There are few longitudinal studies of cognition in patients with multiple sclerosis, and the results of these studies remain inconclusive. No serial neuropsychological data of an exclusively primary progressive series...There are few longitudinal studies of cognition in patients with multiple sclerosis, and the results of these studies remain inconclusive. No serial neuropsychological data of an exclusively primary progressive series are available. Cross-sectional analyses have revealed significant correlations between cognition and magnetic resonance imaging (MRI) parameters in primary progressive multiple sclerosis (PPMS). This study investigated cognitive and MRI change in 99 PPMS patients from five European centres for 2 years. They were assessed at 12 month intervals using the Brief Repeatable Battery, a reasoning test, and a measure of depression. The MRI parameters of T1 hypointensity load, T2 lesion load, and partial brain volume were also calculated at each time point. There were no significant differences between the mean cognitive scores of the patients at year 0 and year 2. However, one-third of the patients demonstrated absolute cognitive decline on individual test scores. Results indicated that initial cognitive status on entry into the study was a good predictor of cognitive ability at 2 years. There was only a small number of significant correlations between changes in cognition and changes on MRI, notably T1 hypointensity load with the two attentional tasks (r = -0.266, P = 0.017; r = -0.303, P = 0.012). It is probable that multiple factors underlie this weak relation between the cognitive and MRI measures.展开更多
Background: Magnetic resonance imaging (MRI) studies in primary progressive multiple sclerosis (PPMS) have shown a reduced frequency of enhancement with the contrast agent gadolinium-DTPA (Gd-DTPA), in comparison with...Background: Magnetic resonance imaging (MRI) studies in primary progressive multiple sclerosis (PPMS) have shown a reduced frequency of enhancement with the contrast agent gadolinium-DTPA (Gd-DTPA), in comparison with relapsing-remitting multiple sclerosis (RRMS), and it has been suggested that there may be a less important role for inflammation in its pathogenesis. However, the earliest clinical stages of PPMS have not been studied and thus it has not been possible to exclude the existence of an early inflammatory phase. Abstract:Objective: To study the presence, characteristics, and implications of inflammation in early PPMS. Methods: 45 patients with a mean disease duration of 3.3 years had triple dose Gd enhanced MRI, expanded disability status scale (EDSS), and multiple sclerosis functional composite (MSFC) assessments at baseline. Repeat MRI was done at 1 and 2 months in 24 patients, and at 6 months in 38. Results: Enhancing brain lesions were present in 42%of patients at baseline but enhancing cord lesions were uncommon (7%); 85%of enhancing lesions enhanced for one month or less. Patients with enhancing lesions had greater disability (EDSS, p = 0.027; MSFC, p = 0.026) and more MRI abnormalities (greater T2 load, p = 0.008; greater T1 hypointensity load, p = 0.001; and reduced partial brain volume, p = 0.012) than those without enhancement. Enhancement at 6 months was seen in 32%of patients and was restricted to a subset of patients who enhanced at baseline. Conclusions: Enhancement is present in some cases of early PPMS and is associated with greater disease impact in terms of both clinical and MRI measures.展开更多
Most patients admitted for inpatient rehabilitation find it beneficial even wh en there is little change in physical disability. The aim of this study was to d etermine the characteristics of patients who felt that th...Most patients admitted for inpatient rehabilitation find it beneficial even wh en there is little change in physical disability. The aim of this study was to d etermine the characteristics of patients who felt that they had not benefited fr om inpatient rehabilitation and to delineate the underlying reasons for this per ception. From a database of 331 patients admitted to a neurological rehabilitati on unit over a three year period, we ascertained those with a low score < 5) on a self rated visual analogue scale (VAS) regarding their perception of the ben efit of rehabilitation. We investigated their disability outcomes, aspects of th e rehabilitation process through analysis of integrated care pathways, and from inspection of the multidisciplinary record identified specific adverse factors w hich might contribute to dissatisfaction. Low VAS scores were detected in 6%of patients (n = 19). These did not correlate with baseline demographic factors or disability levels, but were associated with unresolved external problems regardi ng community care and accommodation, and conflicts between patients and therapis ts. We conclude that from the patientsperspective, successful inpatient rehabi litation depends on adequate attention given to community based issues and heal th care professionals recognising patientsneeds. When these two conditions are not fulfilled, patients are more likely to express a lack of satisfaction with their rehabilitation.展开更多
文摘There are few longitudinal studies of cognition in patients with multiple sclerosis, and the results of these studies remain inconclusive. No serial neuropsychological data of an exclusively primary progressive series are available. Cross-sectional analyses have revealed significant correlations between cognition and magnetic resonance imaging (MRI) parameters in primary progressive multiple sclerosis (PPMS). This study investigated cognitive and MRI change in 99 PPMS patients from five European centres for 2 years. They were assessed at 12 month intervals using the Brief Repeatable Battery, a reasoning test, and a measure of depression. The MRI parameters of T1 hypointensity load, T2 lesion load, and partial brain volume were also calculated at each time point. There were no significant differences between the mean cognitive scores of the patients at year 0 and year 2. However, one-third of the patients demonstrated absolute cognitive decline on individual test scores. Results indicated that initial cognitive status on entry into the study was a good predictor of cognitive ability at 2 years. There was only a small number of significant correlations between changes in cognition and changes on MRI, notably T1 hypointensity load with the two attentional tasks (r = -0.266, P = 0.017; r = -0.303, P = 0.012). It is probable that multiple factors underlie this weak relation between the cognitive and MRI measures.
文摘Background: Magnetic resonance imaging (MRI) studies in primary progressive multiple sclerosis (PPMS) have shown a reduced frequency of enhancement with the contrast agent gadolinium-DTPA (Gd-DTPA), in comparison with relapsing-remitting multiple sclerosis (RRMS), and it has been suggested that there may be a less important role for inflammation in its pathogenesis. However, the earliest clinical stages of PPMS have not been studied and thus it has not been possible to exclude the existence of an early inflammatory phase. Abstract:Objective: To study the presence, characteristics, and implications of inflammation in early PPMS. Methods: 45 patients with a mean disease duration of 3.3 years had triple dose Gd enhanced MRI, expanded disability status scale (EDSS), and multiple sclerosis functional composite (MSFC) assessments at baseline. Repeat MRI was done at 1 and 2 months in 24 patients, and at 6 months in 38. Results: Enhancing brain lesions were present in 42%of patients at baseline but enhancing cord lesions were uncommon (7%); 85%of enhancing lesions enhanced for one month or less. Patients with enhancing lesions had greater disability (EDSS, p = 0.027; MSFC, p = 0.026) and more MRI abnormalities (greater T2 load, p = 0.008; greater T1 hypointensity load, p = 0.001; and reduced partial brain volume, p = 0.012) than those without enhancement. Enhancement at 6 months was seen in 32%of patients and was restricted to a subset of patients who enhanced at baseline. Conclusions: Enhancement is present in some cases of early PPMS and is associated with greater disease impact in terms of both clinical and MRI measures.
文摘Most patients admitted for inpatient rehabilitation find it beneficial even wh en there is little change in physical disability. The aim of this study was to d etermine the characteristics of patients who felt that they had not benefited fr om inpatient rehabilitation and to delineate the underlying reasons for this per ception. From a database of 331 patients admitted to a neurological rehabilitati on unit over a three year period, we ascertained those with a low score < 5) on a self rated visual analogue scale (VAS) regarding their perception of the ben efit of rehabilitation. We investigated their disability outcomes, aspects of th e rehabilitation process through analysis of integrated care pathways, and from inspection of the multidisciplinary record identified specific adverse factors w hich might contribute to dissatisfaction. Low VAS scores were detected in 6%of patients (n = 19). These did not correlate with baseline demographic factors or disability levels, but were associated with unresolved external problems regardi ng community care and accommodation, and conflicts between patients and therapis ts. We conclude that from the patientsperspective, successful inpatient rehabi litation depends on adequate attention given to community based issues and heal th care professionals recognising patientsneeds. When these two conditions are not fulfilled, patients are more likely to express a lack of satisfaction with their rehabilitation.
