ABSTRACT
Introduction In recent years, there has been an increase of studies dedicated to cognitive rehabilitation in patients with multiple sclerosis (MS); however, few of these analyze the impact on such variables as cognitive reserve. The study aims to explore the effects of a cognitive rehabilitation program comprising a combination of cognitive and physical exercises, as well as group sessions to improve cognitive performance, emotional state, and cognitive reserve index. Method Fifty patients with MS were subdivided into 2 groups: the control group, which performed aerobic exercise (n = 25), and the experimental group (n = 25), which participated in the integrated cognitive rehabilitation program (ICRP). All participants were evaluated 3 times (baseline, post-treatment, and long-term) with the Brief Repeatable Battery of Neuropsychological Tests, Cognitive Reserve Scale, Beck Depression Inventory, and a scale evaluating trait and state anxiety. Results Compared with the control group, patients in the experimental group showed improvements in cognitive function, with significant changes in measures of information processing speed, attention, memory, cognitive reserve index, and long-term mood. Conclusions The ICRP was effective in improving cognitive and emotional function in MS, and increased the cognitive reserve index. (AU)
Introducción En los últimos años se ha observado un interés creciente por la rehabilitación cognitiva en pacientes con esclerosis múltiple. Sin embargo, pocos estudios han analizado su impacto en variables como la reserva cognitiva. Analizamos el efecto de un programa de rehabilitación cognitiva que incluye ejercicios físicos y cognitivos, así como sesiones en grupo enfocadas a mejorar el rendimiento cognitivo, el estado emocional y el índice de reserva cognitiva. Métodos Nuestro estudio incluyó a 50 pacientes con esclerosis múltiple, divididos en 2 grupos: un grupo control (n = 25), en el que los pacientes realizaban ejercicio aeróbico, y un grupo experimental (n = 25), al que se administró un programa integral de rehabilitación cognitiva. Evaluamos a todos los pacientes en 3 momentos diferentes (al inicio, tras el tratamiento, y a largo plazo) con la Batería Neuropsicológica Breve, la Escala de Reserva Cognitiva, el Inventario de Depresión de Beck y una escala para medir la ansiedad rasgo y la ansiedad estado. Resultados Los pacientes del grupo experimental mostraron un mejor rendimiento cognitivo que los controles, con cambios significativos en medidas de velocidad de procesamiento de la información, atención, memoria, índice de reserva cognitiva y estado de ánimo a largo plazo. Conclusión Nuestros resultados demuestran la eficacia del programa de rehabilitación cognitiva para mejorar las funciones cognitiva y emocional de los pacientes con esclerosis múltiple y aumentar el índice de reserva cognitiva. (AU)
Subject(s)
Humans , Young Adult , Adult , Middle Aged , Multiple Sclerosis/rehabilitation , Cognition , Exercise , Cognitive Reserve , Pilot ProjectsABSTRACT
INTRODUCTION: In recent years, there has been an increase of studies dedicated to cognitive rehabilitation in patients with multiple sclerosis (MS); however, few of these analyze the impact on such variables as cognitive reserve. The study aims to explore the effects of a cognitive rehabilitation program comprising a combination of cognitive and physical exercises, as well as group sessions to improve cognitive performance, emotional state, and cognitive reserve index. METHOD: Fifty patients with MS were subdivided into 2 groups: the control group, which performed aerobic exercise (n=25), and the experimental group (n=25), which participated in the integrated cognitive rehabilitation program (ICRP). All participants were evaluated 3 times (baseline, post-treatment, and long-term) with the Brief Repeatable Battery of Neuropsychological Tests, Cognitive Reserve Scale, Beck Depression Inventory, and a scale evaluating trait and state anxiety. RESULTS: Compared with the control group, patients in the experimental group showed improvements in cognitive function, with significant changes in measures of information processing speed, attention, memory, cognitive reserve index, and long-term mood. CONCLUSIONS: The ICRP was effective in improving cognitive and emotional function in MS, and increased the cognitive reserve index.
Subject(s)
Multiple Sclerosis , Humans , Pilot Projects , Multiple Sclerosis/psychology , Cognitive Training , Cognition , AffectABSTRACT
INTRODUCTION: In recent years, there has been an increase of studies dedicated to cognitive rehabilitation in patients with multiple sclerosis (MS); however, few of these analyze the impact on such variables as cognitive reserve. The study aims to explore the effects of a cognitive rehabilitation program comprising a combination of cognitive and physical exercises, as well as group sessions to improve cognitive performance, emotional state, and cognitive reserve index. METHOD: Fifty patients with MS were subdivided into 2 groups: the control group, which performed aerobic exercise (n=25), and the experimental group (n=25), which participated in the integrated cognitive rehabilitation program (ICRP). All participants were evaluated 3 times (baseline, post-treatment, and long-term) with the Brief Repeatable Battery of Neuropsychological Tests, Cognitive Reserve Scale, Beck Depression Inventory, and a scale evaluating trait and state anxiety. RESULTS: Compared with the control group, patients in the experimental group showed improvements in cognitive function, with significant changes in measures of information processing speed, attention, memory, cognitive reserve index, and long-term mood. CONCLUSIONS: The ICRP was effective in improving cognitive and emotional function in MS, and increased the cognitive reserve index.
ABSTRACT
Episodic memory impairments caused by temporal lobe epilepsy (TLE) are well documented in the literature. Standard clinical episodic memory tests typically include a 30-min delayed recall test. However, in the past decade, it has become apparent that this standard test does not capture the full range of memory problems in TLE patients. Some patients perform well on a standard 30-min delayed recall test, but show Accelerated Long-term Forgetting (ALF) after 24 h. Although ALF has been investigated in patients with different types of epilepsy, current research on resected TLE patients is missing. In the present study, resected TLE patients were compared to a control group matched on initial learning. They showed normal performance on verbal recall after 30 min, but impairments became apparent after one week. Moreover, the significant interaction between participant group and memory test delay demonstrated that the patients indeed showed an acceleration in forgetting. Furthermore, ALF was present in both left and right resected TLE patients, which contradicts the presence of material-specific hemispheric differences in ALF. In addition, ALF was observed in seizure-free resected TLE patients, thereby demonstrating that this factor is not crucial for long-term memory deficits. The outcome shows that clinicians are likely to underestimate memory deficits in resected TLE patients and, therefore, advocates for the inclusion of ALF tests in standard clinical batteries for both pre- and post-surgery testing sessions.
Subject(s)
Epilepsy, Temporal Lobe/surgery , Memory Disorders/surgery , Memory, Long-Term/physiology , Adult , Epilepsy, Temporal Lobe/complications , Epilepsy, Temporal Lobe/diagnosis , Female , Humans , Learning/physiology , Male , Memory Disorders/etiology , Memory, Episodic , Mental Recall/physiology , Middle Aged , Neuropsychological TestsABSTRACT
According to a large neuropsychological and neuroimaging literature, the bilateral anterior temporal lobe (ATL) is a core region for semantic processing. It seems therefore surprising that semantic memory appears to be preserved in temporal lobe epilepsy (TLE) patients with unilateral ATL resection. However, recent work suggests that the bilateral semantic system is relatively robust against unilateral damage and semantic impairments under these circumstances only become apparent with low frequency specific concepts. In addition, neuroimaging studies have shown that the function of the left and right ATLs differ and therefore left or right ATL resection should lead to a different pattern of impairment. The current study investigated hemispheric differences in the bilateral semantic system by comparing left and right resected TLE patients during verbal semantic processing of low frequency concepts. Picture naming and semantic comprehension tasks with varying word frequencies were included to investigate the pattern of impairment. Left but not right TLE patients showed impaired semantic processing, which was particularly apparent on low frequency items. This indicates that, for verbal information, the bilateral semantic system is more sensitive to damage in the left compared to the right ATL, which is in line with theories that attribute a more prominent role to the left ATL due to connections with pre-semantic verbal regions.
Subject(s)
Epilepsy, Temporal Lobe/complications , Functional Laterality/physiology , Memory Disorders/etiology , Semantics , Verbal Behavior/physiology , Adolescent , Adult , Aged , Case-Control Studies , Comprehension/physiology , Epilepsy, Temporal Lobe/surgery , Female , Humans , Male , Mental Recall , Middle Aged , Names , Neuropsychological Tests , Reaction Time , Statistics, Nonparametric , Young AdultABSTRACT
INTRODUCTION: The scientific evidences associated to the effectiveness of different techniques of cognitive rehabilitation are still contradictory. AIM: To compare a program of combined training (physical and cognitive) in front of a program of physical training and to observe their effectiveness about the optimization of the cognitive functions in patients with multiple sclerosis (MS). PATIENTS AND METHODS: It was carried out an experimental study in 32 patients with MS. The patients were distributed in two groups: 16 to the experimental group (combined cognitive training with aerobic exercises) and 16 patients to the control group (aerobic exercises). The intervention was planned for six weeks combining cognitive tasks by means of a game of dynamic board of cubes and signs (TaDiCS ®) and a program of aerobic exercises. The Brief Repeatable Battery of Neuropsychological Test and the Stroop Test were applied to evaluate the cognitive yield. Also, the Beck Depression Inventory was administered. RESULTS: There were found significant differences in the intergrupal analysis after the intervention in the variable learning and visuoespacial long term memory (p = 0.000), attention (p = 0.026) and inhibitory control (p = 0.007). Also, in the intragroup analysis there were found significant differences in these variables and information processing speed in the group that received the combined training. These patients also showed a significant improvement in the emotional state (p = 0.043). CONCLUSION: The cognitive training combined with the aerobic exercises is effective to improve the cognitive performance.
TITLE: Entrenamiento cognitivo combinado con ejercicios aerobicos en pacientes con esclerosis multiple: estudio piloto.Introduccion. Las evidencias cientificas asociadas a la efectividad de distintas tecnicas de rehabilitacion cognitiva todavia resultan contradictorias. Objetivo. Comparar un programa de entrenamiento combinado (fisico y cognitivo) frente a un programa de entrenamiento fisico y observar su eficacia sobre la optimizacion de las funciones cognitivas en pacientes con esclerosis multiple (EM). Pacientes y metodos. Se realizo un estudio experimental en 32 pacientes con EM. Los pacientes se distribuyeron en dos grupos: 16 al grupo experimental (entrenamiento cognitivo combinado con ejercicios aerobicos) y 16 al grupo control (ejercicios aerobicos). La intervencion se planifico para seis semanas combinando tareas cognitivas mediante un juego de tablero dinamico de cubos y signos (TaDiCS ®) y un programa de ejercicios aerobicos. Se aplico la bateria breve repetible de tests neuropsicologicos y el test de Stroop para evaluar el rendimiento cognitivo. Ademas, se administro el inventario de depresion de Beck. Resultados. Se encontraron diferencias significativas en el analisis intergrupo despues de la intervencion en las variables aprendizaje y memoria a largo plazo visuoespacial (p = 0,000), atencion (p = 0,026) y control inhibitorio (p = 0,007). Asimismo, en el analisis intragrupo se encontraron diferencias significativas en estas variables y en la velocidad en el procesamiento de la informacion en el grupo que recibio el entrenamiento combinado. Estos pacientes tambien mostraron una mejoria significativa en el estado de animo (p = 0,043). Conclusion. El entrenamiento cognitivo combinado con los ejercicios aerobicos resulta eficaz para mejorar el funcionamiento cognitivo.
Subject(s)
Exercise Therapy , Exercise , Games, Experimental , Learning Disabilities/rehabilitation , Memory Disorders/rehabilitation , Multiple Sclerosis/therapy , Adult , Combined Modality Therapy , Disability Evaluation , Female , Humans , Learning Disabilities/etiology , Male , Memory Disorders/etiology , Middle Aged , Multiple Sclerosis/psychology , Multiple Sclerosis/rehabilitation , Neuropsychological Tests , Pilot Projects , Psychomotor Performance , Treatment OutcomeABSTRACT
Evidence suggests that sex/gender is an important factor for understanding multiple sclerosis (MS) and that some of its neuropathological consequences might manifest earlier in males. In the present study, we assessed gray matter (GM) volume and functional connectivity (FC) in a sample of female and male MS patients (MSp) and female and male healthy controls (HCs). As compared to female MSp, male MSp showed decreased GM volume in the bilateral frontal areas and increased FC between different brain regions. Because both sets of changes correlated significantly and no differences in cognitive performance were observed, we suggest that the FC increase observed in male MSp acts as a compensatory mechanism for their more extensive GM loss and that it promotes a functional convergence between male- and female-MSp.
Subject(s)
Brain/pathology , Brain/physiopathology , Gray Matter/pathology , Gray Matter/physiopathology , Multiple Sclerosis/pathology , Multiple Sclerosis/physiopathology , Adolescent , Adult , Atrophy , Brain Mapping , Female , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Sex Factors , Young AdultABSTRACT
OBJECTIVE: To evaluate the utility of an oral fMRI-adapted version of the Symbol Digit Modalities Test (SDMT) to assess information processing speed (IPS) using three different interstimulus intervals (ISI). METHODS: Nineteen right-handed healthy controls performed the adapted version of the SDMT, consisting of a block design that had a total of 6 control/activation block pairs with 3 different ISIs (1.5, 2 and 2.5s) presented in two different runs: in ascending and descending orders. The brain activation patterns during different ISIs were assessed by effective functional connectivity analysis based on independent component analysis. RESULTS: As expected, all conditions yielded activations in the fronto-parietal networks (FPNs) related to attention processes. Shorter ISIs (1.5 and 2s) not only yielded greater patterns of connectivity within fronto-parietal and occipital regions such as the FPN and fronto-occipital network (FON), but also recruited more functional networks overall. Task performance at the shortest ISI was negatively correlated with connectivity at the FPN and activity of the pre-supplementary motor area extending to the cingulate gyrus. CONCLUSION: Increasing IPS demands due to shorter ISIs resulted in an increased level and number of functional networks required, increased connectivity within the FPN and FON, and enhancement of the prefrontal cortex. IPS does not arise from activity of a single b area but from affective information transfer among distant cortical regions of the frontal and parietal cortices. This adapted version of the SDMT may be useful for studying alterations of IPS in clinical and nonclinical populations.
Subject(s)
Brain/physiology , Cognition/physiology , Nerve Net/physiology , Adult , Attention/physiology , Brain Mapping , Female , Functional Neuroimaging , Humans , Magnetic Resonance Imaging , Male , Neuropsychological Tests , Psychomotor Performance/physiologyABSTRACT
An abnormal pattern of brain activations has been shown in patients with multiple sclerosis during the performance of several cognitive tasks. The aim of this study is to investigate abnormalities of the patterns of activation/deactivation in the functional networks related to "task-positive" and "task-negative" events during the execution of the Symbol Digit Modalities Test (SDMT) in patients with clinically isolated syndromes (CIS) and preserved cognitive abilities. Eighteen CIS patients within 3 months from their first clinical attack and 15 healthy controls (HC) underwent neuropsychological assessment and performed an adapted functional magnetic resonance imaging (fMRI) version of the SDMT. "Task-positive" responses to task execution and "task-negative" activity of the default mode network were compared between groups. A regression analysis was performed to investigate the correlation between fMRI results and T2 lesion load (T2 LL) and brain atrophy. Neuropsychological performance did not differ between groups. Compared to HC, CIS patients exhibited an enhanced deactivation of the "task-negative" network at the level of the posterior cingulate cortex, whereas no differences between groups were found when the patterns of "task-positive" events were compared. A regression analysis detected a correlation (p < 0.001,r ranging from 0.62 to 0.73) between T2 LL and "task-positive" activations of areas that are part of the attention network, comprising the anterior cingulate gyrus, left prefrontal gyrus and inferior parietal lobe. No correlation was found between patterns of functional modifications and brain atrophy. CIS patients experience an enhanced pattern of brain deactivations during cognitive performances, which might contribute to their normal neuropsychological status.
Subject(s)
Brain/pathology , Cognition Disorders/etiology , Cognition Disorders/pathology , Multiple Sclerosis/complications , Neural Pathways/pathology , Problem Solving/physiology , Adult , Brain/blood supply , Brain Mapping , Cognition Disorders/diagnosis , Female , Humans , Image Processing, Computer-Assisted , Magnetic Resonance Imaging , Male , Neural Pathways/blood supply , Neuropsychological Tests , Oxygen/blood , Statistics as Topic , Young AdultABSTRACT
BACKGROUND/OBJECTIVE: To assess whether abnormalities on functional magnetic resonance imaging (fMRI) are related to cognitive function in patients at presentation with clinically isolated syndrome (CIS) suggestive of multiple sclerosis. METHODS: Eighteen patients with CIS and 15 healthy controls (HCs) performed an adapted fMRI version of the Paced Auditory Serial Addition Test (PASAT). According to their PASAT performance, CIS patients were divided into two groups: 10 with a low PASAT performance (<1 SD from the mean value of HCs) were considered 'cognitive impairment' (CI); eight patients were defined as 'cognitively preserved' (CP). Between-group differences in the patterns of brain activations and effective connectivity were assessed. RESULTS: During PASAT, compared to HCs, CIS patients showed increased activations of the bilateral inferior parietal lobe (IPL), bilateral precuneus, bilateral middle frontal gyrus (MFG), left anterior cingulate cortex (ACC), left claustrum, right thalamus and right caudate nucleus. When CIS patients were analyzed, the CI group had a more significant activation of the bilateral IPL than HCs and CP patients. Compared to CP patients, they also had more significant recruitment of the right superior parietal lobe, right cerebellum, left MFG and left ACC. The analysis of effective connectivity showed stronger connections between several regions of the right hemisphere involved in working memory function in CI patients versus CP and HC. CONCLUSIONS: During performance of the PASAT, CIS patients show abnormalities in the patterns of cortical recruitment and connectivity related to the level of their cognitive impairment.
Subject(s)
Cognition/physiology , Magnetic Resonance Imaging , Models, Neurological , Multiple Sclerosis/physiopathology , Nerve Net/physiopathology , Adolescent , Adult , Bayes Theorem , Caudate Nucleus/physiopathology , Cerebellum/physiopathology , Female , Gyrus Cinguli/physiopathology , Humans , Male , Middle Aged , Multiple Sclerosis/psychology , Parietal Lobe/physiopathology , Thalamus/physiopathology , Young AdultABSTRACT
Studying the cognitive impairment of multiple sclerosis (MS) patients is fundamental for a global understanding of this disease. Neuroimaging techniques might provide crucial data about the nature of this deficit and their progression. Accordingly to this idea, over the last years there has been a marked increase in the number of studies devoted to explore the possible relationship between the cognitive alterations of this clinical population and different sorts of neuropathological indexes provided by both, classical as well as by more recently developed techniques. The results of the studies using structural information provided by structural techniques, have revealed the important role of atrophic processes in the aethiology of cognitive decline in MS patients. However, this information needs to be complemented with newer indexes of neuropathological alterations in 'apparently normal' gray and white matter. On the other hand, functional magnetic resonance imaging studies have provided clear evidence of the existence and functional significance of neuroplastic processes that can mask the relationship between morphological markers of tissue damage and cognitive performance of MS patients. Those neuroplastic processes need to be taken into account as they might compensate the cognitive decline of this clinical population. In summary, the present review tries to provide a critic and integrative view of different studies assessing the relationship between cognitive impairment in MS patients and different kinds of information provided by neuroimaging techniques.
Subject(s)
Cognition Disorders/pathology , Cognition Disorders/physiopathology , Cognition/physiology , Multiple Sclerosis/pathology , Multiple Sclerosis/physiopathology , Neuroimaging/methods , Cognition Disorders/etiology , Disease Progression , Humans , Multiple Sclerosis/complications , Neuropsychological TestsABSTRACT
The left inferior frontal cortex, the caudate and the anterior cingulate have been proposed as the neural origin of language switching, but most of the studies were conducted in low proficient bilinguals. In the present study, we investigated brain areas involved in language switching in a sample of 19 early, high-proficient Spanish-Catalan bilinguals using a picture naming task that allowed contrasting switch and non-switch trials. Compared to the non-switching condition, language switching elicited greater activation in the head of the left caudate and the pre-SMA/ACC. When the direction of the switching was considered, the left caudate was more associated with forward switching and the pre-SMA/ACC with backward switching. The discussion is focused on the relevance of these brain structures in language control in early, high-proficient bilinguals, and the comparison with previous results in late bilinguals.
Subject(s)
Brain Mapping , Brain/physiology , Multilingualism , Adolescent , Female , Humans , Image Interpretation, Computer-Assisted , Magnetic Resonance Imaging , Male , Time Factors , Young AdultABSTRACT
BACKGROUND AND PURPOSE: Fatigue affects up to 90% of patients with MS. We assessed the regional distribution of lesions and atrophy of the normal-appearing WM and GM in patients with RRMS with fatigue compared with HC and patients with similar characteristics, but without fatigue. MATERIALS AND METHODS: From 14 patients with RRMS without fatigue, 10 with RRMS with fatigue, and 14 HC, we acquired brain dual-echo and high-resolution T1-weighted scans. Voxel-wise distributions of GM, WM damage, and T2 lesions were compared between patients with fatigued and nonfatigued MS by using SPM5 software. We report results at P < .05, FWE corrected. RESULTS: T2 lesion distribution and regional WM atrophy did not differ between patients with fatigued and nonfatigued MS. Compared with HC, patients with MS had significant WM atrophy in the posterior part of the corpus callosum and significant GM atrophy of the left superior frontal sulcus, left precentral gyrus, posterior cingulate cortex, right thalamus, and left middle frontal gyrus. No additional areas of atrophy were found in patients with nonfatigued MS compared with HC, whereas patients with fatigued MS also had atrophy of the left central sulcus. Atrophy in the left central sulcus and the precentral gyrus was more severe in patients with fatigued versus nonfatigued MS. In patients with MS, significant correlations were found between fatigue severity and GM atrophy in the left precentral gyrus (r = -0.73, P < .0001 uncorrected). CONCLUSIONS: Atrophy of the primary sensorimotor area is likely to contribute to MS-related fatigue.
Subject(s)
Brain/pathology , Echo-Planar Imaging/methods , Fatigue/diagnosis , Fatigue/etiology , Imaging, Three-Dimensional/methods , Multiple Sclerosis/complications , Multiple Sclerosis/diagnosis , Adult , Female , Humans , Male , Middle Aged , Sensitivity and SpecificityABSTRACT
Using two languages on an everyday basis appears to have a positive effect on general-purpose executive control in bilinguals. However, the neural correlates of this effect remain poorly understood. To investigate the brain bases of the bilingual advantage in executive control, we tested 21 Spanish monolinguals and 19 Spanish-Catalan early bilinguals in a non-verbal task-switching paradigm. As expected based on previous experiments on non-verbal task switching, we found activation in the right inferior frontal cortex and the anterior cingulate of monolingual participants. While bilingual participants showed a reduced switching cost, they activated the left inferior frontal cortex and the left striatum, a pattern of activation consistent with networks thought to underlie language control. Overall, these results support the hypothesis that bilinguals' early training in switching back and forth between their languages leads to the recruitment of brain regions involved in language control when performing non-linguistic cognitive tasks.
Subject(s)
Attention/physiology , Brain Mapping , Brain/physiology , Cognition/physiology , Multilingualism , Female , Humans , Image Interpretation, Computer-Assisted , Language , Male , Young AdultABSTRACT
The aims of this study were to determine which cognitive domains are evaluated by the Paced Auditory Serial Addition Test (PASAT) and to identify which of them are responsible for the poorer performance displayed by multiple sclerosis (MS) patients in this task. A total of 30 healthy controls and 30 MS patients completed the PASAT task as well as the different tests contained in the Brief Repeatable Battery of Neuropsychological Tests (BRB-N), some Wechsler Adult Intelligence Scale (WAIS-III) subtests, the Spanish version of the Chicago Multiscale Depression Inventory (CMDI), and a new PASAT-based task (ADD1) that was specifically designed for this study. Analysis of covariance and regression-based analyses were performed to identify the predictors that are most strongly associated with the PASAT scores and the between-groups differences in the performance of this task. PASAT execution was associated with scores of the Digit Backward test, Symbol Digit Modality Test (SDMT), and measures of working memory and information-processing speed. On the other hand, differences between healthy volunteers and MS patients were mainly associated with the SDMT scores. MS patients also exhibited poorer execution than controls in the ADD1 task. Our results suggest that reduced information-processing speed (and not working memory) is the primary alteration underlying the lower scores in the PASAT task (and probably other cognitive deficits) that characterize MS patients. Based on these results, we suggest that tests that capitalize the role of information-processing speed may be of special relevance in the neuropsychological assessment of this clinical population.
Subject(s)
Cognition Disorders/etiology , Mental Processes/physiology , Multiple Sclerosis/complications , Acoustic Stimulation/methods , Adult , Analysis of Variance , Female , Humans , Male , Middle Aged , Neuropsychological Tests , Psychiatric Status Rating Scales , Regression Analysis , Serial Learning/physiologyABSTRACT
INTRODUCTION: In recent years, advances have occurred in the description of cognitive alterations in multiple sclerosis (MS) patients and the development of tools for their assessment. However, in the clinical practice, the neuropsychological assessment of these patients is often non-specific and lacks appropriate standardization. Therefore the development of neuropsychological tests and batteries sensitive and specific for detecting the cognitive alterations in MS patients has become an important subject of study. AIM. To provide a short review about the recent developments in the neuropsychological assessment of MS patients. DEVELOPMENT: We introduce and discuss various sensitive and valid tests that assess cognitive functions often altered in MS patients. In addition, because of their possible impact on cognitive performance, we also present guidelines for evaluating other frequently associated problems (such as mood disorders and fatigue) in MS patients. CONCLUSIONS: The use of sensitive and specific tests makes possible to assess the neuropsychological alterations associated with MS, however, the adaptation of such tests to languages other than English (i.e. Spanish) has just begun. Besides assessing cognitive functioning, the neuropsychological assessment of MS patients should also involve the evaluation of other variables (such as depression or fatigue) that may influence cognitive performance. Improvements in assessing these domains should help to provide better and more specific protocols for the neuropsychological evaluation of MS patients.
Subject(s)
Cognition Disorders/diagnosis , Multiple Sclerosis/physiopathology , Neuropsychological Tests , Cognition Disorders/etiology , Cognition Disorders/physiopathology , Disability Evaluation , Fatigue , Humans , Language , Multiple Sclerosis/complications , Multiple Sclerosis/diagnosis , Reproducibility of Results , Sensitivity and Specificity , SpainABSTRACT
Introducción. En los últimos años, se han logrado ciertos avances en la descripción de las alteraciones cognitivas en pacientes con esclerosis múltiple (EM) y en el desarrollo de herramientas para su evaluación. Sin embargo, en la práctica clínica, la evaluación neuropsicológica de estos pacientes suele ser inespecífica y carece de una normalización adecuada. En consecuencia, el desarrollo de tests y baterías neuropsicológicos sensibles y específicos para la detección de las alteraciones cognitivas en pacientes con EM se ha convertido en una importante línea de investigación. Objetivo. Ofrecer una breve revisión de los últimos avances en la evaluación neuropsicológica de los pacientes con EM. Desarrollo. Se presentan y se consideran distintos tests sensibles y válidos para evaluar las funciones cognitivas que con frecuencia se ven alteradas en los pacientes con EM. Además, debido a su posible impacto sobre el funcionamiento cognitivo, también se presentan unas pautas para la evaluación de otros problemas que muchas veces vienen asociados en pacientes con EM (como son los trastornos del estado de ánimo y la fatiga). Conclusiones. El uso de tests sensibles y específicos facilita la evaluación de las alteraciones neuropsicológicas asociadas a la EM; no obstante, los trabajos para adaptar este tipo de tests a otros idiomas que no sean el inglés (por ejemplo, el español) acaban de empezar. Además de evaluar el funcionamiento cognitivo, la evaluación neuropsicológica de los pacientes con EM también debe contemplar la evaluación de otras variables (como la depresión o la fatiga) que pueden influir en el funcionamiento cognitivo. Las mejoras en la evaluación de estos ámbitos deberían ayudar a proporcionar protocolos que sean mejores y más específicos para la evaluación de pacientes con EM
Introduction. In recent years, advances have occurred in the description of cognitive alterations in multiple sclerosis (MS) patients and the development of tools for their assessment. However, in the clinical practice, the neuropsychological assessment of these patients is often non-specific and lacks appropriate standardization. Therefore the development of neuropsychological tests and batteries sensitive and specific for detecting the cognitive alterations in MS patients has become an important subject of study. Aim. To provide a short review about the recent developments in the neuropsychological assessment of MS patients. Development. We introduce and discuss various sensitive and valid tests that assess cognitive functions often altered in MS patients. In addition, because of their possible impact on cognitive performance, we also present guidelines for evaluating other frequently associated problems (such as mood disorders and fatigue) in MS patients. Conclusions. The use of sensitive and specific tests makes possible to assess the neuropsychological alterations associated with MS, however, the adaptation of such tests to languages other than English (i.e. Spanish) has just begun. Besides assessing cognitive functioning, the neuropsychological assessment of MS patients should also involve the evaluation of other variables (such as depression or fatigue) that may influence cognitive performance. Improvements in assessing these domains should help to provide better and more specific protocols for the neuropsychological evaluation of MS patients
Subject(s)
Humans , Cognition Disorders/diagnosis , Multiple Sclerosis/physiopathology , Neuropsychological Tests , Cognition Disorders/etiology , Cognition Disorders/physiopathology , Disability Evaluation , Fatigue , Language , Multiple Sclerosis/complications , Multiple Sclerosis/diagnosis , Reproducibility of Results , Sensitivity and Specificity , SpainABSTRACT
BACKGROUND: Previous studies to determine memory lateralization with functional MR imaging (fMRI) have used encoding or recall tasks. The convergence between the results of both tasks, however, is unknown. OBJECTIVE: The objective of this study was to investigate hemispheric asymmetries of temporal lobe activity (parahippocampus and fusiform gyri) in patients with temporal lesions by using both kinds of fMRI tasks. METHODS: By using blood oxygenation level-dependent fMRI, hemispheric asymmetries of 25 consecutive patients admitted for presurgical evaluation of memory and 12 healthy control participants were studied. Activation was induced by using the picture-encoding task (processing of complex scenes) and the hometown-walking task (requiring mental navigation through one's hometown by using landmarks given by participants themselves). RESULTS: Results in the control group showed that both tasks activated the parahippocampus similarly. The picture-encoding task, however, yielded greater posterior activations in the parahippocampus than did the hometown-walking task. As observed in other studies, more than half the patients showed contralesional representation of memory in each task. It is important to note that estimated memory lateralization from each task was different in 30% of patients, and several cases showed clear discrepancies between both tasks. CONCLUSION: Although previous studies showed that both tasks were useful for evaluating memory lateralization, the present study suggested that the administration of both tasks is necessary for presurgical evaluation of memory lateralization in patients with lesions in the temporal lobe. Therefore, both encoding and recall processes should at least be considered in the evaluation of memory.
Subject(s)
Brain Neoplasms/physiopathology , Functional Laterality , Magnetic Resonance Imaging , Memory , Temporal Lobe/physiopathology , Adult , Aged , Female , Humans , Male , Middle AgedABSTRACT
Cortical reorganization in multiple sclerosis (MS) is defined as a compensatory mechanism which requires MS patients to overactivate specific brain areas in order to perform the task as controls. To investigate this process with the Paced Auditory Serial Addition Test (PASAT) task, we selected 15 MS patients who performed the PASAT task within-normal limits and 10 healthy controls. Once selected, we used functional magnetic resonance imaging (fMRI) to investigate brain areas involved in PASAT performance in both groups. Results showed that the task activated the left frontal (BA6 and 9) and parietal cortex (BA7 and 40) in both groups, but MS patients showed a stronger activation in the left prefrontal cortex (BA9, 44 and 45) when compared with controls. These results confirmed those obtained post hoc by Audoin et al. [Audoin, B., Ibarrola, D., Ranjeva, J.P., Confort-Gouny, S., Malikova, I., Ali-Chérif, A.M., Pelletier, J., Cozzone, P., et al., 2003. Compensatory cortical activation observed by fMRI during cognitive task at the earliest stage of MS. Hum. Brain Mapp. 20, 51-58], and we interpreted this as showing true cortical reorganization.
Subject(s)
Brain Mapping , Cerebral Cortex/anatomy & histology , Cerebral Cortex/physiopathology , Memory, Short-Term/physiology , Multiple Sclerosis/psychology , Adult , Attention , Cognition , Female , Functional Laterality , Humans , Image Processing, Computer-Assisted , Magnetic Resonance Imaging , Male , Mathematics , Middle Aged , Neuropsychological TestsABSTRACT
INTRODUCTION: One of the fundamental lines followed by Neuropsychology today focuses on rehabilitation processes and their effectiveness. Cognitive rehabilitation is an eclectic process that is dependent on a number of variables. This variability makes it necessary to establish a work plan that guides the intervention carried out by professionals and also makes it clear what objectives are to be achieved, as well as the strategies and tools that must be used to reach them. The purpose of this study is to offer a practical examination of the different points that must be developed in a cognitive rehabilitation process--exemplified here in a case of bithalamic infarction. CASE REPORT: From a single case and from the specific needs of the individual, a thorough work plan is drawn up. This plan includes a description of everything from the choice of a practical framework for intervention and its underlying principles up to the different training processes, learning techniques and tools that were used and finally proved to be effective. The efficacy and safety of the different strategies and tools used are demonstrated by the short and long term results of the different neuropsychological examinations carried out, which at the same time proved the effectiveness of the work plan that was selected for application. CONCLUSIONS: A clear understanding of the value of the cognitive rehabilitation processes chosen for use helps to improve the way clinical work is carried out, with the common purpose of restoring neuropsychological deficits and increasing the individual's independence and quality of life.