Cognition In Multiple Sclerosis Research Articles

The Path from Personality to Anxiety and Depression Is Mediated by Cognition in Multiple Sclerosis

Background: Multiple sclerosis (MS) is a neurodegenerative immunological disease causing significant impairment in all life areas. Therefore, personality changes are observed and associated with higher prevalence of depression and anxiety disorders. Considering this relationship, we hypothesized that clinical symptoms and personality disorders are more prevalent in MS and that dysfunctional psychological mechanisms mediate the path from personality disorders to clinical symptoms. Methods: The study sample consisted of 43 patients with MS (age M = 41.9, SD = 11.5) and 31 controls (age M = 39.8, SD = 10.3). Measures of personality, anxiety, depression, fatigue, health status, and dysfunctional psychological mechanisms were conducted. Results: The prevalence of clinical symptoms was increased in MS patients as compared to controls. Also, dependent and schizoid personality traits (PTs) were observed in the patient sample. Negative automatic thoughts (NATs) were found to mediate the association between dependent PT and clinical symptoms. Along with schizoid PT, all dysfunctional psychological mechanisms impacted clinical symptoms. Discussion: The results of our research are in line with previous studies showing that anxiety, depression, and dysfunctional personality traits are more prevalent in MS as compared to controls. Conclusions: PTs and dysfunctional psychological mechanisms predicted depression, anxiety, fatigue, and health status in MS patients. Cognition acts as a strong mediator between PTs and psychopathology in MS. Hence, integrative personalized psychological treatment is recommended to improve the quality of care in MS.

Summary of Research: What Is the True Impact of Cognitive Impairment for People Living with Multiple Sclerosis? A Commentary of Symposium Discussions at the 2020 European Charcot Foundation.

Cognitive symptoms affect disease management and activities of daily living for people living with multiple sclerosis (MS). This summary of research article summarises previously published discussions('What is the true impact of cognitive impairment for people living with multiple sclerosis? A commentary of symposium discussions at the 2020 European Charcot Foundation')from the 2020 European Charcot Foundation meeting between a patient expert living with MS, a neuropsychologist and a neurologist about the impact of cognitive impairment on people living with MS. These discussions highlighted that cognitive impairment may be under-prioritised in MS care and has a substantial impact on the daily lives of people living with MS. To address this, the panel recommended improved awareness about impaired cognition in MS, improved communication between people living with MS and healthcare professionals, and routine cognition screening. This will help improve management of cognitive symptoms to maximise the quality of life of people living with MS.

Relationship between Serum Glial Fibrillary Acidic Protein and Neurogranin Levels and Cognition in Multiple Sclerosis

Multiple sclerosis is an inflammatory neurodegenerative disorder, and cognitive problems occur in the early and late phases of the disease. The purpose of this study was to investigate the relationship between serum glial fibrillary acidic protein and neurogranin levels and cognition in patients with multiple sclerosis (MS). Twenty-three patients and 25 healthy controls were included in the study. Serum glial fibrillary acidic protein (GFAP) and neurogranin (NRGN) levels were determined on blood samples from patients and controls. Disease duration and EDSS scores of patients were recorded, and the Montreal Cognitive Assessment (MOCA) scale was used for cognitive assessment. There was no statistically significant difference between the two groups in terms of serum NRGN and GFAP levels. MOCA scores were lower in the patient group than in the healthy control group. No statistically significant correlation was found between NRGN and GFAP serum levels and MOCA scores. Our study showed that there was no statistically significant association between serum NRGN and GFAP levels and cognition in MS patients. This study is the first to examine serum GFAP and NRGN levels in the context of cognition in MS.

Free-living ambulatory physical activity and cognitive function in multiple sclerosis: the significance of step rate vs. step volume.

Physical activity (PA) represents a promising behavioral approach for managing cognitive dysfunction in multiple sclerosis (MS). However, there is a lack of information on the pattern of free-living PA intensity (e.g., step rate) and its unique association with cognition. Such information is essential for informing clinical trials in MS. We examined associations among PA volume and intensity with cognitive function in persons with MS, and intensity was derived from steps-based metrics (peak 30-min cadence [Peak-30CAD], and time spent in incremental cadence bands). We included data from 147 persons with MS who underwent assessments of cognitive function (via Brief International Cognitive Assessment in MS) and wore an ActiGraph GT3X + accelerometer for 7days. We performed bivariate and partial correlations and regression analyses examining associations among PA metrics and cognitive outcomes. Higher Peak-30CAD was significantly associated with better performance in cognitive processing speed and verbal learning and memory (rs = 0.19-0.38), and the associations remained significant when controlling for daily steps, age, sex, and years of education (p < 0.05). By comparison, daily steps was only correlated with cognitive processing speed (rs = 0.26), and the association was non-significant when controlling for Peak-30CAD and covariates. There were stronger correlations among time spent in higher intensity cadence bands with cognitive performance (rs = 0.18-0.38). Our results highlight the important role of PA intensity for cognition in MS, and may inform future development of focal PA interventions that focusing on step rate patterns for improving cognition in persons with MS.

Relationship between emotion recognition and cognition in multiple sclerosis: a meta-analysis protocol

IntroductionMultiple sclerosis (MS) is a chronic inflammatory and neurodegenerative disease of the central nervous system characterised by a broad and unpredictable range of symptoms, including cognitive and socio-cognitive dysfunction. Alongside...

Neurofilament and Brain Atrophy and Their Association with Cognition in Multiple Sclerosis: A 10-Year Follow-Up Study

Introduction. Cognitive impairment is an important contributor to disability in multiple sclerosis (MS). Disconnection of neuronal circuits due to axonal injury is probably an important underlying mechanism for this disability. Neurofilament light chain (NfL) is a neuron-specific constituent of axons and has gained increasing attention as a biomarker of axonal injury. Objective. To assess the association between NfL in serum (sNfL) and cerebrospinal fluid (cNfL) and cognitive function over 10 years and compare these associations with volumetric brain magnetic resonance imaging (MRI) measurements. Methods. Newly diagnosed MS patients were followed prospectively with baseline NfL and MRI as well as with clinical and cognitive assessments for up to 10 years. Results. Forty-one patients were included. Baseline sNfL correlated negatively with symbol digit modalities test (SDMT) at baseline (r=−0.45, p=0.005), year 5 (r=−0.41, p=0.017), and at year 10 (r=−0.52, p=0.008). Baseline cNfL correlated with baseline SDMT (r=−0.34, p=0.030) and SDMT at year 10 (r=−0.44, p=0.037). Baseline volumes of whole brain (r=0.476, p=0.002), gray matter (r=0.467, p=0.002), T1 (r=−0.627, p&lt;0.001), and T2 lesion volumes (r=−0.475, p=0.002) correlated significantly with baseline SDMT. Longitudinal analyses showed that both MRI volumes and EDSS were associated with the rate of SDMT decline, whereas sNfL and cNfL were not. Conclusion. NfL levels measured in serum and cerebrospinal fluid were both associated with cognitive functioning in MS patients over a 10-year period from diagnosis. However, MRI volumes correlated strongly in addition to the rate of cognitive decline.

Managing cognitive impairment and its impact in multiple sclerosis: An Australian multidisciplinary perspective.

Cognitive impairment in multiple sclerosis (MS) affects approximately 40-70% of patients and can have varying degrees of severity. Even mild cognitive impairment can impact on quality of life and productivity. Despite this, patients are not routinely screened or monitored for cognitive impairment in Australia due to a range of issues, with time and space being the main limiting factors. This Australian multidisciplinary perspective provides recommendations on cognition management in Australia. It gives a broad overview of cognition in MS, advice on the screening and monitoring tools available to clinicians, and strategies that can be implemented in clinics to help monitor for cognitive impairment in patients with MS. We suggest a routine baseline assessment and multidomain cognitive battery in regular intervals; a change should trigger a thorough investigation of the cause.

Depression symptoms and cognition in multiple sclerosis: Longitudinal evidence of a specific link to executive control

Background: Depression symptoms are prevalent in multiple sclerosis (MS) and associated with poorer cognition in cross-sectional studies; it is unknown whether changes in depression symptoms track with cognitive changes longitudinally. Objective: Investigate whether changes in depression symptoms correspond with cognitive changes over time in MS, and identify specific cognitive functions related to depression symptoms. Method: Persons with early relapse-onset MS (n = 165) completed a depression questionnaire (Beck Depression Inventory FastScreen) and tests of cognitive speed, executive control, and memory at baseline and 3-year follow-up. One-way ANOVAs assessed differences in cognitive change across participants with worsened, stable, or improved depression symptoms from baseline to year 3. Results: Change in depression symptoms was related to change in executive control (p = 0.001, ηp2 = 0.08; worsened mood with worsened executive control; improved mood with improved executive control), even when adjusting for cognitive speed (p = 0.002, ηp2 = 0.08). There were no links to cognitive speed (p = 0.826) or memory (p = 0.243). Regarding individual depression symptoms, executive control was related to loss of pleasure and suicidal thoughts. Conclusions: Executive control tracks with depression symptoms, raising hope that management of mood may improve executive control. The specific link between executive control and anhedonia implicates dysfunctional reward processing as a key component of MS depression.

Trial protocol: Feasibility of neuromodulation with connectivity-guided intermittent theta-burst stimulation for improving cognition in multiple sclerosis.

Cognitive impairment in multiple sclerosis (MS) can adversely impact participation in employment, activities of daily living, and wider society. It affects 40-70% of people living with MS (pwMS). There are few effective treatments for cognitive impairment in people with MS. Neuromodulation with intermittent theta-burst stimulation (iTBS) has potential for treating cognitive impairment in pwMS. This single-centre mixed-methods feasibility randomised controlled trial (NCT04931953) will assess feasibility, acceptability, and tolerability of procedures used for applying iTBS for improving cognitive performance in pwMS. Participants will be randomised into three intervention groups with varying lengths of iTBS treatment (from 1 to 4 weeks) and a sham-control group. Quantitative data will be collected at three time points (baseline, end of intervention, and 8-week follow-up). End of the intervention semi-structured interviews will explore the views and experiences of the participants receiving the intervention, analysed using framework analysis. Quantitative and qualitative data will be synthesised to explore the impact of the iTBS intervention. Ethical approval has been received from the Health Research Authority (21/LO/0506) and recruitment started in June 2022. The results will inform the design of an RCT of the efficacy of iTBS as a therapeutic intervention for cognitive impairment in pwMS.

Treatment Effect on Brain Atrophy Correlates with Treatment Effect on Cognition in Multiple Sclerosis.

The purpose of this study was to evaluate the extent to which treatment effect on magnetic resonance imaging (MRI)-derived measures of brain atrophy and focal lesions can mediate, at the trial level, the treatment effect on cognitive outcomes in multiple sclerosis (MS). We collected all published randomized clinical trials in MS lasting at least 2 years and including as end points: active MRI lesions (defined as new/enlarging T2 lesions), brain atrophy (defined as a change in brain volume between month 12 and month 24), and change in cognitive performance (assessed by the Paced Auditory Serial Addition Test [PASAT]). Relative reductions were used to quantify the treatment effect on MRI markers (lesions and atrophy), whereas the standardized mean difference (Hedges g) between baseline and follow-up cognitive assessment was used to quantify the treatment effects on cognition. A linear regression, weighted for trial size, was used to assess the relationship between the treatment effects on MRI markers and cognition. Fourteen trials including more than 8,813 patients with MS were included in the meta-regression. Treatment effect on cognition was strongly associated with the treatment effect on brain atrophy (R2 = 0.79, p < 0.001), but was not correlated with the treatment effect on active MRI lesions (R2 = 0.16, p = 0.14). Results reported here suggest that brain atrophy, a well-established MRI marker in MS clinical trials, can be used as a main outcome for clinical trials with drugs targeting cognitive impairment and neurodegeneration. ANN NEUROL 2023.

Feasibility of detecting atrophy relevant for disability and cognition in multiple sclerosis using 3D-FLAIR.

Disability and cognitive impairment are known to be related to brain atrophy in multiple sclerosis (MS), but 3D-T1 imaging required for brain volumetrics is often unavailable in clinical protocols, unlike 3D-FLAIR. Here our aim was to investigate whether brain volumes derived from 3D-FLAIR images result in similar associations with disability and cognition in MS as do those derived from 3D-T1 images. 3T-MRI scans of 329 MS patients and 76 healthy controls were included in this cross-sectional study. Brain volumes were derived using FreeSurfer on 3D-T1 and compared with brain volumes derived with SynthSeg and SAMSEG on 3D-FLAIR. Relative agreement was evaluated by calculating the intraclass correlation coefficient (ICC) of the 3D-T1 and 3D-FLAIR volumes. Consistency of relations with disability and average cognition was assessed using linear regression, while correcting for age and sex. The findings were corroborated in an independent validation cohort of 125 MS patients. The ICC between volume measured with FreeSurfer and those measured on 3D-FLAIR for brain, ventricle, cortex, total deep gray matter and thalamus was above 0.74 for SAMSEG and above 0.91 for SynthSeg. Worse disability and lower average cognition were similarly associated with brain (adj. R2 = 0.24-0.27, p < 0.01; adj.R2 = 0.26-0.29, p < 0.001) ventricle (adj. R2 = 0.27-0.28, p < 0.001; adj. R2 = 0.19-0.20, p < 0.001) and deep gray matter volumes (adj. R2 = 0.24-0.28, p < 0.001; adj.R2 = 0.27-0.28, p < 0.001) determined with all methods, except for cortical volumes derived from 3D-FLAIR. In this cross-sectional study, brain volumes derived from 3D-FLAIR and 3D-T1 show similar relationships to disability and cognitive dysfunction in MS, highlighting the potential of these techniques in clinical datasets.

Sexual Dysfunction in Multiple Sclerosis: The Role of Executive Function

Cognitive impairment and sexual dysfunction are common symptoms in persons with Multiple Sclerosis (MS). The present study focuses on the relationship between these two dimensions by means of a specific assessment commonly used in clinical practice with this population. Fifty-five persons with a diagnosis of MS underwent specific cognitive tests and answered clinical questionnaires. Two cognitive tests, one for memory (the Selective Reminding Test), and one for attention (the Symbol Digit Modalities Test), were administered together with two tests for executive functions (the D-KEFS Sorting Test and Stroop Test). Two self-report questionnaires to investigate clinical, psychological and sexual features (the Beck Depression Inventory-II and Self-perception of Cognition in Multiple Sclerosis and Multiple Sclerosis Intimacy and Sexuality Questionnaire-19), were also administered. The main result highlights that sexual difficulties are associated with cognitive deficits, particularly with executive disorders, but not with memory and attention. Furthermore, sexual difficulties are better explained when depression symptoms are also taken into account. This study disentangles the interaction between sexual dysfunction, cognitive impairment and depression in persons with MS by emphasising the role of very high cognitive processing (i.e., executive functioning) in determining human behaviour.

Time-Varying Functional Connectivity of the Hippocampus Is Associated With Cognitive Performance in Multiple Sclerosis Patients (P10-3.014)

<h3>Objective:</h3> To explore hippocampal static (sFC) and time-varying functional connectivity (TVFC) and assess their association with cognition in multiple sclerosis (MS). <h3>Background:</h3> The hippocampus has a key role in cognition. Hippocampal TVFC in MS needs to be further explored. <h3>Design/Methods:</h3> 3T structural and resting-state (RS) functional MRI scans were acquired from 108 MS patients and 63 healthy controls (HC). Subjects underwent neuropsychological evaluation. Sliding-window correlation analysis using the left (L) and right (R) hippocampus as seed regions assessed TVFC, quantified by the standard deviation of connectivity across windows. Mean connectivity indicated sFC. <h3>Results:</h3> MS patients had decreased sFC <i>vs</i> HC between L hippocampus and temporo-parietal regions, and increased sFC between L and R hippocampus and thalamus, precuneus and superior frontal regions. TVFC was decreased in MS patients between L hippocampus and temporo-parietal regions. Conversely, TVFC was increased in MS patients between L and R hippocampus and L pre- and postcentral gyri, cuneus, orbitofrontal cortex and inferior temporal gyrus (ITG). In MS patients, better global cognition correlated with higher TVFC between L hippocampus and L pre- and postcentral gyri (r=0.21–0.28; p=0.04–0.006). Better verbal memory correlated with higher TVFC between L hippocampus and L precentral gyrus (r=0.21, p=0.03), and better visuospatial memory correlated with higher TVFC between L and R hippocampus and L cuneus, pre- and postcentral gyri and ITG (r=0.19–0.23, p=0.02–0.04). Better information processing speed correlated with higher TVFC between L hippocampus and L postcentral gyrus (r=0.21, p=0.03) and with higher sFC between R hippocampus and L superior frontal cortex (SFC) (r=0.21, p=0.03). Finally, better attention scores correlated with higher TVFC between L hippocampus and L temporal cortex (r=0.24, p=0.01) and with higher sFC between R hippocampus and L SFC (r=0.20, p=0.05). <h3>Conclusions:</h3> Increased hippocampal connectivity contributed to explain better cognitive performances in MS, with a peculiar association between higher hippocampal TVFC and better memory scores. <b>Disclosure:</b> Monica Margoni has received research support from MAGNIMS. Paola Valsasina has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for ACCMED. Mr. Preziosa has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Bristol Myers Squibb . Mr. Preziosa has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Sanofi Genzyme. Mr. Preziosa has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Novartis. Mr. Preziosa has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Roche. Mr. Preziosa has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Merck. Olga Marchesi has nothing to disclose. Carmen Vizzino has nothing to disclose. Damiano Mistri has nothing to disclose. Dr. Filippi has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Bayer, Biogen Idec, Merck-Serono, Novartis, Roche, Sanofi Genzyme, Takeda, and Teva Pharmaceutical Industries. Dr. Filippi has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Bayer, Biogen Idec, Merck-Serono, Novartis, Roche, Sanofi Genzyme, Takeda, and Teva Pharmaceutical Industries. Dr. Filippi has received personal compensation in the range of $5,000-$9,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Springer Nature. The institution of Dr. Filippi has received research support from Biogen Idec, Merck-Serono, Novartis, Roche, Teva Pharmaceutical Industries, Italian Ministry of Health, Fondazione Italiana Sclerosi Multipla, and ARiSLA (Fondazione Italiana di Ricerca per la SLA). Maria Assunta Rocca has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Bayer, Biogen, Bristol Myers Squibb, Celgene, Genzyme, Merck Serono, Novartis, Roche, and Teva. The institution of Maria Assunta Rocca has received research support from Italian Ministry of Health, MS Society of Canada and Fondazione Italiana Sclerosi Multipla.

Mediterranean Diet is Associated with Cognition in Multiple Sclerosis (S46.010)

<h3>Objective:</h3> To evaluate relationships between Mediterranean diet score and cognitive outcomes in multiple sclerosis (MS) <h3>Background:</h3> The MS community has a high interest in the interaction between diet and disease outcomes. We have previously noted relationships between Mediterranean diet alignment and 1) thalamic volume in early MS and 2) objectively captured MS-related disability (Multiple Sclerosis Functional Composite). Here we evaluated associations between Mediterranean diet score and cognition in a representative clinical MS cohort. <h3>Design/Methods:</h3> Persons with MS (n=563; 71% women; aged 44.2±11.3 years) completed the Mediterranean Diet Adherence Screener (MEDAS, scores 0–14) and an analogue of the BICAMS cognitive battery composed of Symbol Digit Modalities Test, Hopkins Verbal Learning Test, Revised, and CANTAB Paired Associate Learning. Normative z-scores were averaged into a composite cognitive z-score. Multiple regression investigated the independent contribution of MEDAS to cognition adjusting for demographic (age, sex, race, ethnicity, socioeconomic status) and health-related (BMI, exercise, sleep disturbance, hypertension, diabetes, hyperlipidemia, smoking) factors. Logistic regression predicted risk for cognitive impairment (&lt;5^th percentile on 2–3 tasks) with MEDAS adjusting for aforementioned covariates. <h3>Results:</h3> Mean (SD) cognitive z-score was −0.67 (0.95). Higher MEDAS independently predicted better cognition (B=0.08 [95%CI: 0.05, 0.11], β=0.20, p&lt;0.001). Cognitive impairment was observed in 108 patients (19.2%). Higher MEDAS independently predicted 20% lower risk for cognitive impairment (Odds Ratio=0.80 [95% CI: 0.73, 0.89], p&lt;0.001). MEDAS was by far the best health-related predictor of cognitive z-score and cognition impairment. Effect modifications indicated stronger relationships between diet and cognition (z-score and impairment) among persons with progressive (versus relapsing) disease. <h3>Conclusions:</h3> After controlling for important potential confounders, we note a significant association between Mediterranean diet score and cognition in a representative sample of people with MS. The strength of the relationship in progressive disease suggests the possibility of a neuroprotective mechanism. Longitudinal studies and interventional clinical trials are needed. <b>Disclosure:</b> The institution of Dr. Katz Sand has received research support from National Multiple Sclerosis Society. The institution of Dr. Katz Sand has received research support from US Department of Defense. The institution of Dr. Katz Sand has received research support from Biogen. Dr. Katz Sand has received personal compensation in the range of $500-$4,999 for serving as a Grant reviewer with US Department of Defense. The institution of Dr. Fitzgerald has received research support from NIH. The institution of Dr. Fitzgerald has received research support from National MS Society. Mr. Sumowski has nothing to disclose.

Comparative effectiveness of natalizumab on cognition in multiple sclerosis: A cohort study

Background: Cognitive impairment occurs in 40%–70% of persons with multiple sclerosis (MS). Objective: To examine the effectiveness of natalizumab compared with other disease-modifying treatments (DMTs) on improving cognition as measured by the Symbol Digit Modalities Test (SDMT). Methods: Data were collected as part of Swedish nationwide phase IV surveillance studies (2007–2020). An increase in SDMT score by ⩾10% of the difference between maximum score possible (110) and the baseline value was defined as cognitive improvement. The likelihood of improvement was compared between natalizumab-treated individuals and individuals treated with other DMTs using mixed effect logistic regression. Trend in odds of improvement was investigated using slope analyses. Results: We included 2100 persons with relapsing-remitting MS treated with natalizumab and 2622 persons treated with other DMTs. At 6 months, 45% reached improvement. The natalizumab group showed largest odds of improvement during follow-up (odds ratio: 2.3, 95% confidence interval (CI): 1.5–3.5). The odds of improvement increased by 7% (95% CI: 6–7) per month of natalizumab treatment. The equivalent estimate was 4% (95% CI: 2–5) for other monoclonal antibodies and nonsignificant for oral or platform therapies. Conclusion: Treatment with natalizumab or other monoclonal antibodies is associated with a significantly faster likelihood of cognitive improvement than platform or oral DMTs.

Cognitive reserve as a moderating factor between EDSS and cognition in multiple sclerosis.

It is now well recognized that brain damage and/or atrophy apparent on MRI is only moderately correlated to cognitive functioning. The cognitive reserve (CR) hypothesis has been proposed to explain this functional heterogeneity, but it has only been addressed recently in the MS literature and has not yet been thoroughly investigated. The objective of this study is to examine the protective role of CR in cognition using a standardized CR tool in a population with a wide age range. A neuropsychological evaluation was performed on 84 pwMS aged between 27 and 78 years old and the CR Index questionnaire (CRIq) was used to estimate CR. The EDSS scale was used to assess the degree of neurologic impairment and estimate the disease burden. A moderating effect of CR was observed in the relationship between EDSS score and specific cognitive domains: processing efficiency, visuospatial learning and memory, as well as a tendency for verbal memory. In pwMS with a high level of CR, there was no negative relationship between these cognitive domains and EDSS. The results support the protective role of CR in a sample of pwMS with a wide age range. This role seems to be limited to specific cognitive tasks that pose a greater challenge and therefore require greater adaptability.

Cognition and Health-related Quality of Life in Multiple Sclerosis

Background: Cognitive dysfunctions are considered as a poor prognostic factor that influence health-related quality of life in multiple sclerosis. Objective: The aim of the study was to evaluate the impact of cognitive impairment on the quality of life in multiple sclerosis patients. Methods: This study included 60 MS patients treated at the Department of Neurology, Clinical Center University of Sarajevo. Inclusion criteria were clinically definite diagnosis of multiple sclerosis, 18 years of age or older and were able to give written informed consent. Cognitivefunction was evaluated by the Montreal Cognitive Assessment (MoCa) screening test. Quality of life was evaluated by SF36 questionnaire. Results: 88.33% of patients had cognitive impairment with 68.33% with mild cognitive impairment. Abstraction (60,83%), language (56,66%), executive functions (53.66%) and delayed recall (28.33%) were rated the worst. The median value of SF-36 score was 54.1 (27.7-70.01). The lowest results were achieved in the QOL domains of psycial limitation with a median value of 12.5 (0-75) and emotional limitation 33.3 (0-100). It is found statistically significant correlation of the MoCa score with social functioning, energy, vitality and general health (p&lt;0.05) and physical functioning (p&lt;0.001) domains of quality of life, as well as with SF -36 total scores (p&lt;0.05). Among group of patients with cognitive impairment, statistically significant positive correlation between cognitive status mental health HRQOL domain (rho=0.427; p&lt;0.001) was found. Conclusion: Cognitive impairment is very often presented in patients with multiple sclerosis with significant contribution to a poorer quality of life. It is associated with physical and emotional limitations, as well as poorer mental health. Further studies are needed, especially when we take into account very important clinical and prognostic role of cognition in multiple sclerosis.

Antioxidant supplements and cognition in Multiple Sclerosis: a systematic review

Background: Cognitive dysfunction is a debilitating characteristic of multiple sclerosis (MS) that affects approximately 60% of patients. To date, the only effective treatments for cognitive decline are cognitive rehabilitation and exercise training. While previous studies reported the beneficial effect of antioxidants on MS patients, several other studies investigated the effect of antioxidant supplements on the cognitive performance of MS patients. We aimed to conduct a systematic review to examine whether there is an association between antioxidants supplements and cognitive performance in MS patients.Methods: We searched PubMed, Embase, Scopus, and Web of Science for the identification of relevant studies in November 2021. We included control trials, cohort, case-control, and cross-sectional studies which showed the effect of any type of antioxidants on cognitive performance in MS patients.Results: After screening 12 papers were included in our study. Our review included three studies that examined the effect of ginkgo Biloba on cognitive performance, two examined the Mediterranean diet, and remained studies each investigated the vitamin A, Omega 5, Omega 3, estriol, epigallocatechin-3-gallate (EGCG), Boswellia papyrifera, and paleolithic diet. Overall, it seems that there were no benefits of antioxidant administration on cognitive performance in MS patients.

Association of spinal cord lesions with cognition in multiple sclerosis

Amaç: Çalışmamızda, multipl skleroz (MS)da fiziksel özürlülük ve prognozla yakın ilişkisi olan spinal kord tutulumunun, kognitif işlevler üzerine olası etkisi incelenmiştir.&#x0D; Gereç ve Yöntem: Çalışmaya 29 MS hastası (2 klinik izole sendrom, 23 relaps ve remisyonlarla seyreden MS, 2 sekonder progresif MS, 2 primer progresif MS) alındı. Demografik özellikleri, genişletilmiş özürlülük durum skalası (EDSS) skoru, Rao’nun kısa tekrarlanabilir nöropsikolojik test bataryası ile değerlendirilen kognitif durumu, beyin ve spinal kord T2 lezyon sayısı değerlendirildi. Benzer demografik özelliklere sahip 17 sağlıklı kontrol ile kognitif test sonuçları karşılaştırıldı. &#x0D; Bulgular: İleri yaş, hastalık başlangıç yaşının ileri olması, kısa eğitim süresi kognitif test sonuçlarını olumsuz etkileyen özelliklerdir. Beyin ve spinal kord lezyon sayılarının kognitif testler üzerine anlamlı etkisi saptanmamıştır. Spinal kord lezyonu olan hastalar olmayanlara göre daha yüksek EDSS’ye sahiptir, ancak iki grup arasında kognitif test sonuçları açısından anlamlı farklılık saptanmamıştır. &#x0D; Sonuç: Spinal kord lezyonları, EDSS ile değerlendirilen fiziksel özürlülük ile ilişkilidir. Kord plak varlığının ya da sayısının kognitif test sonuçları üzerine etkisini, servikal kord atrofisi ile birlikte değerlendirecek, daha geniş örneklemli boylamsal çalışmalara ihtiyaç vardır.

The comorbidity and cognition in multiple sclerosis (CCOMS) neuroimaging protocol: Study rationale, MRI acquisition, and minimal image processing pipelines.

The Comorbidity and Cognition in Multiple Sclerosis (CCOMS) study represents a coordinated effort by a team of clinicians, neuropsychologists, and neuroimaging experts to investigate the neural basis of cognitive changes and their association with comorbidities among persons with multiple sclerosis (MS). The objectives are to determine the relationships among psychiatric (e.g., depression or anxiety) and vascular (e.g., diabetes, hypertension, etc.) comorbidities, cognitive performance, and MRI measures of brain structure and function, including changes over time. Because neuroimaging forms the basis for several investigations of specific neural correlates that will be reported in future publications, the goal of the current manuscript is to briefly review the CCOMS study design and baseline characteristics for participants enrolled in the three study cohorts (MS, psychiatric control, and healthy control), and provide a detailed description of the MRI hardware, neuroimaging acquisition parameters, and image processing pipelines for the volumetric, microstructural, functional, and perfusion MRI data.