Word finding, prosody and social cognition in multiple sclerosis.

BACKGROUND: Impairments in speech and social cognition have been reported in people with multiple sclerosis (pwMS), although their relationships with neuropsychological outcomes and their clinical utility in MS are unclear. OBJECTIVES: To evaluate word finding, prosody and social cognition in pwMS relative to healthy controls (HC). METHODS: We recruited people with relapsing MS (RMS, n = 21), progressive MS (PMS, n = 24) and HC (n = 25) from an outpatient MS clinic. Participants completed a battery of word-finding, social cognitive, neuropsychological and clinical assessments and performed a speech task for prosodic analysis. RESULTS: Of 45 pwMS, mean (SD) age was 49.4 (9.4) years, and median (range) Expanded Disability Severity Scale score was 3.5 (1.0-6.5). Compared with HC, pwMS were older and had slower information processing speed (measured with the Symbol Digit Modalities Test, SDMT) and higher depression scores. Most speech and social cognitive measures were associated with information processing speed but not with depression. Unlike speech, social cognition consistently correlated with intelligence and memory. Visual naming test mean response time (VNT-MRT) demonstrated worse outcomes in MS versus HC (p = .034, Nagelkerke's R2  = 65.0%), and in PMS versus RMS (p = .009, Nagelkerke's R2  = 50.2%). Rapid automatised object naming demonstrated worse outcomes in MS versus HC (p = .014, Nagelkerke's R2  = 49.1%). These word-finding measures showed larger effect sizes than that of the SDMT (MS vs. HC, p = .010, Nagelkerke's R2  = 40.6%; PMS vs. RMS, p = .023, Nagelkerke's R2  = 43.5%). Prosody and social cognition did not differ between MS and HC. CONCLUSIONS: Word finding, prosody and social cognition in MS are associated with information processing speed and largely independent of mood. Impairment in visual object meaning perception is potentially a unique MS disease-related deficit that could be further explored and cautiously considered as an adjunct disability metric for MS.

Interpreting the clinical importance of the relationship between subjective fatigue and cognitive impairment in multiple sclerosis (MS): How BICAMS performance is affected by MS-related fatigue.

BACKGROUND: There is evidence that subjective fatigue can influence cognitive functioning in multiple sclerosis (MS). DeLuca et al.'s (2004) Relative Consequence Model proposes that impairments to other high-level cognitive functions, such as memory, result from the disease's effect on information processing speed. OBJECTIVE: The primary aims of the study were to investigate both 1) the relationship between subjective fatigue and cognitive functioning, as measured by the widely used Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS) in MS; and 2) the consequential effect of fatigue on information processing speed as predicted by the Relative Consequence Model. METHODS: 192 participants with MS attending tertiary referral MS centre completed the Modified Fatigue Impact Scale and BICAMS. RESULTS: Multiple correlation analyses determined that there were statistically significant relationships between all domains assessed by the BICAMS and levels of fatigue, such that higher levels of self-reported fatigue were associated with lower performance on information-processing, and visual and verbal learning. After controlling for information processing speed, the strength of correlation between fatigue and learning performance weakened. Linear regression analysis showed that fatigue predicted the most variance in verbal learning and 11.7% of the overall variance in BICAMS performance. CONCLUSION: Subjective fatigue and objective cognitive performance in MS are related. Caution is advised in the interpretation of BICAMS scores in cases where high levels of fatigue are present, and more detailed neuropsychological assessments may be required in order to accurately identify objective cognitive impairment independent of subjective fatigue.

Association between speech rate measures and cognitive function in people with relapsing and progressive multiple sclerosis.

Background: Cognitive impairments are well-documented in multiple sclerosis (MS), while speech impairments are often overlooked despite their significant effect on quality of life. For effective clinical management of multisystem conditions such as MS, consideration should be given to the interaction between deficits in multiple domains, such as speech and cognition. To evaluate speech rate measures of spontaneous and read speech, in people with MS and to examine the link between speech and cognition. Methods: Forty-five people with MS and 25 controls underwent an extensive cognitive battery, including executive functioning, information processing and memory tasks, and completed two speech tasks: a reading task and a picture description task, from which speech rate measures were derived. Results: The progressive MS cohort had reduced articulation (p < 0.04) and speech rate (p < 0.02) compared to controls and those with relapsing MS. Regression models also revealed information processing speed accounted for 18% to 30% of the variance of spontaneous speech rate measures, and 27% of read speech. Executive functioning accounted for a further 10% of the variance of speech rate in those with MS. Conclusions: The present study suggests that speech production is contingent on cognitive ability, with information processing speed and executive functioning linked with speech timing patterns.

Investigating the association of mood and fatigue with objective and subjective cognitive impairment in multiple sclerosis.

Discrepancies between subjective cognitive difficulties and objective measures of cognitive function in people with MS have been identified and may be related to mood and fatigue. The aim of the present study was to examine associations of depression and fatigue with discrepancies between subjective and objective cognitive functioning in pwMS. 177 participants with MS attending a University Hospital Department of Neurology MS Outpatient clinic completed the Brief International Cognitive Assessment for MS (BICAMS), MS Neuropsychological Questionnaire (MSNQ), Hospital Anxiety and Depression Scale (HADS) and Modified Fatigue Impact Scale (MFIS). To quantify the discrepancy between objective (BICAMS) and subjective (MSNQ) cognitive functioning, discrepancy scores were calculated by subtracting MSNQ z-score from composite BICAMS z-score. Based on their discrepancy score, participants were grouped as 'Underestimated', 'Overestimated' and 'Non-discrepant'. 39% of the total sample demonstrated poorer subjective cognitive functioning than their objective cognitive performance suggested ('Underestimated'). 23% of the total sample indicated lower objective scores than their subjective report suggests ('Overestimated'). 38% participants indicated relatively no discrepancy between objective and subjective cognitive measures ('Non-discrepant'). Significant differences were observed between the discrepancy groups in terms of depression and fatigue, with the 'Underestimated' group demonstrating greater levels of depression and fatigue (ps < .01). Regression analysis indicated that cognitive fatigue and depression significantly contributed to variance in subjective cognitive functioning. Our findings suggest that subjective reports of cognitive function may be influenced by depression and fatigue, emphasising the importance of cognitive, mood and fatigue screening as part of routine clinical care.

Rural origin, age, and endoparasite fecal prevalence in dogs surrendered to the Regina Humane Society, 2013.

We report the results of fecal parasite surveillance in dogs surrendered to the Regina Humane Society, Saskatchewan, Canada, between May and November 2013. Overall, 23% of 231 dogs were infected with at least 1 intestinal parasite. Endoparasite infection was positively associated with rural origin (P = 0.002) and age (< 12 months; P < 0.001).

Origine rurale, âge et prévalence des endoparasites fécaux chez les chiens livrés à la Regina Humane Society, 2013. Nous rapportons les résultats de la surveillance de parasites fécaux chez les chiens livrés à la Regina Humane Society (Saskatchewan, Canada) entre mai et novembre 2013. En tout, 23 % des 231 chiens ont été infectés avec au moins un parasite intestinal. L'infection aux endoparasites a été positivement associée à une origine rurale (P = 0,002) et à l'âge (< 12 mois; P < 0,001).(Traduit par Emilie Bouchard).

Effects of sub-zero storage temperatures on endoparasites in canine and equine feces.

Fecal samples from wild and domestic carnivores are routinely frozen for three days at -80°C to kill eggs of Echinococcus spp., following recommendations from the World Health Organization (WHO) and World Organization for Animal Health (OIE). This is done to decrease the risk of zoonotic infection with these pathogenic cestodes. In addition, it is often necessary to freeze fecal samples collected for research prior to batch processing by a limited number of personnel, especially large numbers of samples or those collected in remote locations. The effect of freezing on the recovery of endoparasite eggs, cysts and oocysts from fecal samples is not well documented, even in hosts for which veterinary diagnostic submissions are relatively common. In this study, fecal samples from naturally infected dogs and horses were split into four treatment groups: fresh; -80°C for 3 days; -20°C for 30 days; and -80°C for 3 days followed by -20°C for an additional 30 days. Temperatures and times were chosen to simulate diagnostic and research protocols currently in place. Helminth eggs and sporocysts of Sarcocystis spp. were counted using a quantitative double centrifugation sucrose fecal flotation (modified Stoll egg count). Repeated measures ANOVA was used to detect differences in egg/sporocyst counts between the treatment groups for Sarcocystis spp. sporocysts, taeniid eggs (Taenia and/or Echinococcus spp.), ascarid eggs (Parascaris equorum, Toxocara canis, Toxascaris leonina), and strongylid type eggs (Uncinaria stenocephala, and equine strongylids, most likely cyathostomins). Counts for P. equorum and strongylid type eggs (both equine and canine) decreased significantly following freezing. Post-freezing, some samples that had been positive on fresh examination became negative for Parascaris and strongylid eggs. This study suggests that protocols requiring freezing artificially lowers recovery of eggs of Parascaris and strongylid nematodes in fecal surveys; however, recovery rates for eggs of other helminth species as well as sporocysts of Sarcocystis spp. were relatively robust compared to the freshly tested fecal samples. This is reassuring for large scale fecal surveys needed for fecal egg count reduction analyses following treatment, and for surveillance in wildlife and remote human and animal populations.

Can case management interventions reduce the number of emergency department visits by frequent users?

This study examined the impact of nurse case management interventions on the number of visits of frequent users of a level 1, urban Emergency Department that sees over 70,000 patient visits per year. Frequent users, defined as those having over 3 visits in a month, were tracked before and after implementation of nurse case management interventions designed to reduce their visit rate. It is a 50-patient pilot study and data collection includes whether or not the patient had a primary care provider, the patient's age and gender, insurance status, and the type of case management interventions including medical social work, community referrals, referrals to primary care providers, and limitation of narcotic prescriptions. Based on statistical tests, pre and post case management interventions suggest that case management interventions do not make a statistically significant reduction in the overall number of visits. This is a medically vulnerable patient group whose visits add to the contemporary problem of Emergency Department overcrowding. The ability of case management interventions to reduce the volume of visits and associated impact on reducing Emergency Department overcrowding was not proven.