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Cognitive Problems








Cognitive performance profile in different phenotypes of MS with cognitive complaints(03/03/14)


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)

SDMT effective in differentiating employment status in MS individuals(03/02/14)

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 to conduct pilot study on improving memory, function in MS patients(02/01/14)

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)

MS cognitive status is adversely affected by warmer weather - study(01/11/13)

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)

Multiple Sclerosis: functional change in brain as cause of cognitive disorders(14/10/13)

Over the course of the disease, multiple sclerosis is very often combined with a deteriorating memory and attention deficits. Researchers at the University Department of Radiology and Nuclear Medicine at the MedUni Vienna have now demonstrated by means of a meta-analysis of functional image data that increased activations in the involuntary attention system in the brain are responsible for these disorders in MS patients.

MS patients generally often have problems with fading out what is unimportant. Says head of the study Veronika Schöpf: "They are practically in continuous alarm mode." The attention system is too highly activated and also notices – for example when watching the television or when talking to someone – completely unimportant extraneous noises.

Because of this, concentrating on what is important is completely impossible or only possible to a limited extent. In addition, MS patients find it difficult to look for one specific thing and also find it. This high activation thus also leads to a poor memory and at the same time adversely affects the ability to take in new things.

In a meta-analysis in the top journal "Neuroscience & Biobehavioral Reviews" (Impact Factor 9.44) it has now been possible to prove that functional changes in the brain are responsible for these disorders and that these can also be depicted by means of functional imaging.

"In most people the centre for these activities lies in the right half of the brain, in many MS patients however it lies in the left side of the brain, as it does in many epilepsy patients," says the PhD student and primary author Kathrin Kollndorfer. This knowledge could now feed into the development of personalised treatments for people with multiple sclerosis in order to counteract these cognitive disorders in good time.

With this, the working group at the MedUni Vienna has also achieved a better generalisability of the research results so far with regard to working memory and attention in patients with multiple sclerosis. "Most studies that have so far dealt with this question by means of functional imaging have mostly examined only very small and heterogeneous samples, which clearly differ with regard to age, gender or duration of illness. We have included in our evaluation everything in studies so far," explains Veronica Schöpf.

Multiple sclerosis is an incurable, chronic inflammatory disease of the central nervous system, which develops slowly at first and in later stages leads to greater and greater physical and mental handicaps. According to figures of the Austrian Multiple Sclerosis Society (ÖMSG) about 12,500 people suffer from this disease.

Source: Health Canal (14/10/13)

Higher education appears to help in MS cognitive impairment(26/09/13)

High levels of educational attainment appeared to protect multiple sclerosis (MS) patients from the cognitive ravages of brain atrophy and demyelinating lesion burdens, a researcher said here.

Correlations between cognitive test results and the degree of MRI-measured brain pathology in 104 patients with MS and 33 with the pre-MS condition known as clinically isolated syndrome were markedly weaker in those in the top quartile of education compared with those in the lowest, said Daniela Pinter, PhD, of the Medical University of Graz in Austria.

In hierarchical regression models, the interactions between years of education and MRI measures of T2 lesion load and third ventricle width (indicating brain atrophy) were changed by R2=2.2 for T2 lesion volume and by R2=3.4 for third ventricle width (both P<0.05), she told attendees at the World Congress of Neurology.

These models also took account of age, sex, and disease duration.

Pinter said the findings applied across MS severity grades. "In MS patients with different phenotypes at different stages of the disease, higher education attenuated the negative effects of white matter lesion burden and thalamic atrophy on cognitive performance," she concluded.

She suggested that MS patients work to "actively enhance" their cognitive reserve before impairments set in, "in parallel to disease-modifying drugs." Such an approach should also be tested in rigorous studies, Pinter added.

Higher levels of education and other markers of an active cognitive life -- such as working in mentally challenging jobs or engagement with crossword puzzles or other "thinking games" -- have previously been established as protective in patients with Alzheimer's disease-related brain pathologies, an effect dubbed cognitive reserve. Such individuals can carry heavy burdens of beta-amyloid plaques without developing dementia.

Pinter and her colleagues hypothesized that the same concept would apply as well to MS patients, many of whom also develop cognitive impairments in parallel with increasing brain atrophy and inflammatory lesions.

They enrolled 137 patients including 33 with clinically isolated syndrome, 92 with relapsing-remitting MS, and 12 with secondary progressive MS. Overall the mean age was 36 (SD 10), though it reached 44 (SD 7) in the patients with secondary progressive disease.

Mean educational attainment was 13.1 years (SD 2.6) and was similar in the three disease-type subgroups. Mean EDSS disability scores were 1.2 in the clinically isolated syndrome group, 1.9 in those with relapsing-remitting MS, and 5.7 in those with secondary progressive disease.

Patients were administered five standard cognitive function tests, assessing verbal and visuospatial memory, attention and concentration, verbal fluency, and information processing speed. These tests together make up the Brief Repeated Battery of Neuropsychological Tests.

MRI measurements included T2 lesion volume, normalized brain volume, third ventricle width, iron accumulation in the basal ganglia, and magnetization transfer ratios in cognitively relevant brain regions.

Correlations between several of the latter measures and cognitive test results were not affected by educational attainment, Pinter noted. Only T2 lesion volume and third ventricle width showed significant interactions between the MRI metrics and education, she said.

The ameliorating effect of education on the correlation between MRI metrics and cognitive function was most pronounced for T2 lesion volume. Linear regression analyses indicated that the slope of the correlation was roughly tripled in patients in the lowest education quartile compared with the highest.

For third ventricle width, patients in the top education quartile showed almost no diminution in cognitive function with increasing atrophy. Those with in the lowest quartile, on the other hand, had sharp declines in cognition scores as their third ventricle width approached 10 mm.

Source reference: Pinter D, et al "Educational attainment moderates the effect of T2 lesion load and atrophy on cognition in multiple sclerosis" WCN 2013; Abstract 1197.

Source: MedPage Today © 2013 MedPage Today, LLC (26/09/13)

Higher Education may protect against cognitive deficits associated with MS(03/07/13)

Multiple sclerosis (MS) can lead to severe cognitive impairment as the disease progresses. Researchers in Italy have found that patients with high educational levels show less impairment on a neuropsychological evaluation compared with those with low educational levels.

Their results are published in Restorative Neurology and Neuroscience.

MS is a progressive immunologic brain disorder with neuropsychological deficits including selective attention, working memory, executive functioning, information processing speed, and long term memory. These deficits often impact daily life (ability to do household tasks, interpersonal relationships, employment, and overall quality of life).

In this study, investigators first assessed the role of cognitive reserve, the brain's active attempt to focus on how tasks are processed, in compensating for the challenge represented by brain damage. Earlier studies had reported that higher cognitive reserve protects MS subjects from disease-related cognitive inefficiency but in these studies cognitive reserve was mainly estimated through a vocabulary test. Here, investigators considered educational level and occupational attainment instead of vocabulary. They also evaluated both educational and occupational experience, hypothesizing that an individual's lifetime occupational attainment could also be considered a good proxy of CR, similar to the way in which higher occupational attainment reduces the risk of Alzheimer's disease.

The second aim of the study was to investigate the possible role of perceived fatigue. Fatigue can have a great negative influence on daily life, so that higher perceived fatigue might result in lower cognitive performance.

Fifty consecutive clinically diagnosed MS patients took part in the study. A control group included 157 clinically healthy subjects, with no psychiatric or neurological diagnosis. Individuals in both groups were, on average, of the same age, education level and gender. The mean age was 40.41 (± 9.67) years, with 12.37 (± 4.42) years of education.

Cognitive performance was evaluated using the Paced Auditory Serial Addition Test (PASAT), in which a series of single digit numbers are presented and the two most recent digits must be summed. This test has high sensitivity in detecting MS-related cognitive deficits as it relies strongly on working memory and information processing speed abilities. Fatigue was evaluated through the Modified Fatigue Impact Scale (MFIS), which assesses the effects of fatigue in terms of physical, cognitive, and psychosocial functioning.

Of the 50 clinically diagnosed patients, 17 had less than 13 years of schooling, without obtaining any secondary level diploma, and 33 had received more than 13 years of schooling, leading to a diploma at university level. Both groups were administered a short neuropsychological battery including standardized tests for vigilance, alertness and divided attention. None of the tasks showed differences between the groups.

Patients were also classified using the US census categories into low occupations (student, housewife, unskilled/semiskilled, skilled trade or craft, clerical/office worker) and high occupations (manager business/government and professional/technical), where the occupational attainment categories are based on the cognitive complexity and cognitive effort needed to carry out the job efficiently. They were then further divided into three groups: low occupation and low education, low occupation and high education, and high occupation and high education.

The researchers found that high speed PASAT versions were more suitable for identifying compensatory capacities compared to low speed PASAT versions. MS patients with low education performed worse than matched healthy controls at faster PASAT speeds. By contrast, no difference was observed between MS patients with high education and matched healthy controls, regardless of PASAT speed. On the other hand, neither occupational attainment nor fatigue had any impact on cognitive deficits in MS.

"These results indicate that low education is a risk factor for cognitive impairment in people with neurological disease such as MS, whereas a high educational level could be considered a protective factor from disease-associated cognitive impairment," observes lead investigator Elisabetta Làdavas, PhD, Director of the Center for Studies and Research in Cognitive Neuroscience, Cesena and Professor of Neuropsychology at the Department of Psychology of the University of Bologna, Italy. She concludes that "The protective effects of education on the cognitive profile of MS patients should be considered in longitudinal studies of cognitive functions, and in therapeutic attempts to improve cognition in these patients."

Journal Reference:
C. Scarpazza, D. Braghittoni, B. Casale, S. Malagú, F. Mattioli, G. di Pellegrino and E. Ladavas. Education protects against cognitive changes associated with multiple sclerosis. Restorative Neurology and Neuroscience, 2013; DOI: 10.3233/RNN-120261

Source: Science Daily Copyright 2013 by ScienceDaily, LLC (03/07/13)

Researchers say genetics and life experience independently protect against cognitive decline in MS(27/06/13)

U.S. and Italian researchers have determined that brain reserve, as well as cognitive reserve, independently protects against cognitive decline in multiple sclerosis (MS). Their article, "Brain reserve and cognitive reserve in multiple sclerosis: What you've got and how you use it", was published in Neurology on June 11, 2013 (Neurology 2013;80:2186-2193). Authors James Sumowski, PhD, Victoria Leavitt, PhD, and John DeLuca, PhD, are with Kessler Foundation in West Orange, NJ. Maria Rocca, MD, Gianna Riccitelli, PhD, Giancarlo Comi, MD, and Massimo Filippi, MD, are with San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy.

"Our research interests focus on why many people with MS suffer cognitive impairment, while others with MS withstand considerable disease progression without cognitive decline," said Dr. DeLuca, VP for Research & Training at Kessler Foundation. "With our colleagues in Milan, we explore factors associated with lack of cognitive decline despite marked changes on imaging studies." In this study, 62 patients with MS (41 relapsing-remitting MS, 21 secondary progressive MS) had MRIs to estimate brain reserve and disease burden. Early-life cognitive leisure was measured as a source of cognitive reserve. Cognitive status was measured with tasks of cognitive efficiency and memory.

Dr. Sumowski, principal author/investigator, commented on the importance of the study, saying, "We demonstrated for the first time that larger maximal lifetime brain growth (which is heritable) and early life mental stimulation (e.g., reading, games, hobbies) independently and differentially protect against cognitive decline in MS. That is, genetics and life experience independently protect against cognitive decline in persons with MS." Foundation scientists have previously documented the protective effect of intellectual enrichment in MS.

Source: News-Medical.Net (27/06/13)

Cognitive impairment differs between primary progressive and relapsing-remitting MS(21/03/13)


Objectives: To characterize the cognitive abilities of patients with primary progressive multiple sclerosis (PPMS) and relapsing-remitting multiple sclerosis (RRMS) compared with healthy controls (HCs) matched for age, sex, and education level while considering the different characteristics of PPMS and RRMS and to compare the cognitive patterns of these types of multiple sclerosis.

Methods: Forty-one patients with PPMS, 60 patients with RRMS, and 415 HCs were recruited in a cross-sectional study. Controls were divided into 20 groups according to age, sex, and education level. Participants were assessed with a large battery of neuropsychological (NP) tests that included a modified version of the Brief Repeatable Battery, the Stroop test, computerized tests from the Test of Attentional Performance battery, the numerical span test, and the Rey Complex Figure.

Results: Patients with PPMS performed worse than their matched HCs on nearly all NP tests. Patients with RRMS performed worse than matched HCs on a computerized digit-symbol substitution task and the alertness test, reaction time for visual scanning, and Paced-Auditory Serial Addition Test-3 seconds. Patients with PPMS had worse NP scores and were more impaired in cognitive domains than patients with RRMS. After controlling for Expanded Disability Status Scale score, the results remained unchanged.

Conclusion: The patients with PPMS presented with a wide range of cognitive deficits in information processing speed, attention, working memory, executive function, and verbal episodic memory, whereas the impairments in patients with RRMS were limited to information processing speed and working memory compared with their matched HCs. Cognitive deficits were more severe in patients with PPMS than in patients with RRMS.

Full Text

 Aurélie Ruet, MD, Mathilde Deloire, PhD, Julie Charré-Morin, Msc, Delphine Hamel, Msc and Bruno Brochet, MD

Source: Neurology © 2013 American Academy of Neurology (21/03/13)

A new computerised cognitive test for the detection of information processing speed impairment in multiple sclerosis(13/03/13)

Summary: It is well known that cognitive impairment is a prominent feature of MS. Information processing speed (IPS) impairment is the most common cognitive alteration observed in patients with MS.

This research group looked at a new IPS test called the Computerised Speed Cognitive Test (CSCT), which can be easily administered in daily clinical practice for testing IPS impairment. A group of 60 RRMS, 41 PPMS and 415 healthy controls underwent an IPS battery, which included assessment of reaction times of subsets of the Test of Attentional Performance battery, a newly developed digit/symbol substitution task, and the CSCT.

The CSCT is made up of a key displayed on the upper part of the computer screen with a list of nine symbols, with a list of nine digits displayed under this. The sequence of symbols and digits of the key are automatically generated for each session of training and testing.

The CSCT had good reliability, with a weak practice effect at the 6-month time point. There was a strong correlation between the CSCT with the Symbol Digit Modalities Test (SDMT) and with other IPS tests in patients with MS. The CSCT had the best sensitivity for predicting IPS impairment and was one of the most accurate tests among the IPS battery. This test could be used as part of a larger neuropsychological battery, as well as by neurologists in everyday practice.


BACKGROUND: Cognitive impairment in multiple sclerosis (MS) primarily applies to information processing speed (IPS).

OBJECTIVE: To evaluate psychometric properties of a new digit/symbol substitution test in healthy subjects and patients with MS, and assess its ability to detect IPS impairment in patients with MS.

METHODS: A sample of MS patients, 60 relapsing-remitting (RRMS) and 41 primary progressive MS (PPMS), and 415 healthy controls (HCs) underwent an IPS battery, including assessment of reaction times of subtests of the Test of Attentional Performance battery and a newly developed in-house digit/symbol substitution task, the Computerised Speed Cognitive Test (CSCT). The CSCT was additionally evaluated in a second cohort of 31 RRMS and 12 progressive MS patients, for comparison with the Symbol Digit Modalities Test (SDMT).

RESULTS: The CSCT had good reliability in both HCs and patients with MS. It showed a weak practice effect at the 6-month time point. This test had good ecological validity in MS patients. There was a strong correlation between the CSCT with the SDMT and with other IPS tests in patients with MS. The CSCT had the best sensitivity for predicting IPS impairment and was one of the most accurate tests among the IPS battery.

CONCLUSION: The CSCT appeared as a good candidate for detecting IPS impairment in MS patients.

Authors: Ruet A, Deloire MS, Charré-Morin J

Sources: Mult Scler. 2013 Mar 4 & Pubmed PMID: 23459569 (13/03/13)

Study Suggests Multiple sclerosis patients with cognitive problems have more brain damage(07/03/12)

People with multiple sclerosis (MS) who have cognitive problems, or problems with memory, attention, and concentration, have more damage to areas of the brain involved in cognitive processes than people with MS who do not have cognitive problems, according to a study published in the March 6, 2013, online issue of Neurology, the medical journal of the American Academy of Neurology.

The study used a type of MRI brain scan called diffusion tensor imaging along with regular MRI scans to compare brain measurements in 20 people with MS who had related cognitive problems, 35 people with MS who did not have cognitive problems and 30 healthy participants.

The diffusion tensor images showed that, compared to the healthy control participants, 49 percent of the investigated brain white matter had impaired integrity in those with MS and no cognitive problems, while impaired integrity was evident in 76 percent of the investigated white matter of those with MS and related cognitive problems. In the people with MS-related cognitive problems, the extra white matter dysfunction was particularly seen in areas important for cognitive skills, such as the thalamus.

"This state-of-the-art imaging technology confirms that cognitive symptoms in MS have a biological basis," said study author Hanneke E. Hulst, MSc, of VU University Medical Center in Amsterdam, the Netherlands. "The consequence of this discovery is that imaging can now be used to capture a wider spectrum of changes in the brains of people with MS, and will therefore help determine more accurately whether new treatments are helping with all aspects of the disease."

Cognitive problems are common in MS, affecting up to 65 percent of people with the disease.

Source: News-Medical.Net (07/03/12)

Popular Video Dancing Game May Reduce Cognitive, Physical Impacts of Multiple Sclerosis(28/02/13)

Studies have shown that the popular video game, Dance Dance Revolution (DDR), which requires players to coordinate their movements to the beat of music, may help improve balance and mobility in certain patient populations. Now, researchers at The Ohio State University Wexner Medical Center are the first to test the game's ability to help decrease the cognitive and physical effects of multiple sclerosis (MS).

An estimated 2.1 million people have multiple sclerosis (MS), an incurable inflammatory disease which progressively impairs nerve function in the brain and spinal cord. While studies with the elderly and Parkinson's patients have shown exercise can slow cognitive decline and improve coordination, similar information is lacking for patients with MS, leaving clinicians without data to help guide prescription of exercise programs.

"The video dancing game provides a good platform for our research because it addresses multiple issues that MS clinicians and patients face. We think our data will not only help doctors and therapists make good clinical recommendations, but provide an evidence based, in-home tool for patients that helps overcome access and cost issues associated with long term physical therapy," says Anne Kloos, PhD, PT, NCS, associate clinical professor of health and rehabilitation sciences in the Ohio State College of Medicine.

Kloos became interested in DDR as a potential therapy by conducting an earlier study of individuals with Huntington's disease. In that study, Kloos and her colleagues found that the interactive video game was a fun way to boost motivation and provide a mental and physical workout, in addition to being a convenient way to deliver physical therapy.

In early 2012, Kloos received a grant from the Ohio State Center for Clinical and Translational Science (CCTS) to examine the effects of DDR on mobility, brain plasticity and cognition in individuals with MS. In the ongoing trial, participants exercise using DDR three times a week for eight weeks. The patients' cognitive functions are tested at the beginning and end of the trial, and functional and structural magnetic resonance imaging is used to detect brain circuitry changes.

"DDR requires a lot of cognitive processing. Players must look at a screen and time their movements to the arrows on the screen," said research team member, Nora Fritz, DPT. "Incorporating DDR into standard MS treatments has the potential to improve balance, walking, cognition and motivation."

Fritz recently received a supplementary grant from the CCTS to expand the work started by Kloos, and is being mentored by both Dr. Kloos and Deborah Larsen, PhD, PT, Director of the Ohio State School of Health and Rehabilitation Sciences. With the additional funding, Fritz will investigate the differences in dual tasking abilities between individuals with MS and healthy controls and whether playing DDR will improve dual tasking abilities.

Many people diagnosed with MS feel as though they have been given a life sentence of incapacitation. Kloos and Fritz are looking to restore hope and improve the quality of life for patients suffering from this disease, something that study participants feel they are achieving.

"Participating in the study and doing the dance program has helped me feel healthier and more independent. And that is really exciting," says Tracy Blackwell, a study participant.

The trial is still enrolling patients.

Source: Science Daily Copyright © 1995-2012 ScienceDaily LLC (28/02/13)

Mental comorbidity and multiple sclerosis: validating administrative data to support population-based surveillance(07/02/13)

Abstract (provisional)

While mental comorbidity is considered common in multiple sclerosis (MS), its impact is poorly defined; methods are needed to support studies of mental comorbidity. We validated and applied administrative case definitions for any mental comorbidities in MS.

Using administrative health data we identified persons with MS and a matched general population cohort. Administrative case definitions for any mental comorbidity, any mood disorder, depression, anxiety, bipolar disorder and schizophrenia were developed and validated against medical records using a a kappa statistic (k). Using these definitions we estimated the prevalence of these comorbidities in the study populations.

Compared to medical records, administrative definitions showed moderate agreement for any mental comorbidity, mood disorders and depression (all k >=0.49), fair agreement for anxiety (k= 0.23) and bipolar disorder (k=0.30), and near perfect agreement for schizophrenia (k=1.0). The age-standardized prevalence of all mental comorbidities was higher in the MS than in the general populations: depression (31.7% vs. 20.5%), anxiety (35.6% vs. 29.6%), and bipolar disorder (5.83% vs. 3.45%), except for schizophrenia (0.93% vs. 0.93%).

Administrative data are a valid means of surveillance of mental comorbidity in MS. The prevalence of mental comorbidities, except schizophrenia, is increased in MS compared to the general population.

The complete article is available as a provisional PDF.

Source: Biomed Central © 2013 BioMed Central Ltd (07/02/13)

Researchers offer insight into cognitive changes in MS(10/10/12)

Researchers at Trinity College Dublin in collaboration with colleagues in the Department of Neurology at St Vincent's University Hospital and University College Dublin have recently reported new insights into cognitive changes in multiple sclerosis, using newly developed signal processing methods. The findings have been recently published in the international journal PlosOne.

The multidisciplinary research involved neurologists, biomedical engineers and neuropsychologists. Their focus was on cognitive impairment which affects nearly 65% of multiple sclerosis (MS) patients and can occur in the absence of physical disability.

Dysfunctions in speed of information processing, attention, memory and executive functions are most typically observed in MS patients, which have an adverse impact on daily life. It is important to recognise cognitive impairment as early as possible and to monitor its course frequently. However, neuropsychological tests to assess cognitive function can only be carried infrequently and do not provide an objective measure of cognitive impairment.

The research team was led by Professor Richard Reilly, Professor of Neural Engineering at Trinity College, and Professor Niall Tubridy, Department of Neurology at St Vincent's University Hospital. They addressed cognitive impairment assessment by developing new mathematical methods to extract information from MS subjects' scalp with electroencephalography (EEG) data that allows objective measurement of cognitive function at frequent intervals and more importantly offers new insights into the origins of this cognitive impairment in MS.

The team acquired EEG data using 128-scalp electrodes from 95 subjects (MS patients and controls subjects) while they completed a series of visual and auditory stimulus experiments. They then employed their newly developed mathematical methods to process the spatiotemporal EEG data developing a measure of cognitive function.

Professor Reilly commented that "objective, reliable EEG methods such as these developed in this study may have the potential to aid the detection and monitoring of cognitive impairment in MS, and therefore to complement clinical neuropsychological assessment."

Professor Tubridy added that "the relationship between pathological changes in the brain white and grey matter, neurophysiological and neuropsychological cognitive function is imprecisely defined in MS. This study provides new information on the impact of the cognitive impairments on the condition and will help us look for new interventions to improve the quality of life of our patients".

Professor Reilly added that "future studies will explore the neural information using new advanced data analysis methods such as approaches to model the distributed nature of EEG by incorporating activations and structural information from individual subjects' MRI image data". In addition, he said that "longitudinal studies of EEG scalp and deeper brain electrical activity spanning over several years are required to fully determine if EEG data has clinical utility in predicting the changes in cognitive function in MS".

More information: Kiiski H, Reilly RB, Lonergan R, Kelly S, O'Brien MC, et al. (2012) Only Low Frequency Event-Related EEG Activity Is Compromised in Multiple Sclerosis: Insights from an Independent Component Clustering Analysis. PLoS ONE 7(9): e45536. doi:10.1371/journal.pone.0045536

Source: Medical Xpress © Medical Xpress 2011-2012 (10/10/12)

Ginkgo biloba does not improve cognitive function in MS(11/09/12)

Summary: The authors have evaluated the effects of ginkgo biloba on cognitive function in people with MS with impaired cognition.

A treatment regimen of ginkgo 120 mg twice a day did not improve cognitive performance in persons with MS.


To determine whether Ginkgo biloba extract (ginkgo) improves cognitive function in persons with multiple sclerosis (MS).

Persons with MS from the Seattle and Portland VA clinics and adjacent communities who scored 1 SD or more below the mean on one of 4 neuropsychological tests (Stroop Test, California Verbal Learning Test II [CVLT-II], Controlled Oral Word Association Test [COWAT], and Paced Auditory Serial Addition Task [PASAT]) were randomly assigned to receive either one 120-mg tablet of ginkgo (EGb-761; Willmar Schwabe GmbH & Co, Germany) or one placebo tablet twice a day for 12 weeks. As the primary outcome, we compared the performance of the 2 groups on the 4 tests at exit after adjusting for baseline performance.

Fifty-nine subjects received placebo and 61 received ginkgo; 1 participant receiving placebo and 3 receiving ginkgo were lost to follow-up. Two serious adverse events (AEs) (myocardial infarction and severe depression) believed to be unrelated to the treatment occurred in the ginkgo group; otherwise, there were no significant differences in AEs. The differences (ginkgo - placebo) at exit in the z scores for the cognitive tests were as follows: PASAT -0.2 (95% confidence interval [CI] -0.5 to 0.1); Stroop Test -0.5 (95% CI -0.9 to -0.1); COWAT 0.0 (95% CI -0.2 to 0.3); and CVLT-II 0.0 (95% CI -0.3 to 0.3); none was statistically significant.

Treatment with ginkgo 120 mg twice a day did not improve cognitive performance in persons with MS.Classification of evidence:This study provides Class I evidence that treatment with ginkgo 120 mg twice a day for 12 weeks does not improve cognitive performance in people with MS.

Authors: Lovera JF, Kim E, Heriza E, Fitzpatrick M, Hunziker J, Turner AP, Adams J, Stover T, Sangeorzan A, Sloan A, Howieson D, Wild K, Haselkorn J, Bourdette D.

Source: Neurology. 2012 Sep 5 & Pubmed PMID: 22955125 (11/09/12)