Author Of 3 Presentations
LB1171 - Embracing resilience in Multiple Sclerosis: a new perspective from COVID-19 pandemic. (ID 1742)
Abstract
Background
Coronavirus Disease 2019 (COVID-19), a severe acute respiratory syndrome due to Coronavirus 2 (SARS-CoV-2) infection, determined cross-sectional social and emotive consequences, representing an unprecedented social experiment. Past epidemiological experiences and recent studies dealing with COVID-19 pandemic and healthy population already showed the deep albeit heterogeneous psychological repercussions of pandemics. Nevertheless, little is known about the relationship between COVID-19 outbreak and patients with chronic diseases, Multiple Sclerosis (MS) in particular, and about the possible strategies for boosting resilience, a well-known protective and buffering instrument helping in facing the challenges of life.
Objectives
To assess the changes in mental distress during COVID-19 outbreak in patients with MS (pw-MS) and to identify predictive factors that could help in developing resilience and facing COVID-19 pandemic.
Methods
We enrolled 106 pw-MS (69 relapsing-remitting, 20 secondary-progressive and 17 primary-progressive) who had undergone neuropsychological assessment before outbreak (between January the 1st 2019 and March the 1st 2020): patients were previously tested with Brief International Cognitive Assessment for MS (BICAMS), Hospital Anxiety and Depression Scale (HADS) and patient-reported MS Neuropsychological Screening Questionnaire (MSNQ-P). All patients were asked to fulfill an online survey comprehensive of sociodemographic information (e.g. marital and employment status), HADS self-rating Scale, MSNQ-P Questionnaire and finally Connor-Davidson Resilience self-rating Scale (CD-RISC 25), in order to evaluate resilience. Statistical analyses (repeated-measures ANCOVA) were performed using SPSS 23.
Results
Even if no significant changes in HADS and MSNQ-P scores were detected during COVID-19 pandemic in our population, pre-existing lower HADS and MSNQ-P scores were found to be significantly (p<0.0001) and independently associated with a better resilience attitude; conversely, no demographic, disease- and treatment-related elements resulted predictive neither of anxiety, depression and perceived cognitive status nor of better resilient behaviour
Conclusions
Our study confirms the fundamental role of anxiety diagnosis and of neuropsychological evaluation in pw-MS, outlining its compelling role in predicting a resilient and positive response in case of pervasive commitment and the necessity of a comprehensive care for pw-MS.
P0788 - Atrophy of the posterior cerebellar lobules is related to episodic memory difficulties in patients with multiple sclerosis: a 3T MRI study. (ID 1299)
Abstract
Background
Cerebellar pathology is associated with worse cognitive performances in patients with multiple sclerosis (MS), but the structural correlates (in terms of single cerebellar lobules) of different cognitive domains (processing speed, episodic memory and visuospatial memory) are still unknown.
Objectives
To investigate the association of specific cerebellar lobules with impairment in different cognitive domains in MS.
Methods
Patients underwent 3T brain MRI (Siemens,Prisma) and neuropsychological evaluation with assessment of the Symbol Digit Modalities Test (SDMT), the California Verbal Learning Test (CVLT) and the Brief Visuospatial Memory Test (BVMT). 1x1x1mm T1-weighted images were used for cerebral and cerebellar segmentation. MS lesions were manually segmented on T1 and T2 weighted images.
Results
We included 70 pts [58(82.9%) with relapsing-remitting MS]; 52 females (74.3%), mean age 42.9(±11.1) years] with a mean disease duration of 12.4(± 10.1) years and a median (IQR) baseline EDSS of 2.5(1-4). Mean SDMT score was 54.3(±13.7), mean CVLT score was 57.9(±11.5) and mean BVMT score was 28.4(±6.5). Mean brain T2 lesion volume (LV) was 12,2(±12.3) mL, mean brain T1LV was 7.9(±9.0) mL, mean cerebellar T1LV and cerebellar T2LV were 0.2(±0.3) and 0.3(±0.5), respectively. 53(75.7%) pts had at least one cerebellar MS lesion. Mean normalized brain volume (NBV) was 1389(±131) mL and mean normalized grey matter volume (NGMV) was 602(±70) mL. Correlations were found between volumes of the posterior lobe of the cerebellum, lobule VIIIa, VIIIb, IX and X and CVLT scores (0.24<r<0.29, 0.015<p<0.046), with additional correlations of lobule X with BVMT values (r=0.29, p=0.016). Correlations were found between CVLT and BVMT scores and cerebellar T2 and T1LV (-0.29<r<-0.27, 0.017<p<0.024), but not with brain T2 and T1LV. NGMV was associated with SDMT score (r=0.26, p=0.032), but not with CVLT and BVMT scores. At multivariate analyses, accounting for the effects of age, sex, NGMV and cerebellar T2LV, atrophy of the posterior portion of the cerebellum was independently associated with worse performance at CVLT (p=0.038,B=0.19).
Conclusions
Atrophy of the cerebellar lobules VIIIa, VIIIb, IX and X is independently associated with episodic memory difficulties in MS patients, while processing speed seems to relate mostly to brain pathology.
P0793 - Clinical course impacts on the association between general cognition and mentalizing deficits in MS (ID 1614)
Abstract
Background
Theory of Mind (ToM, i.e the ability to decode emotional states) is a cognitive function that plays a key role in social functioning. While ToM deficits have been found to be frequent in subjects with MS, ToM is not routinely assessed in formal neuropsychological assessments in this population. The lack of inclusion of ToM assessment in routine neuropsychological evaluation of MS patients, stems from different causes including a partial characterization of the association between general cognition and ToM in the different phases of the disease.
Objectives
To evaluate the interaction between clinical course (relapsing remitting MS (RRMS) vs progressive MS (PMS)), ToM deficits and general cognition. More in detail we aim to assess if the role played by general cognitive functioning on ToM is different in PMS rather than in RRMS
Methods
120 MS patients (age: 44.9±11.6 years, median EDSS 2.5 range 1-6; 75 subjects with RRMS and 45 with PMS) were assessed with the Symbol Digit Modalities Test (SDMT) to evaluate general cognition and the Reading the Mind in the Eyes Test (RMET) to evaluate ToM. The RMET, developed by Baron-Cohen and colleagues in 2001 is a standardized test that consists of 36 black and white picture of the eye region; the subject has to recognize the emotional state represented in the picture and choose one among four given words that depict an emotion.
Results
Comparing RRMS and PMS patients, there was a significant difference in SDMT (55.3±12.0 vs 40.2±11.0, p=0.001) and in total RMET (27.0±4.0 vs 22.9±3.0 p=0.001) scores. There was a significant correlation between SDMT and ToM in the whole sample (p<0.001, r=0.45) and in the RRMS group (p=0.001, r=0.48, but not in PMS (p=0.83) group.
Conclusions
The association between SDMT and RMET is modulated by clinical course in MS. This observation suggests that a bigger role is played by general cognition on RMET in RRMS rather than in PMS possibly due to the presence of more diffuse damage in PMS. Our data suggest that these two metrics change differently over the disease course and thus provide complementary information in the study of cognitive deficits in MS.