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Saturday

 

MS: The Temperature-Cognitive Status Connection



















Image Source: CRISASANTOS

Multiple sclerosis (MS) is the most common autoimmune inflammatory demyelinating disease of the central nervous system, affecting an estimated 250,000 to 350,000 Americans, according to the National Institute of Neurological Disorders and Stroke. Typical clinical manifestations of MS include optic neuritis; sensory symptoms, such as numbness and tingling; Lhermitte’s phenomenon (electric shock sensation down the spine and radiating to the limbs in response to neck flexion); motor symptoms, such as muscle weakness or paralysis, and spasticity; and autonomic abnormalities, including bowel, bladder, and sexual dysfunction. These symptoms are often exacerbated by warmer outdoor temperatures, known as Uhthoff’s phenomenon.1 A survey of over 2500 patients confirmed heat as a major cause of MS symptom exacerbation, and research into the relationship between temperature and cognitive changes in MS patients has begun in earnest.2

Cognitive impairment, as assessed by neuropsychological testing, may be common even among patients with a recent MS diagnosis. Frequent abnormalities include problems with abstract conceptualization, long-term and recent memory, complex attention, and efficiency and speed of information processing.3 Given that up 40% to 65% of patients with MS have cognitive abnormalities at some point in their disease,3,4 it’s an area that many MS researchers and clinicians would like to understand better. Two recent studies examined this relationship and investigated the neurophysiologic basis using functional magnetic resonance imaging (fMRI).

One publication included both cross-sectional and longitudinal analyses of the relationship between outdoor temperature and cognitive status.5 A group of 40 patients with MS and 40 healthy controls were recruited throughout a calendar year; each had cognitive testing on a single day. Disease severity was gauged by brain atrophy measurements using MRI. A second sample, of 45 patients with MS, was longitudinally tested at baseline, and then again 6 months later for similar cognitive status on each of 2 days. After controlling for age, gender, disease severity, and education, the authors reported a negative partial correlation between outdoor temperature and cognitive status (RP=-0.45, P<.006) in the MS patients in the cross-sectional analysis, indicating worse cognitive performance on warmer days. No such finding was reported in the healthy controls. In the longitudinal analysis, cognitive status within individual patients with MS also declined more when temperatures were warmer.

In a follow-up study, the same research group built upon prior work that found associations between new T2 lesion activity on MRI and warmer outdoor temperatures.6.7 In this prior study, however, only a small portion of this T2 activity actually correlated with a clinical exacerbation. Therefore, the research group used fMRI to establish a neurophysiologic basis for the temperature-cognition relationship. They studied the difference in frontal and parietal blood-oxygen-level dependent (BOLD) activation in fMRI between patients with MS and healthy subjects.

In a study of 28 patients with MS, they found that warmer outdoor temperature was associated with greater BOLD activation when patients were asked to perform simple attention tasks. In healthy controls, there were no cortical regions that showed activation with warmer temperatures, underscoring the MS disease-specific finding. This signaling in MS patients may indicate cerebral inefficiency and previously unacknowledged exacerbation of disease, though this study didn’t assess for new T2 lesions, an important limitation of the study. In addition, the small sample size made it difficult for the investigators to analyze the temperature effects in MS disease subtypes.

In summary, focusing just on sensorimotor symptoms probably underestimates the clinical disease activity of MS, because cognitive dysfunction may be more pervasive though not recognized. The relationship between cognitive status and warmer temperatures may help clinicians and patients better appreciate all forms of MS exacerbations and better guide therapy. Advanced imaging techniques, such as fMRI, may be useful in some patients.

Story Source: The above story is based on materials provided by MEDPAGETODAY
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