Early signs of memory impairment among multiple sclerosis patients with clinically isolated syndrome

Abstract. The study investigates primary and secondary verbal memory and motor/executive functions (response inhibition and strategy shifting ability) in multiple sclerosis (MS) patients with clinically isolated syndrome (CIS). We studied 44 CIS patients and compared them to 49 patients with relapsing remitting MS (RR-MS) displaying mild disability and to a large cohort of ageand education level-matched healthy volunteers (n = 230). Results showed that both CIS and RR-MS patients evidenced a disproportionate impairment in the immediate and delayed recall of the second (as compared to the first) of two short narratives of the Logical Memory WMS-III subtest, and reduced performance on the Memory for Digits-Forward. Performance of either group on the executive tasks was not impaired, showing evidence of a reversed speed-accuracy trade-off. Illness duration emerged as a significant predictor of memory and executive task performance. Clinical, psychoemotional, and brain imaging findings were also examined as potential correlates of memory deficits and disease progression among CIS patients. These findings may signify early-onset decline of specific cognitive functions in CIS, which merits regular follow-up assessments and monitoring of psychoemotional adaptation and everyday functioning

A critical analysis of the potential for EU Common Agricultural Policy measures to support wild pollinators on farmland

1. Agricultural intensification and associated loss of high‐quality habitats are key drivers of insect pollinator declines. With the aim of decreasing the environmental impact of agriculture, the 2014 EU Common Agricultural Policy (CAP) defined a set of habitat and landscape features (Ecological Focus Areas: EFAs) farmers could select from as a requirement to receive basic farm payments. To inform the post‐2020 CAP, we performed a European‐scale evaluation to determine how different EFA options vary in their potential to support insect pollinators under standard and pollinator‐friendly management, as well as the extent of farmer uptake. 2. A structured Delphi elicitation process engaged 22 experts from 18 European countries to evaluate EFAs options. By considering life cycle requirements of key pollinating taxa (i.e. bumble bees, solitary bees and hoverflies), each option was evaluated for its potential to provide forage, bee nesting sites and hoverfly larval resources. 3. EFA options varied substantially in the resources they were perceived to provide and their effectiveness varied geographically and temporally. For example, field margins provide relatively good forage throughout the season in Southern and Eastern Europe but lacked early‐season forage in Northern and Western Europe. Under standard management, no single EFA option achieved high scores across resource categories and a scarcity of late season forage was perceived. 4. Experts identified substantial opportunities to improve habitat quality by adopting pollinator‐friendly management. Improving management alone was, however, unlikely to ensure that all pollinator resource requirements were met. Our analyses suggest that a combination of poor management, differences in the inherent pollinator habitat quality and uptake bias towards catch crops and nitrogen‐fixing crops severely limit the potential of EFAs to support pollinators in European agricultural landscapes. 5. Policy Implications. To conserve pollinators and help protect pollination services, our expert elicitation highlights the need to create a variety of interconnected, well‐managed habitats that complement each other in the resources they offer. To achieve this the Common Agricultural Policy post‐2020 should take a holistic view to implementation that integrates the different delivery vehicles aimed at protecting biodiversity (e.g. enhanced conditionality, eco‐schemes and agri‐environment and climate measures). To improve habitat quality we recommend an effective monitoring framework with target‐orientated indicators and to facilitate the spatial targeting of options collaboration between land managers should be incentivised

Cognitive functions and multiple sclerosis

The goal of this study was to assess passage memory in patients withrelapsing remitting multiple sclerosis (RR-MS). Ninety three RR-MSpatients, the majority of which displayed mild physical disability, weretested on primary and secondary verbal learning tasks. Results showed adisproportionate impairment in both the immediate and delayed recall of thesecond of two short narratives administered as part of the Logical MemoryWMS-III subtest. MS patients who presented with unusually high immediatedifferential recall scores, also, displayed reduced scores on a measure ofworking memory (Memory for Digits-Reversed) and a reduced recencyeffect on both the passage and a list learning task (AVLT). There were noindications of increased susceptibility to proactive or retroactiveinterference. These findings are discussed in relation to individual variabilityin memory impairment among RR-MS patients and their possibleassociation with psychoemotional adaptation and everyday functioning.Στόχος της παρούσας μελέτης ήταν η διερεύνηση της φύσηςμνημονικών ελλειμμάτων ασθενών με Υποτροπιάζουσα-ΔιαλείπουσαΣκλήρυνση Κατά Πλάκας σε σχέση με άτομα του γενικού πληθυσμού, ταοποία δεν νοσούν από τη συγκεκριμένη νόσο και δεν παρουσιάζουν άλλουτύπου νευρολογική ή ψυχιατρική διαταραχή. Ειδικότερα, διερευνήθηκε σεμεγαλύτερο αριθμό ασθενών με Υποτροπιάζουσα-Διαλείπουσα μορφή τηςΣΚΠ (Ν=93) προηγούμενο εύρημα της παρούσης ερευνητικής ομάδας(Panou et al., 2009) σχετικά με τη μειωμένη ικανότητα μνημονικήςανάκλησης της δεύτερης (Ιστορία Β1) σε σχέση με την πρώτη ιστορία(Ιστορία Α) της δοκιμασίας «Μνήμη Ιστοριών».Το βασικό εύρημα της παρούσας μελέτης είναι ότι οι ασθενείς μεΥποτροπιάζουσα-Διαλείπουσα Μορφή Σκλήρυνσης Κατά Πλάκαςπαρουσίασαν δυσανάλογο έλλειμμα όσον αφορά την άμεση καικαθυστερημένη ανάκληση της δεύτερης από τις δύο σύντομες αφηγήσεις(Ιστορία Β), που συμπεριλαμβάνονται στην ελληνική εκδοχή της δοκιμασίας«Μνήμη Ιστοριών» (Wechsler Memory Scale). Η επίδοση των ασθενώντόσο στην καθυστερημένη ανάκληση όσο και στη δοκιμασία αναγνώρισηςτης ίδιας ιστορίας (Ιστορία Β) ήταν σημαντικά χαμηλότερη από τηναναμενόμενη ανάλογα με την ηλικία και το μορφωτικό τους επίπεδο.Συγκριτικά με τους υπόλοιπους ασθενείς της ίδιας ομάδας, εκείνοι πουσημείωσαν ασυνήθιστα υψηλή βαθμολογία στο δείκτη ΔιαφορικήςΙκανότητας Άμεσης Ανάκλησης Ιστοριών παρουσίασαν, επίσης, χαμηλήεπίδοση στην ενεργό μνήμη («Αντίστροφη Μνήμη Ψηφίων») και μειωμένηεπίδραση του φαινομένου του προσφάτου τόσο στις δύο ιστορίες τηςδοκιμασίας «Μνήμη Ιστοριών» όσο και στη δοκιμασία «ΑκουστικήςΛεκτικής Μάθησης». Επιπλέον, δεν παρατηρήθηκαν ενδείξεις αυξημένηςευαισθησίας στην προσθενεργό παρεμβολή. Τα ευρήματα αυτά συζητούνταισε σχέση με την ατομική μεταβλητότητα επίδοσης των ασθενών σεμνημονικούς δείκτες, καθώς και με την πιθανή συσχέτισή τους μεψυχοσυναισθηματικούς παράγοντες.14

Regional MRI Perfusion Measures Predict Motor/Executive Function in Patients with Clinically Isolated Syndrome

Background. Patients with clinically isolated syndrome (CIS) demonstrate brain hemodynamic changes and also suffer from difficulties in processing speed, memory, and executive functions. Objective. To explore whether brain hemodynamic disturbances in CIS patients correlate with executive functions. Methods. Thirty CIS patients and forty-three healthy subjects, matched for age, gender, education level, and FSIQ, were administered tests of visuomotor learning and set shifting ability. Cerebral blood volume (CBV), cerebral blood flow (CBF), and mean transit time (MTT) values were estimated in normal-appearing white matter (NAWM) and normal-appearing deep gray Matter (NADGM) structures, using a perfusion MRI technique. Results. CIS patients showed significantly elevated reaction time (RT) on both tasks, while their CBV and MTT values were globally increased, probably due to inflammatory vasodilation. Significantly, positive correlation coefficients were found between error rates on the inhibition condition of the visuomotor learning task and CBV values in occipital, periventricular NAWM and both thalami. On the set shifting condition of the respective task significant, positive associations were found between error rates and CBV values in the semioval center and periventricular NAWM bilaterally. Conclusion. Impaired executive function in CIS patients correlated positively with elevated regional CBV values thought to reflect inflammatory processes

Distinct hemodynamic and functional connectivity features of fatigue in clinically isolated syndrome and multiple sclerosis: accounting for the confounding effect of concurrent depression symptoms.

peer reviewedPURPOSE: This study aims to identify common and distinct hemodynamic and functional connectivity (FC) features for self-rated fatigue and depression symptoms in patients with clinically isolated syndrome (CIS) and relapsing-remitting multiple sclerosis (RR-MS). METHODS: Twenty-four CIS, 29 RR-MS patients, and 39 healthy volunteers were examined using resting-state fMRI (rs-fMRI) to obtain whole-brain maps of (i) hemodynamic response patterns (through time shift analysis), (ii) FC (via intrinsic connectivity contrast maps), and (iii) coupling between hemodynamic response patterns and FC. Each regional map was correlated with fatigue scores, controlling for depression, and with depression scores, controlling for fatigue. RESULTS: In CIS patients, the severity of fatigue was associated with accelerated hemodynamic response in the insula, hyperconnectivity of the superior frontal gyrus, and evidence of reduced hemodynamics-FC coupling in the left amygdala. In contrast, depression severity was associated with accelerated hemodynamic response in the right limbic temporal pole, hypoconnectivity of the anterior cingulate gyrus, and increased hemodynamics-FC coupling in the left amygdala. In RR-MS patients, fatigue was associated with accelerated hemodynamic response in the insula and medial superior frontal cortex, increased functional role of the left amygdala, and hypoconnectivity of the dorsal orbitofrontal cortex, while depression symptom severity was linked to delayed hemodynamic response in the medial superior frontal gyrus; hypoconnectivity of the insula, ventromedial thalamus, dorsolateral prefrontal cortex, and posterior cingulate; and decreased hemodynamics-FC coupling of the medial orbitofrontal cortex. CONCLUSION: There are distinct FC and hemodynamic responses, as well as different magnitude and topography of hemodynamic connectivity coupling, associated with fatigue and depression in early and later stages of MS