Multiple Sclerosis Dementia Research Articles

The risk of dementia in multiple sclerosis and neuromyelitis optica spectrum disorder.

Cognitive impairment is a common feature of multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD). However, there is a lack of population-based study of dementia risk in these disorders. In the present study, the risk of dementia in MS and NMOSD patients in Republic of Korea was estimated. Data analyzed in this study were obtained from the Korean National Health Insurance Service (KNHIS) database between January 2010 and December 2017. The study included 1,347 MS patients and 1,460 NMOSD patients ≥40 years of age who had not been diagnosed with dementia within 1 year prior to the index date. Matched controls were selected based on age, sex, and the presence of hypertension, diabetes mellitus, or dyslipidemia. In MS and NMOSD patients, the risk of developing any dementia [adjusted hazard ratio (aHR) = 2.34; 95% confidence interval (CI) = 1.84-2.96 and aHR = 2.19; 95% CI = 1.61-3.00, respectively], Alzheimer's disease [AD; aHR = 2.23; 95% confidence interval (CI) = 1.70-2.91 and aHR = 1.99; 95% CI = 1.38-2.88, respectively], and vascular dementia (aHR = 3.75; 95% CI = 1.91-7.35 and aHR = 3.21; 95% CI = 1.47-7.02, respectively) was higher compared with the matched controls. NMOSD patients had a lower risk of any dementia and AD compared with MS patients after adjusting for age, sex, income, hypertension, diabetes, and dyslipidemia (aHR = 0.67 and 0.62). The risk of dementia increased in MS and NMOSD patients and dementia risk was higher in MS than in NMOSD.

Cholinesterase inhibitors for rarer dementias associated with neurological conditions

Cholinesterase inhibitors for rarer dementias associated with neurological conditions

Dementia in multiple sclerosis: why is it rarely discussed?

Cognitive deficits in multiple sclerosis (MS) have been well studied in decades of MS research. Severe deficits are acknowledged, but the frequency is minimized in the literature, and there is a striking lack of discussion of the presence of a dementia state in MS. Possible reasons for this omission are discussed, along with an argument to define the dementia state and to provide terminology that will be palatable to patients.

Dementia in MS complicated by coexistent Alzheimer disease: Diagnosis premortem and postmortem.

Distinguishing dementia due to multiple sclerosis (MS) from that of an accompanying neurodegenerative dementia coexisting with MS has been difficult. The recent introduction of Alzheimer disease (AD) biomarkers of amyloid-β and neuronal degeneration has improved diagnosis of AD premortem. We describe 3 patients with MS with coexisting AD, 1 diagnosed at autopsy before AD biomarkers were available and 2 diagnosed premortem by decreased CSF amyloid-β1-42/tau index, MRI, and 18F-flourodeoxyglucose-PET patterns. AD biomarkers may be of diagnostic value in selected patients with severe dementia and MS.

Dementia in multiple sclerosis: Report of a case with cortical gray matter involvement and frontotemporal-like clinical features

Multiple sclerosis (MS) is primarily a white matter disease, but may also involve the gray matter, a feature not often demonstrated in vivo. This report presents the case of a patient with MS and clinical features mimicking frontotemporal dementia due to clear-cut cortical gray matter involvement in the left frontal lobe.

P01-481 - Dementia in multiple sclerosis: report of a case with cortical grey matter involvement and frontal-type-like clinical features

Background/introductionAlthough multiple sclerosis (MS), a demyelinating disease of unknown aetiology, is primarily a white matter disease, it may also involve the grey matter, a feature not often demonstrated in vivo by means of magnetic resonance imaging (MRI). The involvement of cortical grey matter in MS may account for cognitive dysfunction and behavioural abnormalities.ObjectiveThe purpose of this report is to present the case of a patient with MS and clinical features mimicking dementia of the frontal type due to clear-cut cortical grey matter involvement in the left frontal lobe.Case reportA 55-year-old woman with relapsing remitting MS developed a clinical picture characterized by frontal deficits (e.g. attention, verbal fluency, and speed processing), disinhibition, loss of insight, perseveration, abnormal eating behaviour, agitation, insomnia, and depersonalization phenomena. Neuropsychological evaluation also revealed abnormal performance on the Trail Making and the Stroop tests. Besides typical demyelinating lesions and “black holes”, MRI showed a striking pattern of left frontal opercular involvement including cortical thinning, focal knife-edge appearance of the gyri, and marked gliosis in the adjacent white matter.DiscussionCognitive deficits in MS are typically subcortical, due to the expected predominance of white matter lesions. Nonetheless, the involvement of grey matter structures may contribute to a different pattern of cognitive dysfunction. For example, hippocampal involvement has been linked to memory impairment. This particular case report additionally illustrates how cortical grey matter involvement in the frontal lobe may lead (not unexpectedly) to a clinical condition mostly characterised by frontal deficits and psychiatric symptoms.

Dementia in multiple sclerosis: is it Alzheimer's or a new entity?

Multiple Sclerosis (MS) is a chronic autoimmune multifocal inflammatory demyelinating disease with secondary neurodegeneration affecting predominantly females between 20-40 years. The clinical course over years is very variable. Milder cognitive dysfunctions in various conditions are very frequent in acute stage and in the further courses of the disease. Dementia is reported as a rare condition in MS. Rodriguez et al found in 1994 an incidence of 3,7 %. Over a period of 10 years we have investigated in our outpatient MS center the cognitive state of more than 400 MS patients for dementia according to the DSM IV classification and its correlation to MS. The main neuropsychological instrument was the Minimental Status Examination (MMSE). The Expanded Disability Status Scale (EDSS) of our patients ranged from 0 (no signs, no disability) to 9 (bed ridden, helpless). In our data we classified 3 subtypes of dementia in MS (DMS). In DMS type 1 the cognitive decline is one of the main symptoms and develops early in the disease without marked motor symptoms. The DMS type 2 is associated with an malignant or chronic progressive course of MS itself. Therefore DMS type 2 developed in association with marked motor impairement later in the clinical course. In DMS type 1 and 2 a marked demyelination of the white matter and/or cortical involvement with brain atrophy, demonstrated by magnetic resonanz imaging is present. DMS type 3 is associated with older age with or without major motor disability. In these cases we found no clear correlation between the course and severity of MS and the dementia syndrome itself. In ptients with MS the development of dementia is very heterogenous. DMS type 1 and 2 are directly associated with the progression of the chronic autoimmune disease and the involvement of cortical and/or white matter structures. In DMS type 3 cases a comorbid condition with Alzheimer Dementia is discussed. It seems as DMS is not as rare as described in literature. Further epidemiologic studies are necessary to evaluate the incidence of DMS in a greater population

Mapping of Event-Related Potentials to Auditory and Visual Odd-Ball Paradigms in Patients Affected by Different Forms of Dementia

The paper reports the results of recordings and maps of event-related potentials (ERPs) in patients with Alzheimer's disease (AD), progressive supranuclear palsy (PSP) and in subjects affected by dementia in multiple sclerosis (MS). ERPs were recorded from 19 scalp electrode derivations using both visual and acoustic paradigms. In 43% of AD patients, ERPs were normal; in 20%, although present, ERP components were delayed, while in the other 37% none of the N2 and P3 peaks could be recorded, because of abnormal topography of potentials on the scalp. In patients with PSP, the normal ERP sequence was not identified. In patients with MS delayed ERPs (50%), abnormal topography of ERPs (30%) and absence of ERPs (20%) were observed. The follow-up of AD patients showed a progressive alteration of ERPs. ERP topography alterations were observed in AD, PSP and MS patients with poorest cognitive performances.

Magnetic resonance imaging correlates of dementia in multiple sclerosis.

Thirty-two patients with clinically definite multiple sclerosis were evaluated with neuropsychological procedures and magnetic resonance imaging (MRI). Neuropsychological evaluation included assessment of language, memory, cognition, visuospatial skills, and depression. Significant impairment in any three areas, compatible with diagnosis of a dementia syndrome, was observed in 28% of these patients, and lesser or no cognitive impairment characterized the remaining patients. Magnetic resonance imaging was used to evaluate the number and distribution of lesions as well as the presence of cerebral atrophy and atrophy of specific anatomic structures such as the corpus callosum. Results suggest that neither the number of lesions, the distribution of lesions, nor the extent of generalized cerebral atrophy was significantly greater in demented compared with non-demented patients. The primary finding was that atrophy of the corpus callosum was significantly more extensive on MRI scans in demented patients. Although the callosum itself may not be implicated directly in the pathogenesis of dementia, the presence of callosal atrophy on MRI scans should alert the physician to the possible occurrence of dementia in patients with multiple sclerosis.