Laura Hancock

Objective adherence monitoring in multiple sclerosis: initial validation and association with self-report

Poor adherence to medication is commonplace and contributes to poor health outcomes among numerous patient populations. Studies that have examined treatment adherence in multiple sclerosis focus exclusively on retrospective self-reports and/or imprecise measures of treatment discontinuation. To help address these methodological limitations, the present longitudinal study compared adherence outcomes for patients with multiple sclerosis using retrospective self-reports, adherence diaries, and a novel electronic monitoring device. Sixty-seven patients with relapsing—remitting multiple sclerosis were followed for a period of eight weeks during which they used a medication diary and a sharps container that captured electronically the time and date of each needle disposal. The patients also reported at the outset and conclusion of the study how frequently they missed doses. All measures of adherence were highly correlated. Patients reported better adherence than was indicated by medication diaries and electronic monitoring of needle disposals. Nearly one-fifth of the sample exhibited poor adherence, missing more than 20% of their prescribed medication. The results support the validity of electronic monitoring of needle disposal as an effective means of measuring adherence to disease modifying therapies in multiple sclerosis. In contrast, studies employing only self-report may underestimate poor adherence. Larger scale studies that employ prospective objective methods are necessary to gain a better understanding of adherence patterns in multiple sclerosis.

Changes in brain activation to food pictures after adjustable gastric banding

BACKGROUND Adjustable gastric banding is an effective weight-loss treatment, but little is known about the neural mechanisms underlying weight loss. The purpose of the present study was to determine whether gastric banding affects brain function in regions previously implicated in food motivation, reward, and cognitive control. The setting for the study was the University of Missouri-Kansas City, Department of Psychology; Hoglund Brain Imaging Center, University of Kansas Medical Center; and private practice in the United States. METHODS Ten obese participants were recruited before adjustable gastric banding surgery (mean body mass index before surgery 40.6 ± 1.96 kg/m2). Their mean body mass index at 12 weeks after surgery was 36.1 ± 2.32 kg/m2, with a mean percentage of excess weight loss of 25.21% ± 8.41%. Functional magnetic resonance imaging scans were conducted before and 12 weeks after adjustable gastric banding surgery. At each assessment point, the participants completed questionnaires assessing food motivation and were scanned while hungry (before eating) and immediately after a standardized meal (after eating). During the functional magnetic resonance imaging scans, the participants viewed food pictures, nonfood pictures (animals), and blurred baseline control pictures. The functional magnetic resonance imaging data were analyzed using BrainVoyager QX. RESULTS After surgery, the participants reported significantly less food motivation and more cognitive restraint. The participants also showed decreased brain activation to food versus nonfood pictures in regions implicated in food motivation and reward, including the parahippocampus, medial prefrontal cortex, insula, and inferior frontal gyrus. In contrast, they demonstrated increased activation to food versus nonfood pictures in anterior prefrontal cortex, a region implicated in cognitive control and inhibition. CONCLUSION This is the first study to examine the functional brain changes after gastric banding surgery and 1 of the first studies to longitudinally examine neural changes associated with weight loss. These results have provided preliminary evidence that adjustable gastric banding alters brain function in regions known to regulate reward and cognitive control.

A comparison of functional brain changes associated with surgical versus behavioral weight loss

Few studies have examined brain changes in response to effective weight loss; none have compared different methods of weight‐loss intervention. Functional brain changes associated with a behavioral weight loss intervention to those associated with bariatric surgery were compared.

Processing speed and working memory training in multiple sclerosis: A double-blind randomized controlled pilot study

Between 40–65% of multiple sclerosis patients experience cognitive deficits, with processing speed and working memory most commonly affected. This pilot study investigated the effect of computerized cognitive training focused on improving processing speed and working memory. Participants were randomized into either an active or a sham training group and engaged in six weeks of training. The active training group improved on a measure of processing speed and attention following cognitive training, and data trended toward significance on measures of other domains. Results provide preliminary evidence that cognitive training with multiple sclerosis patients may produce moderate improvement in select areas of cognitive functioning.

Resting-state brain connectivity after surgical and behavioral weight loss.

Changes in food‐cue neural reactivity associated with behavioral and surgical weight loss interventions have been reported. Resting functional connectivity represents tonic neural activity that may contribute to weight loss success. This study explores whether intervention type is associated with differences in functional connectivity after weight loss.

Polypharmacy in multiple sclerosis: relationship with fatigue, perceived cognition, and objective cognitive performance.

OBJECTIVE Patients with multiple sclerosis (MS) commonly use a variety of medications to slow disease progression, alleviate symptoms, and treat comorbid conditions. Polypharmacy has been linked to adverse outcomes in other patient groups, but has not been studied extensively in MS. We investigated the impact of polypharmacy on fatigue, objective neuropsychological performance, and subjective cognitive impairment in a sample of patients with MS. METHODS MS patients (n=85) completed a medication inventory, self-report questionnaires, and a battery of neurocognitive tests. MS patients with polypharmacy were compared to MS patients without polypharmacy, using multivariate analysis of covariance (MANCOVA). RESULTS After controlling for disease characteristics, MS patients with polypharmacy (n=28) exhibited prospective memory deficits and reported significantly more fatigue and subjective cognitive problems than MS patients without polypharmacy. CONCLUSION Clinicians and patients should carefully weigh the costs and benefits of prescribing multiple medications, as these may contribute to iatrogenic fatigue and cognitive problems in MS. Moreover, researchers should account for polypharmacy when conducting studies examining fatigue and cognition in MS.

Exacerbation history is associated with medication and appointment adherence in MS

Disease-modifying treatments are designed to prevent exacerbations in multiple sclerosis (MS). To date, few studies have examined the relationship between disease activity and treatment adherence in MS. The primary aim of this study was to examine the association between disease activity (e.g., annualized relapse rates), medication adherence, and appointment adherence in relapsing-remitting MS. Retrospective exacerbation and appointment data were collected and used to predict prospective medication adherence. Results indicated that patients with higher annualized relapse rates missed fewer doses of medication and were less likely to miss appointments. Conversely, patients with relatively stable disease were more likely to demonstrate poor medication adherence and poor appointment adherence. Patients who missed more appointments also missed more doses of their disease modifying medication. Future studies may wish to examine clinical methods designed to improve immunotherapy adherence among patients who are in relatively symptom-free stages of relapsing-remitting MS.

Impact of armodafinil on cognition in multiple sclerosis: a randomized, double-blind crossover pilot study.

Objective:Examine the efficacy of armodafinil in improving cognition in patients with multiple sclerosis (MS). Background:Many patients with MS experience cognitive difficulties. Armodafinil has shown promise as a cognitive enhancer in other patient populations. No studies have examined whether armodafinil improves cognition in patients with MS. Methods:We conducted a double-blind, placebo-controlled, crossover study testing the efficacy of armodafinil in reducing cognitive problems in patients with MS. We randomized 17 patients to receive a dose of lactose placebo about 2 hours before they underwent a neuropsychological testing session. After a week-long washout period, we gave them a single 250-mg dose of armodafinil about 2 hours before testing them a second time. We randomized another 16 patients to receive the active drug first, then the placebo. We excluded 3 of the participants before analyzing the data. Results:After correcting for multiple comparisons of the 8 neuropsychological dependent measures, we found that the patients had significantly improved delayed memory on a list-learning task after they took armodafinil (P=0.0005), but no improvement on measures of executive function, visual memory, processing speed, or self-reported fatigue. Conclusions:Results provide preliminary evidence that armodafinil may improve delayed verbal recall in patients with MS. A larger trial showing enhanced memory among patients taking long-term armodafinil could serve as a foundation for its possible clinical use as a memory enhancer in patients with MS.

Pre-surgical cortical activation to food pictures is associated with weight loss following bariatric surgery

BACKGROUND Recent research suggests that preintervention functional magnetic resonance imaging (fMRI) data may predict weight loss outcomes among patients who participate in a behavioral weight loss plan. No study has examined whether presurgical brain activation can predict outcomes following bariatric surgery. METHOD The aim of the present study was to determine if brain activations during a presurgical fMRI food-motivation paradigm are associated with weight loss 3 and 6 months following laparoscopic adjustable gastric banding (LAGB). Nineteen participants viewed food and nonfood pictures from a well-established food motivation paradigm during an fMRI scanning session before LAGB surgery. Weight was assessed presurgery and 3 and 6 months postsurgery; data for all participants was available at each time point. fMRI data were analyzed using the BrainVoyager QX statistical package. Whole brain voxelwise correlations of presurgery (food-nonfood) brain activation and weight, corrected for multiple comparisons, were performed to analyze the relationship between presurgical brain activation and subsequent weight loss. The settings were a medical university brain imaging center and 2 surgical weight loss centers in a major metropolitan area. RESULTS Increased activity in frontal regions associated with cognitive control (medial, middle, superior frontal gyrus) and posterior cingulate cortex was associated with weight loss following LAGB. CONCLUSION We found that neural activity in previously established regions associated with cognitive and behavioral self-regulation predicts weight loss following bariatric surgery. These preliminary findings highlight the role of neural circuitry in the success and maintenance of weight loss and suggest a possible future use of fMRI in screening LAGB surgery candidates.

Cognitive predictors of skilled performance with an advanced upper limb multifunction prosthesis: a preliminary analysis

Abstract Purpose The objectives were to 1) identify major cognitive domains involved in learning to use the DEKA Arm; 2) specify cognitive domain-specific skills associated with basic versus advanced users; and 3) examine whether baseline memory and executive function predicted learning. Method Sample included 35 persons with upper limb amputation. Subjects were administered a brief neuropsychological test battery prior to start of DEKA Arm training, as well as physical performance measures at the onset of, and following training. Multiple regression models controlling for age and including neuropsychological tests were developed to predict physical performance scores. Prosthetic performance scores were divided into quartiles and independent samples t-tests compared neuropsychological test scores of advanced scorers and basic scorers. Baseline neuropsychological test scores were used to predict change in scores on physical performance measures across time. Results Cognitive domains of attention and processing speed were statistically significantly related to proficiency of DEKA Arm use and predicted level of proficiency. Conclusions Results support use of neuropsychological tests to predict learning and use of a multifunctional prosthesis. Assessment of cognitive status at the outset of training may help set expectations for the duration and outcomes of treatment. Implications for Rehabilitation Cognitive domains of attention and processing speed were significantly related to level of proficiencyof an advanced multifunctional prosthesis (the DEKA Arm) after training. Results provide initial support for the use of neuropsychological tests to predict advanced learningand use of a multifunctional prosthesis in upper-limb amputees. Results suggest that assessment of patients’ cognitive status at the outset of upper limb prosthetictraining may, in the future, help patients, their families and therapists set expectations for theduration and intensity of training and may help set reasonable proficiency goals.