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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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2
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Ostellino S, Benso A, Politano G. The integration of clinical data in the assessment of multiple sclerosis - A review. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2022; 221:106900. [PMID: 35623208 DOI: 10.1016/j.cmpb.2022.106900] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 05/18/2022] [Accepted: 05/18/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND AND OBJECTIVES Multiple Sclerosis (MS) is a neurological disease associated with various and heterogeneous clinical characteristics. Given its complex nature and its unpredictable evolution over time, there isn't an established and exhaustive clinical protocol (or tool) for its diagnosis nor for monitoring its progression. Instead, different clinical exams and physical/psychological evaluations need to be taken into account. The Expanded Disability Status Scale (EDSS) is the most used clinical scale, but it suffers from several limitations. Developing computational solutions for the identification of bio-markers of disease progression that overcome the downsides of currently used scales is crucial and is gaining interest in current literature and research. METHODS This Review focuses on the importance of approaching MS diagnosis and monitoring by investigating correlations between cognitive impairment and clinical data that refer to different MS domains. We review papers that integrate heterogeneous data and analyse them with statistical methods to understand their applicability into more advanced computational tools. Particular attention is paid to the impact that computational approaches can have on personalized-medicine. RESULTS Personalized medicine for neuro-degenerative diseases is an unmet clinical need which can be addressed using computational approaches able to efficiently integrate heterogeneous clinical data extracted from both private and publicly available electronic health databases. CONCLUSIONS Reliable and explainable Artificial Intelligence are computational approaches required to understand the complex and demonstrated interactions between MS manifestations as well as to provide reliable predictions on the disease evolution, representing a promising research field.
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Affiliation(s)
- Sofia Ostellino
- Department of Control and Computer Engineering, Politecnico di Torino, Italy.
| | - Alfredo Benso
- Department of Control and Computer Engineering, Politecnico di Torino, Italy.
| | - Gianfranco Politano
- Department of Control and Computer Engineering, Politecnico di Torino, Italy.
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3
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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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Li Z, Lin Z, Lu Z, Ying Z. Effects of a traditional Chinese medicine formula containing the Coix seed and Lotus seed on the intestinal morphology and microbiota of local piglets. AMB Express 2021; 11:159. [PMID: 34837549 PMCID: PMC8627543 DOI: 10.1186/s13568-021-01318-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 11/16/2021] [Indexed: 12/19/2022] Open
Abstract
A traditional Chinese medicine formula based on the Coix seed and Lotus seed has been used as a general treatment of malnutrition, excessive fatigue, dysfunction of the spleen and stomach, and disorders of water transport in humans in China. However, there is limited information on its effects on the gut microbiota of piglets in vivo. In this study, the mix of Coix seed and Lotus were added the diet of forty weaned piglets (local piglets), and then evaluated it's affected on the gut microbiota of piglets and on the relations within the gut bacterial community. The results indicated that this traditional Chinese medicine formula (LM) and the extract of the traditional Chinese medicine formula (LMT) downregulated pH of succus gastricus and raised pH of the ileum, and LMT obviously decreased the feed conversion ratio. Further study showed LMT and LM also significantly increased the thick and long of gastrointestinal villi. And then, 16S ribosomal DNA sequencing revealed that groups LMT and LM have higher relative abundance of the genus Lactobacillus in the colon, succus gastricus, and jejunum, which are beneficial bacteria sold as dietary supplements to aid digestion or to augment health. Meanwhile, the relative abundance levels of Prevotellaceae, Alloprevotella, and Prevotella in the colon and Clostridium in succus gastricus and jejunum were lower. These experiments highlight the usefulness of the traditional Chinese medicine formula based on the Coix seed and Lotus seed for decreasing pH in succus gastricus, for improving the structure of intestinal villi and gut microflora, and then for achieving improvements in pig production performance.
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Affiliation(s)
- Zhaolong Li
- Institute of Animal Husbandry and Veterinary Medicine, Fujian Academy of Agricultural Sciences, Pudang, Jin-an District, Fuzhou, 350013, Fujian Province, China.
| | - Zhongning Lin
- Agricultural Ecology Institute, Fujian Academy of Agricultural Sciences, Pudang, Jin-an District, Fuzhou, 350013, Fujian Province, China.
| | - Zheng Lu
- Agricultural Ecology Institute, Fujian Academy of Agricultural Sciences, Pudang, Jin-an District, Fuzhou, 350013, Fujian Province, China
| | - Zhaoyang Ying
- Agricultural Ecology Institute, Fujian Academy of Agricultural Sciences, Pudang, Jin-an District, Fuzhou, 350013, Fujian Province, China
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Olaithe M, Pushpanathan M, Hillman D, Eastwood PR, Hunter M, Skinner T, James A, Wesnes KA, Bucks RS. Cognitive profiles in obstructive sleep apnea: a cluster analysis in sleep clinic and community samples. J Clin Sleep Med 2020; 16:1493-1505. [PMID: 32400387 PMCID: PMC7970596 DOI: 10.5664/jcsm.8564] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 05/03/2020] [Accepted: 05/04/2020] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Although cognitive dysfunction is a recognized consequence of untreated obstructive sleep apnea (OSA), the deficit pattern is heterogeneous. Understanding this heterogeneity may identify those at risk of cognitive deficits and guide intervention strategies. To facilitate understanding, we examined whether distinct profiles of neuropsychological performance were present in OSA and, if so, how they are related to other OSA features. METHODS We studied sleep clinic (n = 121) and community (n = 398) samples with moderate-severe OSA (apnea-hypopnea index ≥ 15 events/h). Attention and memory were assessed using the Cognitive Drug Research system. Sleep was assessed using polysomnography in the clinic sample and dual channel (flow, oximetry) portable monitoring in the community sample. Latent profile analysis was used to determine structure of cognitive clusters. Discriminant function analysis was used to examine associations between nocturnal and diurnal features of OSA and profile membership. RESULTS Both samples were best characterized by a 3-profile solution: (1) strong thinkers (performed well across most domains and showed greater cognitive reserve); (2) inattentive fast thinkers (strong processing speed but poor ability to maintain attention); and (3) accurate slow thinkers (strengths in maintaining attention but poor processing speed). Profile membership was associated with mean overnight oxygen saturation and cognitive reserve in the clinic sample and the presence of cardiovascular disease and/or diabetes in the community sample. CONCLUSIONS These findings help explain the diversity of outcomes in previous studies of cognitive dysfunction in OSA by demonstrating that individual differences in cognitive reserve, nocturnal oxygen saturation, and comorbidities affect how cognition is impacted by OSA.
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Affiliation(s)
- Michelle Olaithe
- School of Psychological Science, University of Western Australia, Perth, Western Australia, Australia
| | - Maria Pushpanathan
- School of Psychological Science, University of Western Australia, Perth, Western Australia, Australia
| | - David Hillman
- Centre for Sleep Science, School of Human Sciences, University of Western Australia, Perth, Western Australia, Australia
- West Australian Sleep Disorders Research Institute, Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Peter R. Eastwood
- Centre for Sleep Science, School of Human Sciences, University of Western Australia, Perth, Western Australia, Australia
- West Australian Sleep Disorders Research Institute, Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Michael Hunter
- Busselton Population Medical Research Institute, Busselton, Western Australia, Australia
- School of Population and Global Health, University of Western Australia, Nedlands, Western Australia, Australia
| | - Timothy Skinner
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Alan James
- West Australian Sleep Disorders Research Institute, Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
- Busselton Population Medical Research Institute, Busselton, Western Australia, Australia
| | - Keith A. Wesnes
- Centre for Human Psychopharmacology, Swinburne University of Technology, Melbourne, Victoria, Australia
- Department of Psychology, Northumbria University, Newcastle, United Kingdom
| | - Romola S. Bucks
- School of Psychological Science, University of Western Australia, Perth, Western Australia, Australia
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Wojcik CM, Beier M, Costello K, DeLuca J, Feinstein A, Goverover Y, Gudesblatt M, Jaworski M, Kalb R, Kostich L, LaRocca NG, Rodgers JD, Benedict RH. Computerized neuropsychological assessment devices in multiple sclerosis: A systematic review. Mult Scler 2019; 25:1848-1869. [PMID: 31637963 PMCID: PMC6875828 DOI: 10.1177/1352458519879094] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background: The proliferation of computerized neuropsychological assessment devices (CNADs) for screening and monitoring cognitive impairment is increasing exponentially. Previous reviews of computerized tests for multiple sclerosis (MS) were primarily qualitative and did not rigorously compare CNADs on psychometric properties. Objective: We aimed to systematically review the literature on the use of CNADs in MS and identify test batteries and single tests with good evidence for reliability and validity. Method: A search of four major online databases was conducted for publications related to computerized testing and MS. Test–retest reliability and validity coefficients and effect sizes were recorded for each CNAD test, along with administration characteristics. Results: We identified 11 batteries and 33 individual tests from 120 peer-reviewed articles meeting the inclusion criteria. CNADs with the strongest psychometric support include the CogState Brief Battery, Cognitive Drug Research Battery, NeuroTrax, CNS-Vital Signs, and computer-based administrations of the Symbol Digit Modalities Test. Conclusion: We identified several CNADs that are valid to screen for MS-related cognitive impairment, or to supplement full, conventional neuropsychological assessment. The necessity of testing with a technician, and in a controlled clinic/laboratory environment, remains uncertain.
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Affiliation(s)
- Curtis M Wojcik
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Meghan Beier
- Division of Rehabilitation Psychology and Neuropsychology, Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - John DeLuca
- Department of Physical Medicine and Rehabilitation and Department of Neurology, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Anthony Feinstein
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Yael Goverover
- New York University, New York, NY, USA/South Shore Neurologic Associates, New York, NY, USA
| | | | - Michael Jaworski
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Rosalind Kalb
- National Multiple Sclerosis Society, New York, NY, USA
| | - Lori Kostich
- The Mandell MS Center, Mount Sinai Rehabilitation Hospital, Hartford, CT, USA
| | | | - Jonathan D Rodgers
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA/Jacobs Neurological Institute, Buffalo, NY, USA/Canisius College, Buffalo, NY, USA
| | - Ralph Hb Benedict
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA/Jacobs Neurological Institute, Buffalo, NY, USA
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Ruano L, Branco M, Severo M, Sousa A, Castelo J, Araújo I, Pais J, Cerqueira J, Amato MP, Lunet N, Cruz VT. Tracking cognitive impairment in multiple sclerosis using the Brain on Track test: a validation study. Neurol Sci 2019; 41:183-191. [PMID: 31631230 DOI: 10.1007/s10072-019-04088-8] [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] [Received: 06/22/2019] [Accepted: 09/24/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND The accurate and regular monitoring cognitive performance in multiple sclerosis (MS) patients is critical to develop new prevention and management strategies for cognitive impairment (CI). The Brain on Track (BoT) test is a self-administered web-based tool developed for cognitive screening and monitoring. The objective of this study was to validate the use of the BoT in MS, by assessing its ability to distinguish between MS patients and matched controls, as well as detect CI among MS patients, by analysing its correlation with standard cognitive tests and its reliability and learning effects in repeatable use. METHODS The BoT was applied in 30 patients with MS consecutively selected and 30 age- and education-matched controls, first in a hospital clinic, under supervision, and then 1 week later from home. After these first two trials, MS patients repeated the test from home every 4 weeks for 3 months. A standard neuropsychological battery was also applied to MS patients at baseline. RESULTS The Cronbach's alpha was 0.89. Test scores were significantly different between MS patients and controls (Cohen's d = 0.87; p < 0.01). Among MS patients, scores were significantly lower in those with CI documented in the standard neuropsychological battery than in their cognitively preserved counterparts (Cohen's d = 2.0; p < 0.001). The BoT scores presented a good correlation with standard neuropsychological tests, particularly for information processing speed. Regarding test-retest reliability, 10/11 subtests presented two-way mixed single intraclass consistency correlation coefficients > 0.70. CONCLUSION The BoT showed good neuropsychological parameters in MS patients, endorsing the use of self-administered computerized tests in this setting.
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Affiliation(s)
- Luis Ruano
- Neurology Department, Centro Hospitalar de Entre Douro e Vouga, Santa Maria da Feira, Portugal. .,Departamento de Ciências da Saúde Pública e Forenses e Educação Médica Faculdade de Medicina da Universidade do Porto, Porto, Portugal. .,EPIUnit, Institute of Public Health, University of Porto, Rua das Taipas 135-139, 4050-600, Porto, Portugal.
| | - Mariana Branco
- Neurology Department, Centro Hospitalar de Entre Douro e Vouga, Santa Maria da Feira, Portugal.,Departamento de Ciências da Saúde Pública e Forenses e Educação Médica Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Milton Severo
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica Faculdade de Medicina da Universidade do Porto, Porto, Portugal.,EPIUnit, Institute of Public Health, University of Porto, Rua das Taipas 135-139, 4050-600, Porto, Portugal
| | - Andreia Sousa
- Neurology Department, Centro Hospitalar de Entre Douro e Vouga, Santa Maria da Feira, Portugal
| | - Juliana Castelo
- Neurology Department, Centro Hospitalar de Entre Douro e Vouga, Santa Maria da Feira, Portugal
| | - Isabel Araújo
- Neurology Department, Centro Hospitalar de Entre Douro e Vouga, Santa Maria da Feira, Portugal
| | - Joana Pais
- EPIUnit, Institute of Public Health, University of Porto, Rua das Taipas 135-139, 4050-600, Porto, Portugal
| | - João Cerqueira
- 2CA Braga, Braga, Portugal.,Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal.,ICVS/3B's - PT Government Associate Laboratory, Braga, Guimarães, Portugal
| | - Maria Pia Amato
- Department NEUROFARBA, Section Neurosciences, University of Florence, Florence, Italy
| | - Nuno Lunet
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica Faculdade de Medicina da Universidade do Porto, Porto, Portugal.,EPIUnit, Institute of Public Health, University of Porto, Rua das Taipas 135-139, 4050-600, Porto, Portugal
| | - Vítor Tedim Cruz
- Neurology Department, Centro Hospitalar de Entre Douro e Vouga, Santa Maria da Feira, Portugal.,IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy.,Neurology Department, Hospital Pedro Hispano, Unidade Local de Saúde de Matosinhos, Sra. da Hora, Portugal
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Heled E, Aloni R, Achiron A. Cognitive functions and disability progression in relapsing-remitting multiple sclerosis: A longitudinal study. APPLIED NEUROPSYCHOLOGY-ADULT 2019; 28:210-219. [PMID: 31204507 DOI: 10.1080/23279095.2019.1624260] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Longitudinal studies have shown inconsistent findings regarding the association between cognition, demographic characteristics, and clinical decline in relapsing-remitting multiple sclerosis (RRMS). Our objective was to further explore these relations, over time, while also considering age and sex. A total of 183 patients with RRMS were assessed at two time points, using a neuropsychological battery and the Expanded Disability Status Scale (EDSS). For the first assessment, participants were divided by age (<29, 30-39, 40-49, 50-60) and sex. Next, they were divided according to their participation in one of three interval assessment points: 2-3, 4-5, and 6-8 years. Cognitive function was not correlated with disease duration but was negatively correlated with EDSS score. Men under 29 and women under 39 showed negative correlations between cognitive and clinical impairment. Executive functions, attention, and information processing speed (IPS) showed cognitive decline between the first and second assessments. Furthermore, at the 4-5 year interval IPS predicted EDSS scores, while at the 6-8 year interval it was IPS and visuo-spatial ability. Therefore, relation between clinical status and cognition is not consistent across different age and sex groups. Additionally, cognitive deterioration is only partially evident longitudinally; however, IPS appears to be the most sensitive in predicting one's future clinical condition.
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Affiliation(s)
- Eyal Heled
- Department of Psychology, Ariel University, Ariel, Israel.,Neurological Rehabilitation Department, Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel
| | - Roy Aloni
- Department of Psychology, Ariel University, Ariel, Israel.,Multiple Sclerosis Center, Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel
| | - Anat Achiron
- Multiple Sclerosis Center, Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
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Giedraitiene N, Kaubrys G. Distinctive Pattern of Cognitive Disorders During Multiple Sclerosis Relapse and Recovery Based on Computerized CANTAB Tests. Front Neurol 2019; 10:572. [PMID: 31214108 PMCID: PMC6558046 DOI: 10.3389/fneur.2019.00572] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 05/15/2019] [Indexed: 01/23/2023] Open
Abstract
Background: Cognition may be affected at least as seriously as physical function during multiple sclerosis (MS) relapse, however MS relapse related cognitive disorders are still underdiagnosed and poorly characterized. The limited number of paper-pencil tests were used for assessment, and nevertheless, some significant changes were found. Unlike the paper-pencil tests, computerized batteries and tests are more sensitive and highly standardized, produce instant scoring and can minimize the learning and practice effects on follow-up. We investigated the cognition during MS relapse with the Cambridge Neuropsychological Test Automated Battery (CANTAB), which has shown sensitivity to cognitive dysfunction across different clinical groups, including patients with MS. Objective: The objective of the study was to assess the cognitive functions with CANTAB battery in MS patients during relapse, in stable MS patients, and healthy controls, and to establish the timing and pattern of cognitive recovery after relapse. Methods: Sixty relapsing, thirty stable MS patients, and thirty controls were assessed with CANTAB. The relapse group was assessed during multiple sclerosis relapse and 1 and 3 months after the first assessment. Results: The score of the difficult task of spatial planning was worse in MS relapse group than in MS stable group (p < 0.05). The scores of medium difficulty tasks of spatial planning, episodic visual recall and working memory were worse in the relapse group than in the control group (p < 0.05), while in stable MS and control groups, the scores of these tasks didn't differ. The most significant improvement of speed of response, spatial planning, episodic visual recall memory and spatial working memory, was established at 1 month after the first assessment, additional improvement of spatial planning and working memory was observed at 3 months after the first assessment. Conclusions: The results of this study indicate that cognitive function is affected during MS relapse. The difficult task of CANTAB battery, which assesses the spatial planning, showed MS relapse related cognitive dysfunction. The changes in scores of episodic visual recall and working memory may be related to MS relapse. A significant improvement in the speed of response, spatial planning, episodic visual recall and working memory was established at 1 month after MS relapse. The additional improvement in spatial planning for the most difficult task and working memory was observed at 3 months after MS relapse. It may be possible that the practice effect had the impact on the improvement of cognitive scores that was noted in relapsing MS patients.
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Affiliation(s)
- Natasa Giedraitiene
- Clinic of Neurology and Neurosurgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Gintaras Kaubrys
- Clinic of Neurology and Neurosurgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
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Neurocognitive Effects of Repetitive Transcranial Magnetic Stimulation With a 2-Coil Device in Treatment-Resistant Major Depressive Disorder. J ECT 2018; 34:258-265. [PMID: 29613944 DOI: 10.1097/yct.0000000000000494] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Neurocognitive dysfunction is an understudied and undertreated aspect of psychiatric research and treatment. There is emerging evidence to suggest that repetitive transcranial magnetic stimulation (rTMS) may possess neurocognition-enhancing capabilities. METHODS This study examined the neurocognitive data from a randomized, double-blind, sham-controlled trial of an investigational 2-coil rTMS device in antidepressant treatment or treatment-intolerant major depressive disorder patients. This device has the potential to stimulate deeper areas of the brain than the Food and Drug Administration-approved TMS devices, which primarily stimulate cortical brain areas and may therefore have different neurocognitive adverse effects. Patients received 20 daily rTMS treatments (10-Hz stimulation; either active or sham) with coil centers positioned over the left dorsolateral prefrontal cortex and dorsomedial prefrontal cortex. Neurocognitive safety was evaluated at baseline and within 72 hours of final treatment session with a computerized battery assessing aspects of attention and memory in 84 participants. RESULTS There were no observed negative neurocognitive effects of the 2-coil rTMS device. A significant effect of active rTMS was observed on the quality of episodic memory. There were no observed effects for attention or working memory. Baseline quality of episodic memory predicted depression treatment response and remission, in that lower baseline episodic memory was associated with greater likelihood of depression response/remission. This was observed in logistic regression analyses controlling for treatment and baseline depressive symptoms. CONCLUSIONS The 2-coil rTMS device is a cognitively safe treatment for treatment-resistant depression that may possess episodic memory-enhancing capabilities. Furthermore, baseline episodic memory may reflect an important predictor of subsequent depression treatment response/remission to rTMS.
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11
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Rouleau I, Dagenais E, Tremblay A, Demers M, Roger É, Jobin C, Duquette P. Prospective memory impairment in multiple sclerosis: a review. Clin Neuropsychol 2017; 32:922-936. [PMID: 28774220 DOI: 10.1080/13854046.2017.1361473] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Multiple sclerosis (MS) is a progressive disease of the central nervous system affecting information processing speed, episodic memory, attention, and executive functions. MS patients also often report prospective memory (PM) failures that directly impact their functional autonomy, including professional and social life. The purpose of this paper was to review the literature concerning the assessment and remediation of PM deficits in MS. METHOD The literature pertaining to PM impairment in MS was carefully reviewed using PubMed, PsyINFO, and Google Scholar, as well as cross-references from the articles published on this topic. Since PM rehabilitation in MS patients is still in its infancy, this review mainly focuses on studies that have directly assessed PM through various measures including questionnaires, standardized clinical tests, and experimental procedures. CONCLUSION This literature review confirms the presence of PM deficits in MS patients, even in the early stages of the disease. A further need for controlled studies on PM assessment and PM interventions in patients with MS is stressed.
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Affiliation(s)
- Isabelle Rouleau
- a Department of Psychology , Université du Québec à Montréal , Montreal , Canada.,b Centre de recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM) , Montreal , Canada
| | - Emmanuelle Dagenais
- a Department of Psychology , Université du Québec à Montréal , Montreal , Canada
| | - Alexandra Tremblay
- a Department of Psychology , Université du Québec à Montréal , Montreal , Canada
| | - Mélanie Demers
- a Department of Psychology , Université du Québec à Montréal , Montreal , Canada
| | - Élaine Roger
- b Centre de recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM) , Montreal , Canada
| | - Céline Jobin
- c Neurology Service , Hôpital du Sacré-Coeur de Montréal , Montreal , Canada
| | - Pierre Duquette
- b Centre de recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM) , Montreal , Canada
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Cognitive Impairment in Multiple Sclerosis: A Review of Neuropsychological Assessments. Cogn Behav Neurol 2017; 29:55-67. [PMID: 27336803 DOI: 10.1097/wnn.0000000000000097] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Of the more than two million people worldwide with multiple sclerosis, 40% to 65% experience cognitive impairment, many of them early in the course of the disease. Cognitive impairment has been found in patients with all subtypes of multiple sclerosis. Because both pharmacologic and nonpharmacologic interventions may improve patients' brain function, cognitive assessment should be a routine part of the clinical evaluation. Traditional paper-and-pencil neuropsychological tests and batteries can help detect and monitor patients' cognitive problems. Computerized cognitive batteries also show promise. Controversy continues over which test is most reliable at assessing cognitive impairment in both everyday clinical practice and research. Each battery has possible disadvantages, such as practice effects, poor sensitivity and specificity, and questionable applicability to multiple sclerosis. Based on our review of the literature, we describe the tests that are currently being used or that might be used in assessing cognitive deficits in patients with multiple sclerosis, and we summarize the strengths and limitations of each.
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Reddy S, Fayyad R, Edgar CJ, Guico-Pabia CJ, Wesnes K. The effect of desvenlafaxine on cognitive functioning in employed outpatients with major depressive disorder: a substudy of a randomized, double-blind, placebo-controlled trial. J Psychopharmacol 2016; 30:559-67. [PMID: 27009044 DOI: 10.1177/0269881116631649] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The objective of this substudy was to examine the effect of desvenlafaxine 50 mg/day compared with placebo on cognitive function in employed outpatients with major depressive disorder. A total of 11/55 (20%) study sites in a 12-week, randomized, double-blind, placebo-controlled trial administered cognitive assessments in memory, attention, and executive functioning domains using the cognitive drug research system. Changes from baseline were subjected to analysis of covariance with baseline levels as covariates, using last observation carried forward data. A significant improvement with desvenlafaxine 50 mg/day (n=52) compared with placebo (n=29) was observed on the quality of working memory composite measure (0.081 units (0.005, 0.156); P=0.0365) at last observation carried forward. Improvement from baseline on the speed of working memory composite was significant for desvenlafaxine (-226.6 msec (-316.7, -136.4); P<0.0001) and for placebo (-133.3 msec (-257.2, -9.4); P=0.0354); however, the treatment effect was not significant. No significant differences between groups were observed on composite measures for attention. Treatment of depression with desvenlafaxine 50 mg/day may improve aspects of cognitive functioning, including working memory.Clinical Trial Registry No.: Clinicaltrials.gov identifier: NCT00824291.
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Affiliation(s)
- Sujana Reddy
- Formerly of Pfizer Inc., formerly Wyeth Research, Collegeville, PA, USA Pottstown Memorial Hospital, Pottstown, PA, USA
| | | | | | - Christine J Guico-Pabia
- Formerly of Pfizer Inc., formerly Wyeth Research, Collegeville, PA, USA CGP Strategic Solutions LLC, Landsdale, PA, USA
| | - Keith Wesnes
- Formerly of Bracket Global, Goring-on-Thames, UK Swinburne University, Melbourne, VIC, Australia Northumbria University, Newcastle, UK
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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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de Bruin NMWJ, Schmitz K, Schiffmann S, Tafferner N, Schmidt M, Jordan H, Häußler A, Tegeder I, Geisslinger G, Parnham MJ. Multiple rodent models and behavioral measures reveal unexpected responses to FTY720 and DMF in experimental autoimmune encephalomyelitis. Behav Brain Res 2015; 300:160-74. [PMID: 26692368 DOI: 10.1016/j.bbr.2015.12.006] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 11/30/2015] [Accepted: 12/09/2015] [Indexed: 10/22/2022]
Abstract
Experimental autoimmune encephalomyelitis (EAE) is a widely-used rodent model for multiple sclerosis (MS), but a single model can hardly capture all features of MS. We investigated whether behavioral parameters in addition to clinical motor function scores could be used to assess treatment efficacy during score-free intervals in the relapsing-remitting EAE model in SJL/J mice. We studied the effects of the clinical reference compounds FTY720 (fingolimod, 0.5mg/kg/day) and dimethyl fumarate (DMF, 20-30 mg/kg/day) on clinical scores in several rodent EAE models in order to generate efficacy profiles. SJL/J mice with relapsing-remitting EAE were studied using behavioral tests, including rotarod, gait analysis, locomotor activity and grip strength. SJL/J mice were also examined according to Crawley's sociability and preference for social novelty test. Prophylactic treatment with FTY720 prevented clinical scores in three of the four EAE rodent models: Dark Agouti (DA) and Lewis rats and C57BL/6J mice. Neither prophylactic nor late-therapeutic treatment with FTY720 reduced clinical scores or reversed deficits in the rotarod test in SJL/J mice, but we observed effects on motor functions and sociability in the absence of clinical scores. Prophylactic treatment with FTY720 improved the gait of SJL/J mice whereas late-therapeutic treatment improved manifestations of reduced social (re)cognition or preference for social novelty. DMF was tested in three EAE models and did not improve clinical scores at the dose used. These data indicate that improvements in behavioral deficits can occur in absence of clinical scores, which indicate subtle drug effects and may have translational value for human MS.
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Affiliation(s)
- N M W J de Bruin
- Fraunhofer Institute for Molecular Biology and Applied Ecology IME, Project Group Translational Medicine & Pharmacology TMP, Theodor-Stern-Kai 7, 60596 Frankfurt am Main, Germany.
| | - K Schmitz
- Pharmazentrum Frankfurt/ZAFES, Institute of Clinical Pharmacology, Goethe-University Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - S Schiffmann
- Fraunhofer Institute for Molecular Biology and Applied Ecology IME, Project Group Translational Medicine & Pharmacology TMP, Theodor-Stern-Kai 7, 60596 Frankfurt am Main, Germany
| | - N Tafferner
- Fraunhofer Institute for Molecular Biology and Applied Ecology IME, Project Group Translational Medicine & Pharmacology TMP, Theodor-Stern-Kai 7, 60596 Frankfurt am Main, Germany
| | - M Schmidt
- Fraunhofer Institute for Molecular Biology and Applied Ecology IME, Project Group Translational Medicine & Pharmacology TMP, Theodor-Stern-Kai 7, 60596 Frankfurt am Main, Germany
| | - H Jordan
- Fraunhofer Institute for Molecular Biology and Applied Ecology IME, Project Group Translational Medicine & Pharmacology TMP, Theodor-Stern-Kai 7, 60596 Frankfurt am Main, Germany
| | - A Häußler
- Pharmazentrum Frankfurt/ZAFES, Institute of Clinical Pharmacology, Goethe-University Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - I Tegeder
- Pharmazentrum Frankfurt/ZAFES, Institute of Clinical Pharmacology, Goethe-University Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - G Geisslinger
- Fraunhofer Institute for Molecular Biology and Applied Ecology IME, Project Group Translational Medicine & Pharmacology TMP, Theodor-Stern-Kai 7, 60596 Frankfurt am Main, Germany; Pharmazentrum Frankfurt/ZAFES, Institute of Clinical Pharmacology, Goethe-University Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - M J Parnham
- Fraunhofer Institute for Molecular Biology and Applied Ecology IME, Project Group Translational Medicine & Pharmacology TMP, Theodor-Stern-Kai 7, 60596 Frankfurt am Main, Germany
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Dagenais E, Rouleau I, Tremblay A, Demers M, Roger É, Jobin C, Duquette P. Role of executive functions in prospective memory in multiple sclerosis: Impact of the strength of cue–action association. J Clin Exp Neuropsychol 2015; 38:127-40. [DOI: 10.1080/13803395.2015.1091063] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Baughman BC, Basso MR, Sinclair RR, Combs DR, Roper BL. Staying on the job: The relationship between work performance and cognition in individuals diagnosed with multiple sclerosis. J Clin Exp Neuropsychol 2015; 37:630-40. [DOI: 10.1080/13803395.2015.1039963] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Interferon Beta-1a (AVONEX®) as a Treatment Option for Untreated Patients with Multiple Sclerosis (AXIOM): A Prospective, Observational Study. Int J Mol Sci 2015; 16:15271-86. [PMID: 26154767 PMCID: PMC4519899 DOI: 10.3390/ijms160715271] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Revised: 05/26/2015] [Accepted: 05/27/2015] [Indexed: 11/25/2022] Open
Abstract
The efficacy and safety of first-line disease-modifying therapies (DMT) for relapsing-remitting multiple sclerosis (RRMS) has been demonstrated in pivotal, randomized trials, but these studies do not reflect the routine care setting where treatment gaps or switches are common. The Avonex as Treatment Option for Untreated MS Patients (AXIOM) trial assessed the efficacy of newly-initiated intramuscular interferon beta-1a (IM IFNb-1a) after a treatment-free interval, with particular consideration of the previous course of disease and therapy. The AXIOM trial was an open, 12-month, observational, non-interventional study with a retrospective and a prospective part conducted in Germany. RRMS patients with a treatment-free interval of at least three months were included and treated with IFNb-1a for up to 12 months. Relapse rate, disability progression, injection-related parameters and quality of life observed during the prospective part were compared with retrospectively-collected data. Two hundred and thirty five RRMS patients participated in AXIOM. The mean relapse rate decreased from 1.1 in the three months before baseline to 0.2 per quarter during the twelve-month observational period; the Multiple Sclerosis Functional Composite score improved during twelve months of IM IFNb-1a treatment, while the Expanded Disability Status Scale score did not change over the course of this study. Compared to previous DMTs (IM IFNb-1a, subcutaneous IFNb-1a (SC IFNb-1a), SC IFNb-1b, glatiramer acetate), the patients experienced less injection site reactions and flu-like symptoms, with a stated improved quality of life. IM IFNb-1a was effective and well accepted in RRMS patients with no or discontinued previous therapy. These results from the routine care setting may inform optimization of DMT treatment in RRMS, but need confirmation in further studies.
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Does Self-Efficacy Affect Cognitive Performance in Persons with Clinically Isolated Syndrome and Early Relapsing Remitting Multiple Sclerosis? Mult Scler Int 2015; 2015:960282. [PMID: 26064686 PMCID: PMC4429205 DOI: 10.1155/2015/960282] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2015] [Accepted: 04/15/2015] [Indexed: 11/28/2022] Open
Abstract
In persons with multiple sclerosis (MS) a lowered self-efficacy negatively affects physical activities. Against this background we studied the relationship between self-efficacy and cognitive performance in the early stages of MS. Thirty-three patients with Clinically Isolated Syndrome (CIS) and early Relapsing Remitting MS (eRRMS) were assessed for self-efficacy (MSSES-18), cognition (CDR System), fatigue (MFIS-5), depressive symptoms (BDI), disease impact (MSIS-29), and disability (EDSS). Correlative analyses were performed between self-efficacy and cognitive scores, and stepwise regression analyses identified predictors of cognition and self-efficacy. Good correlations existed between total self-efficacy and Power of Attention (r= 0.65; P< 0.001), Reaction Time Variability (r= 0.57; P< 0.001), and Speed of Memory (r= 0.53; P< 0.01), and between control self-efficacy and Reaction Time Variability (r= 0.55; P< 0.01). Total self-efficacy predicted 40% of Power of Attention, 34% of Reaction Time Variability, and 40% of Speed of Memory variabilities. Disease impact predicted 65% of total self-efficacy and 58% of control self-efficacy variabilities. The findings may suggest that in persons with CIS and eRRMS self-efficacy may positively affect cognitive performance and that prevention of disease activity may preserve self-efficacy.
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Abstract
Objective:Since a large proportion of multiple sclerosis (MS) patients exhibit cognitive deficits, it is important to have reliable and cost-effective screening measures that can be used to follow patients effectively. the objective of this study was to evaluate the clinical value of the Montreal Cognitive Assessment (MoCA) test in detecting cognitive deficits in MS patients.Methods:Forty-one (70.1% women, mean age 44.51 ±7.43) mildly impaired (EDSS: 2.26 ±1.87) MS patients were recruited for this study. In addition to the MoCA, they were administered the MSNQ-P (patient version) and the MSNQ-I (informant version), the bDI-FS and a comprehensive neuropsychological test battery.Results:there were significant correlations between the MoCA test and the three factors derived from the neuropsychological evaluation (Executive/speed of processing, Learning, Delayed recall). the MoCA test was correlated with the MSNQ-I but only marginally with the MSNQ-P. In addition, there was no significant correlation between the MSNQ-P and the neuropsychological factors, whereas significant correlations were found between two of those factors (Learning and Delayed recall) and the MSNQ-I, suggesting that the informant version is more reliable than the patient version for the presence of cognitive deficits.Conclusion:the results obtained in the present study support the value of the MoCA test as a screening tool for the presence of cognitive dysfunction in MS patients, even in patients with mild functional disability (EDSS).
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Martin PT, Corcoran M, Zhang P, Katic A. Randomized, double-blind, placebo-controlled, crossover study of the effects of lisdexamfetamine dimesylate and mixed amphetamine salts on cognition throughout the day in adults with attention-deficit/hyperactivity disorder. Clin Drug Investig 2014; 34:147-57. [PMID: 24297663 PMCID: PMC3899471 DOI: 10.1007/s40261-013-0156-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Background Understanding the nature and time course of the pharmacodynamic effects of attention-deficit/hyperactivity disorder (ADHD) medications is useful. The Cognitive Drug Research Computerized Battery of Tests (CDR-CBT) is a 20-min battery of ten standardized, validated neuropsychometric tasks. Objective This pilot study examined the sensitivity and responsiveness of the CDR-CBT for assessing cognitive function in adults with ADHD prior to and up to 16 h postdose during treatment with lisdexamfetamine dimesylate (LDX) or mixed amphetamine salts immediate release (MAS-IR; various generics available). Methods This was a double-blind three-period crossover study. Participants received LDX 50 mg/day, MAS-IR 20 mg/day, and placebo (~7 a.m.) for 7 days each in randomized order. CDR-CBT was administered on day 1 of period 1 and day 7 of each period at scheduled times between −0.5 (predose) and 16 h postdose. Composite power of attention (PoA) score (sum of simple reaction time, choice reaction time, and digit vigilance speed) was the primary outcome measure. The Conners’ Adult ADHD Rating Scales-Self-Report: Short Version (CAARS-S:S) was administered at baseline and on day 1 of period 1, and days 6 and 7 of each treatment period. Tertiary outcomes included CDR-CBT composite continuity of attention scores, its component task scores, cognitive reaction time, and response variability scores. No inferential statistical comparisons were conducted. Safety assessments included adverse events (AEs) and vital signs. Results This analysis included 18 participants (mean age 30.8 years); one withdrew because of AEs. Mean pretreatment PoA scores were 1175.9–1361.2 ms, scores commensurate with a normative age of >40 years. Maximum reductions in PoA scores with LDX and MAS-IR occurred at 5 h postdose at day 7 (least squares mean difference [95 % CI] of −150.0 [−235.41 to −64.50] and −79.8 [−165.72 to 6.21] ms vs. placebo, respectively). CAARS-S:S scores were unchanged with LDX and MAS-IR (vs. placebo) at all postdose timepoints. Tertiary attention-related CDR-CBT outcomes were sensitive to LDX and MAS-IR (vs. placebo). Treatment-emergent AEs and vital signs were consistent with previous studies in adult ADHD. Conclusion In adults with ADHD, PoA scores indicated impaired attention at baseline and response to treatment with LDX and MAS-IR (vs. placebo), demonstrating value for measuring the time course of pharmacologic treatment effects.
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Affiliation(s)
- Patrick T Martin
- Shire Development LLC, 725 Chesterbrook Blvd, Wayne, PA, 19087-5637, USA,
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Jongen PJ, Wesnes K, van Geel B, Pop P, Sanders E, Schrijver H, Visser LH, Gilhuis HJ, Sinnige LG, Brands AM. Relationship between working hours and power of attention, memory, fatigue, depression and self-efficacy one year after diagnosis of clinically isolated syndrome and relapsing remitting multiple sclerosis. PLoS One 2014; 9:e96444. [PMID: 24787714 PMCID: PMC4006840 DOI: 10.1371/journal.pone.0096444] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Accepted: 04/09/2014] [Indexed: 11/18/2022] Open
Abstract
The role of cognitive domain dysfunction with respect to vocational changes in persons with Clinically Isolated Syndrome (CIS) and early Relapsing Remitting Multiple Sclerosis (eRRMS) is insufficiently known. We investigated thirty-three patients - 14 CIS, 19 eRRMS -, mean (standard deviation [SD]) time since diagnosis 13.5 (4.8) months and mean (SD) Expanded Disability Status Scale (EDSS) score 1.3 (1.1). Patients were assessed on the CDR System, a set of automated tests of cognitive function, which yielded scores for Power of Attention (ms), Continuity of Attention (#), Working Memory (SI), Episodic Memory (#) and Speed of Memory (ms). Work-related items and the confounding variables fatigue, depression, disease impact and self-efficacy, were assessed by self-report questionnaires. Patients had poorer Power of Attention compared to normative data (1187 [161.5] vs. 1070 [98.6]; P<0.0001) and slower Speed of Memory (4043 [830.6]) vs. 2937 [586.1]; P<0.0001). Power of Attention (Pearson r = −0.42; P<0.04), Working Memory (r = 0.42; P<0.04) and depression r = −0.41; P<0.05) correlated with number of days worked per week. Fatigue (r = −0.56; P<0.005), self-efficacy (r = 0.56; P<0.005) and disease impact (r = −0.46; P<0.05) correlated with number of hours worked per week. Persons who wished to work less had poorer Power of Attention (1247 vs. 1116 ms; P<0.02), those who wished to change job had poorer Episodic Memory (1.35 vs. 1.57; p<0.03). People who reduced working hours within 12 months after diagnosis had higher fatigue and disease impact, and lower self-efficacy. The findings of this pilot study indicate that one year after the diagnosis of CIS and RRMS Power of Attention and Speed of Memory are reduced, that Power of Attention and Memory are associated with a capability of working less hours, and that fatigue, depression and disease impact may negatively, and self-efficacy positively affect working hours.
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Affiliation(s)
| | - Keith Wesnes
- Bracket, Goring-on-Thames, United Kingdom; Swinburne University, Melbourne, Australia
| | | | - Paul Pop
- Viecuri Medisch Centrum, Venlo-Venray, The Netherlands
| | | | | | - Leo H Visser
- St. Elisabeth Ziekenhuis, Tilburg, The Netherlands
| | | | | | - Augustina M Brands
- Department of Experimental Psychology, Utrecht University, The Netherlands; Zuwe Hofpoort Ziekenhuis/Regionaal Psychiatrisch Centrum Woerden, The Netherlands
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Lapshin H, Lanctôt KL, O’Connor P, Feinstein A. Assessing the validity of a computer-generated cognitive screening instrument for patients with multiple sclerosis. Mult Scler 2013; 19:1905-12. [DOI: 10.1177/1352458513488841] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Neuropsychological testing requires considerable time, expense, and expertise to administer. These factors can limit patient access. Computerized cognitive testing has been proposed as an alternative. Objectives: The objective of this paper is to validate a brief, simple-to-use computer-generated cognitive assessment screening battery for multiple sclerosis (MS) patients that has minimal motor involvement. Methods: A sample of 96 MS patients and 98 healthy controls completed a computer-generated battery that included the Stroop, Symbol Digit Modalities Test (C-SDMT), a two- and four-second visual analog of the Paced Auditory Serial Addition Test (PVSAT-2, PVSAT-4), and simple and choice reaction time tests. The Minimal Assessment of Cognitive Function in MS was used to define cognitive impairment in the MS sample. Results: Each newly developed test successfully distinguished between cognitively impaired patients and healthy controls as well as cognitively intact patients. A combination of three computerized tests (C-SDMT, PVSAT-2, PVSAT-4) with a mean administration time of 10 minutes had a sensitivity of 82.5% and specificity of 87.5% in detecting cognitive impairment. Good test-retest reliability was obtained for each measure. Conclusions: Good sensitivity and specificity, brevity, ease of administration, and a limited motor component highlight the feasibility of introducing this computer-generated cognitive screening instrument in a busy MS clinic.
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Affiliation(s)
- Helen Lapshin
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Canada
- University of Toronto, Canada
| | - Krista L Lanctôt
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Canada
- University of Toronto, Canada
| | - Paul O’Connor
- University of Toronto, Canada
- Neurology, St. Michael’s Hospital, Canada
| | - Anthony Feinstein
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Canada
- University of Toronto, Canada
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Pellicano C, Kane RL, Gallo A, Xiaobai L, Stern SK, Ikonomidou VN, Evangelou IE, Ohayon JM, Ehrmantraut M, Cantor FK, Bagnato F. Cognitive impairment and its relation to imaging measures in multiple sclerosis: a study using a computerized battery. J Neuroimaging 2012; 23:445-52. [PMID: 23227967 DOI: 10.1111/j.1552-6569.2011.00687.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND AND PURPOSE Cognitive impairment (CI) is an important component of multiple sclerosis (MS) disability. A complex biological interplay between white matter (WM) and gray matter (GM) disease likely sustains CI. This study aims to address this issue by exploring the association between the extent of normal WM and GM disease and CI. METHODS Cognitive function of 24 MS patients and 24 healthy volunteers (HVs) was studied using the Automated Neuropsychological Assessment Metrics (ANAM) battery. WM focal lesions and normal appearing WM (NAWM) volume in patients, cortical thickness (CTh) and deep GM structure volumes in both patients and HVs were measured by high field strength (3.0-Tesla; 3T) imaging. RESULTS An analysis of covariance showed that patients performed worse than HVs on Code Substitution Delayed Memory (P = .04) and Procedural Reaction Time (P = .05) indicative of reduced performance in memory, cognitive flexibility, and processing speed. A summary score (Index of Cognitive Efficiency) indicating global test battery performance was also lower for the patient group (P = .04). Significant associations, as determined by the Spearman rank correlation tests, were noted between each of these 3 cognitive scores and measures of NAWM volume [CDD-TP1(r = .609; P = .0035), PRO-TP1 (r = .456; P = .029) and ICE (r = .489; P = .0129)], CTh (r = .5; P ≤ .05) and volume of subcortical normal appearing GM (NAGM) structures (r = .4; P≤ .04), but not WM lesions. CONCLUSIONS Both NAWM and NAGM volumes are related to CI in MS. The results highlight once again the urgent need to develop pharmacological strategies protecting patients from widespread neurodegeneration as possible preventive strategies of CI development.
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Affiliation(s)
- Clelia Pellicano
- Neuroimmunology Branch (NIB), National Institute of Neurological Disorders and Stroke (NINDS), NIH, Bethesda, MD, USA
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Lapshin H, O'Connor P, Lanctôt KL, Feinstein A. Computerized cognitive testing for patients with multiple sclerosis. Mult Scler Relat Disord 2012; 1:196-201. [DOI: 10.1016/j.msard.2012.05.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2012] [Revised: 04/27/2012] [Accepted: 05/01/2012] [Indexed: 11/16/2022]
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Caine C, Mehta MP, Laack NN, Gondi V. Cognitive function testing in adult brain tumor trials: lessons from a comprehensive review. Expert Rev Anticancer Ther 2012; 12:655-67. [PMID: 22594900 DOI: 10.1586/era.12.34] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Neurocognitive function (NCF) impairment is an important component of primary and metastatic brain tumors and their therapeutic interventions. As a result, modern clinical trials of cranial irradiation for adult cancer patients have incorporated NCF testing as a primary or secondary end point. In doing so, these clinical trials have provided a novel insight into our understanding of the NCF effects of cranial irradiation and brain tumor progression. In this article, we review these clinical trials both in terms of the trial findings and in terms of the types of NCF tests used in these trials. We also provide an introduction to the strengths and limitations of these NCF tests, as well as expert commentary on the current status and future directions of NCF testing in brain tumor trials.
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Affiliation(s)
- Chip Caine
- Intermountain Medical Center Neuroscience Institute and University of Phoenix, Utah Campus, Murray, UT, USA
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Patti F. Treatment of cognitive impairment in patients with multiple sclerosis. Expert Opin Investig Drugs 2012; 21:1679-99. [DOI: 10.1517/13543784.2012.716036] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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