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Rocca MA, Valsasina P, Romanò F, Tedone N, Amato MP, Brichetto G, Boccia VD, Chataway J, Chiaravalloti ND, Cutter G, Dalgas U, DeLuca J, Farrell RA, Feys P, Freeman J, Inglese M, Meza C, Motl RW, Salter A, Sandroff BM, Feinstein A, Filippi M. Cognitive rehabilitation effects on grey matter volume and Go-NoGo activity in progressive multiple sclerosis: results from the CogEx trial. J Neurol Neurosurg Psychiatry 2024:jnnp-2024-333460. [PMID: 38754979 DOI: 10.1136/jnnp-2024-333460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 04/23/2024] [Indexed: 05/18/2024]
Abstract
BACKGROUND Research on cognitive rehabilitation (CR) and aerobic exercise (EX) to improve cognition in progressive multiple sclerosis (PMS) remains limited. CogEx trial investigated the effectiveness of CR and EX in PMS: here, we present MRI substudy volumetric and task-related functional MRI (fMRI) findings. METHODS Participants were randomised to: 'CR plus EX', 'CR plus sham EX (EX-S)', 'EX plus sham CR (CR-S)' and 'CR-S plus EX-S' and attended 12-week intervention. All subjects performed physical/cognitive assessments at baseline, week 12 and 6 months post intervention (month 9). All MRI substudy participants underwent volumetric MRI and fMRI (Go-NoGo task). RESULTS 104 PMS enrolled at four sites participated in the CogEx MRI substudy; 84 (81%) had valid volumetric MRI and valid fMRI. Week 12/month 9 cognitive performances did not differ among interventions; however, 25-62% of the patients showed Symbol Digit Modalities Test improvements. Normalised cortical grey matter volume (NcGMV) changes at week 12 versus baseline were heterogeneous among interventions (p=0.05); this was mainly driven by increased NcGMV in 'CR plus EX-S' (p=0.02). Groups performing CR (ie, 'CR plus EX' and 'CR plus EX-S') exhibited increased NcGMV over time, especially in the frontal (p=0.01), parietal (p=0.04) and temporal (p=0.04) lobes, while those performing CR-S exhibited NcGMV decrease (p=0.008). In CR groups, increased NcGMV (r=0.36, p=0.01) at week 12 versus baseline correlated with increased California Verbal Learning Test (CVLT)-II scores. 'CR plus EX-S' patients exhibited Go-NoGo activity increase (p<0.05, corrected) at week 12 versus baseline in bilateral insula. CONCLUSIONS In PMS, CR modulated grey matter (GM) volume and insular activity. The association of GM and CVLT-II changes suggests GM plasticity contributes to cognitive improvements. TRIAL REGISTRATION NUMBER NCT03679468.
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Affiliation(s)
- Maria A Rocca
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS Ospedale San Raffaele, Milan, Italy
- Neurology Unit, IRCCS Ospedale San Raffaele, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Paola Valsasina
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Francesco Romanò
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Nicolò Tedone
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Maria Pia Amato
- Department NEUROFARBA, Section Neurosciences, University of Florence, Florence, Italy
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - Giampaolo Brichetto
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genoa, Italy
- AISM Rehabilitation Service, Italian Multiple Sclerosis Society, Genoa, Italy
| | - Vincenzo Daniele Boccia
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, and Center of Excellence for Biomedical Research, University of Genoa, Genoa, Italy
| | - Jeremy Chataway
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
- National Institute for Health Research, University College London Hospitals, Biomedical Research Centre, London, UK
| | - Nancy D Chiaravalloti
- Kessler Foundation, West Orange, NJ, USA
- Department of Physical Medicine & Rehabilitation, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Gary Cutter
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ulrik Dalgas
- Exercise Biology, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - John DeLuca
- Kessler Foundation, West Orange, NJ, USA
- Department of Physical Medicine & Rehabilitation, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Rachel A Farrell
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
| | - Peter Feys
- REVAL, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
- University MS Center, Hasselt University, Pelt, Belgium
| | - Jennifer Freeman
- Faculty of Health, School of Health Professions, University of Plymouth, Plymouth, Devon, UK
| | - Matilde Inglese
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, and Center of Excellence for Biomedical Research, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Cecilia Meza
- Department of Psychiatry, University of Toronto and Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Robert W Motl
- Department of Kinesiology and Nutrition, University of Illinois Chicago, Chicago, Illinois, USA
| | - Amber Salter
- Department of Neurology, Section on Statistical Planning and Analysis, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Brian M Sandroff
- Kessler Foundation, West Orange, NJ, USA
- Department of Physical Medicine & Rehabilitation, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Anthony Feinstein
- Department of Psychiatry, University of Toronto and Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS Ospedale San Raffaele, Milan, Italy
- Neurology Unit, IRCCS Ospedale San Raffaele, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
- Neurorehabilitation Unit, IRCCS Ospedale San Raffaele, Milan, Italy
- Neurophysiology Service, IRCCS Ospedale San Raffaele, Milan, Italy
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Ramari C, D'hooge M, Dalgas U, Feinstein A, Amato MP, Brichetto G, Chataway J, Chiaravalloti ND, Cutter GR, DeLuca J, Farrell R, Filippi M, Freeman J, Inglese M, Meza C, Motl RW, Rocca MA, Sandroff BM, Salter A, Kos D, Feys P. Prevalence and Associated Clinical Characteristics of Walking-Related Motor, Cognitive, and Fatigability in Progressive Multiple Sclerosis: Baseline Results From the CogEx Study. Neurorehabil Neural Repair 2024; 38:327-338. [PMID: 38426484 DOI: 10.1177/15459683241236161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Indexed: 03/02/2024]
Abstract
BACKGROUND People with progressive multiple sclerosis (PMS) present motor (eg, walking) and cognitive impairments, and report fatigue. Fatigue encompasses fatigability which is objectively measured by the capacity to sustain a motor or cognitive task. OBJECTIVE To investigate the prevalence of walking and cognitive fatigability (CF) and the associated clinical characteristics in a large sample of PMS patients. METHODS PMS patients (25-65 years old) were included from 11 sites (Europe and North America), having cognitive impairment (1.28 standard deviation below normative data for the symbol digit modality test [SDMT]). Walking fatigability (WF) was assessed using the distance walk index (DWI) and CF using the SDMT (scores from the last 30 seconds compared to the first 30 seconds). Additional measures were: cognitive assessment-Brief International Cognitive Assessment for multiple sclerosis (MS), cardiorespiratory fitness, 6-minute walk, physical activity, depressive symptoms, perceived fatigue-Modified Fatigue Impact Scale (MFIS), MS impact-MSIS-29, and walking ability. RESULTS Of 298 participants, 153 (51%) presented WF (DWI = -28.9 ± 22.1%) and 196 (66%) presented CF (-29.7 ± 15%). Clinical characteristics (EDSS, disease duration, and use of assistive device) were worse in patients with versus without WF. They also presented worse scores on MSIS-29 physical, MFIS total and physical and reduced physical capacity. CF patients scored better in the MSIS-29 physical and MFIS psychosocial, compared to non-CF group. Magnitude of CF and WF were not related. CONCLUSIONS Half of the cognitively-impaired PMS population presented WF which was associated with higher disability, physical functions, and fatigue. There was a high prevalence of CF but without strong associations with clinical, cognitive, and physical functions. TRIAL REGISTRATION NUMBER The "CogEx-study," www.clinicaltrial.gov identifier number: NCT03679468.
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Affiliation(s)
- Cintia Ramari
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Limburg, Belgium
- UMSC University MS Center Hasselt Pelt, Hasselt Pelt, Belgium
| | - Mieke D'hooge
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Limburg, Belgium
- National MS Center, Melsbroek, Belgium
| | - Ulrik Dalgas
- Exercise Biology, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Anthony Feinstein
- Department of Psychiatry, University of Toronto and Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Maria Pia Amato
- Department NEUROFARBA, Section Neurosciences, University of Florence, Florence, Italy
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - Giampaolo Brichetto
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genoa, Italy
- AISM Rehabilitation Service, Italian Multiple Sclerosis Society, Genoa, Italy
| | - Jeremy Chataway
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
- National Institute for Health Research, University College London Hospitals, Biomedical Research Centre, London, UK
| | - Nancy D Chiaravalloti
- Kessler Foundation, East Hanover, NJ, USA
- Department of Physical Medicine & Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Gary R Cutter
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - John DeLuca
- Kessler Foundation, East Hanover, NJ, USA
- Department of Physical Medicine & Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Rachel Farrell
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
- National Institute for Health Research, University College London Hospitals, Biomedical Research Centre, London, UK
| | - Massimo Filippi
- Neuroimaging Research Unit, Institute of Experimental Neurology, IRCSS San Raffaele Scientific Institute, Milan, Italy
- Neurology Unit, IRCSS San Raffaele Scientific Institute, Milan, Italy
- Neurorehabilitation Unit, IRCSS San Raffaele Scientific Institute, Milan, Italy
- Neurophysiology Service, IRCSS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Jennifer Freeman
- Faculty of Health, School of Health Professions, University of Plymouth, Devon, UK
| | - Matilde Inglese
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, and Center of Excellence for Biomedical Research, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Cecilia Meza
- Department of Psychiatry, University of Toronto and Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Robert W Motl
- Department of Kinesiology and Nutrition, University of Illinois Chicago, Chicago, IL, USA
| | - Maria A Rocca
- Neuroimaging Research Unit, Institute of Experimental Neurology, IRCSS San Raffaele Scientific Institute, Milan, Italy
- Neurology Unit, IRCSS San Raffaele Scientific Institute, Milan, Italy
| | - Brian M Sandroff
- Kessler Foundation, East Hanover, NJ, USA
- Department of Physical Medicine & Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Amber Salter
- Department of Neurology, Section on Statistical Planning and Analysis, UT Southwestern Medical Center, Dallas, TX, USA
| | | | - Peter Feys
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Limburg, Belgium
- UMSC University MS Center Hasselt Pelt, Hasselt Pelt, Belgium
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Wylie GR, Genova HM, Yao B, Chiaravalloti N, Román CAF, Sandroff BM, DeLuca J. Evaluating the effects of brain injury, disease and tasks on cognitive fatigue. Sci Rep 2023; 13:20166. [PMID: 37978235 PMCID: PMC10656417 DOI: 10.1038/s41598-023-46918-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 11/07/2023] [Indexed: 11/19/2023] Open
Abstract
Because cognitive fatigue (CF) is common and debilitating following brain injury or disease we investigated the relationships among CF, behavioral performance, and cerebral activation within and across populations by combining the data from two cross-sectional studies. Individuals with multiple sclerosis (MS) were included to model CF resulting from neurological disease; individuals who had sustained a traumatic brain injury (TBI) were included to model CF resulting from neurological insult; both groups were compared with a control group (Controls). CF was induced while neuroimaging data was acquired using two different tasks. CF significantly differed between the groups, with the clinical groups reporting more CF than Controls-a difference that was statistically significant for the TBI group and trended towards significance for the MS group. The accrual of CF did not differ across the three groups; and CF ratings were consistent across tasks. Increasing CF was associated with longer response time for all groups. The brain activation in the caudate nucleus and the thalamus was consistently correlated with CF in all three groups, while more dorsally in the caudate, activation differed across the groups. These results suggest the caudate and thalamus to be central to CF while more dorsal aspects of the caudate may be sensitive to damage associated with particular types of insult.
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Affiliation(s)
- Glenn R Wylie
- Rocco Ortenzio Neuroimaging Center, Kessler Foundation, 1199 Pleasant Valley Way, West Orange, NJ, 07052, USA.
- Department of Physical Medicine and Rehabilitation, Rutgers University, New Jersey Medical School, Newark, USA.
- Department of Veterans' Affairs, The War Related Illness and Injury Center, East Orange Campus, East Orange, NJ, 07018, USA.
| | - Helen M Genova
- Rocco Ortenzio Neuroimaging Center, Kessler Foundation, 1199 Pleasant Valley Way, West Orange, NJ, 07052, USA
- Department of Physical Medicine and Rehabilitation, Rutgers University, New Jersey Medical School, Newark, USA
| | - Bing Yao
- Rocco Ortenzio Neuroimaging Center, Kessler Foundation, 1199 Pleasant Valley Way, West Orange, NJ, 07052, USA
- Department of Physical Medicine and Rehabilitation, Rutgers University, New Jersey Medical School, Newark, USA
| | - Nancy Chiaravalloti
- Rocco Ortenzio Neuroimaging Center, Kessler Foundation, 1199 Pleasant Valley Way, West Orange, NJ, 07052, USA
- Department of Physical Medicine and Rehabilitation, Rutgers University, New Jersey Medical School, Newark, USA
| | - Cristina A F Román
- Rocco Ortenzio Neuroimaging Center, Kessler Foundation, 1199 Pleasant Valley Way, West Orange, NJ, 07052, USA
| | - Brian M Sandroff
- Rocco Ortenzio Neuroimaging Center, Kessler Foundation, 1199 Pleasant Valley Way, West Orange, NJ, 07052, USA
- Department of Physical Medicine and Rehabilitation, Rutgers University, New Jersey Medical School, Newark, USA
| | - John DeLuca
- Rocco Ortenzio Neuroimaging Center, Kessler Foundation, 1199 Pleasant Valley Way, West Orange, NJ, 07052, USA
- Department of Physical Medicine and Rehabilitation, Rutgers University, New Jersey Medical School, Newark, USA
- Department of Neurology, Rutgers University, New Jersey Medical School, Newark, NJ, 07101, USA
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Genova HM, Chen MH, Botticello A, Voelbel G, Kim G, Elsayed HE, Myszko Z, DeLuca J, McGrath RE, Arnett P, Goverover Y. An Examination of Positive and Negative Outcomes During the COVID-19 Pandemic Among Persons With Multiple Sclerosis. Am J Occup Ther 2023; 77:7706205090. [PMID: 38015490 DOI: 10.5014/ajot.2023.050287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 11/29/2023] Open
Abstract
IMPORTANCE This study provides information to clinicians about how persons with MS coped in both positive and negative ways during a potentially traumatic experience (the coronavirus disease 2019 [COVID-19] pandemic), which will help clinicians to provide better services to this population in the face of stressful events. OBJECTIVE To describe both positive and negative outcomes among persons with multiple sclerosis (MS) and to examine whether resilience and social support were related to positive and negative outcomes during the peak of the pandemic. DESIGN An online survey administered during the COVID-19 pandemic. PARTICIPANTS Participants were 74 individuals with MS and 104 healthy controls (HCs) recruited through social media and community support groups. OUTCOMES AND MEASURES The survey included questionnaires that assessed both positive and negative responses to the pandemic, including benefit finding, loneliness, and distress. Resilience and social support were also assessed. RESULTS Differences were noted between persons with MS and HCs on negative but not positive outcomes. Better social support and resilience were related to positive outcomes. CONCLUSIONS AND RELEVANCE Both persons with MS and HCs were similar in benefit finding and stress management. However, negative outcomes were worse in the MS group. Our findings shed light on the importance of individuals with MS adopting a positive outlook to help during times of adversity. What This Article Adds: Among persons with disabilities such as multiple sclerosis, finding benefits during stressful times can be a potential coping mechanism. Furthermore, resilience and social support should be taken into account to moderate the effects of adverse events.
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Affiliation(s)
- Helen M Genova
- Helen M. Genova, PhD, is Associate Director, Center for Autism Research, and Director, Social Cognition and Neuroscience Laboratory, Kessler Foundation, East Hanover, NJ, and Associate Professor, Department of Physical Medicine and Rehabilitation, New Jersey Medical School, Rutgers, the State University of New Jersey, Newark
| | - Michelle H Chen
- Michelle H. Chen, PhD, is Assistant Professor, Department of Neurology, Robert Wood Johnson Medical School, Rutgers, the State University of New Jersey, New Brunswick
| | - Amanda Botticello
- Amanda Botticello, PhD, MPH, is Associate Director, Centers for Outcomes & Assessment Research, Kessler Foundation, East Hanover, NJ, and Vice Chair of Research Education, Department of Physical Medicine and Rehabilitation, New Jersey Medical School, Rutgers, the State University of New Jersey, Newark
| | - Gerald Voelbel
- Gerald Voelbel, PhD, is Associate Professor, Department of Occupational Therapy, New York University, New York
| | - Grace Kim
- Grace Kim, PhD, is Associate Professor, Department of Occupational Therapy, New York University, New York
| | - Heba E Elsayed
- Heba E. Elsayed, MD, is Associate Research Scientist, Kessler Foundation, East Hanover, NJ
| | - Zuzanna Myszko
- Zuzanna Myszko, BA, is Doctoral Student, Montclair State University, Montclair, NJ
| | - John DeLuca
- John DeLuca, PhD, is Senior Vice President for Research and Training, Kessler Foundation, East Hanover, NJ, and Professor, Department of Physical Medicine and Rehabilitation, New Jersey Medical School, Rutgers, the State University of New Jersey, Newark
| | - Robert E McGrath
- Robert E. McGrath, PhD, is Professor, Psychology Department, School of Psychology and Counseling, Fairleigh Dickinson University, Teaneck, NJ
| | - Peter Arnett
- Peter Arnett, PhD, is Professor, Psychology Department, Pennsylvania State University, University Park
| | - Yael Goverover
- Yael Goverover, PhD, is Visiting Professor, Department of Physical Medicine and Rehabilitation, New Jersey Medical School, Rutgers, the State University of New Jersey, Newark, and Professor, Department of Occupational Therapy, New York University, New York;
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Sandroff BM, Weber E, Wylie GR, Wender CLA, Goverover Y, Lercher K, Tong TT, Robinson B, Moore N, Salter A, DeLuca J, Chiaravalloti ND. The effects of cognitive rehabilitation combined with aerobic exercise or stretching-and-toning on new learning and memory in persons with moderate-to-severe TBI: Protocol for a randomized controlled trial. Contemp Clin Trials 2023; 134:107331. [PMID: 37734538 DOI: 10.1016/j.cct.2023.107331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 08/15/2023] [Revised: 09/14/2023] [Accepted: 09/15/2023] [Indexed: 09/23/2023]
Abstract
This paper describes the protocol for a Phase I/II, parallel-group, blinded randomized controlled trial that compares the effects of 12-weeks of combined learning and memory rehabilitation with either aerobic cycling exercise or stretching on cognitive, neuroimaging, and everyday life outcomes in 60 persons with moderate-to-severe traumatic brain injury (TBI) who demonstrate impairments in new learning. Briefly, participants will undergo baseline testing consisting of neuropsychological testing, neuroimaging, daily life measures, and cardiorespiratory fitness. Following baseline testing, participants will be randomized to one of 2 conditions (30 participants per condition) using concealed allocation. Participants will be masked as to the intent of the conditions. The conditions will both involve supervised administration of an enhanced, 8-week version of the Kessler Foundation modified Story Memory Technique, embedded within either 12-weeks of supervised and progressive aerobic cycling exercise training (experimental condition) or 12-weeks of supervised stretching-and-toning (active control condition). Following the 12-week intervention period, participants will complete the same measures as at baseline that will be administered by treatment-blinded assessors. The primary study outcome is new learning and memory impairment based on California Verbal Learning Test (CVLT)-III slope, the secondary outcomes include neuroimaging measures of hippocampal volume, activation, and connectivity, and the tertiary outcomes involve measures of daily living along with other cognitive outcomes. We further will collect baseline sociodemographic data for examining predictors of response heterogeneity. If successful, this trial will provide the first Class I evidence supporting combined memory rehabilitation and aerobic cycling exercise training for treating TBI-related new learning and memory impairment.
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Affiliation(s)
- Brian M Sandroff
- Centers for Neuropsychology, Neuroscience, Traumatic Brain Injury Research, Kessler Foundation, East Hanover, NJ, United States of America; Department of Physical Medicine & Rehabilitation, Rutgers NJ Medical School, Newark, NJ, United States of America.
| | - Erica Weber
- Centers for Neuropsychology, Neuroscience, Traumatic Brain Injury Research, Kessler Foundation, East Hanover, NJ, United States of America; Department of Physical Medicine & Rehabilitation, Rutgers NJ Medical School, Newark, NJ, United States of America
| | - Glenn R Wylie
- Centers for Neuropsychology, Neuroscience, Traumatic Brain Injury Research, Kessler Foundation, East Hanover, NJ, United States of America; Department of Physical Medicine & Rehabilitation, Rutgers NJ Medical School, Newark, NJ, United States of America
| | - Carly L A Wender
- Centers for Neuropsychology, Neuroscience, Traumatic Brain Injury Research, Kessler Foundation, East Hanover, NJ, United States of America; Department of Physical Medicine & Rehabilitation, Rutgers NJ Medical School, Newark, NJ, United States of America
| | - Yael Goverover
- Centers for Neuropsychology, Neuroscience, Traumatic Brain Injury Research, Kessler Foundation, East Hanover, NJ, United States of America; Department of Occupational Therapy, New York University, New York, NY, United States of America
| | - Kirk Lercher
- Kessler Institute for Rehabilitation, West Orange, NJ, United States of America
| | - Tien T Tong
- Centers for Neuropsychology, Neuroscience, Traumatic Brain Injury Research, Kessler Foundation, East Hanover, NJ, United States of America
| | - Brionna Robinson
- Centers for Neuropsychology, Neuroscience, Traumatic Brain Injury Research, Kessler Foundation, East Hanover, NJ, United States of America
| | - Nancy Moore
- Centers for Neuropsychology, Neuroscience, Traumatic Brain Injury Research, Kessler Foundation, East Hanover, NJ, United States of America
| | - Amber Salter
- Department of Neurology, University of Texas Southwestern, Dallas, TX, United States of America
| | - John DeLuca
- Centers for Neuropsychology, Neuroscience, Traumatic Brain Injury Research, Kessler Foundation, East Hanover, NJ, United States of America; Department of Physical Medicine & Rehabilitation, Rutgers NJ Medical School, Newark, NJ, United States of America
| | - Nancy D Chiaravalloti
- Centers for Neuropsychology, Neuroscience, Traumatic Brain Injury Research, Kessler Foundation, East Hanover, NJ, United States of America; Department of Physical Medicine & Rehabilitation, Rutgers NJ Medical School, Newark, NJ, United States of America
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Román CAF, DeLuca J. H - 37 Impact of Barriers to Healthcare Access on Cognition and Accelerated Brain Aging in Diverse Persons with Multiple Sclerosis: Preliminary Pilot Data. Arch Clin Neuropsychol 2023; 38:1521. [PMID: 37807544 DOI: 10.1093/arclin/acad067.355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023] Open
Abstract
OBJECTIVE Racially/ethnically diverse persons with multiple sclerosis (pwMS) have worse outcomes than their white counterparts. Barriers to healthcare access may contribute to these disparities, though much remains unknown. The current pilot study investigates the impact of barriers to healthcare on cognition and accelerated brain aging in diverse pwMS. We hypothesize that greater barriers to healthcare will be associated with poorer cognitive performance and increased brain aging. METHOD Eighteen middle-aged pwMS (40-60 years) were included. Barriers to healthcare access was evaluated using total and subscale (skills, marginalization, expectations, knowledge, and pragmatics) scores of the modified Barriers to Care Questionnaire. Cognition was measured using raw scores from the Symbol Digit Modalities Test (SDMT), Brief Visuospatial Memory Test-Revised (BVMT-R), and California Verbal Learning Test-II (CVLT-II). Accelerated brain aging was calculated by subtracting chronological age from predicted brain age based on the brainageR paradigm. RESULTS Given established directional hypotheses, one tailed correlations were conducted. Greater marginalization-related barriers to healthcare were associated with poorer performance on the SDMT (r = -0.409, p = 0.046). Greater knowledge-based barriers to healthcare were associated with increased brain aging (r = -0.615, p = 0.004). Lastly, brain age was significantly related to immediate (r = -0.653, p = 0.003) and delayed (r = -0.549, p = 0.014) visual memory, such that increased brain age was associated with poorer visual memory. CONCLUSION To the authors' knowledge, this is among the first studies to examine the impact of barriers to healthcare on cognition and brain health in diverse pwMS. It demonstrates the importance of sociocultural determinants when examining outcomes in MS. This work has implications for culturally informed research and clinical care.
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Feinstein A, Amato MP, Brichetto G, Chataway J, Chiaravalloti ND, Cutter G, Dalgas U, DeLuca J, Farrell R, Feys P, Filippi M, Freeman J, Inglese M, Meza C, Motl RW, Rocca MA, Sandroff BM, Salter A. Cognitive rehabilitation and aerobic exercise for cognitive impairment in people with progressive multiple sclerosis (CogEx): a randomised, blinded, sham-controlled trial. Lancet Neurol 2023; 22:912-924. [PMID: 37739574 DOI: 10.1016/s1474-4422(23)00280-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 07/03/2023] [Accepted: 07/17/2023] [Indexed: 09/24/2023]
Abstract
BACKGROUND Cognitive dysfunction in people with relapsing-remitting multiple sclerosis can improve with cognitive rehabilitation or exercise. Similar effects have not been clearly shown in people with progressive multiple sclerosis. We aimed to investigate the individual and synergistic effects of cognitive rehabilitation and exercise in patients with progressive multiple sclerosis. METHODS CogEx was a randomised, sham-controlled trial completed in 11 hospital clinics, universities, and rehabilitation centres in Belgium, Canada, Denmark, Italy, UK, and USA. Patients with progressive multiple sclerosis were eligible for inclusion if they were aged 25-65 years and had an Expanded Disability Status Scale (EDSS) score of less than 7. All had impaired processing speed defined as a performance of 1·282 SD or greater below normative data on the Symbol Digit modalities Tests (SDMT). Participants were randomly assigned (1:1:1:1), using an interactive web-response system accessed online from each centre, to cognitive rehabilitation plus exercise, cognitive rehabilitation plus sham exercise, exercise plus sham cognitive rehabilitation, or sham exercise plus sham cognitive rehabilitation. The study statistician created the randomisation sequence that was stratified by centre. Participants, outcome assessors, and investigators were blinded to group allocation. The study statistician was masked to treatment during analysis only. Interventions were conducted two times per week for 12 weeks: cognitive rehabilitation used an individualised, computer-based, incremental approach to improve processing speed; sham cognitive rehabilitation consisted of internet training provided individually; the exercise intervention involved individualised aerobic training using a recumbent arm-leg stepper; and the sham exercise involved stretching and balance tasks without inducing cardiovascular strain. The primary outcome measure was processing speed measured by SDMT at 12 weeks; least squares mean differences were compared between groups using linear mixed model in all participants who had a 12-week assessment. The trial is registered with ClinicalTrials.gov, NCT03679468, and is completed. FINDINGS Between Dec 14, 2018, and April 2, 2022, 311 people with progressive multiple sclerosis were enrolled and 284 (91%) completed the 12-week assessment (117/311 [38%] male and 194/311 [62%] female). The least squares mean group differences in SDMT at 12 weeks did not differ between groups (p=0·85). Compared with the sham cognitive rehabilitation and sham exercise group (n=67), differences were -1·30 (95% CI -3·75 to 1·16) for the cognitive rehabilitation plus exercise group (n=70); -2·78 (-5·23 to -0·33) for the sham cognitive rehabilitation plus exercise group (n=71); and -0·71 (-3·11 to 1·70) for the cognitive rehabilitation plus sham exercise group (n=76). 11 adverse events possibly related to the interventions occurred, six in the exercise plus sham cognitive rehabilitation group (pain, dizziness, and falls), two in the cognitive rehabilitation plus sham exercise group (headache and pain), two in the cognitive rehabilitation and exercise group (increased fatigue and pain), and one in the dual sham group (fall). INTERPRETATION Combined cognitive rehabilitation plus exercise does not seem to improve processing speed in people with progressive multiple sclerosis. However, our sham interventions were not inactive. Studies comparing interventions with a non-intervention group are needed to investigate whether clinically meaningful improvements in processing speed might be attainable in people with progressive multiple sclerosis. FUNDING MS Canada.
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Affiliation(s)
- Anthony Feinstein
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
| | - Maria Pia Amato
- Department NEUROFARBA, Section Neurosciences, University of Florence, Florence, Italy; IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - Giampaolo Brichetto
- Scientific Research Area, Italian Multiple Sclerosis Foundation, Genoa, Italy; AISM Rehabilitation Service, Italian Multiple Sclerosis Society, Genoa, Italy
| | - Jeremy Chataway
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK; National Institute for Health Research, University College London Hospitals, Biomedical Research Centre, London, UK
| | - Nancy D Chiaravalloti
- Kessler Foundation, East Hanover, NJ, USA; Department of Physical Medicine & Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Gary Cutter
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ulrik Dalgas
- Exercise Biology, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - John DeLuca
- Kessler Foundation, East Hanover, NJ, USA; Department of Physical Medicine & Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Rachel Farrell
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK; National Institute for Health Research, University College London Hospitals, Biomedical Research Centre, London, UK
| | - Peter Feys
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Belgium; UMSC University MS Center Hasselt Pelt, Belgium
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCSS San Raffaele Scientific Institute, Milan, Italy; Neurology Unit, IRCSS San Raffaele Scientific Institute, Milan, Italy; Neurorehabilitation Unit, IRCSS San Raffaele Scientific Institute, Milan, Italy; Neurophysiology Service, IRCSS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Jennifer Freeman
- Faculty of Health, School of Health Professions, University of Plymouth, Devon, UK
| | - Matilde Inglese
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, and Center of Excellence for Biomedical Research, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Cecilia Meza
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Robert W Motl
- Department of Kinesiology and Nutrition, University of Illinois Chicago, Chicago, IL, USA
| | - Maria A Rocca
- Neuroimaging Research Unit, Division of Neuroscience, IRCSS San Raffaele Scientific Institute, Milan, Italy; Neurology Unit, IRCSS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Brian M Sandroff
- Kessler Foundation, East Hanover, NJ, USA; Department of Physical Medicine & Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Amber Salter
- Department of Neurology, Section on Statistical Planning and Analysis, UT Southwestern Medical Center, Dallas, TX, USA
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Rafizadeh CM, Smith C, Strober LB, DeLuca J, Chen MH. Associations between Social Support and Cognitive Performance among Persons with MS. Mult Scler Relat Disord 2023; 78:104882. [PMID: 37506612 PMCID: PMC10592277 DOI: 10.1016/j.msard.2023.104882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 06/30/2023] [Accepted: 07/12/2023] [Indexed: 07/30/2023]
Abstract
BACKGROUND Social support is a protective factor against cognitive decline in the general population. However, the relationship between social support and cognitive functioning among persons with multiple sclerosis (MS) is not well understood. OBJECTIVE The present study aimed to investigate the associations between different aspects of social support and cognitive performance among persons with MS. METHODS A volunteer sample of 60 persons with MS completed the Medical Outcomes Study Support Social Survey 5-item short form (MSSS-5) and the Social Network Index (SNI). Cognitive functioning was assessed through a virtually-administered neuropsychological battery. Multiple linear regressions were conducted to examine the associations between social support measures and cognitive performance. RESULTS In models adjusting for level of premorbid functioning, both perceived social support (i.e., to what extent one receives assistance from their social network; p = .002) and total size of social network (i.e., total number of people one regularly talks to; p = .002) were significant predictors of processing speed/executive functioning with moderate effect sizes. However, when we accounted for employment status in a post hoc analysis, the association between social network size and processing speed/executive functioning became statistically insignificant, while the relationship between perceived social support and processing speed/executive functioning remained significant (p = .002). CONCLUSIONS Greater perceived social support is associated with better performance on processing speed/executive functioning measures among persons with MS, independent of effects from premorbid functioning and employment status. Maintaining a strong social support network may be an important factor in optimizing cognitive health in MS.
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Affiliation(s)
- Caroline M Rafizadeh
- Center for Neuropsychology and Neuroscience Research, Kessler Foundation, East Hanover, NJ 07936
| | - Cheyenne Smith
- Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, NJ 08901
| | - Lauren B Strober
- Center for Neuropsychology and Neuroscience Research, Kessler Foundation, East Hanover, NJ 07936
| | - John DeLuca
- Center for Neuropsychology and Neuroscience Research, Kessler Foundation, East Hanover, NJ 07936
| | - Michelle H Chen
- Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, NJ 08901; Department of Neurology, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ 08901.
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9
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Goverover Y, Salter A, DeLuca J. Assessing everyday functional activity in cognitively impaired people with multiple sclerosis: The use of Actual Reality TM. Mult Scler 2023; 29:1107-1117. [PMID: 37496331 DOI: 10.1177/13524585231185048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Indexed: 07/28/2023]
Abstract
BACKGROUND There is considerable evidence that persons with multiple sclerosis (PwMS) who experience cognitive impairments (CIs) are at risk of having significant limitations in activities of daily living (ADLs). However, ADL assessment often consists of proxies or self-report of ADLs. This study examined whether the performance of instrumental ADLs (I-ADL) is impaired in PwMS with and without CI. METHODS Participants included 72 PwMS and 48 matched healthy controls (HCs). PwMS were divided into MS-CI (n = 25) and MS-not-impaired (n = 47) groups based on the Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS) scores. All participants performed the Actual RealityTM (AR) test, measuring I-ADL using authentic websites. RESULTS The MS-CI performed significantly worse on AR compared with HC and MS-not-impaired. In addition, the MS-not-impaired performed significantly worse than HC on AR. AR differentiates well between PwMS with and without CI. CONCLUSIONS While CI in MS results in significant limitations in the performance of I-ADL, PwMS who do not show evidence of CI can have limitations in I-ADL. AR assessment is a valid and reliable tool sensitive to CI. It should be used in addition to traditional cognitive assessments to detect early functional deterioration through the course of MS.
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Affiliation(s)
- Yael Goverover
- Department of Occupational Therapy, New York University, New York, NY, USA/Kessler Foundation, West Orange, NJ, USA
| | - Amber Salter
- The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - John DeLuca
- Kessler Foundation, West Orange, NJ, USA/Department of Physical Medicine and Rehabilitation, New Jersey Medical School, Rutgers University, Newark, NJ, USA
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10
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Veldkamp R, D'hooge M, Sandroff BM, DeLuca J, Kos D, Salter A, Feinstein A, Amato MP, Brichetto G, Chataway J, Farrell R, Chiaravalloti ND, Dalgas U, Filippi M, Freeman J, Motl RW, Meza C, Inglese M, Rocca MA, Cutter G, Feys P. Profiling cognitive-motor interference in a large sample of persons with progressive multiple sclerosis and impaired processing speed: results from the CogEx study. J Neurol 2023; 270:3120-3128. [PMID: 36881147 DOI: 10.1007/s00415-023-11636-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 02/15/2023] [Accepted: 02/19/2023] [Indexed: 03/08/2023]
Abstract
BACKGROUND Performing cognitive-motor dual tasks (DTs) may result in reduced walking speed and cognitive performance. The effect in persons with progressive multiple sclerosis (pwPMS) having cognitive dysfunction is unknown. OBJECTIVE To profile DT-performance during walking in cognitively impaired pwPMS and examine DT-performance by disability level. METHODS Secondary analyses were conducted on baseline data from the CogEx-study. Participants, enrolled with Symbol Digit Modalities Test 1.282 standard deviations below normative value, performed a cognitive single task ([ST], alternating alphabet), motor ST (walking) and DT (both). Outcomes were number of correct answers on the alternating alphabet task, walking speed, and DT-cost (DTC: decline in performance relative to the ST). Outcomes were compared between EDSS subgroups (≤ 4, 4.5-5.5, ≥ 6). Spearman correlations were conducted between the DTCmotor with clinical measures. Adjusted significance level was 0.01. RESULTS Overall, participants (n = 307) walked slower and had fewer correct answers on the DT versus ST (both p < 0.001), with a DTCmotor of 15.8% and DTCcognitive of 2.7%. All three subgroups walked slower during the DT versus ST, with DTCmotor different from zero (p's < 0.001). Only the EDSS ≥ 6 group had fewer correct answers on the DT versus ST (p < 0.001), but the DTCcognitive did not differ from zero for any of the groups (p ≥ 0.039). CONCLUSION Dual tasking substantially affects walking performance in cognitively impaired pwPMS, to a similar degree for EDSS subgroups.
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Affiliation(s)
- R Veldkamp
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium.
- UMSC, Hasselt-Pelt, Belgium.
| | - M D'hooge
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
- UMSC, Hasselt-Pelt, Belgium
- National MS Center Melsbroek, Steenokkerzeel, Belgium
| | - B M Sandroff
- Kessler Foundation, East Hanover, NJ, USA
- Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - J DeLuca
- Kessler Foundation, East Hanover, NJ, USA
- Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - D Kos
- National MS Center Melsbroek, Steenokkerzeel, Belgium
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - A Salter
- Department of Neurology, Section on Statistical Planning and Analysis, UT Southwestern Medical Center, Dallas, TX, USA
| | - A Feinstein
- Department of Psychiatry, University of Toronto and Sunnybrook Health Sciences Centre, Toronto, ON, M5R 3B6, Canada
| | - M P Amato
- Department NEUROFARBA, Section Neurosciences, University of Florence, Largo Brambilla 3, 50134, Florence, Italy
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - G Brichetto
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Via Operai 40, 16149, Genoa, Italy
- AISM Rehabilitation Service, Italian Multiple Sclerosis Society (AISM), Via Operai 30, 16149, Genoa, Italy
| | - J Chataway
- Queen Square MS Centre, Department of Neuroinflammation, University College London (UCL) Queen Square Institute of Neurology, Faculty of Brain Sciences, UCL, London, UK
| | - R Farrell
- Queen Square MS Centre, Department of Neuroinflammation, University College London (UCL) Queen Square Institute of Neurology, Faculty of Brain Sciences, UCL, London, UK
| | - N D Chiaravalloti
- Kessler Foundation, East Hanover, NJ, USA
- Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - U Dalgas
- Exercise Biology, Department of Public Health, Aarhus University, Dalgas Avenue 4, 8000, Aarhus, Denmark
| | - M Filippi
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, and Neurology Unit, IRCCS, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - J Freeman
- School of Health Professions, Faculty of Health, University of Plymouth, Devon, UK
| | - R W Motl
- Department of Kinesiology and Nutrition, University of Illinois Chicago, Chicago, IL, USA
| | - C Meza
- Department of Psychiatry, University of Toronto and Sunnybrook Health Sciences Centre, Toronto, ON, M5R 3B6, Canada
| | - M Inglese
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), and Center of Excellence for Biomedical Research, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - M A Rocca
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, and Neurology Unit, IRCCS, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - G Cutter
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, USA
| | - P Feys
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
- UMSC, Hasselt-Pelt, Belgium
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11
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Chiaravalloti ND, Costa S, Armknecht C, Costanza K, Alexander A, DeLuca J. The influence of information processing speed on benefit from learning and memory rehabilitation in TBI: a sub-analysis of the TBI-MEM trial. Brain Inj 2023:1-8. [PMID: 37255417 DOI: 10.1080/02699052.2023.2216024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVE This study examined the influence of processing speed (PS) on benefit from treatment with the Kessler Foundation modified Story Memory Technique® (KF-mSMT®), a cognitive rehabilitation intervention shown to improve new learning and memory in traumatic brain injury (TBI). SETTING Non-profit research center. PARTICIPANTS 62 participants with moderate-to-severe TBI were included, 31 assigned to the treatment group and 31 to the placebo-control group. DESIGN Double-blind, placebo-controlled, randomized clinical trial. The present study represents a post-hoc analysis to examine the role of PS on treatment efficacy. MAIN MEASURES Baseline and follow-up neuropsychological assessment including the California Verbal Learning Test, Second Edition (CVLT-II), Memory Assessment Scales - Prose Memory (MAS-PM) and the Symbol Digit Modalities Test (SDMT). RESULTS A treatment effect was not observed on the CVLT-II learning slope in the treatment group relative to the placebo group post-treatment, after co-varying for education, baseline CVLT slope and PS performance. However, performance on a measure of PS, the SDMT, was a significant predictor of post-treatment change following KF-mSMT® treatment. PS was not a significant predictor of benefit from treatment as documented by the MAS-PM immediate or delayed recall score, both of which showed a significant treatment effect. CONCLUSION Performance on measures of cognitive dysfunction aside from learning and memory impact the benefit from KF-mSMT® treatment. Implications for cognitive rehabilitation for individuals with TBI are discussed.
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Affiliation(s)
- Nancy D Chiaravalloti
- Kessler Foundation, Center for Neuropsychology and Neuroscience Research, East Hanover, New Jersey, USA
- Rutgers -New Jersey Medical School, Department of Physical Medicine and Rehabilitation, Newark, New Jersey, USA
| | - Silvana Costa
- Kessler Foundation, Center for Neuropsychology and Neuroscience Research, East Hanover, New Jersey, USA
- Rutgers -New Jersey Medical School, Department of Physical Medicine and Rehabilitation, Newark, New Jersey, USA
| | - Caroline Armknecht
- Kessler Foundation, Center for Neuropsychology and Neuroscience Research, East Hanover, New Jersey, USA
| | - Kristen Costanza
- Kessler Foundation, Center for Neuropsychology and Neuroscience Research, East Hanover, New Jersey, USA
| | - Aubree Alexander
- Kessler Foundation, Center for Neuropsychology and Neuroscience Research, East Hanover, New Jersey, USA
- Rutgers -New Jersey Medical School, Department of Physical Medicine and Rehabilitation, Newark, New Jersey, USA
| | - John DeLuca
- Kessler Foundation, Center for Neuropsychology and Neuroscience Research, East Hanover, New Jersey, USA
- Rutgers -New Jersey Medical School, Department of Physical Medicine and Rehabilitation, Newark, New Jersey, USA
- Rutgers -New Jersey Medical School, Department of Neurology & Neurosciences, Newark, New Jersey, USA
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12
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Kennedy E, Vadlamani S, Lindsey HM, Lei PW, Jo-Pugh M, Adamson M, Alda M, Alonso-Lana S, Ambrogi S, Anderson TJ, Arango C, Asarnow RF, Avram M, Ayesa-Arriola R, Babikian T, Banaj N, Bird LJ, Borgwardt S, Brodtmann A, Brosch K, Caeyenberghs K, Calhoun VD, Chiaravalloti ND, Cifu DX, Crespo-Facorro B, Dalrymple-Alford JC, Dams-O’Connor K, Dannlowski U, Darby D, Davenport N, DeLuca J, Diaz-Caneja CM, Disner SG, Dobryakova E, Ehrlich S, Esopenko C, Ferrarelli F, Frank LE, Franz C, Fuentes-Claramonte P, Genova H, Giza CC, Goltermann J, Grotegerd D, Gruber M, Gutierrez-Zotes A, Ha M, Haavik J, Hinkin C, Hoskinson KR, Hubl D, Irimia A, Jansen A, Kaess M, Kang X, Kenney K, Keřková B, Khlif MS, Kim M, Kindler J, Kircher T, Knížková K, Kolskår KK, Krch D, Kremen WS, Kuhn T, Kumari V, Kwon JS, Langella R, Laskowitz S, Lee J, Lengenfelder J, Liebel SW, Liou-Johnson V, Lippa SM, Løvstad M, Lundervold A, Marotta C, Marquardt CA, Mattos P, Mayeli A, McDonald CR, Meinert S, Melzer TR, Merchán-Naranjo J, Michel C, Morey RA, Mwangi B, Myall DJ, Nenadić I, Newsome MR, Nunes A, O’Brien T, Oertel V, Ollinger J, Olsen A, de la Foz VOG, Ozmen M, Pardoe H, Parent M, Piras F, Piras F, Pomarol-Clotet E, Repple J, Richard G, Rodriguez J, Rodriguez M, Rootes-Murdy K, Rowland J, Ryan NP, Salvador R, Sanders AM, Schmidt A, Soares JC, Spalleta G, Španiel F, Stasenko A, Stein F, Straube B, Thames A, Thomas-Odenthal F, Thomopoulos SI, Tone E, Torres I, Troyanskaya M, Turner JA, Ulrichsen KM, Umpierrez G, Vilella E, Vivash L, Walker WC, Werden E, Westlye LT, Wild K, Wroblewski A, Wu MJ, Wylie GR, Yatham LN, Zunta-Soares GB, Thompson PM, Tate DF, Hillary FG, Dennis EL, Wilde EA. Bridging Big Data: Procedures for Combining Non-equivalent Cognitive Measures from the ENIGMA Consortium. bioRxiv 2023:2023.01.16.524331. [PMID: 36712107 PMCID: PMC9882238 DOI: 10.1101/2023.01.16.524331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Investigators in neuroscience have turned to Big Data to address replication and reliability issues by increasing sample sizes, statistical power, and representativeness of data. These efforts unveil new questions about integrating data arising from distinct sources and instruments. We focus on the most frequently assessed cognitive domain - memory testing - and demonstrate a process for reliable data harmonization across three common measures. We aggregated global raw data from 53 studies totaling N = 10,505 individuals. A mega-analysis was conducted using empirical bayes harmonization to remove site effects, followed by linear models adjusting for common covariates. A continuous item response theory (IRT) model estimated each individual's latent verbal learning ability while accounting for item difficulties. Harmonization significantly reduced inter-site variance while preserving covariate effects, and our conversion tool is freely available online. This demonstrates that large-scale data sharing and harmonization initiatives can address reproducibility and integration challenges across the behavioral sciences.
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Affiliation(s)
- Eamonn Kennedy
- Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, 84132
- Division of Epidemiology, University of Utah, Salt Lake City, UT, 84132
- George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, UT, 84132
| | - Shashank Vadlamani
- Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, 84132
| | - Hannah M Lindsey
- Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, 84132
- George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, UT, 84132
| | - Pui-Wa Lei
- Department of Educational Psychology, Counseling, and Special Education, Pennsylvania State University, University Park, PA, 16801
| | - Mary Jo-Pugh
- Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, 84132
- Division of Epidemiology, University of Utah, Salt Lake City, UT, 84132
| | - Maheen Adamson
- WRIISC-WOMEN & Rehabilitation Department, VA Palo Alto, Palo Alto, CA, USA
- Neurosurgery, Stanford School of Medicine, Stanford, CA, USA
| | - Martin Alda
- Department of Psychiatry, Dalhousie University, Halifax, Canada
| | - Silvia Alonso-Lana
- FIDMAG Research Foundation, Barcelona, Spain
- Centro Investigación Biomédica en Red Salud Mental (CIBERSAM), Madrid, Spain
| | - Sonia Ambrogi
- Laboratory of Neuropsychiatry, Santa Lucia Foundation IRCCS, Rome, Italy
| | - Tim J Anderson
- Department of Medicine, University of Otago, Christchurch, New Zealand
- New Zealand Brain Research Institute, Christchurch, New Zealand
- Department of Neurology, Te Whatu Ora – Health New Zealand Waitaha Canterbury, Christchurch, New Zealand
| | - Celso Arango
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, CIBERSAM, School of Medicine, Universidad Complutense, Madrid, Spain
| | - Robert F Asarnow
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, CA, USA
- Brain Research Institute, UCLA, Los Angeles, CA, USA
- Department of Psychology, UCLA, Los Angeles, CA, USA
| | - Mihai Avram
- Translational Psychiatry, Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
| | - Rosa Ayesa-Arriola
- Centro Investigación Biomédica en Red Salud Mental (CIBERSAM), Madrid, Spain
- Department of Psychiatry, Marqués de Valdecilla University Hospital, IDIVAL, School of Medicine, University of Cantabria, Santander, Spain
| | - Talin Babikian
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, CA, USA
- UCLA Steve Tisch BrainSPORT Program, Los Angeles, CA, USA
| | - Nerisa Banaj
- Laboratory of Neuropsychiatry, Santa Lucia Foundation IRCCS, Rome, Italy
| | - Laura J Bird
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Melbourne, VIC, Australia
| | - Stefan Borgwardt
- Translational Psychiatry, Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
- Center of Brain, Behaviour and Metabolism (CBBM), University of Lübeck, Lübeck, Germany
| | - Amy Brodtmann
- Cognitive Health Initiative, Central Clinical School, Monash University, Melbourne, VIC, Australia
- Department of Medicine, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Katharina Brosch
- Department of Psychiatry and Psychotherapy, University of Marburg, Marburg, Germany
| | - Karen Caeyenberghs
- Cognitive Neuroscience Unit, School of Psychology, Deakin University, Geelong, Australia
| | - Vince D Calhoun
- Tri-institutional Center for Translational Research in Neuroimaging and Data Science (TReNDS), Georgia State University, Georgia Institute of Technology, and Emory University University, Atlanta, GA, USA
| | - Nancy D Chiaravalloti
- Centers for Neuropsychology, Neuroscience & Traumatic Brain Injury Research, Kessler Foundation, East Hanover, NJ, USA
- Department of Physical Medicine & Rehabilitation, Rutgers, New Jersey Medical School, Newark, NJ, USA
| | - David X Cifu
- Rehabilitation Medicine Department, National Institutes of Health Clinical Center, Bethesda, MD
| | - Benedicto Crespo-Facorro
- Centro Investigación Biomédica en Red Salud Mental (CIBERSAM), Madrid, Spain
- Department of Psychiatry, Virgen del Rocio University Hospital, School of Medicine, University of Seville, IBIS, Seville, Spain
| | - John C Dalrymple-Alford
- Department of Medicine, University of Otago, Christchurch, New Zealand
- New Zealand Brain Research Institute, Christchurch, New Zealand
- School of Psychology, Speech and Hearing, University of Canterbury, Christchurch, New Zealand
| | - Kristen Dams-O’Connor
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Udo Dannlowski
- Institute for Translational Psychiatry, University of Münster, Germany
| | - David Darby
- Department of Neuroscience, Monash University, Melbourne, Australia
- Department of Neurology, Alfred Health, Melbourne, Australia
- The Florey Institute of Neuroscience and Mental Health, Melbourne, Australia
| | - Nicholas Davenport
- Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis, MN
- Minneapolis VA Health Care System, Minneapolis, MN
| | - John DeLuca
- Department of Physical Medicine & Rehabilitation, Rutgers, New Jersey Medical School, Newark, NJ, USA
- Kessler Foundation, East Hanover, NJ, USA
| | - Covadonga M Diaz-Caneja
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, CIBERSAM, School of Medicine, Universidad Complutense, Madrid, Spain
| | - Seth G Disner
- Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis, MN
- Minneapolis VA Health Care System, Minneapolis, MN
| | - Ekaterina Dobryakova
- Department of Physical Medicine & Rehabilitation, Rutgers, New Jersey Medical School, Newark, NJ, USA
- Center for Traumatic Brain Injury, Kessler Foundation, East Hanover, NJ
| | - Stefan Ehrlich
- Translational Developmental Neuroscience Section, Division of Psychological and Social Medicine and Developmental Neurosciences, Faculty of Medicine, TU Dresden, Germany
- Eating Disorders Research and Treatment Center, Department of Child and Adolescent Psychiatry, Faculty of Medicine, TU Dresden, Germany
| | - Carrie Esopenko
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Fabio Ferrarelli
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Lea E Frank
- Department of Psychology, University of Oregon, Eugene, OR, USA
| | - Carol Franz
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
- Center for Behavior Genetics of Aging, University of California, San Diego, La Jolla, CA, USA
| | - Paola Fuentes-Claramonte
- FIDMAG Research Foundation, Barcelona, Spain
- Centro Investigación Biomédica en Red Salud Mental (CIBERSAM), Madrid, Spain
| | - Helen Genova
- Department of Physical Medicine & Rehabilitation, Rutgers, New Jersey Medical School, Newark, NJ, USA
- Center for Autism Research, Kessler Foundation, East Hanover, NJ, USA
| | - Christopher C Giza
- UCLA Steve Tisch BrainSPORT Program, Los Angeles, CA, USA
- Department of Pediatrics, Division of Neurology, UCLA Mattel Children’s Hospital, Los Angeles, CA, USA
- Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Janik Goltermann
- Institute for Translational Psychiatry, University of Münster, Germany
| | - Dominik Grotegerd
- Institute for Translational Psychiatry, University of Münster, Germany
| | - Marius Gruber
- Institute for Translational Psychiatry, University of Münster, Germany
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - Alfonso Gutierrez-Zotes
- Centro Investigación Biomédica en Red Salud Mental (CIBERSAM), Madrid, Spain
- Hospital Universitari Institut Pere Mata, Tarragona, Spain
- Institut d’Investiació Sanitària Pere Virgili-CERCA, Universitat Rovira i Virgili, Tarragona, Spain
| | - Minji Ha
- Department of Brain and Cognitive Sciences, Seoul National University College of Natural Sciences, Seoul, South Korea
| | - Jan Haavik
- Department of Biomedicine, University of Bergen, Bergen, Norway
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Charles Hinkin
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, CA, USA
| | - Kristen R Hoskinson
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH
- Section of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Daniela Hubl
- Translational Research Centre, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Andrei Irimia
- Ethel Percy Andrus Gerontology Center, Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, USA
- Department of Biomedical Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, CA, USA
- Department of Quantitative & Computational Biology, Dornsife College of Arts & Sciences, University of Southern California, Los Angeles CA, USA
| | - Andreas Jansen
- Department of Psychiatry and Psychotherapy, University of Marburg, Marburg, Germany
| | - Michael Kaess
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
- Clinic of Child and Adolescent Psychiatry, Centre of Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Xiaojian Kang
- WRIISC-WOMEN & Rehabilitation Department, VA Palo Alto, Palo Alto, CA, USA
| | - Kimbra Kenney
- Department of Neurology, Uniformed Services University, Bethesda, MD
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD
| | | | - Mohamed Salah Khlif
- Cognitive Health Initiative, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Minah Kim
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, South Korea
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, South Korea
| | - Jochen Kindler
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Tilo Kircher
- Department of Psychiatry and Psychotherapy, University of Marburg, Marburg, Germany
| | - Karolina Knížková
- National Institute of Mental Health, Klecany, Czech Republic
- Department of Psychiatry, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Knut K Kolskår
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
- Department of Psychology, University of Oslo, Oslo, Norway
- Sunnaas Rehabilitation Hospital, Nesodden, Norway
| | - Denise Krch
- Department of Physical Medicine & Rehabilitation, Rutgers, New Jersey Medical School, Newark, NJ, USA
- Center for Traumatic Brain Injury, Kessler Foundation, East Hanover, NJ
| | - William S Kremen
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
- Center for Behavior Genetics of Aging, University of California, San Diego, La Jolla, CA, USA
| | - Taylor Kuhn
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, CA, USA
| | - Veena Kumari
- Department of Life Sciences, College of Health, Medicine and Life Sciences, Brunel University London, Uxbridge, United Kingdom
| | - Jun Soo Kwon
- Department of Brain and Cognitive Sciences, Seoul National University College of Natural Sciences, Seoul, South Korea
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, South Korea
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, South Korea
| | - Roberto Langella
- Laboratory of Neuropsychiatry, Santa Lucia Foundation IRCCS, Rome, Italy
| | - Sarah Laskowitz
- Brain Imaging and Analysis Center, Duke University, Durham, NC
| | - Jungha Lee
- Department of Brain and Cognitive Sciences, Seoul National University College of Natural Sciences, Seoul, South Korea
| | - Jean Lengenfelder
- Department of Physical Medicine & Rehabilitation, Rutgers, New Jersey Medical School, Newark, NJ, USA
- Center for Traumatic Brain Injury, Kessler Foundation, East Hanover, NJ
| | - Spencer W Liebel
- Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, 84132
- George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, UT, 84132
| | | | - Sara M Lippa
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD
- Department of Neuroscience, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Marianne Løvstad
- Department of Psychology, University of Oslo, Oslo, Norway
- Sunnaas Rehabilitation Hospital, Nesodden, Norway
| | - Astri Lundervold
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
| | - Cassandra Marotta
- Department of Neuroscience, Monash University, Melbourne, Australia
- Department of Neurology, Alfred Health, Melbourne, Australia
| | - Craig A Marquardt
- Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis, MN
- Minneapolis VA Health Care System, Minneapolis, MN
| | - Paulo Mattos
- Institute D’Or for Research and Education (IDOR), São Paulo, Brazil
| | - Ahmad Mayeli
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Carrie R McDonald
- Department of Radiation Medicine and Applied Sciences and Psychiatry, UC San Diego, La Jolla, CA, USA
- Center for Multimodal Imaging and Genetics, UC San Diego, San Diego, CA, USA
| | - Susanne Meinert
- Institute for Translational Psychiatry, University of Münster, Germany
- Institute for Translational Neuroscience, University of Münster, Münster, Germany
| | - Tracy R Melzer
- Department of Medicine, University of Otago, Christchurch, New Zealand
- New Zealand Brain Research Institute, Christchurch, New Zealand
- School of Psychology, Speech and Hearing, University of Canterbury, Christchurch, New Zealand
| | - Jessica Merchán-Naranjo
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, CIBERSAM, School of Medicine, Universidad Complutense, Madrid, Spain
| | - Chantal Michel
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Rajendra A Morey
- Brain Imaging and Analysis Center, Duke University, Durham, NC
- VISN 6 MIRECC, Durham VA, Durham, NC
| | - Benson Mwangi
- Center of Excellence on Mood Disorders, Louis A. Faillace, MD, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Daniel J Myall
- New Zealand Brain Research Institute, Christchurch, New Zealand
| | - Igor Nenadić
- Department of Psychiatry and Psychotherapy, University of Marburg, Marburg, Germany
| | - Mary R Newsome
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX
| | - Abraham Nunes
- Department of Psychiatry, Dalhousie University, Halifax, Canada
- Faculty of Computer Science, Dalhousie University, Halifax, NS, Canada
| | - Terence O’Brien
- Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, Parkville, VIC, Australia
- Department of Neuroscience, The Central Clinical School, Alfred Health, Monash University, Melbourne, VIC, Australia
| | - Viola Oertel
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapiey, Frankfurt University, Frankfurt, Germany
| | - John Ollinger
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD
| | - Alexander Olsen
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Physical Medicine and Rehabilitation, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
- NorHEAD - Norwegian Centre for Headache Research, Trondheim, Norway
| | - Victor Ortiz García de la Foz
- Department of Psychiatry, Marqués de Valdecilla University Hospital, IDIVAL, School of Medicine, University of Cantabria, Santander, Spain
| | - Mustafa Ozmen
- Department of Electrical and Electronics Engineering, Antalya Bilim University, Antalya, Turkey
| | - Heath Pardoe
- The Florey Institute of Neuroscience and Mental Health, Melbourne, Australia
| | - Marise Parent
- Neuroscience Institute & Department of Psychology, Georgia State University, Atlanta, GA, USA
| | - Fabrizio Piras
- Laboratory of Neuropsychiatry, Santa Lucia Foundation IRCCS, Rome, Italy
| | - Federica Piras
- Laboratory of Neuropsychiatry, Santa Lucia Foundation IRCCS, Rome, Italy
| | | | - Jonathan Repple
- Institute for Translational Psychiatry, University of Münster, Germany
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - Geneviève Richard
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Jonathan Rodriguez
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Mabel Rodriguez
- National Institute of Mental Health, Klecany, Czech Republic
| | - Kelly Rootes-Murdy
- Tri-institutional Center for Translational Research in Neuroimaging and Data Science (TReNDS), Georgia State University, Georgia Institute of Technology, and Emory University University, Atlanta, GA, USA
| | - Jared Rowland
- W.G. (Bill) Hefner VA Medical Center, Salisbury, NC
- Department of Neurobiology & Anatomy, Wake Forest School of Medicine, Winston-Salem, NC
- VA Mid-Atlantic Mental Illness Research Education and Clinical Center (MA-MIRECC), Durham, NC
| | - Nicholas P Ryan
- Cognitive Neuroscience Unit, School of Psychology, Deakin University, Geelong, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia
| | - Raymond Salvador
- Centro Investigación Biomédica en Red Salud Mental (CIBERSAM), Madrid, Spain
| | - Anne-Marthe Sanders
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
- Department of Psychology, University of Oslo, Oslo, Norway
- Sunnaas Rehabilitation Hospital, Nesodden, Norway
| | - Andre Schmidt
- University of Basel, Department of Psychiatry (UPK), Basel, Switzerland
| | - Jair C Soares
- Center of Excellence on Mood Disorders, Louis A. Faillace, MD, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | | | - Filip Španiel
- National Institute of Mental Health, Klecany, Czech Republic
- 3rd Faculty of Medicine Charles University, Prague, Czech Republic
| | - Alena Stasenko
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
- Center for Multimodal Imaging and Genetics, UC San Diego, San Diego, CA, USA
| | - Frederike Stein
- Department of Psychiatry and Psychotherapy, University of Marburg, Marburg, Germany
| | - Benjamin Straube
- Department of Psychiatry and Psychotherapy, University of Marburg, Marburg, Germany
| | - April Thames
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, CA, USA
| | | | - Sophia I Thomopoulos
- Imaging Genetics Center, Stevens Neuroimaging & Informatics Institute, Keck School of Medicine of USC, Marina del Rey, CA, 90007
| | - Erin Tone
- Department of Psychology, Georgia State University, Atlanta, GA
| | - Ivan Torres
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
- British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, BC, Canada
| | - Maya Troyanskaya
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX
| | - Jessica A Turner
- Psychiatry and Behavioral Health, Ohio State Wexner Medical Center, Columbus, OH, USA
| | - Kristine M Ulrichsen
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
- Department of Psychology, University of Oslo, Oslo, Norway
- Sunnaas Rehabilitation Hospital, Nesodden, Norway
| | - Guillermo Umpierrez
- Division of Endocrinology, Emory University School of Medicine, Atlanta, GA, USA
| | - Elisabet Vilella
- Centro Investigación Biomédica en Red Salud Mental (CIBERSAM), Madrid, Spain
- Hospital Universitari Institut Pere Mata, Tarragona, Spain
- Institut d’Investiació Sanitària Pere Virgili-CERCA, Universitat Rovira i Virgili, Tarragona, Spain
| | - Lucy Vivash
- Department of Neuroscience, Monash University, Melbourne, Australia
- Department of Neurology, Alfred Health, Melbourne, Australia
| | - William C Walker
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA
- Richmond Veterans Affairs (VA) Medical Center, Central Virginia VA Health Care System , Richmond, VA
| | - Emilio Werden
- The Florey Institute of Neuroscience and Mental Health, Melbourne, Australia
| | - Lars T Westlye
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
- Department of Psychology, University of Oslo, Oslo, Norway
- KG Jebsen Center for Neurodevelopmental Disorders, University of Oslo, Oslo, Norway
| | - Krista Wild
- Department of Psychology, Phoenix VA Health Care System, Phoenix, AZ, USA
| | - Adrian Wroblewski
- Department of Psychiatry and Psychotherapy, University of Marburg, Marburg, Germany
| | - Mon-Ju Wu
- Center of Excellence on Mood Disorders, Louis A. Faillace, MD, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Glenn R Wylie
- Department of Physical Medicine & Rehabilitation, Rutgers, New Jersey Medical School, Newark, NJ, USA
- Rocco Ortenzio Neuroimaging Center, Kessler Foundation, East Hanover, NJ, USA
| | - Lakshmi N Yatham
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Giovana B Zunta-Soares
- Center of Excellence on Mood Disorders, Louis A. Faillace, MD, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Paul M Thompson
- Imaging Genetics Center, Stevens Neuroimaging & Informatics Institute, Keck School of Medicine of USC, Marina del Rey, CA, 90007
- Departments of Neurology, Pediatrics, Psychiatry, Radiology, Engineering, and Ophthalmology, USC, Los Angeles, CA, 90007
| | - David F Tate
- Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, 84132
- George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, UT, 84132
| | - Frank G Hillary
- Department of Psychology, Penn State University, State College, PA, 16801
- Department of Neurology, Hershey Medical Center, State College, PA, 16801
- Social Life and Engineering Science Imaging Center, Penn State University, State College, PA, 16801
| | - Emily L Dennis
- Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, 84132
- George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, UT, 84132
| | - Elisabeth A Wilde
- Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, 84132
- George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, UT, 84132
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13
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Romanò F, Motl RW, Valsasina P, Amato MP, Brichetto G, Bruschi N, Chataway J, Chiaravalloti ND, Cutter G, Dalgas U, DeLuca J, Farrell R, Feys P, Freeman J, Inglese M, Meza C, Salter A, Sandroff BM, Feinstein A, Rocca MA, Filippi M. Abnormal thalamic functional connectivity correlates with cardiorespiratory fitness and physical activity in progressive multiple sclerosis. J Neurol 2023; 270:3213-3224. [PMID: 36933030 DOI: 10.1007/s00415-023-11664-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 03/08/2023] [Accepted: 03/09/2023] [Indexed: 03/19/2023]
Abstract
BACKGROUND Altered thalamic volumes and resting state (RS) functional connectivity (FC) might be associated with physical activity (PA) and cardiorespiratory fitness (CRF) in people with progressive multiple sclerosis (PMS). OBJECTIVES To assess thalamic structural and functional alterations and investigate their correlations with PA/CRF levels in people with PMS. METHODS Seven-day accelerometry and cardiopulmonary exercise testing were used to assess PA/CRF levels in 91 persons with PMS. They underwent 3.0 T structural and RS fMRI acquisition with 37 age/sex-matched healthy controls (HC). Between-group comparisons of MRI measures and their correlations with PA/CRF variables were assessed. RESULTS PMS people had lower volumes compared to HC (all p < 0.001). At corrected threshold, PMS showed decreased intra- and inter-thalamic RS FC, and increased RS FC between the thalamus and the hippocampus, bilaterally. At uncorrected threshold, decreased thalamic RS FC with caudate nucleus, cerebellum and anterior cingulate cortex (ACC), as well as increased thalamic RS FC with occipital regions, were also detected. Lower CRF, measured as peak oxygen consumption (VO2peak), correlated with lower white matter volume (r = 0.31, p = 0.03). Moreover, lower levels of light PA correlated with increased thalamic RS FC with the right hippocampus (r = - 0.3, p = 0.05). DISCUSSION People with PMS showed widespread brain atrophy, as well as pronounced intra-thalamic and thalamo-hippocampal RS FC abnormalities. White matter atrophy correlated with CRF, while increased thalamo-hippocampal RS FC was associated to worse PA levels. Thalamic RS FC might be used to monitor physical impairment and efficacy of rehabilitative and disease-modifying treatments in future studies.
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Affiliation(s)
- Francesco Romanò
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Robert W Motl
- Department of Kinesiology and Nutrition, University of Illinois Chicago, Chicago, IL, USA
| | - Paola Valsasina
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Maria Pia Amato
- Section Neurosciences, Department NEUROFARBA, University of Florence, Florence, Italy.,IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - Giampaolo Brichetto
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Via Operai 40, 16149, Genoa, Italy.,AISM Rehabilitation Service, Italian Multiple Sclerosis Society, Via Operai 30, 16149, Genoa, Italy
| | - Nicolò Bruschi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, and Center of Excellence for Biomedical Research, University of Genoa, Genoa, Italy
| | - Jeremy Chataway
- Faculty of Brain Sciences, Queen Square MS Centre, UCL Queen Square Institute of Neurology, UCL, London, UK.,Biomedical Research Centre, National Institute for Health Research, University College London Hospitals, London, UK
| | - Nancy D Chiaravalloti
- Kessler Foundation, West Orange, NJ, USA.,Department of Physical Medicine & Rehabilitation, Rutgers NJ Medical School, Newark, NJ, USA
| | - Gary Cutter
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ulrik Dalgas
- Exercise Biology, Department of Public Health, Aarhus University, Dalgas Avenue 4, 8000, Aarhus, Denmark
| | - John DeLuca
- Kessler Foundation, West Orange, NJ, USA.,Department of Physical Medicine & Rehabilitation, Rutgers NJ Medical School, Newark, NJ, USA
| | - Rachel Farrell
- Faculty of Brain Sciences, Queen Square MS Centre, UCL Queen Square Institute of Neurology, UCL, London, UK
| | - Peter Feys
- Faculty of Rehabilitation Sciences, REVAL, Hasselt University, Diepenbeek, Belgium.,UMSC Hasselt, Pelt, Belgium
| | - Jennifer Freeman
- Faculty of Health, School of Health Professions, University of Plymouth, Devon, UK
| | - Matilde Inglese
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, and Center of Excellence for Biomedical Research, University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Cecilia Meza
- Department of Psychiatry, University of Toronto and Sunnybrook Health Sciences Centre, Toronto, ON, M5R 3B6, Canada
| | - Amber Salter
- Section on Statistical Planning and Analysis, Department of Neurology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Brian M Sandroff
- Kessler Foundation, West Orange, NJ, USA.,Department of Physical Medicine & Rehabilitation, Rutgers NJ Medical School, Newark, NJ, USA
| | - Anthony Feinstein
- Department of Psychiatry, University of Toronto and Sunnybrook Health Sciences Centre, Toronto, ON, M5R 3B6, Canada
| | - Maria A Rocca
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy.,Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy. .,Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy. .,Vita-Salute San Raffaele University, Milan, Italy. .,Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy. .,Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy.
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14
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Hsu WY, Anguera JA, Rizzo A, Campusano R, Chiaravalloti ND, DeLuca J, Gazzaley A, Bove RM. A virtual reality program to assess cognitive function in multiple sclerosis: A pilot study. Front Hum Neurosci 2023; 17:1139316. [PMID: 37007676 PMCID: PMC10060881 DOI: 10.3389/fnhum.2023.1139316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 02/17/2023] [Indexed: 03/18/2023] Open
Abstract
Introduction: Cognitive impairment is a debilitating symptom in people with multiple sclerosis (MS). Most of the neuropsychological tasks have little resemblance to everyday life. There is a need for ecologically valid tools for assessing cognition in real-life functional contexts in MS. One potential solution would involve the use of virtual reality (VR) to exert finer control over the task presentation environment; however, VR studies in the MS population are scarce.Objectives: To explore the utility and feasibility of a VR program for cognitive assessment in MS.Methods: A VR classroom embedded with a continuous performance task (CPT) was assessed in 10 non-MS adults and 10 people with MS with low cognitive functioning. Participants performed the CPT with distractors (i.e., WD) and without distractors (i.e., ND). The Symbol Digit Modalities Test (SDMT), California Verbal Learning Test—II (CVLT-II), and a feedback survey on the VR program was administered.Results: People with MS exhibited greater reaction time variability (RTV) compared to non-MS participants, and greater RTV in both WD and ND conditions was associated with lower SDMT.Conclusions: VR tools warrant further research to determine their value as an ecologically valid platform for assessing cognition and everyday functioning in people with MS.
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Affiliation(s)
- Wan-Yu Hsu
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Joaquin A. Anguera
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
- Neuroscape, University of California, San Francisco, San Francisco, CA, United States
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA, United States
| | - Albert Rizzo
- Institute for Creative Studies, University of Southern California, Los Angeles, CA, United States
| | - Richard Campusano
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
- Neuroscape, University of California, San Francisco, San Francisco, CA, United States
| | - Nancy D. Chiaravalloti
- Kessler Foundation, East Hanover, NJ, United States
- Department of Physical Medicine & Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, United States
| | - John DeLuca
- Kessler Foundation, East Hanover, NJ, United States
- Department of Physical Medicine & Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, United States
| | - Adam Gazzaley
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
- Neuroscape, University of California, San Francisco, San Francisco, CA, United States
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA, United States
- Department of Physiology, University of California, San Francisco, San Francisco, CA, United States
| | - Riley M. Bove
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
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15
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Wilken J, Traboulsee A, Nelson F, Ionete C, Kolind S, Fratto T, Kane R, Gandhi R, Rawlings AM, Roesch N, Ozog MA, DeLuca J. Longitudinal assessment of neurocognitive function in people with relapsing multiple sclerosis initiating alemtuzumab in routine clinical practice: LEM-COG study results. Mult Scler Relat Disord 2023; 73:104677. [PMID: 37028124 DOI: 10.1016/j.msard.2023.104677] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 02/21/2023] [Accepted: 03/26/2023] [Indexed: 03/29/2023]
Abstract
BACKGROUND Alemtuzumab is effective in reducing relapse rate and disability, but limited data exist on its effect on cognitive function in relapsing multiple sclerosis (RMS). The present study assessed neurocognitive function and safety associated with alemtuzumab treatment in RMS. METHODS This longitudinal, single-arm, prospective study included people with RMS (aged 25-55 years) who were treated with alemtuzumab in clinical practice in the United States of America and Canada. The first participant was enrolled in December 2016. The primary endpoint was the change from baseline to post-baseline (month [M] 12/24) in MS-COGnitive (MS-COG) composite score. Secondary endpoints included Paced Auditory Serial Addition Test (PASAT), Symbol Digit Modalities Test (SDMT), Brief Visuospatial Memory Test-Revised (BVMT-R), Selective Reminding Test (SRT), Controlled Oral Word Association Test (COWAT), and Automated Neuropsychological Assessment Metrics (ANAM) scores. Depression and fatigue were assessed using Hamilton Rating Scale-Depression (HAM-D) and Fatigue Severity Scale (FSS)/Modified Fatigue Impact Scale (MFIS), respectively. Magnetic resonance imaging (MRI) parameters were assessed when available. Safety was assessed throughout the study. Descriptive statistics were used for the pre-specified statistical analyses. Since the study was terminated early (November 2019) because of operational and resource difficulties, post hoc analyses for statistical inference were performed among participants who had a baseline value and at least one complete post-baseline assessment for cognitive parameters, fatigue, or depression. RESULTS Of the 112 participants enrolled, 39 were considered as the primary analysis population at M12. At M12, a mean change of 0.25 (95% confidence interval [CI]: 0.04, 0.45; p = 0.0049; effect size [ES]: 0.39) was observed in the MS-COG composite score. Improvements were observed in processing speed (based on PASAT and SDMT; p < 0.0001; ES: 0.62), as well as in individual PASAT, SDMT and COWAT scores. An improvement was also noted in HAM-D (p = 0.0054; ES: -0.44), but not in fatigue scores. Among MRI parameters, decreases in burden of disease volume (BDV; ES: -0.12), new gadolinium-enhancing lesions (ES: -0.41) and newly active lesions (ES: -0.07) were observed at M12. About 92% of participants showed stable or improved cognitive status at M12. There were no new safety signals reported in the study. The most common adverse events (≥10% of participants) were headache, fatigue, nausea, insomnia, urinary tract infection, pain in extremity, chest discomfort, anxiety, dizziness, arthralgia, flushing, and rash. Hypothyroidism (3.7%) was the most frequent adverse event of special interest. CONCLUSION The findings from this study suggest that alemtuzumab has a positive impact on cognitive function with significant improvements in processing speed and depression in people with RMS over a period of 12 months. The safety profile of alemtuzumab was consistent with previous studies.
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Preziosa P, Rocca MA, Pagani E, Valsasina P, Amato MP, Brichetto G, Bruschi N, Chataway J, Chiaravalloti ND, Cutter G, Dalgas U, DeLuca J, Farrell R, Feys P, Freeman J, Inglese M, Meani A, Meza C, Motl RW, Salter A, Sandroff BM, Feinstein A, Filippi M. Structural and functional magnetic resonance imaging correlates of fatigue and dual-task performance in progressive multiple sclerosis. J Neurol 2023; 270:1543-1563. [PMID: 36436069 DOI: 10.1007/s00415-022-11486-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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: 09/28/2022] [Revised: 11/09/2022] [Accepted: 11/10/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Frontal cortico-subcortical dysfunction may contribute to fatigue and dual-task impairment of walking and cognition in progressive multiple sclerosis (PMS). PURPOSE To explore the associations among fatigue, dual-task performance and structural and functional abnormalities of frontal cortico-subcortical network in PMS. METHODS Brain 3 T structural and functional MRI sequences, Modified Fatigue Impact Scale (MFIS), dual-task motor and cognitive performances were obtained from 57 PMS patients and 10 healthy controls (HC). The associations of thalamic, caudate nucleus and dorsolateral prefrontal cortex (DLPFC) atrophy, microstructural abnormalities of their connections and their resting state effective connectivity (RS-EC) with fatigue and dual-task performance were investigated using random forest. RESULTS Thirty-seven PMS patients were fatigued (F) (MFIS ≥ 38). Compared to HC, non-fatigued (nF) and F-PMS patients had significantly worse dual-task performance (p ≤ 0.002). Predictors of fatigue (out-of-bag [OOB]-accuracy = 0.754) and its severity (OOB-R2 = 0.247) were higher Expanded Disability Status scale (EDSS) score, lower RS-EC from left-caudate nucleus to left-DLPFC, lower fractional anisotropy between left-caudate nucleus and left-thalamus, higher mean diffusivity between right-caudate nucleus and right-thalamus, and longer disease duration. Microstructural abnormalities in connections among thalami, caudate nuclei and DLPFC, mainly left-lateralized in nF-PMS and more bilateral in F-PMS, higher RS-EC from left-DLPFC to right-DLPFC in nF-PMS and lower RS-EC from left-caudate nucleus to left-DLPFC in F-PMS, higher EDSS score, higher WM lesion volume, and lower cortical volume predicted worse dual-task performances (OOB-R2 from 0.426 to 0.530). CONCLUSIONS In PMS, structural and functional frontal cortico-subcortical abnormalities contribute to fatigue and worse dual-task performance, with different patterns according to the presence of fatigue.
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Affiliation(s)
- Paolo Preziosa
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Maria A Rocca
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Elisabetta Pagani
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Paola Valsasina
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maria Pia Amato
- Department NEUROFARBA, Section Neurosciences, University of Florence, Florence, Italy.,IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - Giampaolo Brichetto
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genoa, Italy.,AISM Rehabilitation Service, Italian Multiple Sclerosis Society, Genoa, Italy
| | - Nicolò Bruschi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, and Center of Excellence for Biomedical Research, University of Genoa, Genoa, Italy
| | - Jeremy Chataway
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK.,National Institute for Health Research, Biomedical Research Centre, University College London Hospitals, London, UK
| | - Nancy D Chiaravalloti
- Kessler Foundation, West Orange, NJ, USA.,Department of Physical Medicine and Rehabilitation, Rutgers NJ Medical School, Newark, NJ, USA
| | - Gary Cutter
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ulrik Dalgas
- Exercise Biology, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - John DeLuca
- Kessler Foundation, West Orange, NJ, USA.,Department of Physical Medicine and Rehabilitation, Rutgers NJ Medical School, Newark, NJ, USA
| | - Rachel Farrell
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK.,National Institute for Health Research, Biomedical Research Centre, University College London Hospitals, London, UK
| | - Peter Feys
- REVAL, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
| | - Jennifer Freeman
- Faculty of Health, School of Health Professions, University of Plymouth, Plymouth, UK
| | - Matilde Inglese
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, and Center of Excellence for Biomedical Research, University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Alessandro Meani
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Cecilia Meza
- Department of Psychiatry, University of Toronto and Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Robert W Motl
- Department of Kinesiology and Nutrition, University of Illinois Chicago, Chicago, IL, USA
| | - Amber Salter
- Department of Neurology, Section on Statistical Planning and Analysis, UT Southwestern Medical Center, Dallas, TX, USA
| | - Brian M Sandroff
- Kessler Foundation, West Orange, NJ, USA.,Department of Physical Medicine and Rehabilitation, Rutgers NJ Medical School, Newark, NJ, USA
| | - Anthony Feinstein
- Department of Psychiatry, University of Toronto and Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy. .,Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy. .,Vita-Salute San Raffaele University, Milan, Italy.
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Goverover Y, Costa S, DeLuca J, Chiaravalloti N. The Efficacy of the Speed of Processing Training Program in Improving Functional Outcome: From Restoration to Generalization. Arch Phys Med Rehabil 2023:S0003-9993(23)00093-X. [PMID: 36758712 DOI: 10.1016/j.apmr.2023.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 10/19/2022] [Revised: 01/11/2023] [Accepted: 01/21/2023] [Indexed: 02/10/2023]
Abstract
OBJECTIVE To examine the efficacy of Speed of Processing Training (SOPT) in improving everyday functional outcomes in persons with multiple sclerosis (MS). DESIGN Randomized controlled trial. SETTING A nonprofit rehabilitation research institution and the community. PARTICIPANTS In total, 60 participants with MS with impaired processing speed were randomly assigned to SOPT (n=33) or an active control group (n=27). INTERVENTION SOPT, a restorative computerized cognitive intervention involving 10 treatment sessions consisting of visual tasks designed to improve speed and accuracy of information processing MAIN OUTCOME MEASURES: Outcomes included performance on the Timed Instrumental Activities of Daily Living (TIADL) and self-report of functional behavior, quality of life, and affect. RESULTS The treatment group showed improvement in the total TIADL score and 2 subtests compared with the active control group. Participants in the treatment group who demonstrated improved cognitive performance after the intervention also showed improved performance on one TIADL subtest. Quality of life, affective symptomatology, and self-reported functional status were not changed after the intervention. CONCLUSIONS Improvement in underlying cognitive or perceptual deficits is thought to promote recovery and everyday performance as per the restorative approach to cognitive rehabilitation. However, this study showed only selected improvements in everyday functional outcomes for persons with MS.
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Affiliation(s)
- Yael Goverover
- Department of Occupational Therapy, New York University, New York, NY; Kessler Foundation, East Hanover, NJ.
| | - Silvana Costa
- Kessler Foundation, East Hanover, NJ; Rutgers University, Department of Physical Medicine and Rehabilitation, New Jersey Medical School, Newark, NJ
| | - John DeLuca
- Kessler Foundation, East Hanover, NJ; Rutgers University, Department of Physical Medicine and Rehabilitation, New Jersey Medical School, Newark, NJ
| | - Nancy Chiaravalloti
- Kessler Foundation, East Hanover, NJ; Rutgers University, Department of Physical Medicine and Rehabilitation, New Jersey Medical School, Newark, NJ
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18
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Chen MH, Cherian C, Elenjickal K, Rafizadeh CM, Ross MK, Leow A, DeLuca J. Real-time associations among MS symptoms and cognitive dysfunction using ecological momentary assessment. Front Med (Lausanne) 2023; 9:1049686. [PMID: 36714150 PMCID: PMC9877417 DOI: 10.3389/fmed.2022.1049686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 12/28/2022] [Indexed: 01/13/2023] Open
Abstract
Introduction Multiple sclerosis (MS) is characterized by a wide range of disabling symptoms, including cognitive dysfunction, fatigue, depression, anxiety, pain, and sleep difficulties. The current study aimed to examine real-time associations between non-cognitive and cognitive symptoms (latter measured both objectively and subjectively in real-time) using smartphone-administered ecological momentary assessment (EMA). Methods Forty-five persons with MS completed EMA four times per day for 3 weeks. For each EMA, participants completed mobile versions of the Trail-Making Test part B (mTMT-B) and a finger tapping task, as well as surveys about symptom severity. Multilevel models were conducted to account for within-person and within-day clustering. Results A total of 3,174 EMA sessions were collected; compliance rate was 84%. There was significant intra-day variability in mTMT-B performance (p < 0.001) and levels of self-reported fatigue (p < 0.001). When participants reported depressive symptoms that were worse than their usual levels, they also performed worse on the mTMT-B (p < 0.001), independent of upper extremity motor functioning. Other self-reported non-cognitive symptoms were not associated with real-time performance on the mTMT-B [p > 0.009 (Bonferroni-corrected)]. In contrast, when self-reported fatigue (p < 0.001), depression (p < 0.001), anxiety (p < 0.001), and pain (p < 0.001) were worse than the individual's typical levels, they also reported more severe cognitive dysfunction at the same time. Further, there was a statistical trend that self-reported cognitive dysfunction (not mTMT-B performance) predicted one's self-reported sense of accomplishment in real-time. Discussion The current study was the first to identify divergent factors that influence subjectively and objectively measured cognitive functioning in real time among persons with MS. Notably, it is when symptom severity was worse than the individual's usual levels (and not absolute levels) that led to cognitive fluctuations, which supports the use of EMA in MS symptom monitoring.
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Affiliation(s)
- Michelle H. Chen
- Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, NJ, United States,Department of Neurology, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, United States,*Correspondence: Michelle H. Chen,
| | - Christine Cherian
- Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, NJ, United States
| | - Karen Elenjickal
- Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, NJ, United States
| | - Caroline M. Rafizadeh
- Kessler Foundation, East Hanover, NJ, United States,Department of Physical Medicine and Rehabilitation, New Jersey Medical School, Rutgers University, Newark, NJ, United States
| | - Mindy K. Ross
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, United States
| | - Alex Leow
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, United States
| | - John DeLuca
- Kessler Foundation, East Hanover, NJ, United States,Department of Physical Medicine and Rehabilitation, New Jersey Medical School, Rutgers University, Newark, NJ, United States
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19
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Chen MH, Leow A, Ross MK, DeLuca J, Chiaravalloti N, Costa SL, Genova HM, Weber E, Hussain F, Demos AP. Associations between smartphone keystroke dynamics and cognition in MS. Digit Health 2022; 8:20552076221143234. [PMID: 36506490 PMCID: PMC9730018 DOI: 10.1177/20552076221143234] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 11/17/2022] [Indexed: 12/12/2022] Open
Abstract
Objective Examine the associations between smartphone keystroke dynamics and cognitive functioning among persons with multiple sclerosis (MS). Methods Sixteen persons with MS with no self-reported upper extremity or typing difficulties and 10 healthy controls (HCs) completed six weeks of remote monitoring of their keystroke dynamics (i.e., how they typed on their smartphone keyboards). They also completed a comprehensive neuropsychological assessment and symptom ratings about fatigue, depression, and anxiety at baseline. Results A total of 1,335,787 keystrokes were collected, which were part of 30,968 typing sessions. The MS group typed slower (P < .001) and more variably (P = .032) than the HC group. Faster typing speed was associated with better performance on measures of processing speed (P = .016), attention (P = .022), and executive functioning (cognitive flexibility: P = .029; behavioral inhibition: P = .002; verbal fluency: P = .039), as well as less severe impact from fatigue (P < .001) and less severe anxiety symptoms (P = .007). Those with better cognitive functioning and less severe symptoms showed a stronger correlation between the use of backspace and autocorrection events (P < .001). Conclusion Typing speed may be sensitive to cognitive functions subserved by the frontal-subcortical brain circuits. Individuals with better cognitive functioning and less severe symptoms may be better at monitoring their typing errors. Keystroke dynamics have the potential to be used as an unobtrusive remote monitoring method for real-life cognitive functioning among persons with MS, which may improve the detection of relapses, evaluate treatment efficacy, and track disability progression.
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Affiliation(s)
- Michelle H Chen
- Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, NJ, USA,Department of Neurology, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, USA,Michelle H Chen, Institute for Health, Health Care Policy and Aging Research, Rutgers University, 112 Paterson St, New Brunswick,
NJ 08901, USA.
Alex Leow, Department of Psychiatry, University of Illinois at Chicago, 1601 W. Taylor St., SPHPI MC 912, Chicago, IL 60612, USA.
| | - Alex Leow
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
| | - Mindy K Ross
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
| | - John DeLuca
- Kessler Foundation, East Hanover, NJ, USA,Department of Physical Medicine and Rehabilitation, New Jersey Medical School, Rutgers University, Newark, NJ, USA
| | - Nancy Chiaravalloti
- Kessler Foundation, East Hanover, NJ, USA,Department of Physical Medicine and Rehabilitation, New Jersey Medical School, Rutgers University, Newark, NJ, USA
| | - Silvana L Costa
- Kessler Foundation, East Hanover, NJ, USA,Department of Physical Medicine and Rehabilitation, New Jersey Medical School, Rutgers University, Newark, NJ, USA
| | - Helen M Genova
- Kessler Foundation, East Hanover, NJ, USA,Department of Physical Medicine and Rehabilitation, New Jersey Medical School, Rutgers University, Newark, NJ, USA
| | - Erica Weber
- Kessler Foundation, East Hanover, NJ, USA,Department of Physical Medicine and Rehabilitation, New Jersey Medical School, Rutgers University, Newark, NJ, USA
| | - Faraz Hussain
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
| | - Alexander P Demos
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
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20
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Chiaravalloti ND, Weber E, Dobryakova E, Botticello A, Goverover Y, Moore NB, DeLuca J. Kessler Foundation Strategy-Based Training to Enhance Memory (KF-STEM™): Study protocol for a single site double-blind randomized, clinical trial in Multiple Sclerosis. Contemp Clin Trials Commun 2022; 30:101026. [PMID: 36387993 PMCID: PMC9641172 DOI: 10.1016/j.conctc.2022.101026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 09/29/2022] [Accepted: 10/26/2022] [Indexed: 11/06/2022] Open
Abstract
New learning and memory impairments are common in Multiple Sclerosis (MS) and negatively impact everyday life, including occupational and social functioning. Despite the demand for learning and memory treatments, few cognitive rehabilitation protocols are supported by Class I research evidence, limiting the degree to which effective treatments may be utilized with persons with MS. The present double-blind, placebo controlled randomized clinical trial (RCT) examines the efficacy of an 8-session cognitive rehabilitation protocol encompassing training in the application of three strategies with the strongest empirical evidence (self-generation, spaced learning and retrieval practice) to treat impaired learning and memory in persons with MS, Kessler Foundation Strategy-based Training to Enhance Memory (KF-STEM™). A sample of 120 participants with clinically definite MS who have impairments in new learning and memory will be enrolled. Outcomes will be assessed via three mechanisms, an Assessment of Global Functioning, which examines everyday functioning and quality of life, a Neuropsychological Evaluation to examine objective cognitive performance, and functional Magnetic Resonance Imaging to examine the impact of treatment on patterns of cerebral activation. We will additionally evaluate the longer-term efficacy of KF-STEM™ on everyday functioning and neuropsychological assessment through a 6-month follow-up evaluation and evaluate the impact of booster sessions in maintaining the treatment effect over time. The methodologically rigorous design of the current study will provide Class I evidence for the KF-STEM™ treatment protocol for persons with MS.
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21
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Sandroff BM, Motl RW, Román CAF, Wylie GR, DeLuca J, Cutter GR, Benedict RHB, Dwyer MG, Zivadinov R. Thalamic atrophy moderates associations among aerobic fitness, cognitive processing speed, and walking endurance in persons with multiple sclerosis. J Neurol 2022; 269:5531-5540. [PMID: 35718819 PMCID: PMC9474622 DOI: 10.1007/s00415-022-11205-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 03/15/2022] [Revised: 05/18/2022] [Accepted: 05/20/2022] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND OBJECTIVES Thalamic atrophy (TA) represents a biomarker of neurodegeneration and associated dysfunction/decline in physical and cognitive functioning among persons with multiple sclerosis (MS). Aerobic fitness, as an end point of exercise training, represents a promising target for restoring function in MS, but it is unknown if such effects differ by TA. This cross-sectional study examined whether aerobic fitness was differentially associated with cognitive processing speed and walking endurance in persons with MS who present with and without TA. METHODS 44 fully ambulatory persons with MS completed a graded exercise test for measuring aerobic fitness (VO2peak) and underwent 3T MRI for measuring TA, the Symbol Digit Modalities Test (SDMT), and the 6-min walk (6MW). We performed Spearman correlations (rs) among VO2peak, SDMT, and 6MW scores overall, and in persons with and without TA. We applied Fisher's z-test for comparing correlations based on TA status. RESULTS When controlling for age, EDSS score, and global MRI measures of atrophy, VO2peak was strongly associated with SDMT scores (prs = 0.74, p < 0.01) and 6MW performance (prs = 0.77, p < 0.01) in persons with TA, whereas VO2peak was not associated with SDMT scores (prs = - 0.01, p = 0.99) or 6MW performance (prs = 0.25, p = 0.38) in those without TA. The correlations between VO2peak and SDMT (z = 2.86, p < 0.01) and VO2peak and 6MW (z = 2.33, p = 0.02) were significantly stronger in the TA group. DISCUSSION This study provides initial evidence of strong, selective associations among aerobic fitness, cognitive processing speed, and walking endurance in persons with TA as a biomarker for MS-related neurodegeneration. Such data support TA as a moderator of the association among aerobic fitness, cognitive processing speed, and walking endurance in persons with MS. Future research should carefully consider the role of TA when designing trials of aerobic exercise, cognition, and mobility in MS.
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Affiliation(s)
- Brian M. Sandroff
- Center for Neuropsychology and Neuroscience Research, Kessler Foundation, 1199 Pleasant Valley Way, West Orange, NJ 07052, USA,Rutgers New Jersey Medical School, Newark, NJ, USA
| | | | - Cristina A. F. Román
- Center for Neuropsychology and Neuroscience Research, Kessler Foundation, 1199 Pleasant Valley Way, West Orange, NJ 07052, USA,Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Glenn R. Wylie
- Center for Neuropsychology and Neuroscience Research, Kessler Foundation, 1199 Pleasant Valley Way, West Orange, NJ 07052, USA,Rutgers New Jersey Medical School, Newark, NJ, USA
| | - John DeLuca
- Center for Neuropsychology and Neuroscience Research, Kessler Foundation, 1199 Pleasant Valley Way, West Orange, NJ 07052, USA,Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Gary R. Cutter
- University of Alabama at Birmingham, Birmingham, AL, USA
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22
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DeLuca J, Sandroff BM. Exoskeletons in MS rehabilitation are ready for widespread use in clinical practice: Commentary. Mult Scler 2022; 28:1671-1672. [DOI: 10.1177/13524585221102923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- John DeLuca
- Kessler Foundation, West Orange, NJ, USA/Department of Physical Medicine and Rehabilitation, New Jersey Medical School, Rutgers University, Newark, NJ, USA
| | - Brian M Sandroff
- Kessler Foundation, West Orange, NJ, USA/Department of Physical Medicine and Rehabilitation, New Jersey Medical School, Rutgers University, Newark, NJ, USA
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Román CAF, Wylie GR, DeLuca J, Yao B. Associations of White Matter and Basal Ganglia Microstructure to Cognitive Fatigue Rate in Multiple Sclerosis. Front Neurol 2022; 13:911012. [PMID: 35860487 PMCID: PMC9289668 DOI: 10.3389/fneur.2022.911012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 06/13/2022] [Indexed: 11/24/2022] Open
Abstract
Fatigue, including cognitive fatigue, is one of the most debilitating symptoms reported by persons with multiple sclerosis (pwMS). Cognitive fatigue has been associated with disruptions in striato-thalamo-cortical and frontal networks, but what remains unknown is how the rate at which pwMS become fatigued over time relates to microstructural properties within the brain. The current study aims to fill this gap in knowledge by investigating how cognitive fatigue rate relates to white matter and basal ganglia microstructure in a sample of 62 persons with relapsing-remitting MS. Participants rated their level of cognitive fatigue at baseline and after each block (x7) of a within-scanner cognitive fatigue inducing task. The slope of the regression line of all eight fatigue ratings was designated as “cognitive fatigue rate.” Diffusional kurtosis imaging maps were processed using tract-based spatial statistics and regional analyses (i.e., basal ganglia) and associated with cognitive fatigue rate. Results showed cognitive fatigue rate to be related to several white matter tracts, with many having been associated with basal ganglia connectivity or the previously proposed “fatigue network.” In addition, cognitive fatigue rate was associated with the microstructure within the putamen, though this did not survive multiple comparisons correction. Our approach of using cognitive fatigue rate, rather than trait fatigue, brings us closer to understanding how brain pathology may be impacting the experience of fatigue in the moment, which is crucial for developing interventions. These results hold promise for continuing to unpack the complex construct that is cognitive fatigue.
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Affiliation(s)
- Cristina A. F. Román
- Rocco Ortenzio Neuroimaging Center, Kessler Foundation, West Orange, NJ, United States
- Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, New Jersey, NJ, United States
| | - Glenn R. Wylie
- Rocco Ortenzio Neuroimaging Center, Kessler Foundation, West Orange, NJ, United States
- Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, New Jersey, NJ, United States
- Department of Veterans Affairs, The War Related Illness and Injury Center, New Jersey Healthcare System, East Orange, NJ, United States
| | - John DeLuca
- Rocco Ortenzio Neuroimaging Center, Kessler Foundation, West Orange, NJ, United States
- Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, New Jersey, NJ, United States
- Department of Neurology, Rutgers New Jersey Medical School, Newark, NJ, United States
- *Correspondence: John DeLuca
| | - Bing Yao
- Rocco Ortenzio Neuroimaging Center, Kessler Foundation, West Orange, NJ, United States
- Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, New Jersey, NJ, United States
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Wylie GR, Pra Sisto AJ, Genova HM, DeLuca J. Fatigue Across the Lifespan in Men and Women: State vs. Trait. Front Hum Neurosci 2022; 16:790006. [PMID: 35615746 PMCID: PMC9124897 DOI: 10.3389/fnhum.2022.790006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 04/19/2022] [Indexed: 11/13/2022] Open
Abstract
Objective Fatigue is commonly thought to worsen with age, but the literature is mixed: some studies show that older individuals experience more fatigue, others report the reverse. Some inconsistencies in the literature may be related to gender differences in fatigue while others may be due to differences in the instruments used to study fatigue, since the correlation between state (in the moment) and trait (over an extended period of time) measures of fatigue has been shown to be weak. The purpose of the current study was to examine both state and trait fatigue across age and gender using neuroimaging and self-report data. Methods We investigated the effects of age and gender in 43 healthy individuals on self-reported fatigue using the Modified Fatigue Impact Scale (MFIS), a measure of trait fatigue. We also conducted fMRI scans on these individuals and collected self-reported measures of state fatigue using the visual analog scale of fatigue (VAS-F) during a fatiguing task. Results There was no correlation between age and total MFIS score (trait fatigue) (r = –0.029, p = 0.873), nor was there an effect of gender [F(1,31) < 1]. However, for state fatigue, increasing age was associated with less fatigue [F(1,35) = 9.19, p < 0.01, coefficient = –0.4]. In the neuroimaging data, age interacted with VAS-F in the middle frontal gyrus. In younger individuals (20–32), more activation was associated with less fatigue, for individuals aged 33–48 there was no relationship, and for older individuals (55+) more activation was associated with more fatigue. Gender also interacted with VAS-F in several areas including the orbital, middle, and inferior frontal gyri. For women, more activation was associated with less fatigue while for men, more activation was associated with more fatigue. Conclusion Older individuals reported less fatigue during task performance (state measures). The neuroimaging data indicate that the role of middle frontal areas change across age: younger individuals may use these areas to combat fatigue, but this is not the case with older individuals. Moreover, these results may suggest greater resilience in females than males when faced with a fatiguing task.
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Affiliation(s)
- Glenn R. Wylie
- Kessler Foundation, Rocco Ortenzio Neuroimaging Center, West Orange, NJ, United States
- Department of Physical Medicine and Rehabilitation, New Jersey Medical School, Rutgers University, Newark, NJ, United States
- Department of Veterans’ Affairs, War Related Illness and Injury Study Center, New Jersey Healthcare System, East Orange, NJ, United States
- *Correspondence: Glenn R. Wylie,
| | - Amanda J. Pra Sisto
- Kessler Foundation, Rocco Ortenzio Neuroimaging Center, West Orange, NJ, United States
- Department of Physical Medicine and Rehabilitation, New Jersey Medical School, Rutgers University, Newark, NJ, United States
| | - Helen M. Genova
- Kessler Foundation, Rocco Ortenzio Neuroimaging Center, West Orange, NJ, United States
- Department of Physical Medicine and Rehabilitation, New Jersey Medical School, Rutgers University, Newark, NJ, United States
| | - John DeLuca
- Kessler Foundation, Rocco Ortenzio Neuroimaging Center, West Orange, NJ, United States
- Department of Physical Medicine and Rehabilitation, New Jersey Medical School, Rutgers University, Newark, NJ, United States
- Department of Neurology, New Jersey Medical School, Rutgers University, Newark, NJ, United States
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25
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Chiaravalloti ND, DeLuca J, Salter A, Amato MP, Brichetto G, Chataway J, Dalgas U, Farrell R, Feys P, Filippi M, Freeman J, Inglese M, Meza C, Moore NB, Motl RW, Rocca MA, Sandroff BM, Cutter G, Feinstein A. The relationship between processing speed and verbal and non-verbal new learning and memory in progressive multiple sclerosis. Mult Scler 2022; 28:1783-1792. [DOI: 10.1177/13524585221088190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: Processing speed (PS) deficits are the most common cognitive deficits in multiple sclerosis (MS), followed by learning and memory deficits, and are often an early cognitive problem. It has been argued that impaired PS is a primary consequence of MS, which in turn decreases learning. The current analysis examined the association between PS and learning in a large cohort of individuals with progressive MS. Methods: Baseline data from a randomized clinical trial on rehabilitation taking place at 11 centers across North America and Europe were analyzed. Participants included 275 individuals with clinically definite progressive MS (primary, secondary) consented into the trial. Results: Symbol Digit Modalities Test (SDMT) significantly correlated with California Verbal Learning Test-II (CVLT-II) ( r = 0.21, p = 0.0003) and Brief Visuospatial Memory Test–Revised (BVMT-R) ( r = 0.516, p < 0.0001). Receiver operating characteristic (ROC) analysis of the SDMT z score to distinguish between impaired and non-impaired CVLT-II performance demonstrated an area under the curve (AUC) of 0.61 (95% confidence interval (CI): 0.55–0.68) and a threshold of −1.62. ROC analysis between SDMT and BVMT-R resulted in an AUC of 0.77 (95% CI: 0.71–0.83) and threshold of −1.75 for the SDMT z score to predict impaired BVMT-R. Conclusion: Results indicate little ability beyond chance to predict CVLT-II from SDMT (61%), albeit statistically significant. In contrast, there was a 77% chance that the model could distinguish between impaired and non-impaired BVMT-R. Several potential explanations are discussed.
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Affiliation(s)
- Nancy D Chiaravalloti
- Kessler Foundation, East Hanover, NJ, USA/Department of Physical Medicine Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - John DeLuca
- Kessler Foundation, East Hanover, NJ, USA/Department of Physical Medicine Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Amber Salter
- Section on Statistical Planning and Analysis, Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Maria Pia Amato
- Department NEUROFARBA, Section Neurosciences, University of Florence, Florence, Italy/IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - Giampaolo Brichetto
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genoa, Italy/AISM Rehabilitation Service, Italian Multiple Sclerosis Society, Genoa, Italy
| | - Jeremy Chataway
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK/National Institute for Health Research, University College London Hospitals, Biomedical Research Centre, London, UK
| | - Ulrik Dalgas
- Exercise Biology, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Rachel Farrell
- Department of Neurorehabilitation, National Hospital for Neurology and Neurosurgery, London, UK/Department Neuroinflammation, UCL Queen Square Institute of Neurology, London, UK/National Institute for Health Research, University College London Hospitals, Biomedical Research Centre, London, UK
| | - Peter Feys
- REVAL, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy/Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy/Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy/Vita-Salute San Raffaele University, Milan, Italy
| | - Jennifer Freeman
- Faculty of Health, School of Health Professions, University of Plymouth, Devon, UK
| | - Matilde Inglese
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, and Center of Excellence for Biomedical Research, University of Genoa, Genoa, Italy/IRCCS Ospedale Policlinico San Martino-IRCCS, Genoa, Italy
| | - Cecilia Meza
- Department of Psychiatry, University of Toronto and Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | | | - Robert W Motl
- Department of Kinesiology and Nutrition, College of Applied Health Sciences, University of Illinois Chicago, Chicago, IL, USA
| | - Maria Assunta Rocca
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy/Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy/Vita-Salute San Raffaele University, Milan, Italy
| | - Brian M Sandroff
- Kessler Foundation, East Hanover, NJ, USA/Department of Physical Medicine Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Gary Cutter
- Department of Biostatistics, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Anthony Feinstein
- Department of Psychiatry, University of Toronto and Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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26
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Román CAF, DeLuca J, Yao B, Genova HM, Wylie GR. Signal Detection Theory as a Novel Tool to Understand Cognitive Fatigue in Individuals With Multiple Sclerosis. Front Behav Neurosci 2022; 16:828566. [PMID: 35368296 PMCID: PMC8966482 DOI: 10.3389/fnbeh.2022.828566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 02/21/2022] [Indexed: 11/13/2022] Open
Abstract
Multiple Sclerosis (MS) affects 2.8 million persons worldwide. One of the most persistent, pervasive, and debilitating symptoms of MS is cognitive fatigue. While this has been known for over a century, cognitive fatigue has been difficult to study because patients' subjective (self-reported) cognitive fatigue has consistently failed to correlate with more objective measures, such as reaction time (RT) and accuracy. Here, we investigated whether more nuanced metrics of performance, specifically the metrics of Signal Detection Theory (SDT), would show a relationship to cognitive fatigue even if RT and accuracy did not. We also measured brain activation to see whether SDT metrics were related to activation in brain areas that have been shown to be sensitive to cognitive fatigue. Fifty participants (30 MS, 20 controls) took part in this study and cognitive fatigue was induced using four blocks of a demanding working memory paradigm. Participants reported their fatigue before and after each block, and their performance was used to calculate SDT metrics (Perceptual Certainty and Criterion) and RT and accuracy. The results showed that the SDT metric of Criterion (i.e., response bias) was positively correlated with subjective cognitive fatigue. Moreover, the activation in brain areas previously shown to be related to cognitive fatigue, such as the striatum, was also related to Criterion. These results suggest that the metrics of SDT may represent a novel tool with which to study cognitive fatigue in MS and other neurological populations. These results hold promise for characterizing cognitive fatigue in MS and developing effective interventions in the future.
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Affiliation(s)
- Cristina A. F. Román
- Rocco Ortenzio Neuroimaging Center, Kessler Foundation, West Orange, NJ, United States
- Department of Physical Medicine and Rehabilitation, Rutgers University, Newark, NJ, United States
| | - John DeLuca
- Rocco Ortenzio Neuroimaging Center, Kessler Foundation, West Orange, NJ, United States
- Department of Physical Medicine and Rehabilitation, Rutgers University, Newark, NJ, United States
- Department of Neurology, New Jersey Medical School, Newark, NJ, United States
| | - Bing Yao
- Rocco Ortenzio Neuroimaging Center, Kessler Foundation, West Orange, NJ, United States
- Department of Physical Medicine and Rehabilitation, Rutgers University, Newark, NJ, United States
| | - Helen M. Genova
- Rocco Ortenzio Neuroimaging Center, Kessler Foundation, West Orange, NJ, United States
- Department of Physical Medicine and Rehabilitation, Rutgers University, Newark, NJ, United States
| | - Glenn R. Wylie
- Rocco Ortenzio Neuroimaging Center, Kessler Foundation, West Orange, NJ, United States
- Department of Physical Medicine and Rehabilitation, Rutgers University, Newark, NJ, United States
- Department of Veterans Affairs, The War Related Illness and Injury Center, New Jersey Healthcare System, East Orange, NJ, United States
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Goverover Y, Kim G, Chen MH, Volebel GT, Rosenfeld M, Botticello A, DeLuca J, Genova HM. The impact of the COVID-19 pandemic on engagement in activities of daily living in persons with acquired brain injury. Brain Inj 2022; 36:183-190. [PMID: 35213287 DOI: 10.1080/02699052.2022.2043441] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
PRIMARY OBJECTIVES This study examined (a) the impact of coronavirus disease-2019 (COVID-19) pandemic on engagement in activity participation in persons with acquired brain injury (ABI); and (b) whether changes in activity participation during the pandemic were associated participants' health-related quality of life (HRQoL). RESEARCH DESIGN Exploratory online survey study. METHODS Eighty-seven respondents with ABI and 98 healthy adults (HA) participated in this study. Engagement in activity participation during COVID-19 was calculated as a percentage of the activities participants performed before the pandemic. MAIN RESULTS Participants with ABI modified their activities less than HA in order to maintain level of engagement in activity participation. They stopped performing more activities during the pandemic compared to HA and compared to their pre-pandemic engagement. Both groups continued to do similar percentage of activities without modifications compared to before the pandemic. Better HRQoL in both groups was predicted by a larger percentage of activities continued and fewer activities stopped. CONCLUSION Results emphasize the importance of addressing activity participation changes during situations where there are disruptions of the individual's habits and routines in order to minimize negative consequences of such changes.
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Affiliation(s)
- Yael Goverover
- Department of Occupational Therapy, New York University, New York, USA.,Neuropsychology,Kessler Foundation, East Hanover, New Jersey, USA
| | - Grace Kim
- Department of Occupational Therapy, New York University, New York, USA
| | - Michelle H Chen
- Neuropsychology,Kessler Foundation, East Hanover, New Jersey, USA.,Department of Physical Medicine and Rehabilitation, New Jersey Medical School, Rutgers University, New Jersey, USA
| | - Gerald T Volebel
- Department of Occupational Therapy, New York University, New York, USA.,Center of Health and Rehabilitation Research University, New York University, New York
| | - Meirav Rosenfeld
- Department of Occupational Therapy, New York University, New York, USA
| | - Amanda Botticello
- Neuropsychology,Kessler Foundation, East Hanover, New Jersey, USA.,Department of Physical Medicine and Rehabilitation, New Jersey Medical School, Rutgers University, New Jersey, USA
| | - John DeLuca
- Neuropsychology,Kessler Foundation, East Hanover, New Jersey, USA.,Department of Physical Medicine and Rehabilitation, New Jersey Medical School, Rutgers University, New Jersey, USA
| | - Helen M Genova
- Neuropsychology,Kessler Foundation, East Hanover, New Jersey, USA.,Department of Physical Medicine and Rehabilitation, New Jersey Medical School, Rutgers University, New Jersey, USA
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Chiaravalloti ND, Costa SL, Moore NB, Costanza K, DeLuca J. The efficacy of speed of processing training for improving processing speed in individuals with multiple sclerosis: a randomized clinical trial. J Neurol 2022; 269:3614-3624. [PMID: 35150301 DOI: 10.1007/s00415-022-10980-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 10/06/2021] [Revised: 01/10/2022] [Accepted: 01/11/2022] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The current study examines the efficacy of speed of processing training (SOPT) to improve processing speed (PS) in individuals with multiple sclerosis (MS). Outcomes included changes in the useful field of view (UFOV) and neuropsychological evaluation (NPE). METHODS This double-blind, placebo-controlled randomized clinical trial included 84 participants with clinically definite MS and impaired PS, 43 in the treatment group and 41 in the placebo control group. Participants completed a baseline NPE and a repeat NPE post-treatment. The treatment group was randomized to booster sessions or no contact. Long-term follow-up assessments were completed 6 months after treatment. RESULTS A significant effect of SOPT was observed on both the UFOV (large effect) and pattern comparison with a similar pattern of results noted on letter comparison, albeit at a trend level. The treatment effect was maintained 6 months later. The impact of booster sessions was not significant. Correlations between degree of improvement on the UFOV and the number of levels completed within each training task were significant for both speed and divided attention indicating that completion of more levels of training correlated with greater benefit. CONCLUSION SOPT is effective for treating PS deficits in MS with benefit documented on both the UFOV and a neuropsychological measure of PS. Less benefit was observed as the outcome measures became more distinct in cognitive demands from the treatment. Long-term maintenance was observed. The number of training levels completed within the 10-sessions exerted a significant impact on treatment benefit, with more levels completed resulting in greater benefit.
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Affiliation(s)
- Nancy D Chiaravalloti
- Center for Neuropsychology and Neuroscience Research, Kessler Foundation, 120 Eagle Rock Avenue, Suite 100, East Hanover, NJ, 07936, USA. .,Department of Physical Medicine and Rehabilitation, Rutgers -New Jersey Medical School, Newark, NJ, 07103, USA.
| | - Silvana L Costa
- Center for Neuropsychology and Neuroscience Research, Kessler Foundation, 120 Eagle Rock Avenue, Suite 100, East Hanover, NJ, 07936, USA.,Department of Physical Medicine and Rehabilitation, Rutgers -New Jersey Medical School, Newark, NJ, 07103, USA
| | - Nancy B Moore
- Center for Neuropsychology and Neuroscience Research, Kessler Foundation, 120 Eagle Rock Avenue, Suite 100, East Hanover, NJ, 07936, USA
| | - Kristen Costanza
- Center for Neuropsychology and Neuroscience Research, Kessler Foundation, 120 Eagle Rock Avenue, Suite 100, East Hanover, NJ, 07936, USA
| | - John DeLuca
- Center for Neuropsychology and Neuroscience Research, Kessler Foundation, 120 Eagle Rock Avenue, Suite 100, East Hanover, NJ, 07936, USA.,Department of Physical Medicine and Rehabilitation, Rutgers -New Jersey Medical School, Newark, NJ, 07103, USA.,Department of Neurology and Neurosciences, Rutgers -New Jersey Medical School, Newark, NJ, 07103, USA
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29
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Chen MH, DeLuca J, Sandroff BM, Genova HM. Aquatic Exercise for Persons with MS: Patient-Reported Preferences, Obstacles and Recommendations. Mult Scler Relat Disord 2022; 60:103701. [DOI: 10.1016/j.msard.2022.103701] [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] [Received: 11/18/2021] [Revised: 01/28/2022] [Accepted: 02/19/2022] [Indexed: 11/30/2022]
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30
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Lequerica AH, Shoval HA, Yalamanchi K, Lengenfelder J, Marchetta C, Ace J, DeLuca J. Examining the Use of a Rest-Activity Ratio in a Pediatric Rehabilitation Setting. Arch Phys Med Rehabil 2022; 103:1766-1770. [PMID: 35093333 DOI: 10.1016/j.apmr.2021.12.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 11/18/2021] [Revised: 12/22/2021] [Accepted: 12/26/2021] [Indexed: 11/02/2022]
Abstract
OBJECTIVE To examine the relationship between an estimate of sleep/wake regulation derived from actigraphy would be sensitive to neurocognitive dysfunction associated with acquired brain injury (ABI) in a pediatric rehabilitation sample. DESIGN cross-sectional design SETTING: Inpatient pediatric rehabilitation facility PARTICIPANTS: A sample of 31 males (72.1%) and 12 females (27.9%) admitted to a pediatric rehabilitation hospital wore an actigraph (wrist accelerometer) for one week. Ages ranged from 8 to 17 years (M=13.1, SD=2.7). INTERVENTIONS not applicable MAIN OUTCOME MEASURE(S): Raw actigraphy activity counts in 1-minute epochs were used to derive a rest-activity ratio over each 24-hour period and a 5-day average value was calculated covering Monday through Friday. Brain injury status was derived through medical record review and three groups were formed: traumatic brain injury (n=14), non-traumatic brain injury (n=16), and a non-ABI control group (n=13). Functional status was measured using WeeFIM Cognitive and Motor scores extracted from the medical records. RESULTS Unadjusted models showed a significant main group effect for brain injury status (p=0.012). Compared with controls, the rest-activity ratio was significantly lower in both the traumatic brain injury (p = 0.005), and non-traumatic brain injury (p = 0.023) groups. However, the main group effect was no longer significant in an adjusted model controlling for WeeFIM Cognitive and WeeFIM Motor scores at admission. In the context of the adjusted model, there was a significant relationship between the rest-activity ratio and WeeFIM Cognitive scores at admission. CONCLUSIONS Individuals with lower functional status at admission, especially in the cognitive domain, had lower rest-activity ratios, suggesting poorer sleep/wake regulation. Similar to findings in adults with acquired brain injury, this ratio may have utility in tracking sleep/wake regulation in the pediatric rehabilitation setting. Future studies should investigate sensitivity to change over the course of recovery and responsiveness to clinical interventions to improve sleep.
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Affiliation(s)
- Anthony H Lequerica
- Center for Traumatic Brain Injury Research, Kessler Foundation, East Hanover, NJ, USA; Department of Physical Medicine and Rehabilitation, Rutgers - New Jersey Medical School, Newark, NJ, USA.
| | - Hannah Aura Shoval
- Physiatry Section (Medical), Children's Specialized Hospital, Mountainside, NJ, USA
| | - Krishan Yalamanchi
- Inpatient Rehabilitation Unit, Children's Specialized Hospital, New Brunswick, NJ, USA
| | - Jean Lengenfelder
- Center for Traumatic Brain Injury Research, Kessler Foundation, East Hanover, NJ, USA; Department of Physical Medicine and Rehabilitation, Rutgers - New Jersey Medical School, Newark, NJ, USA
| | - Claire Marchetta
- Children's Specialized Hospital Research Center, New Brunswick, NJ, USA
| | - Jessica Ace
- JFK-Johnson Rehabilitation Institute, Edison, NJ, USA
| | - John DeLuca
- Center for Traumatic Brain Injury Research, Kessler Foundation, East Hanover, NJ, USA; Department of Physical Medicine and Rehabilitation, Rutgers - New Jersey Medical School, Newark, NJ, USA
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Chen MH, Goverover Y, Botticello A, DeLuca J, Genova HM. Healthcare disruptions and use of telehealth services among persons with multiple sclerosis during the COVID-19 pandemic. Arch Phys Med Rehabil 2022; 103:1379-1386. [PMID: 35093328 PMCID: PMC8801263 DOI: 10.1016/j.apmr.2021.12.028] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 12/20/2021] [Accepted: 12/27/2021] [Indexed: 11/28/2022]
Abstract
Objective The current study examined health care disruptions and use of telehealth services among people with multiple sclerosis (pwMS) during the COVID-19 pandemic. Design Cross-sectional survey. Setting General community. Participants Participants (N=163) included 70 pwMS and 93 healthy controls (HCs). The majority of respondents were from the United States (88%). Interventions Not applicable. Main Outcome Measures Rates of health care disruptions (eg, missing/canceling appointments, experiencing delays) and telehealth use for MS and non-MS medical care and mental health care. Results In this U.S. majority, predominantly White, and high socioeconomic status sample, 38% to 50% of pwMS reported experiencing disruptions in their MS and non-MS medical care and 20% to 33% reported disruptions in their mental health care; this was significantly lower than the rates observed among HCs. Compared with HCs, pwMS were more likely to use telehealth than in-person services, especially for mental health care. The majority of pwMS and HCs reported being satisfied with telehealth services. Individuals with higher degrees of functional limitation experienced more health care disruptions and were more likely to use telehealth services than individuals with lower degrees of functional limitation. Conclusions Despite high health care disruption rates, pwMS frequently used and were highly satisfied with telehealth services during the COVID-19 pandemic. Due to physical limitations commonly observed in the MS population that may preclude travel, telehealth services should be continued even after resolution of the pandemic to expand access and reduce health care disparities.
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Affiliation(s)
- Michelle H Chen
- Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, NJ; Department of Neurology, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ
| | - Yael Goverover
- Department of Occupational Therapy, Steinhardt School of Culture, Education, and Human Development, New York University, NY
| | - Amanda Botticello
- Kessler Foundation, East Hanover, NJ; Department of Physical Medicine and Rehabilitation, New Jersey Medical School, Rutgers University, Newark, NJ
| | - John DeLuca
- Kessler Foundation, East Hanover, NJ; Department of Physical Medicine and Rehabilitation, New Jersey Medical School, Rutgers University, Newark, NJ
| | - Helen M Genova
- Kessler Foundation, East Hanover, NJ; Department of Physical Medicine and Rehabilitation, New Jersey Medical School, Rutgers University, Newark, NJ.
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32
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Hancock LM, Hermann B, Schoonheim MM, Hetzel SJ, Brochet B, DeLuca J. Comparing diagnostic criteria for the diagnosis of neurocognitive disorders in multiple sclerosis. Mult Scler Relat Disord 2022; 58:103479. [PMID: 35033839 DOI: 10.1016/j.msard.2021.103479] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [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: 11/30/2021] [Accepted: 12/31/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND People with multiple sclerosis (MS) commonly experience cognitive impairment associated with the disease, but there is currently no agreed-upon operational definition for identifying the presence of that impairment, in either research or clinic contexts. The International MS Cognition Society (IMSCOGS) established a task force to begin to examine this issue and this paper represents the results of an initial pilot investigation. The aim of this paper was to compare two criterion sets to determine how to identify cognitive impairment among people with MS: the general Diagnostic and Statistical Manual (DSM-5) Criteria for neurocognitive disorders and criteria derived from existing MS research (scores in two domains fall 1.5 standard deviations below normative controls). METHODS Two hundred and ten people with MS presented for a brief cognitive evaluation in an MS Multidisciplinary Clinic at a midwestern academic medical center in the United States. Participants were generally middle aged (average 51.5 years), female (73.8%), and white (93.3%). McNemar's test was computed to compare the number of individuals whose cognitive test score performance was deemed cognitively normal, mildly impaired, or more significantly impaired. RESULTS DSM-5 criteria classified 87.2% of the sample as cognitively impaired, where 66.7% were more mildly impaired and 20.5% more significantly impaired. By contrast, research-based criteria classified 63.3% of the sample as cognitively impaired, with 49.5% as mildly impaired and 13.8% as more significantly impaired. CONCLUSIONS These findings indicate that compared to research criteria, the DSM-5 criteria classified far more people with MS as having cognitive impairment secondary to the disease. The paper discusses the potential benefits and drawbacks of the two diagnostic methods, highlighting that more work will be needed in order to establish a standardized and validated method for characterizing these impairments.
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Affiliation(s)
- Laura M Hancock
- University of Wisconsin School of Medicine and Public Health, Department of Neurology, 1685 Highland Avenue, MCFB Suite 7, Madison, Wisconsin 53705, USA; William S. Middleton VA Medical Center; 2500 Overlook Terrace, Madison, Wisconsin 53705, USA.
| | - Bruce Hermann
- University of Wisconsin School of Medicine and Public Health, Department of Neurology, 1685 Highland Avenue, MCFB Suite 7, Madison, Wisconsin 53705, USA.
| | - Menno M Schoonheim
- Department of Anatomy and Neurosciences, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, PO Box 7057, 1007MB, Amsterdam, The Netherlands.
| | - Scott J Hetzel
- University of Wisconsin School of Medicine and Public Health, Department of Biostatistics and Medical Informatics, WARF Room 201, 610 Walnut Street, Madison, Wisconsin 53726, USA.
| | - Bruno Brochet
- Neurocentre Magendie, INSERM U 1215, Université de Bordeaux, 146, rue Léo Saignat, 33077 Bordeaux cedex, France.
| | - John DeLuca
- Kessler Foundation, 1199 Pleasant Valley Way, West Orange, New Jersey 07052, USA; Rutgers, New Jersey Medical School, Department of Physical Medicine and Rehabilitation, 185 S Orange Ave, Newark, New Jersey 07103, USA.
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Abstract
Siponimod is a selective sphingosine 1-phosphate receptor subtype 1 (S1P1) and 5 (S1P5) modulator approved in the United States and the European Union as an oral treatment for adults with relapsing forms of multiple sclerosis (RMS), including active secondary progressive multiple sclerosis (SPMS). Preclinical and clinical studies provide support for a dual mechanism of action of siponimod, targeting peripherally mediated inflammation and exerting direct central effects. As an S1P1 receptor modulator, siponimod reduces lymphocyte egress from lymph nodes, thus inhibiting their migration from the periphery to the central nervous system. As a result of its peripheral immunomodulatory effects, siponimod reduces both magnetic resonance imaging (MRI) lesion (gadolinium-enhancing and new/enlarging T2 hyperintense) and relapse activity compared with placebo. Independent of these effects, siponimod can penetrate the blood-brain barrier and, by binding to S1P1 and S1P5 receptors on a variety of brain cells, including astrocytes, oligodendrocytes, neurons, and microglia, exert effects to modulate neural inflammation and neurodegeneration. Clinical data in patients with SPMS have shown that, compared with placebo, siponimod treatment is associated with reductions in levels of neurofilament light chain (a marker of neuroaxonal damage) and thalamic and cortical gray matter atrophy, with smaller reductions in MRI magnetization transfer ratio and reduced confirmed disability progression. This review examines the preclinical and clinical data supporting the dual mechanism of action of siponimod in RMS.
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Affiliation(s)
- Stanley L Cohan
- Providence Multiple Sclerosis Center, Providence Brain Institute, 9135 SW Barnes Rd Suite 461, Portland, OR, 97225, USA.
| | | | - Bruce A C Cree
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | | | - Le H Hua
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, USA
| | - Jerold Chun
- Sanford Burnham Prebys Medical Discovery Institute, La Jolla, CA, USA
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Goverover Y, Chen MH, Botticello A, Voelbel GT, Kim G, DeLuca J, Genova HM. Relationships between changes in daily occupations and health-related quality of life in persons with multiple sclerosis during the COVID-19 pandemic. Mult Scler Relat Disord 2022; 57:103339. [PMID: 35158428 PMCID: PMC8522683 DOI: 10.1016/j.msard.2021.103339] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 09/29/2021] [Accepted: 10/15/2021] [Indexed: 01/26/2023]
Abstract
Background: The COVID-19 pandemic provided a unique opportunity to explore the impact of the mandated lockdown and social distancing policies on engagement in daily occupations for individuals with multiple sclerosis (MS) and able bodied (i.e. healthy) adults. The study also examined whether the changes in daily occupations were associated with health-related quality of life (HrQOL). Methods: Between the spring and early fall of 2020, 69 persons with MS and 95 healthy adults completed an online survey that included measurements of 26 activities of daily life. For each activity, participants reported whether they continued to perform the activity (with or without adjustments), whether they stopped, or started to perform the activity during the pandemic. Social support, HrQOL, and demographics, including financial distress were also obtained. Results: Participants with MS and healthy adults both reduced the number of activities performed during the pandemic. Healthy adults continued to do more activities with and without adjustments compared with participants with MS. In both groups, better HrQOL was associated with the number of activities participants continued to do with and without adjustments, and worse HrQOL with the number of activities they stopped doing. Conclusions: Fewer persons with MS engaged in everyday occupations than healthy adults following the COVID-19 pandemic. The ability to maintain occupational engagement and to participate in social and daily activities is important for maintaining high HrQOL in both groups. Thus, these results call for attention in treatment and self-management of MS symptomatology.
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Strober LB, Bruce JM, Arnett PA, Alschuler KN, DeLuca J, Chiaravalloti N, Lebkuecher A, Di Benedetto M, Cozart J, Thelen J, Cadden M, Guty E, Román CAF. A much needed metric: Defining reliable and statistically meaningful change of the oral version Symbol Digit Modalities Test (SDMT). Mult Scler Relat Disord 2021; 57:103405. [PMID: 34923428 DOI: 10.1016/j.msard.2021.103405] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [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: 08/05/2021] [Revised: 10/31/2021] [Accepted: 11/13/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND The Symbol Digit Modalities Test (SDMT) has been recommended for use in clinical trials and outcome studies to monitor cognitive change. However, defining what is a meaningful change has been elusive for several years. OBJECTIVE The present investigation aimed to develop methods for assessing individual-level statistically significant change on the SDMT - reliable change indices (RCIs) and standardized regression-based (SRB) equations. METHODS A total of 219 healthy individuals completed the oral version SDMT at baseline, 6-month and 1-year follow-up. RESULTS The SDMT demonstrated high reliability across all time points (r's = 0.83 to 0.86). Reliable change scores of 7, 8, and 10 points for the 6-month intervals represented statistically meaningful change at the 0.70, 0.80, and 0.90 confidence intervals, respectively. Over 1-year, a difference of 8, 10, and 12 was statistically meaningful at the 0.70, 0.80, and 0.90 confidence intervals, respectively. SRB equations are also provided taking into account additional factors found to be predictive of SDMT scores over time. CONCLUSION Clinicians frequently denote a decline of 4 points on the SDMT as meaningful. Results in this large normative sample show that higher cut-points are needed to demonstrate statistically significant decline at the individual level. RCIs are provided for 6 month and one year assessment, which is typical in clinical practice and trials. SRB equations are also provided for use when applicable and may provide a more precise assessment of meaningful change.
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Affiliation(s)
- L B Strober
- Kessler Foundation, West Orange, NJ, USA; Rutgers, the State University of New Jersey, New Jersey Medical School, Department of Physical Medicine and Rehabilitation.
| | - J M Bruce
- University of Missouri-Kansas City School of Medicine, Department of Biomedical and Health Informatics
| | - P A Arnett
- The Pennsylvania State University, Department of Psychology
| | - K N Alschuler
- University of Washington, School of Medicine, Department of Rehabilitation Medicine; University of Washington, School of Medicine, Department of Neurology, UW Multiple Sclerosis Center
| | - J DeLuca
- Kessler Foundation, West Orange, NJ, USA; Rutgers, the State University of New Jersey, New Jersey Medical School, Department of Physical Medicine and Rehabilitation
| | - N Chiaravalloti
- Kessler Foundation, West Orange, NJ, USA; Rutgers, the State University of New Jersey, New Jersey Medical School, Department of Physical Medicine and Rehabilitation
| | | | | | - J Cozart
- University of Missouri-Kansas City School of Medicine, Department of Biomedical and Health Informatics
| | - J Thelen
- University of Missouri-Kansas City School of Medicine, Department of Biomedical and Health Informatics
| | - M Cadden
- The Pennsylvania State University, Department of Psychology; Harvard Medical School, Massachusetts General Hospital/Brigham and Women's Hospital
| | - E Guty
- The Pennsylvania State University, Department of Psychology
| | - C A F Román
- Kessler Foundation, West Orange, NJ, USA; The Pennsylvania State University, Department of Psychology
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Sandroff BM, Motl RW, Amato MP, Brichetto G, Chataway J, Chiaravalloti ND, Cutter GR, Dalgas U, DeLuca J, Farrell R, Feys P, Filippi M, Freeman J, Inglese M, Meza C, Rocca MA, Salter A, Feinstein A. Cardiorespiratory fitness and free-living physical activity are not associated with cognition in persons with progressive multiple sclerosis: Baseline analyses from the CogEx study. Mult Scler 2021; 28:1091-1100. [PMID: 34595972 DOI: 10.1177/13524585211048397] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Aerobic exercise training (physical activity for improving cardiorespiratory fitness) represents a promising approach for managing cognitive impairment in multiple sclerosis (MS). However, there is limited evidence that levels of physical activity and fitness are associated with cognition in progressive MS. OBJECTIVE We examined associations among cardiorespiratory fitness, moderate-to-vigorous physical activity (MVPA), and cognitive performance in a large, international progressive MS sample. METHODS Two hundred forty European and North American persons with progressive MS underwent cardiorespiratory fitness measurement on a recumbent stepper, wore an ActiGraph GT3X + accelerometer for 7 days for measuring MVPA, and underwent the Brief International Cognitive Assessment in MS. RESULTS Cardiorespiratory fitness was not significantly correlated with Symbol Digit Modalities Test (SDMT; r = -0.01; r = -0.04), California Verbal Learning Test-II (CVLT-II; r = 0.05; r = 0.05), or Brief Visuospatial Memory Test-Revised (BVMT-R; r = -0.14; r = -0.14) z-scores controlling for age, sex, and education. MVPA and SDMT (r = 0.05), CVLT-II (r = -0.07), and BVMT-R (r = 0.01) z-scores were not significantly correlated. CONCLUSION Cardiorespiratory fitness and MVPA were not associated with cognition in this large progressive MS sample, yet these outcomes represent critical manipulation checks for documenting the success of the CogEx trial. This highlights the importance of examining other exercise-related mechanisms-of-action for improving cognition in progressive MS.
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Affiliation(s)
- Brian M Sandroff
- Kessler Foundation, 1199 Pleasant Valley Way, West Orange, NJ 07052, USA.,Kessler Foundation, West Orange, NJ, USA/Department of Physical Medicine & Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Robert W Motl
- Department of Physical Therapy, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Maria Pia Amato
- Department NEUROFARBA, Section Neurosciences, University of Florence, Florence, Italy/Fondazione IRCCS Don Carlo Gnocchi ONLUS, Florence, Italy
| | - Giampaolo Brichetto
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genoa, Italy/AISM Rehabilitation Service, Italian Multiple Sclerosis Society, Genoa, Italy
| | - Jeremy Chataway
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK/National Institute for Health Research, Biomedical Research Centre, University College London Hospitals, London, UK
| | - Nancy D Chiaravalloti
- Kessler Foundation, West Orange, NJ, USA/Department of Physical Medicine & Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Gary R Cutter
- Department of Biostatistics, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ulrik Dalgas
- Exercise Biology, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - John DeLuca
- Kessler Foundation, West Orange, NJ, USA/Department of Physical Medicine & Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Rachel Farrell
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
| | - Peter Feys
- Rehabilitation Research Center (REVAL), Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, Neurology Unit, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | | | - Matilde Inglese
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy/IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Cecilia Meza
- Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Maria A Rocca
- Neuroimaging Research Unit, Division of Neuroscience, Neurology Unit, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Amber Salter
- The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Anthony Feinstein
- Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
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Wender CLA, Sandroff BM, Krch D, Wylie G, Cirnigliaro CM, Wecht J, Chiaravalloti ND, DeLuca J. The preliminary effects of moderate aerobic training on cognitive function in people with TBI and significant memory impairment: a proof-of-concept randomized controlled trial. Neurocase 2021; 27:430-435. [PMID: 34704543 DOI: 10.1080/13554794.2021.1990964] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
This single-blinded RCT investigated cognitive effects of aerobic exercise in persons with TBI-related memory impairment. Five participants . were randomly assigned to 12-weeks of either supervised moderate intensity aerobic cycling or an active control. Outcome measures included neuropsychological assessments and structural neuroimaging (MRI,). The exercise group demonstrated greater improvements on auditory verbal learning (RAVLT; d=1.54) and processing speed (SDMT; d=1.58). The exercise group showed larger increases in volume of the left hippocampus (d=1.49) and right thalamus (d=1.44). These pilot data suggest that 12-weeks of moderate intensity aerobic cycling may improve memory and processing speed in those with TBI-related memory impairments.
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Affiliation(s)
- Carly L A Wender
- Center for Traumatic Brain Injury Research, Kessler Foundation, East Hanover, USA.,Department of Physical Medicine and Rehabilitation, Rutgers-NJ Medical School, Newark, USA
| | - Brian M Sandroff
- Department of Physical Medicine and Rehabilitation, Rutgers-NJ Medical School, Newark, USA.,Center for Neuropsychology & Neuroscience Research, Kessler Foundation, West Orange, USA
| | - Denise Krch
- Center for Traumatic Brain Injury Research, Kessler Foundation, East Hanover, USA.,Department of Physical Medicine and Rehabilitation, Rutgers-NJ Medical School, Newark, USA
| | - Glenn Wylie
- Department of Physical Medicine and Rehabilitation, Rutgers-NJ Medical School, Newark, USA.,Rocco Ortenzio Neuroimaging Center, Kessler Foundation, West Orange, USA.,War Related Illness and Injury Study Center, West Orange, United States
| | - Christopher M Cirnigliaro
- Center for Neuropsychology & Neuroscience Research, Kessler Foundation, West Orange, USA.,The Department of Veteran's Affairs, Rr&d National Center for the Medical Consequences of Sci, Department of Veterans Affairs Rehabilitation Research & Development Service, National Center for the Medical Consequences of Spinal Cord Injury, East Orange, USA
| | - Jill Wecht
- James J. Peters VAMC, New York, USA.,Department of Medicine and Rehabilitation Medicine, The Icahn School of Medicine, New York, USA
| | - Nancy D Chiaravalloti
- Center for Traumatic Brain Injury Research, Kessler Foundation, East Hanover, USA.,Department of Physical Medicine and Rehabilitation, Rutgers-NJ Medical School, Newark, USA.,Center for Neuropsychology & Neuroscience Research, Kessler Foundation, West Orange, USA
| | - John DeLuca
- Center for Traumatic Brain Injury Research, Kessler Foundation, East Hanover, USA.,Department of Physical Medicine and Rehabilitation, Rutgers-NJ Medical School, Newark, USA.,Center for Neuropsychology & Neuroscience Research, Kessler Foundation, West Orange, USA
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Natsheh JY, DeLuca J, Costa SL, Chiaravalloti ND, Dobryakova E. Methylphenidate may improve mental fatigue in individuals with multiple sclerosis: A pilot clinical trial. Mult Scler Relat Disord 2021; 56:103273. [PMID: 34564057 DOI: 10.1016/j.msard.2021.103273] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 03/23/2021] [Revised: 09/11/2021] [Accepted: 09/19/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Fatigue is the most common symptom in multiple sclerosis (MS), previously attributed to dopamine imbalance. Evidence suggests that methylphenidate, a psychostimulant that increases striatal and prefrontal dopamine levels, is effective in reducing fatigue in various disorders. However, its effect on state vs. trait mental fatigue in MS is yet to be examined. METHODS This pilot study investigates the efficacy of methylphenidate on decreasing self-reported mental fatigue in 12 individuals with MS in a double-blind, placebo-controlled, cross-over randomized clinical trial. RESULTS Our results show that "state", but not "trait" MS-related fatigue, was reduced after 4 weeks of methylphenidate administration as compared to placebo.
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Affiliation(s)
- J Y Natsheh
- Kessler Foundation, 120 Eagle Rock Ave, Suite 100, East Hanover, NJ 07936, USA; Children's Specialized Hospital Research Center, New Brunswick, NJ, USA; Departments of Physical Medicine and Rehabilitation; and Neurology, Rutgers, New Jersey Medical School, Newark, NJ, USA; Palestinian Neuroscience Initiative, Al-Quds University, Jerusalem, Palestine.
| | - J DeLuca
- Kessler Foundation, 120 Eagle Rock Ave, Suite 100, East Hanover, NJ 07936, USA; Departments of Physical Medicine and Rehabilitation; and Neurology, Rutgers, New Jersey Medical School, Newark, NJ, USA
| | - S L Costa
- Kessler Foundation, 120 Eagle Rock Ave, Suite 100, East Hanover, NJ 07936, USA; Departments of Physical Medicine and Rehabilitation; and Neurology, Rutgers, New Jersey Medical School, Newark, NJ, USA
| | - N D Chiaravalloti
- Kessler Foundation, 120 Eagle Rock Ave, Suite 100, East Hanover, NJ 07936, USA; Departments of Physical Medicine and Rehabilitation; and Neurology, Rutgers, New Jersey Medical School, Newark, NJ, USA
| | - E Dobryakova
- Kessler Foundation, 120 Eagle Rock Ave, Suite 100, East Hanover, NJ 07936, USA; Departments of Physical Medicine and Rehabilitation; and Neurology, Rutgers, New Jersey Medical School, Newark, NJ, USA.
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Gromisch ES, DeLuca J, Benedict RH, Foley FW. Managing Cognitive Dysfunction in Multiple Sclerosis: A Snapshot of Changes in Screening, Assessment, and Treatment Practices. Int J MS Care 2021; 24:104-109. [DOI: 10.7224/1537-2073.2020-139] [Citation(s) in RCA: 1] [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: 11/18/2022]
Abstract
Abstract
Background: Cognitive dysfunction is prevalent in multiple sclerosis (MS) and can have a negative effect on several aspects of the daily lives of persons with MS. In 2010, members of the Consortium of Multiple Sclerosis Centers (CMSC) were surveyed to understand MS clinicians’ screening, assessment, and treatment practices for cognitive problems. Given the advancements made in the field in the past decade, it was deemed time to reevaluate how cognitive dysfunction is managed in the clinical setting.
Methods: An online questionnaire was completed by 56 CMSC members in which they were asked to describe their clinical practices, procedures for screening and further evaluation, and treatment recommendations for cognitive dysfunction. Participants were also asked whether their practice had changed in terms of the number of cognitive screenings, prescriptions for cognitive problems, and referrals for neuropsychological assessment and cognitive remediation in the past 5 years to allow for clinicians who had not been in practice for 10 years.
Results: Participants reported an increase in the number of cognitive screenings and referrals for neuropsychological assessments and cognitive remediation during the past 5 years. Compared with 2010, participants endorsed greater use of person-administered screening measures, such as the Symbol Digit Modalities Test, and fewer prescriptions for medications to improve cognitive functioning.
Conclusions: Clinical practices are becoming more in line with the literature, with increased use of cognitive screening and remediation. Continued attention to cognitive problems will be an ongoing important component of MS-related care.
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Affiliation(s)
- Elizabeth S. Gromisch
- From the Mandell Center for Multiple Sclerosis, Mount Sinai Rehabilitation Hospital, Trinity Health Of New England, Hartford, CT, USA (ESG); Department of Neurology, University of Connecticut School of Medicine, Farmington, CT, USA (ESG); Departments of Rehabilitative Medicine and Medical Sciences, Frank H. Netter MD School of Medicine at Quinnipiac University, North Haven, CT, USA (ESG); Kessler
| | - John DeLuca
- From the Mandell Center for Multiple Sclerosis, Mount Sinai Rehabilitation Hospital, Trinity Health Of New England, Hartford, CT, USA (ESG); Department of Neurology, University of Connecticut School of Medicine, Farmington, CT, USA (ESG); Departments of Rehabilitative Medicine and Medical Sciences, Frank H. Netter MD School of Medicine at Quinnipiac University, North Haven, CT, USA (ESG); Kessler
| | - Ralph H.B. Benedict
- From the Mandell Center for Multiple Sclerosis, Mount Sinai Rehabilitation Hospital, Trinity Health Of New England, Hartford, CT, USA (ESG); Department of Neurology, University of Connecticut School of Medicine, Farmington, CT, USA (ESG); Departments of Rehabilitative Medicine and Medical Sciences, Frank H. Netter MD School of Medicine at Quinnipiac University, North Haven, CT, USA (ESG); Kessler
| | - Frederick W. Foley
- From the Mandell Center for Multiple Sclerosis, Mount Sinai Rehabilitation Hospital, Trinity Health Of New England, Hartford, CT, USA (ESG); Department of Neurology, University of Connecticut School of Medicine, Farmington, CT, USA (ESG); Departments of Rehabilitative Medicine and Medical Sciences, Frank H. Netter MD School of Medicine at Quinnipiac University, North Haven, CT, USA (ESG); Kessler
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Sandroff BM, Wylie GR, Baird JF, Jones CD, Diggs MD, Genova H, Bamman MM, Cutter GR, DeLuca J, Motl RW. Effects of walking exercise training on learning and memory and hippocampal neuroimaging outcomes in MS: A targeted, pilot randomized controlled trial. Contemp Clin Trials 2021; 110:106563. [PMID: 34496278 DOI: 10.1016/j.cct.2021.106563] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 06/01/2021] [Revised: 07/26/2021] [Accepted: 09/03/2021] [Indexed: 01/21/2023]
Abstract
PURPOSE The current pilot study involved a single-blind, randomized controlled trial (RCT) on the effects of treadmill walking exercise training compared with an active control condition on learning and memory (L/M) and hippocampal neuroimaging outcomes in 11 fully-ambulatory persons with multiple sclerosis (MS) who demonstrated impairments in new learning. METHODS The study protocol is registered at clinicaltrials.gov: NCT03319771 (February 2018). Eleven fully-ambulatory persons with MS-related impairments in new learning were randomly assigned into either 12-weeks of supervised, treadmill walking exercise training or 12-weeks of low-intensity resistive exercise (active control condition). Participants underwent neuropsychological tests of L/M and hippocampal neuroimaging before and after the 12-week study period; outcomes were administered by treatment-blinded assessors. RESULTS There were moderate-to-large intervention effects on measures of verbal L/M (ηp2 = 0.11, d = 0.63, 95% CI: -0.61, 1.83), whereby those in the intervention condition demonstrated improvement in California Verbal Learning Test-II (CVLT-II) scores compared with the control condition. There were smaller effects on a composite L/M measure (ηp2 = 0.02, d = 0.28, 95% CI: -0.93, 1.46). There were large intervention effects on normalized hippocampal volume (ηp2 = 0.36, d = 1.13, 95% CI: 0.09, 2.82), whereby hippocampal volume was preserved in the intervention condition, compared with hippocampal atrophy in the control condition. By comparison, there were no intervention effects on hippocampal resting-state functional connectivity. CONCLUSIONS Collectively, this study provides initial proof-of-concept data for further examining treadmill walking exercise training as a possible behavioral approach for managing L/M impairment and preserving hippocampal volume as common and debilitating manifestations of MS.
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Affiliation(s)
- Brian M Sandroff
- Kessler Foundation, Center for Neuropsychology and Neuroscience Research, West Orange, NJ, United States of America; Department of Physical Medicine & Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, USA.
| | - Glenn R Wylie
- Kessler Foundation, Center for Neuropsychology and Neuroscience Research, West Orange, NJ, United States of America; Department of Physical Medicine & Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Jessica F Baird
- University of Alabama at Birmingham, Department of Physical Therapy, Birmingham, AL, United States of America
| | - C Danielle Jones
- University of Alabama at Birmingham, Department of Physical Therapy, Birmingham, AL, United States of America
| | - M David Diggs
- University of Georgia, Department of Kinesiology, Athens, GA, United States of America
| | - Helen Genova
- Kessler Foundation, Center for Neuropsychology and Neuroscience Research, West Orange, NJ, United States of America; Department of Physical Medicine & Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Marcas M Bamman
- University of Alabama at Birmingham, Departments of Cell, Developmental, & Integrative Biology; Medicine; and Neurology, Birmingham, AL, United States of America
| | - Gary R Cutter
- University of Alabama at Birmingham, Department of Biostatistics, Birmingham, AL, United States of America
| | - John DeLuca
- Kessler Foundation, Center for Neuropsychology and Neuroscience Research, West Orange, NJ, United States of America; Department of Physical Medicine & Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Robert W Motl
- University of Alabama at Birmingham, Department of Physical Therapy, Birmingham, AL, United States of America
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Malloy S, Genova H, Chiaravalloti N, DeLuca J, Holtzheimer P, Wylie GR. Cognitive fatigue in traumatic brain injury: a pilot study comparing state and trait fatigue. Brain Inj 2021; 35:1254-1258. [PMID: 34487467 DOI: 10.1080/02699052.2021.1972144] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Cognitive fatigue is a common and disabling symptom following a traumatic brain injury (TBI). Literature on cognitive fatigue has distinguished between two types of fatigue: "state" fatigue refers to the acute experience of fatigue, whereas "trait" fatigue refers to the susceptibility to fatigue over an extended period. However, it is not clear whether state and trait fatigue are distinguishable constructs. Here, we examine the relationship between state and trait fatigue in individuals with TBI, hypothesizing that trait and state measures assess different constructs. PARTICIPANTS Twenty-one participants with moderate-severe TBI were recruited. DESIGN Participants underwent a cognitively fatiguing task while in an MRI scanner and completed self-report measures examining trait and state fatigue. RESULTS No correlation was found between state and trait fatigue. However, the two measures of trait fatigue, Fatigue Severity Scale (FSS) and the Modified Fatigue Impact Scale (MFIS), correlated with one another; additionally only trait fatigue correlated with depression scores, consistent with the literature. CONCLUSION These findings suggest that trait and state fatigue may not be interdependent and that it is important to carefully define the type of fatigue under consideration when assessing fatigue in individuals with TBI.
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Affiliation(s)
- S Malloy
- Geisel School of Medicine at Dartmouth, Departments of Psychiatry and Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA.,National Center for Posttraumatic Stress Disorder, Veterans Affairs Medical Center (116d), White River Junction, Vermont, USA.,Beth Israel Deaconess Medical Center, Department of General Medicine, Division of Research, Boston, Massachusetts, USA
| | - H Genova
- Kessler Foundation, West Orange, USA.,Department of Physical Medicine and Rehabilitation, Rutgers University, Newark, New Jersey, USA
| | - N Chiaravalloti
- Kessler Foundation, West Orange, USA.,Department of Physical Medicine and Rehabilitation, Rutgers University, Newark, New Jersey, USA
| | - J DeLuca
- Kessler Foundation, West Orange, USA.,Department of Physical Medicine and Rehabilitation, Rutgers University, Newark, New Jersey, USA.,Department of Neurology, Rutgers University, Newark, New Jersey, USA
| | - P Holtzheimer
- Geisel School of Medicine at Dartmouth, Departments of Psychiatry and Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA.,National Center for Posttraumatic Stress Disorder, Veterans Affairs Medical Center (116d), White River Junction, Vermont, USA
| | - G R Wylie
- Kessler Foundation, West Orange, USA.,Department of Physical Medicine and Rehabilitation, Rutgers University, Newark, New Jersey, USA.,The Department of Veterans' Affairs, The War Related Illness and Injury Center, New Jersey Healthcare System, East Orange, New Jersey, USA
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Goverover Y, Stern BZ, Hurst A, DeLuca J. Internet-based technology in multiple sclerosis: Exploring perceived use and skills and actual performance. Neuropsychology 2021; 35:69-77. [PMID: 33393801 DOI: 10.1037/neu0000695] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE The use of Internet-based technology (IBT) is an important component of everyday living. However, persons with multiple sclerosis (MS) may face barriers to use. This study aimed to compare IBT perceived use and skills and actual performance in persons with MS and healthy controls (HCs). In addition, it aimed to examine IBT perceptions as a unique predictor of IBT performance beyond demographic, cognitive, motor, and affective factors in persons with MS. METHOD Ninety-six persons with MS and 65 HCs aged 18 to 65 completed self-report and performance-based IBT measures along with assessments of cognition, motor function, and affect at a single time point. RESULTS The MS group reported perceptions of less IBT use and poorer skills than HCs and demonstrated worse IBT performance as per accuracy and speed on the Actual Reality. In persons with MS, IBT perceptions and performance were significantly associated. Cognition and dexterity were significantly associated with IBT performance, and anxiety was associated with IBT perceptions. Disease duration, processing speed, and IBT perceptions were unique predictors of IBT performance in the MS group within a multivariate model. CONCLUSION Persons with MS present with poorer IBT performance compared with HCs, which can limit participation. Processing speed and patient perceptions of IBT use and skills should be considered in technology design and training to improve the capabilities of persons with MS to use IBT for everyday living. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
- Yael Goverover
- Department of Occupational Therapy, Steinhardt School of Culture, Education, and Human Development, New York University
| | - Brocha Z Stern
- Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School
| | - Amy Hurst
- Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School
| | - John DeLuca
- Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School
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Androwis GJ, Sandroff BM, Niewrzol P, Fakhoury F, Wylie GR, Yue G, DeLuca J. A pilot randomized controlled trial of robotic exoskeleton-assisted exercise rehabilitation in multiple sclerosis. Mult Scler Relat Disord 2021; 51:102936. [PMID: 33878619 DOI: 10.1016/j.msard.2021.102936] [Citation(s) in RCA: 4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 02/21/2021] [Accepted: 03/29/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Co-occurring mobility and cognitive impairments are common, debilitating, and poorly-managed with pharmacological therapies in persons with multiple sclerosis (MS). Exercise rehabilitation (ER), particularly walking ER, has been suggested as one of the best approaches for managing these manifestations of MS. However, there is a focal lack of efficacy of ER on mobility and cognitive outcomes in persons with MS who present with substantial neurological disability. Such severe neurological disability oftentimes precludes the ability for participation in highly-intensive and repetitive ER that is necessary for eliciting adaptations in mobility and cognition. To address such a concern, robotic exoskeleton-assisted ER (REAER) might represent a promising intervention approach for managing co-occurring mobility and cognitive impairments in those with substantial MS disability who might not benefit from traditional ER. METHODS The current pilot single-blind, randomized controlled trial (RCT) compared the effects of 4-weeks of REAER with 4-weeks of conventional gait training (CGT) as a standard-of-care control condition on functional mobility (timed up-and-go; TUG), walking endurance (six-minute walk test; 6MWT), cognitive processing speed (CPS; Symbol Digit Modalities Test; SDMT), and brain connectivity (thalamocortical resting-state functional connectivity (RSFC) based on fMRI) outcomes in 10 persons with substantial MS-related neurological disability. RESULTS Overall, compared with CGT, 4-weeks of REAER was associated with large improvements in functional mobility (ηp2=.38), CPS (ηp2=.53), and RSFC between the thalamus and ventromedial prefrontal cortex (ηp2=.72), but not walking endurance (ηp2=.01). Further, changes in RSFC were moderately associated with changes in TUG, 6MWT, and SDMT performance, respectively, whereby increased thalamocortical RSFC was associated with improved functional mobility, walking endurance, and CPS (|ρ|>.36). CONCLUSION The current pilot RCT provides initial support for REAER as an approach for improving functional mobility and CPS, perhaps based on adaptive and integrative central nervous system plasticity, namely increases in RSFC between the thalamus and ventromedial prefrontal cortex, in a small sample of persons with substantial MS disability. Such a pilot trial provides proof-of-concept data for the design and implementation of an appropriately-powered RCT of REAER in a larger sample of persons with MS who present with co-occurring impairments in both mobility and cognitive functioning.
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Affiliation(s)
- Ghaith J Androwis
- Kessler Foundation, West Orange, New Jersey, USA; Department of Physical Medicine and Rehabilitation, Rutgers, New Jersey Medical School, Newark, New Jersey, USA.
| | - Brian M Sandroff
- Kessler Foundation, West Orange, New Jersey, USA; Department of Physical Medicine and Rehabilitation, Rutgers, New Jersey Medical School, Newark, New Jersey, USA
| | | | | | - Glenn R Wylie
- Kessler Foundation, West Orange, New Jersey, USA; Department of Physical Medicine and Rehabilitation, Rutgers, New Jersey Medical School, Newark, New Jersey, USA
| | - Guang Yue
- Kessler Foundation, West Orange, New Jersey, USA; Department of Physical Medicine and Rehabilitation, Rutgers, New Jersey Medical School, Newark, New Jersey, USA
| | - John DeLuca
- Kessler Foundation, West Orange, New Jersey, USA; Department of Physical Medicine and Rehabilitation, Rutgers, New Jersey Medical School, Newark, New Jersey, USA
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Zackowski KM, Freeman J, Brichetto G, Centonze D, Dalgas U, DeLuca J, Ehde D, Elgott S, Fanning V, Feys P, Finlayson M, Gold SM, Inglese M, Marrie RA, Ploughman M, Sang CN, Sastre-Garriga J, Sincock C, Strum J, van Beek J, Feinstein A. Prioritizing progressive MS rehabilitation research: A call from the International Progressive MS Alliance. Mult Scler 2021; 27:989-1001. [PMID: 33720795 PMCID: PMC8151585 DOI: 10.1177/1352458521999970] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background: People with multiple sclerosis (MS) experience myriad symptoms that negatively affect their quality of life. Despite significant progress in rehabilitation strategies for people living with relapsing-remitting MS (RRMS), the development of similar strategies for people with progressive MS has received little attention. Objective: To highlight key symptoms of importance to people with progressive MS and stimulate the design and implementation of high-quality studies focused on symptom management and rehabilitation. Methods: A group of international research experts, representatives from industry, and people affected by progressive MS was convened by the International Progressive MS Alliance to devise research priorities for addressing symptoms in progressive MS. Results: Based on information from the MS community, we outline a rationale for highlighting four symptoms of particular interest: fatigue, mobility and upper extremity impairment, pain, and cognitive impairment. Factors such as depression, resilience, comorbidities, and psychosocial support are described, as they affect treatment efficacy. Conclusions: This coordinated call to action—to the research community to prioritize investigation of effective symptom management strategies, and to funders to support them—is an important step in addressing gaps in rehabilitation research for people affected by progressive MS.
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Affiliation(s)
- Kathleen M Zackowski
- KM Zackowski Patient Management Care and Rehabilitation Research, National Multiple Sclerosis Society, 733 3rd Avenue, 3rd floor, New York, NY 10017, USA.
| | - Jennifer Freeman
- School of Health Professions, University of Plymouth, Plymouth UK
| | | | - Diego Centonze
- Department of Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Ulrik Dalgas
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - John DeLuca
- Department of Research, Kessler Foundation, West Orange, NJ, USA
| | - Dawn Ehde
- Department of Rehabilitation Medicine, University of Washington Medicine, Seattle, WA, USA
| | - Sara Elgott
- Global Director of Patient Affairs, MedDay Pharmaceuticals, Maidenhead, UK
| | - Vanessa Fanning
- People Affected by MS Committee, International Progressive MS Alliance, Canberra, ACT, Australia
| | - Peter Feys
- Department of Rehabilitation Sciences and Physiotherapy, Universiteit Hasselt, Hasselt, Belgium
| | - Marcia Finlayson
- School of Rehabilitation Therapy, Queen’s University, Kingston, ON, Canada
| | - Stefan M Gold
- Department of Neuropsychiatry, Charitè—University of Medicine Berlin, Berlin, Germany
| | - Matilde Inglese
- Department of Neurology, Radiology and Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ruth Ann Marrie
- Departments of Internal Medicine and Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Michelle Ploughman
- Department of Physical Medicine and Rehabilitation, Memorial University of Newfoundland, St. Johns, NL, Canada
| | - Christine N Sang
- Department of Anesthesiology, Critical Care and Pain Medicine, Harvard Medical School, Boston, MA, USA
| | | | - Caroline Sincock
- Scientific Steering Committee, International Progressive MS Alliance, Glasgow, UK
| | - Jonathan Strum
- Scientific Steering Committee, International Progressive MS Alliance, Long Beach, CA, USA
| | - Johan van Beek
- Global International Scientific Director, Neuroimmunology, F. Hoffmann-La Roche, Ltd., Basel, Switzerland
| | - Anthony Feinstein
- Department of Psychiatry, University of Toronto and Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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Abstract
When we are fatigued, we feel that our performance is worse than when we are fresh. Yet, for over 100 years, researchers have been unable to identify an objective, behavioral measure that covaries with the subjective experience of fatigue. Previous work suggests that the metrics of signal detection theory (SDT)-response bias (criterion) and perceptual certainty (d')-may change as a function of fatigue, but no work has yet been done to examine whether these metrics covary with fatigue. Here, we investigated cognitive fatigue using SDT. We induced fatigue through repetitive performance of the n-back working memory task, while functional magnetic resonance imaging (fMRI) data was acquired. We also assessed cognitive fatigue at intervals throughout. This enabled us to assess not only whether criterion and d' covary with cognitive fatigue but also whether similar patterns of brain activation underlie cognitive fatigue and SDT measures. Our results show that both criterion and d' were correlated with changes in cognitive fatigue: as fatigue increased, subjects became more conservative in their response bias and their perceptual certainty declined. Furthermore, activation in the striatum of the basal ganglia was also related to cognitive fatigue, criterion, and d'. These results suggest that SDT measures represent an objective measure of cognitive fatigue. Additionally, the overlap and difference in the fMRI results between cognitive fatigue and SDT measures indicate that these measures are related while also separate. In sum, we show the relevance of SDT measures in the understanding of fatigue, thus providing researchers with a new set of tools with which to better understand the nature and consequences of cognitive fatigue.
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Affiliation(s)
- Glenn R Wylie
- Kessler Foundation, Rocco Ortenzio Neuroimaging Center, Kessler Foundation, West Orange, NJ, United States.,Department of Physical Medicine and Rehabilitation, New Jersey Medical School, Newark, NJ, United States.,The Department of Veterans' Affairs, The War Related Illness and Injury Study Center, New Jersey Healthcare System, East Orange Campus, East Orange, NJ, United States
| | - Bing Yao
- Kessler Foundation, Rocco Ortenzio Neuroimaging Center, Kessler Foundation, West Orange, NJ, United States.,Department of Physical Medicine and Rehabilitation, New Jersey Medical School, Newark, NJ, United States
| | - Joshua Sandry
- Psychology Department, Montclair State University, Montclair, NJ, United States
| | - John DeLuca
- Kessler Foundation, Rocco Ortenzio Neuroimaging Center, Kessler Foundation, West Orange, NJ, United States.,Department of Physical Medicine and Rehabilitation, New Jersey Medical School, Newark, NJ, United States.,Department of Neurology, New Jersey Medical School, Newark, NJ, United States
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46
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Wylie GR, Yao B, Genova HM, Chen MH, DeLuca J. Using functional connectivity changes associated with cognitive fatigue to delineate a fatigue network. Sci Rep 2020; 10:21927. [PMID: 33318529 PMCID: PMC7736266 DOI: 10.1038/s41598-020-78768-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 11/24/2020] [Indexed: 12/22/2022] Open
Abstract
Cognitive fatigue, or fatigue related to mental work, is a common experience. A growing body of work using functional neuroimaging has identified several regions that appear to be related to cognitive fatigue and that potentially comprise a "fatigue network". These include the striatum of the basal ganglia, the dorsolateral prefrontal cortex (DLPFC), the dorsal anterior cingulate cortex (dACC), the ventro-medial prefrontal cortex (vmPFC) and the anterior insula. However, no work has been conducted to assess whether the connectivity between these regions changes as a function of cognitive fatigue. We used a task-based functional neuroimaging paradigm to induce fatigue in 39 healthy individuals, regressed the signal associated with the task out of the data, and investigated how the functional connectivity between these regions changed as cognitive fatigue increased. We observed functional connectivity between these regions and other frontal regions largely decreased as cognitive fatigue increased while connectivity between these seeds and more posterior regions increased. Furthermore the striatum, the DLPFC, the insula and the vmPFC appeared to be central 'nodes' or hubs of the fatigue network. These findings represent the first demonstration that the functional connectivity between these areas changes as a function of cognitive fatigue.
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Affiliation(s)
- G R Wylie
- Kessler Foundation, Rocco Ortenzio Neuroimaging Center, 1199 Pleasant Valley Way, West Orange, NJ, 07052, USA.
- Department of Physical Medicine and Rehabilitation, Rutgers University, New Jersey Medical School, Newark, NJ, 07101, USA.
- The Department of Veterans' Affairs, The War Related Illness and Injury Center, New Jersey Healthcare System, East Orange Campus, East Orange, NJ, 07018, USA.
| | - B Yao
- Kessler Foundation, Rocco Ortenzio Neuroimaging Center, 1199 Pleasant Valley Way, West Orange, NJ, 07052, USA
- Department of Physical Medicine and Rehabilitation, Rutgers University, New Jersey Medical School, Newark, NJ, 07101, USA
| | - H M Genova
- Kessler Foundation, Rocco Ortenzio Neuroimaging Center, 1199 Pleasant Valley Way, West Orange, NJ, 07052, USA
- Department of Physical Medicine and Rehabilitation, Rutgers University, New Jersey Medical School, Newark, NJ, 07101, USA
| | - M H Chen
- Kessler Foundation, Rocco Ortenzio Neuroimaging Center, 1199 Pleasant Valley Way, West Orange, NJ, 07052, USA
- Department of Physical Medicine and Rehabilitation, Rutgers University, New Jersey Medical School, Newark, NJ, 07101, USA
| | - J DeLuca
- Kessler Foundation, Rocco Ortenzio Neuroimaging Center, 1199 Pleasant Valley Way, West Orange, NJ, 07052, USA
- Department of Physical Medicine and Rehabilitation, Rutgers University, New Jersey Medical School, Newark, NJ, 07101, USA
- Department of Neurology, Rutgers University, New Jersey Medical School, Newark, NJ, 07101, USA
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47
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DeLuca J, Schippling S, Montalban X, Kappos L, Cree BAC, Comi G, Arnold DL, Hartung HP, Sheffield JK, Liu H, Silva D, Cohen JA. Effect of Ozanimod on Symbol Digit Modalities Test Performance in Relapsing MS. Mult Scler Relat Disord 2020; 48:102673. [PMID: 33454584 DOI: 10.1016/j.msard.2020.102673] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [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: 08/05/2020] [Revised: 11/18/2020] [Accepted: 12/02/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Cognitive dysfunction, including slowed cognitive processing speed (CPS), is one of the most disabling symptoms of multiple sclerosis (MS). The Symbol Digit Modalities Test (SDMT) is a preferred measure of CPS for MS trials and routine screening. Based on encouraging SDMT results in the phase 3 SUNBEAM trial, these post hoc, exploratory analyses were conducted to further compare effects of the sphingosine 1-phosphate receptor modulator ozanimod versus intramuscular interferon β-1a on CPS in participants with relapsing multiple sclerosis (RMS). METHODS In the phase 3, double-blind, double-dummy, SUNBEAM study, adults (aged 18‒55 years) with RMS (N=1,346) were randomized to once-daily oral ozanimod 0.92 or 0.46 mg, or weekly intramuscular interferon β-1a 30 µg. The study continued until the last participant was treated for 12 months. CPS was measured as part of a secondary endpoint using the SDMT. Exploratory, post hoc analyses evaluated SDMT change and percentages of participants with clinically meaningful (≥4-point) SDMT improvement or worsening at months 6 and 12, and relationship between SDMT and brain volume on magnetic resonance imaging. RESULTS Ozanimod improved SDMT scores compared with interferon β-1a at months 6 and 12. At month 12, least squares mean difference in SDMT z-scores for ozanimod 0.92 mg versus interferon β-1a was 0.102 (95% CI, 0.031‒0.174, nominal p = 0.0051; standardized mean difference = 0.1376). A greater percentage of ozanimod 0.92 mg‒treated participants had clinically meaningful improvements in SDMT scores versus interferon β-1a at month 6 (30.0% versus 22.2%) and month 12 (35.6% versus 27.9%). Of those with SDMT improvement at month 6, 66.4% of those treated with ozanimod 0.92 mg and 55.9% of those treated with interferon β-1a had sustained improvement at month 12. Brain volume loss was similar for those with SDMT improvement versus worsening at month 12. CONCLUSIONS In these exploratory analyses, ozanimod had modestly beneficial effects on CPS in RMS participants. The effects of ozanimod on SDMT are being further evaluated in an ongoing 3-year clinical trial. SUNBEAM is registered on clinicaltrials.gov (NCT02294058) and the European Clinical Trials Database (EudraCT 2014-002320-27).
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Affiliation(s)
- John DeLuca
- Kessler Foundation, 1199 Pleasant Valley Way, West Orange, NJ 07052 USA and Departments of Physical Medicine and Rehabilitation, and Neurology, Rutgers - New Jersey Medical School, Newark 07103, NJ, USA.
| | - Sven Schippling
- Neuroimmunology and Multiple Sclerosis Research, Department of Neurology, University Hospital and University of Zürich and Neuroscience Center Zürich, University of Zürich, Frauenklinikstrasse 26, 8091 Zurich, Switzerland and Federal Institute of Technology (ETH) Zürich, Rämistrasse 101, 8092 Zürich, Switzerland.
| | - Xavier Montalban
- Department of Neurology-Neuroimmunology, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitario Vall d'Hebron, Pg. Vall d'Hebron, 119-129, 08035 Barcelona, Spain.
| | - Ludwig Kappos
- Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), Departments of Medicine, Clinical Research, Biomedicine, and Biomedical Engineering, University Hospital and University of Basel, Petersgraben 4, CH-4031 Basel, Switzerland.
| | - Bruce A C Cree
- Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco, 675 Nelson Rising Lane, San Francisco, CA 94158 USA.
| | - Giancarlo Comi
- Department of Neurology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, via Olgettina 48, 20132 Milan, Italy.
| | - Douglas L Arnold
- NeuroRx Research and Montréal Neurological Institute, McGill University, 3801 University Street, Montreal, QC H3A 2B4, Canada.
| | - Hans-Peter Hartung
- Department of Neurology, Medical Faculty, Heinrich-Heine University, University Hospital Dusseldorf, Moorenstr. 5 40225 Dusseldorf, Germany.
| | - James K Sheffield
- Bristol Myers Squibb, 3401 Princeton Pike, Lawrenceville, NJ 08648, USA.
| | - Hongjuan Liu
- Bristol Myers Squibb, 3401 Princeton Pike, Lawrenceville, NJ 08648, USA.
| | - Diego Silva
- Bristol Myers Squibb, 3401 Princeton Pike, Lawrenceville, NJ 08648, USA.
| | - Jeffrey A Cohen
- Department of Neurology, Mellen Center for MS Treatment and Research, Neurological Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195 USA.
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48
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Goverover Y, Chen MH, Costa SL, Chiaravalloti ND, DeLuca J. Smell as a clinical-marker for functional limitations in multiple sclerosis: A pilot study. Mult Scler Relat Disord 2020; 46:102508. [PMID: 33011622 DOI: 10.1016/j.msard.2020.102508] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 06/29/2020] [Revised: 09/08/2020] [Accepted: 09/11/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Olfactory dysfunction is a common symptom of multiple sclerosis (MS). The questions of whether and to what degree olfactory dysfunction can serve as a clinical marker of MS disability (i.e. cognitive impairments and functional limitations) are not yet answered. The current study aimed to explore associations between olfactory function (i.e. smell identification) with cognitive capacities, functional performance and quality of life (QOL) in persons with MS. METHODS Olfactory function was measured by the University of Pennsylvania Smell Identification Test (UPSIT). Functional ability was assessed by the Actual RealityTM (AR) task. QOL was assessed by the Multiple Sclerosis Quality of Life-54 (MSQOL-54). Cognition was assessed by the Brief International Cognitive Assessment for MS (BICAMS) in 23 MS patients and 15 matched healthy controls. RESULTS MS patients had lower UPSIT scores than healthy controls. Worse UPSIT scores were associated with reduced performances on the BICAMS and AR task as well as lower MSQOL-54 scores. Specifically, UPSIT scores were related to MSQOL-54 scores independent of BICAMS composite scores, while the relationship between UPSIT score and AR performance was mediated by BICAMS composite score. CONCLUSION This study confirms previous studies which concluded that olfactory function is impaired in MS. Furthermore, olfactory dysfunction is related to limitations in activity performance and QOL. Taken together with previous studies, olfactory function may be considered as a clinical marker related to MS disability. Longitudinal studies are needed to confirm these results.
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Affiliation(s)
- Yael Goverover
- Department of Occupational Therapy, Steinhardt School of Culture, Education, and Human Development, New York University, and Kessler Foundation, 82 Washington Square East, New York, NY, 10003, United States.
| | - Michelle H Chen
- Kessler Foundation, 120 Eagle Rock Avenue, Suite 100, East Hanover, NJ 07936-3147
| | - Silvana L Costa
- Kessler Foundation, 120 Eagle Rock Avenue, Suite 100, East Hanover, NJ 07936-3147
| | | | - John DeLuca
- Kessler Foundation, 120 Eagle Rock Avenue, Suite 100, East Hanover, NJ 07936-3147
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49
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Benedict RHB, Amato MP, DeLuca J, Geurts JJG. Cognitive impairment in multiple sclerosis: clinical management, MRI, and therapeutic avenues. Lancet Neurol 2020; 19:860-871. [PMID: 32949546 PMCID: PMC10011205 DOI: 10.1016/s1474-4422(20)30277-5] [Citation(s) in RCA: 260] [Impact Index Per Article: 65.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 07/14/2020] [Accepted: 07/21/2020] [Indexed: 12/15/2022]
Abstract
Multiple sclerosis is a chronic, demyelinating disease of the CNS. Cognitive impairment is a sometimes neglected, yet common, sign and symptom with a profound effect on instrumental activities of daily living. The prevalence of cognitive impairment in multiple sclerosis varies across the lifespan and might be difficult to distinguish from other causes in older age. MRI studies show that widespread changes to brain networks contribute to cognitive dysfunction, and grey matter atrophy is an early sign of potential future cognitive decline. Neuropsychological research suggests that cognitive processing speed and episodic memory are the most frequently affected cognitive domains. Narrowing evaluation to these core areas permits brief, routine assessment in the clinical setting. Owing to its brevity, reliability, and sensitivity, the Symbol Digit Modalities Test, or its computer-based analogues, can be used to monitor episodes of acute disease activity. The Symbol Digit Modalities Test can also be used in clinical trials, and data increasingly show that cognitive processing speed and memory are amenable to cognitive training interventions.
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Affiliation(s)
- Ralph H B Benedict
- Department of Neurology and Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA.
| | - Maria Pia Amato
- Department of Neurology, University of Florence, IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | | | - Jeroen J G Geurts
- Department of Anatomy and Neurosciences, Section Clinical Neuroscience, Amsterdam UMC, Location VUmc, Vrije Universiteit, Amsterdam, Netherlands
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Genova H, Dacosta-Aguayo R, Goverover Y, Smith A, Bober C, DeLuca J. Effects of a Single Bout of Aquatic Exercise on Mood in Multiple Sclerosis: A Pilot Study. Int J MS Care 2020; 22:173-177. [PMID: 32863785 DOI: 10.7224/1537-2073.2018-079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background Physical activity is known to be an effective way of managing multiple sclerosis (MS)-related symptoms. Furthermore, it has been reported that even a single bout of physical activity can yield improvements in mood in persons with MS. Aquatic exercise can be an effective and enjoyable physical activity in persons with MS. However, there is little research on the immediate effects of aquatic exercise on mood in people with MS. Thus, we assessed the acute effects of a single bout of aquatic exercise on mood. Methods Eight adults with MS participated in a 45-minute aquatic exercise class as well as 45 minutes of a seated rest control condition. The Profile of Mood States questionnaire was given before and after each condition (rest and aquatic exercise). Repeated-measures analysis of variance and paired-samples t tests were used to examine whether aquatic exercise resulted in improvement in mood. Due to the small sample size, effect sizes were considered. Results Moderate-to-large effect sizes indicated a condition × time interaction such that mood increased and fatigue decreased after a single bout of aquatic exercise compared with after rest. Conclusions This proof-of-concept study suggests that mood symptoms are improved immediately after a short bout of aquatic exercise. Future research is needed to explore whether these effects are reliable and whether they can be sustained with more frequent bouts of aquatic exercise.
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