Academic literature on the topic 'MULTIPLE SCLEROSIS, MRI, COGNITIVE IMPAIRMENT'
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Journal articles on the topic "MULTIPLE SCLEROSIS, MRI, COGNITIVE IMPAIRMENT"
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Millichap, J. Gordon. "Cognitive Impairment in Multiple Sclerosis and MRI." Pediatric Neurology Briefs 25, no. 1 (January 1, 2011): 7. http://dx.doi.org/10.15844/pedneurbriefs-25-1-9.
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Patti, F., MP Amato, M. Trojano, S. Bastianello, MR Tola, B. Goretti, L. Caniatti, et al. "Cognitive impairment and its relation with disease measures in mildly disabled patients with relapsing–remitting multiple sclerosis: baseline results from the Cognitive Impairment in Multiple Sclerosis (COGIMUS) study." Multiple Sclerosis Journal 15, no. 7 (June 19, 2009): 779–88. http://dx.doi.org/10.1177/1352458509105544.
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Background Cognitive impairment is a common symptom of multiple sclerosis (MS), but the association between cognitive impairment and magnetic resonance imaging (MRI) disease measures in patients with relapsing–remitting (RR) MS is unclear. Objectives To study the prevalence of cognitive impairment and its relation with MRI disease measures in mildly disabled patients with RRMS. Methods Patients aged 18–50 years with RRMS (McDonald criteria) and an Expanded Disability Status Scale (EDSS) score ≤4.0, who were enrolled in the Cognitive Impairment in Multiple Sclerosis (COGIMUS) study, underwent baseline standardized MRI complete neurological examination and neuropsychological testing. Results A total of 550 patients were enrolled, 327 of whom underwent MRI assessments. Cognitive impairment (impaired performance in ≥3 cognitive tests) was present in approximately 20% of all patients and in the subgroup who underwent MRI. T2 hyperintense and T1 hypointense lesion volumes were significantly higher in patients with cognitive impairment (defined as impaired performance on at least three tests of the Rao’s battery) than those without. EDSS score was also significantly higher in cognitively impaired than in cognitively preserved patients. Disease duration, depression, and years in formal education did not differ significantly between cognitively impaired and cognitively preserved patients. T2 lesion volume, performance intelligence quotient, and age were significant predictors of cognitive impairment in this population. Weak correlations were found between performance on individual cognitive tests and specific MRI measures, with T1 and T2 lesion volumes correlating with performance on most cognitive tests. Conclusions Cognitive impairment occurs in approximately one-fifth of mildly disabled patients with MS and is associated with specific MRI disease measures. Assessment of cognitive function at diagnosis could facilitate the identification of patients who may benefit from therapeutic intervention with disease-modifying therapies to prevent further lesion development.
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Portaccio, Emilio, Ermelinda De Meo, Angelo Bellinvia, and Maria Pia Amato. "Cognitive Issues in Pediatric Multiple Sclerosis." Brain Sciences 11, no. 4 (March 30, 2021): 442. http://dx.doi.org/10.3390/brainsci11040442.
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Multiple sclerosis (MS) is one of the leading causes of disability in young adults. The onset of MS during developmental age makes pediatric patients particularly susceptible to cognitive impairment, resulting from both disease-related damage and failure of age-expected brain growth. Despite different test batteries and definitions, cognitive impairment has been consistently reported in approximately one-third of pediatric patients with MS. However, the lack of a uniform definition of cognitive impairment and the adoption of different test batteries have led to divergent results in terms of cognitive domains more frequently affected across the cohorts explored. This heterogeneity has hampered large international collaborative studies. Moreover, research aimed at the identification of risk factors (e.g., demographic, clinical, and radiological features) or protective factors (e.g., cognitive reserve, leisure activities) for cognitive decline is still scanty. Mood disorders, such as depression and anxiety, can be detected in these patients alongside cognitive decline or in isolation, and can negatively affect quality of life scores as well as academic performances. By using MRI, cognitive impairment was attributed to damage to specific brain compartments as well as to abnormal network activation patterns. However, multimodal MRI studies are still needed in order to assess the contribution of each MRI metric to cognitive impairment. Importantly, longitudinal studies have recently demonstrated failure of age-expected brain growth and of white matter (WM) and gray matter (GM) maturation plays a relevant role in determining cognitive dysfunction, in addition to MS-related direct damage. Whether these growth retardations might result in specific cognitive profiles according to the age at disease onset has not been studied, yet. A better characterization of cognitive profiles in pediatric MS patients, as well as the definition of neuroanatomical substrates of cognitive impairment and their longitudinal evolution are needed to develop efficient therapeutic strategies against cognitive impairment in this patient population.
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Campbell, Jamie, Mara Cercignani, Dawn Langdon, and Waqar Rashid. "COGNITIVE REHABILITATION IN MULTIPLE SCLEROSIS." Journal of Neurology, Neurosurgery & Psychiatry 86, no. 11 (October 14, 2015): e4.7-e4. http://dx.doi.org/10.1136/jnnp-2015-312379.104.
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Background/aimsTo explore the feasibility and efficacy of computerised, home-based cognitive rehabilitation in patients with multiple sclerosis using neuropsychological assessment and structural and functional MRI techniques.Materials, methods or case report38 patients with MS and evidence of cognitive impairment on the Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS) test battery were enrolled and randomly assigned to undergo computerised cognitive rehabilitation (n=19) for six weeks or to a control condition (n=19). All patients underwent MRI at baseline (T1) and post-intervention (T2). Changes in cortical activations were explored using an n-back fMRI paradigm.ResultsCompared to baseline, patients in the treatment group showed significant improvement in the Brief Visuospatial Memory Test at T2 (p=0.035) and exhibited altered cortical fMRI activations compared to controls.ConclusionOur preliminary data support the hypothesis that home-based, computerised cognitive rehabilitation is a feasible and effective approach to improving cognitive performance in patients with MS and may reflect underlying changes in brain activations.BICAMS is a sensitive and easy to administer tool for identifying cognitive impairment in MS in the outpatient setting. Identification of cognitive impairment may have important treatment implications in the future.
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Tench, Christopher R., and Cris S. Constantinescu. "Conventional and Quantitative Magnetic Resonance Imaging and Cognitive Impairment in Multiple Sclerosis." European Neurological Review 4, no. 2 (2009): 70. http://dx.doi.org/10.17925/enr.2009.04.02.70.
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An estimated 30–70% of patients with multiple sclerosis (MS) have some cognitive impairment. Cognitive function depends on a spectrum of faculties including information processing speed, sustained attention, recent memory and executive function. The broad definition of cognition has resulted in different assessments of function, and repeatable batteries of tests have been devised to gain an overall and repeatable view of cognition in MS. Many studies have attempted to find an association between cognitive function and MS pathology using magnetic resonance imaging (MRI). Conventional MRI has been used to show the relationship between cognitive impairment and MS lesion volume and/or brain volume (reflecting atrophy). Studies using quantitative MRI to estimate the degree of abnormality in tissue that is normal-appearing on conventional MRI have also found correlations with cognitive function. Longitudinally, cognitive decline has been found to correlate with changing MRI-detectable pathology in some studies. However, consistency between studies has been lacking, and the large number of cognitive tests available makes direct comparison of different studies difficult. Focus on specific cognitive domains may alleviate this issue in future studies.
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Langdon, Dawn. "Cognitive Impairment in Multiple Sclerosis - Recent Advances and Future Prospects." European Neurological Review 5, no. 1 (2010): 69. http://dx.doi.org/10.17925/enr.2010.05.01.69.
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Multiple sclerosis (MS) is characterised not only by physical disability but also by gradual cognitive impairment. A large proportion of patients exhibit signs of cognitive deficit that negatively affect their quality of life. Reduced processing speed is often seen with the disease and several tests have been developed to measure its severity, including the Paced Auditory Serial Addition Test (PASAT) and the Symbol Digit Modality Test (SDMT). Long-term memory function is also commonly impaired in MS and studies suggest problems in primary registration of information. Also affected are executive functions used in novel planning and problem-solving. To evaluate cognitive function, cognitive test batteries with varying effectiveness have been introduced. The correlation of cognitive performance with magnetic resonance imaging (MRI) results remains inconsistent as multiple pathologies lead to the observed impairments. Therefore, combinations of MRI data are most successful at predicting deficiencies. The efficacy of current MS treatments in terms of cognition is unclear, making their clinical evaluation a great unmet need; the same is true of universal, validated cognitive measures that can be easily administered to MS patients around the world.
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Mendes, Maria Fernanda, Alessandro Finkelsztejn, Sidney Gomes, and Yára Dadalti Fragoso. "Early and severe cognitive impairment in multiple sclerosis." Dementia & Neuropsychologia 6, no. 1 (March 2012): 48–52. http://dx.doi.org/10.1590/s1980-57642012dn06010008.
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ABSTRACT Objectives: To report on four new cases of severe cognitive impairment in the early stages of multiple sclerosis (MS) and to review data on the subject since few cases have been reported worldwide. Methods: Retrospective evaluation of medical records of patients with severe cognitive impairment within the first five years of MS diagnosis. Results on neuropsychological tests and magnetic resonance imaging (MRI) were disclosed. Results: Four patients from different Brazilian neurological departments in Brazil were evaluated, all presenting with severe cognitive dysfunction classified as rapidly developing dementia. MRI images showed severe brain atrophy and basal ganglia lesions in all patients. Conclusions: Although rare, severe cognitive impairment in MS represents an important disability and may ultimately constitute another form of the disease.
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Glanz, BI, CM Holland, SA Gauthier, EL Amunwa, Z. Liptak, MK Houtchens, RA Sperling, SJ Khoury, CRG Guttmann, and HL Weiner. "Cognitive dysfunction in patients with clinically isolated syndromes or newly diagnosed multiple sclerosis." Multiple Sclerosis Journal 13, no. 8 (July 10, 2007): 1004–10. http://dx.doi.org/10.1177/1352458507077943.
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Cognitive dysfunction is common in patients with multiple sclerosis (MS), and has been associated with MRI measures of lesion burden and atrophy. Little is known about the prevalence of cognitive impairment in patients with early MS. The associations between cognitive impairment and MRI measures of disease severity early in the disease course are also unclear. This study used a brief battery of cognitive tests to determine the prevalence and pattern of cognitive impairment in patients with clinically isolated syndromes or newly diagnosed MS. The associations between cognitive impairment and MRI measures of disease severity early in the disease course were also examined. Ninety-two patients with clinically isolated syndromes or the diagnosis of MS within the last 3 years participating in the CLIMB study underwent a neurologic examination, neuropsychological evaluation and MRI at 1.5T. Forty-nine percent of patients were impaired on one or more cognitive measures. There were no significant correlations between cognitive scores and MRI measures of disease severity including total T2 lesion volume, normal appearing white matter volume, grey matter volume, and brain parenchymal fraction. These findings suggest that cognitive impairment may predate the appearance of gross structural abnormalities on MRI and serve as an early marker of disease activity in MS. Multiple Sclerosis 2007; 13: 1004—1010. http://msj.sagepub.com
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Rocca, M. A., E. De Meo, and M. Filippi. "Functional MRI in investigating cognitive impairment in multiple sclerosis." Acta Neurologica Scandinavica 134 (September 2016): 39–46. http://dx.doi.org/10.1111/ane.12654.
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Rao, Stephen M. "Cognitive Function in Patients with Multiple Sclerosis: Impairment and Treatment." International Journal of MS Care 6, no. 1 (April 1, 2004): 9–22. http://dx.doi.org/10.7224/1537-2073-6.1.9.
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Cognitive impairment is common in multiple sclerosis (MS), with up to 65% of patients exhibiting some type of neuropsychological dysfunction. The cognitive domains most affected by MS are learning and memory, attention, information processing, visuospatial abilities, and executive functioning. It is difficult to detect cognitive dysfunction in patients with MS during routine neurologic examinations because conventional measures of neurologic disability are not sensitive enough to detect cognitive impairment. Furthermore, cognitive dysfunction is only weakly correlated with the type of MS, disease duration, or physical disability. However, brain imaging studies show that a relatively strong correlation exists between cognitive dysfunction and overall lesion burden and brain atrophy in MS. This paper reviews the natural history of cognitive dysfunction, areas of cognition affected, the correlation between MRI measures and cognitive dysfunction, issues related to neuropsychological assessment, and treatment of cognitive impairment with disease-modifying MS drugs.
Dissertations / Theses on the topic "MULTIPLE SCLEROSIS, MRI, COGNITIVE IMPAIRMENT"
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CAMMAROTO, VIVIANA. "Functional and Morphological Correlates of Cognitive and Social Cognition Impairment in Multiple Sclerosis. A Longitudinal Study." Doctoral thesis, Università degli Studi di Milano-Bicocca, 2018. http://hdl.handle.net/10281/241347.
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La sclerosi multipla (SM) è il prototipo delle malattie demielinizzanti, in cui la patologia della sostanza grigia e bianca (GM/WM) contribuisce alla compromissione di diversi domini cognitivi tra cui l’attenzione, la velocità di elaborazione mentale, la memoria, le funzioni esecutive e visuospaziali, così come molti aspetti della cognizione sociale.
L’obiettivo principale del presente studio di risonanza magnetica (MRI) era di indagare l’effetto della SM sulla cognizione e sulla struttura del cervello, combinando indagini neuropsicologiche e morfologiche. Abbiamo mirato ad analizzare i cambiamenti delle principali funzioni cognitive nel tempo in pazienti ambulatoriali con SM recidivante-remittente (SMRR) lieve e iniziale rispetto ai soggetti sani, e correlato questi risultati ai cambiamenti di volume regionale nella GM. Abbiamo inoltre esplorato l’impatto della SM su molti aspetti della cognizione sociale, dell’umore, della fatica, del benessere psicologico e della qualità della vita di questi pazienti tra l’inizio e la fine dello studio.
Il primo risultato MRI importante riguardava l’identificazione di un pattern di atrofia temporale destra (giro temporale inferiore e polo temporale medio) nel gruppo SMRR rispetto ai controlli normali, che è rimasto invariato tra la valutazione basale e il follow-up. Dopo un anno, è emersa una considerevole atrofia della GM profonda dell’emisfero destro (amigdala, globo pallido e putamen) e del cervelletto (14.2%), mentre scompariva nel putamen e nell’insula dell’emisfero sinistro. Inoltre, fattori quali il sesso, l’età e la velocità di elaborazione (cioè, il Symbol Digit Modalities Test) erano in grado di predire il volume della GM dei pazienti a un anno.
Per quanto riguarda la valutazione cognitiva, i risultati primari evidenziavano che una grande percentuale (circa il 50%) del gruppo SMRR era significativamente compromessa rispetto ai controlli in prove riguardanti memoria a breve ed a lungo termine, velocità di elaborazione, funzioni visuospaziali ed esecutive, ed emozioni negative (tristezza e rabbia). I pazienti mostravano inoltre sintomi di disagio psicologico (somatizzazione, ossessività-compulsività, ostilità e problemi interpersonali). Queste difficoltà tendevano ad appiattirsi nel tempo nel gruppo SMRR. Mentre la memoria a lungo termine, le abilità visive percettive e spaziali e l’attribuzione della rabbia sembravano migliorare, i deficit di memoria di lavoro, velocità di elaborazione e inibizione dell’interferenza, e il riconoscimento della tristezza rimanevano stabili dopo un anno. Al follow-up, anche le caratteristiche di disagio psicologico si erano attenuate, ma emergevano nuovi sintomi depressivi.
In conclusione, i nostri risultati hanno evidenziato che vi era un declino cognitivo minimo ma significativo nel gruppo SMRR. Il pattern di atrofia temporale riscontrato nei pazienti rispetto ai controlli poteva rendere conto dei loro deficit iniziali. Dopo un anno, la significativa riduzione dei volumi cerebellari e delle strutture GM profonde poteva inoltre spiegare perché le difficoltà primarie nella memoria e nel riconoscimento della tristezza erano rimaste stabili, mentre le altre erano diminuite. Tutti questi deficit non erano significativamente correlati ad altri fattori, come l’umore, la fatica e le caratteristiche cliniche della malattia. Sebbene le prestazioni in alcune misure esecutive siano probabilmente migliorate a causa dell’effetto della pratica, al follow-up di un anno la memoria di lavoro e la velocità di elaborazione erano ancora compromesse, dimostrando che la progressione a breve termine della malattia ha un impatto clinicamente significativo su queste capacità. Anche gli aspetti emozionali e comportamentali erano migliorati nel tempo, suggerendo che la gestione sanitaria precoce e il trattamento farmacologico possono contribuire al benessere e alla qualità della vita delle persone con SM.Multiple sclerosis (MS) is the prototype of demyelinating diseases, in which both gray and white matter (GM/WM) pathology contribute to impairment of several cognitive domains including attention, mental processing speed, memory, executive and visuospatial functions, as well as many aspects of social cognition. Such deficits have been reported in all stages and subtypes of the disease, and result in significant, negative consequences for mood and quality of life of people with MS. The main goal of the current magnetic resonance imaging (MRI) study was to investigate the effect of MS on cognition and brain structure, by combining neuropsychological and morphological investigations. More precisely, we aimed to analyze changes of main cognitive functions over time in mild and early relapsing-remitting MS (RRMS) outpatients compared to healthy subjects, and correlated these findings to GM regional volume changes. We were also interested to explore the impact of MS on many aspects of social cognition, mood, fatigue, psychological well-being, and quality of life of these patients between the beginning and the end of the study. The first important MRI result was the identification of a right temporal atrophy pattern (inferior temporal gyrus and middle temporal pole) in the RRMS group compared to normal controls, which was unchanged between the baseline and follow-up. After one year, a considerable atrophy in deep GM of right hemisphere (amygdala, globus pallidus and putamen) and cerebellum (14.2%) emerged, while disappeared in the left putamen and insula. In addition, the GM volume of the patients at one year was predicted by sex, age, and processing speed (i.e., Symbol Digit Modalities Test). As for the cognitive evaluation, primary results highlighted that a large proportion (about 50%) of the RRMS group was significantly impaired compared with controls on short- and long-term memory, processing speed, visuospatial and executive functions, and negative emotions (sadness and anger). Patients also showed symptoms of psychological distress (somatization, obsessive-compulsiveness, hostility, and interpersonal problems). These impairments in the RRMS group tended to flatten over time. While long-term memory, perceptual and spatial visual skills, and the anger attribution seemed to improve; deficits in working memory, processing speed and interference inhibition, and the recognition of sadness remained stable after one year. At the follow-up, characteristics of psychological distress were also reduced, but new depressive symptoms emerged. In conclusion, our results highlighted that there was a minimal but significant cognitive impairment in the RRMS group. After one year, a significant reduction in the cerebellar and deep GM structure volumes could also explain why primary deficits in memory and recognition of sadness remained stable, while the others decreased. All these impairments were not significantly related to other factors, such as mood, fatigue and clinical features of the disease. Although performance in some executive measures probably improved due to ‘practice effect’, working memory and processing speed were still impaired at one-year follow-up, proving that the short-term progression of the disease has a clinically meaningful impact on these abilities. Even emotional-behavioral aspects had improved over time, leading to a better adaptation to the disease by patients. Early management of healthcare taking-charge and pharmacological treatment, which occur at the initial stage of the disease, may also contribute to the well-being and quality of life of people with MS.
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VACCHI, LAURA. "Imaging Cognitive Network Dysfunction in Multiple Sclerosis Patients with Relapse-Onset Clinical Phenotypes." Doctoral thesis, Università Vita-Salute San Raffaele, 2016. http://hdl.handle.net/10281/287950.
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Cognitive impairment strongly affects people with multiple sclerosis (MS). It comprises multifactorial symptoms and no consistent treatments are available to date. Although cognitive impairment has been observed in all stages of the disease, the majority of studies mainly focused on a specific clinical phenotype (primarily relapsing-remitting MS) or did not differentiate between MS subtypes. Advanced magnetic resonance imaging (MRI) techniques are providing useful measures of functional and structural abnormalities in patients with MS, allowing to overcome the limits of conventional MRI. This thesis wished to improve the understanding of the mechanisms responsible for the accumulation of cognitive dysfunction in patients with relapse-onset MS by combining different advanced structural and functional MRI techniques.
First, we applied functional MRI (fMRI) to assess brain functional reorganization in relation to different cognitive tasks (face encoding and N-back) in patients with the main relapse-onset clinical phenotypes. We also explored the relationship between functional network alterations and clinical, cognitive, behavioural and structural MRI measures of disease-related damage. Our results provide new evidence for the debate about adaptive/maladaptive functional reorganization in MS, specifically in relation to the clinical and cognitive characteristics of MS phenotypes.
Second, the investigation of resting state default mode network (DMN) functional connectivity enabled us to highlight that different modulations of DMN recruitment lead to different clinical profiles and manifestations. Moreover, functional connectivity of specific DMN areas (hippocampi) was found to be central for the assessment of important cognition-related aspects, such as depression.
Finally, by applying voxel-wise MRI methods (VBM and TBSS) we explored the extent and distribution of brain GM atrophy and WM microstructural alterations in adult MS patients according to their age of disease onset, and we made some assumptions about the possible presence of pathophysiological mechanisms related to age of MS onset, that suggests a preserved reserve for structural plasticity that could modulate the structural and functional brain organization, in order to preserve or slow-down MS-related dysfunction.
To conclude, the application of advanced MRI techniques allowed us to improve our knowledge on neuropsychological features in patients with relapse-onset MS.
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DE, MEO ERMELINDA. "MAPPING STRUCTURAL AND FUNCTIONAL MRI CORRELATES OF CLINICAL DISABILITY AND COGNITIVE IMPAIRMENT IN PEDIATRIC MS." Doctoral thesis, Università Vita-Salute San Raffaele, 2022. http://hdl.handle.net/20.500.11768/122895.
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During this PhD research course, different advanced MRI techniques were applied in pediatric multiple sclerosis (MS) patients to characterize the neuroanatomical substrates of cognitive impairment, to explore the complex interplay between gray matter (GM) maturational processes and disease-related damage and to unravel in vivo potential pathogenetic mechanisms.
In details, inefficient regulation of the functional interaction between different areas of sustained attention system due to abnormal white matter (WM) integrity was identified as a potential substrate of cognitive impairment in pediatric MS patients.
In a longitudinal setting, we observed that pediatric MS patients experienced failures in GM development in several cortical and sub-cortical regions, as well as GM atrophy progression in most of these regions. These abnormalities were only partially related to focal MS lesions, thus suggesting the existence of early neurodegenerative processes independent from WM lesions. Furthermore, higher IQ, a proxy of cognitive reserve in pediatric patients, resulted as a protective factor against GM damage, being associated with reduced deviations from age-expected volumes of specific GM regions at baseline and during the follow-up.
Focusing on the thalamus, we observed a trend toward thalamic atrophy and we detected significant microstructural abnormalities as assessed by using different quantitative MRI measure (fractional anisotropy, mean diffusivity and T1/T2-weighted ratio). Segmenting the thalamus and thalamic WM into concentric bands originating from CSF/thalamus interface, we observed significant microstructural abnormalities in bands nearest to CSF and in those closest to WM. Moreover, the abnormalities detected at CSF/thalamus interface correlated with cortical thickness reduction, while those at thalamus/WM interface with WM lesion volume. These findings support the hypothesis of heterogeneous pathological processes, including retrograde degeneration from WM lesions and CSF-mediated damage, leading to thalamic microstructural abnormalities, likely preceding macroscopic tissue loss.
In a longitudinal setting, we identified several predictors of disease course and prognosis in pediatric MS patients. Shorter time to first relapse was predicted by optic nerve lesions, while longer time was predicted by high-efficacy treatment exposure. Lesion location at baseline MRI scan together with disease activity during the first 2 years of disease significantly accounted for annualized relapse rate over 9-year of follow-up. The involvement of clinically eloquent sites (such as the optic nerve, brainstem, and spinal cord) at baseline, together with disability and MRI activity during the first 2 year of disease were found as significant predictors of 9-year disability.
Finally, analyzing data from the Italian MS Register, we showed that compared to post-pubertal, pre-pubertal onset pediatric MS patients took longer time from disease onset to convert to secondary progressive phenotype and to reach irreversible Expanded Disability Status Scale scores of 3, 4, and 6. These findings highlight a different natural history of pre- vs post-pubertal onset pediatric MS, pointing towards the existence of specific pathophysiological mechanisms, combined with a greater capacity of recovery to counteract damage, in younger pediatric MS patients.Durante questo corso di dottorato di ricerca, sono state applicate diverse tecniche avanzate di risonanza magnetica (RM) in pazienti pediatrici con sclerosi multipla (SM) per caratterizzare i substrati neuroanatomici del deterioramento cognitivo, per esplorare la complessa interazione tra i processi maturativi della sostanza grigia (SG) e il danno correlato alla malattia e per individuare in vivo potenziali meccanismi patogenetici. Un’inefficiente regolazione dell'interazione funzionale tra diverse aree del sistema dell’ attenzione sostenuta a causa del danno macro- e micro-strutturale della sostanza bianca (SB) è stata identificata come un potenziale substrato del deterioramento cognitivo nei pazienti pediatrici con SM. In un setting longitudinale, abbiamo osservato che i pazienti pediatrici con SM vanno incontro ad alterazioni dello sviluppo della SG in diverse regioni corticali e sottocorticali ed a progressiva atrofia nella maggior parte di queste regioni. Queste anomalie apparivano solo parzialmente correlate alle lesioni focali tipiche della SM, suggerendo così l'esistenza di processi neurodegenerativi precoci, indipendenti dalle lesioni della SB. Inoltre, un QI più elevato, misura indiretta della riserva cognitiva nei pazienti pediatrici, è risultato un fattore protettivo contro il danno della SG, essendo associato a minor deviazione dai volumi attesi per età di specifiche regioni di SG. Focalizzandoci sul talamo, abbiamo osservato una tendenza all'atrofia di questa struttura ed abbiamo rilevato anomalie microstrutturali utilizzando diverse misure quantitative di RM (anisotropia frazionaria, diffusività media e rapporto T1/T2). Segmentando il talamo e la SB talamica in bande concentriche partendo dall'interfaccia liquor/talamo, abbiamo osservato anomalie microstrutturali nelle bande più vicine al liquor e in quelle più vicine alla SB. Inoltre, le alterazioni rilevate all'interfaccia liquor/talamo correlavano con la riduzione dello spessore corticale, mentre quelle all’interfaccia talamo/SB con il volume delle lesioni della SB. Questi risultati supportano l'ipotesi di processi patologici eterogenei: degenerazione retrograda da lesioni della SB e danno mediato dal liquor, che portano ad anomalie microstrutturali talamiche precedenti la perdita di sostanza. In un setting longitudinale, abbiamo identificato diversi predittori del decorso di malattia e della prognosi nei pazienti pediatrici con SM. Un intervallo tempo più breve tra l’esordio di malattia e la prima ricaduta appariva associato alla presenza di lesioni del nervo ottico, mentre un intervallo più lungo all'esposizione al trattamento. La localizzazione delle lesioni alla prima RM insieme all'attività di malattia durante i primi 2 anni correlava con il tasso di recidiva annualizzato in 9 anni di follow-up. Il coinvolgimento di siti clinicamente eloquenti (come il nervo ottico, il tronco cerebrale e il midollo spinale) insieme alla disabilità ed all'attività neuroradiologica durante i primi 2 anni di malattia sono stati individuati come predittori della disabilità a 9 anni. Infine, analizzando i dati del Registro Italiano Sclerosi Multipla, abbiamo dimostrato che rispetto ai pazienti pediatrici con SM ad esordio post-pubere, i pazienti con SM con esordio pre-pubere impiegano più tempo dall'insorgenza della malattia per convertire al fenotipo secondariamente progressivo e per raggiungere più elevati livelli di disabilità. Questi risultati evidenziano una diversa storia naturale della SM pediatrica pre- e post-pubere che indica l'esistenza di meccanismi fisiopatologici specifici ed una maggiore capacità di recupero nei pazienti pediatrici più giovani.
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Carlew, Anne R. "The Nature of Cognitive Impairment in Multiple Sclerosis." Thesis, University of North Texas, 2018. https://digital.library.unt.edu/ark:/67531/metadc1248461/.
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Cognitive impairment is common in multiple sclerosis (MS), with as many as 70% of patients with MS affected. Individuals with MS who experience cognitive deficits are less likely to be employed, and may have more difficulty performing independent activities of daily living. Most commonly, deficits are observed in processing speed, complex attention, and memory. Because lesion location varies widely among individuals, no clear pattern of cognitive dysfunction in MS has emerged. However, a number of risk and protective factors may influence the likelihood of individuals to develop and/or express dysfunction, though the contribution of each to specific domains of cognition has not been fully explored. Recently, support for the cognitive reserve hypothesis (i.e., enriching life experiences protect against cognitive decline despite disease burden) has emerged in the MS literature. The current study investigated the contributions of cognitive reserve to learning and memory functioning in MS and the interaction of cognitive reserve variables and risk factors known to impact cognitive functioning in individuals with MS. Finding revealed cognitive reserve protects against decline in the domains of processing speed and complex attention. Furthermore, indirect protective effects of cognitive reserve through these domains were observed for verbal learning and memory. Finally, in line with previous literature, cognitive dysfunction predicted employment status of the current sample. Clinical implications and future directions for intervention efforts are discussed.
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Thornton, Helena Barbara. "Cognition and multiple sclerosis: a neuropsychological and MRI study." Thesis, Rhodes University, 1996. http://hdl.handle.net/10962/d1007290.
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Ten people with multiple sclerosis (MS) who felt they had cognitive difficulties because of their MS were investigated. This study had multiple aims. Firstly, to explore the subjective experience of cognitive deficits. Secondly, to assess whether or not there was objective evidence of cognitive difficulties on neuropsychological testing, and whether this was commensurate with a pattern of subcortical dementia. Thirdly, to determine whether their magnetic resonance imaging (MRI) scans replicated the patterns of atrophy frequently reported in MS patients with cognitive difficulties. And finally, to investigate the psychological well-being of the subjects. In depth neuropsychiatric interviews, psychiatric and psychological inventories, a comprehensive neuropsychological battery, and MRI investigations were done. The mean Full Scale Intelligence Quotient (FSIQ) fell within the superior range, at the 89th percentile. On tests of general intelligence, mental state examinations, there was little or no indication of cognitive deterioration. However, on sophisticated neuropsychological testing, there was convincing evidence of cognitive problems. Magnetic resonance imaging lesions were atypical of the reported research on cognitively compromised MS patients.
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Teng, Shang Yuan. "Assessing cognitive impairment in Multiple Sclerosis: effect of gender, mood and time." Thesis, McGill University, 2010. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=86841.
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Cognitive impairment is an important contributor to disability in multiple sclerosis (MS), one of the most common chronic neurological condition affecting young adults. The clinical presentation of cognitive changes in MS is unique given the progressive nature of the disease and the interaction between cognitive impairments and other MS symptoms. Appropriate evaluation of cognitive deficits is an important issue in assessment for persons with MS. The main objectives of this study are to provide a modern approach to assess stability, unidimentionality and item hierarchy of the Perceived Deficits Questionnaire (PDQ) for persons with MS and to estimate the extend to which there are gender differences in the associations of mood and fatigue with perceived cognitive function and with tested cognitive capacity in persons diagnosed with MS. A center-stratified sample of 185 persons with MS was assembled and participants were evaluated on both perceived and measured cognitive function, as well as other clinical aspects of the disease. To develop an interval-like measure, Rasch analysis was performed, which helped to identify the item hierarchy of PDQ, to confirm the factor structure, item fit and redundancy, unidimensionality, as well as to examine item stability. As a result, an 11-item questionnaire, the PDQ-Rasch was developed. Cognitive function was measured in two ways. The PDQ was used to assess self- perceptions and the PASAT was used to measure processing speed. Multiple linear regression models were used to identify correlates of perceived cognition and measured cognition. PDQ was explained by depressed mood, fatigue, female gender and pain. Furthermore, mood had a stronger effect among women than men on PDQ. PASAT was predicted by physical function and pain.Les déficits cognitifs contribuent de façon importante à l'handicap relié à la sclérose en plaque (SP), une des conditions neurologiques chroniques les plus communes chez les jeunes adultes. La présentation clinique des changements cognitifs chez les personnes atteintes de SP est unique en raison de la nature progressive de la maladie et de l'interaction entre les déficits cognitifs et les autres symptômes de la SP. Une évaluation adéquate des changements cognitifs est donc importante dans l'évaluation des personnes atteintes de la SP. L'objectif principal de cette étude est d'évaluer la stabilité, l'unidimensionalité et la hiérarchie des items de la mesure de perception du fonctionnement cognitif (Questionnaire sur les Déficits Perçus, PDQ), ainsi que d'explorer les différences de gendre dans les associations entre l'humeur, la fatigue et le fonctionnement cognitif chez les personnes atteintes de la SP. La perception du fonctionnement cognitif, le fonctionnement cognitif, ainsi que d'autres aspects cliniques ont été mesurés sur un échantillon, stratifié par centre, de 185 personnes atteintes de la SP. L'analyse Rasch a été effectuée d'identifier la hierarchie des items du PDQ, de confirmer la structure factorielle, la redondance des items, l'unidimensionalité, ainsi que pour examiner la stabilité des items. Un questionnaire de 11 items, le PDQ-Rasch, a été développé. Des modèles de régression linéaire ont servis à identifier les corrélations entre les habilités cognitives perçues (PDQ) et les habiletés cognitives mesurées (par le PASAT). Les résultats du PDQ ont été expliqués par une humeur dépressive, la fatigue, le sexe féminin, et la douleur. De plus, l'humeur avait un effet plus fort sur les femmes que sur les hommes, dans les résultats du PDQ. Les résultats du PASAT ont été prédits par le fonctionnement physique et la douleur.
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Murrell, Rachel C. "Quality of life and severe neurological disability." Thesis, University of Surrey, 1999. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.484182.
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Atkins, Elisabeth Anice. "Self and relative reported executive dysfunction in multiple sclerosis : prevalence and relationship with mood and health status." Thesis, Open University, 2002. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.252384.
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McLaughlin, Stephanie Patrice. "Cognitive Functioning in Multiple Sclerosis: An Investigation of the Utility of a Computerized Cognitive Testing System." BYU ScholarsArchive, 2016. https://scholarsarchive.byu.edu/etd/6013.
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The primary objective of this study was to assess cognitive functioning in participants with relapsing remitting multiple sclerosis (RRMS) using the MicroCog and to compare their performance to that of a demographically matched, healthy control group. It was hypothesized that as a group, participants with RRMS would have worse cognitive function than healthy controls on all Level 1, 2, and 3 Index scores of the MicroCog. Twenty-six participants with RRMS and twenty-nine sex and education matched healthy controls were administered the MicroCog (Standard Form) along with measures of depression and clinical status, and paper-pencil tests of processing speed (Symbol Digit Modalities Test; SDMT and Paced Auditory Serial Addition Test; PASAT). A series of ANCOVAs with depression as a covariate was performed to determine between group differences for each MicroCog Level 3 Index score (General Cognitive Proficiency (GCP) and General Cognitive Functioning (GCF)), Level 2 Index score (Information Processing Accuracy (IPA) and Information Processing Speed (IPS)), and Level 1 Index score (Attention/Mental Control, Memory, Reasoning/Calculation, Spatial Processing, and Reaction Time). Pearson's and point biserial r correlations were calculated in order to assess the degree to which Level 2 and 3 Index scores correlated with clinical and demographic factors (sex, disease duration, depression, and clinical status) and to correlate the MicroCog IPS index score with traditional measures of processing speed. Eight RRMS and two control participants met criteria for cognitive impairment on the MicroCog. ANCOVA results indicated there were significant differences between RRMS and control performance for two MicroCog scores (GCF and IPS). There were not significant differences for GCP, IPS, and all Level 1 scores. A post-hoc analysis performed for the same hypothesis with a group of age equivalent participants suggested a significant RRMS by depression interaction for Level 3 scores. RRMS was not predictive of Level 2 scores after controlling for depression in the age equivalent sample. Correlations for clinical and demographic factors with cognitive outcomes indicated significant relationships for clinical status and depression. There was not a significant relationship detected for disease duration or sex. MicroCog and processing speed measures were significantly related. Post-hoc analyses supported that the criterion validity of the MicroCog is comparable to other cognitive screening tools in RRMS. The results and limitations of our study are discussed, in addition to recommendations for future research.
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Planche, Vincent. "Pathophysiology and imaging of early memory impairment in multiple sclerosis." Thesis, Bordeaux, 2016. http://www.theses.fr/2016BORD0392/document.
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Les troubles mnésiques sont fréquents dans la sclérose en plaques (SEP) mais leurs substrats anatomique et biologique sont mal connus. L’objectif de cette thèse translationnelle était de comprendre les mécanismes physiopathologiques des troubles mnésiques à la phase précoce de la SEP, avec pour perspective de trouver de nouvelles cibles thérapeutiques et de définir de nouveaux marqueurs d’imagerie. Nous avons réalisé une analyse neuropsychologique et IRM de patients atteints de forme précoce de SEP et nous avons étudié des souris à la phase précoce d’une encéphalomyélite auto-immune expérimentale (EAE, le modèle animal de la SEP) avec une combinaison d’expériences comportementales, d’IRM, histologiques, électrophysiologiques et pharmacologiques. Nous avons démontré que l’atteinte hippocampique était précoce dans l’histoire de la maladie et qu’elle était corrélée au déclin mnésique des patients atteints de SEP. Nous avons identifié chez les souris EAE que la structure et la fonction du gyrus denté étaient plus vulnérables que les autres sous-champs de l’hippocampe au stade précoce de la maladie et nous avons transposé cette découverte à la pathologie humaine en démontrant une perte des capacités de pattern separation chez des patients atteints de forme précoce de SEP. Du point de vue mécanistique, nous avons démontré que l’activation microgliale précoce était responsable de l’atteinte du gyrus denté et des troubles mnésiques dans l’EAE et que cette cascade physiopathologique pouvait être prévenue grâce à un traitement par minocycline. Du point de vue de l’imagerie, nous avons également démontré que l’atteinte microstructurale de l’hippocampe ainsi que la neurodégénérescence précoce du gyrus denté pouvaient être étudiées in vivo en tenseur de diffusion (DTI). Nous travaillons à la mise en place de méthode encore plus spécifique par l’imagerie de densité neuritique et d’orientation/dispersion (NODDI). Nos résultats relient l’atteinte mnésique précoce de la SEP à une neurodégénérescence sélective du gyrus denté. Ce processus physiopathologique peut être prévenu en inhibant l’activation microgliale chez les souris EAE et peut être étudié in vivo grâce au DTI chez la souris comme chez l’homme, offrant d’évidentes perspectives cliniques dans la prise en charge des patients atteints de SEPMemory impairment is frequent in multiple sclerosis (MS) but its anatomical and biological substrates are poorly understood. The objective of this translational thesis was to understand the pathophysiological mechanisms of early memory impairment in MS, to find new potential therapeutic targets and to define new imaging biomarkers related to memory impairment. We used neuropsychological and MRI experiments in patients with early MS and we explored experimental autoimmune encephalomyelitis (EAE) mice (a mouse model of MS) at the early stage of the disease with a combination of behavioral, in vivo MRI, histological, electrophysiological and pharmacological approaches. In patients with MS, we demonstrated that hippocampal damage occurs early during the course of the disease and that it correlates with memory impairment. In EAE-mice, we identified that dentate gyrus structure and function are more vulnerable than other hippocampal subfields at the early stage of the disease and we translated this finding back to humans by demonstrating loss of pattern separation performances in patients with early MS. From a mechanistic point of view, we demonstrated that early microglial activation causes dentate gyrus disruption and memory impairment in EAE-mice and that this pathophysiological cascade can be prevented with minocycline. From the imaging point of view, we demonstrated that hippocampal microstructural damage and early dentate gyrus degeneration can be monitored in vivo with diffusion tensor imaging (DTI). We are currently developing more specific imaging approaches with optimization of the Neurite Orientation Dispersion and Density Imaging (NODDI) to assess hippocampal subfields. Our results link early memory impairment in MS to a selective disruption of the dentate gyrus. We were able to prevent this neurodegenerative process with microglial inhibitors in EAE-mice and to capture these features non-invasively with DTI in both humans and rodents, paving the way toward new clinical perspectives in MS
Books on the topic "MULTIPLE SCLEROSIS, MRI, COGNITIVE IMPAIRMENT"
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Filippi, Massimo, and Maria A. Rocca. Multiple Sclerosis: White Matter versus Gray Matter Involvement (The Cause of Disability in MS). Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199937837.003.0083.
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The classic view of multiple sclerosis (MS) as a chronic, inflammatory-demyelinating condition affecting solely the white matter (WM) of the central nervous system (CNS) has been challenged by the demonstration, from pathologic and magnetic resonance imaging (MRI) studies, of an extensive and diffuse involvement of the gray matter (GM). This observation has driven the application of modern MR technology and methods of analysis to quantify the extent and distribution of damage to the different compartments of the CNS, with the ultimate goal of improving our understanding of the factors associated with the accumulation of clinical disability and cognitive impairment in these patients.
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Larocca, Nicholas G. Cognitive Impairment and Mood Disturbances. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199341016.003.0018.
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This chapter presents a comprehensive review of two of the most prevalent symptoms in persons with multiple sclerosis. While cognitive impairment and mood disorders may affect at least half of the MS population, and can have a significant effect on function and quality of life, they are often under recognized and under treated. The epidemiology and most common clinical manifestations of cognitive dysfunction and mood disorders are presented, along with a detailed discussion of screening and assessment tools. Pharmacologic and behavioral treatment interventions are reviewed, with analyses of their comparative efficacy.
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Nuwer, Marc R. Evoked Potentials. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199341016.003.0009.
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Visual evoked potentials, brainstem auditory evoked potentials, and somatosensory evoked potentials are established clinical tests that are useful for the diagnosis of multiple sclerosis. Motor evoked potentials, cognitive event-related potentials, and vestibular evoked potentials also are used clinically to test additional pathways and functions. These objective, reproducible tools can identify clinically silent lesions, predict clinical deterioration risk, and localize levels of impairment. They differ from magnetic resonance imaging in that they assess function rather than anatomy and thereby fill a complementary role in clinical care. They also are useful in therapeutic trials because they can predict outcomes in parallel with, or earlier than, clinical examinations.
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Passaro, Antony, Foteini Christidi, Vasiliki Tsirka, and Andrew C. Papanicolaou. White Matter Connectivity. Edited by Andrew C. Papanicolaou. Oxford University Press, 2014. http://dx.doi.org/10.1093/oxfordhb/9780199764228.013.5.
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The applications of diffusion tensor imaging (DTI) have increased considerably among both normal and diverse neuropsychiatric populations in recent years. In this chapter, the authors examine the contributions of DTI in identifying profiles of trait-specific connectivity in several groups defined in terms of gender, age, handedness, and general intelligence. Additionally, the DTI literature is reviewed across a range of neurodegenerative disorders including Alzheimer’s disease, mild cognitive impairment, frontotemporal dementia, Parkinson disease, multiple sclerosis, and acquired neurological disorders resulting from neuronal injury such as traumatic brain injury, aphasia, agnosia, amnesia, and apraxia. DTI metrics sensitive to psychiatric disorders encompassing obsessive-compulsive disorder, depression, bipolar disorder, schizophrenia, and alcoholism are reviewed. Future uses of DTI as a promising means of confirming diagnoses and identifying in vivo early microstructural changes of patients’ clinical symptoms are discussed.
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Shaibani, Aziz. Pseudoneurologic Syndromes. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190661304.003.0022.
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The term functional has almost replaced psychogenic in the neuromuscular literature for two reasons. It implies a disturbance of function, not structural damage; therefore, it defies laboratory testing such as MRIS, electromyography (EMG), and nerve conduction study (NCS). It is convenient to draw a parallel to the patients between migraine and brain tumors, as both cause headache, but brain MRI is negative in the former without minimizing the suffering of the patient. It is a “software” and not a “hardware” problem. It avoids irritating the patient by misunderstanding the word psychogenic which to many means “madness.”The cause of this functional impairment may fall into one of the following categories:• Conversion reaction: conversion of psychological stress to physical symptoms. This may include paralysis, hemisensory or distal sensory loss, or conversion spasms. It affects younger age groups.• Somatization: chronic multiple physical and cognitive symptoms due to chronic stress. It affects older age groups.• Factions disorder: induced real physical symptoms due to the need to be cared for, such as injecting oneself with insulin to produce hypoglycemia.• Hypochondriasis: overconcern about body functions such as suspicion of ALS due to the presence of rare fasciclutations that are normal during stress and after ingestion of a large amount of coffee. Medical students in particular are targets for this disorder.The following points are to be made on this topic. FNMD should be diagnosed by neuromuscular specialists who are trained to recognize actual syndrome whether typical or atypical. Presentations that fall out of the recognition pattern of a neuromuscular specialist, after the investigations are negative, they should be considered as FNMDs. Sometimes serial examinations are useful to confirm this suspicion. Psychatrists or psychologists are to be consulted to formulate a plan to discover the underlying stress and to treat any associated psychiatric disorder or psychological aberration. Most patients think that they are stressed due to the illness and they fail to connect the neuromuscular manifestations and the underlying stress. They offer shop around due to lack of satisfaction, especially those with somatization disorders. Some patients learn how to imitate certain conditions well, and they can deceive health care professionals. EMG and NCS are invaluable in revealing FNMD. A normal needle EMG of a weak muscles mostly indicates a central etiology (organic or functional). Normal sensory responses of a severely numb limb mean that a lesion is preganglionic (like roots avulsion, CISP, etc.) or the cause is central (a doral column lesion or functional). Management of FNMD is difficult, and many patients end up being chronic cases that wander into clinics and hospitals seeking solutions and exhausting the health care system with unnecessary expenses.It is time for these disorders to be studied in detail and be classified and have criteria set for their diagnosis so that they will not remain diagnosed only by exclusion. This chapter will describe some examples of these disorders. A video clip can tell the story better than many pages of writing. Improvement of digital cameras and electronic media has improved the diagnosis of these conditions, and it is advisable that patients record some of their symptoms when they happen. It is not uncommon for some Neuromuscular disorders (NMDs), such as myasthenia gravis (MG), small fiber neuropathy, and CISP, to be diagnosed as functional due to the lack of solid physical findings during the time of the examination. Therefore, a neuromuscular evaluation is important before these disorders are labeled as such. Some patients have genuine NMDs, but the majority of their symptoms are related to what Joseph Marsden called “sickness behavior.” A patient with carpal tunnel syndrome (CTS) may unconsciously develop numbness of the entire side of the body because he thinks that he may have a stroke.
Book chapters on the topic "MULTIPLE SCLEROSIS, MRI, COGNITIVE IMPAIRMENT"
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Liang, Zhengrong, Lihong Li, Hongbing Lu, Wei Huang, Alina Tudorica, and Lauren Krupp. "An Integrated MRI and MRS Approach to Evaluation of Multiple Sclerosis with Cognitive Impairment." In Lecture Notes in Computer Science, 200–207. Berlin, Heidelberg: Springer Berlin Heidelberg, 2007. http://dx.doi.org/10.1007/978-3-540-77413-6_26.
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Morrow, Sarah. "Cognitive impairment." In Case Studies in Multiple Sclerosis, 91–96. Cham: Springer International Publishing, 2016. http://dx.doi.org/10.1007/978-3-319-31190-6_12.
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Mendozzi, L., M. G. Landoni, A. Ghezzi, and C. L. Cazzullo. "Cognitive Impairment in Multiple Sclerosis." In Virology and Immunology in Multiple Sclerosis: Rationale for Therapy, 228–30. Berlin, Heidelberg: Springer Berlin Heidelberg, 1988. http://dx.doi.org/10.1007/978-3-642-73032-0_35.
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Ruet, Aurélie. "Cognitive Impairment in Multiple Sclerosis." In Neuropsychiatric Symptoms of Inflammatory Demyelinating Diseases, 227–47. Cham: Springer International Publishing, 2015. http://dx.doi.org/10.1007/978-3-319-18464-7_16.
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Gonzalez, Carlos F., D. R. Mitchell, T. Sachetti, J. D. Seward, R. L. Knobler, and F. D. Lublin. "Correlation between structural brain lesions and emotional and cognitive function in patients with multiple sclerosis: an MRI study." In Proceedings of the XIV Symposium Neuroradiologicum, 123–24. Berlin, Heidelberg: Springer Berlin Heidelberg, 1991. http://dx.doi.org/10.1007/978-3-642-49329-4_41.
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Kassa, Roman, and B. Mark Keegan. "A Septuagenarian With Progressive Hemiparesis." In Mayo Clinic Cases in Neuroimmunology, edited by Andrew McKeon, B. Mark Keegan, and W. Oliver Tobin, 48–50. Oxford University Press, 2021. http://dx.doi.org/10.1093/med/9780197583425.003.0015.
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A 78-year-old man with no pertinent medical history sought care for an 18-month history of progressive right lower extremity weakness, gait impairment, and falls. On neurologic examination, he had a hemiparetic gait. He had normal higher cognitive function and cranial nerve function. Motor examination showed decreased bulk over the right hand with no fasciculations, mild spasticity over the right leg, and right hemiparesis with an upper motor neuron pattern. Deep tendon reflexes were brisk throughout his limbs, and he had an extensor plantar reflex on the right side. He had impaired vibratory sense at the toes, with otherwise normal sensory and coordination examinations. Magnetic resonance imaging (MRI) of the brain showed ovoid periventricular and punctate subcortical and deep white matter T2 hyperintense foci. Some of these had corresponding T1 hypointensity. MRI of the cervical spine showed 1 eccentrically located T2 hyperintense lesion over the right lateral aspect of C2. Cerebrospinal fluid analysis showed no pleocytosis, an increased protein concentration of 66 mg/dL, and 4 unique oligoclonal bands. A diagnosis of primary progressive multiple sclerosis, very late onset, was made. With any diagnosis of late-onset multiple sclerosis, a decision about whether multiple sclerosis disease-modifying agents are indicated should be carefully considered. Our older patient had a progressive disease course, and neuroimaging studies did not reveal evidence of active disease. Based on this, a decision was made to monitor him clinically and radiologically. Management of spasticity with regular daily stretching exercises was discussed with him. A first clinical manifestation of multiple sclerosis can occur at a later-than-typical age. Most studies consider an onset at age 50 years or older to be late-onset multiple sclerosis, whereas first symptoms occurring at age 60 years or older are commonly referred to as very late–onset MS.
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"Cognitive Impairment in Multiple Sclerosis." In Handbook of Multiple Sclerosis, 250–73. CRC Press, 2001. http://dx.doi.org/10.1201/9780824741846-14.
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Amato, M. P., and B. Goretti. "Cognitive Impairment in Multiple Sclerosis." In Translational Neuroimmunology in Multiple Sclerosis, 365–84. Elsevier, 2016. http://dx.doi.org/10.1016/b978-0-12-801914-6.00027-1.
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Fischer, Jill. "Cognitive Impairment in Multiple Sclerosis." In Neurological Disease and Therapy. Informa Healthcare, 2001. http://dx.doi.org/10.1201/9780824741846.ch10.
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Valencia-Sanchez, Cristina, and Jonathan L. Carter. "Multiple Sclerosis and Cognitive Impairment." In Mayo Clinic Cases in Neuroimmunology, edited by Andrew McKeon, B. Mark Keegan, and W. Oliver Tobin, 39–41. Oxford University Press, 2021. http://dx.doi.org/10.1093/med/9780197583425.003.0012.
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A 60-year-old woman with a history of multiple sclerosis was evaluated for cognitive concerns. At age 30 years she had an episode of optic neuritis, followed by an episode of bilateral lower extremity numbness at age 35 years. In the following years, she had at least 6 further multiple sclerosis relapses, the last one approximately 3 years before the current presentation. She was initially treated with interferon, but she did not tolerate it. She had been taking glatiramer acetate for the past 3 years. She had noticed progressive deterioration of her gait for the past 3 years, having to use a cane on occasions. Magnetic resonance imaging of the brain showed multiple demyelinating lesions), and magnetic resonance imaging of the cervical spine showed 1 small demyelinating lesion at C6. Vitamin B12 level and thyroid function were normal. Comprehensive neuropsychological testing showed multidomain cognitive impairment, mainly impairment of speed of information processing, spatial discrimination skills, and attention/concentration. The patient’s multiple sclerosis phenotype was consistent with secondary progressive multiple sclerosis. Her cognitive impairment profile, mainly affecting information processing speed and disinhibition suggestive of frontal dysfunction, was consistent with multiple sclerosis. The patient began a cognitive rehabilitation program, and learning and memory aids were recommended. Lifestyle changes were also recommended, including weight loss and physical exercise. She was given recommendations for sleep hygiene and began taking gabapentin for neuropathic pain and restless legs. Cognitive impairment is common in patients with multiple sclerosis. Slowed cognitive processing speed and episodic memory decline are the most common cognitive deficits in MS, with additional difficulties in executive function, verbal fluency, and visuospatial analysis.
Conference papers on the topic "MULTIPLE SCLEROSIS, MRI, COGNITIVE IMPAIRMENT"
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Guerrera, Brittany, Samantha Farrow, Gloria Zeng, and Sally F. Shady. "Multiple Sclerosis Symptom Analyzer." In ASME 2016 International Mechanical Engineering Congress and Exposition. American Society of Mechanical Engineers, 2016. http://dx.doi.org/10.1115/imece2016-66217.
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Multiple Sclerosis (MS) is a chronic neurodegenerative disease of the central nervous system. MS is typically diagnosed between the ages of 20 and 40. There is no known cause of the disease and each individual experiences varying signs and symptoms depending on the severity of their disease. The most common symptoms include tremor, debilitated gait, visual impairment, or cognitive and emotional disturbances. Current methods used to treat MS include oral medication and surgical treatment. The issues with oral medication are the unwanted side effects to otherwise healthy tissue and the lack of patient adherence. Surgical treatment can be invasive and require longer recovery times. An alternate strategy to treat MS is by increasing the knowledge base of the practitioner to potentially treat specific symptoms. Currently, physicians use observations and MRI scans of the brain and spinal cord to help diagnose and track the progression of MS. There are several studies that analyze existing assistive technology to aid in the treatment of MS tremors. Most of these studies did not involve large test groups, therefore it is difficult to prove their validity. Additionally, none of the current devices are able to track symptoms while simultaneously creating medical history records. The goal of the design is to create a new device that will obtain the frequency and amplitude of tremors, while analyzing the effects of temperature and heart rate on the intensity of the tremor. With this data, the device will advance further MS research and lead to better diagnosis and treatment.
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Santiago, Igor, Victor Elias, Ivna Nóbrega, Gabriela Martins, José Artur D’Almeida, and Norberto Frota. "COEXISTENCE OF MULTIPLE SCLEROSIS AND ALZHEIMER DISEASE: WHAT WE KNOW SO FAR?" In XIII Meeting of Researchers on Alzheimer's Disease and Related Disorders. Zeppelini Editorial e Comunicação, 2021. http://dx.doi.org/10.5327/1980-5764.rpda107.
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Background: Multiple sclerosis (MS) and Alzheimer disease (AD) are neurodegenerative diseases with distinct pathophysiology but similar burdens. Early cognitive impairment in MS is unusual but, due to disease modifying therapies (DMT) advancements and bigger life expectancy, its coexistence with AD has become more common. Objective: To report a coexistence case of MS and AD. Methods: Retrospective case report and literature review. Results: 58-year-old patient presented with work issues, behavioral changes, gait disturbance and unbalance. It was disclosed an impairment of attention span, multitasking, executive dysfunction, and loss of memory for recent events. A PET/CT showed hypometabolism in frontal lobes and CSF analysis disclosed oligoclonal bands and increased TAU protein levels. The patient was initially treated with donepezil, with poor response. A later brain MRI showed typical demyelinating MS lesions. The patient was treated with Natalizumab due to high lesion load and functional impairment. Conclusion: As MS patients live longer, it’s important to recognize age-related comorbidities such as AD. In our patient a poor relapse perception contributed for a late MS diagnosis. The evaluation with PET/CT and increased TAU levels in CSF highly suggests a coexistence with AD. There are no peer-reviewed studies regarding coexisting MS and AD. Further research is necessary to better understand the clinical, demographic, and neuropathological features of the coexistence of both diseases.
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Fernandez, Paulo Eduardo Lahoz, Guilherme Diogo Silva, and Eduardo Genaro Mutarelli. "Studies across subspecialties of neurology (SON) report noninferiority of telemedicine (TM) compared with face-to-face intervention (FTF-I)." In XIII Congresso Paulista de Neurologia. Zeppelini Editorial e Comunicação, 2021. http://dx.doi.org/10.5327/1516-3180.680.
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Background: Studies across subspecialties of neurology (SON) report noninferiority of telemedicine (TM) compared with face-to-face intervention (FTF-I). Clinical scales (CS) are important tools for outcome measures in clinical care. However, which CS in FTF-I can be used in teleneurology is unclear. Objectives: Define the most used CS in studies comparing TM with FTF-I in different SON. Design and Setting/Methods: We searched PubMed and Embase for randomized controlled trials, published from 2011 to April 2021, with Key words ‘’telemedicine’’ cross-referenced with ‘’neurology’’ or neurological diseases, considering the synonyms. Results: 43 eligible studies in 400 records, from 12 countries, with 5600 patients and 8 SON: stroke (10), headache (4), epilepsy (6), cognitive disorders (7), demyelinating diseases (8), movement disorders (3), neuromuscular diseases (3), and vestibular diseases (2). The most used CS: National Institute of Health Stroke Scale (NIHSS) and Modified Rankin Scale (MRS) for stroke impairment and limitation; Headache Impact Test (HIT-6) and Migraine Disability Assessment Scale (MIDAS) for headache disability; Quality Of Life in Epilepsy Inventory (QOL-31) for seizure burden; Mini-Mental State Exam (MMSE) and Zarit Burden Interview (ZBI) for cognitive function and caregiver burden in dementia care; Expanded Disability Status Scale (EDSS) and Fatigue Impact Scale (FIS) for disability and fatigue in Multiple Sclerosis; Parkinson’s disease Questionnaire (PDQ-39) and Unified Parkinson’s Disease Rating Scale (UPDRS) for QOL and disability in PD; Amyotrophic Lateral Sclerosis Functional Rating Scale Revised (ALSFRS-R) for severity in ALS; and Vertigo Symptom Scale Short form (VSS-SF) for vertigo. Conclusions: We present feasible CS usually applied in teleneurology that can be used as important tools for future findings in TM research and practice.
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Rački, Valentino, Vladimira Vuletić, and Sten Fredrikson. "Multiple sclerosis and cognitive impairment: where do we stand? /, ,." In Rijeka Forum on Neurodegenerative Diseases (2 ; 2018 ; Rijeka). Hrvatska akademija znanosti i umjetnosti, 2019. http://dx.doi.org/10.21857/90836cwj3y.
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Tangaro, Sabina, Nicola Amoroso, Roberto Bellotti, Maria Liguori, L. Margari, Marta Simone, R. G. Viterbo, Alfonso Monaco, Annarita Fanizzi, and Angela Lombardi. "Association between MRI structural features and cognitive measures in pediatric multiple sclerosis." In Applications of Digital Image Processing XL, edited by Andrew G. Tescher. SPIE, 2017. http://dx.doi.org/10.1117/12.2273834.
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Brusini, Lorenza, Federica Cruciani, Ilaria Boscolo Galazzo, Marco Pitteri, Silvia F. Storti, Massimiliano Calabrese, Marco Lorenzi, and Gloria Menegaz. "Multivariate Data Analysis Suggests The Link Between Brain Microstructure And Cognitive Impairment In Multiple Sclerosis." In 2021 IEEE 18th International Symposium on Biomedical Imaging (ISBI). IEEE, 2021. http://dx.doi.org/10.1109/isbi48211.2021.9433799.
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Casalino, Gabriella, Gennaro Vessio, and Arianna Consiglio. "Evaluation of Cognitive Impairment in Pediatric Multiple Sclerosis with Machine Learning: An Exploratory Study of miRNA Expressions." In 2020 IEEE Conference on Evolving and Adaptive Intelligent Systems (EAIS). IEEE, 2020. http://dx.doi.org/10.1109/eais48028.2020.9122758.
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van's Gravesande, Karin Storm, Elke Kalbe, Astrid Blaschek, Pasquale Calabrese, Josef Kessler, Heike Schuler, and Volker Mall. "FV 658. Cognitive Impairment, Depression, Fatigue, and Quality of Life in Pediatric-Onset Multiple Sclerosis: Results of the Multiple Sclerosis Inventory of Cognition in ADOlescents Study." In Abstracts of the 44th Annual Meeting of the Society for Neuropediatrics. Georg Thieme Verlag KG, 2018. http://dx.doi.org/10.1055/s-0038-1675945.
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Moghadasi, Mohammad, and Gabor Fazekas. "Multiple Sclerosis Detection via Machine Learning Algorithm, Accurate Simulated Database 3D MRI to 2D Images, using value of Binary Pattern Classification - A Case Study." In 2019 10th IEEE International Conference on Cognitive Infocommunications (CogInfoCom). IEEE, 2019. http://dx.doi.org/10.1109/coginfocom47531.2019.9089962.
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Machado, Roberta Ismael Lacerda, Bruno de Mattos Lombardi Badia, Wladimir Bocca Vieira de Rezende Pinto, Igor Braga Farias, José Marcos Vieira de Albuquerque Filho, Paulo Victor Sgobbi de Souza, and Acary Souza Bulle Oliveira. "INPP5K-Related congenital muscular dystrophy: when juvenile cataracts give clues to a complex diagnosis." In XIII Congresso Paulista de Neurologia. Zeppelini Editorial e Comunicação, 2021. http://dx.doi.org/10.5327/1516-3180.511.
Full textAbstract:
Introduction: Congenital muscular dystrophies (CMDs) are a group of rare genetic muscle diseases that present at birth or during infancy with hypotonia and weakness. Multiple forms of CMDs are also associated with cerebral and ocular phenotypes. Recently, INPP5K mutations have been described associated with CMD, cataracts and cognitive impairment. The INPP5K gene, encodes SKIP, one of the enzymes that phosphorylate the 5-phosphate position of phosphoinositides and is highly expressed in developing and adult brain, eye and muscle. Methods: We performed a case report of three Brazilian patients with INPP5KCMD with cataracts and intellectual disability under clinical follow-up at our service. Results: Case 1: 39 years old, female, presenting with progressive leg weakness since childhood, mild intellectual disability and bilateral cataracts at 20 years. Her 35-yearold sister (Case 2) had a similar clinical picture with limb-girdle weakness since childhood, cognitive impairment and early- onset bilateral cataracts. Both with myopathic pattern in EMG, elevated creatine phosphokinase (CK) and dystrophic pattern in muscle biopsy. Brain MRI studies disclosed a large megacistern in the elderly and no abnormalities in the younger sister. Genetic testing: c.653_655del(p.(Ser218del) in homozygosity in INPP5K gene. Case 3: 20 years old, female, normal motor development but learning difficulties since childhood. Presented with progressive pelvic girdle weakness in childhood and bilateral cataracts in late adolescence. Exams disclosed elevated CK, brain MRI was normal and genetic testing with the following mutation in INPP5K gene:c.[881_883del];[1088T>C];p.[Ser294del];[Ile363Thr]. Conclusion: We describe patients with CMD, cataracts and intellectual disability, caused by mutation in the INPP5K gene. In literature few cases are reported.