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Balloff C, Janßen LK, Hartmann CJ, Meuth SG, Schnitzler A, Penner IK, Albrecht P. Predictive value of synaptic plasticity for functional decline in patients with multiple sclerosis. Front Neurol 2024; 15:1410673. [PMID: 38974686 PMCID: PMC11224454 DOI: 10.3389/fneur.2024.1410673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Accepted: 06/10/2024] [Indexed: 07/09/2024] Open
Abstract
Background Previous research suggested that quadripulse (QPS)-induced synaptic plasticity is associated with both cognitive and motor function in patients with multiple sclerosis (MS) and does not appear to be reduced compared to healthy controls (HCs). Objective This study aimed to explore the relationship between the degree of QPS-induced plasticity and clinically significant decline in motor and cognitive functions over time. We hypothesized that MS patients experiencing functional decline would exhibit lower levels of baseline plasticity compared to those without decline. Methods QPS-induced plasticity was evaluated in 80 MS patients (56 with relapsing-remitting MS and 24 with progressive MS), and 69 age-, sex-, and education-matched HCs. Cognitive and motor functions, as well as overall disability status were evaluated annually over a median follow-up period of 2 years. Clinically meaningful change thresholds were predefined for each outcome measure. Linear mixed-effects models, Cox proportional hazard models, logistic regression, and receiver-operating characteristic analysis were applied to analyse the relationship between baseline plasticity and clinical progression in the symbol digit modalities test, brief visuospatial memory test revised (BVMT-R), nine-hole peg test (NHPT), timed 25-foot walk test, and expanded disability status scale. Results Overall, the patient cohort showed no clinically relevant change in any functional outcome over time. Variability in performance was observed across time points in both patients and HCs. MS patients who experienced clinically relevant decline in manual dexterity and/or visuospatial learning and memory had significantly lower levels of synaptic plasticity at baseline compared to those without such decline (NHPT: β = -0.25, p = 0.02; BVMT-R: β = -0.50, p = 0.005). Receiver-operating characteristic analysis underscored the predictive utility of baseline synaptic plasticity in discerning between patients experiencing functional decline and those maintaining stability only for visuospatial learning and memory (area under the curve = 0.85). Conclusion Our study suggests that QPS-induced plasticity could be linked to clinically relevant functional decline in patients with MS. However, to solidify these findings, longer follow-up periods are warranted, especially in cohorts with higher prevalences of functional decline. Additionally, the variability in cognitive performance in both patients with MS and HCs underscores the importance of conducting further research on reliable change based on neuropsychological tests.
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Affiliation(s)
- Carolin Balloff
- Department of Neurology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University, Düsseldorf, Germany
- Department of Neurology, Kliniken Maria Hilf GmbH, Mönchengladbach, Germany
| | - Lisa Kathleen Janßen
- Department of Neurology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University, Düsseldorf, Germany
| | - Christian Johannes Hartmann
- Department of Neurology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University, Düsseldorf, Germany
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University, Düsseldorf, Germany
| | - Sven Günther Meuth
- Department of Neurology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University, Düsseldorf, Germany
| | - Alfons Schnitzler
- Department of Neurology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University, Düsseldorf, Germany
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University, Düsseldorf, Germany
| | - Iris-Katharina Penner
- Department of Neurology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University, Düsseldorf, Germany
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Philipp Albrecht
- Department of Neurology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University, Düsseldorf, Germany
- Department of Neurology, Kliniken Maria Hilf GmbH, Mönchengladbach, Germany
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Gosetti di Sturmeck T, Malimpensa L, Ferrazzano G, Belvisi D, Leodori G, Lembo F, Brandi R, Pascale E, Cattaneo A, Salvetti M, Conte A, D’Onofrio M, Arisi I. Exploring miRNAs' Based Modeling Approach for Predicting PIRA in Multiple Sclerosis: A Comprehensive Analysis. Int J Mol Sci 2024; 25:6342. [PMID: 38928049 PMCID: PMC11203572 DOI: 10.3390/ijms25126342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Revised: 05/31/2024] [Accepted: 06/05/2024] [Indexed: 06/28/2024] Open
Abstract
The current hypothesis on the pathophysiology of multiple sclerosis (MS) suggests the involvement of both inflammatory and neurodegenerative mechanisms. Disease Modifying Therapies (DMTs) effectively decrease relapse rates, thus reducing relapse-associated disability in people with MS. In some patients, disability progression, however, is not solely linked to new lesions and clinical relapses but can manifest independently. Progression Independent of Relapse Activity (PIRA) significantly contributes to long-term disability, stressing the urge to unveil biomarkers to forecast disease progression. Twenty-five adult patients with relapsing-remitting multiple sclerosis (RRMS) were enrolled in a cohort study, according to the latest McDonald criteria, and tested before and after high-efficacy Disease Modifying Therapies (DMTs) (6-24 months). Through Agilent microarrays, we analyzed miRNA profiles from peripheral blood mononuclear cells. Multivariate logistic and linear models with interactions were generated. Robustness was assessed by randomization tests in R. A subset of miRNAs, correlated with PIRA, and the Expanded Disability Status Scale (EDSS), was selected. To refine the patient stratification connected to the disease trajectory, we computed a robust logistic classification model derived from baseline miRNA expression to predict PIRA status (AUC = 0.971). We built an optimal multilinear model by selecting four other miRNA predictors to describe EDSS changes compared to baseline. Multivariate modeling offers a promising avenue to uncover potential biomarkers essential for accurate prediction of disability progression in early MS stages. These models can provide valuable insights into developing personalized and effective treatment strategies.
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Affiliation(s)
- Tommaso Gosetti di Sturmeck
- European Brain Research Institute (EBRI) Rita Levi-Montalcini, 00161 Rome, Italy; (T.G.d.S.); (R.B.); (A.C.)
| | - Leonardo Malimpensa
- IRCCS Istituto Neurologico Mediterraneo Neuromed, 86077 Pozzilli, Italy; (L.M.); (D.B.); (G.L.); (M.S.); (A.C.)
| | - Gina Ferrazzano
- Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy; (G.F.); (F.L.)
| | - Daniele Belvisi
- IRCCS Istituto Neurologico Mediterraneo Neuromed, 86077 Pozzilli, Italy; (L.M.); (D.B.); (G.L.); (M.S.); (A.C.)
- Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy; (G.F.); (F.L.)
| | - Giorgio Leodori
- IRCCS Istituto Neurologico Mediterraneo Neuromed, 86077 Pozzilli, Italy; (L.M.); (D.B.); (G.L.); (M.S.); (A.C.)
- Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy; (G.F.); (F.L.)
| | - Flaminia Lembo
- Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy; (G.F.); (F.L.)
| | - Rossella Brandi
- European Brain Research Institute (EBRI) Rita Levi-Montalcini, 00161 Rome, Italy; (T.G.d.S.); (R.B.); (A.C.)
| | - Esterina Pascale
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, 04100 Latina, Italy;
| | - Antonino Cattaneo
- European Brain Research Institute (EBRI) Rita Levi-Montalcini, 00161 Rome, Italy; (T.G.d.S.); (R.B.); (A.C.)
- Bio@SNS Laboratory of Biology, Scuola Normale Superiore (SNS), 56126 Pisa, Italy
| | - Marco Salvetti
- IRCCS Istituto Neurologico Mediterraneo Neuromed, 86077 Pozzilli, Italy; (L.M.); (D.B.); (G.L.); (M.S.); (A.C.)
- Centre for Experimental Neurological Therapies (CENTERS), Department of Neurosciences, Mental Health and Sensory Organs, Sapienza University of Rome, 00189 Rome, Italy
| | - Antonella Conte
- IRCCS Istituto Neurologico Mediterraneo Neuromed, 86077 Pozzilli, Italy; (L.M.); (D.B.); (G.L.); (M.S.); (A.C.)
- Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy; (G.F.); (F.L.)
| | - Mara D’Onofrio
- European Brain Research Institute (EBRI) Rita Levi-Montalcini, 00161 Rome, Italy; (T.G.d.S.); (R.B.); (A.C.)
| | - Ivan Arisi
- European Brain Research Institute (EBRI) Rita Levi-Montalcini, 00161 Rome, Italy; (T.G.d.S.); (R.B.); (A.C.)
- Institute of Translational Pharmacology, National Research Council, 00133 Rome, Italy
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Wills O, Probst Y. Towards new perspectives: A scoping review and meta-synthesis to redefine brain health for multiple sclerosis. Eur J Neurol 2024; 31:e16210. [PMID: 38226556 PMCID: PMC11235954 DOI: 10.1111/ene.16210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 12/03/2023] [Accepted: 12/28/2023] [Indexed: 01/17/2024]
Abstract
BACKGROUND AND PURPOSE Research promoting the health of the brain has increased exponentially over the last decade. The importance of 'brain health' for multiple sclerosis (MS), as one example, is a high priority. However, as research into the concept increases, so does varied use of the term. METHODS A scoping review, guided by the methodological framework of the Joanna Briggs Institute, was conducted to collate the evidence relating to brain health for MS. A comprehensive literature search incorporated six search strategies to retrieve both scientific and grey literature sources. All evidence sources were qualitatively charted and synthesized (meta-synthesis) according to their definition of brain health used, outcome measures and brain-healthy lifestyle elements. RESULTS Seventy evidence sources (34 peer reviewed, 36 grey literature) were eligible for inclusion. Of these, just over half (n = 40, 57%) provided a definition of brain health. The most common definition alluded to the biomedical model of neurological reserve (n = 22, 55%), a self-remodelling theory described to retain optimal brain function. Twenty-nine outcome measures of brain health were identified, the most frequent being magnetic resonance imaging metrics (n = 25, 83%). Physical activity was the most prevalent brain-healthy lifestyle element (n = 44), followed by avoidance of smoking (n = 26) and diet (n = 24). CONCLUSIONS Brain health should be considered a primary target for optimal disease and lifestyle management across the MS disease course. A working definition reflecting a shift from a medical lens towards broader biopsychosocial contexts that may influence brain health for people living with MS is proposed.
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Affiliation(s)
- Olivia Wills
- School of Medical, Indigenous and Health SciencesUniversity of WollongongWollongongNew South WalesAustralia
| | - Yasmine Probst
- School of Medical, Indigenous and Health SciencesUniversity of WollongongWollongongNew South WalesAustralia
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Wei W, Wang K, Shi J, Li Z. Instruments to Assess Cognitive Reserve Among Older Adults: a Systematic Review of Measurement Properties. Neuropsychol Rev 2024; 34:511-529. [PMID: 37115436 DOI: 10.1007/s11065-023-09594-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 03/27/2023] [Indexed: 04/29/2023]
Abstract
Cognitive reserve explains the differences in the susceptibility to cognitive impairment related to brain aging, pathology, or insult. Given that cognitive reserve has important implications for the cognitive health of typically and pathologically aging older adults, research needs to identify valid and reliable instruments for measuring cognitive reserve. However, the measurement properties of current cognitive reserve instruments used in older adults have not been evaluated according to the most up-to-date COnsensus-based Standards for the selection of health status Measurement INstruments (COSMIN). This systematic review aimed to critically appraise, compare, and summarize the quality of the measurement properties of all existing cognitive reserve instruments for older adults. A systematic literature search was performed to identify relevant studies published up to December 2021, which was conducted by three of four researchers using 13 electronic databases and snowballing method. The COSMIN was used to assess the methodological quality of the studies and the quality of measurement properties. Out of the 11,338 retrieved studies, only seven studies that concerned five instruments were eventually included. The methodological quality of one-fourth of the included studies was doubtful and three-seventh was very good, while only four measurement properties from two instruments were supported by high-quality evidence. Overall, current studies and evidence for selecting cognitive reserve instruments suitable for older adults were insufficient. All included instruments have the potential to be recommended, while none of the identified cognitive reserve instruments for older adults appears to be generally superior to the others. Therefore, further studies are recommended to validate the measurement properties of existing cognitive reserve instruments for older adults, especially the content validity as guided by COSMIN.Systematic Review Registration numbers: CRD42022309399 (PROSPERO).
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Affiliation(s)
- Wanrui Wei
- School of Nursing, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 33 Ba Da Chu Road, Shijingshan District, 100144, Beijing, China
| | - Kairong Wang
- School of Nursing, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 33 Ba Da Chu Road, Shijingshan District, 100144, Beijing, China
| | - Jiyuan Shi
- School of Nursing, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 33 Ba Da Chu Road, Shijingshan District, 100144, Beijing, China
| | - Zheng Li
- School of Nursing, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 33 Ba Da Chu Road, Shijingshan District, 100144, Beijing, China.
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Meira T, Coelho A, Onat S, Ruano L, Cerqueira JJ. One-year regional brain volume changes as potential predictors of cognitive function in multiple sclerosis: a pilot study. Ir J Med Sci 2024; 193:957-965. [PMID: 37773245 PMCID: PMC10961282 DOI: 10.1007/s11845-023-03528-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 09/12/2023] [Indexed: 10/01/2023]
Abstract
BACKGROUND The most reliable magnetic resonance imaging (MRI) marker of cognitive dysfunction in multiple sclerosis (MS) is brain atrophy. However, 1-year volumetric changes prior to cognitive assessment were never studied as potential predictors of cognition, which we aim to assess with this pilot work. METHODS Twenty-two MS patients were submitted to a baseline measure of 83 regional brain volumes with MRI and re-evaluated 1 year later; they were also tested with the Brief International Cognitive Assessment for MS (BICAMS): sustained attention and processing speed were examined with the Symbol Digit Modalities Test (SDMT), verbal and visuo-spatial learning and memory with the learning trials from the California Verbal Learning Test-II (CVLT) and the Brief Visuo-spatial Memory Test-revised (BVMT), respectively. Controlling for age, sex, and years of education, a multivariate linear regression model was created for each cognitive score at 1-year follow-up in a backward elimination manner, considering cross-sectional regional volumes and 1-year volume changes as potential predictors. RESULTS Decreases in the volumes of the left amygdala and the right lateral orbitofrontal cortex in the year prior to assessment were identified as possible predictors of worse performance in verbal memory (P = 0.009) and visuo-spatial memory (P = 0.001), respectively, independently of cross-sectional brain regional volumes at time of testing. CONCLUSION Our work reveals novel 1-year regional brain volume changes as potential predictors of cognitive deficits in MS. This suggests a possible role of these regions in such deficits and might contribute to uncover cognitively deteriorating patients, whose detection is still unsatisfying in clinical practice.
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Affiliation(s)
- Torcato Meira
- Life and Health Sciences Research Institute (ICVS), School of Medicine, Campus de Gualtar, University of Minho, 4710-057, Braga, Portugal
- Neuroradiology Department, Hospital de Braga, Rua da Comunidades Lusíadas 133, Braga, Portugal
| | - Ana Coelho
- Life and Health Sciences Research Institute (ICVS), School of Medicine, Campus de Gualtar, University of Minho, 4710-057, Braga, Portugal
| | - Seyda Onat
- Life and Health Sciences Research Institute (ICVS), School of Medicine, Campus de Gualtar, University of Minho, 4710-057, Braga, Portugal
| | - Luís Ruano
- Neurology Department, Centro Hospitalar de Entre Douro e Vouga, Rua Dr. Cândido Pinho 5, 4520-211, Santa Maria da Feira, Portugal
- EPIUnit, Institute of Public Health, University of Porto, Rua das Taipas 135, 4050-600, Porto, Portugal
| | - João José Cerqueira
- Life and Health Sciences Research Institute (ICVS), School of Medicine, Campus de Gualtar, University of Minho, 4710-057, Braga, Portugal.
- Neurology Department, Hospital de Braga, Rua da Comunidades Lusíadas 133, Braga, Portugal.
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Ekdahl N, Möller MC, Deboussard CN, Stålnacke BM, Lannsjö M, Nordin LE. Investigating cognitive reserve, symptom resolution and brain connectivity in mild traumatic brain injury. BMC Neurol 2023; 23:450. [PMID: 38124076 PMCID: PMC10731820 DOI: 10.1186/s12883-023-03509-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 12/13/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND A proportion of patients with mild traumatic brain injury (mTBI) suffer long-term consequences, and the reasons behind this are still poorly understood. One factor that may affect outcomes is cognitive reserve, which is the brain's ability to maintain cognitive function despite injury. It is often assessed through educational level or premorbid IQ tests. This study aimed to explore whether there were differences in post-concussion symptoms and symptom resolution between patients with mTBI and minor orthopedic injuries one week and three months after injury. Additional aims were to explore the relationship between cognitive reserve and outcome, as well as functional connectivity according to resting state functional magnetic resonance imaging (rs-fMRI). METHOD Fifteen patients with mTBI and 15 controls with minor orthopedic injuries were recruited from the emergency department. Assessments, including Rivermead Post-Concussion Questionnaire (RPQ), neuropsychological testing, and rs-fMRI scans, were conducted on average 7 days (SD = 2) and 122 days (SD = 51) after injury. RESULTS At the first time point, significantly higher rates of post-concussion symptoms (U = 40.0, p = 0.003), state fatigue (U = 56.5, p = 0.014), and fatigability (U = 58.5, p = 0.025) were observed among the mTBI group than among the controls. However, after three months, only the difference in post-concussion symptoms remained significant (U = 27.0, p = 0.003). Improvement in post-concussion symptoms was found to be significantly correlated with cognitive reserve, but only in the mTBI group (Spearman's rho = -0.579, p = .038). Differences in the trajectory of recovery were also observed for fatigability between the two groups (U = 36.5, p = 0.015). Moreover, functional connectivity differences in the frontoparietal network were observed between the groups, and for mTBI patients, functional connectivity differences in an executive control network were observed over time. CONCLUSION The findings of this pilot study suggest that mTBI, compared to minor orthopedic trauma, is associated to both functional connectivity changes in the brain and concussion-related symptoms. While there is improvement in these symptoms over time, a small subgroup with lower cognitive reserve appears to experience more persistent and possibly worsening symptoms over time. This, however, needs to be validated in larger studies. TRIAL REGISTRATION NCT05593172. Retrospectively registered.
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Affiliation(s)
- Natascha Ekdahl
- Centre for Research and Development, Uppsala University/ County Council of Gävleborg, Gävle, Sweden.
- Department of Clinical Sciences, Karolinska Institutet, Stockholm, Sweden.
| | - Marika C Möller
- Department of Clinical Sciences, Karolinska Institutet, Stockholm, Sweden
- Department of Rehabilitation Medicine, Danderyd University Hospital, Stockholm, Sweden
| | - Catharina Nygren Deboussard
- Department of Clinical Sciences, Karolinska Institutet, Stockholm, Sweden
- Department of Rehabilitation Medicine, Danderyd University Hospital, Stockholm, Sweden
| | - Britt-Marie Stålnacke
- Department of Community Medicine and Rehabilitation, Rehabilitation Medicine, Umeå University, Umeå, Sweden
| | - Marianne Lannsjö
- Centre for Research and Development, Uppsala University/ County Council of Gävleborg, Gävle, Sweden
- Department of Neuroscience, Rehabilitation Medicine, Uppsala University, Uppsala, Sweden
| | - Love Engström Nordin
- Department of Neurobiology, Care Sciences and Society (NVS), Division of Clinical Geriatrics, Karolinska Institutet, Stockholm, Sweden
- Department of Diagnostic Medical Physics, Karolinska Institutet, Stockholm, Sweden
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7
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Prosperini L, Alcamisi I, Quartuccio ME, Rossi I, Fortuna D, Ruggieri S. Brain and cognitive reserve mitigate balance dysfunction in multiple sclerosis. Neurol Sci 2023; 44:4411-4420. [PMID: 37464205 DOI: 10.1007/s10072-023-06951-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 07/05/2023] [Indexed: 07/20/2023]
Abstract
BACKGROUND Approximately two-thirds of patients with multiple sclerosis (MS) complain different degrees of balance dysfunction, but some of them are able to withstand considerable disease burden without an overt balance impairment. Here, we tested the hypothesis that brain and cognitive reserve lessen the effect of MS-related tissue damage on balance control. METHODS We measured the postural sway of 148 patients and 74 sex- and age-matched healthy controls by force platform under different conditions reflecting diverse neuro-pathological substrates of balance dysfunction: eyes opened (EO), eyes closed (EC), and while performing the Stroop test, i.e., dual-task (DT). Lesion volumes on T2-hyperintense and T1-hypointense sequences, and normalized brain volume provided estimations of MS-related tissue damage in patients with MS. Hierarchical linear regressions explored the protective effect against the MS-related tissue damage of intracranial volume and educational attainment (proxies for brain and cognitive reserve, respectively) on balance. RESULTS Larger intracranial volume and high educational attainment mitigated the detrimental effect of MS-related tissue damage on postural sway under EO (adjusted-R2=0.20 and 0.27, respectively, p<0.01) and DT (adjusted-R2=0.22 and 0.30, respectively, p<0.06) conditions. Neither educational level nor brain size was associated with postural sway under EC condition. CONCLUSION Our findings suggest a protective role of brain and cognitive reserve even on balance, an outcome that relies on both motor control and higher order processing resources. The lack of a protective effect on postural sway under EC condition confirms that this latter outcome is closer associated with spinal cord rather than brain damage.
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Affiliation(s)
- Luca Prosperini
- Department of Neurosciences, S. Camillo-Forlanini Hospital, C.ne Gianicolense 87, 00152, Rome, Italy.
| | - Irene Alcamisi
- Department of Rehabilitation Sciences and Health Professions, Sapienza University, Via Cardarelli s.n.c, 01100, Viterbo, Italy
| | | | - Ilaria Rossi
- Department of Neurosciences, S. Camillo-Forlanini Hospital, C.ne Gianicolense 87, 00152, Rome, Italy
| | - Deborah Fortuna
- Azienda Sanitaria Locale di Rieti, Via del Terminillo 42, 02100, Rieti, Italy
| | - Serena Ruggieri
- Department of Human Neurosciences, Sapienza University, Viale dell'Università 30, 00185, Rome, Italy
- Neuroimmunology Unit, Santa Lucia Foundation, Via del Fosso di Fiorano 64/65, 00143, Rome, Italy
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Müller J, Cagol A, Lorscheider J, Tsagkas C, Benkert P, Yaldizli Ö, Kuhle J, Derfuss T, Sormani MP, Thompson A, Granziera C, Kappos L. Harmonizing Definitions for Progression Independent of Relapse Activity in Multiple Sclerosis: A Systematic Review. JAMA Neurol 2023; 80:1232-1245. [PMID: 37782515 DOI: 10.1001/jamaneurol.2023.3331] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
Importance Emerging evidence suggests that progression independent of relapse activity (PIRA) is a substantial contributor to long-term disability accumulation in relapsing-remitting multiple sclerosis (RRMS). To date, there is no uniform agreed-upon definition of PIRA, limiting the comparability of published studies. Objective To summarize the current evidence about PIRA based on a systematic review, to discuss the various terminologies used in the context of PIRA, and to propose a harmonized definition for PIRA for use in clinical practice and future trials. Evidence Review A literature search was conducted using the search terms multiple sclerosis, PIRA, progression independent of relapse activity, silent progression, and progression unrelated to relapses in PubMed, Embase, Cochrane, and Web of Science, published between January 1990 and December 2022. Findings Of 119 identified single records, 48 eligible studies were analyzed. PIRA was reported to occur in roughly 5% of all patients with RRMS per annum, causing at least 50% of all disability accrual events in typical RRMS. The proportion of PIRA vs relapse-associated worsening increased with age, longer disease duration, and, despite lower absolute event numbers, potent suppression of relapses by highly effective disease-modifying therapy. However, different studies used various definitions of PIRA, rendering the comparability of studies difficult. Conclusion and Relevance PIRA is the most frequent manifestation of disability accumulation across the full spectrum of traditional MS phenotypes, including clinically isolated syndrome and early RRMS. The harmonized definition suggested here may improve the comparability of results in current and future cohorts and data sets.
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Affiliation(s)
- Jannis Müller
- Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland
- Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Faculty of Medicine, University Hospital Basel and University of Basel, Basel, Switzerland
- Neurologic Clinic and Policlinic, Department of Neurology, University Hospital Basel, Basel, Switzerland
| | - Alessandro Cagol
- Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland
- Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Faculty of Medicine, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Johannes Lorscheider
- Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland
- Neurologic Clinic and Policlinic, Department of Neurology, University Hospital Basel, Basel, Switzerland
| | - Charidimos Tsagkas
- Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland
- Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Faculty of Medicine, University Hospital Basel and University of Basel, Basel, Switzerland
- Neurologic Clinic and Policlinic, Department of Neurology, University Hospital Basel, Basel, Switzerland
| | - Pascal Benkert
- Department of Clinical Research, Clinical Trial Unit, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Özgür Yaldizli
- Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland
- Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Faculty of Medicine, University Hospital Basel and University of Basel, Basel, Switzerland
- Neurologic Clinic and Policlinic, Department of Neurology, University Hospital Basel, Basel, Switzerland
| | - Jens Kuhle
- Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland
- Neurologic Clinic and Policlinic, Department of Neurology, University Hospital Basel, Basel, Switzerland
| | - Tobias Derfuss
- Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland
- Neurologic Clinic and Policlinic, Department of Neurology, University Hospital Basel, Basel, Switzerland
| | - Maria Pia Sormani
- Department of Health Sciences, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Alan Thompson
- Queen Square MS Centre, UCL Institute of Neurology, London, United Kingdom
- NIHR University College London Hospitals Biomedical Research Centre, London, United Kingdom
| | - Cristina Granziera
- Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland
- Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Faculty of Medicine, University Hospital Basel and University of Basel, Basel, Switzerland
- Neurologic Clinic and Policlinic, Department of Neurology, University Hospital Basel, Basel, Switzerland
| | - Ludwig Kappos
- Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland
- Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Faculty of Medicine, University Hospital Basel and University of Basel, Basel, Switzerland
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9
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Morrow SA, Baldwin C, Alkabie S. Importance of Identifying Cognitive Impairment in Multiple Sclerosis. Can J Neurol Sci 2023; 50:813-819. [PMID: 36503630 DOI: 10.1017/cjn.2022.334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
This article aims to highlight the impact of cognitive impairment on outcomes and quality of life for people with multiple sclerosis (MS) and to review current evidence for the efficacy of disease-modifying therapies (DMTs) and other interventions. In addition, we provide clinical practice insights regarding screening and management of cognitive impairment in people with MS. Evidence suggests that cognitive deterioration often accompanies magnetic resonance imaging changes. Neocortical volume and deep grey matter atrophy correlate with cognitive impairment. Similarly, cognitive decline is predictive of a higher lesion burden. Cognitive impairment is an important clinical measure of disability and negatively impacts quality of life. Phase 3 studies suggest that DMTs such as natalizumab, ozanimod and fingolimod may provide long-lasting, clinically meaningful effects on cognition in people with MS. Further data are needed to support the use of adjunct cognitive behavioural and exercise interventions for people with MS who have cognitive impairment. More data are needed to define appropriate management strategies for cognitive impairment in people with MS. Baseline and periodic screening for cognitive impairment and inclusion of cognitive impairment as a clinical trial endpoint will help to inform efforts to manage this important aspect of MS.
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Affiliation(s)
- Sarah A Morrow
- London Multiple Sclerosis Clinic, London Health Sciences Centre, University Hospital, Department of Clinical Neurological Sciences, Western University, London, ON, Canada
| | - Chantal Baldwin
- London Multiple Sclerosis Clinic, London Health Sciences Centre, University Hospital, Department of Clinical Neurological Sciences, Western University, London, ON, Canada
| | - Samir Alkabie
- London Multiple Sclerosis Clinic, London Health Sciences Centre, University Hospital, Department of Clinical Neurological Sciences, Western University, London, ON, Canada
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10
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Grant JG, Rapport LJ, Darling R, Waldron-Perrine B, Lumley MA, Whitfield KE, Bernitsas E. Cognitive enrichment and education quality moderate cognitive dysfunction in black and white adults with multiple sclerosis. Mult Scler Relat Disord 2023; 78:104916. [PMID: 37552903 DOI: 10.1016/j.msard.2023.104916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 05/30/2023] [Accepted: 07/23/2023] [Indexed: 08/10/2023]
Abstract
OBJECTIVE To examine the extent to which three sociobehavioral proxies of cognitive reserve-years of education, education quality, and cognitive enrichment-differ in their prediction of cognitive performance among Black and White people with MS (PwMS). METHODS 82 PwMS (Black n = 41, White n = 41) underwent a neurological examination and a neuropsychological evaluation that included tests of word recognition (Wechsler Test of Adult Reading) as well as measures of verbal memory, visuospatial memory, and processing speed (the Brief International Cognitive Assessment for MS; BICAMS). Participants rated their lifetime engagement in various cognitively-enriching activities (Cognitive Reserve Scale). RESULTS For the full sample, education quality and cognitive enrichment were more strongly associated with cognitive performance than were years of education. Cognitive enrichment was not associated with cognitive performance among participants with high education quality. In contrast, among participants with low education quality, cognitive enrichment was strongly associated with cognitive performance, suggesting that high engagement in cognitively-enriching activities provided similar protection to high education quality. Furthermore, among Black participants, cognitive enrichment and educational quality moderated the relationship between disability level and cognitive performance. In contrast, among White participants, cognitive enrichment did not provide additional protection beyond the buffering effect of education quality. CONCLUSIONS PwMS can successfully build reserve through multiple routes, including formal education or informal cognitive enrichment. Treatment for MS should incorporate cognitively-enriching activities to build resilience against cognitive decline, particularly for members of marginalized racial/ethnic groups, who are at greatest risk for poor health outcomes, and for whom years of education may not best reflect education quality.
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Affiliation(s)
- Jeremy G Grant
- Department of Psychology, Wayne State University, 5057 Woodward Ave., Detroit, MI 48202, USA.
| | - Lisa J Rapport
- Department of Psychology, Wayne State University, 5057 Woodward Ave., Detroit, MI 48202, USA
| | - Rachel Darling
- Department of Neurology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Brigid Waldron-Perrine
- Department of Physical Medicine & Rehabilitation, Wayne State University School of Medicine, Detroit, MI, USA
| | - Mark A Lumley
- Department of Psychology, Wayne State University, 5057 Woodward Ave., Detroit, MI 48202, USA
| | - Keith E Whitfield
- Department of Psychology and Department of Brain Health, University of Nevada, Las Vegas, NV, USA
| | - Evanthia Bernitsas
- Department of Neurology, Wayne State University School of Medicine, Detroit, MI, USA
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11
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Tranfa M, Iuzzolino VV, Perrella P, Carotenuto A, Pontillo G, Moccia M, Cocozza S, Elefante A, Lanzillo R, Brunetti A, Brescia Morra V, Petracca M. Exploring the relation between reserve and fatigue in multiple sclerosis. Mult Scler Relat Disord 2023; 76:104842. [PMID: 37392716 DOI: 10.1016/j.msard.2023.104842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 06/07/2023] [Accepted: 06/19/2023] [Indexed: 07/03/2023]
Abstract
INTRODUCTION Intellectual enrichment and brain reserve modulate the expression of cognitive and motor disability in multiple sclerosis (MS). Their association with fatigue, one of the most debilitating and common symptoms of MS, has never been explored. MATERIALS AND METHODS Forty-eight MS patients underwent clinical and MRI examination at baseline and after 1 year. Physical and cognitive MS-related fatigue were evaluated via Modified Fatigue Impact subscales (MFIS-P and MFIS-C). Differences in reserve indexes between fatigued and non-fatigued patients were tested. The relationship between clinico-demographic features, global brain structural damage, indexes of reserve (age-adjusted intracranial volume and cognitive reserve index) and fatigue were tested via correlations and hierarchical linear/binary logistic regression, to predict MFIS-P and MFIS-C (at baseline) or new-onset fatigue and meaningful worsening in MFIS (at follow-up). RESULTS At baseline, although a significant difference was identified for cognitive reserve questionnaire between fatigued and non-fatigued patients (18.19 ± 4.76 versus 15.15 ± 3.56, p = 0.015), only depression accounted for significant variance in MFIS-P and MFIS-C (R2=0.248, p = 0.002; R2=0.252, p<0.001). MFIS-T, MFIS-P and MFIS-C changes over time were associated to depression changes over time (r = 0.56, r = 0.55, and r = 0.57, respectively; all p<0.001). Indexes of reserve did not differ between non-fatigued patients and patients developing new-onset fatigue at follow-up. None of the baseline features was able to predict the new-onset fatigue or meaningful worsening in MFIS at follow-up. CONCLUSIONS Among the explored features, only depression was strongly associated to both physical and cognitive fatigue. Intellectual enrichment and brain reserve did not seem to affect fatigue symptoms in MS patients.
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Affiliation(s)
- Mario Tranfa
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Valentina Virginia Iuzzolino
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Naples, Italy
| | - Pierpaolo Perrella
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Antonio Carotenuto
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Naples, Italy
| | - Giuseppe Pontillo
- Department of Advanced Biomedical Sciences and Electrical Engineering and Information Technology, University of Naples "Federico II", Naples, Italy; Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom; Department of Radiology and Nuclear Medicine, VU Medical Centre, Amsterdam, the Netherlands
| | - Marcello Moccia
- Department of Molecular Medicine and Medical Biotechnology, University of Naples "Federico II", Naples, Italy; Multiple Sclerosis Unit, AOU "Federico II", Naples, Italy
| | - Sirio Cocozza
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy.
| | - Andrea Elefante
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Roberta Lanzillo
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Naples, Italy
| | - Arturo Brunetti
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Vincenzo Brescia Morra
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Naples, Italy
| | - Maria Petracca
- Department of Human Neurosciences, University of Rome Sapienza, Rome, Italy
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12
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Zenebe Y, Akele B, W/Selassie M, Necho M. Neurocognitive Impairment and Associated Factors Among People Living with HIV: A Systematic Review and Meta-Analysis of African Studies. Neuropsychiatr Dis Treat 2023; 19:673-687. [PMID: 37012987 PMCID: PMC10066635 DOI: 10.2147/ndt.s377636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 03/23/2023] [Indexed: 04/05/2023] Open
Abstract
Background Neurocognitive impairment (NCI) is one of the most common neurological complications in HIV-positive individuals, particularly in resource-limited countries. Neurocognitive impairments can occur at any stage of HIV infection, although the risk increases as the infection progresses. However, in Africa, there are few studies with highly variable and inconsistent results. Therefore, this study aimed to determine the prevalence and factors associated with NCI among HIV-positive people in Africa. Methods For this systematic review and meta-analysis, we used PubMed/Medline, Scopus, Web of Science, the Cochrane Library, Embase, and PsycINFO to comprehensively search a number of papers. Studies reporting the prevalence of NCI and its factors were included in the estimation of the pooled prevalence. A consistent data extraction format was created in Microsoft Excel to extract the data, which was then imported into STATA 11 statistical software for analysis. The heterogeneity was evaluated using the I2 test, and a random effect meta-analysis model was employed to calculate the pooled prevalence of NCI because the included studies showed significant heterogeneity. Results In all, Africa had a pooled prevalence of NCI of 45.15% (95% CI: 36.86, 53.43). According to the subgroup analysis of this study, West Africa had the lowest frequency, at 42.40% (95% CI: 22.03, 62.77), whereas Central and South Africa had the highest prevalence, at 49.33% (95% CI: 10.72-87.95). Conclusion In Africa, the cumulative prevalence of NCI was high. Being a woman, not having a formal education, those with only an elementary education, being older, having late-stage HIV, and abusing drugs were all often associated with NCI. The average burden of NCI in Africa is high and that would be a significant figure for interventional actions in the area.
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Affiliation(s)
- Yosef Zenebe
- Department of Psychiatry, Wollo University, Dessie, Ethiopia
| | - Baye Akele
- Department of Pharmacy, Wollo University, Dessie, Ethiopia
| | - Mulugeta W/Selassie
- Department of Pediatrics and Child Health Nursing, Wollo University, Dessie, Ethiopia
| | - Mogesie Necho
- Department of Psychiatry, Wollo University, Dessie, Ethiopia
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Bretzner M, Bonkhoff AK, Schirmer MD, Hong S, Dalca A, Donahue K, Giese AK, Etherton MR, Rist PM, Nardin M, Regenhardt RW, Leclerc X, Lopes R, Gautherot M, Wang C, Benavente OR, Cole JW, Donatti A, Griessenauer C, Heitsch L, Holmegaard L, Jood K, Jimenez-Conde J, Kittner SJ, Lemmens R, Levi CR, McArdle PF, McDonough CW, Meschia JF, Phuah CL, Rolfs A, Ropele S, Rosand J, Roquer J, Rundek T, Sacco RL, Schmidt R, Sharma P, Slowik A, Sousa A, Stanne TM, Strbian D, Tatlisumak T, Thijs V, Vagal A, Wasselius J, Woo D, Wu O, Zand R, Worrall BB, Maguire J, Lindgren AG, Jern C, Golland P, Kuchcinski G, Rost NS. Radiomics-Derived Brain Age Predicts Functional Outcome After Acute Ischemic Stroke. Neurology 2023; 100:e822-e833. [PMID: 36443016 PMCID: PMC9984219 DOI: 10.1212/wnl.0000000000201596] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 10/06/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND AND OBJECTIVES While chronological age is one of the most influential determinants of poststroke outcomes, little is known of the impact of neuroimaging-derived biological "brain age." We hypothesized that radiomics analyses of T2-FLAIR images texture would provide brain age estimates and that advanced brain age of patients with stroke will be associated with cardiovascular risk factors and worse functional outcomes. METHODS We extracted radiomics from T2-FLAIR images acquired during acute stroke clinical evaluation. Brain age was determined from brain parenchyma radiomics using an ElasticNet linear regression model. Subsequently, relative brain age (RBA), which expresses brain age in comparison with chronological age-matched peers, was estimated. Finally, we built a linear regression model of RBA using clinical cardiovascular characteristics as inputs and a logistic regression model of favorable functional outcomes taking RBA as input. RESULTS We reviewed 4,163 patients from a large multisite ischemic stroke cohort (mean age = 62.8 years, 42.0% female patients). T2-FLAIR radiomics predicted chronological ages (mean absolute error = 6.9 years, r = 0.81). After adjustment for covariates, RBA was higher and therefore described older-appearing brains in patients with hypertension, diabetes mellitus, a history of smoking, and a history of a prior stroke. In multivariate analyses, age, RBA, NIHSS, and a history of prior stroke were all significantly associated with functional outcome (respective adjusted odds ratios: 0.58, 0.76, 0.48, 0.55; all p-values < 0.001). Moreover, the negative effect of RBA on outcome was especially pronounced in minor strokes. DISCUSSION T2-FLAIR radiomics can be used to predict brain age and derive RBA. Older-appearing brains, characterized by a higher RBA, reflect cardiovascular risk factor accumulation and are linked to worse outcomes after stroke.
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Affiliation(s)
- Martin Bretzner
- From the J. Philip Kistler Stroke Research Center (M.B., A.K.B., M.D.S., S.H., A. Dalca, K.D., A.-K.G., M.R.E., P.M.R., M.N., R.W.R., C.W., N.S.R.), A.A. Martinos Center for Biomedical Imaging (A. Dalca, O.W.), and Henry and Allison McCance Center for Brain Health (J. Rosand), Massachusetts General Hospital, Harvard Medical School, Boston; Lille Neuroscience & Cognition (M.B., X.L., R. Lopes, G.K.), Inserm, CHU Lille, U1172 and Institut Pasteur de Lille (M.G.), CNRS, Inserm, CHU Lille, US 41 - UMS 2014 - PLBS, Lille University, France; Computer Science and Artificial Intelligence Lab (A. Dalca, C.W., P.G.), Massachusetts Institute of Technology, Cambridge; Division of Preventive Medicine (P.M.R.), Department of Medicine, Brigham and Women's Hospital, Boston, MA; Department of Medicine (O.R.B.), Division of Neurology, University of British Columbia, Vancouver, Canada; Department of Neurology (J.W.C., S.J.K.), University of Maryland School of Medicine and Veterans Affairs Maryland Health Care System, Baltimore, MD; School of Medical Sciences (A. Donatti, A. Sousa), University of Campinas (UNICAMP) and the Brazilian Institute of Neuroscience and Neurotechnology (BRAINN), Campinas, São Paulo; Departments of Neurosurgery (C.G.) and Neurology (R.Z.), Geisinger, Danville, PA; Department of Neurosurgery (C.G.), Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria; Division of Emergency Medicine (Laura Heitsch), Washington University School of Medicine, St. Louis; Department of Neurology (Laura Heitsch, C.-L.P.), Washington University School of Medicine & Barnes-Jewish Hospital, St. Louis, MO; Department of Clinical Neuroscience (L. Holmegaard, K.J., T.M.S., T.T.), Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Sweden; Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Neurology (J.J.-C.), Neurovascular Research Group (NEUVAS), IMIM-Hospital del Mar (Institut Hospital del Mar d'Investigacions M`ediques), Universitat Autonoma de Barcelona, Spain; Department of Neurosciences (R. Lemmens), Experimental Neurology and Leuven Research Institute for Neuroscience and Disease (LIND), KU Leuven - University of Leuven, Belgium; Department of Neurology (R. Lemmens), Laboratory of Neurobiology, VIB Vesalius Research Center, University Hospitals Leuven, Belgium; School of Medicine and Public Health (C.R.L.), University of Newcastle, New South Wales; Department of Neurology, John Hunter Hospital, Newcastle, New South Wales, Australia; Division of Endocrinology (P.F.M.), Diabetes and Nutrition, Department of Medicine, University of Maryland School of Medicine, Baltimore; Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics (C.W.M.), University of Florida, Gainesville; Department of Neurology (J.F.M.), Mayo Clinic, Jacksonville, FL; Klinik und Poliklinik für Neurologie (A.R.), Universitätsmedizin Rostock, Germany; Department of Neurology (S.R., R.S.), Clinical Division of Neurogeriatrics, Medical University Graz, Austria; Center for Genomic Medicine (J. Rosand), Massachusetts General Hospital, Boston; Broad Institute (J. Rosand), Cambridge, MA; Department of Neurology and Evelyn F. McKnight Brain Institute (J. Roquer, T.R., R.L.S./M.S.), Miller School of Medicine, University of Miami, FL; Institute of Cardiovascular Research (P.S.), Royal Holloway University of London (ICR2UL), UK St Peter's and Ashford Hospitals, Egham, United Kingdom; Department of Neurology (A. Slowik), Jagiellonian University Medical College, Krakow, Poland; Division of Neurocritical Care & Emergency Neurology (D.S.), Department of Neurology, Helsinki University Central Hospital, Finland; Stroke Division (V.T.), Florey Institute of Neuroscience and Mental Health, Heidelberg; Department of Neurology (V.T.), Austin Health, Heidelberg, Australia; Departments of Radiology (A.V.) and Neurology and Rehabilitation Medicine (D.W.), University of Cincinnati College of Medicine, OH; Department of Clinical Sciences Lund, Radiology (J.W.) and Neurology (A.G.L.), Lund University, Sweden; Department of Radiology, Neuroradiology, Skåne University Hospital, Malmö, Sweden; Departments of Neurology and Public Health Sciences (B.B.W.), University of Virginia, Charlottesville, VA; University of Technology Sydney (J.M.), Australia; Section of Neurology (A.G.L.), Skåne University Hospital, Lund, Sweden; Department of Laboratory Medicine (C.J.), Institute of Biomedicine, the Sahlgrenska Academy, University of Gothenburg, Sweden; and Department of Clinical Genetics and Genomics (C.J.), Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden.
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Schoonheim MM, Broeders TAA, Geurts JJG. The network collapse in multiple sclerosis: An overview of novel concepts to address disease dynamics. Neuroimage Clin 2022; 35:103108. [PMID: 35917719 PMCID: PMC9421449 DOI: 10.1016/j.nicl.2022.103108] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 07/01/2022] [Accepted: 07/10/2022] [Indexed: 11/16/2022]
Abstract
Multiple sclerosis is a neuroinflammatory and neurodegenerative disorder of the central nervous system that can be considered a network disorder. In MS, lesional pathology continuously disconnects structural pathways in the brain, forming a disconnection syndrome. Complex functional network changes then occur that are poorly understood but closely follow clinical status. Studying these structural and functional network changes has been and remains crucial to further decipher complex symptoms like cognitive impairment and physical disability. Recent insights especially implicate the importance of monitoring network hubs in MS, like the thalamus and default-mode network which seem especially hit hard. Such network insights in MS have led to the hypothesis that as the network continues to become disconnected and dysfunctional, exceeding a certain threshold of network efficiency loss leads to a "network collapse". After this collapse, crucial network hubs become rigid and overloaded, and at the same time a faster neurodegeneration and accelerated clinical (and cognitive) progression can be seen. As network neuroscience has evolved, the MS field can now move towards a clearer classification of the network collapse itself and specific milestone events leading up to it. Such an updated network-focused conceptual framework of MS could directly impact clinical decision making as well as the design of network-tailored rehabilitation strategies. This review therefore provides an overview of recent network concepts that have enhanced our understanding of clinical progression in MS, especially focusing on cognition, as well as new concepts that will likely move the field forward in the near future.
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Affiliation(s)
- Menno M Schoonheim
- Department of Anatomy and Neurosciences, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
| | - Tommy A A Broeders
- Department of Anatomy and Neurosciences, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Jeroen J G Geurts
- Department of Anatomy and Neurosciences, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Validation of the Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS) in the Russian Population. J Int Neuropsychol Soc 2022; 28:503-510. [PMID: 34132190 DOI: 10.1017/s1355617721000722] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Cognitive dysfunction is common in multiple sclerosis (MS). The Brief International Cognitive Assessment for MS (BICAMS) battery of tests has been suggested as a measure for the evaluation of the cognitive status of MS patients. This study aims to validate the BICAMS battery in the Russian population of MS patients. METHODS Age- and sex-matched MS patients (n = 98) and healthy individuals (n = 86) were included in the study. Symbol Digit Modalities Test (SDMT), California Verbal Learning Test, 2nd edition (CVLT-II) and the Brief Visuospatial Memory Test - Revised (BVMT-R) were administered to all participants. The battery was readministered 1 month later to 44 MS patients to investigate the test-retest reliability. RESULTS MS patients exhibited a significantly lower performance in testing with BICAMS than the control group in all three neuropsychological tests. Test-retest reliability was good for SDMT and CVLT-II (r = .82 and r = .85, respectively) and adequate for BVMT-R (r = .70). Based on the proposed criterion for impairment as z score below 1.5 SD the mean of the control group, we found that 34/98 (35%) of MS patients were found impaired at least in one cognitive domain. Patients with Expanded Disability Status Scale score ≥3.5 performed significantly worse than controls (SDMT, p < .0001; CVLT-II, p = .03; BVMT-R, p = .0004), while those with ≤3.0 scores did not. CONCLUSION This study demonstrates that the BICAMS battery is a valid instrument to identify cognitive impairment in MS patients and it can be recommended for routine use in the Russian Federation.
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Portaccio E, Bellinvia A, Razzolini L, Pastò L, Goretti B, Niccolai C, Fonderico M, Zaffaroni M, Pippolo L, Moiola L, Falautano M, Celico C, Viterbo R, Patti F, Chisari C, Gallo P, Riccardi A, Borghi M, Bertolotto A, Simone M, Pozzilli C, Bianchi V, Roscio M, Martinelli V, Comi G, Filippi M, Trojano M, Ghezzi A, Amato MP. Long-term Cognitive Outcomes and Socioprofessional Attainment in People With Multiple Sclerosis With Childhood Onset. Neurology 2022; 98:e1626-e1636. [DOI: 10.1212/wnl.0000000000200115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 01/11/2022] [Indexed: 11/15/2022] Open
Abstract
Background and ObjectivesPatients with pediatric-onset multiple sclerosis (MS) can be especially vulnerable to cognitive impairment (CI) due to the onset of MS during a critical period for CNS development and maturation. The objective of this longitudinal study was to assess long-term cognitive functioning and socioprofessional attainment in the Italian pediatric MS cohort, previously assessed at baseline and 2 and 5 years.MethodsThe 48 patients evaluated at the 5-year assessment were screened for inclusion. All participants were assessed with a cognitive test battery exploring 4 different cognitive abilities. Depression, fatigue, and socioprofessional attainment were also assessed. Mean cognitive z scores were calculated for the whole cohort, and their evolution over time was analyzed with an analysis of variance for repeated measurements test. Predictors of cognitive worsening or improvement were assessed with a linear mixed-model analysis.ResultsThirty-three participants were included (mean follow-up 12.8 ± 0.8 years). The global cognitive performance worsened at year 2 and improved at year 5, although the z score remained significantly lower than at baseline (−0.9 ± 1.2 vs −0.3 ± 0.9, p = 0.002). There was no significant variation between years 5 and 12 (−0.7 ± 1.1, p = 0.452). Higher IQ (>90) at baseline (effect 0.3, 95% CI 0.1–0.5, p = 0.017) and lower number of relapses in the 2 years before baseline (effect −0.1, 95% CI −0.1 to 0.1, p = 0.025) predicted better cognitive performances. Eighteen (54.5%) patients failed at least 2 tests compared with healthy controls and were defined as cognitively impaired. The presence of CI predicted worse socioprofessional attainment (β = 4.8, 95% CI 1.4–8.2, p = 0.008).DiscussionThe longitudinal cognitive trajectory in pediatric-onset MS has a heterogeneous course over time, with a decline in the first years followed by a partial recovery over the long term. However, at the last follow-up evaluation, the proportion of impaired patients was more than double compared with baseline, with a negative impact on the individual’s socioprofessional attainment in adulthood. This study underscores how cognitive reserve may partially mitigate the negative effects of brain damage, highlighting the critical importance of intellectual enrichment early during the disease course.
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Maltby VE, Lea RA, Reeves P, Saugbjerg B, Lechner-Scott J. Reduced cognitive function contributes to economic burden of multiple sclerosis. Mult Scler Relat Disord 2022; 60:103707. [DOI: 10.1016/j.msard.2022.103707] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 02/14/2022] [Accepted: 02/19/2022] [Indexed: 11/28/2022]
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Völter C, Götze L, Bajewski M, Dazert S, Thomas JP. Cognition and Cognitive Reserve in Cochlear Implant Recipients. Front Aging Neurosci 2022; 14:838214. [PMID: 35391751 PMCID: PMC8980358 DOI: 10.3389/fnagi.2022.838214] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 01/24/2022] [Indexed: 12/16/2022] Open
Abstract
At present, dementia is a hot topic. Hearing loss is considered to be a modifiable risk factor for cognitive decline. The underlying mechanism remains unclear and might be mediated by socioeconomic and psychosocial factors. Cochlear implantation has been shown not only to restore auditory abilities, but also to decrease mental distress and to improve cognitive functions in people with severe hearing impairment. However, the promising results need to be confirmed. In a prospective single-center study, we tested the neurocognitive abilities of a large group of 71 subjects with bilateral severe hearing impairment with a mean age of 66.03 (SD = 9.15) preoperatively and 6, 12, and 24 months after cochlear implantation using a comprehensive non-auditory computer-based test battery, and we also assessed the cognitive reserve (CR) [Cognitive Reserve Index (CRI)], health-related quality of life (QoL) (Nijmegen Cochlear Implant Questionnaire), and depression (Geriatric Depression Scale-15). Cognitive functions significantly increased after 6 months in attention (p = 0.00004), working memory (operation span task; p = 0.002), and inhibition (p = 0.0002); and after 12 months in recall (p = 0.003) and verbal fluency (p = 0.0048), and remained stable up to 24 months (p ≥ 0.06). The CR positively correlated with cognitive functions pre- and post-operatively (both p < 0.005), but postoperative improvement in cognition was better in subjects with poor CR (p = 0.003). Depression had only a slight influence on one subtest. No correlation was found among cognitive skills, quality of life, and speech perception (each p ≥ 0.05). Cochlear implantation creates an enriched environment stimulating the plasticity of the brain with a global positive impact on neurocognitive functions, especially in subjects with poor preoperative cognitive performance and low cognitive reserve.
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Affiliation(s)
- Christiane Völter
- Department of Otorhinolaryngology, Head and Neck Surgery, Catholic Hospital Bochum, Bochum, Germany
- *Correspondence: Christiane Völter,
| | - Lisa Götze
- Department of Otorhinolaryngology, Head and Neck Surgery, Catholic Hospital Bochum, Bochum, Germany
| | - Marcel Bajewski
- Department of Otorhinolaryngology, Head and Neck Surgery, Catholic Hospital Bochum, Bochum, Germany
| | - Stefan Dazert
- Department of Otorhinolaryngology, Head and Neck Surgery, Catholic Hospital Bochum, Bochum, Germany
| | - Jan Peter Thomas
- Department of Otorhinolaryngology, Head and Neck Surgery, St.-Johannes-Hospital, Dortmund, Germany
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19
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Vonk JMJ, Ghaznawi R, Zwartbol MHT, Stern Y, Geerlings MI. The role of cognitive and brain reserve in memory decline and atrophy rate in mid and late-life: The SMART-MR study. Cortex 2022; 148:204-214. [PMID: 35189525 PMCID: PMC11018269 DOI: 10.1016/j.cortex.2021.11.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 07/25/2021] [Accepted: 11/17/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Investigate associations of cognitive and brain reserve with trajectories of memory decline in mid-life and late-life, and whether the relationship of memory decline with atrophy differs as a function of reserve. METHODS Participants were 989 Dutch middle-aged to older adults from the SMART-MR prospective cohort, followed up to 12 years with up to 3 measurements of memory and brain MRI. Education and Dutch National Adult Reading Test (DART) were used as proxies of cognitive reserve, and intracranial volume (ICV) and baseline brain parenchymal fraction (BPF) for brain reserve. Univariate growth curve models analyzed associations of reserve with memory decline, and multiple-group bivariate growth curve models tested the longitudinal brain-memory relationship as a function of reserve. Models were additionally stratified by mid-life and late-life. RESULTS Higher DART, education, and BPF were related to a slower rate of memory decline, particularly in late-life, but ICV was not. A positive covariance indicated that an individual who undergoes atrophy also undergoes memory decline-this relationship did not differ across cognitive or brain reserve, but was not present in mid-life. Memory declined slower than brain volume, yet rates were more similar in the low DART, education, and BPF groups. DISCUSSION Higher cognitive (DART, education) and brain reserve (BPF) work protectively in longitudinal memory change. ICV is an inappropriate proxy of brain reserve, failing to show any association with memory performance at baseline or over time. Deconstructing relationships of reserve capacities with longitudinal cognitive and brain outcomes may identify focus areas with potential for intervention.
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Affiliation(s)
- Jet M J Vonk
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands; Department of Neurology, Taub Institute for Research on Alzheimer's Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Rashid Ghaznawi
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands; Department of Radiology, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands
| | - Maarten H T Zwartbol
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands; Department of Radiology, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands
| | - Yaakov Stern
- Department of Neurology, Taub Institute for Research on Alzheimer's Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Mirjam I Geerlings
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands.
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20
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Zenebe Y, Akele B, W/Selassie M, Necho M. A systematic review and meta-analysis of HIV associated neurocognitive disorders (HAND) among people with HIV in Ethiopia. AIDS Res Ther 2021; 18:99. [PMID: 34924002 PMCID: PMC8684693 DOI: 10.1186/s12981-021-00424-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 12/13/2021] [Indexed: 11/10/2022] Open
Abstract
Background Ethiopia, being in the Sub Saharan region of Africa, is one of the countries with a substantial burden of HIV infection. Because of the high burden of HIV and poor health care settings, HAND is prevalent as demonstrated in various cross-sectional studies. However, no review has been conducted to report the consolidated magnitude of HAND among people with HIV in Ethiopia. Therefore, this systematic review and meta-analysis aimed to estimate the prevalence of HAND in Ethiopia. Methods Following the PRISMA guidelines, we systematically reviewed and meta-analyzed studies that investigated the prevalence of HAND in Ethiopia from PubMed, Google Scholar, Science Direct, HINARI, EMBASE, and Cochrane library databases. We also looked at the reference lists of the included studies to include other relevant studies. Subgroup analysis was performed based on publication year, study location, and sample size. Heterogeneity across studies was evaluated using the I2 test. Potential publication bias was assessed using Egger’s test and visual inspection of symmetry in the funnel plots. Results In the present meta-analysis, 627 articles were initially identified and evaluated. Of these, 8 studies that met the inclusion criteria were included in the final analysis. The pooled prevalence of HAND in people with HIV in Ethiopia was 39.15% (95% CI 29.36, 48.94). The highest prevalence observed in the Southern Nations, Nationalities, and Peoples’ Region (SNNPR) with 53.20% (95% CI 25.96, 80.44) followed by others 34.87% (Tigray, Addis Ababa, and Oromia) (95% CI 33.49, 36.24) and Amhara 34.07% (95% CI 25.39, 42.74).The funnel plot was asymmetrical. However, Egger’s regression tests provided no evidence of publication bias in the prevalence of HAND. Conclusion In this meta-analysis, the pooled prevalence of HAND, in Ethiopia, was high. Older age, substance use, advanced stages of the disease, and lack of education were the main determinants of HAND in Ethiopia. Health education, early screening of people with HIV, and training of health professionals working in hospitals on HAND are highly recommended.
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21
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Podda J, Ponzio M, Pedullà L, Monti Bragadin M, Battaglia MA, Zaratin P, Brichetto G, Tacchino A. Predominant cognitive phenotypes in multiple sclerosis: Insights from patient-centered outcomes. Mult Scler Relat Disord 2021; 51:102919. [PMID: 33799285 DOI: 10.1016/j.msard.2021.102919] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 03/15/2021] [Accepted: 03/18/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Since combining information from different domains could be useful to increase prediction accuracy over and above what can be achieved at the level of single category of markers, this study aimed to identify distinct and predominant subtypes, i.e., cognitive phenotypes, in people with multiple sclerosis (PwMS) considering both cognitive impairment and mood disorders. METHODS A latent class analysis (LCA) was applied on data from 872 PwMS who were tested with Montreal Cognitive Assessment (MoCA), Symbol Digit Modalities Test (SDMT) and Hospital Anxiety and Depression Scale (HADS). Furthermore, the distribution of demographic (i.e., age, gender, years of education) and clinical characteristics (i.e., disease duration, disease course, disability level) was examined amongst the identified phenotypes. RESULTS Based on model fit and parsimony criteria, LCA identified four cognitive phenotypes: 1) only memory difficulties (n = 247; 28.3%); 2) minor memory and language deficits with mood disorders (n = 185; 21.2%); 3) moderate memory, language and attention impairments (n = 164; 18.8%); 4) severe memory, language, attention, information processing and executive functions difficulties (n = 276; 31.7%). CONCLUSIONS Since less is known about the progressive deterioration of cognition in PwMS, a taxonomy of distinct subtypes that consider information from different clustered domains (i.e., cognition and mood) represents both a challenge and opportunity for an advanced understanding of cognitive impairments and development of tailored cognitive treatments in MS.
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Affiliation(s)
- Jessica Podda
- Scientific Research Area, Italian Multiple Sclerosis Foundation, Genoa, Italy.
| | - Michela Ponzio
- Scientific Research Area, Italian Multiple Sclerosis Foundation, Genoa, Italy
| | - Ludovico Pedullà
- Scientific Research Area, Italian Multiple Sclerosis Foundation, Genoa, Italy
| | - Margherita Monti Bragadin
- Scientific Research Area, Italian Multiple Sclerosis Foundation, Genoa, Italy; AISM Rehabilitation Service, Italian Multiple Sclerosis Society, Genoa, Italy
| | - Mario Alberto Battaglia
- Department of Physiopathology, Experimental Medicine and Public Health, University of Siena, Siena, Italy
| | - Paola Zaratin
- Scientific Research Area, Italian Multiple Sclerosis Foundation, Genoa, Italy
| | - Giampaolo Brichetto
- Scientific Research Area, Italian Multiple Sclerosis Foundation, Genoa, Italy; AISM Rehabilitation Service, Italian Multiple Sclerosis Society, Genoa, Italy
| | - Andrea Tacchino
- Scientific Research Area, Italian Multiple Sclerosis Foundation, Genoa, Italy
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22
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Abstract
IMPORTANCE Multiple sclerosis (MS) is an autoimmune-mediated neurodegenerative disease of the central nervous system characterized by inflammatory demyelination with axonal transection. MS affects an estimated 900 000 people in the US. MS typically presents in young adults (mean age of onset, 20-30 years) and can lead to physical disability, cognitive impairment, and decreased quality of life. This review summarizes current evidence regarding diagnosis and treatment of MS. OBSERVATIONS MS typically presents in young adults aged 20 to 30 years with unilateral optic neuritis, partial myelitis, sensory disturbances, or brainstem syndromes such as internuclear ophthalmoplegia developing over several days. The prevalence of MS worldwide ranges from 5 to 300 per 100 000 people and increases at higher latitudes. Overall life expectancy is less than in the general population (75.9 vs 83.4 years), and MS more commonly affects women (female to male sex distribution of nearly 3:1). Diagnosis is made based on a combination of signs and symptoms, radiographic findings (eg, magnetic resonance imaging [MRI] T2 lesions), and laboratory findings (eg, cerebrospinal fluid-specific oligoclonal bands), which are components of the 2017 McDonald Criteria. Nine classes of disease-modifying therapies (DMTs), with varying mechanisms of action and routes of administration, are available for relapsing-remitting MS, defined as relapses at onset with stable neurologic disability between episodes, and secondary progressive MS with activity, defined as steadily increasing neurologic disability following a relapsing course with evidence of ongoing inflammatory activity. These drugs include interferons, glatiramer acetate, teriflunomide, sphingosine 1-phosphate receptor modulators, fumarates, cladribine, and 3 types of monoclonal antibodies. One additional DMT, ocrelizumab, is approved for primary progressive MS. These DMTs reduce clinical relapses and MRI lesions (new T2 lesions, gadolinium-enhancing lesions). Efficacy rates of current DMTs, defined by reduction in annualized relapse rates compared with placebo or active comparators, range from 29%-68%. Adverse effects include infections, bradycardia, heart blocks, macular edema, infusion reactions, injection-site reactions, and secondary autoimmune adverse effects, such as autoimmune thyroid disease. CONCLUSIONS AND RELEVANCE MS is characterized by physical disability, cognitive impairment, and other symptoms that affect quality of life. Treatment with DMT can reduce the annual relapse rate by 29% to 68% compared with placebo or active comparator.
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Affiliation(s)
| | | | - Alexander D Rae-Grant
- Cleveland Clinic Mellen Center, Cleveland, Ohio
- Now with Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio
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23
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Ozakbas S, Yigit P, Akyuz Z, Sagici O, Abasiyanik Z, Ozdogar AT, Kahraman T, Bozan HR, Hosgel I. Validity and reliability of "Cognitive Reserve Index Questionnaire" for the Turkish Population. Mult Scler Relat Disord 2021; 50:102817. [PMID: 33592382 DOI: 10.1016/j.msard.2021.102817] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 01/28/2021] [Accepted: 02/02/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Cognitive reserve (CR) is the ability to counteract brain damage through differential recruitment of brain networks. Besides, it has also been observed that lifetime intellectual enriching skills reduce the effect of disease burden on cognitive status. The Cognitive Reserve Index questionnaire (CRIq), which is a method for the quantitative measurement and comprehensive evaluation of the CR, that individuals have accumulated throughout their lifetimes. The present study aimed to adapt CRIq to the Turkish population. METHODS CRIq is a 20-item questionnaire consisting of 3 sub-scales (CRI-Education, CRI- Working Activity, CRI-Leisure Time). 271 females and 228 males, a total of 499 healthy volunteers participated in the study (mean age: 39.54±14.05, mean education years 13.14±4.84). Participants were evaluated with the "Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS)" and CRIq was applied. BICAMS was used to determine the validity of the CRIq. To determine the reliability, the questionnaire was applied again two weeks after the first application. Internal consistency and test-retest reliability were measured for reliability analysis. Independent sample t-test was conducted to observe the difference between genders. RESULTS The Cronbach alpha coefficient of the questionnaire was 0.78, and the reliability of the questionnaire was acceptable. The findings showed that inter-rater reliability was quite high (ICC:0.95, 95% CI=1.000, n=36). The correlation between the first and second application of the questionnaire was found to be acceptable for both the sub-scales and the whole questionnaire. The highest CRIq scores were shown for young adults in CRI-Education and CRI-LeisureTime, for the middle-aged in CRIq-WorkingActivity, no significant differences in total CRIq scores. The males scored significantly higher in CRIq total scores than females, but there was not a significant difference in CRI-LeisureTime between genders. CONCLUSION The Turkish version of CRIq was found to be a valid and reliable method for evaluating cognitive reserve in healthy individuals.
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Affiliation(s)
- Serkan Ozakbas
- Department of Neurology, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Pinar Yigit
- Graduate School of Health Sciences, Dokuz Eylul University, Izmir, Turkey.
| | - Zeynep Akyuz
- Department of Psychology, Dokuz Eylul University, Izmir, Turkey
| | - Ozge Sagici
- Graduate School of Health Sciences, Dokuz Eylul University, Izmir, Turkey
| | - Zuhal Abasiyanik
- Graduate School of Health Sciences, Dokuz Eylul University, Izmir, Turkey; Department of Physiotherapy and Rehabilitation, Izmir Katip Celebi University, Izmir, Turkey
| | - Asiye Tuba Ozdogar
- Graduate School of Health Sciences, Dokuz Eylul University, Izmir, Turkey
| | - Turhan Kahraman
- Department of Physiotherapy and Rehabilitation, Izmir Katip Celebi University, Izmir, Turkey
| | | | - Ilknur Hosgel
- Department of Neurology, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
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24
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Alirezaei M, Forouzannia SM, Yarahmadi P, Sahraian MA, Owji M, Bidadian M, Ghadiri F, Naser Moghadasi A. Demographic features, behavioral measures, and clinical factors as predictors of cognitive function in patients with multiple sclerosis. Mult Scler Relat Disord 2021; 49:102758. [PMID: 33567391 DOI: 10.1016/j.msard.2021.102758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 12/12/2020] [Accepted: 12/30/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND One of the most concerning features that involves 40-70% of patients with multiple sclerosis (MS) is cognitive impairment. Moreover, it affects various aspects of patients' life. In this regard, this study was conducted to find independent predictors of cognitive function. METHOD We performed a cross-sectional analysis on 92 patients chosen from MS clinic of Sina hospital, Iran. After completing a general questionnaire of demographic and various clinical features, the included participants (patients with RRMS) underwent neuropsychological assessment using Minimal Assessment of Cognitive function in Multiple Sclerosis (MACFIMS), Expanded disability Status Scale (EDSS), Beck Depression Inventory II (BDI-II), and National American Adult Reading Test (NAART). An un-weighted average of MACFIMS subscales z-scores was reported as cognitive index. In order to find the association between CI and different factors, each variable was entered in a simple regression model first. Then, a univariate multiple regression model was invoked to evaluate the predictors of cognitive index in patients. RESULTS Simple regression for cognitive index of 92 patients (86% female) with a mean age of 33.4±7.6 years old suffering of RRMS for 6.8±4.8 years revealed patients with history of former smoking (p=0.001), sole visual symptoms as the presentation sign of the study (β=-0.341, p=0.001), lower EDSS score (β=-0.299, p=0.005), higher NAART score (β=0.416, p≤0.0001), and college education (p=0.001), had better cognitive function in our study population. Such factors including age, educational status, BDI-II score, EDSS score, and disease duration were fixed and the other significant factors entered once separately and then simultaneously in the univariate multiple linear regression model. It was revealed that former smoking (β=-0.372, p≤0.0001), NAART (β=0.304, p=0.002), and EDSS (β= -0.185, P=0.045) are associated significantly with the cognitive function of patients with multiple sclerosis. CONCLUSION This study demonstrated NAART, as a proxy of premorbid intelligence, history of former smoking, and EDSS score may have effects on cognitive function in MS. Future studies need to be invoked for the evaluation of the causality relation of these factors.
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Affiliation(s)
- Mohammad Alirezaei
- Multiple Sclerosis Research Center; Neuroscience institute; Tehran University of Medical Sciences; Tehran; Iran
| | - Seyed Mohammad Forouzannia
- Multiple Sclerosis Research Center; Neuroscience institute; Tehran University of Medical Sciences; Tehran; Iran
| | - Pourya Yarahmadi
- Multiple Sclerosis Research Center; Neuroscience institute; Tehran University of Medical Sciences; Tehran; Iran
| | - Mohammad Ali Sahraian
- Multiple Sclerosis Research Center; Neuroscience institute; Tehran University of Medical Sciences; Tehran; Iran
| | - Mahsa Owji
- Multiple Sclerosis Research Center; Neuroscience institute; Tehran University of Medical Sciences; Tehran; Iran
| | - Maryam Bidadian
- Department of psychology, School of humanities, Tarbiat Modares University, Tehran, Iran
| | - Fereshteh Ghadiri
- Multiple Sclerosis Research Center; Neuroscience institute; Tehran University of Medical Sciences; Tehran; Iran
| | - Abdorreza Naser Moghadasi
- Multiple Sclerosis Research Center; Neuroscience institute; Tehran University of Medical Sciences; Tehran; Iran.
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25
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Chard DT, Alahmadi AAS, Audoin B, Charalambous T, Enzinger C, Hulst HE, Rocca MA, Rovira À, Sastre-Garriga J, Schoonheim MM, Tijms B, Tur C, Gandini Wheeler-Kingshott CAM, Wink AM, Ciccarelli O, Barkhof F. Mind the gap: from neurons to networks to outcomes in multiple sclerosis. Nat Rev Neurol 2021; 17:173-184. [PMID: 33437067 DOI: 10.1038/s41582-020-00439-8] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2020] [Indexed: 12/21/2022]
Abstract
MRI studies have provided valuable insights into the structure and function of neural networks, particularly in health and in classical neurodegenerative conditions such as Alzheimer disease. However, such work is also highly relevant in other diseases of the CNS, including multiple sclerosis (MS). In this Review, we consider the effects of MS pathology on brain networks, as assessed using MRI, and how these changes to brain networks translate into clinical impairments. We also discuss how this knowledge can inform the targeting of MS treatments and the potential future directions for research in this area. Studying MS is challenging as its pathology involves neurodegenerative and focal inflammatory elements, both of which could disrupt neural networks. The disruption of white matter tracts in MS is reflected in changes in network efficiency, an increasingly random grey matter network topology, relative cortical disconnection, and both increases and decreases in connectivity centred around hubs such as the thalamus and the default mode network. The results of initial longitudinal studies suggest that these changes evolve rather than simply increase over time and are linked with clinical features. Studies have also identified a potential role for treatments that functionally modify neural networks as opposed to altering their structure.
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Affiliation(s)
- Declan T Chard
- NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK. .,National Institute for Health Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre, London, UK.
| | - Adnan A S Alahmadi
- Department of Diagnostic Radiology, Faculty of Applied Medical Science, King Abdulaziz University (KAU), Jeddah, Saudi Arabia
| | - Bertrand Audoin
- Aix-Marseille University, CNRS, CRMBM, Marseille, France.,AP-HM, University Hospital Timone, Department of Neurology, Marseille, France
| | - Thalis Charalambous
- NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
| | - Christian Enzinger
- Department of Neurology, Research Unit for Neuronal Repair and Plasticity, Medical University of Graz, Graz, Austria.,Department of Radiology, Division of Neuroradiology, Vascular and Interventional Radiology, Medical University of Graz, Graz, Austria
| | - Hanneke E Hulst
- Department of Anatomy and Neurosciences, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Maria A Rocca
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Àlex Rovira
- Section of Neuroradiology, Department of Radiology Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jaume Sastre-Garriga
- Servei de Neurologia/Neuroimmunologia, Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Menno M Schoonheim
- Department of Anatomy and Neurosciences, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Betty Tijms
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Carmen Tur
- NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK.,Department of Neurology, Luton and Dunstable University Hospital, Luton, UK
| | - Claudia A M Gandini Wheeler-Kingshott
- NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK.,Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy.,Brain MRI 3T Research Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Alle Meije Wink
- Department of Radiology & Nuclear Medicine, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Olga Ciccarelli
- NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK.,National Institute for Health Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre, London, UK
| | - Frederik Barkhof
- National Institute for Health Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre, London, UK.,Department of Radiology & Nuclear Medicine, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Institutes of Neurology and Healthcare Engineering, University College London, London, UK
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26
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Machado R, Lima C, d'Almeida OC, Afonso A, Macário C, Castelo-Branco M, Sousa L, Santana I, Batista S. Protective effects of cognitive and brain reserve in multiple sclerosis: Differential roles on social cognition and 'classic cognition'. Mult Scler Relat Disord 2020; 48:102716. [PMID: 33421706 DOI: 10.1016/j.msard.2020.102716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 12/14/2020] [Accepted: 12/21/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND According to cognitive reserve (CR) and brain reserve (BR) theories, lifetime intellectual enrichment and maximal brain volume protect against cognitive decline. OBJECTIVE To examine the effects of CR and BR on social cognition in multiple sclerosis (MS), and compare it with 'classic cognition'. METHODS We included 60 MS patients and 60 healthy controls matched on age, sex, and education. Education was used has a proxy of CR and intracranial volume (ICV) as a proxy of BR. Participants underwent Theory of Mind (ToM) testing (Eyes Test, Videos Test), comprehensive neuropsychological assessment and 3Tesla brain MRI. Cortical and subcortical grey matter (GM) volumes were calculated. RESULTS We found positive effects of education and ICV on general cognitive status and ToM performance, respectively. Higher education moderated the impact of subcortical GM atrophy on 'classic' cognitive status (R2=0.219, p=<0.001). Conversely, greater ICV attenuated the impact of cortical GM atrophy on Eyes Test (R2=0.158, p=0.002) and Videos Test (R2=0.198, p=0.001). Stratification for disease duration showed that the protective effect of education/ICV occurred in early stages of disease (<10 years). CONCLUSION CR and BR have differential protective roles in MS, with BR having a positive effect on social cognition and CR on 'classic' cognitive domains.
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Affiliation(s)
- Rita Machado
- Department of Neurology, Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra 3000-075, Portugal.
| | - Cláudia Lima
- Department of Neurology, Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra 3000-075, Portugal
| | - Otília C d'Almeida
- Visual Neuroscience Laboratory, Institute for Biomedical Imaging and Life Sciences (IBILI), Faculty of Medicine, University of Coimbra, Coimbra, Portugal; Centre for Neuroscience and Cell Biology (CNC). IBILI, University of Coimbra, Coimbra, Portugal; Institute for Nuclear Sciences Applied to Health (ICNAS), University of Coimbra, Coimbra, Portugal
| | - Ana Afonso
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Carmo Macário
- Department of Neurology, Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra 3000-075, Portugal
| | - Miguel Castelo-Branco
- Visual Neuroscience Laboratory, Institute for Biomedical Imaging and Life Sciences (IBILI), Faculty of Medicine, University of Coimbra, Coimbra, Portugal; Centre for Neuroscience and Cell Biology (CNC). IBILI, University of Coimbra, Coimbra, Portugal; Institute for Nuclear Sciences Applied to Health (ICNAS), University of Coimbra, Coimbra, Portugal; Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Lívia Sousa
- Department of Neurology, Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra 3000-075, Portugal; Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Isabel Santana
- Department of Neurology, Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra 3000-075, Portugal; Centre for Neuroscience and Cell Biology (CNC). IBILI, University of Coimbra, Coimbra, Portugal; Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Sónia Batista
- Department of Neurology, Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra 3000-075, Portugal; Faculty of Medicine, University of Coimbra, Coimbra, Portugal
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Canosa A, Palumbo F, Iazzolino B, Peotta L, Di Pede F, Manera U, Vasta R, Grassano M, Solero L, Arena V, Moglia C, Calvo A, Chiò A, Pagani M. The interplay among education, brain metabolism, and cognitive impairment suggests a role of cognitive reserve in Amyotrophic Lateral Sclerosis. Neurobiol Aging 2020; 98:205-213. [PMID: 33316576 DOI: 10.1016/j.neurobiolaging.2020.11.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 11/08/2020] [Accepted: 11/10/2020] [Indexed: 01/09/2023]
Abstract
We tested the Cognitive Reserve (CR) hypothesis in Amyotrophic Lateral Sclerosis (ALS), enrolling 111 patients, using education as CR proxy, 18F-FDG-PET to assess brain damage, and ECAS to measure cognition. Education was regressed out against brain metabolism, including age, sex, spinal/bulbar onset, ALSFRS-R, and ECAS as covariates. Clusters showing a significant correlation were used as seed regions in an interregional correlation analysis (IRCA) in the ALS group and in 40 controls. In the ALS group, we found a negative correlation between brain metabolism and education in the right anterior cingulate and bilateral medial frontal gyrus. In the IRCA in the ALS group, the medial frontal cluster metabolism positively correlated with that of frontotemporal regions (right > left), bilateral caudate nuclei, and right insula, and negatively correlated with that of corticospinal tracts, cerebellum, and pons. In controls, the IRCA showed significant positive correlations in the same regions but less extended. Our results agree with the CR hypothesis. The negative correlation between the medial frontal cluster and the cerebellum found only in ALS patients might reflect cerebellar compensation.
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Affiliation(s)
- Antonio Canosa
- ALS Centre, "Rita Levi Montalcini" Department of Neuroscience, University of Turin, Turin, Italy; Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, SC Neurologia 1U, Turin, Italy.
| | - Francesca Palumbo
- ALS Centre, "Rita Levi Montalcini" Department of Neuroscience, University of Turin, Turin, Italy
| | - Barbara Iazzolino
- ALS Centre, "Rita Levi Montalcini" Department of Neuroscience, University of Turin, Turin, Italy
| | - Laura Peotta
- ALS Centre, "Rita Levi Montalcini" Department of Neuroscience, University of Turin, Turin, Italy
| | - Francesca Di Pede
- ALS Centre, "Rita Levi Montalcini" Department of Neuroscience, University of Turin, Turin, Italy
| | - Umberto Manera
- ALS Centre, "Rita Levi Montalcini" Department of Neuroscience, University of Turin, Turin, Italy
| | - Rosario Vasta
- ALS Centre, "Rita Levi Montalcini" Department of Neuroscience, University of Turin, Turin, Italy
| | - Maurizio Grassano
- ALS Centre, "Rita Levi Montalcini" Department of Neuroscience, University of Turin, Turin, Italy
| | - Luca Solero
- ALS Centre, "Rita Levi Montalcini" Department of Neuroscience, University of Turin, Turin, Italy
| | - Vincenzo Arena
- Positron Emission Tomography Centre AFFIDEA-IRMET S.P.A., Turin, Italy
| | - Cristina Moglia
- ALS Centre, "Rita Levi Montalcini" Department of Neuroscience, University of Turin, Turin, Italy; Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, SC Neurologia 1U, Turin, Italy
| | - Andrea Calvo
- ALS Centre, "Rita Levi Montalcini" Department of Neuroscience, University of Turin, Turin, Italy; Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, SC Neurologia 1U, Turin, Italy; Neuroscience Institute of Turin (NIT), Turin, Italy
| | - Adriano Chiò
- ALS Centre, "Rita Levi Montalcini" Department of Neuroscience, University of Turin, Turin, Italy; Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, SC Neurologia 1U, Turin, Italy; Neuroscience Institute of Turin (NIT), Turin, Italy; Institute of Cognitive Sciences and Technologies, C.N.R., Rome, Italy
| | - Marco Pagani
- Institute of Cognitive Sciences and Technologies, C.N.R., Rome, Italy; Department of Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden
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28
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Lopez-Soley E, Solana E, Martínez-Heras E, Andorra M, Radua J, Prats-Uribe A, Montejo C, Sola-Valls N, Sepulveda M, Pulido-Valdeolivas I, Blanco Y, Martinez-Lapiscina EH, Saiz A, Llufriu S. Impact of Cognitive Reserve and Structural Connectivity on Cognitive Performance in Multiple Sclerosis. Front Neurol 2020; 11:581700. [PMID: 33193039 PMCID: PMC7662554 DOI: 10.3389/fneur.2020.581700] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 09/30/2020] [Indexed: 01/07/2023] Open
Abstract
Background: Cognitive reserve (CR) could attenuate the impact of the brain burden on the cognition in people with multiple sclerosis (PwMS). Objective: To explore the relationship between CR and structural brain connectivity and investigate their role on cognition in PwMS cognitively impaired (PwMS-CI) and cognitively preserved (PwMS-CP). Methods: In this study, 181 PwMS (71% female; 42.9 ± 10.0 years) were evaluated using the Cognitive Reserve Questionnaire (CRQ), Brief Repeatable Battery of Neuropsychological tests, and MRI. Brain lesion and gray matter volumes were quantified, as was the structural network connectivity. Patients were classified as PwMS-CI (z scores = −1.5 SD in at least two tests) or PwMS-CP. Linear and multiple regression analyses were run to evaluate the association of CRQ and structural connectivity with cognition in each group. Hedges's effect size was used to compute the strength of associations. Results: We found a very low association between CRQ scores and connectivity metrics in PwMS-CP, while in PwMS-CI, this relation was low to moderate. The multiple regression model, adjusted for age, gender, mood, lesion volume, and graph metrics (local and global efficiency, and transitivity), indicated that the CRQ (β = 0.26, 95% CI: 0.17–0.35) was associated with cognition (adj R2 = 0.34) in PwMS-CP (55%). In PwMS-CI, CRQ (β = 0.18, 95% CI: 0.07–0.29), age, and network global efficiency were independently associated with cognition (adj R2 = 0.55). The age- and gender-adjusted association between CRQ score and global efficiency on having an impaired cognitive status was −0.338 (OR: 0.71, p = 0.036) and −0.531 (OR: 0.59, p = 0.002), respectively. Conclusions: CR seems to have a marginally significant effect on brain structural connectivity, observed in patients with more severe clinical impairment. It protects PwMS from cognitive decline regardless of their cognitive status, yet once cognitive impairment has set in, brain damage and aging are also influencing cognitive performance.
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Affiliation(s)
- Elisabet Lopez-Soley
- Laboratory of Advanced Imaging in Neuroimmunological Diseases, Center of Neuroimmunology, Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Hospital Clinic Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Elisabeth Solana
- Laboratory of Advanced Imaging in Neuroimmunological Diseases, Center of Neuroimmunology, Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Hospital Clinic Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Eloy Martínez-Heras
- Laboratory of Advanced Imaging in Neuroimmunological Diseases, Center of Neuroimmunology, Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Hospital Clinic Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Magi Andorra
- Laboratory of Advanced Imaging in Neuroimmunological Diseases, Center of Neuroimmunology, Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Hospital Clinic Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Joaquim Radua
- Imaging of Mood- and Anxiety-Related Disorders (IMARD) Group, Mental Health Research Networking Center (CIBERSAM), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Department of Psychosis Studies, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom.,Department of Clinical Neuroscience, Centre for Psychiatric Research and Education, Karolinska Institutet, Solna, Sweden
| | - Albert Prats-Uribe
- Centre for Statistics in Medicine, Botnar Research Centre, Nuffiel Department of Orthopeadics, rheumatology and musculoskeletal sciences (NDORMS), University of Oxford, Oxford, United Kingdom
| | - Carmen Montejo
- Laboratory of Advanced Imaging in Neuroimmunological Diseases, Center of Neuroimmunology, Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Hospital Clinic Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Nuria Sola-Valls
- Laboratory of Advanced Imaging in Neuroimmunological Diseases, Center of Neuroimmunology, Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Hospital Clinic Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Maria Sepulveda
- Laboratory of Advanced Imaging in Neuroimmunological Diseases, Center of Neuroimmunology, Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Hospital Clinic Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Irene Pulido-Valdeolivas
- Laboratory of Advanced Imaging in Neuroimmunological Diseases, Center of Neuroimmunology, Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Hospital Clinic Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Yolanda Blanco
- Laboratory of Advanced Imaging in Neuroimmunological Diseases, Center of Neuroimmunology, Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Hospital Clinic Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Elena H Martinez-Lapiscina
- Laboratory of Advanced Imaging in Neuroimmunological Diseases, Center of Neuroimmunology, Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Hospital Clinic Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Albert Saiz
- Laboratory of Advanced Imaging in Neuroimmunological Diseases, Center of Neuroimmunology, Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Hospital Clinic Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Sara Llufriu
- Laboratory of Advanced Imaging in Neuroimmunological Diseases, Center of Neuroimmunology, Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Hospital Clinic Barcelona, Universitat de Barcelona, Barcelona, Spain
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29
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A Scope of the Social Brain in Multiple Sclerosis: Insights From Neuroimaging Studies. Cogn Behav Neurol 2020; 33:90-102. [PMID: 32496294 DOI: 10.1097/wnn.0000000000000227] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Multiple sclerosis (MS) is the most common inflammatory neurologic disease in young adults. Its pathological mechanisms include demyelination, neurodegeneration, and synaptopathy. Cognitive deficits occur in up to 65% of individuals with MS and affect both nonsocial (eg, information processing speed, memory, and executive functions) and social (ie, emotion recognition, theory of mind, and empathy) cognitive domains. In the last 3 decades, there has been a growing interest in social cognition and its relationship with neuropsychological, sociodemographic, and disease characteristics in individuals with MS. Uncovering the neuropathological correlates of social cognitive deficits is now a crucial aim that would also help us better understand the underlying mechanisms of social cognition. We reviewed 11 neuroimaging studies to investigate social cognition in MS. These studies focused mainly on facial emotion recognition and theory of mind, with the findings suggesting that a disrupted cortico-subcortical network forms the basis of social deficits involving both domains. We then interpreted these results in the context of multiple disconnection syndrome, which occurs as a result of axonal demyelination and degeneration within the connexome of several neural hubs devoted to social cognition. Heterogeneity in social cognitive performance, observed among our study participants, is discussed with reference to the cognitive reserve and brain reserve hypotheses. These reserves may explain why individuals with comparable clinical characteristics of MS may exhibit different cognitive profiles. Further research is required to generalize these findings to the MS population and to inform the development of effective interventions to improve psychosocial functioning in individuals with MS.
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Predictors of clinically significant anxiety in people with multiple sclerosis: A one-year follow-up study. Mult Scler Relat Disord 2020; 45:102417. [DOI: 10.1016/j.msard.2020.102417] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 07/15/2020] [Accepted: 07/21/2020] [Indexed: 11/19/2022]
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Bizzo BC, Arruda-Sanchez T, Tobyne SM, Bireley JD, Lev MH, Gasparetto EL, Klawiter EC. Anterior Insular Resting-State Functional Connectivity is Related to Cognitive Reserve in Multiple Sclerosis. J Neuroimaging 2020; 31:98-102. [PMID: 32857919 DOI: 10.1111/jon.12779] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 08/07/2020] [Accepted: 08/15/2020] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND AND PURPOSE Cognitive dysfunction is common in multiple sclerosis (MS). The dorsal anterior insula (dAI) is a key hub of the salience network (SN) orchestrating access to critical cognitive brain regions. The aim of this study was to assess whole-brain dAI intrinsic functional connectivity (iFC) using resting-state functional MRI (rs-fMRI) in people with MS and healthy controls (HC) and test the relationship between cognitive reserve (CR) and dAI iFC in people with MS. METHODS We studied 28 people with relapsing-remitting MS and 28 HC. CR index was quantified by combining premorbid IQ, leisure activities, and education level. For whole-brain iFC analyses, the bilateral dAI were used as seeds. Individual subject correlation maps were entered into general linear models for group comparison and to analyze the effect of CR index on dAI iFC, controlling for multiple comparisons. The correlation between CR index and iFC was assessed using a linear regression model. RESULTS rs-fMRI analyses revealed a negative relationship between CR index and iFC within the left dAI and a left occipital cluster in people with MS including regions of the cuneus, superior occipital gyrus, and parieto-occipital sulcus. The regression analysis showed that people with MS and a higher CR index had a statistically significantly reduced iFC within the left dAI and the cluster. CONCLUSIONS CR is relevant to functional connectivity within one of the main nodes of the SN, the dAI, and occipital regions in MS. These results have implications for how CR may modulate the susceptibility to cognitive dysfunction in MS.
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Affiliation(s)
- Bernardo Canedo Bizzo
- Department of Radiology, Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.,Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA.,A.A. Martinos Center for Biomedical Imaging, Charlestown, MA
| | - Tiago Arruda-Sanchez
- Department of Radiology, Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Sean M Tobyne
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - John Daniel Bireley
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Michael Howard Lev
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Emerson Leandro Gasparetto
- Department of Radiology, Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Eric C Klawiter
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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Filippi M, Preziosa P, Langdon D, Lassmann H, Paul F, Rovira À, Schoonheim MM, Solari A, Stankoff B, Rocca MA. Identifying Progression in Multiple Sclerosis: New Perspectives. Ann Neurol 2020; 88:438-452. [PMID: 32506714 DOI: 10.1002/ana.25808] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 05/18/2020] [Accepted: 05/25/2020] [Indexed: 01/10/2023]
Abstract
The identification of progression in multiple sclerosis is typically retrospective. Given the profound burden of progressive multiple sclerosis, and the recent development of effective treatments for these patients, there is a need to establish measures capable of identifying progressive multiple sclerosis early in the disease course. Starting from recent pathological findings, this review assesses the state of the art of potential measures able to predict progressive multiple sclerosis. Future promising biomarkers that might shed light on mechanisms of progression are also discussed. Finally, expansion of the concept of progressive multiple sclerosis, by including an assessment of cognition, patient-reported outcomes, and comorbidities, is considered. ANN NEUROL 2020;88:438-452.
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Affiliation(s)
- Massimo Filippi
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Neurophysiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Paolo Preziosa
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Dawn Langdon
- Royal Holloway, University of London, London, United Kingdom
| | - Hans Lassmann
- Center for Brain Research, Medical University of Vienna, Vienna, Austria
| | - Friedemann Paul
- NeuroCure Clinical Research Center and Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine and Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Àlex Rovira
- Neuroradiology Section, Department of Radiology, Vall d'Hebron University Hospital and Research Institute, Autonomous University of Barcelona, Barcelona, Spain
| | - Menno M Schoonheim
- Department of Anatomy and Neurosciences, Multiple Sclerosis Center Amsterdam, Amsterdam Neuroscience, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Alessandra Solari
- Unit of Neuroepidemiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Bruno Stankoff
- Sorbonne Université, Institut du Cerveau-Paris Brain Institute - ICM, Inserm, CNRS, APHP, Paris, France
| | - Maria A Rocca
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
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33
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Budd KR, Johnson M, Glaubiger SA, Jewells VL. Understanding the Radiologist's Role in Evaluating Multiple Sclerosis: A Review of the Tip of the Iceberg. Semin Ultrasound CT MR 2020; 41:275-283. [DOI: 10.1053/j.sult.2020.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Oset M, Stasiolek M, Matysiak M. Cognitive Dysfunction in the Early Stages of Multiple Sclerosis-How Much and How Important? Curr Neurol Neurosci Rep 2020; 20:22. [PMID: 32444997 PMCID: PMC7244611 DOI: 10.1007/s11910-020-01045-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Purpose of Review Multiple sclerosis (MS) is a demyelinating disease of the central nervous system that mainly affects young adults and that is one of the leading causes of disability in this age group, with cognitive impairment occurring early in the course of the disease. This article summarizes the current knowledge about cognitive dysfunction in the early phase of MS, including biomarkers, MRI correlates, and its value as a prognostic marker. Recent Findings New sets of neuropsychological tests have been established to screen for cognitive dysfunction more easily and accurately. Moreover, structural changes detected by brain MRI and several biomarkers found in cerebrospinal fluid and blood serum have been recently correlated with decreased cognitive performance. Additionally, factors influencing cognition in MS, such as disease-modifying therapy, mood disorders, and lifestyle, are better described. Summary Cognitive impairment early in the course of MS is suggested as a prognostic factor for disease progression. However, clear-cut definitions of the early stage of MS as well as unified criteria for the diagnosis of cognitive impairment are still lacking. New and more reliable tools for evaluating cognition in MS patients should be developed and introduced into everyday practice to facilitate the implementation of effective disease-modifying therapy, cognitive rehabilitation, and lifestyle management.
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Affiliation(s)
- Magdalena Oset
- Department of Neurology, Medical University of Lodz, Kopcinskiego 22, 90-153, Lodz, Poland
| | - Mariusz Stasiolek
- Department of Neurology, Medical University of Lodz, Kopcinskiego 22, 90-153, Lodz, Poland.
| | - Mariola Matysiak
- Department of Neurology, Medical University of Lodz, Kopcinskiego 22, 90-153, Lodz, Poland
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Cognitive reserve and working memory in cognitive performance of adults with subjective cognitive complaints: longitudinal structural equation modeling. Int Psychogeriatr 2020; 32:515-524. [PMID: 31547899 DOI: 10.1017/s1041610219001248] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To study the influence of cognitive reserve (CR) on cognitive performance of individuals with subjective cognitive complaints (SCCs) within a period of 36 months. DESIGN We used a general linear model repeated measures procedure to analyze the differences in performance between three assessments. We used a longitudinal structural equation modeling to analyze the relationship between CR and cognitive performance at baseline and at two follow-up assessments. SETTING Participants with SCCs were recruited and assessed in primary care health centers. PARTICIPANTS A total of 212 participants older than 50 years with SCCs. MEASUREMENTS Cognitive reserve data were collected with an ad hoc questionnaire administered to the subjects in an interview. General cognitive performance (GCP), episodic memory (EM), and working memory (WM) have been evaluated. The Mini-Mental State Examination and the total score of Spanish version of the Cambridge Cognitive Examination evaluated the GCP. Episodic memory was assessed with the Spanish version of the California Verbal Learning. Working memory was evaluated by the counting span task and the listening span task. RESULTS The satisfactory fit of the proposed model confirmed the direct effects of CR on WM and GCP at baseline, as well as indirect effects on EM and WM at first and second follow-up. Indirect effects of CR on other cognitive constructs via WM were observed over time. CONCLUSION The proposed model is useful for measuring the influence of CR on cognitive performance over time. Cognitive response acquired throughout life may influence cognitive performance in old age and prevent cognitive deterioration, thus increasing processing resources via WM.
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Ehling R, Amprosi M, Kremmel B, Bsteh G, Eberharter K, Zehentner M, Steiger R, Tuovinen N, Gizewski ER, Benke T, Berger T, Spöttl C, Brenneis C, Scherfler C. Second language learning induces grey matter volume increase in people with multiple sclerosis. PLoS One 2019; 14:e0226525. [PMID: 31869402 PMCID: PMC6927643 DOI: 10.1371/journal.pone.0226525] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 11/29/2019] [Indexed: 11/25/2022] Open
Abstract
Background Grey matter volume (GMV) decline is a frequent finding in multiple sclerosis (MS), the most common chronic neurological disease in young adults. Increases of GMV were detected in language related brain regions following second language (L2) learning in healthy adults. Effects of L2 learning in people with MS (pwMS) have not been investigated so far. Methods This study prospectively evaluated the potential of an eight-week L2 training on grey matter plasticity measured by 3T-MRI, L2 proficiency and health-related quality of life (HRQoL) in people with relapsing-remitting MS (pwMS, n = 11) and healthy, sex- and age-matched controls (HCs; n = 12). Results Categorical voxel-based analysis revealed significantly less GMV bilaterally of the insula extending to the temporal pole in pwMS at baseline. Following L2 training, significant increases of GMV were evident in the right hippocampus, parahippocampus and putamen of pwMS and in the left insula of HCs. L2 training resulted in significant improvements of listening comprehension, speaking fluency and vocabulary knowledge in both pwMS and HCs. GMV increases of right hippocampus and parahippocampus significantly correlated with vocabulary knowledge gain and L2 learning was associated with a significant increase of HRQoL in pwMS. Conclusion Our findings demonstrate distinct patterns of GMV increases of language related brain regions in pwMS and HCs and indicate disease-related compensatory cortical and subcortical plasticity to acquire L2 proficiency in pwMS.
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Affiliation(s)
- Rainer Ehling
- Department of Neurology, Clinic for Rehabilitation Münster, Münster, Austria
- Karl Landsteiner Institut für Interdisziplinäre Forschung am Reha Zentrum Münster, Münster, Austria
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
- * E-mail:
| | - Matthias Amprosi
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Benjamin Kremmel
- Language Testing Research Group Innsbruck, Department for Subject Specific Education, University of Innsbruck, Innsbruck, Austria
| | - Gabriel Bsteh
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Kathrin Eberharter
- Language Testing Research Group Innsbruck, Department for Subject Specific Education, University of Innsbruck, Innsbruck, Austria
| | - Matthias Zehentner
- Language Testing Research Group Innsbruck, Department for Subject Specific Education, University of Innsbruck, Innsbruck, Austria
| | - Ruth Steiger
- Department of Neuroradiology, Medical University of Innsbruck, Innsbruck, Austria
- Neuroimaging Research Core Facility, Medical University Innsbruck, Innsbruck, Austria
| | - Noora Tuovinen
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Elke R. Gizewski
- Department of Neuroradiology, Medical University of Innsbruck, Innsbruck, Austria
- Neuroimaging Research Core Facility, Medical University Innsbruck, Innsbruck, Austria
| | - Thomas Benke
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Thomas Berger
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Carol Spöttl
- Language Testing Research Group Innsbruck, Department for Subject Specific Education, University of Innsbruck, Innsbruck, Austria
| | - Christian Brenneis
- Department of Neurology, Clinic for Rehabilitation Münster, Münster, Austria
- Karl Landsteiner Institut für Interdisziplinäre Forschung am Reha Zentrum Münster, Münster, Austria
| | - Christoph Scherfler
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
- Neuroimaging Research Core Facility, Medical University Innsbruck, Innsbruck, Austria
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Abstract
The concept of cognitive reserve (CR) was proposed to account for the discrepancy between levels of brain pathologic process or damage and clinical and cognitive function. We provide a detailed review of prospective longitudinal studies that have investigated the interaction between CR and Alzheimer disease (AD) biomarkers on clinical and cognitive outcomes among individuals with normal cognition at baseline. Current evidence is consistent with the view that higher levels of CR are associated with a delay in the onset of symptoms of mild cognitive impairment and that there may be multiple pathways by which CR exerts its protective effects.
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Ifantopoulou P, Artemiadis AK, Bakirtzis C, Zekiou K, Papadopoulos TS, Diakogiannis I, Hadjigeorgiou G, Grigoriadis N, Orologas A. Cognitive and brain reserve in multiple sclerosis––A cross-sectional study. Mult Scler Relat Disord 2019; 35:128-134. [DOI: 10.1016/j.msard.2019.07.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 06/29/2019] [Accepted: 07/27/2019] [Indexed: 10/26/2022]
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Brandstadter R, Sand IK, Sumowski JF. Beyond rehabilitation: A prevention model of reserve and brain maintenance in multiple sclerosis. Mult Scler 2019; 25:1372-1378. [PMID: 31469354 PMCID: PMC6719722 DOI: 10.1177/1352458519856847] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Persons with multiple sclerosis (MS) experience cognitive and physical decline despite more effective disease-modifying therapies (DMTs), and symptomatic treatments currently have limited efficacy. The best treatment of MS disability may, therefore, be prevention of decline. Here, we present a working model of reserve and brain maintenance, with a focus on modifiable risk and protective factors. At disease onset, patients have varying degrees of reserve, broadly conceptualized as the dynamic availability of cerebral resources to support functional capacity. A clinical focus on prevention aims to minimize factors that deplete reserve (e.g. disease burden, comorbidities) and maximize factors that preserve reserve (e.g. DMTs, cardiovascular health). We review evidence for cardiovascular health, diet, and sleep as three potentially important modifiable factors that may modulate cerebral reserve generally, but also in disease-specific ways. We frame the brain as a limited capacity system in which inefficient usage of available cerebral capacity (reserve) leads to or exacerbates functional deficits, and we provide examples of factors that may lead to such inefficiency (e.g. poor mood, obesity, cognitive-motor dual-tasking). Finally, we discuss the challenges and responsibilities of MS neurologists and patients in pursuing comprehensive brain maintenance as a preventive approach.
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Affiliation(s)
- Rachel Brandstadter
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Corinne Goldsmith Dickinson Center for MS, Mount Sinai Hospital, New York, NY, USA
| | - Ilana Katz Sand
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Corinne Goldsmith Dickinson Center for MS, Mount Sinai Hospital, New York, NY, USA
| | - James F. Sumowski
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Corinne Goldsmith Dickinson Center for MS, Mount Sinai Hospital, New York, NY, USA
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40
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Fuchs TA, Benedict RHB, Bartnik A, Choudhery S, Li X, Mallory M, Oship D, Yasin F, Ashton K, Jakimovski D, Bergsland N, Ramasamy DP, Weinstock-Guttman B, Zivadinov R, Dwyer MG. Preserved network functional connectivity underlies cognitive reserve in multiple sclerosis. Hum Brain Mapp 2019; 40:5231-5241. [PMID: 31444887 PMCID: PMC6864900 DOI: 10.1002/hbm.24768] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 07/26/2019] [Accepted: 08/08/2019] [Indexed: 12/27/2022] Open
Abstract
Cognitive reserve is one's mental resilience or resistance to the effects of structural brain damage. Reserve effects are well established in people with multiple sclerosis (PwMS) and Alzheimer's disease, but the neural basis of this phenomenon is unclear. We aimed to investigate whether preservation of functional connectivity explains cognitive reserve. Seventy‐four PwMS and 29 HCs underwent neuropsychological assessment and 3 T MRI. Structural damage measures included gray matter (GM) atrophy and network white matter (WM) tract disruption between pairs of GM regions. Resting‐state functional connectivity was also assessed. PwMS exhibited significantly impaired cognitive processing speed (t = 2.14, p = .037) and visual/spatial memory (t = 2.72, p = .008), and had significantly greater variance in functional connectivity relative to HCs within relevant networks (p < .001, p < .001, p = .016). Higher premorbid verbal intelligence, a proxy for cognitive reserve, predicted relative preservation of functional connectivity despite accumulation of GM atrophy (standardized‐β = .301, p = .021). Furthermore, preservation of functional connectivity attenuated the impact of structural network WM tract disruption on cognition (β = −.513, p = .001, for cognitive processing speed; β = −.209, p = .066, for visual/spatial memory). The data suggests that preserved functional connectivity explains cognitive reserve in PwMS, helping to maintain cognitive capacity despite structural damage.
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Affiliation(s)
- Tom A Fuchs
- Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York (SUNY), Buffalo, New York.,Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York (SUNY), Buffalo, New York
| | - Ralph H B Benedict
- Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York (SUNY), Buffalo, New York
| | - Alexander Bartnik
- Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York (SUNY), Buffalo, New York.,Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York (SUNY), Buffalo, New York
| | - Sanjeevani Choudhery
- Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York (SUNY), Buffalo, New York.,Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York (SUNY), Buffalo, New York
| | - Xian Li
- Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York (SUNY), Buffalo, New York.,Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York (SUNY), Buffalo, New York
| | - Matthew Mallory
- Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York (SUNY), Buffalo, New York.,Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York (SUNY), Buffalo, New York
| | - Devon Oship
- Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York (SUNY), Buffalo, New York.,Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York (SUNY), Buffalo, New York
| | - Faizan Yasin
- Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York (SUNY), Buffalo, New York
| | - Kira Ashton
- Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York (SUNY), Buffalo, New York.,Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York (SUNY), Buffalo, New York
| | - Dejan Jakimovski
- Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York (SUNY), Buffalo, New York.,Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York (SUNY), Buffalo, New York
| | - Niels Bergsland
- Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York (SUNY), Buffalo, New York.,Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York (SUNY), Buffalo, New York
| | - Deepa P Ramasamy
- Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York (SUNY), Buffalo, New York.,Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York (SUNY), Buffalo, New York
| | - Bianca Weinstock-Guttman
- Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York (SUNY), Buffalo, New York
| | - Robert Zivadinov
- Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York (SUNY), Buffalo, New York.,Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York (SUNY), Buffalo, New York.,Center for Biomedical Imaging, Clinical Translational Science Institute, University at Buffalo, State University of New York (SUNY), Buffalo, New York
| | - Michael G Dwyer
- Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York (SUNY), Buffalo, New York.,Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York (SUNY), Buffalo, New York
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41
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Kartschmit N, Mikolajczyk R, Schubert T, Lacruz ME. Measuring Cognitive Reserve (CR) - A systematic review of measurement properties of CR questionnaires for the adult population. PLoS One 2019; 14:e0219851. [PMID: 31390344 PMCID: PMC6685632 DOI: 10.1371/journal.pone.0219851] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 07/02/2019] [Indexed: 02/07/2023] Open
Abstract
Aim The aim of this systematic review was to summarize and critically appraise the quality of published literature on measurement properties of questionnaires assessing Cognitive Reserve (CR) in adults (>18 years). Methods We systematically searched for published studies on MEDLINE, PsycINFO, and Web of Science through August 2018. We evaluated the methodological quality of the included studies and the results on measurement properties based on a consensus-based standard checklist. Results The search strategy identified 991 publications, of which 37 were selected evaluating the measurement properties of six different questionnaires. Construct validity of the Cognitive Reserve Index questionnaire was most extensively evaluated, while evaluation of the remaining measurement properties of this questionnaire was scarce. Measurement properties of the Cognitive Reserve Questionnaire and the Cognitive Reserve Scale were assessed more completely. While the Lifetime of Experience Questionnaire seems to be the most thorough instrument, a finale recommendation for one specific questionnaire cannot be drawn, since about half of the measurement properties for each questionnaire were poorly or not assessed at all. Conclusions There is a need of high quality methodological studies assessing measurement properties of CR questionnaires, especially regarding content validity, structural validity, and responsiveness. Trial registration PROSPERO Registration number CRD42018107766.
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Affiliation(s)
- Nadja Kartschmit
- Institute for Medical Epidemiology, Biometrics, and Informatics (IMEBI), Medical Faculty of the Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Rafael Mikolajczyk
- Institute for Medical Epidemiology, Biometrics, and Informatics (IMEBI), Medical Faculty of the Martin Luther University Halle-Wittenberg, Halle, Germany
- * E-mail:
| | - Torsten Schubert
- Department of Psychology, Martin-Luther University Halle-Wittenberg, Halle, Germany
| | - Maria Elena Lacruz
- Institute for Medical Epidemiology, Biometrics, and Informatics (IMEBI), Medical Faculty of the Martin Luther University Halle-Wittenberg, Halle, Germany
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42
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Franzmeier N, Düzel E, Jessen F, Buerger K, Levin J, Duering M, Dichgans M, Haass C, Suárez-Calvet M, Fagan AM, Paumier K, Benzinger T, Masters CL, Morris JC, Perneczky R, Janowitz D, Catak C, Wolfsgruber S, Wagner M, Teipel S, Kilimann I, Ramirez A, Rossor M, Jucker M, Chhatwal J, Spottke A, Boecker H, Brosseron F, Falkai P, Fliessbach K, Heneka MT, Laske C, Nestor P, Peters O, Fuentes M, Menne F, Priller J, Spruth EJ, Franke C, Schneider A, Kofler B, Westerteicher C, Speck O, Wiltfang J, Bartels C, Araque Caballero MÁ, Metzger C, Bittner D, Weiner M, Lee JH, Salloway S, Danek A, Goate A, Schofield PR, Bateman RJ, Ewers M. Left frontal hub connectivity delays cognitive impairment in autosomal-dominant and sporadic Alzheimer's disease. Brain 2019; 141:1186-1200. [PMID: 29462334 PMCID: PMC5888938 DOI: 10.1093/brain/awy008] [Citation(s) in RCA: 73] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 12/01/2017] [Indexed: 12/02/2022] Open
Abstract
Patients with Alzheimer’s disease vary in their ability to sustain cognitive abilities in the presence of brain pathology. A major open question is which brain mechanisms may support higher reserve capacity, i.e. relatively high cognitive performance at a given level of Alzheimer’s pathology. Higher functional MRI-assessed functional connectivity of a hub in the left frontal cortex is a core candidate brain mechanism underlying reserve as it is associated with education (i.e. a protective factor often associated with higher reserve) and attenuated cognitive impairment in prodromal Alzheimer’s disease. However, no study has yet assessed whether such hub connectivity of the left frontal cortex supports reserve throughout the evolution of pathological brain changes in Alzheimer’s disease, including the presymptomatic stage when cognitive decline is subtle. To address this research gap, we obtained cross-sectional resting state functional MRI in 74 participants with autosomal dominant Alzheimer’s disease, 55 controls from the Dominantly Inherited Alzheimer’s Network and 75 amyloid-positive elderly participants, as well as 41 amyloid-negative cognitively normal elderly subjects from the German Center of Neurodegenerative Diseases multicentre study on biomarkers in sporadic Alzheimer’s disease. For each participant, global left frontal cortex connectivity was computed as the average resting state functional connectivity between the left frontal cortex (seed) and each voxel in the grey matter. As a marker of disease stage, we applied estimated years from symptom onset in autosomal dominantly inherited Alzheimer’s disease and cerebrospinal fluid tau levels in sporadic Alzheimer’s disease cases. In both autosomal dominant and sporadic Alzheimer’s disease patients, higher levels of left frontal cortex connectivity were correlated with greater education. For autosomal dominant Alzheimer’s disease, a significant left frontal cortex connectivity × estimated years of onset interaction was found, indicating slower decline of memory and global cognition at higher levels of connectivity. Similarly, in sporadic amyloid-positive elderly subjects, the effect of tau on cognition was attenuated at higher levels of left frontal cortex connectivity. Polynomial regression analysis showed that the trajectory of cognitive decline was shifted towards a later stage of Alzheimer’s disease in patients with higher levels of left frontal cortex connectivity. Together, our findings suggest that higher resilience against the development of cognitive impairment throughout the early stages of Alzheimer’s disease is at least partially attributable to higher left frontal cortex-hub connectivity.
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Affiliation(s)
- Nicolai Franzmeier
- Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilians-Universität LMU, Feodor-Lynen Straße 17, 81377 Munich, Germany
| | - Emrah Düzel
- German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany
| | - Frank Jessen
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Sigmund-Freud-Str. 27, 53127 Bonn, Germany.,Department of Psychiatry, University of Cologne, Medical Faculty, Kerpener Strasse 62, 50924 Cologne, Germany
| | - Katharina Buerger
- Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilians-Universität LMU, Feodor-Lynen Straße 17, 81377 Munich, Germany.,German Center for Neurodegenerative Diseases (DZNE, Munich), Munich, Germany
| | - Johannes Levin
- German Center for Neurodegenerative Diseases (DZNE, Munich), Munich, Germany.,Department of Neurology, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Marco Duering
- Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilians-Universität LMU, Feodor-Lynen Straße 17, 81377 Munich, Germany
| | - Martin Dichgans
- Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilians-Universität LMU, Feodor-Lynen Straße 17, 81377 Munich, Germany.,German Center for Neurodegenerative Diseases (DZNE, Munich), Munich, Germany.,Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Christian Haass
- German Center for Neurodegenerative Diseases (DZNE, Munich), Munich, Germany.,Munich Cluster for Systems Neurology (SyNergy), Munich, Germany.,Biomedical Center, Biochemistry, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Marc Suárez-Calvet
- German Center for Neurodegenerative Diseases (DZNE, Munich), Munich, Germany.,Biomedical Center, Biochemistry, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Anne M Fagan
- Department of Radiology, Washington University in St Louis, St Louis, Missouri, USA.,Knight Alzheimer's Disease Research Center, Washington University in St. Louis, St. Louis, MO, USA.,Hope Center for Neurological Disorders, Washington University in St. Louis, St. Louis, MO, USA
| | - Katrina Paumier
- Department of Radiology, Washington University in St Louis, St Louis, Missouri, USA
| | - Tammie Benzinger
- Department of Radiology, Washington University in St Louis, St Louis, Missouri, USA.,Knight Alzheimer's Disease Research Center, Washington University in St. Louis, St. Louis, MO, USA
| | - Colin L Masters
- The Florey Institute, The University of Melbourne, Parkville, Victoria, Australia
| | - John C Morris
- Department of Radiology, Washington University in St Louis, St Louis, Missouri, USA.,Knight Alzheimer's Disease Research Center, Washington University in St. Louis, St. Louis, MO, USA.,Hope Center for Neurological Disorders, Washington University in St. Louis, St. Louis, MO, USA
| | - Robert Perneczky
- German Center for Neurodegenerative Diseases (DZNE, Munich), Munich, Germany.,Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-Universität München, Nußbaumstr. 7, 80336 Munich, Germany.,Neuroepidemiology and Ageing Research Unit, School of Public Health, The Imperial College of Science, Technology and Medicine, Exhibition Road, SW7 2AZ London, UK.,West London Mental Health Trust, 13 Uxbridge Road, UB1 3EU London, UK
| | - Daniel Janowitz
- Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilians-Universität LMU, Feodor-Lynen Straße 17, 81377 Munich, Germany
| | - Cihan Catak
- Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilians-Universität LMU, Feodor-Lynen Straße 17, 81377 Munich, Germany
| | - Steffen Wolfsgruber
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Sigmund-Freud-Str. 27, 53127 Bonn, Germany.,Department of Psychiatry and Psychotherapy, University of Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany
| | - Michael Wagner
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Sigmund-Freud-Str. 27, 53127 Bonn, Germany.,Department of Psychiatry and Psychotherapy, University of Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany.,Department of Neurodegeneration and Geriatric Psychiatry, University of Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany
| | - Stefan Teipel
- German Center for Neurodegenerative Diseases (DZNE), Rostock, Germany.,Department of Psychosomatic, University of Rostock, Gehlsheimer Str. 20, 18147 Rostock, Germany
| | - Ingo Kilimann
- Department of Neurodegeneration and Geriatric Psychiatry, University of Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany.,German Center for Neurodegenerative Diseases (DZNE), Rostock, Germany
| | - Alfredo Ramirez
- Department of Psychiatry, University of Cologne, Medical Faculty, Kerpener Strasse 62, 50924 Cologne, Germany.,Department of Psychiatry and Psychotherapy, University of Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany.,Institute of Human Genetics, University of Bonn, 53127, Bonn, Germany
| | - Martin Rossor
- Dementia Research Centre, University College London, Queen Square, London, UK
| | - Mathias Jucker
- Hertie Institute for Clinical Brain Research, Tübingen, Germany and German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - Jasmeer Chhatwal
- Departments of Neurology, Massachusetts General Hospital, Charlestown HealthCare Center, Charlestown, Massachusetts 02129, USA.,Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown HealthCare Center, Charlestown, Massachusetts 02129, USA
| | - Annika Spottke
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Sigmund-Freud-Str. 27, 53127 Bonn, Germany.,Department of Neurology, University of Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany
| | - Henning Boecker
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Sigmund-Freud-Str. 27, 53127 Bonn, Germany.,Department of Radiology, University of Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany
| | - Frederic Brosseron
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Sigmund-Freud-Str. 27, 53127 Bonn, Germany.,Department of Neurodegeneration and Geriatric Psychiatry, University of Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany
| | - Peter Falkai
- German Center for Neurodegenerative Diseases (DZNE, Munich), Munich, Germany.,Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-Universität München, Nußbaumstr. 7, 80336 Munich, Germany
| | - Klaus Fliessbach
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Sigmund-Freud-Str. 27, 53127 Bonn, Germany.,Department of Neurodegeneration and Geriatric Psychiatry, University of Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany
| | - Michael T Heneka
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Sigmund-Freud-Str. 27, 53127 Bonn, Germany.,Department of Neurodegeneration and Geriatric Psychiatry, University of Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany
| | - Christoph Laske
- Dementia Research Centre, University College London, Queen Square, London, UK.,Section for Dementia Research, Hertie Institute for Clinical Brain Research and Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Peter Nestor
- German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany.,Queensland Brain Institute, University of Queensland, Brisbane, Australia
| | - Oliver Peters
- German Center for Neurodegenerative Diseases (DZNE), Berlin, Germany.,Department of Psychiatry and Psychotherapy, Charité, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Manuel Fuentes
- German Center for Neurodegenerative Diseases (DZNE), Berlin, Germany
| | - Felix Menne
- German Center for Neurodegenerative Diseases (DZNE), Berlin, Germany.,Department of Psychiatry and Psychotherapy, Charité, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Josef Priller
- German Center for Neurodegenerative Diseases (DZNE), Berlin, Germany.,Department of Neuropsychiatry, Charite - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Eike J Spruth
- German Center for Neurodegenerative Diseases (DZNE), Berlin, Germany.,Department of Neuropsychiatry, Charite - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Christiana Franke
- German Center for Neurodegenerative Diseases (DZNE), Berlin, Germany.,Department of Neuropsychiatry, Charite - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Anja Schneider
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Sigmund-Freud-Str. 27, 53127 Bonn, Germany.,Department of Neurodegeneration and Geriatric Psychiatry, University of Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany
| | - Barbara Kofler
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Sigmund-Freud-Str. 27, 53127 Bonn, Germany.,Department of Psychiatry and Psychotherapy, University of Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany
| | - Christine Westerteicher
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Sigmund-Freud-Str. 27, 53127 Bonn, Germany.,Department of Psychiatry and Psychotherapy, University of Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany
| | - Oliver Speck
- German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany.,Leibniz Institute for Neurobiology, Magdeburg, Germany.,Center for Behavioral Brain Sciences, Magdeburg, Germany.,Department of Biomedical Magnetic Resonance, Leipziger Str. 44, 39120 Magdeburg, Germany
| | - Jens Wiltfang
- German Center for Neurodegenerative Diseases (DZNE), Goettingen, Germany.,Department of Psychiatry and Psychotherapy, University Medical Center Goettingen, University of Goettingen, Von-Siebold-Str. 5, 37075 Goettingen, Germany.,iBiMED, Medical Sciences Department, University of Aveiro, Aveiro, Portugal
| | - Claudia Bartels
- Department of Psychiatry and Psychotherapy, University Medical Center Goettingen, University of Goettingen, Von-Siebold-Str. 5, 37075 Goettingen, Germany
| | - Miguel Ángel Araque Caballero
- Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilians-Universität LMU, Feodor-Lynen Straße 17, 81377 Munich, Germany
| | - Coraline Metzger
- German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany
| | - Daniel Bittner
- German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany
| | - Michael Weiner
- University of California at San Francisco, 505 Parnassus Ave, San Francisco, CA94143, USA
| | - Jae-Hong Lee
- Department of Neurology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Stephen Salloway
- Department of Neurology, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Adrian Danek
- German Center for Neurodegenerative Diseases (DZNE, Munich), Munich, Germany.,Department of Neurology, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Alison Goate
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Ronald M. Loeb Center for Alzheimer's Disease, Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Peter R Schofield
- Neuroscience Research Australia, Barker Street Randwick, Sydney 2031, Australia.,School of Medical Sciences, University of New South Wales, Sydney 2052, Australia
| | - Randall J Bateman
- Department of Radiology, Washington University in St Louis, St Louis, Missouri, USA.,Knight Alzheimer's Disease Research Center, Washington University in St. Louis, St. Louis, MO, USA.,Hope Center for Neurological Disorders, Washington University in St. Louis, St. Louis, MO, USA
| | - Michael Ewers
- Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilians-Universität LMU, Feodor-Lynen Straße 17, 81377 Munich, Germany
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43
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Zivadinov R, Dwyer MG. Network Dynamics and Cognitive Impairment in Multiple Sclerosis: Functional MRI-based Decoupling of Complex Relationships. Radiology 2019; 292:458-459. [PMID: 31237815 DOI: 10.1148/radiol.2019191125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Robert Zivadinov
- From the Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, 100 High St, Buffalo, NY 14203; and Center for Biomedical Imaging at the Clinical Translational Science Institute, University at Buffalo, State University of New York, Buffalo, NY
| | - Michael G Dwyer
- From the Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, 100 High St, Buffalo, NY 14203; and Center for Biomedical Imaging at the Clinical Translational Science Institute, University at Buffalo, State University of New York, Buffalo, NY
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44
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Abstract
Millions of Americans now entering midlife and old age were exposed to high levels of lead, a neurotoxin, as children. Evidence from animal-model and human observational studies suggest that childhood lead exposure may raise the risk of adult neurodegenerative disease, particularly dementia, through a variety of possible mechanisms including epigenetic modification, delayed cardiovascular and kidney disease, direct degenerative CNS injury from lead remobilized from bone, and lowered neural and cognitive reserve. Within the next ten years, the generation of children with the highest historical lead exposures, those born in the 1960s, 1970s, and 1980s, will begin to enter the age at which dementia symptoms tend to emerge. Many will also enter the age in which lead stored in the skeleton may be remobilized at greater rates, particularly for women entering menopause and men and women experiencing osteoporosis. Should childhood lead exposure prove pro-degenerative, the next twenty years will provide the last opportunities for possible early intervention to forestall greater degenerative disease burden across the aging lead-exposed population. More evidence is needed now to characterize the nature and magnitude of the degenerative risks facing adults exposed to lead as children and to identify interventions to limit long-term harm.
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Affiliation(s)
- Aaron Reuben
- Department of Psychology and Neuroscience, Duke University, Durham, NC, USA
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45
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Klineova S, Brandstadter R, Fabian MT, Sand IK, Krieger S, Leavitt VM, Lewis C, Riley CS, Lublin F, Miller AE, Sumowski JF. Psychological resilience is linked to motor strength and gait endurance in early multiple sclerosis. Mult Scler 2019; 26:1111-1120. [PMID: 31172846 DOI: 10.1177/1352458519852725] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Psychologically resilient persons persist despite obstacles and bounce back after adversity, leading to better outcomes in non-neurologic populations. It is unknown whether psychological resilience relates to objective functional outcomes in multiple sclerosis (MS). OBJECTIVE To determine whether psychological resilience explains differential objective cognitive and motor functioning in persons with early MS. METHODS Psychological resilience was assessed in 185 patients with early MS and 50 matched healthy controls with the Connors-Davidson Resilience Scale (CDRS-10). Subjects completed the MS Functional Composite (MSFC) and a comprehensive neurobehavioral evaluation. Correlations assessed links between CDRS-10 and MSFC, motor indices (Total, Fine Motor, Gross Motor), and cognitive indices (Total, Cognitive Efficiency, Memory). RESULTS Higher CDRS-10 among patients was linked to better MSFC and motor outcomes (but not cognition), with the most robust relationships for gross motor function (grip strength, gait endurance). Findings were independent of mood and fatigue. CDRS-10 was unrelated to MS disease burden. CDRS-10 was also specifically linked to motor outcomes in healthy controls. CONCLUSION Functional outcomes vary across persons with MS, even when disease burden and neurologic disability are low. These findings identify high psychological resilience as a non-disease-specific contributor to motor strength and endurance, which may explain differential outcomes across patients.
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Affiliation(s)
- Sylvia Klineova
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Rachel Brandstadter
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Michelle T Fabian
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ilana Katz Sand
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Stephen Krieger
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Victoria M Leavitt
- Department of Neurology, Columbia University Medical Center, New York, NY, USA
| | - Christina Lewis
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Claire S Riley
- Department of Neurology, Columbia University Medical Center, New York, NY, USA
| | - Fred Lublin
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Aaron E Miller
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - James F Sumowski
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Does cognitive reserve play any role in multiple sclerosis? A meta-analytic study. Mult Scler Relat Disord 2019; 30:265-276. [DOI: 10.1016/j.msard.2019.02.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 02/07/2019] [Accepted: 02/11/2019] [Indexed: 12/12/2022]
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Filippi M, Preziosa P, Rocca MA. Brain mapping in multiple sclerosis: Lessons learned about the human brain. Neuroimage 2019; 190:32-45. [DOI: 10.1016/j.neuroimage.2017.09.021] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 09/07/2017] [Accepted: 09/09/2017] [Indexed: 02/07/2023] Open
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Amato MP, Prestipino E, Bellinvia A. Identifying risk factors for cognitive issues in multiple sclerosis. Expert Rev Neurother 2019; 19:333-347. [PMID: 30829076 DOI: 10.1080/14737175.2019.1590199] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Cognitive impairment (CI) in Multiple Sclerosis (MS) has progressively regained clinical and research interest and is currently recognized as a debilitating and burdensome problem for these patients. Studying risk and protecting factors that may influence the development and course of CI is currently an area of increasing interest, due to the potential for preventive strategies. Areas covered: In this narrative review the authors briefly addressed the physiopathologic basis, assessment and management of CI in MS and then focused on identifying modifiable and not modifiable risk factors for CI in MS, providing an overview of the current knowledge in the field and indicating avenues for future research. Expert opinion: Improving our understanding of potentially modifiable environmental and lifestyle risk factors or protective factors for CI is important in order to prompt preventive strategies and orient patient counselling and clinical management. To this aim, we need to enhance the current level of evidence linking lifestyle factors to cognition and evaluate some factors that were only preliminary addressed in research. Moreover, we need to explore the role of each factor into the subject cognitive outcome, next to the possible interactions between different environmental factors as well as between environmental and genetic factors.
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Affiliation(s)
- Maria Pia Amato
- a NEUROFARBA Department, Neuroscience section , University of Florence , Florence , Italy.,b IRCSS Fondazione Don Carlo Gnocchi , Florence , Italy
| | - Elio Prestipino
- a NEUROFARBA Department, Neuroscience section , University of Florence , Florence , Italy
| | - Angelo Bellinvia
- a NEUROFARBA Department, Neuroscience section , University of Florence , Florence , Italy
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Prevalence of Cognitive Impairment and Its Predictors among HIV/AIDS Patients on Antiretroviral Therapy in Jimma University Medical Center, Southwest Ethiopia. PSYCHIATRY JOURNAL 2019; 2019:8306823. [PMID: 31001550 PMCID: PMC6436374 DOI: 10.1155/2019/8306823] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Revised: 02/09/2019] [Accepted: 02/24/2019] [Indexed: 11/18/2022]
Abstract
Background Cognitive impairment among human immunodeficiency virus (HIV) infected patients can lead to treatment nonadherence, faster progression of the illness, disability, and bed ridden state if we fail to detect it early. However, there is scarcity of previous published studies in Ethiopia on the assessment of cognitive impairment among HIV-positive patients. Hence, this study aimed to determine the prevalence and associated factors of cognitive impairment among HIV-positive patients receiving antiretroviral therapy (ART) at Jimma University Medical Center, Ethiopia. Methods Hospital-based cross-sectional study was conducted among 328 HIV-positive patients attending Jimma University Medical Center, Ethiopia. Data were collected from a face-to-face interview and review of medical records using semistructured questionnaire. Validated International HIV Dementia Scale (IHDS) was used to screen for cognitive impairment. Data was analyzed using SPSS version 20. Results A total of 328 (191 females and 137 males) HIV-positive patients were included in the study with a response rate of 97.04%. The prevalence of cognitive impairment among HIV-positive patients was 35.7%. Factors significantly associated with cognitive impairment were age group of 41-64 years (adjusted odds ratio [AOR] = 3.1, 95% confidence interval [CI] (1.3, 7.4)], plasma HIV-1 RNA load between 1.7log10 and 3log10 copies/ml [AOR = 2.2, 95% CI (1.1,4.3)] and ≥ 3log10 copies/ml [AOR = 7.5, 95% CI (2.6, 21.5)], khat chewing [AOR = 4.4, 95% CI (2.3, 8.3)], and clinical stage III of the disease [AOR = 5.6, 95% CI (1.7, 19.2)]. Conclusion Despite the use of ART, the burden of cognitive impairment among HIV patients was high. Older age, khat chewing, advanced stage of the disease, and higher viral load were the independent factors associated with cognitive impairment. Thus, continuous screening of cognitive impairment, identification of the possible risk factors, and proper management strategy should be designed.
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Abstract
PURPOSE OF REVIEW The aim of this review is to summarize current conceptual models of cognitive reserve (CR) and related concepts and to discuss evidence for these concepts within the context of aging and Alzheimer's disease. RECENT FINDINGS Evidence to date supports the notion that higher levels of CR, as measured by proxy variables reflective of lifetime experiences, are associated with better cognitive performance, and with a reduced risk of incident mild cognitive impairment/dementia. However, the impact of CR on longitudinal cognitive trajectories is unclear and may be influenced by a number of factors. Although there is promising evidence that some proxy measures of CR may influence structural brain measures, more research is needed. The protective effects of CR may provide an important mechanism for preserving cognitive function and cognitive well-being with age, in part because it can be enhanced throughout the lifespan. However, more research on the mechanisms by which CR is protective is needed.
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Affiliation(s)
- Corinne Pettigrew
- Department of Neurology, Johns Hopkins University School of Medicine, 1620 McElderry St., Reed Hall 1-West, Baltimore, MD, 21205, USA
| | - Anja Soldan
- Department of Neurology, Johns Hopkins University School of Medicine, 1620 McElderry St., Reed Hall 1-West, Baltimore, MD, 21205, USA.
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