Pattern of neuropsychological impairment in the early phase of relapsing-remitting multiple sclerosis

Altered social cognition in early relapsing remitting multiple sclerosis

INTRODUCTION

People with multiple sclerosis (pwMS) may suffer from some degree of impaired social cognition (SC), the process that integrates the mental operations underlying social interactions. SC is still not clearly characterized in the early stages of MS, and it is not defined whether SC is independent of cognitive impairment.

METHODS

In this cross-sectional study, we aimed to compare SC measures in a population of early (≤5 years) relapsing-remitting MS (RRMS) with an age, sex, and education-matched control group. All participants performed a clinical and a comprehensive neuropsychological assessment. SC evaluation included assessment of facial emotion recognitionn by the Emotion Recognition Task, affective theory of mind (ToM) by the Reading the Mind in the eyes Test (RMET) and cognitive ToM by the Faux Pas test (FPT). Depression, anxiety, fatigue, and quality of life were also assessed. We included 38 pwMS (mean age 34.8 ± 8.7, 78.9% female sex, mean disease duration 1.9±1.3 years) and 38 healthy controls (mean age 34.9 ± 8.4, 81.6% female sex).

RESULTS

Altered social cognition was present in 34.2% of pwMS. Participants with MS performed worse than controls on measures of cognitive ToM, and affective ToM. There were no differences regarding FER. Cognitive ToM and FER correlated with cognitive functions, but no correlation was found between affective ToM and cognitive tests. The only clinical factor associated with altered SC was poor quality of life.

CONCLUSIONS

Social cognition impairment is already present in a significant percentage of early RRMS patients, namely ToM deficits. While cognitive ToM and FER appears to correlate with impaired cognitive results, affective ToM is likely independent of other cognitive functions.

Narrative recall in relapsing-remitting multiple sclerosis: A potentially useful speech task for detecting subtle cognitive changes

Our research studied relapsing-remitting multiple sclerosis (RRMS). In half of the RRMS cases, mild cognitive difficulties are present, but often remain undetected despite their adverse effects on individuals' daily life. Detecting subtle cognitive alterations using speech analysis have rarely been implemented in MS research. We applied automatic speech recognition technology to devise a speech task with potential diagnostic value. Therefore, we used two narrative tasks adjusted for the neural and cognitive characteristics of RRMS; namely narrative recall and personal narrative. In addition to speech analysis, we examined the information processing speed, working memory, verbal fluency, and naming skills. Twenty-one participants with RRMS and 21 gender-, age-, and education-matched healthy controls took part in the study. All the participants with RRMS achieved a normal performance on Addenbrooke's Cognitive Examination. The following parameters of speech were measured: articulation and speech rate, the proportion, duration, frequency, and average length of silent and filled pauses. We found significant differences in the temporal parameters between groups and speech tasks. ROC analysis produced high classification accuracy for the narrative recall task (0.877 and 0.866), but low accuracy for the personal narrative task (0.617 and 0.592). The information processing speed affected the speech of the RRMS group but not that of the control group. The higher cognitive load of the narrative recall task may be the cause of significant changes in the speech of the RRMS group relative to the controls. Results suggest that narrative recall task may be effective for detecting subtle cognitive changes in RRMS.

Identifying Early Neuropsychological Indicators of Cognitive Involvement in Multiple Sclerosis

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.

Cognitive Dysfunction in the Early Stages of Multiple Sclerosis-How Much and How Important?

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.

The relationship between amplitude of low frequency fluctuations and gray matter volume of the mirror neuron system: Differences between low disability multiple sclerosis patients and healthy controls

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The study of the relationship between function and structure of the brain is interesting in multiple sclerosis patients.

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Different relationship between amplitude of low frequency fluctuations (ALFF) and gray matter volume has been detected.

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This difference may be associated with the presence of white matter lesions involving specific tracts.

The study of the relationship between function and structure of the brain could be particularly interesting in neurodegenerative diseases like multiple sclerosis (MS).

The aim of the present work is to identify differences of the amplitude of low frequency fluctuations (ALFF) in the mirror neuron system (MNS) between MS patients and healthy controls and to study the relationship between ALFF and the gray matter volume (GMV) of the regions that belong to the MNS.

Relapsing-remitting MS patients with minor disability were compared to healthy controls (HC) using resting-state functional magnetic resonance imaging (fMRI), anatomic T1 weighted images and diffusion tensor imaging (DTI). Region of interest (ROI) analyses was performed in the MNS regions.

A decrease of ALFF in MS patients was observed in the left inferior frontal gyrus (IFG). Furthermore, a correlation between ALFF in the IFG and the GMV of the left inferior parietal lobule (IPL) was identified. This relationship was different for MS patients than for HC, which may be associated with changes in diffusivity measures which were impaired in MS patients.

MS patients with low disability may show ALFF differences in the MNS without clinical correspondence. This functional difference may be associated with cortical and subcortical changes related to the disease.

Amyloid-β Homeostasis Bridges Inflammation, Synaptic Plasticity Deficits and Cognitive Dysfunction in Multiple Sclerosis

Cognitive deficits are frequently observed in multiple sclerosis (MS), mainly involving processing speed and episodic memory. Both demyelination and gray matter atrophy can contribute to cognitive deficits in MS. In recent years, neuroinflammation is emerging as a new factor influencing clinical course in MS. Inflammatory cytokines induce synaptic dysfunction in MS. Synaptic plasticity occurring within hippocampal structures is considered as one of the basic physiological mechanisms of learning and memory. In experimental models of MS, hippocampal plasticity is profoundly altered by proinflammatory cytokines. Although mechanisms of inflammation-induced hippocampal pathology in MS are not completely understood, alteration of Amyloid-β (Aβ) metabolism is emerging as a key factor linking together inflammation, synaptic plasticity and neurodegeneration in different neurological diseases. We explored the correlation between concentrations of Aβ_1–42 and the levels of some proinflammatory and anti-inflammatory cytokines (interleukin-1β (IL-1β), IL1-ra, IL-8, IL-10, IL-12, tumor necrosis factor α (TNFα), interferon γ (IFNγ)) in the cerebrospinal fluid (CSF) of 103 remitting MS patients. CSF levels of Aβ_1–42 were negatively correlated with the proinflammatory cytokine IL-8 and positively correlated with the anti-inflammatory molecules IL-10 and interleukin-1 receptor antagonist (IL-1ra). Other correlations, although noticeable, were either borderline or not significant. Our data show that an imbalance between proinflammatory and anti-inflammatory cytokines may lead to altered Aβ homeostasis, representing a key factor linking together inflammation, synaptic plasticity and cognitive dysfunction in MS. This could be relevant to identify novel therapeutic approaches to hinder the progression of cognitive dysfunction in MS.

Neuropsychological Assessment in Multiple Sclerosis

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.

Pattern separation performance is decreased in patients with early multiple sclerosis

BACKGROUND

Hippocampal-dependent memory impairment is frequent and occurs early during the course of multiple sclerosis (MS). While mechanisms responsible for episodic memory dysfunction in patients with MS remain largely unknown, dentate gyrus structure has been suggested as particularly vulnerable at the early stage of the disease. If true, we hypothesized that the pattern separation component of episodic memory (a function known to be critically dependent to dentate gyrus function) would be impaired in patients with early MS (PweMS).

METHODS

Thirty eight participants (19 PweMS and 19 healthy controls matched on age, gender and education level) were tested with a behavioral pattern separation task and also for information processing speed and visuospatial episodic memory.

RESULTS

We report a significant decrease in pattern separation performance in PweMS compared to healthy controls (27.07 vs. 40.01, p = .030 after Holm-Bonferroni correction, d = 1.02) together with a significantly higher pattern completion rate (56.11 vs. 40.95, p = .004 after Holm-Bonferroni correction, d = 1.07) while no difference was found among groups for information processing speed and "global" visuospatial episodic memory regarding learning, long-term recall or recognition.

CONCLUSION

Our results suggest that behavioral pattern separation task can detect subtle memory decline in patients with MS and argue for early dentate gyrus dysfunction during the course of the disease.

The correlation between EDSS and cognitive impairment in MS patients. Assessment of a Brazilian population using a BICAMS version

Objectives

To investigate the correlation between the disabilities of MS patients and their cognitive impairment assessed by the Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS).

Methods

Forty patients with definitive diagnoses of MS were selected. The correlation coefficient (r) between the Expanded Disability Status Scale (EDSS) and the neuropsychological tests of BICAMS were calculated.

Results

The correlation was clinically substantial and significant with r = 0.55 (p < 0.01) in the Symbol Digit Modalities Test (SDMT), 0.54 (p < 0.01) in the Brief Visuospacial Memory Test (BVMT) and 0.40 (p < 0.05) in the California Verbal Learning Test (CVLT).

Conclusion

BICAMS has easy and satisfactory application and evaluation for routine visits and presents a significant correlation with the EDSS. Its use may be indicated for screening and monitoring of cognitive impairment in patients with MS.

Language disorders in multiple sclerosis: A systematic review

BACKGROUND

Although cognitive impairments are common in patients with multiple sclerosis (MS), language impairments are not well defined.

OBJECTIVE

The goal of this review was to examine the presence and nature of language disorders associated with MS.

METHOD

A search of PubMed and PsycINFO databases was conducted using combinations of the following terms: language disorders, language pathology, language impairment, multiple sclerosis, communication, language and speech. Studies were chosen based on the original language of the text, year of publication, peer-review status and specificity of the results regarding language and communication disorders.

RESULTS

This review covers 30 articles from 13 countries. The studies involved patients with different types of MS. Various language impairments were reported in MS. However, since the methods used in the studies varied widely, it is difficult to draw any conclusions thus far.

CONCLUSION

Given the various cognitive deficits in MS, it is expected that higher language abilities would be affected. This aspect should be investigated in future studies.

Information processing speed in multiple sclerosis: Past, present, and future

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.

Meaningful Change in Cognition in Multiple Sclerosis: Method Matters

Objective:

To determine if different methods of evaluating cognitive change over time yield measurably different outcomes.

Methods:

Twelve cognitively impaired patients with clinically definite Multiple sclerosis (10 relapsing-remitting, 2 secondary progressive) underwent neuropsychological testing (baseline, 6, 12 months). Data was analysed using: t-tests evaluating group differences on individual tests, group differences in composite scores, reliable change analyses at the level of the individual, and comparisons regarding number of tests failed at each time point.

Results:

Group t-tests on individual tests yielded no change. When tests were grouped according to theoretical constructs, analyses revealed change in processing speed. Reliable change estimates revealed that 16% of the sample deteriorated. When change was measured with respect to the number of domains affected at each time point, 58% of the sample deteriorated on at least one subtest.

Conclusions:

Methodology has a significant impact on interpretation of longitudinal data. In the same group of subjects, traditional group analyses documented no change in individual test scores or change on a single composite score. Analyses of individual results documented change from 16 to 58% of the sample. Advantages and disadvantages of each method were discussed. Findings have implications for interpretation of longitudinal studies.

Reduced information processing speed as primum movens for cognitive decline in MS

Background:

Cognitive impairment affects half of the multiple sclerosis (MS) patient population and is an important contributor to patients’ daily activities. Most cognitive impairment studies in MS are, however, cross-sectional or/and focused on the early disease stages.

Objective:

We aim to assess the time course of decline of different cognitive domains.

Methods:

We collected neuropsychological data on 514 MS patients to construct Kaplan-Meier survival curves of the tests included in the Neuropsychological Screening Battery for MS (NSBMS) and the Symbol Digit Modalities Test (SDMT). Cox-proportional hazard models were constructed to examine the influence of MS onset type, age at onset, gender, depression and level of education on the time course, expressed as age or disease.

Results:

Survival curves of tests focusing on information processing speed (IPS) declined significantly faster than tests with less specific demands of IPS. Median age for pathological decline was 56.2 years (95% CI: 54.4–58.2) on the SDMT and 63.9 years (95% CI: 60–66.9) on the CLTR, a memory task.

Conclusion:

In conclusion, IPS is the cognitive domain not only most widely affected by MS but it is also the first cognitive deficit to emerge in MS.

Thalamic atrophy and cognitive impairment in clinically isolated syndrome and multiple sclerosis

BACKGROUND

Cognitive deficits worsen the quality of life in multiple sclerosis and may be predicted by deep gray matter atrophy, especially thalamic atrophy. This relationship has not been studied in the clinically isolated syndrome (CIS). The aims of this study were to assess cognitive deficits in patients with CIS and relapsing-remitting multiple sclerosis (RRMS) using neuropsychological testing, to search for thalamic atrophy on brain MRI, and to test for their correlations.

METHODS

Forty-three patients (19 with CIS and 24 with RRMS) underwent brain MRI and neuropsychological testing involving multiple cognitive domains and the severity of depression. Thalamic volumes automatically segmented from MRI data were compared to 19 healthy controls. Correlations were sought between cognitive performance and thalamic volume.

RESULTS

Cognitive impairment was detected in the majority of both CIS and MS patients, most affected in executive functions, auditory memory, lexical verbal fluency, distribution of attention and psychomotor speed. Cognitive impairment and depression were not significantly correlated to disease duration. Both CIS and MS patients demonstrated thalamic atrophy compared to controls, while many cognitive deficits correlated with thalamic volume in both patient groups.

CONCLUSION

Cognitive deficits in CIS resemble those found in the later stages of MS and may be directly related to the amount of thalamic damage.

The progress of cognitive decline in newly diagnosed MS patients

OBJECTIVES

Cognitive impairment occurs in multiple sclerosis already in the early stages of the disease. Less is known about the evolution of cognitive decline, especially in newly diagnosed MS patients. The results of existing studies are contradictory in that both cognitive preservation and progressive deterioration have been reported. The purpose of this study was to examine how cognitive impairment evolves over time in the early stages of MS.

MATERIAL AND METHODS

At baseline, the participants were 36 newly diagnosed MS patients and 37 controls. A group of 30 patients were followed longitudinally at a mean test-retest interval of 6.1 years. The test battery covered attention, information processing, memory and learning, verbal and motor functions and reasoning.

RESULTS

There was a significant decline in divided attention (dual task) and information-processing speed (SDMT) at follow-up, but no significant deterioration in overall cognitive performance.

CONCLUSIONS

Overall cognitive functioning remained quite stable during the 6-year follow-up, whereas divided attention and processing speed deteriorated. However, deterioration in performance on the SDMT and the dual task does not seem to indicate more extensive cognitive deterioration. Given the impact of cognitive impairment on patients' quality of life, early detection of its occurrence in MS is extremely important.

The nature of verbal memory impairment in multiple sclerosis: a list-learning and meta-analytic study

The primary purpose of this study was to test the hypothesis that multiple sclerosis (MS) patients have impaired acquisition rather than a retrieval deficit. Verbal memory impairment in MS was examined in 53 relapsing-remitting MS patients and 31 healthy controls (HC), and in a meta-analysis of studies that examined memory functioning in MS with list-learning tasks. The MS group demonstrated significantly lower acquisition and delayed recall performance than the HC group, and the meta-analysis revealed that the largest effect sizes were obtained for acquisition measures relative to delayed recall and recognition. Our data argue against a retrieval deficit as the sole explanation for verbal memory impairment in MS, and make a consistent case for the position that deficient acquisition contributes to the memory dysfunction of MS patients. Deficient acquisition may result from demyelination in relevant white matter tracts that reduces encoding efficiency as a result of impaired speed of information processing.

Neuropsychiatric manifestations of multiple sclerosis

Multiple sclerosis is one of the most frequently observed neurological causes of progressive disability in early to middle adulthood. The disease is variable in its presentation and course, affects roughly 100 to 300 per 100,000 persons within the US alone and is slightly more common among females than males. Multiple sclerosis places substantial burdens on patients, families and caregivers. Its presentation includes disturbances in cognitive abilities and psychiatric functioning, as well as motor difficulties. This article reviews the current literature on the neuropsychiatric manifestations of multiple sclerosis. Cognitive domains discussed include general cognitive functioning, learning and memory ability, attention, processing speed, executive functioning, visual perceptual ability and language functioning. Attention is also given to alterations in neuropsychiatric functioning associated with disease progression and across various disease subtypes. In addition, reports are also reviewed regarding various psychiatric disturbances, affective changes, quality of life issues and fatigue and pain in individuals with multiple sclerosis. Finally, factors pertaining to pediatric populations in multiple sclerosis are addressed.

The role of speed versus working memory in predicting learning new information in multiple sclerosis

The most common cognitive impairments in multiple sclerosis (MS) have been documented in specific domains, including new learning and memory, working memory, and information processing speed. However, little attempt has been made to increase our understanding of their relationship to one another. While recent studies have shown that processing speed impacts new learning and memory abilities in MS, the role of working memory in this relationship has received less attention. The present study examines the relative contribution of impaired working memory versus processing speed in new learning and memory functions in MS. Participants consisted of 51 individuals with clinically definite MS. Participants completed two measures of processing speed, two measures of working memory, and two measures of episodic memory. Data were analyzed via correlational and multiple regression analysis. Results indicate that the variance in new learning abilities in this sample was primarily associated with processing speed, with working memory exerting much less of an influence. Results are discussed in terms of the role of cognitive rehabilitation of new learning and memory abilities in persons with MS.

Cognitive rehabilitation in multiple sclerosis

Cognitive impairments are frequent in multiple sclerosis (MS). However, most studies about efficacy of cognitive rehabilitation interventions have been criticized in terms of methods and/or design. The aim of this study is to evaluate the efficacy of cognitive rehabilitation in MS patients with a cognitive intervention (ProCogSEP* program), compared to a control intervention (discussion program). Twenty MS patients have completed this simple blind study: 10 patients followed 13 sessions (2 hours) of the ProCog-SEP(1) program. Ten other patients followed 13 sessions (2 hours) of a discussion program (Control Group). All patients underwent neuropsychological assessment, before and after their program, in order to evaluate cognitive functions. Two neuropsychologists respectively assessed the patients and conducted the group sessions. Compared to its own baseline, ProCog-SEP Group show improvements in verbal memory [free recall (p = .02), learning (p = .002)], in visual memory [free (p = .05) and delayed recall (p = .007)], in working-memory (p = .03), in verbal fluency (p = .05) and in language (p = .01). Inter group analysis show a benefit of cognitive program mainly in verbal and visual memory, and in verbal fluencies. These results support the interest of a cognitive therapeutic management of MS patients.

Memory performance and normalized regional brain volumes in patients with pediatric-onset multiple sclerosis

Studies in adults with multiple sclerosis (MS) have associated regional brain abnormalities with memory impairment. While memory problems in children with MS are often reported, little is known about the neural correlates that may contribute to these difficulties. We measured verbal and nonverbal memory using the Test of Memory and Learning (TOMAL-2) in 32 children and adolescents with MS and 26 age- and sex-matched healthy controls. Memory performance was correlated with volumetric measures of the whole brain, hippocampus, amygdala, and thalamus. Brain volumes were normalized for age and sex using magnetic resonance imaging (MRI) data from the National Institutes of Health MRI Study of Normal Brain development. With the exception of story recall, performance on memory tests was similar to that of the control group. Relative to controls, patient with MS showed reduced volume in the whole brain (p < .001), amygdala (p < .005), and thalamus (p < .001), but not the hippocampus. In the patient group, word-list learning correlated with whole brain volume (r = .53) and hippocampal volume (r = .43), whereas visual recognition memory correlated with thalamic volume (r = .48). Findings are consistent with the well-established role of the hippocampus in learning and consolidation and also highlight the importance of diffuse brain pathology on memory function.

Assessment and rehabilitation of cognitive impairment in multiple sclerosis

Patients with multiple sclerosis (MS) have a substantial risk of cognitive dysfunction, even in the earliest stages of the disease, where there is minimum physical disability. Despite the high prevalence rates and the significant impact of cognitive dysfunction on quality of life in this population, cognitive functions are not routinely assessed due to the high cost and time consumption. This article provides an overview of the current state of knowledge related to cognition in MS and on the optimal approach to neuropsychological assessment of this population. It then focuses on the pharmacological and other treatment options available for MS patients with, or at risk for developing, cognitive impairment. The available immune-modulating agents may reduce the development of new lesions and therefore prevent or minimize the progression of cognitive decline. However, there is currently insufficient evidence concerning the efficiency of symptomatic treatment in MS. There is also currently no optimal non-pharmacological treatment strategy for cognitive decline in MS, as the studies published to date report heterogeneous results. Nevertheless, non-pharmacological treatments such as cognitive rehabilitation may benefit some MS patients. As cognition is increasingly recognized as a major feature of MS, its assessment and rehabilitation will become a greater priority.

The Audio Recorded Cognitive Screen (ARCS) in patients with multiple sclerosis: a practical tool for multiple sclerosis clinics

Background: Cognitive impairment is a common complication of multiple sclerosis, even in early stage disease, with significant impacts on life quality and social interaction. However, its detection is highly test-dependent.

Objective: To validate a recently described screening tool, the ARCS, for detecting cognitive impairment in a multiple sclerosis population.

Methods: The ARCS administers tests of executive function, memory, visual spatial construction and language via an audio device to unsupervised patients who write their responses for later scoring. Some 127 patients with a wide variety of disease course and severity were assessed by ARCS, of whom 87 also completed the Paced Auditory Serial Addition Test (PASAT) and 45 underwent formal (‘gold standard’) neuropsychological testing.

Results: Compared with PASAT, we found that the ARCS showed better sensitivity (86% versus 68%) at equivalent specificity (71%) for detection of impairment in any cognitive domain, and superiority in the detection of memory and executive impairments. Acceptance and completion rates for the ARCS were as good or better than for the PASAT.

Conclusions: ARCS is sensitive, well-tolerated, easy to administer and facilitates comprehensive cognitive assessment in less than 5 min of clinician time. It has several advantages over the PASAT for detecting cognitive impairment in patients with multiple sclerosis.

Early treatment of multiple sclerosis: a Latin American experts meeting

Patients with clinically isolated syndrome (CIS) by definition do not have multiple sclerosis (MS) but are at risk of developing it. While studies show earlier immunomodulating drug use is effective, treatment must consider likely patient prognosis. In this paper we review current diagnosis, prognosis, and treatment literature for patients with CIS within Latin American clinical settings. Latin American MS experts, convened by ACINDES (The Civil Association for Research and Development in Health), reviewed current CIS (and early MS) literature and drew consensus conclusions. Three subgroups addressed separate questionnaires on CIS issues: prognosis, diagnosis, and treatment. MRI can contribute to predicting MS risk in patients with CIS; in Latin America, investigation of haplotype presence associated with CIS would be appropriate. McDonald's criteria and subsequent revisions enable earlier, more accurate MS diagnosis. Type A evidence exists supporting all leading immunomodulating MS drugs for effective treatment of CIS with a high risk of conversion to MS. In conclusion, patients with CIS are usually young, with often-limited symptomatic manifestations, and must be adequately prepared to receive preventive treatment. This consensus review should contribute to the dialogue between physicians and patients.

Cognitive impairment in multiple sclerosis

Multiple sclerosis (MS) is a progressive disease of the CNS that is characterised by widespread lesions in the brain and spinal cord. MS results in motor, cognitive, and neuropsychiatric symptoms, all of which can occur independently of one another. The common cognitive symptoms include deficits in complex attention, efficiency of information processing, executive functioning, processing speed, and long-term memory. These deficits detrimentally affect many aspects of daily life, such as the ability to run a household, participate fully in society, and maintain employment--factors that can all affect the overall quality of life of the patient. The increased use of neuroimaging techniques in patients with MS has advanced our understanding of structural and functional changes in the brain that are characteristic of this disease, although much remains to be learned. Moreover, examination of efforts to treat the cognitive deficits in MS is still in the early stages.

Cognitive impairments in relapsing-remitting multiple sclerosis: a meta-analysis

There is debate in the literature regarding the magnitude, nature, and influence of cognitive impairment in individuals with relapsing-remitting multiple sclerosis (RRMS). Therefore, we conducted a meta-analysis that quantified the overall magnitude of cognitive impairment in individuals with RRMS and identified the domains of cognition and clinical/demographic variables that were moderators of the overall effect. We included 57 studies with 3891 participants that yielded a total of 755 effect sizes. Overall, there was a moderate decline in cognitive functioning in individuals with RRMS compared with healthy controls. Larger effects were observed in cognitive domains of motor functioning, mood status and memory and learning. Regarding demographic and clinical variables, age and gender were moderators of cognitive impairment in all cognitive domains, whereas neurological disability and disease duration primarily moderated performance on tasks assessing memory and learning.

Cognitive impairment in multiple sclerosis

PURPOSE OF REVIEW

For a long time, cognitive impairment in multiple sclerosis patients has been considered less important than, for instance, physical disability. This is no longer true because of the crucial role that cognitive deficits play in the good day-to-day adjustment of patients. This review highlights recent progress made in this area. A special focus lies on studies investigating the neural correlates of cognitive impairment in multiple sclerosis patients as detectable by conventional, quantitative and functional magnetic resonance imaging.

RECENT FINDINGS

Measures of information-processing speed appear to be the most robust and sensitive markers of cognitive impairment in multiple sclerosis patients. Recent studies demonstrate that single, predominantly speed-related cognitive tests may be superior to extensive and time-consuming test batteries in screening overall cognitive decline. Quantitative magnetic-resonance-imaging findings suggest the extent of subtle tissue damage in normal-appearing white and grey matter to correlate best with the severity of cognitive impairment in multiple sclerosis patients.

SUMMARY

From neuropsychological test data, and findings from magnetic resonance imaging and functional magnetic resonance imaging it is evident that cognitive impairment in multiple sclerosis is not just the result of tissue destruction, but rather a balance between tissue destruction, tissue repair, and adaptive functional reorganization.

Early cognitive impairment in patients with clinically isolated syndrome suggestive of multiple sclerosis

Cognitive impairment in patients with multiple sclerosis (MS) is a common occurrence and is generally fairly circumscribed. The prevalence of the cognitive deficits usually encountered could vary with the clinical course of the disease. To investigate whether the presence of cognitive impairment may occur in the very early stage of MS, we assessed the cognitive status of a group of 40 patients presenting with a recently diagnosed clinically isolated syndrome suggestive of MS (CISSMS), in comparison with 30 age-, sex-, and educational level-matched healthy control subjects. An extensive battery of neuropsychological tests was used to explore verbal and non-verbal memory, attention, concentration, speed of information processing, language and abstract reasoning. Patients with CISSMS had a significant, frequent (57%), and circumscribed cognitive impairment, focused on memory, speed of information processing, attention and executive functions.

Spiral drawing performance as an indicator of fine motor function in people with multiple sclerosis

This study investigated spiral drawing performance as an indicator of fine motor function, as well as to gain insight into adaptive movement strategies used by people with multiple sclerosis (MS). Seven people with MS, nine younger controls (mean age of 20) and eight older controls (mean age of 40) drew spirals on a graphics tablet at a comfortable speed and size. Spirography (i.e., a subjective visual assessment of the static trace) revealed indications of reduced control of the pen for people with MS. Analysis of the movements showed that people with MS tended to draw the spirals slower and with less pen pressure than controls. All groups increased their speed and pressure along with spiral size, but this increase was much steeper for the controls. MS participants drew spirals with more variability around an ideal trajectory, highlighting fine motor control degradation. MS patients tended to use a smaller scaling ratio, resulting in smaller spirals for a given number of revolutions. The younger and older control groups drew the spirals in a similar manner, and age was not a significant factor in any of the analyses. It is argued that the relatively lower pressure used, and slower, smaller movements (particularly during the more difficult outer sections of the spiral) are in part an adaptive strategy used to reduce movement variability. These results demonstrate the utility of the analysis of spiral movements as an objective technique for assessing motor control degradation, which can compliment the subjective rating based on the static pen trace. As such, it can provide further insight into the biomechanical strategies used when performing fine movements.