Cognitive assessment with BICAMS and computerized CANTAB tests during and after multiple sclerosis relapse

The analysis of cognition during multiple sclerosis relapse and recovery period both in Lithuania and in the world the first time is presented in this doctoral dissertation. The assessment of prognostic factors that predict the recovery of cognition after relapse is investigated as well. Brief International Cognitive Assessment for Multiple Sclerosis was prepared and adapted for quick and meaningful assessment of cognitive status in Lithuania. 90 patients with multiple sclerosis and 30 healthy controls were included in the study. Physical disability, relapse, its treatment mode and biological activity of interferon-beta with MxA expression method were assessed in multiple sclerosis patients. Also cognitive functions with Brief Cognitive Assessment and computerized tests both in multiple sclerosis patients and healthy controls were asssessed. Various cognitive and non-cognitive factors that had the impact on the recovery of cognitive functions after multiple sclerosis relapse were recognized. The independent predictors of relatively good cognition recovery and significant early cognitive improvement were identified. Practical recommendations for quick and effective assessment of cognition during multiple sclerosis relapse and relapse treatment in case of better recovery after relapse were proposed. The results of this study could be helpful for all clinicians and scientists, who are interested in evaluation and monitoring of cognitive functions in multiple sclerosis both during relapse and remission

Kognityvinių funkcijų vertinimas išsėtinės sklerozės paūmėjimo ir atsistatymo laikotarpiais remiantis BICAMS ir kompiuterizuotų CANTAB testų rezultatais.

The analysis of cognition during multiple sclerosis relapse and recovery period both in Lithuania and in the world the first time is presented in this doctoral dissertation. The assessment of prognostic factors that predict the recovery of cognition after relapse is investigated as well. Brief International Cognitive Assessment for Multiple Sclerosis was prepared and adapted for quick and meaningful assessment of cognitive status in Lithuania. 90 patients with multiple sclerosis and 30 healthy controls were included in the study. Physical disability, relapse, its treatment mode and biological activity of interferon-beta with MxA expression method were assessed in multiple sclerosis patients. Also cognitive functions with Brief Cognitive Assessment and computerized tests both in multiple sclerosis patients and healthy controls were asssessed. Various cognitive and non-cognitive factors that had the impact on the recovery of cognitive functions after multiple sclerosis relapse were recognized. The independent predictors of relatively good cognition recovery and significant early cognitive improvement were identified. Practical recommendations for quick and effective assessment of cognition during multiple sclerosis relapse and relapse treatment in case of better recovery after relapse were proposed. The results of this study could be helpful for all clinicians and scientists, who are interested in evaluation and monitoring of cognitive functions in multiple sclerosis both during relapse and remission

Adherence to disease modifying therapies in patients with multiple sclerosis

Introduction. Multiple sclerosis is an inflammatory demyelinating disease of the central nervous system. Disease modifying treatment tends to reduce the risk for relapses rate and disease progression, therefore adherence to treatment is essential for outcome. Aim of the study. To examine adherence to disease-modifying therapy in multiple sclerosis patients and identify the factors affecting it. Material and methods. The research was conducted in 2019 at Vilnius University Hospital Santaros Clinics Neurology department using an anonymous questionnaire. Statistical data analysis was performed on IBM SPSS. P value <0.05 was considered statistically significant. Results. Significantly more patients assessed their health as worse if they had the relapse in the last 24 months (p=0.003). Almost half of the patients said they forgot to take at least one dose of medication. Respondents significantly more often forgot to take pills than to inject drugs (p=0.024). Patients who assessed their health better significantly more often forgot to take the medication (p=0.008). Most patients, 78.8% (n=67), acknowledged that their health depended on disease-modifying therapy, though 51.7% (n=44) of respondents were concerned about the side effects that may occur with prolonged use of the drugs.Conclusion. Almost half of the patients forgot at least one dose of medication. Those patients who assessed their health better significantly more often forgot to take the medication. Most respondents relied on the medication prescribed by their physicians and used it responsibly, despite the anxiety about the side effects of long-term medication

Distinctive pattern of cognitive disorders during multiple sclerosis relapse and recovery based on computerized CANTAB tests

Background: Cognition may be affected at least as seriously as physical function during multiple sclerosis (MS) relapse, however MS relapse related cognitive disorders are still underdiagnosed and poorly characterized. The limited number of paper-pencil tests were used for assessment, and nevertheless, some significant changes were found. Unlike the paper-pencil tests, computerized batteries and tests are more sensitive and highly standardized, produce instant scoring and can minimize the learning and practice effects on follow-up. We investigated the cognition during MS relapse with the Cambridge Neuropsychological Test Automated Battery (CANTAB), which has shown sensitivity to cognitive dysfunction across different clinical groups, including patients with MS. Objective: The objective of the study was to assess the cognitive functions with CANTAB battery in MS patients during relapse, in stable MS patients, and healthy controls, and to establish the timing and pattern of cognitive recovery after relapse. Methods: Sixty relapsing, thirty stable MS patients, and thirty controls were assessed with CANTAB. The relapse group was assessed during multiple sclerosis relapse and 1 and 3 months after the first assessment. Results: The score of the difficult task of spatial planning was worse inMS relapse group than in MS stable group (p < 0.05). The scores of medium difficulty tasks of spatial planning, episodic visual recall and working memory were worse in the relapse group than in the control group (p < 0.05), while in stable MS and control groups, the scores of these tasks didn’t differ. The most significant improvement of speed of response, spatial planning, episodic visual recall memory and spatial working memory, was established at 1 month after the first assessment, additional improvement of spatial planning and working memory was observed at 3 months after the first assessment. Conclusions: The results of this study indicate that cognitive function is affected during MS relapse. The difficult task of CANTAB battery, which assesses the spatial planning, showed MS relapse related cognitive dysfunction. The changes in scores of episodic visual recall and working memory may be related to MS relapse. A significant improvement in the speed of response, spatial planning, episodic visual recall and working memory was established at 1 month after MS relapse. The additional improvement in spatial planning for the most difficult task and working memory was observed at 3months afterMS relapse. Itmay be possible that the practice effect had the impact on the improvement of cognitive scores that was noted in relapsing MS patients

Intensyviosios terapijos reikalingumo įvertinimas pacientams, sergantiems ūminiu bakteriniu meningitu: atvejų aprašymai ir literatūros apžvalga

Bacterial meningitis remains a disease associated with high mortality. Thus, in some hospitals admission of most patients presenting with bacterial meningitis to the intensive care unit (ICU) was a standard procedure. However, ICUs require advanced technologies and highly specialized personnel. Since both economic and human resources are scarce, countries are attempting to develop the most accurate ICU admission criteria that can minimize over- and undertriage. The guidelines designed so far mainly suggest admitting patients to ICU based on their neurological status. However, since neurological condition is not the only factor contributing to the outcomes of bacterial meningitis, over- and undertriage cannot always be avoided. In this article, we present two cases of bacterial meningitis: an elderly man who was denied ICU care since his consciousness was only mildly altered, and a woman who was admitted to ICU because she was diagnosed with meningococcus meningitis. We will also review some literature regarding prognostic factors for bacterial meningitis in an attempt to distinguish valuable criteria for ICU admission

Neuroborreliosis mimicking demyelinating disease of the central nervous system: case reports

We present two patients with neuroborreliosis initially considered as demyelinating disease of the central nervous system. The first patient developed facial numbness on the right side, diplopia and dizziness that lasted about half a year. Magnetic resonance imaging of the brain showed confluent hyperintense lesions and visual evoked potentials revealed prolonged latencies of the P wave. The second patient developed weakness, numbness and pain in the left hand that lasted several weeks. Magnetic resonance imaging of the cervical spine demonstrated hyperintense lesions commonly found in multiple sclerosis. In both cases, positive serology for Borrelia burgdorferi was an indicator of past infection. However, the cerebrospinal fluid analysis showed proteinorrhachia and lymphocytic pleocytosis and the presence of specific IgM and IgG antibodies in the cerebrospinal fluid confirmed the diagnosis of neuroborreliosis. The clinical symptoms, abnormal cytological, biochemical and immunological cerebrospinal fluid findings in combination with good response to antibiotic therapy confirmed the diagnosis of neuroborreliosis in our patient

Impact of autologous HSCT on the quality of life and fatigue in patients with relapsing multiple sclerosis

In this study, we aimed to assess the quality of life, fatigue, anxiety, and depression after Autologous haematopoietic stem cell transplantation (AHSCT) and to investigate its impact of on separate domains of health status and fatigue in patients with multiple sclerosis (MS). Overall, 18 patients with highly active relapsing MS (mean age 36.3 years, 83.3% female) underwent the AHSCT in Vilnius Multiple Sclerosis center, and we prospectively collected Short Form 36, Health Survey Questionnaire, Fatigue Descriptive Scale, and Hospital Anxiety and Depression Scale beforeand Month3, 12, and 24 after AHSCT. The median score of Expanded Disability Status Scale at Month3 after transplant improved in 14 patients (77.8%). A significant improvement in physical functioning, vitality, and pain was found at Month3 after AHSCT (p < 0.05), which was sustained until Month12 and 24. The improvement in fatigue score was found at Month12 after AHSCT, which was sustained until Month24. Decrease in EDSS score had a positive impact on the better HRQoL outcomes, especially physical and social outcomes. Thus, AHSCT improved quality of life and reduced symptoms of fatigue in patients with highly active relapsing MS. The improvement was determined earlier in the domains of QoL than in the fatigue

Cognition during and after multiple sclerosis relapse as assessed with the brief international cognitive assessment for multiple sclerosis

There is some evidence that cognition may be impaired during multiple sclerosis (MS) relapse. The aims of this study were to assess the cognitive status with the Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS) in MS patients during relapse, in stable patients, and in healthy controls; to evaluate cognitive changes up to 3 months after relapse; and to estimate the impact of different factors on cognition after relapse. BICAMS was performed in 60 relapsing, 30 stable patients and 30 controls. Relapsing MS patients were assessed during relapse and one and three months after relapse. SDMT score was lower in relapsing than in stable patients. The mean scores of all BICAMS tests were higher one month after relapse than during relapse (p < 0.001). SDMT score after relapse improved in younger patients, who had more severe relapse (p < 0.05). BVMT-R score improved more in men, in patients with biologically active interferon-beta, in patients treated with methylprednisolone and in patients who were rehabilitated (p < 0.05). CVLT-II score improved in women and in patients with shorter relapse (p < 0.05). A neuropsychological assessment, like the evaluation of physical disability, is important during relapse. BICAMS may be suitable for a quick and effective assessment of cognition during relapse

Relationship between cognition and treatment adherence to disease-modifying therapy in multiple sclerosis: a prospective, cross-sectional study

Less than half of patients with chronic diseases, including multiple sclerosis (MS), adhere to their prescribed medications. Treatment selection is essential for patient adherence. The aim of this study was to explore the potential factors influencing nonadherence to disease-modifying therapies (DMTs) in MS. This prospective, cross-sectional study was performed at the Multiple Sclerosis Center between 2018 and 2021. In total, 85 patients were eligible for final analysis. Forty-one patient (48.2%) with MS were non-adherent to DMT. Male sex, oral administration of drugs, and longer treatment duration were associated with nonadherence. The mean Expanded Disability Status Scale score did not differ between the adherent and non-adherent patients (p > 0.05). Patients with a higher score on the Symbol Digit Modalities Test, who were receiving self-injection therapy, had shorter treatment duration, and higher disability, were more likely to be adherent to DMT than those without. To minimize nonadherence in patients with MS, the patient’s information processing speed should be considered before DMT initiation, and appropriate treatment options should be discussed