Objective: Multiple Sclerosis (MS) is a chronic neurological disorder characterized by a wide range of symptoms, of which physical and cognitive impairments are prominent. Cognitive functioning in...Show moreObjective: Multiple Sclerosis (MS) is a chronic neurological disorder characterized by a wide range of symptoms, of which physical and cognitive impairments are prominent. Cognitive functioning in MS has received increasing attention due to its significant impact on quality of life. However, the exact relationship between physical functioning and cognitive functioning in people with MS (PwMS) remains insufficiently understood. This study aimed to explore the predictive value of physical outcome measures on cognitive functioning. Furthermore, the influence of disease severity and anxiety and depression on the relationship between physical outcome measures and cognitive functioning is explored. Methods: Conducted as part of the ‘Don’t be late!’ project, this study included 23 PwMS (Mean age = 46.63, SD = 11.13; 60.9 % female). Physical functioning was assessed using balance, walking speed, grip strength, dexterity and endurance. Furthermore, cognitive functioning was assessed using the Minimal Assessment of Cognitive Functions in MS and disease severity and anxiety and depression were measured using the Expanded Disability Status Scale and the Hospital Anxiety and Depression Scale, respectively. Multiple regression analyses were performed to determine the predictive value of physical functioning on cognitive functioning. Mediation analyses were performed with disease severity and anxiety and depression as mediating factors. Results: No significant model for the predictive value of physical outcome measures on cognitive functioning was found (p = .117). Furthermore, the study found no significant mediating effects of disease severity (p = .979) or anxiety and depression (p = .633) on this relationship. Due to missing values on the Paced Auditory Serial Addition Test (PASAT), a post-hoc analysis was conducted. Significant effects were found for the predictive value of balance (p = .016), dexterity (p = .045) and walking speed (p = .008) on cognitive functioning. Conclusion: The study identified significant links between balance, dexterity, walking speed, and cognitive functioning in PwMS. It faced limitations including a small sample size and its cross-sectional nature. Despite these limitations, this study suggests that the interplay between physical and cognitive domains in MS is multifaceted and warrants more nuance investigation.Show less
General cognitive decline has frequently been described in multiple sclerosis literature. Specific predictors of memory decline have yet to be determined. Furthermore, general cognitive differences...Show moreGeneral cognitive decline has frequently been described in multiple sclerosis literature. Specific predictors of memory decline have yet to be determined. Furthermore, general cognitive differences between sexes have already been determined in MS. However, relatively little is known about sex differences in specific memory functioning and its decline over time. The aims of this paper were to identify sex differences in memory functioning in MS patients’ latest and second to latest visits to a MS clinic, and to identify predicting factors of memory decline in MS. This was a longitudinal cohort study of retrospective nature in which data was obtained from 253 MS patients (26.5 % male, 73.5% female, mean age in years = 53.9, mean disease duration in years = 17.3, SD = 10.2SD = 13.2, 8.8% had primary progressive MS, 30.3% had secondary progressive MS, 60.2% had relapse remitting MS, and the phenotype of 0.7% was unknown) in an MS rehabilitation center in Belgium. Verbal memory functioning was determined with the use of two subtests of the Buschke Selective Reminding Test. Visuospatial memory was determined with the Spatial Recall Test (SPART). To determine if patients were impaired in memory functioning at baseline, a cutoff score of 1.5SD or lower compared to the norm group was used. Patients that showed a decline in memory scores of >0.25SD per year were defined as “declining”. Our results showed that more women than men were impaired on all memory tests at their latest visit. Furthermore, patients declining on visual memory were found to perceive more pain and discomfort (p = .017, Cohen’s d = .730), problems in daily activities (p = .038, Cohen’s d = .632), and experienced more problems with selfcare (p = .035, Cohen’s d = .641). Moreover, patients declining on verbal memory showed more signs of depressive thoughts (p = .025, Cohen’s d = .816) and anxiety (p = .013, Cohen’s d = .828). The current research was successful in identifying differences between men and women at their latest visit, although we were not able to identify predicting factors of memory decline. Furthermore, we were successful in depicting cognitive differences between declining and non- declining MS patients. Future research should elaborate on the effect of depression, anxiety, quality of life, and possibly fatigue, on memory decline. Additionally, predictors of decline should be identified to eventually improve the care of MS patients and consequently decrease their rate of cognitive deterioration.Show less
Multiple Sclerosis (MS) is a chronic disease of the central nervous system that affects an estimate of 2.8 million people worldwide. Fatigue, impairments in processing speed, and depression are...Show moreMultiple Sclerosis (MS) is a chronic disease of the central nervous system that affects an estimate of 2.8 million people worldwide. Fatigue, impairments in processing speed, and depression are common symptoms reported by People with MS (PwMS). However, the relationship between these symptoms is not well understood. This study aimed to investigate this relationship and examine the (in)stability of fatigue levels over time in PwMS. The study utilized a longitudinal, retrospective cohort design and included participants diagnosed with MS (n= 141) who attended a specialized clinic in Overpelt, Belgium. Seventy-three percent of the sample was female, with a mean age of 51.88 (SD ±13.46). The average disease duration was of 16.94 years (SD ± 8.86), and a majority of the sample had the relapsing-remitting type of MS (RRMS) (n= 43). The median of disease severity, as measured by the EDSS, was of 3.50 (IQR – 3.5). The study hypothesized that fatigue levels would increase over time and that depression would moderate the relationship between fatigue and processing speed. Fatigue levels did not significantly change over time (p = 0.055). A significant relationship was found between fatigue and processing speed impairment (p < 0.05). However, depression did not significantly moderate this relationship (p = 0.215). These findings show that cognitive symptoms may influence each other in MS. Future research should look into the relationship of mood disorders, such as anxiety and depression, and cognitive impairment in PwMS.Show less
Background: Multiple Sclerosis (MS) is a chronic neurological disorder presenting with a variety of symptoms. Next to motor deficits, cognitive deficits such as memory impairment and decreased...Show moreBackground: Multiple Sclerosis (MS) is a chronic neurological disorder presenting with a variety of symptoms. Next to motor deficits, cognitive deficits such as memory impairment and decreased information processing speed occur in approximately 50% of people with MS (PwMS). Cognitive deficits are often missed by the clinicians, however, and not routinely assessed. Keystroke dynamics (KD), a digital metric based on users’ typing behaviours, differ between PwMS and healthy controls, and could potentially be a valuable monitoring tool for cognitive impairment in MS. Objectives: To assess whether smartphone-based KD are able to differentiate between cognitive status (Impaired/Preserved) in PwMS and predict cognitive functioning. Methods: A total of 95 PwMS with an average age of 46 years (SD = 9.9) and of which 74% were female, participated in the observational cohort study. They had a median disease duration of 5.7 years (IQR = 3.0 - 13.1) with a median EDSS score of 3.5 (IQR = 2.5 - 4.0). Cognition was measured using the BICAMS, and the NeuroKeys application was used for 18 consecutive days to measure KD features. Fifteen KD features were included based on correlations to cognitive measures. PwMS were classified as cognitively impaired (CI) or cognitively preserved (CP) via 1.5 SD cut-off scores based on normative BICAMS data. Independent-samples t-tests were used to investigate differences between CP and CI; logistic regression was used to predict cognitive status. A p-value of ≤ 0.05 was considered significant. Results: Compared to CP (N = 65), CI (N = 30) had slower typing speed e.g. as measured by flight time between keystrokes (t(37.49) = -3.76, p < .001, d = 1.01) as well as slowed correction times e.g. a longer post-correction slowing (t(40.53) = -3.63, p < .001, d = 0.92). They also made longer pauses between sentences (U = 605, p < .01, r = 0.26). Cognitive functioning could be predicted by post-correction slowing, the frequency of long pauses and the educational level of PwMS (AUC = .78) with acceptable to excellent accuracy. Conclusion: CI PwMS exhibit distinctly different typing behaviour than CP, and a combination of KD features and educational level can accurately predict cognitive status. Consequently, KD could potentially be a valuable tool for identifying cognitive impairment in MS.Show less
