1
|
Cacciaguerra L, Pagani E, Mesaros S, Dackovic J, Dujmovic-Basuroski I, Drulovic J, Valsasina P, Filippi M, Rocca MA. Dynamic volumetric changes of hippocampal subfields in clinically isolated syndrome patients: A 2-year MRI study. Mult Scler 2018; 25:1232-1242. [DOI: 10.1177/1352458518787347] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background:Different subregional patterns of hippocampal involvement have been observed in diverse multiple sclerosis (MS) phenotypes.Objective:To evaluate the occurrence of regional hippocampal variations in clinically isolated syndrome (CIS) patients, their relationships with focal white matter (WM) lesions, and their prognostic implications.Methods:Brain dual-echo and three-dimensional (3D) T1-weighted scans were acquired from 14 healthy controls and 36 CIS patients within 2 months from clinical onset and after 3, 12, and 24 months. Radial distance distribution was assessed using 3D parametric surface mesh models. A cognitive screening was also performed.Results:Patients showed clusters of reduced radial distance in the Cornu Ammonis 1 from month 3, progressively extending to the subiculum, negatively correlated with ipsilateral T2 and T1 lesion volume. Increased radial distance appeared in the right dentate gyrus after 3 ( p < 0.05), 12, and 24 ( p < 0.001) months, and in the left one after 3 and 24 months ( p < 0.001), positively correlated with lesional measures. Hippocampal volume variations were more pronounced in patients converting to MS after 24 months and did not correlate with cognitive performance.Conclusion:Regional hippocampal changes occur in CIS, are more pronounced in patients converting to MS, and are modulated by focal WM lesions.
Collapse
Affiliation(s)
- Laura Cacciaguerra
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy/Department of Neurology, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Elisabetta Pagani
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Sharlota Mesaros
- Clinic of Neurology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Jelena Dackovic
- Clinic of Neurology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | | | - Jelena Drulovic
- Clinic of Neurology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Paola Valsasina
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy/Department of Neurology, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Maria Assunta Rocca
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy/Department of Neurology, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| |
Collapse
|
2
|
Preziosa P, Pagani E, Mesaros S, Riccitelli GC, Dackovic J, Drulovic J, Filippi M, Rocca MA. Progression of regional atrophy in the left hemisphere contributes to clinical and cognitive deterioration in multiple sclerosis: A 5-year study. Hum Brain Mapp 2017; 38:5648-5665. [PMID: 28792103 DOI: 10.1002/hbm.23755] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 06/22/2017] [Accepted: 07/25/2017] [Indexed: 01/18/2023] Open
Abstract
In this longitudinal study, we investigated the regional patterns of focal lesions accumulation, and gray (GM) and white matter (WM) atrophy progression over a five-year follow-up (FU) in multiple sclerosis (MS) patients and their association with clinical and cognitive deterioration. Neurological, neuropsychological and brain MRI (dual-echo and 3D T1-weighted sequences) assessments were prospectively performed at baseline (T0) and after a median FU of 4.9 years from 66 MS patients (including relapse-onset and primary progressive MS) and 16 matched controls. Lesion probability maps were obtained. Longitudinal changes of GM and WM volumes and their association with clinical and cognitive deterioration were assessed using tensor-based morphometry and SPM12. At FU, 36/66 (54.5%) MS patients showed a significant disability worsening, 14/66 (21.2%) evolved to a worse clinical phenotype, and 18/63 (28.6%) developed cognitive deterioration. At T0, compared to controls, MS patients showed a widespread pattern of GM atrophy, involving cortex, deep GM and cerebellum, and atrophy of the majority of WM tracts, which further progressed at FU (P < 0.001, uncorrected). Compared to stable patients, those with clinical and cognitive worsening showed a left-lateralized pattern of GM and WM atrophy, involving deep GM, fronto-temporo-parieto-occipital regions, cerebellum, and several WM tracts (P < 0.001, uncorrected).GM and WM atrophy of relevant brain regions occur in MS after 5 years. A different vulnerability of the two brain hemispheres to irreversible structural damage may be among the factors contributing to clinical and cognitive worsening in these patients. Hum Brain Mapp 38:5648-5665, 2017. © 2017 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
- Paolo Preziosa
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy.,Department of Neurology, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Elisabetta Pagani
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Sarlota Mesaros
- Neurology Clinic, Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Gianna C Riccitelli
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Jelena Dackovic
- Neurology Clinic, Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Jelena Drulovic
- Neurology Clinic, Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Massimo Filippi
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy.,Department of Neurology, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Maria A Rocca
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy.,Department of Neurology, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| |
Collapse
|
3
|
Gagic M, Markovic MK, Kecmanovic M, Keckarevic D, Mladenovic J, Dackovic J, Milic-Rasic V, Romac S. Analysis of PMP22 duplication and deletion using a panel of six dinucleotide tandem repeats. Clin Chem Lab Med 2017; 54:773-80. [PMID: 26479344 DOI: 10.1515/cclm-2015-0602] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 09/10/2015] [Indexed: 11/15/2022]
Abstract
BACKGROUND Charcot-Marie-Tooth type 1A (CMT1A) is the most common type of hereditary motor and sensory neuropathies (HMSN), caused by the duplication of the 17p11.2 region that includes the PMP22 gene. Reciprocal deletion of the same region is the main cause of hereditary neuropathy with liability to pressure palsies (HNPP). CMT1A accounts for approximately 50% of HMSN patients. Diagnostics of CMT1A and HNPP are based on quantitative analysis of the affected region or RFLP detection of breakage points. The aim of this study was to improve the sensitivity and efficiency of CMT1A and HNPP genetic diagnostics by introducing analysis of six STR markers (D17S261-D17S122-D17S839-D17S1358-D17S955-D17S921) spanning the duplicated region. METHODS Forty-six CMT1A and seven HNPP patients, all genetically diagnosed by RFLP analysis, were tested for duplication or deletion using six STR markers. RESULTS In all CMT1A and HNPP patients, microsatellite analysis comprising six STR markers confirmed the existence of a duplication or deletion. In 89% (41/46) CMT1A patients the confirmation was based on detecting three alleles on at least one locus. In the remaining 11% (5) CMT1A patients, duplication was also confirmed based on two peaks with clear dosage difference for at least two different markers. All HNPP patients (7/7) displayed only one allele for each analyzed locus. CONCLUSIONS Microsatellite analysis using six selected STR loci showed a high level of sensitivity and specificity for genetic diagnostics of CMT1A and HNPP. The results here strongly suggest STR marker analysis as a method of choice in PMP22 duplication/deletion testing.
Collapse
|
4
|
Dujmovic I, Radovanovic S, Martinovic V, Dackovic J, Maric G, Mesaros S, Pekmezovic T, Kostic V, Drulovic J. Gait pattern in patients with different multiple sclerosis phenotypes. Mult Scler Relat Disord 2017; 13:13-20. [PMID: 28427694 DOI: 10.1016/j.msard.2017.01.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 12/13/2016] [Accepted: 01/25/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND Gait pattern is frequently impaired in multiple sclerosis (MS), however gait characteristics in patients with different MS phenotypes have not been fully elucidated. METHODS We analyzed spatio-temporal gait pattern characteristics in patients with relapsing-remitting (RR, n=52) and primary-progressive (PP, n=18) MS in comparison with age-matched healthy controls (HC, n=40). All subjects performed a standardized simple walking task, a dual motor- motor task, a dual motor-mental task, and a triple combined motor-mental task at a GAITRite electronic walkway of 5.5m active area. We measured: cycle time (CT), stride length (SL), swing time (ST), double support time (DST), gait velocity (GV) and calculated symmetry index (SI) for CT, SL and ST. RESULTS With each task performed, CT and DST in the total MS group were significantly longer while SL was significantly shorter and GV significantly lower than in HC. ST was similar in the total MS patient group and HC. In both MS patients and HC, CT and DST increased and SL and GV decreased over repeated assessments. Dual and triple tasks while walking influenced walking performance in both MS patients and HC. Although patients with PPMS differed significantly from those with RRMS in the majority of gait parameters, the subgroup analysis in patients matched for age and disability (Expanded Disability Status Scale Score -EDSS, 3.0-5.0) showed similar gait performance in RRMS and PPMS patients having the same level of disability, except for CT and ST- symmetry parameters that were more impaired in the PPMS group. The EDSS score correlated significantly with CT, DST, SL and GV, but no significant correlation was found with ST except at the triple combined motor-mental task. CONCLUSION A disturbed gait pattern in MS patients with different MS phenotypes depends on disability and reflects a cognitive-motor interference.
Collapse
Affiliation(s)
- Irena Dujmovic
- Clinic of Neurology, Clinical Centre of Serbia, Dr Subotica 6, 11129 Belgrade 102, Serbia; University of Belgrade School of Medicine, Department of Neurology, Dr Subotica 6, 11129 Belgrade 102, Serbia.
| | - Sasa Radovanovic
- Institute for Medical Investigations, Dr Subotica 4, 11129 Belgrade 102, Belgrade, Serbia.
| | - Vanja Martinovic
- University of Belgrade School of Medicine, Dr Subotica 8, Belgrade, Serbia.
| | - Jelena Dackovic
- Clinic of Neurology, Clinical Centre of Serbia, Dr Subotica 6, 11129 Belgrade 102, Serbia.
| | - Gorica Maric
- University of Belgrade School of Medicine, Institute of Epidemiology, Visegradska 26A, 11000 Belgrade, Serbia.
| | - Sarlota Mesaros
- Clinic of Neurology, Clinical Centre of Serbia, Dr Subotica 6, 11129 Belgrade 102, Serbia; University of Belgrade School of Medicine, Department of Neurology, Dr Subotica 6, 11129 Belgrade 102, Serbia.
| | - Tatjana Pekmezovic
- University of Belgrade School of Medicine, Institute of Epidemiology, Visegradska 26A, 11000 Belgrade, Serbia.
| | - Vladimir Kostic
- Clinic of Neurology, Clinical Centre of Serbia, Dr Subotica 6, 11129 Belgrade 102, Serbia; University of Belgrade School of Medicine, Department of Neurology, Dr Subotica 6, 11129 Belgrade 102, Serbia.
| | - Jelena Drulovic
- Clinic of Neurology, Clinical Centre of Serbia, Dr Subotica 6, 11129 Belgrade 102, Serbia; University of Belgrade School of Medicine, Department of Neurology, Dr Subotica 6, 11129 Belgrade 102, Serbia.
| |
Collapse
|
5
|
Drulovic J, Cukic M, Grgic S, Dincic E, Raicevic R, Nadj C, Toncev G, Vojinovic S, Mesaros S, Kisic Tepavcevic D, Dujmovic I, Tadic D, Miletic-Drakulic S, Dackovic J, Kostic S, Erakovic J, Sakalas L, Savic D, Suknjaja V, Martinovic V, Maric G, Pekmezovic T. The impact of betaplus program on patient treatment satisfaction with interferon beta-1b in multiple sclerosis: Multicentric cross-sectional survey in the western Balkan countries. Mult Scler Relat Disord 2017; 11:56-61. [DOI: 10.1016/j.msard.2016.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 10/30/2016] [Accepted: 12/07/2016] [Indexed: 11/29/2022]
|
6
|
Dackovic J, Pekmezovic T, Mesaros S, Dujmovic I, Stojsavljevic N, Martinovic V, Drulovic J. The Rao's Brief Repeatable Battery in the study of cognition in different multiple sclerosis phenotypes: application of normative data in a Serbian population. Neurol Sci 2016; 37:1475-81. [PMID: 27207679 DOI: 10.1007/s10072-016-2610-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2015] [Accepted: 05/12/2016] [Indexed: 11/25/2022]
Abstract
Cognitive impairment is prevalent in multiple sclerosis (MS) occurring in 43-72 % of patients with all MS phenotypes. The aim of our study was to assess cognitive performance in different MS subtypes in Serbian population. Rao's Brief Repeatable Battery of neuropsychological tests (BRB-N) was administered to 168 MS patients [37 patients with clinically isolated syndrome (CIS) suggestive of MS, 65 with relapsing-remitting MS (RRMS), 31 with secondary progressive MS (SPMS) and 35 patients with primary progressive MS (PPMS)]. The percentage of cognitively impaired patients in our total MS cohort was 58.9 %. Prevalence of cognitive dysfunction was 40.5 % in CIS group, 36.9 % in RRMS, 96.8 % in SPMS, and 85.7 % in PPMS group. Patients in CIS and RRMS groups performed consistently better all tests of the Rao's battery than patients in SPMS and PPMS cohort. CIS and RRMS groups performed consistently better in all tests of the Rao's battery than SPMS and PPMS cohort. Additionally, difference in the performance of any of the BRB-N tests was not found between CIS and RRMS. However, there was a significant difference between SPMS and PPMS patients in the performance on five tests of Rao's battery. Statistical significance (p < 0.05) in favor of PPMS patients was demonstrated for the following tasks: SRT_lts, SRT_cltr, SDMT, SRT_D, SPART_D. Our study demonstrates that cognitive impairment is frequent in all MS phenotypes. Furthermore, we have found that cognitive deficit is most severe and most frequent in SPMS patients, followed by PPMS subjects and then CIS and RRMS patients.
Collapse
Affiliation(s)
- Jelena Dackovic
- Clinic of Neurology, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Dr Subotica 6, Belgrade, 11000, Serbia.
| | - Tatjana Pekmezovic
- Institute of Epidemiology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Sarlota Mesaros
- Clinic of Neurology, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Dr Subotica 6, Belgrade, 11000, Serbia
| | - Irena Dujmovic
- Clinic of Neurology, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Dr Subotica 6, Belgrade, 11000, Serbia
| | - Nebojsa Stojsavljevic
- Clinic of Neurology, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Dr Subotica 6, Belgrade, 11000, Serbia
| | - Vanja Martinovic
- Clinic of Neurology, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Dr Subotica 6, Belgrade, 11000, Serbia
| | - Jelena Drulovic
- Clinic of Neurology, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Dr Subotica 6, Belgrade, 11000, Serbia
| |
Collapse
|
7
|
Nedeljkovic U, Dackovic J, Tepavcevic DK, Basuroski ID, Mesaros S, Pekmezovic T, Drulovic J. Multidisciplinary rehabilitation and steroids in the management of multiple sclerosis relapses: a randomized controlled trial. Arch Med Sci 2016; 12:380-9. [PMID: 27186184 PMCID: PMC4848347 DOI: 10.5114/aoms.2015.47289] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2014] [Accepted: 09/18/2014] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Periodic relapses are one of the main characteristics of multiple sclerosis (MS), from which recovery is often incomplete despite high-dose methylprednisolone (HDMP) treatment. The aim of our study was to evaluate the potential benefits of short-term HDMP combined with multidisciplinary rehabilitation (MDR) in persons with MS in relapse in order to assess whether combination of steroid therapy with MDR is more beneficial than steroid therapy alone. MATERIAL AND METHODS This investigation was conducted as a randomized controlled trial. The MS patients were eligible if they had an established diagnosis and relapse requiring application of HDMP. Forty-nine patients were included in the study and randomized to control and treatment groups, and 37 completed the study. High-dose methylprednisolone was administered to all patients. The treatment group additionally underwent an MDR program over a 3-week period. All outcome measures were completed at baseline and 1 and 3 months later. RESULTS The Expanded Disability Status Scale (EDSS) and Functional Independence Measure (FIM) motor scores improved statistically significantly 1 month after HDMP, in both treatment and control groups. During the study period, in the treatment group, a sustained large effect size (ES) was found for both physical and mental composite scores of Multiple Sclerosis Quality of Life-54 (MSQoL-54), while in the controls, a sustained moderate ES was demonstrated only for physical composite score. CONCLUSIONS Our findings suggest that MDR improves MS relapse outcome.
Collapse
Affiliation(s)
- Una Nedeljkovic
- Clinic of Physical Medicine and Rehabilitation, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Jelena Dackovic
- Clinic of Neurology, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | | | - Irena Dujmovic Basuroski
- Clinic of Neurology, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Sarlota Mesaros
- Clinic of Neurology, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Tatjana Pekmezovic
- Institute of Epidemiology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Jelena Drulovic
- Clinic of Neurology, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| |
Collapse
|
8
|
Rocca MA, Preziosa P, Mesaros S, Pagani E, Dackovic J, Stosic-Opincal T, Drulovic J, Filippi M. Clinically Isolated Syndrome Suggestive of Multiple Sclerosis: Dynamic Patterns of Gray and White Matter Changes—A 2-year MR Imaging Study. Radiology 2016; 278:841-53. [DOI: 10.1148/radiol.2015150532] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
9
|
Sumowski JF, Rocca MA, Leavitt VM, Dackovic J, Mesaros S, Drulovic J, DeLuca J, Filippi M. Brain reserve and cognitive reserve protect against cognitive decline over 4.5 years in MS. Neurology 2014; 82:1776-83. [PMID: 24748670 DOI: 10.1212/wnl.0000000000000433] [Citation(s) in RCA: 125] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE Based on the theories of brain reserve and cognitive reserve, we investigated whether larger maximal lifetime brain growth (MLBG) and/or greater lifetime intellectual enrichment protect against cognitive decline over time. METHODS Forty patients with multiple sclerosis (MS) underwent baseline and 4.5-year follow-up evaluations of cognitive efficiency (Symbol Digit Modalities Test, Paced Auditory Serial Addition Task) and memory (Selective Reminding Test, Spatial Recall Test). Baseline and follow-up MRIs quantified disease progression: percentage brain volume change (cerebral atrophy), percentage change in T2 lesion volume. MLBG (brain reserve) was estimated with intracranial volume; intellectual enrichment (cognitive reserve) was estimated with vocabulary. We performed repeated-measures analyses of covariance to investigate whether larger MLBG and/or greater intellectual enrichment moderate/attenuate cognitive decline over time, controlling for disease progression. RESULTS Patients with MS declined in cognitive efficiency and memory (p < 0.001). MLBG moderated decline in cognitive efficiency (p = 0.031, ηp (2) = 0.122), with larger MLBG protecting against decline. MLBG did not moderate memory decline (p = 0.234, ηp (2) = 0.039). Intellectual enrichment moderated decline in cognitive efficiency (p = 0.031, ηp (2) = 0.126) and memory (p = 0.037, ηp (2) = 0.115), with greater intellectual enrichment protecting against decline. MS disease progression was more negatively associated with change in cognitive efficiency and memory among patients with lower vs higher MLBG and intellectual enrichment. CONCLUSION We provide longitudinal support for theories of brain reserve and cognitive reserve in MS. Larger MLBG protects against decline in cognitive efficiency, and greater intellectual enrichment protects against decline in cognitive efficiency and memory. Consideration of these protective factors should improve prediction of future cognitive decline in patients with MS.
Collapse
Affiliation(s)
- James F Sumowski
- From Neuropsychology and Neuroscience (J.F.S., J. DeLuca), Kessler Foundation Research Center, West Orange; Rutgers (J.F.S., J. DeLuca), New Jersey Medical School, Newark, NJ; Neuroimaging Research Unit (M.A.R., M.F.) and Department of Neurology (M.A.R., M.F.), San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy; Manhattan Memory Center (V.M.L.), New York, NY; and Clinic of Neurology (J. Dackovic, S.M., J. Drulovic), Faculty of Medicine, University of Belgrade, Serbia.
| | - Maria A Rocca
- From Neuropsychology and Neuroscience (J.F.S., J. DeLuca), Kessler Foundation Research Center, West Orange; Rutgers (J.F.S., J. DeLuca), New Jersey Medical School, Newark, NJ; Neuroimaging Research Unit (M.A.R., M.F.) and Department of Neurology (M.A.R., M.F.), San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy; Manhattan Memory Center (V.M.L.), New York, NY; and Clinic of Neurology (J. Dackovic, S.M., J. Drulovic), Faculty of Medicine, University of Belgrade, Serbia
| | - Victoria M Leavitt
- From Neuropsychology and Neuroscience (J.F.S., J. DeLuca), Kessler Foundation Research Center, West Orange; Rutgers (J.F.S., J. DeLuca), New Jersey Medical School, Newark, NJ; Neuroimaging Research Unit (M.A.R., M.F.) and Department of Neurology (M.A.R., M.F.), San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy; Manhattan Memory Center (V.M.L.), New York, NY; and Clinic of Neurology (J. Dackovic, S.M., J. Drulovic), Faculty of Medicine, University of Belgrade, Serbia
| | - Jelena Dackovic
- From Neuropsychology and Neuroscience (J.F.S., J. DeLuca), Kessler Foundation Research Center, West Orange; Rutgers (J.F.S., J. DeLuca), New Jersey Medical School, Newark, NJ; Neuroimaging Research Unit (M.A.R., M.F.) and Department of Neurology (M.A.R., M.F.), San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy; Manhattan Memory Center (V.M.L.), New York, NY; and Clinic of Neurology (J. Dackovic, S.M., J. Drulovic), Faculty of Medicine, University of Belgrade, Serbia
| | - Sarlota Mesaros
- From Neuropsychology and Neuroscience (J.F.S., J. DeLuca), Kessler Foundation Research Center, West Orange; Rutgers (J.F.S., J. DeLuca), New Jersey Medical School, Newark, NJ; Neuroimaging Research Unit (M.A.R., M.F.) and Department of Neurology (M.A.R., M.F.), San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy; Manhattan Memory Center (V.M.L.), New York, NY; and Clinic of Neurology (J. Dackovic, S.M., J. Drulovic), Faculty of Medicine, University of Belgrade, Serbia
| | - Jelena Drulovic
- From Neuropsychology and Neuroscience (J.F.S., J. DeLuca), Kessler Foundation Research Center, West Orange; Rutgers (J.F.S., J. DeLuca), New Jersey Medical School, Newark, NJ; Neuroimaging Research Unit (M.A.R., M.F.) and Department of Neurology (M.A.R., M.F.), San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy; Manhattan Memory Center (V.M.L.), New York, NY; and Clinic of Neurology (J. Dackovic, S.M., J. Drulovic), Faculty of Medicine, University of Belgrade, Serbia
| | - John DeLuca
- From Neuropsychology and Neuroscience (J.F.S., J. DeLuca), Kessler Foundation Research Center, West Orange; Rutgers (J.F.S., J. DeLuca), New Jersey Medical School, Newark, NJ; Neuroimaging Research Unit (M.A.R., M.F.) and Department of Neurology (M.A.R., M.F.), San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy; Manhattan Memory Center (V.M.L.), New York, NY; and Clinic of Neurology (J. Dackovic, S.M., J. Drulovic), Faculty of Medicine, University of Belgrade, Serbia
| | - Massimo Filippi
- From Neuropsychology and Neuroscience (J.F.S., J. DeLuca), Kessler Foundation Research Center, West Orange; Rutgers (J.F.S., J. DeLuca), New Jersey Medical School, Newark, NJ; Neuroimaging Research Unit (M.A.R., M.F.) and Department of Neurology (M.A.R., M.F.), San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy; Manhattan Memory Center (V.M.L.), New York, NY; and Clinic of Neurology (J. Dackovic, S.M., J. Drulovic), Faculty of Medicine, University of Belgrade, Serbia
| |
Collapse
|
10
|
Preziosa P, Rocca MA, Mesaros S, Pagani E, Drulovic J, Stosic-Opincal T, Dackovic J, Copetti M, Caputo D, Filippi M. Relationship between damage to the cerebellar peduncles and clinical disability in multiple sclerosis. Radiology 2014; 271:822-30. [PMID: 24555637 DOI: 10.1148/radiol.13132142] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
PURPOSE To assess whether a structural disconnection between the cerebellum and the cerebral hemispheres contributes to cerebellar and brainstem symptoms in multiple sclerosis (MS). MATERIALS AND METHODS This study was approved by the local ethics committee, and written informed consent was obtained from each participant. Brain T2 lesion load, cerebellar white matter and gray matter volumes, and tract-specific measures of the middle and superior cerebellar peduncles were derived from 172 patients with MS and 46 control subjects. Predictors of clinical impairment, which was determined at ambulation and with cerebellar and brainstem functional system scores, were identified by using random forest analysis. RESULTS Of the 172 patients, 112 (65%) had middle cerebellar peduncle T2 lesions and 74 (43%) had superior cerebellar peduncle T2 lesions. T2 lesions in the middle and superior cerebellar peduncles were more common in clinically impaired patients than in unimpaired patients (P = .05 to <.0001). Most conventional magnetic resonance imaging metrics were more abnormal in impaired patients than in unimpaired patients (P = .03 to <.0001). Except for axial diffusivity, diffusivity abnormalities of the middle and superior cerebellar peduncles were more severe in clinically impaired patients than in unimpaired patients (P = .04 to <.0001). A minimal overlap was found between diffusivity abnormalities and T2 lesions. Compared with volumetric measures of T2 lesions or cerebellar atrophy, diffusivity measures of middle or superior cerebellar peduncle damage enabled better differentiation between clinically impaired and unimpaired patients (C statistics: 61%-70%). CONCLUSION The assessment of middle and superior cerebellar peduncle damage contributes to the explanation of cerebellar and/or brainstem symptoms and ambulatory impairment in MS.
Collapse
Affiliation(s)
- Paolo Preziosa
- From the Neuroimaging Research Unit (P.P., M.A.R., E.P., M.F.) and Department of Neurology (P.P., M.A.R., M.F.), Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy; Clinics of Neurology (S.M., J. Drulovic, J. Dackovic) and Radiology (T.S.O.), Faculty of Medicine, University of Belgrade, Belgrade, Serbia; Biostatistics Unit, IRCCS-Ospedale Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy (M.C.); and Department of Neurology, Scientific Institute Fondazione Don Gnocchi, Milan, Italy (D.C.)
| | | | | | | | | | | | | | | | | | | |
Collapse
|
11
|
Nedeljkovic U, Dubljanin-Raspopovic E, Ilic N, Dackovic J, Dujmovic I. Endurance and resistance training in rehabilitation of patients with multiple sclerosis. VOJNOSANIT PREGL 2014. [DOI: 10.2298/vsp130116003n] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Una Nedeljkovic
- Clinical Center of Serbia, Clinic for Physical Medicine and Rehabilitation, Belgrade
| | - Emilija Dubljanin-Raspopovic
- Clinical Center of Serbia, Clinic for Physical Medicine and Rehabilitation, Belgrade + Faculty of Medicine, Belgrade
| | - Nela Ilic
- Clinical Center of Serbia, Clinic for Physical Medicine and Rehabilitation, Belgrade + Faculty of Medicine, Belgrade
| | | | - Irena Dujmovic
- Clinical Center of Serbia, Neurology Clinic, Belgrade + Faculty of Medicine, Belgrade
| |
Collapse
|
12
|
Keckarevic Markovic MP, Dackovic J, Mladenovic J, Milic-Rasic V, Kecmanovic M, Keckarevic D, Romac S. An algorithm for genetic testing of Serbian patients with demyelinating Charcot-Marie-Tooth. Genet Test Mol Biomarkers 2012; 17:85-7. [PMID: 23163601 DOI: 10.1089/gtmb.2012.0238] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Charcot-Marie Tooth (CMT) is a clinically and genetically heterogeneous group of diseases with rough genotype-phenotype correlation, so the final diagnosis requires extensive clinical and electrophysiological examination, family data, and gene mutation analysis. Although there is a common pattern of genetic basis of CMT, there could be some population differences that should be taken into account to facilitate analyses. Here we present the algorithm for genetic testing in Serbian patients with demyelinating CMT, based on their genetic specificities: in cases of no PMP22 duplication, and if -X-linked CMT (CMTX) is not contraindicated by pattern of inheritance (male-to-male transmission), one should test for c.94A>G GJB founder mutation, first. Also, when a patient is of Romani ethnicity, or if there is an autosomal recessive inheritance in a family and unclear ethnicity, c.442C>T mutation in NDRG1 should be tested.
Collapse
|
13
|
Srejic V, Bogdanovic G, Milutinovic S, Rakocevic V, Dujmovic I, Dackovic J. P-57 THERAPEUTIC PLASMA EXCHANGE IN NEUROLOGICAL PATIENTS: EVALUATION OF CLINICAL EFFECTS. Transfus Apher Sci 2012. [DOI: 10.1016/s1473-0502(12)70093-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
14
|
Keckarevic-Markovic M, Milic-Rasic V, Mladenovic J, Dackovic J, Kecmanovic M, Keckarevic D, Savic-Pavicevic D, Romac S. Mutational analysis of GJB1, MPZ, PMP22, EGR2, and LITAF/SIMPLE in Serbian Charcot-Marie-Tooth patients. J Peripher Nerv Syst 2009; 14:125-36. [PMID: 19691535 DOI: 10.1111/j.1529-8027.2009.00222.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
We report the results of mutational analysis in the following genes: GJB1, MPZ, PMP22, EGR2, and LITAF/SIMPLE in 57 Charcot-Marie-Tooth (CMT) patients of Serbian origin without the PMP22 duplication. We found 10 different mutations in 14 CMT patients: 6 mutations in GJB1, 3 in MPZ, and 1 in PMP22. Five of six GJB1 mutations are reported for the first time, and the most frequent one appears to be a founder mutation in the Serbian population. No mutations were found in EGR2 or LITAF. Thus, GJB1 mutation analysis should be done in patients without the PMP22 duplication and male-to-male transmission of CMT.
Collapse
|
15
|
Rakocevic-Stojanovic V, Skender-Gazibara M, Grujicic D, Lavrnic D, Dackovic J, Vujic A, Apostolski S. Tumor-like brain lesions in a patient with Hashimoto encephalopathy and hereditary motor and sensory neuropathy. Acta Myol 2006; 25:38-9. [PMID: 17039979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
|