Benign multiple sclerosis: cognitive, psychological and social aspects in a clinical cohort.

Department of Neurology, University of Florence, Viale Morgagni 85, 50134 Florence, Italy.
Journal of Neurology (Impact Factor: 3.84). 08/2006; 253(8):1054-9.
Source: PubMed

ABSTRACT A study of cognitive, psychological and social aspects in benign multiple sclerosis (MS). Methods One hundred and sixty three patients with benign MS (defined as disease duration > or = 15 years and Expanded Disability Status Scale (EDSS) score < or = 3.0 ) underwent neuropsychological testing on the Rao's Brief Repeatable Battery (BRB) and the Stroop test, evaluation of depression on the Montgomery and Asberg Depression Rating Scale (MADRS), of fatigue on the Fatigue Severity Scale (FSS) and of handicap on the Environmental Status Scale (ESS). Patients' cognitive performance was compared with that of 111 demographically matched healthy controls. Cognitive impairment was defined as the failure in at least 3 tests, using the fifth percentile of controls' performance as the cut-off point. Clinical correlates of cognitive impairment were determined by multiple logistic regression analysis.
Cognitive assessment led to the identification of 74 subjects (45%) with cognitive impairment. Significant fatigue was found in 80 subjects (49%) and depression in 88 patients (54%). In comparison with cognitively preserved subjects, cognitively impaired patients exhibited higher handicap scores on the ESS (p = 0.005). In the regression analysis, only EDSS scores were significantly associated with cognitive impairment (OR 1.8, 95%CI 1.2-2.6).
Current definitions of benign MS may overestimate this entity, since they are mainly weighted for the patients' motor abilities and fail to capture relevant disease-related cognitive, psychological and social problems.

1 Follower
  • [Show abstract] [Hide abstract]
    ABSTRACT: Clinical expression of brain damage varies over time and among individuals. This is particularly evident in Multiple Sclerosis (MS) where the expression clinico-radiological paradox has been coined to indicate the weak association between common neuroradiological markers of MS and clinical disability. Here we will review available data suggesting a possible role of adaptive synaptic long-term potentiation (LTP) in the clinical course of MS. We propose that the capacity of the brain to potentiate synaptic excitability in a long-lasting way is the brain's core adaptive property to bridge neuronal damage and clinical expression in multiple sclerosis. LTP, in fact, consists in the strengthening of synaptic communication between two connected neurons, and is virtually able therefore to restore membrane excitability of neurons that have lost part of their synaptic inputs. Consistently, recent studies have shown that cortical LTP reserve, explored through transcranial magnetic stimulation (TMS), contrasts disability progression in MS. Furthermore, promotion of cortical LTP through TMS induces acute cortical remapping and ameliorates motor symptoms in MS and in other neurological disorders.
    Neuroscience & Biobehavioral Reviews 04/2014; DOI:10.1016/j.neubiorev.2014.03.023 · 10.28 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Background Prevalence rates of cognitive impairment (CI) in multiple sclerosis (MS) vary between 40% and 80%. Differences in classification criteria for CI may explain this variance. Objective This study reviewed and compared classification criteria for CI in patients with early and late MS. Methods The paper consists of two parts: a systematic review of published classification criteria and the presentation of new data. Criteria were reviewed in respect to percentage of abnormal parameters and cut-offs concerning standard deviations. Thereafter, criteria were applied to cognitive data of 25 patients with early MS (duration ≤ 2y), 52 matched patients with late MS (≥ 12y), and 75 matched controls. The test battery assessed alertness, divided attention, mental flexibility, verbal and visual learning, memory, and visuospatial abilities. Results Seventy classification criteria were revealed and grouped into 20 distinct approaches that can be subdivided into three basic classification strategies. Most commonly, CI was defined as performing 1.5 SD or 2 SD below the normative mean in 18-30% of test parameters (n = 42). Other criteria utilized cognitive domains (n = 6), composite indices (n = 8), or combinations of cut-offs and strategies. The stringency of the criteria was correlated with the prevalence rate of CI (r = -.43) and disease duration (r = .48). In the new data, a substantial effect of classification criteria was found with a prevalence rate ranging from 0 to 68% in early and 4 to 81% in late MS. Increased rates of CI in patients vs. controls were found following 18 out of 20 criteria in the sample of late MS. In early MS, an increased rate of CI was only found following a liberal 1.5 SD cut-off criterion. Inter-rater reliability between all criteria was moderate. However, between criteria of comparable stringency the inter-rater reliability was found to be strong. Conclusion Classification based on different published criteria is not fully comparable and criteria need to be better homogenized.
    Journal of the Neurological Sciences 08/2014; 343(1-2). DOI:10.1016/j.jns.2014.05.042 · 2.26 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: ABSTRACT Germline polymorphisms of detoxification genes could influence susceptibility to Multiple Sclerosis (MS). Glutathione-S-transferases (GSTs) and NAD(P)H:quinone oxidoreductase 1 (NQO1) are detoxifying enzymes involved in biotransformation of metabolites preventing cells from oxidative damage. In order to evaluate the possible contribution of the A(313)G GSTP1 inactivating polymorphism, alone and in combination with the C(609)T NQO1 genetic variant in MS susceptibility, we performed a case-control study consisting of 254 MS patients and 370 healthy donors. Genotypes were investigated using a new Real-Time PCR and PCR-RFLP assays. The GSTP1 polymorphism was evaluated in relation to patients' characteristics (clinical subtypes, age and gender) and the NQO1 gene status. GSTP1 genotype distribution was similar between cases and controls. Higher frequency of GSTP1 heterozygotes was observed in patients with relapsing remitting disease (RRMS) (p = 0.019), especially in those presenting a benign form (EDSS ≤2 after 10-15 years from the disease onset). Interestingly, genotype distribution analysis of combined GSTP1 and NQO1 polymorphisms revealed significantly higher frequency of GSTP1 heterozygous (A/G) and NQO1 variant genotypes (C/T and T/T) in patients as compared to the controls (p = 0.031). The increased incidence of combined GSTP1 and NQO1 variant genotypes in MS patients may suggest that defective function of detoxification enzymes might be an important determinant of susceptibility and clinical manifestation of the disease. Moreover, the results suggest a possible role for the GSTP1 heterozygous background in the development of RRMS.
    The International journal of neuroscience 03/2014; DOI:10.3109/00207454.2014.899597 · 1.53 Impact Factor