Dual-Task Performance in Multiple Sclerosis’ Patients: Cerebellum Matters?

2020 ◽  
Author(s):  
Ornella Argento ◽  
Barbara Spanò ◽  
Valerio Pisani ◽  
Chiara C Incerti ◽  
Marco Bozzali ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Dual Task ◽  
Mutual Influence ◽  
Cognitive Task ◽  
Word List ◽  
Generation Task ◽  
Dual Tasking ◽  
Concurrent Execution ◽  
Magnetic Resonance Imaging Mri ◽  
Multiple Sclerosis Patients

Abstract Objective Gait, cognitive impairments, and their mutual influence in dual tasking (cognitive–motor dual tasking, CM-DT) are important to address therapeutic approaches in patients with multiple sclerosis (PMS). CM-DT correlates have been widely investigated with variable and dissimilar results, due to differences in methods. However, although the cerebellum has recently shown to be involved in both motor and cognitive functions, few studies have explored its role in the integration of the concurrent execution of gait and cognition. This case–control study aims to explore the effects of adding a cognitive task to walking in PMS and to investigate the role of the cerebellum in the interfering process. Methods In total, 20 patients and 18 healthy controls (HC) underwent clinical assessments, dual task (DT), and 3 T magnetic resonance imaging (MRI). DT was composed by three 2-min trials requiring fast walking. In 2 of them 2 different cognitive tasks were added. Results Both groups evidenced the presence of cognitive–motor interference (CMI) for both cognitive conditions with a greater effect of word list generation task in PMS. Analysis of variance between HC and patients with high or low performances showed a significantly increased volume in Vermis lobules VIIIa and IX of high performers compared with HC. Conclusion Our results show that CMI is also present in healthy individuals but is significantly more disabling in PMS. Furthermore, MRI data point to the existence of an initial mechanism of cerebellar reorganization in PMS with lower interference. Subsequently, the failure of this mechanism due to the progression of disability leads to a more evident expression of symptoms.

Walking and talking: an investigation of cognitive—motor dual tasking in multiple sclerosis

2009 ◽  
Vol 15 (10) ◽  
pp. 1215-1227 ◽  
Author(s):  
F. Hamilton ◽  
L. Rochester ◽  
L. Paul ◽  
D. Rafferty ◽  
CP O'Leary ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Dual Task ◽  
Cognitive Task ◽  
Time Variability ◽  
Healthy Controls ◽  
Motor Functioning ◽  
Dual Tasking ◽  
Risk Of Falls ◽  
Clinical Tools ◽  
Task Conditions

Background: Deficits in motor functioning, including walking, and in cognitive functions, including attention, are known to be prevalent in multiple sclerosis (MS), though little attention has been paid to how impairments in these areas of functioning interact. Objectives: This study investigated the effects of performing a concurrent cognitive task when walking in people with MS. Level of task demand was manipulated to investigate whether this affected level of dual-task decrement. Method: Eighteen participants with MS and 18 healthy controls took part. Participants completed walking and cognitive tasks under single- and dual-task conditions. Results: Compared to healthy controls, MS participants showed greater decrements in performance under dual-task conditions in cognitive task performance, walking speed and swing time variability. In the MS group, the degree of decrement under dual-task conditions was related to levels of fatigue, a measure of general cognitive functioning and self-reported everyday cognitive errors, but not to measures of disease severity or duration. Conclusions: Difficulty with walking and talking in MS may be a result of a divided attention deficit or of overloading of the working memory system, and further investigation is needed. We suggest that difficulty with walking and talking in MS may lead to practical problems in everyday life, including potentially increasing the risk of falls. Clinical tools to assess cognitive—motor dual-tasking ability are needed.

Cognitive-motor interference in persons with multiple sclerosis during five upper limb motor tasks with different complexity

2018 ◽  
Vol 25 (13) ◽  
pp. 1736-1745 ◽  
Author(s):  
Joke Raats ◽  
Ilse Lamers ◽  
Ilse Baert ◽  
Barbara Willekens ◽  
Renee Veldkamp ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Upper Limb ◽  
Test Group ◽  
Word List ◽  
Finger Tapping ◽  
Motor Tasks ◽  
Generation Task ◽  
Bimanual Task ◽  
Finger Tapping Test ◽  
Block Test

Background: Cognitive-motor interference in multiple sclerosis has been well examined during walking, but not during upper limb (UL) performance. Objectives: To examine the dual-task cost (DTC) in persons with multiple sclerosis (pwMS) and healthy controls (HC) in various type and complexity of UL motor tasks. Method: In total, 30 pwMS without major UL impairment and 30 HC performed five different UL tasks, in single condition and combined with the phonemic word list generation task. The percent change in performances was evaluated by the motor, cognitive, and combined DTC. The motor tasks consisted of four unimanual (sustained hand grip strength, box-and-block test, Purdue pegboard test, finger tapping task) and one bimanual task (Purdue pegboard test). Group and task differences were analyzed with unpaired and paired t-tests, respectively, and overall effect with a multivariate analysis of variance. Results: The motor DTC ranged between 10% (Purdue pegboard bimanual) and 35% (box-and-block test). The cognitive DTC ranged between −8% (finger tapping test) and +21% (bimanual Purdue pegboard). The magnitude of the combined DTC did not differ significantly between pwMS and HC in any task. Conclusion: DTC is influenced by the complexity of the UL task, but was not significantly different between HC and cognitive intact, but mildly motor disabled pwMS.

scholarly journals Effect of a Combined Program of Strength and Dual Cognitive-Motor Tasks in Multiple Sclerosis Subjects

2020 ◽  
Vol 17 (17) ◽  
pp. 6397
Author(s):  
Carmen Gutiérrez-Cruz ◽  
F.Javier Rojas-Ruiz ◽  
Juan Carlos De la Cruz-Márquez ◽  
Marcos Gutiérrez-Dávila
Keyword(s):  
Multiple Sclerosis ◽  
Training Program ◽  
Force Measurement ◽  
Intervention Group ◽  
Daily Activities ◽  
Control Group ◽  
Motor Tasks ◽  
Dual Tasking ◽  
Combined Training ◽  
Multiple Sclerosis Patients

This study investigated the effects of a 24-week combined training program (CTP) based on strength exercises and cognitive–motor tasks performed concurrently in participants with multiple sclerosis. A randomized, controlled intervention study was carried out. In total, 31 subjects with a confirmed diagnosis of multiple sclerosis (14 men and 17 women) were stratified and randomized into an intervention group (17 subjects) and a control group (14 subjects). The intervention group completed three weekly training sessions for 24 weeks, while the control group pursued their normal daily activities. In this program, cognitive–motor tasks were completed at once (dual tasking). A 3D photogrammetry connected to a selective attention system designed for dual tasking while walking was used. Ground reaction forces were measured using two force plates, one for sit-to-stand testing, while the other was used for static force measurement. Postural equilibrium was examined using a stabilometric plate based for Romberg test assessment. The 24-week training program for multiple sclerosis patients improved their static peak force by 11% (p < 0 .05), their rate of force development by 36% (p < 0.05), and their balance (p < 0.05). Performance in daily activities such as walking or sitting-to-standing improved significantly in multiple sclerosis participants. CTP training was effective in reducing the dual-task costs of step length (48%) and walking velocity (54%), as compared to a matched control group.

scholarly journals Asymmetric interference between cognitive task components and concurrent sensorimotor coordination

2018 ◽  
Vol 120 (1) ◽  
pp. 330-342
Author(s):  
Joshua Baker ◽  
Antonio Castro ◽  
Andrew K. Dunn ◽  
Suvobrata Mitra
Keyword(s):  
Information Processing ◽  
Dual Task ◽  
Time Course ◽  
Cognitive Task ◽  
Tracking Task ◽  
Cognitive Tasks ◽  
State Monitoring ◽  
Sensorimotor Coordination ◽  
Dual Tasking ◽  
Task Conditions

Everyday cognitive tasks are frequently performed under dual-task conditions alongside continuous sensorimotor coordinations (CSCs) such as driving, walking, or balancing. Observed interference in these dual-task settings is commonly attributed to demands on executive function or attentional resources, but the time course and reciprocity of interference are not well understood at the level of information-processing components. Here we used electrophysiology to study the detailed chronometry of dual-task interference between a visual oddball task and a continuous visuomanual tracking task. The oddball task’s electrophysiological components were linked to underlying cognitive processes, and the tracking task served as a proxy for the continuous cycle of state monitoring and adjustment inherent to CSCs. Dual-tasking interfered with the oddball task’s accuracy and attentional processes (attenuated P2 and P3b magnitude and parietal alpha-band event-related desynchronization), but errors in tracking due to dual-tasking accrued at a later timescale and only in trials in which the target stimulus appeared and its tally had to be incremented. Interference between cognitive tasks and CSCs can be asymmetric in terms of timing as well as affected information-processing components. NEW & NOTEWORTHY Interference between cognitive tasks and continuous sensorimotor coordination (CSC) has been widely reported, but this is the first demonstration that the cognitive operation that is impaired by concurrent CSC may not be the one that impairs the CSC. Also demonstrated is that interference between such tasks can be temporally asymmetric. The asynchronicity of this interference has significant implications for understanding and mitigating loss of mobility in old age, and for rehabilitation for neurological impairments.

scholarly journals Balancing the Demands of Two Tasks: An Investigation of Cognitive–Motor Dual-Tasking in Relapsing Remitting Multiple Sclerosis

2017 ◽  
Vol 24 (3) ◽  
pp. 247-258 ◽  
Author(s):  
Emma Butchard-MacDonald ◽  
Lorna Paul ◽  
Jonathan J. Evans
Keyword(s):  
Multiple Sclerosis ◽  
Dual Task ◽  
Postural Stability ◽  
Digit Span ◽  
Dual Tasking ◽  
Stable Surface ◽  
Relapsing Remitting ◽  
Task Conditions ◽  
Relapsing Remitting Multiple Sclerosis ◽  
The Impact

AbstractBackground:People with relapsing remitting multiple sclerosis (PwRRMS) suffer disproportionate decrements in gait under dual-task conditions, when walking and a cognitive task are combined. There has been much less investigation of the impact of cognitive demands on balance.Objectives:This study investigated whether: (1) PwRRMS show disproportionate decrements in postural stability under dual-task conditions compared to healthy controls, and (2) dual-task decrements are associated with everyday dual-tasking difficulties. The impact of mood, fatigue, and disease severity on dual-tasking was also examined.Methods:A total of 34 PwRRMS and 34 matched controls completed cognitive (digit span) and balance (movement of center of pressure on Biosway on stable and unstable surfaces) tasks under single- and dual-task conditions. Everyday dual-tasking was measured using the Dual-Tasking Questionnaire. Mood was measured by the Hospital Anxiety & Depression Scale. Fatigue was measuredviathe Modified Fatigue Index Scale.Results:No differences in age, gender, years of education, estimated pre-morbid IQ, or baseline digit span between groups. Compared with controls, PwRRMS showed significantly greater decrement in postural stability under dual-task conditions on an unstable surface (p=.007), but not a stable surface (p=.679). Balance decrement scores were not correlated with everyday dual-tasking difficulties or fatigue. Stable surface balance decrement scores were significantly associated with levels of anxiety (rho=0.527;p=.001) and depression (rho=0.451;p=.007).Conclusions:RRMS causes dual-tasking difficulties, impacting balance under challenging conditions, which may contribute to increased risk of gait difficulties and falls. The relationship between anxiety/depression and dual-task decrement suggests that emotional factors may be contributing to dual-task difficulties. (JINS, 2018,24, 247–258)

Three-year clinical outcomes of relapsing multiple sclerosis patients treated with dimethyl fumarate in a United States community health center

2017 ◽  
Vol 24 (7) ◽  
pp. 942-950 ◽  
Author(s):  
Kyle Smoot ◽  
Kateri J Spinelli ◽  
Tamela Stuchiner ◽  
Lindsay Lucas ◽  
Chiayi Chen ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Disease Duration ◽  
Community Health Center ◽  
Dimethyl Fumarate ◽  
Clinical Relapse ◽  
Disease Modifying Therapy ◽  
Magnetic Resonance Imaging Mri ◽  
Multiple Sclerosis Patients ◽  
Previous Disease ◽  
Relapsing Multiple Sclerosis

Background: Following approval of dimethyl fumarate (DMF), we established a registry of relapsing multiple sclerosis (RMS) patients taking DMF at our community MS center. Objective: To track DMF patients’ tolerability, disease progression, and lymphopenia. Methods: Patients prescribed DMF for RMS from March 2013 to March 2016 were prospectively enrolled ( N = 412). Baseline data, clinical relapses, magnetic resonance imaging (MRI) activity, discontinuation, and lymphocyte counts were captured through chart review. Results: The mean age of patients starting DMF was 49.4 ± 12.0 years and 70% transitioned from a previous disease-modifying therapy (DMT). Of the patients, 38% discontinued DMF, 76% of whom discontinued due to side effects. Clinical relapse and MRI activity were low. Comparing patients who transitioned from interferon-β (IFN), glatiramer acetate (GA), or natalizumab (NTZ), patients previously on NTZ had higher rates of relapse than those previously on GA (annualized relapse rate p = 0.039, percent relapse p = 0.021). Grade III lymphopenia developed in 11% of patients. Lymphopenia was associated with older age ( p < 0.001) and longer disease duration ( p < 0.001). Conclusion: Given the high rates of lymphopenia and discontinuation, it has become our clinical practice to more closely scrutinize older patients and those with a longer disease duration who are potential candidates for initiating DMF therapy.

scholarly journals Gadopentetate but not gadobutrol accumulates in the dentate nucleus of multiple sclerosis patients

2016 ◽  
Vol 23 (7) ◽  
pp. 963-972 ◽  
Author(s):  
Ludwig Schlemm ◽  
Claudia Chien ◽  
Judith Bellmann-Strobl ◽  
Jan Dörr ◽  
Jens Wuerfel ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Magnetic Resonance ◽  
Dentate Nucleus ◽  
Alternative Explanation ◽  
Disease Duration ◽  
Gadopentetate Dimeglumine ◽  
Progressive Neurodegeneration ◽  
Magnetic Resonance Imaging Mri ◽  
T1 Hyperintensity ◽  
Multiple Sclerosis Patients

Background: Previous studies have postulated an association between dentate nucleus T1 hyperintensity and multiple sclerosis (MS)-related progressive neurodegeneration. Therefore, MS patients have been excluded from most studies investigating brain deposition of gadolinium-based contrast agents (GBCAs). Objective: To study the hypothesis that dentate nucleus T1 hyperintensity in MS patients is associated with GBCA administration. Methods: In a cohort of 97 MS patients, the dentate-to-pons signal intensity ratio (DPSIR) was calculated for 265 consecutive T1-weighted magnetic resonance (MR) scans (including sessions with and without the administration of GBCA). Patients exclusively received either gadopentetate dimeglumine (Gd-DTPA, linear) or gadobutrol (Gd-BT-DO3A, macrocyclic). Results: In patients receiving Gd-DTPA, DPSIR increased significantly between the first and the last scan (+0.009, p < 0.001), and following magnetic resonance imaging (MRI) with Gd-DTPA administration as compared to following an MRI without Gd-DTPA administration (+0.005 vs −0.001; p = 0.022). Additionally, there was a positive linear relationship between the number of Gd-DTPA administrations and the increase in DPSIR ( p = 0.017). No DPSIR increase was observed after Gd-BT-DO3A administration. Conclusion: Dentate nucleus T1 hyperintensity in MS patients is associated with Gd-DTPA (but not Gd-BT-DO3A) administration, suggesting an alternative explanation for the association of T1 hyperintensity with disease duration and severity.

Contrast-enhanced magnetic resonance activity in relapsing remitting multiple sclerosis patients: a short term natural history study

2000 ◽  
Vol 6 (1) ◽  
pp. 43-49 ◽  
Author(s):  
F Bagnato ◽  
A Tancredi ◽  
N Richert ◽  
C Gasperini ◽  
S Bastianello ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Magnetic Resonance ◽  
Natural History ◽  
Initial Examination ◽  
Short Baseline ◽  
Relapsing Remitting ◽  
History Of ◽  
Magnetic Resonance Imaging Mri ◽  
Multiple Sclerosis Patients ◽  
The Relationship

Magnetic resonance imaging (MRI) has been used to study the history of multiple sclerosis (MS). We analyze the relationship between MRI activity in the first scan compared to the subsequent five scans, and we evaluate whether a shorter observation period of 3 months may predict the subsequent 3 months. Monthly enhanced MRI was performed in 103 relapsing remitting (RR) MS patients for 6 months. Thirty-five per cent of patients had an inactive scan on the initial examination. More than 80% of them developed MRI activity during the following 5 months. Eighteen per cent of patients had three consecutive inactive scans; 65% of them had at least one active scan on the subsequent 3 monthly MRI's. The relationship between the first scan and all subsequent scans demonstrates a clear weakening over time. Eighty-two per cent of patients had at least one active scan during the initial 3 consecutive months, the chance of becoming inactive decreased from 23% to 0% over the subsequent 3 months, according with the mean number of enhancing lesions during the first 3 months. These results suggest that neither a single scan nor a short baseline of 3 months may adequately describe the natural history of disease in an individual RRMS patient.

scholarly journals Antibody Response in Seropositive Multiple Sclerosis Patients Vaccinated with Attenuated Live Varicella Zoster Virus

1996 ◽  
Vol 7 (5) ◽  
pp. 303-306 ◽  
Author(s):  
RT Ross ◽  
MR Dawood ◽  
Mary Cheang ◽  
Lindsay E Nicolle
Keyword(s):  
Multiple Sclerosis ◽  
Varicella Zoster Virus ◽  
Tertiary Care ◽  
Progressive Multiple Sclerosis ◽  
Initial Assessment ◽  
Varicella Zoster ◽  
Post Entry ◽  
Magnetic Resonance Imaging Mri ◽  
Immunogenic Proteins ◽  
Multiple Sclerosis Patients

OBJECTIVE: To determine the safety and effectiveness of live attenuated varicella zoster virus (VZV) vaccine (OKA/Merck) on 50 patients with chronic progressive multiple sclerosis (MS), based on the hypothesis that VZV might be the antigen or antigen mimic of MS plus the fact that repeated high antigen doses have produced ‘antigen paralysis’ in experimental allergic encephalomyelitis mice.DESIGN: Fifty patients were randomly selected without controls. They were assessed clinically at entry and on four other occasions over 14 months. Enhanced cranial magnetic resonance imaging (MRI) was performed at entry and at six and 12 months post entry. All were vaccinated after initial assessment and again six weeks later.SETTING: All clinical and laboratory assessments were performed at the Health Sciences Centre, Winnipeg, in the out-patient department. All MRI examinations were performed at the St Boniface General Hospital, Winnipeg, Manitoba. Both are tertiary care hospitals.POPULATION STUDIED: Fifty randomly selected patients with chronic progressive MS, age 18 to 60 years, and a disability status scale of 2.0 or greater were included. Forty-five patients completed the study.INTERVENTIONS: Two vaccinations with attenuated live VZV six weeks apart.RESULTS: All patients were VZV seropositive at entry and all showed an increased antibody level following vaccination. No one was harmed by the vaccine. There may have been some changes in the MS of 15 patients.CONCLUSIONS: It may be reasonable and safe to challenge the process of MS using large doses of the immunogenic proteins of the VZV to induce ‘immune paralysis’.

An MRI study of Chlamydia pneumoniae infection in Italian multiple sclerosis patients

2003 ◽  
Vol 9 (5) ◽  
pp. 467-471 ◽  
Author(s):  
L ME Grimaldi ◽  
A Pincherle ◽  
F Martinelli-Boneschi ◽  
M Filippi ◽  
F Patti ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Chlamydia Pneumoniae ◽  
Neurological Diseases ◽  
Disease Onset ◽  
Progressive Multiple Sclerosis ◽  
Relapsing Remitting ◽  
The Central Nervous System ◽  
Magnetic Resonance Imaging Mri ◽  
Multiple Sclerosis Patients ◽  
Mri Study

We amplified sequences of the Chlamydia pneumoniae (C P) major-outer membrane protein in the cerebrospinal fluid (CSF) from 23 of 107 (21.5%) relapsing-remitting or secondary progressive multiple sclerosis (MS) patients and two of 77 (2.6%) patients with other neurological diseases (OND) (P =0.00022). C P+ patients showed magnetic resonance imaging (MRI) evidence of more active disease (P =0.02) compared to CP-MS patients and tended to have an anticipation of age at disease onset (32.39-12 versus 28.59-10 years; P =ns) causing a longer disease duration (7.59-5 versus 4.49-4 years; P =0.016) at the time of clinical evaluation. These findings, although indirectly, suggest that C P infection of the central nervous system (C NS) might affect disease course in a subgroup of MS patients.

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