Moulin
- Integrative and Clinical Neurosciences EA481, Bourgogne Franche-Comte University, Besançon, France.,Department of Neurology, University Hospital of Besançon, Besançon, France
| | - Pierre Decavel
- Integrative and Clinical Neurosciences EA481, Bourgogne Franche-Comte University, Besançon, France.,Laboratory of Clinical Functional Exploration of Movement, University Hospital of Besançon, Besançon, France
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19
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Oset M, Stasiolek M, Matysiak M. Cognitive Dysfunction in the Early Stages of Multiple Sclerosis-How Much and How Important? Curr Neurol Neurosci Rep 2020; 20:22. [PMID: 32444997 PMCID: PMC7244611 DOI: 10.1007/s11910-020-01045-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Purpose of Review Multiple sclerosis (MS) is a demyelinating disease of the central nervous system that mainly affects young adults and that is one of the leading causes of disability in this age group, with cognitive impairment occurring early in the course of the disease. This article summarizes the current knowledge about cognitive dysfunction in the early phase of MS, including biomarkers, MRI correlates, and its value as a prognostic marker. Recent Findings New sets of neuropsychological tests have been established to screen for cognitive dysfunction more easily and accurately. Moreover, structural changes detected by brain MRI and several biomarkers found in cerebrospinal fluid and blood serum have been recently correlated with decreased cognitive performance. Additionally, factors influencing cognition in MS, such as disease-modifying therapy, mood disorders, and lifestyle, are better described. Summary Cognitive impairment early in the course of MS is suggested as a prognostic factor for disease progression. However, clear-cut definitions of the early stage of MS as well as unified criteria for the diagnosis of cognitive impairment are still lacking. New and more reliable tools for evaluating cognition in MS patients should be developed and introduced into everyday practice to facilitate the implementation of effective disease-modifying therapy, cognitive rehabilitation, and lifestyle management.
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Affiliation(s)
- Magdalena Oset
- Department of Neurology, Medical University of Lodz, Kopcinskiego 22, 90-153, Lodz, Poland
| | - Mariusz Stasiolek
- Department of Neurology, Medical University of Lodz, Kopcinskiego 22, 90-153, Lodz, Poland.
| | - Mariola Matysiak
- Department of Neurology, Medical University of Lodz, Kopcinskiego 22, 90-153, Lodz, Poland
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20
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Johansson S, Ytterberg C, Gottberg K, Holmqvist LW, von Koch L, Conradsson D. Participation in social/lifestyle activities in people with multiple sclerosis: Changes across 10 years and predictors of sustained participation. Mult Scler 2019; 26:1775-1784. [DOI: 10.1177/1352458519881991] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Background: Identification of people with multiple sclerosis (PwMS) with increased risk of restricted participation in social and lifestyle activities (e.g. social outings and pursuing a hobby) could guide the development of interventions supporting sustained participation. Objective: To explore changes in participation in complex and social everyday activities over 10 years in PwMS in relation to multiple sclerosis (MS) severity and to identify predictors of sustained participation. Methods: This study was based on a 10-year follow-up of 264 PwMS living in Stockholm County, Sweden. Ten-year changes in participation in social/lifestyle activities were assessed and compared between PwMS with different MS severity with the Frenchay Activities Index using age- and sex-related normative values. Multiple logistic regression analyses were used to predict sustained participation at 10 years using personal factors, disease severity and functioning as independent variables. Results: While a majority of people with mild MS demonstrated sustained participation (67%), a minority of PwMS moderately (26%) and severely affected by MS (5%) demonstrated sustained participation. Significant predictors of sustained participation after 10 years were walking speed ⩾1.2 m/s and ⩾32 correct responses on the Symbol Digit Modalities Test. Conclusion: Our findings accentuate the importance for health services to support mobility and cognition to obtain sustained participation.
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Affiliation(s)
- Sverker Johansson
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Stockholm, Sweden/Allied Health Professionals Function, Function Area Occupational Therapy & Physiotherapy, Karolinska University Hospital, Stockholm, Sweden
| | - Charlotte Ytterberg
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Stockholm, Sweden/Allied Health Professionals Function, Function Area Occupational Therapy & Physiotherapy, Karolinska University Hospital, Stockholm, Sweden
| | - Kristina Gottberg
- Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Lotta Widén Holmqvist
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Stockholm, Sweden/Allied Health Professionals Function, Function Area Occupational Therapy & Physiotherapy, Karolinska University Hospital, Stockholm, Sweden
| | - Lena von Koch
- Theme Neuro, Karolinska University Hospital, Stockholm, Sweden; Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - David Conradsson
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Stockholm, Sweden/Allied Health Professionals Function, Function Area Occupational Therapy & Physiotherapy, Karolinska University Hospital, Stockholm, Sweden
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21
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De Luca R, Russo M, Gasparini S, Leonardi S, Foti Cuzzola M, Sciarrone F, Zichittella C, Sessa E, Maggio MG, De Cola MC, Calabrò RS. Do people with multiple sclerosis benefit from PC-based neurorehabilitation? A pilot study. APPLIED NEUROPSYCHOLOGY-ADULT 2019; 28:427-435. [PMID: 31414887 DOI: 10.1080/23279095.2019.1650747] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Multiple Sclerosis (MS) is an inflammatory degenerative disease of the central nervous system. Cognitive impairment is a frequent feature of MS at both the earlier and later stages of the disease, and it tends to worsen over time. Cognitive rehabilitation (CR) is becoming a standard component of neurorehabilitation in patients with MS. The aim of this study is to evaluate the effect of computerized CR, by using the Italian software ERICA, on cognitive and daily life performance in MS patients with mild to moderate cognitive impairment. We studied 40 individuals affected by MS, randomized into either traditional CR group (TCRG: n = 20), which performed a conventional cognitive training, or the computer-assisted CR group (CCRG: n = 20), which performed PC-based CR. The cognitive dysfunctions were investigated through a complete neuropsychological battery, administered before (T0) and after (T1) each different training. Both the trainings were well-tolerated and led to improvement in cognitive function. Notably, the CCRG had a significant effect in improving memory, attention, and processing speed, as compared to TCRG. ERICA training could be a valuable tool for the CR in patients affected by MS. Further studied are needed to confirm these promising results and evaluate the long-term effects.
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Affiliation(s)
| | - Margherita Russo
- Regional Epilepsy Center, "Great Metropolitan Hospital", via Melacrino, Reggio Calabria, Italy
| | - Sara Gasparini
- Department of Medical and Surgical Sciences, "Magna Graecia" University of Catanzaro, Germaneto, Italy
| | | | | | | | | | - Edoardo Sessa
- IRCCS Centro Neurolesi "Bonino Pulejo", Messina, Italy
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22
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Conradsson D, Ytterberg C, Engelkes C, Johansson S, Gottberg K. Activity limitations and participation restrictions in people with multiple sclerosis: a detailed 10-year perspective. Disabil Rehabil 2019; 43:406-413. [PMID: 31190568 DOI: 10.1080/09638288.2019.1626919] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
AIM To conduct a detailed investigation into changes in activity limitations and participation restrictions over 10 years in people with mild, moderate and severe multiple sclerosis. METHODS This study was a 10-year longitudinal study of 264 people with multiple sclerosis living in Stockholm County, Sweden. Ten-year changes in personal and instrumental activities in daily living were assessed using the Katz Activities in Daily Living Index Extended and participation in social/lifestyle activities using the Frenchay Activities Index. RESULTS While people with moderate multiple sclerosis, compared to baseline, demonstrated significantly higher proportions of dependency in most activities of personal and instrumental activities in daily living at the 10-year follow-up, the mild group primarily increased their dependency in instrumental activities and the severe group in personal activities. Significantly higher proportions of the moderate group showed restricted participation in domestic and outdoor activities whereas the mild group only showed restrictions in a few domains of participation. A majority of people with severe multiple sclerosis showed restricted participation in all social/lifestyle activities at baseline and the 10-year follow-up. CONCLUSIONS Prominent long-term increases in activity limitations and participation restrictions occurred across the spectrum of disease severity but was most pronounced in those more moderately affected. Implications for rehabilitation This study provides guidance with regard to specific activities that are prone to deteriorate across 10 years and thereby reflect important targets and outcomes for interventions. Increases in activity limitations and participation restrictions were most pronounced in those moderately affected by multiple sclerosis. Those mildly affected by multiple sclerosis primarily increased their dependency in instrumental activities of daily living while those severely affected increased their dependency in personal activities of daily living.
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Affiliation(s)
- David Conradsson
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden.,Function Area Occupational Therapy & Physiotherapy, Allied Health Professionals Function, Karolinska University Hospital, Stockholm, Sweden
| | - Charlotte Ytterberg
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden.,Function Area Occupational Therapy & Physiotherapy, Allied Health Professionals Function, Karolinska University Hospital, Stockholm, Sweden
| | - Catharina Engelkes
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden.,Physiotherapy Department, Clinic of Medicine, Capio S:t Görans Hospital, Stockholm, Sweden
| | - Sverker Johansson
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden.,Function Area Occupational Therapy & Physiotherapy, Allied Health Professionals Function, Karolinska University Hospital, Stockholm, Sweden
| | - Kristina Gottberg
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden
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23
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Abdel Naseer M, Fathi S, Roshdy NK, Labib DM, Khalil DH, Ibrahim W, Magdy R. Cognitive and physical disability in Egyptian patients with multiple sclerosis: genetic and optical coherence tomography study. Neurol Res 2019; 41:644-651. [PMID: 31025605 DOI: 10.1080/01616412.2019.1609203] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Objectives: The aim of this study was to explore the relationship between cognitive dysfunction, neurodegeneration, and genetic factors among multiple sclerosis (MS) patients. Methods: Fifty patients of definite MS were included. Physical disability was assessed by expanded disability status scale (EDSS). Cognitive functions were assessed by using the Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS). For each eye, optical coherence tomography (OCT) was used to track thickness of retinal nerve fiber layer (RNFL) and ganglion cell complex (GCC), respecting the previous history of optic neuritis (ON). All patients were genotyped for glutamate N-methyl-D-aspartate receptors (NMDARs). Results: A statistically significant negative correlation was found between scores of EDSS and each of neuropsychological tests scores and thickness of both RNFL and GCC. The predictor for progressive disability assessed by EDSS was Symbol Digit Modalities Test (SDMT) (P = 0.021), that is dependent on the educational level of the patients (P = 0.016). A statistically significant positive correlation was found between scores of all neuropsychological tests and the thickness of both RNFL and GCC. Eighty-three percent of MS patients with CC genotype reported previous attacks of ON with significant thinning in RNFL and GCC despite their higher cognitive performance in comparison to other genotypes. Discussion: Deficit in information processing speed measured by SDMT is a predictor of early progressive disability in MS patients. Thinning of RNFL and GCC is a potential biomarker for cognitive and physical disability in MS. The CC genotype of glutamate NMDAR gene has a divergent effect on visual and cognitive functions.
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Affiliation(s)
- Maged Abdel Naseer
- a Department of Neurology, Faculty of Medicine , Cairo University , Cairo , Egypt
| | - Shereen Fathi
- a Department of Neurology, Faculty of Medicine , Cairo University , Cairo , Egypt
| | - Nagwa K Roshdy
- b Department of Medical Biochemistry and Molecular Biology , Future University , Khartoum , Egypt
| | - Dalia M Labib
- a Department of Neurology, Faculty of Medicine , Cairo University , Cairo , Egypt
| | - Dalia H Khalil
- c Department of Ophthalmology, Faculty of Medicine , Cairo University , Cairo , Egypt
| | - Walaa Ibrahim
- d Department of Medical Biochemistry, Faculty of Medicine , Cairo University , Cairo , Egypt
| | - Rehab Magdy
- a Department of Neurology, Faculty of Medicine , Cairo University , Cairo , Egypt
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24
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Sormani MP, De Stefano N, Giovannoni G, Langdon D, Piani-Meier D, Haering DA, Kappos L, Tomic D. Learning ability correlates with brain atrophy and disability progression in RRMS. J Neurol Neurosurg Psychiatry 2019; 90:38-43. [PMID: 30322898 PMCID: PMC6327865 DOI: 10.1136/jnnp-2018-319129] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 09/10/2018] [Accepted: 09/17/2018] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To assess the prognostic value of practice effect on Paced Auditory Serial Addition Test (PASAT) in multiple sclerosis. METHODS We compared screening (day -14) and baseline (day 0) PASAT scores of 1009 patients from the FTY720 Research Evaluating Effects of Daily Oral therapy in Multiple Sclerosis (FREEDOMS) trial. We grouped patients into high and low learners if their PASAT score change was above or below the median change in their screening PASAT quartile group. We used Wilcoxon test to compare baseline disease characteristics between high and low learners, and multiple regression models to assess the respective impact of learning ability, baseline normalised brain volume and treatment on brain volume loss and 6-month confirmed disability progression over 2 years. RESULTS The mean PASAT score at screening was 45.38, increasing on average by 3.18 from day -14 to day 0. High learners were younger (p=0.003), had lower Expanded Disability Status Scale score (p=0.031), higher brain volume (p<0.001) and lower T2 lesion volume (p=0.009) at baseline. Learning status was not significantly associated with disability progression (HR=0.953, p=0.779), when adjusting for baseline normalised brain volume, screening PASAT score and treatment arm. However, the effect of fingolimod on disability progression was more pronounced in high learners (HR=0.396, p<0.001) than in low learners (HR=0.798, p=0.351; p for interaction=0.05). Brain volume loss at month 24 tended to be higher in low learners (0.17%, p=0.058), after adjusting for the same covariates. CONCLUSIONS Short-term practice effects on PASAT are related to brain volume, disease severity and age and have clinically meaningful prognostic implications. High learners benefited more from fingolimod treatment.
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Affiliation(s)
- Maria Pia Sormani
- Biostatistics Unit, Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Nicola De Stefano
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Gavin Giovannoni
- Barts and The London School of Medicine and Dentistry, Blizard Institute, Queen Mary University of London, London, UK
| | - Dawn Langdon
- Department of Psychology, Royal Holloway, University of London, Egham, UK
| | | | | | - Ludwig Kappos
- Neurological Clinic and Polyclinic, Departments of Medicine, Clinical Research, Biomedicine and Biomedical Engineering, University Hospital Basel, University of Basel, Basel, Switzerland
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25
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Miller E, Morel A, Redlicka J, Miller I, Saluk J. Pharmacological and Non-pharmacological Therapies of Cognitive Impairment in Multiple Sclerosis. Curr Neuropharmacol 2018; 16:475-483. [PMID: 29119933 PMCID: PMC6018194 DOI: 10.2174/1570159x15666171109132650] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 10/09/2017] [Accepted: 11/07/2017] [Indexed: 01/27/2023] Open
Abstract
Background Cognitive impairment is one of the most important clinical features of neurodegenerative disorders including multiple sclerosis (MS). Conducted research shows that up to 65 percent of MS patients have cognitive deficits such as episodic memory, sustained attention, reduced verbal fluency; however, the cognitive MS domain is information processing speed. It is the first syndrome of cognitive dysfunction and the most widely affected in MS. Occasionally these impairments occur even before the appearance of physical symptoms. Methods Therefore, this review focused on the current status of our knowledge about possible methods of treatment cognitive impairment in MS patients including novel strategies. Research and online content was performed using Medline and EMBASE databases. Results The most recent research suggests that cognitive impairment is correlated with brain lesion volume and brain atrophy. The examination of the cognitive impairment is usually based on particular neuropsychological batteries. However, it can be not enough to make a precise diagnosis. This creates a demand to find markers that might be useful for identifying patients with risk of cognitive impairment at an early stage of the disease. Currently the most promising methods consist of neuroimaging indicators, such as diffusion tensor imaging, the magnetization transfer ratio, and N-acetyl aspartate levels. Diagnosis problems are strictly connected with treatment procedures. There are two main cognitive therapies: pharmacological (disease modifying drugs (DMD), symptomatic treatments) and non-pharmacological interventions that are focused on psychological and physical rehabilitation. Some trials have shown a positive association between physical activity and the cognitive function. Conclusion This article is an overview of the current state of knowledge related to cognition impairment treatment in MS. Additionally, novel strategies for cognitive impairments such as cryostimulation and other complementary methods are presented.
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Affiliation(s)
- Elzbieta Miller
- Department of Physical Medicine, Medical University of Lodz, Lodz, Poland.,Neurorehabilitation Ward, 3rd General Hospital in Lodz, Lodz, Milionowa 14, Poland
| | - Agnieszka Morel
- Department of General Biochemistry, Faculty of Biology and Environmental Protection. University of Lodz, Pomorska 141/143, Lodz, Poland
| | - Justyna Redlicka
- Department of Physical Medicine, Medical University of Lodz, Lodz, Poland.,Neurorehabilitation Ward, 3rd General Hospital in Lodz, Lodz, Milionowa 14, Poland
| | - Igor Miller
- Department of Physical Medicine, Medical University of Lodz, Lodz, Poland
| | - Joanna Saluk
- Department of General Biochemistry, Faculty of Biology and Environmental Protection. University of Lodz, Pomorska 141/143, Lodz, Poland
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26
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Role of Demographic and Clinical Factors in Cognitive Functioning of Persons with Relapsing-Remitting and Progressive Multiple Sclerosis. J Int Neuropsychol Soc 2018; 24:139-146. [PMID: 28830576 DOI: 10.1017/s1355617717000777] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Age and time post-diagnosis can significantly impact cognitive and motor functions in multiple sclerosis (MS); however, studies often fail to account for these factors when assessing differences between disease courses. OBJECTIVES Examine differences between relapsing-remitting and progressive MS in cognition, motor function, and everyday activities, controlling for age, education, and time post-diagnosis. METHODS Twenty-one persons with relapsing-remitting MS (RRMS group), 21 with progressive MS (PMS group), and 21 healthy participants (HCs), matched on age, education, and time post-diagnosis, completed tests of cognitive abilities, motor functions, and everyday functional activities. RESULTS The two groups with MS did not differ on cognitive performance. Poorer performance in processing speed was noted in both MS groups in comparison with the HC group. Motor function was worse for the PMS group compared with the HC and RRMS groups. The RRMS group showed poorer upper limb functioning compared to the HC group. The PMS group had more difficulty with everyday activities as compared with both the RRMS and HC group. CONCLUSIONS When comparing differences in functioning between MS disease courses, attention should be paid to the demographic characteristics of the samples. (JINS, 2018, 24, 139-146).
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27
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Estudio del estatus laboral y el nivel socioeconómico en personas con esclerosis múltiple en 2 centros de Buenos Aires. ACTA ACUST UNITED AC 2018. [DOI: 10.1016/j.neuarg.2017.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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28
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Conradsson D, Ytterberg C, von Koch L, Johansson S. Changes in disability in people with multiple sclerosis: a 10-year prospective study. J Neurol 2017; 265:119-126. [PMID: 29159465 PMCID: PMC5760611 DOI: 10.1007/s00415-017-8676-8] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Revised: 11/07/2017] [Accepted: 11/08/2017] [Indexed: 12/15/2022]
Abstract
Background Little is known about the long-term course of disability in relation with disease severity in people with multiple sclerosis (PwMS). Objective To explore changes in a broad spectrum of disability over 10 years in relation with disease severity in PwMS. Methods We conducted a longitudinal study of 155 PwMS who attended the MS Centre at Karolinska University Hospital, Stockholm. Disease severity was determined by the use of the Expanded Disability Status Scale (EDSS) and classified as mild MS (EDSS score 0–3.5) or moderate/severe MS (EDSS score 4–9.5). Ten-year changes in perceived physical and psychological impacts of MS, walking, cognition, manual dexterity, participation in social/lifestyle activities, and signs of depression were compared between PwMS with mild and moderate/severe MS at baseline. Results Although walking, manual dexterity, and cognition declined in both groups, only the moderate/severe group demonstrated that long-term increased physical impact of MS, increased wheel-chair dependency, and reduced participation in social/lifestyle activities. Perceived psychological impact of MS declined in both groups, while signs of depression were experienced by fewer in the mild group and remained unaltered in the moderate/severe group. Conclusion We found a more pronounced increase in disability across 10 years in individuals with moderate/severe MS compared to mild MS. These findings accentuate the importance of developing a variety of interventions that can be applied across the spectrum of disease severity.
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Affiliation(s)
- David Conradsson
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, 23100, Huddinge, 141 83, Stockholm, Sweden. .,Allied Health Professionals Function, Function Area Occupational Therapy and Physiotherapy, Karolinska University Hospital, Stockholm, Sweden.
| | - Charlotte Ytterberg
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, 23100, Huddinge, 141 83, Stockholm, Sweden.,Allied Health Professionals Function, Function Area Occupational Therapy and Physiotherapy, Karolinska University Hospital, Stockholm, Sweden
| | - Lena von Koch
- Division of Occupational Therapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
| | - Sverker Johansson
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, 23100, Huddinge, 141 83, Stockholm, Sweden.,Allied Health Professionals Function, Function Area Occupational Therapy and Physiotherapy, Karolinska University Hospital, Stockholm, Sweden
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29
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Information processing deficits as a driving force for memory impairment in MS: A cross--sectional study of memory functions and MRI in early and late stage MS. Mult Scler Relat Disord 2017; 18:119-127. [PMID: 29141793 DOI: 10.1016/j.msard.2017.09.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 09/08/2017] [Accepted: 09/23/2017] [Indexed: 11/21/2022]
Abstract
BACKGROUND Memory impairment (MI) is a common symptom of MS. Previous studies were conflicting in respect to the possible existence of early MI and the role of hippocampal atrophy. The objective of this study was to investigate MI and structural MRI correlates in homogenous groups of early and late MS, controlling for a potential information-processing speed (IPS) deficit, and utilizing multiple memory test paradigms. METHODS 152 individually matched subjects were recruited: early MS (EMS, N = 25, disease duration 1.0 ± 0.8 years), late MS (LMS, N = 52, 16.5 ± 5.2 years), and corresponding controls. Five memory tests were utilized to account for differences in learning material (verbal, visual), encoding (incidental, intentional), and retrieval (free recall, recognition, recurring recognition). Performance was related to IPS, memory-specific (hippocampal volumes), and unspecific MRI measures (T1/T2LL, brain volume, cortical thickness). RESULTS Memory was impaired across all tests in LMS, but not in EMS. LMS-patients were also significantly impaired in IPS which was correlated with several memory scores. Regression analyses revealed IPS and cortical thickness as predictors for visual MI, and IPS, sex, and left hippocampal volume as predictors for verbal MI. CONCLUSION Additionally to direct destructions in memory specific tracts such as the hippocampus, memory decline in MS may also be related to a general factor comprising slowed information-processing and global tissue loss.
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30
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Hansen S, Lautenbacher S. Neuropsychological Assessment in Multiple Sclerosis. ZEITSCHRIFT FUR NEUROPSYCHOLOGIE 2017. [DOI: 10.1024/1016-264x/a000197] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Abstract. Neuropsychological deficits in multiple sclerosis (MS) are common. Over the past decades, many different procedures have been employed in diagnosing these deficits. Even though certain aspects of cognitive performance such as information processing speed and working memory may be affected more frequently than other cognitive functions, no specific deficit profile has been established in MS. This article provides an overview of the neuropsychological diagnostic procedures in MS and allows the reader to reach an informed decision on the applicability of specific procedures and the availability of study data in the context of MS. Additionally, it makes recommendations on the compilation of both screening procedures and extensive test batteries.
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Affiliation(s)
- Sascha Hansen
- Klinikum Bayreuth GmbH, Betriebsstätte Hohe Warte, Department of Neurology, Bayreuth, Germany
- Otto-Friedrich-University, Department of Physiological Psychology, Bamberg, Germany
| | - Stefan Lautenbacher
- Otto-Friedrich-University, Department of Physiological Psychology, Bamberg, Germany
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31
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Lanz TV, Williams SK, Stojic A, Iwantscheff S, Sonner JK, Grabitz C, Becker S, Böhler LI, Mohapatra SR, Sahm F, Küblbeck G, Nakamura T, Funakoshi H, Opitz CA, Wick W, Diem R, Platten M. Tryptophan-2,3-Dioxygenase (TDO) deficiency is associated with subclinical neuroprotection in a mouse model of multiple sclerosis. Sci Rep 2017; 7:41271. [PMID: 28117398 PMCID: PMC5259766 DOI: 10.1038/srep41271] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 12/19/2016] [Indexed: 11/15/2022] Open
Abstract
The catabolism of tryptophan to immunosuppressive and neuroactive kynurenines is a key metabolic pathway regulating immune responses and neurotoxicity. The rate-limiting step is controlled by indoleamine-2,3-dioxygenase (IDO) and tryptophan-2,3-dioxygenase (TDO). IDO is expressed in antigen presenting cells during immune reactions, hepatic TDO regulates blood homeostasis of tryptophan and neuronal TDO influences neurogenesis. While the role of IDO has been described in multiple immunological settings, little is known about TDO’s effects on the immune system. TDO-deficiency is neuroprotective in C. elegans and Drosophila by increasing tryptophan and specific kynurenines. Here we have determined the role of TDO in autoimmunity and neurodegeneration in experimental autoimmune encephalomyelitis (EAE), a model of multiple sclerosis. We created reporter-TDO mice for in vivo imaging to show that hepatic but not CNS TDO expression is activated during EAE. TDO deficiency did not influence myelin-specific T cells, leukocyte infiltration into the CNS, demyelination and disease activity. TDO-deficiency protected from neuronal loss in the spinal cord but not in the optic nerves. While this protection did not translate to an improved overt clinical outcome, our data suggest that spatially distinct neuroprotection is conserved in mammals and support TDO as a potential target for treatment of diseases associated with neurodegeneration.
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Affiliation(s)
- Tobias V Lanz
- DKTK Clinical Cooperation Unit Neuroimmunology and Brain Tumor Immunology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg, Germany.,Department of Neurology and National Center for Tumor Diseases, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
| | - Sarah K Williams
- AG Neuroinflammation, Department of Neurology, University Hospital Heidelberg, Otto-Meyerhof Zentrum, Im Neuenheimer Feld 350, 69120 Heidelberg, Germany
| | - Aleksandar Stojic
- AG Neuroinflammation, Department of Neurology, University Hospital Heidelberg, Otto-Meyerhof Zentrum, Im Neuenheimer Feld 350, 69120 Heidelberg, Germany
| | - Simeon Iwantscheff
- DKTK Clinical Cooperation Unit Neuroimmunology and Brain Tumor Immunology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg, Germany
| | - Jana K Sonner
- DKTK Clinical Cooperation Unit Neuroimmunology and Brain Tumor Immunology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg, Germany
| | - Carl Grabitz
- DKTK Clinical Cooperation Unit Neuroimmunology and Brain Tumor Immunology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg, Germany
| | - Simon Becker
- DKTK Clinical Cooperation Unit Neuroimmunology and Brain Tumor Immunology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg, Germany
| | - Laura-Inés Böhler
- DKTK Clinical Cooperation Unit Neuroimmunology and Brain Tumor Immunology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg, Germany
| | - Soumya R Mohapatra
- AG Brain Tumor Metabolism, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg, Germany
| | - Felix Sahm
- Department of Neuropathology, University Hospital Heidelberg, and Clinical Cooperation Unit Neuropathology, German Cancer Consortium (DKTK), German cancer Research Center (DKFZ), Im Neuenheimer Feld 224, 69120 Heidelberg, Germany
| | - Günter Küblbeck
- Department of Molecular Immunology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg, Germany
| | | | - Hiroshi Funakoshi
- Center for Advanced Research and Education (CARE), Asahikawa Medical University, 2-1-1-1 Midorigaoka-Higashi, Asahikawa, Hokkaido, 078-8510, Japan
| | - Christiane A Opitz
- Department of Neurology and National Center for Tumor Diseases, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany.,AG Brain Tumor Metabolism, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg, Germany
| | - Wolfgang Wick
- Department of Neurology and National Center for Tumor Diseases, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany.,DKTK Clinical Cooperation Unit Neurooncology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg, Germany
| | - Ricarda Diem
- Department of Neurology and National Center for Tumor Diseases, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany.,AG Neuroinflammation, Department of Neurology, University Hospital Heidelberg, Otto-Meyerhof Zentrum, Im Neuenheimer Feld 350, 69120 Heidelberg, Germany
| | - Michael Platten
- DKTK Clinical Cooperation Unit Neuroimmunology and Brain Tumor Immunology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg, Germany.,Department of Neurology and National Center for Tumor Diseases, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany.,Department of Neurology, University Medical Center Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, Mannheim, Germany
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32
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Louapre C, Govindarajan ST, Giannì C, Madigan N, Nielsen AS, Sloane JA, Kinkel RP, Mainero C. The association between intra- and juxta-cortical pathology and cognitive impairment in multiple sclerosis by quantitative T 2* mapping at 7 T MRI. NEUROIMAGE-CLINICAL 2016; 12:879-886. [PMID: 27872810 PMCID: PMC5107649 DOI: 10.1016/j.nicl.2016.11.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 10/09/2016] [Accepted: 11/01/2016] [Indexed: 12/18/2022]
Abstract
Using quantitative T2* at 7 Tesla (T) magnetic resonance imaging, we investigated whether impairment in selective cognitive functions in multiple sclerosis (MS) can be explained by pathology in specific areas and/or layers of the cortex. Thirty-one MS patients underwent neuropsychological evaluation, acquisition of 7 T multi-echo T2* gradient-echo sequences, and 3 T anatomical images for cortical surfaces reconstruction. Seventeen age-matched healthy subjects served as controls. Cortical T2* maps were sampled at various depths throughout the cortex and juxtacortex. Relation between T2*, neuropsychological scores and a cognitive index (CI), calculated from a principal component analysis on the whole battery, was tested by a general linear model. Cognitive impairment correlated with T2* increase, independently from white matter lesions and cortical thickness, in cortical areas highly relevant for cognition belonging to the default-mode network (p < 0.05 corrected). Dysfunction in different cognitive functions correlated with longer T2* in selective cortical regions, most of which showed longer T2* relative to controls. For most tests, this association was strongest in deeper cortical layers. Executive dysfunction, however, was mainly related with pathology in juxtameningeal cortex. T2* explained up to 20% of the variance of the CI, independently of conventional imaging metrics (adjusted-R2: 52–67%, p < 5.10− 4). Location of pathology across the cortical width and mantle showed selective correlation with impairment in differing cognitive domains. These findings may guide studies at lower field strength designed to develop surrogate markers of cognitive impairment in MS. Cognitive deficit in multiple sclerosis is associated with cortical T2* increase. Location of clusters of correlation varies upon affected cognitive domains. Global cognitive deficit was associated with T2* increase in deepest cortical layers. Executive dysfunction was associated with T2* increase in outer cortical layers. Regional T2* explained up to 20% of the variance of cognitive performance in MS.
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Key Words
- 7 Tesla MRI
- BVMT - DR, brief visuo-spatial memory test delayed recall
- BVMT, brief visual memory test
- CI, cognitive index
- CVLT, California verbal learning test
- Cognitive impairment
- DB, digit span backward
- DF, digit span forward
- DR, delayed recall
- EDSS, expanded disability status score
- JLOT, judgment of line orientation test
- LDCR, long delayed cued recall
- LDFR, long delayed free recall
- Laminar cortical pathology
- MRI, magnetic resonance imaging
- MS, multiple sclerosis
- Multiple sclerosis
- NP, neuropsychological
- PCA, principal component analysis
- SDMT, symbol digit modalities test
- T2*
- TMT, trail making test
- TOT, total recall
- WCST, Wisconsin card sorting test
- WM, white matter
- WMLV, white matter lesion volume
- q-T2*, quantitative T2*
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Affiliation(s)
- Céline Louapre
- A. A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Sindhuja T Govindarajan
- A. A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
| | - Costanza Giannì
- A. A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Nancy Madigan
- Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | - Jacob A Sloane
- Harvard Medical School, Boston, MA, USA; Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Revere P Kinkel
- University of California San Diego, Department of Neuroscience, San Diego, CA, USA
| | - Caterina Mainero
- A. A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA; Harvard Medical School, Boston, MA, USA
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33
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Costa SL, Genova HM, DeLuca J, Chiaravalloti ND. Information processing speed in multiple sclerosis: Past, present, and future. Mult Scler 2016; 23:772-789. [PMID: 27207446 DOI: 10.1177/1352458516645869] [Citation(s) in RCA: 120] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Information processing speed (IPS) is a prevalent cognitive impairment in multiple sclerosis (MS). OBJECTIVES This review aims to summarize the methods applied to assess IPS in MS and its theoretical conceptualization. A PubMed search was performed to select articles published between 1 January 2004 and 31 December 2013, resulting in 157 articles included. RESULTS The majority (54%) of studies assessed IPS with heterogeneous samples (several disease courses). Studies often report controlling for presence of other neurological disorders (60.5%), age (58.6%), education (51.6%), alcohol history (47.8%), or use of steroids (39.5%). Potential confounding variables, such as recent relapses (50.3%), history of developmental disorders (19.1%), and visual problems (29.9%), were often neglected. Assessments used to study IPS were heterogeneous (ranging from simple to complex tasks) among the studies under review, with 62 different tasks used. Only 9.6% of articles defined the construct of IPS and 22.3% discussed IPS in relation to a theoretical model. FUTURE DIRECTIONS The challenges for the upcoming decade include clarification of the definition of IPS as well as its theoretical conceptualization and a consensus on assessment. Based on the results obtained, we propose a new theoretical model, the tri-factor model of IPS.
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Affiliation(s)
- Silvana L Costa
- Neuropsychology & Neuroscience Laboratory, Kessler Foundation, West Orange, NJ, USA/Department of Physical Medicine & Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Helen M Genova
- Neuropsychology & Neuroscience Laboratory, Kessler Foundation, West Orange, NJ, USA/Department of Physical Medicine & Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - John DeLuca
- Neuropsychology & Neuroscience Laboratory, Kessler Foundation, West Orange, NJ, USA/Department of Physical Medicine & Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, USA/Department of Neurology, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Nancy D Chiaravalloti
- Neuropsychology & Neuroscience Laboratory, Kessler Foundation, West Orange, NJ, USA/Department of Physical Medicine & Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, USA
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D'Amico E, Leone C, Hayrettin T, Patti F. Can we define a rehabilitation strategy for cognitive impairment in progressive multiple sclerosis? A critical appraisal. Mult Scler 2016; 22:581-9. [PMID: 26920381 DOI: 10.1177/1352458516632066] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 01/17/2016] [Indexed: 01/25/2023]
Abstract
Cognitive impairment (CI) has been shown to be severe in patients with progressive forms of multiple sclerosis (MS), and the most frequently impaired domains are sustained attention, information processing speed, memory, and executive functions. In contrast to relapsing forms of MS, where studies have shown favorable results from cognitive rehabilitation, there is a lack of data on cognitive rehabilitation in progressive forms of MS. A specific approach in assessing CI and in designing and administering rehabilitation training for patients with progressive forms of MS is needed.
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Affiliation(s)
| | | | - Tumani Hayrettin
- Klinik und PoliklinikfürNeurologie der Universität Ulm, Ulm, Germany
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Pinto J, Lopes E, Gonçalves G, Silva Â, Carnero-Pardo, Peixoto B. Phototest for neurocognitive screening in multiple sclerosis. Dement Neuropsychol 2016; 10:12-18. [PMID: 29213425 PMCID: PMC5674908 DOI: 10.1590/s1980-57642016dn10100003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Multiple Sclerosis (MS) is one of the most common neurological disorders. Cognitive dysfunction is considered a clinical marker of MS, where approximately half of patients with MS have cognitive impairment. Objective The Phototest (PT) is a brief cognitive test with high diagnostic sensitivity, accuracy and cost-effectiveness for detecting cognitive deterioration. Our aim was to test the utility of the PT as a neurocognitive screening instrument for MS. Methods The study enrolled 30 patients with different types of MS from an outpatient clinic as well as 19 healthy participants. In conjunction with the PT, the Montreal Cognitive Assessment (MoCA), Barthel Index (BI), Expanded Disability Status Scale (EDSS), and Fatigue Severity Scale (FSS) were administered. Results The MS group obtained significantly lower results on all domains of the PT, except for the naming task. The PT showed good concurrent validity with the MoCA. In direct comparison to the MoCA, PT showed a greater area under the curve and higher levels of sensitivity and specificity for MS neurocognitive impairments. A cut-off score of 31 on the Phototest was associated with sensitivity of 100% and specificity of 76.7%. Conclusion The PT is a valid, specific, sensitive and brief test that is not dependent on motor functions. The instrument could be an option for neurocognitive screening in MS, especially in identifying cases for further neuropsychological assessment and intervention.
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Affiliation(s)
- Joana Pinto
- CESPU, Instituto de Investigação e Formação Avançada em Ciências e Tecnologias da Saúde, Gandra, Portugal.,Centro Hospitalar do Alto Ave, Guimarães, Portugal
| | | | | | - Ângela Silva
- Centro Hospitalar do Alto Ave, Guimarães, Portugal
| | - Carnero-Pardo
- Cognitive Behavioral Neurology Unit of the Hospital Universitario Virgen de las Nieves, Granada, Spain.,FIDYAN Neurocenter, Granada, Spain
| | - Bruno Peixoto
- CESPU, Instituto Superior de Ciências da Saúde - Norte (Sciences Department), Gandra, Portugal
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Magnin E, Sagawa Jr Y, Chamard L, Berger E, Moulin T, Decavel P. Verbal Fluencies and Fampridine Treatment in Multiple Sclerosis. Eur Neurol 2015; 74:243-50. [DOI: 10.1159/000442348] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 11/09/2015] [Indexed: 11/19/2022]
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Moccia M, Lanzillo R, Palladino R, Chang KCM, Costabile T, Russo C, De Rosa A, Carotenuto A, Saccà F, Maniscalco GT, Brescia Morra V. Cognitive impairment at diagnosis predicts 10-year multiple sclerosis progression. Mult Scler 2015; 22:659-67. [PMID: 26362896 DOI: 10.1177/1352458515599075] [Citation(s) in RCA: 94] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 07/11/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Cognitive impairment occurs from the early phases of multiple sclerosis (MS), and more frequently affects secondary progressive (SP) subjects than relapsing-remitting (RR). OBJECTIVE To investigate relationships between cognitive dysfunctions in newly diagnosed RRMS, and long-term MS-related outcomes. METHODS The present 10-year retrospective longitudinal study included 155 RRMS subjects, tested with the Rao Brief Repeatable Battery at MS diagnosis. The reaching of Expanded Disability Status Scale (EDSS) 4.0, and the SP conversion were recorded. RESULTS 67 subjects (43.2%) reached EDSS 4.0, and 34 subjects (21.9%) converted to SP during a follow-up period of 10.0±1.8 years. Subjects with cognitive impairment at diagnosis had a rate of reaching EDSS 4.0 more than three times greater (p<0.001; HR=3.183), and a rate of SP conversion more than two times greater, as compared to cognitively preserved subjects (p=0.008; HR=2.535). In particular, better scores in the Selective Reminding Test-Delayed Recall and in the Symbol Digit Modalities Test at baseline were associated with lower SP conversion rates during the follow-up period (p=0.018; HR=0.835; and p=0.001; HR=0.941, respectively). CONCLUSION Cognitive impairment, with particular involvement of processing speed and memory, predicts disability progression and SP conversion in newly diagnosed RRMS, highlighting the importance of cognitive assessment from the beginning of MS.
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Affiliation(s)
- Marcello Moccia
- Department of Neuroscience, Reproductive Science and Odontostomatology, Federico II University, Naples, Italy
| | - Roberta Lanzillo
- Department of Neuroscience, Reproductive Science and Odontostomatology, Federico II University, Naples, Italy
| | - Raffaele Palladino
- Department of Primary Care and Public Health, Imperial College, London, UK/Department of Public Health, Federico II University, Naples, Italy
| | | | - Teresa Costabile
- Department of Neuroscience, Reproductive Science and Odontostomatology, Federico II University, Naples, Italy
| | - Cinzia Russo
- Department of Neuroscience, Reproductive Science and Odontostomatology, Federico II University, Naples, Italy
| | - Anna De Rosa
- Department of Neuroscience, Reproductive Science and Odontostomatology, Federico II University, Naples, Italy
| | - Antonio Carotenuto
- Department of Neuroscience, Reproductive Science and Odontostomatology, Federico II University, Naples, Italy
| | - Francesco Saccà
- Department of Neuroscience, Reproductive Science and Odontostomatology, Federico II University, Naples, Italy
| | - Giorgia Teresa Maniscalco
- Department of Neuroscience, Reproductive Science and Odontostomatology, Federico II University, Naples, Italy/Clinic of Neurology, AORN "Antonio Cardarelli", Naples, Italy
| | - Vincenzo Brescia Morra
- Department of Neuroscience, Reproductive Science and Odontostomatology, Federico II University, Naples, Italy
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