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Stavrogianni K, Kitsos DK, Giannopapas V, Chasiotis AK, Christouli N, Paraskevas PG, Zompola C, Tsivgoulis G, Paraskevas GP, Giannopoulos S. Neuropsychological profiles comparison between Multiple Sclerosis patients and Multiple Sclerosis patients with overlapping features of Systemic Lupus Erythematosus. J Neuroimmunol 2024; 387:578270. [PMID: 38176314 DOI: 10.1016/j.jneuroim.2023.578270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 11/30/2023] [Accepted: 12/18/2023] [Indexed: 01/06/2024]
Abstract
AIM Multiple sclerosis (MS) and Systemic Lupus Erythematosus (SLE) are autoimmune disorders that may lead to cognitive impairment. This study aimed to compare the neuropsychological profiles of patients with MS, and MS and coexisting SLE features. METHODS We included a total of 90 participants, divided into 3 groups: 30 patients with clinically definite relapsing remitting MS, 30 with coexisting MS and incomplete SLE (overlap group) and 30 healthy controls (HC). All participants underwent neuropsychological assessment with the Montreal Cognitive Assessment (MoCA), Symbol Digit Modalities Test (SDMT), Paced Auditory Serial Addition Test (PASAT), and Selective Reminding Test (SRT). RESULTS Both groups scored lower on the MoCA compared to the HC (p < .001). The overlap group showed the lowest performance on the SDMT and PASAT compared to the other two groups (p < .01), while the MS group scored similarly to the HC in the PASAT (p > .05). Regarding the learning rate and long-term recall, the overlap group had lower scores compared to both the MS and HC (p < .001), but it outperformed both groups in the retention efficacy score (p < .001). The MS group did not differ significantly from the HC in these memory domains (p > .05). CONCLUSION The overlap group exhibited a broader range of impairments, including slower processing speed, decreased working memory, reduced learning rate, and long-term retrieval deficits. Their retention ability remained intact. The coexistence of MS with SLE pathology had additive impacts on cognitive function.
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Affiliation(s)
- Konstantina Stavrogianni
- Second Department of Neurology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece; Department of Physiology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Dimitrios K Kitsos
- Second Department of Neurology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Vasileios Giannopapas
- Second Department of Neurology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece; Department of Physical Therapy, University of West Attica, Attica, Greece; Laboratory of Neuromuscular and Cardiovascular Study of Motion-LANECASM, University of West Attica, Attica, Greece
| | - Athanasios K Chasiotis
- Second Department of Neurology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece; Department of Physical Therapy, University of West Attica, Attica, Greece; Laboratory of Neuromuscular and Cardiovascular Study of Motion-LANECASM, University of West Attica, Attica, Greece
| | - Niki Christouli
- Second Department of Neurology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Panagiotis G Paraskevas
- Second Department of Neurology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Christina Zompola
- Second Department of Neurology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgios Tsivgoulis
- Second Department of Neurology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - George P Paraskevas
- Second Department of Neurology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Sotirios Giannopoulos
- Second Department of Neurology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
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Akaishi T, Fujimori J, Nakashima I. Basal Ganglia Atrophy and Impaired Cognitive Processing Speed in Multiple Sclerosis. Cureus 2024; 16:e52603. [PMID: 38374834 PMCID: PMC10875397 DOI: 10.7759/cureus.52603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2024] [Indexed: 02/21/2024] Open
Abstract
Impaired cognitive processing speed is among the important higher brain dysfunctions in multiple sclerosis (MS). However, the exact structural mechanisms of the dysfunction remain uncertain. This study aimed to identify the brain regions associated with the impaired cognitive processing speed in MS by comparing the cognitive processing speed, measured using the Cognitive Processing Speed Test (CogEval) z-score, and brain regional volumetric data. Altogether, 80 patients with MS (64 with relapsing-remitting MS [RRMS] and 16 with secondary progressive MS [SPMS]) were enrolled. Consequently, CogEval z-scores were worse in patients with SPMS than in those with RRMS (p=0.001). In the univariate correlation analyses, significant correlations with CogEval z-score were suggested in the MS lesion volume (p<0.001; Spearman's rank correlation test) and atrophies in the cerebral cortex (p=0.031), cerebral white matter (p=0.013), corpus callosum (p=0.001), thalamus (p=0.001), and putamen (p<0.001). Multiple linear regression analysis revealed that putamen atrophy was significantly associated with CogEval z-score (p=0.038) independent of volume in other brain regions, while thalamic atrophy was not (p=0.79). Univariate correlation analyses were further performed in each of RRMS and SPMS. None of the evaluated volumetric data indicated a significant correlation with the CogEval z-score in RRMS. Meanwhile, atrophies in the cerebral white matter (p=0.008), corpus callosum (p=0.002), putamen (p=0.011), and pallidum (p=0.017) demonstrated significant correlations with CogEval z-score in SPMS. In summary, the putamen could be an important region of atrophy contributing to the impaired cognitive speed in MS, especially in the later disease stages after a transition to SPMS.
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Affiliation(s)
- Tetsuya Akaishi
- Department of Education and Support for Regional Medicine, Tohoku University Hospital, Sendai, JPN
| | - Juichi Fujimori
- Department of Neurology, Tohoku Medical and Pharmaceutical University, Sendai, JPN
| | - Ichiro Nakashima
- Department of Neurology, Tohoku Medical and Pharmaceutical University, Sendai, JPN
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Kania K, Ambrosius W, Kozubski W, Kalinowska-Łyszczarz A. The impact of disease modifying therapies on cognitive functions typically impaired in multiple sclerosis patients: a clinician's review. Front Neurol 2023; 14:1222574. [PMID: 37503514 PMCID: PMC10368887 DOI: 10.3389/fneur.2023.1222574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 06/28/2023] [Indexed: 07/29/2023] Open
Abstract
Objective Over the last few decades clinicians have become aware that cognitive impairment might be a major cause of disability, loss of employment and poor quality of life in patients suffering from multiple sclerosis [MS].The impact of disease modifying therapies [DMTs] on cognition is still a matter of debate. Theoretically, DMTs could exert a substantial beneficial effect by means of reducing neuroinflammation and brain atrophy, which are established correlates of cognitive dysfunction. The aim of the study was to review the evidence concerning the effect of DMTs on cognitive functions. Methods PubMed, Scopus, and the European Committee for Treatment and Research in Multiple Sclerosis [ECTRIMS] Library were searched for articles concerning the pediatric and adult populations of patients with multiple sclerosis, including clinical trials and RWD, where psychometric results were analyzed as secondary or exploratory endpoints. Results We reviewed a total of 44 studies that were found by our search strategy, analyzed the psychological tests that were applied, the length of the follow-up, and possible limitations. We pointed out the difficulties associated with assessing of DMTs' effects on cognitive functions, and pitfalls in cognitive tools used for evaluating of MS patients. Conclusion There is a need to highlight this aspect of MS therapies, and to collect adequate data to make informed therapeutic decisions, to improve our understanding of MS-related cognitive dysfunction and provide new therapeutic targets.
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Affiliation(s)
- Karolina Kania
- Department of Neurology, Poznan University of Medical Sciences, Poznań, Poland
| | - Wojciech Ambrosius
- Department of Neurology, Poznan University of Medical Sciences, Poznań, Poland
| | - Wojciech Kozubski
- Department of Neurology, Poznan University of Medical Sciences, Poznań, Poland
| | - Alicja Kalinowska-Łyszczarz
- Department of Neurology, Division of Neurochemistry and Neuropathology, Poznan University of Medical Sciences, Poznań, Poland
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Nitu NS, Sultana SZ, Haq A, Sumi SA, Bose SK, Sinha S, Kumar S, Haque M. Histological Study on the Thickness of Gray Matter at the Summit and Bottom of Folium in Different Age Groups of Bangladeshi People. Cureus 2023; 15:e42103. [PMID: 37476298 PMCID: PMC10354462 DOI: 10.7759/cureus.42103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2023] [Indexed: 07/22/2023] Open
Abstract
Context The cerebellum is a part of the hindbrain and consists of cortical gray matter (GM) at the surface and a medullary core of white matter (WM). The GM contains a cell body of neurons that helps process and transmit any command type through nerve fibers found in the WM. The main functions of GM in the central nervous system empower persons to control motor activity, recollection, and passion. So, this research aims to assess the thickness of GM at the summit and bottom of folia by histologically studying the cerebellum cortex. Methods The collection of data was a descriptive type of cross-sectional study. The method was the purposive type. This study was conducted from August 2016 to March 2017, and the research was carried out at Mymensingh Medical College's Department of Anatomy, Bangladesh. Specimens containing cerebellum were preserved from Bangladeshi cadavers according to sexes and ages ranging in years. We chose fresh specimens from people who died within the last 12 hours and preserved them in 10% formol saline. The size of the tissue that was collected for the histological study was not more than 2 cm2 and not more than 4-5 mm thick. Then the tissue was placed in 10% formol saline. This fluid was used for quick fixation and partial dehydration of the tissue. After dehydration, each tissue segment is processed for infiltration and embedding separately. Every section was stained with hematoxylin and eosin stain (H&E) before being coated with dibutyl phthalate polystyrene xylene (DPX) coverslips on slides. Result The mean (±SD) thickness of GM at the summit of folium was 886.2±29.7µm in Group A, 925.2±25.9µm in Group B, 912.7±22.3µm in Group C, and 839.9±40.7µm in Group D. Mean (±SD) GM thickness at the bottom of the fissure was 395.6±12.2 µm, 403.9±26.0µm, 380.4±23.4 µm, and 375.8±28.8 µm in Groups A, B, C, and D respectively. Conclusion The thickness of the cortex is an essential factor in the normal development process, and it was similar in the current study. Normal aging, Alzheimer's disease, and other dementias cause reduced GM which makes the cortical sheet thin. Huntington's disease, corticobasal degeneration, amyotrophic lateral sclerosis, and schizophrenia are all examples of neurological disorders. Cortical thinning is typically locally localized, and the progression of atrophy can thus disclose much about a disease's history and causal variables. The present study correspondingly found that GM was reduced after the age of 50 years onward. Furthermore, longitudinal investigations of cortical atrophy have the potential to be extremely useful in measuring the efficacy of a wide range of treatments.
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Affiliation(s)
| | | | - Ahsanul Haq
- Statistics, Gonoshasthaya-RNA Molecular Diagnostic and Research Center, Dhanmondi, BGD
| | - Sharmin A Sumi
- Anatomy, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, BGD
| | | | - Susmita Sinha
- Physiology, Khulna City Medical College and Hospital, Khulna, BGD
| | - Santosh Kumar
- Periodontology and Implantology, Karnavati School of Dentistry, Karnavati University, Gandhinagar, IND
| | - Mainul Haque
- Karnavati Scientific Research Center (KSRC), School of Dentistry, Karnavati University, Gandhinagar, IND
- Pharmacology and Therapeutics, National Defence University of Malaysia, Kuala Lumpur, MYS
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Ganzetti M, Graves JS, Holm SP, Dondelinger F, Midaglia L, Gaetano L, Craveiro L, Lipsmeier F, Bernasconi C, Montalban X, Hauser SL, Lindemann M. Neural correlates of digital measures shown by structural MRI: a post-hoc analysis of a smartphone-based remote assessment feasibility study in multiple sclerosis. J Neurol 2023; 270:1624-1636. [PMID: 36469103 PMCID: PMC9970954 DOI: 10.1007/s00415-022-11494-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 11/15/2022] [Accepted: 11/17/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND A study was undertaken to evaluate remote monitoring via smartphone sensor-based tests in people with multiple sclerosis (PwMS). This analysis aimed to explore regional neural correlates of digital measures derived from these tests. METHODS In a 24-week, non-randomized, interventional, feasibility study (NCT02952911), sensor-based tests on the Floodlight Proof-of-Concept app were used to assess cognition (smartphone-based electronic Symbol Digit Modalities Test), upper extremity function (Draw a Shape Test, Pinching Test), and gait and balance (Static Balance Test, Two-Minute Walk Test, U-Turn Test). In this post-hoc analysis, digital measures and standard clinical measures (e.g., Nine-Hole Peg Test [9HPT]) were correlated against regional structural magnetic resonance imaging outcomes. Seventy-six PwMS aged 18-55 years with an Expanded Disability Status Scale score of 0.0-5.5 were enrolled from two different sites (USA and Spain). Sixty-two PwMS were included in this analysis. RESULTS Worse performance on digital and clinical measures was associated with smaller regional brain volumes and larger ventricular volumes. Whereas digital and clinical measures had many neural correlates in common (e.g., putamen, globus pallidus, caudate nucleus, lateral occipital cortex), some were observed only for digital measures. For example, Draw a Shape Test and Pinching Test measures, but not 9HPT score, correlated with volume of the hippocampus (r = 0.37 [drawing accuracy over time on the Draw a Shape Test]/ - 0.45 [touching asynchrony on the Pinching Test]), thalamus (r = 0.38/ - 0.41), and pons (r = 0.35/ - 0.35). CONCLUSIONS Multiple neural correlates were identified for the digital measures in a cohort of people with early MS. Digital measures showed associations with brain regions that clinical measures were unable to demonstrate, thus providing potential novel information on functional ability compared with standard clinical assessments.
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Affiliation(s)
- Marco Ganzetti
- grid.417570.00000 0004 0374 1269F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | - Jennifer S. Graves
- grid.266100.30000 0001 2107 4242Department of Neurosciences, University of California San Diego, San Diego, CA USA
| | - Sven P. Holm
- grid.417570.00000 0004 0374 1269F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | - Frank Dondelinger
- grid.417570.00000 0004 0374 1269F. Hoffmann-La Roche Ltd, Basel, Switzerland ,grid.419481.10000 0001 1515 9979Present Address: Novartis Institutes for Biomedical Research, Basel, Switzerland
| | - Luciana Midaglia
- grid.411083.f0000 0001 0675 8654Department of Neurology-Neuroimmunology, Centre d’Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d’Hebron, Barcelona, Spain ,grid.7080.f0000 0001 2296 0625Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | - Laura Gaetano
- grid.417570.00000 0004 0374 1269F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | - Licinio Craveiro
- grid.417570.00000 0004 0374 1269F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | | | - Corrado Bernasconi
- grid.417570.00000 0004 0374 1269F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | - Xavier Montalban
- grid.411083.f0000 0001 0675 8654Department of Neurology-Neuroimmunology, Centre d’Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d’Hebron, Barcelona, Spain ,grid.7080.f0000 0001 2296 0625Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | - Stephen L. Hauser
- grid.266102.10000 0001 2297 6811Department of Neurology, University of California San Francisco, San Francisco, CA USA
| | - Michael Lindemann
- grid.417570.00000 0004 0374 1269F. Hoffmann-La Roche Ltd, Basel, Switzerland
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Moridi T. Association between brain volume and disability over time in multiple sclerosis. Mult Scler J Exp Transl Clin 2022; 8:20552173221144230. [PMID: 36570871 PMCID: PMC9768834 DOI: 10.1177/20552173221144230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 11/23/2022] [Indexed: 12/23/2022] Open
Abstract
Background Most previous multiple sclerosis (MS) brain atrophy studies using MS impact scale 29 (MSIS-29) or symbol digit modalities test (SDMT) have been cross-sectional with limited sets of clinical outcomes. Objectives To investigate which brain and lesion volume metrics show the strongest long-term associations with the expanded disability status scale (EDSS), SDMT, and MSIS-29, and whether MRI-clinical associations vary with age. Methods We acquired MRI and clinical data from a real-world Swedish MS cohort. FreeSurfer and SPM Lesion Segmentation Tool were used to obtain brain parenchymal, cortical and subcortical grey matter, thalamic and white matter fractions as well as T1- and T2-lesion volumes. Mixed-effects and rolling regression models were used in the statistical analyses. Results We included 989 persons with MS followed for a median of 9.3 (EDSS), 10.1 (SDMT), and 9.3 (MSIS-29) years, respectively. In a cross-sectional analysis, the strength of the associations of the MRI metrics with the EDSS and MSIS-29 was found to drastically increase after 40-50 years of age. Low baseline regional grey matter fractions were associated with longitudinal increase of EDSS and physical MSIS-29 scores and decrease in SDMT scores and these atrophy measures were stronger predictors than the lesion volumes. Conclusions The strength of MRI-clinical associations increase with age. Grey matter volume fractions are stronger predictors of long-term disability measures than lesion volumes.
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Affiliation(s)
- Thomas Moridi
- Thomas Moridi, Department of Clinical Neuroscience, Karolinska Institutet, K8 Klinisk neurovetenskap, K8 Neuro Kockum, Stockholm, 171 77, Sweden.
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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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Buyukturkoglu K, Dworkin JD, Leiva V, Provenzano FA, Guevara P, De Jager PL, Leavitt VM, Riley CS. Brain volumetric correlates of remotely versus in-person administered symbol digit modalities test in multiple sclerosis. Mult Scler Relat Disord 2022; 68:104247. [PMID: 36274283 DOI: 10.1016/j.msard.2022.104247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 09/25/2022] [Accepted: 10/15/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Prior studies in multiple sclerosis (MS) support reliability of telehealth-delivered cognitive batteries, although, to date, none have reported relationships of cognitive test performance to neural correlates across administration modalities. In this study we aimed to compare brain-behavior relationships, using the Symbol Digit Modalities Test (SDMT), the most reliable and sensitive cognitive measure in MS, measured from patients seen via telehealth versus in-person. METHODS SDMT was administered to individuals with MS either in-person (N=60, mean age=39.7) or remotely via video conference (N=51, mean age=47.4). Magnetic resonance imaging (MRI) data was collected in 3-Tesla scanners. Using 3-dimensional T1 images cerebral, cortical, deep gray, cerebral white matter and thalamic nuclei volumes were calculated. Using a meta-analysis approach with an interaction term for participant group, individual regression models were run for each MRI measure having SDMT scores as the outcome variable in each model. In addition, the correlation and average difference between In-person and Remote group associations across the MRI measures were calculated. Finally, for each MRI variable I2 score was quantified to test the heterogeneity between the groups. RESULTS Administration modality did not affect the association of SDMT performance with MRI measures. Brain tissue volumes showing high associations with the SDMT scores in one group also showed high associations in the other (r = 0.83; 95% CI = [0.07, 0.86]). The average difference between the In-person and the Remote group associations was not significant (βRemote - βIn-person = 0.14, 95% CI = [-0.04, 0.34]). Across MRI measures, the average I2 value was 14%, reflecting very little heterogeneity in the relationship of SDMT performance to brain volume. CONCLUSION We found consistent relationships to neural correlates across in-person and remote SDMT administration modalities. Hence, our study extended the findings of the previous studies demonstrating the feasibility of remote administration of the SDMT.
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Affiliation(s)
- Korhan Buyukturkoglu
- Department of Neurology, Columbia University Irving Medical Center, 630 W. 168th Street, PH 18-324, New York, NY 10032, USA; The Center for Translational and Computational Neuroimmunology, NY, USA; Columbia University MS Center, NY, USA.
| | - Jordan D Dworkin
- Department of Psychiatry, Columbia University and the New York State Psychiatric Institute, NY, USA
| | - Victor Leiva
- Department of Biomedical Engineering, Universidad de Concepción, Santiago, Chile
| | - Frank A Provenzano
- Department of Neurology, Columbia University Irving Medical Center, 630 W. 168th Street, PH 18-324, New York, NY 10032, USA
| | - Pamela Guevara
- Department of Biomedical Engineering, Universidad de Concepción, Santiago, Chile
| | - Philip L De Jager
- Department of Neurology, Columbia University Irving Medical Center, 630 W. 168th Street, PH 18-324, New York, NY 10032, USA; The Center for Translational and Computational Neuroimmunology, NY, USA; Columbia University MS Center, NY, USA
| | - Victoria M Leavitt
- Department of Neurology, Columbia University Irving Medical Center, 630 W. 168th Street, PH 18-324, New York, NY 10032, USA
| | - Claire S Riley
- Department of Neurology, Columbia University Irving Medical Center, 630 W. 168th Street, PH 18-324, New York, NY 10032, USA; The Center for Translational and Computational Neuroimmunology, NY, USA; Columbia University MS Center, NY, USA
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Grothe M, Jochem K, Strauss S, Langner S, Kirsch M, Hoffeld K, Penner IK, Nagels G, Klepzig K, Domin M, Lotze M. Performance in information processing speed is associated with parietal white matter tract integrity in multiple sclerosis. Front Neurol 2022; 13:982964. [DOI: 10.3389/fneur.2022.982964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 09/20/2022] [Indexed: 11/06/2022] Open
Abstract
BackgroundThe Symbol Digit Modalities Test (SDMT) is most frequently used to test processing speed in patients with multiple sclerosis (MS). Functional imaging studies emphasize the importance of frontal and parietal areas for task performance, but the influence of frontoparietal tracts has not been thoroughly studied. We were interested in tract-specific characteristics and their association with processing speed in MS patients.MethodsDiffusion tensor imaging was obtained in 100 MS patients and 24 healthy matched controls to compare seed-based tract characteristics descending from the superior parietal lobule [Brodman area 7A (BA7A)], atlas-based tract characteristics from the superior longitudinal fasciculus (SLF), and control tract characteristics from the corticospinal tract (CST) and their respective association with ability on the SDMT.ResultsPatients had decreased performance on the SDMT and decreased white matter volume (each p < 0.05). The mean fractional anisotropy (FA) for the BA7A tract and CST (p < 0.05), but not the SLF, differed between MS patients and controls. Furthermore, only the FA of the SLF was positively associated with SDMT performance even after exclusion of the lesions within the tract (r = 0.25, p < 0.05). However, only disease disability and total white matter volume were associated with information processing speed in a linear regression model.ConclusionsProcessing speed in MS is associated with the structural integrity of frontoparietal white matter tracts.
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Miyazaki Y, Niino M, Takahashi E, Nomura T, Naganuma R, Amino I, Akimoto S, Minami N, Kikuchi S. Stages of brain volume loss and performance in the Brief International Cognitive Assessment for Multiple Sclerosis. Mult Scler Relat Disord 2022; 67:104183. [PMID: 36116381 DOI: 10.1016/j.msard.2022.104183] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 08/28/2022] [Accepted: 09/11/2022] [Indexed: 12/22/2022]
Abstract
BACKGROUND Cognitive dysfunction occurs in a substantial proportion of patients with multiple sclerosis (MS), negatively affects their daily activities, and is associated with poor prognosis. Cognitive dysfunction in MS can extend across multiple cognitive domains, depending on the patterns and extent of the brain regions affected. Therefore, a combination of tests, including the Brief International Cognitive Assessment for MS (BICAMS), that assess different aspects of cognition is recommended to capture the full picture of cognitive impairment in each patient. However, the temporal relationships between the progression of the MS brain pathology and the performances in different cognitive tests remain unclear. METHODS Global and regional brain volume data were obtained based on T1-weighted magnetic resonance imaging from 61 patients with MS, and hierarchical cluster analysis was performed using these brain volume data. Cognitive function was assessed using the three subcomponents of the BICAMS: the Symbol Digit Modalities Test (SDMT), California Verbal Learning Test Second Edition (CVLT2), and Brief Visuospatial Memory Test-Revised (BVMTR). Clinical characteristics, patterns of regional brain volume loss, and cognitive test scores were compared among clusters. RESULTS Cluster analysis of the global and regional brain volume data classified patients into three clusters (Clusters 1, 2, and 3) in order of decreasing global brain volume. A comparison of the clinical profiles of the patients suggested that those in Clusters 1, 2, and 3 are in the early, intermediate, and advanced stages of MS, respectively. Pair-wise analysis of regional brain volume among the three clusters suggested brain regions where volume loss starts early and continues throughout the disease course, occurs preferentially at the early phase, or evolves relatively slowly. SDMT scores differed significantly among the three clusters, with a decrease from Clusters 1 to 3. BVMTR scores also declined in this order, whereas the CVLT2 was significantly impaired only in Cluster 3. CONCLUSION Our results suggest that SDMT performance declines in conjunction with brain volume loss throughout the disease course of MS. Performance in the BVMTR also declines in line with the brain volume loss, but impairment in the CVLT2 becomes particularly apparent at the late phase of MS.
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Affiliation(s)
- Yusei Miyazaki
- Departments of Neurology, National Hospital Organization Hokkaido Medical Center, 1-1 Yamanote, 5-jo 7-chome, Nishi-ku, Sapporo 063-0005, Japan.
| | - Masaaki Niino
- Departments of Clinical Research, National Hospital Organization Hokkaido Medical Center, 1-1 Yamanote, 5-jo 7-chome, Nishi-ku, Sapporo 063-0005, Japan
| | - Eri Takahashi
- Departments of Clinical Research, National Hospital Organization Hokkaido Medical Center, 1-1 Yamanote, 5-jo 7-chome, Nishi-ku, Sapporo 063-0005, Japan
| | - Taichi Nomura
- Departments of Neurology, National Hospital Organization Hokkaido Medical Center, 1-1 Yamanote, 5-jo 7-chome, Nishi-ku, Sapporo 063-0005, Japan
| | - Ryoji Naganuma
- Departments of Neurology, National Hospital Organization Hokkaido Medical Center, 1-1 Yamanote, 5-jo 7-chome, Nishi-ku, Sapporo 063-0005, Japan
| | - Itaru Amino
- Departments of Neurology, National Hospital Organization Hokkaido Medical Center, 1-1 Yamanote, 5-jo 7-chome, Nishi-ku, Sapporo 063-0005, Japan
| | - Sachiko Akimoto
- Departments of Neurology, National Hospital Organization Hokkaido Medical Center, 1-1 Yamanote, 5-jo 7-chome, Nishi-ku, Sapporo 063-0005, Japan
| | - Naoya Minami
- Departments of Neurology, National Hospital Organization Hokkaido Medical Center, 1-1 Yamanote, 5-jo 7-chome, Nishi-ku, Sapporo 063-0005, Japan
| | - Seiji Kikuchi
- Departments of Neurology, National Hospital Organization Hokkaido Medical Center, 1-1 Yamanote, 5-jo 7-chome, Nishi-ku, Sapporo 063-0005, Japan
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11
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Combined progressive functional exercise effect on contactin-1 and contactin-2 level in mildly disabled persons with multiple sclerosis. Mult Scler Relat Disord 2022; 67:104095. [PMID: 35963206 DOI: 10.1016/j.msard.2022.104095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 07/31/2022] [Accepted: 08/07/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Although contactin-1 and contactin-2 are known as two proteins involved in axonal regeneration, it is unclear whether these proteins are induced by exercise in persons with multiple sclerosis (PwMS). OBJECTIVE The aim of this study was to determine the serum levels of contactin-1 and contactin-2 in PwMS and to investigate the change of these markers with exercise. METHODS A total of 60 participants with relapsing-remitting MS were divided into groups by stratified randomization. The progressive functional exercise was applied to the intervention group. Participants in the control group continued the treatments and lives of the routines. Participants' contactin-1 and contactin-2, cognitive performance and aerobic capacities were evaluated. RESULTS The comparison of the pre-and post-study values of contactin-1 and contactin-2 showed significant differences only in the intervention group. The contactin-1 and contactin-2 values were similar between the groups before the exercise, whereas a significant difference was found in favor of the intervention group after the exercise. Paced Auditory Serial Addition Test-3 value increased significantly only in the intervention group. CONCLUSION With this study, it was shown for the first time that contactin-1 and contactin-2, which play an important role in axonal regeneration and axonal organization, can be increased by exercise.
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12
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Bonacchi R, Meani A, Pagani E, Marchesi O, Falini A, Filippi M, Rocca MA. Association of Age at Onset With Gray Matter Volume and White Matter Microstructural Abnormalities in People With Multiple Sclerosis. Neurology 2021; 97:e2007-e2019. [PMID: 34607928 DOI: 10.1212/wnl.0000000000012869] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 08/27/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES To investigate whether age at onset influences brain gray matter volume (GMV) and white matter (WM) microstructural abnormalities in adult patients with multiple sclerosis (MS), given its influence on clinical phenotype and disease course. METHODS In this hypothesis-driven cross-sectional study, we enrolled 67 patients with pediatric-onset MS (POMS) and 143 sex- and disease duration (DD)-matched randomly selected patients with adult-onset MS (AOMS), together with 208 healthy controls. All participants underwent neurologic evaluation and 3T MRI acquisition. MRI variables were standardized based on healthy controls, to remove effects of age and sex. Associations with DD in patients with POMS and patients with AOMS were studied with linear models. Time to reach clinical and MRI milestones was assessed with product-limit approach. RESULTS At DD 1 year, GMV and WM fractional anisotropy (FA) were abnormal in AOMS but not in POMS. Significant interaction of age at onset (POMS vs AOMS) into the association with DD was found for GMV and WM FA. The crossing point of regression lines in POMS and AOMS was at 20 years of DD for GMV and 14 for WM FA. For POMS and AOMS, median DD was 29 and 19 years to reach Expanded Disability Status Scale score 3 (p < 0.001), 31 and 26 years to reach abnormal Paced Auditory Serial Addition Task, 3-second version (p = 0.01), 24 and 18 years to reach abnormal GMV (p = 0.04), and 19 and 17 years to reach abnormal WM FA (p = 0.36). DISCUSSION Younger patients are initially resilient to MS-related damage. Then, compensatory mechanisms start failing with loss of WM integrity, followed by GM atrophy and finally disability.
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Affiliation(s)
- Raffaello Bonacchi
- From the Neuroimaging Research Unit, Division of Neuroscience (R.B., A.M., E.P., O.M., M.F., M.A.R.), Neurology Unit (R.B., M.F., M.A.R.), Neuroradiology Unit (A.F.), Neurorehabilitation Unit (M.F.), and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute; and Vita-Salute San Raffaele University (A.F., M.F., M.A.R.), Milan, Italy
| | - Alessandro Meani
- From the Neuroimaging Research Unit, Division of Neuroscience (R.B., A.M., E.P., O.M., M.F., M.A.R.), Neurology Unit (R.B., M.F., M.A.R.), Neuroradiology Unit (A.F.), Neurorehabilitation Unit (M.F.), and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute; and Vita-Salute San Raffaele University (A.F., M.F., M.A.R.), Milan, Italy
| | - Elisabetta Pagani
- From the Neuroimaging Research Unit, Division of Neuroscience (R.B., A.M., E.P., O.M., M.F., M.A.R.), Neurology Unit (R.B., M.F., M.A.R.), Neuroradiology Unit (A.F.), Neurorehabilitation Unit (M.F.), and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute; and Vita-Salute San Raffaele University (A.F., M.F., M.A.R.), Milan, Italy
| | - Olga Marchesi
- From the Neuroimaging Research Unit, Division of Neuroscience (R.B., A.M., E.P., O.M., M.F., M.A.R.), Neurology Unit (R.B., M.F., M.A.R.), Neuroradiology Unit (A.F.), Neurorehabilitation Unit (M.F.), and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute; and Vita-Salute San Raffaele University (A.F., M.F., M.A.R.), Milan, Italy
| | - Andrea Falini
- From the Neuroimaging Research Unit, Division of Neuroscience (R.B., A.M., E.P., O.M., M.F., M.A.R.), Neurology Unit (R.B., M.F., M.A.R.), Neuroradiology Unit (A.F.), Neurorehabilitation Unit (M.F.), and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute; and Vita-Salute San Raffaele University (A.F., M.F., M.A.R.), Milan, Italy
| | - Massimo Filippi
- From the Neuroimaging Research Unit, Division of Neuroscience (R.B., A.M., E.P., O.M., M.F., M.A.R.), Neurology Unit (R.B., M.F., M.A.R.), Neuroradiology Unit (A.F.), Neurorehabilitation Unit (M.F.), and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute; and Vita-Salute San Raffaele University (A.F., M.F., M.A.R.), Milan, Italy
| | - Maria A Rocca
- From the Neuroimaging Research Unit, Division of Neuroscience (R.B., A.M., E.P., O.M., M.F., M.A.R.), Neurology Unit (R.B., M.F., M.A.R.), Neuroradiology Unit (A.F.), Neurorehabilitation Unit (M.F.), and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute; and Vita-Salute San Raffaele University (A.F., M.F., M.A.R.), Milan, Italy.
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13
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Davion JB, Lopes R, Jougleux C, Viard R, Dumont J, Leclerc X, Outteryck O. Brief International Cognitive Assessment for Multiple Sclerosis scores are associated with the cortical thickness of specific cortical areas in relapsing-remitting patients. Rev Neurol (Paris) 2021; 178:326-336. [PMID: 34657733 DOI: 10.1016/j.neurol.2021.06.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 06/02/2021] [Accepted: 06/22/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Cognitive impairment is frequent and disabling in multiple sclerosis (MS). The Brief International Cognitive Assessment in MS (BICAMS) is a recent short battery usable in clinical practice for cognitive evaluation of MS patients. OBJECTIVE To find cortical areas or brain volumes on magnetic resonance imaging (MRI) structural sequences associated with BICAMS scores in MS. METHODS In this cross-sectional single-center study (NCT03656055, September 4, 2018), 96 relapsing remitting-MS patients under natalizumab and without recent clinical or radiological inflammation were included. Patients underwent brain MRI and the three BICAMS tests, evaluating information processing speed (SDMT), visuo-spatial memory (BVMT-R), and verbal memory (FVLT). RESULTS Cortical thickness in the left frontal superior and the right precentral gyri was associated with BVMT-R scores whereas cortical thickness in the left Broca's area and the right superior temporal gyrus was associated with FVLT scores. We observed associations between white matter inflammatory lesions connected to these cortical regions and BICAMS subscores. CONCLUSIONS BICAMS scores are associated with specific cortical areas, the cognitive domain matching the known functions of the cortical area. Specific cognitive impairments in MS may be associated with specific cortical regions, themselves influenced by white matter inflammatory lesions and demographical parameters (age, sex, education level).
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Affiliation(s)
- J-B Davion
- U1172 - LilNCog - Lille Neuroscience & Cognition, university Lille, 59000 Lille, France; Department of neurology, CHU Lille, 59000 Lille, France
| | - R Lopes
- U1172 - LilNCog - Lille Neuroscience & Cognition, university Lille, 59000 Lille, France; Department of neuroradiology, CHU Lille, 59000 Lille, France; CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, US 41 - UMS 2014 - PLBS, university Lille, 59000 Lille, France
| | - C Jougleux
- U1172 - LilNCog - Lille Neuroscience & Cognition, university Lille, 59000 Lille, France; Department of neurology, CHU Lille, 59000 Lille, France
| | - R Viard
- Department of neuroradiology, CHU Lille, 59000 Lille, France; CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, US 41 - UMS 2014 - PLBS, university Lille, 59000 Lille, France
| | - J Dumont
- Department of neuroradiology, CHU Lille, 59000 Lille, France; CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, US 41 - UMS 2014 - PLBS, university Lille, 59000 Lille, France
| | - X Leclerc
- U1172 - LilNCog - Lille Neuroscience & Cognition, university Lille, 59000 Lille, France; Department of neuroradiology, CHU Lille, 59000 Lille, France
| | - O Outteryck
- U1172 - LilNCog - Lille Neuroscience & Cognition, university Lille, 59000 Lille, France; Department of neuroradiology, CHU Lille, 59000 Lille, France.
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14
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Beaudoin AM, Rheault F, Theaud G, Laberge F, Whittingstall K, Lamontagne A, Descoteaux M. Modern Technology in Multi-Shell Diffusion MRI Reveals Diffuse White Matter Changes in Young Adults With Relapsing-Remitting Multiple Sclerosis. Front Neurosci 2021; 15:665017. [PMID: 34447292 PMCID: PMC8383891 DOI: 10.3389/fnins.2021.665017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 07/20/2021] [Indexed: 11/13/2022] Open
Abstract
Objective To characterize microstructural white matter changes related to relapsing-remitting multiple sclerosis using advanced diffusion MRI modeling and tractography. The association between imaging data and patient’s cognitive performance, fatigue severity and depressive symptoms is also explored. Methods In this cross-sectional study, 24 relapsing-remitting multiple sclerosis patients and 11 healthy controls were compared using high angular resolution diffusion imaging (HARDI). The imaging method includes a multi-shell scheme, free water correction to obtain tissue-specific measurements, probabilistic tracking algorithm robust to crossing fibers and white matter lesions, automatic streamlines and bundle dissection and tract-profiling with tractometry. The neuropsychological evaluation included the Symbol Digit Modalities Test, Paced Auditory Serial Addition Test, Modified Fatigue Impact Scale and Beck Depression Inventory-II. Results Bundle-wise analysis by tractometry revealed a difference between patients and controls for 11 of the 14 preselected white matter bundles. In patients, free water corrected fractional anisotropy was significantly reduced while radial and mean diffusivities were increased, consistent with diffuse demyelination. The fornix and left inferior fronto-occipital fasciculus exhibited a higher free water fraction. Eight bundles showed an increase in total apparent fiber density and four bundles had a higher number of fiber orientations, suggesting axonal swelling and increased organization complexity, respectively. In the association study, depressive symptoms were associated with diffusion abnormalities in the right superior longitudinal fasciculus. Conclusion Tissue-specific diffusion measures showed abnormalities along multiple cerebral white matter bundles in patients with relapsing-remitting multiple sclerosis. The proposed methodology combines free-water imaging, advanced bundle dissection and tractometry, which is a novel approach to investigate cerebral pathology in multiple sclerosis. It opens a new window of use for HARDI-derived measures and free water corrected diffusion measures. Advanced diffusion MRI provides a better insight into cerebral white matter changes in relapsing-remitting multiple sclerosis, namely diffuse demyelination, edema and increased fiber density and complexity.
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Affiliation(s)
- Ann-Marie Beaudoin
- Department of Neurology, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - François Rheault
- Sherbrooke Connectivity Imaging Laboratory (SCIL), Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Guillaume Theaud
- Sherbrooke Connectivity Imaging Laboratory (SCIL), Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Frédéric Laberge
- Sherbrooke Connectivity Imaging Laboratory (SCIL), Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Kevin Whittingstall
- Department of Radiology, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Albert Lamontagne
- Department of Neurology, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Maxime Descoteaux
- Sherbrooke Connectivity Imaging Laboratory (SCIL), Université de Sherbrooke, Sherbrooke, QC, Canada
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15
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Koenig KA, Beall EB, Sakaie KE, Ontaneda D, Stone L, Rao SM, Nakamura K, Jones SE, Lowe MJ. Evaluation of a connectivity-based imaging metric that reflects functional decline in Multiple Sclerosis. PLoS One 2021; 16:e0251338. [PMID: 34101741 PMCID: PMC8186801 DOI: 10.1371/journal.pone.0251338] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 04/23/2021] [Indexed: 11/26/2022] Open
Abstract
Cognitive impairment is a common symptom in individuals with Multiple Sclerosis (MS), but meaningful, reliable biomarkers relating to cognitive decline have been elusive, making evaluation of the impact of therapeutics on cognitive function difficult. Here, we combine pathway-based MRI measures of structural and functional connectivity to construct a metric of functional decline in MS. The Structural and Functional Connectivity Index (SFCI) is proposed as a simple, z-scored metric of structural and functional connectivity, where changes in the metric have a simple statistical interpretation and may be suitable for use in clinical trials. Using data collected at six time points from a 2-year longitudinal study of 20 participants with MS and 9 age- and sex-matched healthy controls, we probe two common symptomatic domains, motor and cognitive function, by measuring structural and functional connectivity in the transcallosal motor pathway and posterior cingulum bundle. The SFCI is significantly lower in participants with MS compared to controls (p = 0.009) and shows a significant decrease over time in MS (p = 0.012). The change in SFCI over two years performed favorably compared to measures of brain parenchymal fraction and lesion volume, relating to follow-up measures of processing speed (r = 0.60, p = 0.005), verbal fluency (r = 0.57, p = 0.009), and score on the Multiple Sclerosis Functional Composite (r = 0.67, p = 0.003). These initial results show that the SFCI is a suitable metric for longitudinal evaluation of functional decline in MS.
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Affiliation(s)
- Katherine A. Koenig
- Imaging Sciences, Imaging Institute, Cleveland Clinic, Cleveland, OH, United States of America
- * E-mail:
| | - Erik B. Beall
- Imaging Sciences, Imaging Institute, Cleveland Clinic, Cleveland, OH, United States of America
| | - Ken E. Sakaie
- Imaging Sciences, Imaging Institute, Cleveland Clinic, Cleveland, OH, United States of America
| | - Daniel Ontaneda
- Mellen Center, Neurologic Institute, Cleveland Clinic, Cleveland, OH, United States of America
| | - Lael Stone
- Mellen Center, Neurologic Institute, Cleveland Clinic, Cleveland, OH, United States of America
| | - Stephen M. Rao
- Schey Center for Cognitive Neuroimaging, Neurologic Institute, Cleveland Clinic, Cleveland, OH, United States of America
| | - Kunio Nakamura
- Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States of America
| | - Stephen E. Jones
- Imaging Sciences, Imaging Institute, Cleveland Clinic, Cleveland, OH, United States of America
| | - Mark J. Lowe
- Imaging Sciences, Imaging Institute, Cleveland Clinic, Cleveland, OH, United States of America
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16
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Lozano-Soto E, Cruz-López ÁJ, Gutiérrez R, González M, Sanmartino F, Rashid-Lopez R, Espinosa-Rosso R, Forero L, González-Rosa JJ. Predicting Neuropsychological Impairment in Relapsing Remitting Multiple Sclerosis: The Role of Clinical Measures, Treatment, and Neuropsychiatry Symptoms. Arch Clin Neuropsychol 2021; 36:475-484. [PMID: 33067616 DOI: 10.1093/arclin/acaa088] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2020] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE This retrospective observational study aimed to define neuropsychological impairment (NI) profiles and determine the influence of clinical, demographic, and neuropsychiatric measures in specific cognitive domains in a cohort of relapsing-remitting multiple sclerosis (RRMS) patients. METHODS Ninety-one RRMS patients underwent a neurological examination and a brief neuropsychological assessment. Patients were classified according to the disease-modifying therapies (DMTs) received (platform or high-efficacy). Differences between groups and multiple regression analyses were performed to determine the predictive value of the assessed measures in cognitive performance. RESULTS More than two-thirds of the patients showed NI. Specifically, mild to moderate NI was presented in approximately half of the participants. Paced Auditory Serial Addition Test (PASAT-3) and Symbol Digit Modalities Test (SDMT) were the most frequently impaired cognitive tests (45.3% and 41.3%, respectively) followed by phonemic verbal fluency (PVF) (27.8%). Expanded Disability Status Scale (EDSS), age, depressive symptoms, and disease duration were the best predictors of SDMT (R2 = .34; p < .01), whereas disease duration, EDSS, and anxiety-state levels predicted PASAT-3 (R2 = .33, p < .01). Educational level, age, EDSS, and depressive symptoms demonstrated the strongest association with PVF (R2 = .31, p < .01). CONCLUSIONS Our results indicated a significant prevalence of NI in RRMS patients that was not dependent on the DMT type. In addition to the meaningful working memory (PASAT-3) and information processing speed (SDMT) impairments found, PVF deficits may also be an important marker of cognitive impairment in RRMS patients. This study supports the relevance of standard clinical measures and reinforces the importance of quantifying clinical and neuropsychiatric symptoms to predict subsequent cognitive performance on a similar multiple sclerosis phenotype and disease stage.
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Affiliation(s)
- Elena Lozano-Soto
- Psychophysiology and Neuroimaging Group, Institute of Biomedical Research and Innovation of Cádiz (INiBICA), Cádiz, Spain
| | | | - Rafael Gutiérrez
- Neurology Department, Puerta del Mar University Hospital, Cádiz, Spain
| | - Macarena González
- Neurology Department, Puerta del Mar University Hospital, Cádiz, Spain
| | - Florencia Sanmartino
- Psychophysiology and Neuroimaging Group, Institute of Biomedical Research and Innovation of Cádiz (INiBICA), Cádiz, Spain
| | - Raúl Rashid-Lopez
- Neurology Department, Puerta del Mar University Hospital, Cádiz, Spain
| | | | - Lucía Forero
- Neurology Department, Puerta del Mar University Hospital, Cádiz, Spain
| | - Javier J González-Rosa
- Psychophysiology and Neuroimaging Group, Institute of Biomedical Research and Innovation of Cádiz (INiBICA), Cádiz, Spain.,Institute of Biomedical Research and Innovation of Cádiz (INiBICA), Cádiz, Spain
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17
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Conti L, Riccitelli GC, Preziosa P, Vizzino C, Marchesi O, Rocca MA, Filippi M. Effect of cognitive reserve on structural and functional MRI measures in healthy subjects: a multiparametric assessment. J Neurol 2021; 268:1780-1791. [PMID: 33387014 DOI: 10.1007/s00415-020-10331-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 11/19/2020] [Accepted: 11/19/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Cognitive reserve (CR) contributes to inter-individual variability of cognitive performance and to preserve cognitive functioning facing aging and brain damage. However, brain anatomical and functional substrates of CR still need to be fully explored in young healthy subjects (HS). By evaluating a relatively large cohort of young HS, we investigated the associations between CR and structural and functional magnetic resonance imaging (MRI) measures in early adulthood. METHODS A global Cognitive Reserve Index (CRI), combining intelligence quotient, leisure activities and education, was measured from 77 HS and its brain anatomical and functional substrates were evaluated through a multiparametric MRI approach. Substrates of the three subdomains (cognitive/social/physical) of leisure activities were also explored. RESULTS Higher global and subdomain CRIs were associated with higher gray matter volume of brain regions involved in motor and cognitive functions, such as the right (R) supplementary motor area, left (L) middle frontal gyrus and L cerebellum. No correlation with measures of white matter (WM) integrity was found. Higher global and subdomains CRIs were associated with lower resting-state functional connectivity (RS FC) of L postcentral gyrus and R insula in sensorimotor network, L postcentral gyrus in salience network and R cerebellum in the executive-control network. Moreover, several CRIs were also associated with higher RS FC of R cuneus in default-mode network. CONCLUSIONS CR modulates structure and function of several brain motor and cognitive networks responsible for complex cognitive functioning already in young HS. CR could promote optimization of the recruitment of brain networks.
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Affiliation(s)
- Lorenzo Conti
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Gianna C Riccitelli
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Paolo Preziosa
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Carmen Vizzino
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Olga Marchesi
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maria A Rocca
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy. .,Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy. .,Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy. .,Neurophysiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy. .,Vita-Salute San Raffaele University, Milan, Italy.
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18
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Benedict RHB, Tomic D, Cree BA, Fox R, Giovannoni G, Bar-Or A, Gold R, Vermersch P, Pohlmann H, Wright I, Karlsson G, Dahlke F, Wolf C, Kappos L. Siponimod and Cognition in Secondary Progressive Multiple Sclerosis: EXPAND Secondary Analyses. Neurology 2020; 96:e376-e386. [PMID: 33328324 DOI: 10.1212/wnl.0000000000011275] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 08/20/2020] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVE To investigate the effects of siponimod on cognitive processing speed in patients with secondary progressive (SP) multiple sclerosis (MS), by means of a predefined exploratory and post hoc analysis of the Exploring the Efficacy and Safety of Siponimod in Patients With Secondary Progressive Multiple Sclerosis (EXPAND) study, a randomized controlled trial comparing siponimod and placebo. METHODS EXPAND was a double-blind, placebo-controlled phase 3 trial involving 1,651 patients with SPMS randomized (2:1) to either siponimod 2 mg/d or placebo. Cognitive function was assessed with the Symbol Digit Modalities Test (SDMT), Paced Auditory Serial Addition Test (PASAT), and Brief Visuospatial Memory Test-Revised (BVMT-R) administered at baseline, 6-month intervals, and end of treatment. RESULTS Between-group differences in mean change from baseline in SDMT scores were significantly better in siponimod- vs placebo-treated patients at month 12 (difference 1.08 [95% confidence interval 0.23-1.94]; p = 0.0132), month 18 (1.23 [0.25-2.21); p = 0.0135), and month 24 (2.30 [1.11-3.50]; p = 0.0002). Siponimod-treated patients were at significantly lower risk for having a 4-point sustained decrease in SDMT score (hazard ratio [HR] 0.79 [0.65-0.96]; p = 0.0157), while their chance for having a 4-point sustained increase in SDMT score was higher (HR 1.28 [1.05-1.55]; p = 0.0131). PASAT and BVMT-R scores did not differ significantly between the 2 treatment groups (all p > 0.28). CONCLUSION Siponimod had a significant benefit on SDMT in patients with SPMS. Siponimod-treated patients were at significantly lower risk for having a ≥4-point decrease in SDMT score and had a significantly higher chance for having a ≥4-point increase in SDMT score, a magnitude of change accepted as clinically meaningful. CLINICALTRIALSGOV IDENTIFIER NCT01665144. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that, for patients with SPMS, siponimod had a significant benefit on cognitive processing speed.
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Affiliation(s)
- Ralph H B Benedict
- From the Department of Neurology (R.H.B.B.), University at Buffalo, NY; Novartis Pharma AG (D.T., H.P., G.K., F.D.), Basel, Switzerland; Weill Institute for Neurosciences (B.A.C.), Department of Neurology, University of California San Francisco; Mellen Center for Treatment and Research in Multiple Sclerosis (R.F.), Neurological Institute, Cleveland Clinic, OH; Blizard Institute (GG), Barts and The London School of Medicine and Dentistry, Queen Mary University of London, UK; Department of Neurology (A.B.-O.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Neurology (R.G.), St. Josef-Hospital/Ruhr-University Bochum, Germany; Department of Neurology (P.V.), University of Lille, INSERM U1172, CHU Lille, FHU Imminent, France; Novartis Ireland Ltd (I.W.), Dublin; Lycalis sprl (C.W.), Brussels, Belgium; and Neurologic Clinic and Policlinic (G.K., L.K.), Departments of Medicine, Clinical Research, Biomedicine, and Biomedical Engineering, University Hospital and University of Basel, Switzerland.
| | - Davorka Tomic
- From the Department of Neurology (R.H.B.B.), University at Buffalo, NY; Novartis Pharma AG (D.T., H.P., G.K., F.D.), Basel, Switzerland; Weill Institute for Neurosciences (B.A.C.), Department of Neurology, University of California San Francisco; Mellen Center for Treatment and Research in Multiple Sclerosis (R.F.), Neurological Institute, Cleveland Clinic, OH; Blizard Institute (GG), Barts and The London School of Medicine and Dentistry, Queen Mary University of London, UK; Department of Neurology (A.B.-O.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Neurology (R.G.), St. Josef-Hospital/Ruhr-University Bochum, Germany; Department of Neurology (P.V.), University of Lille, INSERM U1172, CHU Lille, FHU Imminent, France; Novartis Ireland Ltd (I.W.), Dublin; Lycalis sprl (C.W.), Brussels, Belgium; and Neurologic Clinic and Policlinic (G.K., L.K.), Departments of Medicine, Clinical Research, Biomedicine, and Biomedical Engineering, University Hospital and University of Basel, Switzerland
| | - Bruce A Cree
- From the Department of Neurology (R.H.B.B.), University at Buffalo, NY; Novartis Pharma AG (D.T., H.P., G.K., F.D.), Basel, Switzerland; Weill Institute for Neurosciences (B.A.C.), Department of Neurology, University of California San Francisco; Mellen Center for Treatment and Research in Multiple Sclerosis (R.F.), Neurological Institute, Cleveland Clinic, OH; Blizard Institute (GG), Barts and The London School of Medicine and Dentistry, Queen Mary University of London, UK; Department of Neurology (A.B.-O.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Neurology (R.G.), St. Josef-Hospital/Ruhr-University Bochum, Germany; Department of Neurology (P.V.), University of Lille, INSERM U1172, CHU Lille, FHU Imminent, France; Novartis Ireland Ltd (I.W.), Dublin; Lycalis sprl (C.W.), Brussels, Belgium; and Neurologic Clinic and Policlinic (G.K., L.K.), Departments of Medicine, Clinical Research, Biomedicine, and Biomedical Engineering, University Hospital and University of Basel, Switzerland
| | - Robert Fox
- From the Department of Neurology (R.H.B.B.), University at Buffalo, NY; Novartis Pharma AG (D.T., H.P., G.K., F.D.), Basel, Switzerland; Weill Institute for Neurosciences (B.A.C.), Department of Neurology, University of California San Francisco; Mellen Center for Treatment and Research in Multiple Sclerosis (R.F.), Neurological Institute, Cleveland Clinic, OH; Blizard Institute (GG), Barts and The London School of Medicine and Dentistry, Queen Mary University of London, UK; Department of Neurology (A.B.-O.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Neurology (R.G.), St. Josef-Hospital/Ruhr-University Bochum, Germany; Department of Neurology (P.V.), University of Lille, INSERM U1172, CHU Lille, FHU Imminent, France; Novartis Ireland Ltd (I.W.), Dublin; Lycalis sprl (C.W.), Brussels, Belgium; and Neurologic Clinic and Policlinic (G.K., L.K.), Departments of Medicine, Clinical Research, Biomedicine, and Biomedical Engineering, University Hospital and University of Basel, Switzerland
| | - Gavin Giovannoni
- From the Department of Neurology (R.H.B.B.), University at Buffalo, NY; Novartis Pharma AG (D.T., H.P., G.K., F.D.), Basel, Switzerland; Weill Institute for Neurosciences (B.A.C.), Department of Neurology, University of California San Francisco; Mellen Center for Treatment and Research in Multiple Sclerosis (R.F.), Neurological Institute, Cleveland Clinic, OH; Blizard Institute (GG), Barts and The London School of Medicine and Dentistry, Queen Mary University of London, UK; Department of Neurology (A.B.-O.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Neurology (R.G.), St. Josef-Hospital/Ruhr-University Bochum, Germany; Department of Neurology (P.V.), University of Lille, INSERM U1172, CHU Lille, FHU Imminent, France; Novartis Ireland Ltd (I.W.), Dublin; Lycalis sprl (C.W.), Brussels, Belgium; and Neurologic Clinic and Policlinic (G.K., L.K.), Departments of Medicine, Clinical Research, Biomedicine, and Biomedical Engineering, University Hospital and University of Basel, Switzerland
| | - Amit Bar-Or
- From the Department of Neurology (R.H.B.B.), University at Buffalo, NY; Novartis Pharma AG (D.T., H.P., G.K., F.D.), Basel, Switzerland; Weill Institute for Neurosciences (B.A.C.), Department of Neurology, University of California San Francisco; Mellen Center for Treatment and Research in Multiple Sclerosis (R.F.), Neurological Institute, Cleveland Clinic, OH; Blizard Institute (GG), Barts and The London School of Medicine and Dentistry, Queen Mary University of London, UK; Department of Neurology (A.B.-O.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Neurology (R.G.), St. Josef-Hospital/Ruhr-University Bochum, Germany; Department of Neurology (P.V.), University of Lille, INSERM U1172, CHU Lille, FHU Imminent, France; Novartis Ireland Ltd (I.W.), Dublin; Lycalis sprl (C.W.), Brussels, Belgium; and Neurologic Clinic and Policlinic (G.K., L.K.), Departments of Medicine, Clinical Research, Biomedicine, and Biomedical Engineering, University Hospital and University of Basel, Switzerland
| | - Ralf Gold
- From the Department of Neurology (R.H.B.B.), University at Buffalo, NY; Novartis Pharma AG (D.T., H.P., G.K., F.D.), Basel, Switzerland; Weill Institute for Neurosciences (B.A.C.), Department of Neurology, University of California San Francisco; Mellen Center for Treatment and Research in Multiple Sclerosis (R.F.), Neurological Institute, Cleveland Clinic, OH; Blizard Institute (GG), Barts and The London School of Medicine and Dentistry, Queen Mary University of London, UK; Department of Neurology (A.B.-O.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Neurology (R.G.), St. Josef-Hospital/Ruhr-University Bochum, Germany; Department of Neurology (P.V.), University of Lille, INSERM U1172, CHU Lille, FHU Imminent, France; Novartis Ireland Ltd (I.W.), Dublin; Lycalis sprl (C.W.), Brussels, Belgium; and Neurologic Clinic and Policlinic (G.K., L.K.), Departments of Medicine, Clinical Research, Biomedicine, and Biomedical Engineering, University Hospital and University of Basel, Switzerland
| | - Patrick Vermersch
- From the Department of Neurology (R.H.B.B.), University at Buffalo, NY; Novartis Pharma AG (D.T., H.P., G.K., F.D.), Basel, Switzerland; Weill Institute for Neurosciences (B.A.C.), Department of Neurology, University of California San Francisco; Mellen Center for Treatment and Research in Multiple Sclerosis (R.F.), Neurological Institute, Cleveland Clinic, OH; Blizard Institute (GG), Barts and The London School of Medicine and Dentistry, Queen Mary University of London, UK; Department of Neurology (A.B.-O.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Neurology (R.G.), St. Josef-Hospital/Ruhr-University Bochum, Germany; Department of Neurology (P.V.), University of Lille, INSERM U1172, CHU Lille, FHU Imminent, France; Novartis Ireland Ltd (I.W.), Dublin; Lycalis sprl (C.W.), Brussels, Belgium; and Neurologic Clinic and Policlinic (G.K., L.K.), Departments of Medicine, Clinical Research, Biomedicine, and Biomedical Engineering, University Hospital and University of Basel, Switzerland
| | - Harald Pohlmann
- From the Department of Neurology (R.H.B.B.), University at Buffalo, NY; Novartis Pharma AG (D.T., H.P., G.K., F.D.), Basel, Switzerland; Weill Institute for Neurosciences (B.A.C.), Department of Neurology, University of California San Francisco; Mellen Center for Treatment and Research in Multiple Sclerosis (R.F.), Neurological Institute, Cleveland Clinic, OH; Blizard Institute (GG), Barts and The London School of Medicine and Dentistry, Queen Mary University of London, UK; Department of Neurology (A.B.-O.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Neurology (R.G.), St. Josef-Hospital/Ruhr-University Bochum, Germany; Department of Neurology (P.V.), University of Lille, INSERM U1172, CHU Lille, FHU Imminent, France; Novartis Ireland Ltd (I.W.), Dublin; Lycalis sprl (C.W.), Brussels, Belgium; and Neurologic Clinic and Policlinic (G.K., L.K.), Departments of Medicine, Clinical Research, Biomedicine, and Biomedical Engineering, University Hospital and University of Basel, Switzerland
| | - Ian Wright
- From the Department of Neurology (R.H.B.B.), University at Buffalo, NY; Novartis Pharma AG (D.T., H.P., G.K., F.D.), Basel, Switzerland; Weill Institute for Neurosciences (B.A.C.), Department of Neurology, University of California San Francisco; Mellen Center for Treatment and Research in Multiple Sclerosis (R.F.), Neurological Institute, Cleveland Clinic, OH; Blizard Institute (GG), Barts and The London School of Medicine and Dentistry, Queen Mary University of London, UK; Department of Neurology (A.B.-O.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Neurology (R.G.), St. Josef-Hospital/Ruhr-University Bochum, Germany; Department of Neurology (P.V.), University of Lille, INSERM U1172, CHU Lille, FHU Imminent, France; Novartis Ireland Ltd (I.W.), Dublin; Lycalis sprl (C.W.), Brussels, Belgium; and Neurologic Clinic and Policlinic (G.K., L.K.), Departments of Medicine, Clinical Research, Biomedicine, and Biomedical Engineering, University Hospital and University of Basel, Switzerland
| | - Göril Karlsson
- From the Department of Neurology (R.H.B.B.), University at Buffalo, NY; Novartis Pharma AG (D.T., H.P., G.K., F.D.), Basel, Switzerland; Weill Institute for Neurosciences (B.A.C.), Department of Neurology, University of California San Francisco; Mellen Center for Treatment and Research in Multiple Sclerosis (R.F.), Neurological Institute, Cleveland Clinic, OH; Blizard Institute (GG), Barts and The London School of Medicine and Dentistry, Queen Mary University of London, UK; Department of Neurology (A.B.-O.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Neurology (R.G.), St. Josef-Hospital/Ruhr-University Bochum, Germany; Department of Neurology (P.V.), University of Lille, INSERM U1172, CHU Lille, FHU Imminent, France; Novartis Ireland Ltd (I.W.), Dublin; Lycalis sprl (C.W.), Brussels, Belgium; and Neurologic Clinic and Policlinic (G.K., L.K.), Departments of Medicine, Clinical Research, Biomedicine, and Biomedical Engineering, University Hospital and University of Basel, Switzerland
| | - Frank Dahlke
- From the Department of Neurology (R.H.B.B.), University at Buffalo, NY; Novartis Pharma AG (D.T., H.P., G.K., F.D.), Basel, Switzerland; Weill Institute for Neurosciences (B.A.C.), Department of Neurology, University of California San Francisco; Mellen Center for Treatment and Research in Multiple Sclerosis (R.F.), Neurological Institute, Cleveland Clinic, OH; Blizard Institute (GG), Barts and The London School of Medicine and Dentistry, Queen Mary University of London, UK; Department of Neurology (A.B.-O.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Neurology (R.G.), St. Josef-Hospital/Ruhr-University Bochum, Germany; Department of Neurology (P.V.), University of Lille, INSERM U1172, CHU Lille, FHU Imminent, France; Novartis Ireland Ltd (I.W.), Dublin; Lycalis sprl (C.W.), Brussels, Belgium; and Neurologic Clinic and Policlinic (G.K., L.K.), Departments of Medicine, Clinical Research, Biomedicine, and Biomedical Engineering, University Hospital and University of Basel, Switzerland
| | - Christian Wolf
- From the Department of Neurology (R.H.B.B.), University at Buffalo, NY; Novartis Pharma AG (D.T., H.P., G.K., F.D.), Basel, Switzerland; Weill Institute for Neurosciences (B.A.C.), Department of Neurology, University of California San Francisco; Mellen Center for Treatment and Research in Multiple Sclerosis (R.F.), Neurological Institute, Cleveland Clinic, OH; Blizard Institute (GG), Barts and The London School of Medicine and Dentistry, Queen Mary University of London, UK; Department of Neurology (A.B.-O.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Neurology (R.G.), St. Josef-Hospital/Ruhr-University Bochum, Germany; Department of Neurology (P.V.), University of Lille, INSERM U1172, CHU Lille, FHU Imminent, France; Novartis Ireland Ltd (I.W.), Dublin; Lycalis sprl (C.W.), Brussels, Belgium; and Neurologic Clinic and Policlinic (G.K., L.K.), Departments of Medicine, Clinical Research, Biomedicine, and Biomedical Engineering, University Hospital and University of Basel, Switzerland
| | - Ludwig Kappos
- From the Department of Neurology (R.H.B.B.), University at Buffalo, NY; Novartis Pharma AG (D.T., H.P., G.K., F.D.), Basel, Switzerland; Weill Institute for Neurosciences (B.A.C.), Department of Neurology, University of California San Francisco; Mellen Center for Treatment and Research in Multiple Sclerosis (R.F.), Neurological Institute, Cleveland Clinic, OH; Blizard Institute (GG), Barts and The London School of Medicine and Dentistry, Queen Mary University of London, UK; Department of Neurology (A.B.-O.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Neurology (R.G.), St. Josef-Hospital/Ruhr-University Bochum, Germany; Department of Neurology (P.V.), University of Lille, INSERM U1172, CHU Lille, FHU Imminent, France; Novartis Ireland Ltd (I.W.), Dublin; Lycalis sprl (C.W.), Brussels, Belgium; and Neurologic Clinic and Policlinic (G.K., L.K.), Departments of Medicine, Clinical Research, Biomedicine, and Biomedical Engineering, University Hospital and University of Basel, Switzerland
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19
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CogniSoft: A Platform for the Automation of Cognitive Assessment and Rehabilitation of Multiple Sclerosis. COMPUTERS 2020. [DOI: 10.3390/computers9040093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Cognitive disorders remain a major cause of disability in Multiple Sclerosis (MS). They lead to unemployment, the need for daily assistance, and a poor quality of life. The understanding of the origin, factors, processes, and consequences of cognitive disfunction is key to its prevention, early diagnosis, and rehabilitation. The neuropsychological testing and continuous monitoring of cognitive status as part of the overall evaluation of patients with MS in parallel with clinical and paraclinical examinations are highly recommended. In order to improve health and disease understanding, a close linkage between fundamental, clinical, epidemiological, and socio-economic research is required. The effective sharing of data, standardized data processing, and the linkage of such data with large-scale cohort studies is a prerequisite for the translation of research findings into the clinical setting. In this context, this paper proposes a software platform for the cognitive assessment and rehabilitation of patients with MS called CogniSoft. The platform automates the Beck Depression Inventory (BDI-II) test and diagnostic tests for the evaluation of memory and executive functions based on the nature of Brief International Cognitive Assessment for MS (BICAMS), as well as implementing a set of games for cognitive rehabilitation based on BICAMS. The software architecture, core modules, and technologies used for their implementation are presented. Special attention is given to the development of cognitive tests for diagnostics and rehabilitation. Their automation enables better perception, avoids bias as a result of conducting the classic paper tests of various neurophysiologists, provides easy administration, and allows data collection in a uniform manner, which further enables analysis using statistical and machine learning algorithms. The CogniSoft platform is registered as medical software by the Bulgarian Drug Agency and it is currently deployed in the Neurological Clinic of the National Hospital of Cardiology in Sofia, Bulgaria. The first experiments prove the feasibility of the platform, showing that it saves time and financial resources while providing subjectivity in the interpretation of the cognitive test results.
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Linortner P, McDaniel C, Shahid M, Levine TF, Tian L, Cholerton B, Poston KL. White Matter Hyperintensities Related to Parkinson's Disease Executive Function. Mov Disord Clin Pract 2020; 7:629-638. [PMID: 32775508 PMCID: PMC7396844 DOI: 10.1002/mdc3.12956] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 03/05/2020] [Accepted: 04/04/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND People with Parkinson's disease (PD) can develop multidomain cognitive impairments; however, it is unclear whether different pathologies underlie domain-specific cognitive dysfunction. OBJECTIVES We investigated the contribution of vascular copathology severity and location, as measured by MRI white matter hyperintensities (WMHs), to domain-specific cognitive impairment in PD. METHODS We studied 85 PD (66.6 ± 9.2 years) and 18 control (65.9 ± 6.6) participants. Using the Fazekas scale for rating the severity of WMH, we subdivided PD into 14 PD-WMH+ and 71 PD-WMH-. Participants underwent global, executive, visuospatial, episodic memory, and language testing. We performed nonparametric permutation testing to create WMH probability maps based on PD-WMH group and cognitive test performance. RESULTS The PD-WMH+ group showed worse global and executive cognitive performance than the PD-WMH- group. On individual tests, the PD-WMH+ group showed worse Montreal Cognitive Assessment (MoCA), Stroop, Symbol Digit Modalities Test (SDMT), and Digit Span scores. WMH probability maps showed that in the PD-WMH+ group, worse Stroop was associated with lesions centered around the corticospinal tract (CST), forceps major, inferior-fronto-occipital fasciculus, and superior longitudinal fasciculus; worse SDMT with lesions around the CST, forceps major, and posterior corona radiata; worse Digit Span with lesions around the posterior corona radiata; and worse MoCA with lesions around the CST. CONCLUSIONS We found that WMH severity was associated with PD executive dysfunction, including worse attention, working memory, and processing speed. Disruption of key white matter tracts in proximity to vascular lesions could contribute to these specific cognitive impairments. Early treatment of vascular disease might mitigate some executive dysfunction in a subset of patients with PD.
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Affiliation(s)
- Patricia Linortner
- Department of Neurology and Neurological SciencesStanford UniversityPalo AltoCaliforniaUSA
| | - Colin McDaniel
- Department of Neurology and Neurological SciencesStanford UniversityPalo AltoCaliforniaUSA
| | - Marian Shahid
- Department of Neurology and Neurological SciencesStanford UniversityPalo AltoCaliforniaUSA
| | - Taylor F. Levine
- Department of Neurology and Neurological SciencesStanford UniversityPalo AltoCaliforniaUSA
- Psychological & Brain SciencesWashington UniversitySt. LouisMissouriUSA
| | - Lu Tian
- Department of Biomedical Data ScienceStanford UniversityPalo AltoCaliforniaUSA
| | - Brenna Cholerton
- Department of PathologyStanford UniversityPalo AltoCaliforniaUSA
| | - Kathleen L. Poston
- Department of Neurology and Neurological SciencesStanford UniversityPalo AltoCaliforniaUSA
- Department of NeurosurgeryStanford UniversityPalo AltoCaliforniaUSA
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21
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Artemiadis A, Bakirtzis C, Ifantopoulou P, Zis P, Bargiotas P, Grigoriadis N, Hadjigeorgiou G. The role of cognitive reserve in multiple sclerosis: A cross-sectional study in 526 patients. Mult Scler Relat Disord 2020; 41:102047. [DOI: 10.1016/j.msard.2020.102047] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Revised: 03/04/2020] [Accepted: 03/07/2020] [Indexed: 11/17/2022]
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22
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Liu S, Li A, Liu Y, Yan H, Wang M, Sun Y, Fan L, Song M, Xu K, Chen J, Chen Y, Wang H, Guo H, Wan P, Lv L, Yang Y, Li P, Lu L, Yan J, Wang H, Zhang H, Wu H, Ning Y, Zhang D, Jiang T, Liu B. Polygenic effects of schizophrenia on hippocampal grey matter volume and hippocampus-medial prefrontal cortex functional connectivity. Br J Psychiatry 2020; 216:267-274. [PMID: 31169117 DOI: 10.1192/bjp.2019.127] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Schizophrenia is a complex mental disorder with high heritability and polygenic inheritance. Multimodal neuroimaging studies have also indicated that abnormalities of brain structure and function are a plausible neurobiological characterisation of schizophrenia. However, the polygenic effects of schizophrenia on these imaging endophenotypes have not yet been fully elucidated. AIMS To investigate the effects of polygenic risk for schizophrenia on the brain grey matter volume and functional connectivity, which are disrupted in schizophrenia. METHOD Genomic and neuroimaging data from a large sample of Han Chinese patients with schizophrenia (N = 509) and healthy controls (N = 502) were included in this study. We examined grey matter volume and functional connectivity via structural and functional magnetic resonance imaging, respectively. Using the data from a recent meta-analysis of a genome-wide association study that comprised a large number of Chinese people, we calculated a polygenic risk score (PGRS) for each participant. RESULTS The imaging genetic analysis revealed that the individual PGRS showed a significantly negative correlation with the hippocampal grey matter volume and hippocampus-medial prefrontal cortex functional connectivity, both of which were lower in the people with schizophrenia than in the controls. We also found that the observed neuroimaging measures showed weak but similar changes in unaffected first-degree relatives of patients with schizophrenia. CONCLUSIONS These findings suggested that genetically influenced brain grey matter volume and functional connectivity may provide important clues for understanding the pathological mechanisms of schizophrenia and for the early diagnosis of schizophrenia.
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Affiliation(s)
- Shu Liu
- MSc Student, Brainnetome Center and National Laboratory of Pattern Recognition, Institute of Automation, Chinese Academy of Sciences.,School of Artificial Intelligence, University of Chinese Academy of Sciences, China
| | - Ang Li
- School of Artificial Intelligence, University of Chinese Academy of Sciences, China.,PhD Student, Brainnetome Center and National Laboratory of Pattern Recognition, Institute of Automation, Chinese Academy of Sciences
| | - Yong Liu
- School of Artificial Intelligence, University of Chinese Academy of Sciences, China.,Professor, Brainnetome Center and National Laboratory of Pattern Recognition, Institute of Automation, Chinese Academy of Sciences
| | - Hao Yan
- Associate Professor, Peking University Sixth Hospital, Institute of Mental Health.,Key Laboratory of Mental Health, Ministry of Health (Peking University), China
| | - Meng Wang
- School of Artificial Intelligence, University of Chinese Academy of Sciences, China.,PhD Student, Brainnetome Center and National Laboratory of Pattern Recognition, Institute of Automation, Chinese Academy of Sciences
| | - Yuqing Sun
- School of Artificial Intelligence, University of Chinese Academy of Sciences, China.,PhD Student, Brainnetome Center and National Laboratory of Pattern Recognition, Institute of Automation, Chinese Academy of Sciences
| | - Lingzhong Fan
- School of Artificial Intelligence, University of Chinese Academy of Sciences, China.,Professor, Brainnetome Center and National Laboratory of Pattern Recognition, Institute of Automation, Chinese Academy of Sciences
| | - Ming Song
- School of Artificial Intelligence, University of Chinese Academy of Sciences, China.,Associate Professor, Brainnetome Center and National Laboratory of Pattern Recognition, Institute of Automation, Chinese Academy of Sciences
| | - Kaibin Xu
- School of Artificial Intelligence, University of Chinese Academy of Sciences, China.,PhD Student, Brainnetome Center and National Laboratory of Pattern Recognition, Institute of Automation, Chinese Academy of Sciences
| | - Jun Chen
- Associate Professor, Department of Radiology, Renmin Hospital of Wuhan University, China
| | - Yunchun Chen
- Associate Professor, Department of Psychiatry, Xijing Hospital, The Fourth Military Medical University, China
| | - Huaning Wang
- Associate Professor, Department of Psychiatry, Xijing Hospital, The Fourth Military Medical University, China
| | - Hua Guo
- Professor, Zhumadian Psychiatric Hospital, China
| | - Ping Wan
- Professor, Zhumadian Psychiatric Hospital, China
| | - Luxian Lv
- Professor, Department of Psychiatry, Henan Mental Hospital, The Second Affiliated Hospital of Xinxiang Medical University.,Henan Key Lab of Biological Psychiatry, Xinxiang Medical University, China
| | - Yongfeng Yang
- Henan Key Lab of Biological Psychiatry, Xinxiang Medical University, China.,Attending Doctor, Department of Psychiatry, Henan Mental Hospital, The Second Affiliated Hospital of Xinxiang Medical University
| | - Peng Li
- Key Laboratory of Mental Health, Ministry of Health (Peking University), China.,Associate Professor, Peking University Sixth Hospital, Institute of Mental Health
| | - Lin Lu
- Key Laboratory of Mental Health, Ministry of Health (Peking University), China.,Professor, Peking University Sixth Hospital, Institute of Mental Health
| | - Jun Yan
- Key Laboratory of Mental Health, Ministry of Health (Peking University), China.,Professor, Peking University Sixth Hospital, Institute of Mental Health
| | - Huiling Wang
- Professor, Department of Radiology, Renmin Hospital of Wuhan University, China
| | - Hongxing Zhang
- Henan Key Lab of Biological Psychiatry, Xinxiang Medical University, China.,Professor, Department of Psychiatry, Henan Mental Hospital, The Second Affiliated Hospital of Xinxiang Medical University
| | - Huawang Wu
- Attending Doctor, Guangzhou Brain Hospital, The Affiliated Brain Hospital of Guangzhou Medical University, China
| | - Yuping Ning
- Professor, Guangzhou Brain Hospital, The Affiliated Brain Hospital of Guangzhou Medical University, China
| | - Dai Zhang
- Key Laboratory of Mental Health, Ministry of Health (Peking University), China.,Professor, Peking University Sixth Hospital, Institute of Mental Health
| | - Tianzi Jiang
- School of Artificial Intelligence, University of Chinese Academy of Sciences, China.,Professor, Brainnetome Center and National Laboratory of Pattern Recognition, Institute of Automation, Chinese Academy of Sciences
| | - Bing Liu
- School of Artificial Intelligence, University of Chinese Academy of Sciences, China.,Professor, Brainnetome Center and National Laboratory of Pattern Recognition, Institute of Automation, Chinese Academy of Sciences
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Tóth E, Faragó P, Király A, Szabó N, Veréb D, Kocsis K, Kincses B, Sandi D, Bencsik K, Vécsei L, Kincses ZT. The Contribution of Various MRI Parameters to Clinical and Cognitive Disability in Multiple Sclerosis. Front Neurol 2019; 9:1172. [PMID: 30728801 PMCID: PMC6351478 DOI: 10.3389/fneur.2018.01172] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 12/18/2018] [Indexed: 11/13/2022] Open
Abstract
Next to the disseminated clinical symptoms, cognitive dysfunctions are common features of multiple sclerosis (MS). Over the recent years several different MRI measures became available representing the various features of the pathology, but the contribution to various clinical and cognitive functions is not yet fully understood. In this multiparametric MRI study we set out to identify the set of parameters that best predict the clinical and cognitive disability in MS. High resolution T1 weighted structural and high angular resolution diffusion MRI images were measured in 53 patients with relapsing remitting MS and 53 healthy controls. Clinical disability was inflicted by EDSS and cognitive functions were evaluated with the BICAMS tests. The contribution of lesion load, partial brain, white matter, gray matter and subcortical volumes as well as the diffusion parameters in the area of the lesions and the normal appearing white matter were examined by model free, partial least square (PLS) approach. Significance of the predictors was tested with Variable Importance in the Projection (VIP) score and 1 was used for threshold of significance. The PLS analysis indicated that the axial diffusivity of the NAWM contributed the most to the clinical disability (VIP score: 1.979). For the visuo-spatial working memory the most critical contributor was the size of the bilateral hippocampi (VIP scores: 1.183 and 1.2 left and right respectively). For the verbal memory the best predictors were the size of the right hippocampus (VIP score: 1.972), lesion load (VIP score: 1.274) and the partial brain volume (VIP score: 1.119). In case of the information processing speed the most significant contribution was from the diffusion parameters (fractional anisotropy, mean and radial diffusivity, VIP scores: 1.615, 1.321 respectively) of the normal appearing white matter. Our results indicate that various MRI measurable factors of MS pathology contribute differently to clinical and cognitive disability. These results point out the importance of the volumetry of the subcortical structures and the diffusion measures of the white matter in understanding the disability progression.
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Affiliation(s)
- Eszter Tóth
- Department of Neurology, Albert Szent-Györgyi Clinical Centre, University of Szeged, Szeged, Hungary
| | - Péter Faragó
- Department of Neurology, Albert Szent-Györgyi Clinical Centre, University of Szeged, Szeged, Hungary
| | - András Király
- Department of Neurology, Albert Szent-Györgyi Clinical Centre, University of Szeged, Szeged, Hungary
| | - Nikoletta Szabó
- Department of Neurology, Albert Szent-Györgyi Clinical Centre, University of Szeged, Szeged, Hungary
| | - Dániel Veréb
- Department of Neurology, Albert Szent-Györgyi Clinical Centre, University of Szeged, Szeged, Hungary
| | - Krisztián Kocsis
- Department of Neurology, Albert Szent-Györgyi Clinical Centre, University of Szeged, Szeged, Hungary
| | - Bálint Kincses
- Department of Neurology, Albert Szent-Györgyi Clinical Centre, University of Szeged, Szeged, Hungary
| | - Dániel Sandi
- Department of Neurology, Albert Szent-Györgyi Clinical Centre, University of Szeged, Szeged, Hungary
| | - Krisztina Bencsik
- Department of Neurology, Albert Szent-Györgyi Clinical Centre, University of Szeged, Szeged, Hungary
| | - László Vécsei
- Department of Neurology, Albert Szent-Györgyi Clinical Centre, University of Szeged, Szeged, Hungary.,MTA-SZTE Neuroscience Research Group, University of Szeged, Szeged, Hungary
| | - Zsigmond Tamás Kincses
- Department of Neurology, Albert Szent-Györgyi Clinical Centre, University of Szeged, Szeged, Hungary.,Department of Radiology, Albert Szent-Györgyi Clinical Centre, University of Szeged, Szeged, Hungary
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24
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Matias-Guiu JA, Cortés-Martínez A, Montero P, Pytel V, Moreno-Ramos T, Jorquera M, Yus M, Arrazola J, Matías-Guiu J. Structural MRI correlates of PASAT performance in multiple sclerosis. BMC Neurol 2018; 18:214. [PMID: 30572821 PMCID: PMC6300910 DOI: 10.1186/s12883-018-1223-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 12/10/2018] [Indexed: 12/05/2022] Open
Abstract
Background The Paced Auditory Serial Addition Test (PASAT) is a useful cognitive test in patients with multiple sclerosis (MS), assessing sustained attention and information processing speed. However, the neural underpinnings of performance in the test are controversial. We aimed to study the neural basis of PASAT performance by using structural magnetic resonance imaging (MRI) in a series of 242 patients with MS. Methods PASAT (3-s) was administered together with a comprehensive neuropsychological battery. Global brain volumes and total T2-weighted lesion volumes were estimated. Voxel-based morphometry and lesion symptom mapping analyses were performed. Results Mean PASAT score was 42.98 ± 10.44; results indicated impairment in 75 cases (31.0%). PASAT score was correlated with several clusters involving the following regions: bilateral precuneus and posterior cingulate, bilateral caudate and putamen, and bilateral cerebellum. Voxel-based lesion symptom mapping showed no significant clusters. Region of interest–based analysis restricted to white matter regions revealed a correlation with the left cingulum, corpus callosum, bilateral corticospinal tracts, and right arcuate fasciculus. Correlations between PASAT scores and global volumes were weak. Conclusion PASAT score was associated with regional volumes of the posterior cingulate/precuneus and several subcortical structures, specifically the caudate, putamen, and cerebellum. This emphasises the role of both cortical and subcortical structures in cognitive functioning and information processing speed in patients with MS. Electronic supplementary material The online version of this article (10.1186/s12883-018-1223-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jordi A Matias-Guiu
- Department of Neurology, San Carlos Health Research Institute (IdISSC), Universidad Complutense de Madrid, C/ Profesor Martín Lagos s/n, 28040, Madrid, Spain.
| | - Ana Cortés-Martínez
- Department of Neurology, San Carlos Health Research Institute (IdISSC), Universidad Complutense de Madrid, C/ Profesor Martín Lagos s/n, 28040, Madrid, Spain
| | - Paloma Montero
- Department of Neurology, San Carlos Health Research Institute (IdISSC), Universidad Complutense de Madrid, C/ Profesor Martín Lagos s/n, 28040, Madrid, Spain
| | - Vanesa Pytel
- Department of Neurology, San Carlos Health Research Institute (IdISSC), Universidad Complutense de Madrid, C/ Profesor Martín Lagos s/n, 28040, Madrid, Spain
| | - Teresa Moreno-Ramos
- Department of Neurology, San Carlos Health Research Institute (IdISSC), Universidad Complutense de Madrid, C/ Profesor Martín Lagos s/n, 28040, Madrid, Spain
| | - Manuela Jorquera
- Department of Radiology, IdISSC, Universidad Complutense de Madrid, Madrid, Spain
| | - Miguel Yus
- Department of Radiology, IdISSC, Universidad Complutense de Madrid, Madrid, Spain
| | - Juan Arrazola
- Department of Radiology, IdISSC, Universidad Complutense de Madrid, Madrid, Spain
| | - Jorge Matías-Guiu
- Department of Neurology, San Carlos Health Research Institute (IdISSC), Universidad Complutense de Madrid, C/ Profesor Martín Lagos s/n, 28040, Madrid, Spain
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25
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Wecht JM, Weir JP, Katzelnick CG, Wylie G, Eraifej M, Nguyen N, Dyson-Hudson T, Bauman WA, Chiaravalloti N. Systemic and Cerebral Hemodynamic Contribution to Cognitive Performance in Spinal Cord Injury. J Neurotrauma 2018; 35:2957-2964. [DOI: 10.1089/neu.2018.5760] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Jill M. Wecht
- VA RR&D National Center for the Medical Consequences of SCI, James J. Peters VAMC, Bronx, New York
- Department of Medicine, The Icahn School of Medicine, Mount Sinai, New York, New York
- Rehabilitation Medicine, The Icahn School of Medicine, Mount Sinai, New York, New York
| | - Joseph P. Weir
- Department of Health, Sport, and Exercise Sciences, University of Kansas, Lawrence, Kansas
| | - Caitlyn G. Katzelnick
- VA RR&D National Center for the Medical Consequences of SCI, James J. Peters VAMC, Bronx, New York
- Kessler Foundation, West Orange, New Jersey
| | - Glenn Wylie
- Kessler Foundation, West Orange, New Jersey
- Department of Physical Medicine and Rehabilitation, Rutgers Medical School, Newark, New Jersey
- VA War Related Illness and Injury Study Center, East Orange, New Jersey
| | - Mastanna Eraifej
- VA RR&D National Center for the Medical Consequences of SCI, James J. Peters VAMC, Bronx, New York
| | - Nhuquynh Nguyen
- VA RR&D National Center for the Medical Consequences of SCI, James J. Peters VAMC, Bronx, New York
| | - Trevor Dyson-Hudson
- Kessler Foundation, West Orange, New Jersey
- Department of Physical Medicine and Rehabilitation, Rutgers Medical School, Newark, New Jersey
| | - William A. Bauman
- VA RR&D National Center for the Medical Consequences of SCI, James J. Peters VAMC, Bronx, New York
- Department of Medicine, The Icahn School of Medicine, Mount Sinai, New York, New York
- Rehabilitation Medicine, The Icahn School of Medicine, Mount Sinai, New York, New York
| | - Nancy Chiaravalloti
- Kessler Foundation, West Orange, New Jersey
- Department of Physical Medicine and Rehabilitation, Rutgers Medical School, Newark, New Jersey
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26
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Jurick SM, Hoffman SN, Sorg S, Keller AV, Evangelista ND, DeFord NE, Sanderson-Cimino M, Bangen KJ, Delano-Wood L, Deoni S, Jak AJ. Pilot investigation of a novel white matter imaging technique in Veterans with and without history of mild traumatic brain injury. Brain Inj 2018; 32:1256-1265. [DOI: 10.1080/02699052.2018.1493225] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Sarah M. Jurick
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | | | - Scott Sorg
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Amber V. Keller
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA
| | | | - Nicole E. DeFord
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA
| | - Mark Sanderson-Cimino
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - Katherine J. Bangen
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Lisa Delano-Wood
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Sean Deoni
- Department of Pediatrics, Brown University, Providence, RI, USA
| | - Amy J. Jak
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
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