Association between limbic system lesions and anxiety in persons with multiple sclerosis

Aging and the neuropsychiatry of multiple sclerosis: a cross-sectional study

Aging in multiple sclerosis (MS) affects clinical and radiological disease activity. Yet, evidence is equivocal about the effects of aging on the neuropsychiatric sequelae of MS, including anxiety, depression, fatigue, and cognitive dysfunction. This study aimed to clarify how the neuropsychiatric symptoms of MS vary across ages. A consecutive cohort of 1194 people with MS (pwMS) underwent neuropsychological testing using the Minimal Assessment of Cognitive Function in MS, the Hospital Anxiety and Depression Scale sub-scales for anxiety (HADS-A) and depression (HADS-D), Modified Fatigue Impact Scale (MFIS), and the Perceived Deficits Questionnaire (PDQ) for cognitive complaints. Participants were stratified into age sub-groups: 18-29, 30-39, 40-49, 50-59 years. t-tests were undertaken to compare symptoms between the 18-29 and 50-59 sub-groups. Linear regression analyses, controlling for disability (Expanded Disability Status Scale; EDSS), sex, educational years, and high-efficacy disease-modifying therapy use, were used to evaluate whether age significantly predicted neuropsychiatric sequelae. Mean age was 42.15 years, 74.12% were female, and median EDSS was 2.00. Older pwMS had reduced HADS-A, PDQ, California Verbal Learning Test (CVLT), Brief Visuospatial Memory Test (BVMT), Symbol Digit Modalities Test (SDMT), and Delis-Kaplan Executive Function System (D-KEFS) scores, all p < 0.01. There were no age differences on the HADS-D, MFIS, Controlled Oral Word Association Test, Judgment of Line Orientation, or Paced Auditory Serial Addition Test. Controlling for covariates, older age independently predicted reduced HADS-A, CVLT, BVMT, SDMT, and D-KEFS scores, all p < 0.01. In summary, as pwMS age, anxiety declines and performance on learning, memory, processing speed, and executive function tests worsens.

Proposal for local SAR safety margin in pediatric neuro-imaging using 7 T MRI and parallel transmission

Objective.Ultra-high field MRI with parallel transmission (pTx) provides a powerful neuroimaging tool with potential application in pediatrics. The use of pTx, however, necessitates a dedicated local specific absorption rate (SAR) management strategy, able to predict and monitor the peak local SAR (pSAR10g). In this work, we address the pSAR10gassessment for an in-house built 7 T 16Tx32Rx pediatric head coil, using the concept of virtual observation points (VOPs) for SAR estimation.Approach. We base our study on full-wave electromagnetic simulations performed on a database of 64 numerical anatomical head models of children aged between 4 and 16 years. We built VOPs on different subsets of this database ofN= 2 up to 30 models, and cross-validated the pSAR10gprediction using non-intersecting subsets, each containing 30 models. We thereby propose a minimum anatomical safety factor (ASF) to apply to the VOP set to enforce safety, despite intersubject variability. Our analysis relies on the computation of the worst case SAR to VOP-SAR ratio, independent of the pTx RF excitation.Main results.The interpolation model provides that the minimum ASF decreases as1+5.37⋅N-0.75withN. Using all 64 models to build VOPs leads to an estimated ASF of 1.24 when considering the VOP validity for an infinite number of subjects.Significance.We propose a general simulation workflow to guide ASF estimation and quantify the trade-off between the number of numerical models available for VOP construction and the safety factor. The approach would apply to any simulation dataset and any pTx setup.

Fatigue and depression influence the prevalence of anxiety in patients with multiple sclerosis

BACKGROUND

There is scarce information in Middle-Eastern Europe regarding the prevalence of anxiety in patients with multiple sclerosis (pwMS) and its association with different clinical-demographic factors.

OBJECTIVE

We aimed to determine the prevalence of anxiety in Hungarian MS patients and to analyze associated factors.

MATERIALS AND METHODS

We evaluated 260 PwMS with the STAI-5 anxiety questionnaire. Fatigue (FIS), depression (BDI-II) and cognition (BICAMS) were also measured. Patients underwent standard neurological evaluations to evaluate Expanded Disability Status Scale (EDSS), and also measured the fine motor skills of the hand with the 9-hole peg test (9HPT), and the walking distance with the 25-foot walking test (T25FW).

RESULTS

We identified 23.1% (N = 60) of the patients with anxiety (only state, trait or both forms concurrently). According to our two univariate, multivariable logistic regression analysis, fatigue and depression are strongly associated with both state and trait anxiety. In the absence of fatigue, the odds of trait anxiety are 82% lower (OR: 0.18; 95% CI: 0.06-0.53; p = 0.002), while in the case of pwMS without depression, the odds are reduced by 81% (OR: 0.19; CI95%= 0.07-0.51, p = 0.001). This association with fatigue (OR: 0.33; CI95%= 0.13-0.85, p = 0.021) and depression (OR: 0.14; CI95%=0.06-0.35; p < 0.001) can also be statistically verified on state anxiety. Importantly, a significant association with state anxiety was found in SPSM patients as well (OR: 34.94; CI95%=2.55-479.61; p = 0.008).

CONCLUSIONS

Anxiety was strongly associated with fatigue, depression, and secondary progressive disease form. These results emphasize the burden of psychiatric morbidity in pwMS.

Behavioral disorders in multiple sclerosis: a comprehensive review

Multiple sclerosis (MS) is a heterogenous autoimmune-mediated disease of the central nervous system (CNS) characterized by inflammation, demyelination and chronic progressive neurodegeneration. Among its broad and unpredictable range of neuropsychiatric symptoms, behavioral changes are common, even from the early stages of the disease, while they are associated with cognitive deficits in advanced MS. According to DSM-5, behavioral disorders include attention deficits, oppositional, defiant and conduct disorders, anxiety, panic, obsessive-compulsive disorders (OCD), disruptive and emotional disorders, while others include also irritability, agitation, aggression and executive dysfunctions. Approximately 30 to 80% of individuals with MS demonstrate behavioral changes associated with disease progression. They are often combined with depression and other neuropsychiatric disorders, but usually not correlated with motor deficits, suggesting different pathomechanisms. These and other alterations contribute to disability in MS. While no specific neuropathological data for behavioral changes in MS are available, those in demyelination animal models share similarities with white matter and neuroinflammatory abnormalities in humans. Neuroimaging revealed prefrontal cortical atrophy, interhemispheric inhibition and disruption of fronto-striato-thalamic and frontoparietal networks. This indicates multi-regional patterns of cerebral disturbances within the MS pathology although their pathogenic mechanisms await further elucidation. Benefits of social, psychological, behavioral interventions and exercise were reported. Based on systematical analysis of PubMed, Google Scholar and Cochrane library, current epidemiological, clinical, neuroimaging and pathogenetic evidence are reviewed that may aid early identification of behavioral symptoms in MS, and promote new therapeutic targets and strategies.

Quantitative susceptibility mapping of the fear circuit: Associations with silent symptoms in relapsing-remitting multiple sclerosis

Background: Multiple sclerosis (MS) is a long-term autoimmune inflammatory disorder that affects the central nervous system leading to neurodegeneration, and can involve a variety of symptoms. These symptoms can include fatigue, anxiety, depression, and cognitive decline, which may be silent. The objective of this study was to explore changes in brain iron deposition in people with relapsing-remitting MS (pw-RRMS) compared to healthy controls (HCs), with a particular focus on regions of fear circuit. Additionally, the study aimed to evaluate relationship between iron deposition in these areas and clinical measurements. Methods: Pw-RRMS and HCs participants underwent brain MRI scans using quantitative susceptibility mapping (QSM) to assess iron deposition in the fear circuit between the two groups. The study analyzed correlations between brain susceptibility changes and clinical measurements. Results: We recruited 35 pw-RRMS (mean age = 46.7 ± 11 years; median EDSS = 2.5) and 18 HCs (mean age = 40.6 ± 17.8 years). Our research revealed significant increases in QSM signals relating to iron deposition in pw-RRMS compared to HCs, whole fear circuit (β = 5.82, p < 0.001), caudate (β = 21.48, p < 0.001), and putamen (β = 17.53, p = 0.03), showing the greatest difference. The whole fear circuit and particularly the caudate are strongly associated with fatigue in pw-RRMS. QSM values in the anterior cingulate cortex significantly differed between pw-RRMS with normal and abnormal depression scores (p = 0.007). Conclusions: These results strengthen the relationship between increased iron deposition in fear circuit regions and specific silent symptoms in pw-RRMS. However, further studies are required to confirm these findings and clarify the implications of iron accumulation in MS pathophysiology.

The influence of depression and anxiety on cognition in people with multiple sclerosis: a cross-sectional analysis

There are conflicting findings about the relationships between depression, anxiety, and cognitive dysfunction in people with multiple sclerosis (MS), and a paucity of research has examined the cumulative influence on cognition of depression plus anxiety. This study aimed to determine whether elevated symptoms of depression and anxiety alone or in combination are associated with worse cognition in people with MS. In this cross-sectional analysis, people with MS consecutively seen at a tertiary neuropsychiatry clinic completed the Hospital Anxiety and Depression Scale for symptoms of depression (HADS-D) and anxiety (HADS-A), and the Minimal Assessment of Cognitive Function in MS for cognitive indices. Accounting for covariates, regression models predicted cognitive indices from scores for HADS-D, HADS-A, and the interaction. Of 831 people with MS, 72% were female, mean age was 43.2 years, and median Expanded Disability Status Scale score was 2.0. Depressive symptoms were independently predictive of lower verbal fluency (Controlled Oral Word Association Test, p < 0.01), verbal learning (California Verbal Learning Test-II (CVLT-II) total learning, p = 0.02), verbal delayed recall (CVLT-II delayed recall, p < 0.01), and processing speed (Symbol Digit Modalities Test, p < 0.01; three-second Paced Auditory Serial Addition Test (PASAT), p = 0.05; two-second PASAT, p = 0.01). Anxiety in people with depression predicted decreased visuospatial function (Judgment of Line Orientation, p = 0.05), verbal learning (p < 0.01), verbal delayed recall (p < 0.01), visuospatial recall (Brief Visuospatial Memory Test-Revised, p = 0.02), and executive function (Delis-Kaplan Executive Function System, p < 0.01). Anxiety alone was not independently predictive of cognition. In conclusion, depression, especially with comorbid anxiety, is associated with cognitive dysfunction in people with MS.

Depression and anxiety in multiple sclerosis. Review of a fatal combination

Depression and anxiety are the most frequent neuropsychiatric symptoms of multiple sclerosis (MS), an autoimmune-mediated demyelinating neurodegenerative disease. Their prevalence is 25-65% and 20-54%, respectively, often associated with chronic fatigue and cognitive impairment, but usually not correlated with motor and other deficits, suggesting different pathophysiological mechanisms. Both disorders often arise before MS diagnosis, lead to faster disability and impair the quality of life. Risk factors are (young) age, genetic and family history burden. While no specific neuropathological data for depression (and anxiety) in MS are available, modern neuroimaging studies showed bilateral fronto-temporal, subcortical and limbic atrophies, microstructural white matter lesions and disruption of frontoparietal, limbic and neuroendocrine networks. The pathogenesis of both depression and anxiety in MS is related to shared mechanisms including oxidative stress, mitochondrial dysfunction, neuroinflammation and neuroendocrine mechanisms inducing complex functional and structural brain lesions, but they are also influenced by social and other factors. Unfortunately, MS patients with anxiety, major depression or suicidal thoughts are often underassessed and undertreated. Current treatment, in addition to antidepressant therapy include transcranial magnetic stimulation, cognitive, relaxation, dietary and other healthcare measures that must be individualized. The present state-of- the-art review is based on systematic analysis of PubMed, Google Scholar and Cochrane Library until May 2024, with focus on the prevalence, clinical manifestation, neuroimaging data, immune mechanisms and treatment options. Depression and anxiety in MS, like in many other neuroimmune disorders, are related, among others, to multi-regional patterns of cerebral disturbances and complex pathogenic mechanisms that deserve further elucidation as a basis for early diagnosis and adequate management to improve the quality of life in this disabling disease.

Oscillation-Specific Nodal Differences in Parkinson's Disease Patients with Anxiety

Background

Parkinson's disease (PD) is a common neurodegenerative disorder that is predominantly known for its motor symptoms but is also accompanied by non-motor symptoms, including anxiety.

Objective

The underlying neurobiological substrates and brain network changes associated with comorbid anxiety in PD require further exploration.

Methods

An analysis of oscillation-specific nodal properties in patients with and without anxiety was conducted using resting-state functional magnetic resonance imaging (rs-fMRI) and graph theory. We used a band-pass filtering approach to differentiate oscillatory frequency bands for subsequent functional connectivity (FC) and graph analyses.

Results

The study included 68 non-anxiety PD (naPD) patients, 62 anxiety PD (aPD) patients, and 64 healthy controls (NC). Analyses of nodal betweenness centrality (BC), degree centrality (DC), and efficiency were conducted across multiple frequency bands. The findings indicated no significant differences in BC among naPD, aPD, and NC within the 0.01-0.08 Hz frequency range. However, we observed a specific reduction in BC at narrower frequency ranges in aPD patients, as well as differing patterns of change in DC and efficiency, which are believed to reflect the neurophysiological bases of anxiety symptoms in PD.

Conclusions

Differential oscillation-specific nodal characteristics have been identified in PD patients with anxiety, suggesting potential dysregulations in brain network dynamics. These findings emphasize the complexity of brain network alterations in anxiety-associated PD and identify oscillatory frequencies as potential biomarkers. The study highlights the importance of considering oscillatory frequency bands in the analysis of brain network changes.