Cognitive impairment at the onset of multiple sclerosis: relationship to lesion location

2011 ◽  
Vol 17 (6) ◽  
pp. 755-758 ◽  
Author(s):  
Françoise Reuter ◽  
Wafaa Zaaraoui ◽  
Lydie Crespy ◽  
Anthony Faivre ◽  
Audrey Rico ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Cognitive Impairment ◽  
Verbal Learning ◽  
Clinically Isolated Syndrome ◽  
Deep White Matter ◽  
Lesion Location ◽  
And Performance ◽  
The Right ◽  
The Impact ◽  
Learning Performances

The impact of lesion location on cognitive functioning was assessed in a group of 97 patients with a clinically isolated syndrome. Using the Brief Repeatable Battery, we evidenced that 24% of patients showed at least one abnormal test, 20% at least two and 15% at least three. Verbal learning performances were inversely associated with presence of lesions in Broca’s area, in the right frontal lobe and in the splenium while spatial learning performances were inversely correlated to the presence of lesions in the deep white matter. No associations were evidenced between lesion location and performance of tasks exploring attention and executive functions.

scholarly journals The Impact of Cognitive Dysfunction on Locomotor Rehabilitation Potential in Multiple Sclerosis

2019 ◽  
Vol 11 ◽  
pp. 117957351988404
Author(s):  
Stijn Denissen ◽  
Alexander De Cock ◽  
Tom Meurrens ◽  
Luc Vleugels ◽  
Ann Van Remoortel ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Cognitive Impairment ◽  
Cognitive Dysfunction ◽  
Word Association ◽  
Verbal Learning ◽  
Cognitive Status ◽  
Attentional Deficits ◽  
Ambulatory Patients ◽  
The Impact ◽  
Locomotor Rehabilitation

Background: Cognitive dysfunction is a frequent manifestation of multiple sclerosis (MS) but its effect on locomotor rehabilitation is unknown. Objective: To study the impact of cognitive impairment on locomotor rehabilitation outcome in people with MS. Methods: We performed a retrospective analysis involving ambulatory patients with MS who were admitted for intensive, inpatient, multidisciplinary rehabilitation at the National Multiple Sclerosis Center of Melsbroek between the years 2012 and 2017. The Brief Repeatable Battery of Neuropsychological Tests (BRB-N) was used to determine the cognitive status of subjects as either impaired (COG–) or preserved (COG+). Locomotor outcome was compared between groups with the difference in 6-minute walk test (6MWT) measured at admission and discharge (Δ6MWT). In addition, individual test scores of the BRB-N for attention (Paced Auditory Serial Addition Test 2” and 3”), visuospatial learning/memory (7/24 Spatial Recall Test), verbal learning/memory (Selective Reminding Test) and verbal fluency (Controlled Oral Word Association Test) were correlated to the Δ6MWT. Results: A total of 318 complete and unique records were identified. Both groups showed a significant within-group Δ6MWT during hospitalization (COG+: 47.51 m; COG–: 40.97 m; P < .01). In contrast, Δ6MWT values were comparable between groups. The odds of achieving a minimal clinical important difference on the 6MWT did not differ significantly between both groups. Only attention/concentration was significantly correlated with Δ6MWT (r = 0.16, P = .013). Conclusion: Cognitive impairment based on BRB-N results appears not to impede locomotor rehabilitation in ambulatory patients with MS. Attentional deficits are correlated to the extent of locomotor rehabilitation, suggesting the presence of a subtle effect of cognition.

T1 cortical hypointensities and their association with cognitive disability in multiple sclerosis

2010 ◽  
Vol 16 (10) ◽  
pp. 1203-1212 ◽  
Author(s):  
Francesca Bagnato ◽  
Zeena Salman ◽  
Robert Kane ◽  
Sungyoung Auh ◽  
Fredric K Cantor ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Cognitive Impairment ◽  
White Matter ◽  
Statistical Significance ◽  
Verbal Learning ◽  
Lesion Volume ◽  
Cognitive Disability ◽  
3.0 Tesla ◽  
Multiple Sclerosis Patients ◽  
The Impact

Background: Neocortical lesions (NLs) largely contribute to the pathology of multiple sclerosis (MS), although their relevance in patients’ disability remains unknown. Objective: To assess the incidence of T1 hypointense NLs by 3.0-Tesla magnetic resonance imaging (MRI) in patients with MS and examine neocortical lesion association with cognitive impairment. Methods: In this case-control study, 21 MS patients and 21 age-, sex- and years of education-matched healthy volunteers underwent: (i) a neuropsychological examination rating cognitive impairment (Minimal Assessment of Cognitive Function in MS); (ii) a 3.0-Tesla MRI inclusive of an isotropic 1.0 mm3 three-dimensional inversion prepared spoiled gradient-recalled-echo (3D-IRSPGR) image and T1- and T2-weighted images. Hypointensities on 3D-IRSPGR lying in the cortex, either entirely or partially were counted and association between NLs and cognitive impairment investigated. Results: A total of 95 NLs were observed in 14 (66.7%) patients. NL+ patients performed poorer (p = 0.020) than NLpatients only on the delayed recall component of the California Verbal Learning Test. This difference lost statistical significance when a correction for white matter lesion volume was employed. Conclusions: Although T 1 hypointense NLs may be present in a relatively high proportion of multiple sclerosis patients, the impact that they have in cognitive impairment is not independent from white matter disease.

New-Onset Right-Sided Numbness and Double Vision

2021 ◽  
pp. 14-16
Author(s):  
W. Oliver Tobin
Keyword(s):  
Magnetic Resonance Imaging ◽  
Multiple Sclerosis ◽  
Magnetic Resonance ◽  
Immunoglobulin G ◽  
Clinically Isolated Syndrome ◽  
Resonance Imaging ◽  
Deep White Matter ◽  
The Right ◽  
The Brain

A 40-year-old right-handed man sought care for right hand numbness, right-sided facial numbness, and diplopia progressing to maximal severity over 10 days. At his worst he was unable to write. His symptoms remained maximal for 4 weeks. He was hospitalized and treated with 5 days of intravenous methylprednisolone. He improved to approximately 95% of normal over 4 weeks. He had residual mild right-sided facial and right leg numbness. Antibodies to JC polyoma virus and varicella-zoster virus were positive, which indicated prior exposure to these viruses. Total 25-hydroxyvitamin D level was low at 8.2 ng/mL. Optical coherence tomography findings were normal. Magnetic resonance imaging of the brain performed 3 months after the onset of symptoms demonstrated a T2-hyperintense lesion in the left midbrain peduncle extending into the upper pons, without gadolinium enhancement. A small area of T2 hyperintensity was seen in the right frontal deep white matter. Follow-up brain magnetic resonance imaging showed almost complete resolution of the left midbrain peduncle lesion with persistence of the right frontal deep white matter lesion. Spinal fluid analysis showed 1 white blood cell/µL with 95% lymphocytes, protein 35 mg/dL, 0 unique oligoclonal bands, and normal immunoglobulin G index (0.54). A diagnosis of clinically isolated syndrome-first episode of multiple sclerosis was made. After detailed discussion with the patient, he elected to commence disease-modifying therapy with fingolimod. He underwent routine monitoring with magnetic resonance imaging of the brain and cervical and thoracic spine on an annual basis, without any further relapses at 5-year follow-up. Patients with typical demyelinating syndromes may not always fulfill the diagnostic criteria for multiple sclerosis. After careful exclusion of other mimicking conditions, most notably aquaporin-4-immunoglobulin G– and myelin oligodendrocyte glycoprotein-immunoglobulin G–associated disease, a diagnosis of clinically isolated syndrome may be made.

scholarly journals Functional magnetic resonance imaging correlates of cognitive performance in patients with a clinically isolated syndrome suggestive of multiple sclerosis at presentation: an activation and connectivity study

2011 ◽  
Vol 18 (2) ◽  
pp. 153-163 ◽  
Author(s):  
C Forn ◽  
MA Rocca ◽  
P Valsasina ◽  
I Boscá ◽  
B Casanova ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Multiple Sclerosis ◽  
Cognitive Impairment ◽  
Magnetic Resonance ◽  
Parietal Lobe ◽  
Effective Connectivity ◽  
Clinically Isolated Syndrome ◽  
Functional Magnetic Resonance ◽  
Resonance Imaging ◽  
The Right

Background/Objective: To assess whether abnormalities on functional magnetic resonance imaging (fMRI) are related to cognitive function in patients at presentation with clinically isolated syndrome (CIS) suggestive of multiple sclerosis. Methods: Eighteen patients with CIS and 15 healthy controls (HCs) performed an adapted fMRI version of the Paced Auditory Serial Addition Test (PASAT). According to their PASAT performance, CIS patients were divided into two groups: 10 with a low PASAT performance (<1 SD from the mean value of HCs) were considered ‘cognitive impairment’ (CI); eight patients were defined as ‘cognitively preserved’ (CP). Between-group differences in the patterns of brain activations and effective connectivity were assessed. Results: During PASAT, compared to HCs, CIS patients showed increased activations of the bilateral inferior parietal lobe (IPL), bilateral precuneus, bilateral middle frontal gyrus (MFG), left anterior cingulate cortex (ACC), left claustrum, right thalamus and right caudate nucleus. When CIS patients were analyzed, the CI group had a more significant activation of the bilateral IPL than HCs and CP patients. Compared to CP patients, they also had more significant recruitment of the right superior parietal lobe, right cerebellum, left MFG and left ACC. The analysis of effective connectivity showed stronger connections between several regions of the right hemisphere involved in working memory function in CI patients versus CP and HC. Conclusions: During performance of the PASAT, CIS patients show abnormalities in the patterns of cortical recruitment and connectivity related to the level of their cognitive impairment.

Performance measurement and resource sharing among business sub-units in the presence of non-discretionary factors

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Rita Shakouri ◽  
Maziar Salahi
Keyword(s):  
Resource Sharing ◽  
Content Type ◽  
Development Level ◽  
Proposed Model ◽  
Decision Making Unit ◽  
Efficiency Estimation ◽  
Overall Efficiency ◽  
And Performance ◽  
The Right ◽  
The Impact

Purpose This paper aims to apply a new approach for resource sharing and efficiency estimation of subunits in the presence of non-discretionary factors and partial impacts among inputs and outputs in the data envelopment analysis (DEA) framework. Design/methodology/approach First, inspired by the Imanirad et al.’s model (2013), the authors consider that each decision-making unit (DMU) may consist of several subunits, that each of which can be affected by non-discretionary inputs. After that, the Banker and Morey’s model (1996) is used for modeling non-discretionary factors. For measuring performance of several subunits, which can be considered as DMUs, the aggregate efficiency is suggested. At last, the overall efficiency is computed and compared with each other. Findings One of the important features of proposed model is that each output in this model applies discretionary input according to its need; therefore, the result of this study will make it easier for the managers to make better decisions. Also, it indicates that significant predictions of the development of the overall efficiency of DMUs can be based on observing the development level of subunits because of the influence of non-discretionary input. Therefore, the proposed model provides a more reasonable and encompassing measure of performance in participating non-discretionary and discretionary inputs to better efficiency. An application of the proposed model for gaining efficiency of 17 road patrols is provided. Research limitations/implications More non-discretionary and discretionary inputs can be taken into consideration for a better analysis. This study provides us with a framework for performance measures along with useful managerial insights. Focusing upon the right scope of operations may help out the management in improving their overall efficiency and performance. In the recent highway maintenance management systems, the environmental differences exist among patrols and other geotechnical services under the climate diverse. Further, in some cases, there might exist more than one non-discretionary factor that can have different effects on the subunits’ performance. Practical implications The purpose of this paper was to measure the performance of a set of the roadway maintenance crews and to analyze the impact of non-discretionary inputs on the efficiency of the roadway maintenance. The application of the proposed model, on the one hand, showed that each output in this model uses discretionary input according to its requirement, and on the other hand, the result showed that meaningful predictions of the development of the overall efficiency of DMUs can be based on observing the development level of subunits because of the impact of non-discretionary input. Originality/value Providing information on resource sharing by taking into account non-discretionary factors for each subunit can help managers to make better decisions to increase the efficiency.

scholarly journals Corporate Governance Role in Improving the Financial Information Quality within the Saudi Electricity Company: دور حوكمة الشركات في تحسين جودة المعلومات المحاسبة في الشركة السعودية للكهرباء

2020 ◽  
Vol 4 (1) ◽  
Author(s):  
Arwa Hassan Baabbad
Keyword(s):  
Corporate Governance ◽  
Significant Relationship ◽  
Information Quality ◽  
Survey Methodology ◽  
Governance System ◽  
And Performance ◽  
The Right ◽  
Descriptive Survey ◽  
The Impact

The present study aimed to find out the role of corporate governance in improving the quality of information in the Saudi Electricity Company. The researcher used the descriptive survey methodology. As to achieve the study objectives، the researcher utilized the questionnaire tool، in which the study sample (50) members of SEC distributed into employees، managers and decision makers. The study concluded to many results، among of which are: there is a statistically significant relationship between the availability of corporate governance system and performance improvement of the Saudi Electricity Company، there is a statistically significant relationship between corporate governance and appropriateness in improving the performance of the Saudi Electricity Company، it was also found that there is a statistically significant relationship between corporate governance and optimal disclosure in improving the performance of Saudi Electricity Company. The study also found that there is a statistically significant relationship between corporate governance and the right timing in improving the performance of the Saudi Electricity Company. The study suggested number of recommendations، among of which are: the importance of the shareholding companies to comply with the corporate governance regulations considering the interest of companies and their shareholders and all other parties benefiting from the financial statements، attempting to take advantage of the multiple benefits of corporate governance and expand its application in the various economic units in Saudi Arabia، conduct studies on companies that applies the requirement of the Corporate Governance Regulations، and the impact of the application of corporate governance on the shares of these units to find out the relationship between the quality of accounting information in light of the application of corporate governance and the stock market from another angle، imposing deterrent penalties concerning the Corporate Governance Regulations on companies that did not apply this regulation.

scholarly journals Validity and Reliability of Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS) in Indonesia and the Correlation with Quality of Life

2019 ◽  
Vol 2019 ◽  
pp. 1-7
Author(s):  
Riwanti Estiasari ◽  
Yuhyi Fajrina ◽  
Diatri Nari Lastri ◽  
Syarli Melani ◽  
Kartika Maharani ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Multiple Sclerosis ◽  
Cognitive Impairment ◽  
Cognitive Function ◽  
Cognitive Assessment ◽  
Verbal Learning ◽  
Retest Reliability ◽  
Cognitive Evaluation ◽  
Test Retest Reliability

Introduction. Multiple Sclerosis (MS) can affect cognitive function that might interfere with quality of life. Processing speed and memory are the most common area of cognitive impairment. Cognitive evaluation in daily practice is often difficult to be performed since it needs neuropsychological expert and is time-consuming. Brief International Cognitive Assessment for MS (BICAMS) is valid and practical for cognitive evaluation. This study aims to validate BICAMS in Indonesian MS patients and healthy controls (HC) and to analyse the effect of cognitive impairment on quality of life. Methods. BICAMS, which composes Symbol Digits Modalities Test (SDMT), California Verbal Learning Test-Second Edition (CVLT-II), and Brief Visuospatial Memory Test-Revised (BVMT-R), was translated and cross-culturally adapted to Indonesian from the original BICAMS and then administered to 40 Indonesian MS patients and 66 HC matched by sex, age, and education. Test-retest reliability was performed on 16-MS patients and 42 HC. Quality of life was measured using Multiple Sclerosis Quality of Life (MSQOL-54) instrument. Results. The SDMT, CVLT-II, and BVMT-R score in MS patients were significantly lower than those in HC (effect size, r: 0.61, 0.36, and 0.47, respectively). Test-retest reliability for all tests was satisfactory with correlation coefficient for SDMT, CVLT-II, and BVMT-R in MS subjects 0.86, 0.81, and 0.83, respectively. Using 5th percentile of HC score as cut-off, 15% MS subjects had impairment in one test, 27.5% in two tests, and 40% in three tests. BICAMS was moderately correlated with EDSS but was not correlated with disease duration and relapse rate. SDMT score correlated with physical function and physical and mental role limitation. Conclusion. BICAMS is valid and reliable for assessing cognitive function of Indonesia MS patients.

Brain lesion location and clinical status 20 years after a diagnosis of clinically isolated syndrome suggestive of multiple sclerosis

2011 ◽  
Vol 18 (3) ◽  
pp. 322-328 ◽  
Author(s):  
CM Dalton ◽  
B Bodini ◽  
RS Samson ◽  
M Battaglini ◽  
LK Fisniku ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Spatial Distribution ◽  
Brain Lesion ◽  
Multiple Linear Regression Model ◽  
Clinically Isolated Syndrome ◽  
Optic Radiation ◽  
Lesion Location ◽  
T2 Lesions ◽  
Significant Difference ◽  
T1 And T2

Background/Objectives: The objective of this study was to investigate associations between the spatial distribution of brain lesions and clinical outcomes in a cohort of people followed up 20 years after presentation with a clinically isolated syndrome (CIS) suggestive of multiple sclerosis (MS). Methods: Brain lesion probability maps (LPMs) of T1 and T2 lesions were generated from 74 people who underwent magnetic resonance imaging (MRI) and clinical assessment a mean of 19.9 years following a CIS. One-tailed t-test statistics were used to compare LPMs between the following groups: clinically definite (CD) MS and those who remained with CIS, with an abnormal MRI; people with MS and an Expanded Disability Status Scale (EDSS) ≤3 and >3; people with relapsing–remitting (RR) and secondary progressive (SP) MS. The probability of each voxel being lesional was analysed adjusting for age and gender using a multiple linear regression model. Results: People with CDMS were significantly more likely than those with CIS and abnormal scan 20 years after onset to have T1 and T2 lesions in the corona radiata, optic radiation, and splenium of the corpus callosum (periventricularly) and T2 lesions in the right fronto-occipital fasciculus. People with MS EDSS >3, compared with those with EDSS ≤3, were more likely to have optic radiation and left internal capsule T2 lesions. No significant difference in lesion distribution was noted between RRMS and SPMS. Conclusion: This work demonstrates that lesion location characteristics are associated with CDMS and disability after long-term follow-up following a CIS. The lack of lesion spatial distribution differences between RRMS and SPMS suggests focal pathology affects similar regions in both subgroups.

Memantine for cognitive impairment in multiple sclerosis: a randomized placebo-controlled trial

2010 ◽  
Vol 16 (6) ◽  
pp. 715-723 ◽  
Author(s):  
JF Lovera ◽  
E. Frohman ◽  
TR Brown ◽  
D. Bandari ◽  
L. Nguyen ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Cognitive Impairment ◽  
Free Recall ◽  
Controlled Trial ◽  
Neuropsychiatric Symptoms ◽  
Verbal Learning ◽  
Self Report ◽  
California Verbal Learning Test ◽  
Cognitive Improvement ◽  
Learning Test

Background: Memantine, an NMDA antagonist, is effective for moderate to severe Alzheimer’s disease. Objective: Determine whether memantine improves cognitive performance (CP) among subjects with multiple sclerosis (MS) and cognitive impairment (CI). Methods: This double-blind, randomized, placebo-controlled trial (Clinicaltrials.gov NCT00300716) compared memantine 10 mg twice a day (4 week titration followed by 12 weeks on the highest tolerated dose) with placebo. The primary outcome was the change from baseline to exit on the Paced Auditory Serial Addition Test (PASAT) and the California Verbal Learning Test-II (CVLT-II) Long Delay Free Recall (LDFR). Secondary outcomes included additional neuropsychological tests; self-report measures of quality of life, fatigue, and depression; and family/caregiver reports of subjects’ CI and neuropsychiatric symptoms. Results: The differences between the groups on the change on the PASAT (placebo—memantine = 0.0 correct responses, 95% CI 3.4, 3.4; p = 0.9) and on CVLT-II LDFR (placebo—memantine =—0.6 words, 95% CI —2.1, 0.8; p = 0.4) as well as on the other cognitive tests were not significant. Subjects on memantine had no serious adverse events (AEs) but had more fatigue and neurological AEs as well as, per family members’ reports, less cognitive improvement and greater neuropsychiatric symptoms than subjects on placebo. Conclusion: Memantine 10 mg twice a day does not improve CP in subjects with MS, ages 18—65, without major depression, who have subjective cognitive complaints and perform worse than one SD below the mean on the PASAT or on the California Verbal Learning Test-II (total recall or delayed free recall).

scholarly journals Intelligence Deficits in Chinese Patients with Brain Tumor: The Impact of Tumor Resection

2013 ◽  
Vol 2013 ◽  
pp. 1-6 ◽  
Author(s):  
Chao Shen ◽  
Rong Xie ◽  
Xiaoyun Cao ◽  
Weimin Bao ◽  
Bojie Yang ◽  
...  
Keyword(s):  
Brain Tumor ◽  
Pituitary Adenoma ◽  
Tumor Resection ◽  
Chinese Patients ◽  
Adult Intelligence Scale ◽  
Wechsler Adult Intelligence Scale ◽  
Significant Difference ◽  
And Performance ◽  
The Right ◽  
The Impact

Background. Intelligence is much important for brain tumor patients after their operation, while the reports about surgical related intelligence deficits are not frequent. It is not only theoretically important but also meaningful for clinical practice.Methods. Wechsler Adult Intelligence Scale was employed to evaluate the intelligence of 103 patients with intracranial tumor and to compare the intelligence quotient (IQ), verbal IQ (VIQ), and performance IQ (PIQ) between the intracerebral and extracerebral subgroups.Results. Although preoperative intelligence deficits appeared in all subgroups, IQ, VIQ, and PIQ were not found to have any significant difference between the intracerebral and extracerebral subgroups, but with VIQ lower than PIQ in all the subgroups. An immediate postoperative follow-up demonstrated a decline of IQ and PIQ in the extracerebral subgroup, but an improvement of VIQ in the right intracerebral subgroup. Pituitary adenoma resection exerted no effect on intelligence. In addition, age, years of education, and tumor size were found to play important roles.Conclusions. Brain tumors will impair IQ, VIQ, and PIQ. The extracerebral tumor resection can deteriorate IQ and PIQ. However, right intracerebral tumor resection is beneficial to VIQ, and transsphenoidal pituitary adenoma resection performs no effect on intelligence.

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