Background

Brain-predicted age difference (BPAD) is the difference between chronological and brain age, the latter being decoded from brain MR images by a machine learning model. BPAD has been established as a biomarker for physical deterioration in multiple sclerosis (MS).

Objectives

The objective was to examine the value of brain-predicted age difference as a biomarker for cognitive deterioration in MS.

Methods

In the first phase we used supervised machine learning (ridge regression, 7-fold cross-validation) to predict chronological age from brain volumes. This was achieved on a sample of 1743 healthy controls (HC) with T1-weighted MR images from a range of public collections, using the icobrain software to compute normalized brain volumes (whole brain, white matter, (cortical) grey matter and lateral ventricles). The age range of this sample was 8 to 94 years. In the second phase we applied this algorithm to decode brain age in 231 T1-weighted MR images from MS patients from two clinical centers. The age range of this sample was 14 to 77 years. BPAD computed for HC (BPAD_HC) and MS (BPAD_MS) were compared with an independent student t-test. Cognitive functioning was assessed through the symbol digit modalities test (SDMT), available for all 231 included MS patients, the brief visuospatial memory test revised (BVMT-R) and California verbal learning test II (CVLT-II), the latter two being available for a subset of 97 patients from one center. Pearson correlation was computed between the BPAD values and scores on each cognitive test. P-values were corrected for multiple comparisons by the Benjamini/Hochberg method.

Results

After training, the mean (SD) BPAD_HC in the best-performing of seven folds was -0.5 (9.2) years, opposed to 9.7 (12.0) years for BPAD_MS. This difference was statistically significant (p < 0.001). Correlations between BPAD_MS and SDMT, BVMT-R and CVLT-II were -0.19 (p = 0.005), -0.14 (p = 0.157) and -0.30 (p = 0.005) respectively.

Conclusions

Our results showed a significant association between BPAD_MS and two cognitive measures in MS, information processing speed and verbal memory. These findings support a potential role for BPAD_MS as a cognitive biomarker in MS.

Background

In multiple sclerosis, the interplay of neurodegeneration, demyelination and inflammation leads to changes in neurophysiological functioning.

Objectives

This study aims to characterise the relation between reduced brain volumes and spectral power in multiple sclerosis patients and matched healthy subjects.

Methods

During resting-state eyes closed, we collected magnetoencephalographic data in 67 multiple sclerosis patients and 47 healthy subjects, matched for age and gender. Additionally, we quantified different brain volumes (white matter, cortical and deep grey matter, FLAIR lesion load and volume of black holes) and calculated the power spectral density. Instead of using the traditionally used frequency bands, we calculated the source reconstructed power spectral density in frequency bins of 0.25 Hz (range: 0-40 Hz) and corrected for multiple comparisons through permutation testing.

Results

First, a principal component analysis (PCA) of brain volumes demonstrates that atrophy can be largely described by two components: one overall degenerative component that is indicative of brain integrity and correlates strongly with different cognitive tests, and one component that mainly captures degeneration of the cortical grey matter that strongly correlates with age. As the first PC was observed both when performing the PCA on the full cohort and on the two subcohorts, we denote this component as an index of brain integrity. Logically, this component was more strongly expressed in the MS cohort.

Next, a multimodal correlation analysis indicates that reduced brain integrity is accompanied by increased alpha1 power in the temporoparietal junction (TPJ). Patients showing this local increase in alpha-peak also scored significantly worse on different cognitive tests and reduced thalamic volumes. The increase in alpha1-power comes from both a slowing of the main alpha-peak and an increase in power.

Conclusions

MS patients with reduced brain integrity demonstrated increased alpha1 power in the TPJ and impaired cognitive functioning.

Background

Classic health care (HC) models are currently being challenged by the ‘coronavirus disease of 2019’ (COVID-19) pandemic for which social isolation and unprecedented mobility restrictions have been deployed as essential measures of constrain. Digital communication services have the potential to preserve and improve access to specialized medical facilities in a cost- and time-efficient manner. Nonetheless, studies on live interaction between patients with multiple sclerosis (MS) and HC providers for neurological follow-up are still scarce. In a recent pilot project, we have shown that individual real-time audiovisual teleconsultations (TCs) over the internet are feasible and highly appreciated in patients with MS, but compliance and technical reliability over time remain to be demonstrated.

Objectives

To evaluate feasibility of real-time audiovisual TCs over the internet for neurological follow-up of patients with MS.

Methods

Thirty patients with MS presenting at a specialized center in Belgium were recruited for this ongoing study, and scheduled to receive 4 TCs over the course of 12 months. Patients were provided a unique hyperlink by mail in advance, leading them automatically and directly to the virtual waiting room, where they could accept or decline our incoming call. All TCs are performed by a trained HC professional with the intention to keep the conversation similar to what is usually discussed during a classic face-to-face MS consultation. The approach will be considered feasible if at least 80% of the planned TCs can be successfully completed at the foreseen moment. We present the results of an interim analysis (July 8, 2020), when at least 2 TCs were executed in each participant. Patient satisfaction (technical quality, convenience, quality of care and added value) was evaluated via telephone by means of 5-point Likert scales containing the categories very unsatisfied, unsatisfied, neutral, satisfied and highly satisfied.

Results

Three participants dropped out of the study due to loss of interest (2) or a broken device (1). Sixty of the 75 scheduled TCs were successfully completed (80%). Failures were due to patients not responding (7/56) or technical issues (8/56). Out of the 27 active participants, 24 responded to the telephone call for satisfaction analysis. Rates of patients declaring themselves satisfied or highly satisfied regarding the TCs were 19/24 for technical quality, 23/24 for convenience, 22/24 for quality of care and 21/24 for added value.

Conclusions

Real-time audiovisual TCs over the internet appear to be feasible and well-received in patients with MS. Full completion of this trial is expected early next year. Incorporation of digital communication services in routine MS practice is expected to improve access to specialized care, particularly in dire times such as the current COVID-19 crisis.

Background

Classic health care (HC) models are currently being challenged by the ‘coronavirus disease of 2019’ (COVID-19) pandemic for which social isolation and unprecedented mobility restrictions have been deployed as essential measures of constrain. Digital communication services have the potential to preserve and improve access to specialized medical facilities in a cost- and time-efficient manner. Nonetheless, studies on live interaction between patients with multiple sclerosis (MS) and HC providers for neurological follow-up are still scarce. In a recent pilot project, we have shown that individual real-time audiovisual teleconsultations (TCs) over the internet are feasible and highly appreciated in patients with MS, but compliance and technical reliability over time remain to be demonstrated.

Objectives

To evaluate feasibility of real-time audiovisual TCs over the internet for neurological follow-up of patients with MS.

Methods

Thirty patients with MS presenting at a specialized center in Belgium were recruited for this ongoing study, and scheduled to receive 4 TCs over the course of 12 months. Patients were provided a unique hyperlink by mail in advance, leading them automatically and directly to the virtual waiting room, where they could accept or decline our incoming call. All TCs are performed by a trained HC professional with the intention to keep the conversation similar to what is usually discussed during a classic face-to-face MS consultation. The approach will be considered feasible if at least 80% of the planned TCs can be successfully completed at the foreseen moment. We present the results of an interim analysis (July 8, 2020), when at least 2 TCs were executed in each participant. Patient satisfaction (technical quality, convenience, quality of care and added value) was evaluated via telephone by means of 5-point Likert scales containing the categories very unsatisfied, unsatisfied, neutral, satisfied and highly satisfied.

Results

Three participants dropped out of the study due to loss of interest (2) or a broken device (1). Sixty of the 75 scheduled TCs were successfully completed (80%). Failures were due to patients not responding (7/56) or technical issues (8/56). Out of the 27 active participants, 24 responded to the telephone call for satisfaction analysis. Rates of patients declaring themselves satisfied or highly satisfied regarding the TCs were 19/24 for technical quality, 23/24 for convenience, 22/24 for quality of care and 21/24 for added value.

Conclusions

Real-time audiovisual TCs over the internet appear to be feasible and well-received in patients with MS. Full completion of this trial is expected early next year. Incorporation of digital communication services in routine MS practice is expected to improve access to specialized care, particularly in dire times such as the current COVID-19 crisis.