Author Of 3 Presentations
LB1152 - COVID-19 and lockdown in patients with multiple sclerosis: a descriptive study of prevalence and emotional impact (ID 954)
Abstract
Background
The SARS-Cov2 produced a world-wide health-pandemia situation where people must stay home. People with multiple sclerosis (MS) were considered one of high-risk infection population groups due to their immunological status. This situation may increase the risk of emotional unbalance and produced a high uncertainty for MS patients.
Objectives
To describe medical, demographical and emotional characteristics of a sample from our own MS Unit in a tertiary Hospital in Madrid during lockdown.
Methods
In one month we consecutively interviewed 138 MS patients, collecting information about their demographic characteristics (age, gender, years of education, house-company), their MS (physical disability, treatment, years with MS), the SARS-Cov2 (if they had it, someone living with him, the type of lockdown, protection method used outdoors) and their emotional status (previously to SARS-Cov2, compare to before, about their quality of live (QoL), coping strategies, depression and anxiety). We applied standardized questionnaires for QoL, disability related to health condition and emotion.
Results
The majority of participants were woman (69,9%) middle age (42,8) and high education (71% university), with a low disability (EDSS mode=1) after 10,3 years with MS and under treatment (97%). Smokers as frequent comorbidity (23,9%), they lived with company at home (87%) and they followed lockdown completely (61,6%), using mainly face-mask and gel as outdoors protection. Emotional situation during lockdown was described as “worse than before” in 46,4% but some patients reported feeling better (15,2%). Self-reported health was rated as 67,1 over 100 with a high EQ-5D index (M=0,73) and they were not depressed (M=4,8; SD=3,7) neither anxious (M=6,7; SD= 4,3). Infected-MS patients (only 8 cases) showed significantly higher depression (p=0,039) and lower rating in health (p=0,012) in EQ-5D than non-infected patients, using equivalent coping-strategies and rating similar physical independence.
Conclusions
Despite the immunological special status of MS patients, we found that the prevalence of SARS-Cov2 was really low, as stated in the literature. Our patients were quite responsible with lockdown rules and almost half of them confessed that lockdown affected their emotional status to the worse even though they were not infected. Interestingly, those who reported a positive lockdown indicated that not commuting, slowing down and teleworking improved their QoL significantly.
P0796 - Cognitive differences in aging patients with multiple sclerosis compared to healthy controls (ID 1851)
Abstract
Background
It´s stated that as we get older, cognitive processes change. Healthy control (HC) and people with multiple sclerosis (MS) share a decrement in speed of processing with age. Nevertheless, demyelinating and neurodegenerative characteristics of MS may implicate neuropsychological differences when analyzing aging.
Objectives
To study the differences in cognitive processes between MS patients and HC when considering two age groups: yound adults and older ones.
Methods
We had two groups: MS from 45 to 55 years old (MS1) and from 56 to 70 (MS2) and a HC group (HC1 and HC2) paired in age and years of education (YoE). We applied a neuropsychological comprehensive battery including Symbol Digit Modality Test (SDMT), PASAT 3”, Spanish California Verbal Learning Test (TAVEC), Spatial Recall Test (SPART), Brief Visual Memory Test (BVMT-R), Five Digit Test (5DT), WAIS-Digits and Corsi and verbal fluency (letter, category and exclusion). Mild (MCI) and moderated (ModCI) cognitive impairment was based on Z scores for the following cognitive domains: speed of processing (SP), attention, working memory, verbal and visual memory and executive functions.
Results
We assessed 137 MS patients, 62,7% women with a mean age of 52.7, secondary education (M=14.3) with a mean Expanded Disability Status Scale (EDSS) of 3.3 (Mode=6), relapsing-remitting MS (82,5%) after a mean of 14,3 years having MS. We also evaluated 34 matching HC. MS patients were MCI (43.1%) followed by no impairment (33.6%) and they were equivalent in age, YoE or EDSS. When comparing groups, HC1 scored higher than HC2 in SDMT (p<0.001), SPART-recall (p=0.21) and they retrieved more words in TAVEC when cued were offered short-term (p=0.024), long-term (p=0.034) and free long-term recall (p=0.043). When MS group was analyzed, MS1 performed better than MS2 in SDMT (P=0.004), total learning in TAVEC (p=0.026 list A and p=0.004 list B), hits and dyads in PASAT (p=0.004 and P=0.01), digits-forward (p=0.035) and exclusion fluency (p=0.014). When comparing the same age group, MS1 scored lower in SMDT, SPART learning and recall compared to HC1. In older group, MS2 showed less hits and dyads in PASAT with higher interference errors and less fluency in exclusion trial compared to HC2.
Conclusions
Cognitive ageing for MS patients is different: as HC, they get slower when processing information but they also perform worse in verbal and visual learning tasks together with executive functioning, whereas for HC the cognitive deficit is more memory-specific related. When younger, MS were equal to HC but slower. When older, MS displayed dysexecutive aspects instead of mainly amnesic ones. The added cognitive features of the older MS group support the idea of an added subcortical damage, responsible of a frontal-like neuropsychological profile.
P0801 - Default Mode Network functioning and Multiple Sclerosis: the importance of phenotypes and cognition (ID 1661)
Abstract
Background
There is controversial data on the differential activity of the default mode network (DMN) in patients with Multiple Sclerosis (MS), and how it is linked to cognitive status. For some authors, there could be an initial hypercompensation, followed by a late exhaustion of the DMN. More research is needed to clarify how those changes may be related to cognition and the different phenotypes of MS.
Objectives
To evaluate the functional connectivity of DMN of MS patients with different phenotypes (relapsing-remitting (RR), clinically isolated syndrome (CIS) and primary progressive (PP) compared to healthy controls (HC).
Methods
Sixty-two participants (16 HC, 16 RR, 15 CIS and 14 PP) were evaluated with a neuropsychological battery to establish their cognitive profile. A functional magnetic resonance (fMRI) with a seed-to-voxel approach was performed to study the DMN, as defined by the Human Connectome Project. We selected four regions of interest: Posterior cingulated cortex (PCC); Medial prefrontal cortex (MPFC); Lateral parietal cortex Left (L-LPC) and Lateral parietal cortex Right (R-LPC). Correlation of their functional connectivity was analyzed considering different groups according to the MS phenotype.
Results
MS patients and HC were equivalent in age, years of education and gender. A 35,5% of MS patients were cognitively preserved, whereas 24(64,5%) had cognitive impairment: 12 were mild(MCI) and 12 moderate(ModCI). RR patients were significantly younger (M=37,9 old; SD=7,3) compared to CIS (M=40,8; SD=9,9) and PP (M= 49,4; SD=7,8). CIS patients had a shorter duration of MS (M=4,3 years; SD=3,9; p=0,013) compared to RR (age M=9,5; SD=5,6) and PP (M=9,9; SD=6,9). Groups were not homogeneous in terms of physical disability, being PP the most disabled (Mode=6) vs RR (Mode=2) or CIS (Mode=0). Regarding global DMN connectivity, no differences were found between HC and MS patients. However, when focusing on phenotypes, we found that CIS had a trend to a higher connectivity than HC and that connectivity steadily decreased though RR to PP, so that PP activity was significantly lower than that of CIS (p=0,019). No differences were found based on cognitive impairment. Antero-posterior connectivity was significantly higher for CIS than RR (p=0,017) and PP (p=0,018); and in cognitively preserved vs ModCI (p=0,03).
Conclusions
Our data supports the dynamic theory for functional connectivity that suggests an initial overcompensation followed by a gradual decline, which is elicited by studying MS phenotypes. Within the DMN, anterior-posterior connectivity was related to a worse cognitive performance.