Cognitive impairment in multiple sclerosis – a review of current knowledge and recent research

2017 ◽  
Vol 28 (8) ◽  
Author(s):  
Tomasz Grzegorski ◽  
Jacek Losy
Keyword(s):  
Multiple Sclerosis ◽  
Cognitive Impairment ◽  
Cognitive Rehabilitation ◽  
Current Knowledge ◽  
Cognitive Domains ◽  
Speed Of Information Processing ◽  
Chronic Progressive Disease ◽  
The Central Nervous System ◽  
Scientific Results ◽  
Underlying Mechanisms

AbstractMultiple sclerosis (MS) is a chronic, progressive disease of the central nervous system that is characterised by inflammatory damage to the myelin sheath. Though often neglected, cognitive impairment is a common feature of MS that affects 43–70% of patients. It has a sophisticated neuroanatomic and pathophysiologic background and disturbs such vital cognitive domains as speed of information processing, memory, attention, executive functions and visual perceptual functions. In recent years there has been growing interest in neuroimaging findings with regard to cognitive impairment in MS. The possible options of managing cognitive dysfunction in MS are pharmacologic interventions, cognitive rehabilitation and exercise training; however, not enough evidence has been presented in this field. The aim of our article is to provide current knowledge on cognitive impairment in MS based on the most recent scientific results and conclusions with regard to affected cognitive domains, neuropsychological assessment, underlying mechanisms of this disturbance, neuroimaging findings and therapeutic options.

scholarly journals Pediatric Multiple Sclerosis and Cognition: A Review of Clinical, Neuropsychologic, and Neuroradiologic Features

2017 ◽  
Vol 2017 ◽  
pp. 1-11 ◽  
Author(s):  
Ozgul Ekmekci
Keyword(s):  
Multiple Sclerosis ◽  
Cognitive Impairment ◽  
Social Life ◽  
Cognitive Rehabilitation ◽  
Neuropsychological Test ◽  
Disease Onset ◽  
Long Term Effects ◽  
Cognitive Domains

Multiple sclerosis (MS) is an inflammatory demyelinating and neurodegenerative disease. Although cognitive impairment has been well established in adult patients with MS, its occurrence in patients with pediatric-onset MS has recently been reported. In this review, I discuss the main features of cognitive impairment in pediatric MS as determined by long-term follow-up studies, neuropsychiatric test batteries, and the results of neuroradiological imaging studies that investigated the pathogenesis of pediatric MS. The most commonly affected cognitive domains in adults are attention, processing speed, and visuomotor skills; language and intelligence are also affected in pediatric MS. A young age at disease onset is the strongest risk factor for these impairments, which may be due to the effect of inflammatory demyelination and neurodegeneration on the developing central nervous system and neural networks in children. Cognitive impairment has long-term effects on patients’ academic life and the quality of their social life. Therefore, all patients with pediatric MS should be screened and monitored for cognitive impairment. This review also highlights the need for neuropsychological test batteries that assess different cognitive domains in children and adolescents with multiple sclerosis and for cognitive rehabilitation programs to improve the quality of their academic and social life.

Multiple Sclerosis

2019 ◽  
pp. 481-503
Author(s):  
Brian M. Sandroff ◽  
John DeLuca
Keyword(s):  
Multiple Sclerosis ◽  
Cognitive Impairment ◽  
Cognitive Rehabilitation ◽  
Daily Life ◽  
Cognitive Impairments ◽  
Brain Pathology ◽  
Future Directions ◽  
Immune Mediated ◽  
The Central Nervous System ◽  
The Impact

Multiple sclerosis (MS) is a nontraumatic, immune-mediated and neurodegenerative disease of the central nervous system. This chapter describes cognitive dysfunction in persons with MS. The chapter begins with a description of the disease and its prevalence and economic impact. This is followed by its diagnosis and current understanding of the mechanisms of the disease and its symptoms. The bulk of the chapter describes the cognitive impairments commonly observed in persons with MS. This includes the assessment of cognitive impairment, neuroimaging studies of how cognition is affected by brain pathology, the impact of cognitive impairment on daily life, and cognitive rehabilitation in MS. The chapter concludes with a brief discussion on future directions.

Early detection of cognitive dysfunction in patients with multiple sclerosis: Implications on outcome

2019 ◽  
Vol 21 (2) ◽  
pp. 208-216
Author(s):  
Maged Abdel Naseer ◽  
Shereen Fathi ◽  
Dalia M. Labib ◽  
Dalia H. Khalil ◽  
Alshaimaa M. Aboulfotooh ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Cognitive Impairment ◽  
Early Detection ◽  
Negative Correlation ◽  
Cognitive Rehabilitation ◽  
Word Association ◽  
Significant Negative Correlation ◽  
Fiber Layer ◽  
Rnfl Thickness ◽  
Increased Risk

AbstractObjective:Cognitive impairment in multiple sclerosis (MS) has a complex relationship with disease progression and neurodegeneration. The aim of this study was to shed light on the importance of early detection of cognitive impairment in MS patients.Methods:The study comprised two groups of definite MS patients, relapsing remitting multiple sclerosis (RRMS) and secondary progressive multiple sclerosis (SPMS), each with 25 patients. Physical disability was assessed using the Expanded Disability Status Scale (EDSS), while the risk of secondary progression was assessed using the Bayesian Risk Estimate for Multiple Sclerosis (BREMS). Cognitive functions were assessed using the Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS) and Controlled Oral Word Association Test (COWAT). Assessment of neurodegeneration was done using optical coherence tomography (OCT) via quantification of retinal nerve fiber layer (RNFL).Results:MS patients with higher RNFL thickness demonstrated a larger learning effect size than patients who had lower values in RNFL thickness regardless of MS type. RRMS patients showed significant improvement in delayed recall after giving cues than SPMS. The symbol digit modalities test was the only neuropsychological test that showed a significant negative correlation with EDSS (P = 0.009). There was a statistically significant negative correlation between BREMS scores and performance in all neuropsychological tests.Conclusion:Inclusion of neurocognitive evaluation in the periodic assessment of MS patients is mandatory to detect patients at increased risk of secondary progression. The thickness of RNFL is suggested as a method to estimate the expected benefit of cognitive rehabilitation, regardless of MS type.

scholarly journals Cognitive Impairment in Multiple Sclerosis

Folia Medica ◽  
2016 ◽  
Vol 58 (3) ◽  
pp. 157-163 ◽  
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.

The use of laboratory gait analysis for understanding gait deterioration in people with multiple sclerosis

2016 ◽  
Vol 22 (14) ◽  
pp. 1768-1776 ◽  
Author(s):  
L Eduardo Cofré Lizama ◽  
Fary Khan ◽  
Peter VS Lee ◽  
Mary P Galea
Keyword(s):  
Multiple Sclerosis ◽  
Gait Analysis ◽  
Muscle Activation ◽  
New Technologies ◽  
Current Knowledge ◽  
Three Dimensional ◽  
Activation Patterns ◽  
Clinical Utilization ◽  
Muscle Activation Patterns ◽  
Underlying Mechanisms

Laboratory gait analysis or three-dimensional gait analysis (3DGA), which uses motion capture, force plates and electromyography (EMG), has allowed a better understanding of the underlying mechanisms of gait deterioration in patients with multiple sclerosis (PwMS). This review will summarize the current knowledge on multiple sclerosis (MS)-related changes in kinematics (angles), kinetics (forces) and electromyographic (muscle activation) patterns and how these measures can be used as markers of disease progression. We will also discuss the potential causes of slower walking in PwMS and the implications for 3DGA. Finally, we will describe new technologies and methods that will increase precision and clinical utilization of 3DGA in PwMS. Overall, 3DGA studies have shown that functionality of the ankle joint is the most affected during walking and that compensatory actions to maintain a functional speed may be insufficient in PwMS. However, altered gait patterns may be a strategy to increase stability as balance is also affected in PwMS.

scholarly journals The blood–brain barrier in health and disease: Important unanswered questions

2020 ◽  
Vol 217 (4) ◽  
Author(s):  
Caterina P. Profaci ◽  
Roeben N. Munji ◽  
Robert S. Pulido ◽  
Richard Daneman
Keyword(s):  
Multiple Sclerosis ◽  
Central Nervous System ◽  
Blood Brain Barrier ◽  
Current Knowledge ◽  
Brain Barrier ◽  
Barrier Dysfunction ◽  
Blood Brain ◽  
The Central Nervous System ◽  
Health And Disease ◽  
Neurological Conditions

The blood vessels vascularizing the central nervous system exhibit a series of distinct properties that tightly control the movement of ions, molecules, and cells between the blood and the parenchyma. This “blood–brain barrier” is initiated during angiogenesis via signals from the surrounding neural environment, and its integrity remains vital for homeostasis and neural protection throughout life. Blood–brain barrier dysfunction contributes to pathology in a range of neurological conditions including multiple sclerosis, stroke, and epilepsy, and has also been implicated in neurodegenerative diseases such as Alzheimer’s disease. This review will discuss current knowledge and key unanswered questions regarding the blood–brain barrier in health and disease.

A functional magnetic resonance proof of concept pilot trial of cognitive rehabilitation in multiple sclerosis

2010 ◽  
Vol 17 (4) ◽  
pp. 457-467 ◽  
Author(s):  
J Sastre-Garriga ◽  
J Alonso ◽  
M Renom ◽  
MJ Arévalo ◽  
I González ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Cognitive Impairment ◽  
Magnetic Resonance ◽  
Healthy Subjects ◽  
Cognitive Rehabilitation ◽  
Brain Activity ◽  
Cognitive Stimulation ◽  
Rehabilitation Programme ◽  
Functional Magnetic Resonance ◽  
Computer Aided

Background: Cognitive impairment is frequent in multiple sclerosis (MS) and lacks effective treatment. Cognitive rehabilitation is widely applied in neurorehabilitation settings. Functional magnetic resonance imaging (fMRI) may help in investigating changes in brain activity and provide a tool to assess the efficacy of rehabilitation. Aim: To investigate the effect on brain activity as measured by fMRI of a cognitive rehabilitation programme in patients with MS and cognitive impairment. Method: Fifteen patients with MS and cognitive impairment and five healthy subjects were recruited. Neuropsychological assessments were performed in patients with MS at study entry and after rehabilitation to assess cognitive changes. fMRI scans were performed at week −5 (baseline), week 0 (immediately before rehabilitation) and week 5 (immediately after rehabilitation). The fMRI paradigm was the Paced Auditory Serial Addition Test (PASAT). The cognitive rehabilitation programme was composed of 15 computer-aided drill and practice sessions and five non-computer-aided cognitive stimulation group sessions (over 5 weeks). Strict guidelines ensured comparability of all rehabilitation interventions. Results: Patients had increased brain fMRI activity after rehabilitation in several cerebellar areas when compared with healthy subjects. After rehabilitation, patients had significantly improved their performance on the backward version of the Digit Span Test ( p = 0.007) and on a composite score of neuropsychological outcomes ( p = 0.009). Conclusion: The results of the present study indicate that this cognitive rehabilitation programme increases brain activity in the cerebellum of cognitively impaired patients with MS. The role of fMRI in the assessment of neurorehabilitation schemes warrants further investigation.

Cognitive Function in Patients with Multiple Sclerosis: Impairment and Treatment

2004 ◽  
Vol 6 (1) ◽  
pp. 9-22 ◽  
Author(s):  
Stephen M. Rao
Keyword(s):  
Multiple Sclerosis ◽  
Cognitive Impairment ◽  
Cognitive Dysfunction ◽  
Disease Duration ◽  
Cognitive Domains ◽  
Neuropsychological Dysfunction ◽  
Visuospatial Abilities ◽  
Assessment And Treatment ◽  
Neurologic Disability ◽  
History Of

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.

scholarly journals New Directions in Multiple Sclerosis Therapy: Matching Therapy with Pathogenesis

2010 ◽  
Vol 37 (S2) ◽  
pp. S42-S48 ◽  
Author(s):  
Jack Antel
Keyword(s):  
Multiple Sclerosis ◽  
Tissue Injury ◽  
Disease Stage ◽  
New Agents ◽  
Clinical Disorder ◽  
Multiple Sclerosis Therapy ◽  
The Central Nervous System ◽  
Underlying Mechanisms ◽  
Injury And Repair ◽  
Sclerosis Therapy

ABSTRACT:All currently approved therapies for multiple sclerosis (MS) modulate systemic immune components prior to their entry into the central nervous system (CNS). Available data indicate they lack impact on the progressive phases of disease; the more potent systemic immune-directed agents predispose to development of infectious or neoplastic disorders. Development of new agents that enhance disease stage related efficacy and limit systemic toxicity will need to consider the underlying mechanisms related to each phase of the clinical disorder, namely relapses, remission, and progression. This report focuses on disease related mechanisms ongoing within the CNS that contribute to the different phases of MS and how these may serve as potential therapeutic targets. Such mechanisms include CNS compartment specific immunologic properties especially as related to the innate immune system and neural cell-related properties that are determinants of the extent of actual tissue injury and repair (or lack thereof).

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