Epameinondas Lyros

Assessment and rehabilitation of cognitive impairment in multiple sclerosis

Patients with multiple sclerosis (MS) have a substantial risk of cognitive dysfunction, even in the earliest stages of the disease, where there is minimum physical disability. Despite the high prevalence rates and the significant impact of cognitive dysfunction on quality of life in this population, cognitive functions are not routinely assessed due to the high cost and time consumption. This article provides an overview of the current state of knowledge related to cognition in MS and on the optimal approach to neuropsychological assessment of this population. It then focuses on the pharmacological and other treatment options available for MS patients with, or at risk for developing, cognitive impairment. The available immune-modulating agents may reduce the development of new lesions and therefore prevent or minimize the progression of cognitive decline. However, there is currently insufficient evidence concerning the efficiency of symptomatic treatment in MS. There is also currently no optimal non-pharmacological treatment strategy for cognitive decline in MS, as the studies published to date report heterogeneous results. Nevertheless, non-pharmacological treatments such as cognitive rehabilitation may benefit some MS patients. As cognition is increasingly recognized as a major feature of MS, its assessment and rehabilitation will become a greater priority.

Does motor subtype influence neurocognitive performance in Parkinson’s disease without dementia?

The postural instability and gait difficulty (PIGD) motor subtype has been shown to represent a risk factor for development of dementia in Parkinson’s disease. Whether this relationship extends to a more subtle cognitive dysfunction in patients is less clear. Therefore, we administered a battery of selected neuropsychological tests to two groups of non‐demented patients with mild to moderate disease classified either as PIGD or as non‐PIGD subtype and to a group of healthy controls. Groups were matched on potential confounders of neuropsychological performance. No significant differences were revealed between the two groups of patients in the performance of any of the administered neuropsychological tests. However, relative to controls there was a tendency towards a differential pattern of cognitive dysfunction. The PIGD group had slower performance in a test of psychomotor speed and cognitive flexibility, whilst the non‐PIGD group performed worse in measures of verbal learning and visuo‐spatial perception. In conclusion, the PIGD subtype was not associated with more severe cognitive deficits and may to a certain extent share common mechanisms of cognitive dysfunction with non‐PIGD subtypes. Diverse pathological processes however may develop to account for unequal rates of dementia amongst different motor subtypes.

Neuropsychological functioning in buprenorphine maintained patients versus abstinent heroin abusers on naltrexone hydrochloride therapy.

Methadone and buprenorphine are among the most widely employed pharmacological treatments currently available for opioid addiction. Cognitive effects of buprenorphine in abstinent heroin abusers are nevertheless far from being understood.

Benton Visual Retention Test performance in normal adults and acute stroke patients: demographic considerations, discriminant validity, and test-retest reliability.

We examined relationships between demographic variables and Benton Visual Retention Test performance in 352 healthy Greek adults, aged 18–84 years. We derived norms for BVRT total number correct and error scores adjusted for variables that contributed significantly to the variance. We also investigated BVRT performance in 28 acute stroke patients M = 6.14 days after insult. Age, education, and IQ, but not gender, were significantly associated with BVRT performance in healthy participants. However, only age contributed significantly to BVRT performance in acute stroke patients. Test–retest reliability was moderate (.782) for number correct and low for number error (.596) scores. Practice effects were noted only for number correct score. The test appears to discriminate adequately between acute stroke patients and matched healthy controls.

Multiple sclerosis, cannabinoids, and cognition.

There is increasing interest in the therapeutic potential of cannabis-based medicinal extracts in multiple sclerosis. Cognitive deficits that have been attributed to long-term heavy recreational use of cannabis are not necessarily extended to controlled pharmaceutical use of cannabis-based medicinal extracts. Available data indicate that after relatively short-term administration of cannabis-based medicinal extracts no significant cognitive decline occurs. Due to the absence of large scale long-term systematic clinical trials of cannabis-based medicinal extracts in multiple sclerosis therapeutics, however, many issues remain unresolved, including the possible adverse effects of cannabis-based medicinal extracts on cognition. This article critically reviews the current literature and considers the potential for cognitive adverse effects of long-term cannabinoid use in multiple sclerosis therapeutics.

Cognitive dysfunction in multiple sclerosis: The effect of pharmacological interventions

Research has recently focused on cognitive dysfunction in multiple sclerosis (MS). Cognitive deficits are frequently encountered in patients and account for important impairment in quality of life, therefore posing a major therapeutic challenge for the disease. We presently review studies on cognitive effects of pharmacological treatments in MS. There is evidence for a possible beneficial effect of immunomodulatory treatments, particularly of interferons, and also of acetylcholinesterase inhibitors on cognition in MS, which, however, requires evaluation in larger, multi-centre, longitudinal studies. Methodological issues and future prospects regarding the investigation of this issue are also discussed.

Communicating the diagnosis of multiple sclerosis

In the frame of current treatment options for multiple sclerosis (MS) and recommendations for early intervention, we investigated the practice and attitudes of neurologists towards MS-diagnosis communication in Greece. We constructed and sent out a 22-item questionnaire to neurologists practising in different employment settings and geographic regions in Greece. Overall, 217 (37.41 %) of 580 neurologists replied. The vast majority (94.9 %) informs the patient of a definite MS diagnosis, and 73.6 % do so immediately, but only 41.7 % use the term multiple sclerosis. Furthermore, neurologists strongly agreed that timing of diagnosis communication depends to a large extent on the individual patient’s personality (62.5 %) and mental state (52.3 %). Most neurologists (78.7 %) inform relatives about the diagnosis, but only in the presence of the patient. In cases where disclosure was delayed, 59.5 % noted that they did not observe any changes as regards the trust or confidence of their patients towards them. Most neurologists also noted that education level (72 %) and mental state (51.9 %), at the time of disclosure influenced patients who did not fully understand the meaning of their diagnosis. This survey provided some useful new findings with respect to MS diagnosis communication; however, the questions of how and possibly how much to communicate warrant further cross-cultural investigation.

Neuropsychological Functions and SPECT Neuroimaging in Parkinson’s Disease

Parkinson’s disease (PD) is a chronic progressive neurodegenerative disorder, characterized by motor and non-motor signs. It was Charcot, who first in 1875 pointed out that ‘psychic faculties are definitely impaired’ and that ‘the mind becomes clouded and the memory is lost’. Most patients with PD experience some degree of cognitive impairment, ranging from mild selective deficits to Parkinson’s disease dementia (Dubois & Pillon, 1997). PD patients may also spend several years in a transition state called Mild Cognitive Impairment (MCI), which is now recognized as one of the cardinal non-motor manifestations of PD. It is a major cause of disability, and has been shown to be an important predictor for quality of life (Karlsen et al., 1998). Recent studies have reported a 21% prevalence rate of MCI in a large PD population and consider MCI as a risk factor for developing Parkinson’s disease Dementia (PDD) (Caviness et al., 2007; Janvin et al., 2006; Levin et al., 1992). The neuropathophysiological basis of cognitive deficits in PD is complicated and includes degeneration of dopaminergic neurons mainly of the nigrostriatal pathway and to a lesser degree the mesocortical and mesolimbic pathways. The striatum is closely interrelated to cortical areas mainly to the frontal lobes. The neuropathophysiological puzzle is further complicated by multiple neurotransmitter deficits including noradrenalin, serotonin and acetylcholine pathway as well as Lewy bodytype degeneration in cortical and limbic structures (Mandir & Vaughan, 2000). The direct dopaminergic connections between the ventral tegmental area and the prefrontal cortex may also influence changes in cognition (Cools 2006; Mattay et al., 2002). The pattern of cognitive impairment seen even in early PD mainly resembles that produced by frontal lobe damage, as the basal ganglia and prefrontal cortex are closely interrelated through anatomofunctional circuits (Alexander et al., 1986; Bondi et al., 1993) and include deficits mainly in cognitive flexibility, planning, working memory and learning. Perfusion brain single photon emission computed tomography (SPECT) provides a wellestablished means of studying regional cerebral blood flow (rCBF) which is known to reflect cortical function. On the other hand Dopamine Transporter (DAT) SPECT imaging can be used as a marker for the degree of loss of dopaminergic nerve endings. It is well known that SPECT Neuroimaging can assist in the differential diagnosis of parkinsonian and dementia

Repeatable Battery for the Assessment of Neuropsychological Status (RBANS): Clinical validation in Greece

OF NEUROPSYCHOLOGICAL STATUS (RBANS): CLINICALVALIDATION IN GREECE Konstantinos Petsanis, Lambros Messinis, Epameinondas Lyros, Thanaos Papathanasiou, Panagiotis Papathanasopoulos, Amaryllis Malegiannaki, School of Psychology, Aristotle University of Thessaloniki, Thessaloniki, Greece; 2 Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece; University of Patras Medical School, Patras, Greece.

Increased Self-Report of Obsessive-Compulsive Behaviors Among Hemodialysis Patients: A Case-Control Study

BACKGROUND Patients with end-stage renal insufficiency undergoing hemodialysis show important psychiatric morbidity, particularly increased depression and anxiety. Obsessive-compulsive symptoms, however, are much less frequently investigated. The purpose of the present study was thus to assess obsessive-compulsive symptoms in hemodialysis patients. METHOD Patients treated at an outpatient hospital hemodialysis unit (July 2007) were compared with controls on scores on the Maudsley Obsessional-Compulsive Inventory (MOCI) and its checking, cleaning, slowness, and doubting components as well as on measures of emotional (Beck Depression Inventory-Fast Screen), anxiety (Beck Anxiety Inventory), and cognitive (Trail Making Test) status. Student t tests, analyses of covariance, or nonparametric tests were used. Correlations were applied between behavioral outcomes and demographic, clinical, and laboratory data of patients. RESULTS Patients showed more obsessive traits than controls on the MOCI total score (P < .001) and on the checking, cleaning, and doubting subscales. Significant differences between groups occurred also in Beck Depression and Anxiety Inventories (P ≤ .001). The MOCI total score did not correlate with marital status, education level, duration of hemodialysis, or the other psychological instrument scores in patients. By contrast, the MOCI total score was associated with the level of creatinine, and it showed an inverse correlation with the urea reduction ratio in patients (P < .05). CONCLUSIONS Obsessive-compulsive symptoms may constitute an important aspect of the psychiatric profile of patients undergoing hemodialysis. Potential interpretation involves disease- and treatment-associated factors or adaptive responses to emergence of otherwise uncontrollable stress.