Predictive Value of the Third Ventricle Width for Neurological Status in Multiple Sclerosis.

The third ventricle width (3VW) is an easily calculated measure of brain atrophy. The aim of this study was to evaluate the relation of 3VW to cognitive impairment with adjustment for demographic and clinical confounders, including depression, anxiety, and fatigue, as well as to disability in patients with multiple sclerosis (MS). Symbol Digit Modalities Test, California Verbal Learning Test, Brief Visuospatial Memory Test-Revised, Expanded Disability Status Scale (EDSS), Hospital Anxiety and Depression Scale, and Modified Fatigue Impact Scale (MFIS) were analysed in 93 patients with MS. Neuropsychological performance was compared to that of 150 healthy controls. Axial images from 3D FLAIR were used to measure 3VW. In total, 25% of MS patients were impaired in at least two neuropsychological tests. Cognitive impairment and EDSS were associated with 3VW. Age and 3VW were the strongest predictors of cognitive impairment. The multiple regression model including age, 3VW, education, EDSS, and MFIS explained 63% of the variance of neuropsychological tests results, whereas 3VW, age and duration of the disease were significant predictors of EDSS. This study confirms the predictive value of 3VW for neurological status of patients with MS, especially for cognitive impairment after adjustment for demographic and clinical confounders.

JC Virus Seroprevalence and JCVAb Index in Polish Multiple Sclerosis Patients Treated with Immunomodulating or Immunosuppressive Therapies.

The use of a highly-effective treatment for multiple sclerosis (MS) is associated with a severe risk of developing complications, such as progressive multifocal leukoencephalopathy (PML) caused by the John Cunningham virus (JCV). The aim of this study was to evaluate the correlation between anti-JCV Ab seroprevalence, anti-JCV AI, demographic and clinical factors as well as the type of therapy used in the Polish MS population. This is a multicentre, prospective and cross-sectional study involving 1405 MS patients. The seroprevalence of anti-JCV Ab and anti-JCV AI levels as well as AI categories were analysed with the use of a second-generation two-step ELISA test (STRATIFY JCV DxSelect). The overall prevalence of anti-JCV Ab was 65.8%. It was shown that seroprevalence increases with the patient's age. The seroprevalence was significantly associated with the treatment type, and the highest values (76%) were obtained from immunosuppressant-treated patients. Overall, 63.3% of seropositive patients had an antibody index (AI) level of >1.5. In the seropositive patient group, the mean AI level amounted to 2.09. Similarly to the seroprevalence, AI levels correlated with the patient's age; AI level for patients above 40 years old and from subsequent age quintiles plateaued, amounting to at least 1.55. Patients treated with immunosuppressants and immunomodulatory drugs obtained the highest (1.67) and lowest (1.35) AI levels, respectively. Of the immunosuppressants used, the highest mean AI levels were observed in mitoxantrone and cladribine groups, amounting to 1.75 and 1.69, respectively. In patients treated with immunomodulatory drugs, the lowest AI levels were observed in the dimethyl fumarate (DMF) group (1.11). The seroprevalence rate in the Polish MS population is one of the highest in Europe. The majority of seropositive patients had an anti-JCV Ab level qualifying them for a high-risk category. The highest mean AI levels are observed in patients receiving immunosuppressants, especially mitoxantrone and cladribine. Patients receiving immunomodulatory drugs have lower AI levels compared to treatment-naïve subjects, especially when treated with DMF. Further studies, especially longitudinal studies, are required to determine the impact of MS drugs on the seroprevalence of anti-JCV Ab and AI levels.

Memory in Polish multiple sclerosis patients - correlations with mood and fatigue. / Pamiec u polskich pacjentów ze stwardnieniem rozsianym ­ korelacje z nastrojem i zespolem zmeczenia.

OBJECTIVES: Assessment of the selected aspects of memory in Polish patients with multiple sclerosis (MS) and the associations between memory and clinical course, neurological status, mood, fatigue, and employment status. METHODS: The initial five learning trials of the California Verbal Learning Test (CVLT), the initial three learning trials of the Brief Visuospatial Memory Test-revised (BVMT-R), the Hospital Anxiety and Depression Scale and Modified Fatigue Impact Scale were administered to 100 MS patients and 150 healthy participants (HP). RESULTS: The MS group performed worse than the HP group on both the CVLT and the BVMT-R. The lowest scores were obtained by secondary progressive MS patients. There were significant differences between the MS and HP group on fatigue and depression, but not anxiety. Multivariate analysis showed worse neurological status was the only clinical predictor of memory disturbances. CVLT scores were significantly associated with employment status. CONCLUSIONS: Memory impairment occurs in patients with MS and affects employment status. Depressive symptoms, anxiety and fatigue, unlike neurological status, were not directly related to memory status.

Polish validation of the Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS battery): correlation of cognitive impairment with mood disorders and fatigue.

BACKGROUND: Cognitive impairment is recognised as a significant clinical issue in Multiple Sclerosis (MS). It can occur at any stage of the disease, affecting quality of life, occupational activity, and adherence to therapy. This makes the availability of a validated assessment tool for detecting and monitoring cognitive dysfunction in multiple sclerosis essential. The Brief International Cognitive Assessment for Multiple Sclerosis is a practical and simple means of administering a battery of three neuropsychological tests, and does not require any formal neuropsychological training. OBJECTIVE: To establish the validity of BICAMS in the Polish MS population; to assess the correlations of cognitive status with demographic and clinical factors, including affective symptoms and fatigue. METHODS: BICAMS was administered to 61 MS patients and 61 HC subjects. Examination of 20 participants with MS was repeated after one to three weeks to assess test-retest reliability. The patients with MS and HC subjects also completed the Hospital Anxiety and Depression Scale (HADS) and Modified Fatigue Impact Scale (MFIS). RESULTS: The MS group performed worse than the HC group in all three BICAMS components, obtaining the following values respectively: 51.7 and 56.1 (p = 0.02) for CVLT, 25 and 28 (p = 0.03) for BVMT-R, and 48.8 and 57.2 (p < 0.001) for SDMT. All BICAMS tests had very significant correlations in test-retest reliability (r = 0.83, p < 0.001 for CVLT; r = 0.84, p < 0.001 for BVMTR; r = 0.9, p < 0.001 for SDMT). 34% of MS patients presented cognitive dysfunction based on the criterion of one or more test scores below the 5th percentile value of the HC group. Significant anxiety and depressive symptoms were reported by 31.1% and 18.0% of MS patients. 31.1% of PwMS reported significant fatigue. BICAMS test results were not associated with HADS or MFIS scores. CONCLUSIONS: The Polish version of BICAMS is a valid and reliable tool for the assessment of cognitive impairment in patients with MS.

JC Virus Seroprevalence and JCVAb Index in Polish Multiple Sclerosis Treatment-Naïve Patients.

Multiple sclerosis (MS) treatment with new agents is associated with the risk of the development of progressive multifocal leukoencephalopathy (PML). The seropositivity and a high index of anti-John Cunningham virus (JCV) antibodies are some of the risk factors for PML development. The aim of this study was to assess the seroprevalence of anti-JCVAb and JCVAb index (AI), as well as its correlations with demographic and clinical characteristics in treatment-naïve Polish MS patients. This is a multicenter, prospective, and cross-sectional study involving 665 MS patients. The overall prevalence of anti-JCVAb was 65.3%, while 63.1% of seropositive patients had an index level of >1.5. The seroprevalence was shown to increase along with the patient's age. Except for age, the prevalence of anti-JCVAb was not associated with demographic or clinical data. No correlations between the index levels and the demographic or clinical data were observed. In Poland, the seroprevalence of anti-JCVAb in treatment-naïve MS patients is one of the highest in Europe. The majority of seropositive patients had an anti-JCV antibody level denoting a high-risk category. This means that we need further studies to be conducted on the individualization of MS treatment in order to provide patients with an appropriate therapeutic safety level.

Neurochemical Changes in the Brain and Neuropsychiatric Symptoms in Clinically Isolated Syndrome.

To assess cognitive impairment and affective symptoms and their association with damage to normal-appearing white matter (NAWM) in patients with clinically isolated syndrome (CIS), we compared neuropsychological test scores between patients with CIS and healthy controls and examined correlations between these and proton magnetic resonance spectroscopy (1H-MRS) outcomes in patients with CIS. Forty patients with CIS and 40 healthy participants were tested with a set of neuropsychological tests, which included the Beck Depression Inventory (BDI) and the Hospital Anxiety and Depression Scale (HADS). Single-voxel 1H-MRS was performed on frontal and parietal NAWM of patients with CIS to assess ratios of N-acetyl-aspartate (NAA) to creatine (Cr), myo-inositol (mI), and choline (Cho), as well as mI/Cr and Cho/Cr ratios. Patients with CIS had lower cognitive performance and higher scores for the BDI and anxiety subscale of HADS than healthy controls. There were significant correlations between the following neuropsychological tests and metabolic ratios in the frontal NAWM: Stroop Color-Word Test and Cho/Cr, Symbol Digit Modalities Test and mI/Cr, as well as NAA/mI, Go/no-go reaction time, and NAA/Cho, as well as NAA/mI, Californian Verbal Learning Test, and NAA/Cr. BDI scores were related to frontal NAA/mI and parietal NAA/Cr and Cho/Cr ratios, whereas HADS-depression scores were associated with frontal NAA/Cr and NAA/mI and parietal NAA/Cr and Cho/Cr ratios. HADS-anxiety correlated with parietal NAA/Cr ratio. This study suggests that neurochemical changes in the NAWM assessed with single-voxel 1H-MRS are associated with cognitive performance and affective symptoms in patients with CIS.

Behavioral variant frontotemporal dementia with dominant gait disturbances - case report. / Wariant behawioralny otepienia czolowo-skroniowego z dominujacymi zaburzeniami chodu w obrazie klinicznym - opis przypadku.

INTRODUCTION.: Behavioural variant frontotemporal dementia is a clinically and pathologically heterogeneous neurodegenerative disorder, characterised by progressive behavioural changes and executive function impairment. It is the second most common neurodegenerative cause of dementia after Alzheimer's type dementia. Atypical course of the disease, including cases with other symptoms relevantly interfering with the clinical picture, provides a challenge in the diagnostic process. AIM AND MATERIAL.: The aim of this paper is to present a case of patient with BvFTD and gait disturbance as a main reported symptom masking behavioural changes and cognitive function impairment. Gait disturbance commonly occurs at the late stage of dementia disorders. It results from gait apraxia, extrapyramidal syndrome or motor neuron dysfunction. However, it is not a predominant symptom of behavioural variant frontotemporal dementia excluding terminal stage of the disease. RESULTS: Presented case emphasises the significance of accurately gathered anamnesis with patient and his family. Behavioural variant frontotemporal dementia should be considered in cases of unexplained gait abnormalities.

Neuroimaging and genetic correlates of cognitive dysfunction in multiple sclerosis.

Cognitive impairment occurs in 40-70% of patients with multiple sclerosis (MS). It is observed even at the early stage of disease, including clinically isolated syndrome (CIS). Cognitive dysfunction develops irrespectively of the physical disability. Affected domains include: information processing speed, visuospatial abilities, attention, verbal memory and executive functions. Cognitive deficits have relevant implication because of their impact on daily living, quality of life and increased risk of conversion from CIS to MS. In the recent years the issue of cognitive impairment in MS became an important research problem. The fundamental aim is to understand the neurobiological substrates of these mental symptoms. As we know neurodegenerative process associated with the disease, pathology of cerebral cortex and damage to the normal appearing brain tissue are potentially involved in the development of cognitive symptoms. Better assessment of these cerebral changes is possible through the improvement of magnetic resonance imaging techniques. Influence of genetic profile on the course of MS, including cognitive dysfunction, is still under evaluation. Despite using the new neuroimaging methods, the substrate of cognitive impairment in MS has not been clearly defined so far. Understanding the mechanisms underlying cognitive symptoms may extend our knowledge of the pathophysiology of the disease and also contribute to the development of new strategies and objectives for treatment. This paper provides a summary of the results obtained from the application of conventional and modern magnetic resonance imaging techniques to assess structural pathologies occurring in MS as well as genetic factors and their association with cognitive dysfunction.

Does Toxoplasma gondii infection affect cognitive function? A case control study.

According to studies, latent Toxoplasma gondii infection may affect several functions of the human brain. Here we search for the association between latent toxoplasmosis and cognitive performance. We tested 70 individuals for latent T. gondii infection. There were 26 Toxoplasma-infected subjects and 44 Toxoplasma-free subjects. Within these two groups we assessed cognitive performance using a set of standardized, widely recognized neuropsychological tests: Trail Making Test, Stroop Test, Verbal Fluency Test, Digit Span Test and N-back test. The relationship between chronic toxoplasmosis and cognitive performance was assessed, with adjustment for age and sex. Patients with latent toxoplasmosis performed worse on one neuropsychological test, N-back Test--percentage of correct answers (beta -8.08; 95% CI - 15.64 to -0.53; p < 0.05) compared to seronegative patients. However, after adjustment for age and sex, no statistically significant associations between latent toxoplasmosis and the scores on any cognitive tests were noticed. As statistically significant relationship was not observed, this study does not confirm that chronic latent T. gondii infection affects cognition.