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Hechenberger S, Helmlinger B, Tinauer C, Jauk E, Ropele S, Heschl B, Wurth S, Damulina A, Eppinger S, Demjaha R, Khalil M, Enzinger C, Pinter D. Evaluation of a self-administered iPad ®-based processing speed assessment for people with multiple sclerosis in a clinical routine setting. J Neurol 2024; 271:3268-3278. [PMID: 38441609 PMCID: PMC11136781 DOI: 10.1007/s00415-024-12274-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 02/21/2024] [Accepted: 02/23/2024] [Indexed: 05/30/2024]
Abstract
BACKGROUND Limited resources often hinder regular cognitive assessment of people with multiple sclerosis (pwMS) in standard clinical care. A self-administered iPad®-based cognitive screening-tool (Processing Speed Test; PST) might mitigate this problem. OBJECTIVE To evaluate the PST in clinical routine. METHODS We investigated the feasibility of the PST in both a quiet and a waiting room setting. We assessed the validity of the PST in comparison with the established Symbol Digit Modalities Test (SDMT). We explored associations between processing speed assessments and the Brief International Cognitive Assessment for MS (BICAMS), magnetic resonance imaging (MRI) parameters, and psychological factors. Additionally, we explored the ability of the PST to detect impairment in processing speed compared to the SDMT. RESULTS The PST was feasible in the waiting room setting. PST and SDMT correlated comparably with the BICAMS, MRI parameters, and psychological variables. Of 172 pwMS, 50 (30.8%) showed cognitive impairment according to the BICAMS; respective values were 47 (27.3%) for the SDMT and 9 (5.2%) for the PST. CONCLUSIONS The PST performed in a waiting room setting correlates strongly with established cognitive tests. It thus may be used to assess processing speed in a resource-efficient manner and complement cognitive assessment in clinical routine. Despite comparable validity of the PST and SDMT, we identified more pwMS with impaired processing speed using normative data of the SDMT compared to the PST and advise caution, that the common cut-off score of - 1.5 SD from the current PST is not appropriate in Europe.
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Affiliation(s)
- Stefanie Hechenberger
- Research Unit for Neuronal Plasticity and Repair, Medical University of Graz, Graz, Austria
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - Birgit Helmlinger
- Research Unit for Neuronal Plasticity and Repair, Medical University of Graz, Graz, Austria
- Department of Neurology, Medical University of Graz, Graz, Austria
| | | | - Emanuel Jauk
- Department of Medical Psychology, Psychosomatics, and Psychotherapy, Medical University of Graz, Graz, Austria
- Clinical Psychology and Behavioral Neuroscience, Technische Universität Dresden, Dresden, Germany
| | - Stefan Ropele
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - Bettina Heschl
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - Sebastian Wurth
- Department of Neurology, Medical University of Graz, Graz, Austria
- Division of Neuroradiology and Interventional Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
| | - Anna Damulina
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - Sebastian Eppinger
- Department of Neurology, Medical University of Graz, Graz, Austria
- Division of Neuroradiology and Interventional Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
| | - Rina Demjaha
- Department of Neurology, Medical University of Graz, Graz, Austria
- Neurology Biomarker Research Unit, Medical University of Graz, Graz, Austria
| | - Michael Khalil
- Department of Neurology, Medical University of Graz, Graz, Austria
- Neurology Biomarker Research Unit, Medical University of Graz, Graz, Austria
| | - Christian Enzinger
- Research Unit for Neuronal Plasticity and Repair, Medical University of Graz, Graz, Austria
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - Daniela Pinter
- Research Unit for Neuronal Plasticity and Repair, Medical University of Graz, Graz, Austria.
- Department of Neurology, Medical University of Graz, Graz, Austria.
- Head of Research Unit for Neuronal Plasticity and Repair, Department of Neurology, Medical University of Graz, Auenbruggerplatz 22, 8036, Graz, Austria.
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Lindberg M, Larsson-Lund M, Berg Jansson A, Ranner M. Employer representatives' experiences of supporting employees with cognitive impairments in a digital work environment. Work 2024:WOR230690. [PMID: 38820057 DOI: 10.3233/wor-230690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2024] Open
Abstract
BACKGROUND Digital work poses cognitive demands on all employees, but the impact is greater for employees with cognitive impairments. Digitalization also has significant implications for employer representatives as they are responsible for the work environment. However, knowledge is scarce concerning employer representatives' perspectives on identifying needs and support for employees with cognitive impairments working in a digital work environment. OBJECTIVE To describe employer representatives' experiences of work environment management with focus on employees with cognitive impairments working in a digital environment. METHODS Focus group methodology was used. Six employer representatives with work environment responsibilities participated. RESULTS One overall theme "Mastering the interconnected processes in a transformative digital work environment" as well as three themes "Facilitating good digital work conditions", "Identifying needs and difficulties in work tasks among employees' with cognitive impairments" and "Pursuing knowledge and collaborations to support employees with cognitive impairments" with subthemes were identified. The themes describe employer representatives' challenges and efforts to identify fluctuating needs in employees with cognitive impairments and, also, to organize and reduce cognitive demands in the work environment to support them. CONCLUSIONS Managing the challenges of an evolving digital work environment and matching individual work ability of employees with cognitive impairments in relation to cognitive demands is an ongoing process. The participants valued cooperation with employees with cognitive impairments but lacked support from expertise. The need to develop and implement a functioning support system for vocational rehabilitation to ensure a sustainable work in digital work environments is indicated.
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Affiliation(s)
- Monika Lindberg
- Department of Health, Education and Technology, Division of Health, Medicine and Rehabilitation, Luleå University of Technology, Luleå, Sweden
| | - Maria Larsson-Lund
- Department of Health, Education and Technology, Division of Health, Medicine and Rehabilitation, Luleå University of Technology, Luleå, Sweden
| | - Anna Berg Jansson
- Department of Social Sciences, Technology and Arts, Division of Humans and Technology, Luleå University of Technology, Luleå, Sweden
| | - Maria Ranner
- Department of Health, Education and Technology, Division of Health, Medicine and Rehabilitation, Luleå University of Technology, Luleå, Sweden
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3
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Espiritu AI, Soliman Y, Blair M, Santo J, Casserly C, Racosta JM, Morrow SA. Self-reported cognitive function mediates the relationship between employment status and cognitive functioning in persons with multiple sclerosis. Mult Scler Relat Disord 2024; 87:105645. [PMID: 38761696 DOI: 10.1016/j.msard.2024.105645] [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: 09/13/2023] [Revised: 04/16/2024] [Accepted: 04/25/2024] [Indexed: 05/20/2024]
Abstract
BACKGROUND Cognitive impairment (CI) is common in people with MS (PwMS). Evidence is lacking for the self-reported CI's mediation effect on employment status and objective cognitive performance. Self-reported CI was found to be unreliable and seemed to be more associated with depression rather than formal cognitive performance. We hypothesized that the link between subjective and objective assessments of cognitive functions, mood, and employment status may be more complex in PwMS than previously reported. OBJECTIVE The aims of this study are the following: (Romero-Pinel et al., 2022) to determine whether employment status could affect performance in cognitive function testing and (Rao et al., 1991) whether their relationship may be mediated by self-reported CI; and (Deluca et al., 2013) to determine whether self-reported depression interacts with self-reported CI in influencing performance in various cognitive domains in PwMS. METHODOLOGY A retrospective study was performed involving PwMS who completed the self-report Multiple Sclerosis Neuropsychological Questionnaire (MSNQ), Hospital Anxiety and Depression Scale-depression scale (HADS-D), Minimal Assessment of Cognitive Function in MS (MACFIMS) and had data regarding employment status. Included PwMS were classified as employed or unemployed. A structural equation modeling (SEM) approach was taken due to the advantage of examining multiple cognitive outcomes simultaneously while accounting for shared associations. First, a latent factor of memory and executive functioning modeled the error-free associations between both factors and a processing speed task (SDMT). Next, the model tested for the indirect effect of self-reported cognition (MSNQ) on employment status differences in each outcome (memory, speed, and executive functioning). Finally, we tested interactions between MSNQ and HADS-D on each of the outcomes. RESULTS We included 590 PwMS: 72.5% female, mean age 44.2 years (SD = 10.5), mean disease duration 8.6 years (SD 9.0). The majority (n = 455, 77.1%) had relapsing MS; 357 (60.5%) were employed. About half (n = 301, 51%) did not report CI on the MSNQ; of those, 213 (70.8%) were employed. The mean MSNQ for employed PwMS was 24.5 (SD = 10.7) and 29.8 (SD = 11.2) for unemployed PwMS. Employed PwMS had significantly better memory (β = .16, p < .05), executive functioning (β = .25, p < .05), and processing speed (β = .22, p < .05). MSNQ partially indirectly mediated the effect of employment status on memory (Δβ = .03, p < .05) and executive functioning (Δβ = .03, p < .05) and processing speed (Δβ = .04, p < .05), indicating that self-report CI partially explains the influence of employment status on these cognitive domains. The association between MSNQ with both memory and executive functioning was moderated by depression, meaning that in PwMS with high HADS-D scores, MSNQ was more strongly related to worse memory and executive functioning. The final model was an acceptable fit to the data (χ2(87) = 465.07, p < .05; CFI = .90, RMSEA = .08, 90% CI [.06, .09], SRMR = .05) explaining 41.20%, 38.50% and 33.40% of the variability in memory, executive functioning, and processing speed, respectively. CONCLUSION Self-reported CI partially explains the associations between employment status and objective cognitive assessment in PwMS. Depression may moderate the relationship between self-reported cognitive assessment and objective cognitive performance. Thus, employment status and mood may guide the interpretation of self-reported CI.
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Affiliation(s)
- Adrian I Espiritu
- Ontario Shores Centre for Mental Health Sciences, Whitby, Ontario, Canada; Department of Psychiatry and Department of Medicine (Division of Neurology), University of Toronto, Toronto, Ontario, Canada; Department of Clinical Epidemiology, College of Medicine, University of the Philippines Manila, Manila, Philippines; Concussion Canadian Center, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Yasmin Soliman
- Department of Clinical Neurological Sciences, London Health Sciences Centre, Western University, London, ON, Canada; Concussion Canadian Center, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Mervin Blair
- Ontario Shores Centre for Mental Health Sciences, Whitby, Ontario, Canada; Concussion Canadian Center, University Health Network, University of Toronto, Toronto, ON, Canada; Parkwood Institute, St. Joseph's Health Care Centre, London, ON, Canada
| | - Jonathan Santo
- Concussion Canadian Center, University Health Network, University of Toronto, Toronto, ON, Canada; Department of Psychology, University of Nebraska Omaha, United States
| | - Courtney Casserly
- Department of Clinical Neurological Sciences, London Health Sciences Centre, Western University, London, ON, Canada; Concussion Canadian Center, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Juan M Racosta
- Department of Clinical Neurological Sciences, London Health Sciences Centre, Western University, London, ON, Canada; Concussion Canadian Center, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Sarah A Morrow
- Department of Clinical Neurological Sciences, London Health Sciences Centre, Western University, London, ON, Canada; Concussion Canadian Center, University Health Network, University of Toronto, Toronto, ON, Canada; Parkwood Institute, St. Joseph's Health Care Centre, London, ON, Canada; Department of Clinical Neurological Sciences, Hotchkiss Brain Institute, University of Calgary, Calgary AB, Canada.
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4
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van Dam M, Krijnen EA, Nauta IM, Fuchs TA, de Jong BA, Klein M, van der Hiele K, Schoonheim MM, Hulst HE. Identifying and understanding cognitive profiles in multiple sclerosis: a role for visuospatial memory functioning. J Neurol 2024; 271:2195-2206. [PMID: 38409536 PMCID: PMC11055708 DOI: 10.1007/s00415-024-12227-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 01/26/2024] [Accepted: 01/27/2024] [Indexed: 02/28/2024]
Abstract
BACKGROUND The heterogeneous nature of cognitive impairment in people with multiple sclerosis (PwMS) hampers understanding of the underlying mechanisms and developing patient-tailored interventions. We aim to identify and classify cognitive profiles in PwMS, comparing these to cognitive status (preserved versus impaired). METHODS We included 1213 PwMS (72% female, age 45.4 ± 10.7 years, 83% relapsing-remitting MS). Cognitive test scores were converted to Z-scores compared to healthy controls for the functions: attention, inhibition, information processing speed (IPS), verbal fluency and verbal/visuospatial memory. Concerning cognitive status, impaired cognition (CI) was defined as performing at Z ≤ - 1.5 SD on ≥ 2 functions. Cognitive profiles were constructed using latent profile analysis on all cognitive functions. Cognitive profiles or status was classified using gradient boosting decision trees, providing the importance of each feature (demographics, clinical, cognitive and psychological functioning) for the overall classification. RESULTS Six profiles were identified, showing variations in overall performance and specific deficits (attention, inhibition, IPS, verbal fluency, verbal memory and visuospatial memory). Across the profiles, IPS was the most impaired function (%CI most preserved profile, Profile 1 = 22.4%; %CI most impaired profile, Profile 6 = 76.6%). Cognitive impairment varied from 11.8% in Profile 1 to 95.3% in Profile 6. Of all cognitive functions, visuospatial memory was most important in classifying profiles and IPS the least (area under the curve (AUC) = 0.910). For cognitive status, IPS was the most important classifier (AUC = 0.997). CONCLUSIONS This study demonstrated that cognitive heterogeneity in MS reflects a continuum of cognitive severity, distinguishable by distinct cognitive profiles, primarily explained by variations in visuospatial memory functioning.
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Affiliation(s)
- Maureen van Dam
- MS Center Amsterdam, Anatomy and Neurosciences, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands.
- Institute of Psychology, Health, Medical and Neuropsychology Unit, Leiden University, Wassenaarseweg 52, Leiden, The Netherlands.
| | - Eva A Krijnen
- MS Center Amsterdam, Anatomy and Neurosciences, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Ilse M Nauta
- MS Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands
| | - Tom A Fuchs
- MS Center Amsterdam, Anatomy and Neurosciences, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands
| | - Brigit A de Jong
- MS Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands
| | - Martin Klein
- Medical Psychology, Amsterdam UMC Location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Karin van der Hiele
- Institute of Psychology, Health, Medical and Neuropsychology Unit, Leiden University, Wassenaarseweg 52, Leiden, The Netherlands
| | - Menno M Schoonheim
- MS Center Amsterdam, Anatomy and Neurosciences, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands
| | - Hanneke E Hulst
- Institute of Psychology, Health, Medical and Neuropsychology Unit, Leiden University, Wassenaarseweg 52, Leiden, The Netherlands
- Leiden Institute for Brain and Cognition, Leiden University, Wassenaarseweg 52, 2333AK, Leiden, The Netherlands
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Waskowiak PT, Ruitenberg MFL, Hulst HE. Neuropsychological assessment in MS is outdated and is in need for innovation: Yes. Mult Scler 2024; 30:150-151. [PMID: 38291552 PMCID: PMC10851638 DOI: 10.1177/13524585241230184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Affiliation(s)
- Pauline T Waskowiak
- MS Center Amsterdam, Department of Medical Psychology, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands
| | - Marit FL Ruitenberg
- Health, Medical and Neuropsychology Unit, Leiden University, Leiden, The Netherlands
- Leiden Institute for Brain and Cognition, Leiden University, Leiden, The Netherlands
| | - Hanneke E Hulst
- Health, Medical and Neuropsychology Unit, Leiden University, Leiden, The Netherlands
- Leiden Institute for Brain and Cognition, Leiden University, Leiden, The Netherlands
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Aarts J, Saddal SRD, Bosmans JE, de Groot V, de Jong BA, Klein M, Ruitenberg MFL, Schaafsma FG, Schippers ECF, Schoonheim MM, Uitdehaag BMJ, van der Veen S, Waskowiak PT, Widdershoven GAM, van der Hiele K, Hulst HE. Don't be late! Postponing cognitive decline and preventing early unemployment in people with multiple sclerosis: a study protocol. BMC Neurol 2024; 24:28. [PMID: 38225561 PMCID: PMC10789039 DOI: 10.1186/s12883-023-03513-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 12/17/2023] [Indexed: 01/17/2024] Open
Abstract
BACKGROUND Up to 65% of people with multiple sclerosis (PwMS) develop cognitive deficits, which hampers their ability to work, participating in day-to-day life and ultimately reducing quality of life (QoL). Early cognitive symptoms are often less tangible to PwMS and their direct environment and are noticed only when symptoms and work functioning problems become more advanced, i.e., when (brain) damage is already advanced. Treatment of symptoms at a late stage can lead to cognitive impairment and unemployment, highlighting the need for preventative interventions in PwMS. AIMS This study aims to evaluate the (cost-) effectiveness of two innovative preventative interventions, aimed at postponing cognitive decline and work functioning problems, compared to enhanced usual care in improving health-related QoL (HRQoL). METHODS Randomised controlled trial including 270 PwMS with mild cognitive impairment, who have paid employment ≥ 12 h per week and are able to participate in physical exercise (Expanded Disability Status Scale < 6.0). Participants are randomised across three study arms: 1) 'strengthening the brain' - a lifestyle intervention combining personal fitness, mental coaching, dietary advice, and cognitive training; 2) 'strengthening the mind' - a work-focused intervention combining the capability approach and the participatory approach in one-on-one coaching by trained work coaches who have MS themselves; 3) Control group-receiving general information about cognitive impairment in MS and receiving care as usual. Intervention duration is four months, with short-term and long-term follow-up measurements at 10 and 16 months, respectively. The primary outcome measure of the Don't be late! intervention study will be HRQoL as measured with the 36-item Short Form. Secondary outcomes include cognition, work related outcomes, physical functioning, structural and functional brain changes, psychological functioning, and societal costs. Semi-structured interviews and focus groups with stakeholders will be organised to qualitatively reflect on the process and outcome of the interventions. DISCUSSION This study seeks to prevent (further) cognitive decline and job loss due to MS by introducing tailor-made interventions at an early stage of cognitive symptoms, thereby maintaining or improving HRQoL. Qualitative analyses will be performed to allow successful implementation into clinical practice. TRIAL REGISTRATION Retrospectively registered at ClinicalTrials.gov with reference number NCT06068582 on 10 October 2023.
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Affiliation(s)
- Jip Aarts
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Faculty of Social Sciences, Leiden University, Wassenaarseweg 52, Leiden, 2333 AK, The Netherlands.
- Leiden Institute for Brain and Cognition, Leiden, The Netherlands.
- MS Center Amsterdam, Anatomy and Neurosciences, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands.
| | - Shalina R D Saddal
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Faculty of Social Sciences, Leiden University, Wassenaarseweg 52, Leiden, 2333 AK, The Netherlands
- MS Center Amsterdam, Public and Occupational Health, Vrije Universiteit Amsterdam, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands
| | - Judith E Bosmans
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Vincent de Groot
- MS Center Amsterdam, Rehabilitation Medicine, Vrije Universiteit Amsterdam, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands
| | - Brigit A de Jong
- MS Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands
| | - Martin Klein
- Medical Psychology, MS Center Amsterdam, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands
| | - Marit F L Ruitenberg
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Faculty of Social Sciences, Leiden University, Wassenaarseweg 52, Leiden, 2333 AK, The Netherlands
- Leiden Institute for Brain and Cognition, Leiden, The Netherlands
| | - Frederieke G Schaafsma
- MS Center Amsterdam, Public and Occupational Health, Vrije Universiteit Amsterdam, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands
| | - Esther C F Schippers
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Faculty of Social Sciences, Leiden University, Wassenaarseweg 52, Leiden, 2333 AK, The Netherlands
| | - Menno M Schoonheim
- MS Center Amsterdam, Anatomy and Neurosciences, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands
| | - Bernard M J Uitdehaag
- MS Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands
| | - Sabina van der Veen
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Faculty of Social Sciences, Leiden University, Wassenaarseweg 52, Leiden, 2333 AK, The Netherlands
| | - Pauline T Waskowiak
- Medical Psychology, MS Center Amsterdam, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands
| | - Guy A M Widdershoven
- Ethics, Law & Medical Humanities, Vrije Universiteit Amsterdam, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands
| | - Karin van der Hiele
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Faculty of Social Sciences, Leiden University, Wassenaarseweg 52, Leiden, 2333 AK, The Netherlands
- Leiden Institute for Brain and Cognition, Leiden, The Netherlands
| | - Hanneke E Hulst
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Faculty of Social Sciences, Leiden University, Wassenaarseweg 52, Leiden, 2333 AK, The Netherlands
- Leiden Institute for Brain and Cognition, Leiden, The Netherlands
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7
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Waskowiak PT, de Jong BA, Uitdehaag BMJ, Saddal SRD, Aarts J, Roovers AAM, van Oirschot P, de Groot V, Schaafsma FG, van der Hiele K, Ruitenberg MFL, Schoonheim MM, Widdershoven GAM, van der Veen S, Schippers ECF, Klein M, Hulst HE. Don't be late! Timely identification of cognitive impairment in people with multiple sclerosis: a study protocol. BMC Neurol 2024; 24:26. [PMID: 38218777 PMCID: PMC10787411 DOI: 10.1186/s12883-023-03495-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 12/08/2023] [Indexed: 01/15/2024] Open
Abstract
BACKGROUND Cognitive impairment occurs in up to 65% of people with multiple sclerosis (PwMS), negatively affecting daily functioning and health-related quality of life. In general, neuropsychological testing is not part of standard MS-care due to insufficient time and trained personnel. Consequently, a baseline assessment of cognitive functioning is often lacking, hampering early identification of cognitive decline and change within a person over time. To assess cognitive functioning in PwMS in a time-efficient manner, a BICAMS-based self-explanatory digital screening tool called the Multiple Screener©, has recently been developed. The aim of the current study is to validate the Multiple Screener© in a representative sample of PwMS in the Netherlands. Additionally, we aim to investigate how cognitive functioning is related to psychological factors, and both work and societal participation. METHODS In this cross-sectional multicentre study, 750 PwMS (aged 18-67 years) are included. To obtain a representative sample, PwMS are recruited via 12 hospitals across the Netherlands. They undergo assessment with the Minimal Assessment of Cognitive Functioning in MS (MACFIMS; reference-standard) and the Multiple Screener©. Sensitivity, specificity, and predictive values for identifying (mild) cognitive impairment are determined in a subset of 300 participants. In a second step, the identified cut-off values are tested in an independent subset of at least 150 PwMS. Moreover, test-retest reliability for the Multiple Screener© is determined in 30 PwMS. Information on psychological and work-related factors is assessed with questionnaires. DISCUSSION Validating the Multiple Screener© in PwMS and investigating cognition and its determinants will further facilitate early identification and adequate monitoring of cognitive decline in PwMS.
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Affiliation(s)
- Pauline T Waskowiak
- MS Center Amsterdam, Medical Psychology, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC Location VUmc, De Boelelaan, 1118, Amsterdam, The Netherlands.
| | - Brigit A de Jong
- MS Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands
| | - Bernard M J Uitdehaag
- MS Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands
| | - Shalina R D Saddal
- MS Center Amsterdam, Public and Occupational Health, Vrije Universiteit Amsterdam, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Faculty of Social Sciences, Leiden University, Leiden, The Netherlands
| | - Jip Aarts
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Faculty of Social Sciences, Leiden University, Leiden, The Netherlands
- Leiden Institute for Brain and Cognition, Leiden, The Netherlands
- MS Center Amsterdam, Anatomy and Neurosciences, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands
| | - Aïda A M Roovers
- MS Center Amsterdam, Medical Psychology, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC Location VUmc, De Boelelaan, 1118, Amsterdam, The Netherlands
| | | | - Vincent de Groot
- MS Center Amsterdam, Rehabilitation Medicine, Vrije Universiteit Amsterdam, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands
| | - Frederieke G Schaafsma
- MS Center Amsterdam, Public and Occupational Health, Vrije Universiteit Amsterdam, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands
| | - Karin van der Hiele
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Faculty of Social Sciences, Leiden University, Leiden, The Netherlands
- Leiden Institute for Brain and Cognition, Leiden, The Netherlands
| | - Marit F L Ruitenberg
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Faculty of Social Sciences, Leiden University, Leiden, The Netherlands
- Leiden Institute for Brain and Cognition, Leiden, The Netherlands
| | - Menno M Schoonheim
- MS Center Amsterdam, Anatomy and Neurosciences, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands
| | - Guy A M Widdershoven
- Ethics, Law & Medical Humanities, Vrije Universiteit Amsterdam, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands
| | - Sabina van der Veen
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Faculty of Social Sciences, Leiden University, Leiden, The Netherlands
| | - Esther C F Schippers
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Faculty of Social Sciences, Leiden University, Leiden, The Netherlands
| | - Martin Klein
- MS Center Amsterdam, Medical Psychology, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC Location VUmc, De Boelelaan, 1118, Amsterdam, The Netherlands
| | - Hanneke E Hulst
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Faculty of Social Sciences, Leiden University, Leiden, The Netherlands
- Leiden Institute for Brain and Cognition, Leiden, The Netherlands
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8
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Altieri M, Cerciello F, Gallo A, Santangelo G. The relationship between depression and cognitive performance in multiple sclerosis: A meta-analysis. Clin Neuropsychol 2024; 38:21-41. [PMID: 36964744 DOI: 10.1080/13854046.2023.2192963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 03/14/2023] [Indexed: 03/26/2023]
Abstract
Objective: Studies on the relationship between depression and cognition on patients with multiple sclerosis (MS) are inconsistent and it is not clear whether higher depression levels are associated with impairment of specific cognitive domains or processes. This meta-analytic study aimed at evaluating the possible association between depressive symptomatology and performance on cognitive tests assessing several cognitive domains (global cognition, attention, processing speed, verbal, spatial and working memory, verbal fluency, inhibitory control, set-shifting) in individuals living with MS. Method: The literature search on three electronic databases yielded 5402 studies (4333 after the duplicates removal); after the evaluation of titles, abstracts full-text articles, 37 studies were included in the meta-analytic study. A random-effect model meta-analysis was performed and mean weighted effect sizes (ESs) were calculated using Hedges' g. Results: Small ESs were found for the relationship between depression and verbal memory (g = 0.25, p < 0.001), spatial memory (g = 0.23, p < 0.001), verbal fluency (g = 0.26, p < 0.001), and inhibitory control (g = 0.32, p = 0.003). Medium ESs were found for the relationship between depression and global cognition (g = 0.46, p < 0.001), attention (g = 0.43, p < 0.001), processing speed (g = 0.47, p < 0.001) and working memory (g = 0.38, p = 0.037). The relationship between set-shifting abilities and depression was not significant (g = 0.39, p = 0.095). Conclusions: Results suggest that patients with MS and higher levels of depressive symptomatology may also show more difficulties in several aspects of cognition, especially those needed to retain, respond, and process information in one's environment, and to those needed be adequately stimulated in processing relevant information.
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Affiliation(s)
- Manuela Altieri
- Department of Psychology, University of Campania "Luigi Vanvitelli", Caserta, CE, Italy
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Napoli, NA, Italy
| | - Francesco Cerciello
- Department of Psychology, University of Campania "Luigi Vanvitelli", Caserta, CE, Italy
| | - Antonio Gallo
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Napoli, NA, Italy
| | - Gabriella Santangelo
- Department of Psychology, University of Campania "Luigi Vanvitelli", Caserta, CE, Italy
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9
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Elosúa MR, Villadangos N. Executive functions in relapsing-remitting multiple sclerosis. APPLIED NEUROPSYCHOLOGY. ADULT 2023:1-9. [PMID: 37930795 DOI: 10.1080/23279095.2023.2252125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Abstract
Some studies suggest that patients with relapsing-remitting multiple sclerosis have problems in the functioning of working memory, and more specifically in executive functions, but the available results are still inconsistent. The aim of the present study was to examine executive functioning in multiple sclerosis using classical and representative tasks for divided attention, updating, attentional shifting, and inhibition. The sample was composed of 48 participants aged between 18 and 59 years (24 persons living with multiple sclerosis and 24 healthy participants matched in age and education level). The executive functions of divided attention, updating, attentional shifting, and inhibition were analyzed through the Dual-Task Paradigm, the N-Back task, the Trail Making Test (TMT), and the Stroop test, respectively. The analyses of the data showed that the functioning of working memory was impaired in multiple sclerosis in the executive functions of divided attention and updating when the group of persons living with MS and the control group were compared. In addition, the performance in the four executive functions analyzed did not show the same profile across the persons living with MS in the sample, as no deficit in attentional shifting or inhibition was observed. It can be concluded that the presence of deficits was observed only in the executive functions of divided attention and updating under the condition of greater cognitive demand. The clinical implications of these results are underlined due to their impact on daily life.
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Affiliation(s)
- M Rosa Elosúa
- Departamento de Psicología Básica I, UNED, Madrid, Spain
| | - Noelia Villadangos
- Departamento de Psicología Básica I, UNED, Madrid, Spain
- Fundación de Esclerosis Múltiple de Madrid, Madrid, Spain
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10
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Stein C, O'Keeffe F, Strahan O, McGuigan C, Bramham J. Systematic review of cognitive reserve in multiple sclerosis: Accounting for physical disability, fatigue, depression, and anxiety. Mult Scler Relat Disord 2023; 79:105017. [PMID: 37806233 DOI: 10.1016/j.msard.2023.105017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 08/03/2023] [Accepted: 09/17/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND Cognitive reserve (CR) describes an individual's ability to adapt cognitive processes in response to brain atrophy, and has been reported to explain some of the discrepancy between brain atrophy and cognitive functioning outcomes in multiple sclerosis (MS). CR in MS is typically investigated by assessing an individual's pre- and/or post-diagnosis enrichment, which includes premorbid intellectual abilities, educational level, occupational attainment, and engagement in cognitively enriching leisure activities. Common MS symptoms (e.g., physical disability, fatigue, depression, anxiety) may impact an individual's ability to engage in various CR-enhancing activities post-diagnosis. It is unknown to what extent these MS symptoms have been taken into account in MS research on CR. As such, we identified whether studies assessed CR using measures of premorbid or continuous (including post-diagnosis) enrichment. For studies investigating continuous enrichment, we identified whether studies accounted for MS-impact, which MS symptoms were accounted for, and how, and whether studies acknowledged MS symptoms as potential CR-confounds. METHODS Three electronic databases (PsycINFO, PubMed, Scopus) were searched. Eligible studies investigated CR proxies (e.g., estimated premorbid intellectual abilities, vocabulary knowledge, educational level, occupational attainment, cognitively enriching leisure activities, or a combination thereof) in relation to cognitive, brain atrophy or connectivity, or daily functioning outcomes in adult participants with MS. We extracted data on methods and measures used, including any MS symptoms taken into account. Objectives were addressed using frequency analyses and narrative synthesis. RESULTS 115 studies were included in this review. 47.8% of all studies investigated continuous enrichment. Approximately half of the studies investigating continuous enrichment accounted for potential MS-impact in their analyses, with only 31.0% clearly identifying that they treated MS symptoms as potential confounds for CR-enhancement. A narrative synthesis of studies which investigated CR with and without controlling statistically for MS-impact indicated that accounting for MS symptoms may impact findings concerning the protective nature of CR. CONCLUSION Fewer than half of the studies investigating CR proxies in MS involved continuous enrichment. Just over half of these studies accounted for potential MS-impact in their analyses. To achieve a more complete and accurate understanding of CR in MS, future research should investigate both pre-MS and continuous enrichment. In doing so, MS symptoms and their potential impact should be considered. Establishing greater consistency and rigour across CR research in MS will be crucial to produce an evidence base for the development of interventions aimed at improving quality of care and life for pwMS.
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Affiliation(s)
- Clara Stein
- University College Dublin, Belfield, Dublin 4, Ireland.
| | - Fiadhnait O'Keeffe
- University College Dublin, Belfield, Dublin 4, Ireland; St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Orla Strahan
- University College Dublin, Belfield, Dublin 4, Ireland
| | - Christopher McGuigan
- University College Dublin, Belfield, Dublin 4, Ireland; St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Jessica Bramham
- University College Dublin, Belfield, Dublin 4, Ireland; St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
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11
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Weinstock ZL, Jaworski M, Dwyer MG, Jakimovski D, Burnham A, Wicks TR, Youngs M, Santivasci C, Cruz S, Gillies J, Covey TJ, Suchan C, Bergsland N, Weinstock-Guttman B, Zivadinov R, Benedict RH. Auditory Test of Processing Speed: Preliminary validation of a smartphone-based test of mental speed. Mult Scler 2023; 29:1646-1658. [PMID: 37842763 DOI: 10.1177/13524585231199311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2023]
Abstract
BACKGROUND The Symbol Digit Modalities Test (SDMT) is a gold-standard measure of cognitive efficiency and processing speed for people with multiple sclerosis (PwMS) but relies on vision and oculomotor function. OBJECTIVES To develop and validate a new processing speed test with minimal memory involvement and no eye function requirements. METHODS We created an Auditory Test of Processing Speed (ATOPS). A total of 122 PwMS, of whom 33 were severely disabled (median Expanded Disability Status Scale 8.0) and 37 healthy volunteers (HVs), were enrolled. We assessed sensitivity to discriminate MS participants from HVs, convergent validity between ATOPS and SDMT, sensitivity to discriminate between cognitively impaired (CI) and cognitively preserved (CP) MS participants, and correlations with MS pathology (overall brain lesion burden). Acceptability was examined with completion rates and participant ratings of ATOPS. RESULTS ATOPS discriminated PwMS from HVs (d = 0.739-0.856), correlated with SDMT (|r| = 0.528-0.587), discriminated between CI and CP PwMS (d = 0.623-0.776), and correlated with lesion burden (r = 0.332-0.436). All groups indicated high favorability of ATOPS and severely disabled MS patients could be assessed by ATOPS more frequently than by SDMT (100% vs. 72.4% completion). CONCLUSIONS ATOPS is a novel, accessible, and acceptable cognitive processing speed test that may be useful in clinical and/or research settings.
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Affiliation(s)
- Zachary L Weinstock
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo-The State University of New York, Buffalo, NY, USA
| | - Michael Jaworski
- Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo-The State University of New York, Buffalo, NY, USA
| | - Michael G Dwyer
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo-The State University of New York, Buffalo, NY, USA
- Center for Biomedical Imaging at the Clinical Translational Science Institute, University at Buffalo-The State University of New York, Buffalo, NY, USA
| | - Dejan Jakimovski
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo-The State University of New York, Buffalo, NY, USA
| | | | - Taylor R Wicks
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo-The State University of New York, Buffalo, NY, USA
| | - Margaret Youngs
- Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo-The State University of New York, Buffalo, NY, USA
| | - Celeste Santivasci
- Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo-The State University of New York, Buffalo, NY, USA
| | - Sara Cruz
- Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo-The State University of New York, Buffalo, NY, USA
| | - John Gillies
- Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo-The State University of New York, Buffalo, NY, USA
| | - Thomas J Covey
- Division of Cognitive and Behavioral Neurosciences, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo-The State University of New York, Buffalo, NY, USA
| | - Christopher Suchan
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo-The State University of New York, Buffalo, NY, USA
| | - Niels Bergsland
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo-The State University of New York, Buffalo, NY, USA
| | - Bianca Weinstock-Guttman
- Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo-The State University of New York, Buffalo, NY, USA
| | - Robert Zivadinov
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo-The State University of New York, Buffalo, NY, USA
- Center for Biomedical Imaging at the Clinical Translational Science Institute, University at Buffalo-The State University of New York, Buffalo, NY, USA
| | - Ralph Hb Benedict
- Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo-The State University of New York, Buffalo, NY, USA
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12
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Morrow SA, Baldwin C, Alkabie S. Importance of Identifying Cognitive Impairment in Multiple Sclerosis. Can J Neurol Sci 2023; 50:813-819. [PMID: 36503630 DOI: 10.1017/cjn.2022.334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
This article aims to highlight the impact of cognitive impairment on outcomes and quality of life for people with multiple sclerosis (MS) and to review current evidence for the efficacy of disease-modifying therapies (DMTs) and other interventions. In addition, we provide clinical practice insights regarding screening and management of cognitive impairment in people with MS. Evidence suggests that cognitive deterioration often accompanies magnetic resonance imaging changes. Neocortical volume and deep grey matter atrophy correlate with cognitive impairment. Similarly, cognitive decline is predictive of a higher lesion burden. Cognitive impairment is an important clinical measure of disability and negatively impacts quality of life. Phase 3 studies suggest that DMTs such as natalizumab, ozanimod and fingolimod may provide long-lasting, clinically meaningful effects on cognition in people with MS. Further data are needed to support the use of adjunct cognitive behavioural and exercise interventions for people with MS who have cognitive impairment. More data are needed to define appropriate management strategies for cognitive impairment in people with MS. Baseline and periodic screening for cognitive impairment and inclusion of cognitive impairment as a clinical trial endpoint will help to inform efforts to manage this important aspect of MS.
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Affiliation(s)
- Sarah A Morrow
- London Multiple Sclerosis Clinic, London Health Sciences Centre, University Hospital, Department of Clinical Neurological Sciences, Western University, London, ON, Canada
| | - Chantal Baldwin
- London Multiple Sclerosis Clinic, London Health Sciences Centre, University Hospital, Department of Clinical Neurological Sciences, Western University, London, ON, Canada
| | - Samir Alkabie
- London Multiple Sclerosis Clinic, London Health Sciences Centre, University Hospital, Department of Clinical Neurological Sciences, Western University, London, ON, Canada
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13
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Bergmann C, Becker S, Watts A, Sullivan C, Wilken J, Golan D, Zarif M, Bumstead B, Buhse M, Kaczmarek O, Covey TJ, Doniger GM, Penner IK, Hancock LM, Bogaardt H, Barrera MA, Morrow S, Gudesblatt M. Multiple sclerosis and quality of life: The role of cognitive impairment on quality of life in people with multiple sclerosis. Mult Scler Relat Disord 2023; 79:104966. [PMID: 37690436 DOI: 10.1016/j.msard.2023.104966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 07/05/2023] [Accepted: 08/28/2023] [Indexed: 09/12/2023]
Abstract
BACKGROUND Multiple Sclerosis (MS), a chronic disease of the central nervous system (CNS), affects functional ability and quality of life (QoL). Depression, fatigue, and disability status are among the many factors that have been shown to impact QoL in people with MS, but the extent to which MS-related cognitive impairment is related to QoL is understudied in the literature. OBJECTIVE The purpose of this study was to determine relevant predictors of QoL from a wide list of symptoms including physical disability, and a multi-dimensional computerized cognitive assessment battery (CAB), depression, fatigue, and demographic variables (including employment status). In addition, the unique predictive power of cognitive impairment on QoL was explored in relation to other common factors of disease impact. METHODS 171 people with MS (PwMS) were evaluated with a computerized assessment battery (CAB), EDSS examination, and validated Patient Reported Outcome (PRO) measures (Multiple Sclerosis Impact Scale, MSIS-29; Beck Depression Inventory - Second Edition BDI-2; and the Modified Fatigue Impact Scale, MFIS). RESULTS 171 PwMS were included [Age: 46.02 years ± 9.85, 124 (72.5%) female]. Depression and fatigue scores were highly correlated with MSIS-29. EDSS, unemployment, memory, executive functioning, and motor skills were moderately correlated with MSIS-29. Predictors of QoL were EDSS, depression, fatigue, executive functioning, and attention. Attention and executive functioning were predictive of QoL even after controlling for demographic variables, fatigue, depression, and physical disability status. CONCLUSION Findings indicate the need for comprehensive and quantified evaluation of all factors associated with disease burden, which will ultimately serve to improve the QoL in PwMS through more targeted and patient-centered care.
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Affiliation(s)
| | - Shenira Becker
- Department of Veteran Affairs, Cedar Park, Texas, United States; Senseye, Inc., Austin, Texas, United States
| | - Adreanna Watts
- Washington Neuropsychology Research Group, Fairfax, Virginia
| | - Cynthia Sullivan
- Washington Neuropsychology Research Group, Fairfax, Virginia; Department of Neurology, Georgetown University, Washington, D.C, United States
| | - Jeffrey Wilken
- Washington Neuropsychology Research Group, Fairfax, Virginia; Department of Neurology, Georgetown University, Washington, D.C, United States
| | - Daniel Golan
- Multiple Sclerosis and Neuroimmunology Center, Clalit Health Services, Nazareth, Israel; Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Myassar Zarif
- NYU Langone South Shore Neurologic Associates, New York University, Patchogue, New York, USA
| | - Barbara Bumstead
- NYU Langone South Shore Neurologic Associates, New York University, Patchogue, New York, USA
| | - MariJean Buhse
- NYU Langone South Shore Neurologic Associates, New York University, Patchogue, New York, USA; Department of Nursing, State University of Stony Brook, Stony Brook, New York, USA
| | - Olivia Kaczmarek
- NYU Langone South Shore Neurologic Associates, New York University, Patchogue, New York, USA
| | - Thomas J Covey
- Division of Cognitive and Behavioral Neurosciences, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Sherman Hall Annex Room 114, Buffalo, NY 14214, USA; Neuroscience Program, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Glen M Doniger
- Department of Clinical Research, NeuroTrax Corporation, Modiin, Israel
| | - Iris-Katharina Penner
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Laura M Hancock
- Department of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Hans Bogaardt
- School of Allied Health Science and Practice, University of Adelaide, Adelaide, Australia
| | - Marissa A Barrera
- Katz School of Science & Health, Yeshiva University, New York, NY, USA
| | - Sara Morrow
- London Health Sciences Centre, University of Western Ontario, Canada
| | - Mark Gudesblatt
- NYU Langone South Shore Neurologic Associates, New York University, Patchogue, New York, USA
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14
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Wang M, Liu C, Zou M, Niu Z, Zhu J, Jin T. Recent progress in epidemiology, clinical features, and therapy of multiple sclerosis in China. Ther Adv Neurol Disord 2023; 16:17562864231193816. [PMID: 37719665 PMCID: PMC10504852 DOI: 10.1177/17562864231193816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 07/24/2023] [Indexed: 09/19/2023] Open
Abstract
Multiple sclerosis (MS) is a demyelinating disease of the central nervous system characterized by inflammation, demyelination, and neurodegeneration. It mainly affects young adults, imposing a heavy burden on families and society. The epidemiology, clinical features, and management of MS are distinct among different countries. Although MS is a rare disease in China, there are 1.4 billion people in China, so the total number of MS patients is not small. Because of the lack of specific diagnostic biomarkers for MS, there is a high misdiagnosis rate in China, as in other regions. Due to different genetic backgrounds, the clinical manifestations of MS in Chinese are different from those in the West. Herein, this review aims to summarize the disease comprehensively, including clinical profile and the status of disease-modifying therapies in China based on published population-based observation and cohort studies, and also to compare with data from other countries and regions, thus providing help to develop diagnostic guideline and the novel therapeutic drugs. Meanwhile, we also discuss the problems and challenges we face, specifically for the diagnosis and treatment of MS in the middle- and low-income countries.
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Affiliation(s)
- Meng Wang
- Neuroscience Center, Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Caiyun Liu
- Neuroscience Center, Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Meijuan Zou
- Neuroscience Center, Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Zixuan Niu
- Neuroscience Center, Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Jie Zhu
- Neuroscience Center, Department of Neurology, The First Hospital of Jilin University, No. 1, Xinmin Street, Changchun 130021, China
- Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Karolinska University Hospital, Solna, Stockholm 171 64, Sweden
| | - Tao Jin
- Neuroscience Center, Department of Neurology, The First Hospital of Jilin University, No. 1, Xinmin Street, Changchun 130021, China
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15
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Coll-Martinez C, Salavedra-Pont J, Buxó M, Quintana E, Quiroga-Varela A, Robles-Cedeño R, Puig M, Álvarez-Bravo G, Ramió-Torrentà L, Gich J. Differences in metacognition between multiple sclerosis phenotypes: cognitive impairment and fatigue are key factors. Front Psychol 2023; 14:1163112. [PMID: 37680235 PMCID: PMC10481161 DOI: 10.3389/fpsyg.2023.1163112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 07/20/2023] [Indexed: 09/09/2023] Open
Abstract
Background Cognitive impairment is present in 40-65% of patients with multiple sclerosis (pwMS). Objectively measured cognitive performance often does not match patients' subjective perception of their own performance. Objective We aimed to compare cognitive performance and subjective perception of cognitive deficits between pwMS and healthy controls (HCs), as well as the accuracy of subjective perception. Methods In total, 54 HC and 112 pwMS (relapsing-remitting, RRMS, and progressive PMS) underwent neuropsychological evaluation and completed perceived deficit, fatigue, and anxiety-depression scales. Participants were classified according to their consistency between subjective self-evaluation of cognitive abilities and objective cognitive performance to assess accuracy. Regression models were used to compare cognitive performance between groups and explore factors explaining inaccuracy in the estimation of cognitive performance. Results PMS showed greater and more widespread cognitive differences with HC than RRMS. No differences were found between pwMS and HC in the perception of deficit. PMS had higher ratios of overestimators. In explaining inaccuracy, fatigue and cognitive preservation were found to be risk factors for underestimation, whereas physical disability and cognitive impairment were risk factors for overestimation. Conclusion PwMS have metacognitive knowledge impairments. This study provides new information about metacognition, data on the prevalence of impairments over a relatively large sample of PwMS, and new insights into factors explaining it. Anosognosia, related to cognitive impairment, may be present in pwMS. Fatigue is a key factor in underestimating cognition.
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Affiliation(s)
- Clàudia Coll-Martinez
- Girona Neuroimmumology and Multiple Sclerosis Unit, Neurology Department, Dr. Josep Trueta University Hospital and Santa Caterina Hospital, Girona, Spain
- Neurodegeneration and Neuroinflammation Research Group, Girona Biomedical Research Institute (IDIBGI), Salt, Spain
- Redes de Investigación Cooperativa Orientada a Resultados en Salud (RICORS), Red de Enfermedades inflamatorias (RD21/0002/0063), Instituto de Salud Carlos III, Madrid, Spain
| | - Judit Salavedra-Pont
- Girona Neuroimmumology and Multiple Sclerosis Unit, Neurology Department, Dr. Josep Trueta University Hospital and Santa Caterina Hospital, Girona, Spain
- Neurodegeneration and Neuroinflammation Research Group, Girona Biomedical Research Institute (IDIBGI), Salt, Spain
| | - Maria Buxó
- Statistical Unit, Girona Biomedical Research Institute (IDIBGI), Salt, Spain
| | - Ester Quintana
- Neurodegeneration and Neuroinflammation Research Group, Girona Biomedical Research Institute (IDIBGI), Salt, Spain
| | - Ana Quiroga-Varela
- Neurodegeneration and Neuroinflammation Research Group, Girona Biomedical Research Institute (IDIBGI), Salt, Spain
- Redes de Investigación Cooperativa Orientada a Resultados en Salud (RICORS), Red de Enfermedades inflamatorias (RD21/0002/0063), Instituto de Salud Carlos III, Madrid, Spain
| | - René Robles-Cedeño
- Girona Neuroimmumology and Multiple Sclerosis Unit, Neurology Department, Dr. Josep Trueta University Hospital and Santa Caterina Hospital, Girona, Spain
- Neurodegeneration and Neuroinflammation Research Group, Girona Biomedical Research Institute (IDIBGI), Salt, Spain
- Redes de Investigación Cooperativa Orientada a Resultados en Salud (RICORS), Red de Enfermedades inflamatorias (RD21/0002/0063), Instituto de Salud Carlos III, Madrid, Spain
- Medical Sciences Department, University of Girona, Girona, Spain
| | - Marc Puig
- Girona Neuroimmumology and Multiple Sclerosis Unit, Neurology Department, Dr. Josep Trueta University Hospital and Santa Caterina Hospital, Girona, Spain
- Neurodegeneration and Neuroinflammation Research Group, Girona Biomedical Research Institute (IDIBGI), Salt, Spain
| | - Gary Álvarez-Bravo
- Girona Neuroimmumology and Multiple Sclerosis Unit, Neurology Department, Dr. Josep Trueta University Hospital and Santa Caterina Hospital, Girona, Spain
- Neurodegeneration and Neuroinflammation Research Group, Girona Biomedical Research Institute (IDIBGI), Salt, Spain
| | - Lluís Ramió-Torrentà
- Girona Neuroimmumology and Multiple Sclerosis Unit, Neurology Department, Dr. Josep Trueta University Hospital and Santa Caterina Hospital, Girona, Spain
- Neurodegeneration and Neuroinflammation Research Group, Girona Biomedical Research Institute (IDIBGI), Salt, Spain
- Redes de Investigación Cooperativa Orientada a Resultados en Salud (RICORS), Red de Enfermedades inflamatorias (RD21/0002/0063), Instituto de Salud Carlos III, Madrid, Spain
- Medical Sciences Department, University of Girona, Girona, Spain
| | - Jordi Gich
- Girona Neuroimmumology and Multiple Sclerosis Unit, Neurology Department, Dr. Josep Trueta University Hospital and Santa Caterina Hospital, Girona, Spain
- Neurodegeneration and Neuroinflammation Research Group, Girona Biomedical Research Institute (IDIBGI), Salt, Spain
- Medical Sciences Department, University of Girona, Girona, Spain
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16
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Jiang Q, Wang W, Chen W, Xu Y. The impact of cognitive impairment on disease burden in Chinese patients with multiple sclerosis: A model simulation study. Mult Scler Relat Disord 2023; 73:104626. [DOI: 10.1016/j.msard.2023.104626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 02/02/2023] [Accepted: 03/18/2023] [Indexed: 03/28/2023]
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17
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Eizaguirre MB, Yastremiz C, Ciufia N, Sol Roman M, Alonso R, Silva BA, Garcea O, Cáceres F, Vanotti S. Relevance and Impact of Social Support on Quality of Life for Persons With Multiple Sclerosis. Int J MS Care 2023; 25:99-103. [PMID: 37250192 PMCID: PMC10211354 DOI: 10.7224/1537-2073.2022-012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
BACKGROUND Social support is crucial for persons with multiple sclerosis (MS). We sought to analyze differences in perceived social support in persons with MS vs controls; to study associations between perceived social support, clinical measures, and health-related quality of life (HRQOL) variables in persons with MS; and to establish a predictive value of perceived social support for HRQOL. METHODS We studied 151 persons with MS (mean ± SD: age, 42.01 ± 9.97 years; educational level, 14.05 ± 3.26 years) and 89 controls (mean ± SD: age, 41.46 ± 12.25 years; educational level, 14.60 ± 2.44 years) using the Medical Outcomes Study Social Support Survey (MOS-SSS), Expanded Disability Status Scale, Fatigue Severity Scale, Beck Depression Inventory, and Multiple Sclerosis International Quality of Life (MusiQoL) questionnaire. Parametric and nonparametric statistical methods were used accordingly; P < .05. RESULTS Persons with MS exhibited lower scores on the MOS-SSS's overall support index (t238 = -1.98, P = .04) and on each functional subscale (t238 = -2.56 to -2.19, P < .05). No significant differences were found on the social support structural component (P > .05). Significant associations were observed between social support and depression and fatigue (r = -0.20 to -0.29, P < .05) and with MusiQoL dimensions (r = -0.18 to 0.48, P < .05). Multiple regression analysis showed all 4 tested models contributed to HRQOL-explained variance (41%-47%). The emotional/informational support model explained the most HRQOL variability (47%). CONCLUSIONS Persons with MS perceived reduced social support, presenting lower functional scores than controls. Perceived social support proved to be a predictor of HRQOL. These findings should be considered during therapeutic treatment.
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Affiliation(s)
- María Bárbara Eizaguirre
- From the Multiple Sclerosis University Center, Ramos Mejia Hospital, Buenos Aires, Argentina (MBE, CY, NC, RA, BS, OG)
- The Research Institute in Psychology, School of Psychology, Buenos Aires University, Buenos Aires, Argentina (MBE, NC, MSR, SV)
| | - Cecilia Yastremiz
- From the Multiple Sclerosis University Center, Ramos Mejia Hospital, Buenos Aires, Argentina (MBE, CY, NC, RA, BS, OG)
| | - Natalia Ciufia
- From the Multiple Sclerosis University Center, Ramos Mejia Hospital, Buenos Aires, Argentina (MBE, CY, NC, RA, BS, OG)
- The Research Institute in Psychology, School of Psychology, Buenos Aires University, Buenos Aires, Argentina (MBE, NC, MSR, SV)
| | - María Sol Roman
- The Research Institute in Psychology, School of Psychology, Buenos Aires University, Buenos Aires, Argentina (MBE, NC, MSR, SV)
- The Institute of Restorative Neurosciences, Buenos Aires, Argentina (MSR, FC, SV)
| | - Ricardo Alonso
- From the Multiple Sclerosis University Center, Ramos Mejia Hospital, Buenos Aires, Argentina (MBE, CY, NC, RA, BS, OG)
| | - Berenice Anabel Silva
- From the Multiple Sclerosis University Center, Ramos Mejia Hospital, Buenos Aires, Argentina (MBE, CY, NC, RA, BS, OG)
| | - Orlando Garcea
- From the Multiple Sclerosis University Center, Ramos Mejia Hospital, Buenos Aires, Argentina (MBE, CY, NC, RA, BS, OG)
| | - Fernando Cáceres
- The Institute of Restorative Neurosciences, Buenos Aires, Argentina (MSR, FC, SV)
| | - Sandra Vanotti
- The Research Institute in Psychology, School of Psychology, Buenos Aires University, Buenos Aires, Argentina (MBE, NC, MSR, SV)
- The Institute of Restorative Neurosciences, Buenos Aires, Argentina (MSR, FC, SV)
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London F, El Sankari S, De Haan A, Benyahia Z, Landenne G, Duprez T, van Pesch V. Patient-reported outcome measurements in a selective cohort of relapsing-remitting multiple sclerosis patients: relationships with physical disability, cognitive impairment, and MRI-derived metrics. Acta Neurol Belg 2023:10.1007/s13760-023-02225-x. [PMID: 36877357 DOI: 10.1007/s13760-023-02225-x] [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: 10/04/2022] [Accepted: 02/23/2023] [Indexed: 03/07/2023]
Abstract
BACKGROUND The added value of patient-reported outcome measures (PROMs) in addition to standard clinical outcome tools in the assessment of relapsing-remitting multiple sclerosis (RRMS) patients' status is increasingly recognized. PROMs facilitate the detection of hidden aspects of MS and help to integrate the patient's subjective experience of health-related quality of life (HRQoL) status and treatment satisfaction in a holistic way. However, the relationship between PROMs and clinical and cognitive status has been scarcely investigated up to now. OBJECTIVE To investigate the association of PROMs with physical and cognitive disability in a cohort of RRMS patients at initiation of a new disease-modifying treatment. METHODS In this cross-sectional bicenter study, 59 consecutive RRMS patients underwent neurological examination with EDSS assessment, comprehensive cognitive tests (BVMT-R, SDMT, CVLT-II) and a set of self-reported questionnaires. Lesion and brain volumes were analyzed and processed by the automated MSmetrix® software (Icometrix®, Leuven, Belgium). Spearman's correlation coefficient was used to evaluate the association of collected variables. A cross-sectional logistic regression analysis was performed to find baseline correlates of cognitive impairment. RESULTS Of the 59 RRMS patients (mean age 39 ± 9.8 years, 79.7% female, median EDSS 2.0), 33 (56%) had cognitive impairment. While almost all dimensions of health, explored by PROMs, were impacted in the overall sample, no significant difference was observed in patients with and without cognitive impairment. All PROMs were significantly associated with EDSS (R = 0.37-0.55; p < 0.05), except for the psychological component of MSIS-29, BDI and DEX-Q scores. No significant correlation was found between PROMs and cognitive performances. The cross-sectional logistic regression analysis included age, gender (female), education, EDSS, hippocampus and FLAIR lesion volumes as significant predictors of cognitive impairment. CONCLUSIONS The data highlight that PROMs provide valuable information on the well-being of PwMS closely paralleling the extent of MS-related disability, as measured by the EDSS. Additional research should determine the relevance of PROMs as longitudinal outcome measures.
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Affiliation(s)
- Frédéric London
- Department of Neurology, CHU UCL Namur Site Godinne, Université catholique de Louvain (UCLouvain), 1 avenue G. Thérasse, B-5530, Yvoir, Belgium.
| | - Souraya El Sankari
- Department of Neurology, Cliniques Universitaires Saint-Luc, Université catholique de Louvain (UCLouvain), Brussels, Belgium
| | - Alice De Haan
- Department of Neurology, Cliniques Universitaires Saint-Luc, Université catholique de Louvain (UCLouvain), Brussels, Belgium
| | - Zohra Benyahia
- Department of Neurology, Cliniques Universitaires Saint-Luc, Université catholique de Louvain (UCLouvain), Brussels, Belgium
| | - Gaëtane Landenne
- Department of Neurology, Cliniques Universitaires Saint-Luc, Université catholique de Louvain (UCLouvain), Brussels, Belgium
| | - Thierry Duprez
- Department of Radiology, Cliniques Universitaires Saint-Luc, Université catholique de Louvain (UCLouvain), Brussels, Belgium
| | - Vincent van Pesch
- Department of Neurology, Cliniques Universitaires Saint-Luc, Université catholique de Louvain (UCLouvain), Brussels, Belgium
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Relationship between subjective report and objective assessment of neurocognitive functioning in persons with multiple sclerosis. J Int Neuropsychol Soc 2023; 29:266-273. [PMID: 35469588 DOI: 10.1017/s1355617722000212] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Persons with multiple sclerosis (PwMS) are at increased risk for cognitive dysfunction. Considering the impact and potential ramifications of cognitive dysfunction, it is important that cognition is routinely assessed in PwMS. Thus, it is also important to identify a screener that is accurate and sensitive to MS-related cognitive difficulties, which can inform decisions for more resource-intensive neuropsychological testing. However, research focused on available self-report screeners has been mixed, such as with the Multiple Sclerosis Neuropsychological Screening Questionnaire (MSNQ). This study aims to clarify the relationship between subjective and objective assessment of cognitive functioning in MS by examining domain-specific performance and intraindividual variability (IIV). METHODS 87 PwMS (F = 65, M = 22) completed a comprehensive neuropsychological battery which included self- and informant-report measures of neurocognitive functioning. Scores were examined in relation to mean performance on five domains of cognitive functioning and two measures of IIV. RESULTS The MSNQ-Self was inversely associated with executive function, verbal memory, and visual memory; it was not associated with IIV. The MSNQ-Informant was inversely associated with executive function and verbal memory, and positively associated with one measure of IIV. The MSNQ-Self showed a correlation of moderate effect size with depression (r = .39) while the MSNQ-Informant did not. CONCLUSIONS Results suggest that the MSNQ-Self and MSNQ-Informant show similar utility. Our findings also suggest that domains of executive function and memory may be most salient, thus more reflected in subjective reports of cognitive functioning. Future work should further examine the impact of mood disturbance with cognitive performance and IIV.
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Lindberg M, Månsson Lexell E, Ranner M, Lund ML. Self-initiated management strategies in digitalized work and everyday life - experiences of people with cognitive difficulties due to neurological disorders. Scand J Occup Ther 2023; 30:559-571. [PMID: 36780367 DOI: 10.1080/11038128.2023.2175724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
Background: Digitalized work life can increase cognitive demands and influence people's everyday life. This can be challenging for people with cognitive difficulties, yet there is scarce knowledge of how they manage these. It is essential to learn how self-initiated management strategies can be a resource to support sustainable work and everyday life.Aim: To describe how people with cognitive difficulties due to neurological disorders experience their use of self-initiated strategies to manage digitalized work and other activities of everyday life.Material and Methods: Eleven employees in digital work with cognitive difficulties and neurological disorders participated in qualitative interviews supported by a dialogue support tool. Data were analyzed using content analysis.Results: A complexity of strategies was used to manage digital work and other activities. Based on how strategies were applied, three different profiles were found. These reflected efforts to manage situations in everyday life and how these influenced strategies applied and their importance.Conclusion: This knowledge can support people with cognitive difficulties and professionals to become aware of the potential of strategies and acknowledge a person's own management resources. Reflections on how to manage situations can give perspectives on prevention or vocational rehabilitation to facilitate a sustainable work life.
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Affiliation(s)
- Monika Lindberg
- Department of Health, Education and Technology, Division of Health, Medicine and Rehabilitation, Luleå University of Technology, Luleå, Sweden
| | - Eva Månsson Lexell
- Department of Health Sciences, Lund University, Lund, Sweden.,Department of Neurology, Rehabilitation Medicine, Memory clinic and Geriatrics, Skane University Hospital, Lund-Malmö, Sweden
| | - Maria Ranner
- Department of Health, Education and Technology, Division of Health, Medicine and Rehabilitation, Luleå University of Technology, Luleå, Sweden
| | - Maria Larsson Lund
- Department of Health, Education and Technology, Division of Health, Medicine and Rehabilitation, Luleå University of Technology, Luleå, Sweden
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Grant JG, Rapport LJ, Darling R, Waldron-Perrine B, Bernitsas E. Incremental validity of brief and abbreviated neuropsychological tests toward predicting functional outcomes in multiple sclerosis. APPLIED NEUROPSYCHOLOGY. ADULT 2023:1-11. [PMID: 36773023 DOI: 10.1080/23279095.2023.2176766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
OBJECTIVE This study examined the relationships among functional outcomes and performance on standard-length and abbreviated cognitive screening measures for multiple sclerosis (MS). METHOD 72 adults with MS underwent neurological examination and cognitive screening. They completed standard-length and abbreviated versions of tests from the Minimal Assessment of Cognitive Function in MS (MACFIMS), the abbreviated aMACFIMS, and the Brief International Cognitive Assessment for MS (BICAMS). Functional outcomes included neurological disability, physical and psychological dysfunction, and employment status. RESULTS Concordance of impairment classifications was examined between standard-length and abbreviated tests using logistic regression and ROC curve analyses. Overall, the abbreviated test versions showed a broad range of concordance with impairment classifications made using the full-length tests. Processing speed was the strongest correlate of neurological disability and employment status; immediate recall was the strongest predictor of subjective physical dysfunction. Test performance provided unique value toward predicting neurological disability and employment status, but not physical and psychological dysfunction. CONCLUSIONS The findings replicate some support for abbreviated tests in MS assessment, although caveats regarding loss of validity associated with abbreviation remain. The findings extend prior research showing that abbreviated tests of processing speed and immediate recall can provide unique predictive information regarding objective functional outcomes.
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Affiliation(s)
- Jeremy G Grant
- Department of Psychology, Wayne State University, Detroit, MI, USA
| | - Lisa J Rapport
- Department of Psychology, Wayne State University, Detroit, MI, USA
| | - Rachel Darling
- Department of Neurology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Brigid Waldron-Perrine
- Department of Physical Medicine & Rehabilitation, Wayne State University School of Medicine, Detroit, MI, USA
| | - Eva Bernitsas
- Department of Neurology, Wayne State University School of Medicine, Detroit, MI, USA
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Bellinvia A, Portaccio E, Amato MP. Current advances in the pharmacological prevention and management of cognitive dysfunction in multiple sclerosis. Expert Opin Pharmacother 2023; 24:435-451. [PMID: 36542754 DOI: 10.1080/14656566.2022.2161882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Cognitive impairment (CI) is a core feature of Multiple Sclerosis (MS), being detectable in up to 65% of subjects. Treatment of CI can be considered of paramount importance. However, no standardized strategies are available to date to define the best treatment approach, especially for the pharmacological management. AREAS COVERED In this narrative review, the authors outline the latest advances in pharmacological management of CI in MS, including Disease Modifying Treatments (DMTs) which indirectly may or may not influence CI and symptomatic drugs. Selected publications were restricted to those written in English, reporting on an adult relapsing-remitting MS or progressive MS sample, assessing the effects of (at least) 1 DMT or treatment in a longitudinal design, reporting data on (at least) one standardized cognitive test performed at baseline and follow-up, and published between January 2018 and May 2022. EXPERT OPINION Recent data can be considered encouraging and inspiring for future studies. Overall, there is preliminary evidence of a beneficial effect of DMTs on cognition, particularly for high-efficacy DMTs. As for symptomatic treatments, dalfampridine appears to be the only medication with robust evidence of a positive effect on cognition. However, the definition of clinically meaningful change/improvement in cognitive functions remains an unmet need. Future studies should assess the role of other patient-related factors that can be associated with a better cognitive response to treatments and investigate the possible positive effect of multimodal interventions on cognition.
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Affiliation(s)
| | | | - Maria Pia Amato
- NEUROFARBA Department, University of Florence, Florence, Italy.,IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
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Radial diffusivity reflects general decline rather than specific cognitive deterioration in multiple sclerosis. Sci Rep 2022; 12:21771. [PMID: 36526708 PMCID: PMC9758146 DOI: 10.1038/s41598-022-26204-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022] Open
Abstract
Advanced structural brain imaging techniques, such as diffusion tensor imaging (DTI), have been used to study the relationship between DTI-parameters and cognitive scores in multiple sclerosis (MS). In this study, we assessed cognitive function in 61 individuals with MS and a control group of 35 healthy individuals with the Symbol Digit Modalities Test, the California Verbal Learning Test-II, the Brief Visuospatial Memory Test-Revised, the Controlled Oral Word Association Test, and Stroop-test. We also acquired diffusion-weighted images (b = 1000; 32 directions), which were processed to obtain the following DTI scalars: fractional anisotropy, mean, axial, and radial diffusivity. The relation between DTI scalars and cognitive parameters was assessed through permutations. Although fractional anisotropy and axial diffusivity did not correlate with any of the cognitive tests, mean and radial diffusivity were negatively correlated with all of these tests. However, this effect was not specific to any specific white matter tract or cognitive test and demonstrated a general effect with only low to moderate individual voxel-based correlations of <0.6. Similarly, lesion and white matter volume show a general effect with medium to high voxel-based correlations of 0.5-0.8. In conclusion, radial diffusivity is strongly related to cognitive impairment in MS. However, the strong associations of radial diffusivity with both cognition and whole brain lesion volume suggest that it is a surrogate marker for general decline in MS, rather than a marker for specific cognitive functions.
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24
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Coll-Martinez C, Quintana E, Buxó M, Salavedra-Pont J, Gasull-Vicens L, Quiroga-Varela A, Costa-Frossard L, Villar LM, Fernández-Díaz E, Gracia J, Aladro Y, Méndez-Burgos A, Cerezo M, Ramió-Torrentà L, Gich J. Oligoclonal IgM bands are a promising biomarker for long-term cognitive outcomes in multiple sclerosis. Mult Scler Relat Disord 2022; 68:104397. [PMID: 36544326 DOI: 10.1016/j.msard.2022.104397] [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: 10/14/2022] [Revised: 10/20/2022] [Accepted: 11/03/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND The presence of lipid-specific oligoclonal IgM bands (LS-OCMB) in cerebrospinal fluid is associated with a more severe clinical multiple sclerosis (MS) course. OBJECTIVE To investigate LS-OCMB as a prognostic biomarker of cognitive long-term outcomes in MS. METHODS Ninety-nine patients underwent neuropsychological assessment. Cognitive performance between LS-OCMB- and LS-OCMB+ patients was compared adjusting by age, education, anxiety-depression, disease duration, and disability. RESULTS LS-OCMB+ patients of ∼13 years of disease duration performed worse on Symbol Digit Modalities Test (SDMT) (p = 0.005). CONCLUSION LS-OCMB+ perform worse on information processing speed and working memory (SDMT), suggesting that LS-OCMB could be a useful biomarker for long-term cognitive outcomes.
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Affiliation(s)
- Clàudia Coll-Martinez
- Girona Neuroimmumology and Multiple Sclerosis Unit, Neurology Department, Dr. Josep Trueta University Hospital and Santa Caterina Hospital, Dr Castany s/n, Girona, Salt 17190, Spain; Neurodegeneration and Neuroinflammation Research Group, Girona Biomedical Research Institute (IDIBGI), Salt, Spain; Redes de Investigación Cooperativa Orientada a Resultados en Salud (RICORS), Red de Enfermedades inflamatorias (RD21/0002/0063), Instituto de Salud Carlos III, Madrid, Spain
| | - Ester Quintana
- Neurodegeneration and Neuroinflammation Research Group, Girona Biomedical Research Institute (IDIBGI), Salt, Spain
| | - Maria Buxó
- Girona Biomedical Research Institute (IDIBGI), Salt, Spain
| | - Judit Salavedra-Pont
- Girona Neuroimmumology and Multiple Sclerosis Unit, Neurology Department, Dr. Josep Trueta University Hospital and Santa Caterina Hospital, Dr Castany s/n, Girona, Salt 17190, Spain; Neurodegeneration and Neuroinflammation Research Group, Girona Biomedical Research Institute (IDIBGI), Salt, Spain
| | - Laia Gasull-Vicens
- Girona Neuroimmumology and Multiple Sclerosis Unit, Neurology Department, Dr. Josep Trueta University Hospital and Santa Caterina Hospital, Dr Castany s/n, Girona, Salt 17190, Spain
| | - Ana Quiroga-Varela
- Neurodegeneration and Neuroinflammation Research Group, Girona Biomedical Research Institute (IDIBGI), Salt, Spain; Redes de Investigación Cooperativa Orientada a Resultados en Salud (RICORS), Red de Enfermedades inflamatorias (RD21/0002/0063), Instituto de Salud Carlos III, Madrid, Spain
| | - Lucienne Costa-Frossard
- Redes de Investigación Cooperativa Orientada a Resultados en Salud (RICORS), Red de Enfermedades inflamatorias (RD21/0002/0063), Instituto de Salud Carlos III, Madrid, Spain; Neurology Department, Ramon y Cajal University Hospital, Madrid, Spain; Universidad de Alcalá, Madrid, Spain; Multiple Sclerosis Group, Instituto Ramón y Cajal de investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Luisa María Villar
- Redes de Investigación Cooperativa Orientada a Resultados en Salud (RICORS), Red de Enfermedades inflamatorias (RD21/0002/0063), Instituto de Salud Carlos III, Madrid, Spain; Multiple Sclerosis Group, Instituto Ramón y Cajal de investigación Sanitaria (IRYCIS), Madrid, Spain; Immunology Department, Ramon y Cajal University Hospital, Madrid, Spain
| | | | - Julia Gracia
- Neurology Department, Albacete University Hospital Albacete, Spain
| | - Yolanda Aladro
- Redes de Investigación Cooperativa Orientada a Resultados en Salud (RICORS), Red de Enfermedades inflamatorias (RD21/0002/0063), Instituto de Salud Carlos III, Madrid, Spain; Neurology Department, Getafe University Hospital, Madrid, Spain; Universidad Europea de Madrid, Madrid, Spain
| | - Alejandro Méndez-Burgos
- Neurology Department, Getafe University Hospital, Madrid, Spain; Universidad Europea de Madrid, Madrid, Spain
| | - Marta Cerezo
- Neurology Department, Getafe University Hospital, Madrid, Spain; Universidad Complutense de Madrid, Madrid, Spain
| | - Lluís Ramió-Torrentà
- Girona Neuroimmumology and Multiple Sclerosis Unit, Neurology Department, Dr. Josep Trueta University Hospital and Santa Caterina Hospital, Dr Castany s/n, Girona, Salt 17190, Spain; Neurodegeneration and Neuroinflammation Research Group, Girona Biomedical Research Institute (IDIBGI), Salt, Spain; Redes de Investigación Cooperativa Orientada a Resultados en Salud (RICORS), Red de Enfermedades inflamatorias (RD21/0002/0063), Instituto de Salud Carlos III, Madrid, Spain; Medical Sciences Department, University of Girona, Girona, Spain.
| | - Jordi Gich
- Girona Neuroimmumology and Multiple Sclerosis Unit, Neurology Department, Dr. Josep Trueta University Hospital and Santa Caterina Hospital, Dr Castany s/n, Girona, Salt 17190, Spain; Neurodegeneration and Neuroinflammation Research Group, Girona Biomedical Research Institute (IDIBGI), Salt, Spain; Medical Sciences Department, University of Girona, Girona, Spain.
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Dykukha I, Essner U, Schreiber H, Raithel LM, Penner IK. Effects of Sativex Ⓡ on cognitive function in patients with multiple sclerosis: A systematic review and meta-analysis. Mult Scler Relat Disord 2022; 68:104173. [PMID: 36174323 DOI: 10.1016/j.msard.2022.104173] [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: 01/05/2022] [Revised: 09/05/2022] [Accepted: 09/08/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Cognitive impairment is a common manifestation of multiple sclerosis (MS). OBJECTIVE To assess by systematic review and meta-analysis available evidence regarding the impact of nabiximols oromucosal spray on cognition in patients with MS. METHODS A systematic literature search of clinical studies (all types, any comparator) that measured cognitive function in patients with MS spasticity treated with nabiximols. Meta-analysis for cognitive endpoints was not possible due to heterogenous measurement instruments and outcomes. Meta-analysis was performed for adverse events (AEs) of special interest (cognition disorders) reported in randomized controlled trials (RCTs) of nabiximols versus placebo in patients with MS (with or without spasticity). Certainty of evidence and risk of bias were assessed. RESULTS Seven clinical studies (three RCTs) directly assessing cognitive function were included in the qualitative analysis. There was no consistent evidence to suggest that nabiximols causes cognitive impairment as assessed by a range of specific psychometric instruments across cognitive domains. Thirteen double-blind, placebo-controlled RCTs (nabiximols, n = 964; placebo, n = 904) were included in the meta-analysis of cognitive AEs. Most cognitive AEs (30 of 32 events, 93.8%) reported with nabiximols in MS patients occurred with not in-label use, i.e., dosage >12 sprays per day and/or not administered primarily for treatment of spasticity. CONCLUSIONS Within the limitations of the review, we can conclude that no detrimental effects of nabiximols on cognitive function were observed in patients with MS spasticity during up to 12 months follow-up and that cognitive AEs were rare and occurred only when nabiximols was not used according to its approved label.
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Affiliation(s)
- Igor Dykukha
- Medical Affairs, Almirall Hermal GmbH, Reinbek, Germany
| | - Ute Essner
- O. Meany Consultancy GmbH, Hamburg, Germany
| | - Herbert Schreiber
- Neurological Practice Center, Neuropoint Academy, NTD & Neurosys, Ulm, Germany
| | - Lina Marie Raithel
- COGITO Center for Applied Neurocognition and Neuropsychological Research, Düsseldorf, Germany
| | - Iris-Katharina Penner
- Department of Neurology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany.
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van Wegen J, van Egmond E, Benedict R, Beenakker E, van Eijk J, Frequin S, de Gans K, Gerlach O, van Gorp D, Hengstman G, Jongen P, van der Klink J, Reneman M, Verhagen W, Middelkoop H, Visser L, Hulst H, van der Hiele K. Subjective cognitive impairment is related to work status in people with multiple sclerosis. IBRO Neurosci Rep 2022; 13:513-522. [DOI: 10.1016/j.ibneur.2022.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 10/31/2022] [Indexed: 11/06/2022] Open
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Sousa C, Jacques T, Sá MJ, Alves RA. Cognitive impairment in multiple sclerosis phenotypes: Neuropsychological assessment in a portuguese sample. APPLIED NEUROPSYCHOLOGY. ADULT 2022:1-10. [PMID: 35977707 DOI: 10.1080/23279095.2022.2112681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Cognitive impairment affects 40-65% of MS patients, encompassing all disease stages and types of clinical courses. This estimation is based on different instruments used and population normative data. OBJECTIVE This study aims to assess the cognitive function in a hospital-based cohort of Portuguese MS patients, to allow estimating the prevalence of cognitive impairment in different phenotypes. METHODS Three hundred and thirteen patients with Multiple Sclerosis (MS) underwent neuropsychological assessment with the brief repeatable battery of neuropsychological tests (BRBN-T) and the brief international cognitive assessment for multiple sclerosis (BICAMS). RESULTS Differences were observed in the cognitive impairment profile of different disease phenotypes and of the different disease severity stages. RRMS patients performed better in the cognitive test of the BRBN-T and BICAMS than those with progressive disease phenotypes. Relationships between cognitive impairment and disability and professional status were relevant. Although similarities could be observed in the cognitive profile of the MS phenotypes, with predominant involvement of verbal memory, verbal fluency, and information processing speed, the latter was found to be more frequent as the disease progressed. CONCLUSION This study contributes to improve knowledge about the cognitive profile of the different MS phenotypes and understand the cognitive characteristics of Portuguese patients.
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Affiliation(s)
- Cláudia Sousa
- Department of Neurology, Centro Hospitalar Universitário São João Porto, EPE, Porto, Portugal
- Faculty of Psychology and Educational Sciences, University of Porto, Porto, Portugal
- Department of Psychology, Centro Hospitalar Universitário São João Porto, EPE, Porto, Portugal
| | - Teresa Jacques
- Faculty of Psychology and Educational Sciences, University of Porto, Porto, Portugal
| | - Maria José Sá
- Department of Neurology, Centro Hospitalar Universitário São João Porto, EPE, Porto, Portugal
- Faculty of Health Sciences, Universidade Fernando Pessoa, Porto, Portugal
| | - Rui A Alves
- Faculty of Psychology and Educational Sciences, University of Porto, Porto, Portugal
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Dreyer-Alster S, Menascu S, Aloni R, Givon U, Dolev M, Achiron A, Kalron A. Motoric cognitive risk syndrome in people with multiple sclerosis: prevalence and correlations with disease-related factors. Ther Adv Neurol Disord 2022; 15:17562864221109744. [PMID: 35813608 PMCID: PMC9260572 DOI: 10.1177/17562864221109744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 06/09/2022] [Indexed: 11/21/2022] Open
Abstract
Background: The motoric cognitive risk (MCR) syndrome, defined as the coexistence of slow
gait and subjective cognitive complaints, has as yet not been researched in
people with multiple sclerosis (pwMS). Objective: To examine the prevalence of the MCR syndrome in pwMS and its association
with disability, disease duration, perceived fatigue, and fear of
falling. Methods: The study comprised 618 pwMS [43.7 (SD = 12.6) years, 61.7% females]. Gait
speed was measured by the GAITRite™ electronic walkway (CIR Systems, Inc.
Haverton, PA, USA). Cognitive status was defined according to the global
cognitive score computed by the NeuroTrax™ cognitive battery (NeuroTrax
Corporation, Medina, NY, USA). The sample was divided into four main groups:
‘normal’, ‘cognitively impaired’, ‘gait impaired’ or ‘MCR’. Perceived
fatigue was assessed by the Modified Fatigue Impact Scale; fear of falling
by the Falls Efficacy Scale International. Results: Sixty-three (10.2%) patients were diagnosed with MCR. The percentage of
subjects categorized as MCR was 26.0% in severely disabled pwMS compared
with 10.9%, 6.0%, and 4.6% in moderately, mildly and very mildly disabled
pwMS, respectively. Subjects in the MCR group presented with elevated
fatigue compared with patients classified as normal [49.7 (SD = 23.3) vs
26.5 (SD = 19.2), p < 0.001]. Fear of falling was
significantly higher in the MCR and gait impairment groups compared with the
cognitively impaired and normal groups. Conclusions: The current study corroborates the presence of MCR in pwMS. Nevertheless,
future longitudinal research is warranted to better understand its
application.
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Affiliation(s)
| | - Shay Menascu
- Multiple Sclerosis Center, Sheba Medical Center, Tel Hashomer, Israel
| | - Roy Aloni
- Multiple Sclerosis Center, Sheba Medical Center, Tel Hashomer, Israel
| | - Uri Givon
- Multiple Sclerosis Center, Sheba Medical Center, Tel Hashomer, Israel
| | - Mark Dolev
- Multiple Sclerosis Center, Sheba Medical Center, Tel Hashomer, Israel
| | - Anat Achiron
- Multiple Sclerosis Center, Sheba Medical Center, Tel Hashomer, Israel
| | - Alon Kalron
- Department of Physical Therapy, School of Health Professions, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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29
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Efendi H, Ünal A, Akçalı A, Altunan B, Bingöl A, Altunrende B, Köseoğlu M, Deringöl D, Uzunköprü C, Eğilmez C, Balcı FB, Akman G, Tarhan KG, Gündoğdu AA, Ertürk S, Beckmann Y. The effect of cognitive performance on self-management behavior of multiple sclerosis patients. Mult Scler Relat Disord 2022; 63:103880. [DOI: 10.1016/j.msard.2022.103880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 05/06/2022] [Accepted: 05/13/2022] [Indexed: 11/17/2022]
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30
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Davenport L, Cogley C, Monaghan R, Gaughan M, Yap M, Bramham J, Tubridy N, McGuigan C, O'Keeffe F. Investigating the association of mood and fatigue with objective and subjective cognitive impairment in multiple sclerosis. J Neuropsychol 2022; 16:537-554. [PMID: 35765743 DOI: 10.1111/jnp.12283] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 06/01/2022] [Indexed: 12/01/2022]
Abstract
Discrepancies between subjective cognitive difficulties and objective measures of cognitive function in people with MS have been identified and may be related to mood and fatigue. The aim of the present study was to examine associations of depression and fatigue with discrepancies between subjective and objective cognitive functioning in pwMS. 177 participants with MS attending a University Hospital Department of Neurology MS Outpatient clinic completed the Brief International Cognitive Assessment for MS (BICAMS), MS Neuropsychological Questionnaire (MSNQ), Hospital Anxiety and Depression Scale (HADS) and Modified Fatigue Impact Scale (MFIS). To quantify the discrepancy between objective (BICAMS) and subjective (MSNQ) cognitive functioning, discrepancy scores were calculated by subtracting MSNQ z-score from composite BICAMS z-score. Based on their discrepancy score, participants were grouped as 'Underestimated', 'Overestimated' and 'Non-discrepant'. 39% of the total sample demonstrated poorer subjective cognitive functioning than their objective cognitive performance suggested ('Underestimated'). 23% of the total sample indicated lower objective scores than their subjective report suggests ('Overestimated'). 38% participants indicated relatively no discrepancy between objective and subjective cognitive measures ('Non-discrepant'). Significant differences were observed between the discrepancy groups in terms of depression and fatigue, with the 'Underestimated' group demonstrating greater levels of depression and fatigue (ps < .01). Regression analysis indicated that cognitive fatigue and depression significantly contributed to variance in subjective cognitive functioning. Our findings suggest that subjective reports of cognitive function may be influenced by depression and fatigue, emphasising the importance of cognitive, mood and fatigue screening as part of routine clinical care.
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Affiliation(s)
- Laura Davenport
- University College Dublin, Dublin, Ireland.,St. Vincent's University Hospital, Dublin, Ireland
| | - Clodagh Cogley
- University College Dublin, Dublin, Ireland.,St. Vincent's University Hospital, Dublin, Ireland
| | | | | | - Mei Yap
- St. Vincent's University Hospital, Dublin, Ireland
| | - Jessica Bramham
- University College Dublin, Dublin, Ireland.,St. Vincent's University Hospital, Dublin, Ireland
| | | | | | - Fiadhnait O'Keeffe
- University College Dublin, Dublin, Ireland.,St. Vincent's University Hospital, Dublin, Ireland
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31
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Dominguez-Mozo MI, Casanova I, De Torres L, Aladro-Benito Y, Perez-Perez S, Garcia-Martínez A, Gomez P, Abellan S, De Antonio E, Lopez-De-Silanes C, Alvarez-Lafuente R. microRNA Expression and Its Association With Disability and Brain Atrophy in Multiple Sclerosis Patients Treated With Glatiramer Acetate. Front Immunol 2022; 13:904683. [PMID: 35774792 PMCID: PMC9239306 DOI: 10.3389/fimmu.2022.904683] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 05/17/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundMicroRNAs are small non-coding RNA that regulate gene expression at a post-transcriptional level affecting several cellular processes including inflammation, neurodegeneration and remyelination. Different patterns of miRNAs expression have been demonstrated in multiple sclerosis compared to controls, as well as in different courses of the disease. For these reason they have been postulated as promising biomarkers candidates in multiple sclerosis.Objectiveto correlate serum microRNAs profile expression with disability, cognitive functioning and brain volume in patients with remitting-relapsing multiple sclerosis.Methodscross-sectional study in relapsing-remitting multiple sclerosis patients treated with glatiramer acetate. Disability was measured with Expanded Disability Status Scale (EDSS) and cognitive function was studied with Symbol Digit Modalities Test (SDMT). Brain volume was analyzed with automatic software NeuroQuant®.ResultsWe found an association between miR.146a.5p (rs:0.434, p=0.03) and miR.9.5p (rs:0.516, p=0.028) with EDSS; and miR-146a.5p (rs:-0.476, p=0.016) and miR-126.3p (rs:-0.528, p=0.007) with SDMT. Regarding to the brain volume, miR.9.5p correlated with thalamus (rs:-0.545, p=0.036); miR.200c.3p with pallidum (rs:-0.68, p=0.002) and cerebellum (rs:-0.472, p=0.048); miR-138.5p with amygdala (rs:0.73, p=0.016) and pallidum (rs:0.64, p=0.048); and miR-223.3p with caudate (rs:0.46, p=0.04).ConclusionsThese data support the hypothesis of microRNA as potential biomarkers in this disease. More studies are needed to validate these results and to better understand the role of microRNAs in the pathogenesis, monitoring and therapeutic response of multiple sclerosis.
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Affiliation(s)
- María I Dominguez-Mozo
- Research Group in Environmental Factors of Neurodegenerative Diseases, Health Research Institute Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Ignacio Casanova
- Department of Neurology, Hospital Universitario de Torrejón, Madrid, Spain
- School of Medicine, Universidad Francisco de Vitoria, Madrid, Spain
| | - Laura De Torres
- Department of Neurology, Hospital Universitario de Torrejón, Madrid, Spain
| | | | - Silvia Perez-Perez
- Research Group in Environmental Factors of Neurodegenerative Diseases, Health Research Institute Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Angel Garcia-Martínez
- Research Group in Environmental Factors of Neurodegenerative Diseases, Health Research Institute Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Patricia Gomez
- Department of Neurology, Hospital Universitario de Torrejón, Madrid, Spain
- School of Medicine, Universidad Francisco de Vitoria, Madrid, Spain
| | - Sara Abellan
- Department of Neurology, Hospital Universitario de Torrejón, Madrid, Spain
| | - Esther De Antonio
- Department of Radiology, Hospital Universitario de Torrejón, Madrid, Spain
| | - Carlos Lopez-De-Silanes
- Department of Neurology, Hospital Universitario de Torrejón, Madrid, Spain
- School of Medicine, Universidad Francisco de Vitoria, Madrid, Spain
| | - Roberto Alvarez-Lafuente
- Research Group in Environmental Factors of Neurodegenerative Diseases, Health Research Institute Hospital Clínico San Carlos (IdISSC), Madrid, Spain
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32
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Balloff C, Penner IK, Ma M, Georgiades I, Scala L, Troullinakis N, Graf J, Kremer D, Aktas O, Hartung HP, Meuth SG, Schnitzler A, Groiss SJ, Albrecht P. The degree of cortical plasticity correlates with cognitive performance in patients with Multiple Sclerosis. Brain Stimul 2022; 15:403-413. [PMID: 35182811 DOI: 10.1016/j.brs.2022.02.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 02/14/2022] [Accepted: 02/14/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Cortical reorganization and plasticity may compensate for structural damage in Multiple Sclerosis (MS). It is important to establish sensitive methods to measure these compensatory mechanisms, as they may be of prognostic value. OBJECTIVE To investigate the association between the degree of cortical plasticity and cognitive performance and to compare plasticity between MS patients and healthy controls (HCs). METHODS The amplitudes of the motor evoked potential (MEP) pre and post quadripulse stimulation (QPS) applied over the contralateral motor cortex served as measure of the degree of cortical plasticity in 63 patients with relapsing-remitting MS (RRMS) and 55 matched HCs. The main outcomes were the correlation coefficients between the difference of MEP amplitudes post and pre QPS and the Symbol Digit Modalities Test (SDMT) and Brief Visuospatial Memory Test-Revised (BVMT-R), and the QPSxgroup interaction in a mixed model predicting the MEP amplitude. RESULTS SDMT and BVMT-R correlated significantly with QPS-induced cortical plasticity in RRMS patients. Plasticity was significantly reduced in patients with cognitive impairment compared to patients with preserved cognitive function and the degree of plasticity differentiated between both patient groups. Interestingly, the overall RRMS patient cohort did not show reduced plasticity compared to HCs. CONCLUSIONS We provide first evidence that QPS-induced plasticity may inform about the global synaptic plasticity in RRMS which correlates with cognitive performance as well as clinical disability. Larger longitudinal studies on patients with MS are needed to investigate the relevance and prognostic value of this measure for disease progression and recovery.
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Affiliation(s)
- Carolin Balloff
- Department of Neurology, Medical Faculty, Heinrich-Heine University, 40225, Duesseldorf, Germany; Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich-Heine University, 40225, Duesseldorf, Germany
| | - Iris-Katharina Penner
- Department of Neurology, Medical Faculty, Heinrich-Heine University, 40225, Duesseldorf, Germany; Cogito Center for Applied Neurocognition and Neuropsychological Research, 40225, Düsseldorf, Germany; Department of Neurology, Inselspital, University Hospital Bern, 3010, Bern, Switzerland
| | - Meng Ma
- Department of Neurology, Medical Faculty, Heinrich-Heine University, 40225, Duesseldorf, Germany
| | - Iason Georgiades
- Department of Neurology, Medical Faculty, Heinrich-Heine University, 40225, Duesseldorf, Germany
| | - Lina Scala
- Department of Neurology, Medical Faculty, Heinrich-Heine University, 40225, Duesseldorf, Germany
| | - Nina Troullinakis
- Department of Neurology, Medical Faculty, Heinrich-Heine University, 40225, Duesseldorf, Germany
| | - Jonas Graf
- Department of Neurology, Medical Faculty, Heinrich-Heine University, 40225, Duesseldorf, Germany
| | - David Kremer
- Department of Neurology, Medical Faculty, Heinrich-Heine University, 40225, Duesseldorf, Germany
| | - Orhan Aktas
- Department of Neurology, Medical Faculty, Heinrich-Heine University, 40225, Duesseldorf, Germany
| | - Hans-Peter Hartung
- Department of Neurology, Medical Faculty, Heinrich-Heine University, 40225, Duesseldorf, Germany; Brain and Mind Center, University of Sydney, NSW, 2006, Australia; Department of Neurology, Medical University of Vienna, 1090, Vienna, Austria
| | - Sven Günther Meuth
- Department of Neurology, Medical Faculty, Heinrich-Heine University, 40225, Duesseldorf, Germany
| | - Alfons Schnitzler
- Department of Neurology, Medical Faculty, Heinrich-Heine University, 40225, Duesseldorf, Germany; Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich-Heine University, 40225, Duesseldorf, Germany
| | - Stefan Jun Groiss
- Department of Neurology, Medical Faculty, Heinrich-Heine University, 40225, Duesseldorf, Germany; Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich-Heine University, 40225, Duesseldorf, Germany.
| | - Philipp Albrecht
- Department of Neurology, Medical Faculty, Heinrich-Heine University, 40225, Duesseldorf, Germany
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Measuring cognitive function by the SDMT across functional domains: Useful but not sufficient. Mult Scler Relat Disord 2022; 60:103704. [DOI: 10.1016/j.msard.2022.103704] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 01/21/2022] [Accepted: 02/19/2022] [Indexed: 11/20/2022]
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34
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Mashayekhi F, Sadigh-Eteghad S, Naseri A, Asadi M, Abbasi Garravnd N, Talebi M. ApoE4-positive multiple sclerosis patients are more likely to have cognitive impairment: a cross-sectional study. Neurol Sci 2022; 43:1189-1196. [PMID: 34120271 DOI: 10.1007/s10072-021-05383-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 06/04/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Multiple sclerosis (MS) presents with a wide variety of symptoms, including cognitive dysfunction. Previous studies in terms of the possible function of the ApoE4 allele as a risk factor for cognitive dysfunction in MS patients were associated with conflicting results. The role of the ε4 isoform of apolipoprotein (ApoE4) was investigated in this study as a risk factor for cognitive dysfunction in MS patients. METHODS Mildly disabled relapsing-remitting MS (RRMS) patients were involved in this study. The neurocognitive assessment is conducted by the Minimal Assessment of Cognitive Function in MS (MACFIMS) battery. After determining the genotype, patients were divided into two groups of ApoE4-positive and ApoE4-negative groups, and cognitive findings were compared. RESULTS Seventy-one patients with a mean age of 31.43 ± 8.75 were involved in this study. Eleven out of 17 (64.70%) patients in the ApoE4-positive group had at least one impaired test, while this rate was 16 out of 54 (29.62%) in the ApoE4-negative group (p < 0.01). The rate of overall cognitive impairment (failure in ≥ 2 tests) was not statistically different between groups of the study (p = 0.75). Impairment in Paced Auditory Serial Addition Test (PASAT) task and also the mean score of Brief Visuospatial Memory Test-Revised (BVMT-R) tests were different between two groups (p = 0.01 and 0.02, respectively). CONCLUSION MS ApoE4-positive patients are more likely to have at least one impaired cognitive test, but there is a need for more studies with larger sample sizes and based on MS-specific cognitive tests to confirm these findings.
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Affiliation(s)
- Farshid Mashayekhi
- Neurosciences Research Center (NSRC), Tabriz University of Medical Sciences, 5166614756, Tabriz, Iran
| | - Saeed Sadigh-Eteghad
- Neurosciences Research Center (NSRC), Tabriz University of Medical Sciences, 5166614756, Tabriz, Iran
| | - Amirreza Naseri
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Milad Asadi
- Immunology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Mahnaz Talebi
- Neurosciences Research Center (NSRC), Tabriz University of Medical Sciences, 5166614756, Tabriz, Iran.
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35
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Kavaliunas A, Danylaitė Karrenbauer V, Binzer S, Hillert J. Systematic Review of the Socioeconomic Consequences in Patients With Multiple Sclerosis With Different Levels of Disability and Cognitive Function. Front Neurol 2022; 12:737211. [PMID: 35069404 PMCID: PMC8770980 DOI: 10.3389/fneur.2021.737211] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 11/25/2021] [Indexed: 11/13/2022] Open
Abstract
Multiple sclerosis (MS) is a challenging and disabling condition, predominantly affecting individuals in early adulthood. MS affects the physical, cognitive, and mental health of persons suffering from the disease as well as having a great impact on their financial status and quality of life. However, there is a lack of systematic approach toward assessing the socioeconomic consequences of MS. Our objective was to systematically review analytical observational studies investigating the socioeconomic consequences in persons with MS with different levels of physical disability and cognitive function. We conducted a systematic review on socioeconomic consequences of MS with a focus on employment-, income-, work ability-, and relationship-related outcomes in persons with MS with special focus on disability and cognition. Additionally, the educational characteristics were examined. From 4,957 studies identified, 214 were assessed for eligibility and a total of 19 studies were included in this qualitative assessment; 21 different outcomes were identified. All identified studies reported higher unemployment, higher early retirement, and higher risk of unemployment in relation to higher physical disability. Also, cognitive function was found to be a predictor of employment (unemployment). The studies pointed out significant correlations between greater disability and lower earnings and higher income from benefits. A study found the same correlation in relation to cognitive function. The studies reported higher work disability in relation to higher physical disability and lower cognitive function. In conclusion, this systematic review summarizes the pronounced differences in various socioeconomic outcomes between patients with MS with regards to their physical disability and cognitive function. In addition, we identified a lack of studies with longitudinal design in this field that can provide more robust estimates with covariate adjustments, such as disease modifying treatments.
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Affiliation(s)
- Andrius Kavaliunas
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Virginija Danylaitė Karrenbauer
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Neurology Medical Unit, Karolinska University Hospital, Huddinge, Sweden
| | - Stefanie Binzer
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Neurology, Kolding Hospital, Kolding, Denmark
| | - Jan Hillert
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Neurology Medical Unit, Karolinska University Hospital, Huddinge, Sweden
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36
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Hollinger KR, Sharma A, Tallon C, Lovell L, Thomas AG, Zhu X, Wiseman R, Wu Y, Kambhampati SP, Liaw K, Sharma R, Rojas C, Rais R, Kannan S, Kannan RM, Slusher BS. Dendrimer-2PMPA selectively blocks upregulated microglial GCPII activity and improves cognition in a mouse model of multiple sclerosis. Nanotheranostics 2022; 6:126-142. [PMID: 34976589 PMCID: PMC8671953 DOI: 10.7150/ntno.63158] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 08/04/2021] [Indexed: 12/19/2022] Open
Abstract
Cognitive impairment is a common aspect of multiple sclerosis (MS) for which there are no treatments. Reduced brain N-acetylaspartylglutamate (NAAG) levels are linked to impaired cognition in various neurological diseases, including MS. NAAG levels are regulated by glutamate carboxypeptidase II (GCPII), which hydrolyzes the neuropeptide to N-acetyl-aspartate and glutamate. GCPII activity is upregulated multifold in microglia following neuroinflammation. Although several GCPII inhibitors, such as 2-PMPA, elevate brain NAAG levels and restore cognitive function in preclinical studies when given at high systemic doses or via direct brain injection, none are clinically available due to poor bioavailability and limited brain penetration. Hydroxyl-dendrimers have been successfully used to selectively deliver drugs to activated glia. Methods: We attached 2-PMPA to hydroxyl polyamidoamine (PAMAM) dendrimers (D-2PMPA) using a click chemistry approach. Cy5-labelled-D-2PMPA was used to visualize selective glial uptake in vitro and in vivo. D-2PMPA was evaluated for anti-inflammatory effects in LPS-treated glial cultures. In experimental autoimmune encephalomyelitis (EAE)-immunized mice, D-2PMPA was dosed biweekly starting at disease onset and cognition was assessed using the Barnes maze, and GCPII activity was measured in CD11b+ hippocampal cells. Results: D-2PMPA showed preferential uptake into microglia and robust anti-inflammatory activity, including elevations in NAAG, TGFβ, and mGluR3 in glial cultures. D-2PMPA significantly improved cognition in EAE mice, even though physical severity was unaffected. GCPII activity increased >20-fold in CD11b+ cells from EAE mice, which was significantly mitigated by D-2PMPA treatment. Conclusions: Hydroxyl dendrimers facilitate targeted drug delivery to activated microglia. These data support further development of D-2PMPA to attenuate elevated microglial GCPII activity and treat cognitive impairment in MS.
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Affiliation(s)
| | - Anjali Sharma
- Center for Nanomedicine, Department of Ophthalmology, Johns Hopkins University, Baltimore, MD, USA
| | - Carolyn Tallon
- Johns Hopkins Drug Discovery, Johns Hopkins University, Baltimore, MD, USA.,Department of Neurology, Johns Hopkins University, Baltimore, MD, USA
| | - Lyndah Lovell
- Johns Hopkins Drug Discovery, Johns Hopkins University, Baltimore, MD, USA
| | - Ajit G Thomas
- Johns Hopkins Drug Discovery, Johns Hopkins University, Baltimore, MD, USA
| | - Xiaolei Zhu
- Johns Hopkins Drug Discovery, Johns Hopkins University, Baltimore, MD, USA.,Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Robyn Wiseman
- Department of Pharmacology and Molecular Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Ying Wu
- Johns Hopkins Drug Discovery, Johns Hopkins University, Baltimore, MD, USA
| | - Siva P Kambhampati
- Center for Nanomedicine, Department of Ophthalmology, Johns Hopkins University, Baltimore, MD, USA
| | - Kevin Liaw
- Center for Nanomedicine, Department of Ophthalmology, Johns Hopkins University, Baltimore, MD, USA.,Department of Chemical and Biomolecular Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Rishi Sharma
- Center for Nanomedicine, Department of Ophthalmology, Johns Hopkins University, Baltimore, MD, USA
| | - Camilo Rojas
- Johns Hopkins Drug Discovery, Johns Hopkins University, Baltimore, MD, USA.,Department of Neurology, Johns Hopkins University, Baltimore, MD, USA
| | - Rana Rais
- Johns Hopkins Drug Discovery, Johns Hopkins University, Baltimore, MD, USA.,Department of Neurology, Johns Hopkins University, Baltimore, MD, USA
| | - Sujatha Kannan
- Center for Nanomedicine, Department of Ophthalmology, Johns Hopkins University, Baltimore, MD, USA.,Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA.,Kennedy Krieger Institute, Johns Hopkins University, Baltimore, MD, USA
| | - Rangaramanujam M Kannan
- Center for Nanomedicine, Department of Ophthalmology, Johns Hopkins University, Baltimore, MD, USA.,Department of Chemical and Biomolecular Engineering, Johns Hopkins University, Baltimore, MD, USA.,Kennedy Krieger Institute, Johns Hopkins University, Baltimore, MD, USA
| | - Barbara S Slusher
- Johns Hopkins Drug Discovery, Johns Hopkins University, Baltimore, MD, USA.,Department of Neurology, Johns Hopkins University, Baltimore, MD, USA.,Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD, USA.,Department of Pharmacology and Molecular Sciences, Johns Hopkins University, Baltimore, MD, USA.,Department of Neuroscience, Johns Hopkins University, Baltimore, MD, USA.,Department of Medicine, Johns Hopkins University, Baltimore, MD, USA.,Department of Oncology, Johns Hopkins University, Baltimore, MD, USA
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37
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Coll-Martinez C, Quintana E, Salavedra-Pont J, Buxó M, González-Del-Rio M, Gómez I, Muñoz-San Martín M, Villar LM, Álvarez-Bravo G, Robles-Cedeño R, Ramió-Torrentà L, Gich J. Assessing the presence of oligoclonal IgM bands as a prognostic biomarker of cognitive decline in the early stages of multiple sclerosis. Brain Behav 2021; 11:e2405. [PMID: 34796675 PMCID: PMC8671794 DOI: 10.1002/brb3.2405] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 09/09/2021] [Accepted: 10/12/2021] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND An association has been found between the presence of lipid-specific oligoclonal IgM bands (LS-OCMB) in cerebrospinal fluid and a more severe clinical multiple sclerosis course. OBJECTIVE To investigate lipid-specific oligoclonal IgM bands as a prognostic biomarker of cognitive impairment in the early stages of multiple sclerosis. METHODS Forty-four patients underwent neuropsychological assessment at baseline and 4 years. Cognitive performance at follow-up was compared adjusting by age, education, anxiety-depression, and baseline performance. RESULTS LS-OCMB+ patients only performed worse for Long-Term Storage in the Selective Reminding Test (p = .018). CONCLUSION There are no remarkable cognitive differences between LS-OCMB- and LS-OCMB+ patients in the early stages of MS.
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Affiliation(s)
- Clàudia Coll-Martinez
- Girona Neuroimmumology and Multiple Sclerosis Unit, Neurology Department, Dr. Josep Trueta University Hospital and Santa Caterina Hospital, Girona/Salt, Spain.,Neurodegeneration and Neuroimflammation Research Group, Institut d'Investigació Biomèdica de Girona Dr. Josep Trueta, Salt, Spain
| | - Ester Quintana
- Neurodegeneration and Neuroimflammation Research Group, Institut d'Investigació Biomèdica de Girona Dr. Josep Trueta, Salt, Spain.,Medical Sciences Department, University of Girona, Girona, Spain.,REEM, Multiple Sclerosis Spanish Network, Instituo de Salud Carlos III, Madrid, Spain
| | - Judit Salavedra-Pont
- Girona Neuroimmumology and Multiple Sclerosis Unit, Neurology Department, Dr. Josep Trueta University Hospital and Santa Caterina Hospital, Girona/Salt, Spain.,Neurodegeneration and Neuroimflammation Research Group, Institut d'Investigació Biomèdica de Girona Dr. Josep Trueta, Salt, Spain
| | - Maria Buxó
- Institut d'Investigació Biomèdica de Girona Dr. Josep Trueta, Salt, Spain
| | - Marina González-Del-Rio
- Girona Neuroimmumology and Multiple Sclerosis Unit, Neurology Department, Dr. Josep Trueta University Hospital and Santa Caterina Hospital, Girona/Salt, Spain.,Neurodegeneration and Neuroimflammation Research Group, Institut d'Investigació Biomèdica de Girona Dr. Josep Trueta, Salt, Spain
| | - Immaculada Gómez
- Neurodegeneration and Neuroimflammation Research Group, Institut d'Investigació Biomèdica de Girona Dr. Josep Trueta, Salt, Spain
| | - María Muñoz-San Martín
- Neurodegeneration and Neuroimflammation Research Group, Institut d'Investigació Biomèdica de Girona Dr. Josep Trueta, Salt, Spain
| | - Luisa María Villar
- REEM, Multiple Sclerosis Spanish Network, Instituo de Salud Carlos III, Madrid, Spain.,Immunology Department, Ramon y Cajal University Hospital, IRYCIS, Madrid, Spain
| | - Gary Álvarez-Bravo
- Girona Neuroimmumology and Multiple Sclerosis Unit, Neurology Department, Dr. Josep Trueta University Hospital and Santa Caterina Hospital, Girona/Salt, Spain.,Neurodegeneration and Neuroimflammation Research Group, Institut d'Investigació Biomèdica de Girona Dr. Josep Trueta, Salt, Spain
| | - René Robles-Cedeño
- Girona Neuroimmumology and Multiple Sclerosis Unit, Neurology Department, Dr. Josep Trueta University Hospital and Santa Caterina Hospital, Girona/Salt, Spain.,Neurodegeneration and Neuroimflammation Research Group, Institut d'Investigació Biomèdica de Girona Dr. Josep Trueta, Salt, Spain.,Medical Sciences Department, University of Girona, Girona, Spain.,REEM, Multiple Sclerosis Spanish Network, Instituo de Salud Carlos III, Madrid, Spain
| | - Lluís Ramió-Torrentà
- Girona Neuroimmumology and Multiple Sclerosis Unit, Neurology Department, Dr. Josep Trueta University Hospital and Santa Caterina Hospital, Girona/Salt, Spain.,Neurodegeneration and Neuroimflammation Research Group, Institut d'Investigació Biomèdica de Girona Dr. Josep Trueta, Salt, Spain.,Medical Sciences Department, University of Girona, Girona, Spain.,REEM, Multiple Sclerosis Spanish Network, Instituo de Salud Carlos III, Madrid, Spain
| | - Jordi Gich
- Girona Neuroimmumology and Multiple Sclerosis Unit, Neurology Department, Dr. Josep Trueta University Hospital and Santa Caterina Hospital, Girona/Salt, Spain.,Neurodegeneration and Neuroimflammation Research Group, Institut d'Investigació Biomèdica de Girona Dr. Josep Trueta, Salt, Spain.,Medical Sciences Department, University of Girona, Girona, Spain
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Correlation of the symbol digit modalities test with the quality of life and depression in Japanese patients with multiple sclerosis. Mult Scler Relat Disord 2021; 57:103427. [PMID: 34861614 DOI: 10.1016/j.msard.2021.103427] [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: 09/24/2021] [Revised: 11/16/2021] [Accepted: 11/21/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND This study aimed to evaluate the association between cognitive impairment and health-related quality of life (HRQOL), fatigue, and depression in Japanese patients with multiple sclerosis (MS). METHODS The Brief International Cognitive Assessment for MS (BICAMS) was performed in 184 Japanese patients with MS. The Functional Assessment of MS (FAMS), Fatigue Severity Scale (FSS), and Beck Depression Inventory-Second Edition (BDI-II) were used to evaluate HRQOL, fatigue, and depression, respectively. RESULTS Multiple linear regression analysis demonstrated positive correlations of the Symbol Digit Modalities Test (SDMT) with the scores on the FAMS subscales of mobility, symptoms, emotional well-being, and additional concerns and with the total FAMS score even after controlling for the Expanded Disability Status Scale score, age at examination, and duration of education. The SDMT score in the BICAMS battery had negative correlations with the BDI-II score, as revealed by multiple linear regression analysis. None of the three tests in the BICAMS had any correlation with the FSS score. CONCLUSION The SDMT has a significant relationship with HRQOL and depression in Japanese patients with MS.
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Lindberg M, Ranner M, Månsson-Lexell E, Jacobsson L, Larsson-Lund M. Work and everyday life in a digitalized time: Experiences of people with subjective cognitive difficulties related to neurological disorders. PLoS One 2021; 16:e0260013. [PMID: 34780560 PMCID: PMC8592488 DOI: 10.1371/journal.pone.0260013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 10/30/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Digitalization has changed working life and increased cognitive demands on employees in general. Nevertheless, the consequences for employees with cognitive impairments and subjective cognitive difficulties are to a large extent unexplored. The aim of this study was to explore and describe how employees with subjective cognitive difficulties who are performing digital work tasks experience their vocational situation and how this situation influences their everyday life. METHODS A qualitative, descriptive, multiple-case study was designed. Self-reports, assessments and qualitative interviews were used to collect data from the seven participants with neurological disorders. The data were analysed using pattern matching. FINDINGS The analysed data formed four categories conceptualized as "Working to my full potential", "Working, but it is largely up to me", "Working at the expense of everyday life" and "Working without known difficulties", and these categories included one to four subcategories. CONCLUSION Managing subjective cognitive difficulties in vocational situations and everyday life was challenging in a digitalized working life for participants with neurological disorders. To provide equal access to preventive measures and rehabilitation and a sustainable working life, it is important to investigate the influence of subjective cognitive difficulties systematically on work, everyday life and management strategies in people with neurological disorders in digitalized work.
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Affiliation(s)
- Monika Lindberg
- Department of Health, Education and Technology, Division of Health, Medicine and Rehabilitation, Luleå University of Technology, Luleå, Sweden
| | - Maria Ranner
- Department of Health, Education and Technology, Division of Health, Medicine and Rehabilitation, Luleå University of Technology, Luleå, Sweden
| | - Eva Månsson-Lexell
- Department of Health Sciences, Lund University, Lund, Sweden
- Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund-Malmö, Sweden
| | - Lars Jacobsson
- Department of Health, Education and Technology, Division of Health, Medicine and Rehabilitation, Luleå University of Technology, Luleå, Sweden
| | - Maria Larsson-Lund
- Department of Health, Education and Technology, Division of Health, Medicine and Rehabilitation, Luleå University of Technology, Luleå, Sweden
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van der Ham IJ, Koutzmpi V, van der Kuil MN, van der Hiele K. Spatial navigation performance in people with multiple sclerosis-a large-scale online study. Mult Scler Relat Disord 2021; 58:103423. [DOI: 10.1016/j.msard.2021.103423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 11/17/2021] [Accepted: 11/20/2021] [Indexed: 10/19/2022]
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41
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Quality of life in individuals newly diagnosed with multiple sclerosis or clinically isolated syndrome. J Neurol 2021; 269:2560-2572. [PMID: 34665331 DOI: 10.1007/s00415-021-10842-w] [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: 03/09/2021] [Revised: 10/07/2021] [Accepted: 10/08/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Little is known about quality of life (QOL) at the time of multiple sclerosis (MS) or clinically isolated syndrome (CIS) diagnosis and how it evolves in the critical adjustment period immediately following a new diagnosis. OBJECTIVES To (1) describe QOL trajectory in the first year post-MS/CIS diagnosis and (2) examine associations of demographic and biopsychosocial factors with QOL at baseline and as it evolves over the first year post-MS/CIS diagnosis. METHODS Participants were N = 250 individuals newly diagnosed with MS or CIS. Participants completed self-report assessments of QOL, demographics, and biopsychosocial factors at 1, 2, 3, 6, 9, and 12 months post-diagnosis using validated measures. RESULTS At 1-month post-diagnosis, QOL M = 75.2/100 with subsequent assessments revealing consistent ratings on average. Modelling revealed a small number of variables that were predictive of QOL at baseline and/or change in QOL over time. CONCLUSION QOL in the first year post-MS/CIS diagnosis was, on average, high and stable. A subset of modifiable factors across the biopsychosocial spectrum was associated with baseline level of QOL and change in QOL over time. The stability in QOL suggests that patients can be assessed early after diagnosis for key variables that are predictive of both current and future QOL.
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Pitteri M, Dapor C, Ziccardi S, Guandalini M, Meggiato R, Calabrese M. A Videogame-Based Approach to Measuring Information Processing Speed in Multiple Sclerosis Patients. Games Health J 2021; 10:115-120. [PMID: 33818136 DOI: 10.1089/g4h.2020.0069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Objective: Slowing information processing speed (IPS) is a biomarker of neuronal damage in patients with multiple sclerosis (pwMS). A focus on IPS might be the ideal solution in the perspective of promptly detecting cognitive changes over time. We developed a tablet-based home-made videogame to test the sensitivity of this device in measuring subclinical IPS in pwMS. Materials and Methods: Forty-three pwMS without cognitive impairment and 20 healthy controls (HCs) were administered the videogame task with a tablet. Response times (RTs) and accuracy were recorded. Results: PwMS (mean RTs = 505.5 ± 73.9 ms) were significantly slower than HCs (mean RTs = 462.3 ± 40.3 ms, P = 0.014) on the videogame task. A moderate but significant correlation (r = -0.35, P = 0.03) between mean RTs and the Symbol Digit Modalities Test was observed. Conclusion: Our videogame showed good sensitivity in measuring IPS in apparently cognitive normal pwMS. Computerized testing might be useful in screening initial cognitive dysfunction that should be monitored as a marker of underlying disease progression. IRB approval Number is 2332CESC.
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Affiliation(s)
- Marco Pitteri
- Neurology Section, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Caterina Dapor
- Neurology Section, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Stefano Ziccardi
- Neurology Section, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Maddalena Guandalini
- Neurology Section, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Riccardo Meggiato
- Neurology Section, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Massimiliano Calabrese
- Neurology Section, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
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van Dam M, Sikkes SA, Rammeloo E, Reinders E, Jelgerhuis JR, Geurts JJ, Uitdehaag BM, Hulst HE. Cognitive functioning in everyday life: The development of a questionnaire on instrumental activities of daily living in multiple sclerosis. Mult Scler J Exp Transl Clin 2021; 7:20552173211038027. [PMID: 34408904 PMCID: PMC8365017 DOI: 10.1177/20552173211038027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 07/19/2021] [Indexed: 12/03/2022] Open
Abstract
Neuropsychological test scores in people with MS (PwMS) do not fully reflect cognitive functioning in daily life. Therefore, we developed a questionnaire based on instrumental activities of daily living (IADL), using the Amsterdam IADL-Q© for Alzheimer’s disease as starting point. Forty-eight items were evaluated on relevance and clarity by (inter)national experts (n = 30), PwMS (n = 61) and proxies (n = 30). Consequently, four items were omitted, two items were merged and seven items were added. Fifty items were included in the IADL questionnaire specific to cognitive functioning in MS (the MS-IADL-Q). Future studies are warranted to assess the psychometric properties of the MS-IADL-Q.
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Affiliation(s)
- Maureen van Dam
- Department of Anatomy and Neurosciences, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Sietske Am Sikkes
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Emma Rammeloo
- Department of Anatomy and Neurosciences, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Evy Reinders
- Department of Anatomy and Neurosciences, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Julia R Jelgerhuis
- Department of Anatomy and Neurosciences, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Jeroen Jg Geurts
- Department of Anatomy and Neurosciences, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Bernhard Mj Uitdehaag
- Department of Epidemiology and Biostatistics, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Hanneke E Hulst
- Department of Anatomy and Neurosciences, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Francalancia J, Mavrogiorgou P, Juckel G, Mitrovic T, Kuhle J, Naegelin Y, Kappos L, Calabrese P. Death Anxiety and Attitudes towards Death in Patients with Multiple Sclerosis: An Exploratory Study. Brain Sci 2021; 11:brainsci11080964. [PMID: 34439584 PMCID: PMC8391402 DOI: 10.3390/brainsci11080964] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 07/13/2021] [Accepted: 07/15/2021] [Indexed: 12/02/2022] Open
Abstract
Background: Death and the anxiety of it becomes more apparent when confronted with a chronic disease. Even though multiple sclerosis (MS) is a treatable condition today, it is still accompanied by a multitude of impairments, which in turn may intensify of death anxiety. Objective: The aim of this study is to explore the relationship between depression, anxiety and death anxiety in individuals with MS. Methods: Fifty-six MS patients were recruited at the Department of Neurology of the University Clinic in Basel. Death anxiety was assessed using the Bochumer Questionnaire on attitude to death and death anxiety 2.0 (BOFRETTA 2.0). Results: Scores of death anxiety towards it in MS patients were low. Only disability (EDSS) was moderately correlated with death anxiety. Depression in MS was significantly correlated with fatigue and disability, but not with the BOFRETTA 2.0. Conclusion: Scores of death anxiety and the attitude towards death are low in this MS cohort. It was shown that both psychopathological and neurological deficits impact the subject of death with respect to multiple sclerosis.
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Affiliation(s)
- Jara Francalancia
- Neuropsychology and Behavioral Neurology Unit, Division of Molecular and Cognitive Neuroscience, Department of Psychology, University of Basel, Birmannsgasse 8, 4055 Basel, Switzerland; (J.F.); (T.M.)
| | - Paraskevi Mavrogiorgou
- Department of Psychiatry, Ruhr University Bochum, Alexandrinenstr. 1, 44791 Bochum, Germany; (P.M.); (G.J.)
| | - Georg Juckel
- Department of Psychiatry, Ruhr University Bochum, Alexandrinenstr. 1, 44791 Bochum, Germany; (P.M.); (G.J.)
| | - Tina Mitrovic
- Neuropsychology and Behavioral Neurology Unit, Division of Molecular and Cognitive Neuroscience, Department of Psychology, University of Basel, Birmannsgasse 8, 4055 Basel, Switzerland; (J.F.); (T.M.)
- Department of Neurology, University Clinic Basel, Petersgraben 4, 4031 Basel, Switzerland; (J.K.); (Y.N.); (L.K.)
| | - Jens Kuhle
- Department of Neurology, University Clinic Basel, Petersgraben 4, 4031 Basel, Switzerland; (J.K.); (Y.N.); (L.K.)
| | - Yvonne Naegelin
- Department of Neurology, University Clinic Basel, Petersgraben 4, 4031 Basel, Switzerland; (J.K.); (Y.N.); (L.K.)
| | - Ludwig Kappos
- Department of Neurology, University Clinic Basel, Petersgraben 4, 4031 Basel, Switzerland; (J.K.); (Y.N.); (L.K.)
| | - Pasquale Calabrese
- Neuropsychology and Behavioral Neurology Unit, Division of Molecular and Cognitive Neuroscience, Department of Psychology, University of Basel, Birmannsgasse 8, 4055 Basel, Switzerland; (J.F.); (T.M.)
- Department of Neurology, University Clinic Basel, Petersgraben 4, 4031 Basel, Switzerland; (J.K.); (Y.N.); (L.K.)
- Correspondence:
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Rumrill P, Li J, Strauser D, Roessler RT, Bishop M, Chan F, Adams C, Leslie M. Personal, health and function, and career maintenance factors as determinants of quality of life among employed people with multiple sclerosis. Work 2021; 67:81-94. [PMID: 32986637 DOI: 10.3233/wor-203254] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Multiple sclerosis (MS) is an intrusive disease that significantly affects labor force participation. OBJECTIVE This study examined the extent to which factors at the personal, health and function, and environmental/career maintenance levels contribute to the predictability power for quality of life among employed people with MS. METHOD Participants consisted of 523 members of nine National Multiple Sclerosis Society chapters representing 21 states and Washington, DC. These individuals were employed at the time of the survey, and they were primarily middle age (average age of 48 years) and Caucasian (74%). RESULTS The final hierarchical multiple regression model explained 54 percent of the variability in participants' quality of life scores, although none of the hypothesized personal/demographic predictors were significant. Participants who perceived better overall health and lower levels of stress, who experienced less severe cognitive and mobility-related MS symptoms, and who expressed stronger job-person matches and higher levels of job satisfaction reported higher quality of life scores than did other participants. CONCLUSIONS The findings underscore the complexity involved in predicting perceived quality of life among employed people with MS. Implications of these findings for future research and clinical practice are discussed.
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Affiliation(s)
| | - Jian Li
- Kent State University, Kent, Ohio, USA
| | | | | | | | - Fong Chan
- University of Wisconsin, Madison, Wisconsin, USA
| | - Chithra Adams
- University of Illinois, Champaign-Urbana, Illinois, USA
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Homayuni A, Abedini S, Hosseini Z, Etemadifar M, Ghanbarnejad A. Explaining the facilitators of quality of life in patients with multiple sclerosis: a qualitative study. BMC Neurol 2021; 21:193. [PMID: 33975555 PMCID: PMC8111999 DOI: 10.1186/s12883-021-02213-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 04/26/2021] [Indexed: 12/05/2022] Open
Abstract
Background In patients with multiple sclerosis (MS), the disease’s complications and manifestations affect a person’s ability to function normally and leads to further disruptions in their education, family life, job opportunities, and daily life activities, thereby reduce their quality of life. Different factors as facilitators or inhibitors affect the quality of life in patients with MS. This study aimed to explain the facilitators of quality of life in patients with MS. Methods This research applied qualitative methodology, utilizing semi-structured interviews with individuals with MS and their family members/caregivers. Purposeful sampling was done among people who referred to Isfahan MS Association. Participants were selected with a maximum variation in terms of gender, age, education, occupation and marital status. Interviews were continued to reach data saturation. The gathered data were concurrently analyzed by the content analysis technique. MAXQDA software version 10 was used for data management. Results Saturation was reached after eighteen interviews. A total of three main categories and 8 sub-categories were extracted from the data. The identified facilitators were: personal facilitators (leisure time and coping strategies), interpersonal facilitators (exercise therapy, social support and social organizations) and needs and suggestions for improvement (family therapy, adopting urban architecture and facilities, and supportive systems). Conclusions Based on these findings, in order to improve the quality of life in patients with MS, we should pay attention to factors such as leisure time, spirituality and positive thinking, exercise, social support and social organizations. Health professionals, the government, community and families could help to improve patients’ quality of life through adapting urban architecture, holding family therapy sessions and providing supportive systems. Supplementary Information The online version contains supplementary material available at 10.1186/s12883-021-02213-9.
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Affiliation(s)
- Atefeh Homayuni
- Health School, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Sedigheh Abedini
- Social Determinants in Health Promotion Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran.
| | - Zahra Hosseini
- Tobacco and Health Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Masoud Etemadifar
- Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Amin Ghanbarnejad
- Department of Public Health, School of Health, Tobacco and Health Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
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Lincoln NB, Bradshaw LE, Constantinescu CS, Day F, Drummond AE, Fitzsimmons D, Harris S, Montgomery AA, das Nair R. Group cognitive rehabilitation to reduce the psychological impact of multiple sclerosis on quality of life: the CRAMMS RCT. Health Technol Assess 2021; 24:1-182. [PMID: 31934845 DOI: 10.3310/hta24040] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND People with multiple sclerosis have problems with memory and attention. The effectiveness of cognitive rehabilitation has not been established. OBJECTIVES The objectives were to assess the clinical effectiveness and cost-effectiveness of a cognitive rehabilitation programme for people with multiple sclerosis. DESIGN This was a multicentre, randomised controlled trial in which participants were randomised in a ratio of 6 : 5 to receive cognitive rehabilitation plus usual care or usual care alone. Participants were assessed at 6 and 12 months after randomisation. SETTING The trial was set in hospital neurology clinics and community services. PARTICIPANTS Participants were people with multiple sclerosis who had cognitive problems, were aged 18-69 years, could travel to attend group sessions and gave informed consent. INTERVENTION The intervention was a group cognitive rehabilitation programme delivered weekly by an assistant psychologist to between four and six participants for 10 weeks. MAIN OUTCOME MEASURES The primary outcome was the Multiple Sclerosis Impact Scale - Psychological subscale at 12 months. Secondary outcomes included results from the Everyday Memory Questionnaire, the 30-Item General Health Questionnaire, the EuroQol-5 Dimensions, five-level version and a service use questionnaire from participants, and the Everyday Memory Questionnaire - relative version and the Modified Carer Strain Index from a relative or friend of the participant. RESULTS Of the 449 participants randomised, 245 were allocated to cognitive rehabilitation (intervention group) and 204 were allocated to usual care (control group). Of these, 214 in the intervention group and 173 in the control group were included in the primary analysis. There was no clinically important difference in the Multiple Sclerosis Impact Scale - Psychological subscale score between the two groups at the 12-month follow-up (adjusted difference in means -0.6, 95% confidence interval -1.5 to 0.3; p = 0.20). There were no important differences between the groups in relation to cognitive abilities, fatigue, employment, or carer strain at follow-up. However, there were differences, although small, between the groups in the Multiple Sclerosis Impact Scale - Psychological subscale score at 6 months (adjusted difference in means -0.9, 95% confidence interval -1.7 to -0.1; p = 0.03) and in everyday memory on the Everyday Memory Questionnaire as reported by participants at 6 (adjusted difference in means -5.3, 95% confidence interval -8.7 to -1.9) and 12 months (adjusted difference in means -4.4, 95% confidence interval -7.8 to -0.9) and by relatives at 6 (adjusted difference in means -5.4, 95% confidence interval -9.1 to -1.7) and 12 months (adjusted difference in means -5.5, 95% confidence interval -9.6 to -1.5) in favour of the cognitive rehabilitation group. There were also differences in mood on the 30-Item General Health Questionnaire at 6 (adjusted difference in means -3.4, 95% confidence interval -5.9 to -0.8) and 12 months (adjusted difference in means -3.4, 95% confidence interval -6.2 to -0.6) in favour of the cognitive rehabilitation group. A qualitative analysis indicated perceived benefits of the intervention. There was no evidence of a difference in costs (adjusted difference in means -£574.93, 95% confidence interval -£1878.93 to £729.07) or quality-adjusted life-year gain (adjusted difference in means 0.00, 95% confidence interval -0.02 to 0.02). No safety concerns were raised and no deaths were reported. LIMITATIONS The trial included a sample of participants who had relatively severe cognitive problems in daily life. The trial was not powered to perform subgroup analyses. Participants could not be blinded to treatment allocation. CONCLUSIONS This cognitive rehabilitation programme had no long-term benefits on quality of life for people with multiple sclerosis. FUTURE WORK Future research should evaluate the selection of those who may benefit from cognitive rehabilitation. TRIAL REGISTRATION Current Controlled Trials ISRCTN09697576. FUNDING This project was funded by the National Institute for Health Research Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 4. See the National Institute for Health Research Journals Library website for further project information.
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Affiliation(s)
- Nadina B Lincoln
- Division of Rehabilitation and Ageing, University of Nottingham, Nottingham, UK
| | - Lucy E Bradshaw
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | | | - Florence Day
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | | | | | - Shaun Harris
- Swansea Centre for Health Economics, Swansea University, Swansea, UK
| | - Alan A Montgomery
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
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Validity of the Italian multiple sclerosis neuropsychological screening questionnaire. Neurol Sci 2021; 42:4583-4589. [PMID: 33651198 DOI: 10.1007/s10072-021-05141-1] [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: 10/17/2020] [Accepted: 02/22/2021] [Indexed: 10/22/2022]
Abstract
The Multiple Sclerosis Neuropsychological Questionnaire (MSNQ) is a brief questionnaire useful for screening patients with multiple sclerosis (MS) at risk for cognitive impairment. It includes a patient self-assessment (MSNQ-p) and a section for the caregiver (informant) (MSNQ-i). This study's aim was to validate the Italian version of MSNQ and to compare MSNQ scores with Symbol Digit Modality Test (SDMT), Beck Depression Inventory (BDI), and Expanded Disability Status Scale (EDSS) score, measuring cognitive skills, mood status, and physical disability respectively. We enrolled 122 MS patients (and related caregivers) at MS center of Tor Vergata University Hospital of Rome. The final study sample consisted of 122 patients with MS (90 relapsing-remitting, 24 secondary progressive, and 8 primary progressive). Our results highlighted that MSNQ has a unidimensional factor structure. Correlational analyses found a good correlation between both versions (MSNQ-p and MSNQ-i) of the questionnaire. Both MSNQ-p and MSNQ-i were correlated with clinical variables, specifically with cognitive impairment, mood disorder, and with disability. The Italian version of MSNQ is reliable and useful as screening tool to identify MS patients at high risk of cognitive impairment.
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Doskas T, Vavougios GD, Karampetsou P, Kormas C, Synadinakis E, Stavrogianni K, Sionidou P, Serdari A, Vorvolakos T, Iliopoulos I, Vadikolias Κ. Neurocognitive impairment and social cognition in multiple sclerosis. Int J Neurosci 2021; 132:1229-1244. [PMID: 33527857 DOI: 10.1080/00207454.2021.1879066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE/AIM OF THE STUDY The impairment of neurocognitive functions occurs in all subtypes of multiple sclerosis, even from the earliest stages of the disease. Commonly reported manifestations of cognitive impairment include deficits in attention, conceptual reasoning, processing efficiency, information processing speed, memory (episodic and working), verbal fluency (language), and executive functions. Multiple sclerosis patients also suffer from social cognition impairment, which affects their social functioning. The objective of the current paper is to assess the effect of neurocognitive impairment and its potential correlation with social cognition performance and impairment in multiple sclerosis patients. MATERIALS AND METHODS An overview of the available-to-date literature on neurocognitive impairment and social cognition performance in multiple sclerosis patients by disease subtype was performed. RESULTS It is not clear if social cognition impairment occurs independently or secondarily to neurocognitive impairment. There are associations of variable strengths between neurocognitive and social cognition deficits and their neural basis is increasingly investigated. CONCLUSIONS The prompt detection of neurocognitive predictors of social cognition impairment that may be applicable to all multiple sclerosis subtypes and intervention are crucial to prevent further neural and social cognition decline in multiple sclerosis patients.
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Affiliation(s)
- Triantafyllos Doskas
- Department of Neurology, Athens Naval Hospital, Athens, Greece.,Department of Neurology, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | | | | | | | | | | | | | - Aspasia Serdari
- Department of Psychiatry, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Theofanis Vorvolakos
- Department of Psychiatry, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Ioannis Iliopoulos
- Department of Neurology, University Hospital of Alexandroupolis, Alexandroupolis, Greece
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Han A. Effects of mindfulness-and acceptance-based interventions on quality of life, coping, cognition, and mindfulness of people with multiple sclerosis: a systematic review and meta-analysis. PSYCHOL HEALTH MED 2021; 27:1514-1531. [PMID: 33629885 DOI: 10.1080/13548506.2021.1894345] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
This systematic review and meta-analysis of randomized controlled trials (RCTs) examined effects of mindfulness- and acceptance-based interventions (MABIs) on quality of life (QoL), coping, cognition, and mindfulness among people with multiple sclerosis (MS). Four electronic databases were searched to 3 July 2020. Data was combined in a random-effects meta-analysis model. Eighteen RCTs met the eligibility criteria. Meta-analyses at the immediate posttest found: moderate effects of MABIs on QoL, coping, and attention; and a large effect on memory. A large effect of MABIs on QoL was found at follow-up. There was no significant effect of MABIs on mindfulness. Relatively fewer studies in outcomes other than QoL were found, and the overall risk of bias across the included 18 RCTs was unclear. Future high-quality studies with follow-up evaluations are needed to support effects of MABIs on QoL, coping, cognition, and mindfulness in people with MS and examine intervention features that increase and maintain effects.
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Affiliation(s)
- Areum Han
- Department of Occupational Therapy, University of Alabama at Birmingham, Birmingham, Alabama, USA
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