Cognitive impairment continues to be a growing area of research in patients with multiple sclerosis, and the scientific program of the joint meeting of the European and Americas committees for Treatment and Research in Multiple Sclerosis has plenty to offer.
In the first young investigators session on Sept. 10, a multicenter study will provide evidence in support of the view that regional thalamic structural connectivity abnormalities play a significant role in cognitive impairment in relapsing-remitting MS patients. Dr. Alvino Bisecco of Vita-Salute San Raffaele University in Milan, Italy, and his colleagues will show that particular patterns of damage to gray matter (viewed as increased fractional anisotropy on diffusion tensor MR imaging) and to white matter (decreased fractional anisotropy) in thalamic subregions contributes to cognitive impairment in MS, compared with patterns observed in healthy control patients.
Another group, led by Dr. Prejaas Tewarie of VU University Medical Center in Amsterdam also will report on Sept. 11 evidence linking thalamic atrophy with disrupted cortical function in MS patients with cognitive impairment. Dr. Tewarie will present data indicating that in MS patients, reduced thalamic volume on MRI is positively associated with a shift in functional network topology between the thalamus and cortex on magnetoencephalography and increased thalamocortical functional connectivity, compared with healthy controls, that proved to be associated with worse cognition and functional status on the Kurtzke Expanded Disability Status Scale.
However, these abnormalities in thalamic functional connectivity could be treated with a brain-training video game, according to a study also to be presented at the first young investigators session on Sept. 10. An 8-week training period in patients who had failing results on at least one cognitive test led to improved test results and a significantly changed pattern of thalamocortical resting-state functional connectivity on MRI, when compared with a wait-list control group. Lead investigator Dr. Laura De Giglio and her associates at Sapienza University of Rome had previously shown that thalamocortical resting-state functional connectivity is disrupted in MS.
During the Sept. 11 hot topics session on symptomatic and rehabilitation strategies, Dr. Maria Pia Amato of the University of Florence (Italy) will review promising results coming from well-designed studies involving behavioral treatment and computerized training, as well as findings from other interventions on cognition, including modest improvement with interferon treatments in patients with relapsing-remitting disease and negative or inconsistent results seen with symptomatic therapies.
Finally, in the second young investigators session on Sept. 10, a unique study will reveal how patients with pediatric-onset and adult-onset relapsing-remitting MS appear to have similar cognitive outcomes at the same age in young adulthood. At mean ages of about 26-27 years in patients who were matched for level of education and physical disability, there were similar mean scores on neuropsychological tests, similar numbers of failed tests, and no difference in the percentage of patients classified as cognitively impaired (14% among pediatric-onset and 27% for adult-onset disease), according to data that will be presented by Dr. Bahia Hakiki of the University of Florence. Because "disease onset in a period of active brain growth and maturation may render pediatric-onset subjects more vulnerable to cognitive issues, our findings suggest good compensatory/recovery abilities in these subjects, possibly related with enhanced brain plasticity in early life," Dr. Hakiki and colleagues wrote.