Background

Pre-existing chronic illness is associated with increased psychiatric distress due to the spread of COVID-19, specifically increased stress, anxiety and depression. This potentially placed individuals with MS in a uniquely vulnerable position to experience greater psychiatric symptomatology.

Objectives

To examine the impact of the COVID-19 pandemic on emotional symptomatology and quality of life in individuals with Progressive Multiple Sclerosis (PMS).

Methods

Data were obtained during a randomized clinical trial on rehabilitation taking place at 11 centers in North America and Europe (The CogEx Trial, ClinicalTrials.gov Identifier: NCT03679468). Participants included 131 individuals with PMS. Study procedures were interrupted in accordance with governmental restrictions as COVID-19 spread. During study closure, a COVID Impact Survey was administered via telephone or email to all participants, along with patient report outcome (PRO) measures of depressive and anxiety symptoms, quality of life and MS symptomatology that were previously administered pre-pandemic.

Results

The time between baseline PRO completion and lockdown survey completion varied (M=9.5 months, SD=4.1 months). 4% of respondents reported COVID-19 infection. No significant changes were noted in anxiety, quality of life, or the impact of MS symptomatology on daily life from baseline to lockdown. While total HADS depression scores increased significantly at follow up, this did not translate into more participants scoring above the HADS threshold for clinically significant depression. No significant relationships were noted between disease duration, processing speed ability or EDSS and changes in symptoms of depression or anxiety.

Most participants reported impact of the virus on their psychological well-being, with little impact on financial well-being. Perceived impact of the pandemic on physical and psychological well-being correlated significantly with the impact of MS symptomatology on daily life, as well as changes in depression.

Conclusions

Overall, in a sample confined exclusively to people with chronic progressive MS, little clinically significant change was noted in symptoms of depression or anxiety or quality of life during the pandemic lockdown.

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.