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

Persons with Multiple Sclerosis (pwMS) experience a decline in cognitive and physical performance, which could affect their walking and their ability to attend to their surrounding environment during walking. Therefore, pwMS may show higher recruitment of brain attention network regions like parietal and premotor areas during walking (WALK), a recruitment that could increase more during obstacle avoidance while walking (OBSAV).

Objectives

This study explored Electroencephalography (EEG) based brain activation and brain connectivity during treadmill walking and during walking while avoiding virtual reality obstacles on the treadmill. The study included a group of pwMS and a health control group (HC) matched by age and gender. We expected higher brain activity and brain connectivity in parietal and premotor cortices in the pwMS group, especially in the OBSAV condition.

Methods

Data of 9 pwMS and 8 healthy controls were collected. Kessler Foundation Institutional Review Board (IRB) approved the protocol. Brain and muscles activations were collected as participants walked on an instrumented treadmill (C-MILL, Motekforce, The Netherlands). The C-MILL CueFor2 software was used to collect loading force of each participant during the walking tasks, and captured the timing of the major events of the gait cycle. EEG data were collected using a 64-channel wireless ActiCap EEG system from Brain Products (Munich, Germany). EEG data collection sampling rate was set to 500Hz and FCz EEG channel was chosen as the reference during data collection. Data were collected for a minimum 100 trials of 30-second walking at self-selected speed. Each WALK trial was followed by a 30-second trial of walking while avoiding randomly projected virtual obstacles (OBSAV). Outcomes measures included EEG signal power within alpha (8-12 Hz) and beta (12-30 Hz) bands in 11 regions of interest that included bilateral parietal, premotor, frontal, and motor cortices and supplementary motor area and coherence between these regions.

Results

In comparison to the HC group, the pwMS group showed higher power of EEG signals within the beta band in the left parietal (F=7.8, p=0.008) and left premotor cortex (F=4.11, p=0.05). They also showed higher coherence between left parietal and left premotor cortices and between left premotor and left motor cortices. There was no difference in these outcomes between WALK and OBS conditions.

Conclusions

Our findings confirm the role of attention network in the control of walking and obstacle avoidance in the MS group. Our group will further investigate this network and connectivity between the brain and muscles to acquire better understanding of the interaction between cognitive and motor performance and cortical control centers and muscles participating in walking in pwMS and how that could affect pwMS daily activity.

Background

Cognitive impairments, particularly information processing speed (IPS) and learning and memory, are very common in multiple sclerosis (MS), appearing both at disease onset and later in the disease. The Symbol Digit Modalities Test (SDMT) is the most commonly used test to assess IPS in MS. The SDMT has many advantages including, ease of administration, good reliability, predictive validity, sensitivity and specificity. Additionally, it is the single test common to all recommended cognitive batteries in MS. Although widely used, the SDMT has several limitations often overlooked.

Objectives

The current study examines performance on an adapted version of the SDMT (aSDMT), designed to control for learning, potential verbalization of symbols, mirror images or symbols, visual noise, and spatial working memory demands inherent with the standard SDMT, and to establish its reliability.

Methods

Performance on the aSDMT was assessed behaviorally and by examining eye movement indices with an eye tracker. Twenty-nine participants with clinically definite multiple sclerosis and fourteen healthy controls completed two versions of the aSDMT and a battery of neuropsychological tests, examining the most common cognitive deficits in MS. Differences between groups were assessed with one-way ANOVAs and test-retest reliability was assessed with Interclass Correlation Coefficient Analysis.

Results

Poorer IPS efficiency (total time to complete the aSDMT) was correlated with higher visual temporal fixation durations and more visual fixations. Eye movement indices were correlated with traditional neuropsychological tests of learning and memory and visuospatial working memory. The newly developed aSDMT showed significant correlations (total correct responses on the aSDMT r = .85, p <.01; and total time to complete the aSDMT r = .83, p <.01) with the standard SDMT and moderate to good test-retest reliability.

Conclusions

This study provides preliminary proof of concept data for the impact of visuospatial working memory, learning and memory on performance of the aSDMT, confirming the multifaceted nature of IPS efficiency.

Background

Persons with Multiple Sclerosis (pwMS) experience a decline in cognitive and physical performance, which could affect their walking and their ability to attend to their surrounding environment during walking. Therefore, pwMS may show higher recruitment of brain attention network regions like parietal and premotor areas during walking (WALK), a recruitment that could increase more during obstacle avoidance while walking (OBSAV).

Objectives

This study explored Electroencephalography (EEG) based brain activation and brain connectivity during treadmill walking and during walking while avoiding virtual reality obstacles on the treadmill. The study included a group of pwMS and a health control group (HC) matched by age and gender. We expected higher brain activity and brain connectivity in parietal and premotor cortices in the pwMS group, especially in the OBSAV condition.

Methods

Data of 9 pwMS and 8 healthy controls were collected. Kessler Foundation Institutional Review Board (IRB) approved the protocol. Brain and muscles activations were collected as participants walked on an instrumented treadmill (C-MILL, Motekforce, The Netherlands). The C-MILL CueFor2 software was used to collect loading force of each participant during the walking tasks, and captured the timing of the major events of the gait cycle. EEG data were collected using a 64-channel wireless ActiCap EEG system from Brain Products (Munich, Germany). EEG data collection sampling rate was set to 500Hz and FCz EEG channel was chosen as the reference during data collection. Data were collected for a minimum 100 trials of 30-second walking at self-selected speed. Each WALK trial was followed by a 30-second trial of walking while avoiding randomly projected virtual obstacles (OBSAV). Outcomes measures included EEG signal power within alpha (8-12 Hz) and beta (12-30 Hz) bands in 11 regions of interest that included bilateral parietal, premotor, frontal, and motor cortices and supplementary motor area and coherence between these regions.

Results

In comparison to the HC group, the pwMS group showed higher power of EEG signals within the beta band in the left parietal (F=7.8, p=0.008) and left premotor cortex (F=4.11, p=0.05). They also showed higher coherence between left parietal and left premotor cortices and between left premotor and left motor cortices. There was no difference in these outcomes between WALK and OBS conditions.

Conclusions

Our findings confirm the role of attention network in the control of walking and obstacle avoidance in the MS group. Our group will further investigate this network and connectivity between the brain and muscles to acquire better understanding of the interaction between cognitive and motor performance and cortical control centers and muscles participating in walking in pwMS and how that could affect pwMS daily activity.