1
|
Ayoobi F, Bidaki R, Shamsizadeh A, Moghadam-Ahmadi A, Amiri H. Impact of opium dependency on clinical and neuropsychological indices of multiple sclerosis patients. Neurol Sci 2019; 40:2501-2507. [PMID: 31264108 DOI: 10.1007/s10072-019-03971-8] [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: 07/16/2018] [Accepted: 06/06/2019] [Indexed: 11/25/2022]
Abstract
The aim of this study was to determine the effect of opium on clinical and neuropsychological parameters in multiple sclerosis (MS) patients with substance dependency. A cross-sectional study was conducted on MS patients in Rafsanjan, Iran. Forty opium-addict MS patients (10 males and 30 females) aged between 18 and 50 years were compared with 40 MS patients with no addiction. Word-Pair Learning, Mini-Mental State Examination (MMSE), Wisconsin Card-Sorting Test (WCST), Depression, Anxiety, Expanded Disability Status Scale (EDSS), Fatigue, and the Multiple Sclerosis Functional Composite (MSFC) were measured and compared in the two groups. The comparison of two groups showed a significant increase trait anxiety (P < 0.001), fatigue (P = 0.009) and significant decrease in the executive function (P = 0.003), MMSE (P = 0.003), and working memory (P < 0.001) in addicted MS. It indicates the better efficiency of processing in the non-addicted MS patients. The MSFC z-score also was significantly higher in the non-addicted group (P < 0.001). The opium addiction has a negative impact on the clinical and neuropsychological outcome in MS patients.
Collapse
Affiliation(s)
- Fatemeh Ayoobi
- Non-Communicable Diseases Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran.,, Rafsanjan, Iran
| | - Reza Bidaki
- Diabetes Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.,Research Center of Addiction and Behavioral Sciences, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Ali Shamsizadeh
- Department of Physiology and Pharmacology, School of Medicine, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Amir Moghadam-Ahmadi
- Non-Communicable Diseases Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran.
| | - Houshang Amiri
- Neuroscience Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran.,Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands
| |
Collapse
|
2
|
Kouvatsou Z, Masoura E, Kiosseoglou G, Kimiskidis VK. Working memory profiles of patients with multiple sclerosis: Where does the impairment lie? J Clin Exp Neuropsychol 2019; 41:832-844. [PMID: 31204607 DOI: 10.1080/13803395.2019.1626805] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Introduction: Previous studies have mostly provided general estimations regarding Working Memory impairment in patients with Multiple Sclerosis. The aim of the present study was to investigate the relative degree of impairment in the four Working Memory components in Multiple Sclerosis. Method: Thirty-eight patients diagnosed with MS and 27 matched controls were assessed using 12 different cognitive tasks of the four components, i.e. phonological loop, visuospatial sketchpad, central executive and episodic buffer. More precisely, Greek translated and adapted versions of the following tasks were administered: Digit recall, Word recall, Non-word recall, Block recall, Mazes recall, Visual Patterns recall, Backward Digit recall, Backward Block recall, Listening recall, Logical Memory I-Immediate Story recall and Greek Verbal Learning Test, which is based on the California Verbal Learning Test. Results: The phonological loop, the central executive and the spatial subcomponent of the visuospatial sketchpad were found to be equally disrupted in MS patients. The episodic buffer was found to be more heavily affected. On the other hand, the visual subcomponent of the visuospatial sketchpad proved to be preserved. Conclusions: WM subcomponents are differentially affected in patients with MS. This novel finding is discussed within the framework of existing knowledge regarding WM impairment in MS.
Collapse
Affiliation(s)
- Zoe Kouvatsou
- a School of Psychology, Department of Experimental Cognitive Psychology, Aristotle University of Thessaloniki , Thessaloniki , Greece
| | - Elvira Masoura
- a School of Psychology, Department of Experimental Cognitive Psychology, Aristotle University of Thessaloniki , Thessaloniki , Greece
| | - Grigoris Kiosseoglou
- a School of Psychology, Department of Experimental Cognitive Psychology, Aristotle University of Thessaloniki , Thessaloniki , Greece
| | - Vasilios K Kimiskidis
- b Laboratory of Clinical Neurophysiology, AHEPA Hospital, Aristotle University of Thessaloniki , Thessaloniki , Greece
| |
Collapse
|
3
|
Does cognitive reserve play any role in multiple sclerosis? A meta-analytic study. Mult Scler Relat Disord 2019; 30:265-276. [DOI: 10.1016/j.msard.2019.02.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 02/07/2019] [Accepted: 02/11/2019] [Indexed: 12/12/2022]
|
4
|
Beste C, Mückschel M, Paucke M, Ziemssen T. Dual-Tasking in Multiple Sclerosis - Implications for a Cognitive Screening Instrument. Front Hum Neurosci 2018; 12:24. [PMID: 29445335 PMCID: PMC5797790 DOI: 10.3389/fnhum.2018.00024] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 01/16/2018] [Indexed: 01/22/2023] Open
Abstract
The monitoring of cognitive functions is central to the assessment and consecutive management of multiple sclerosis (MS). Though, especially cognitive processes that are central to everyday behavior like dual-tasking are often neglected. We examined dual-task performance using a psychological-refractory period (PRP) task in N = 21 patients and healthy controls and conducted standard neuropsychological tests. In dual-tasking, MS patients committed more erroneous responses when dual-tasking was difficult. In easier conditions, performance of MS patients did not differ to controls. Interestingly, the response times were generally not affected by the difficulty of the dual task, showing that the deficits observed do not reflect simple motor deficits or deficits in information processing speed but point out deficits in executive control functions and response selection in particular. Effect sizes were considerably large with d∼0.80 in mild affected patients and the achieved power was above 99%. There are cognitive control and dual tasking deficits in MS that are not attributable to simple motor speed deficits. Scaling of the difficulty of dual-tasking makes the test applied suitable for a wide variety of MS-patients and may complement neuropsychological assessments in clinical care and research setting.
Collapse
Affiliation(s)
- Christian Beste
- Cognitive Neurophysiology, Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Moritz Mückschel
- Cognitive Neurophysiology, Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany.,Multiple Sclerosis Center, Center of Clinical Neuroscience, Department of Neurology, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Madlen Paucke
- Multiple Sclerosis Center, Center of Clinical Neuroscience, Department of Neurology, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Tjalf Ziemssen
- Multiple Sclerosis Center, Center of Clinical Neuroscience, Department of Neurology, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| |
Collapse
|
5
|
Hansen S, Lautenbacher S. Neuropsychological Assessment in Multiple Sclerosis. ZEITSCHRIFT FUR NEUROPSYCHOLOGIE 2017. [DOI: 10.1024/1016-264x/a000197] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Abstract. Neuropsychological deficits in multiple sclerosis (MS) are common. Over the past decades, many different procedures have been employed in diagnosing these deficits. Even though certain aspects of cognitive performance such as information processing speed and working memory may be affected more frequently than other cognitive functions, no specific deficit profile has been established in MS. This article provides an overview of the neuropsychological diagnostic procedures in MS and allows the reader to reach an informed decision on the applicability of specific procedures and the availability of study data in the context of MS. Additionally, it makes recommendations on the compilation of both screening procedures and extensive test batteries.
Collapse
Affiliation(s)
- Sascha Hansen
- Klinikum Bayreuth GmbH, Betriebsstätte Hohe Warte, Department of Neurology, Bayreuth, Germany
- Otto-Friedrich-University, Department of Physiological Psychology, Bamberg, Germany
| | - Stefan Lautenbacher
- Otto-Friedrich-University, Department of Physiological Psychology, Bamberg, Germany
| |
Collapse
|
6
|
Grigsby J, Kaye K, Busenbark D. Alphanumeric Sequencing: A Report on a Brief Measure of Information Processing Used among Persons with Multiple Sclerosis. Percept Mot Skills 2017; 78:883-7. [PMID: 8084709 DOI: 10.1177/003151259407800341] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Alphanumeric Sequencing involves the alternating recitation of counting and the alphabet. We report data on the use of this measure with two clinical samples of persons with multiple sclerosis, having either the chronic progressive (n = 23) or relapsing-remitting form (n = 52) of the disease. Patients were administered Alphanumeric Sequencing and several other tests of information-processing speed/capacity and short-term memory. Chronic progressive MS patients performed worse than 23 healthy controls on both the speed and error components of the test, while relapsing-remitting patients were worse than 35 controls only on the total time to complete the task. The time score was correlated with several measures of information processing and short-term memory.
Collapse
Affiliation(s)
- J Grigsby
- Rocky Mountain Multiple Sclerosis Center, Englewood, Colorado
| | | | | |
Collapse
|
7
|
Zahiri N, Abollahi I, Nabavi SM, Ehsani F, Arab AM, Shaw I, Shariat A, Shaw BS, Dastoorpoor M, Danaee M, Sangelaji B. Interference Effect of Prior Explicit Information on Motor Sequence Learning in Relapsing-Remitting Multiple Sclerosis Patients. Malays J Med Sci 2017; 24:69-80. [PMID: 28381930 DOI: 10.21315/mjms2017.24.1.8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 11/07/2016] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Multiple sclerosis (MS) is the most widespread disabling neurological condition in young adults around the world. The purpose of this study was to investigate the impact of explicit information (EI) on motor-sequence learning in MS patients. METHODS Thirty patients with relapsing-remitting MS (RRMS), age: 29.5 (SD = 5.6) years and 30 healthy gender-, age-, and education-matched control group participants, age: 28.8 (SD = 6.0) years, were recruited for this study. The participants in the healthy group were then randomly assigned into an EI (n = 15) group and a no-EI (n = 15) group. Similarly, the participants in the control group were then randomly assigned into EI (n = 15) and no-EI (n = 15) groups. The participants performed a serial reaction time (SRT) task and reaction times. A retention test was performed after 48 hours. RESULTS All participants reduced their reaction times across acquisition (MS group: 46.4 (SD = 3.3) minutes, P < 0.001, and healthy group: 39.4 (SD = 3.3) minutes, P < 0.001). The findings for the within-participants effect of repeated measures of time were significant (F(5.06, 283.7) = 71.33. P < 0.001). These results indicate that the interaction between group and time was significant (F(5.06, 283.7) = 6.44. P < 0.001), which indicated that the reaction time in both groups was significantly changed between the MS and healthy groups across times (B1 to B10). The main effect of the group (MS and healthy) (F(1, 56) = 22.78. P < 0.001) and also the main effect of no-EI vs EI (F(1, 56) = 4.71. P < 0.001) were significant. CONCLUSION This study demonstrated that that RRMS patients are capable of learning new skills, but the provision of EI prior to physical practice is deleterious to implicit learning. It is sufficient to educate MS patients on the aim and general content of the training and only to provide feedback at the end of the rehabilitative session.
Collapse
Affiliation(s)
- Nahid Zahiri
- Department of Physiotherapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Iraj Abollahi
- Department of Physiotherapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | | | - Fatemeh Ehsani
- Neuromuscular Rehabilitation Research Center, Semnan University of Medical Sciences, Semnan, Iran
| | - Amir Masoud Arab
- Department of Physiotherapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Ina Shaw
- Department of Sport and Movement Studies, University of Johannesburg, Doornfontein, Johannesburg, Republic of South Africa
| | - Ardalan Shariat
- Department of Occupational Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Malaysia
| | - Brandon S Shaw
- Department of Sport and Movement Studies, University of Johannesburg, Doornfontein, Johannesburg, Republic of South Africa
| | - Maryam Dastoorpoor
- Department of Epidemiology and Biostatistics, Faculty of Public Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mahmoud Danaee
- University of Malaya Centre of Addiction Sciences (UMCAS), Malaysia
| | | |
Collapse
|
8
|
Williams IM, Schofield P, Khade N, Abel LA. Divided visual attention: A comparison of patients with multiple sclerosis and controls, assessed with an optokinetic nystagmus suppression task. J Clin Neurosci 2016; 34:187-192. [DOI: 10.1016/j.jocn.2016.06.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 06/22/2016] [Accepted: 06/27/2016] [Indexed: 11/28/2022]
|
9
|
Pedullà L, Brichetto G, Tacchino A, Vassallo C, Zaratin P, Battaglia MA, Bonzano L, Bove M. Adaptive vs. non-adaptive cognitive training by means of a personalized App: a randomized trial in people with multiple sclerosis. J Neuroeng Rehabil 2016; 13:88. [PMID: 27716336 PMCID: PMC5050994 DOI: 10.1186/s12984-016-0193-y] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 09/17/2016] [Indexed: 11/26/2022] Open
Abstract
Background Cognitive impairment is common in multiple sclerosis (MS), but the definition of the best cognitive rehabilitation tools and features is still an open issue among researchers. The aims of the present study were to evaluate the effectiveness of COGNI-TRAcK (a customized application software delivering personalized working memory-based exercises) on cognitively impaired people with MS and to investigate the effects of an adaptive vs. a non-adaptive cognitive training administered by means of COGNI-TRAcK. Methods Twenty eight patients (20 women, age 47.5 ± 9.3 years, Expanded Disability Status Scale score 3.8 ± 1.9) were randomized in two homogeneous groups, both performing a 8-week home-based cognitive rehabilitation treatment by means of COGNI-TRAcK. The study group (ADAPT-gr) underwent an adaptive training given by the automatic adjustment of tasks difficulty to the subjects’ performance, whilst the control group (CONST-gr) was trained at constant difficulty levels. Before and after the treatment, patients’ cognitive status was assessed using a gold standard neuropsychological evaluation. Moreover, the mostly affected cognitive domains in MS (i.e., attention, concentration and information processing speed) were also assessed 6 months after the end of the treatment. Results The analysis of variance showed a significant Group*Time interaction in six out of ten tests of the cognitive evaluation. Post-hoc analysis revealed a significant improvement between the performances before and after the intervention only in the ADAPT-gr in tests evaluating verbal memory acquisition (p <0.05) and delayed recall (p = 0.001), verbal fluency (p = 0.01), sustained attention, concentration and information processing speed (p < 0.01). This last effect was maintained also after 6 months (p < 0.05). Conclusions We concluded that COGNI-TRAcK represents a suitable tool to administer a personalized training to cognitively impaired subjects and that an adaptive working load is a crucial feature determining the effectiveness of cognitive treatment, allowing transfer effects to several cognitive domains and long-term maintenance of results.
Collapse
Affiliation(s)
- Ludovico Pedullà
- Department of Experimental Medicine, Section of Human Physiology, University of Genoa, Genoa, Italy.,Italian Multiple Sclerosis Foundation, Scientific Research Area, Genoa, Italy
| | - Giampaolo Brichetto
- Italian Multiple Sclerosis Foundation, Scientific Research Area, Genoa, Italy.
| | - Andrea Tacchino
- Italian Multiple Sclerosis Foundation, Scientific Research Area, Genoa, Italy
| | - Claudio Vassallo
- Italian Multiple Sclerosis Foundation, Scientific Research Area, Genoa, Italy
| | - Paola Zaratin
- Italian Multiple Sclerosis Foundation, Scientific Research Area, Genoa, Italy
| | | | - Laura Bonzano
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Marco Bove
- Department of Experimental Medicine, Section of Human Physiology, University of Genoa, Genoa, Italy.
| |
Collapse
|
10
|
Abstract
When performing a novel task, people need to generate and apply a working strategy. The applicatio n of an appro priate working strategy enables patients with cognitive impairment (C I) to perform tasks efficiently, which in turn makes it easier to meet the challenges of daily life tasks. We investigated the strategy application abilities (SAA) of multiple sclerosis (MS) patients and compared these results with data based on healthy subjects’ performance. Seventy-six patients performed a Strategy A pplication Test (SAT) along with other cognitive tests, and completed depression, fatigue, and activity of daily living (A DL) questionnaires. O ur results indicated that 76% of the MS patients included had impaired SAA, and that this impairment was not correlated with their depression, fatigue, Expanded Disability Severity Scale (EDSS), or A DL. These findings may have important implications for the understanding of the capability of MS patients to cope with nonroutine tasks, as well as for the potential of future implementation of cognitive rehabilitation in improving the SAA of patients with MS or other cognitive disorders.
Collapse
Affiliation(s)
- Smadar Birnboim
- The Center of Multiple Sclerosis and Brain Research, Carmel Medical Center, Haifa, Israel
| | | |
Collapse
|
11
|
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]
|
12
|
Neuropsychological correlates of multiple sclerosis across the lifespan. Mult Scler 2015; 21:1355-64. [DOI: 10.1177/1352458515586088] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Accepted: 04/13/2015] [Indexed: 11/15/2022]
Abstract
Multiple sclerosis can adversely affect cognitive functioning whether the disease has an adult or pediatric onset. The research thus far suggests that pediatric MS shares many features with adult MS but is also unique in several respects. One particular characteristic of pediatric MS is that, while physical disability develops more slowly as compared with adult patients, the impact of cognitive deficits in children may be more substantial as they are in a period of life during which they acquire many skills that are needed to transition into independently functioning adults. Our review takes a lifespan approach to MS, comparing and contrasting the neuropsychology (i.e., cognitive, psychological, and psychosocial factors) of these two populations. Understanding how MS manifests across the lifespan has important implications for tailoring assessment and treatment for individuals with MS as they transition from childhood to adulthood, and later life.
Collapse
|
13
|
Mitolo M, Venneri A, Wilkinson ID, Sharrack B. Cognitive rehabilitation in multiple sclerosis: A systematic review. J Neurol Sci 2015; 354:1-9. [DOI: 10.1016/j.jns.2015.05.004] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Revised: 04/26/2015] [Accepted: 05/04/2015] [Indexed: 10/23/2022]
|
14
|
Chiaravalloti ND, DeLuca J. The influence of cognitive dysfunction on benefit from learning and memory rehabilitation in MS: A sub-analysis of the MEMREHAB trial. Mult Scler 2015; 21:1575-82. [PMID: 25662348 DOI: 10.1177/1352458514567726] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Accepted: 12/16/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND This study examined the influence of processing speed (PS) on benefit from treatment with the modified Story Memory Technique(©) (mSMT), a behavioral intervention shown to improve new learning and memory in multiple sclerosis (MS). METHODS This double-blind, placebo-controlled, randomized clinical trial included 85 participants with clinically definite MS, 45 assigned to the treatment group and 40 to the placebo-control group. Participants completed baseline and follow-up neuropsychological assessment. The present study represents a post-hoc analysis to examine the role of PS on treatment efficacy. FINDINGS The treatment group showed a significantly improved CVLT learning slope relative to the placebo group post-treatment, after co-varying PS performance. SDMT performance was a significant predictor of benefit from mSMT treatment, beyond group assignment. Post-hoc analysis indicated a significant correlation between the SDMT and overall cognition, indicating that the SDMT may be serving as a proxy for overall cognitive impairment. INTERPRETATION Performance on measures of cognitive dysfunction aside from learning and memory impact the benefit of mSMT treatment. While the current study focused on PS as a critical factor, PS may be serving as a marker for generalized cognitive dysfunction. Implications for cognitive rehabilitation in MS are discussed.
Collapse
Affiliation(s)
- Nancy D Chiaravalloti
- Kessler Foundation, Neuropsychology & Neuroscience Laboratory, USA/Rutgers, New Jersey Medical School, Department of Physical Medicine and Rehabilitation, USA
| | - John DeLuca
- Kessler Foundation, Senior Vice President for Research USA/Rutgers, New Jersey Medical School, Department of Physical Medicine and Rehabilitation, USA/Rutgers, New Jersey Medical School, Department of Neurology & Neurosciences, USA
| |
Collapse
|
15
|
Abnormalities of motor imagery and relationship with depressive symptoms in mildly disabling relapsing-remitting multiple sclerosis. J Neurol Phys Ther 2014; 38:111-8. [PMID: 24531344 DOI: 10.1097/npt.0000000000000033] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND PURPOSE The effectiveness of motor imagery (MI) as an adjunct to physical rehabilitation has previously been shown. Motor imagery ability can be affected by neurologic disorders that affect motor and cognitive function. This study was designed to assess MI ability in persons with mildly disabling relapsing-remitting multiple sclerosis (RRMS) based on the functional and cognitive dysfunctions. METHODS Twenty-two participants with RRMS and 23 age-, gender-, and education-matched comparison subjects were evaluated by a battery of MI tasks, including a kinesthetic and visual imagery questionnaire, a mental hand rotation task, and a visual guided pointing task. RESULTS There was no significant difference in MI vividness between the participants with MS and the comparison group, but the accuracy and temporal correspondence of MI in the participants with MS differed significantly from those in the comparison group. Depression scores were significantly higher in participants with MS (P < 0.001), and depression was significantly correlated with disability (r = 0.4; P < 0.05). The correlation between accuracy of MI in the participants with MS and their cognitive ability was significant (r = 0.57; P < 0.05). The MI duration of participants with MS was significantly correlated with their disability (r = 0.59; P < 0.05) and their cognitive ability (r = -0.38; P = 0.009). DISCUSSION The preservation of MI ability was observed in participants with RRMS; however, abnormalities in accuracy and temporal aspects of MI were observed even in the participants with mild disease. Abnormalities in temporal aspects and accuracy of MI were related to disability and cognitive ability, respectively. In participants with MS, depression should be considered as a confounding factor for the MI task results. CONCLUSIONS Our finding could be considered in the application of MI during the rehabilitation of persons with MS.
Collapse
|
16
|
Van Schependom J, D’hooghe MB, Cleynhens K, D’hooge M, Haelewyck MC, De Keyser J, Nagels G. Reduced information processing speed as primum movens for cognitive decline in MS. Mult Scler 2014; 21:83-91. [DOI: 10.1177/1352458514537012] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Cognitive impairment affects half of the multiple sclerosis (MS) patient population and is an important contributor to patients’ daily activities. Most cognitive impairment studies in MS are, however, cross-sectional or/and focused on the early disease stages. Objective: We aim to assess the time course of decline of different cognitive domains. Methods: We collected neuropsychological data on 514 MS patients to construct Kaplan-Meier survival curves of the tests included in the Neuropsychological Screening Battery for MS (NSBMS) and the Symbol Digit Modalities Test (SDMT). Cox-proportional hazard models were constructed to examine the influence of MS onset type, age at onset, gender, depression and level of education on the time course, expressed as age or disease. Results: Survival curves of tests focusing on information processing speed (IPS) declined significantly faster than tests with less specific demands of IPS. Median age for pathological decline was 56.2 years (95% CI: 54.4–58.2) on the SDMT and 63.9 years (95% CI: 60–66.9) on the CLTR, a memory task. Conclusion: In conclusion, IPS is the cognitive domain not only most widely affected by MS but it is also the first cognitive deficit to emerge in MS.
Collapse
Affiliation(s)
- Jeroen Van Schependom
- Center for Neurosciences, UZ Brussel, Vrije Universiteit Brussel (VUB) Brussels/Faculté de Psychologie et des sciences de l’éducation, Place du Parc, 20 UMons, Mons, Belgium
| | - Marie B D’hooghe
- Center for Neurosciences, UZ Brussel, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | | | | | - Marie-Claire Haelewyck
- Faculté de Psychologie et des sciences de l’éducation, Place du Parc, 20 UMons, Mons, Belgium
| | - Jacques De Keyser
- Center for Neurosciences UZ Brussel Vrije Universiteit Brussel (VUB), Brussels/University Medical Center Groningen, Groningen, The Netherlands
| | - Guy Nagels
- Center for Neurosciences, UZ Brussel, Vrije Universiteit Brussel (VUB), Brussels/Faculté de Psychologie et des sciences de l’éducation, Place du Parc, 20 UMons, Mons/National MS Center Melsbroek, Belgium
| |
Collapse
|
17
|
Aldrete Cortez V, Duriez-Sotelo E, Carrillo-Mora P, Pérez-Zuno J. Correlation between demyelinating lesions and executive function decline in a sample of Mexican patients with multiple sclerosis. NEUROLOGÍA (ENGLISH EDITION) 2013. [DOI: 10.1016/j.nrleng.2012.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
|
18
|
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.
Collapse
Affiliation(s)
- Helen M Genova
- Neuropsychology and Neuroscience Laboratory, Kessler Foundation Research Center, West Orange, New Jersey, USA
| | | | | | | | | |
Collapse
|
19
|
Chiaravalloti ND, Stojanovic-Radic J, DeLuca J. The role of speed versus working memory in predicting learning new information in multiple sclerosis. J Clin Exp Neuropsychol 2013; 35:180-91. [PMID: 23350959 DOI: 10.1080/13803395.2012.760537] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The most common cognitive impairments in multiple sclerosis (MS) have been documented in specific domains, including new learning and memory, working memory, and information processing speed. However, little attempt has been made to increase our understanding of their relationship to one another. While recent studies have shown that processing speed impacts new learning and memory abilities in MS, the role of working memory in this relationship has received less attention. The present study examines the relative contribution of impaired working memory versus processing speed in new learning and memory functions in MS. Participants consisted of 51 individuals with clinically definite MS. Participants completed two measures of processing speed, two measures of working memory, and two measures of episodic memory. Data were analyzed via correlational and multiple regression analysis. Results indicate that the variance in new learning abilities in this sample was primarily associated with processing speed, with working memory exerting much less of an influence. Results are discussed in terms of the role of cognitive rehabilitation of new learning and memory abilities in persons with MS.
Collapse
Affiliation(s)
- Nancy D Chiaravalloti
- Kessler Foundation Research Center, Neuropsychology and Neuroscience Laboratory, West Orange, NJ, USA.
| | | | | |
Collapse
|
20
|
[Correlation between demyelinating lesions and executive function decline in a sample of Mexican patients with multiple sclerosis]. Neurologia 2012; 28:394-9. [PMID: 23260448 DOI: 10.1016/j.nrl.2012.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2012] [Revised: 08/10/2012] [Accepted: 10/04/2012] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Multiple Sclerosis (MS) is characterised by several neurological symptoms including cognitive impairment, which has recently been the subject of considerable study. At present, evidence pointing to a correlation between lesion characteristics and specific cognitive impairment is not conclusive. OBJECTIVE To investigate the presence of a correlation between the characteristics of demyelinating lesions and performance of basic executive functions in a sample of MS patients. PATIENTS AND METHODS We included 21 adult patients with scores of 0 to 5 on the Kurtzke scale and no exacerbations of the disease in at least 3 months prior to the evaluation date. They completed the Stroop test and the Wisconsin Card Sorting Test (WCST). The location of the lesions was determined using magnetic resonance imaging (MRI) performed by a blinded expert in neuroimaging. RESULTS Demyelinating lesions were more frequently located in the frontal and occipital lobes. The Stroop test showed that as cognitive demand increased on each of the sections in the test, reaction time and number of errors increased. On the WCST, 33.33% of patients registered as having moderate cognitive impairment. No correlation could be found between demyelinating lesion characteristics (location, size, and number) and patients' scores on the tests. CONCLUSION Explanations of the causes of cognitive impairment in MS should examine a variety of biological, psychological, and social factors instead of focusing solely on demyelinating lesions.
Collapse
|
21
|
Brissart H, Morele E, Baumann C, Debouverie M. Verbal episodic memory in 426 multiple sclerosis patients: impairment in encoding, retrieval or both? Neurol Sci 2012; 33:1117-23. [DOI: 10.1007/s10072-011-0915-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2011] [Accepted: 12/20/2011] [Indexed: 01/20/2023]
|
22
|
Gmeindl L, Courtney SM. Deconstructing spatial working memory and attention deficits in multiple sclerosis. Neuropsychology 2012; 26:57-70. [PMID: 22059650 PMCID: PMC3302951 DOI: 10.1037/a0026213] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE To investigate whether spatial working memory (WM) is impaired in multiple sclerosis (MS), and, if it is, to localize impairment to specific cognitive subprocess(es). METHOD In Experiment 1, MS and control participants performed computerized memory-span and visuomotor tasks. WM subprocesses were taxed by manipulating (1) the requirement to remember serial order, (2) delay duration, and (3) the presence of irrelevant stimuli during target presentation. In Experiment 2, recall and recognition tests varied the difficulty of WM retrieval. In Experiment 3, an attention-cueing task tested the ability to voluntarily and rapidly reorient attention. RESULTS Performance was worse for MS than for control participants in both spatial recall (Exp. 1 span: 95% CIMS = [5.11, 5.57], 95% CIControls = [5.58, 6.03], p = .003, 1-tailed; Exp. 2 span: 95% CIMS = [4.44, 5.54], 95% CIControls = [5.47, 6.57], p = .006, 1-tailed) and recognition (accuracy: 95% CIMS = [0.71, 0.81], 95% CIControls = [0.79, 0.88], p = .01, 1-tailed) tests. However, there was no evidence for deficits in spatiotemporal binding, maintenance, retrieval, distractor suppression, or visuomotor processing. In contrast, MS participants were abnormally slow to reorient attention (cueing effect (ms): 95% CIMS: [90, 169], 95% CIControls: [29, 107], p = .015, 1-tailed). CONCLUSIONS Results suggest that, whereas spatial WM is impaired in MS, once spatial information has been adequately encoded into WM, individuals with MS are, on average, able to maintain and retrieve this information. Impoverished encoding of spatial information, however, may be due to inefficient voluntary orienting of attention.
Collapse
Affiliation(s)
- Leon Gmeindl
- Department of Psychological and Brain Sciences, Johns Hopkins University, 3400 N. Charles St., Baltimore, MD 21218-2686, USA.
| | | |
Collapse
|
23
|
Brissart H, Leininger M, Le Perf M, Taillemite L, Morele E, Debouverie M. La mémoire de travail dans la sclérose en plaques : revue de la littérature. Rev Neurol (Paris) 2012; 168:15-27. [DOI: 10.1016/j.neurol.2011.05.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2011] [Revised: 05/03/2011] [Accepted: 05/17/2011] [Indexed: 10/15/2022]
|
24
|
Nelson F, Datta S, Garcia N, Rozario NL, Perez F, Cutter G, Narayana PA, Wolinsky JS. Intracortical lesions by 3T magnetic resonance imaging and correlation with cognitive impairment in multiple sclerosis. Mult Scler 2011; 17:1122-9. [PMID: 21543552 PMCID: PMC3151473 DOI: 10.1177/1352458511405561] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Accurate classification of multiple sclerosis (MS) lesions in the brain cortex may be important in understanding their impact on cognitive impairment (CI). Improved accuracy in identification/classification of cortical lesions was demonstrated in a study combining two magnetic resonance imaging (MRI) sequences: double inversion recovery (DIR) and T1-weighted phase-sensitive inversion recovery (PSIR). OBJECTIVE To evaluate the role of intracortical lesions (IC) in MS-related CI and compare it with the role of mixed (MX), juxtacortical (JX), the sum of IC + MX and with total lesions as detected on DIR/PSIR images. Correlations between CI and brain atrophy, disease severity and disease duration were also sought. METHODS A total of 39 patients underwent extensive neuropsychological testing and were classified into normal and impaired groups. Images were obtained on a 3T scanner and cortical lesions were assessed blind to the cognitive status of the subjects. RESULTS Some 238 cortical lesions were identified (130 IC, 108 MX) in 82% of the patients; 39 JX lesions were also identified. Correlations between CI and MX lesions alone (p = 0.010) and with the sum of IC + MX lesions (p = 0.030) were found. A correlation between severity of CI and Expanded Disability Status Scale was also seen (p = 0.009). CONCLUSION Cortical lesions play an important role in CI. However, our results suggest that lesions that remain contained within the cortical ribbon do not play a more important role than ones extending into the adjacent white matter; furthermore, the size of the cortical lesion, and not the tissue-specific location, may better explain their correlation with CI.
Collapse
Affiliation(s)
- Flavia Nelson
- Department of Neurology, University of Texas-Houston, Health Science Center, Houston, Texas, USA.
| | | | | | | | | | | | | | | |
Collapse
|
25
|
Bonzano L, Tacchino A, Roccatagliata L, Sormani M, Mancardi G, Bove M. Impairment in explicit visuomotor sequence learning is related to loss of microstructural integrity of the corpus callosum in multiple sclerosis patients with minimal disability. Neuroimage 2011; 57:495-501. [DOI: 10.1016/j.neuroimage.2011.04.037] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2011] [Revised: 04/18/2011] [Accepted: 04/19/2011] [Indexed: 11/26/2022] Open
|
26
|
Haupts M, Calabrese P, Babinsky R, Markowitsch H, Gehlen W. Everyday memory impairment, neuroradiological findings and physical disability in multiple sclerosis. Eur J Neurol 2011; 1:159-63. [DOI: 10.1111/j.1468-1331.1994.tb00065.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
27
|
|
28
|
Sweet LH, Vanderhill SD, Jerskey BA, Gordon NM, Paul RH, Cohen RA. Subvocal articulatory rehearsal during verbal working memory in multiple sclerosis. Neurocase 2010; 16:418-25. [PMID: 20401804 DOI: 10.1080/13554791003620314] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
This study was designed to examine verbal working memory (VWM) components among multiple sclerosis (MS) patients and determine the influence of information processing speed. Of two frequently studied VWM sub-components, subvocal rehearsal was expected to be more affected by MS than short-term memory buffering. Furthermore, worse subvocal rehearsal was predicted to be specifically related to slower cognitive processing. Fifteen MS patients were administered a neuropsychological battery assessing VWM, processing speed, mood, fatigue, and disability. Participants performed a 2-Back VWM task with modified nested conditions designed to increase subvocal rehearsal (via inter-stimulus interval) and short-term memory buffering demands (via phonological similarity). Performance during these 2-Back conditions did not significantly differ and both exhibited strong positive correlations with disability. However, only scores on the subvocal rehearsal 2-Back were significantly related to performance on the remaining test battery, including processing speed and depressive symptoms. Findings suggest that performance during increased subvocal rehearsal demands is specifically influenced by cognitive processing speed and depressive symptoms.
Collapse
Affiliation(s)
- Lawrence H Sweet
- The Warren Alpert Medical School of Brown University, Butler Hospital, Providence, RI 02906 , USA.
| | | | | | | | | | | |
Collapse
|
29
|
Messinis L, Kosmidis MH, Lyros E, Papathanasopoulos P. Assessment and rehabilitation of cognitive impairment in multiple sclerosis. Int Rev Psychiatry 2010; 22:22-34. [PMID: 20233112 DOI: 10.3109/09540261003589372] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Patients with multiple sclerosis (MS) have a substantial risk of cognitive dysfunction, even in the earliest stages of the disease, where there is minimum physical disability. Despite the high prevalence rates and the significant impact of cognitive dysfunction on quality of life in this population, cognitive functions are not routinely assessed due to the high cost and time consumption. This article provides an overview of the current state of knowledge related to cognition in MS and on the optimal approach to neuropsychological assessment of this population. It then focuses on the pharmacological and other treatment options available for MS patients with, or at risk for developing, cognitive impairment. The available immune-modulating agents may reduce the development of new lesions and therefore prevent or minimize the progression of cognitive decline. However, there is currently insufficient evidence concerning the efficiency of symptomatic treatment in MS. There is also currently no optimal non-pharmacological treatment strategy for cognitive decline in MS, as the studies published to date report heterogeneous results. Nevertheless, non-pharmacological treatments such as cognitive rehabilitation may benefit some MS patients. As cognition is increasingly recognized as a major feature of MS, its assessment and rehabilitation will become a greater priority.
Collapse
Affiliation(s)
- Lambros Messinis
- Department of Neurology, Neuropsychology Section, University of Patras Medical School, Patras, Greece.
| | | | | | | |
Collapse
|
30
|
Fuso SF, Callegaro D, Pompéia S, Bueno OF. Working memory impairment in multiple sclerosis relapsing-remitting patients with episodic memory deficits. ARQUIVOS DE NEURO-PSIQUIATRIA 2010; 68:205-11. [DOI: 10.1590/s0004-282x2010000200010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2009] [Accepted: 10/16/2009] [Indexed: 11/22/2022]
Abstract
Episodic memory is impaired in multiple sclerosis (MS) patients, possibly because of deficits in working memory (WM) functioning. If so, WM alterations should necessarily be found in patients with episodic memory deficits, but this has not yet been demonstrated. In this study we aimed at determining whether episodic memory deficits in relapsing-remitting MS are found in conjunction with impaired WM. We evaluated 32 MS patients and 32 matched healthy controls. Nineteen of the 32 patients had episodic memory impairment, and as a group only these individuals showed deficits in WM capacity, which may lead to difficulty in encoding, and/or retrieving information from episodic memory.
Collapse
|
31
|
Reuter F, Audoin B, Rico A, Malikova I, Ranjeva JP, Pelletier J. [Cognitive impairment]. Rev Neurol (Paris) 2009; 165 Suppl 4:S113-22. [PMID: 19361675 DOI: 10.1016/s0035-3787(09)72122-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Cognitive impairment is common in multiple sclerosis (MS), occurring at all stages of the disease, even at the earliest, and can be a major source of disability, social impairment, and impoverished quality of life. Cognitive dysfunction is mainly focused on working memory, conceptual reasoning, verbal fluency, speed of information processing, attention and executive function. Measures of information-processing speed appear to be the most robust and sensitive markers of cognitive impairment in MS patients. Cognitive testing in MS patients is complex and cognitive screening tests are time- and cost-saving test instruments. A comprehensive and sensitive cognitive test procedure should be administered to detect cognitive dysfunction, and recent studies demonstrate that single, predominantly speed-related cognitive tests may be superior to extensive and time-consuming test batteries in screening cognitive decline. Additional clinical factors, including disease course, fatigue, and affective disturbance, can impact the degree of MS-related cognitive impairment. Despite weak correlation with disease duration and physical disability status, the degree of cognitive impairment in MS has been related to the extent of topographically specific neuronal tissue damage and loss. Numerous studies have applied conventional and quantitative magnetic resonance imaging (MRI) techniques to correlate the profile and degree of cognitive impairment with various MRI-detectable abnormalities. The burden of MRI-visible lesions does not fully account for the degree of MS-related cognitive impairment. Nonconventional MRI findings suggest the extent of subtle tissue damage in normal-appearing white and grey matter to correlate best with the severity of cognitive impairment in MS patients. Structural MRI approaches have recently been extended by functional MRI studies scrutinizing the brain's ability for adaptive functional reorganization in the presence of widespread tissue damage. Cognitive impairment in MS seems to be not simply the result of tissue destruction, but also a balance between tissue destruction, tissue repair, and adaptive functional reorganization. These findings highlight the need to screen for cognitive deficits in MS patients to conduct potential cognitive rehabilitation intervention.
Collapse
Affiliation(s)
- F Reuter
- Pôle de Neurosciences Cliniques, Service de Neurologie, CHU Timone, Rue Saint Pierre, 13385 Marseille cedex 5, France
| | | | | | | | | | | |
Collapse
|
32
|
Grazioli E, Yeh AE, Benedict RHB, Parrish J, Weinstock-Guttman B. Cognitive dysfunction in MS: bridging the gap between neurocognitive deficits, neuropsychological batteries and MRI. FUTURE NEUROLOGY 2008. [DOI: 10.2217/14796708.3.1.49] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Multiple sclerosis (MS) is an inflammatory and neurodegenerative disease of the CNS. Its sequelae include both physical and cognitive disability. Advances in neuropsychological testing and screening have led to increased recognition of cognitive impairment in MS; more than half of MS patients have been found to have some degree of cognitive impairment. Strong correlations have been found between neuropsychological testing, brain atrophy and other brain imaging techniques. These tools can aid in the comprehensive evaluation of MS patients. Genetic markers, such as ApoE and brain-derived neurotrophic factor polymorphisms, may also correlate with cognitive impairment in MS. This review details advances in recognizing and predicting cognitive dysfunction in MS. Increased understanding and better evaluation and monitoring of cognitive status in MS may improve the sensitivity of studies designed to test new disease-modifying therapies and interventions for cognitive impairment.
Collapse
Affiliation(s)
- Erica Grazioli
- Jacobs Neurological Institute, Baird Multiple Sclerosis Center, 100 High Street, Buffalo, 14203 NY, USA and, Northshore Neurosciences, Erie, PA, USA
| | - Ann E Yeh
- Jacobs Neurological Institute, Baird Multiple Sclerosis Center, 100 High Street, Buffalo, 14203 NY, USA and Women & Children’s Hospital of Buffalo, Buffalo, 14203 NY, USA
| | - Ralph HB Benedict
- Jacobs Neurological Institute, Baird Multiple Sclerosis Center, 100 High Street, Buffalo, 14203 NY, USA
| | - Joy Parrish
- Jacobs Neurological Institute, Baird Multiple Sclerosis Center, 100 High Street, Buffalo, 14203 NY, USA
| | - Bianca Weinstock-Guttman
- Jacobs Neurological Institute, Baird Multiple Sclerosis Center, 100 High Street, Buffalo, 14203 NY, USA
| |
Collapse
|
33
|
Abstract
Cognitive dysfunctions are frequent symptoms of multiple sclerosis (MS) and occur in up to 65% of patients. Especially memory, attention, executive and visual constructive functions are impaired. These problems strongly affect patients' ability to work, social relationships, and quality of life. Symptoms of physical disabilities can arise independently. Cognitive dysfunctions are clear indicators of MS progression, because they represent highly complex functions that depend on the integrity of the neuronal networks. Once manifested after a relapse, they remain stable . Given a differentiating diagnosis, it is possible to treat these dysfunctions by cognitive training and with pharmaceutical drugs, for example by immunomodulating drugs. However, treatment options are limited at present. This report provides a detailed description of cognitive functions and performance in MS patients, their comorbidities such as fatigue and depression and therapeutic options.
Collapse
Affiliation(s)
- Alexander Winkelmann
- Department of Neurology, University of Rostock, Gehlsheimer Strasse 20, 18147, Rostock, Germany
| | | | | | | |
Collapse
|
34
|
Parmenter BA, Shucard JL, Benedict RHB, Shucard DW. Working memory deficits in multiple sclerosis: comparison between the n-back task and the Paced Auditory Serial Addition Test. J Int Neuropsychol Soc 2006; 12:677-87. [PMID: 16961949 DOI: 10.1017/s1355617706060826] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2005] [Revised: 05/04/2006] [Accepted: 05/04/2006] [Indexed: 11/05/2022]
Abstract
Working memory (WM) deficits are common in multiple sclerosis (MS). The Paced Auditory Serial Addition Test (PASAT) is used frequently to measure WM in clinical settings. The n-back paradigm is used often in experimental studies of WM. One unique component of the n-back task is that it provides a measure of reaction time (RT), an additional behavioral index of processing speed and task difficulty. Despite the use of both tasks to measure WM, their common variance has not been documented. We tested 32 MS patients and 20 controls; performance measures were obtained for both tasks. Compared with controls, MS patients generally had poorer performance on both the PASAT and n-back task. MS patients also had slower RTs on the n-back than controls and showed more slowing than controls as a function of WM load. Correlational analyses showed a high correspondence between performance measures on the PASAT and n-back. Principal components analysis pointed to a common feature of the PASAT, n-back, and specific other neuropsychological measures, that is, processing speed. Although the PASAT and n-back were shown to have a significant amount of shared variance, each test has specific advantages and disadvantages for use in clinical populations.
Collapse
Affiliation(s)
- Brett A Parmenter
- Division of Developmental and Behavioral Neurosciences, Department of Neurology/The Jacobs Neurological Institute, School of Medicine and Biomedical Sciences, University at Buffalo-State University of New York, 100 High Street, Buffalo, NY 14203, USA
| | | | | | | |
Collapse
|
35
|
Defer GL, Daniel F, Marié RM. Étude de la mémoire épisodique dans la sclérose en plaques grâce au California Verbal Learning Test : données en faveur d’une altération de l’encodage. Rev Neurol (Paris) 2006; 162:852-7. [PMID: 17028547 DOI: 10.1016/s0035-3787(06)75089-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Alteration of episodic memory is one of the main cognitive deficits observed in MS patients. PATIENTS AND METHODS We studied episodic memory in a group of 71 MS patients (37 RR, 34 SP) with the California Verbal Learning test (CVLT). Direct scores and calculated indices from CVLT performances were analyzed in comparison with controls. RESULTS We observed a deficit of episodic memory in 69 p.cent of patients. This deficit was related to an alteration of encoding and retrieval processes. Despite SP-MS patients performances were constantly lower than those of RR-MS patients no significant difference was observed between the two groups. Significant correlation between the disease duration and CVLT performances were observed for the whole group but not for RR- or SP-MS groups separately, indicating that duration is more important than the phase of the disease in the worsening of memory deficit.
Collapse
Affiliation(s)
- G L Defer
- UPRES-EA 3917, Service de Neurologie Déjerine, CHU de Caen, 14033 Cedex.
| | | | | |
Collapse
|
36
|
Abstract
Neuropsychological dysfunctions have been well documented in patients with multiple sclerosis. We herein give an overview of the main findings of recent decades. The pros and cons of considering the cognitive deficits of multiple sclerosis patients as a form of 'subcortical dementia' are discussed. By comparing the neuropsychological descriptions of multiple sclerosis patients as given in the literature to other neurological diseases which are also associated with neuropsychological deficiencies, we propose the term 'multiple disconnection syndrome' to describe the variety of neuropsychological deficits encountered in this demyelinating disease. Furthermore, a ' threshold of cerebral tolerance' is assumed which must be crossed before cognitive dysfunctions are manifested clinically.
Collapse
Affiliation(s)
- Pasquale Calabrese
- Dept. of Neurology, Knappschaftskrankenhaus, Neuropsychology Unit, Ruhr-University Bochum, In der Schornau 23-25, 44892, Bochum, Germany.
| |
Collapse
|
37
|
Morgen K, Sammer G, Courtney SM, Wolters T, Melchior H, Blecker CR, Oschmann P, Kaps M, Vaitl D. Evidence for a direct association between cortical atrophy and cognitive impairment in relapsing–remitting MS. Neuroimage 2006; 30:891-8. [PMID: 16360321 DOI: 10.1016/j.neuroimage.2005.10.032] [Citation(s) in RCA: 177] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2005] [Revised: 09/07/2005] [Accepted: 10/20/2005] [Indexed: 11/25/2022] Open
Abstract
Cognitive deficits affecting memory, attention and speed of information processing are common in multiple sclerosis (MS). The mechanisms of cognitive impairment remain unclear. Here, we examined the association between neuropsychological test performance and brain atrophy in a group of mildly disabled patients with relapsing-remitting MS. We applied voxel-based morphometry (SPM2) to investigate the distribution of brain atrophy in relation to cognitive performance. Patients had lower scores than control subjects on tests of memory and executive function, including the PASAT, Digit Span Backward and a test of short-term verbal memory (Memo). Among patients, but not healthy controls, performance on the PASAT, a comprehensive measure of cognitive function and reference task for the cognitive evaluation of MS-patients, correlated with global grey matter volume as well as with grey matter volume in regions associated with working memory and executive function, including bilateral prefrontal cortex, precentral gyrus and superior parietal cortex as well as right cerebellum. Compared to healthy subjects, patients showed a volume reduction in left temporal and prefrontal cortex, recently identified as areas predominantly affected by diffuse brain atrophy in MS. A comparison of low performers in the patient group with their matched control subjects showed more extensive and bilateral temporal and frontal volume reductions as well as bilateral parietal volume loss, compatible with the progression of atrophy found in more advanced MS-patients. These findings indicate that MS-related deficits in cognition are closely associated with cortical atrophy.
Collapse
Affiliation(s)
- Katrin Morgen
- Department of Neurology, University of Giessen, Germany.
| | | | | | | | | | | | | | | | | |
Collapse
|
38
|
Abstract
Brain atrophy has emerged as a clinically relevant component of disease progression in multiple sclerosis. Progressive loss of brain tissue bulk can be detected in vivo in a sensitive and reproducible manner by MRI. Clinical studies have shown that brain atrophy begins early in the disease course. The increasing amount of data linking brain atrophy to clinical impairments suggest that irreversible tissue destruction is an important determinant of disease progression to a greater extent than can be explained by conventional lesion assessments. In this review, we will summarise the proposed mechanisms contributing to brain atrophy in patients with multiple sclerosis. We will critically discuss the wide range of MRI-based methods used to quantify regional and whole-brain-volume loss. Based on a review of current information, we will summarise the rate of atrophy among phenotypes for multiple sclerosis, the clinical relevance of brain atrophy, and the effect of disease-modifying treatments on its progression.
Collapse
Affiliation(s)
- Robert A Bermel
- Department of Neurology, Cleveland Clinic Foundation, Cleveland, OH, USA
| | | |
Collapse
|
39
|
Griffiths SY, Yamamoto A, Boudreau VG, Ross LK, Kozora E, Thornton AE. Memory interference in multiple sclerosis. J Int Neuropsychol Soc 2005; 11:737-46. [PMID: 16248909 DOI: 10.1017/s135561770505085x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2004] [Revised: 06/01/2005] [Accepted: 06/06/2005] [Indexed: 11/07/2022]
Abstract
To explore verbal memory impairments associated with multiple sclerosis (MS), we compared proactive and retroactive interference effects on the California Verbal Learning Test (CVLT; Delis et al., 1987) in a sample of 83 community-residing individuals with MS and 80 healthy participants. Individuals with MS demonstrated normal accumulation of proactive interference (PI), but attenuated release from PI relative to healthy individuals. Furthermore, accumulation of retroactive interference (RI) at short-delay free recall (SDFR) was intensified for those with MS as compared to healthy participants. Interestingly, accumulation of RI predicted long-term memory (LTM) only for participants with MS. These findings suggest that individuals with MS may experience particular difficulty when required to use semantic properties of information flexibly to facilitate verbal LTM.
Collapse
Affiliation(s)
- Stephanie Y Griffiths
- Human Neuropsychology Laboratory, Department of Psychology, Simon Fraser University, Burnaby, British Columbia, Canada
| | | | | | | | | | | |
Collapse
|
40
|
Benedict RHB. Effects of using same- versus alternate-form memory tests during short-interval repeated assessments in multiple sclerosis. J Int Neuropsychol Soc 2005; 11:727-36. [PMID: 16248908 DOI: 10.1017/s1355617705050782] [Citation(s) in RCA: 93] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2005] [Revised: 05/31/2005] [Accepted: 06/07/2005] [Indexed: 11/07/2022]
Abstract
Repeated neuropsychological testing gives rise to practice effects in that patients become familiar with test material as well as test-taking procedures. Using alternate forms prevents the learning of specific test stimuli, potentially mitigating practice effects. However, changing forms could diminish test-retest reliability coefficients. Our objective was to examine test-retest effects in multiple sclerosis (MS) patients randomly assigned to same- (SF) or alternate-form (AF) conditions. Thirty-four MS patients underwent neuropsychological evaluation. The battery included the California Verbal Learning Test II (CVLT-II) and the Brief Visuospatial Memory Test-Revised (BVMT-R), memory tests recommended by a recently convened consensus panel. Patients were randomly assigned to SF or AF groups and then tested at baseline and follow-up examination 1 week later. Analysis of variance tests (ANOVAs) revealed significant group x time interactions, with SF patients showing greater gain than AF patients. SF practice effects were often large, compromising test validity. Reliability coefficients were either equivalent or higher in the AF group, a finding attributed to ceiling effects and reduced variance in the SF group at retest. The generalizability of the findings may be limited to short test-retest intervals and the MS population. Nevertheless, I conclude that the use of CVLT-II and BVMT-R alternate forms likely helps preserve test validity without compromising test-retest reliability.
Collapse
Affiliation(s)
- Ralph H B Benedict
- State University of New York at Buffalo School of Medicine, Department of Neurology, Buffalo General Hospital, New York 14203, USA.
| |
Collapse
|
41
|
Engel C, Greim B, Zettl UK. Kognitive Defizite bei Multipler Sklerose. DER NERVENARZT 2005; 76:943-4, 946-8, 951-3. [PMID: 15765229 DOI: 10.1007/s00115-005-1901-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Cognitive dysfunctions are frequent symptoms of multiple sclerosis (MS) and occur in up to 65% of patients. Especially memory, attention, executive and visual constructive functions are impaired. These problems strongly affect patients' ability to work, social relationships, and quality of life. Symptoms of physical disabilities can arise independently. Cognitive dysfunctions are clear indicators of MS progression, since they represent highly complex functions depending on the integrity of neuronal networks. Once manifested after a relapse, they remain stable. Given a differentiating diagnosis, it is possible to treat these dysfunctions by cognitive training and pharmacologically for example by immunomodulating drugs. However, treatment options are limited at present. This report provides a detailed description of cognitive functions and performance in MS patients, their comorbidities such as fatigue and depression, currently available diagnostic tools, and therapeutic options.
Collapse
Affiliation(s)
- C Engel
- Klinik und Poliklinik für Neurologie der Universität Rostock.
| | | | | |
Collapse
|
42
|
Benedict RHB. Integrating cognitive function screening and assessment into the routine care of multiple sclerosis patients. CNS Spectr 2005; 10:384-91. [PMID: 15858456 DOI: 10.1017/s1092852900022756] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Cognitive dysfunction, a common feature of multiple sclerosis (MS), frequently leads to impaired activities of daily living, social skills deficits, diminished social support, and unemployment. There is growing evidence indicating that cognitive impairment is amenable to the effects of medication and behavioral counseling. Unfortunately, routine neuropsychological testing is rare in MS clinics because screening is ineffective and testing strategies are often too cumbersome or expensive. Recent research supports the reliability of a brief screening test called the Multiple Sclerosis Neuropsychological Screening Questionnaire as well as a minimal neuropsychological battery called the Minimal Assessment of Cognitive Function in Multiple Sclerosis. Data indicate that the Multiple Sclerosis Neuropsychological Screening Questionnaire has excellent split-half and test-retest reliability, and that it predicts neuropsychological deficiency with good sensitivity and specificity. Recently acquired data also show that the Minimal Assessment of Cognitive Function in Multiple Sclerosis tests have good test-retest reliability, discriminate MS patients from normal controls, and predict unemployment in MS patients. Thus, these or similar methods should be employed for the routine monitoring of cognitive functioning of MS patients.
Collapse
Affiliation(s)
- Ralph H B Benedict
- Department of Neurology, State University of New York at Buffalo, Buffalo, NY, USA
| |
Collapse
|
43
|
Randolph JJ, Wishart HA, Saykin AJ, McDonald BC, Schuschu KR, MacDonald JW, Mamourian AC, Fadul CE, Ryan KA, Kasper LH. FLAIR lesion volume in multiple sclerosis: relation to processing speed and verbal memory. J Int Neuropsychol Soc 2005; 11:205-9. [PMID: 15962708 DOI: 10.1017/s1355617705050253] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Information processing speed and episodic memory are two commonly affected cognitive abilities in MS. Insights into the mechanisms of and relationships between these abilities have recently come from structural neuroimaging techniques, but few studies have used fluid-attenuated inversion recovery (FLAIR), a neuroimaging sequence known to be sensitive to cortical and juxtacortical lesions in MS. We hypothesized that a volumetric index of FLAIR total lesion volume (TLV) would be associated with slowed processing speed and verbal memory dysfunction in MS. Twenty MS patients underwent FLAIR imaging and were administered measures of verbal memory and processing speed. Correlational and regression analyses indicated that TLV was directly and independently related to measures of processing speed and verbal memory, and TLV accounted for 56% of the variance in cognitive performance. These findings, considered in the context of prior work, suggest that FLAIR TLV is a useful predictor of commonly impaired cognitive functions in MS, and shows promise as a functionally relevant biomarker for disease status.
Collapse
Affiliation(s)
- John J Randolph
- Brain Imaging Laboratory, Department of Psychiatry, Dartmouth Medical School, Lebanon, New Hampshire 03756-0001, USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
44
|
Benedict RHB, Carone DA, Bakshi R. Correlating Brain Atrophy With Cognitive Dysfunction, Mood Disturbances, and Personality Disorder in Multiple Sclerosis. J Neuroimaging 2004. [DOI: 10.1111/j.1552-6569.2004.tb00277.x] [Citation(s) in RCA: 98] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
|
45
|
Shucard JL, Parrish J, Shucard DW, McCabe DC, Benedict RHB, Ambrus J. Working memory and processing speed deficits in systemic lupus erythematosus as measured by the paced auditory serial addition test. J Int Neuropsychol Soc 2004; 10:35-45. [PMID: 14751005 DOI: 10.1017/s1355617704101057] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2002] [Revised: 04/07/2003] [Indexed: 11/06/2022]
Abstract
As many as 66% of systemic lupus erythematosus (SLE) patients have been reported to have cognitive deficits. These deficits are often associated with information processing speed and working memory. Similarly, processing speed and working memory impairments are the hallmark of cognitive dysfunction in multiple sclerosis (MS). The Paced Auditory Serial Addition Test (PASAT) places high demands on processing speed and working memory. Fisk and Archibald, however, demonstrated that the total score of the PASAT does not accurately reflect impairments in these cognitive processes. They found that MS patients used a chunking strategy to obtain correct responses and reduce the cognitive demands of the task. In the present study, PASAT performance was examined for 45 SLE patients and 27 controls using alternative scoring procedures. Although the total number of correct responses did not differ between SLE and controls at the 2.4 or 2.0 s presentation rates, SLE patients had fewer dyads (correct consecutive responses) than controls at the faster rate, and more chunking responses than controls at both rates. Disease activity, disease duration, depression, fatigue, and corticosteroids could not account for these differences. The findings suggest that SLE patients, like MS patients, chunk responses more often than controls, and that this scoring procedure may better reflect the working memory and processing speed deficits present in SLE.
Collapse
Affiliation(s)
- Janet L Shucard
- Department of Neurology, Division of Developmental and Behavioral Neurosciences, State University of New York at Buffalo School of Medicine and Biomedical Sciences, USA.
| | | | | | | | | | | |
Collapse
|
46
|
Kalmar JH, Bryant D, Tulsky D, DeLuca J. Information Processing Deficits in Multiple Sclerosis: Does Choice of Screening Instrument Make a Difference? Rehabil Psychol 2004. [DOI: 10.1037/0090-5550.49.3.213] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
47
|
Audoin B, Ibarrola D, Ranjeva J, Confort‐Gouny S, Malikova I, Ali‐Chérif A, Pelletier J, Cozzone P. Compensatory cortical activation observed by fMRI during a cognitive task at the earliest stage of MS. Hum Brain Mapp 2003; 20:51-8. [PMID: 14505331 PMCID: PMC6872003 DOI: 10.1002/hbm.10128] [Citation(s) in RCA: 190] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Recent functional magnetic resonance imaging (fMRI) studies have suggested that functional cortical changes seen in patients with early relapsing-remitting multiple sclerosis (MS) can have an adaptive role to limit the clinical impact of tissue injury. To determine whether cortical reorganization occurs during high cognitive processes at the earliest stage of multiple sclerosis (MS), we performed an fMRI experiment using the conventional Paced Auditory Serial Addition Test (PASAT) as paradigm in a population of ten patients with clinically isolated syndrome suggestive of multiple sclerosis (CISSMS). At the time of the fMRI exploration, mean disease duration was 6.8 +/- 3.3 months. We compared these results to those obtained in a group of ten education-, age-, and sex-matched healthy controls. Subjects were explored on a 1.5 T MRI system using single-shot gradient-echo EPI sequence. Performances of the two groups during PASAT recorded inside the MR scanner were not different. Statistical assessment of brain activation was based on the random effect analysis (between-group analysis two-sample t-test P < 0.005 confirmed by individual analyses performed in the surviving regions P < 0.05 Mann Whitney U-test). Compared to controls, patients showed significantly greater activation in the right frontopolar cortex, the bilateral lateral prefrontal cortices, and the right cerebellum. Healthy controls did not show greater activation compared to CISSMS patients. The present study argues in favor of the existence of compensatory cortical activations at the earliest stage of MS mainly located in regions involved in executive processing in patients performing PASAT. It also suggests that fMRI can evidence the active processes of neuroplasticity contributing to mask the clinical cognitive expression of brain pathology at the earliest stage of MS.
Collapse
Affiliation(s)
- Bertrand Audoin
- Centre de Résonance Magnétique Biologique et Médicale, UMR CNRS no. 6612, Faculté de Médecine, Marseille, France
- Département de Neurologie, CHU Timone, Marseille, France
| | - Danielle Ibarrola
- Centre de Résonance Magnétique Biologique et Médicale, UMR CNRS no. 6612, Faculté de Médecine, Marseille, France
| | - Jean‐Philippe Ranjeva
- Centre de Résonance Magnétique Biologique et Médicale, UMR CNRS no. 6612, Faculté de Médecine, Marseille, France
| | - Sylviane Confort‐Gouny
- Centre de Résonance Magnétique Biologique et Médicale, UMR CNRS no. 6612, Faculté de Médecine, Marseille, France
| | - Irina Malikova
- Département de Neurologie, CHU Timone, Marseille, France
| | | | - Jean Pelletier
- Centre de Résonance Magnétique Biologique et Médicale, UMR CNRS no. 6612, Faculté de Médecine, Marseille, France
- Département de Neurologie, CHU Timone, Marseille, France
| | - Patrick Cozzone
- Centre de Résonance Magnétique Biologique et Médicale, UMR CNRS no. 6612, Faculté de Médecine, Marseille, France
| |
Collapse
|
48
|
Ruggieri RM, Palermo R, Vitello G, Gennuso M, Settipani N, Piccoli F. Cognitive impairment in patients suffering from relapsing-remitting multiple sclerosis with EDSS < or = 3.5. Acta Neurol Scand 2003; 108:323-6. [PMID: 14616301 DOI: 10.1034/j.1600-0404.2003.00157.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Previous papers have mainly demonstrated the presence and the frequency of cognitive impairment in patients suffering from relapsing-remitting multiple sclerosis. The purpose of this study was to investigate subjects with the relapsing-remitting form of the disease and mild clinical disability (EDSS < or = 3.5), so as to quantify this deficit when the illness does not yet interfere with daily living and the ability to work. METHODS Fifty patients and 50 healthy controls were submitted to a wide neuropsychological battery, including Wechsler Memory Scale I- (WMS), Benton Visual Retention Test D- (BVRT), Raven Coloured Progressive Matrices (RCPM), Kohs' test (KT), Judgement of Lines Orientation H- (JLO), Facial Recognition (FR) and Aachner Aphasie Test (AAT). They also underwent Clinical Depression Scale (CDQ) and State-Trait Anxiety Inventory (STAI). RESULTS The results show the presence of significant memory impairment on both WMS (P = 0.000) and BVRT (P = 0.000) in patients compared with controls. Patients were also impaired in abstract reasoning and problem-solving deficit (KT P = 0.003; RCPM P = 0.000) and in FR (P = 0.019). Cognitive decline correlated with illness duration (r = 0.761), but was independent of EDSS (r = 0.085). CONCLUSION Cognitive decline was present even when physical disability was not yet severe, but it was mild and did not limit patients' ability to work. The cognitive impairment outlined was of the subcortical type and correlated with illness duration. This study emphasizes the importance of cognitive examination in clinical practice. It is suggested that a complete neurological examination include tests on memory and abstract reasoning.
Collapse
Affiliation(s)
- R M Ruggieri
- Department of Neurology, University of Palermo, Italy.
| | | | | | | | | | | |
Collapse
|
49
|
Attree EA, Dancey CP, Keeling D, Wilson C. Cognitive function in people with chronic illness: inflammatory bowel disease and irritable bowel syndrome. APPLIED NEUROPSYCHOLOGY 2003; 10:96-104. [PMID: 12788684 DOI: 10.1207/s15324826an1002_05] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Recent research has shown that people with chronic illnesses often experience cognitive deficits, such deficits may be specific to a particular type of illness, reflecting the disease process itself, or they may be deficits that are common across a number of chronic illnesses. Our study investigated whether people with an organic disease (Inflammatory Bowel Disease) show cognitive dysfunction relative to the control group and people with a functional illness (Irritable Bowel Syndrome), and if so, to elucidate the mechanisms by which such dysfunction occurs. A quasi-experimental design using three groups of participants provided scores on IQ, memory, and cognitive flexibility. Differences in absolute scores were slight. However, a noticeable interaction effect was found between group and IQ: The illness groups showed a deficit in verbal IQ relative to both their own performance IQ and to that of the control group's verbal IQ. This verbal deficit cannot be explained by depression, cognitive load, or medication.
Collapse
Affiliation(s)
- Elizabeth A Attree
- School of Psychology, University of East London, Stratford, London, United Kingdom.
| | | | | | | |
Collapse
|
50
|
Lengenfelder J, Chiaravalloti ND, Ricker JH, DeLuca J. Deciphering Components of Impaired Working Memory in Multiple Sclerosis. Cogn Behav Neurol 2003; 16:28-39. [PMID: 14764999 DOI: 10.1097/00146965-200303000-00004] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To identify working memory (WM) impairment by examining components of auditory working memory with the same sample of individuals with multiple sclerosis (MS). BACKGROUND Although individuals with MS have consistently demonstrated WM impairments, the specific components involved (i.e., central executive versus storage/maintenance) remain unclear. METHOD Individuals with MS with and without cognitive impairment and healthy controls were administered a task primarily assessing storage and rehearsal/maintenance (auditory n-back) and a task with a significant central executive component (Paced Auditory Serial Addition Task). RESULTS Results indicate when the phonological loop is minimally challenged, maintenance of information is generally efficient. However, the addition of a central executive component to processing appears to be the key factor in differentiating individuals with MS with cognitive impairment from those without cognitive impairment and healthy controls. CONCLUSIONS Results indicated that the primary WM impairment in MS is within the central executive rather than the phonological loop.
Collapse
Affiliation(s)
- Jean Lengenfelder
- Kessler Medical Rehabilitation Research and Education Corporation, Neuropsychology and Neuroscience Laboratory, West Orange, NJ 07052, USA
| | | | | | | |
Collapse
|