Neuropsychological correlates of multiple sclerosis across the lifespan

Abstract

Neurobiology of pediatric and adult MSThe few pathological studies of pediatric MS suggest that it shares many features with the adult disease. As in adult MS, myelin and axonal damage have also been found in normal-appearing intrahemispheric, interhemispheric, and projection white matter tracts. 9 Despite some remyelination after an attack, over time neurological functioning is permanently decreased due to irreversible axonal injury, depletion of oligodendrocytes, and gliosis. 10 Notably, a recent study has suggested that the extent of acute axonal damage in early active demyelinating lesions is increased by 50% in pediatric patients as compared to adults. 11 This finding may provide some explanation for the often observed severe onset in pediatric MS. Neuropsychological correlates of multiple sclerosis across the lifespanJulia Nunan-Saah, Selvi R Paulraj, Emmanuelle Waubant, Lauren B Krupp and Rowena G Gomez Abstract: Multiple sclerosis can adversely affect cognitive functioning whether the disease has an adult or pediatric onset. The research thus far suggests that pediatric MS shares many features with adult MS but is also unique in several respects. One particular characteristic of pediatric MS is that, while physical disability develops more slowly as compared with adult patients, the impact of cognitive deficits in children may be more substantial as they are in a period of life during which they acquire many skills that are needed to transition into independently functioning adults. Our review takes a lifespan approach to MS, comparing and contrasting the neuropsychology (i.e., cognitive, psychological, and psychosocial factors) of these two populations. Understanding how MS manifests across the lifespan has important implications for tailoring assessment and treatment for individuals with MS as they transition from childhood to adulthood, and later life.

Patients with paediatric-onset multiple sclerosis are at higher risk of cognitive impairment in adulthood: An Italian collaborative study

“…13 Other studies comparing children with POMS and adult patients with AOMS also showed lower prevalence rates of depression and fatigue in the first group. 1 This is an interesting finding because higher depression and fatigues scores in adult POMS compared to AOMS patients might be expected, due to the reported association with higher physical disability 26,27 and recent report of an association between psychiatric morbidity and cognitive dysfunction in POMS. 28 We can hypothesize that these patients could develop better coping strategies, due to living with the diagnosis since early age.…”

“…4 The most affected cognitive domains in the paediatric population with MS are similar to those observed in adults, with a predominant involvement of memory, complex attention, information processing speed, executive functions and visual-spatial abilities. [3][4][5][6] Additionally, in POMS subjects, there is accumulating evidence of involvement of linguistic faculties 1,6 and lower intellectual efficiency in terms of intelligence quotient (IQ), particularly in those with younger age at MS onset. 7 An early MS disease onset can have a negative influence in school achievements and overall quality of life, [8][9][10][11] but it is unclear if it could lead to an increased risk for CI in later life.…”

“…13 A worse performance in language abilities could also be expected, given the more prominent language deficits in the paediatric population. 1,6 In this cross-sectional, collaborative study, we aimed at comparing the differences in the prevalence and profile of CI in adulthood between adult patients with a history of POMS and patients with classic AOMS. We also explored potential differences between these two groups in terms of other clinical variables, such as disability, fatigue and depression.…”

Cognitive Functioning in Patients with Pediatric-Onset Multiple Sclerosis, an Updated Review and Future Focus

“…Rater differences were evident, with self-reported cognitive fatigue associated with impaired problem solving, while parent-reported cognitive fatigue was associated with impaired verbal learning, cognitive flexibility, and comprehension. By contrast, several authors have found minimal evidence for a relationship between subjective fatigue (either self- or parent-reported) and objective cognitive functioning [51,52,53].…”

Association between miRNAs expression and cognitive performances of Pediatric Multiple Sclerosis patients: A pilot study

“…The pathogenic mechanisms underlying the neuropsychiatric and cognitive disorders in PedMS are not fully understood yet; they may be the result of the irreversible impact that inflammation (demyelination) and/or neurodegeneration produce on the ongoing maturation of the cognitive pathways (Amato et al, 2004(Amato et al, , 2007Di Filippo, Portaccio, Mancini, & Calabresi, 2018). This should be particularly plausible for the language skills that are more commonly involved in PedMS than in adult patients (Nunan-Saah, Paulraj, Waubant, Krupp, & Gomez, 2015).…”