Feasibility of cognitive rehabilitation in patients with advanced multiple sclerosis: A pilot study.

BACKGROUND: The feasibility of cognitive rehabilitation is rarely investigated in patients with advanced multiple sclerosis. METHODS: Eighteen patients with advanced multiple sclerosis (median EDSS = 7.5) were randomized into restorative or compensatory cognitive rehabilitation. Feasibility was determined by adherence rate, completion rate, patient satisfaction, self-reported fatigue, training difficulty, and training duration. RESULTS: Adherence rates and completion rates were over 70%, and patients were highly satisfied in both groups. Energy levels decreased minimally during the sessions (pre = 6.9 vs post = 6.4). Training difficulty (4.6) and duration (5.7) were close to ideal (scale 1-10, 5 = ideal). CONCLUSIONS: Cognitive rehabilitation, with minor adjustments, appears feasible in patients with advanced multiple sclerosis.

Sensory Function and Chronic Pain in Multiple Sclerosis.

Objective: To examine whether hypoesthesia and chronic pain are related in patients with MS. Methods: Sixty-seven MS patients with pain and 80 persons without MS were included. Sensory functioning was tested by bedside neurological examination. Touch, joint position (dorsal column-medial lemniscus pathway), temperature sense, and pain (spinothalamic tract) were tested. Pain intensity was measured by the Colored Analogue Scale (CAS Intensity) and the Faces Pain Scale (FPS); pain affect was also measured by CAS Affect and Number of Words Chosen-Affective (NWC-A). Mood was assessed with the SCL-90 anxiety and depression subscales and the Beck Depression Inventory (BDI). Results: A significant negative relationship was found between pain intensity and the function of the dorsal column-medial lemniscal pathway, but not with the spinothalamic tract. Conclusion: In addition to the already known relation between hyperesthesia and pain, hypoesthesia for touch and joint position also seems to be related to chronic pain in MS patients.

Psychiatric and physical comorbidities and pain in patients with multiple sclerosis.

BACKGROUND: It has been observed that patients with multiple sclerosis (MS), who have psychiatric and physical comorbidities such as depression and COPD, have an increased risk of experiencing more pain. In this study, we have distinguished between pain intensity and pain affect, as the latter, particularly, requires treatment. Furthermore, while pain and comorbidities have been assessed using questionnaires, this is possibly a less reliable method for those who are cognitively vulnerable. OBJECTIVE: The aim of this study was to determine whether psychiatric and physical comorbidities can predict pain intensity and pain affect in MS patients, susceptible to cognitive impairment. METHODS: Ninety-four patients with MS and 80 control participants participated in this cross-sectional study. Besides depression and anxiety, 47 additional comorbidities were extracted from patients' medical records. Depression and anxiety were assessed using the Beck Depression Inventory and the Symptom Check List-90. Pain was assessed using the Number of Words Chosen Affective, Coloured Analog Scale, and the Faces Pain Scale. Cognitive functions, for example, memory and executive functions, were assessed using several neuropsychological tests. RESULTS: The main findings indicate that psychiatric comorbidities (depression and anxiety) predict both pain intensity and pain affect and that total physical comorbidity predicts only pain affect in MS patients, susceptible to cognitive impairment. CONCLUSION: Both psychiatric and physical comorbidities predict pain affect. All three clinical outcomes enhance MS patients' suffering.

Dissociations between Spatial and Temporal Order Memory: A Neuropsychological Patient Study.

OBJECTIVES: In complex real life situations, memories for temporal and spatial information are naturally linked since sequential events coincide in time and space. Whether this connection is inseparable or instead whether these processes are functionally dissociable was investigated in this patient study. METHODS: Spatial object-location and temporal order memory tasks were administered to 36 stroke patients and 44 healthy control participants. RESULTS: On group level, patients with a stroke in the left hemisphere performed worse on temporal order memory, compared to the control participants. On individual level, using a multiple case-study approach, a clear pattern of dissociations was found between memory for temporal and for spatial features. CONCLUSIONS: These findings indicate that location and temporal order memory contain functionally separable processes. This adds to our understanding of how context information is processed in human memory. (JINS, 2017, 23, 421-430).

Transcranial direct current stimulation to the parietal cortex in hemispatial neglect: A feasibility study.

OBJECTIVES: Prior research suggests that dampening neural activity of the intact, presumably overactive hemisphere, combined with increasing neural activity in the damaged hemisphere, might restore cortical interhemispheric balance and reduce neglect. In the present study we repeatedly applied a relatively new technique, transcranial direct current stimulation (tDCS), to the posterior parietal cortex to modulate spontaneous neural activity levels in a polarity dependent fashion to find evidence for improvements in severe hemispatial neglect in chronic patients. METHODS: Eighty-nine patients were initially identified from our databases as having neglect, after thoroughly screening databases, consulting medical practitioners and baseline testing, only five met our inclusion criteria and agreed to participate. Sixty-five patients were excluded as they did not meet safety criteria for tDCS (epilepsy, metal implants), suffered from other medical conditions (i.e., heart disease, epilepsy, current psychiatric disorder) or displayed only mild neglect at baseline testing. Five patients with severe chronic hemispatial neglect were enrolled in a double-blind, placebo-controlled treatment program. TDCS or placebo was applied for 20 minutes over the left (cathodal) and right (anodal) posterior parietal cortex at an intensity of 2 mA on five consecutive days. Treatment conditions were separated by a four week wash-out period. Baseline corrected change in performance on the conventional subtests of the Behavioral Inattention Test (BIT) was our primary endpoint. RESULTS: No treatment-related effects were observed for the BIT change scores and performance on individual subtests. Moreover, patients' performance somewhat improved only during the stimulation period (day one vs day five, irrespective of whether it was placebo or tDCS), but not thirty days later, indicating a practice effect. DISCUSSION: The present study does not provide evidence that tDCS to the posterior parietal cortex improves chronic hemispatial neglect. As a result of in- and exclusion health and safety criteria the majority of patients were excluded, which indicates that performing large randomized controlled trials is not feasible in chronic neglect patients.

Functional correlates of prospective memory in stroke.

INTRODUCTION: Prospective memory is the ability to remember actions to be performed later in time or when a certain event occurs. Multiple cognitive processes are involved in prospective memory, and the degree to which automatic or effortful processes are involved may differ for different types of prospective memory tasks. This study aimed to investigate prospective memory (dys)functioning in stroke patients, and to get more insight in which cognitive processes are involved in time- versus event-based prospective memory. METHODS: We investigated 39 community-dwelling stroke survivors and 53 matched control participants. Assessment included naturalistic and experimental event- and time-based prospective memory tasks, as well as standard neuropsychological measures of (retrospective) memory, processing speed and attention/executive functioning. RESULTS: 41% of the stroke patients performed significantly worse than control participants on prospective memory tasks. Deficits in prospective memory occurred as frequently as impairments in retrospective memory (33%, χ(2)(1, N=39)=3.4, p=.066), and more often than impairments in attention/executive functioning (15%, χ(2)(1, N=39)=5.2, p=.022) and speed of processing (23%, χ(2)(1, N=39)=6.5, p=.011). Regression analyses showed that event-based ('focal') prospective memory is supported by retrospective memory, indicating that it is a relatively simple and automatic process. Time-based (non-'focal') prospective memory proved to be a more complex process, requiring active monitoring of the environment. Performance was predicted by speed of processing, attention/executive functioning and retrospective memory. Thirteen percent of the patients suffered from selective prospective memory impairment, which was associated with damage to the superior temporal gyrus. CONCLUSIONS: Impairment of prospective memory occurs frequently after stroke. Different cognitive operations are involved in distinct types of prospective memory. Results fit within the multi-process framework of prospective memory and help further specify its contents.

Is navigation ability a problem in mild stroke patients? Insights from self-reported navigation measures.

OBJECTIVE: The aim of this study was to measure the prevalence of navigation problems in patients with mild stroke, using a navigation questionnaire (the Wayfinding Questionnaire; WQ). In addition, the correlations between WQ scores and quality of life measures and neuropsychological test scores were studied. METHODS: A sample of 62 patients with mild stroke completed a questionnaire measuring self-reported navigation ability and spatial anxiety. A subset of this sample (n = 31) also completed a questionnaire on quality of life. Additional relevant neuropsychological data were retrieved from medical files and correlated with WQ and quality of life scores. RESULTS: The results indicate that self-reported navigation impairment occurs in a substantial proportion of patients (29.0%), compared with a large control group (n = 384) of which 19.9% showed impairment. Moreover, these ratings are closely linked to quality of life and negatively correlated with spatial anxiety. The neuro-psychological data show that there is very little correlation between scores on commonly administered tests and navigation ability, which is in line with the results of a previous study. CONCLUSION: As our data indicate that navigation impairment is common among patients with mild stroke, we recommend a specific focus on navigation ability as part of neuropsychological assessment. This focus is currently lacking. Furthermore, the use of dedicated, experimental navigation tests in cases of explicit problems with navigation should be considered, in order objectively to measure such impairments.

Remember to buy milk on the way home! A meta-analytic review of prospective memory in mild cognitive impairment and dementia.

Prospective memory (PM) is the ability to remember to execute delayed intentions. Previous studies indicate that PM is impaired in persons with mild cognitive impairment (MCI) and dementia, but the extent, nature, and cognitive correlates are unclear. A meta-analytic review was, therefore, performed (literature search 1990 to July 2011) on case-control studies on PM in dementia (10 studies, 336 patients, 505 controls) and MCI (7 studies, 225 patients, 253 controls). Differences between event-based and time-based PM and between measures of prospective and retrospective memory were examined, as well as correlations with other cognitive functions. Results showed that patients with dementia or MCI exhibit large deficits in PM (Hedges' d -1.62 [95% confidence interval -1.98 to -1.27; p < .0001] for dementia; -1.24 [-1.51 to -0.995; p < .0001] for MCI; difference dementia vs. MCI: QM = 1.94, p = .16). Impairments were comparable in size for event-based and time-based PM (p > .05), as well as for prospective and retrospective memory (p > .05). PM showed modest correlations with measures of retrospective memory (median r = 0.27) and executive functioning (median r = 0.30). PM appears a valid construct in neuropsychological assessment in patients with dementia or MCI, but more insight is needed in the optimal characteristics of PM tasks to be used in clinical practice.

Spatial and temporal aspects of navigation in two neurological patients.

We present two cases (A.C. and W.J.) with navigation problems resulting from parieto-occipital right hemisphere damage. For both the cases, performance on the neuropsychological tests did not indicate specific impairments in spatial processing, despite severe subjective complaints of spatial disorientation. Various aspects of navigation were tested in a new virtual reality task, the Virtual Tübingen task. A double dissociation between spatial and temporal deficits was found; A.C. was impaired in route ordering, a temporal test, whereas W.J. was impaired in scene recognition and route continuation, which are spatial in nature. These findings offer important insights in the functional and neural architecture of navigation.