E ISSN 2791-7851
Volume : 2 Issue : 3 Year : 2023
Volume: 2  Issue: 3 - December 2022

Pages I - IX

2.Relationship Between Dual-task Walking and Cognitive Functions in Persons with Multiple Sclerosis
Zuhal Abasiyanik, Pinar Yigit, Hilal Karakas, Sinem Ozcelik
doi: 10.4274/jmsr.galenos.2022.2022-7-3  Pages 57 - 61
INTRODUCTION: Dual-task performance assessment is a holistic approach that incorporates both motor and cognitive assessment. However, there is scarce data on the relationship between dual-task walking and cognitive functions in persons with multiple sclerosis (pwMS). The aim was to investigate the relationship between dual-task walking and cognitive functions in pwMS.
METHODS: This study analyzed 156 patients (median age 35 years, 73.1% female). Timed Up and Go tests (TUG), with and without cognitive task (TUG), were performed to assess dual-task performance. Dual-task cost (DTC) was calculated. Cognitive information processing speed, visuospatial memory, and verbal memory were assessed using a Brief International Cognitive Assessment for MS (BICAMS).
RESULTS: The DTC was 11.8%. The TUG-cog tests were moderately correlated with all subtests of BICAMS (r=-0.322 to -0.440). However, DTC has a significant but small correlation with cognitive tests (r=0.227-0.254). Disability level was the significant predictor of dual-task performance.
DISCUSSION AND CONCLUSION: Our findings confirm that higher dual-task performance is significantly associated with better cognitive processing speed, visuospatial memory, and verbal memory in pwMS. This result may facilitate the use of dual-tasking paradigms in studies on cognitive impairment screening methods. However, such research undertakings should be supported by longitudinal studies.

3.Determining the Prognostic Characteristics of People with Multiple Sclerosis with Bowel and Bladder Dysfunction as the Initial Presentation: A Cohort Study
Ipek Yavas, Ergi Kaya, Asiye Tuba Ozdogar
doi: 10.4274/jmsr.galenos.2022.2022-7-4  Pages 62 - 67
INTRODUCTION: This study’s first aim is to assess the prognostic characteristics of people with multiple sclerosis (pwMS) who initially had bowel-bladder dysfunction and to present their relationship with the transition to secondary progressive MS (SPMS). The second aim of the study is to show the frequency of relapses that affect bowel-bladder functions as one of the first reasons for hospital admission among pwMS. The third aim is to present the frequency of relapses affecting bowel-bladder functions in pwMS throughout the disease process.
METHODS: Study data of this retrospective cohort study were obtained from longitudinal follow-up data of pwMS who were followed up since 1996 in an Dokuz Eylul University Hospital MS Unit. A total of 3448 pwMS were assessed for eligibility, and those who met the eligibility criteria were included in the study. Included pwMS were assessed for relapse affecting bowel and bladder functions and transition from the Relapsing-Remitting MS (RRMS) course to the SPMS course.
RESULTS: A total of 459 (13.3%) pwMS experienced at least one relapse affecting their bowel-bladder functions at any point in their disease process, and these bowel-bladder functions were affected in 129 of 3,448 (3.7%) patients during their first relapse. Affected bowel and bladder functions during the first relapse were ineffective in predicting the transition to the SPMS course (p>0.05). The initial Expanded Disability Status Scale score (p=0.001), age of disease onset (p<0.001), age at the start of progression (p=0.035), and spinal cord involvement in the functional systems affected at first admission (p=0.013) effectively predicted the transition to the SPMS course.
DISCUSSION AND CONCLUSION: Bowel and bladder dysfunction is a common but poorly-addressed clinical presentation. It is observed even at the onset of the disease. Although the affected bowel and bladder function at first relapse is not effective in predicting the transition from the RRMS course to the SPMS course, the onset of the disease at a young age, severe disability at the beginning, and the spinal origin of the first symptom are promising predictors. Bowel and bladder dysfunction and factors predicting the transition to the SPMS course should be addressed in many ways.

4.Determination of the Factors Related to Neuropsychological Competence in People with Multiple Sclerosis
Ozge Sagici, Hilal Karakas, Sinem Ozcelik
doi: 10.4274/jmsr.galenos.2022.2022-11-1  Pages 68 - 73
INTRODUCTION: Cognitive impairment occurs in 34-65% of persons with multiple sclerosis (pwMS). MS Neuropsychological Screening Questionnaire (MSNQ) is a self-report scale that measures neuropsychological competence and has the power to detect cognitive impairment. However, there are many other objective tests that can measure cognitive impairment. The aim of this study is to examine the relationship between neuropsychological competence and anxiety, depression, cognitive functions, fatigue, quality of life, disease duration and disability level in pwMS.
METHODS: Six hundred and forty-eight pwMS (n=479 female) were enrolled in this study. PwMS with a score of 23 and above on the MSNQ were considered positive for neuropsychological competence impairment test, while pwMS with a score below 23 in MSNQ were considered negative. Disability was assessed using the Expanded Disability Status Scale (EDSS), quality of life with EuroQol 5-Dimensions (EQ-5-D), cognitive functions with the Brief International Cognitive Assessment in Multiple Sclerosis, fatigue with the brief Modified Fatigue Impact Scale, and anxiety and depression levels with The Hospital Anxiety and Depression Scale.
RESULTS: Positive MSNQ was detected in 264 (41%) pwMS, which means worse neuropsychological competence. A statistically significant difference was found between pwMS with positive MSNQ and pwMS with negative MSNQ in terms of age, education, gender, EDSS, fatigue, quality of life, anxiety and depression levels, and cognitive functions. While increasing anxiety level was considered a risk factor for positive MSNQ, each additional increase in the usual activities subscore of the EQ-5D was found to be related to the decrease in the odds of having positive MSNQ.
DISCUSSION AND CONCLUSION: In this study, it was found that pwMS with positive MSNQ had worse cognitive functions, had higher fatigue levels, were unemployed, and had higher levels of depression and anxiety. Also, the dependence and anxiety level of the pwMS should be considered during cognitive rehabilitation.

5.The Relationship between Depression, Anxiety, Fatigue, and the Symbol Digit Modalities Test in Persons with Multiple Sclerosis
Pinar Yigit, Zuhal Abasiyanik, Ergi Kaya
doi: 10.4274/jmsr.galenos.2022.2022-11-3  Pages 74 - 79
INTRODUCTION: Cognitive impairment, fatigue, and neuropsychiatric symptoms are commonly intertwined in multiple sclerosis. The multifactorial etiology of these disease-related symptoms has not been delineated clearly. This study aimed to investigate the relationship between fatigue, anxiety, depression, and cognitive function, as assessed by Symbol Digit Modalities Test (SDMT), in people with multiple sclerosis (pwMS).
METHODS: The oral version of the SDMT was used to measure cognitive function, the Hospital Anxiety and Depression Scale (HADS) for depression and anxiety, and the shortened version of the Modified Fatigue Impact Scale in MS (MFIS-5) for fatigue.
RESULTS: This single-center study included 269 pwMS (206 female, mean age: 33.66±9.57, mean education years: 11.97±3.5). The demographic and clinical outcomes were collected retrospectively. The hierarchical regression analyses demonstrated that the model was significant and explained the 44% of the variance (R2=0.44). The SDMT scores were not associated with fatigue, depression, and anxiety symptoms. Longer disease duration, fewer education years, and younger age were also independently associated with lower SDMT scores. PwMS with cognitive impairment (CI) (15.6%) and without CI differ significantly in disability level, age, HADS-depression score, and subscores and overall score of MFIS-5 (p<0.05).
DISCUSSION AND CONCLUSION: In conclusion, lower education level, longer disease duration, and older age were associated with lower information processing speed in pwMS. No associations were found between SDMT and fatigue, anxiety, or depression levels.

6.Cognitive Assessment Has Never Been Faster! The Clock Drawing Test as a Screening Test for Cognitive Impairment in MS Clinical Practice
Meral Seferoğlu, Ali Ozhan Sivaci, Didem Oz, Yagmur Ozbek Isbitiren
doi: 10.4274/jmsr.galenos.2022.2022-11-2  Pages 80 - 84
INTRODUCTION: Cognitive changes are commonly seen in patients with multiple sclerosis (MS), which is a chronic autoimmune, demyelinating disease. The Clock Drawing Test (CDT) is an easy to use and highly reliable cognitive assessment tool that evaluates planning, visuospatial abilities, and abstract thinking. In this study, the CDT was scored with the Shulman, Manos-Wu, and Watson methods, which are the most frequently used scoring methods, and the correlation was examined between clinical evaluation tests.
METHODS: A total of 109 participants with a diagnosis of MS were included in the study. Participants were followed longitudinally, three times in total, at intervals of 3-6 months. Clinical tests and the CDT (scored with the Shulman, Manos-Wu, and Watson methods) were applied to the participants. The relationships between the CDT, the clinical evaluations, and the demographic data were analyzed by Pearson’s correlation analysis. Differences between the participants’ first and follow-up clinical tests and the CDT scores were assessed by repeated-measures analysis of variance.
RESULTS: Significant moderate to strong correlations were detected between the CDT score and the Expanded Disability Status Scale, the Nine Hole Peg Test, the 25-Foot Walk Test, education, age, and disease duration. No significant differences were observed between the baseline and follow-up CDT or the clinical evaluation test scores.
DISCUSSION AND CONCLUSION: The CDT scored by three different methods was moderate to strongly correlated with clinical tests frequently used to assess motor symptoms. This finding suggests that the CDT is a useful cognitive evaluation tool that is closely related to general clinical evaluation tests.

7.Referee Index

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8.Author Index

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9.Subject Index

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