Neuropsychology of Multiple Sclerosis: Looking Back and Moving Forward

AbstractThe neuropsychological aspects of multiple sclerosis (MS) have evolved over the past three decades. What was once thought to be a rare occurrence, cognitive dysfunction is now viewed as one of the most disabling symptoms of the disease, with devastating effects on patients’ quality of life. This selective review will highlight major innovations and scientific discoveries in the areas of neuropathology, neuroimaging, diagnosis, and treatment that pertain to our understanding of the neuropsychological aspects of MS. Specifically, we focus on the recent discovery that MS produces pathogical lesions of gray matter (GM) that have consequences for cognitive functions. Methods for imaging these GM lesions in MS are discussed along with multimodal imaging studies that integrate structural and functional imaging methods to provide a better understanding of the relationship between cognitive test performance and functional reserve. Innovations in the screening and comprehensive assessment of cognitive disorders are presented along with recent research that examines cognitive dysfunction in pediatric MS. Results of innovative outcome studies in cognitive rehabilitation are discussed. Finally, we highlight trends for potential future innovations over the next decade. (JINS, 2017, 23, 832–842)

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Perceived Cognitive Difficulties and Cognitive Test Performance as Predictors of Employment Outcomes in People with Multiple Sclerosis

Journal of the International Neuropsychological Society ◽

10.1017/s1355617715000053 ◽

2015 ◽

Vol 21 (2) ◽

pp. 156-168 ◽

Cited By ~ 42

Author(s):

Cynthia A. Honan ◽

Rhonda F. Brown ◽

Jennifer Batchelor

Keyword(s):

Multiple Sclerosis ◽

Cognitive Impairment ◽

Prospective Memory ◽

Test Performance ◽

Work Hours ◽

Work Outcomes ◽

Cognitive Test ◽

Cognitive Difficulties ◽

Cognitive Test Performance ◽

The Relationship

AbstractPerceived cognitive difficulties and cognitive impairment are important determinants of employment in people with multiple sclerosis (pwMS). However, it is not clear how they are related to adverse work outcomes and whether the relationship is influenced by depressive symptoms. Thus, this study examined perceived and actual general cognitive and prospective memory function, and cognitive appraisal accuracy, in relation to adverse work outcomes. The possible mediating and/or moderating role of depression was also examined. A cross-sectional community-based sample of 111 participants (33 males, 78 females) completed the Multiple Sclerosis Work Difficulties Questionnaire (MSWDQ), Beck Depression Inventory – Fast Screen (BDI-FS), and questions related to their current or past employment. They then underwent cognitive testing using the Screening Examination for Cognitive Impairment, Auditory Consonant Trigrams test, Zoo Map Test, and Cambridge Prospective Memory Test. Perceived general cognitive and prospective memory difficulties in the workplace and performance on the respective cognitive tests were found to predict unemployment and reduced work hours since MS diagnosis due to MS. Depression was also related to reduced work hours, but it did not explain the relationship between perceived cognitive difficulties and the work outcomes. Nor was it related to cognitive test performance. The results highlight a need to address the perceptions of cognitive difficulties together with cognitive impairment and levels of depression in vocational rehabilitation programs in pwMS. (JINS, 2015,21, 156–168)

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CogniSoft: A Platform for the Automation of Cognitive Assessment and Rehabilitation of Multiple Sclerosis

Computers ◽

10.3390/computers9040093 ◽

2020 ◽

Vol 9 (4) ◽

pp. 93

Author(s):

Dessislava Petrova-Antonova ◽

Ivaylo Spasov ◽

Yanita Petkova ◽

Ilina Manova ◽

Sylvia Ilieva

Keyword(s):

Multiple Sclerosis ◽

Cognitive Assessment ◽

Cognitive Rehabilitation ◽

Large Scale ◽

Cognitive Disorders ◽

Cognitive Status ◽

Machine Learning Algorithms ◽

Cognitive Test ◽

Economic Research ◽

Medical Software

Cognitive disorders remain a major cause of disability in Multiple Sclerosis (MS). They lead to unemployment, the need for daily assistance, and a poor quality of life. The understanding of the origin, factors, processes, and consequences of cognitive disfunction is key to its prevention, early diagnosis, and rehabilitation. The neuropsychological testing and continuous monitoring of cognitive status as part of the overall evaluation of patients with MS in parallel with clinical and paraclinical examinations are highly recommended. In order to improve health and disease understanding, a close linkage between fundamental, clinical, epidemiological, and socio-economic research is required. The effective sharing of data, standardized data processing, and the linkage of such data with large-scale cohort studies is a prerequisite for the translation of research findings into the clinical setting. In this context, this paper proposes a software platform for the cognitive assessment and rehabilitation of patients with MS called CogniSoft. The platform automates the Beck Depression Inventory (BDI-II) test and diagnostic tests for the evaluation of memory and executive functions based on the nature of Brief International Cognitive Assessment for MS (BICAMS), as well as implementing a set of games for cognitive rehabilitation based on BICAMS. The software architecture, core modules, and technologies used for their implementation are presented. Special attention is given to the development of cognitive tests for diagnostics and rehabilitation. Their automation enables better perception, avoids bias as a result of conducting the classic paper tests of various neurophysiologists, provides easy administration, and allows data collection in a uniform manner, which further enables analysis using statistical and machine learning algorithms. The CogniSoft platform is registered as medical software by the Bulgarian Drug Agency and it is currently deployed in the Neurological Clinic of the National Hospital of Cardiology in Sofia, Bulgaria. The first experiments prove the feasibility of the platform, showing that it saves time and financial resources while providing subjectivity in the interpretation of the cognitive test results.

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Cognitive Impairment in Multiple Sclerosis

Folia Medica ◽

10.1515/folmed-2016-0029 ◽

2016 ◽

Vol 58 (3) ◽

pp. 157-163 ◽

Cited By ~ 12

Author(s):

Anastasiya G. Trenova ◽

Georgi S. Slavov ◽

Maria G. Manova ◽

Jana B. Aksentieva ◽

Lyuba D. Miteva ◽

...

Keyword(s):

Multiple Sclerosis ◽

Cognitive Impairment ◽

Cognitive Disorders ◽

Social Burden ◽

Immune Mediated ◽

The Social ◽

The Central Nervous System ◽

Axonal Transection ◽

The Relationship

Abstract Multiple sclerosis (MS) is a socially significant immune-mediated disease, characterized by demyelination, axonal transection and oligodendropathy in the central nervous system. Inflammatory demyelination and neurodegeneration lead to brain atrophy and cognitive deficit in up to 75% of the patients. Cognitive dysfunctions impact significantly patients’ quality of life, independently from the course and phase of the disease. The relationship between pathological brain findings and cognitive impairment is a subject of intensive research. Summarizing recent data about prevalence, clinical specificity and treatment of cognitive disorders in MS, this review aims to motivate the necessity of early diagnosis and complex therapeutic approach to these disturbances in order to reduce the social burden of the disease.

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Disease-modifying treatments and cognition in relapsing-remitting multiple sclerosis

Neurology ◽

10.1212/wnl.0000000000009522 ◽

2020 ◽

Vol 94 (22) ◽

pp. e2373-e2383 ◽

Cited By ~ 8

Author(s):

Nils C. Landmeyer ◽

Paul-Christian Bürkner ◽

Heinz Wiendl ◽

Tobias Ruck ◽

Hans-Peter Hartung ◽

...

Keyword(s):

Multiple Sclerosis ◽

Systematic Review ◽

Cognitive Impairment ◽

Test Performance ◽

Meta Analysis ◽

Cognitive Test ◽

Current Evidence ◽

Relapsing Remitting ◽

Disease Modifying ◽

Cognitive Test Performance

ObjectiveDisease-modifying treatments (DMTs) are the gold standard for slowing disability progression in multiple sclerosis (MS), but their effects on cognitive impairment, a key symptom of the disease, are mostly unknown. We conducted a systematic review and meta-analysis to evaluate the differential effects of DMTs on cognitive test performance in relapsing-remitting MS (RRMS).MethodsPubMed, Scopus, and Cochrane Library were searched for studies reporting longitudinal cognitive performance data related to all major DMTs. The standardized mean difference (Hedges g) between baseline and follow-up cognitive assessment was used as the main effect size measure.ResultsForty-four studies, including 55 distinct MS patient samples, were found eligible for the systematic review. Twenty-five studies were related to platform therapies (mainly β-interferon [n = 17] and glatiramer acetate [n = 4]), whereas 22 studies were related to escalation therapies (mainly natalizumab [n = 14] and fingolimod [n = 6]). Reported data were mostly confined to the cognitive domain processing speed. A meta-analysis including 41 studies and 7,131 patients revealed a small to moderate positive effect on cognitive test performance of DMTs in general (g = 0.27, 95% confidence interval [CI] = [0.21–0.33]), but no statistically significant differences between platform (g = 0.27, 95% CI = [0.18–0.35]) and escalation therapies (g = 0.28, 95% CI = [0.19–0.37]) or between any single DMT and β-interferon.ConclusionsDMTs are effective in improving cognitive test performance in RRMS, but a treatment escalation mainly to amend cognition is not supported by the current evidence. Given the multitude of DMTs and their widespread use, the available data regarding differential treatment effects on cognitive impairment are remarkably scant. Clinical drug trials that use more extensive cognitive outcome measures are urgently needed.

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