TY - JOUR
T1 - Visual deficits and cognitive assessment of multiple sclerosis
T2 - confounder, correlate, or both?
AU - Jakimovski, Dejan
AU - Benedict, Ralph H.B.
AU - Weinstock-Guttman, Bianca
AU - Ozel, Osman
AU - Fuchs, Tom A.
AU - Lincoff, Norah
AU - Bergsland, Niels
AU - Dwyer, Michael G.
AU - Zivadinov, Robert
N1 - Funding Information:
Dejan Jakimovski, Niels Bergsland, Osman Ozel, Tom A Fuchs, and Norah Lincoff have nothing to disclose. Ralph H. B. Benedict has received research support from Accorda, Novartis, Genzyme, Biogen Idec, and Mallinkrodt, and is on the speakers’ bureau for EMD Serono, and consults for Biogen Idec, Genentech, Roche, Sanofi/Genzyme, Takeda, NeuroCog Trials, and Novartis. Dr. Benedict also receives royalties for Psychological Assessment Resources. Michael G. Dwyer has received consultant fees from Claret Medical and EMD Serono and research grant support from Novartis. Bianca Weinstock-Guttman received honoraria as a speaker and/or as a consultant for Biogen Idec, EMD Serono, Genentech, Novartis, Mallinckrodt, Celgene, and Abbvie. Dr Weinstock-Guttman received research funds from Biogen Idec, EMD Serono, Genentech, and Novartis. Robert Zivadinov received personal compensation from EMD Serono, Sanofi, Bristol Myers Squibb, Keystone Heart, and Novartis for speaking and consultant fees. He received financial support for research activities from Novartis, Protembis, Bristol Myers Squibb, Keystone Heart, Mapi Pharma, and V-WAVE Medical and Boston Scientific.
Publisher Copyright:
© 2021, Springer-Verlag GmbH, DE part of Springer Nature.
Copyright:
Copyright 2021 Elsevier B.V., All rights reserved.
PY - 2021
Y1 - 2021
N2 - Background: The relationship between visual impairment and cognitive performance in multiple sclerosis (MS) remains poorly understood. Objective: To determine associations between visual acuity and optical coherence tomography (OCT) measures with cognitive performance of MS patients and healthy controls (HCs). Methods: 141 MS patients (with and without MS optic neuritis; MSON) and 50 HCs underwent neuropsychological, visual, and OCT testing. California Verbal Learning Test (CVLT-II), Brief Visuospatial Memory Test (BVMT-R), and Symbol Digit Modalities Test (SDMT) were used. Patients with test performance below − 1.5 standard deviations of the mean HCs scores were labeled as cognitive impairment. Visual ability was assessed with 100%, 2.5%, and 1.25% low-contrast letter acuity (LCLA) charts. OCT-derived peripapillary retinal nerve fiber layer (pRNFL) thickness, macular volume (MV), macular ganglion cell inner plexiform (mGCIP) thickness (as a sum of GC and IP layers), and macular inner nuclear layer (mINL) were computed. Results: 100% and 2.5% LCLA associated with SDMT in MS and HCs (p < 0.001; and p < 0.012, respectively). In MSON patients, visually demanding tests were explained by pRNFL and macular volume for SDMT (β = 0.172, p = 0.039 and β = 0.27, p = 0.001) and MV for BVMT-R (β = 0.21, p = 0.012). In non-MSON, only mINL was predictor of CVLT-II. pRNFL and MV predicted cognitive impairment with an accuracy of 72.2% (Negelkerke R2 = 0.234). These findings were driven by associations within the progressive MS subgroup. HC’s SDMT performance was explained by mGCIP (β = 0.316, p = 0.001). Conclusions: Both LCLA and OCT-based measures (pRNFL and macular volume) were associated with MS cognitive performance. OCT-based measures were also significant predictors of cognitive status in MS patients. mGCIP associated with cognitive performance in HCs.
AB - Background: The relationship between visual impairment and cognitive performance in multiple sclerosis (MS) remains poorly understood. Objective: To determine associations between visual acuity and optical coherence tomography (OCT) measures with cognitive performance of MS patients and healthy controls (HCs). Methods: 141 MS patients (with and without MS optic neuritis; MSON) and 50 HCs underwent neuropsychological, visual, and OCT testing. California Verbal Learning Test (CVLT-II), Brief Visuospatial Memory Test (BVMT-R), and Symbol Digit Modalities Test (SDMT) were used. Patients with test performance below − 1.5 standard deviations of the mean HCs scores were labeled as cognitive impairment. Visual ability was assessed with 100%, 2.5%, and 1.25% low-contrast letter acuity (LCLA) charts. OCT-derived peripapillary retinal nerve fiber layer (pRNFL) thickness, macular volume (MV), macular ganglion cell inner plexiform (mGCIP) thickness (as a sum of GC and IP layers), and macular inner nuclear layer (mINL) were computed. Results: 100% and 2.5% LCLA associated with SDMT in MS and HCs (p < 0.001; and p < 0.012, respectively). In MSON patients, visually demanding tests were explained by pRNFL and macular volume for SDMT (β = 0.172, p = 0.039 and β = 0.27, p = 0.001) and MV for BVMT-R (β = 0.21, p = 0.012). In non-MSON, only mINL was predictor of CVLT-II. pRNFL and MV predicted cognitive impairment with an accuracy of 72.2% (Negelkerke R2 = 0.234). These findings were driven by associations within the progressive MS subgroup. HC’s SDMT performance was explained by mGCIP (β = 0.316, p = 0.001). Conclusions: Both LCLA and OCT-based measures (pRNFL and macular volume) were associated with MS cognitive performance. OCT-based measures were also significant predictors of cognitive status in MS patients. mGCIP associated with cognitive performance in HCs.
KW - Cognitive performance
KW - GCIP
KW - Low-contrast letter acuity
KW - Macular volume
KW - Multiple sclerosis
KW - Optical coherence tomography
KW - RNFL
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U2 - 10.1007/s00415-021-10437-5
DO - 10.1007/s00415-021-10437-5
M3 - Article
AN - SCOPUS:85101476463
JO - Journal of Neurology
JF - Journal of Neurology
SN - 0340-5354
ER -