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Stein C, O'Keeffe F, Strahan O, McGuigan C, Bramham J. Systematic review of cognitive reserve in multiple sclerosis: Accounting for physical disability, fatigue, depression, and anxiety. Mult Scler Relat Disord 2023; 79:105017. [PMID: 37806233 DOI: 10.1016/j.msard.2023.105017] [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: 06/21/2023] [Revised: 08/03/2023] [Accepted: 09/17/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND Cognitive reserve (CR) describes an individual's ability to adapt cognitive processes in response to brain atrophy, and has been reported to explain some of the discrepancy between brain atrophy and cognitive functioning outcomes in multiple sclerosis (MS). CR in MS is typically investigated by assessing an individual's pre- and/or post-diagnosis enrichment, which includes premorbid intellectual abilities, educational level, occupational attainment, and engagement in cognitively enriching leisure activities. Common MS symptoms (e.g., physical disability, fatigue, depression, anxiety) may impact an individual's ability to engage in various CR-enhancing activities post-diagnosis. It is unknown to what extent these MS symptoms have been taken into account in MS research on CR. As such, we identified whether studies assessed CR using measures of premorbid or continuous (including post-diagnosis) enrichment. For studies investigating continuous enrichment, we identified whether studies accounted for MS-impact, which MS symptoms were accounted for, and how, and whether studies acknowledged MS symptoms as potential CR-confounds. METHODS Three electronic databases (PsycINFO, PubMed, Scopus) were searched. Eligible studies investigated CR proxies (e.g., estimated premorbid intellectual abilities, vocabulary knowledge, educational level, occupational attainment, cognitively enriching leisure activities, or a combination thereof) in relation to cognitive, brain atrophy or connectivity, or daily functioning outcomes in adult participants with MS. We extracted data on methods and measures used, including any MS symptoms taken into account. Objectives were addressed using frequency analyses and narrative synthesis. RESULTS 115 studies were included in this review. 47.8% of all studies investigated continuous enrichment. Approximately half of the studies investigating continuous enrichment accounted for potential MS-impact in their analyses, with only 31.0% clearly identifying that they treated MS symptoms as potential confounds for CR-enhancement. A narrative synthesis of studies which investigated CR with and without controlling statistically for MS-impact indicated that accounting for MS symptoms may impact findings concerning the protective nature of CR. CONCLUSION Fewer than half of the studies investigating CR proxies in MS involved continuous enrichment. Just over half of these studies accounted for potential MS-impact in their analyses. To achieve a more complete and accurate understanding of CR in MS, future research should investigate both pre-MS and continuous enrichment. In doing so, MS symptoms and their potential impact should be considered. Establishing greater consistency and rigour across CR research in MS will be crucial to produce an evidence base for the development of interventions aimed at improving quality of care and life for pwMS.
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Affiliation(s)
- Clara Stein
- University College Dublin, Belfield, Dublin 4, Ireland.
| | - Fiadhnait O'Keeffe
- University College Dublin, Belfield, Dublin 4, Ireland; St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Orla Strahan
- University College Dublin, Belfield, Dublin 4, Ireland
| | - Christopher McGuigan
- University College Dublin, Belfield, Dublin 4, Ireland; St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Jessica Bramham
- University College Dublin, Belfield, Dublin 4, Ireland; St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
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Morrow SA, Kruger P, Langdon D, Alexandri N. What Is the True Impact of Cognitive Impairment for People Living with Multiple Sclerosis? A Commentary of Symposium Discussions at the 2020 European Charcot Foundation. Neurol Ther 2023; 12:1419-1429. [PMID: 37466762 PMCID: PMC10444737 DOI: 10.1007/s40120-023-00519-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 06/15/2023] [Indexed: 07/20/2023] Open
Abstract
Multiple sclerosis (MS) is a chronic, neurodegenerative, inflammatory condition usually associated with physical disability. Clinical care has been skewed toward the physical manifestations of the disease, yet a range of silent symptoms occurs including the cognitive aspects of MS. In a 2018 meeting of MS in the 21st Century (MS21), an international steering committee comprising both specialists and patient experts recognised that the 'invisible symptoms' of MS pose a significant challenge to patient engagement. These findings prompted the European Charcot Foundation (ECF) MS21 symposium (2020), where a panel consisting of two leading MS clinicians and an MS patient expert (who were all members of the MS21 steering group) gathered to discuss the impact of cognitive impairment on the everyday lives of people with MS.The perspectives and experiences of the panellists are summarised in this paper. The key points raised were that (1) the cognitive manifestations of MS are under-recognised and have consequently been undermanaged from a clinical perspective and (2) cognitive impairment due to MS has a significant impact upon daily living and patient quality of life. During discussions about how these challenges can be addressed, the panel advocated for an improvement in education about cognitive symptoms for people living with MS and healthcare professionals (HCPs) to raise awareness about this aspect of MS. Furthermore, the panel emphasised the importance of open and proactive communication between HCPs and their patients with MS about cognitive symptoms to reduce the stigma attached to these symptoms. In the opinion of the panel, future clinical trials which include cognitive outcomes as key endpoints are needed. Reflecting this point, cognitive impairment in MS care also needs to be treated as an important disease symptom, as is done with physical symptoms of the disease. Implementing early and routine cognition screening and promoting measures for protecting cognition to people living with MS, such as cognitive rehabilitation and a 'brain-healthy' lifestyle, are actions which can drive forward the recognition of cognitive impairment as a care priority.If prioritised as highly as physical disability in both the MS care and clinical drug development setting, and proactively discussed in conversations between HCPs and patients with MS, the 'invisibility' of cognitive impairment in MS can be lifted and a better quality of life can be promoted for people living with MS.
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Affiliation(s)
- Sarah A Morrow
- Department of Clinical Neurological Sciences, Western University, London, ON, Canada.
- Department of Clinical Neurological Sciences, London Health Sciences Centre, University Hospital, 339 Windermere Road, London, ON, N6A 5A5, Canada.
| | | | - Dawn Langdon
- Professor of Neuropsychology, Royal Holloway, University of London, London, UK
| | - Nektaria Alexandri
- Global Medical Affairs, Neurology and Immunology, The Healthcare Business of Merck KGaA, Darmstadt, Germany
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Margoni M, Preziosa P, Rocca MA, Filippi M. Depressive symptoms, anxiety and cognitive impairment: emerging evidence in multiple sclerosis. Transl Psychiatry 2023; 13:264. [PMID: 37468462 PMCID: PMC10356956 DOI: 10.1038/s41398-023-02555-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 06/28/2023] [Accepted: 06/30/2023] [Indexed: 07/21/2023] Open
Abstract
Neuropsychiatric abnormalities may be broadly divided in two categories: disorders of mood, affect, and behavior and abnormalities affecting cognition. Among these conditions, clinical depression, anxiety and neurocognitive disorders are the most common in multiple sclerosis (MS), with a substantial impact on patients' quality of life and adherence to treatments. Such manifestations may occur from the earliest phases of the disease but become more frequent in MS patients with a progressive disease course and more severe clinical disability. Although the pathogenesis of these neuropsychiatric manifestations has not been fully defined yet, brain structural and functional abnormalities, consistently observed with magnetic resonance imaging (MRI), together with genetic and immunologic factors, have been suggested to be key players. Even though the detrimental clinical impact of such manifestations in MS patients is a matter of crucial importance, at present, they are often overlooked in the clinical setting. Moreover, the efficacy of pharmacologic and non-pharmacologic approaches for their amelioration has been poorly investigated, with the majority of studies showing marginal or no beneficial effect of different therapeutic approaches, possibly due to the presence of multiple and heterogeneous underlying pathological mechanisms and intrinsic methodological limitations. A better evaluation of these manifestations in the clinical setting and improvements in the understanding of their pathophysiology may offer the potential to develop tools for differentiating these mechanisms in individual patients and ultimately provide a principled basis for treatment selection. This review provides an updated overview regarding the pathophysiology of the most common neuropsychiatric symptoms in MS, the clinical and MRI characteristics that have been associated with mood disorders (i.e., depression and anxiety) and cognitive impairment, and the treatment approaches currently available or under investigation.
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Affiliation(s)
- Monica Margoni
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Paolo Preziosa
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Maria A Rocca
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.
- Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
- Vita-Salute San Raffaele University, Milan, Italy.
- Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy.
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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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Ringin E, Meyer D, Neill E, Phillipou A, Tan EJ, Toh WL, Sumner PJ, Owen N, Hallgren M, Dunstan DW, Rossell SL, Van Rheenen TE. Psychological-health correlates of physical activity and sedentary behaviour during the COVID pandemic. Ment Health Phys Act 2022; 23:100481. [PMID: 36406837 PMCID: PMC9664206 DOI: 10.1016/j.mhpa.2022.100481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 10/04/2022] [Accepted: 10/05/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND While physical inactivity is associated with adverse psychological outcomes, less is known about the psychological outcomes associated with sedentary behaviour, and specifically, its mentally active and passive forms. The COVID-19 pandemic represents a unique opportunity to study associations between these variables in light of widespread stay-at-home mandates and restrictions on outdoor exercise/social activities. Using a cross-sectional dataset acquired during the COVID-19 pandemic in Australia, we examined whether physical activity and sedentary behaviour were associated with subjective quality of life (sQoL) and subjective cognitive dysfunction, and whether these associations were mediated by depressive symptoms. METHODS 658 participants (males = 169, females = 489) self-reported data on physical activity and sedentary behaviour in an online survey during May 2020-May 2021. Data on physical activity and sedentary behaviour (both mentally active and passive types) was compared according to whether it was collected during or out of a lockdown period. Regression models were used to test associations of physical activity and sedentary behaviour with sQoL and subjective cognitive dysfunction, and whether these associations were mediated by depression severity. RESULTS Physical activity was beneficially associated with sQoL, whereas sedentary behaviour (both total hours and the reduction of mentally active/increase in mentally passive behaviour) was detrimentally associated with sQoL. These associations were mediated by depression severity. Physical activity and sedentary behaviour were also indirectly associated with subjective cognitive dysfunction by virtue of their associations with depression severity. CONCLUSIONS There are important differences in the psychological correlates of mentally passive and active sedentary behaviours. Our findings suggest that health promotion strategies should focus on not only increasing physical activity but also reducing passive sedentary behaviours as a means of maintaining good psychological health.
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Affiliation(s)
- Elysha Ringin
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne and Melbourne Health, Melbourne, Australia
| | - Denny Meyer
- Centre for Mental Health, School of Health Sciences, Swinburne University, Melbourne, Australia
| | - Erica Neill
- Centre for Mental Health, School of Health Sciences, Swinburne University, Melbourne, Australia
- St Vincent's Mental Health, St Vincent's Hospital, Victoria, Australia
| | - Andrea Phillipou
- Centre for Mental Health, School of Health Sciences, Swinburne University, Melbourne, Australia
- Department of Mental Health, Austin Hospital, Melbourne, Victoria, Australia
| | - Eric J Tan
- Centre for Mental Health, School of Health Sciences, Swinburne University, Melbourne, Australia
- St Vincent's Mental Health, St Vincent's Hospital, Victoria, Australia
| | - Wei Lin Toh
- Centre for Mental Health, School of Health Sciences, Swinburne University, Melbourne, Australia
| | - Philip J Sumner
- Centre for Mental Health, School of Health Sciences, Swinburne University, Melbourne, Australia
| | - Neville Owen
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
- Centre for Urban Transitions, Swinburne University of Technology, Melbourne, Victoria, Australia
| | - Mats Hallgren
- Epidemiology of Psychiatric Conditions, Substance Use and Social Environment (EPiCSS), Department of Global Public Health Sciences, Karolinska Institutet, Stockholm, 171 77, Sweden
| | - David W Dunstan
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Susan L Rossell
- Centre for Mental Health, School of Health Sciences, Swinburne University, Melbourne, Australia
- St Vincent's Mental Health, St Vincent's Hospital, Victoria, Australia
| | - Tamsyn E Van Rheenen
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne and Melbourne Health, Melbourne, Australia
- Centre for Mental Health, School of Health Sciences, Swinburne University, Melbourne, Australia
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6
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Kever A, Buyukturkoglu K, Levin SN, Riley CS, De Jager P, Leavitt VM. Associations of social network structure with cognition and amygdala volume in multiple sclerosis: An exploratory investigation. Mult Scler 2021; 28:228-236. [PMID: 34037495 DOI: 10.1177/13524585211018349] [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] [Indexed: 11/16/2022]
Abstract
BACKGROUND Humans are inherently social, biologically programmed to connect with others. Social connections are known to impact mental and physical health. OBJECTIVE The aim of this study was to test whether social network structure is linked to cognition, mood, fatigue, and regional brain volumes in persons with multiple sclerosis (MS). METHODS A questionnaire quantifying individual-level social network structure (size, density, effective size, and constraint), a comprehensive battery of neuropsychological tests, and magnetic resonance imaging (MRI) was administered to 51 persons with relapsing-remitting MS. Linear regressions assessed associations of network variables to cognition, depression, fatigue, and structural brain volumes. RESULTS Higher network density and constraint, indicating stronger connections among network members, were associated with worse language functions. Conversely, larger network effective size, a measure of non-redundant network members, was associated with better language functions. No relationships of network structure to depression or fatigue were found. Larger network size was related to larger amygdala volume. CONCLUSION Findings suggest that social network structure is linked to language function and amygdala volume in persons with MS. Patients with close-knit networks showed worse language function than those with open networks. Longitudinal studies with larger samples are warranted to evaluate potential causal links between social network structure and MS-related cognitive impairment.
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Affiliation(s)
- Anne Kever
- Translational Cognitive Neuroscience Laboratory, Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
| | - Korhan Buyukturkoglu
- Translational Cognitive Neuroscience Laboratory, Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
| | - Seth N Levin
- Multiple Sclerosis Center, Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA/Center for Translational & Computational Neuroimmunology, Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
| | - Claire S Riley
- Multiple Sclerosis Center, Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
| | - Philip De Jager
- Multiple Sclerosis Center, Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA/Center for Translational & Computational Neuroimmunology, Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
| | - Victoria M Leavitt
- Translational Cognitive Neuroscience Laboratory, Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA/Multiple Sclerosis Center, Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
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Levin SN, Riley CS, Dhand A, White CC, Venkatesh S, Boehm B, Nassif C, Socia L, Onomichi K, Leavitt VM, Levine L, Heyman R, Farber RS, Vargas WS, Xia Z, De Jager PL. Association of social network structure and physical function in patients with multiple sclerosis. Neurology 2020; 95:e1565-e1574. [PMID: 32769139 DOI: 10.1212/wnl.0000000000010460] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 03/18/2020] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE To test the association between physical function and the social environment in multiple sclerosis (MS), we quantified personal social networks. METHODS In this cross-sectional study, we analyzed data from 2 academic MS centers, with center 1 serving as a discovery group and center 2 as the extension group. We performed a meta-analysis of the centers to extend the analysis. We used responses from a questionnaire to map the structure and health habits of participants' social networks as well as the NIH Patient-Reported Outcomes Measurement Information System (PROMIS) physical function scale (0-100, mean 50 for US general population) as the primary outcome. We applied multivariable models to test the association between network metrics and physical function. RESULTS The discovery cohort included 263 patients with MS: 81% were women, 96% non-Hispanic European, 78% had relapsing MS, average age was 50 (12.4) years, and mean disease duration was 17 (12.3) years. The extension group included 163 patients, who were younger, more racially diverse, and less physically disabled, and had shorter disease duration. In the meta-analysis, higher network constraint, a measure of tightly bound networks, was associated with worse physical function (β = -0.163 ± 0.047, p < 0.001), while larger network effective size, a measure of clustered groups in the network, correlated with better physical function (β = 0.134 ± 0.046, p = 0.003). CONCLUSIONS Our study highlights personal networks as an important environmental factor associated with physical function in MS. Patients with close-knit networks had worse function than those with more open networks. Longitudinal studies are warranted to evaluate a causal relationship between network structure and physical impairment.
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Affiliation(s)
- Seth N Levin
- From the Multiple Sclerosis Center and the Center for Translational & Computational Neuroimmunology, Department of Neurology (S.N.L., C.S.R., C.N., L.S., K.O., V.M.L., L.L., R.S.F., W.S.V., P.L.D.J.), and The Taub Institute for Alzheimer's Disease Research (P.L.D.J.), Columbia University Irving Medical Center, New York, NY; Department of Neurology (A.D.), Brigham and Women's Hospital, Harvard Medical School; Network Science Institute (A.D.), Northeastern University, Boston; Broad Institute (C.C.W., Z.X., P.L.D.J.), Cell Circuits Program, Cambridge, MA; and Department of Neurology (S.V., B.B., R.H., Z.X.), University of Pittsburgh, PA
| | - Claire S Riley
- From the Multiple Sclerosis Center and the Center for Translational & Computational Neuroimmunology, Department of Neurology (S.N.L., C.S.R., C.N., L.S., K.O., V.M.L., L.L., R.S.F., W.S.V., P.L.D.J.), and The Taub Institute for Alzheimer's Disease Research (P.L.D.J.), Columbia University Irving Medical Center, New York, NY; Department of Neurology (A.D.), Brigham and Women's Hospital, Harvard Medical School; Network Science Institute (A.D.), Northeastern University, Boston; Broad Institute (C.C.W., Z.X., P.L.D.J.), Cell Circuits Program, Cambridge, MA; and Department of Neurology (S.V., B.B., R.H., Z.X.), University of Pittsburgh, PA
| | - Amar Dhand
- From the Multiple Sclerosis Center and the Center for Translational & Computational Neuroimmunology, Department of Neurology (S.N.L., C.S.R., C.N., L.S., K.O., V.M.L., L.L., R.S.F., W.S.V., P.L.D.J.), and The Taub Institute for Alzheimer's Disease Research (P.L.D.J.), Columbia University Irving Medical Center, New York, NY; Department of Neurology (A.D.), Brigham and Women's Hospital, Harvard Medical School; Network Science Institute (A.D.), Northeastern University, Boston; Broad Institute (C.C.W., Z.X., P.L.D.J.), Cell Circuits Program, Cambridge, MA; and Department of Neurology (S.V., B.B., R.H., Z.X.), University of Pittsburgh, PA
| | - Charles C White
- From the Multiple Sclerosis Center and the Center for Translational & Computational Neuroimmunology, Department of Neurology (S.N.L., C.S.R., C.N., L.S., K.O., V.M.L., L.L., R.S.F., W.S.V., P.L.D.J.), and The Taub Institute for Alzheimer's Disease Research (P.L.D.J.), Columbia University Irving Medical Center, New York, NY; Department of Neurology (A.D.), Brigham and Women's Hospital, Harvard Medical School; Network Science Institute (A.D.), Northeastern University, Boston; Broad Institute (C.C.W., Z.X., P.L.D.J.), Cell Circuits Program, Cambridge, MA; and Department of Neurology (S.V., B.B., R.H., Z.X.), University of Pittsburgh, PA
| | - Shruthi Venkatesh
- From the Multiple Sclerosis Center and the Center for Translational & Computational Neuroimmunology, Department of Neurology (S.N.L., C.S.R., C.N., L.S., K.O., V.M.L., L.L., R.S.F., W.S.V., P.L.D.J.), and The Taub Institute for Alzheimer's Disease Research (P.L.D.J.), Columbia University Irving Medical Center, New York, NY; Department of Neurology (A.D.), Brigham and Women's Hospital, Harvard Medical School; Network Science Institute (A.D.), Northeastern University, Boston; Broad Institute (C.C.W., Z.X., P.L.D.J.), Cell Circuits Program, Cambridge, MA; and Department of Neurology (S.V., B.B., R.H., Z.X.), University of Pittsburgh, PA
| | - Blake Boehm
- From the Multiple Sclerosis Center and the Center for Translational & Computational Neuroimmunology, Department of Neurology (S.N.L., C.S.R., C.N., L.S., K.O., V.M.L., L.L., R.S.F., W.S.V., P.L.D.J.), and The Taub Institute for Alzheimer's Disease Research (P.L.D.J.), Columbia University Irving Medical Center, New York, NY; Department of Neurology (A.D.), Brigham and Women's Hospital, Harvard Medical School; Network Science Institute (A.D.), Northeastern University, Boston; Broad Institute (C.C.W., Z.X., P.L.D.J.), Cell Circuits Program, Cambridge, MA; and Department of Neurology (S.V., B.B., R.H., Z.X.), University of Pittsburgh, PA
| | - Caren Nassif
- From the Multiple Sclerosis Center and the Center for Translational & Computational Neuroimmunology, Department of Neurology (S.N.L., C.S.R., C.N., L.S., K.O., V.M.L., L.L., R.S.F., W.S.V., P.L.D.J.), and The Taub Institute for Alzheimer's Disease Research (P.L.D.J.), Columbia University Irving Medical Center, New York, NY; Department of Neurology (A.D.), Brigham and Women's Hospital, Harvard Medical School; Network Science Institute (A.D.), Northeastern University, Boston; Broad Institute (C.C.W., Z.X., P.L.D.J.), Cell Circuits Program, Cambridge, MA; and Department of Neurology (S.V., B.B., R.H., Z.X.), University of Pittsburgh, PA
| | - Lauren Socia
- From the Multiple Sclerosis Center and the Center for Translational & Computational Neuroimmunology, Department of Neurology (S.N.L., C.S.R., C.N., L.S., K.O., V.M.L., L.L., R.S.F., W.S.V., P.L.D.J.), and The Taub Institute for Alzheimer's Disease Research (P.L.D.J.), Columbia University Irving Medical Center, New York, NY; Department of Neurology (A.D.), Brigham and Women's Hospital, Harvard Medical School; Network Science Institute (A.D.), Northeastern University, Boston; Broad Institute (C.C.W., Z.X., P.L.D.J.), Cell Circuits Program, Cambridge, MA; and Department of Neurology (S.V., B.B., R.H., Z.X.), University of Pittsburgh, PA
| | - Kaho Onomichi
- From the Multiple Sclerosis Center and the Center for Translational & Computational Neuroimmunology, Department of Neurology (S.N.L., C.S.R., C.N., L.S., K.O., V.M.L., L.L., R.S.F., W.S.V., P.L.D.J.), and The Taub Institute for Alzheimer's Disease Research (P.L.D.J.), Columbia University Irving Medical Center, New York, NY; Department of Neurology (A.D.), Brigham and Women's Hospital, Harvard Medical School; Network Science Institute (A.D.), Northeastern University, Boston; Broad Institute (C.C.W., Z.X., P.L.D.J.), Cell Circuits Program, Cambridge, MA; and Department of Neurology (S.V., B.B., R.H., Z.X.), University of Pittsburgh, PA
| | - Victoria M Leavitt
- From the Multiple Sclerosis Center and the Center for Translational & Computational Neuroimmunology, Department of Neurology (S.N.L., C.S.R., C.N., L.S., K.O., V.M.L., L.L., R.S.F., W.S.V., P.L.D.J.), and The Taub Institute for Alzheimer's Disease Research (P.L.D.J.), Columbia University Irving Medical Center, New York, NY; Department of Neurology (A.D.), Brigham and Women's Hospital, Harvard Medical School; Network Science Institute (A.D.), Northeastern University, Boston; Broad Institute (C.C.W., Z.X., P.L.D.J.), Cell Circuits Program, Cambridge, MA; and Department of Neurology (S.V., B.B., R.H., Z.X.), University of Pittsburgh, PA
| | - Libby Levine
- From the Multiple Sclerosis Center and the Center for Translational & Computational Neuroimmunology, Department of Neurology (S.N.L., C.S.R., C.N., L.S., K.O., V.M.L., L.L., R.S.F., W.S.V., P.L.D.J.), and The Taub Institute for Alzheimer's Disease Research (P.L.D.J.), Columbia University Irving Medical Center, New York, NY; Department of Neurology (A.D.), Brigham and Women's Hospital, Harvard Medical School; Network Science Institute (A.D.), Northeastern University, Boston; Broad Institute (C.C.W., Z.X., P.L.D.J.), Cell Circuits Program, Cambridge, MA; and Department of Neurology (S.V., B.B., R.H., Z.X.), University of Pittsburgh, PA
| | - Rock Heyman
- From the Multiple Sclerosis Center and the Center for Translational & Computational Neuroimmunology, Department of Neurology (S.N.L., C.S.R., C.N., L.S., K.O., V.M.L., L.L., R.S.F., W.S.V., P.L.D.J.), and The Taub Institute for Alzheimer's Disease Research (P.L.D.J.), Columbia University Irving Medical Center, New York, NY; Department of Neurology (A.D.), Brigham and Women's Hospital, Harvard Medical School; Network Science Institute (A.D.), Northeastern University, Boston; Broad Institute (C.C.W., Z.X., P.L.D.J.), Cell Circuits Program, Cambridge, MA; and Department of Neurology (S.V., B.B., R.H., Z.X.), University of Pittsburgh, PA
| | - Rebecca S Farber
- From the Multiple Sclerosis Center and the Center for Translational & Computational Neuroimmunology, Department of Neurology (S.N.L., C.S.R., C.N., L.S., K.O., V.M.L., L.L., R.S.F., W.S.V., P.L.D.J.), and The Taub Institute for Alzheimer's Disease Research (P.L.D.J.), Columbia University Irving Medical Center, New York, NY; Department of Neurology (A.D.), Brigham and Women's Hospital, Harvard Medical School; Network Science Institute (A.D.), Northeastern University, Boston; Broad Institute (C.C.W., Z.X., P.L.D.J.), Cell Circuits Program, Cambridge, MA; and Department of Neurology (S.V., B.B., R.H., Z.X.), University of Pittsburgh, PA
| | - Wendy S Vargas
- From the Multiple Sclerosis Center and the Center for Translational & Computational Neuroimmunology, Department of Neurology (S.N.L., C.S.R., C.N., L.S., K.O., V.M.L., L.L., R.S.F., W.S.V., P.L.D.J.), and The Taub Institute for Alzheimer's Disease Research (P.L.D.J.), Columbia University Irving Medical Center, New York, NY; Department of Neurology (A.D.), Brigham and Women's Hospital, Harvard Medical School; Network Science Institute (A.D.), Northeastern University, Boston; Broad Institute (C.C.W., Z.X., P.L.D.J.), Cell Circuits Program, Cambridge, MA; and Department of Neurology (S.V., B.B., R.H., Z.X.), University of Pittsburgh, PA
| | - Zongqi Xia
- From the Multiple Sclerosis Center and the Center for Translational & Computational Neuroimmunology, Department of Neurology (S.N.L., C.S.R., C.N., L.S., K.O., V.M.L., L.L., R.S.F., W.S.V., P.L.D.J.), and The Taub Institute for Alzheimer's Disease Research (P.L.D.J.), Columbia University Irving Medical Center, New York, NY; Department of Neurology (A.D.), Brigham and Women's Hospital, Harvard Medical School; Network Science Institute (A.D.), Northeastern University, Boston; Broad Institute (C.C.W., Z.X., P.L.D.J.), Cell Circuits Program, Cambridge, MA; and Department of Neurology (S.V., B.B., R.H., Z.X.), University of Pittsburgh, PA
| | - Philip L De Jager
- From the Multiple Sclerosis Center and the Center for Translational & Computational Neuroimmunology, Department of Neurology (S.N.L., C.S.R., C.N., L.S., K.O., V.M.L., L.L., R.S.F., W.S.V., P.L.D.J.), and The Taub Institute for Alzheimer's Disease Research (P.L.D.J.), Columbia University Irving Medical Center, New York, NY; Department of Neurology (A.D.), Brigham and Women's Hospital, Harvard Medical School; Network Science Institute (A.D.), Northeastern University, Boston; Broad Institute (C.C.W., Z.X., P.L.D.J.), Cell Circuits Program, Cambridge, MA; and Department of Neurology (S.V., B.B., R.H., Z.X.), University of Pittsburgh, PA.
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8
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Van Rheenen TE, Cropley V, Fagerlund B, Wannan C, Bruggemann J, Lenroot RK, Sundram S, Weickert CS, Weickert TW, Zalesky A, Bousman CA, Pantelis C. Cognitive reserve attenuates age-related cognitive decline in the context of putatively accelerated brain ageing in schizophrenia-spectrum disorders. Psychol Med 2020; 50:1475-1489. [PMID: 31274065 DOI: 10.1017/s0033291719001417] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND In schizophrenia, relative stability in the magnitude of cognitive deficits across age and illness duration is inconsistent with the evidence of accelerated deterioration in brain regions known to support these functions. These discrepant brain-cognition outcomes may be explained by variability in cognitive reserve (CR), which in neurological disorders has been shown to buffer against brain pathology and minimize its impact on cognitive or clinical indicators of illness. METHODS Age-related change in fluid reasoning, working memory and frontal brain volume, area and thickness were mapped using regression analysis in 214 individuals with schizophrenia or schizoaffective disorder and 168 healthy controls. In patients, these changes were modelled as a function of CR. RESULTS Patients showed exaggerated age-related decline in brain structure, but not fluid reasoning compared to controls. In the patient group, no moderation of age-related brain structural change by CR was evident. However, age-related cognitive change was moderated by CR, such that only patients with low CR showed evidence of exaggerated fluid reasoning decline that paralleled the exaggerated age-related deterioration of underpinning brain structures seen in all patients. CONCLUSIONS In schizophrenia-spectrum illness, CR may negate ageing effects on fluid reasoning by buffering against pathologically exaggerated structural brain deterioration through some form of compensation. CR may represent an important modifier that could explain inconsistencies in brain structure - cognition outcomes in the extant literature.
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Affiliation(s)
- Tamsyn E Van Rheenen
- Department of Psychiatry, Melbourne Neuropsychiatry Centre, University of Melbourne and Melbourne Health, Melbourne, Australia
- Centre for Mental Health, Faculty of Health, Arts and Design, School of Health Sciences, Swinburne University, Melbourne, Australia
| | - Vanessa Cropley
- Department of Psychiatry, Melbourne Neuropsychiatry Centre, University of Melbourne and Melbourne Health, Melbourne, Australia
- Centre for Mental Health, Faculty of Health, Arts and Design, School of Health Sciences, Swinburne University, Melbourne, Australia
| | - Birgitte Fagerlund
- Center for Neuropsychiatric Schizophrenia Research and Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS), Mental Health Center, Glostrup, Denmark
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Cassandra Wannan
- Department of Psychiatry, Melbourne Neuropsychiatry Centre, University of Melbourne and Melbourne Health, Melbourne, Australia
| | - Jason Bruggemann
- School of Psychiatry, University of New South Wales, New South Wales, Australia
- Neuroscience Research Australia, New South Wales, Australia
| | - Rhoshel K Lenroot
- School of Psychiatry, University of New South Wales, New South Wales, Australia
- Neuroscience Research Australia, New South Wales, Australia
| | - Suresh Sundram
- Florey Institute of Neuroscience and Mental Health, Melbourne, Australia
- Department of Psychiatry, School of Clinical Sciences, Monash University, Clayton, Australia
- Mental Health Program, Monash Health, Clayton, Victoria, Australia
| | - Cynthia Shannon Weickert
- Department of Psychiatry, Melbourne Neuropsychiatry Centre, University of Melbourne and Melbourne Health, Melbourne, Australia
- School of Psychiatry, University of New South Wales, New South Wales, Australia
- Neuroscience Research Australia, New South Wales, Australia
- Department of Neuroscience & Physiology, Upstate Medical University, Syracuse, New York13210, USA
| | - Thomas W Weickert
- Department of Psychiatry, Melbourne Neuropsychiatry Centre, University of Melbourne and Melbourne Health, Melbourne, Australia
- School of Psychiatry, University of New South Wales, New South Wales, Australia
- Neuroscience Research Australia, New South Wales, Australia
| | - Andrew Zalesky
- Department of Psychiatry, Melbourne Neuropsychiatry Centre, University of Melbourne and Melbourne Health, Melbourne, Australia
- Department of Electrical and Electronic Engineering, University of Melbourne, VIC, Australia
| | - Chad A Bousman
- Department of Psychiatry, Melbourne Neuropsychiatry Centre, University of Melbourne and Melbourne Health, Melbourne, Australia
- Florey Institute of Neuroscience and Mental Health, Melbourne, Australia
- Departments of Medical Genetics, Psychiatry, and Physiology & Pharmacology, University of Calgary, Calgary, AB, Canada
| | - Christos Pantelis
- Department of Psychiatry, Melbourne Neuropsychiatry Centre, University of Melbourne and Melbourne Health, Melbourne, Australia
- Florey Institute of Neuroscience and Mental Health, Melbourne, Australia
- Department of Electrical and Electronic Engineering, University of Melbourne, VIC, Australia
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9
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Detecting Subtle Cognitive Impairment in Multiple Sclerosis with the Montreal Cognitive Assessment. Can J Neurol Sci 2020; 47:620-626. [PMID: 32450922 DOI: 10.1017/cjn.2020.97] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Although cognitive deficits are frequent in multiple sclerosis (MS), screening for them with tools such as the Montreal Cognitive Assessment (MoCA) test is usually not performed unless there is a subjective complaint. The Multiple Sclerosis Neuropsychological Questionnaire (MSNQ) is among the instruments most commonly used to assess self-reported subjective complaints in MS. Nonetheless, it does not always accurately reflect cognitive status; many patients with cognitive deficits thus fail to receive appropriate referral for detailed neuropsychological evaluation. The objective of this study was to examine the validity of the MoCA test to detect the presence of objective cognitive deficits among patients with MS without subjective complaints using the Minimal Assessment of Cognitive Function in MS (MACFIMS) as the gold standard. METHODS The sample included 98 patients who were recruited from a university hospital MS clinic. The MSNQ was used to select patients without subjective cognitive complaints who also completed the MACFIMS, MoCA test and MSQOL-54. RESULTS 23.5% of patients without subjective cognitive complaints had evidence of objective cognitive impairment on the MACFIMS (z score < -1.5 on two or more tests). The MoCA had a sensitivity of 87% and a specificity of 68% for detecting objective cognitive impairment in this patient population using a cut-off score of 27. CONCLUSION A significant proportion of patients without self-reported cognitive impairment do have evidence of cognitive deficits on more exhaustive cognitive assessment. The MoCA is a rapid screening test that could be used to target patients for whom a more detailed neuropsychological assessment would be recommended.
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10
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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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11
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Cognitive Reserve Protects Against Memory Decrements Associated With Neuropathology in Traumatic Brain Injury. J Head Trauma Rehabil 2019; 34:E57-E65. [PMID: 30829821 DOI: 10.1097/htr.0000000000000472] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate whether cognitive reserve (CR) moderates the relationship between neuropathology and cognitive outcomes after traumatic brain injury (TBI). SETTING Outpatient research organization. PARTICIPANTS Patients with complicated mild (n = 8), moderate (n = 9), and severe (n = 44) TBI. DESIGN Prospective, cross-sectional study. MAIN MEASURES Cognitive reserve was estimated using a test of word reading (Wechsler Test of Adult Reading). Diffusion tensor imaging (functional anisotropy) was used to quantify neuropathology. Neuropsychological test scores were submitted to principal components analyses to create cognitive composites for memory, attention, executive function, and processing speed domains. RESULTS At lower levels of neuropathology, people with higher CR exhibited better memory than those with lower CR. This benefit diminished as neuropathology increased and disappeared at the highest levels of neuropathology. Cognitive reserve ceased exerting a protective effect at premorbid intelligence levels below average. CONCLUSION Cognitive reserve may differentially protect some cognitive domains against neuropathology relative to others. A clinical cutoff below which CR is no longer protective, together with a possible neuropathology ceiling effect, may be instructive for prognostication and clinical decision-making in cognitive rehabilitation.
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12
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Bakirtzis C, Ioannidis P, Messinis L, Nasios G, Konstantinopoulou E, Papathanasopoulos P, Grigoriadis N. The Rationale for Monitoring Cognitive Function in Multiple Sclerosis: Practical Issues for Clinicians. Open Neurol J 2018; 12:31-40. [PMID: 30008964 PMCID: PMC6008981 DOI: 10.2174/1874205x01812010031] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Revised: 04/14/2018] [Accepted: 05/07/2018] [Indexed: 11/22/2022] Open
Abstract
About half of patients with multiple sclerosis exhibit cognitive impairment which negatively affects their quality of life. The assessment of cognitive function in routine clinical practice is still undervalued, although various tools have been proposed for this reason. In this article, we describe the potential benefits of implementing cognitive assessment tools in routine follow -ups of MS patients. Early detection of changes in cognitive performance may provide evidence of disease activity, could unmask depression or medication side-effects and provide suitable candidates for cognitive rehabilitation. Since apathy and cognitive deficiencies are common presenting symptoms in Progressive Multifocal Leukoencephalopathy, we discuss the utility of frequent monitoring of mental status in multiple sclerosis patients at increased risk. In addition, we propose a relevant algorithm aiming to incorporate a systematic evaluation of cognitive function in every day clinical practice in multiple sclerosis.
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Affiliation(s)
- Christos Bakirtzis
- The Multiple Sclerosis Center, 2nd Department of Neurology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Panagiotis Ioannidis
- The Multiple Sclerosis Center, 2nd Department of Neurology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Lambros Messinis
- Department of Neurology, Neuropsychology Section, University of Patras Medical School, Patras, Greece
| | - Grigorios Nasios
- Department of Speech and Language Therapy, Higher Educational Institute of Epirus, Ioannina, Greece
| | - Elina Konstantinopoulou
- Lab of Cognitive Neuroscience, School of Psychology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Nikolaos Grigoriadis
- The Multiple Sclerosis Center, 2nd Department of Neurology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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13
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Santangelo G, Bisecco A, Trojano L, Sacco R, Siciliano M, d’Ambrosio A, Della Corte M, Lavorgna L, Bonavita S, Tedeschi G, Gallo A. Cognitive performance in multiple sclerosis: the contribution of intellectual enrichment and brain MRI measures. J Neurol 2018; 265:1772-1779. [DOI: 10.1007/s00415-018-8905-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 05/11/2018] [Accepted: 05/12/2018] [Indexed: 11/24/2022]
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14
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Della Corte M, Santangelo G, Bisecco A, Sacco R, Siciliano M, d'Ambrosio A, Docimo R, Cuomo T, Lavorgna L, Bonavita S, Tedeschi G, Gallo A. A simple measure of cognitive reserve is relevant for cognitive performance in MS patients. Neurol Sci 2018; 39:1267-1273. [PMID: 29728936 DOI: 10.1007/s10072-018-3422-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Accepted: 04/21/2018] [Indexed: 10/17/2022]
Abstract
Cognitive reserve (CR) contributes to preserve cognition despite brain damage. This theory has been applied to multiple sclerosis (MS) to explain the partial relationship between cognition and MRI markers of brain pathology. Our aim was to determine the relationship between two measures of CR and cognition in MS. One hundred and forty-seven MS patients were enrolled. Cognition was assessed using the Rao's Brief Repeatable Battery and the Stroop Test. CR was measured as the vocabulary subtest of the WAIS-R score (VOC) and the number of years of formal education (EDU). Regression analysis included raw score data on each neuropsychological (NP) test as dependent variables and demographic/clinical parameters, VOC, and EDU as independent predictors. A binary logistic regression analysis including clinical/CR parameters as covariates and absence/presence of cognitive deficits as dependent variables was performed too. VOC, but not EDU, was strongly correlated with performances at all ten NP tests. EDU was correlated with executive performances. The binary logistic regression showed that only the Expanded Disability Status Scale (EDSS) and VOC were independently correlated with the presence/absence of CD. The lower the VOC and/or the higher the EDSS, the higher the frequency of CD. In conclusion, our study supports the relevance of CR in subtending cognitive performances and the presence of CD in MS patients.
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Affiliation(s)
- Marida Della Corte
- Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, University of Campania "Luigi Vanvitelli", Piazza Luigi Miraglia, 2, 80138, Naples, Italy.,MRI-Center "SUN-FISM", University of Campania "Luigi Vanvitelli" and Institute of Diagnosis and Care "Hermitage-Capodimonte", Naples, Italy
| | - Gabriella Santangelo
- MRI-Center "SUN-FISM", University of Campania "Luigi Vanvitelli" and Institute of Diagnosis and Care "Hermitage-Capodimonte", Naples, Italy.,Department of Psychology, University of Campania "Luigi Vanvitelli", Caserta, Italy
| | - Alvino Bisecco
- Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, University of Campania "Luigi Vanvitelli", Piazza Luigi Miraglia, 2, 80138, Naples, Italy.,MRI-Center "SUN-FISM", University of Campania "Luigi Vanvitelli" and Institute of Diagnosis and Care "Hermitage-Capodimonte", Naples, Italy
| | - Rosaria Sacco
- Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, University of Campania "Luigi Vanvitelli", Piazza Luigi Miraglia, 2, 80138, Naples, Italy
| | - Mattia Siciliano
- Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, University of Campania "Luigi Vanvitelli", Piazza Luigi Miraglia, 2, 80138, Naples, Italy.,Department of Psychology, University of Campania "Luigi Vanvitelli", Caserta, Italy
| | - Alessandro d'Ambrosio
- Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, University of Campania "Luigi Vanvitelli", Piazza Luigi Miraglia, 2, 80138, Naples, Italy
| | - Renato Docimo
- Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, University of Campania "Luigi Vanvitelli", Piazza Luigi Miraglia, 2, 80138, Naples, Italy
| | - Teresa Cuomo
- Department of Neurology, "Umberto I" Hospital, Nocera Inferiore, SA, Italy
| | - Luigi Lavorgna
- Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, University of Campania "Luigi Vanvitelli", Piazza Luigi Miraglia, 2, 80138, Naples, Italy
| | - Simona Bonavita
- Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, University of Campania "Luigi Vanvitelli", Piazza Luigi Miraglia, 2, 80138, Naples, Italy.,MRI-Center "SUN-FISM", University of Campania "Luigi Vanvitelli" and Institute of Diagnosis and Care "Hermitage-Capodimonte", Naples, Italy
| | - Gioacchino Tedeschi
- Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, University of Campania "Luigi Vanvitelli", Piazza Luigi Miraglia, 2, 80138, Naples, Italy.,MRI-Center "SUN-FISM", University of Campania "Luigi Vanvitelli" and Institute of Diagnosis and Care "Hermitage-Capodimonte", Naples, Italy
| | - Antonio Gallo
- Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, University of Campania "Luigi Vanvitelli", Piazza Luigi Miraglia, 2, 80138, Naples, Italy. .,MRI-Center "SUN-FISM", University of Campania "Luigi Vanvitelli" and Institute of Diagnosis and Care "Hermitage-Capodimonte", Naples, Italy.
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15
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Reynoso-Alcántara V, Silva-Pereyra J, Fernández-Harmony T, Mondragón-Maya A. Principales efectos de la reserva cognitiva sobre diversas enfermedades: una revisión sistemática. ACTA ACUST UNITED AC 2018. [DOI: 10.1016/j.psiq.2018.02.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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16
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Rimkus CDM, Avolio IMB, Miotto EC, Pereira SA, Mendes MF, Callegaro D, Leite CDC. The protective effects of high-education levels on cognition in different stages of multiple sclerosis. Mult Scler Relat Disord 2018; 22:41-48. [DOI: 10.1016/j.msard.2018.03.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 02/15/2018] [Accepted: 03/01/2018] [Indexed: 10/17/2022]
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17
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Fenu G, Lorefice L, Arru M, Sechi V, Loi L, Contu F, Cabras F, Coghe G, Frau J, Fronza M, Sbrescia G, Lai V, Boi M, Mallus S, Murru S, Porcu A, Barracciu MA, Marrosu MG, Cocco E. Cognition in multiple sclerosis: Between cognitive reserve and brain volume. J Neurol Sci 2018; 386:19-22. [PMID: 29406960 DOI: 10.1016/j.jns.2018.01.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Revised: 12/13/2017] [Accepted: 01/09/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Several correlations between cognitive impairment (CI), radiologic markers and cognitive reserve (CR) have been documented in MS. OBIECTIVE To evaluate correlation between CI and brain volume (BV) considering CR as possibile mitigating factor. METHODS 195 relapsing MS patients underwent a neuropsychological assessment using BICAMS. BV was estimated using SIENAX to obtain normalized volume of brain (NBV), white matter (NWV), gray matter (NGV) and cortical gray matter (CGV). CR was estimated using a previously validated tool. RESULTS Pearson test showed a correlation between the symbol digit modality test (SDMT) score and NBV (r=0.38; p<0.000) NGV(r=0.31; p<0.000), CGV (r=0.35; p<0.000) and CRI score(r=0.42; p<0.000). Linear regression (dependent variable:SDMT) showed a relationship with CR scores (p=0.000) and NGV(p<0.000). A difference was detected between cognitive impaired and preserved patients regarding mean of NBV(p=0.002), NGV(p=0.007), CGV(p=0.002) and CR Scores (p=0.007). Anova showed a association between the presence of CI (dependent variable) and the interaction term CRIQ × CGV (p=0.004) whit adjustment for age and disability evaluated by EDSS. CONCLUSIONS Our study shows a correlation between cognition and BV, in particular gray matter volume. Cognitive reserve is also confirmed as an important element playing a role in the complex interaction to determine the cognitive functions in MS.
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Affiliation(s)
- G Fenu
- Multiple Sclerosis Center, Binaghi Hospital, ATS Sardegna, Department of Medical Sciences and Public Health, University of Cagliari, Italy.
| | - L Lorefice
- Multiple Sclerosis Center, Binaghi Hospital, ATS Sardegna, Department of Medical Sciences and Public Health, University of Cagliari, Italy
| | - M Arru
- Multiple Sclerosis Center, Binaghi Hospital, ATS Sardegna, Department of Medical Sciences and Public Health, University of Cagliari, Italy
| | - V Sechi
- Radiology Unit, Binaghi Hospital, ATS Sardegna, Cagliari, Italy
| | - L Loi
- Radiology Unit, Binaghi Hospital, ATS Sardegna, Cagliari, Italy
| | - F Contu
- Radiology Unit, Binaghi Hospital, ATS Sardegna, Cagliari, Italy
| | - F Cabras
- Radiology Unit, Binaghi Hospital, ATS Sardegna, Cagliari, Italy
| | - G Coghe
- Multiple Sclerosis Center, Binaghi Hospital, ATS Sardegna, Department of Medical Sciences and Public Health, University of Cagliari, Italy
| | - J Frau
- Multiple Sclerosis Center, Binaghi Hospital, ATS Sardegna, Department of Medical Sciences and Public Health, University of Cagliari, Italy
| | - M Fronza
- Multiple Sclerosis Center, Binaghi Hospital, ATS Sardegna, Department of Medical Sciences and Public Health, University of Cagliari, Italy
| | - G Sbrescia
- Radiology Unit, Binaghi Hospital, ATS Sardegna, Cagliari, Italy
| | - V Lai
- Radiology Unit, Binaghi Hospital, ATS Sardegna, Cagliari, Italy
| | - M Boi
- Radiology Unit, Binaghi Hospital, ATS Sardegna, Cagliari, Italy
| | - S Mallus
- Radiology Unit, Binaghi Hospital, ATS Sardegna, Cagliari, Italy
| | - S Murru
- Radiology Unit, Binaghi Hospital, ATS Sardegna, Cagliari, Italy
| | - A Porcu
- Radiology Unit, Binaghi Hospital, ATS Sardegna, Cagliari, Italy
| | - M A Barracciu
- Radiology Unit, Binaghi Hospital, ATS Sardegna, Cagliari, Italy
| | - M G Marrosu
- Multiple Sclerosis Center, Binaghi Hospital, ATS Sardegna, Department of Medical Sciences and Public Health, University of Cagliari, Italy
| | - E Cocco
- Multiple Sclerosis Center, Binaghi Hospital, ATS Sardegna, Department of Medical Sciences and Public Health, University of Cagliari, Italy
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18
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Assessing reserve-building pursuits and person characteristics: psychometric validation of the Reserve-Building Measure. Qual Life Res 2017; 27:423-436. [DOI: 10.1007/s11136-017-1694-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2017] [Indexed: 10/18/2022]
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19
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Akbar N, Signori A, Amato MP, Sormani MP, Portaccio E, Niccolai C, Goretti B, Till C, Banwell B. Maturational Trajectory of Processing Speed Performance in Pediatric Multiple Sclerosis. Dev Neuropsychol 2017; 42:299-308. [DOI: 10.1080/87565641.2017.1351974] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Nadine Akbar
- School of Rehabilitation Therapy, Queen’s University, Kingston, Ontario, Canada
| | - Alessio Signori
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Maria Pia Amato
- Neurologic Unit, Department NEUROFARBA, Section Neurosciences, University of Florence, Florence, Italy
| | - Maria Pia Sormani
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | | | - Claudia Niccolai
- Neurologic Unit, Department NEUROFARBA, Section Neurosciences, University of Florence, Florence, Italy
| | - Benedetta Goretti
- Neurologic Unit, Department NEUROFARBA, Section Neurosciences, University of Florence, Florence, Italy
| | - Christine Till
- Department of Psychology, York University, Toronto, Ontario, Canada
| | - Brenda Banwell
- Department of Neurology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
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Patel VP, Walker LAS, Feinstein A. Revisiting cognitive reserve and cognition in multiple sclerosis: A closer look at depression. Mult Scler 2017; 24:186-195. [DOI: 10.1177/1352458517692887] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: The protective effect of cognitive reserve (CR) on cognition in people with multiple sclerosis (PwMS) has been well described. Objective: To explore the relationship between aspects of CR, namely, leisure pursuits and depression. Methods: In a cross-sectional study, a sample of 155 PwMS and 115 healthy controls (HC) underwent cognitive testing with the Minimal Assessment of Cognitive Function in Multiple Sclerosis (MACFIMS) battery. Leisure activity was retrospectively recorded using the Leisure Activity Scale (LAS). Depression was assessed using the Hospital Anxiety and Depression Scale. Results: PwMS demonstrated greater decreases in leisure activity over time compared to the HC group, particularly in the past year ( p < 0.001). Here, depression accounted for 17% of the variance in determining the level of leisure activity ( p < 0.001). Premorbid IQ and leisure activity within the past year emerged as significant predictors of information processing speed, learning, memory and executive function. After controlling for depression, the influence of leisure activity on cognition was insignificant. Conclusion: Depression can cause significant changes in behaviour which can influence indices of CR, such as leisure pursuits. Successfully treating depression may lead to a more active lifestyle thereby offsetting in part the cognitive burden of disease.
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Affiliation(s)
- Viral P Patel
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Lisa AS Walker
- Ottawa Hospital Research Institute, Ottawa, ON, Canada/Brain and Mind Research Institute, University of Ottawa, Ottawa, ON, Canada/Carleton University, Ottawa, ON, Canada
| | - Anthony Feinstein
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada/University of Toronto, Toronto, ON, Canada
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21
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Freitas S, Batista S, Afonso AC, Simões MR, de Sousa L, Cunha L, Santana I. The Montreal Cognitive Assessment (MoCA) as a screening test for cognitive dysfunction in multiple sclerosis. APPLIED NEUROPSYCHOLOGY-ADULT 2016; 25:57-70. [DOI: 10.1080/23279095.2016.1243108] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Sandra Freitas
- Centre for Neuroscience and Cell Biology (CNC), University of Coimbra, Coimbra, Portugal
- Centro de Investigação do Núcleo de Estudos e Intervenção Cognitivo Comportamental (CINEICC), University of Coimbra, Coimbra, Portugal
- PsyAssessmentLab, Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
| | - Sónia Batista
- Neurology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | | | - Mário R. Simões
- Centro de Investigação do Núcleo de Estudos e Intervenção Cognitivo Comportamental (CINEICC), University of Coimbra, Coimbra, Portugal
- PsyAssessmentLab, Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
| | - Lívia de Sousa
- Neurology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Luís Cunha
- Neurology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Isabel Santana
- Centre for Neuroscience and Cell Biology (CNC), University of Coimbra, Coimbra, Portugal
- Neurology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
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22
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Paul F. Pathology and MRI: exploring cognitive impairment in MS. Acta Neurol Scand 2016; 134 Suppl 200:24-33. [PMID: 27580903 DOI: 10.1111/ane.12649] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2016] [Indexed: 01/24/2023]
Abstract
Cognitive impairment is a frequent symptom in people with multiple sclerosis, affecting up to 70% of patients. This article reviews the published association of cognitive dysfunction with neuroimaging findings. Cognitive impairment has been related to focal T2 hyperintense lesions, diffuse white matter damage and corical and deep gray matter atrophy. Focal lesions cannot sufficiently explain cognitive dysfunction in MS; microstructural tissue damage detectable by diffusion tensor imaging and gray matter atrophy are probably at least as relevant. Resting state functional magnetic resonance imaging is increasingly used to investigate the contribution of functional connectivity changes to cognitive function in MS. The fact that at least one third of MS patients are not overtly cognitively impaired despite significant radiographic tissue damage argues for protective factors (brain reserve, cognitive reserve) that require further clarification. It is concluded that the reported correlations between imaging findings and cognitive function do not imply causality. Well conceived and sufficiently powered longitudinal studies are lacking. Such studies would help unravel protective mechanisms against cogniitve decline and identify suitable imaging techniques to monitor cognitive function in individual patients with MS.
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Affiliation(s)
- F. Paul
- NeuroCure Clinical Research Center and Clinical and Experimental Multiple Sclerosis Research Center; Department of Neurology; Charité - Universitaetsmedizin Berlin; Berlin Germany
- Experimental and Clinical Research Center; Max Delbrueck Center for Molecular Medicine and Charité - Universitaetsmedizin Berlin; Berlin Germany
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23
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Schwartz CE, Dwyer MG, Benedict R, Weinstock-Guttman B, Bergsland NP, Li J, Ramanathan M, Zivadinov R. Reserve-related activities and MRI metrics in multiple sclerosis patients and healthy controls: an observational study. BMC Neurol 2016; 16:108. [PMID: 27430316 PMCID: PMC4949926 DOI: 10.1186/s12883-016-0624-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 06/24/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To examine whether past and current reserve-related activities make the brain less susceptible to MS pathology (i.e., lesions or disease-related atrophy). METHODS This secondary analysis of a cohort study included 276 healthy controls (HC), and 65 clinically isolated syndrome (CIS), 352 relapsing-remitting MS (RR) and 109 secondary- progressive MS (SPMS) patients. Past reserve-related activities comprised educational and occupational attainment. Current reserve-related activities comprised strenuous and non-strenuous activities. MRI was performed on 3 T scanner. Regression and non-parametric analysis examined relationships between MRI metrics and reserve-related activities. RESULTS Multivariate models (HC as referent) revealed significant interactions in predicting strenuous reserve-related activities with chronic lesion burden (for CIS), brain- (for RR & SPMS), subcortical- (for CIS, RR, & SPMS) and amygdala- (for RR) volumes. Maximal Lifetime Brain Growth was higher for RR patients who engaged in running before and after diagnosis, rather than only before or never. Residual Brain Volume was higher in RR patients who did weights-exercise before and after diagnosis, as compared to only before. CONCLUSIONS Reserve-related activities are related to brain health cross-sectionally in all MS subgroups, and longitudinally in RR patients. Consistent with reserve theory, RR patients who maintained strenuous activities had higher Maximal Lifetime Brain Growth and Residual Brain Volume. The study's limitations are discussed, including the potential for recall bias and design limitations that preclude causal inference.
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Affiliation(s)
- Carolyn E Schwartz
- DeltaQuest Foundation, Inc, 31 Mitchell Road, Concord, MA, 01742, USA. .,Departments of Medicine and Orthopaedic Surgery, Tufts University Medical School, Boston, MA, USA.
| | - Michael G Dwyer
- Buffalo Neuroimaging Analysis Center, Department of Neurology, School of Medicine and Biomedical Sciences, State University of New York, Buffalo, NY, USA.,Department of Biomedical Informatics, University of Buffalo, State University of New York, Buffalo, NY, USA
| | - Ralph Benedict
- Department of Neurology, School of Medicine and Biomedical Sciences, University of Buffalo, State University of New York, Buffalo, NY, USA
| | - Bianca Weinstock-Guttman
- Department of Neurology, School of Medicine and Biomedical Sciences, University of Buffalo, State University of New York, Buffalo, NY, USA
| | - Niels P Bergsland
- Buffalo Neuroimaging Analysis Center, Department of Neurology, School of Medicine and Biomedical Sciences, State University of New York, Buffalo, NY, USA.,Istituto Di Ricovero e Cura a Carattere Scientifico, "S.Maria Nascente", Don Gnocchi Foundation, Milan, Italy.,Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Jei Li
- DeltaQuest Foundation, Inc, 31 Mitchell Road, Concord, MA, 01742, USA.,Department of Biostatistics, University of Massachusetts, Amherst, MA, USA
| | - Murali Ramanathan
- Department of Neurology, School of Medicine and Biomedical Sciences, University of Buffalo, State University of New York, Buffalo, NY, USA.,Department of Pharmaceutical Sciences, School of Medicine and Biomedical Sciences, State University of New York, Buffalo, NY, USA
| | - Robert Zivadinov
- Buffalo Neuroimaging Analysis Center, Department of Neurology, School of Medicine and Biomedical Sciences, State University of New York, Buffalo, NY, USA.,Department of Neurology, School of Medicine and Biomedical Sciences, University of Buffalo, State University of New York, Buffalo, NY, USA.,MR Imaging Clinical Translational Research Center, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
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24
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Patel VP, Zambrana A, Walker LAS, Herrmann N, Feinstein A. Distraction adds to the cognitive burden in multiple sclerosis. Mult Scler 2016; 23:106-113. [DOI: 10.1177/1352458516641208] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Cognitive dysfunction in multiple sclerosis (MS) causes numerous limitations in activities of daily living. Objectives: To develop an improved method of cognitive assessment in people with MS using novel real-world distracters. Methods: A sample of 99 people with MS and 55 demographically matched healthy controls underwent testing with the Minimal Assessment of Cognitive Functioning in Multiple Sclerosis (MACFIMS) and a modified version of the computerized Symbol Digit Modalities Test (c-SDMT). Half of the subjects completed the c-SDMT with built-in real-world distracters and half without. Results: The mean time on the c-SDMT was significantly greater in MS subjects than healthy controls for both distracter ( p = 0.001) and non-distracter ( p < 0.001) versions. Significantly more MS subjects were impaired on the c-SDMT with distracters than the traditional SDMT (47.1% vs 30.3%, p = 0.04). There were no differences in impairment between the c-SDMT with and without distracters (47.1% vs 37.5%, p = 0.34). The distracter version had a sensitivity of 81% and specificity of 88% in detecting global cognitive impairment. Conclusions: The incorporation of distracters improves the sensitivity of a validated computerized version of the SDMT relative to the non-distracter and traditional versions and offers a quick and easy means of detecting cognitive impairment in people with MS.
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Affiliation(s)
- Viral P Patel
- Sunnybrook Health Sciences Centre, Department of Psychiatry, University of Toronto, Toronto, ON, Canada/University of Toronto, Toronto, ON, Canada
| | | | - Lisa AS Walker
- Ottawa Hospital Research Institute, Ottawa, ON, Canada/University of Ottawa, Ottawa, ON, Canada/Carleton University, Ottawa, ON, Canada
| | - Nathan Herrmann
- Sunnybrook Health Sciences Centre, Department of Psychiatry, University of Toronto, Toronto, ON, Canada/University of Toronto, Toronto, ON, Canada
| | - Anthony Feinstein
- Sunnybrook Health Sciences Centre, Department of Psychiatry, University of Toronto, Toronto, ON, Canada/University of Toronto, Toronto, ON, Canada
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25
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Giovannoni G, Butzkueven H, Dhib-Jalbut S, Hobart J, Kobelt G, Pepper G, Sormani MP, Thalheim C, Traboulsee A, Vollmer T. Brain health: time matters in multiple sclerosis. Mult Scler Relat Disord 2016; 9 Suppl 1:S5-S48. [PMID: 27640924 DOI: 10.1016/j.msard.2016.07.003] [Citation(s) in RCA: 253] [Impact Index Per Article: 31.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 07/01/2016] [Indexed: 01/10/2023]
Abstract
INTRODUCTION We present international consensus recommendations for improving diagnosis, management and treatment access in multiple sclerosis (MS). Our vision is that these will be used widely among those committed to creating a better future for people with MS and their families. METHODS Structured discussions and literature searches conducted in 2015 examined the personal and economic impact of MS, current practice in diagnosis, treatment and management, definitions of disease activity and barriers to accessing disease-modifying therapies (DMTs). RESULTS Delays often occur before a person with symptoms suggestive of MS sees a neurologist. Campaigns to raise awareness of MS are needed, as are initiatives to improve access to MS healthcare professionals and services. We recommend a clear treatment goal: to maximize neurological reserve, cognitive function and physical function by reducing disease activity. Treatment should start early, with DMT and lifestyle measures. All parameters that predict relapses and disability progression should be included in the definition of disease activity and monitored regularly when practical. On suboptimal control of disease activity, switching to a DMT with a different mechanism of action should be considered. A shared decision-making process that embodies dialogue and considers all appropriate DMTs should be implemented. Monitoring data should be recorded formally in registries to generate real-world evidence. In many jurisdictions, access to DMTs is limited. To improve treatment access the relevant bodies should consider all costs to all parties when conducting economic evaluations and encourage the continuing investigation, development and use of cost-effective therapeutic strategies and alternative financing models. CONCLUSIONS The consensus findings of an international author group recommend a therapeutic strategy based on proactive monitoring and shared decision-making in MS. Early diagnosis and improved treatment access are also key components.
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Affiliation(s)
- Gavin Giovannoni
- Queen Mary University London, Blizard Institute, Barts and The London School of Medicine and Dentistry, London, UK.
| | - Helmut Butzkueven
- Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia.
| | - Suhayl Dhib-Jalbut
- Department of Neurology, RUTGERS-Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
| | - Jeremy Hobart
- Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK.
| | | | | | | | | | - Anthony Traboulsee
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
| | - Timothy Vollmer
- Department of Neurology, University of Colorado Denver, Aurora, CO, USA.
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Kuusisto H, Vahvelainen T, Hämäläinen P, Luukkaala T, Elovaara I. Asymptomatic subjects differ less from their twin siblings with MS than from healthy controls in cognitive functioning. A Finnish Twin Cohort study. J Neurol Sci 2016; 365:50-3. [DOI: 10.1016/j.jns.2016.03.046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Revised: 03/27/2016] [Accepted: 03/28/2016] [Indexed: 11/24/2022]
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27
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Measurement and maintenance of reserve in multiple sclerosis. J Neurol 2016; 263:2158-2169. [DOI: 10.1007/s00415-016-8104-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 03/15/2016] [Accepted: 03/16/2016] [Indexed: 11/27/2022]
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28
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Pini RTB, Ferreira do Vales LDM, Braga Costa TM, Almeida SS. Effects of cafeteria diet and high fat diet intake on anxiety, learning and memory in adult male rats. Nutr Neurosci 2016; 20:396-408. [DOI: 10.1080/1028415x.2016.1149294] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Renata Tavares Beschizza Pini
- Laboratory of Nutrition and behavior, FFLCLRP, University of São Paulo, Avenida dos Bandeirantes, 3900, Ribeirão Preto, SP 14040-901, Brazil
| | | | - Telma Maria Braga Costa
- Nutrition Course, UNAERP, University of Ribeirão Preto, Avenida Costabile Romano, 2201, Ribeirão Preto, SP 14096-900, Brazil
| | - Sebastião Sousa Almeida
- Laboratory of Nutrition and behavior, FFLCLRP, University of São Paulo, Avenida dos Bandeirantes, 3900, Ribeirão Preto, SP 14040-901, Brazil
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Abstract
Due to its sensitivity to the different multiple sclerosis (MS)-related abnormalities, magnetic resonance imaging (MRI) has become an established tool to diagnose MS and to monitor its evolution. MRI has been included in the diagnostic workup of patients with clinically isolated syndromes suggestive of MS, and ad hoc criteria have been proposed and are regularly updated. In patients with definite MS, the ability of conventional MRI techniques to explain patients' clinical status and progression of disability is still suboptimal. Several advanced MRI-based technologies have been applied to estimate overall MS burden in the different phases of the disease. Their use has allowed the heterogeneity of MS pathology in focal lesions, normal-appearing white matter and gray matter to be graded in vivo. Recently, additional features of MS pathology, including macrophage infiltration and abnormal iron deposition, have become quantifiable. All of this, combined with functional imaging techniques, is improving our understanding of the mechanisms associated with MS evolution. In the near future, the use of ultrahigh-field systems is likely to provide additional insight into disease pathophysiology. However, the utility of advanced MRI techniques in clinical trial monitoring and in assessing individual patients' response to treatment still needs to be assessed.
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Affiliation(s)
- Massimo Filippi
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy.
| | - Paolo Preziosa
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Maria A Rocca
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
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30
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Atteinte de la mémoire épisodique verbale dans la sclérose en plaques : revue critique des processus cognitifs concernés et de leur exploration. Rev Neurol (Paris) 2015; 171:624-45. [DOI: 10.1016/j.neurol.2015.02.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Revised: 02/01/2015] [Accepted: 02/13/2015] [Indexed: 11/22/2022]
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31
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Sundgren M, Wahlin Å, Maurex L, Brismar T. Event related potential and response time give evidence for a physiological reserve in cognitive functioning in relapsing–remitting multiple sclerosis. J Neurol Sci 2015; 356:107-12. [DOI: 10.1016/j.jns.2015.06.025] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Revised: 06/12/2015] [Accepted: 06/13/2015] [Indexed: 10/23/2022]
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Sumowski JF. Cognitive Reserve as a Useful Concept for Early Intervention Research in Multiple Sclerosis. Front Neurol 2015; 6:176. [PMID: 26347706 PMCID: PMC4542634 DOI: 10.3389/fneur.2015.00176] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2015] [Accepted: 07/27/2015] [Indexed: 01/03/2023] Open
Affiliation(s)
- James F Sumowski
- Kessler Foundation , West Orange, NJ , USA ; Rutgers New Jersey Medical School , Newark, NJ , USA
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33
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Pinter D, Khalil M, Pichler A, Langkammer C, Ropele S, Marschik PB, Fuchs S, Fazekas F, Enzinger C. Predictive value of different conventional and non-conventional MRI-parameters for specific domains of cognitive function in multiple sclerosis. NEUROIMAGE-CLINICAL 2015; 7:715-20. [PMID: 25844323 PMCID: PMC4375639 DOI: 10.1016/j.nicl.2015.02.023] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Revised: 02/23/2015] [Accepted: 02/27/2015] [Indexed: 11/28/2022]
Abstract
Objective While many studies correlated cognitive function with changes in brain morphology in multiple sclerosis (MS), few of them used a multi-parametric approach in a single dataset so far. We thus here assessed the predictive value of different conventional and quantitative MRI-parameters both for overall and domain-specific cognitive performance in MS patients from a single center. Methods 69 patients (17 clinically isolated syndrome, 47 relapsing–remitting MS, 5 secondary-progressive MS) underwent the “Brief Repeatable Battery of Neuropsychological Tests” assessing overall cognition, cognitive efficiency and memory function as well as MRI at 3 Tesla to obtain T2-lesion load (T2-LL), normalized brain volume (global brain volume loss), normalized cortical volume (NCV), normalized thalamic volume (NTV), normalized hippocampal volume (NHV), normalized caudate nuclei volume (NCNV), basal ganglia R2* values (iron deposition) and magnetization transfer ratios (MTRs) for cortex and normal appearing brain tissue (NABT). Results Regression models including clinical, demographic variables and MRI-parameters explained 22–27% of variance of overall cognition, 17–26% of cognitive efficiency and 22–23% of memory. NCV, T2-LL and MTR of NABT were the strongest predictors of overall cognitive function. Cognitive efficiency was best predicted by NCV, T2-LL and iron deposition in the basal ganglia. NTV was the strongest predictor for memory function and NHV was particularly related to memory function. Conclusions The predictive value of distinct MRI-parameters differs for specific domains of cognitive function, with a greater impact of cortical volume, focal and diffuse white matter abnormalities on overall cognitive function, an additional role of basal ganglia iron deposition on cognitive efficiency, and thalamic and hippocampal volume on memory function. This suggests the usefulness of using multiparametric MRI to assess (micro)structural correlates of different cognitive constructs. The predictive value of MRI-parameters for cognition was assessed in 69 MS-patients. Cortical volume and focal white matter lesions predict overall cognitive function. T2-lesion load is a strong predictor for cognition (overall and specific domains). Cortical volume and basal ganglia iron deposition predict cognitive efficiency. Thalamic volume, MTR of NABT and hippocampal volume predict memory function.
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Affiliation(s)
- Daniela Pinter
- Department of Neurology, Medical University of Graz, Auenbruggerplatz 22, Graz 8036, Austria
| | - Michael Khalil
- Department of Neurology, Medical University of Graz, Auenbruggerplatz 22, Graz 8036, Austria
| | - Alexander Pichler
- Department of Neurology, Medical University of Graz, Auenbruggerplatz 22, Graz 8036, Austria
| | - Christian Langkammer
- Department of Neurology, Medical University of Graz, Auenbruggerplatz 22, Graz 8036, Austria
| | - Stefan Ropele
- Department of Neurology, Medical University of Graz, Auenbruggerplatz 22, Graz 8036, Austria
| | - Peter B Marschik
- Institute of Physiology, Medical University of Graz, Harrachgasse 21, Graz 8010, Austria ; Department of Women's and Children's Health, Karolinska Institute, Gävlegatan 22, Stockholm 11330, Sweden
| | - Siegrid Fuchs
- Department of Neurology, Medical University of Graz, Auenbruggerplatz 22, Graz 8036, Austria
| | - Franz Fazekas
- Department of Neurology, Medical University of Graz, Auenbruggerplatz 22, Graz 8036, Austria
| | - Christian Enzinger
- Department of Neurology, Medical University of Graz, Auenbruggerplatz 22, Graz 8036, Austria ; Department of Radiology, Division of Neuroradiology, Medical University of Graz, Auenbruggerplatz 9, Graz 8036, Austria
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Rocca MA, Amato MP, De Stefano N, Enzinger C, Geurts JJ, Penner IK, Rovira A, Sumowski JF, Valsasina P, Filippi M. Clinical and imaging assessment of cognitive dysfunction in multiple sclerosis. Lancet Neurol 2015; 14:302-17. [PMID: 25662900 DOI: 10.1016/s1474-4422(14)70250-9] [Citation(s) in RCA: 368] [Impact Index Per Article: 40.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
In patients with multiple sclerosis (MS), grey matter damage is widespread and might underlie many of the clinical symptoms, especially cognitive impairment. This relation between grey matter damage and cognitive impairment has been lent support by findings from clinical and MRI studies. However, many aspects of cognitive impairment in patients with MS still need to be characterised. Standardised neuropsychological tests that are easy to administer and sensitive to disease-related abnormalities are needed to gain a better understanding of the factors affecting cognitive performance in patients with MS than exists at present. Imaging measures of the grey matter are necessary, but not sufficient to fully characterise cognitive decline in MS. Imaging measures of both lesioned and normal-appearing white matter lend support to the hypothesis of the existence of an underlying disconnection syndrome that causes clinical symptoms to trigger. Findings on cortical reorganisation support the contribution of brain plasticity and cognitive reserve in limiting cognitive deficits. The development of clinical and imaging biomarkers that can monitor disease development and treatment response is crucial to allow early identification of patients with MS who are at risk of cognitive impairment.
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Affiliation(s)
- Maria A Rocca
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy; Department of Neurology, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Maria P Amato
- Department of Neurofarba, Section of Neurosciences, University of Florence, Florence, Italy
| | - Nicola De Stefano
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | | | - Jeroen J Geurts
- Department of Anatomy and Neuroscience, Section of Clinical Neuroscience, VU University Medical Centre, VUmc Multiple Sclerosis Centre Amsterdam, Amsterdam, Netherlands
| | - Iris-K Penner
- University and University Children's Hospital Basel, Cognitive Psychology and Methodology and Division of Paediatric Neurology and Developmental Medicine, Basel, Switzerland
| | - Alex Rovira
- Magnetic Resonance Unit, Department of Radiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - James F Sumowski
- Neuropsychology and Neuroscience, Kessler Foundation Research Center, West Orange, NJ, USA
| | - Paola Valsasina
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy; Department of Neurology, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy.
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35
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Working memory capacity links cognitive reserve with long-term memory in moderate to severe TBI: a translational approach. J Neurol 2014; 262:59-64. [DOI: 10.1007/s00415-014-7523-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Revised: 09/24/2014] [Accepted: 09/29/2014] [Indexed: 10/24/2022]
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Working memory mediates the relationship between intellectual enrichment and long-term memory in multiple sclerosis: an exploratory analysis of cognitive reserve. J Int Neuropsychol Soc 2014; 20:868-72. [PMID: 25017699 DOI: 10.1017/s1355617714000630] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Some individuals with multiple sclerosis (MS) show decrements in long-term memory (LTM) while other individuals do not. The theory of cognitive reserve suggests that individuals with greater pre-morbid intellectual enrichment are protected from disease-related cognitive decline. How intellectual enrichment affords this benefit remains poorly understood. The present study tested an exploratory meditational hypothesis whereby working memory (WM) capacity may mediate the relationship between intellectual enrichment and verbal LTM decline in MS. Intellectual enrichment, verbal LTM, and WM capacity were estimated with the Wechsler Test of Adult Reading and Peabody Picture Vocabulary Test, delayed recall of the Hopkins Verbal Learning Test-Revised and Logical Memory of the Wechsler Memory Scale, and Digit Span Total, respectively. Intellectual enrichment predicted LTM (B=.54; p=.003) and predicted WM capacity (B=.91; p<.001). WM capacity predicted LTM, (B=.44; p<.001) and fully mediated the relationship between intellectual enrichment (B=.24; p=.27) and LTM (B=.33, p=.03), Sobel test, Z=3.31, p<.001. These findings implicate WM capacity as an underlying mechanism of cognitive reserve and are an initial first step in understanding the relationship between intellectual enrichment, WM, and LTM in MS.
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Sumowski JF, Rocca MA, Leavitt VM, Dackovic J, Mesaros S, Drulovic J, DeLuca J, Filippi M. Brain reserve and cognitive reserve protect against cognitive decline over 4.5 years in MS. Neurology 2014; 82:1776-83. [PMID: 24748670 DOI: 10.1212/wnl.0000000000000433] [Citation(s) in RCA: 125] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE Based on the theories of brain reserve and cognitive reserve, we investigated whether larger maximal lifetime brain growth (MLBG) and/or greater lifetime intellectual enrichment protect against cognitive decline over time. METHODS Forty patients with multiple sclerosis (MS) underwent baseline and 4.5-year follow-up evaluations of cognitive efficiency (Symbol Digit Modalities Test, Paced Auditory Serial Addition Task) and memory (Selective Reminding Test, Spatial Recall Test). Baseline and follow-up MRIs quantified disease progression: percentage brain volume change (cerebral atrophy), percentage change in T2 lesion volume. MLBG (brain reserve) was estimated with intracranial volume; intellectual enrichment (cognitive reserve) was estimated with vocabulary. We performed repeated-measures analyses of covariance to investigate whether larger MLBG and/or greater intellectual enrichment moderate/attenuate cognitive decline over time, controlling for disease progression. RESULTS Patients with MS declined in cognitive efficiency and memory (p < 0.001). MLBG moderated decline in cognitive efficiency (p = 0.031, ηp (2) = 0.122), with larger MLBG protecting against decline. MLBG did not moderate memory decline (p = 0.234, ηp (2) = 0.039). Intellectual enrichment moderated decline in cognitive efficiency (p = 0.031, ηp (2) = 0.126) and memory (p = 0.037, ηp (2) = 0.115), with greater intellectual enrichment protecting against decline. MS disease progression was more negatively associated with change in cognitive efficiency and memory among patients with lower vs higher MLBG and intellectual enrichment. CONCLUSION We provide longitudinal support for theories of brain reserve and cognitive reserve in MS. Larger MLBG protects against decline in cognitive efficiency, and greater intellectual enrichment protects against decline in cognitive efficiency and memory. Consideration of these protective factors should improve prediction of future cognitive decline in patients with MS.
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Affiliation(s)
- James F Sumowski
- From Neuropsychology and Neuroscience (J.F.S., J. DeLuca), Kessler Foundation Research Center, West Orange; Rutgers (J.F.S., J. DeLuca), New Jersey Medical School, Newark, NJ; Neuroimaging Research Unit (M.A.R., M.F.) and Department of Neurology (M.A.R., M.F.), San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy; Manhattan Memory Center (V.M.L.), New York, NY; and Clinic of Neurology (J. Dackovic, S.M., J. Drulovic), Faculty of Medicine, University of Belgrade, Serbia.
| | - Maria A Rocca
- From Neuropsychology and Neuroscience (J.F.S., J. DeLuca), Kessler Foundation Research Center, West Orange; Rutgers (J.F.S., J. DeLuca), New Jersey Medical School, Newark, NJ; Neuroimaging Research Unit (M.A.R., M.F.) and Department of Neurology (M.A.R., M.F.), San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy; Manhattan Memory Center (V.M.L.), New York, NY; and Clinic of Neurology (J. Dackovic, S.M., J. Drulovic), Faculty of Medicine, University of Belgrade, Serbia
| | - Victoria M Leavitt
- From Neuropsychology and Neuroscience (J.F.S., J. DeLuca), Kessler Foundation Research Center, West Orange; Rutgers (J.F.S., J. DeLuca), New Jersey Medical School, Newark, NJ; Neuroimaging Research Unit (M.A.R., M.F.) and Department of Neurology (M.A.R., M.F.), San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy; Manhattan Memory Center (V.M.L.), New York, NY; and Clinic of Neurology (J. Dackovic, S.M., J. Drulovic), Faculty of Medicine, University of Belgrade, Serbia
| | - Jelena Dackovic
- From Neuropsychology and Neuroscience (J.F.S., J. DeLuca), Kessler Foundation Research Center, West Orange; Rutgers (J.F.S., J. DeLuca), New Jersey Medical School, Newark, NJ; Neuroimaging Research Unit (M.A.R., M.F.) and Department of Neurology (M.A.R., M.F.), San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy; Manhattan Memory Center (V.M.L.), New York, NY; and Clinic of Neurology (J. Dackovic, S.M., J. Drulovic), Faculty of Medicine, University of Belgrade, Serbia
| | - Sarlota Mesaros
- From Neuropsychology and Neuroscience (J.F.S., J. DeLuca), Kessler Foundation Research Center, West Orange; Rutgers (J.F.S., J. DeLuca), New Jersey Medical School, Newark, NJ; Neuroimaging Research Unit (M.A.R., M.F.) and Department of Neurology (M.A.R., M.F.), San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy; Manhattan Memory Center (V.M.L.), New York, NY; and Clinic of Neurology (J. Dackovic, S.M., J. Drulovic), Faculty of Medicine, University of Belgrade, Serbia
| | - Jelena Drulovic
- From Neuropsychology and Neuroscience (J.F.S., J. DeLuca), Kessler Foundation Research Center, West Orange; Rutgers (J.F.S., J. DeLuca), New Jersey Medical School, Newark, NJ; Neuroimaging Research Unit (M.A.R., M.F.) and Department of Neurology (M.A.R., M.F.), San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy; Manhattan Memory Center (V.M.L.), New York, NY; and Clinic of Neurology (J. Dackovic, S.M., J. Drulovic), Faculty of Medicine, University of Belgrade, Serbia
| | - John DeLuca
- From Neuropsychology and Neuroscience (J.F.S., J. DeLuca), Kessler Foundation Research Center, West Orange; Rutgers (J.F.S., J. DeLuca), New Jersey Medical School, Newark, NJ; Neuroimaging Research Unit (M.A.R., M.F.) and Department of Neurology (M.A.R., M.F.), San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy; Manhattan Memory Center (V.M.L.), New York, NY; and Clinic of Neurology (J. Dackovic, S.M., J. Drulovic), Faculty of Medicine, University of Belgrade, Serbia
| | - Massimo Filippi
- From Neuropsychology and Neuroscience (J.F.S., J. DeLuca), Kessler Foundation Research Center, West Orange; Rutgers (J.F.S., J. DeLuca), New Jersey Medical School, Newark, NJ; Neuroimaging Research Unit (M.A.R., M.F.) and Department of Neurology (M.A.R., M.F.), San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy; Manhattan Memory Center (V.M.L.), New York, NY; and Clinic of Neurology (J. Dackovic, S.M., J. Drulovic), Faculty of Medicine, University of Belgrade, Serbia
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Abstract
Cognitive impairment is common among persons with multiple sclerosis (MS), but some patients are able to withstand considerable disease burden (e.g. white matter lesions, cerebral atrophy) without cognitive impairment (cognitive inefficiency, memory decline). What protects these patients from cognitive impairment? We review the literature on cognitive reserve in MS, which shows that heritable (larger maximal lifetime brain growth) and environmental (greater intellectual enrichment) factors attenuate the negative effect of disease burden on cognitive status. That is, persons with larger maximal lifetime brain growth, greater vocabulary knowledge, and/or greater early life participation in cognitive leisure activities (e.g. reading, hobbies) are better able to cope with MS disease without cognitive impairment. We review evidence that benefits of intellectual enrichment on cognitive status may stem from more efficient patterns of brain function. We discuss clinical implications and highlight important unanswered questions for future research on reserve against cognitive impairment in MS.
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Affiliation(s)
- James F Sumowski
- Kessler Foundation Research Center, USA, and Rutgers, New Jersey Medical School, USA.
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Pinter D, Sumowski J, DeLuca J, Fazekas F, Pichler A, Khalil M, Langkammer C, Fuchs S, Enzinger C. Higher education moderates the effect of T2 lesion load and third ventricle width on cognition in multiple sclerosis. PLoS One 2014; 9:e87567. [PMID: 24475309 PMCID: PMC3903771 DOI: 10.1371/journal.pone.0087567] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Accepted: 12/20/2013] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Previous work suggested greater intellectual enrichment might moderate the negative impact of brain atrophy on cognition. This awaits confirmation in independent cohorts including investigation of the role of T2-lesion load (T2-LL), which is another important determinant of cognition in MS. We here thus aimed to test this cognitive reserve hypothesis by investigating whether educational attainment (EA) moderates the negative effects of both brain atrophy and T2-LL on cognitive function in a large sample of MS patients. METHODS 137 patients participated in the study. Cognition was assessed by the "Brief Repeatable Battery of Neuropsychological Tests." T2-LL, normalized brain volume (global volume loss) and third ventricle width (regional volume loss) served as MRI markers. RESULTS Both T2-LL and atrophy predicted worse cognition, with a stronger effect of T2-LL. Higher EA (as assessed by years of education) also predicted better cognition. Interactions showed that the negative effects of T2-LL and regional brain atrophy were moderated by EA. CONCLUSIONS In a cohort with different stages of MS, higher EA attenuated the negative effects of white matter lesion burden and third ventricle width (suggestive of thalamic atrophy) on cognitive performance. Actively enhancing cognitive reserve might thus be a means to reduce or prevent cognitive problems in MS in parallel to disease modifying drugs.
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Affiliation(s)
- Daniela Pinter
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - James Sumowski
- Neuropsychology & Neuroscience Laboratory, Kessler Foundation Research Center in West Orange, New Jersey, United States of America
| | - John DeLuca
- Department of Physical Medicine and Rehabilitation & Neurology and Neurosciences, Kessler Foundation Research Center in West Orange, New Jersey, United States of America
| | - Franz Fazekas
- Department of Neurology, Medical University of Graz, Graz, Austria
| | | | - Michael Khalil
- Department of Neurology, Medical University of Graz, Graz, Austria
| | | | - Siegrid Fuchs
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - Christian Enzinger
- Department of Neurology, Medical University of Graz, Graz, Austria
- Division of Neuroradiology, Medical University of Graz, Graz, Austria
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40
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Filippi M, Charil A, Rovaris M, Absinta M, Rocca MA. Insights from magnetic resonance imaging. HANDBOOK OF CLINICAL NEUROLOGY 2014; 122:115-149. [PMID: 24507516 DOI: 10.1016/b978-0-444-52001-2.00006-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Recent years have witnessed impressive advancements in the use of magnetic resonance imaging (MRI) for the assessment of patients with multiple sclerosis (MS). Complementary to the clinical evaluation, conventional MRI (cMRI) provides crucial pieces of information for the diagnosis of MS, the understanding of its natural history, and monitoring the efficacy of experimental treatments. Measures derived from cMRI present clear advantages over the clinical assessment, including their more objective nature and an increased sensitivity to MS-related changes. However, the correlation between these measures and the clinical manifestations of the disease remains weak, and this can be explained, at least partially, by the limited ability of cMRI to characterize and quantify the heterogeneous features of MS pathology. Quantitative MR-based techniques have the potential to overcome the limitations of cMRI. Magnetization transfer MRI, diffusion-weighted and diffusion tensor MRI with fiber tractography, proton magnetic resonance spectroscopy, T1 and T2 relaxation time measurement, and functional MRI are contributing to elucidate the mechanisms that underlie injury, repair, and functional adaptation in patients with MS. All conventional and nonconventional MR techniques will benefit from the use of high-field MR systems (3.0T or more).
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Affiliation(s)
- Massimo Filippi
- Neuroimaging Research Unit, Department of Neurology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy.
| | - Arnaud Charil
- Neuroimaging Research Unit, Department of Neurology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Marco Rovaris
- Neuroimaging Research Unit, Department of Neurology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Martina Absinta
- Neuroimaging Research Unit, Department of Neurology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Maria Assunta Rocca
- Neuroimaging Research Unit, Department of Neurology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
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Genova HM, Lengenfelder J, Chiaravalloti ND, Moore NB, DeLuca J. Processing speed versus working memory: contributions to an information-processing task in multiple sclerosis. APPLIED NEUROPSYCHOLOGY-ADULT 2013; 19:132-40. [PMID: 23373581 DOI: 10.1080/09084282.2011.643951] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Individuals with multiple sclerosis (MS) often experience cognitive impairments in information processing. However, the relative contributions of processing speed abilities and working memory abilities to information-processing tasks are not yet fully understood. The current study examined the extent to which processing speed and/or working memory abilities contributed to an information-processing task, the Keeping Track Task (KTT). Forty-nine individuals with MS were given tests to assess processing speed and working memory, as well as the KTT. Regression analyses indicated that in the MS group, processing speed abilities accounted for the majority of the explained variance in KTT performance. The findings suggest that processing speed plays a significant role on KTT performance in MS. Implications for cognitive rehabilitation treatments aimed at improving processing speed abilities in MS are discussed.
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Affiliation(s)
- Helen M Genova
- Neuropsychology and Neuroscience Laboratory, Kessler Foundation Research Center, West Orange, New Jersey, USA
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42
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Schoonheim MM, Vigeveno RM, Rueda Lopes FC, Pouwels PJW, Polman CH, Barkhof F, Geurts JJG. Sex-specific extent and severity of white matter damage in multiple sclerosis: implications for cognitive decline. Hum Brain Mapp 2013; 35:2348-58. [PMID: 23982918 DOI: 10.1002/hbm.22332] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Revised: 04/24/2013] [Accepted: 05/06/2013] [Indexed: 12/13/2022] Open
Abstract
Cognitive dysfunction is common in multiple sclerosis (MS). However, the relationship between white matter (WM) damage and cognition remains insufficiently clear. This study investigates the extent and severity of WM diffusion abnormalities in MS patients and relations with cognition. Diffusion tensor imaging scans were obtained in 131 MS patients (88 women, 6 years postdiagnosis) and 49 age-matched controls (29 women). Patient groups were equal in terms of disease duration, disability, and WM lesion volume. Fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD) were compared between groups. Post hoc analyses calculated the spatial extent and severity of diffusion abnormalities to relate these to cognitive performance. In controls, 31% of WM voxels showed higher FA in men; therefore, all patient analyses were within-sex. The extent of diffusion changes was higher in male patients than in female patients for all parameters (FA: 24% in women, 53% in men), as was the severity of changes (FA: Z = -0.18 in women, Z = -0.41 in men). Especially the extent of FA abnormalities was strongly related to cognitive performance in all patients (r = -0.42, P < 0.0001). Regionally, thalamic decreases in FA were especially correlated with cognitive performance. Cognitively impaired patients showed greater extent and severity on all diffusion parameters compared to cognitively preserved patients. The WM of male patients was both more extensively and also more severely affected than that of female patients. The extent of WM FA changes, especially in the thalamus, was associated with cognitive performance in this cohort of early MS patients.
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Affiliation(s)
- Menno M Schoonheim
- Department of Radiology, VU University Medical Center, Amsterdam, The Netherlands; Department of Anatomy and Neuroscience, VU University Medical Center, Amsterdam, The Netherlands
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Sumowski JF, Chiaravalloti N, Krch D, Paxton J, DeLuca J. Education attenuates the negative impact of traumatic brain injury on cognitive status. Arch Phys Med Rehabil 2013; 94:2562-2564. [PMID: 23932968 DOI: 10.1016/j.apmr.2013.07.023] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Revised: 07/25/2013] [Accepted: 07/25/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To investigate whether the cognitive reserve hypothesis helps to explain differential cognitive impairment among survivors of traumatic brain injury (TBI), whereby survivors with greater intellectual enrichment (estimated with education) are less vulnerable to cognitive impairment. DESIGN Cross-sectional study. SETTING Medical rehabilitation research center. PARTICIPANTS Survivors of moderate or severe TBI (n=44) and healthy controls (n=36). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Intellectual enrichment was estimated with educational attainment. Group was defined as TBI or healthy control. Current cognitive status (processing speed, working memory, episodic memory) was evaluated with neuropsychological tasks. RESULTS TBI survivors exhibited worse cognitive status than healthy persons (P<.001), and education was positively correlated with cognitive status in TBI survivors (r=.54, P<.001). Most importantly, regression analysis revealed an interaction between group and education (R(2) change=.036, P=.004), whereas higher education attenuated the negative impact of TBI on cognitive status. TBI survivors with lower education performed much worse than matched healthy persons, but this TBI-related performance discrepancy was attenuated at higher levels of education. CONCLUSIONS Higher intellectual enrichment (estimated with education) reduces the negative effect of TBI on cognitive outcomes, thereby supporting the cognitive reserve hypothesis in persons with TBI. Future work is necessary to investigate whether intellectual enrichment can build cognitive reserve as a rehabilitative intervention in survivors of TBI.
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Affiliation(s)
- James F Sumowski
- Neuropsychology and Neuroscience, Kessler Foundation, West Orange, NJ; Department of Physical Medicine and Rehabilitation, Rutgers-New Jersey Medical School, Newark, NJ.
| | - Nancy Chiaravalloti
- Neuropsychology and Neuroscience, Kessler Foundation, West Orange, NJ; Department of Physical Medicine and Rehabilitation, Rutgers-New Jersey Medical School, Newark, NJ; Traumatic Brain Injury Laboratory, Kessler Foundation, West Orange, NJ
| | - Denise Krch
- Department of Physical Medicine and Rehabilitation, Rutgers-New Jersey Medical School, Newark, NJ; Traumatic Brain Injury Laboratory, Kessler Foundation, West Orange, NJ
| | - Jessica Paxton
- Neuropsychology and Neuroscience, Kessler Foundation, West Orange, NJ; Department of Physical Medicine and Rehabilitation, Rutgers-New Jersey Medical School, Newark, NJ
| | - John DeLuca
- Neuropsychology and Neuroscience, Kessler Foundation, West Orange, NJ; Department of Physical Medicine and Rehabilitation, Rutgers-New Jersey Medical School, Newark, NJ; Department of Neurology and Neurosciences, Rutgers-New Jersey Medical School, Newark, NJ
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Abstract
Huntington disease (HD) is associated with decline in cognition and progressive morphological changes in brain structures. Cognitive reserve may represent a mechanism by which disease-related decline may be delayed or slowed. The current study examined the relationship between cognitive reserve and longitudinal change in cognitive functioning and brain volumes among prodromal (gene expansion-positive) HD individuals. Participants were genetically confirmed individuals with prodromal HD enrolled in the PREDICT-HD study. Cognitive reserve was computed as the composite of performance on a lexical task estimating premorbid intellectual level, occupational status, and years of education. Linear mixed effects regression (LMER) was used to examine longitudinal changes on four cognitive measures and three brain volumes over approximately 6 years. Higher cognitive reserve was significantly associated with a slower rate of change on one cognitive measure (Trail Making Test, Part B) and slower rate of volume loss in two brain structures (caudate, putamen) for those estimated to be closest to motor disease onset. This relationship was not observed among those estimated to be further from motor disease onset. Our findings demonstrate a relationship between cognitive reserve and both a measure of executive functioning and integrity of certain brain structures in prodromal HD individuals.
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Sub-threshold cognitive impairment in multiple sclerosis: the association with cognitive reserve. J Neurol 2013; 260:2256-61. [DOI: 10.1007/s00415-013-6952-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Revised: 05/01/2013] [Accepted: 05/03/2013] [Indexed: 11/30/2022]
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Sumowski JF, Rocca MA, Leavitt VM, Riccitelli G, Comi G, DeLuca J, Filippi M. Brain reserve and cognitive reserve in multiple sclerosis: what you've got and how you use it. Neurology 2013; 80:2186-93. [PMID: 23667062 DOI: 10.1212/wnl.0b013e318296e98b] [Citation(s) in RCA: 122] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE We first tested the brain reserve (BR) hypothesis in multiple sclerosis (MS) by examining whether larger maximal lifetime brain volume (MLBV; determined by genetics) protects against disease-related cognitive impairment, and then investigated whether cognitive reserve (CR) gained through life experience (intellectually enriching leisure activities) protects against cognitive decline independently of MLBV (BR). METHODS Sixty-two patients with MS (41 relapsing-remitting MS, 21 secondary progressive MS) received MRIs to estimate BR (MLBV, estimated with intracranial volume [ICV]) and disease burden (T2 lesion load; atrophy of gray matter, white matter, thalamus, and hippocampus). Early-life cognitive leisure was measured as a source of CR. We assessed cognitive status with tasks of cognitive efficiency and memory. Hierarchical regressions were used to investigate whether higher BR (ICV) protects against cognitive impairment, and whether higher CR (leisure) independently protects against cognitive impairment over and above BR. RESULTS Cognitive status was positively associated with ICV (R(2) = 0.066, p = 0.017). An ICV × disease burden interaction (R(2) = 0.050, p = 0.030) revealed that larger ICV attenuated the impact of disease burden on cognition. Controlling for BR, higher education (R(2) = 0.047, p = 0.030) and leisure (R(2) = 0.090, p = 0.001) predicted better cognition. A leisure × disease burden interaction (R(2) = 0.037, p = 0.030) showed that leisure independently attenuated the impact of disease burden on cognition. Follow-up analyses revealed that BR protected against cognitive inefficiency, not memory deficits, whereas CR was more protective against memory deficits than cognitive inefficiency. CONCLUSION We provide evidence of BR in MS, and show that CR independently protects against disease-related cognitive decline over and above BR. Lifestyle choices protect against cognitive impairment independently of genetic factors outside of one's control.
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Affiliation(s)
- James F Sumowski
- Neuropsychology and Neuroscience, Kessler Foundation Research Center, West Orange, NJ, USA.
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Premorbid physical activity predicts disability progression in relapsing–remitting multiple sclerosis. J Neurol Sci 2012; 323:123-7. [DOI: 10.1016/j.jns.2012.08.033] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2012] [Revised: 08/29/2012] [Accepted: 08/30/2012] [Indexed: 11/20/2022]
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48
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Amato MP, Langdon D, Montalban X, Benedict RHB, DeLuca J, Krupp LB, Thompson AJ, Comi G. Treatment of cognitive impairment in multiple sclerosis: position paper. J Neurol 2012. [DOI: 10.1007/s00415-012-6678-0] [Citation(s) in RCA: 165] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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49
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Brooks JBB, Borela MCM, Fragoso YD. Assessment of cognition using the Rao's Brief Repeatable Battery of Neuropsychological Tests on a group of Brazilian patients with multiple sclerosis. ARQUIVOS DE NEURO-PSIQUIATRIA 2012; 69:887-91. [PMID: 22297873 DOI: 10.1590/s0004-282x2011000700007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2011] [Accepted: 06/20/2011] [Indexed: 11/22/2022]
Abstract
UNLABELLED To assess the cognition of patients with multiple sclerosis (MS) using the Rao's Brief Repeatable Battery of Neuropsychological Tests (BRB-N). METHOD BRB-N was translated and adapted for control subjects. Subsequently, it was applied to a group of patients with relapsing-remitting (RR) MS. RESULTS The assessment on the healthy controls (n=47) showed that the correlation between tests on the same cognitive domain was high and that there was a five-factor solution that explained 90% of the total variance. Except for the Word List Generation subset of tests, the performance of patients with RRMS (n=39) was worse than that of the healthy controls. CONCLUSION BRB-N is a relatively simple method to assess cognition of patients with MS in the daily clinic. It does not take long to apply and does not require special skills or equipment.
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Ghaffar O, Fiati M, Feinstein A. Occupational attainment as a marker of cognitive reserve in multiple sclerosis. PLoS One 2012; 7:e47206. [PMID: 23071757 PMCID: PMC3465293 DOI: 10.1371/journal.pone.0047206] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2012] [Accepted: 09/12/2012] [Indexed: 11/29/2022] Open
Abstract
Cognitive dysfunction affects half of MS patients. Although brain atrophy generally yields the most robust MRI correlations with cognition, significant variance in cognition between individual MS patients remains unexplained. Recently, markers of cognitive reserve such as premorbid intelligence have emerged as important predictors of neuropsychological performance in MS. In the present study, we aimed to extend the cognitive reserve construct by examining the potential contribution of occupational attainment to cognitive decline in MS patients. Brain atrophy, estimated premorbid IQ, and occupational attainment were assessed in 72 MS patients. The Minimal Assessment of Cognitive Functioning in MS was used to evaluate indices of information processing speed, memory, and executive function. Results showed that occupational attainment was a significant predictor of information processing speed, memory, and executive function in hierarchical linear regressions after accounting for brain atrophy and premorbid IQ. These data suggest that MS patients with low occupational attainment fare worse cognitively than those with high occupational attainment after controlling for brain atrophy and premorbid IQ. Occupation, like premorbid IQ, therefore may make an independent contribution to cognitive outcome in MS. Information regarding an individual's occupation is easily acquired and may serve as a useful proxy for cognitive reserve in clinical settings.
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Affiliation(s)
- Omar Ghaffar
- Neuropsychiatry and Brain Sciences Programs, Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
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