A comparison Of Memory Performance In Relapsing/Remitting, Primary/Progressive And Secondary/Progressive, Multiple Sclerosis
Gaudino EA, Chiaravalloti ND, DeLuca J, Diamond BJ
NeuroPsychiatry NeuroPsychol Behav Neurol 2001 Jan;14(1):32-44
Kessler Medical Rehabilitation Research and Education Corporation, West Orange, New Jersey 07052, USA
The current investigation was designed to examine the influence of disease course on the specific patterns of Acquisition and Retrieval Impairments in Multiple Sclerosis (MS).
Recent investigations of Learning and Memory in MS have shown that many subjects have impaired Verbal and Visual new Learning abilities, but normal Long-Term Recall and Recognition.
However, heterogeneity in Learning and Memory abilities of subjects has been documented. Some evidence in the literature suggests that this heterogeneity may be in part attributable to clinical variables, such as disease course.
Verbal and Visual Learning and Memory tests, modified to equate MS groups with healthy controls on initial acquisition of information, were administered to 64 individuals with Clinically Definite MS:
- Relapse/Remitting = 21
- Primary/Progressive = 18
- Secondary/Progressive = 25
- 20 healthy control participants
Recall and Recognition performance then was evaluated at 30 minutes, at 90 minutes, and at 1 week for the Verbal Learning task, and at 30 minutes and at 90 minutes for the Visual Learning task.
Results indicate that the two Progressive forms of MS result in significantly greater deficits in regard to the Acquisition of new Verbal information.
With the Secondary/Progressive group showing a significantly higher failure rate in regard to meeting the Learning criterion.
Performance for Recognition measures was not significantly different among groups.
Whereas Recall performance of the Primary/Progressive group was significantly below that of the control group and of the Secondary/Progressive group.
When testing new Learning with VisuoSpatial information, individuals with Relapse/Remitting MS and Secondary/Progressive MS required more trials than control participants to learn the same amount of Visual information.
Visual Recall and Recognition performance did not differ between groups. No group differences in rates of forgetting for VisuoSpatial material was observed after equating for acquisition.
Results of the current study indicate that the primary problem in MS with regard to Memory functioning is in the acquisition of new information.
Our findings support previous research showing Verbal Memory Deficits with a Progressive disease course and VisuoSpatial Memory Deficits in Relapse/Remitting MS.
However, the detailed analysis of New Learning and Memory performed in the current study indicated that the Primary/Progressive group may be showing difficulty in their ability to use Newly Learned information.
The pattern of New Learning deficits observed between MS disease subtypes in the current study was determined to be unrelated to the duration of MS and to the physical severity of the disease.
The degree of physical disability observed in patients with MS does not appear to be related to the degree of Cognitive decline:
Because, of the distinct patterns and severity of Memory Dysfunction noted within each disease type, independent of physical disability.
Longitudinal Study Of Cognitive Dysfunction In MS:
NeuroPsychological, NeuroRadiological, And
Piras MR, Magnano I, Canu ED, Paulus KS, Satta WM, Soddu A, Conti M, Achene A, Solinas G, Aiello I
J Neurol NeuroSurg Psychiatry 2003 Jul;74(7):878-85
University of Sassari, Institute of Clinical Neurology, Institute of Radiology, Laboratory of Epidemiology and BioStatistics, Institute of Hygiene and Preventive Medicine, Sassari, Italy
To assess Cognitive function and Cerebral Magnetic Resonance Imaging (MRI) involvement in Relapsing/Remitting Multiple Sclerosis
To monitor disease evolution, Cognitive Dysfunction, and Cerebral lesion burden over time (mean 8.5 year follow up period)
To study the relation between Clinical, NeuroPsychological, and MRI data
On follow up assessment, Visual and Auditory oddball Event Related Potentials (ERPs) were recorded as PsychoPhysiological evaluation of Cognitive status. Correlations between NeuroPsychological, MRI, and ERP data were also analyzed.
NeuroPsychological study assessed Verbal and Non-Verbal IQ, Deterioration Index (DI) from WAIS subtests, Conceptual Reasoning, Attention, Verbal and VisuoSpatial Short-Term and Long Term Memory.
MRI assessment detected presence of DeMyelinating lesions by using a semiquantitative method as well as Cortical and SubCortical Atrophy over time.
Attention, Short-Term and Long Term VisuoSpatial Memory were mildly impaired at baseline and remained unaltered longitudinally.
At retesting a significant worsening of Verbal Long Term Memory (p=0.023), DI presence (p=0.041) and the increase of SupraTentorial and SubTentorial MRI lesions load (p=0.001) emerged.
Expanded Disability Status scale score correlated significantly with total lesion burden at both evaluations (p=0.043 and p=0.024 respectively).
Temporal, Occipital, and Frontal Horn lesions as well as Cortical Atrophy correlated significantly with Attention and Memory Tests at baseline.
Follow up assessment revealed significant correlation between Cortical Atrophy and Attention as well as VisuoSpatial Short-Term Memory; Spatial Long Term Memory correlated significantly with lesions in body of Lateral Ventricle and Frontal Lobe.
ERP study showed P300 latency abnormalities in 75% of patients, involving specifically more Visual P300 (58.4 % of cases) than Auditory Wave (41.6 %).
Visual P300 latency and amplitude correlated significantly with DI and Auditory P300 Latency with Frontal Horn and BrainStem lesions.
These findings revealed mild Cognitive Impairment in MS patients particularly consistent with Slowing Information Processing over time.
Increased MRI lesions do not correlate with the clinical course of the disease and Cognitive Deficit evolution.
Thus, Cognitive Dysfunction could be related to disease peculiarity and not to the time course.
Correlations between P300, NeuroPsychological, and MRI findings provide further information about ERP application to examine Cognitive Impairment in MS and probably to investigate their Neural origin.
Psychological And NeuroPsychological Problems
In Multiple Sclerosis
Bequet D, Taillia H, Clervoy P, Renard JL, Flocard F
Bull Acad Natl Med 2003;187(4):683-94; discussion 695-7
Service de Neurologie, HIA du Val de Grace, 74 Boulevard de Port Royal-75005 Paris
NeuroPsychological investigations have demonstrated that Cognitive Disorders are common (about 60%) in patients with Multiple Sclerosis.
22 patients and 22 controls participated in the study with a review of literature.
The Cognitive Dysfunction may be termed a SubCortical White Matter Dementia. The hallmarks are:
- Reduced Information Processing Speed
- Impaired Attention and Slowness of Thought Processes
- Impaired Ability to Manipulate Acquired Knowledge
Psychiatric disturbance have also high prevalence: Emotional or personality changes, Depression. Pathological Laughing and Crying are classical but not well understood.
This intellectual and Emotional changes in Multiple Sclerosis are studied by adapted Psychometric Psychiatric examination. Correlation of Magnetic Resonance Imaging with NeuroPsychological testing is now demonstrated.
Total lesion score is the best predictor of Cognitive Deficits, also Cerebral Atrophy and lesions of the Corpus Callosum.
NeuroPsychological rehabilitation techniques and symptomatic treatments must be applied to patients with Multiple Sclerosis.
NeoCortical Volume Decrease In Relapsing/Remitting MS Patients With Mild Cognitive Impairment
Amato MP, Bartolozzi ML, Zipoli V, Portaccio E, Mortilla M, Guidi L, Siracusa G, Sorbi S, Federico A, De Stefano N
Neurology 2004 Jul 13;63(1):89-93
University of Florence, Department of Neurology, Viale Morgagni, 85-50134 Florence, Italy
To assess NeoCortical changes and their relevance to Cognitive Impairment in early Relapsing/Remitting (RR) Multiple Sclerosis (MS).
Conventional MR was acquired in 41 patients with RR MS and 16 demographically matched Normal Control subjects (NCs).
An automated analysis tool was used with conventional T1-weighted MRI to obtain measures of Cortical Brain Volumes normalized for head size.
NeuroPsychological performance of MS patients was assessed using the Rao Brief Repeatable Battery. Relationship between volumetric MR measures and NeuroPsychological scores was assessed.
NeuroPsychological assessment allowed for the identification of 18 Cognitively preserved (MS-cp) and 23 Cognitively impaired (MS-ci) MS patients.
The whole MS sample showed lower values of Normalized Cortical Volumes (NCVs) than did the NC group (p = 0.01).
Upon grouping of MS patients according to Cognitive performance, NCV values were lower (p = 0.02) in MS-ci patients than in both MS-cp patients and NCs.
Moreover, there were positive correlations between NCV values and measures of Verbal Memory (r = 0.51, p = 0.02), Verbal Fluency (r = 0.51, p = 0.01), and Attention/Concentration (r = 0.65, p < 0.001) in MS-ci patients.
Furthermore, NCV values were decreased in patients who scored lower on a greater number of tests (r = -0.58, p < 0.01) in the MS-ci group.
None of the NeuroPsychological measures correlated to NCV values in the MS-cp patient group.
Cortical Atrophy was found only in Cognitively impaired patients.
And, was significantly correlated with a poorer performance on tests of Verbal Memory, Attention/Concentration, and Verbal Fluency.
Gray Matter pathology may contribute to the development of Cognitive Impairment in MS from the earliest stages of the disease.