Symbol Digit Modalities Test Scores Research Articles

Natalizumab is associated with early improvement of working ability in relapsing-remitting multiple sclerosis patients: WANT observational study results.

The Work Ability in Natalizumab-Treated MS Patients (WANT) study assessed work ability, quality of life, and cognitive processing speed during natalizumab treatment. WANT was a 1-year, prospective, multicenter observational study conducted in Italy. Inclusion criteria included relapsing-remitting multiple sclerosis (MS), natalizumab treatment, full-time worker status, and loss of working hours due to MS as measured by the Work Productivity and Activity Impairment Questionnaire for MS (WPAI:MS). The primary endpoint was change in WPAI:MS domain scores after 1 year on natalizumab. Secondary endpoints included change in annualized relapse rate (ARR), Multiple Sclerosis Impact Scale (MSIS-29) score, and Symbol Digit Modalities Test (SDMT) score. At enrollment, the 91 patients had a mean age of 38.3 (standard deviation [SD], 9.0) years and a mean ARR of 1.5 (SD, 0.8). After 1 year, improvements were observed in all WPAI:MS domains, with significant reductions in Absenteeism (-4.2 [SD, 26.0], p = 0.0190) and Work Productivity Loss (-7.2 [SD, 28.6]; p = 0.0456). These changes were accompanied by a low ARR (0.1), and 87.9% of patients were relapse free. Significant improvement was observed in MSIS-29 physical and psychological domains (reductions of 2.8 [SD, 11.6; p = 0.0295] and 6.3 [SD, 15.6; p = 0.0007], respectively) and SDMT score (increase of 2.4 [SD, 7.9; p = 0.0006]). Adverse events were reported in 32 of 104 patients (30.8%). The reductions in Absenteeism and Work Productivity Loss and the improved physical and psychological functioning reported after 1 year of natalizumab treatment in real-world settings extend our understanding of natalizumab's effects on patient-centric and health economics outcomes.

Prestroke Physical Activity and Poststroke Cognitive Performance

Introduction: Physical activity (PA) is associated with a lower risk of stroke and stroke mortality as well as a favorable stroke outcome. PA may also prevent general cognitive decline. Poststroke cognitive impairment is both common and disabling, and focusing on all possible preventive measures is important. Studies on the effect of PA on poststroke cognitive performance are sparse, however. We therefore aimed to examine the association between prestroke PA and poststroke cognitive performance. Methods: We studied the correlation between prestroke PA and poststroke cognitive performance in a prespecified analysis in The Efficacy of Citalopram Treatment in Acute Ischemic Stroke (TALOS) trial. We used the Physical Activity Scale for the Elderly (PASE) to collect information on PA during the 7-day period before stroke. PA was quantified, and patients were stratified into quartiles based on their PASE score. Cognitive performance was measured using the Symbol Digit Modalities Test (SDMT) at 1 and 6 months and the Mini-Mental State Examination (MMSE) at 6 months. The functional outcome was assessed using the modified Rankin Scale (mRS). Results: In total, 625 of 642 patients (97%) completed the PASE questionnaire. The median age was 69 (interquartile range [IQR]: 60–77), and the median PASE score was 137 (82–205). Higher prestroke PASE quartiles (2nd, 3rd, and 4th, each compared to the 1st) were independently associated with a higher SDMT score at 1 month in the both the univariable and multivariable analyses (2nd: 3.99 points, 95% confidence interval [CI]: 1.01–6.97; 3rd: 3.6, CI: 0.6–6.61; 4th: 4.1, CI: 0.95–7.24). This association remained at 6 months. PA was not statistically associated with the MMSE score or mRS. Conclusion: Higher prestroke PA was associated with a better cognitive performance as measured by the SDMT at 1 and 6 months poststroke. We found no significant association between prestroke PA and functional outcome. Our results are encouraging and support further investigations of PA as a protective measure against poststroke cognitive impairment.

More continuous flow, better learning? The effect of aortic valve opening in patients with left ventricular assist device.

The aim of this study was to analyze neurocognitive function in patients who underwent continuous flow left ventricular assist device (LVAD) implantation. This cross-sectional study included three groups: LVAD (n = 31), heart failure patients (n = 26), and healthy volunteers (n = 27). The Rey Auditory-Verbal Learning Test (RAVLT), Judgement of Line Orientation Test (JLOT), Trail Making Test (TMT), Stroop Color-Word Interference Test (SCWIT), Verbal Fluency Test (VFT), Symbol-Digit Modality Test (SDMT) were used to assess the neurocognitive functions. Data were analyzed at a median 12 (3-47) months after LVAD implantation. The LVAD patients were also divided by aortic valve opening (AVO) into three subgroups as "closed" (n = 9), "1-6" (n = 8) and "7-10" (n = 14) opening per ten beats and data were re-analyzed accordingly. There was no significant difference among the groups according to SCWIT, JLOT, SDMT, TMT, and VFT scores. Post-hoc analyzes of RAVLT scores showed significant differences between the LVAD and the other two groups in favor of the LVAD group. Also, the patients with AVO "7-10" the response times were longer and learning scores were found to be lower than those without AVO. With continuous-flow LVAD, neurocognitive functions were not impaired. The learning performance was better in cases where there was no AVO and flow was completely device dependent. We may speculate that neurocognitive functions are not worsening with continuous cerebral blood flow and even it may improve learning performance.

Symbol Digit Modalities Test Variant in a Smartphone App for Persons With Multiple Sclerosis: Validation Study

BackgroundThe decline of cognitive processing speed (CPS) is a common dysfunction in persons with multiple sclerosis (MS). The Symbol Digit Modalities Test (SDMT) is widely used to formally quantify CPS. We implemented a variant of the SDMT in MS sherpa, a smartphone app for persons with MS.ObjectiveThe aim of this study was to investigate the construct validity and test-retest reliability of the MS sherpa smartphone variant of the SDMT (sSDMT).MethodsWe performed a validation study with 25 persons with relapsing-remitting MS and 79 healthy control (HC) subjects. In the HC group, 21 subjects were matched to the persons with MS with regard to age, gender, and education and they followed the same assessment schedule as the persons with MS (the “HC matched” group) and 58 subjects had a less intense assessment schedule to determine reference values (the “HC normative” group). Intraclass correlation coefficients (ICCs) were determined between the paper-and-pencil SDMT and its smartphone variant (sSDMT) on 2 occasions, 4 weeks apart. Other ICCs were determined for test-retest reliability, which were derived from 10 smartphone tests per study participant, with 3 days in between each test. Seven study participants with MS were interviewed regarding their experiences with the sSDMT.ResultsThe SDMT scores were on average 12.06% higher than the sSDMT scores, with a standard deviation of 10.68%. An ICC of 0.838 was found for the construct validity of the sSDMT in the combined analysis of persons with MS and HC subjects. Average ICCs for test-retest reliability of the sSDMT for persons with MS, the HC matched group, and the HC normative group were 0.874, 0.857, and 0.867, respectively. The practice effect was significant between the first and the second test of the persons with MS and the HC matched group and trivial for all other test-retests. The interviewed study participants expressed a positive attitude toward the sSDMT, but they also discussed the importance of adapting a smartphone cognition test in accordance with the needs of the individual persons with MS.ConclusionsThe high correlation between sSDMT and the conventional SDMT scores indicates a very good construct validity. Similarly, high correlations underpin a very good test-retest reliability of the sSDMT. We conclude that the sSDMT has the potential to be used as a tool to monitor CPS in persons with MS, both in clinical studies and in clinical practice.

White matter correlates of slowed information processing speed in unimpaired multiple sclerosis patients with young age onset

Slowed information processing speed is among the earliest markers of cognitive impairment in multiple sclerosis (MS) and has been associated with white matter (WM) structural integrity. Localization of WM tracts associated with slowing, but not significant impairment, on specific cognitive tasks in pediatric and young age onset MS can facilitate early and effective therapeutic intervention. Diffusion tensor imaging data were collected on 25 MS patients and 24 controls who also underwent the Symbol Digit Modalities Test (SDMT) and the computer-based Cogstate simple and choice reaction time tests. Fractional anisotropy (FA), mean (MD), radial (RD) and axial (AD) diffusivities were correlated voxel-wise with processing speed measures. All DTI metrics of several white matter tracts were significantly different between groups (p < 0.05). Notably, higher MD, RD, and AD, but not FA, in the corpus callosum correlated with lower scores on both SDMT and simple reaction time. Additionally, all diffusivity metrics in the left corticospinal tract correlated negatively with SDMT scores, whereas only MD in the right superior fronto-occipital fasciculus correlated with simple reaction time. In conclusion, subtle slowing of processing speed is correlated with WM damage in the visual-motor processing pathways in patients with young age of MS onset.

Visual and motor confounds on the symbol digit modalities test

BackgroundSlowed information processing speed is the most prevalent cognitive symptom in persons with multiple sclerosis (MS). The most commonly used instrument to measure information processing speed in MS is the Symbol Digit Modalities Test (SDMT). However, visual, oculomotor, and oralmotor deficits are frequently observed in persons with MS, and performance on the SDMT relies on these visual and motor functions, in addition to cognition. MethodsThe current study examined the relationship between the SDMT and the King-Devick Test (KDT). The KDT encompasses similar oculomotor and oralmotor demands as the SDMT but requires a smaller attentional load. One hundred and thirty participants with MS completed the oral version of the SDMT and the KDT. Ordinary nonparametric bootstrapped regression models were performed with 1000 bootstrapped samples. Bootstrapped confidence intervals (CIs) were bias-corrected. ResultsKDT performance explained 31% (bootstrapped CI: 18 – 43%) of the variance of SDMT performance (moderate correlation), much more than demographic and disease-related variables (0.7% and 10%, respectively). ConclusionsVisual, oralmotor, and oculomotor functions contributed significantly to SDMT performance. Therefore, these sensory and motor functions must be taken into account when interpreting SDMT scores.

Pediatric Multiple Sclerosis Severity Score in a large US cohort.

To characterize disease severity and distribution of disability in pediatric-onset multiple sclerosis (POMS) and to develop an optimized modeling scale for measuring disability, we performed a multicenter retrospective analysis of disability scores in 873 persons with POMS over time and compared this to previously published data in adults with multiple sclerosis (MS). This was a retrospective analysis of prospectively collected data collected from 12 centers of the US Network of Pediatric MS Centers. Patients were stratified by the number of years from first symptoms of MS to Expanded Disability Status Scale (EDSS) assessment and an MS severity score (Pediatric Multiple Sclerosis Severity Score [Ped-MSSS]) was calculated per criteria developed by Roxburgh et al. in 2005. In total, 873 patients were evaluated. In our cohort, 52%, 19.4%, and 1.5% of all patients at any time point reached an EDSS of 2.0, 3.0, and 6.0. Comparison of our Ped-MSSS scores and previously published adult Multiple Sclerosis Severity Scores (MSSS) showed slower progression of Ped-MSSS with increasing gaps between higher EDSS score and years after diagnosis. Decile scores in our POMS cohort for EDSS of 2.0, 3.0, and 6.0 were 8.00/9.46/9.94, 7.86/9.39/9.91, and 7.32/9.01/9.86 at 2, 5, and 10 years, respectively. Notable predictors of disease progression in both EDSS and Ped-MSSS models were ever having a motor relapse and EDSS at year 1. Symbol Digit Modalities Test (SDMT) scores were inversely correlated with duration of disease activity and cerebral functional score. Persons with POMS exhibit lower EDSS scores compared to persons with adult-onset MS. Use of a Ped-MSSS model may provide an alternative to EDSS scoring in clinical assessment of disease severity and disability accrual.

Measurements of the corpus callosum index and fractional anisotropy of the corpus callosum and their cutoff values are useful to assess global brain volume loss in multiple sclerosis

ObjectivesRecent studies suggest that parameters of the corpus callosum (CC), such as the CC index (CCI) and fractional anisotropy (FA) of the CC, may be related to the degree of brain volume loss (BVL) in MS patients; however, cutoff values that determine the degree of BVL have not been set. MethodsSeventy-five MS patients and 21 healthy controls (HCs) underwent volumetric MRI examinations. MS patients were also evaluated for T2 lesion load, the CCI, and FA of the CC. Among the 75 MS patients, 20 had undergone cognitive assessments with the Symbol Digit Modalities Test (SDMT). After 75 MS patients were categorized into mild, moderate, or severe BVL subgroups according to our previous report, we performed receiver operating characteristic analysis to determine the cutoff values of CCI and FA, categorizing the MS patients into the three subgroups. ResultsThe volume of the CC was significantly reduced in MS patients compared to that in HCs. The CCI and FA were significantly associated with EDSS, disease duration, clinical phenotype, T2-lesion load, and whole brain volume. The FA was significantly correlated with the SDMT score. We identified optimal cutoff values for the CCI and FA of 0.32 (85% sensitivity, 92% specificity) and 0.39 (100% sensitivity, 92% specificity), respectively, which discriminated the severe BVL group from others, and 0.385 (84% sensitivity, 74% specificity) and 0.45 (81% sensitivity, 89% specificity), respectively, which discriminated the mild BVL group from others. ConclusionThe CCI and FA cutoff values may be useful for evaluating the degree of MS brain atrophy in clinical practice.

Switching to fingolimod in PREFERMS: Effect of treatment history and naïvety on clinical, MRI and treatment satisfaction outcomes✰

BackgroundInjectable disease-modifying therapies (iDMTs) are often used as first-line treatments for relapsing multiple sclerosis. Fingolimod is frequently used following treatment with iDMTs. Whether prior iDMT treatment impacts the effectiveness of subsequent fingolimod therapy is unclear. Here, we assessed switching from iDMTs to fingolimod, and the impact of treatment history on fingolimod escalation using data from the 12-month ‘Prospective, Randomized, active-controlled, open-label study to Evaluate patient retention on Fingolimod versus approved first-line disease-modifying thErapies in adults with Relapsing–remitting Multiple Sclerosis’ (PREFERMS). The study design and results at the end of randomized treatment (EoRT) in PREFERMS have been published. MethodsBoth treatment-naïve patients and those who had previously received an iDMT were eligible for enrolment in PREFERMS, and one treatment switch was permitted on study. Pre-specified exploratory analyses compared outcomes in those randomized to fingolimod or to an iDMT at end of study (EoS), which included time spent on randomized and on switch treatment. Post hoc exploratory analyses (unadjusted for multiplicity owing to the large number of comparisons) among patients randomized to an iDMT who switched to fingolimod, compared outcomes longitudinally before (EoRT) and after (EoS) switching, and compared outcomes at EoRT and EoS among subgroups stratified by iDMT-treatment history. Outcomes included brain volume, various measures of gadolinium-enhancing [Gd+] lesion counts, annualized relapse rate (ARR), Symbol Digit Modalities Test (SDMT) score, patient-reported treatment satisfaction using the Medication Satisfaction Questionnaire (MSQ) and adverse event (AE) rates. ResultsAt EoS, 255 of 439 patients randomized to an iDMT had switched to fingolimod and 27 of 436 patients randomized to fingolimod had switched to an iDMT. By EoS, 44.2% of total treatment exposure in the iDMT group was to fingolimod and the mean time spent on fingolimod in this group was 220 days (approximately 7 months). Outcomes in the fingolimod group at EoS (brain volume, changes in Gd+ lesion counts, ARR, oral SDMT score and MSQ score) were similar to those seen at EoRT, but in the iDMT group these outcomes were more favorable at EoS than at EoRT and were similar to rates seen in the fingolimod group. Among patients who switched from iDMT to fingolimod, there were longitudinal improvements in ARR (EoRT, 0.3 [95% confidence interval (CI), 0.2–0.4]; EoS, 0.2 [0.1–0.3]; odds ratio, 0.5 [0.3–0.9]) and in treatment satisfaction (proportion of patients with MSQ > 5; EoRT, 67.4%; EoS, 90.4%; odds ratio, 5.7 [95% CI, 3.4–9.4]) after fingolimod treatment, and changes in brain volume, Gd+ lesion count, and AEs or AEs causing discontinuation were also more favorable at EoS than at EoRT. In all patient groups stratified by iDMT-treatment history, differences in outcomes narrowed or disappeared after fingolimod treatment. ConclusionThese analyses indicate that patients in PREFERMS had improved outcomes within months of switching to fingolimod from an iDMT and that improvements occurred irrespective of the number of iDMTs previously administered. These data provide a unique opportunity to explore clinical, radiological and safety outcomes associated with a range of clinically relevant treatment pathways.

Vestibular, Spatial Cognition And Mental Fatigue Status Of Female Soccer Players Before A Competitive Season

PURPOSE: To examine visual-vestibular interaction and the relationship to visuospatial cognition, mental fatigue, and concussion history in female soccer players before the start of a competitive season. METHODS: Twenty-four NCAA Division 1 women’s soccer athletes participated in the study. All players completed medical history including dates and number of prior concussions. Vestibular and visual interaction was assessed using the Dynamic Visual Acuity Test (DVAT) which examines the loss in visual acuity when the head is moving in the yaw plane at 85 deg/sec or more compared to head stationary. Visuospatial cognition was assessed using the Symbol Digit Modalities Test (SDMT) and the Ray-Osterrieth Complex Figure (ROCF) while current fatigue level was assessed using the Mental Fatigue Scale (MFS). Spearman's correlations examined the correlations between DVAT loss and MFS, SDMT, and ROCF. Comparison of MFS, SDMT score, and ROCF score between groups based based on number of concussions was completed using t-tests. RESULTS: Of the 24 participants (mean age 19.3 ± 1.3), 15 had a prior history of concussion (range 1-7). Mean loss of visual acuity in the pitch plane in logMAR upwards was 0.14 ± 0.08 and downwards was 0.19 ± 0.1, and in the yaw plane was 0.15 ± 0.08 to the right and 0.14 ± 0.1 to the left (normative values for this age group are 0.08 ± 0.17 logMAR). The SDMT score was 59.88 ± 6.7, ROCF score was 29.9 ± 5.4, and MFS score was 6.9 ± 5.8. Spearman’s correlations showed significant relationships between DVAT loss to the right (p=0.04) and mental fatigue (p=0.04). Comparisons of athletes who had sustained 2 or more concussions compared to those with 0-1 showed significant differences in the MFS (p=0.03). CONCLUSIONS: Greater loss of dynamic visual acuity was seen in female soccer players before the start of a competitive season. Gaze stability deficits are correlated with higher mental fatigue and athletes who had 2 or more concussions had more mental fatigue.

Associations Of Concussion And Playing History With Clinical Outcomes In Young College Football Alumni

The effects of concussion history (CH) and years of playing football on cognitive function and mood-related symptoms in former football players is unclear. Most former player studies include mid-to-late life individuals, and little is known about younger cohorts. PURPOSE: Assess the influence of CH and years played on cognitive function, mood-related symptoms, and life satisfaction in former football players. METHODS: Former collegiate football players (n = 58; age 37.9 + 1.5 years; BMI 31.3 + 5.0 kg/m2) from 16 schools completed a health survey and subsequent in-person evaluation 15 yrs post-college football. Outcomes included cognitive tests: Symbol Digit Modalities Test (SDMT), Controlled Oral Word Association Test (COWAT), revised Hopkins Verbal Learning Test (HVLTr), and Trails A (TMTA) and B (TMTB); and self-reported outcomes: NeuroQOL Cognition Short Form (NQC), Beck Depression (BDI-II) and Anxiety (BAI-II) inventories, and Satisfaction with Life Scale (SWLS). Current symptom severity (SS) was reported on the Graded Symptom Checklist alongside typical hours slept per night. CH was split into tertiles: 0-1, 3-6, or 7+ prior concussions. Multivariable linear regression models were used to assess the influence of CH and years played on each outcome with BMI, sleep, and SS as covariates. RESULTS: Model predictors and adjusted R2 values are in Table 1. Higher SS was associated with worse outcomes on most measures. Worse SDMT scores were partially explained by greater CH and years played. In addition to SS, greater CH related to better COWAT performance; those with more sleep had longer TMTA times; and those with lower BMI and more sleep had higher SWLS. CONCLUSIONS: Our data show no clear influence of CH or years played on cognitive function, mood-related symptoms, or life satisfaction. In our relatively young sample, SS at the time of testing was associated with worse outcomes. Continued longitudinal analyses may explain age related changes on these outcomes.

Supplementation with Matured Hop Bitter Acids Improves Cognitive Performance and Mood State in Healthy Older Adults with Subjective Cognitive Decline.

Background:Prevention of age-related cognitive decline and depression is becoming urgent because of rapid growing aging populations. Effects of vagal nerve activation on brain function by food ingredients are inadequately investigated; matured hop bitter acid (MHBA) administration reportedly improves cognitive function and depression via vagal nerve activation in model mice.Objective:We investigated the effects of MHBA supplementation on cognitive function and mood state in healthy older adults with perceived subjective cognitive decline.Methods:Using a randomized double-blind placebo-controlled trial design, 100 subjects (aged 45–69 years) were randomly assigned into placebo (n = 50) and MHBA (n = 50) groups, and received placebo or MHBA capsules daily for 12 weeks.Results:Symbol Digit Modalities Test (SDMT) score assessing divided attention at week 12 was significantly higher (p = 0.045) and β-endorphin at week 12 was significantly lower (p = 0.043) in the subjects receiving MHBA. Transthyretin in serum, a putative mild cognitive impairment marker, was significantly higher at week 12 in the MHBA group than in the placebo group (p = 0.048). Subgroup analysis classified by the subjective cognitive decline questionnaire revealed that in addition to improved SDMT scores, memory retrieval assessed using the standard verbal paired-associate learning tests and the Ray Verbal Learning Test at week 12 had significantly improved in the subgroup with perceived subjective cognitive decline and without requirement for medical assistance in the MHBA group compared with that in the placebo group.Conclusion:This study suggested that MHBA intake improves cognitive function, attention, and mood state in older adults.

A novel in-home digital treatment to improve processing speed in people with multiple sclerosis: A pilot study

Objective: To assess whether a videogame-like digital treatment is superior to a control in improving processing speed in adults with multiple sclerosis (MS). Methods: Adults with MS and baseline Symbol Digit Modalities Test (SDMT) z-scores between −2 and 0 were enrolled in a double-blind randomized controlled clinical trial. After completing a baseline in-clinic evaluation (Visit 1), they were randomized to complete an in-home, tablet-based videogame-like digital treatment (AKL-T03) or control word game (AKL-T09) for up to 25 minutes/day, 5 days/week, for 6 weeks. A repeat in-clinic evaluation occurred at 6 weeks (Visit 2), and again 8 weeks later to determine persistence of effects (Visit 3). The pre-specified primary outcome was change in SDMT score between Visits 1 and 2. Results: SDMT increased at Visit 2 for participants randomized to both AKL-T03 (p < 0.001) and AKL-T09 (p = 0.024). These respective mean improvements were +6.10 and +3.55 (comparison p = 0.21). At Visit 3, 70% of participants randomized to AKL-T03 maintained a clinically meaningful 4+-point increase in SDMT above their baseline, compared with 37% for AKL-T09 (p = 0.038). Conclusion: This in-home digital intervention resulted in substantial and durable improvements in processing speed. A larger randomized controlled clinical trial is planned. Trial Registration: This trial is registered on ClinicalTrials.gov under “NCT03569618,” https://clinicaltrials.gov/ct2/show/NCT03569618.

A self-administered, artificial intelligence (AI) platform for cognitive assessment in multiple sclerosis (MS)

BackgroundCognitive impairment is common in patients with multiple sclerosis (MS). Accurate and repeatable measures of cognition have the potential to be used as markers of disease activity.MethodsWe developed a 5-min computerized test to measure cognitive dysfunction in patients with MS. The proposed test – named the Integrated Cognitive Assessment (ICA) – is self-administered and language-independent. Ninety-one MS patients and 83 healthy controls (HC) took part in Substudy 1, in which each participant took the ICA test and the Brief International Cognitive Assessment for MS (BICAMS). We assessed ICA’s test-retest reliability, its correlation with BICAMS, its sensitivity to discriminate patients with MS from the HC group, and its accuracy in detecting cognitive dysfunction. In Substudy 2, we recruited 48 MS patients, 38 of which had received an 8-week physical and cognitive rehabilitation programme and 10 MS patients who did not. We examined the association between the level of serum neurofilament light (NfL) in these patients and their ICA scores and Symbol Digit Modalities Test (SDMT) scores pre- and post-rehabilitation.ResultsThe ICA demonstrated excellent test-retest reliability (r = 0.94), with no learning bias, and showed a high level of convergent validity with BICAMS. The ICA was sensitive in discriminating the MS patients from the HC group, and demonstrated high accuracy (AUC = 95%) in discriminating cognitively normal from cognitively impaired participants. Additionally, we found a strong association (r = − 0.79) between ICA score and the level of NfL in MS patients before and after rehabilitation.ConclusionsThe ICA has the potential to be used as a digital marker of cognitive impairment and to monitor response to therapeutic interventions. In comparison to standard cognitive tools for MS, the ICA is shorter in duration, does not show a learning bias, and is independent of language.

Early putamen hypertrophy and ongoing hippocampus atrophy predict cognitive performance in the first ten years of relapsing-remitting multiple sclerosis.

The first years of relapsing-remitting multiple sclerosis (RRMS) constitute the most vulnerable phase for the progression of cognitive impairment (CImp), due to a gradual decrease of compensatory mechanisms. In the first 10years of RRMS, the temporal volumetric changes of deep gray matter structures must be clarified, since they could constitute reliable cognitive biomarkers for diagnostic, prognostic, and therapeutic purposes. Forty-five cognitively asymptomatic patients with RRMS lasting≤ 10years, and witha brain MRI performed in a year from the neuropsychological evaluation (Te-MRI), were included. They performed the Brief International Cognitive Assessment battery for MS. Thirty-onebrain MRIs performed in the year of diagnosis (Td-MRI) and 13brain MRIs of age- and sex-matched healthy controls (HCs) were also included in the study. The relationships between clinical features, cognitive performances, and Te- and Td-MRI volumes were statistically analyzed. Cognitively preserved (CP) patients had significantly increased Td-L-putamen (P = 0.035) and Td-R-putamen volume (P = 0.027) with respect to cognitively impaired (CI) ones. CI patients had significantly reduced Te-L-hippocampus (P = 0.019) and Te-R-hippocampus volume (P = 0.042) compared, respectively, with Td-L-hippocampus and Td-R-hippocampus volume. Td-L-putamen volume (P = 0.011) and Te-L-hippocampus volume (P = 0.023) were independent predictors of the Symbol Digit Modalities Test score in all patients (r2 = 0.31, F = 6.175, P = 0.001). In the first years of RRMS, putamen hypertrophy and hippocampus atrophy could represent promising indices of cognitive performance and reserve, and become potentially useful tools for diagnostic, prognostic, and therapeutic purposes.

Patient Attitudes to Routine Cognitive Testing in Multiple Sclerosis.

Background and AimIn recent years, cognitive dysfunction (CD) in multiple sclerosis (MS) has received increased attention. Neuropsychological tests have been developed allowing to monitor changes in patients’ cognitive functions. Knowledge is lacking, however, about patients’ attitudes towards introducing routine cognitive testing. It was the aim of this qualitative study to explore this.Materials and MethodsBased on a literature study, semi-structured interview guides were designed and used in qualitative interviews with 12 Danish patients. Participants were selected to represent different perspectives on CD and included patients with relapsing-remitting MS (RRMS) and secondary-progressive MS (SPMS), women and men with varying time since diagnosis and cognitive test scores using the Symbol Digit Modalities Test (SDMT). The data were analysed using a constructivist approach in order to identify significant relations between the quality of life (QoL) impact of CD, and attitudes towards routine cognitive testing.ResultsMost participants reported several subtypes of CD, yet objective CD did not coincide with subjective CD nor did it translate directly into poorer QoL. Overall, CD appeared to have larger impact on the QoL of patients with RRMS and higher SDMT scores, compared to patients with SPMS and lower SDMT scores. The QoL impact of CD manifested itself in the encounter between individual symptoms, expectations, coping and meaningful activities. All patients supported an introduction of routine cognitive testing, but patients with RRMS and SPMS had different main reasons to do so. These were related to supporting research, optimising treatment decisions, and providing documentation of this invisible MS symptom.ConclusionAll aspects of MS patients’ QoL may be affected by CD. Introducing routine cognitive testing was widely supported by patients in all phases of MS calling for comprehensive care taking both physical and cognitive difficulties into account.

Brain Structural-Functional Connectivity Relationship Underlying the Information Processing Speed.

Human cognition and behavior emerge from neuronal interactions on a brain structural architecture. The convergence (or divergence) between functional dynamics and structural connectivity (SC) and their relationship with cognition are still a pivotal question about the brain. We focused on the information processing speed (IPS), assessed by the Symbol Digit Modalities Test (SDMT), once delayed IPS underlies attention deficits in various clinical conditions. We hypothesize that the SC constrains but does not determine functional connectivity, and such a relationship is related to the cognitive performance. Blood oxygenation level-dependent and diffusion tensor images of healthy young volunteers were acquired in a 3T magnetic resonance imaging machine. Activation maps included the left and right middle frontal gyri, left superior parietal lobule, left precuneus, left inferior frontal gyrus (IFG), right cuneus, left lingual gyrus, and left declive. A network involving such regions and signal propagation from visual, through cognitive, up to motor regions was proposed. Random effects Bayesian model selection showed that the top-down connections have the highest expected and exceedance probabilities. Moreover, all pairs of task-related regions were connected by at least one tract, except for the left declive with the left IFG. The interactions between the right cuneus with left declive were related to the interindividual variability in SDMT performance. Altogether, our findings suggest that the IPS functional network is related to the highest SDMT scores when its effective endogenous connections are suppressed to the detriment of modulation caused by the experimental conditions, with the underlying structure providing low diffusion environments.

Trajectories of Symbol Digit Modalities Test performance in individuals with multiple sclerosis

Background: Although cognitive problems have been identified in people with multiple sclerosis (PwMS), few studies have investigated the long-term change in cognitive functioning. Objective: To identify trajectories of change in cognitive functioning for PwMS. Methods: Participants enrolled in the quality-of-life subgroup from the Comprehensive Longitudinal Investigation of Multiple Sclerosis at Brigham and Women’s Hospital (CLIMB) were eligible for our analysis. In 2006, participants in this group began to complete the Symbol Digit Modalities Test (SDMT) annually. Latent trajectory models were used to identify groups of participants with similar longitudinal change in SDMT scores. Linear and quadratic trajectory models were fit, and the models were compared. Latent trajectory models were also fit adjusting for baseline age and disease duration as well as using normalized SDMT scores. The groups identified across the approaches were compared. Results: We found that classes with higher-than-average baseline values improved, classes with average baseline values remained relatively constant, and classes with lower baseline values experienced cognitive worsening. Similar results were observed in the alternative latent trajectory models accounting for other variables. Conclusion: Our models show that subjects with higher SDMT scores at baseline showed improvement, while subjects with lower SDMT scores at baseline showed worsening. Baseline age and disease duration were also associated with SDMT performance.

Cognitive function characteristics in patients with myasthenia gravis

Objective To evaluate the cognitive function characteristics in patients with myasthenia gravis(MG). Methods The cognitive function of 83 MG patients and 39 healthy controls (HC) were evaluated by MMSE, California verbal learning test( CVLT), brief visuospatial memory test revised(BVMT-R), symbol digit modalities test(SDMT), benton judgment of line orientation test(BJLOT), paced auditory serial addition Test(PASAT) and verbal fluency test(VFT). The depression state was assessed by beck depression inventory (BDI). The results were compared between MG and HC groups.The effect of clinical characteristics such as disease type, comorbidities, course of disease, disease severity, and drug treatment on cognitive impairment in MG group was further analysed. Results The scale scores of MMSE(28(26, 29), 29(28, 30)), CVLT, BVMT-R, SDMT((37.06±12.18), (47.54±14.91)) and PASAT((32.86±10.23), (37.00±8.82)) in MG were significantly lower than those in control group (P 0.05). Spearman correlation analysis showed that QMG scores were negatively correlated with SDMT scores(r=-0.234, P<0.05). MG-ADL scores were inversely correlated with total BVMT-R scores of three trials(r=-0.283, P<0.05). Conclusion Patients with MG suffered from cognitive impairment, mainly in memory, attention, processing speed and visual memory, which supported the hypothesis of CNS involvement in MG.Dysfunction in some cognitive domains may be related to the disease severity.Clinicians need take morce attention to early assessment, developing long-term follow-ups and appropriate intervention. Key words: Myasthenia gravis; Neuropsychology; Cognitive function; Depression

Influence of maltreatment, bullying, and neurocognitive impairment on recidivism in adolescents with conduct disorder: A 3-Year prospective study

We sought to clarify the influence of family developmental conditions (e.g., adverse childhood experiences: ACEs), peer relationships (e.g., bullying), and neurocognitive impairment on recidivism in adolescents with conduct disorder (CD). We interviewed 290 adolescents with CD (265 males, 25 females) who had been admitted to a juvenile justice assessment center for the first time about their offense(s), onset of delinquency, ACEs, and peer relationships. The participants also completed tests of neurocognitive activities and self-report symptom measures: the Symbol Digit Modalities Test (SDMT), the Memory Updating test for the assessment of attention, the Adolescent Dissociative Experiences Scale (A-DES) for the assessment of dissociation, and the Barratt Impulsiveness Scale 11th version (BIS-11) for the assessment of impulsivity. After the family court judgement and discharge, the participants were followed for 3 years. Readmissions to the center during the follow-up period were considered cases of “recidivism.” During the follow-up, 102 (35.2%) participants were readmitted to the center. A survival analysis (Cox proportional hazard model) showed that lower age, bullying (as the perpetrator), and impaired cognitive function (e.g., a lower SDMT score) significantly increased recidivism, whereas bullying (as both victim and perpetrator) decreased recidivism. ACEs showed no clear effect on recidivism. Lower age and impaired cognitive function appear to predispose adolescent first-time offenders with CD to recidivism. However, the peer bullying analysis showed that being a perpetrator positively influenced recidivism, whereas being both a victim and a perpetrator negatively influenced recidivism. Further research considering the heterogeneity and comorbidity of CD could clarify bullying’s influence on recidivism.