Cognitive dysfunction in Multiple sclerosis, its relationship with demographic and clinical factors and changes in Magnetic resonance imaging

Multiple sclerosis (MS) is a chronic demyelinating inflammatory neurological disease in young adults. Cognitive dysfunction (CD) contributes significantly to patient’s disability status. Although almost all kind of CD can be observed in MS, the typical profile is the impairment of information processing speed, memory, attention and often executive skills. The aim of the study was to investigate the influence of different demographic and clinical markers of the disease and changes in MRI tomography on cognitive functions in MS patients. The study involved 120 patients with MS and 40 healthy controls. Neurological examination, complaints of memory and fatigue, objective depression, anxiety and objective fatigue were evaluated. Cognitive functions (CF) were tested using battery of 11 cognitive tests. Brain MRI was performed to evaluate focal demyelinised lesions and to calculate regional linear markers of brain atrophy. The impairment of CF was much more expressed in MS patients as compared to controls. CF were negatively affected by objective depression and disease course. Subjective memory complaints and subjective fatigue in MS patients did not correlate with CF however they did correlate with objective fatigue. Self reported memory impairment worsened with the progression of disease. CD and brain atrophy reflected by MRI linear parameters were more expressed in secondary progressive (SP) MS as compared to relapsing remitting (RR) MS. Number of demyelinated lesions were related to CF in RR MS. MRI linear measurements bicaudatus ratio and width of the third ventricle, also cognitive tests reflecting verbal learning and memory, speed of psychomotor reactions and attention were mostly suitable to differentiate RR and SP MS courses

Multiple sclerosis: overview of orally administrated disease-modifying drugs. Do genetics influence the success of treatment?

Multiple sclerosis (MS) is the main cause of acquired neurological disability in the young people. In MS treatment, disease modifying therapies (DMTs) are essential to reduce disease progression by suppressing the inflammatory response responsible for promoting lesion formation. Injectable (Interferons and Glatiramer acetate) and infusion (Natalizumab, Alemtuzumab) therapies are both effective however rather exhausting for patients. Recently, in addition to the injectable and infusion DMTs, new orally administered drugs have been approved for MS therapy: fingolimode, dimethyl fumarate, and teriflunomide. These drugs act with different mechanisms on the immune system and are more comfortable for MS patients. In this review we provide a systematic description of the new oral drugs fingolimod, dimethyl fumarate and teriflunomide and also introduce the influence of polymorphic gene variants in the Human Leukocyte Antigen region on the risk of developing MS and its progression and effectiveness of DMTs

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

Belief in omens and superstitions among patients with chronic neurological disorders

IntroductionChronic neurological disorders may affect various cognitive processes, including religiosity or superstitious belief. We investigated whether superstitious beliefs are equally prevalent in patients with Parkinson’s disease (PD), people with epilepsy (PWE), patients with multiple sclerosis (MS) and healthy controls (HCs).MethodsFrom late 2014 to early 2023 we conducted a cross-sectional in-person anonymous paper-based survey at the tertiary clinic of Vilnius University Hospital Santaros Klinikos among outpatients and HCs by asking them to ascribe meaning or report belief for 27 culturally adapted statements (9 omens and 18 superstitions). The sum of items that a respondent believes in was labeled the superstition index (SI). The SI was compared between groups by means of the Kruskal-Wallis (H) test and negative binomial regression modeling. A two-step cluster analysis was performed to discern different subgroups based on answers to the items of the SI.ResultsThere were 553 respondents who completed the questionnaire (183 PWE, 124 patients with PD, 133 with MS and 113 HCs). Complete SI scores were collected for 479 (86.6%) participants and they were lower in patients with PD (n = 96, Md = 1, IQR = 0–5.75) in comparison to those with epilepsy (n = 155, Md = 6, IQR = 1–14), MS (n = 120, Md = 4, IQR = 0–12) or HCs (n = 108, Md = 4.5, IQR = 1–10), H (3) = 26.780, p &lt; 0.001. In a negative binomial regression model (n = 394, likelihood ratio χ2 = 35.178, p &lt; 0.001), adjusted for sex, place of residence, income and education, female sex was the only characteristic associated with the SI (β = 0.423, OR = 1.526, 95% CI = 1.148 to 2.028). Both female sex (β = 0.422, OR = 1.525, 95% CI = 1.148 to 2.026) and Parkinson’s disease (β = −0.428, OR = 0.652, 95% CI = 0.432 to 0.984) were significant predictors of the SI when age was removed from the model. Two-step cluster analysis resulted in individuals with PD being grouped into “extreme non-believer,” “non-believer” and “believer” rather than “non-believer” and “believer” clusters characteristic for PWE, patients with MS and HCs.ConclusionOur study suggests that individuals with PD believe in less superstitions than patients with MS, PWE or HCs. The results of this investigation should be independently confirmed after adjusting for PD-specific variables

Biomechanical markers of impaired motor coordination

This study is devoted to movement analysis from a biomechanical perspective to evaluate coordination lesions. It aims to find the most characteristic biomechanical markers that would help to quantitatively evaluate impaired motor coordination without performing or supplementing clinical tests. A total of 54 (31 – multiple sclerosis (MS) and 23 – healthy (CO)) subjects performed the heel-to-shin test (HST) and correspondingly, kinematic parameters of lower extremity were measured by using six 9DOF wireless inertial sensors (IMUs). Three-dimensional data from IMUs was processed utilizing Madgwick's Attitude and Heading Reference Systems (AHRS) algorithm. MS group was compared to CO, as well as impaired body side with an intact among MS subjects. Obtained results revealed following meaningful parameters for coordination between MS and CO (p<0.01): motion time, range of motion (ROMs) of the ankle, knee in the sagittal plane; hip in frontal plane; variability and SD variation. Following biomechanical indices, namely ROMs of the ankle, knee in the sagittal plane; hip in frontal plane; hip in transverse plane, were used for the evaluation of MS body sides’ (p<0.01). Latter biomechanical markers clearly describe impaired motor coordination and enables distinguishing from the sound. New information precisely explain movement quality and it is useful for the assessment of the impairment

Incidence rate and sex ratio in multiple sclerosis in Lithuania

Objectives: To determine the temporal changes in incidence rates of multiple sclerosis (MS) over the past 15 years in Lithuania with prediction up to 2020, and to estimate female‐to‐male sex ratio and its changes among MS patients. Materials and methods: We conducted a descriptive incidence study. The crude incidence rates (CIR) were calculated using 15‐year period, sex, age‐groups, and the number of newly registered MS patients. Standardized incidence rates (SIR) were calculated using European standard in order to evaluate the influence of resident structure changes on incidence of MS during the last 15 years. The data were processed using Minitab set to estimate a linear trend model for the temporal changes of 16 parameters. Results: The data showed a substantial growth of the incidence rate of MS in Lithuania during the period of 2001–2015. In 2001, MS was diagnosed to 162 new individuals, whereas 343 new cases of MS were diagnosed in 2015. During 2001–2015, the incidence of MS was on average 6.5 (95% CI 5.70–7.30) cases per 100,000 residents, and 4.9 (95% CI 4.46–5.34) and 8.1 (5.86–9.34) for 100,000 male and female, respectively. Female‐to‐male sex ratio in MS in Lithuania had a tendency to increase over the period. Females were affected from 1.5 to 2 times more often than males. Conclusions: In 2020, the incidence rate of MS is estimated to reach 13 cases per 100,000 persons and females are expected to be diagnosed with MS two times more often than males