Visual evoked potential latency predicts cognitive function in people with multiple sclerosis.

Effects of transcranial alternating current stimulation on cognitive function in people with multiple sclerosis: A randomized controlled trial

Objective: To examine the association of visual evoked potential (VEP) latency and high-contrast visual acuity (VA) with cognitive function in MS patients using a standardized computerized battery. Background Cognition and vision are now recognized as important domains for clinical trials assessment in MS. The correlation of VEP conduction delay and VA with cognitive impairment has not been described. Design/Methods: Participants received a VEP evaluation as well as a Snellen vision test and completed a standardized, validated MindStreams battery designed to detect mild impairment (NeuroTrax Corp., NY) in their primary language. VEP latency categories were: normal =113 and =130 and =150 and 170 msec. Results: Among MS patients (n=435, 870 eyes), Accounting for age, disease duration, and within-patient, inter-eye correlations, abnormal VEP latency was associated with poorer overall battery performance (Global Cognitive Score, p Conclusions: Abnormal VEP latency and high-contrast VA in patients with MS may be associated with reduced cognitive function, particularly in domains related to executive function. Longer VEP latency may be particularly related to poorer visual spatial processing. Further studies will examine the role of afferent visual dysfunction and retinal axonal and neuronal loss in the relation of VEP latency to cognitive impairment and work disability in MS cohorts. Disclosure: Dr. Chahin has nothing to disclose. Dr. Balcer has received personal compensation for activities with Biogen Idec, Vaccinex and Bayer as a consultant and has received honoraria from Biogen Idec and Novartis. Dr. Zarif has received personal compensation for activities with Biogen Idec as a consultant. Ms. Bumstead has received personal compenstion for activities with Biogen Idec and Teva Neuroscience as a consultant. Dr. Fafard has nothing to disclose. Dr. Mebrahtu has nothing to disclose. Dr. Galetta has received personal compensation for activities with Biogen Idec Teva, and Novartis as a speaker.Dr. Galetta has received research support from Biogen Idec. Dr. Doniger has received personal compensation for activities with NeuroTrax Corporation as an employee. Dr. Gudesblatt has received personal compensation for activities with Biogen Idec, Teva Neuroscience, Lundbeck Research USA, Inc. and Medtronic as a consultant.

Neurorehabilitation that involves learning new motor skills is one of the promising clinical methods for motor recovery in people with multiple sclerosis (PwMS); therefore, factors that influence the acquisition of motor skills in PwMS need to be investigated. Sleep disturbances are common in PwMS; however, no study has investigated the effect of sleep and sleep-related biomarkers on skill acquisition in PwMS. This study aimed to examine the effect of sleep and sleep-related biomarkers on motor acquisition in PwMS. Forty participants with MS and 40 controls were recruited in this study. To assess motor acquisition, each participant was asked to perform a novel game through a virtual reality (VR) system 5 times (blocks). The main outcome measures for each block were the required time to complete the VR game and the recorded errors. The difference in scores between Block 5 and Block 1 for both outcomes were considered to represent motor skill acquisition. Sleep was assessed by self-report using the Pittsburgh Sleep Quality Index (PSQI) and objectively using sleep monitor technology. Serotonin level was assessed using means of enzyme-linked immunosorbent assay using plasma samples. There were significant positive correlations in both groups between motor skill acquisition and PSQI score. In PwMS, significant negative correlation between motor skill acquisition and sleep efficiency and significant positive correlation between motor skill acquisition and sleep latency were also observed. Interestingly, a significant negative correlation was observed between motor skill acquisition and the plasma serotonin level in both groups. Most of these correlations remained significant after controlling for disease severity, fatigue, baseline performance, and cognitive status. Sleep quality may influence motor skill acquisition in PwMS. Circulatory serotonin level might explain this relationship. Physical therapists are encouraged to be aware of sleep quality and sleep assessment. Sleep management strategies should be considered when treating PwMS.

Using cognitive testing to predict employment status in multiple sclerosis: A comparative study of the SDMT and a computerized cognitive assessment tool.

Background. Although investigations of the use of humour in the management of people with multiple sclerosis (PwMS) are not numerous, some significant findings have created the need to go deeper into the topic.Main research question. What are some of the potential benefits of humour in the management of PwMS, given the current state of scientific knowledge?Materials and methods. A scoping review was conducted using the PRISMA-ScR methodology. Information for the literature review was collected from the PubMed and Embase databases using the keywords “humour” and “multiple sclerosis”. Overall, 10 scientific investigations were analysed, grouped, interpreted, and generalized.Results. The research revealed: humour-based stress reduction for PwMS; the relationship between executive function and humour coping in PwMS; the distinctive influence of humour on employment status among individuals with relapsing-remiting multiple sclerosis (RRMS); the relationship between humour and personal long-term prognosis in PwMS; and the differences in perception of humour in PwMS.Conclusions. Appropriate use of humour (among other factors) can significantly improve the neuropsychological status in persons with RRMS and help them staying employed. Executive function and personalized long-term prognosis for PwMS are to some extent related to humor. Group analyses revealed lower scores in RRMS patients on humoristic visual tasks compared to scores on verbal tasks, and PwMS had impaired comprehension of figurative and humorous items compared to their comprehension of the literal items of simple medical responses.

Purpose The aim of the present study was to adapt and validate the Speech Pathology-Specific Questionnaire for Persons with Multiple Sclerosis (SMS) into the Greek language. Method The study sample consisted of 124 people with multiple sclerosis (PwMS) and 50 healthy controls (HCs). All PwMS underwent cognitive assessment using the Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS). Both PwMS and HCs completed the SMS, the Eating Assessment tool (EAT-10), the Voice Handicap Index (VHI), and the Stroke and Aphasia Quality of Life Scale-39 (SAQOL-39). Result Significant difference was found between PwMS and HCs for the EAT-10, SAQOL-39, the total SMS, and the SMS subscales. Discriminant validity analyses revealed a statistically significant difference between PwMS and HCs for the total and subscales SMS. Convergent validity analyses between the total SMS and the SMS subscales, and scores on the BICAMS, EAT-10, SAQOL-39, and VHI in PwMS were significantly correlated, with exception of the SMS Speech/Voice with the Symbol Digit Modalities Test (SDMT) and the Greek Verbal Learning Test-II (GVLT-II). Scores on the EAT-10, SAQOL-39, and VHI in PwMS were also correlated with the total SMS and the SMS subscales in PwMS, HCs, and the total sample. Construct validity analyses revealed that the total SMS and the SMS subscales were significantly correlated with the Expanded Disability Status Scale (EDSS) and years of education, while no associations were found with regards to age, MS subtype (relapsing-remitting MS [RRMS] vs progressive MS [PMS]), disease duration, or sex. The internal consistency of all items was excellent in PwMS and the total sample (Cronbach’s alpha was >0.7 after deletion of one item), with the exception of two items, which still fell within the acceptable range (>0.6) for PwMS and the total sample. Conclusion The Greek version of the SMS is a reliable and valid patient-reported outcome measure to assess speech-language and swallowing pathology related symptoms in PwMS, and can be used for research and clinical purposes.

Subjective mental fatigue (MF) and cognitive dysfunction significantly impair the quality of life in people with multiple sclerosis (PwMS), particularly impacting information processing speed (IPS) and verbal learning-memory (VL/M). We assessed 66 PwMS and 38 healthy controls (HC) via the oral form of the symbol digit modalities test (SDMT-Of) for IPS, the Greek verbal learning test (GVLT) for VL/M, and the cognitive subscale of the modified fatigue impact scale (MFIS-c) for MF. This aimed at investigating the mediating role of MF in the relationship between IPS and VL/M in PwMS. PwMS performed significantly worse than HC across all domains. Mediation analysis, controlling for age, sex, education, disease duration, and MS-type, revealed a significant effect of IPS on VL/M in PwMS. This effect became non-significant once MF was introduced, whereas the indirect effect of IPS on VL/M through MF remained significant. No significant mediation effects were observed in HC, even after controlling for age, sex, and education, underscoring the unique impact of MF on MS. This study highlights the mediating role of subjective MF in cognitive deficits among PwMS, suggesting that interventions targeting MF could enhance cognitive performance. Trial registration: The study is registered with ClinicalTrials.gov Identifier NCT04806568 ( https://www.clinicaltrials.gov/study/NCT04806568 ).

Multiple sclerosis is characterized by a spectrum of motor, sensory, and cognitive impairments often overlooked in low-disabled people with multiple sclerosis (PwMS). The assessment of subtle functional deficits in this population is crucial to track the evolution of impairments and treatments effects. This study aims to explore the prevalence of multidomain impairments and their association with walking disorders in minimally disabled PwMS. In this cross-sectional study, 80 PwMS with EDSS scores < 2.5 underwent a comprehensive assessment that included both EDSS Functional Scores (EDSS FS) and clinical scales measuring lower limb strength (Squat Jump test), tactile sensitivity (Monofilament Test), balance (instrumented test), fatigue (Fatigue Severity Scale) and cognitive function (Symbol Digit Modalities Test). Walking performances in PwMS were objectively measured with the Six-Minute Walking Test (6MWT) and subjectively by the MS Walking Scale-12 (MSWS-12). Abnormalities in EDSS FS were common, with over 50% (95% CI 43-65%) of PwMS exhibiting impaired Pyramidal FS and more than 20% (95% CI 13-32%) showing deficit in sensory FS. Compared with normative values, 30% of PwMS demonstrated reduced lower limb strength (95% CI 21-41%), impaired tactile sensation (95% CI 20-40%), and increased fatigue (95% CI 9-26%). Multivariate analyses indicated that while EDSS FS moderately predicted subjective (MSWS-12) and objective (6MWT) walking impairments, strength (β = 8.62, p < 0.001) and fatigue (β = 0.10, p < 0.001) emerged as stronger predictors. Low-disabled PwMS exhibit multidomain impairments and incorporating sensitive clinical assessments may facilitate early identification of subtle deficits, thereby enabling targeted interventions to improve mobility. NCT06219291 (09/11/2023).

BackgroundThe prevalence of multiple sclerosis (MS) is thought to be increasing among UK minority ethnic groups but little is known about their illness perceptions of its causation. These may influence...

Introduction Limitations associated with Multiple Sclerosis (MS) can restrain work capacity and productivity, reducing the possibility to remain in work. Whilst access to sickness compensation might be an option, transitions to other types of employment, such as self-employment, might be considered. We aim to investigate the association of Sickness Absence (SA) and Disability Pension (DP) with employment status among people with multiple sclerosis (PwMS) before and after MS diagnosis compared with people without MS. Methods A prospective longitudinal study was conducted using Swedish register data of 2,779 MS patients diagnosed with MS in 2008-2012 in working ages (20-59 years) and 13,863 population-based matched references. Levels of SA and DP one year before and four years after MS diagnosis were analyzed. Risk of annual SA and DP levels of more than 180 days were compared among the MS patients and references and, their different types of employment, by means of Cox proportional hazard models and adjusted for socio-demographic variables and SA and DP before MS diagnosis. Results In general, people with MS had higher levels of SA and DP before and shortly after MS diagnosis compared to references. PwMS showed a significantly higher probability of reaching over 180 days of SA (Hazard Ratio [HR]=4.89, 95% Confidence interval [CI]=4.43-5.40) and over 180 days of DP (HR = 6.31, 95% CI = 5.46-7.30)) than the references, regardless of type of employment. Moreover, when compared to employed references, self-employed PwMS had similar likelihood to reach over 180 days of SA than employed PwMS, (HR = 4.27, 95% CI = 3.81-4.77) and (HR = 3.83, 95% CI = 2.73-5.38), respectively. In contrast, self-employed references showed less probability (HR = 0.49, 95% CI = 0.31-0.78) to reach over 180 days of SA compared to the employed references. Conclusions In contrast to references, employed and self-employed PwMS had similar probabilities of reaching over 180 days of SA. Key messages This study emphasizes that in Sweden also self-employed have access to sickness compensation, independently of employment status condition. Access to sickness compensation is utilized by PwMS.

Dynamic balance during walking in people with multiple sclerosis: A cross-sectional study.

BackgroundGait impairments and fatigue are the most common and disabling symptoms in people with multiple sclerosis (PwMS). Objective 6-min walk test (6MWT) gait testing can be improved through body-worn accelerometers, but its association to subjective fatigue and objective fatigability is contradictory. This study aims to validate an algorithm using smartphone sensor data for spatial–temporal gait parameters in PwMS and healthy controls, and evaluate its accuracy in detecting fatigability, and quantify its association with fatigue in PwMS.MethodsWe recruited PwMS with mild to moderate disability (EDSS 0.0–6.5) and healthy controls in a supervised, lab-based cohort study. All participants performed the 6MWT while wearing a smartphone at the hip, which collected acceleration data of step count, cadence and walking speed. Algorithm validation included the mean absolute percentage error (MAPE) and Bland–Altman analysis. Fatigability and fatigue were measured in PwMS, with fatigability defined as a 10% decline in gait performance, and fatigue using the fatigue scale for motor and cognitive functions (FSMC). Further, correlations between gait parameters and FSMC were assessed.ResultsA total of 38 PwMS and 24 healthy controls were included. The algorithm demonstrated high validity for step count (MAPE < 3%) and cadence (MAPE < 10%). Gait analyses revealed fatigability in between 2.6 and 15.8% of PwMS, with large differences between the gait parameter assessed. Significant correlations were found especially between FSMC motor fatigue scores and step count (r = − 0.50), cadence (r = 0.51) and walking speed (r = 0.50).ConclusionSmartphone-based gait analysis provides an accessible and valid method for detecting steps and cadence. There are major differences in the assessment of fatigability, but an allover association to subjective motor fatigue.

BackgroundAlthough it is well known that people with multiple sclerosis (PwMS) retire from work early, little is known about how long-term changes in functioning and perceived impact of multiple sclerosis (MS) interact with sustainability of employment. ObjectiveTo explore changes in functioning and in perceived impact of MS over 10 years, in relation to employment status of PwMS. MethodsIn order to measure functioning, data on activities (walking ability, fine hand use, personal activities in daily living); participation in activities of everyday life (domestic, outdoor and leisure activities); body functions (cognitive function, fatigue, depressive symptoms); and perceived impact of MS were collected in 116 PwMS at baseline and at a 10-year follow-up. Ten-year changes were explored with the participants divided into four subgroups based on employment status at the follow-up: 1) full-time work at the 10-year follow-up; 2) part-time work at the 10-year follow-up; 3) declined from working at baseline to not working at the 10-year follow-up; and 4) not working at baseline nor at the 10-year follow-up. ResultsPatterns of change in functioning for PwMS who worked showed a more apparent deterioration over 10 years among those working part-time with regard to walking ability, fatigue and depressive symptoms. Members of the subgroups who declined from working at baseline to not working at the 10-year follow-up or who were working neither at baseline nor at the follow-up deteriorated the most in functioning. The subgroup whose employment status declined from baseline to follow-up showed a significant decrease in cognitive function and an increase in perceived physical impact of the disease. All subgroups experienced a deterioration in walking ability over the 10-year span, and in all subgroups a majority had limited fine hand use over the span of the study period. ConclusionThe deterioration in functioning was most apparent in those PwMS whose employment status declined from working at baseline to not working at the 10-year follow-up. Close monitoring of work situation and frequency of activities and participation in everyday activities, as well as recurrent training of functioning, are suggested for maintaining a high level of functioning and work status, or for supporting transition to an appropriate number of working hours.

Sixty-one PwMS were randomized into an MBT, aCT, or a WL control group for four weeks. Participants completed daily diaries assessing their use of emotion regulation strategies and measures of cognitive functioning at pre- and posttraining. The frequency of acceptance use, maladaptive strategies, and cognitive reappraisal, as well as the success of acceptance use, were the primary outcomes of interest. We also examined whether a cognitive composite score moderated treatment gains. Relative to pretraining, at posttraining, participants in the MBT group used acceptance more frequently, and this change was significantly greater compared to the change in aCT and WL groups. Training did not have differential effects on the frequency of maladaptive strategy and cognitive reappraisal use or on the success of acceptance use. Cognitive functioning did not moderate observed treatment gains. Our findings, based on this pilot study, suggest that after brief training in mindfulness meditation, PwMS used more acceptance strategies to regulate their emotions. Future studies with larger sample sizes, longer duration of treatment, and longitudinal follow-up are needed to better understand the efficacy of mindfulness mediation for promoting affective and cognitive health in PwMS. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

BackgroundVaccination campaign to contrast the spread of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has raised the issue of vaccine immunogenicity in special populations such as people with multiple sclerosis (PwMS) on highly effective disease modifying treatments (DMTs). While humoral responses to SARS-CoV-2 mRNA vaccines have been well characterized in the general population and in PwMS, very little is known about cell-mediated responses in conferring protection from SARS-CoV-2 infection and severe coronavirus disease-2019 (COVID-19).MethodsPwMS on ocrelizumab, fingolimod or natalizumab, vaccinated with two doses of mRNABNT162b2 (Comirnaty®) vaccine were enrolled. Anti-Spike (S) and anti-Nucleoprotein (N) antibody titers, IFN-gamma production upon S and N peptide libraries stimulation, peripheral blood lymphocyte absolute counts were assessed after at least 1 month and within 4 months from vaccine second dose administration. A group of age and sex matched healthy donors (HD) were included as reference group. Statistical analysis was performed using GraphPad Prism 8.2.1.ResultsThirty PwMS and 9 HDs were enrolled. All the patients were negative for anti-N antibody detection, nor reported previous symptoms of COVID-19. Peripheral blood lymphocyte counts were assessed in PwMS showing: (i) reduction of circulating B-lymphocytes in PwMS on ocrelizumab; (ii) reduction of peripheral blood B- and T-lymphocyte absolute counts in PwMS on fingolimod and (iii) normal B- and T-lymphocyte absolute counts with an increase in circulating CD16+CD56+ NK-cells in PwMS on natalizumab. Three patterns of immunological responses were identified in PwMS. In patients on ocrelizumab, anti-S antibody were lacking or reduced, while T-cell responses were normal. In patients on fingolimod both anti-S titers and T-cell mediated responses were impaired. In patients on natalizumab both anti-S titers and T-cell responses were present and comparable to those observed in HD.ConclusionsThe evaluation of T-cell responses, anti-S titers and peripheral blood lymphocyte absolute count in PwMS on DMTs can help to better characterize the immunological response after SARS-CoV-2 vaccination. The evaluation of T-cell responses in longitudinal cohorts of PwMS will help to clarify their protective role in preventing SARS-CoV-2 infection and severe COVID-19. The correlation between DMT treatment and immunological responses to SARS-CoV-2 vaccines could help to better evaluate vaccination strategies in PwMS.