Cognitive impairment in multiple sclerosis: An exploratory analysis of environmental and lifestyle risk factors

Amato, Maria Pia; Prestipino, Elio; Bellinvia, Angelo; Niccolai, Claudia; Razzolini, Lorenzo; Pastò, Luisa; Fratangelo, Roberto; Tudisco, Laura; Fonderico, Mattia; Mattiolo, Paolo; Goretti, Benedetta; Zimatore, Giovanni Bosco; Losignore, Nunzia Alessandra; Portaccio, Emilio; Lolli, Francesco

doi:10.1371/journal.pone.0222929

Cited by 43 publications

(32 citation statements)

References 56 publications

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“…Multiple sclerosis (MS) is a common neuroinflammatory and neurodegenerative disorder of the central nervous system (CNS) [ 1 ]. The etiology of multiple sclerosis is still unknown.…”

Section: Introductionmentioning

confidence: 99%

Kappa Free Light Chains and IgG Combined in a Novel Algorithm for the Detection of Multiple Sclerosis

et al. 2020

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Background: It is well known that the cerebrospinal fluid (CSF) concentrations of free light chains (FLC) and immunoglobulin G (IgG) are elevated in multiple sclerosis patients (MS). Therefore, in this study we aimed to develop a model based on the concentrations of free light chains and IgG to predict multiple sclerosis. We tried to evaluate the diagnostic usefulness of the novel κIgG index and λIgG index, here presented for the first time, and compare them with the κFLC index and the λFLC index in multiple sclerosis patients. Methods: CSF and serum samples were obtained from 76 subjects who underwent lumbar puncture for diagnostic purposes and, as a result, were divided into two groups: patients with multiple sclerosis (n = 34) and patients with other neurological disorders (control group; n = 42). The samples were analyzed using turbidimetry and isoelectric focusing. The κIgG index, λIgG index, κFLC index, and λFLC index were calculated using specific formulas. Results: The concentrations of CSF κFLC, CSF λFLC, and serum κFLC and the values of κFLC index, λFLC index, and κIgG index were significantly higher in patients with multiple sclerosis compared to controls. CSF κFLC concentration and the values of κFLC index, λFLC index, and κIgG index differed in patients depending on their pattern type of oligoclonal bands. κFLC concentration was significantly higher in patients with pattern type 2 and type 3 in comparison to those with pattern type 1 and type 4. The κFLC index, λFLC index, and κIgG index were significantly higher in patients with pattern type 2 in comparison to those with pattern type 4. The κFLC index and κIgG index were significantly higher in patients with pattern type 2 in comparison to those with pattern type 1, and in patients with pattern type 3 compared to those with pattern type 4. The κIgG index was markedly elevated in patients with pattern type 3 compared to those with pattern type 1. In the total study group, κFLC, λFLC, κFLC index, λFLC index, κIgG index, and λIgG index correlated with each other. The κIgG index showed the highest diagnostic power (area under the curve, AUC) in the detection of multiple sclerosis. The κFLC index and κIgG index showed the highest diagnostic sensitivity, and the κIgG index presented the highest ability to exclude multiple sclerosis. Conclusion: This study provides novel information about the diagnostic significance of four markers combined in the κIgG index. More investigations in larger study groups are needed to confirm that the κIgG index can reflect the intrathecal synthesis of immunoglobulins and may improve the diagnosis of multiple sclerosis.

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“…Multiple sclerosis (MS) is a common neuroinflammatory and neurodegenerative disorder of the central nervous system (CNS) [ 1 ]. The etiology of multiple sclerosis is still unknown.…”

Section: Introductionmentioning

confidence: 99%

Kappa Free Light Chains and IgG Combined in a Novel Algorithm for the Detection of Multiple Sclerosis

et al. 2020

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“…The sleep quality of respondents was measured through the Insomnia Severity Index (ISI)(18). The total ISI score was divided into: no clinically significant insomnia (0-7), subthreshold insomnia ( 1935 SJSoiisvrJEP , Amato et al, 2014 , Amato et al, 2010 , Amato et al, 2008 , Bohnert and Breslau, 2011 , Kimerling et al, 2006 , Le et al, 2019 ), moderately severe clinical insomnia ( TAN et al, 2020 , WANG et al, 2020 , WANG C et al, 2020 , Bastien et al, 2001 , Amato et al, 2019 , Butler et al, 2016 , Feinstein et al, 2014 ) and severe clinical insomnia (https://www.nationalmssociety.org/NationalMSSociety/media/MSNationalFiles/Brochures/DMT_Consensus_MS_Coalition.pdf–28).…”

Section: Methodsmentioning

confidence: 99%

“…The SSS-DSM IV, DASS-21 and ISI scores of RRMS patients after they were approved to return to work. No (0-7) 190 (44%) Mild (Stroop, 1935;Amato et al, 2014) 32 (7.4%) Moderate (Amato et al, 2010;Amato et al, 2008;Bohnert and Breslau, 2011;Kimerling et al, 2006;Le et al, 2019) 150 (34.7%) Severe (TAN et al, 2020;Bastien et al, 2001;Amato et al, 2019) 60 (13.9%) Extremely Severe (20+) 0 (0%) Mean DASS-21 Depression score (SD) 10.9 (5.3) DASS-21 (Depression) No (0-9) 225 (52.1%) Mild (Amato et al, 2010;Amato et al, 2008;Bohnert and Breslau, 2011;Kimerling et al, 2006) 112(25.9%) Moderate (Le et al, 2019;TAN et al, 2020;Bastien et al, 2001;Amato et al, 2019;Butler et al, 2016) 80 (18.5%) Severe ( (Feinstein et al, 2014-27) 15 (3.5%) Extremely Severe (28+) 0 (0%) Mean DASS-21 Stress score (SD) 20.2 (4.9) DASS-21 (Stress)…”

Section: Tablementioning

confidence: 99%

Mental health status of relapsing-remitting multiple sclerosis Italian patients returning to work soon after the easing of lockdown during COVID-19 pandemic: A monocentric experience

Zanghì

D’Amico

Luca

et al. 2020

Multiple Sclerosis and Related Disorders

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Highlights Prolonged lockdown and business closure determined disruption of lifestyle, social isolation, and loss on personal incomes. In our cohort of Relapsing Remitting Multiple Sclerosis patients the return to work was associated with the presence of psychiatric concerns that were higher in patients who have started /switched Disease Modifying Therapies in the last 12 months or in those with higher levels of disability. Multiple Sclerosis patients, already burdened in physical and psychological terms, may be more vulnerable to the concerns and neuropsychiatric consequences related to COVID-19.

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“…Among MS patients, cognitive decline affects up to 65% of patients ( 32 ), and may include changes in memory, attention, executive function, information processing, and processing speed ( 33 ). Cognitive impairment in MS is of particular importance to menopausal patients as it has been consistently shown to worsen with older age ( 34 , 35 ), despite no consistent evidence in the literature for different frequencies of cognitive problems between men and women with MS ( 34 ).…”

Section: Clinical Assessment and Care Of Women With Msmentioning

confidence: 99%

Effects of Menopause in Women With Multiple Sclerosis: An Evidence-Based Review

et al. 2021

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Over two thirds of all individuals who develop multiple sclerosis (MS) will be women prior to the age of menopause. Further, an estimated 30% of the current MS population consists of peri- or postmenopausal women. The presence of MS does not appear to influence age of menopausal onset. In clinical practice, symptoms of MS and menopause can frequently overlap, including disturbances in cognition, mood, sleep, and bladder function, which can create challenges in ascertaining the likely cause of symptoms to be treated. A holistic and comprehensive approach to address these common physical and psychological changes is often suggested to patients during menopause. Although some studies have suggested that women with MS experience reduced relapse rates and increased disability progression post menopause, the data are not consistent enough for firm conclusions to be drawn. Mechanisms through which postmenopausal women with MS may experience disability progression include neuroinflammation and neurodegeneration from age-associated phenomena such as immunosenescence and inflammaging. Additional effects are likely to result from reduced levels of estrogen, which affects MS disease course. Following early retrospective studies of women with MS receiving steroid hormones, more recent interventional trials of exogenous hormone use, albeit as oral contraceptive, have provided some indications of potential benefit on MS outcomes. This review summarizes current research on the effects of menopause in women with MS, including the psychological impact and symptoms of menopause on disease worsening, and the treatment options. Finally, we highlight the need for more inclusion of MS patients from underrepresented racial and geographic groups in clinical trials, including among menopausal women.

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Cognitive impairment in multiple sclerosis: An exploratory analysis of environmental and lifestyle risk factors

Cited by 43 publications

References 56 publications

Kappa Free Light Chains and IgG Combined in a Novel Algorithm for the Detection of Multiple Sclerosis

Kappa Free Light Chains and IgG Combined in a Novel Algorithm for the Detection of Multiple Sclerosis

Mental health status of relapsing-remitting multiple sclerosis Italian patients returning to work soon after the easing of lockdown during COVID-19 pandemic: A monocentric experience

Effects of Menopause in Women With Multiple Sclerosis: An Evidence-Based Review

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