MS Briefs

Subjective cognitive concern in multiple sclerosis (MS) is associated with reduced thalamic and cortical gray matter volumes, areas of the brain that have been implicated in objective cognitive impairment, according to a recent study. These findings may lend neuroanatomical significance to subjective cognitive concerns and patient-reported outcomes as measured by the Quality of Life in Neurologic Disorders Measures (Neuro-QoL). A total of 158 patients with MS completed the Neuro-QoL short forms to assess subjective cognitive concerns and underwent brain magnetic resonance imaging. Regional brain volumes from regions of interest implicated in cognitive dysfunction were measured using NeuroQuant automated volumetric quantitation. Linear regression was used to analyze the relationship between subjective cognitive concerns and brain volume. Researchers found:

• Controlling for age, disease duration, gender, depression and fatigue, increased subjective cognitive concerns were associated with reduced thalamic volume (standardized β = 0.223, t₁₅₀ =2.406) and reduced cortical gray matter volume (standardized β = 0.240, t₁₅₀ = 2.777).
• Increased subjective cognitive concerns were not associated with any other regions of interest that were analyzed.

Kletenik I, Alvarez E, Honce JM, Valdez B, Vollmer TL. Subjective cognitive concern in multiple sclerosis is associated with reduced thalamic and cortical gray matter volumes. Mult Scler J Exp Transl Clin. 2019;5(1); doi:10.1177/2055217319827618.

Subjective cognitive concern in multiple sclerosis (MS) is associated with reduced thalamic and cortical gray matter volumes, areas of the brain that have been implicated in objective cognitive impairment, according to a recent study. These findings may lend neuroanatomical significance to subjective cognitive concerns and patient-reported outcomes as measured by the Quality of Life in Neurologic Disorders Measures (Neuro-QoL). A total of 158 patients with MS completed the Neuro-QoL short forms to assess subjective cognitive concerns and underwent brain magnetic resonance imaging. Regional brain volumes from regions of interest implicated in cognitive dysfunction were measured using NeuroQuant automated volumetric quantitation. Linear regression was used to analyze the relationship between subjective cognitive concerns and brain volume. Researchers found:

• Controlling for age, disease duration, gender, depression and fatigue, increased subjective cognitive concerns were associated with reduced thalamic volume (standardized β = 0.223, t₁₅₀ =2.406) and reduced cortical gray matter volume (standardized β = 0.240, t₁₅₀ = 2.777).
• Increased subjective cognitive concerns were not associated with any other regions of interest that were analyzed.

Kletenik I, Alvarez E, Honce JM, Valdez B, Vollmer TL. Subjective cognitive concern in multiple sclerosis is associated with reduced thalamic and cortical gray matter volumes. Mult Scler J Exp Transl Clin. 2019;5(1); doi:10.1177/2055217319827618.

Subjective cognitive concern in multiple sclerosis (MS) is associated with reduced thalamic and cortical gray matter volumes, areas of the brain that have been implicated in objective cognitive impairment, according to a recent study. These findings may lend neuroanatomical significance to subjective cognitive concerns and patient-reported outcomes as measured by the Quality of Life in Neurologic Disorders Measures (Neuro-QoL). A total of 158 patients with MS completed the Neuro-QoL short forms to assess subjective cognitive concerns and underwent brain magnetic resonance imaging. Regional brain volumes from regions of interest implicated in cognitive dysfunction were measured using NeuroQuant automated volumetric quantitation. Linear regression was used to analyze the relationship between subjective cognitive concerns and brain volume. Researchers found:

• Controlling for age, disease duration, gender, depression and fatigue, increased subjective cognitive concerns were associated with reduced thalamic volume (standardized β = 0.223, t₁₅₀ =2.406) and reduced cortical gray matter volume (standardized β = 0.240, t₁₅₀ = 2.777).
• Increased subjective cognitive concerns were not associated with any other regions of interest that were analyzed.

Kletenik I, Alvarez E, Honce JM, Valdez B, Vollmer TL. Subjective cognitive concern in multiple sclerosis is associated with reduced thalamic and cortical gray matter volumes. Mult Scler J Exp Transl Clin. 2019;5(1); doi:10.1177/2055217319827618.

Most patients with multiple sclerosis (MS) aged >60 who discontinued disease modifying therapy (DMT) remained off treatment, a recent study found. Among the outcomes, only the European Quality of Life 5 Dimensions (EQ-5D) index demonstrated significant differences over time, with continuers having lower quality of life scores compared to discontinuers before discontinuation (DBD). Researchers conducted a retrospective, observational study in which they identified patients from MS clinics aged ≥60 years who had been on DMT ≥2 years. They compared outcome evolution over time among treatment groups (continuers, DBD), and discontinuers after discontinuation [DAD]), by creating separate mixed-effects linear regression models that included an interaction term between time from age 60 and treatment group to study outcome trajectories. They found:

• 178 of 600 patients discontinued DMT, and 89.3% (n=159) of those who discontinued remained off DMT.
• Only the EQ-5D mixed-effects linear regression model with the interaction term was statistically significant.
• The slope relating time to EQ-5D was significantly different when comparing continuers to DBD.
• The slopes were not significantly different when comparing continuers to DAD, or when comparing the before and after discontinuation slopes among the discontinuers.

Hua LH, Harris H, Conway D, Thompson NR. Changes in patient-reported outcomes between continuers and discontinuers of disease modifying therapy in patients with multiple sclerosis over age 60. [Published online ahead of print March 1, 2019]. Mult Scler Relat Disord. doi:10.1016/j.msard.2019.02.028.

Most patients with multiple sclerosis (MS) aged >60 who discontinued disease modifying therapy (DMT) remained off treatment, a recent study found. Among the outcomes, only the European Quality of Life 5 Dimensions (EQ-5D) index demonstrated significant differences over time, with continuers having lower quality of life scores compared to discontinuers before discontinuation (DBD). Researchers conducted a retrospective, observational study in which they identified patients from MS clinics aged ≥60 years who had been on DMT ≥2 years. They compared outcome evolution over time among treatment groups (continuers, DBD), and discontinuers after discontinuation [DAD]), by creating separate mixed-effects linear regression models that included an interaction term between time from age 60 and treatment group to study outcome trajectories. They found:

• 178 of 600 patients discontinued DMT, and 89.3% (n=159) of those who discontinued remained off DMT.
• Only the EQ-5D mixed-effects linear regression model with the interaction term was statistically significant.
• The slope relating time to EQ-5D was significantly different when comparing continuers to DBD.
• The slopes were not significantly different when comparing continuers to DAD, or when comparing the before and after discontinuation slopes among the discontinuers.

Hua LH, Harris H, Conway D, Thompson NR. Changes in patient-reported outcomes between continuers and discontinuers of disease modifying therapy in patients with multiple sclerosis over age 60. [Published online ahead of print March 1, 2019]. Mult Scler Relat Disord. doi:10.1016/j.msard.2019.02.028.

Most patients with multiple sclerosis (MS) aged >60 who discontinued disease modifying therapy (DMT) remained off treatment, a recent study found. Among the outcomes, only the European Quality of Life 5 Dimensions (EQ-5D) index demonstrated significant differences over time, with continuers having lower quality of life scores compared to discontinuers before discontinuation (DBD). Researchers conducted a retrospective, observational study in which they identified patients from MS clinics aged ≥60 years who had been on DMT ≥2 years. They compared outcome evolution over time among treatment groups (continuers, DBD), and discontinuers after discontinuation [DAD]), by creating separate mixed-effects linear regression models that included an interaction term between time from age 60 and treatment group to study outcome trajectories. They found:

• 178 of 600 patients discontinued DMT, and 89.3% (n=159) of those who discontinued remained off DMT.
• Only the EQ-5D mixed-effects linear regression model with the interaction term was statistically significant.
• The slope relating time to EQ-5D was significantly different when comparing continuers to DBD.
• The slopes were not significantly different when comparing continuers to DAD, or when comparing the before and after discontinuation slopes among the discontinuers.

Hua LH, Harris H, Conway D, Thompson NR. Changes in patient-reported outcomes between continuers and discontinuers of disease modifying therapy in patients with multiple sclerosis over age 60. [Published online ahead of print March 1, 2019]. Mult Scler Relat Disord. doi:10.1016/j.msard.2019.02.028.

Recent findings support previous studies on the activities of daily living in people with multiple sclerosis (MS) and the effect of aerobic exercise on independence regarding instrumental activities of daily living (IADLs) in this population. 62 adults with MS completed an incremental exercise test as a measure of aerobic fitness (peak oxygen consumption), a demographic questionnaire, and an IADL scale and underwent a neurologic examination for characterization of disability level (ie, Expanded Disability Status Scale) in a single session. Researchers found:

• The analysis revealed a weak but significant association between aerobic fitness and total IADL score (r=0.28).
• Those reporting dependence in different IADL categories (eg, shopping, food preparation, housekeeping, laundry, and responsibility for own medication) presented with lower aerobic fitness compared with those reporting independence, although the difference was not statistically significant.

Sebastião E, Pilutti LA, Motl RW. Aerobic fitness and instrumental activities of daily living in people with multiple sclerosis. A cross-sectional study. Int J MS Care. 2019;21(1):23-28. doi:10.7224/1537-2073.2017-078.

Recent findings support previous studies on the activities of daily living in people with multiple sclerosis (MS) and the effect of aerobic exercise on independence regarding instrumental activities of daily living (IADLs) in this population. 62 adults with MS completed an incremental exercise test as a measure of aerobic fitness (peak oxygen consumption), a demographic questionnaire, and an IADL scale and underwent a neurologic examination for characterization of disability level (ie, Expanded Disability Status Scale) in a single session. Researchers found:

• The analysis revealed a weak but significant association between aerobic fitness and total IADL score (r=0.28).
• Those reporting dependence in different IADL categories (eg, shopping, food preparation, housekeeping, laundry, and responsibility for own medication) presented with lower aerobic fitness compared with those reporting independence, although the difference was not statistically significant.

Sebastião E, Pilutti LA, Motl RW. Aerobic fitness and instrumental activities of daily living in people with multiple sclerosis. A cross-sectional study. Int J MS Care. 2019;21(1):23-28. doi:10.7224/1537-2073.2017-078.

Recent findings support previous studies on the activities of daily living in people with multiple sclerosis (MS) and the effect of aerobic exercise on independence regarding instrumental activities of daily living (IADLs) in this population. 62 adults with MS completed an incremental exercise test as a measure of aerobic fitness (peak oxygen consumption), a demographic questionnaire, and an IADL scale and underwent a neurologic examination for characterization of disability level (ie, Expanded Disability Status Scale) in a single session. Researchers found:

• The analysis revealed a weak but significant association between aerobic fitness and total IADL score (r=0.28).
• Those reporting dependence in different IADL categories (eg, shopping, food preparation, housekeeping, laundry, and responsibility for own medication) presented with lower aerobic fitness compared with those reporting independence, although the difference was not statistically significant.

Sebastião E, Pilutti LA, Motl RW. Aerobic fitness and instrumental activities of daily living in people with multiple sclerosis. A cross-sectional study. Int J MS Care. 2019;21(1):23-28. doi:10.7224/1537-2073.2017-078.

Lifestyle risk factors contribute to accelerated central brain atrophy in patients with multiple sclerosis (MS), whereas unhealthier diet is associated with MS lesion accrual, a recent study found. 175 MS or clinically isolated syndrome (CIS) patients and 42 age- and sex-matched healthy controls (HCs) were enrolled and longitudinally followed for 5.5 years. The 20-year cardiovascular disease risk was calculated by Healthy Heart Score (HHS) prediction model, which includes age, smoking, body mass index, dietary intake, exercise, and alcohol consumption. Baseline and follow-up MRI scans were obtained and cross-sectional and longitudinal changes of T2-lesion volume (LV), whole brain volume (WBV), white matter volume (WMV), gray matter volume (GMV), and lateral ventricular volume (LVV) were calculated. Researchers found:

• After correcting for disease duration, the baseline HHS values of the MS group were associated with baseline GMV, and longitudinal LVV change.
• The association with LVV remained significant after adjusting for baseline LVV volumes in MS patients.
• The diet component of the HHS was associated with the 5-year T2-LV accrual in MS.
• In the HC group, the HHS was associated with LVV, GMV, WBV, T2-LV, and WMV.

Jakimovski D, Weinstock-Guttman B, Gandhi S, et al. Dietary and lifestyle factors in multiple sclerosis progression: Results from a 5-year longitudinal MRI study. [Published online ahead of print February 13, 2019]. J Neurol. doi:10.1007/s00415-019-09208-0.

Lifestyle risk factors contribute to accelerated central brain atrophy in patients with multiple sclerosis (MS), whereas unhealthier diet is associated with MS lesion accrual, a recent study found. 175 MS or clinically isolated syndrome (CIS) patients and 42 age- and sex-matched healthy controls (HCs) were enrolled and longitudinally followed for 5.5 years. The 20-year cardiovascular disease risk was calculated by Healthy Heart Score (HHS) prediction model, which includes age, smoking, body mass index, dietary intake, exercise, and alcohol consumption. Baseline and follow-up MRI scans were obtained and cross-sectional and longitudinal changes of T2-lesion volume (LV), whole brain volume (WBV), white matter volume (WMV), gray matter volume (GMV), and lateral ventricular volume (LVV) were calculated. Researchers found:

• After correcting for disease duration, the baseline HHS values of the MS group were associated with baseline GMV, and longitudinal LVV change.
• The association with LVV remained significant after adjusting for baseline LVV volumes in MS patients.
• The diet component of the HHS was associated with the 5-year T2-LV accrual in MS.
• In the HC group, the HHS was associated with LVV, GMV, WBV, T2-LV, and WMV.

Jakimovski D, Weinstock-Guttman B, Gandhi S, et al. Dietary and lifestyle factors in multiple sclerosis progression: Results from a 5-year longitudinal MRI study. [Published online ahead of print February 13, 2019]. J Neurol. doi:10.1007/s00415-019-09208-0.

Lifestyle risk factors contribute to accelerated central brain atrophy in patients with multiple sclerosis (MS), whereas unhealthier diet is associated with MS lesion accrual, a recent study found. 175 MS or clinically isolated syndrome (CIS) patients and 42 age- and sex-matched healthy controls (HCs) were enrolled and longitudinally followed for 5.5 years. The 20-year cardiovascular disease risk was calculated by Healthy Heart Score (HHS) prediction model, which includes age, smoking, body mass index, dietary intake, exercise, and alcohol consumption. Baseline and follow-up MRI scans were obtained and cross-sectional and longitudinal changes of T2-lesion volume (LV), whole brain volume (WBV), white matter volume (WMV), gray matter volume (GMV), and lateral ventricular volume (LVV) were calculated. Researchers found:

• After correcting for disease duration, the baseline HHS values of the MS group were associated with baseline GMV, and longitudinal LVV change.
• The association with LVV remained significant after adjusting for baseline LVV volumes in MS patients.
• The diet component of the HHS was associated with the 5-year T2-LV accrual in MS.
• In the HC group, the HHS was associated with LVV, GMV, WBV, T2-LV, and WMV.

Jakimovski D, Weinstock-Guttman B, Gandhi S, et al. Dietary and lifestyle factors in multiple sclerosis progression: Results from a 5-year longitudinal MRI study. [Published online ahead of print February 13, 2019]. J Neurol. doi:10.1007/s00415-019-09208-0.

The specific computerized assessment battery (CAB) evaluated is valid for cognitive screening of people with multiple sclerosis (MS) and may be more likely to detect prolonged response times and impaired executive function, according to a recent study. 81 people with MS (PwMS) and 15 healthy controls (HC) completed the CAB and a set of traditional neuropsychological tests recommended for MS on the same day. Principal component factor analysis was used to assess construct validity. For criterion validity, the gold standard definition of cognitive impairment was a score of ≥1.5SD below average on at least 1 cognitive domain, based upon traditional test normative data. Researchers found:

• Traditional and computerized tests of memory, processing speed, visuospatial, and executive function converged by factor analysis.
• Computerized tests detected cognitive impairment with 85% sensitivity and 70% specificity.
• PwMS classified as impaired on only the computerized battery had significantly prolonged response times and a higher rate of unemployment compared with PwMS classified as unimpaired on both batteries.
• Poor executive function was more likely to be revealed by the CAB.

Golan D, Wilken J, Doniger GM, et al. Validity of a multi-domain computerized cognitive assessment battery for patients with multiple sclerosis. Mult Scler Relat Disord. 2019(30):154–162. doi:10.1016/j.msard.2019.01.051.

The specific computerized assessment battery (CAB) evaluated is valid for cognitive screening of people with multiple sclerosis (MS) and may be more likely to detect prolonged response times and impaired executive function, according to a recent study. 81 people with MS (PwMS) and 15 healthy controls (HC) completed the CAB and a set of traditional neuropsychological tests recommended for MS on the same day. Principal component factor analysis was used to assess construct validity. For criterion validity, the gold standard definition of cognitive impairment was a score of ≥1.5SD below average on at least 1 cognitive domain, based upon traditional test normative data. Researchers found:

• Traditional and computerized tests of memory, processing speed, visuospatial, and executive function converged by factor analysis.
• Computerized tests detected cognitive impairment with 85% sensitivity and 70% specificity.
• PwMS classified as impaired on only the computerized battery had significantly prolonged response times and a higher rate of unemployment compared with PwMS classified as unimpaired on both batteries.
• Poor executive function was more likely to be revealed by the CAB.

Golan D, Wilken J, Doniger GM, et al. Validity of a multi-domain computerized cognitive assessment battery for patients with multiple sclerosis. Mult Scler Relat Disord. 2019(30):154–162. doi:10.1016/j.msard.2019.01.051.

The specific computerized assessment battery (CAB) evaluated is valid for cognitive screening of people with multiple sclerosis (MS) and may be more likely to detect prolonged response times and impaired executive function, according to a recent study. 81 people with MS (PwMS) and 15 healthy controls (HC) completed the CAB and a set of traditional neuropsychological tests recommended for MS on the same day. Principal component factor analysis was used to assess construct validity. For criterion validity, the gold standard definition of cognitive impairment was a score of ≥1.5SD below average on at least 1 cognitive domain, based upon traditional test normative data. Researchers found:

• Traditional and computerized tests of memory, processing speed, visuospatial, and executive function converged by factor analysis.
• Computerized tests detected cognitive impairment with 85% sensitivity and 70% specificity.
• PwMS classified as impaired on only the computerized battery had significantly prolonged response times and a higher rate of unemployment compared with PwMS classified as unimpaired on both batteries.
• Poor executive function was more likely to be revealed by the CAB.

Golan D, Wilken J, Doniger GM, et al. Validity of a multi-domain computerized cognitive assessment battery for patients with multiple sclerosis. Mult Scler Relat Disord. 2019(30):154–162. doi:10.1016/j.msard.2019.01.051.

The estimated US national multiple sclerosis (MS) prevalence for 2010 is the highest reported to date and provides evidence that the north-south gradient persists, according to a recent study. A validated algorithm was applied to private, military, and public agglomerative hierarchical clustering (AHC) datasets to identify adult cases of MS between 2008 and 2010. In each dataset, researchers determined the 3-year cumulative prevalence overall and stratified by age, sex, and census region. They applied insurance-specific and stratum-specific estimates to the 2010 US Census data and pooled the findings to calculate the 2010 prevalence of MS in the US cumulated over 3 years. They also estimated the 2010 prevalence cumulated over 10 years using 2 models and extrapolated their estimate to 2017. They found:

• The estimated 2010 prevalence of MS in the US adult population cumulated over 10 years was 309.2 per 100,000, representing 727,344 cases.
• During the same time period, the MS prevalence was 450.1 per 100,000 for women and 159.7 for men (female:male ratio 2:8).
• The estimated 2010 prevalence of MS was highest in the 55- to 64-year age group.
• A US north-south decreasing prevalence gradient was identified.

Wallin MT, Culpepper WJ, Campbell JD, et al. The prevalence of MS in the United States. A population-based estimate using health claims data. [Published online ahead of print February 15, 2019]. Neurology. doi:10.1212/WNL.0000000000007035.

The estimated US national multiple sclerosis (MS) prevalence for 2010 is the highest reported to date and provides evidence that the north-south gradient persists, according to a recent study. A validated algorithm was applied to private, military, and public agglomerative hierarchical clustering (AHC) datasets to identify adult cases of MS between 2008 and 2010. In each dataset, researchers determined the 3-year cumulative prevalence overall and stratified by age, sex, and census region. They applied insurance-specific and stratum-specific estimates to the 2010 US Census data and pooled the findings to calculate the 2010 prevalence of MS in the US cumulated over 3 years. They also estimated the 2010 prevalence cumulated over 10 years using 2 models and extrapolated their estimate to 2017. They found:

• The estimated 2010 prevalence of MS in the US adult population cumulated over 10 years was 309.2 per 100,000, representing 727,344 cases.
• During the same time period, the MS prevalence was 450.1 per 100,000 for women and 159.7 for men (female:male ratio 2:8).
• The estimated 2010 prevalence of MS was highest in the 55- to 64-year age group.
• A US north-south decreasing prevalence gradient was identified.

Wallin MT, Culpepper WJ, Campbell JD, et al. The prevalence of MS in the United States. A population-based estimate using health claims data. [Published online ahead of print February 15, 2019]. Neurology. doi:10.1212/WNL.0000000000007035.

The estimated US national multiple sclerosis (MS) prevalence for 2010 is the highest reported to date and provides evidence that the north-south gradient persists, according to a recent study. A validated algorithm was applied to private, military, and public agglomerative hierarchical clustering (AHC) datasets to identify adult cases of MS between 2008 and 2010. In each dataset, researchers determined the 3-year cumulative prevalence overall and stratified by age, sex, and census region. They applied insurance-specific and stratum-specific estimates to the 2010 US Census data and pooled the findings to calculate the 2010 prevalence of MS in the US cumulated over 3 years. They also estimated the 2010 prevalence cumulated over 10 years using 2 models and extrapolated their estimate to 2017. They found:

• The estimated 2010 prevalence of MS in the US adult population cumulated over 10 years was 309.2 per 100,000, representing 727,344 cases.
• During the same time period, the MS prevalence was 450.1 per 100,000 for women and 159.7 for men (female:male ratio 2:8).
• The estimated 2010 prevalence of MS was highest in the 55- to 64-year age group.
• A US north-south decreasing prevalence gradient was identified.

Wallin MT, Culpepper WJ, Campbell JD, et al. The prevalence of MS in the United States. A population-based estimate using health claims data. [Published online ahead of print February 15, 2019]. Neurology. doi:10.1212/WNL.0000000000007035.

In the presence of mild levels of depression or significant fatigue in persons with multiple sclerosis (MS), subjective cognitive measures are unlikely to provide accurate estimates of objective cognitive functioning. This according to a recent study that aimed to examine the degree to which depressive symptoms and fatigue in individuals with MS are associated with discrepancies between subjective and objective cognitive impairment. 99 adults with MS completed the Patient Health Questionnaire–8 (PHQ-8), Fatigue Severity Scale (FSS), MS Neuropsychological Screening Questionnaire (MSNQ), and Brief International Cognitive Assessment for MS (BICAMS). Participants were classified as “Accurates,” “Underestimators,” or “Overestimators” based on discrepancies between their MSNQ (subjective) and BICAMS (objective) scores. Researchers found:

• The PHQ-8 (r=.58) and FSS (r=.48) significantly correlated with the MSNQ, but not with the
  BICAMS (rs<.07).
• Underestimators (ie, participants who underestimated their objective cognitive functioning) exhibited higher PHQ-8 and FSS scores compared to Accurates and Overestimators.
• Optimal cut-scores of ≥6 on the PHQ-8 and ≥36 on the FSS provided fair accuracy (78% and 74%) for identifying Underestimators.
• Identification of Underestimators based on PHQ-8 and FSS scores was not moderated by any demographic or MS clinical variables.

Hughes AJ. Depressive symptoms and fatigue as predictors of objective-subjective discrepancies in cognitive function in multiple sclerosis. [Published online ahead of print January 31, 2019]. Mult Scler Relat Disord. doi:10.1016/j.msard.2019.01.055.

In the presence of mild levels of depression or significant fatigue in persons with multiple sclerosis (MS), subjective cognitive measures are unlikely to provide accurate estimates of objective cognitive functioning. This according to a recent study that aimed to examine the degree to which depressive symptoms and fatigue in individuals with MS are associated with discrepancies between subjective and objective cognitive impairment. 99 adults with MS completed the Patient Health Questionnaire–8 (PHQ-8), Fatigue Severity Scale (FSS), MS Neuropsychological Screening Questionnaire (MSNQ), and Brief International Cognitive Assessment for MS (BICAMS). Participants were classified as “Accurates,” “Underestimators,” or “Overestimators” based on discrepancies between their MSNQ (subjective) and BICAMS (objective) scores. Researchers found:

• The PHQ-8 (r=.58) and FSS (r=.48) significantly correlated with the MSNQ, but not with the
  BICAMS (rs<.07).
• Underestimators (ie, participants who underestimated their objective cognitive functioning) exhibited higher PHQ-8 and FSS scores compared to Accurates and Overestimators.
• Optimal cut-scores of ≥6 on the PHQ-8 and ≥36 on the FSS provided fair accuracy (78% and 74%) for identifying Underestimators.
• Identification of Underestimators based on PHQ-8 and FSS scores was not moderated by any demographic or MS clinical variables.

Hughes AJ. Depressive symptoms and fatigue as predictors of objective-subjective discrepancies in cognitive function in multiple sclerosis. [Published online ahead of print January 31, 2019]. Mult Scler Relat Disord. doi:10.1016/j.msard.2019.01.055.

In the presence of mild levels of depression or significant fatigue in persons with multiple sclerosis (MS), subjective cognitive measures are unlikely to provide accurate estimates of objective cognitive functioning. This according to a recent study that aimed to examine the degree to which depressive symptoms and fatigue in individuals with MS are associated with discrepancies between subjective and objective cognitive impairment. 99 adults with MS completed the Patient Health Questionnaire–8 (PHQ-8), Fatigue Severity Scale (FSS), MS Neuropsychological Screening Questionnaire (MSNQ), and Brief International Cognitive Assessment for MS (BICAMS). Participants were classified as “Accurates,” “Underestimators,” or “Overestimators” based on discrepancies between their MSNQ (subjective) and BICAMS (objective) scores. Researchers found:

• The PHQ-8 (r=.58) and FSS (r=.48) significantly correlated with the MSNQ, but not with the
  BICAMS (rs<.07).
• Underestimators (ie, participants who underestimated their objective cognitive functioning) exhibited higher PHQ-8 and FSS scores compared to Accurates and Overestimators.
• Optimal cut-scores of ≥6 on the PHQ-8 and ≥36 on the FSS provided fair accuracy (78% and 74%) for identifying Underestimators.
• Identification of Underestimators based on PHQ-8 and FSS scores was not moderated by any demographic or MS clinical variables.

Hughes AJ. Depressive symptoms and fatigue as predictors of objective-subjective discrepancies in cognitive function in multiple sclerosis. [Published online ahead of print January 31, 2019]. Mult Scler Relat Disord. doi:10.1016/j.msard.2019.01.055.

Higher baseline trait conscientiousness predicts slower rates of longitudinal cognitive decline in multiple sclerosis (MS), according to a recent study. Researchers conducted a retrospective analysis of 531 patients with MS whose data were gleaned from a multi-study database, aggregated over 16 years. Linear mixed effects modeling was applied to estimate the average rate of decline on Symbol Digit Modalities Test (SDMT) performance and to predict rates of decline using baseline clinical variables. They found:

• Participants exhibited an average estimated decline of 0.22 SDMT raw-score points/year.
• There was a significant main effect of time from baseline (t = −2.78), test form (t = 2.13), disease course (t = 2.91), age (t = −2.76), sex (t = −2.71), subjective cognitive impairment (t = −2.00), premorbid verbal intelligence (t = 5.14), and trait Conscientiousness (t = 2.69).
• A significant interaction emerged for Conscientiousness and time from baseline (t = 2.57).

Fuchs TA, Wojcik C, Wilding GE, et al. Trait Conscientiousness predicts rate of longitudinal SDMT decline in multiple sclerosis. [Published online ahead of print January 7, 2019]. Mult Scler. doi:10.1177%2F1352458518820272.

Higher baseline trait conscientiousness predicts slower rates of longitudinal cognitive decline in multiple sclerosis (MS), according to a recent study. Researchers conducted a retrospective analysis of 531 patients with MS whose data were gleaned from a multi-study database, aggregated over 16 years. Linear mixed effects modeling was applied to estimate the average rate of decline on Symbol Digit Modalities Test (SDMT) performance and to predict rates of decline using baseline clinical variables. They found:

• Participants exhibited an average estimated decline of 0.22 SDMT raw-score points/year.
• There was a significant main effect of time from baseline (t = −2.78), test form (t = 2.13), disease course (t = 2.91), age (t = −2.76), sex (t = −2.71), subjective cognitive impairment (t = −2.00), premorbid verbal intelligence (t = 5.14), and trait Conscientiousness (t = 2.69).
• A significant interaction emerged for Conscientiousness and time from baseline (t = 2.57).

Fuchs TA, Wojcik C, Wilding GE, et al. Trait Conscientiousness predicts rate of longitudinal SDMT decline in multiple sclerosis. [Published online ahead of print January 7, 2019]. Mult Scler. doi:10.1177%2F1352458518820272.

Higher baseline trait conscientiousness predicts slower rates of longitudinal cognitive decline in multiple sclerosis (MS), according to a recent study. Researchers conducted a retrospective analysis of 531 patients with MS whose data were gleaned from a multi-study database, aggregated over 16 years. Linear mixed effects modeling was applied to estimate the average rate of decline on Symbol Digit Modalities Test (SDMT) performance and to predict rates of decline using baseline clinical variables. They found:

• Participants exhibited an average estimated decline of 0.22 SDMT raw-score points/year.
• There was a significant main effect of time from baseline (t = −2.78), test form (t = 2.13), disease course (t = 2.91), age (t = −2.76), sex (t = −2.71), subjective cognitive impairment (t = −2.00), premorbid verbal intelligence (t = 5.14), and trait Conscientiousness (t = 2.69).
• A significant interaction emerged for Conscientiousness and time from baseline (t = 2.57).

Fuchs TA, Wojcik C, Wilding GE, et al. Trait Conscientiousness predicts rate of longitudinal SDMT decline in multiple sclerosis. [Published online ahead of print January 7, 2019]. Mult Scler. doi:10.1177%2F1352458518820272.

The prevalence of multiple sclerosis (MS) has increased substantially in many regions around the world since 1990, according to The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD). These recent findings will be useful for resource allocation and planning in health services. Researchers assessed the epidemiology of MS from 1990 to 2016. Data on prevalence and deaths are summarized in the indicator, disability-adjusted life-years (DALYs), which was calculated as the sum of years of life lost (YLLs) and years of life lived with a disability. They found:

• In 2016, there were 2,221,188 prevalent cases of MS globally, which corresponded to a 10.4% increase in the age-standardized prevalence since 1990.
• The highest age-standardized MS prevalence estimates per 100,000 persons were in high-income North America (164.6), western Europe (127.0), and Australasia (91.1), and the lowest were in eastern sub-Saharan Africa (3.3), central sub-Saharan African (2.8), and Oceania (2.0).
• There were 18,932 deaths due to MS and 1,151,478 DALYs due to MS in 2016.
• Globally, age-standardized death rates decreased significantly (change −11.5%), whereas the change in age-standardized DALYs was not significant (−4.2%,).

GBD 2016 Multiple Sclerosis Collaborators. Global, regional, and national burden of multiple sclerosis 1990–2016: A systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol. 2019;18(3):269-285. doi:10.1016/S1474-4422(18)30443-5.

The prevalence of multiple sclerosis (MS) has increased substantially in many regions around the world since 1990, according to The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD). These recent findings will be useful for resource allocation and planning in health services. Researchers assessed the epidemiology of MS from 1990 to 2016. Data on prevalence and deaths are summarized in the indicator, disability-adjusted life-years (DALYs), which was calculated as the sum of years of life lost (YLLs) and years of life lived with a disability. They found:

• In 2016, there were 2,221,188 prevalent cases of MS globally, which corresponded to a 10.4% increase in the age-standardized prevalence since 1990.
• The highest age-standardized MS prevalence estimates per 100,000 persons were in high-income North America (164.6), western Europe (127.0), and Australasia (91.1), and the lowest were in eastern sub-Saharan Africa (3.3), central sub-Saharan African (2.8), and Oceania (2.0).
• There were 18,932 deaths due to MS and 1,151,478 DALYs due to MS in 2016.
• Globally, age-standardized death rates decreased significantly (change −11.5%), whereas the change in age-standardized DALYs was not significant (−4.2%,).

GBD 2016 Multiple Sclerosis Collaborators. Global, regional, and national burden of multiple sclerosis 1990–2016: A systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol. 2019;18(3):269-285. doi:10.1016/S1474-4422(18)30443-5.

The prevalence of multiple sclerosis (MS) has increased substantially in many regions around the world since 1990, according to The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD). These recent findings will be useful for resource allocation and planning in health services. Researchers assessed the epidemiology of MS from 1990 to 2016. Data on prevalence and deaths are summarized in the indicator, disability-adjusted life-years (DALYs), which was calculated as the sum of years of life lost (YLLs) and years of life lived with a disability. They found:

• In 2016, there were 2,221,188 prevalent cases of MS globally, which corresponded to a 10.4% increase in the age-standardized prevalence since 1990.
• The highest age-standardized MS prevalence estimates per 100,000 persons were in high-income North America (164.6), western Europe (127.0), and Australasia (91.1), and the lowest were in eastern sub-Saharan Africa (3.3), central sub-Saharan African (2.8), and Oceania (2.0).
• There were 18,932 deaths due to MS and 1,151,478 DALYs due to MS in 2016.
• Globally, age-standardized death rates decreased significantly (change −11.5%), whereas the change in age-standardized DALYs was not significant (−4.2%,).

GBD 2016 Multiple Sclerosis Collaborators. Global, regional, and national burden of multiple sclerosis 1990–2016: A systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol. 2019;18(3):269-285. doi:10.1016/S1474-4422(18)30443-5.

Contrary to recent reports, resting core temperature is not elevated in patients with relapsing-remitting multiple sclerosis (RRMS) compared to healthy controls when measured using precision thermometry, according to a recent study. Furthermore, no association was observed between resting rectal temperature (T_re) and any subjective measures of fatigue in a subset of participants with MS. Across 2 international data collection sites (Sydney and Dallas), 28 RRMS patients and 27 aged-matched controls (CON) were exposed to either 30°C, 30% relative humidity (RH) (Sydney) or 25°C, 30% RH (Dallas). Resting T_re and esophageal (T_eso) temperature and resting oxygen consumption (VO₂) was measured in MS (n=28) and CON (n=27) groups who completed the 25°C and 30°C trials. Tympanic membrane (T_tym) temperature was measured in MS (n=16) and CON (n=15) groups in the 30°C condition. A modified fatigue impact scale (MFIS) questionnaire was used to assess subjective measures of psychosocial, physical, and cognitive fatigue in the 30°C condition. Researchers found:

• Irrespective of ambient temperature, no group differences were observed for T_re, T_eso, or resting VO₂.
• Similarly, no group differences were observed for T_tym in the 30°C condition.

Chaseling GK, Allen DR, Vucic S, et al. Core temperature is not elevated at rest in people with relapsing-remitting multiple sclerosis. [Published online ahead of print January 3, 2019]. Mult Scler Relat Disord. doi:10.1016/j.msard.2019.01.013.

Contrary to recent reports, resting core temperature is not elevated in patients with relapsing-remitting multiple sclerosis (RRMS) compared to healthy controls when measured using precision thermometry, according to a recent study. Furthermore, no association was observed between resting rectal temperature (T_re) and any subjective measures of fatigue in a subset of participants with MS. Across 2 international data collection sites (Sydney and Dallas), 28 RRMS patients and 27 aged-matched controls (CON) were exposed to either 30°C, 30% relative humidity (RH) (Sydney) or 25°C, 30% RH (Dallas). Resting T_re and esophageal (T_eso) temperature and resting oxygen consumption (VO₂) was measured in MS (n=28) and CON (n=27) groups who completed the 25°C and 30°C trials. Tympanic membrane (T_tym) temperature was measured in MS (n=16) and CON (n=15) groups in the 30°C condition. A modified fatigue impact scale (MFIS) questionnaire was used to assess subjective measures of psychosocial, physical, and cognitive fatigue in the 30°C condition. Researchers found:

• Irrespective of ambient temperature, no group differences were observed for T_re, T_eso, or resting VO₂.
• Similarly, no group differences were observed for T_tym in the 30°C condition.

Chaseling GK, Allen DR, Vucic S, et al. Core temperature is not elevated at rest in people with relapsing-remitting multiple sclerosis. [Published online ahead of print January 3, 2019]. Mult Scler Relat Disord. doi:10.1016/j.msard.2019.01.013.

Contrary to recent reports, resting core temperature is not elevated in patients with relapsing-remitting multiple sclerosis (RRMS) compared to healthy controls when measured using precision thermometry, according to a recent study. Furthermore, no association was observed between resting rectal temperature (T_re) and any subjective measures of fatigue in a subset of participants with MS. Across 2 international data collection sites (Sydney and Dallas), 28 RRMS patients and 27 aged-matched controls (CON) were exposed to either 30°C, 30% relative humidity (RH) (Sydney) or 25°C, 30% RH (Dallas). Resting T_re and esophageal (T_eso) temperature and resting oxygen consumption (VO₂) was measured in MS (n=28) and CON (n=27) groups who completed the 25°C and 30°C trials. Tympanic membrane (T_tym) temperature was measured in MS (n=16) and CON (n=15) groups in the 30°C condition. A modified fatigue impact scale (MFIS) questionnaire was used to assess subjective measures of psychosocial, physical, and cognitive fatigue in the 30°C condition. Researchers found:

• Irrespective of ambient temperature, no group differences were observed for T_re, T_eso, or resting VO₂.
• Similarly, no group differences were observed for T_tym in the 30°C condition.

Chaseling GK, Allen DR, Vucic S, et al. Core temperature is not elevated at rest in people with relapsing-remitting multiple sclerosis. [Published online ahead of print January 3, 2019]. Mult Scler Relat Disord. doi:10.1016/j.msard.2019.01.013.