scholarly journals Coming off cannabis: a cognitive and magnetic resonance imaging study in patients with multiple sclerosis

Brain ◽  
2019 ◽  
Vol 142 (9) ◽  
pp. 2800-2812 ◽  
Author(s):  
Anthony Feinstein ◽  
Cecilia Meza ◽  
Cristiana Stefan ◽  
Richard W. Staines
Keyword(s):  
Multiple Sclerosis ◽  
Executive Function ◽  
Functional Mri ◽  
Processing Speed ◽  
Visual Memory ◽  
Cognitive Change ◽  
Group Differences ◽  
Lesion Volume ◽  
Memory Processing ◽  
Cognitive Improvement

AbstractCognitive dysfunction affects 40–80% of patients with multiple sclerosis. Smoking cannabis may add to these deficits. It is unclear whether coming off cannabis results in cognitive improvement. To address this question, 40 patients with multiple sclerosis who started using cannabis after the onset of multiple sclerosis and who used it for at least 4 days a week over many years were divided by odd-even number selection into two groups: cannabis continuation and cannabis withdrawal. Assessments took place at baseline and after 28 days and included serial versions of the Brief Repeatable Neuropsychological Battery for multiple sclerosis containing tests of verbal and visual memory, processing speed and executive function; structural and functional MRI, the latter entailing a compatible version of the Symbol Digit Modalities Test; urine for cannabinoid metabolites to detect compliance with abstinence. Only those participants deemed globally impaired at baseline (failure on at least two cognitive domains) were enrolled. The results revealed that the two groups were well matched demographically and neurologically. One subject was removed from the withdrawal group because of failed abstinence. Urine analysis revealed the cannabinoid consumed was predominantly tetrahydrocannabinol (THC). There were no baseline between group cognitive differences, but by Day 28 the withdrawal group performed significantly better on every cognitive index (P < 0.0001 for all). Significant within group differences were present for every test over time, but only in the abstinent group (P < 0.0001 for all tests). There were no between group baseline or Day 28 differences in structural MRI indices (global atrophy, total T1 and T2 lesion volume). At index assessment the two groups had a similar performance on the functional MRI-compatible Symbol Digit Modalities Test and there were no group differences in brain activation. However, by Day 28, the withdrawal group completed more trials correctly (P < 0.012) and had a faster reaction time (P < 0.002), associated with significantly increased activation in brain regions known to be associated with performance of the test (bilateral inferior frontal gyri, caudate and declive/cerebellum, P < 0.001 for all regions). These results reveal that patients with multiple sclerosis who are frequent, long-term cannabis users can show significant improvements in memory, processing speed and executive function after 28 days of drug abstinence. The absence of similar improvements in a matched multiple sclerosis group that remained on cannabis shows that beneficial cognitive change after stopping cannabis is not solely attributable to the effects of practice.

scholarly journals Using dual-calibrated functional MRI to map brain oxygen supply and consumption in multiple sclerosis

2021 ◽  
Author(s):  
Hannah L Chandler ◽  
Rachael C Stickland ◽  
Michael Germuska ◽  
Eleonora Patitucci ◽  
Catherine Foster ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Oxygen Consumption ◽  
Healthy Volunteers ◽  
Oxygen Supply ◽  
Oxygen Extraction Fraction ◽  
Oxygen Extraction ◽  
Group Differences ◽  
Lesion Volume ◽  
Brain Physiology ◽  
Significant Difference

Evidence suggests that cerebrovascular function and oxygen consumption are altered in multiple sclerosis (MS). Here, we quantified the vascular and oxygen metabolic MRI burden in patients with MS (PwMS) and assessed the relationship between these MRI measures of and metrics of damage and disability. In PwMS and in matched healthy volunteers, we applied a newly developed dual-calibrated fMRI method of acquisition and analysis to map grey matter (GM) cerebral blood flow (CBF), oxygen extraction fraction (OEF), cerebral metabolic rate of oxygen consumption (CMRO2) and effective oxygen diffusivity of the capillary network (DC). We also quantified physical and cognitive function in PwMS and controls. There was no significant difference in GM volume between 22 PwMS and 20 healthy controls (p=0.302). Significant differences in CBF (PwMS vs. controls: 44.91 +/- 6.10 vs. 48.90 +/- 5.87 ml/100g/min, p=0.010), CMRO2 (117.69 +/- 17.31 vs. 136.49 +/- 14.48 μmol/100g/min p<0.001) and DC (2.70 +/- 0.51 vs. 3.18 +/- 0.41 μmol/100g/mmHg/min, p=0.002) were observed in the PwMS. No significant between-group differences were observed for OEF (PwMS vs. controls: 0.38 +/- 0.09 vs. 0.39 +/- 0.02, p=0.358). Regional analysis showed widespread reductions in CMRO2 and DC for PwMS compared to healthy volunteers. There was a significant correlation between physiological measures and T2 lesion volume, but no association with current clinical disability. Our findings demonstrate concurrent reductions in oxygen supply and consumption in the absence of an alteration in oxygen extraction that may be indicative of a reduced demand for oxygen (O2), an impaired transfer of O2 from capillaries to mitochondria, and/or a reduced ability to utilise O2 that is available at the mitochondria. With no between-group differences in GM volume, our results suggest that changes in brain physiology may precede MRI-detectable GM loss and thus may be one of the pathological drivers of neurodegeneration and disease progression.

scholarly journals Human Leukocyte Antigen Genotype as a Marker of Multiple Sclerosis Prognosis

2019 ◽  
Vol 47 (2) ◽  
pp. 189-196 ◽  
Author(s):  
Andreas P. Lysandropoulos ◽  
Gaetano Perrotta ◽  
Thibo Billiet ◽  
Annemie Ribbens ◽  
Renaud Du Pasquier ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Human Leukocyte Antigen ◽  
Visual Memory ◽  
Verbal Learning ◽  
Human Leukocyte ◽  
Hla Typing ◽  
Lesion Volume ◽  
Leukocyte Antigen ◽  
Hla Genotype

ABSTRACT:Objective:In a previous pilot monocentric study, we investigated the relation between human leukocyte antigen (HLA) genotype and multiple sclerosis (MS) disease progression over 2 years. HLA-A*02 allele was correlated with better outcomes, whereas HLA-B*07 and HLA-B*44 were correlated with worse outcomes. The objective of this extension study was to further investigate the possible association of HLA genotype with disease status and progression in MS as measured by sensitive and complex clinical and imaging parameters.Methods:Hundred and forty-six MS patients underwent HLA typing. Over a 4-year period of follow-up, we performed three clinical and magnetic resonance imaging (MRI) assessments per patient, which respectively included Expanded Disability Status Scale, Multiple Sclerosis Severity Scale, Timed-25-Foot-Walk, 9-Hole Peg Test, Symbol Digit Modalities Test, Brief Visual Memory Test, California Verbal Learning Test-II, and whole-brain atrophy, fluid-attenuated inversion recovery (FLAIR) lesion volume change and number of new FLAIR lesions using icobrain. We then compared the clinical and MRI outcomes between predefined HLA patient groups.Results:Results of this larger study with a longer follow-up are in line with what we have previously shown. HLA-A*02 allele is associated with potentially better MS outcomes, whereas HLA-B*07, HLA-B*44, HLA-B*08, and HLA-DQB1*06 with a potential negative effect. Results for HLA-DRB1*15 are inconclusive.Conclusion:In the era of MS treatment abundance, HLA genotype might serve as an early biomarker for MS outcomes to inform individualized treatment decisions.

FLAIR lesion volume in multiple sclerosis: Relation to processing speed and verbal memory

2005 ◽  
Vol 11 (02) ◽  
Author(s):  
JOHN J. RANDOLPH ◽  
HEATHER A. WISHART ◽  
ANDREW J. SAYKIN ◽  
BRENNA C. MCDONALD ◽  
KIMBERLY R. SCHUSCHU ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Processing Speed ◽  
Verbal Memory ◽  
Lesion Volume

scholarly journals Efficacy of a Computer-Assisted Cognitive Rehabilitation Intervention in Relapsing-Remitting Multiple Sclerosis Patients: A Multicenter Randomized Controlled Trial

2017 ◽  
Vol 2017 ◽  
pp. 1-17 ◽  
Author(s):  
Lambros Messinis ◽  
Grigorios Nasios ◽  
Mary H. Kosmidis ◽  
Petros Zampakis ◽  
Sonia Malefaki ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Randomized Controlled Trial ◽  
Cognitive Impairment ◽  
Episodic Memory ◽  
Processing Speed ◽  
Controlled Trial ◽  
Computer Assisted ◽  
Memory Processing ◽  
Randomized Controlled ◽  
Multicenter Randomized Controlled Trial

Cognitive impairment is frequently encountered in multiple sclerosis (MS) affecting between 40–65% of individuals, irrespective of disease duration and severity of physical disability. In the present multicenter randomized controlled trial, fifty-eight clinically stable RRMS patients with mild to moderate cognitive impairment and relatively low disability status were randomized to receive either computer-assisted (RehaCom) functional cognitive training with an emphasis on episodic memory, information processing speed/attention, and executive functions for 10 weeks (IG; n=32) or standard clinical care (CG; n=26). Outcome measures included a flexible comprehensive neuropsychological battery of tests sensitive to MS patient deficits and feedback regarding personal benefit gained from the intervention on four verbal questions. Only the IG group showed significant improvements in verbal and visuospatial episodic memory, processing speed/attention, and executive functioning from pre - to postassessment. Moreover, the improvement obtained on attention was retained over 6 months providing evidence on the long-term benefits of this intervention. Group by time interactions revealed significant improvements in composite cognitive domain scores in the IG relative to the demographically and clinically matched CG for verbal episodic memory, processing speed, verbal fluency, and attention. Treated patients rated the intervention positively and were more confident about their cognitive abilities following treatment.

scholarly journals Structural and functional connectomes in people with multiple sclerosis

2020 ◽  
Author(s):  
Ceren Tozlu ◽  
Keith Jamison ◽  
Susan Gauthier ◽  
Amy Kuceyeski
Keyword(s):  
Multiple Sclerosis ◽  
Functional Mri ◽  
Imaging Modality ◽  
Structural Connectivity ◽  
Receiver Operating Curve ◽  
Ensemble Prediction ◽  
P Value ◽  
Lesion Volume ◽  
Healthy Controls ◽  
Functional Connectome

One of the challenges in multiple sclerosis is that lesion volume does not correlate with symptom severity. Advanced techniques such as diffusion and functional MRI allow imaging of the brain's connectivity networks, which may provide better insight as to brain-behavior relationships in impairment and compensation in multiple sclerosis. We aim to build machine learning models based on structural and functional connectomes to classify a) healthy controls versus people with multiple sclerosis and b) impaired versus not impaired people with multiple sclerosis. We also aim to identify the most important imaging modality for both classification tasks, and, finally, to investigate which brain regions' connectome measures contribute most to the classification. Fifteen healthy controls (age=43.6 ± 8.6, 53% female) and 76 people with multiple sclerosis (age: 45.2 ± 11.4 years, 65% female, disease duration: 12.2 ± 7.2 years) were included. Twenty-three people with multiple sclerosis were considered impaired, with an Expanded Disability Status Scale of 2 or higher. Subjects underwent MRI scans that included anatomical, diffusion and resting-state functional MRI. Random Forest models were constructed using structural and static/dynamic functional connectome measures independently; single modality models were then combined for an ensemble prediction. The accuracy of the models was assessed by the area under the receiver operating curve. Models that included structural connectomes significantly outperformed others when classifying healthy controls and people with multiple sclerosis, having a median accuracy of 0.86 (p-value<0.05, corrected). Models that included dynamic functional connectome metrics significantly outperformed others when distinguishing people with multiple sclerosis by impairment level, having a median accuracy of 0.63 (p-value<0.05, corrected). Structural connectivity between subcortical, somatomotor, and visual networks was most damaged by multiple sclerosis. For the classification of patients with multiple sclerosis into impairment severity groups, the most discriminatory metric was dwell time in a dynamic functional connectome state characterized by strong connectivity between and among somatomotor and visual networks. These results suggest that damage to the structural connectome, particularly in the subcortical, visual, and somatomotor networks, is a hallmark of multiple sclerosis, and, furthermore, that increased functional coordination between these same regions may be related to severity of motor disability in multiple sclerosis. The use of multi-modal connectome imaging has the potential to shed light on mechanisms of disease and compensation in multiple sclerosis, thus enabling more accurate prognoses and possibly the development of novel therapeutics.

Diffusion-weighted imaging predicts cognitive impairment in multiple sclerosis

2007 ◽  
Vol 13 (6) ◽  
pp. 722-730 ◽  
Author(s):  
Ralph H.B. Benedict ◽  
Jared Bruce ◽  
Michael G. Dwyer ◽  
Bianca Weinstock-Guttman ◽  
Chris Tjoa ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Processing Speed ◽  
Diffusion Weighted Imaging ◽  
Diffusion Tensor ◽  
Lesion Volume ◽  
Additive Variance ◽  
Whole Brain ◽  
Visual Spatial ◽  
Diffusion Weighted ◽  
And Performance

Following a previous study with diffusion tensor imaging, we investigated the correlation between diffusion-weighted imaging (DWI) and cognitive dysfunction in multiple sclerosis (MS). We studied 60 MS patients (mean age 45.8±9.0 years) using 1.5-T MRI. Disease course was RR=40 and SP = 20. Mean disease duration was 12.8±8.7 years. Mean EDSS was 3.4±1.7. Whole brain, gray and white matter normalized volumes were calculated on 3D SPGR T1-WI using a fully automated Hybrid SIENAX method. Parenchymal mean diffusivity (PMD) maps were created after automated segmentation of the brain parenchyma and cerebrospinal fluid using T2-WI and DW images. Histogram analysis was performed and DWI indices of peak position (PP), peak height (PH), mean parenchymal diffusivity (MPD) and entropy were obtained. Neuropsychological (NP) evaluation emphasized auditory/verbal and visual/spatial memory, as well as processing speed and executive function. We found significant correlations between DWI and performance in all cognitive domains. Overall, stronger correlations emerged for MPD and entropy than other DWI measures, although all correlations were in the expected direction. The strongest association was between DWI entropy and performance on the Symbol Digit Modalities Test, which assesses processing speed and working memory (r = -0.54). Fisher r to z transformations revealed that DWI, gray matter (GMF) and whole brain (BPF) atrophy, T1-lesion volume (LV) and T2-LV all accounted for similar amounts of variance in NP testing. Stepwise regression models determined whether multiple MRI measures predicted unique additive variance in test performance. GMF (R2 = 0.35, F =30.82, P <0.01) and entropy (ΔR2 =0.06, ΔF=5.47, P <0.05) both accounted for unique variance in processing speed. Our data make a stronger case for the clinical validity of DWI in MS than heretofore reported. DWI has very short acquisition times, and the segmentation method applied in the present study is reliable and fully automated. Given its overall simplicity and moderate correlation with cognition, DWI may offer several logistic advantages over more traditional MRI measures when predicting the presence of NP impairment. Multiple Sclerosis 2007; 13: 722-730. http://msj.sagepub.com

scholarly journals Dissociable cognitive patterns related to depression and anxiety in multiple sclerosis

2019 ◽  
Vol 26 (10) ◽  
pp. 1247-1255 ◽  
Author(s):  
Victoria M Leavitt ◽  
Rachel Brandstadter ◽  
Michelle Fabian ◽  
Ilana Katz Sand ◽  
Sylvia Klineova ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Sex Education ◽  
Processing Speed ◽  
Anxiety And Depression ◽  
Lesion Volume ◽  
Depression And Anxiety ◽  
Nonverbal Memory ◽  
Cognitive Correlates ◽  
Partial Correlations ◽  
Mood And Cognition

Background: Individuals with multiple sclerosis (MS) frequently present with depression and anxiety, as well as cognitive impairment, challenging clinicians to disentangle interrelationships among these symptoms. Objective: To identify cognitive functions associated with anxiety and depression in MS. Methods: Mood and cognition were measured in 185 recently diagnosed patients (Reserve Against Disability in Early Multiple Sclerosis (RADIEMS) cohort), and an independent validation sample (MEM CONNECT cohort, n = 70). Partial correlations evaluated relationships of cognition to anxiety and depression controlling for age, sex, education, and premorbid verbal intelligence. Results: In RADIEMS cohort, lower anxiety was associated with better nonverbal memory ( rp = –0.220, p = 0.003) and lower depression to better attention/processing speed ( rp = –0.241, p = 0.001). Consistently, in MEM CONNECT cohort, lower anxiety was associated with better nonverbal memory ( rp = –0.271, p = 0.028) and lower depression to better attention/processing speed ( rp = –0.367, p = 0.002). Relationships were unchanged after controlling for T2 lesion volume and fatigue. Conclusion: Consistent mood–cognition relationships were identified in two independent cohorts of MS patients, suggesting that cognitive correlates of anxiety and depression are separable. This dissociation may support more precise models to inform treatment development. Treatment of mood symptoms may mitigate effects on cognition and/or treatment of cognition may mitigate effects on mood.

scholarly journals A comparison of cognitive performances between neuromyelitis optica spectrum disorder and multiple sclerosis patients in Indian context

2021 ◽  
Vol 57 (1) ◽  
Author(s):  
Swati Kumar ◽  
Goutam Gangopadhyay ◽  
Atanu Biswas ◽  
Souvik Dubey ◽  
Alak Pandit ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Cognitive Impairment ◽  
Information Processing ◽  
Executive Function ◽  
Neuromyelitis Optica ◽  
Processing Speed ◽  
Verbal Fluency ◽  
Spectrum Disorder ◽  
Neuromyelitis Optica Spectrum Disorder ◽  
Information Processing Speed

Abstract Background To compare the frequency and pattern of cognitive impairment in neuromyelitis optica spectrum disorder (NMOSD) and multiple sclerosis (MS) patients. Results Twenty NMOSD and forty MS patients were included. Clinical and detailed neuropsychological assessment was done using frontal assessment battery and Kolkata cognitive battery supplemented with additional standard tests for different domains of cognitive functions. Domain wise tests were performed and compared. 15/20 (75%) NMOSD and 32/40 (80%) MS patients had cognitive impairment (p = 0.65). Executive function, verbal fluency, information processing speed, visuo-constructional ability, attention, complex calculation, and memory were more commonly involved in NMOSD in decreasing order. Compared to MS, the pattern was similar except that verbal fluency was more impaired in NMOSD. Expanded Disability Status scale (EDSS) correlated with cognitive involvement in NMOSD (p = 0.02) as against MS. Conclusions Executive function, verbal fluencies, and information processing speed were more affected compared to visual and verbal memory in NMOSD patients. The pattern of cognitive performance was similar in the MS group, even though clinical and radiological characteristics and pathophysiology is different, suggesting similar brain involvement.

scholarly journals Higher Cortical Dysfunction Resembling Corticobasal Syndrome in 2 Patients with Multiple Sclerosis

2018 ◽  
Vol 1 (1) ◽  
pp. 01-06
Author(s):  
Margaret M Swanberg
Keyword(s):  
Multiple Sclerosis ◽  
Executive Function ◽  
Cognitive Dysfunction ◽  
Processing Speed ◽  
Corticobasal Syndrome ◽  
Growing Body ◽  
Cortical Dysfunction

The cognitive dysfunction in Multiple Sclerosis is classically defined as deficits in executive function, processing speed and memory. This pattern has been termed “subcorticaldy sfunction”. However, a growing body of literature suggests that there is cortical disruption in patients with Multiple Sclerosis and higher cortical dysfunction may manifest as symptoms. Here is presented two patients with Multiple Sclerosis who developed symptoms suggestive of Corticobasal syndrome, a disorder of higher cortical dysfunction due to a number of different pathologic substrates.

Sign in / Sign up

Export Citation Format

Share Document