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Dimitriou N, Bakirtzis C, Nteli E, Nousia A, Siokas V, Malefaki S, Messinis L, El-Wahsh S, Virvidaki IE, Grigoriadis P, Dardiotis E, Nasios G. Adaptation and validation of the Greek version of the Speech Pathology-Specific Questionnaire for Persons with Multiple Sclerosis (SMS). INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024; 26:59-67. [PMID: 37539484 DOI: 10.1080/17549507.2023.2180094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
PURPOSE The aim of the present study was to adapt and validate the Speech Pathology-Specific Questionnaire for Persons with Multiple Sclerosis (SMS) into the Greek language. METHOD The study sample consisted of 124 people with multiple sclerosis (PwMS) and 50 healthy controls (HCs). All PwMS underwent cognitive assessment using the Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS). Both PwMS and HCs completed the SMS, the Eating Assessment tool (EAT-10), the Voice Handicap Index (VHI), and the Stroke and Aphasia Quality of Life Scale-39 (SAQOL-39). RESULT Significant difference was found between PwMS and HCs for the EAT-10, SAQOL-39, the total SMS, and the SMS subscales. Discriminant validity analyses revealed a statistically significant difference between PwMS and HCs for the total and subscales SMS. Convergent validity analyses between the total SMS and the SMS subscales, and scores on the BICAMS, EAT-10, SAQOL-39, and VHI in PwMS were significantly correlated, with exception of the SMS Speech/Voice with the Symbol Digit Modalities Test (SDMT) and the Greek Verbal Learning Test-II (GVLT-II). Scores on the EAT-10, SAQOL-39, and VHI in PwMS were also correlated with the total SMS and the SMS subscales in PwMS, HCs, and the total sample. Construct validity analyses revealed that the total SMS and the SMS subscales were significantly correlated with the Expanded Disability Status Scale (EDSS) and years of education, while no associations were found with regards to age, MS subtype (relapsing-remitting MS [RRMS] vs progressive MS [PMS]), disease duration, or sex. The internal consistency of all items was excellent in PwMS and the total sample (Cronbach's alpha was >0.7 after deletion of one item), with the exception of two items, which still fell within the acceptable range (>0.6) for PwMS and the total sample. CONCLUSION The Greek version of the SMS is a reliable and valid patient-reported outcome measure to assess speech-language and swallowing pathology related symptoms in PwMS, and can be used for research and clinical purposes.
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Affiliation(s)
- Nefeli Dimitriou
- Department of Speech and Language Therapy, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Christos Bakirtzis
- B' Department of Neurology, Multiple Sclerosis Center, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Elli Nteli
- B' Department of Neurology, Multiple Sclerosis Center, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Anastasia Nousia
- Department of Speech and Language Therapy, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Vasileios Siokas
- Department of Neurology, University Hospital of Larissa, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Sonia Malefaki
- Department of Mechanical Engineering and Aeronautics, University of Patras, Patras, Greece
| | - Lambros Messinis
- Lab of Cognitive Neuroscience, School of Psychology, Aristotle University of Thessaloniki, Greece
| | - Sarah El-Wahsh
- Communication Sciences and Disorders, School of Health Sciences, The University of Sydney, Australia, and
| | - Ioanna-Eleni Virvidaki
- Department of Speech and Language Therapy, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | | | - Efthimios Dardiotis
- Department of Neurology, University Hospital of Larissa, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Grigorios Nasios
- Department of Speech and Language Therapy, School of Health Sciences, University of Ioannina, Ioannina, Greece
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Pogoda-Wesołowska A, Dziedzic A, Maciak K, Stȩpień A, Dziaduch M, Saluk J. Neurodegeneration and its potential markers in the diagnosing of secondary progressive multiple sclerosis. A review. Front Mol Neurosci 2023; 16:1210091. [PMID: 37781097 PMCID: PMC10535108 DOI: 10.3389/fnmol.2023.1210091] [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: 04/24/2023] [Accepted: 08/25/2023] [Indexed: 10/03/2023] Open
Abstract
Approximately 70% of relapsing-remitting multiple sclerosis (RRMS) patients will develop secondary progressive multiple sclerosis (SPMS) within 10-15 years. This progression is characterized by a gradual decline in neurological functionality and increasing limitations of daily activities. Growing evidence suggests that both inflammation and neurodegeneration are associated with various pathological processes throughout the development of MS; therefore, to delay disease progression, it is critical to initiate disease-modifying therapy as soon as it is diagnosed. Currently, a diagnosis of SPMS requires a retrospective assessment of physical disability exacerbation, usually over the previous 6-12 months, which results in a delay of up to 3 years. Hence, there is a need to identify reliable and objective biomarkers for predicting and defining SPMS conversion. This review presents current knowledge of such biomarkers in the context of neurodegeneration associated with MS, and SPMS conversion.
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Affiliation(s)
| | - Angela Dziedzic
- Department of General Biochemistry, Faculty of Biology and Environmental Protection, University of Lodz, Lodz, Poland
| | - Karina Maciak
- Department of General Biochemistry, Faculty of Biology and Environmental Protection, University of Lodz, Lodz, Poland
| | - Adam Stȩpień
- Clinic of Neurology, Military Institute of Medicine–National Research Institute, Warsaw, Poland
| | - Marta Dziaduch
- Medical Radiology Department of Military Institute of Medicine – National Research Institute, Warsaw, Poland
| | - Joanna Saluk
- Department of General Biochemistry, Faculty of Biology and Environmental Protection, University of Lodz, Lodz, Poland
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Plotas P, Nanousi V, Kantanis A, Tsiamaki E, Papadopoulos A, Tsapara A, Glyka A, Mani E, Roumelioti F, Strataki G, Fragkou G, Mavreli K, Ziouli N, Trimmis N. Speech deficits in multiple sclerosis: a narrative review of the existing literature. Eur J Med Res 2023; 28:252. [PMID: 37488623 PMCID: PMC10364432 DOI: 10.1186/s40001-023-01230-3] [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: 06/02/2023] [Accepted: 07/15/2023] [Indexed: 07/26/2023] Open
Abstract
Multiple sclerosis (MS) is a chronic inflammatory and demyelinating autoimmune disease. MS patients deal with motor and sensory impairments, visual disabilities, cognitive disorders, and speech and language deficits. The study aimed to record, enhance, update, and delve into our present comprehension of speech deficits observed in patients with MS and the methodology (assessment tools) studies followed. The method used was a search of the literature through the databases for May 2015 until June 2022. The reviewed studies offer insight into speech impairments most exhibited by MS patients. Patients with MS face numerous communication changes concerning the phonation system (changes observed concerning speech rate, long pause duration) and lower volume. Moreover, the articulation system was affected by the lack of muscle synchronization and inaccurate pronunciations, mainly of vowels. Finally, there are changes regarding prosody (MS patients exhibited monotonous speech). Findings indicated that MS patients experience communication changes across various domains. Based on the reviewed studies, we concluded that the speech system of MS patients is impaired to some extent, and the patients face many changes that impact their conversational ability and the production of slower and inaccurate speech. These changes can affect MS patients' quality of life.
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Affiliation(s)
- Panagiotis Plotas
- Department of Speech and Language Therapy, School of Health Rehabilitation Sciences, University of Patras, Patras, Greece
- Laboratory of Primary Health Care, School of Health Rehabilitation Sciences, University of Patras, Patras, Greece
| | - Vasiliki Nanousi
- Department of Speech and Language Therapy, School of Health Rehabilitation Sciences, University of Patras, Patras, Greece
| | - Anastasios Kantanis
- Laboratory of Primary Health Care, School of Health Rehabilitation Sciences, University of Patras, Patras, Greece
| | - Eirini Tsiamaki
- Department of Neurology, Medical School, University of Patras, Patras, Greece
| | - Angelos Papadopoulos
- Department of Speech and Language Therapy, School of Health Rehabilitation Sciences, University of Patras, Patras, Greece.
| | - Angeliki Tsapara
- Laboratory of Primary Health Care, School of Health Rehabilitation Sciences, University of Patras, Patras, Greece
| | - Aggeliki Glyka
- Department of Speech and Language Therapy, School of Health Rehabilitation Sciences, University of Patras, Patras, Greece
| | - Efraimia Mani
- Department of Speech and Language Therapy, School of Health Rehabilitation Sciences, University of Patras, Patras, Greece
| | - Fay Roumelioti
- Department of Speech and Language Therapy, School of Health Rehabilitation Sciences, University of Patras, Patras, Greece
| | - Georgia Strataki
- Department of Speech and Language Therapy, School of Health Rehabilitation Sciences, University of Patras, Patras, Greece
| | - Georgia Fragkou
- Department of Speech and Language Therapy, School of Health Rehabilitation Sciences, University of Patras, Patras, Greece
| | - Konstantina Mavreli
- Department of Speech and Language Therapy, School of Health Rehabilitation Sciences, University of Patras, Patras, Greece
| | - Natalia Ziouli
- Department of Speech and Language Therapy, School of Health Rehabilitation Sciences, University of Patras, Patras, Greece
| | - Nikolaos Trimmis
- Department of Speech and Language Therapy, School of Health Rehabilitation Sciences, University of Patras, Patras, Greece.
- Laboratory of Primary Health Care, School of Health Rehabilitation Sciences, University of Patras, Patras, Greece.
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Statsenko Y, Smetanina D, Arora T, Östlundh L, Habuza T, Simiyu GL, Meribout S, Talako T, King FC, Makhnevych I, Gelovani JG, Das KM, Gorkom KNV, Almansoori TM, Al Zahmi F, Szólics M, Ismail F, Ljubisavljevic M. Multimodal diagnostics in multiple sclerosis: predicting disability and conversion from relapsing-remitting to secondary progressive disease course - protocol for systematic review and meta-analysis. BMJ Open 2023; 13:e068608. [PMID: 37451729 PMCID: PMC10351237 DOI: 10.1136/bmjopen-2022-068608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 05/03/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND The number of patients diagnosed with multiple sclerosis (MS) has increased significantly over the last decade. The challenge is to identify the transition from relapsing-remitting to secondary progressive MS. Since available methods to examine patients with MS are limited, both the diagnostics and prognostication of disease progression would benefit from the multimodal approach. The latter combines the evidence obtained from disparate radiologic modalities, neurophysiological evaluation, cognitive assessment and molecular diagnostics. In this systematic review we will analyse the advantages of multimodal studies in predicting the risk of conversion to secondary progressive MS. METHODS AND ANALYSIS We will use peer-reviewed publications available in Web of Science, Medline/PubMed, Scopus, Embase and CINAHL databases. In vivo studies reporting the predictive value of diagnostic methods will be considered. Selected publications will be processed through Covidence software for automatic deduplication and blind screening. Two reviewers will use a predefined template to extract the data from eligible studies. We will analyse the performance metrics (1) for the classification models reflecting the risk of secondary progression: sensitivity, specificity, accuracy, area under the receiver operating characteristic curve, positive and negative predictive values; (2) for the regression models forecasting disability scores: the ratio of mean absolute error to the range of values. Then, we will create ranking charts representing performance of the algorithms for calculating disability level and MS progression. Finally, we will compare the predictive power of radiological and radiomical correlates of clinical disability and cognitive impairment in patients with MS. ETHICS AND DISSEMINATION The study does not require ethical approval because we will analyse publicly available literature. The project results will be published in a peer-review journal and presented at scientific conferences. PROSPERO REGISTRATION NUMBER CRD42022354179.
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Affiliation(s)
- Yauhen Statsenko
- Radiology Department, United Arab Emirates University, College of Medicine and Health Sciences, Al Ain, Abu Dhabi Emirate, UAE
- Medical Imaging Platform, ASPIRE Precision Medicine Research Institute Abu Dhabi, Al Ain, Abu Dhabi Emirate, UAE
- Big Data Analytics Center, United Arab Emirates University, Al Ain, Abu Dhabi Emirate, UAE
| | - Darya Smetanina
- Radiology Department, United Arab Emirates University, College of Medicine and Health Sciences, Al Ain, Abu Dhabi Emirate, UAE
- Medical Imaging Platform, ASPIRE Precision Medicine Research Institute Abu Dhabi, Al Ain, Abu Dhabi Emirate, UAE
| | - Teresa Arora
- Psychology Department, College of Natural and Health Sciences, Zayed University, Abu Dhabi, Abu Dhabi Emirate, UAE
| | - Linda Östlundh
- National Medical Library, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, Abu Dhabi Emirate, UAE
- Library, Örebro University, Örebro, Sweden
| | - Tetiana Habuza
- Big Data Analytics Center, United Arab Emirates University, Al Ain, Abu Dhabi Emirate, UAE
- Department of Computer Science, College of Information Technology, United Arab Emirates University, Al Ain, Abu Dhabi Emirate, UAE
| | - Gillian Lylian Simiyu
- Radiology Department, United Arab Emirates University, College of Medicine and Health Sciences, Al Ain, Abu Dhabi Emirate, UAE
- Medical Imaging Platform, ASPIRE Precision Medicine Research Institute Abu Dhabi, Al Ain, Abu Dhabi Emirate, UAE
| | - Sarah Meribout
- Radiology Department, United Arab Emirates University, College of Medicine and Health Sciences, Al Ain, Abu Dhabi Emirate, UAE
- Medical Imaging Platform, ASPIRE Precision Medicine Research Institute Abu Dhabi, Al Ain, Abu Dhabi Emirate, UAE
- Internal Medicine Department, Maimonides Medical Center, New York, New York, USA
| | - Tatsiana Talako
- Radiology Department, United Arab Emirates University, College of Medicine and Health Sciences, Al Ain, Abu Dhabi Emirate, UAE
- Department of Oncohematology, Minsk Scientific and Practical Center for Surgery, Transplantology and Hematology, Minsk, Belarus
| | - Fransina Christina King
- Physiology Department, United Arab Emirates University, College of Medicine and Health Sciences, Al Ain, Abu Dhabi Emirate, UAE
- Neuroscience Platform, ASPIRE Precision Medicine Research Institute Abu Dhabi, Al Ain, Abu Dhabi Emirate, UAE
| | - Iryna Makhnevych
- Radiology Department, United Arab Emirates University, College of Medicine and Health Sciences, Al Ain, Abu Dhabi Emirate, UAE
| | - Juri George Gelovani
- Radiology Department, United Arab Emirates University, College of Medicine and Health Sciences, Al Ain, Abu Dhabi Emirate, UAE
- Biomedical Engineering Department, Wayne State University, College of Engineering, Detroit, Michigan, USA
- Radiology Department, Siriraj Hospital, Faculty of Medicine, Mahidol University, Bangkok, Thailand
- Provost Office, United Arab Emirates University, Al Ain, Abu Dhabi Emirate, UAE
| | - Karuna M Das
- Radiology Department, United Arab Emirates University, College of Medicine and Health Sciences, Al Ain, Abu Dhabi Emirate, UAE
| | - Klaus Neidl-Van Gorkom
- Radiology Department, United Arab Emirates University, College of Medicine and Health Sciences, Al Ain, Abu Dhabi Emirate, UAE
| | - Taleb M Almansoori
- Radiology Department, United Arab Emirates University, College of Medicine and Health Sciences, Al Ain, Abu Dhabi Emirate, UAE
| | - Fatmah Al Zahmi
- Neurology Department, Mediclinic Parkview Hospital, Dubai, Dubai Emirate, UAE
- Neurology Department, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, Dubai Emirate, UAE
| | - Miklós Szólics
- Internal Medicine Department, United Arab Emirates University, College of Medicine and Health Sciences, Al Ain, Abu Dhabi Emirate, UAE
- Division of Neurology, Department of Medicine, Tawam Hospital, Al Ain, Abu Dhabi Emirate, UAE
| | - Fatima Ismail
- Pediatrics Department, United Arab Emirates University, College of Medicine and Health Sciences, Al Ain, Abu Dhabi, UAE
| | - Milos Ljubisavljevic
- Physiology Department, United Arab Emirates University, College of Medicine and Health Sciences, Al Ain, Abu Dhabi Emirate, UAE
- Neuroscience Platform, ASPIRE Precision Medicine Research Institute Abu Dhabi, Al Ain, Abu Dhabi Emirate, UAE
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5
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Šubert M, Novotný M, Tykalová T, Srpová B, Friedová L, Uher T, Horáková D, Rusz J. Lexical and syntactic deficits analyzed via automated natural language processing: the new monitoring tool in multiple sclerosis. Ther Adv Neurol Disord 2023; 16:17562864231180719. [PMID: 37384113 PMCID: PMC10293520 DOI: 10.1177/17562864231180719] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 05/13/2023] [Indexed: 06/30/2023] Open
Abstract
Background Impairment of higher language functions associated with natural spontaneous speech in multiple sclerosis (MS) remains underexplored. Objectives We presented a fully automated method for discriminating MS patients from healthy controls based on lexical and syntactic linguistic features. Methods We enrolled 120 MS individuals with Expanded Disability Status Scale ranging from 1 to 6.5 and 120 age-, sex-, and education-matched healthy controls. Linguistic analysis was performed with fully automated methods based on automatic speech recognition and natural language processing techniques using eight lexical and syntactic features acquired from the spontaneous discourse. Fully automated annotations were compared with human annotations. Results Compared with healthy controls, lexical impairment in MS consisted of an increase in content words (p = 0.037), a decrease in function words (p = 0.007), and overuse of verbs at the expense of noun (p = 0.047), while syntactic impairment manifested as shorter utterance length (p = 0.002), and low number of coordinate clause (p < 0.001). A fully automated language analysis approach enabled discrimination between MS and controls with an area under the curve of 0.70. A significant relationship was detected between shorter utterance length and lower symbol digit modalities test score (r = 0.25, p = 0.008). Strong associations between a majority of automatically and manually computed features were observed (r > 0.88, p < 0.001). Conclusion Automated discourse analysis has the potential to provide an easy-to-implement and low-cost language-based biomarker of cognitive decline in MS for future clinical trials.
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Affiliation(s)
- Martin Šubert
- Department of Circuit Theory, Faculty of Electrical Engineering, Czech Technical University in Prague, Prague, Czech Republic
| | - Michal Novotný
- Department of Circuit Theory, Faculty of Electrical Engineering, Czech Technical University in Prague, Prague, Czech Republic
| | - Tereza Tykalová
- Department of Circuit Theory, Faculty of Electrical Engineering, Czech Technical University in Prague, Prague, Czech Republic
| | - Barbora Srpová
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Lucie Friedová
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Tomáš Uher
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Dana Horáková
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Jan Rusz
- Department of Circuit Theory, Faculty of Electrical Engineering, Czech Technical University in Prague, Technická 2, 160 00 Prague, Czech Republic
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
- Department of Neurology and ARTORG Center for Biomedical Engineering Research, Inselspital (Bern University Hospital), University of Bern, Bern, Switzerland
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Taranu D, Tumani H, Holbrook J, Tumani V, Uttner I, Fissler P. The TRACK-MS Test Battery: A Very Brief Tool to Track Multiple Sclerosis-Related Cognitive Impairment. Biomedicines 2022; 10:biomedicines10112975. [PMID: 36428543 PMCID: PMC9687502 DOI: 10.3390/biomedicines10112975] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 11/12/2022] [Accepted: 11/16/2022] [Indexed: 11/22/2022] Open
Abstract
Tracking cognition in patients with multiple sclerosis (MS) is important for detection of disease progression but it is often not performed in routine settings due to time constraints. This exploratory cohort study aims to develop a very brief repeatable tracking tool with comparable test quality criteria to the current gold standard, the Brief International Cognitive Assessment for MS (BICAMS). The study included 88 participants (22 healthy controls, 66 MS patients) who were examined at baseline and at one-year follow-up. As a validity criterion for the six administered cognitive tests, we assessed the difference between MS patients and HC, and the correlation with MS-related disability. Combining the two tests with the highest validity-the Controlled Oral Word Association Test and Symbol Digit Modalities Test-yielded an administration time of 5 min. Comparing this new TRACK-MS test battery with the 15 min BICAMS indicated that TRACK-MS showed larger differences between MS patients and healthy controls, a higher correlation with MS-related disability, smaller practice effects, and a good test-retest reliability. We provide evidence that TRACK-MS, although faster to administer, showed at least comparable quality criteria as the BICAMS. As the study was exploratory, replication of these results is necessary.
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Affiliation(s)
- Daniela Taranu
- Department of Neurology, Faculty of Medicine, Ulm University, D-89071 Ulm, Germany
- Correspondence: (D.T.); (H.T.)
| | - Hayrettin Tumani
- Department of Neurology, Faculty of Medicine, Ulm University, D-89071 Ulm, Germany
- Correspondence: (D.T.); (H.T.)
| | - Jill Holbrook
- Department of Neurology, Faculty of Medicine, Ulm University, D-89071 Ulm, Germany
| | - Visal Tumani
- Department of Psychiatry, Faculty of Medicine, Ulm University, D-89071 Ulm, Germany
| | - Ingo Uttner
- Department of Neurology, Faculty of Medicine, Ulm University, D-89071 Ulm, Germany
| | - Patrick Fissler
- Department of Neurology, Faculty of Medicine, Ulm University, D-89071 Ulm, Germany
- Psychiatric Services Thurgau, CH-8596 Münsterlingen, Switzerland
- University Hospital for Psychiatry and Psychotherapy, Paracelsus Medical University, A-5020 Salzburg, Austria
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Krajnc N, Bsteh G, Berger T. Clinical and Paraclinical Biomarkers and the Hitches to Assess Conversion to Secondary Progressive Multiple Sclerosis: A Systematic Review. Front Neurol 2021; 12:666868. [PMID: 34512500 PMCID: PMC8427301 DOI: 10.3389/fneur.2021.666868] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 07/06/2021] [Indexed: 12/11/2022] Open
Abstract
Conversion to secondary progressive (SP) course is the decisive factor for long-term prognosis in relapsing multiple sclerosis (MS), generally considered the clinical equivalent of progressive MS-associated neuroaxonal degeneration. Evidence is accumulating that both inflammation and neurodegeneration are present along a continuum of pathologic processes in all phases of MS. While inflammation is the prominent feature in early stages, its quality changes and relative importance to disease course decreases while neurodegenerative processes prevail with ongoing disease. Consequently, anti-inflammatory disease-modifying therapies successfully used in relapsing MS are ineffective in SPMS, whereas specific treatment for the latter is increasingly a focus of MS research. Therefore, the prevention, but also the (anticipatory) diagnosis of SPMS, is of crucial importance. The problem is that currently SPMS diagnosis is exclusively based on retrospectively assessing the increase of overt physical disability usually over the past 6–12 months. This inevitably results in a delay of diagnosis of up to 3 years resulting in periods of uncertainty and, thus, making early therapy adaptation to prevent SPMS conversion impossible. Hence, there is an urgent need for reliable and objective biomarkers to prospectively predict and define SPMS conversion. Here, we review current evidence on clinical parameters, magnetic resonance imaging and optical coherence tomography measures, and serum and cerebrospinal fluid biomarkers in the context of MS-associated neurodegeneration and SPMS conversion. Ultimately, we discuss the necessity of multimodal approaches in order to approach objective definition and prediction of conversion to SPMS.
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Affiliation(s)
- Nik Krajnc
- Department of Neurology, Medical University of Vienna, Vienna, Austria.,Department of Neurology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Gabriel Bsteh
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Thomas Berger
- Department of Neurology, Medical University of Vienna, Vienna, Austria
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8
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Trufanov A, Bisaga G, Skulyabin D, Temniy A, Poplyak M, Chakchir O, Efimtsev A, Dmitriy T, Odinak M, Litvinenko I. Thalamic nuclei degeneration in multiple sclerosis. J Clin Neurosci 2021; 89:375-380. [PMID: 34090763 DOI: 10.1016/j.jocn.2021.05.043] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 10/05/2020] [Accepted: 05/23/2021] [Indexed: 12/21/2022]
Abstract
OBJECTIVES To define both the severity and extent of structural alteration in certain thalamic nuclei by means of MR morphometry and to compare these findings with clinical performance in different phenotypes of multiple sclerosis (MS). METHODS We comparatively measured the thalamus nuclei volumes of patients with remitting-relapsing (RRMS) and secondary-progressive (SPMS) phenotypes of multiple sclerosis and healthy control subjects (HC). The evaluation of neurological performance was based on the results of Expanded Disability Status Scale and Multiple Sclerosis Severity Scale. Cognitive and mental state was rated according to the results of Mini-Mental State Examination, Frontal Assessment Battery, Montreal Cognitive Assessment and Symbol Digit Modalities Test. Freesurfer 6.0 was used for thalamic nuclei volumes calculation. RESULTS The median volume decline in thalamic pulvinar nuclei in RRMS group on the left side (anterior nucleus - 186,6 mm3, posterior nucleus - 149,4 mm3, medial nucleus 852,4 mm3) compared to HC (anterior nucleus - 229,2 mm3, posterior nucleus - 187,5 mm3, medical nucleus - 1081,3 mm3). Same group, right side - anterior nucleus - 219,5 mm3, posterior nucleus 187,1 mm3, medial nucleus - 989,6 mm3; HC group - anterior nucleus 261,1 mm3, posterior nucleus 240,5 mm3, medial nucleus - 1196,7 mm3 (p < 0,05). The highest correlation of the written section of SDMT was observed with the left ventral anterior nucleus (r = 0,71). CONCLUSION These findings indicate the credible correlation between clinical progression of neurological and cognitive impairment in MS patients with asymmetry left-sided thalamic nuclei atrophy and may be considered a potential predicting tool of MS progression.
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Affiliation(s)
- Artem Trufanov
- Department of Nanobiotechnology, Autonomous Non-profit Higher Education Organization (University associated with the Interparliamentary Assembly of the Eurasian Economic Community), 14/1, letter B, Smolyachkova Street, 194044 Saint-Petersburg, Russia; Department of Neurology, Kirov Military Medical Academy, 6, Lebedeva Street, 194044 Saint-Petersburg, Russia.
| | - Gennady Bisaga
- Department of Neurology, Almazov National Medical Research Centre, 2, Akkuratova Street, 197341 Saint-Petersburg, Russia
| | - Dmitry Skulyabin
- Department of Neurology, Kirov Military Medical Academy, 6, Lebedeva Street, 194044 Saint-Petersburg, Russia
| | - Alexandr Temniy
- Department of Neurology, Kirov Military Medical Academy, 6, Lebedeva Street, 194044 Saint-Petersburg, Russia
| | - Mariya Poplyak
- Department of Neurology, Kirov Military Medical Academy, 6, Lebedeva Street, 194044 Saint-Petersburg, Russia
| | - Oleg Chakchir
- Department of Nanobiotechnology, Autonomous Non-profit Higher Education Organization (University associated with the Interparliamentary Assembly of the Eurasian Economic Community), 14/1, letter B, Smolyachkova Street, 194044 Saint-Petersburg, Russia
| | - Aleksandr Efimtsev
- Department of Radiology, Almazov National Medical Research Centre, 2, Akkuratova Street, 197341 Saint-Petersburg, Russia
| | - Tarumov Dmitriy
- Department of Psychiatry, Kirov Military Medical Academy, 6, Lebedeva Street, 194044 Saint-Petersburg, Russia
| | - Miroslav Odinak
- Department of Neurology, Kirov Military Medical Academy, 6, Lebedeva Street, 194044 Saint-Petersburg, Russia
| | - Igor Litvinenko
- Department of Neurology, Kirov Military Medical Academy, 6, Lebedeva Street, 194044 Saint-Petersburg, Russia
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Lebkuecher AL, Chiaravalloti ND, Strober LB. The role of language ability in verbal fluency of individuals with multiple sclerosis. Mult Scler Relat Disord 2021; 50:102846. [PMID: 33626431 DOI: 10.1016/j.msard.2021.102846] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 01/15/2021] [Accepted: 02/13/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND While cognitive deficits in memory and processing speed have been well-documented in individuals with multiple sclerosis (MS), language is largely considered to be intact. Verbal fluency deficits observed in MS are often attributed to impaired processing speed and executive functions rather than language ability. The current study evaluates the contribution of various cognitive factors to verbal fluency including language ability, oral-motor speed, processing speed, and executive functions. METHODS We analyzed pre-existing data from seventy-four (74) individuals with MS who completed a battery of neuropsychological tests designed to assess individual ability for various cognitive factors. We conducted linear multiple regression analyses with letter and category verbal fluency as outcome variables and performance on other cognitive domains (e.g., processing speed, executive functioning) as predictors. RESULTS Both vocabulary and processing speed predicted letter fluency while only vocabulary predicted category fluency. These findings suggest that the observed verbal fluency deficits in MS may reflect both impaired language ability and processing speed. CONCLUSION We propose that further research on language ability in MS is needed to determine if comprehensive neuropsychological test batteries for persons with MS should include tests of language ability to fully understand the cognitive profile of any given patient. Given the importance of language ability, it may be necessary to conduct a more thorough assessment of language in individuals with MS who experience a deficit in this domain.
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Affiliation(s)
- Amy L Lebkuecher
- Department of Psychology, The Pennsylvania State University, 140 Moore Building, University Park, PA 16802, United States.
| | - Nancy D Chiaravalloti
- Cognitive Functioning and Cognitive Rehabilitation Laboratory, Kessler Foundation, 120 Eagle Rock Avenue, East Hanover, NJ 07936, United States; Department of Physical Medicine & Rehabilitation, Rutgers New Jersey Medical School, Medical Science Building, 185 South Orange Avenue, Newark, NJ 07103, United States
| | - Lauren B Strober
- Department of Physical Medicine & Rehabilitation, Rutgers New Jersey Medical School, Medical Science Building, 185 South Orange Avenue, Newark, NJ 07103, United States; Center for Neuropsychology and Neuroscience Research, Kessler Foundation, 120 Eagle Rock Avenue, East Hanover, NJ 07936, United States
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10
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Amin M, Ontaneda D. Thalamic Injury and Cognition in Multiple Sclerosis. Front Neurol 2021; 11:623914. [PMID: 33613423 PMCID: PMC7892763 DOI: 10.3389/fneur.2020.623914] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 12/30/2020] [Indexed: 11/13/2022] Open
Abstract
Multiple sclerosis (MS) produces demyelination and degeneration in both gray and white matter. Both cortical and deep gray matter injury is observed during the course of MS. Among deep gray matter structures, the thalamus has received special attention, as it undergoes volume loss in different MS subtypes and is involved in the earliest form of the disease, radiologically isolated syndrome. The thalamus plays an important role as an information relay center, and involvement of the thalamus in MS has been associated with a variety of clinical manifestations in MS, including fatigue, movement disorders, pain, and cognitive impairment (CI). Similar to thalamic volume loss, CI is seen from the earliest stages of MS and is potentially one of the most debilitating manifestations of the disease. The thalamus, particularly the dorsomedial nucleus as part of the basolateral limbic circuit and anterior thalamic nuclei through connections with the prefrontal cortex, has been shown to be involved in CI. Specifically, several cognitive performance measures such as processing speed and memory correlate with thalamic volume. Thalamic atrophy is one of the most important predictors of CI in MS, and both thalamic volume, diffusion tensor imaging measures, and functional activation correlate with the degree of CI in MS. Although the exact mechanism of thalamic atrophy is not well-understood, it is hypothesized to be secondary to degeneration following white matter injury resulting in secondary neurodegeneration and neuronal loss. The thalamus may represent an ideal biomarker for studies aiming to test neuroprotective or restorative therapies aimed at cognition.
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Affiliation(s)
- Moein Amin
- Neurological Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Daniel Ontaneda
- Mellen Center for Multiple Sclerosis Treatment and Research, Neurological Institute, Cleveland Clinic, Cleveland, OH, United States
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11
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Messinis L, Bakirtzis C, Kosmidis MH, Economou A, Nasios G, Anyfantis E, Konitsiotis S, Ntoskou A, Peristeri E, Dardiotis E, Grigoriadis N, Gourzis P, Papathanasopoulos P. Symbol Digit Modalities Test: Greek Normative Data for the Oral and Written Version and Discriminative Validity in Patients with Multiple Sclerosis. Arch Clin Neuropsychol 2021; 36:117-125. [PMID: 32385488 DOI: 10.1093/arclin/acaa028] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Revised: 02/18/2020] [Accepted: 04/02/2020] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVES The purpose of this study was to generate normative data on the Symbol Digits Modalities Test (SDMT) for the written and oral versions in the Greek adult population. We also investigated the test's validity in discriminating the performance of healthy adults from two groups of adults diagnosed with relapsing remitting (RRMS) and secondary progressive (SPMS) multiple sclerosis. METHOD The sample consisted of 609 healthy men and women between the ages of 18 and 65. All participants were monolingual native Greek adult speakers. Each healthy participant was administered either the written (n = 460) or oral (n = 149) versions of the SDMT. Discriminant validity was examined by comparing 35 healthy participants who had completed the oral version of the SDMT to 35 age - and education-matched RRMS and SPMS patients. RESULTS Linear regression models explained between 36% and 55% of the variance in the SDMT oral and written version scores. Age was the strongest predictor of difference in SDMT written and oral version performance, followed by education that also accounted for a further proportion of the SDMT variance. On the contrary, gender was found not to contribute significantly to the variance in the SDMT for either the written or the oral versions. As a result, age- and education-adjusted norms were generated. Regarding the tests discriminative validity, we found that both MS patient groups scored significantly lower than the healthy group. CONCLUSIONS This is the first study to provide comprehensive normative data for the SDMT in the adult population in Greece, impacting the future practice of neuropsychological assessment in this country.
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Affiliation(s)
- Lambros Messinis
- Neuropsychology Section, Departments of Neurology and Psychiatry, University Hospital of Patras and University of Patras Medical School, Patras, Greece
| | - Christos Bakirtzis
- B'Department of Neurology and the MS Center, AHEPA University Hospital, Central Macedonia, Thessaloniki, Greece
| | - Mary Helen Kosmidis
- Laboratory of Cognitive Neuroscience, School of Psychology, Aristotle University of Thessaloniki, Greece
| | - Alexandra Economou
- Department of Psychology, School of Philosophy, University of Athens, Athens, Greece
| | - Grigorios Nasios
- Department of Speech and Language Therapy, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Emmanouil Anyfantis
- Department of Speech and Language Therapy, School of Health Sciences, University of Ioannina, Ioannina, Greece.,Department of Neurology, University of Ioannina Medical School, Ioannina, Greece
| | - Spiridon Konitsiotis
- Department of Neurology, University of Ioannina Medical School, Ioannina, Greece
| | - Aikaterini Ntoskou
- Rehabilitation Unit for Patients with Spinal Cord Injury, "Demetrios and Vera Sfikas" Department of Medicine, University of Patras Medical School, Patras, Greece
| | - Eleni Peristeri
- Department of Neurology, University of Thessaly Medical School, Larissa, Greece
| | - Efthymios Dardiotis
- Department of Neurology, University of Thessaly Medical School, Larissa, Greece
| | - Nikolaos Grigoriadis
- B'Department of Neurology and the MS Center, AHEPA University Hospital, Central Macedonia, Thessaloniki, Greece
| | - Phillipos Gourzis
- Department of Psychiatry, University of Patras Medical School, Patras, Greece
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12
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Fyndanis V, Messinis L, Nasios G, Dardiotis E, Martzoukou M, Pitopoulou M, Ntoskou A, Malefaki S. Impaired Verb-Related Morphosyntactic Production in Multiple Sclerosis: Evidence From Greek. Front Psychol 2020; 11:2051. [PMID: 32973621 PMCID: PMC7481395 DOI: 10.3389/fpsyg.2020.02051] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 07/24/2020] [Indexed: 01/28/2023] Open
Abstract
Background A recent systematic review found that language deficits are not very common in individuals with multiple sclerosis (MS). However, there are significant gaps in our knowledge about language abilities in MS. For instance, morphosyntactic production has not been explored adequately thus far. This study investigated verb-related morphosyntactic production in MS focusing on Greek, a morphologically rich language. Methods A sentence completion task tapping into the production of subject-verb agreement, time reference/tense, and grammatical aspect was administered to 39 Greek-speaking individuals with MS [25 individuals with relapsing-remitting MS (RRMS group) and 14 individuals with secondary progressive MS (SPMS group)]. The task included only regular verbs. Generalized linear mixed-effects models were used to investigate the ability of individuals with MS to produce the above-mentioned morphosyntactic categories. Results Overall, the RRMS and SPMS groups performed significantly worse than their matched control groups. Moreover, all four groups performed significantly worse on grammatical aspect than on subject-verb agreement and time reference. The difference between subject-verb agreement and time reference was not significant in any of the four groups. The overall performances of the RRMS and SPMS groups did not differ significantly. Conclusion Individuals with MS are impaired in verb-related morphosyntactic production. Moreover, the pattern of performance of individuals with MS is identical to that exhibited by neurologically healthy individuals. Thus, the production performance of individuals with MS on verb inflection differs from that of healthy controls quantitatively but not qualitatively.
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Affiliation(s)
- Valantis Fyndanis
- Center for Multilingualism in Society Across the Lifespan (MultiLing), University of Oslo, Oslo, Norway.,Department of Rehabilitation Sciences, Cyprus University of Technology, Limassol, Cyprus
| | - Lambros Messinis
- Neuropsychology Section, Departments of Psychiatry and Neurology, University Hospital of Patras and University of Patras Medical School, Patras, Greece
| | - Grigorios Nasios
- Department of Speech and Language Therapy, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Efthimios Dardiotis
- Department of Neurology, University Hospital of Larisa, University of Thessaly, Larisa, Greece
| | - Maria Martzoukou
- Department of Speech and Language Therapy, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Maria Pitopoulou
- Department of Speech and Language Therapy, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Aikaterini Ntoskou
- Rehabilitation Unit for Patients with Spinal Cord Injury, "Demetrios and Vera Sfikas", Department of Medicine, University of Patras, Patras, Greece
| | - Sonia Malefaki
- Department of Mechanical Engineering and Aeronautics, University of Patras, Patras, Greece
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13
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Nasios G, Bakirtzis C, Messinis L. Cognitive Impairment and Brain Reorganization in MS: Underlying Mechanisms and the Role of Neurorehabilitation. Front Neurol 2020; 11:147. [PMID: 32210905 PMCID: PMC7068711 DOI: 10.3389/fneur.2020.00147] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 02/14/2020] [Indexed: 12/29/2022] Open
Abstract
Multiple sclerosis (MS) is a chronic, immune-mediated, inflammatory, and degenerative disease of the central nervous system (CNS) that affects both white and gray matter. Various mechanisms throughout its course, mainly regarding gray matter lesions and brain atrophy, result in cognitive network dysfunction and can cause clinically significant cognitive impairment in roughly half the persons living with MS. Altered cognition is responsible for many negative aspects of patients' lives, independently of physical disability, such as higher unemployment and divorce rates, reduced social activities, and an overall decrease in quality of life. Despite its devastating impact it is not included in clinical ratings and decision making in the way it should be. It is interesting that only half the persons with MS exhibit cognitive dysfunction, as this implies that the other half remain cognitively intact. It appears that a dynamic balance between brain destruction and brain reorganization is taking place. This balance acts in favor of keeping brain systems functioning effectively, but this is not so in all cases, and the effect does not last forever. When these systems collapse, functional brain reorganization is not effective anymore, and clinically apparent impairments are evident. It is therefore important to reveal which factors could make provision for the subpopulation of patients in whom cognitive impairment occurs. Even if we manage to detect this subpopulation earlier, effective pharmaceutical treatments will still be lacking. Nevertheless, recent evidence shows that cognitive rehabilitation and neuromodulation, using non-invasive techniques such as transcranial magnetic or direct current stimulation, could be effective in cognitively impaired patients with MS. In this Mini Review, we discuss the mechanisms underlying cognitive impairment in MS. We also focus on mechanisms of reorganization of cognitive networks, which occur throughout the disease course. Finally, we review theoretical and practical issues of neurorehabilitation and neuromodulation for cognition in MS as well as factors that influence them and prevent them from being widely applied in clinical settings.
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Affiliation(s)
- Grigorios Nasios
- Department of Speech and Language Therapy, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Christos Bakirtzis
- Department of Neurology, The Multiple Sclerosis Center, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Lambros Messinis
- Neuropsychology Section, Departments of Neurology and Psychiatry, University of Patras Medical School, Patras, Greece
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14
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Shamsian F, Dastjerdi RM, Kavosh A, Ashtari F. Naming error in multiple sclerosis patients: A pilot study in Isfahan, Iran. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2020; 24:105. [PMID: 31949456 PMCID: PMC6950351 DOI: 10.4103/jrms.jrms_497_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Revised: 08/21/2018] [Accepted: 08/27/2019] [Indexed: 11/06/2022]
Abstract
Background: Although cognitive impairment is common in multiple sclerosis (MS) patients, language difficulties are controversy and little information is available on nonEnglish languages. Therefore, the present cross-sectional study was conducted to assess the naming accuracy in Persian relapsing-remitting MS (RRMS) patients. Materials and Methods: Thirty RRMS patients were recruited from Kashani Comprehensive MS Center, Isfahan, Iran. Their performance on measures of mini mental state examination (MMSE), Expanded Disability Status Scale, and Naming Test was compared with control participants. Results: MS patients were found to have much more naming errors than the control group (2.1 ± 1.8 vs. 0.54 ± 1.1 P = 0.02). Average MMSE score of MS patients was 27.23 (range = 18–30, standard deviation [SD] = 2) versus 28.96 (range = 19–30, SD = 3.2) in controls. Conclusion: The present study suggests that naming ability can be impaired in RRMS regardless of disability score. Specific language function tests including naming should be considered in the process of evaluating and rehabilitating patients with MS.
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Affiliation(s)
- Fereshteh Shamsian
- Department of Speech Therapy, School of Rehabilitation Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Arian Kavosh
- School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fereshteh Ashtari
- Department of Neurology, Isfahan University of Medical Sciences, Isfahan, Iran
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15
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Yu Z, Qin J, Xiong X, Xu F, Wang J, Hou F, Yang A. Abnormal topology of brain functional networks in unipolar depression and bipolar disorder using optimal graph thresholding. Prog Neuropsychopharmacol Biol Psychiatry 2020; 96:109758. [PMID: 31493423 DOI: 10.1016/j.pnpbp.2019.109758] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 08/09/2019] [Accepted: 09/03/2019] [Indexed: 12/27/2022]
Abstract
Two popular debilitating illness, unipolar depression (UD) and bipolar disorder (BD), have the similar symptoms and tight association on the psychopathological level, leading to a clinical challenge to distinguish them. In order to figure out the underlying common and different mechanism of both mood disorders, resting-state functional magnetic resonance imaging (rs-fMRI) data derived from 36 UD patients, 42 BD patients (specially type I, BD-I) and 45 healthy controls (HC) were analyzed retrospectively in this study. Functional brain networks were firstly constructed on both group and individual levels with a density 0.2, which was determined by a network thresholding approach based on modular similarity. Then we investigated the alterations of modular structure and other topological properties of the functional brain network, including global network characteristics and nodal network measures. The results demonstrated that the functional brain networks of UD and BD-I groups preserved the modularity and small-worldness property. However, compared with HC, reduced number of modules was observed in both patients' groups with shared alterations occurring in hippocampus, para hippocampal gyrus, amygdala and superior parietal gyrus and distinct changes of modular composition mainly in the caudate regions of basal ganglia. Additionally, for the network characteristics, compared to HC, significantly decreased global efficiency and small-worldness were observed in BD-I. For the nodal metrics, significant decrease of local efficiency was found in several regions in both UD and BD-I, while a UD-specified increase of participant coefficient was found in the right paracentral lobule and the right thalamus. These findings may contribute to throw light on the neuropathological mechanisms underlying the two disorders and further help to explore objective biomarkers for the correct diagnosis of UD and BD.
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Affiliation(s)
- Zhinan Yu
- Key Laboratory of Biomedical Functional Materials, School of Science, China Pharmaceutical University, Nanjing 210009, China
| | - Jiaolong Qin
- Key Laboratory of Intelligent Perception and Systems for High-Dimensional Information of Ministry of Education, School of Computer Science and Engineering, Nanjing University of Science and Technology, Nanjing 210094, China
| | - Xinyuan Xiong
- School of Software Institute, Nanjing University, Nanjing 210093, China
| | - Fengguo Xu
- Key Laboratory of Drug Quality Control & Pharmacovigilance, China Pharmaceutical University, Nanjing 210009, China
| | - Jun Wang
- School of Geographic and Biologic Information, Nanjing University of Posts and Telecommunications, Nanjing 210003, China
| | - Fengzhen Hou
- Key Laboratory of Biomedical Functional Materials, School of Science, China Pharmaceutical University, Nanjing 210009, China.
| | - Albert Yang
- Division of Interdisciplinary Medicine and Biotechnology, Department of Medicine, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA, USA
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16
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Messinis L, Kosmidis MH, Nasios G, Konitsiotis S, Ntoskou A, Bakirtzis C, Grigoriadis N, Patrikelis P, Panagiotopoulos E, Gourzis P, Malefaki S, Papathanasopoulos P. Do Secondary Progressive Multiple Sclerosis patients benefit from Computer- based cognitive neurorehabilitation? A randomized sham controlled trial. Mult Scler Relat Disord 2020; 39:101932. [PMID: 31927200 DOI: 10.1016/j.msard.2020.101932] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 12/21/2019] [Accepted: 01/02/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Cognitive impairment is common in multiple sclerosis (MS), but deficits tend to be more pronounced in progressive MS, negatively impacting daily functional capacity. Despite this, most cognitive rehabilitation (CR) interventions to date have focused on relapsing-remitting MS (RRMS). Moreover, information on the efficacy of CR in progressive MS is limited and controversial. The present study investigated the efficacy of a home based, computer assisted cognitive rehabilitation (HBCACR) intervention (RehaComTM software) exclusively in a Secondary Progressive Multiple Sclerosis (SPMS) sample. METHODS This was a randomized, multi site, sham controlled trial. Thirty six (36) individuals with SPMS, naïve to the RehaCom software, with cognitive deficits were randomized to the treatment (IG; n= 19) or control group condition (CG; n=17). Treatment with the RehaCom modules consisted of 24 domain and task specific, 45 minute session's over an 8-week period, three sessions per week, applied by each patient at home. The CG completed non specific computer based activities at home with the same frequency and duration. Primary cognitive outcome measures included the Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS) battery, and secondary outcome measures for depression (BDI-FS), fatigue (MFIS), and quality of life (EuroQol EQ-5D) visual analogue scale (VAS). RESULTS The two groups were well matched on demographic and clinical characteristics, cognitive reserve and severity of cognitive deficits at baseline assessment. At post treatment assessment the IG group showed significant improvements with large effect sizes; in verbal learning [z = -4.759, p <.0005, g = 2.898], visuospatial memory [z = -3.940, p <.0005, g = 1.699] and information processing speed [z= -4.792, p <.0005, g = 2.980], compared with the sham control group. We also found significant between group differences on physical [z=-3.308, p = .001, g= -.604], cognitive [z = -4.011, p <.0005, g = -1.654], psychosocial [z= 3.308, p = .010, g = -.940], and general fatigue impact [z= -2.623, p = .008, g = -.519], depression severity [z = -2.730, p = .006, g = -.519], and quality of life [z= -4.239, p <.0005, g = -1.885] in favor of the treated group. CONCLUSION These data provide the first evidence supporting the efficacy of computer based restorative cognitive rehabilitation applied at home exclusively in SPMS patients, suggesting that adaptive neuroplasticity may occur after functional cognitive training in progressive MS. Improved cognitive functioning in combination with mood augmentation appear to have ameliorated fatigue, which impacted daily functioning activity and culminated in improved health related quality of life.
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Affiliation(s)
- Lambros Messinis
- Neuropsychology Section, Departments of Neurology and Psychiatry, University Hospital of Patras and University of Patras Medical School.
| | - Mary H Kosmidis
- Lab of Cognitive Neuroscience, School of Psychology, Aristotle University of Thessaloniki, Greece
| | - Grigorios Nasios
- Department of Speech and Language Therapy, School of Health Sciences, University of Ioannina
| | | | - Aikaterini Ntoskou
- Rehabilitation Unit for patients with Spinal Cord Injury, "Demetrios and Vera Sfikas" Department of Medicine, University of Patras Medical School
| | - Christos Bakirtzis
- B'Department of Neurology and the MS Center, AHEPA University Hospital, Central Macedonia, Thessaloniki, Greece
| | - Nikolaos Grigoriadis
- B'Department of Neurology and the MS Center, AHEPA University Hospital, Central Macedonia, Thessaloniki, Greece
| | - Panayiotis Patrikelis
- First Department of Neurosurgery, Medical School, National and Kapodistrian University of Athens, Greece
| | - Elias Panagiotopoulos
- Rehabilitation Unit for patients with Spinal Cord Injury, "Demetrios and Vera Sfikas" Department of Medicine, University of Patras Medical School
| | | | - Sonia Malefaki
- Department of Mechanical Engineering & Aeronautics, University of Patras (statistics)
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17
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Giedraitiene N, Kaubrys G. Distinctive Pattern of Cognitive Disorders During Multiple Sclerosis Relapse and Recovery Based on Computerized CANTAB Tests. Front Neurol 2019; 10:572. [PMID: 31214108 PMCID: PMC6558046 DOI: 10.3389/fneur.2019.00572] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 05/15/2019] [Indexed: 01/23/2023] Open
Abstract
Background: Cognition may be affected at least as seriously as physical function during multiple sclerosis (MS) relapse, however MS relapse related cognitive disorders are still underdiagnosed and poorly characterized. The limited number of paper-pencil tests were used for assessment, and nevertheless, some significant changes were found. Unlike the paper-pencil tests, computerized batteries and tests are more sensitive and highly standardized, produce instant scoring and can minimize the learning and practice effects on follow-up. We investigated the cognition during MS relapse with the Cambridge Neuropsychological Test Automated Battery (CANTAB), which has shown sensitivity to cognitive dysfunction across different clinical groups, including patients with MS. Objective: The objective of the study was to assess the cognitive functions with CANTAB battery in MS patients during relapse, in stable MS patients, and healthy controls, and to establish the timing and pattern of cognitive recovery after relapse. Methods: Sixty relapsing, thirty stable MS patients, and thirty controls were assessed with CANTAB. The relapse group was assessed during multiple sclerosis relapse and 1 and 3 months after the first assessment. Results: The score of the difficult task of spatial planning was worse in MS relapse group than in MS stable group (p < 0.05). The scores of medium difficulty tasks of spatial planning, episodic visual recall and working memory were worse in the relapse group than in the control group (p < 0.05), while in stable MS and control groups, the scores of these tasks didn't differ. The most significant improvement of speed of response, spatial planning, episodic visual recall memory and spatial working memory, was established at 1 month after the first assessment, additional improvement of spatial planning and working memory was observed at 3 months after the first assessment. Conclusions: The results of this study indicate that cognitive function is affected during MS relapse. The difficult task of CANTAB battery, which assesses the spatial planning, showed MS relapse related cognitive dysfunction. The changes in scores of episodic visual recall and working memory may be related to MS relapse. A significant improvement in the speed of response, spatial planning, episodic visual recall and working memory was established at 1 month after MS relapse. The additional improvement in spatial planning for the most difficult task and working memory was observed at 3 months after MS relapse. It may be possible that the practice effect had the impact on the improvement of cognitive scores that was noted in relapsing MS patients.
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Affiliation(s)
- Natasa Giedraitiene
- Clinic of Neurology and Neurosurgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Gintaras Kaubrys
- Clinic of Neurology and Neurosurgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
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18
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Macías Islas MÁ, Ciampi E. Assessment and Impact of Cognitive Impairment in Multiple Sclerosis: An Overview. Biomedicines 2019; 7:E22. [PMID: 30893874 PMCID: PMC6466345 DOI: 10.3390/biomedicines7010022] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 03/13/2019] [Accepted: 03/14/2019] [Indexed: 12/30/2022] Open
Abstract
Cognitive impairment affects 40⁻60% of patients with multiple sclerosis. It may be present early in the course of the disease and has an impact on a patient's employability, social interactions, and quality of life. In the last three decades, an increasing interest in diagnosis and management of cognitive impairment has arisen. Neuropsychological assessment and neuroimaging studies focusing on cognitive impairment are now being incorporated as primary outcomes in clinical trials. However, there are still key uncertainties concerning the underlying mechanisms of damage, neural basis, sensitivity and validity of neuropsychological tests, and efficacy of pharmacological and non-pharmacological interventions. The present article aimed to present an overview of the assessment, neural correlates, and impact of cognitive impairment in multiple sclerosis.
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Affiliation(s)
| | - Ethel Ciampi
- Neurology, Pontificia Universidad Católica de Chile, Neurology, Hospital Dr. Sótero del Río, Santiago 8320000, Chile.
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