Persons With Multiple Sclerosis Research Articles

Multiple Sclerosis and Depression: Translation and Adaptation of the Spanish Version of the Chicago Multiscale Depression Inventory and the Study of Factors Associated with Depressive Symptoms.

Depressive disorder occurs in up to 50% of persons with Multiple Sclerosis (PwMS). Accurate assessment of depression in MS is essential in clinical settings because depressive symptomatology can affect the clinical course of the disease. We translated, adapted, and tested the Spanish version of the Chicago Multiscale Depression Inventory (CMDI), a specific test to assess depression in neurological disorders. We compare our results with those obtained with previous versions of the questionnaire (English and Italian). Finally, we also analyze the relationship between the results obtained on the CMDI and demographic, clinical, and cognitive variables. The results obtained with the Spanish version of the CMDI were similar to those observed in previous published versions. We also observed higher depression scores in PwMS (especially in progressive forms) compared with healthy controls. Moreover, depression symptomatology was related to higher disability and fatigue and worse cognitive performance in PwMS. The results support the validity of the CDMI in the Spanish population, as well as the association between depression and other characteristic symptoms of MS. These findings also emphasize the importance of good assessment and multidisciplinary treatment of depression in PwMS.

Low-dose naltrexone reduced anxiety in persons with multiple sclerosis during the COVID-19 pandemic.

Persons with multiple sclerosis (PwMS) have been considered at high risk for vaccination and/or acquisition of COVID-19 related to their reduced immune systems and daily regimen of immune suppressing therapy. Substantiated and unsubstantiated reports on these unknown circumstances increased anxiety and depression. Low-dose naltrexone (LDN) is a potentially effective off-label therapy shown to be effective at controlling fatigue for several autoimmune disorders including MS. This study utilized a small population of PwMS from central Pennsylvania in order to determine whether LDN therapy altered their perceived anxiety or depression during the early months of COVID-19. Utilizing mailed surveys, self-reported anxiety and depression scores were found to be significantly lower for PwMS who were prescribed LDN either alone or as an adjuvant to a standard disease modifying therapy (DMT) in comparison to those on oral disease-modifying therapies (DMTs). The data suggest that the non-toxic, inexpensive biotherapeutic may be beneficial in lessening anxiety.

Pilot Study of a Fall Prevention and Management Intervention Program for People With Multiple Sclerosis Who Use a Wheelchair or Scooter Full-Time

To examine the efficacy of a fall prevention/management intervention among persons with multiple sclerosis (PwMS) who use a wheelchair (WC) or scooter full-time. Pre-post/follow-up trial. Community and research laboratory. Twenty-one PwMS who used a WC or scooter full-time, self-reported at least 1 fall/12 months, and could transfer independently or with minimal/moderate assistance (N=21). Six-week, group and community-based fall prevention and management intervention. The intervention included six 2-hour in-person weekly sessions led by a physical or occupational therapist featuring interactive group discussions, skill practice, and action planning opportunities. Fall frequency tracked 12 weeks pre- and 24 weeks post intervention. Outcomes were assessed pre- and post intervention and 12 weeks post intervention. Measures included surveys to examine fear of falling (FOF), fall prevention/management, quality of life, community participation, and assessment of functional mobility skills. Semistructured interviews were administered post intervention to ascertain overall experiences with the program and effect on daily life. A Friedman test with signed-rank post hoc analysis was run to determine differences across the 3 study visits. After the intervention, fall incidence did not significantly change, but fall management strategies (P=.01-0.05), importance of community participation (P=.01), and transfer quality (P=.02) significantly improved. Moderate effect sizes were noted among concerns about falling, activity curtailment because of to FOF, and WC skills. Qualitative results indicate that participants found the intervention beneficial and applied intervention content in their daily lives. This study is the first to describe the effect of a multicomponent fall prevention/management intervention designed specifically for PwMS who use a WC or scooter full-time. Results indicate the program has potential to reduce fall risk; however, further testing is needed to fully examine the effect of the program.

Optical coherence tomography (OCT) measurements and cognitive performance in multiple sclerosis: a systematic review and meta-analysis.

Several studies report mixed associations between the retinal nerve fiber layer (RNFL) thickness with cognitive and physical disability in persons with multiple sclerosis (PwMS). Systematic synthesis of these findings is crucial in deriving credible conclusions. Five databases were searched from their inception to March 2022. The inclusion criteria for studies were MS-specific and required RNFL and cognitive performance data in order to be analyzed. The selection processes followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The systematic review yielded 31 studies that investigated the association between RNFL thickness and cognitive performance. Twenty-two studies reported positive associations, and nine did not. The meta-analysis included 11 studies with a total of 782 PwMS with mean age of 40.5years, mean Expanded Disability Status Scale (EDSS) of 2.7, and disease duration of 11.3years. RNFL thickness was significantly associated Symbol Digit Modalities Test (pooled r = 0.306, p < 0.001), Paced Auditory Serial Addition Test (pooled r = 0.374, p < 0.001) and Word List Generation (WLG, pooled r = 0.177, p < 0.001). RNFL was also significantly correlated with visuospatial learning and memory tests (pooled r = 0.148, p = 0.042) and verbal learning and memory tests (pooled r = 0.245, p = 0.005). Within three eligible studies, no significant association between ganglion cell inner-plexiform layer and SDMT 0.083 (95% CI -0.186, 0.352) was noted. The heterogeneity was high in all correlation studies (I2 > 63% and p < 0.008) except for the WLG and visuospatial memory findings. RNFL thickness is associated with cognitive processing speed, verbal learning and memory, visual learning and memory, as well as verbal fluency in PwMS. The number of studies included in the meta-analyses were limited due to non-standardized reporting.

Communicating the relevance of neurodegeneration and brain atrophy to multiple sclerosis patients: patient, provider and researcher perspectives.

Central nervous system (CNS) atrophy provides valuable additional evidence of an ongoing neurodegeneration independent of lesion accrual in persons with multiple sclerosis (PwMS). However, there are limitations for interpretation of CNS volume changes at individual patient-level. Patients are receiving information on the topic of atrophy through various sources, including media, patient support groups and conferences, and discussions with their providers. Whether or not the topic of CNS atrophy should be proactively discussed with PwMS during office appointments is currently controversial. This commentary/perspective article represents perspectives of PwMS, providers and researchers with recommendations for minimizing confusion and anxiety, and facilitating proactive discussion about brain atrophy, as an upcoming routine measure in evaluating disease progression and treatment response monitoring. The following recommendations were created based on application of patient's and provider's surveys, and various workshops held over a period of 2years: (1) PwMS should receive basic information on understanding of brain functional anatomy, and explanation of inflammation and neurodegeneration; (2) the expertise for atrophy measurements should be characterized as evolving; (3) quality patient education materials on these topics should be provided; (4) the need for standardization of MRI exams has to be explained and communicated; (5) providers should discuss background on volumetric changes, including references to normal aging; (6) the limitations of brain volume assessments at an individual-level should be explained; (7) the timing and language used to convey this information should be individualized based on the patient's background and disease status; (8) a discussion guide may be a very helpful resource for use by providers/staff to support these discussions; (9) understanding the role of brain atrophy and other MRI metrics may elicit greater patient satisfaction and acceptance of the value of therapies that have proven efficacy around these outcomes; (10) the areas that represent possibilities for positive self-management of MS symptoms that foster hope for improvement should be emphasized, and in particular regarding use of physical and mental exercise that build or maintain brain reserve through increased network efficiency, and (11) an additional time during clinical visits should be allotted to discuss these topics, including creation of specific educational programs.

Cholesterol pathway biomarkers are associated with neuropsychological measures in multiple sclerosis

BackgroundCognitive impairment (CI) is frequent in persons with multiple sclerosis (PwMS) and is linked to neurodegeneration. Cholesterol pathway biomarkers (CPB) are associated with blood-brain barrier breakdown, lesions, and neurodegeneration in multiple sclerosis (MS). CPB could influence CI. MethodsThis cross-sectional study (n = 163) included 74 relapsing-remitting MS (RR-MS), 48 progressive MS (P-MS) and 41 healthy control (HC) subjects. The assessed physical disability and cognitive measures were: Nine-hole Peg Test (NHPT), Timed 25-Foot Walk, Symbol Digit Modalities Test (SDMT), Paced Auditory Serial Addition Test-3, and Beck Depression Inventory-Fast Screen. CPB panel included plasma total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C) and the apolipoproteins (Apo), ApoA-I, ApoA-II, ApoB, ApoC-II and ApoE. Disability and cognitive measures were assessed as dependent variables in regression analyzes with age, sex, body mass index, years of education, HC vs. RR-MS vs. P-MS status, CPB, and a HC vs. RR-MS vs. P-MS status × CPB interaction term as predictors. ResultsSDMT was associated with the interaction terms for HDL-C (p = 0.045), ApoA-I (p = 0.032), ApoB (p = 0.032), TC/HDL-C (p = 0.013), and ApoB/ApoA-I (p = 0.008) ratios. CPB associations of SDMT were not abrogated upon adjusting for brain parenchymal volume. NHPT performance was associated with the interaction terms for TC (p = 0.047), LDL-C (p = 0.017), ApoB (p = 0.001), HDL-C (p = 0.035), ApoA-I (p = 0.032), ApoC-II (p = 0.049) and ApoE (p = 0.037), TC/HDL-C (p < 0.001), and ApoB/ApoA-I ratios (p < 0.001). ConclusionsThe LDL to HDL proportion is associated with SDMT and NHPT in MS. The findings are consistent with a potential role for CPB in CI.

Low socioeconomic status was associated with a higher mortality risk in multiple sclerosis

Background: The relationship between socioeconomic status (SES) and mortality among persons with multiple sclerosis (PwMS) is poorly understood. Objective: To investigate the association between SES and mortality risk in PwMS. Methods: From health-administrative data, we identified 12,126 incident MS cases with a first demyelinating event (MS ‘onset’) occurring between 1994 and 2017. Cox proportional hazard model assessed the association between socioeconomic status quintiles (SES-Qs) at MS onset and all-cause mortality. Results: Lower SES-Qs were associated with higher mortality risk; adjusted hazard ratios: SES-Q1 (most deprived) =1.61 (95% confidence interval (CI) = 1.36–1.91); SES-Q2 = 1.26 (95% CI = 1.05–1.50); SES-Q3 = 1.22 (95% CI = 1.02–1.46); SES-Q4 = 1.13 (95% CI = 0.94–1.35) versus SES-Q5 (least deprived). Conclusion: A lower SES was associated with higher mortality risk in PwMS.

Associations between myelin water imaging and measures of fall risk and functional mobility in multiple sclerosis.

Myelin water fraction (MWF) deficits as measured by myelin water imaging (MWI) have been related to worse motor function in persons with multiple sclerosis (PwMS). However, it is unknown if measures from MWI metrics in motor areas relate to fall risk measures in PwMS. The objective of this study was to examine the relationship between MWI measures in motor areas to performance on clinical measures of fall risk and disability in PwMS. Sixteen individuals with relapsing-remitting MS participated (1 male, 15 female; age 47.1 years [12.3]; Expanded Disability Status Scale 4.0 [range 0-6.5]) and completed measures of walking and fall risk (Timed 25 Foot Walk [T25FW] and Timed Up and Go). MWF and the geometric mean of the intra-/extracellular water T2 (geomT2IEW ) values reflecting myelin content and contribution of large-diameter axons/density, respectively, were assessed in three motor-related regions. The geomT2IEW of the corticospinal tract (r=-.599; p=.018) and superior cerebellar peduncles (r=-.613; p=.015) demonstrated significant inverse relationships with T25FW, suggesting that decreased geomT2IEW was related to slower walking. Though not significant, MWF in the corticospinal tract and superior cerebellar peduncles also demonstrated fair relationships with the T25FW, suggesting that worse performance on the T25FW was associated with lower MWF values. MWI of key motor regions was associated with walking performance in PwMS. Further MWI studies are needed to identify relationships between pathology and clinical function in PwMS to guide targeted rehabilitation therapies aimed at preventing falls.

Open-source dataset reveals relationship between walking bout duration and fall risk classification performance in persons with multiple sclerosis.

Falls are frequent and associated with morbidity in persons with multiple sclerosis (PwMS). Symptoms of MS fluctuate, and standard biannual clinical visits cannot capture these fluctuations. Remote monitoring techniques that leverage wearable sensors have recently emerged as an approach sensitive to disease variability. Previous research has shown that fall risk can be identified from walking data collected by wearable sensors in controlled laboratory conditions however this data may not be generalizable to variable home environments. To investigate fall risk and daily activity performance from remote data, we introduce a new open-source dataset featuring data collected from 38 PwMS, 21 of whom are identified as fallers and 17 as non-fallers based on their six-month fall history. This dataset contains inertial-measurement-unit data from eleven body locations collected in the laboratory, patient-reported surveys and neurological assessments, and two days of free-living sensor data from the chest and right thigh. Six-month (n = 28) and one-year repeat assessment (n = 15) data are also available for some patients. To demonstrate the utility of these data, we explore the use of free-living walking bouts for characterizing fall risk in PwMS, compare these data to those collected in controlled environments, and examine the impact of bout duration on gait parameters and fall risk estimates. Both gait parameters and fall risk classification performance were found to change with bout duration. Deep learning models outperformed feature-based models using home data; the best performance was observed with all bouts for deep-learning and short bouts for feature-based models when evaluating performance on individual bouts. Overall, short duration free-living walking bouts were found to be the least similar to laboratory walking, longer duration free-living walking bouts provided more significant differences between fallers and non-fallers, and an aggregation of all free-living walking bouts yields the best performance in fall risk classification.

THE EFFECTS OF EXERCISE TRAINING ON UPPER EXTREMITY FUNCTION FOR PERSONS WITH MULTIPLE SCLEROSIS: A SYSTEMATIC REVIEW.

ObjectiveTo evaluate the effects of exercise training on upper extremity physical function and physiological fitness outcomes in persons with multiple sclerosis (PwMS).MethodsA search of 3 electronic databases (EMBASE, CINAHL, and ovidMEDLINE) was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. The included studies were randomized control trials that reported at least one outcome measure related to upper extremity function, contained a component of exercise training, and included PwMS.ResultsOf the 1381 articles retrieved from the electronic databases, 8 articles met the specific inclusion criteria. All the included articles incorporated strength training exercises into the rehabilitation intervention. Reported outcomes included the 9 Hole Peg Test (9HPT), Action Research Arm Test (ARAT), and Fugl-Meyer Assessment, with 3, 3, and 0 reporting significant improvements, respectively. Only grip strength was included as a physiological fitness outcome, with 2 articles reporting significant improvements.ConclusionThe results of this review suggest that strength training may elicit improvements in functional and physiological upper extremity outcomes for PwMS. Several limitations of the current review must be noted, including a limited number of studies and the combination of strength training with other rehabilitative modalities.LAY ABSTRACTPersons with multiple sclerosis experience reduced strength and function in their arms. The purpose of this review was to examine the evidence available on the effects of using exercise to improve strength and function in the arms of persons with multiple sclerosis. Our research team searched through 1381 studies and found 8 that were relevant to what we were looking for. The 8 studies suggest that exercise, specifically strength training (e.g., weight lifting or resistance exercise), can improve strength and function of the arms in persons with multiple sclerosis. However, the strength training was part of a larger rehabilitation program, and we cannot definitively conclude that all of the improvements were solely because of strength training. Regardless, strength training appears to be an important part of rehabilitation programs aiming to improve strength and function in the arms of persons with multiple sclerosis.

How Much Data Is Enough? A Reliable Methodology to Examine Long-Term Wearable Data Acquisition in Gait and Postural Sway.

Wearable sensors facilitate the evaluation of gait and balance impairment in the free-living environment, often with observation periods spanning weeks, months, and even years. Data supporting the minimal duration of sensor wear, which is necessary to capture representative variability in impairment measures, are needed to balance patient burden, data quality, and study cost. Prior investigations have examined the duration required for resolving a variety of movement variables (e.g., gait speed, sit-to-stand tests), but these studies use differing methodologies and have only examined a small subset of potential measures of gait and balance impairment. Notably, postural sway measures have not yet been considered in these analyses. Here, we propose a three-level framework for examining this problem. Difference testing and intra-class correlations (ICC) are used to examine the agreement in features computed from potential wear durations (levels one and two). The association between features and established patient reported outcomes at each wear duration is also considered (level three) for determining the necessary wear duration. Utilizing wearable accelerometer data continuously collected from 22 persons with multiple sclerosis (PwMS) for 6 weeks, this framework suggests that 2 to 3 days of monitoring may be sufficient to capture most of the variability in gait and sway; however, longer periods (e.g., 3 to 6 days) may be needed to establish strong correlations to patient-reported clinical measures. Regression analysis indicates that the required wear duration depends on both the observation frequency and variability of the measure being considered. This approach provides a framework for evaluating wear duration as one aspect of the comprehensive assessment, which is necessary to ensure that wearable sensor-based methods for capturing gait and balance impairment in the free-living environment are fit for purpose.

The relationship between energy cost of walking, ankle push-off and walking speed in persons with multiple sclerosis

BackgroundThe energy cost of walking (ECw) is an important indicator of walking dysfunction in persons with multiple sclerosis (PwMS). However, its underlying causes and its relation with ankle push-off and walking speed are not well understood. Research questionWhat is the contribution of ankle push-off and walking speed to increased ECw in PwMS? MethodsTen PwMS with walking limitations and 10 individually gender- and age-matched healthy controls (HC) were included. All participants performed two 6-min walking trials on a treadmill at comfortable walking speed (CWS of PwMS) and fast walking speed (FWS, 130 % of CWS of PwMS). Kinetics and metabolic cost were evaluated. Generalized estimating equations were performed to investigate effects of group and walking speed, and their interaction. Spearman correlations were conducted to examine whether ECw was related to ankle push-off in PwMS, controlling for differences in walking speed in PwMS. ResultsECw at matched walking speed was significantly higher in PwMS compared to HC. Kinetic parameters were not different between the most impaired leg in PwMS and HC at matched walking speed, but asymmetry between both legs of PwMS was observed. At FWS, ECw reduced and ankle push-off increased similarly in both groups. ECw was inversely related to peak ankle power of the most impaired leg in PwMS at CWS. SignificanceSlow walking speed is one factor that contributes to increased ECw in PwMS. Furthermore, PwMS who had a higher ECw showed a lower peak ankle power, independent of walking speed. This indicates that ankle push-off could be a contributor to increased ECw.

A-12 Physical Activity Attenuates the Effect of Pain on Depression Symptoms in Multiple Sclerosis

Abstract Objective: This study examined physical activity as a potential moderator of the relationship between pain and depression symptoms in persons with multiple sclerosis (PwMS). We hypothesized that pain would predict depression symptoms only in PwMS with low physical activity. Method: Fifty-four PwMS (38 female) completed a comprehensive neuropsychological test battery and questionnaires. Pain was operationalized as a composite of measures from the Brief Pain Inventory (BPI). The metabolic equivalents (METs) of energy expended during vigorous activity (VA), moderate activity (MA), and walking, as well as global activity which combined the three, were derived from the International Physical Activity Questionnaire-Short Form (IPAQ-SF) based on parameters previously used by Dlugonski et al. (2011). Lower METs suggest less physical activity. The Beck Depression Inventory-Fast Screen (BDI-FS) was used to measure depression symptoms. Linear regressions on depression examining pain, each physical activity index, and their interactions were explored. Results: Regression analyses showed that the interaction between pain and global MET significantly predicted depression (p = 0.01). Simple effects tests revealed that pain predicted depression symptoms only in PwMS with low MET scores (p &amp;lt; 0.001). The separate interactions between pain and VA, MA, and walking predicting depression symptoms were not significant. Conclusion: We found that global physical activity moderated the relationship between pain and depression in MS. Specifically, pain predicted depression symptoms in PwMS who engaged in less physical activity. These results highlight the importance of screening PwMS for pain and suggest that interventions aimed at increasing overall physical activity may be useful in improving depression outcomes in PwMS with pain.

A-11 Cognitive Fatigue Predicts Subjective Report of Cognitive Functioning Over and Above Depression and Anxiety in Persons with Multiple Sclerosis

Abstract Objective: Self-and informant-reports may be used to evaluate perceived neurocognitive functioning, such as with the Multiple Sclerosis Neuropsychological Screening Questionnaire (MSNQ). However, these measures may be influenced by depression, anxiety, and fatigue. This study aims to further examine the potential influence of affect and fatigue on MSNQ scores. Method: 86 persons with Multiple Sclerosis (PwMS) (F = 65,M = 21) completed a comprehensive neuropsychological battery that included self-report measures of anxiety, depression, fatigue, and self-reported neurocognitive function with the MSNQ-Self-Report (MSNQ-S) and MSNQ-Informant-Report (MSNQ-I). Hierarchical regressions were conducted with MSNQ-S and MSNQ-I as outcome variables and with depression, anxiety, cognitive fatigue, and physical fatigue as predictors. Predicted full-scale IQ (FSIQ) was included as a covariate. Results: The model including only FSIQ and depression showed that depression was positively correlated with the MSNQ-S, F(2,82) = 15.12, p &amp;lt; 0.001, ∆R2 = 0.15. When including anxiety in the model, depression was still positively associated with the MSNQ-S, F(3,81) = 4.57, p = 0.04, as was anxiety, F(3,81) = 8.07, p = 0.006, ∆R2 = 0.07. However, when including cognitive fatigue, the relationships between the MSNQ-S and depression and anxiety were no longer significant, though cognitive fatigue was positively correlated with MSNQ-S scores, F(5,79) = 71.32, p &amp;lt; 0.001, ∆R2 = 0.35. The MSNQ-I was not correlated with the affective measures or physical fatigue, though there was a positive relationship between the MSNQ-I and cognitive fatigue, F(5,79) = 14.58, p &amp;lt; 0.001, ∆R2 = 0.14. Conclusions: Findings suggest that cognitive fatigue impacts subjective report of neurocognitive impairment for both patients and informants. Notably, when accounting for cognitive fatigue, affective disturbance was no longer significantly associated with reported neurocognitive functioning, which highlights the importance of examining fatigue and mood in PwMS.

High-intensity resistance training in people with multiple sclerosis experiencing fatigue: A randomised controlled trial

BackgroundExercise studies including only fatigued persons with multiple sclerosis (PwMS) with fatigue as primary endpoint are lacking. ObjectiveTo evaluate the effects of high-intensity resistance training (HIRT) on self-reported fatigue in fatigued PwMS in a single center randomised controlled trial. MethodsWe recruited 71 PwMS scoring ≥ 53 on the Fatigue Scale for Motor and Cognitive Functions (FSMC), who were randomised 1:1 to either twice (group A) or once (group B) weekly supervised HIRT for twelve weeks. A non-randomised FSMC score-matched group (n=69) served as non-intervention control. ResultsBetween HIRT-group differences were non-significant for primary and most secondary endpoints. Mean difference in FSMC score (95% confidence intervals) was -10.9 (-14.8; -6.9) in group A and -9.8 (-13.2; -6.3) in group B. Corresponding values for combined HIRT groups vs non-intervention control were -10.3 (-12.9; -7.7) and 1.5 (-0.6;3.6), respectively, p<0.001. Secondary endpoints also improved in both HIRT groups, though only Hospital Anxiety and Depression Scale anxiety and MS Impact Scale-29 psychological subscales significantly favoured the twice a week HIRT (group A). As an exploratory endpoint, changes in plasma inflammatory protein markers were associated with reduced FSMC scores in the pooled material. ConclusionThe finding that HIRT in fatigued PwMS leads to clinically relevant reductions in self-reported fatigue, associated with changes in plasma inflammatory protein levels, provide evidence for recommending HIRT for fatigued PwMS.

Combined progressive functional exercise effect on contactin-1 and contactin-2 level in mildly disabled persons with multiple sclerosis

BackgroundAlthough contactin-1 and contactin-2 are known as two proteins involved in axonal regeneration, it is unclear whether these proteins are induced by exercise in persons with multiple sclerosis (PwMS). ObjectiveThe aim of this study was to determine the serum levels of contactin-1 and contactin-2 in PwMS and to investigate the change of these markers with exercise. MethodsA total of 60 participants with relapsing-remitting MS were divided into groups by stratified randomization. The progressive functional exercise was applied to the intervention group. Participants in the control group continued the treatments and lives of the routines. Participants' contactin-1 and contactin-2, cognitive performance and aerobic capacities were evaluated. ResultsThe comparison of the pre-and post-study values of contactin-1 and contactin-2 showed significant differences only in the intervention group. The contactin-1 and contactin-2 values were similar between the groups before the exercise, whereas a significant difference was found in favor of the intervention group after the exercise. Paced Auditory Serial Addition Test-3 value increased significantly only in the intervention group. ConclusionWith this study, it was shown for the first time that contactin-1 and contactin-2, which play an important role in axonal regeneration and axonal organization, can be increased by exercise.

Effects of multiple sclerosis on the audio-vestibular system: a systematic review

ObjectiveSystematically investigate the effects of multiple sclerosis (MS) on the audio-vestibular system.MethodsSystematic review of literature investigating audio-vestibular conditions in persons with MS (PwMS) aged ≥18 years. PubMed, Scopus, NICE and...

The effect of applying the nursing process based on the Theory of Goal Attainment on activities of daily living and quality of life in persons with multiple sclerosis during COVID-19 pandemic: a clinical trial.

BackgroundThe chronic nature of multiple sclerosis (MS) affects patient’s activities of daily living (ADL) and quality of life (QOL). Nursing interventions based on patients’ active participation in goal-setting can be beneficial in improving ADL and QOL.AimsThis study aimed to determine the effect of applying the nursing process based on King’s Theory of Goal Attainment (TGA) on ADL and QOL of persons with multiple sclerosis (PwMS) during the COVID-19 pandemic.MethodsIn this clinical trial, 70 patients referred to the MS Society of Hamadan, Iran, were recruited using the convenience sampling method and randomly assigned into 2 groups. A 4-stage TGA was developed and implemented for the intervention group for a month. Data were gathered by ADL, instrumental ADL (IADL), and QOL questionnaires, and Goal of Attainment Scale (GAS) before and 2 months after the intervention.ResultsIntervention group achieved a higher number of prioritized goals (p < 0.001) and reported higher QOL (P < 0.001) and instrumental ADL (IADL; P = 0.002) than the control group.ConclusionsGiven the results, TGA could effectively promote mutual goal attainment, QOL, and IADL for PwMS during the COVID-19 pandemic.Trial registrationClinicalTriasl.gov Identifier: IRCT20201210049668N1.

Angle-Angle Diagrams in the Assessment of Locomotion in Persons with Multiple Sclerosis: A Preliminary Study

Gait analysis is clinically relevant in persons with multiple sclerosis (PwMS) and consists of several joint angular displacement–time relationships and spatiotemporal parameters. However, it lacks representation by means of diagrams in which knee-angle/hip-angle and knee-angle/ankle-angle variations are plotted against each other at the same points of time. Three-dimensional kinematic analysis was performed on 20 subjects (10 PwMS/10 healthy controls, HCs), and the knee-angle/hip-angle and knee-angle/ankle-angle diagrams of both lower limbs were determined in the sagittal plane while walking on a motorized treadmill. The area (a quantifier of range of motion) and the perimeter (a quantifier of coordination) of angle-angle diagram loops were calculated. PwMS showed reduced knee-angle/ankle-angle loops compared to HCs (p &lt; 0.05), whereas the hip-angle/ankle-angle loops between the PwMS and HCs was not significant (p &gt; 0.05). Similarly, the activation of leg muscles showed significant differences between PwMS and HCs (p ranged from 0.05 to 0.001). The results indicate that the proposed knee-angle/hip-angle diagram is feasible and could be applied as a reliable tool in future studies aimed at assessing the acute and long-term effects of specific exercise programmes and/or pharmacological treatment in PwMS.

Avoidant Coping Is Associated with Quality of Life in Persons with Multiple Sclerosis with High Cognitive Reserve

The goal of this study was to determine the impact of the relationship between cognitive reserve and coping strategy on quality of life (QoL) outcomes in persons with MS (PwMS) across multiple domains. We examined the effect of the interactions between coping style and cognitive reserve on QoL and disease burden in 97 persons with MS (PwMS). Coping strategy, either active or avoidant, was measured using the COPE inventory. We defined cognitive reserve as a composite measure of years of education and scores on the Shipley-2 Vocabulary subtest. QoL and disease burden were assessed using the Functional Assessment of MS (FAMS) scale and the Expanded Disability Status Scale, respectively. We examined both the FAMS individual subscales and the overall QoL score. For those with higher cognitive reserve, greater avoidant coping was associated with lower QoL for the thinking and fatigue subscale (p < 0.001) and poorer overall QoL (p = 0.03); greater active coping was associated with poorer QoL for mobility (p = 0.001). However, these associations did not hold for those with lower cognitive reserve. Furthermore, there were no associations between coping strategy and cognitive reserve with disease burden. This study extends previous findings by demonstrating that avoidant coping, rather than active coping, is associated with poorer thinking and fatigue and overall QoL only for PwMS with greater cognitive reserve. Counseling PwMS on the impact of coping strategies on QoL outcomes, especially for those with greater cognitive reserve, may improve quality of life outcomes in this population.