Author Of 3 Presentations
P0566 - Diffusion tensor imaging of the nucleus basalis of Meynert reveals associations with cognitive state in patients with multiple sclerosis (ID 1427)
Abstract
Background
Previous studies have shown that the nucleus basalis of Meynert (NBM), a group of neurons in the basal forebrain representing the major source of cholinergic innervations for the cerebral and subcortical cortex, is particularly vulnerable to neurodegeneration in Alzheimer’s disease (AD) and Parkinson’s disease (PD). Microstructural NBM damage, as reflected by increased diffusion tensor imaging (DTI)-derived measures of diffusivity, has been shown to be related to cognitive impairment in these diseases. As of now, the NBM has been scarcely investigated in multiple sclerosis (MS).
Objectives
To determine associations between microstructural properties of the NBM and cognitive outcomes in patients with MS (PwMS).
Methods
84 PwMS (54 relapsing-remitting MS, 30 secondary progressive MS) underwent 3T MRI with a protocol that included a diffusion-weighted imaging acquisition. All PwMS underwent cognitive assessment with the Brief International Cognitive Assessment for MS (BICAMS), which includes the Symbol Digit Modalities Test (SDMT), Brief Visuospatial Memory Test-Revised (BVMT-R) and California Verbal Learning Test-2nd edition (CVLT-2). Standard DTI measures, including fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD) and radial diffusivity (RD) were calculated. A probabilistic map of the NBM was utilized to calculate DTI-derived measures. Partial correlations were used to assess the relationship between BICAMS cognitive outcomes and DTI assessments of the NBM, controlling for age and education.
Results
Neuropsychological outcomes correlated with altered diffusivity within the NBM in PwMS. SDMT scores were associated with NBM measures of MD (r=-0.38, p<0.001), AD (r=-0.26, p=0.017), and RD (r=-0.40, p<0.001). BVMT-R was associated with MD (r=-0.33, p=0.002) and RD (r=-0.37, p=0.001), while CVLT-2 was associated with MD (r=-0.27, p=0.015), AD (r=-0.22, p=0.050) and RD (r=-0.27, p=0.016). After accounting for normalized NBM volume, NBM RD explained additional variance for SDMT (R2=0.24, p<0.001) and BVMT-R (R2=0.18, p=0.001), while NBM MD was retained for CVLT-2 (R2=0.17, p=0.015).
Conclusions
Our results show an association between cognitive impairment and microstructural NBM damage in PwMS, highlighting the potential role of NBM damage in determining the cognitive state in PwMS.
P0617 - Predicting Disease Progression in Multiple Sclerosis from Clinical Routine T2-FLAIR MRI (ID 1670)
Abstract
Background
Although quantitative measures from research-quality MRI relate well to clinical outcomes in persons with multiple sclerosis (PwMS), these metrics are largely unavailable in clinical settings.
Objectives
To determine how well a quantitative snapshot of brain pathology, measured on routine clinical T2-FLAIR MRI, relates to standard research-quality MRI, clinical disability, and clinical progression over mid-term.
Methods
This retrospective study of prospectively collected data was approved by the local Institutional Review Board. 3T MRI was acquired for 172 PwMS at baseline and neurologic disability was assessed at baseline and five-years later. Five measures (thalamus volume, lateral ventricle volume, medulla oblongata volume, lesion volume, and network efficiency) for quantifying disparate aspects of brain pathology from low-resolution T2-FLAIR were applied to predict similar measures obtained from research-quality MRI and associated with neurologic disability and disease progression over five years.
Results
The combination of the five T2-FLAIR measures explained most of the variance in standard research-quality MRI, including T2-lesion volume (R2=0.97, p<0.001) and thalamus volume (R2=0.90, p<0.001). T2-FLAIR measures (R2=0.279, p<0.001; R2=0.382, p<0.001) were associated with neurologic disability and cognitive function five-years later, similar to standard research-quality MRI (R2=0.279, p<0.001; R2=0.366, p<0.001). They also similarly predicted disability progression over five years (%-correctly-classified=69.8, R2=0.145, p=0.034), compared to standard research-quality MRI (%-correctly-classified=72.4%, R2=0.196, p=0.022) in relapsing-remitting MS.
Conclusions
T2-FLAIR measures explained considerable variance of standard research-quality MRI, correlated with neurologic disability, and predicted progression of disability over five years. Quantifying brain pathology at a single time-point with clinical-quality T2-FLAIR can be useful in clinical settings.
P1026 - Employment outcomes in multiple sclerosis (ID 852)
Abstract
Background
Multiple sclerosis (MS) causes physical and cognitive deficits that are known to impact employment.1 Approximately 50% of people with MS (PwMS) will lose their job 5 years after diagnosis.2 This quick vocational deterioration emphasizes a need to study MS specific work problems prior to job loss.
Objectives
Report descriptive statistics and analyze differences of baseline time points comparing an employed sample of 607 PwMS and 140 healthy controls (HC).
Methods
Using the Buffalo Vocational Monitoring Survey, respondents were asked questions about demographics, work status, job-type, work duties, income, hours worked, disclosure, negative work events (NWEs), and work accommodations.
Results
MS and HC groups were matched on age, sex, and education. Of the PwMS, 89.9% had relapsing remitting MS with an average disease duration of 10.1±8.8 years and of this group 58.9% self-reported having physical disability.3 Additionally, 76.1% and 85.4% of PwMS disclosed their MS diagnosis to an employer or co-workers respectively. The five most common job descriptions among both PwMS and HCs were healthcare support/technician, office/administrative support, education/training or library work, sales, and business or financial operations. PwMS worked significantly more years for their employer (10.4±9.6 vs. 7.8±8.8, p=0.003), worked more hours unpaid (3.0±5.9 vs. 1.9 ± 4.2, p=0.014), and experienced significantly more NWEs (0.5±1.0 vs. 0.2±0.5, p<0.001) than HCs. Specifically, verbal criticism (p=0.012), removal of job responsibility (p=0.005), harassment (p=0.013), and “other” (p=0.019), coded as attendance complaints, poor performance reviews, deteriorated employer/co-worker relationships, dissatisfied clients, and unspecified. Groups were equivalent in annual income/hourly wage, hours worked, years working their current position (p>0.05), but trended toward significant difference when comparing missed work days (p=0.108). PwMS used significantly more work accommodations than HCs (2.4±3.5 vs. 1.1±2.5, p<0.001), most frequently flexible work hours (28.9%), air-conditioning (18.4%), and working from home (14.8%).
Conclusions
PwMS and HCs share similar jobs and incomes but the impact from MS is clear. PwMS use more accommodations to maintain job performance, work more hours unpaid, report a higher number of NWEs, and experience more harassment. Further study into factors and interventions that prevent negative work outcomes is warranted.
Presenter Of 1 Presentation
P0617 - Predicting Disease Progression in Multiple Sclerosis from Clinical Routine T2-FLAIR MRI (ID 1670)
Abstract
Background
Although quantitative measures from research-quality MRI relate well to clinical outcomes in persons with multiple sclerosis (PwMS), these metrics are largely unavailable in clinical settings.
Objectives
To determine how well a quantitative snapshot of brain pathology, measured on routine clinical T2-FLAIR MRI, relates to standard research-quality MRI, clinical disability, and clinical progression over mid-term.
Methods
This retrospective study of prospectively collected data was approved by the local Institutional Review Board. 3T MRI was acquired for 172 PwMS at baseline and neurologic disability was assessed at baseline and five-years later. Five measures (thalamus volume, lateral ventricle volume, medulla oblongata volume, lesion volume, and network efficiency) for quantifying disparate aspects of brain pathology from low-resolution T2-FLAIR were applied to predict similar measures obtained from research-quality MRI and associated with neurologic disability and disease progression over five years.
Results
The combination of the five T2-FLAIR measures explained most of the variance in standard research-quality MRI, including T2-lesion volume (R2=0.97, p<0.001) and thalamus volume (R2=0.90, p<0.001). T2-FLAIR measures (R2=0.279, p<0.001; R2=0.382, p<0.001) were associated with neurologic disability and cognitive function five-years later, similar to standard research-quality MRI (R2=0.279, p<0.001; R2=0.366, p<0.001). They also similarly predicted disability progression over five years (%-correctly-classified=69.8, R2=0.145, p=0.034), compared to standard research-quality MRI (%-correctly-classified=72.4%, R2=0.196, p=0.022) in relapsing-remitting MS.
Conclusions
T2-FLAIR measures explained considerable variance of standard research-quality MRI, correlated with neurologic disability, and predicted progression of disability over five years. Quantifying brain pathology at a single time-point with clinical-quality T2-FLAIR can be useful in clinical settings.