Differential diagnosis, discerning depression from cognition

Portaccio, Emilio

doi:10.1111/ane.12652

Cited by 15 publications

(11 citation statements)

References 37 publications

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“…In contrast to previous data, 32 the applied battery of tests did not reveal an association between depression and cognition in the current study. This might be due to the mild severity of both or be attributed to a short disease duration with preserved cognition leading to patients with depression still performing well in cognitive screening.…”

Section: Discussioncontrasting

confidence: 99%

Treatment choices and neuropsychological symptoms of a large cohort of early MS

Bismarck

Dankowski²,

Ambrosius³

et al. 2018

Neurol Neuroimmunol Neuroinflamm

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ObjectiveTo assess clinical characteristics, distribution of disease-modifying treatments (DMTs), and neuropsychological symptoms in a large cohort of patients with early-stage MS.MethodsThe German National MS Cohort is a multicenter prospective longitudinal cohort study that has recruited DMT-naive patients with clinically isolated syndrome (CIS) and relapsing-remitting MS (RRMS) since 2010. We evaluated their baseline characteristics and the prevalence of neuropsychological symptoms.ResultsOf 1,124 patients, with a 2.2:1 female-to-male ratio and median age at onset of 31.71 years (interquartile range [IQR]: 26.06–40.33), 44.6% and 55.3% had CIS and RRMS, respectively. The median Expanded Disability Status Scale (EDSS) score at baseline was 1.5 (IQR: 1.0–2.0). A proportion of 67.8% of patients started DMT after a median time of 167.0 days (IQR 90.0–377.5) since the first manifestation. A total of 64.7% and 70.4% of the 762 patients receiving early DMT were classified as CIS and RRMS, respectively. Fatigue, depressive symptoms, and cognitive dysfunction were detected in 36.5%, 33.5%, and 14.7% of patients, respectively.ConclusionBaseline characteristics of this large cohort of patients with early, untreated MS corroborated with other cohorts. Most patients received early DMT within the first year after disease onset, irrespective of a CIS or RRMS diagnosis. Despite the low EDSS score, neuropsychological symptoms affected a relevant proportion of patients.

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Section: Discussioncontrasting

confidence: 99%

Treatment choices and neuropsychological symptoms of a large cohort of early MS

Bismarck

Dankowski²,

Ambrosius³

et al. 2018

Neurol Neuroimmunol Neuroinflamm

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“…In the present study we observed moderate levels of depression in both groups, but depressive symptomatology, and particularly somatic symptoms, improved only in the ITG group. This finding underlines the link between depression and cognitive performance in MS ( Portaccio, 2016 ). At the behavioral level, depression seems to alter attentional capacity, working memory and executive functions.…”

Section: Discussionsupporting

confidence: 72%

“…At the behavioral level, depression seems to alter attentional capacity, working memory and executive functions. This interaction is not surprising, considering the overlap between emotional regulatory regions and the executive network, and the results of neuroimaging studies in depressed patients with MS reporting an involvement of frontal areas ( Portaccio, 2016 ). However, a dysexecutive syndrome secondary to MS might precipitate depression, by altering emotional processing and favoring use of maladaptive cognitive strategies.…”

Section: Discussionmentioning

confidence: 90%

Integrated Cognitive and Neuromotor Rehabilitation in Multiple Sclerosis: A Pragmatic Study

Barbarulo

Lus

Signoriello

et al. 2018

Front. Behav. Neurosci.

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Background: Few studies examined the effects of combined motor and cognitive rehabilitation in patients with multiple sclerosis (MS). The present prospective, multicenter, observational study aimed to determine the efficacy of an integrated cognitive and neuromotor rehabilitation program versus a traditional neuromotor training on walking, balance, cognition and emotional functioning in MS patients.Methods: Sixty three MS patients were selected and assigned either to the Integrated Treatment Group (ITG; n = 32), receiving neuropsychological treatment (performed by ERICA software and paper–pencil tasks) complemented by conventional neuromotor rehabilitation, or to the Motor Treatment Group (n = 31) receiving neuromotor rehabilitation only. The intervention included two 60-min sessions per week for 24 weeks. At baseline and at end of the training all patients underwent a wide-range neuropsychological, psychological/emotional, and motor assessment.Results: At baseline the two groups did not differ for demographic, neuropsychological, psychological/emotional, and motor features significantly. After rehabilitation, only ITG group significantly (p-corrected for False Discovery Rate) improved on test tapping spatial memory, attention and cognitive flexibility, as well as on scales assessing depression and motor performance (balance and gait). A regression analysis showed that neuropsychological and motor improvement was not related to improvements in fatigue and depression.Conclusion: The present study demonstrated positive effects in emotional, motor, and cognitive aspects in MS patients who received an integrated cognitive and neuromotor training. Overall, results are supportive of interventions combining motor and cognitive training for MS.

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“…Depression and anxiety appear to worsen memory, processing speed and executive functioning in people with MS. 105 – 107 , 138 , 139 …”

Section: Introductionmentioning

confidence: 99%

Recommendations for cognitive screening and management in multiple sclerosis care

et al. 2018

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Purpose:To promote understanding of cognitive impairment in multiple sclerosis (MS), recommend optimal screening, monitoring, and treatment strategies, and address barriers to optimal management.Methods:The National MS Society (“Society”) convened experts in cognitive dysfunction (clinicians, researchers, and lay people with MS) to review the published literature, reach consensus on optimal strategies for screening, monitoring, and treating cognitive changes, and propose strategies to address barriers to optimal care.Recommendations:Based on current evidence, the Society makes the following recommendations, endorsed by the Consortium of Multiple Sclerosis Centers and the International Multiple Sclerosis Cognition Society:Increased professional and patient awareness/education about the prevalence, impact, and appropriate management of cognitive symptoms.For adults and children (8+ years of age) with clinical or magnetic resonance imaging (MRI) evidence of neurologic damage consistent with MS:As a minimum, early baseline screening with the Symbol Digit Modalities Test (SDMT) or similarly validated test, when the patient is clinically stable;Annual re-assessment with the same instrument, or more often as needed to (1) detect acute disease activity; (2) assess for treatment effects (e.g. starting/changing a disease-modifying therapy) or for relapse recovery; (3) evaluate progression of cognitive impairment; and/or (4) screen for new-onset cognitive problems.For adults (18+ years): more comprehensive assessment for anyone who tests positive on initial cognitive screening or demonstrates significant cognitive decline, especially if there are concerns about comorbidities or the individual is applying for disability due to cognitive impairment.For children (<18 years): neuropsychological evaluation for any unexplained change in school functioning (academic or behavioral).Remedial interventions/accommodations for adults and children to improve functioning at home, work, or school.

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Differential diagnosis, discerning depression from cognition

Cited by 15 publications

References 37 publications

Treatment choices and neuropsychological symptoms of a large cohort of early MS

Treatment choices and neuropsychological symptoms of a large cohort of early MS

Integrated Cognitive and Neuromotor Rehabilitation in Multiple Sclerosis: A Pragmatic Study

Recommendations for cognitive screening and management in multiple sclerosis care

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