Visual deficits and cognitive assessment of multiple sclerosis: confounder, correlate, or both?

Jakimovski, Dejan; Benedict, Ralph H. B.; Weinstock‐Guttman, Bianca; Ozel, Osman; Fuchs, Tom; Lincoff, Norah S.; Bergsland, Niels; Dwyer, Michael G.; Zivadinov, Robert

doi:10.1007/s00415-021-10437-5

Cited by 24 publications

(24 citation statements)

References 43 publications

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“…It correlates less strongly with EDSS and other performance measures, supporting its additive value to assess functions that are not captured by the latter [ 47 ]. Still, some correlation between LCLA and cognitive performance, measured by SDMT, has been described lately [ 78 ]. LCLA charts have some limitations such as a potential floor effect with lower contrast levels and a ceiling effect with higher contrast levels as most letters on the chart are easily readable with no potential for improvement over time [ 79 ].…”

Section: Resultsmentioning

confidence: 99%

Measuring Treatment Response in Progressive Multiple Sclerosis—Considerations for Adapting to an Era of Multiple Treatment Options

2021

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Disability in multiple sclerosis accrues predominantly in the progressive forms of the disease. While disease-modifying treatment of relapsing MS has drastically evolved over the last quarter-century, the development of efficient drugs for preventing or at least delaying disability in progressive MS has proven more challenging. In that way, many drugs (especially disease-modifying treatments) have been researched in the aspect of delaying disability progression in patients with a progressive course of the disease. While there are some disease-modifying treatments approved for progressive multiple sclerosis, their effect is moderate and limited mostly to patients with clinical and/or radiological signs of disease activity. Several phase III trials have used different primary outcomes with different time frames to define disease progression and to evaluate the efficacy of a disease-modifying treatment. The lack of sufficiently sensitive outcome measures could be a possible explanation for the negative clinical trials in progressive multiple sclerosis. On the other hand, even with a potential outcome measure that would be sensitive enough to determine disease progression and, thus, the efficacy or failure of a disease-modifying treatment, the question of clinical relevance remains unanswered. In this systematic review, we analyzed outcome measures and definitions of disease progression in phase III clinical trials in primary and secondary progressive multiple sclerosis. We discuss advantages and disadvantages of clinical and paraclinical outcome measures aiming for practical ways of combining them to detect disability progression more sensitively both in future clinical trials and current clinical routine.

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Section: Resultsmentioning

confidence: 99%

Measuring Treatment Response in Progressive Multiple Sclerosis—Considerations for Adapting to an Era of Multiple Treatment Options

2021

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“…As for the correlation between retinal thickness and disease severity in PSP, we demonstrated a significant relationship between MoCA visuospatial subscore and IRL, INL, and the total retinal layer of the 5 central regions, which remained statistically significant after correcting for multiple comparisons. Retinal thickness has been associated with cognitive performances in tests requiring visual processing in other neurological conditions including multiple sclerosis [ 23 ]. Such association may have two possible explanations.…”

Section: Discussionmentioning

confidence: 99%

“…First, greater retinal thinning may result in subclinical vision difficulties, which in turn affect the performance of cognitive testing requiring visual processing. Alternatively or complementary, greater retinal thinning may represent a marker of a more severe form of disease manifesting with poorer cognitive functions [ 23 – 25 ]. Since we missed to assess visual acuity and visual field, as well as perform neuroimaging studies in the present study, we cannot draw firm conclusions, and further studies are needed to clarify this aspect.…”

Section: Discussionmentioning

confidence: 99%

Retinal thinning in progressive supranuclear palsy: differences with healthy controls and correlation with clinical variables

et al. 2022

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Background Available evidence reports conflicting data on retinal thickness in progressive supranuclear palsy (PSP). In studies including healthy controls, PSP showed either the thinning of the retinal nerve fiber layer, macular ganglion cell, inner nuclear, or outer retina layer. Objectives The goals of the present study were to describe retinal layer thickness in a large cohort of PSP compared to healthy controls and in PSP phenotypes using spectral-domain optical coherence tomography (SD-OCT). The additional objective was to verify the relationship between retinal layers thickness and clinical variables in PSP. Methods Using a cross-sectional design, we examined retinal structure in 27 PSP patients and 27 controls using standard SD-OCT. Motor and cognitive impairment in PSP was rated with the PSP rating scale and the Montreal Cognitive Assessment battery (MoCA), respectively. Eyes with poor image quality or confounding diseases were excluded. SD-OCT measures of PSP and controls were compared with parametric testing, and correlations between retinal layer thicknesses and disease severity were evaluated. Results PSP showed significant thinning of the inner retinal layer (IRL), ganglion cell layer (GCL), inner plexiform layer (IPL), and the outer plexiform layer (OPL) compared to healthy controls. PSP phenotypes showed similar retinal layer thicknesses. Retinal layer thickness correlated with MoCA visuospatial subscore (p < 0.001). Conclusions We demonstrated PSP patients disclosed thinner IRL, GCL, IPL, and OPL compared to healthy controls. Furthermore, we found a significant correlation between visuospatial abilities and retinal layers suggesting the existence of a mutual relationship between posterior cognitive function and retinal structure.

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“…but exhibited mild decline of visual acuity that correlated with lower score of SDMT (34). Visual, oculomotor, and oral motor abilities contribute signifi cantly to performance on the SDMT and other cognitive tests (35,36). Therefore, these sensory and motor functions must be considered when interpreting SDMT scores (35,36).…”

Section: Correlation Of Sdmt With Optic Chiasmamentioning

confidence: 99%

Information-processing speed in mildly disabled relapsing-remitting multiple sclerosis patients correlates with volumetry of optic chiasma and subcortical grey matter nuclei

Kováčová¹,

Hnilicová²,

Čierný³

et al. 2022

BLL

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INTRODUCTION: Multiple sclerosis (MS) is an infl ammatory demyelinating disease leading not only to physical disability but also to cognitive dysfunction. The aim of our study was to test cognitive functions of MS patients with mild relapsing-remitting form and to fi nd out the relationship between cognitive functions and brain volumetry. METHODS: 52 patients (RRMSp) and 23 age-related healthy participants (CON) were enrolled. Mild disability was defi ned by mean EDSS 2.4 (≤ 4.0), and by median of disease duration 5.2 years. Cognitive status was tested using Single Digit Modality Test (SDMT). Brain volumetry was processed in FreeSurfer 2.0.0. RESULTS: RRMSp patients showed signifi cantly lower SDMT score than CON. SDMT results correlated positively with volume of thalamus, putamen and nc. caudate, and negatively with optic chiasma volume. Compared with CON, RRMSp presented with signifi cantly lower volume in left and right nc. accumbent, cuneus and insular GM, right putamen, total brain cortical grey matter (GM), white matters hypointensities, and 3 rd ventricular widths. CONCLUSION: To our best knowledge, this is the fi rst study that presents results showing a correlation of lower SDMT with higher optic chiasma volume, due to its subclinical chronic demyelination. We confi rmed that GM atrophy is involved in cognitive functions in MS (Tab.

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Visual deficits and cognitive assessment of multiple sclerosis: confounder, correlate, or both?

Cited by 24 publications

References 43 publications

Measuring Treatment Response in Progressive Multiple Sclerosis—Considerations for Adapting to an Era of Multiple Treatment Options

Measuring Treatment Response in Progressive Multiple Sclerosis—Considerations for Adapting to an Era of Multiple Treatment Options

Retinal thinning in progressive supranuclear palsy: differences with healthy controls and correlation with clinical variables

Information-processing speed in mildly disabled relapsing-remitting multiple sclerosis patients correlates with volumetry of optic chiasma and subcortical grey matter nuclei

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