A study from a team of researchers at the Kessler Foundation provides new findings on multiple sclerosis (MS). According to the study, published in the journal Frontiers in Neurology, cognitive fatigue exhibited by MS patients is related to the length of the task they are involved in.
Fatigue is one of the most reported symptoms of Multiple Sclerosis (MS) with a prevalence estimation ranging from 70 to 90%. Cognitive fatigue can be a result of both cognitive and physical exertion, and usually presents as subjective sensations or objective changes in performance, fatigue, and fatigability.
Treating cognitive fatigue clinically is complicated because there is a poor understanding of the factors contributing to this combination of symptoms.
In their study titled “Subjective cognitive fatigue in MS depends on task length,” Joshua Sandry from the Neuropsychology and Neuroscience Research, Kessler Foundation, and colleagues examined the relationships between subjective and objective cognitive fatigue, information processing domain (PS), working memory (WM) cognitive load and time on a task in 32 patients with Multiple Sclerosis (MS). The results were compared with 24 healthy controls.
Data analysis showed that subjective cognitive fatigue was higher for the PS task, increased across time, and was higher in the MS group compared to healthy controls. Furthermore, the results revealed that subjective and objective fatigue were independent variables. Morevoer, subjective cognitive fatigue increased with the length of time spent on a task, strongly suggesting that cognitive fatigue in MS is a function of time.
The researchers indicate that this new understanding may help to inform future research studies and help clinicians conduct evaluations of cognitive fatigue in MS. This can ultimately lead to better treatment strategies to cognitive fatigue in Multiple Sclerosis.
Concerning these results, lead author Dr. Joshua Sandry said in a recent press release, “In our study, task length was the factor associated with subjective cognitive fatigue,” “which supports the hypothesis of Temporal Fatigue. This finding should be considered when designing cognitive studies in MS populations. More research is needed to look at these parameters in people with different types of MS, different levels of cognitive impairment and in more advanced stages.”
Source: Multiple Sclerosis News Today © BioNews-tx.com 2015 (23/01/15)
A 17-year longitudinal study published online ahead of print in the Multiple Sclerosis Journal found that corpus callosum area (CCA) was closely associated with cognitive decline in multiple sclerosis patients (Granberg et al., 2014). The results may point to a refreshingly uncomplicated biomarker for cognitive and physical disability in MS patients.
The researchers examined a cohort of 37 MS patients in 1996, with follow-up examinations in 2004 and 2013, to assess changes in their CCA. In order to compare CCA from patient to patient, the researchers normalised each patient’s midsagittal CCA to his or her midsagittal intracranial skull surface area. They called the resulting measurement the normalized corpus callosum area (nCCA).
In the 2004 and 2013 follow-ups, only 23 of the patients remained in the study, and the researchers compared their results with those of 23 age- and sex-matched healthy controls. At each examination the participants were assessed on the Expanded Disability Status Scale (EDSS) and they performed the Symbol Digit Modalities Test (SDMT), a measurement of processing speed.
Overall, nCCA correlated well with SDMT and EDSS scores in patients (r = 0.793, p < 0.001; r = −0.545, p < 0.001, respectively) after adjusting for disease duration, age, and sex and also adjusting for multiple comparisons. These correlations outperformed other measures of brain atrophy such as gray matter fraction and normalised lesion volume.
“I wouldn’t have expected that the simple measurements of the corpus callosum would actually outperform the volumetric measurements,” Tobias Granberg, M.D., who is a current Ph.D. candidate at Karolinska Institutet in Stockholm, Sweden, told MSDF. He said that it takes only about 45 seconds to obtain the measurement from each MRI sequence.
Although the nCCA measurements showed a strong correlation with patients’ SDMT and EDSS scores at each time point, the nCCA measurements taken in 1996 were not predictive of each patient's SDMT and EDSS scores 17 years later. Granberg and his colleagues adjusted the patients’ nCCA with their SDMT and EDSS scores at the outset and found no statistically significant relationship between nCCA and SDMT or EDSS in 2013. Granberg told MSDF that he felt the lack of statistical significance was due to the small sample size, and that future studies with larger sample sizes would show greater predictive power of nCCA.
“There are some previous studies that have used these simple measurements and have proven that they can help in deciding which patients will be going from having clinically isolated syndrome into having MS,” Granberg said.
Granberg also said that he and his colleagues are conducting a companion study to this one directly comparing corpus callosum area to the corpus callosum index, another method of measuring atrophy. He’s also testing nCCA as a way to potentially differentiate patients in the relapsing versus the progressive phase of the disease.
Corpus callosum atrophy is strongly associated with cognitive impairment in multiple sclerosis: Results of a 17-year longitudinal study. Granberg T, Martola J, Bergendal G, Shams S, Damangir S, Aspelin P, Fredrikson S, Kristoffersen-Wiberg M Mult Scler. 2014 Dec 5. PMID: 25480866. Abstract
Source: Multiple Sclerosis Discovery Forum Copyright © 2014 MGH and ACP (19/01/15)
Have you ever eaten a turkey dinner and afterwards someone says that the feeling of drowsiness is caused by the tryptophan in the meat? According to Texas A&M University Professor Dr. Nicolaas Deutz, “This story about tryptophan in turkey is just kind of a running joke, it has nothing to do with the tryptophan.” Sleepiness probably has more to do with eating a big meal, according to Deutz.
It’s not that the amino acid can’t have potent effects on the central nervous system — it simply turns out that turkey does not have unusual levels of tryptophan. Tryptophan is normally converted to the neurotransmitter serotonin. Serotonin controls sleepiness, and higher levels of serotonin seem to improve mood.
While the fable of turkey making you tired might be a joke, using tryptophan to try to improve memory problems in people with multiple sclerosis, however, is far from funny, according to Dr. Deutz. Funded by the Maastricht University Medical Center, he is studying tryptophan-enriched diets and their effect on both mood and cognition in people with the de-myelinating autoimmune disorder.
Deutz and his colleagues at Texas A&M’s Center for Translational Research in Aging and Longevity (CTRAL) have studied tryptophan depletion for several years. They have found that both memory and cognition are adversely impaired when people do not get enough tryptophan. Using brain imaging, they saw less activity in an area of the brain responsible for memory encoding — called the hippocampus — when people lacked tryptophan. In a separate study in women, they saw that mood also became worse in people with a family history of depression.
Because of these effects of tryptophan depletion, Deutz decided to try giving older people with multiple sclerosis tryptophan. He noted that although the onset of multiple sclerosis is during age 20-50, older people with the disease have particular problems with cognition and depression. He noted, “In many ways, multiple sclerosis is almost like the brain getting older on its own. The memory problems really look similar to dementia, Parkinson’s and other diseases that affect older people.”
Previous studies of tryptophan supplementation were limited by a toxic byproduct. According to the investigators of the current trial, tryptophan can now be supplied in a non-toxic form as a component of different natural proteins.
“This research has been around for nearly 30 or 40 years,” said Deutz. “What makes it new is finally bringing it to a translational/clinical level and having a practical application. We now have more tools to measure metabolism and safer ways to digest large amounts of tryptophan.”
Source: Multiple Sclerosis News Today © BioNews-tx.com 2014 (18/12/14)
The Cognitive Rehabilitation for Attention and Memory trial (CRAMMS), a major study to be conducted on patients with multiple sclerosis, was recently awarded £1,167,000 by the National Health Service (NHS), through its Health Technology Assessment (HTA) Program.
The study, which is expected to be the largest trial of its kind in the United Kingdom, is designed to examine MS patients’ cognitive rehabilitation capacities and determine if a group of cognitive rehabilitation programs is able to improve patients’ quality of life.
This symptom management clinical trial for MS is being conducted because so many patients experience difficulties in cognitive processes, including loss in memory, decision making, and concentration, and there are currently few effective treatments available for the management of these symptoms. Therefore, the CRAMMS trial is expected to be able to advance the development of new therapies to improve the lives of patients with these problems.
The trial, which is expected to occur between September of 2014 and August of 2018 at four centres in Nottingham, Sheffield, Liverpool, and Birmingham, is currently enrolling patients, who must be diagnosed with MS and between the ages of 18 and 70 years old. During the trial, participants will be enrolled over the course of 16 months and will participate in either weekly group cognitive rehabilitation sessions with a psychologist and their usual care, or just their usual care. The investigators will then evaluate and compare the effects on the two groups.
“We do not know whether taking part in the study will help but we expect that some people will find the intervention helps them cope with memory and attention problems,” the website of the trial states. “However, the information we get from this study may help us to treat people with MS and attention and memory problems better in future. There are no particular risks involved in taking part in this study.”
In addition, the trial is also expected to raise particular attention and investment into other research focused to the disease.
Source: Multiple Sclerosis News Today © Copyright 2014 BioNews Services, LLC (21/11/14)
Prematurely severe cognitive impairment in multiple sclerosis patients could be an effect of autoantibodies against the N-methyl-D-aspartate (NMDA) receptor complex, with natalizumab (Tysabri) withdrawal a potential contributor, a case report from Germany suggested.
In an MS patient who had to be confined to a nursing home at age 39 because of cognitive deficits amounting to dementia, immunoglobulin G-type antibodies to the NMDA receptor's NR1 subunit were found in cerebrospinal fluid samples, according to Klemens Ruprecht, MD, of Charité-Universitätsmedizin Berlin, and colleagues.
These autoantibodies are "the characteristic laboratory finding of anti-NMDA receptor encephalitis," they wrote online in JAMA Neurology.
When severe cognitive deficits appear at young ages, Ruprecht and colleagues concluded, they could "be related to a superimposed antibody-mediated autoimmune encephalitis."
Cognitive deficits are common in MS patients but the mechanisms underlying them are not well understood, the researchers noted. Normally these come on gradually and at later ages. However, as in the current case, occasionally such deficits appear early and progress rapidly. In such cases, clinicians should consider causes outside the MS disease process, Ruprecht and colleagues suggested.
"The diagnosis of those patients will require a high degree of clinical suspicion as cognitive symptoms are rather frequent in MS and may mask or be confounded with features of antibody-mediated encephalitides," they wrote. "Nevertheless, testing for antineuronal antibodies appears warranted in patients with MS with unusual neuropsychiatric symptoms."
Also, in the patient who was the subject of the case report, the anti-NMDA antibody pathology may have had some relation to treatment with natalizumab.
The woman was first diagnosed with MS at age 33. Her disease course was unremarkable until age 37 when she gave birth, and then rapidly developed cognitive deficits marked primarily by memory loss. She was treated aggressively with MS therapies including natalizumab, cyclophosphamide, and mitoxantrone, with no impact on the progression of cognitive decline.
At age 43, during her fourth year of nursing home residency, she underwent a complete re-evaluation that included analysis of current and stored serum and CSF samples. At that point, anti-NMDA antibodies were discovered in the CSF samples, including those taken shortly after the cognitive symptoms appeared.
The natalizumab was withdrawn 2 years after the patient started on it, out of concern for the risk of progressive multifocal leukoencephalopathy since she had also been on immunosuppressive therapy.
Five months later, she developed a "fulminant" MS relapse, the researchers indicated, which was accompanied by a spike in anti-NMDA antibody titers -- a sign that the latter may have had some connection to the natalizumab withdrawal.
Ruprecht and colleagues noted that the drug suppresses CD138-positive plasma cells. "Therefore, it seems plausible that natalizumab withdrawal facilitated entry of NMDA receptor antibody-producing plasma cells to the central nervous system," they wrote.
The patient died of urosepsis last December, almost 8 years after the onset of cognitive symptoms.
She represented only the second known case of anti-NMDA encephalitis in an MS patient, the researchers indicated, and the first in whom the antibodies targeted the receptor complex's NR1 subunit (NR2B was the target in the previous case).
But they suggested the comorbid conditions may occur more frequently than these case reports might suggest, because cognitive impairments are common in MS and clinicians may not think to look for other causes.
The study was funded by the German government. Authors reported relationships with Bayer Healthcare, Merck Serono, Biogen Idec, Novartis, Ovamed, Teva, Diamed, Genzyme, and Sanofi.
Primary source: JAMA Neurology
Source reference: Fleischmann R, et al "Severe cognitive impairment associated with intrathecal antibodies to the NR1 subunit of the N-methyl-D-aspartate receptor in a patient with multiple sclerosis" JAMA Neurology 2014; DOI: 10.1001/jamaneurol.2014.1817.
Source: Medpage Today © 2014 MedPage Today, LLC (11/11/14)
Research supports the slowed processing speed in the executive deficits found in individuals with multiple sclerosis (MS), according to a paper from the Kessler Foundation.
The investigators wanted to further explore cognitive deficits, since they affect nearly half the population of MS patients. These disabling symptoms can adversely affect patients' quality of life. Data was collected from 50 MS patients and 28 healthy controls and all patients were evaluated through executive functioning tasks both with and without a processing speed element. The tasks included the Trail Making and Wisconsin Card Sorting tests.
The researchers found the MS patients performed on tasks related to executive function compared to their healthy counterparts. While analyzing the data for speed control, the scientists discovered the differences between the healthy and MS group disappeared. The data also revealed no difference on executive tasks with non-processing speed demands.
Disease progression was also something the researchers investigated throughout this study in the MS group. For MS patients, higher atrophy was associated with greater deficits on speeded executive tasks. However, the relationship vanished when the researchers controlled for processing speed. The researchers noted there was no association between atrophy and performance when analyzing non-processing speed executive tasks.
“Our results point to slowed processing speed as the mechanism underlying deficits in executive function,” Nancy Chiaravalloti, PhD, said in a press release. “Understanding this association is an important step toward the development of effective cognitive rehabilitation strategies for individuals with MS. We should focus our efforts on 2 key domains - processing speed and memory.”
Executive deficits in MS may be explained by slow processing speed, the researchers concluded in their paper. Slowed processing speed may be a primary impairment which underlies other cognitive functions. They believe it is important to unwrap processing speed contributions to executive function, which would be an important step toward the development of appropriate treatment and rehabilitation techniques for MS patients.
"Additional neuropsychological measures should be included in future studies,” Chiaravalloti added. “We also need to focus on the contribution of specific brain pathology, such as frontal atrophy and lesion load, to executive deficits.”
Source: Rehabilitation Psychology & HCPLive Copyright HCPLive 2006-2014 (07/10/14)
Kessler Foundation scientists have shown that working memory may be an underlying mechanism of cognitive reserve in multiple sclerosis (MS).
This finding informs the relationships between working memory, intellectual enrichment (the proxy measure for cognitive reserve) and long-term memory in this population.
"Working memory mediates the relationship between intellectual enrichment and long-term memory in multiple sclerosis: An exploratory analysis of cognitive reserve" (doi: 10.1017/S1355617714000630) was published online ahead of print by the Journal of the International Neuropsychological Society on July 14. The authors are Joshua Sandry, PhD, and research scientist James F. Sumowski, PhD, of Neuropsychological & Neuroscience Research at Kessler Foundation. Dr. Sandry is a postdoctoral fellow funded by a grant from the National MS Society.
Cognitive symptoms, including deficits in long-term memory, are known to affect approximately half of individuals with MS. This study was conducted in 70 patients with MS, who were evaluated for intellectual enrichment, verbal long-term memory, and working memory capacity.
"We found that working memory capacity explained the relationship between intellectual enrichment and long-term memory in this population," said Dr Sandry. "This suggests that interventions targeted at working memory in people with MS may help build cognitive reserve to protect against decline in long-term memory."
Source: Science Codex (10/09/14)
Persons with MS may be able to improve self-awareness via task-oriented cognitive rehabilitation(26/08 14)
A new study of self-awareness by Kessler Foundation researchers shows that persons with multiple sclerosis (MS) may be able to improve their self-awareness through task-oriented cognitive rehabilitation. The study was epublished ahead of print on July 2 in NeuroRehabilitation. (Yael Goverover, Helen Genova, Hali Griswold, Nancy D. Chiaravalloti & John DeLuca: Metacognitive knowledge and online awareness in persons with multiple sclerosis doi: 10.3233/NRE-141113). Self-awareness is one's ability to recognise cognitive problems caused by brain injury. This is the first study of self-awareness in MS that includes assessment of online awareness, as well as metacognitive awareness.
Yael Goverover, PhD, OT, is a visiting scientist at Kessler Foundation. She is an associate professor at New York University. Dr. Goverover is a recipient of the National Institute on Disability and Rehabilitation Research Fellowship award (Mary Switzer Award). Drs. Genova, Chiaravalloti and DeLuca are MS researchers at Kessler Foundation.
The researchers assessed 18 people with MS and 16 healthy controls for 2 types of self-awareness - metacognitive knowledge of disabilities (or intellectual awareness) and online awareness (emergent or anticipatory awareness). They also looked at the relationships among self-awareness, functional performance and quality of life (QoL). Assessment involved the Functional Behavior Profile, questionnaires administered before and after functional tasks (purchasing cookies and airline tickets via the Internet) and the Functional Assessment of Multiple Sclerosis measure.
"Results showed that compared with controls, people with MS assessed their actual performance more realistically following completion of a task. This suggests that individuals may be able to improve their self-awareness through more experience with tasks," noted Nancy Chiaravalloti, PhD, director of Neuropsychology & Neuroscience Research at Kessler Foundation. "Research that leads to better understanding of types of self-awareness, functional outcomes and QOL will aid the development of effective assessments and rehabilitation interventions," said Dr. Chiaravalloti. "The association between online awareness and task performance in this study, for example, may have implications for cognitive rehabilitation strategies in the MS population."
Source: News-Medical.Net Copyright AZoM.com Limited 2000-2014 (26/08 14)
Researchers at Kessler Foundation and the Cleveland Clinic have published one of the longest longitudinal studies of cognition in multiple sclerosis (MS). The article, "Cognitive impairment in multiple sclerosis: An 18-year follow-up study," was epublished by Multiple Sclerosis and Related Disorders on April 13, 2014. Results provide insight into the natural evolution of cognitive changes over time, an important consideration for researchers and clinicians. Authors are Lauren B. Strober, PhD, of Kessler Foundation and Stephen M. Rao, PhD, Jar-Chi Lee, Elizabeth Fisher, PhD, and Richard Rudick, MD, of the Cleveland Clinic.
"While cognitive impairment is known to affect 40 to 65% of individuals with MS, few studies have followed the pattern of cognitive decline over time, which is important for understanding long-term care and outcomes associated with MS," said Dr. Strober, senior research scientist at Kessler Foundation. "Our study was based on a unique sample of 22 patients who underwent neuropsychological testing at entry into the original phase 3 clinical trial of intramuscular interferon beta-1a, and again at 18-year followup."
At baseline, 9 patients (41%) had cognitive impairment; at 18-year followup, 13 patients (59%), were found to be impaired. Significant declines over time were found in information processing speed, auditory attention, memory, episodic learning and visual construction. Decline was steeper in the unimpaired than in the impaired group, as indicated by the Symbol Digit Modalities Test (SDMT).
"These longitudinal data contribute substantially to our knowledge of the course of cognitive decline in MS," noted John DeLuca, PhD, VP of Research & Training at Kessler Foundation. "In light of the young age at diagnosis, this perspective is fundamental to the development of rehabilitation strategies that meet the needs of people dealing with the cognitive effects of MS."
The study was funded by Biogen Idec.
Source: Medical Xpress © Medical Xpress 2011-2014 (25/06/14)
Extensive White Matter Dysfunction in Cognitively Impaired Patients with Secondary-Progressive Multiple Sclerosis.
Francis PL, Chia TL, Jakubovic R, O'Connor P, Lee L, Feinstein A, Aviv RI.
BACKGROUND AND PURPOSE: Cognitive impairment is a common, disabling symptom of MS. We investigated the association between cognitive impairment and WM dysfunction in secondary-progressive multiple sclerosis using DTI.
MATERIALS AND METHODS: Cognitive performance was assessed with a standard neuropsychological battery, the Minimal Assessment of Cognitive Function in Multiple Sclerosis. Cognitive impairment was defined as scoring >1.5 standard deviations below healthy controls on ≥2 subtests. Fractional anisotropy maps were compared against cognitive status using tract-based spatial statistics with threshold-free cluster enhancement.
RESULTS: Forty-five patients with secondary-progressive multiple sclerosis (median age: 55 years, female/male: 27/18, median Expanded Disability Status Scale Score: 6.5) were prospectively recruited. Cognitively impaired patients (25/45) displayed significantly less normalized global GM and WM volumes (P = .001, P = .024), more normalized T2-weighted and T1-weighted WM lesion volumes (P = .002, P = .006), and lower WM skeleton fractional anisotropy (P < .001) than non-impaired patients. Impaired patients also had significantly lower fractional anisotropy (pcorr < .05) in over 50% of voxels within every major WM tract. The most extensively impinged tracts were the left posterior thalamic radiation (100.0%), corpus callosum (97.8%), and right sagittal stratum (97.5%). No WM voxels had significantly higher fractional anisotropy in patients with cognitive impairment compared with their non-impaired counterparts (pcorr > .05). After the inclusion of confounders in a multivariate logistic regression, only fractional anisotropy remained a significant predictor of cognitive status.
CONCLUSIONS: Cognitively impaired patients with secondary-progressive multiple sclerosis exhibited extensive WM dysfunction, though preferential involvement of WM tracts associated with cognition, such as the corpus callosum, was apparent. Multivariate analysis revealed that only WM skeleton fractional anisotropy was a significant predictor of cognitive status.
Source: AJNR Am J Neuroradiol. 2014 May 15 & Pubmed PMID: 24831599 (03/06/14)
Among adult patients with multiple sclerosis (MS), pain severity can impact performance on cognitive tests, suggesting that pain independently contributes to impaired brain function in MS.
For their pilot study presented at the American Pain Society 33rd Annual Scientific Meeting, held April 30, 2014, to May 3, 2014, in Tampa, FL, Anna L. Kratz, PhD, of the Center for Outcomes Development & Application in the Department of Physical Medicine and Rehabilitation at the University of Michigan, and Tiffany J. Braley, MD, MS, of Multiple Sclerosis and Sleep Disorders Centers in the Department of Neurology at the University of Michigan, examined the correlation between pain intensity and cognitive test scores in 40 adult patients diagnosed with MS and explored the underlying mechanisms among those elements, such as sleep duration.
While previous studies have linked pain severity to cognitive functioning in the general population and determined that cognitive dysfunction is more common in those with chronic pain, the authors said “little has been done to explore symptoms that may exacerbate cognitive dysfunction in MS, including pain,” despite the fact that approximately two-thirds of MS patients have a chronic pain condition, 25% of whom experience severe chronic pain.
Within the current research sample, 26 patients had relapsing-remitting MS, 9 had secondary-progressive MS, and 5 had primary-progressive MS. Subjects were excluded from the study if they demonstrated “severe cognitive impairment, severe depression, visual and/or hearing impairments, lack of independent mobility, use of medical treatment for obstructive sleep apnea (OSA), and drug and/or alcohol dependence,” Kratz and Braley said.
During the study’s baseline visit, the investigators calculated the patients’ PROMIS Pain Intensity and Expanded Disability Status Scale (EDSS) scores and then showed them how to use a wrist-worn accelerometer, which continuously collected data on objective sleep parameters by recording ambient light and physical movements. In order to assess the association between pain and cognitive performance with and without sleep duration as a factor, the authors conducted the Controlled Oral Word Association Test (COWAT), Judgment of Line Orientation (JLO) test, and the Symbol Digit Modalities Test (SDMT) on the patients.
When they left out sleep duration in their analysis, Kratz and Braley found “pain intensity was independently associated with poorer performance on tests of verbal fluency (COWAT), visuospatial judgment (JLO), attention, working memory, and psychomotor speed (SDMT) above and beyond the effects of age and MS-related disability.” In fact, pain severity explained 8-10% of the variance in performance across those cognitive tests.
Even after they included sleep duration, the researchers said “the associated between pain and cognitive functioning was maintained for … poorer visuospatial judgment (JLO) and verbal fluency (COWAT).” In this set of regression models, pain intensity similarly accounted for 5-10% of the deviation in cognitive test performance. Based on their findings, Kratz and Braley speculated that “pain contributes to cognitive dysfunction in MS beyond the effects of neuronal damage, cumulative neurological disability, or actigraphy-based sleep measures.” Additionally, the investigators said further research on the mechanisms underlying this association “could lead to novel advances in the management of cognitive dysfunction in MS through pain-based interventions.”
Source: HCPLive Copyright HCPLive 2006-2013 Intellisphere, LLC (07/05/14)
Multiple sclerosis researchers have found that brain reserve and cognitive reserve confer a long-term protective effect against cognitive decline. The study has been published in Neurology.
James Sumowski, PhD, lead author of the article, and John DeLuca, PhD, are at Kessler Foundation. Co-authors are from the Manhattan Memory Center, New York, NY, the San Raffaele Scientific Institute, Milan, Italy, and the University of Belgrade, Serbia. Neurology is the official journal of the American Academy of Neurology. Dr. Sumowski presented this research at the 2014 AAN conference in Philadelphia.
"Our research aims to answer these questions," explained Dr. DeLuca. "Why do some people with MS experience disabling symptoms of cognitive decline, while others maintain their cognitive abilities despite neuroimaging evidence of significant disease progression? Can the theories of brain reserve and cognitive reserve explain this dichotomy? Can we identify predictors of cognitive decline?"
In this study, memory, cognitive efficiency, vocabulary (a measure of intellectual enrichment/cognitive reserve), brain volume (a measure of brain reserve), and disease progression on MRI, were evaluated in 40 patients with MS at baseline and at 4.5-year followup. After controlling for disease progression, scientists looked at the impact of brain volume and intellectual enrichment on cognitive decline.
Results supported the protective effects of brain reserve and cognitive reserve," noted Dr. Sumowski. "Patients with greater intellectual enrichment experienced lesser degrees of cognitive decline. Those with greater brain reserve showed a protective effect for cognitive efficiency. This study not only confirms these protective effects of brain and cognitive reserve, it shows that these beneficial effects persist for years."
More information: Sumowski JF, Leavitt VM. Body Temperature Is Elevated and Linked to Fatigue in Relapsing-Remitting Multiple Sclerosis, Even Without Heat Exposure. Arch Phys Med Rehabil. 2014 Feb 20.
Sumowski JF, Coyne J, Cohen A, Deluca J.Retrieval practice improves memory in survivors of severe traumatic brain injury. Arch Phys Med Rehabil. 2014 Feb;95(2):397-400
Sumowski JF, Chiaravalloti N, Krch D, Paxton J, Deluca J. Education attenuates the negative impact of traumatic brain injury on cognitive status. Arch Phys Med Rehabil. 2013 Dec;94(12):2562-4.
Source: Medical Xpress © Medical Xpress 2011-2014 (01/05/14)
Background: The relationship between cognitive impairment and disease course and severity of multiple sclerosis (MS) is not well understood.
Objective: The aim of the study was to evaluate whether cognitive complaints in different clinical phenotypes and severity stages of MS are associated with differences in the profile of cognitive impairment.
Methods: 196 MS patients (relapsing-remitting RRMS n=138; secondary progressive SPMS n=32; primary progressive PPMS n=26) with perceived cognitive deficits underwent neuropsychological assessment with the brief repeatable battery of neuropsychological tests (BRBNT). Mood, impact of the disease, and quality of life were evaluated with self-reports.
Results: Only minor differences were observed in the cognitive impairment profile of different disease phenotypes and different disease severity stages. RRMS patients performed better only in one cognitive test of the BRBNT, than patients with progressive disease types. When RRMS, SPMS, and PPMS groups were evaluated separately, PPMS showed more pronounced cognitive impairments than RRMS and SPMS. The relationships between cognitive impairment and severity of disability as well as duration of disease were weak.
Conclusion: MS patients with cognitive complaints tend to have a relatively similar cognitive impairment profile which is not dependent on the disease course and severity.
Eija Rosti-Otajärviemail address, Juhani Ruutiainen, Heini Huhtala, Päivi Hämäläinen
Source: Multiple Sclerosis Copyright © 2014 Elsevier Inc (03/03/14)
Researchers at Kessler Foundation have studied the measurement tools used in multiple sclerosis for their effectiveness in predicting employment status. They compared the Expanded Disability Status Scale (EDSS), the Multiple Sclerosis Functional Composite (MSFC), the Paced Auditory Serial Addition Task (PASAT), and the Symbol Digit Modalities Test (SDMT), and found the SDMT effective in differentiating employed from unemployed individuals. The article, Unemployment in multiple sclerosis (MS): utility of the MS Functional Composite and cognitive testing, was published in the January 2014 issue of Multiple Sclerosis Journal (doi: 10.1177/1352458513488235). The authors are Lauren Strober, PhD, Nancy Chiaravalloti, PhD, Nancy Moore, PhD, and John DeLuca, PhD, of Kessler Foundation.
"The population with MS comprises people of working age," noted Dr. Strober, senior research scientist, "which is why factors related to employment status are a major concern for individuals and clinicians." The researchers studied 77 people with MS; 40 were employed and 37 were unemployed. To determine which factor(s) were predictive of employment status, they compared the two groups in regard to demographic factors, disease variables, MSFC, and cognitive performance. Differences were found in disease duration and progression, upper extremity function, processing speed, verbal learning and memory, and executive function. Analysis revealed the SDMT to be the only predictor of employment status, with an overall accuracy of 67%. "These findings suggest that clinical use of the SDMT may help identify those individuals who are at risk for unemployment," she explained. "This would allow clinicians to advise them on strategies for maintaining employment."
"Unemployment research is a priority at Kessler Foundation," remarked Dr. Chiaravalloti, "because maintaining employment is such an important factor in the quality of life of persons with MS."
Source: News Medical (03/02/14)
Kessler Foundation has been awarded a new grant by the US National Multiple Sclerosis (MS) Society for a pilot study of memory and learning difficulties in individuals with MS. Scientists will test the effectiveness of using of self-generated learning in a treatment intervention to improve memory and functional performance. Yael Goverover, PhD, visiting scientist in Neuropsychology & Neuroscience Research, is the study's principal investigator. Dr. Goverover, an associate professor at New York University, will work with John DeLuca, PhD, the Foundation's senior VP for Research & Training. They will test the efficacy of self-generated learning in individuals with MS who have memory and learning difficulties and in controls. The total pilot award for the one-year grant is $42,185.
"Past research has shown that items that are "self-generated" by an individual, such as words or concepts, are remembered better than items that are simply read or heard," said Dr. DeLuca. The aim of the clinical trial to demonstrate the effects of learning to use a self-generation strategy as a treatment intervention to improve performance of both laboratory tasks (e.g. words and concepts) as well as functional tasks (e.g. activities of daily living). Forty persons with MS with memory impairment, age 18 to 65, will be recruited. Half will receive self-generation training while learning different types of tasks (experimental group) and half (control group) will be asked to learn the same information using more conventional methods (e.g. repetitions).
"Self-generated learning is geared toward helping patients self-discover their own strengths and abilities while learning to use principles of self-generation independently in everyday life situations," noted Dr. DeLuca. "We anticipate that participants undergoing the self-generation-training intervention will show better memory performance, functional performance, quality of life, and satisfaction with treatment and life compared with controls."
Source: News-Medical.Net (02/01/14)
Kessler Foundation scientists correlated functional magnetic resonance imaging (fMRI) findings with the negative impact of outdoor temperature on cognitive functioning in multiple sclerosis (MS).
This study, "Warmer outdoor temperature is associated with task-related increased BOLD activation in patients with multiple sclerosis," released by Brain Imaging & Behavior corroborates the group's previous study that established that people with MS performed worse on processing speed and memory tasks during warmer outdoor temperatures versus during cooler outdoor temperatures. "Increased MS disease activity during warmer months is a recent discovery. Now, this work is the first report of brain activation associated with outdoor temperature in MS. This finding is novel and important for persons with MS who are shown to have worse cognition during warmer weather," said Victoria M. Leavitt, Ph.D., research scientist at Kessler Foundation and principal investigator for the study, funded by a grant from the National MS Society.
Kessler Foundation researchers previously demonstrated that patients with multiple sclerosis (MS) demonstrate worse cognition on warmer days. (Leavitt VM, Sumowski JF, Chiaravalloti N, DeLuca J. Warmer outdoor temperature is associated with worse cognitive status in multiple sclerosis. Neurology. 2012 Mar 27;78(13):964-8). The purpose of the current study was to identify the neurophysiological basis for worse cognition. "Here, we examined the neurophysiology underlying this temperature-cognition relationship, said Dr. Leavitt. "The association between task-related BOLD fMRI activation and outdoor temperature was investigated in 28 MS patients who demonstrated worse cognitive function on warmer days. In MS patients, warmer outdoor temperature was associated with greater BOLD activation during performance of a simple sustained attention task. The brain areas that showed greater activation on warmer days were regions typically activated by MS patients during task performance: the frontal, dorsolateral, prefrontal and parietal cortex. The relationship between outdoor temperature and cerebral activation was absent in healthy controls. Increased brain activation required by MS patients on warmer days to perform a simple task may signify neural inefficiency."
According to Dr. Sumowski, "The significant effect of warmer weather on cognition should be considered when designing and conducting clinical trials. This information might assist clinicians in choosing clinical treatment, and help researchers develop effective strategies for coping with the negative effects of weather-related effects on cognition that impact independence, education, employment and activities of daily living."
Source: Science Daily Copyright 2013 by ScienceDaily, LLC (01/11/13)