ICYMI Multiple Sclerosis

DALLAS – The theme for ACTRIMS Forum 2019 revolves around precision medicine for patients with multiple sclerosis. In an interview at the meeting held by the Americas Committee for Treatment and Research in Multiple Sclerosis, the conference’s cochair, Tanuja Chitnis, MD, explained why this is the right time to take a deep dive into what precision medicine means in MS, for patients and physicians alike.

“We chose the topic of precision medicine for this forum because it’s a really timely issue,” said Dr. Chitnis, noting that there are now over 16 approved treatments for MS, and an increasing recognition that “not every patient has the same disease course.”

“It’s the right time to think about individualized treatment, and not a one-size-fits-all approach,” she said, noting that clinicians and patients stand to benefit from guidance about treatment choices.

“In addition, we are aided by the number of biomarkers that are becoming available,” including quantitative MRI and serum biomarkers. “I think we – as a field – need to understand how to use these in clinical settings in order to guide treatment decisions,” said Dr. Chitnis, professor of neurology at Harvard Medical School, Boston.

Advances in data science are allowing the connection of disparate kinds of data for discovery and hypothesis testing and validation, said Dr. Chitnis, who serves as medical director for the large longitudinal CLIMB study. The study follows about 2,000 patients who have yearly neurologic examinations and brain MRI; serum biomarkers and self-report data are also acquired annually.

“Network science can help in the precision medicine approach to multiple sclerosis, because we have a very clear understanding that MS is a complex disease. It is not one gene; it is not one modality,” she said.

Dr. Chitnis reported that she has received research funding from multiple pharmaceutical companies.
 

koakes@mdedge.com

DALLAS – The theme for ACTRIMS Forum 2019 revolves around precision medicine for patients with multiple sclerosis. In an interview at the meeting held by the Americas Committee for Treatment and Research in Multiple Sclerosis, the conference’s cochair, Tanuja Chitnis, MD, explained why this is the right time to take a deep dive into what precision medicine means in MS, for patients and physicians alike.

“We chose the topic of precision medicine for this forum because it’s a really timely issue,” said Dr. Chitnis, noting that there are now over 16 approved treatments for MS, and an increasing recognition that “not every patient has the same disease course.”

“It’s the right time to think about individualized treatment, and not a one-size-fits-all approach,” she said, noting that clinicians and patients stand to benefit from guidance about treatment choices.

“In addition, we are aided by the number of biomarkers that are becoming available,” including quantitative MRI and serum biomarkers. “I think we – as a field – need to understand how to use these in clinical settings in order to guide treatment decisions,” said Dr. Chitnis, professor of neurology at Harvard Medical School, Boston.

Advances in data science are allowing the connection of disparate kinds of data for discovery and hypothesis testing and validation, said Dr. Chitnis, who serves as medical director for the large longitudinal CLIMB study. The study follows about 2,000 patients who have yearly neurologic examinations and brain MRI; serum biomarkers and self-report data are also acquired annually.

“Network science can help in the precision medicine approach to multiple sclerosis, because we have a very clear understanding that MS is a complex disease. It is not one gene; it is not one modality,” she said.

Dr. Chitnis reported that she has received research funding from multiple pharmaceutical companies.
 

koakes@mdedge.com

DALLAS – The theme for ACTRIMS Forum 2019 revolves around precision medicine for patients with multiple sclerosis. In an interview at the meeting held by the Americas Committee for Treatment and Research in Multiple Sclerosis, the conference’s cochair, Tanuja Chitnis, MD, explained why this is the right time to take a deep dive into what precision medicine means in MS, for patients and physicians alike.

“We chose the topic of precision medicine for this forum because it’s a really timely issue,” said Dr. Chitnis, noting that there are now over 16 approved treatments for MS, and an increasing recognition that “not every patient has the same disease course.”

“It’s the right time to think about individualized treatment, and not a one-size-fits-all approach,” she said, noting that clinicians and patients stand to benefit from guidance about treatment choices.

“In addition, we are aided by the number of biomarkers that are becoming available,” including quantitative MRI and serum biomarkers. “I think we – as a field – need to understand how to use these in clinical settings in order to guide treatment decisions,” said Dr. Chitnis, professor of neurology at Harvard Medical School, Boston.

Advances in data science are allowing the connection of disparate kinds of data for discovery and hypothesis testing and validation, said Dr. Chitnis, who serves as medical director for the large longitudinal CLIMB study. The study follows about 2,000 patients who have yearly neurologic examinations and brain MRI; serum biomarkers and self-report data are also acquired annually.

“Network science can help in the precision medicine approach to multiple sclerosis, because we have a very clear understanding that MS is a complex disease. It is not one gene; it is not one modality,” she said.

Dr. Chitnis reported that she has received research funding from multiple pharmaceutical companies.
 

koakes@mdedge.com

DALLAS – A number of sociodemographic factors may influence health and disability insurance access by individuals with multiple sclerosis, including employment, age, gender, disease duration, marital status, and ethnicity, results from a large survey suggest.

“The last similar work was conducted over 10 years ago and so much has happened in the meantime, including the Great Recession and the introduction of the Affordable Care Act, that offers protection for health care but not for other important types of insurance (short- and long-term disability, long-term care, and life),” lead study author Sarah Planchon, PhD, said in an interview in advance of the meeting held by the Americas Committee for Treatment and Research in Multiple Sclerosis. “MS is one of the most costly chronic diseases today. That is not only because of the cost of disease-modifying therapies but also because of lost employment and income. We wanted to better understand the insurance landscape so that we could in turn educate patients and professionals about the protection these insurances offer and advise them on how to obtain these policies.”

In an effort to evaluate factors that affect insurance access in MS, Dr. Planchon, a project scientist at the Mellen Center for Multiple Sclerosis at the Cleveland Clinic in Ohio, and her colleagues used the North American Research Committee on MS (NARCOMS), iConquerMS, and the National Multiple Sclerosis Society to survey 2,507 individuals with the disease regarding insurance, demographic, health, disability, and employment status. They used covariate-adjusted nominal logistic regression to estimate odds ratios for the likelihood of having or not having a type of insurance. The majority of respondents (83%) were female, their mean age was 54 years, 91% were white, 65% were currently married, and their mean disease duration at the time of the survey was 16 years. In addition, 43% were employed full/part-time, and 29% were not employed or retired because of disability. Nearly all respondents (96%) reported having health insurance, while 59% had life insurance, 29% had private long-term disability insurance, 18% had short-term disability insurance, and 10% had long-term care insurance.

The researchers found that employment status had the greatest impact on insurance coverage. Of those with health insurance, 33% were employed full-time, compared with 89% of those with short-term disability insurance, 42% of those with private long-term disability insurance, 44% of those with long-term care insurance, and 41% of those with life insurance. Logistic regression analyses indicated that respondents employed part time were significantly more likely to have short-term disability insurance if they were currently married (odds ratio, 4.4). Short-term disability insurance was significantly more likely among fully employed patients with disease duration of 5-10 years vs. more than 20 years (OR, 2.0). Private long-term disability insurance was significantly associated with female gender (OR, 1.6), age 50-59 years vs. younger than 40 (OR, 1.6), full-time vs. part-time employment (OR, 2.3), and shorter disease duration (ORs, 1.4-1.6 for 6-10, 11-15, and 16-20 years’ duration). Long-term care insurance was associated with older age (ORs, 2.5 and 4.3 for those aged 50-59 and 60-65 vs. younger than 40), and having excellent or good general health status vs. fair or poor (OR, 1.8). Life insurance was associated with non-Hispanic ethnicity (OR, 1.6), full-time vs. part-time employment (OR, 2.4), older age (ORs, 1.6-1.7 for ages 40-49 and 50-59 vs. younger than 40), and marital status (currently/previously married, ORs, 1.6-2.6). Considering the high rate of survey respondents with health insurance, covariate-adjusted modeling was not applicable.

“The number of people with MS who do not have long-term care insurance was surprisingly high,” Dr. Planchon said. “Although the improved treatment climate recently may decrease the long-term disability levels, we do not yet know this with certainty. A large number of people with MS are likely to need long-term care in the future, which often is a significant financial burden to families.” The findings suggest that clinical care teams “need to initiate early discussions of possible long-term needs with their patients,” she continued. “Incorporation of social work teams, who are familiar with the needs of people with MS and insurance options available to them, within MS specialty practices will bolster the comprehensive care of patients and their families.”

She acknowledged certain limitations of the study, including the low proportion of respondents who were Hispanic/Latino and African American (about 4% each). “The insurance landscape may differ in these groups compared to the majority Caucasian population who responded to this survey,” Dr. Planchon said.

The National Multiple Sclerosis Society funded the study. Dr. Planchon reported having no relevant financial disclosures.

dbrunk@mdedge.com

SOURCE: Planchon S et al. ACTRIMS Forum 2019, Abstract P295.

DALLAS – A number of sociodemographic factors may influence health and disability insurance access by individuals with multiple sclerosis, including employment, age, gender, disease duration, marital status, and ethnicity, results from a large survey suggest.

“The last similar work was conducted over 10 years ago and so much has happened in the meantime, including the Great Recession and the introduction of the Affordable Care Act, that offers protection for health care but not for other important types of insurance (short- and long-term disability, long-term care, and life),” lead study author Sarah Planchon, PhD, said in an interview in advance of the meeting held by the Americas Committee for Treatment and Research in Multiple Sclerosis. “MS is one of the most costly chronic diseases today. That is not only because of the cost of disease-modifying therapies but also because of lost employment and income. We wanted to better understand the insurance landscape so that we could in turn educate patients and professionals about the protection these insurances offer and advise them on how to obtain these policies.”

In an effort to evaluate factors that affect insurance access in MS, Dr. Planchon, a project scientist at the Mellen Center for Multiple Sclerosis at the Cleveland Clinic in Ohio, and her colleagues used the North American Research Committee on MS (NARCOMS), iConquerMS, and the National Multiple Sclerosis Society to survey 2,507 individuals with the disease regarding insurance, demographic, health, disability, and employment status. They used covariate-adjusted nominal logistic regression to estimate odds ratios for the likelihood of having or not having a type of insurance. The majority of respondents (83%) were female, their mean age was 54 years, 91% were white, 65% were currently married, and their mean disease duration at the time of the survey was 16 years. In addition, 43% were employed full/part-time, and 29% were not employed or retired because of disability. Nearly all respondents (96%) reported having health insurance, while 59% had life insurance, 29% had private long-term disability insurance, 18% had short-term disability insurance, and 10% had long-term care insurance.

The researchers found that employment status had the greatest impact on insurance coverage. Of those with health insurance, 33% were employed full-time, compared with 89% of those with short-term disability insurance, 42% of those with private long-term disability insurance, 44% of those with long-term care insurance, and 41% of those with life insurance. Logistic regression analyses indicated that respondents employed part time were significantly more likely to have short-term disability insurance if they were currently married (odds ratio, 4.4). Short-term disability insurance was significantly more likely among fully employed patients with disease duration of 5-10 years vs. more than 20 years (OR, 2.0). Private long-term disability insurance was significantly associated with female gender (OR, 1.6), age 50-59 years vs. younger than 40 (OR, 1.6), full-time vs. part-time employment (OR, 2.3), and shorter disease duration (ORs, 1.4-1.6 for 6-10, 11-15, and 16-20 years’ duration). Long-term care insurance was associated with older age (ORs, 2.5 and 4.3 for those aged 50-59 and 60-65 vs. younger than 40), and having excellent or good general health status vs. fair or poor (OR, 1.8). Life insurance was associated with non-Hispanic ethnicity (OR, 1.6), full-time vs. part-time employment (OR, 2.4), older age (ORs, 1.6-1.7 for ages 40-49 and 50-59 vs. younger than 40), and marital status (currently/previously married, ORs, 1.6-2.6). Considering the high rate of survey respondents with health insurance, covariate-adjusted modeling was not applicable.

“The number of people with MS who do not have long-term care insurance was surprisingly high,” Dr. Planchon said. “Although the improved treatment climate recently may decrease the long-term disability levels, we do not yet know this with certainty. A large number of people with MS are likely to need long-term care in the future, which often is a significant financial burden to families.” The findings suggest that clinical care teams “need to initiate early discussions of possible long-term needs with their patients,” she continued. “Incorporation of social work teams, who are familiar with the needs of people with MS and insurance options available to them, within MS specialty practices will bolster the comprehensive care of patients and their families.”

She acknowledged certain limitations of the study, including the low proportion of respondents who were Hispanic/Latino and African American (about 4% each). “The insurance landscape may differ in these groups compared to the majority Caucasian population who responded to this survey,” Dr. Planchon said.

The National Multiple Sclerosis Society funded the study. Dr. Planchon reported having no relevant financial disclosures.

dbrunk@mdedge.com

SOURCE: Planchon S et al. ACTRIMS Forum 2019, Abstract P295.

DALLAS – A number of sociodemographic factors may influence health and disability insurance access by individuals with multiple sclerosis, including employment, age, gender, disease duration, marital status, and ethnicity, results from a large survey suggest.

“The last similar work was conducted over 10 years ago and so much has happened in the meantime, including the Great Recession and the introduction of the Affordable Care Act, that offers protection for health care but not for other important types of insurance (short- and long-term disability, long-term care, and life),” lead study author Sarah Planchon, PhD, said in an interview in advance of the meeting held by the Americas Committee for Treatment and Research in Multiple Sclerosis. “MS is one of the most costly chronic diseases today. That is not only because of the cost of disease-modifying therapies but also because of lost employment and income. We wanted to better understand the insurance landscape so that we could in turn educate patients and professionals about the protection these insurances offer and advise them on how to obtain these policies.”

In an effort to evaluate factors that affect insurance access in MS, Dr. Planchon, a project scientist at the Mellen Center for Multiple Sclerosis at the Cleveland Clinic in Ohio, and her colleagues used the North American Research Committee on MS (NARCOMS), iConquerMS, and the National Multiple Sclerosis Society to survey 2,507 individuals with the disease regarding insurance, demographic, health, disability, and employment status. They used covariate-adjusted nominal logistic regression to estimate odds ratios for the likelihood of having or not having a type of insurance. The majority of respondents (83%) were female, their mean age was 54 years, 91% were white, 65% were currently married, and their mean disease duration at the time of the survey was 16 years. In addition, 43% were employed full/part-time, and 29% were not employed or retired because of disability. Nearly all respondents (96%) reported having health insurance, while 59% had life insurance, 29% had private long-term disability insurance, 18% had short-term disability insurance, and 10% had long-term care insurance.

The researchers found that employment status had the greatest impact on insurance coverage. Of those with health insurance, 33% were employed full-time, compared with 89% of those with short-term disability insurance, 42% of those with private long-term disability insurance, 44% of those with long-term care insurance, and 41% of those with life insurance. Logistic regression analyses indicated that respondents employed part time were significantly more likely to have short-term disability insurance if they were currently married (odds ratio, 4.4). Short-term disability insurance was significantly more likely among fully employed patients with disease duration of 5-10 years vs. more than 20 years (OR, 2.0). Private long-term disability insurance was significantly associated with female gender (OR, 1.6), age 50-59 years vs. younger than 40 (OR, 1.6), full-time vs. part-time employment (OR, 2.3), and shorter disease duration (ORs, 1.4-1.6 for 6-10, 11-15, and 16-20 years’ duration). Long-term care insurance was associated with older age (ORs, 2.5 and 4.3 for those aged 50-59 and 60-65 vs. younger than 40), and having excellent or good general health status vs. fair or poor (OR, 1.8). Life insurance was associated with non-Hispanic ethnicity (OR, 1.6), full-time vs. part-time employment (OR, 2.4), older age (ORs, 1.6-1.7 for ages 40-49 and 50-59 vs. younger than 40), and marital status (currently/previously married, ORs, 1.6-2.6). Considering the high rate of survey respondents with health insurance, covariate-adjusted modeling was not applicable.

“The number of people with MS who do not have long-term care insurance was surprisingly high,” Dr. Planchon said. “Although the improved treatment climate recently may decrease the long-term disability levels, we do not yet know this with certainty. A large number of people with MS are likely to need long-term care in the future, which often is a significant financial burden to families.” The findings suggest that clinical care teams “need to initiate early discussions of possible long-term needs with their patients,” she continued. “Incorporation of social work teams, who are familiar with the needs of people with MS and insurance options available to them, within MS specialty practices will bolster the comprehensive care of patients and their families.”

She acknowledged certain limitations of the study, including the low proportion of respondents who were Hispanic/Latino and African American (about 4% each). “The insurance landscape may differ in these groups compared to the majority Caucasian population who responded to this survey,” Dr. Planchon said.

The National Multiple Sclerosis Society funded the study. Dr. Planchon reported having no relevant financial disclosures.

dbrunk@mdedge.com

SOURCE: Planchon S et al. ACTRIMS Forum 2019, Abstract P295.

DALLAS – A battery of smartphone-based tests has been developed to help detect visual pathway disturbances in MS patients and to follow them over time.

“One of the ideas is, can you design something that’s so easy to use and quick that it’s not a burden on the patient?” Randy H. Kardon, MD, PhD, said in an interview at the meeting held by the Americas Committee for Treatment and Research in Multiple Sclerosis. “The other was to test a couple of different modalities. By that I mean we test visual acuity, contrast sensitivity, and critical flicker fusion, which is a way of measuring the speed of conduction of nerves in the visual system.”

Dr. Kardon, professor of neuro-ophthalmology at the University of Iowa, Iowa City, worked with colleagues from Aalborg University, Denmark, to study these tests and a novel measure known as the vanishing optotype on 117 patients with MS and 103 age-matched controls. They found that the tests “very nicely discriminated between normal eyes from patients that had MS,” said Dr. Kardon, director of the Iowa City VA Center for Prevention and Treatment of Visual Loss. “Furthermore, we could determine which eyes from the MS patients had previous optic neuritis and which eyes hadn’t. We’re now looking for partners to go forward with larger studies to validate it further and refine these tests even more.”

Dr. Kardon disclosed that he has received funding from the National Eye Institute, the Department of Defense, and from VA Rehabilitation Research and Development. He was also a member of the Novartis steering committee for the OCTiMS study and is a cofounder of MedFace and FaceX.

dbrunk@mdedge.com

DALLAS – A battery of smartphone-based tests has been developed to help detect visual pathway disturbances in MS patients and to follow them over time.

“One of the ideas is, can you design something that’s so easy to use and quick that it’s not a burden on the patient?” Randy H. Kardon, MD, PhD, said in an interview at the meeting held by the Americas Committee for Treatment and Research in Multiple Sclerosis. “The other was to test a couple of different modalities. By that I mean we test visual acuity, contrast sensitivity, and critical flicker fusion, which is a way of measuring the speed of conduction of nerves in the visual system.”

Dr. Kardon, professor of neuro-ophthalmology at the University of Iowa, Iowa City, worked with colleagues from Aalborg University, Denmark, to study these tests and a novel measure known as the vanishing optotype on 117 patients with MS and 103 age-matched controls. They found that the tests “very nicely discriminated between normal eyes from patients that had MS,” said Dr. Kardon, director of the Iowa City VA Center for Prevention and Treatment of Visual Loss. “Furthermore, we could determine which eyes from the MS patients had previous optic neuritis and which eyes hadn’t. We’re now looking for partners to go forward with larger studies to validate it further and refine these tests even more.”

Dr. Kardon disclosed that he has received funding from the National Eye Institute, the Department of Defense, and from VA Rehabilitation Research and Development. He was also a member of the Novartis steering committee for the OCTiMS study and is a cofounder of MedFace and FaceX.

dbrunk@mdedge.com

DALLAS – A battery of smartphone-based tests has been developed to help detect visual pathway disturbances in MS patients and to follow them over time.

“One of the ideas is, can you design something that’s so easy to use and quick that it’s not a burden on the patient?” Randy H. Kardon, MD, PhD, said in an interview at the meeting held by the Americas Committee for Treatment and Research in Multiple Sclerosis. “The other was to test a couple of different modalities. By that I mean we test visual acuity, contrast sensitivity, and critical flicker fusion, which is a way of measuring the speed of conduction of nerves in the visual system.”

Dr. Kardon, professor of neuro-ophthalmology at the University of Iowa, Iowa City, worked with colleagues from Aalborg University, Denmark, to study these tests and a novel measure known as the vanishing optotype on 117 patients with MS and 103 age-matched controls. They found that the tests “very nicely discriminated between normal eyes from patients that had MS,” said Dr. Kardon, director of the Iowa City VA Center for Prevention and Treatment of Visual Loss. “Furthermore, we could determine which eyes from the MS patients had previous optic neuritis and which eyes hadn’t. We’re now looking for partners to go forward with larger studies to validate it further and refine these tests even more.”

Dr. Kardon disclosed that he has received funding from the National Eye Institute, the Department of Defense, and from VA Rehabilitation Research and Development. He was also a member of the Novartis steering committee for the OCTiMS study and is a cofounder of MedFace and FaceX.

dbrunk@mdedge.com

DALLAS – The rate of spinal cord atrophy at the C1 level is promising as a prognostic biomarker for the future conversion to secondary progressive disease in patients with relapsing remitting multiple sclerosis (RRMS), results from a novel, single-center study suggest.

“Among all magnetic resonance imaging measures, spinal cord area shows the strongest correlations with MS disability and has been shown to discriminate progressive from relapsing remitting disease subtypes,” lead study author Antje Bischof, MD, said in an interview in advance of the meeting held by the Americas Committee for Treatment and Research in Multiple Sclerosis. “In our work, we used a novel method to accurately measure upper cervical cord area at C1 vertebral level from brain MRI. This enabled us to show for the first time that spinal cord atrophy rates are faster in relapsing remitting MS patients who later converted to secondary progressive disease, compared to a matched group of patients who remained relapsing remitting MS over 2 decades.”


Dr. Bischof, a postdoctoral research fellow in the department of neurology at the University of California, San Francisco, and her colleagues matched 54 RRMS patients who converted to secondary progressive MS (SPMS) during the 12-year observation period with 54 RRMS patients who remained RRMS during the observation period, based on demographic and clinical criteria. Additionally, they evaluated 54 age- and sex-matched healthy controls at baseline. From routine T1-weighted brain MRI, they analyzed brain measures and spinal cord area at C1 level over 12 years to evaluate their potential to discriminate between the two matched groups during the preconversion period.

Subjects who developed SPMS showed higher rates of spinal cord atrophy (–2.2% per year; standard error, 0.2) before conversion to a secondary progressive course, compared with their RRMS matches who did not convert to SPMS (–0.7% per year; SE, 0.2; P less than .0001). Their data suggest that this difference exists at least 4 years before conversion to SPMS. “None of the commonly used measures of the brain including global brain volumes like white matter and gray matter, regional brain volumes like thalamus, and MS lesion volumes, discriminated between the patients with relapsing remitting MS who later converted to secondary progressive disease and the patients who remained RRMS,” Dr. Bischof said.

She acknowledged certain limitations of the study, including the small sample size and the fact that the results require confirmation in a second MS cohort in order to be generalizable. “These results suggest cervical cord atrophy rate at C1 level as a prognostic biomarker for the conversion to secondary progressive MS and could be useful for treatment decisions early in the disease course, and for the study of genetic, epidemiologic, and immune variables in MS,” Dr. Bischof concluded.

She reported having no financial disclosures.

dbrunk@mdedge.com

SOURCE: Bischof A et al. ACTRIMS Forum 2019, Abstract P157.

DALLAS – The rate of spinal cord atrophy at the C1 level is promising as a prognostic biomarker for the future conversion to secondary progressive disease in patients with relapsing remitting multiple sclerosis (RRMS), results from a novel, single-center study suggest.

“Among all magnetic resonance imaging measures, spinal cord area shows the strongest correlations with MS disability and has been shown to discriminate progressive from relapsing remitting disease subtypes,” lead study author Antje Bischof, MD, said in an interview in advance of the meeting held by the Americas Committee for Treatment and Research in Multiple Sclerosis. “In our work, we used a novel method to accurately measure upper cervical cord area at C1 vertebral level from brain MRI. This enabled us to show for the first time that spinal cord atrophy rates are faster in relapsing remitting MS patients who later converted to secondary progressive disease, compared to a matched group of patients who remained relapsing remitting MS over 2 decades.”


Dr. Bischof, a postdoctoral research fellow in the department of neurology at the University of California, San Francisco, and her colleagues matched 54 RRMS patients who converted to secondary progressive MS (SPMS) during the 12-year observation period with 54 RRMS patients who remained RRMS during the observation period, based on demographic and clinical criteria. Additionally, they evaluated 54 age- and sex-matched healthy controls at baseline. From routine T1-weighted brain MRI, they analyzed brain measures and spinal cord area at C1 level over 12 years to evaluate their potential to discriminate between the two matched groups during the preconversion period.

Subjects who developed SPMS showed higher rates of spinal cord atrophy (–2.2% per year; standard error, 0.2) before conversion to a secondary progressive course, compared with their RRMS matches who did not convert to SPMS (–0.7% per year; SE, 0.2; P less than .0001). Their data suggest that this difference exists at least 4 years before conversion to SPMS. “None of the commonly used measures of the brain including global brain volumes like white matter and gray matter, regional brain volumes like thalamus, and MS lesion volumes, discriminated between the patients with relapsing remitting MS who later converted to secondary progressive disease and the patients who remained RRMS,” Dr. Bischof said.

She acknowledged certain limitations of the study, including the small sample size and the fact that the results require confirmation in a second MS cohort in order to be generalizable. “These results suggest cervical cord atrophy rate at C1 level as a prognostic biomarker for the conversion to secondary progressive MS and could be useful for treatment decisions early in the disease course, and for the study of genetic, epidemiologic, and immune variables in MS,” Dr. Bischof concluded.

She reported having no financial disclosures.

dbrunk@mdedge.com

SOURCE: Bischof A et al. ACTRIMS Forum 2019, Abstract P157.

DALLAS – The rate of spinal cord atrophy at the C1 level is promising as a prognostic biomarker for the future conversion to secondary progressive disease in patients with relapsing remitting multiple sclerosis (RRMS), results from a novel, single-center study suggest.

“Among all magnetic resonance imaging measures, spinal cord area shows the strongest correlations with MS disability and has been shown to discriminate progressive from relapsing remitting disease subtypes,” lead study author Antje Bischof, MD, said in an interview in advance of the meeting held by the Americas Committee for Treatment and Research in Multiple Sclerosis. “In our work, we used a novel method to accurately measure upper cervical cord area at C1 vertebral level from brain MRI. This enabled us to show for the first time that spinal cord atrophy rates are faster in relapsing remitting MS patients who later converted to secondary progressive disease, compared to a matched group of patients who remained relapsing remitting MS over 2 decades.”


Dr. Bischof, a postdoctoral research fellow in the department of neurology at the University of California, San Francisco, and her colleagues matched 54 RRMS patients who converted to secondary progressive MS (SPMS) during the 12-year observation period with 54 RRMS patients who remained RRMS during the observation period, based on demographic and clinical criteria. Additionally, they evaluated 54 age- and sex-matched healthy controls at baseline. From routine T1-weighted brain MRI, they analyzed brain measures and spinal cord area at C1 level over 12 years to evaluate their potential to discriminate between the two matched groups during the preconversion period.

Subjects who developed SPMS showed higher rates of spinal cord atrophy (–2.2% per year; standard error, 0.2) before conversion to a secondary progressive course, compared with their RRMS matches who did not convert to SPMS (–0.7% per year; SE, 0.2; P less than .0001). Their data suggest that this difference exists at least 4 years before conversion to SPMS. “None of the commonly used measures of the brain including global brain volumes like white matter and gray matter, regional brain volumes like thalamus, and MS lesion volumes, discriminated between the patients with relapsing remitting MS who later converted to secondary progressive disease and the patients who remained RRMS,” Dr. Bischof said.

She acknowledged certain limitations of the study, including the small sample size and the fact that the results require confirmation in a second MS cohort in order to be generalizable. “These results suggest cervical cord atrophy rate at C1 level as a prognostic biomarker for the conversion to secondary progressive MS and could be useful for treatment decisions early in the disease course, and for the study of genetic, epidemiologic, and immune variables in MS,” Dr. Bischof concluded.

She reported having no financial disclosures.

dbrunk@mdedge.com

SOURCE: Bischof A et al. ACTRIMS Forum 2019, Abstract P157.

Lifestyle risk factors contribute to accelerated central brain atrophy in patients with multiple sclerosis (MS), whereas unhealthier diet is associated with MS lesion accrual, a recent study found. 175 MS or clinically isolated syndrome (CIS) patients and 42 age- and sex-matched healthy controls (HCs) were enrolled and longitudinally followed for 5.5 years. The 20-year cardiovascular disease risk was calculated by Healthy Heart Score (HHS) prediction model, which includes age, smoking, body mass index, dietary intake, exercise, and alcohol consumption. Baseline and follow-up MRI scans were obtained and cross-sectional and longitudinal changes of T2-lesion volume (LV), whole brain volume (WBV), white matter volume (WMV), gray matter volume (GMV), and lateral ventricular volume (LVV) were calculated. Researchers found:

• After correcting for disease duration, the baseline HHS values of the MS group were associated with baseline GMV, and longitudinal LVV change.
• The association with LVV remained significant after adjusting for baseline LVV volumes in MS patients.
• The diet component of the HHS was associated with the 5-year T2-LV accrual in MS.
• In the HC group, the HHS was associated with LVV, GMV, WBV, T2-LV, and WMV.

Jakimovski D, Weinstock-Guttman B, Gandhi S, et al. Dietary and lifestyle factors in multiple sclerosis progression: Results from a 5-year longitudinal MRI study. [Published online ahead of print February 13, 2019]. J Neurol. doi:10.1007/s00415-019-09208-0.

Lifestyle risk factors contribute to accelerated central brain atrophy in patients with multiple sclerosis (MS), whereas unhealthier diet is associated with MS lesion accrual, a recent study found. 175 MS or clinically isolated syndrome (CIS) patients and 42 age- and sex-matched healthy controls (HCs) were enrolled and longitudinally followed for 5.5 years. The 20-year cardiovascular disease risk was calculated by Healthy Heart Score (HHS) prediction model, which includes age, smoking, body mass index, dietary intake, exercise, and alcohol consumption. Baseline and follow-up MRI scans were obtained and cross-sectional and longitudinal changes of T2-lesion volume (LV), whole brain volume (WBV), white matter volume (WMV), gray matter volume (GMV), and lateral ventricular volume (LVV) were calculated. Researchers found:

• After correcting for disease duration, the baseline HHS values of the MS group were associated with baseline GMV, and longitudinal LVV change.
• The association with LVV remained significant after adjusting for baseline LVV volumes in MS patients.
• The diet component of the HHS was associated with the 5-year T2-LV accrual in MS.
• In the HC group, the HHS was associated with LVV, GMV, WBV, T2-LV, and WMV.

Jakimovski D, Weinstock-Guttman B, Gandhi S, et al. Dietary and lifestyle factors in multiple sclerosis progression: Results from a 5-year longitudinal MRI study. [Published online ahead of print February 13, 2019]. J Neurol. doi:10.1007/s00415-019-09208-0.

Lifestyle risk factors contribute to accelerated central brain atrophy in patients with multiple sclerosis (MS), whereas unhealthier diet is associated with MS lesion accrual, a recent study found. 175 MS or clinically isolated syndrome (CIS) patients and 42 age- and sex-matched healthy controls (HCs) were enrolled and longitudinally followed for 5.5 years. The 20-year cardiovascular disease risk was calculated by Healthy Heart Score (HHS) prediction model, which includes age, smoking, body mass index, dietary intake, exercise, and alcohol consumption. Baseline and follow-up MRI scans were obtained and cross-sectional and longitudinal changes of T2-lesion volume (LV), whole brain volume (WBV), white matter volume (WMV), gray matter volume (GMV), and lateral ventricular volume (LVV) were calculated. Researchers found:

• After correcting for disease duration, the baseline HHS values of the MS group were associated with baseline GMV, and longitudinal LVV change.
• The association with LVV remained significant after adjusting for baseline LVV volumes in MS patients.
• The diet component of the HHS was associated with the 5-year T2-LV accrual in MS.
• In the HC group, the HHS was associated with LVV, GMV, WBV, T2-LV, and WMV.

Jakimovski D, Weinstock-Guttman B, Gandhi S, et al. Dietary and lifestyle factors in multiple sclerosis progression: Results from a 5-year longitudinal MRI study. [Published online ahead of print February 13, 2019]. J Neurol. doi:10.1007/s00415-019-09208-0.

The specific computerized assessment battery (CAB) evaluated is valid for cognitive screening of people with multiple sclerosis (MS) and may be more likely to detect prolonged response times and impaired executive function, according to a recent study. 81 people with MS (PwMS) and 15 healthy controls (HC) completed the CAB and a set of traditional neuropsychological tests recommended for MS on the same day. Principal component factor analysis was used to assess construct validity. For criterion validity, the gold standard definition of cognitive impairment was a score of ≥1.5SD below average on at least 1 cognitive domain, based upon traditional test normative data. Researchers found:

• Traditional and computerized tests of memory, processing speed, visuospatial, and executive function converged by factor analysis.
• Computerized tests detected cognitive impairment with 85% sensitivity and 70% specificity.
• PwMS classified as impaired on only the computerized battery had significantly prolonged response times and a higher rate of unemployment compared with PwMS classified as unimpaired on both batteries.
• Poor executive function was more likely to be revealed by the CAB.

Golan D, Wilken J, Doniger GM, et al. Validity of a multi-domain computerized cognitive assessment battery for patients with multiple sclerosis. Mult Scler Relat Disord. 2019(30):154–162. doi:10.1016/j.msard.2019.01.051.

The specific computerized assessment battery (CAB) evaluated is valid for cognitive screening of people with multiple sclerosis (MS) and may be more likely to detect prolonged response times and impaired executive function, according to a recent study. 81 people with MS (PwMS) and 15 healthy controls (HC) completed the CAB and a set of traditional neuropsychological tests recommended for MS on the same day. Principal component factor analysis was used to assess construct validity. For criterion validity, the gold standard definition of cognitive impairment was a score of ≥1.5SD below average on at least 1 cognitive domain, based upon traditional test normative data. Researchers found:

• Traditional and computerized tests of memory, processing speed, visuospatial, and executive function converged by factor analysis.
• Computerized tests detected cognitive impairment with 85% sensitivity and 70% specificity.
• PwMS classified as impaired on only the computerized battery had significantly prolonged response times and a higher rate of unemployment compared with PwMS classified as unimpaired on both batteries.
• Poor executive function was more likely to be revealed by the CAB.

Golan D, Wilken J, Doniger GM, et al. Validity of a multi-domain computerized cognitive assessment battery for patients with multiple sclerosis. Mult Scler Relat Disord. 2019(30):154–162. doi:10.1016/j.msard.2019.01.051.

The specific computerized assessment battery (CAB) evaluated is valid for cognitive screening of people with multiple sclerosis (MS) and may be more likely to detect prolonged response times and impaired executive function, according to a recent study. 81 people with MS (PwMS) and 15 healthy controls (HC) completed the CAB and a set of traditional neuropsychological tests recommended for MS on the same day. Principal component factor analysis was used to assess construct validity. For criterion validity, the gold standard definition of cognitive impairment was a score of ≥1.5SD below average on at least 1 cognitive domain, based upon traditional test normative data. Researchers found:

• Traditional and computerized tests of memory, processing speed, visuospatial, and executive function converged by factor analysis.
• Computerized tests detected cognitive impairment with 85% sensitivity and 70% specificity.
• PwMS classified as impaired on only the computerized battery had significantly prolonged response times and a higher rate of unemployment compared with PwMS classified as unimpaired on both batteries.
• Poor executive function was more likely to be revealed by the CAB.

Golan D, Wilken J, Doniger GM, et al. Validity of a multi-domain computerized cognitive assessment battery for patients with multiple sclerosis. Mult Scler Relat Disord. 2019(30):154–162. doi:10.1016/j.msard.2019.01.051.

The estimated US national multiple sclerosis (MS) prevalence for 2010 is the highest reported to date and provides evidence that the north-south gradient persists, according to a recent study. A validated algorithm was applied to private, military, and public agglomerative hierarchical clustering (AHC) datasets to identify adult cases of MS between 2008 and 2010. In each dataset, researchers determined the 3-year cumulative prevalence overall and stratified by age, sex, and census region. They applied insurance-specific and stratum-specific estimates to the 2010 US Census data and pooled the findings to calculate the 2010 prevalence of MS in the US cumulated over 3 years. They also estimated the 2010 prevalence cumulated over 10 years using 2 models and extrapolated their estimate to 2017. They found:

• The estimated 2010 prevalence of MS in the US adult population cumulated over 10 years was 309.2 per 100,000, representing 727,344 cases.
• During the same time period, the MS prevalence was 450.1 per 100,000 for women and 159.7 for men (female:male ratio 2:8).
• The estimated 2010 prevalence of MS was highest in the 55- to 64-year age group.
• A US north-south decreasing prevalence gradient was identified.

Wallin MT, Culpepper WJ, Campbell JD, et al. The prevalence of MS in the United States. A population-based estimate using health claims data. [Published online ahead of print February 15, 2019]. Neurology. doi:10.1212/WNL.0000000000007035.

The estimated US national multiple sclerosis (MS) prevalence for 2010 is the highest reported to date and provides evidence that the north-south gradient persists, according to a recent study. A validated algorithm was applied to private, military, and public agglomerative hierarchical clustering (AHC) datasets to identify adult cases of MS between 2008 and 2010. In each dataset, researchers determined the 3-year cumulative prevalence overall and stratified by age, sex, and census region. They applied insurance-specific and stratum-specific estimates to the 2010 US Census data and pooled the findings to calculate the 2010 prevalence of MS in the US cumulated over 3 years. They also estimated the 2010 prevalence cumulated over 10 years using 2 models and extrapolated their estimate to 2017. They found:

• The estimated 2010 prevalence of MS in the US adult population cumulated over 10 years was 309.2 per 100,000, representing 727,344 cases.
• During the same time period, the MS prevalence was 450.1 per 100,000 for women and 159.7 for men (female:male ratio 2:8).
• The estimated 2010 prevalence of MS was highest in the 55- to 64-year age group.
• A US north-south decreasing prevalence gradient was identified.

Wallin MT, Culpepper WJ, Campbell JD, et al. The prevalence of MS in the United States. A population-based estimate using health claims data. [Published online ahead of print February 15, 2019]. Neurology. doi:10.1212/WNL.0000000000007035.

The estimated US national multiple sclerosis (MS) prevalence for 2010 is the highest reported to date and provides evidence that the north-south gradient persists, according to a recent study. A validated algorithm was applied to private, military, and public agglomerative hierarchical clustering (AHC) datasets to identify adult cases of MS between 2008 and 2010. In each dataset, researchers determined the 3-year cumulative prevalence overall and stratified by age, sex, and census region. They applied insurance-specific and stratum-specific estimates to the 2010 US Census data and pooled the findings to calculate the 2010 prevalence of MS in the US cumulated over 3 years. They also estimated the 2010 prevalence cumulated over 10 years using 2 models and extrapolated their estimate to 2017. They found:

• The estimated 2010 prevalence of MS in the US adult population cumulated over 10 years was 309.2 per 100,000, representing 727,344 cases.
• During the same time period, the MS prevalence was 450.1 per 100,000 for women and 159.7 for men (female:male ratio 2:8).
• The estimated 2010 prevalence of MS was highest in the 55- to 64-year age group.
• A US north-south decreasing prevalence gradient was identified.

Wallin MT, Culpepper WJ, Campbell JD, et al. The prevalence of MS in the United States. A population-based estimate using health claims data. [Published online ahead of print February 15, 2019]. Neurology. doi:10.1212/WNL.0000000000007035.

Introducing the Multiple Sclerosis Resource Center Editor-in-Chief, Joseph R. Berger, M.D., FACP, FAAN, FANA.

Dr. Berger is Professor of Neurology and  Associate Chief of the Multiple Sclerosis Division of the Department of Neurology at the Perelman School of Medicine at the University of Pennsylvania in Philadelphia. He is a fellow of the American College of Physicians, American Academy of Neurology and the American Neurological Association. He has published more than 240 refereed papers, more than 100 chapters, and has co-edited three textbooks.  Dr. Berger co-founded and chaired the first international conference on the neurological complications of HIV, the Neuroscience of HIV meeting.  He also established the Commonwealth Neurological Society for neurologists in the state of Kentucky. Dr. Berger has a longstanding interest in international health and was one of the founding members of People-to-People, an organization for HIV/AIDS care and education in East Africa.

Introducing the Multiple Sclerosis Resource Center Editor-in-Chief, Joseph R. Berger, M.D., FACP, FAAN, FANA.

Dr. Berger is Professor of Neurology and  Associate Chief of the Multiple Sclerosis Division of the Department of Neurology at the Perelman School of Medicine at the University of Pennsylvania in Philadelphia. He is a fellow of the American College of Physicians, American Academy of Neurology and the American Neurological Association. He has published more than 240 refereed papers, more than 100 chapters, and has co-edited three textbooks.  Dr. Berger co-founded and chaired the first international conference on the neurological complications of HIV, the Neuroscience of HIV meeting.  He also established the Commonwealth Neurological Society for neurologists in the state of Kentucky. Dr. Berger has a longstanding interest in international health and was one of the founding members of People-to-People, an organization for HIV/AIDS care and education in East Africa.

Introducing the Multiple Sclerosis Resource Center Editor-in-Chief, Joseph R. Berger, M.D., FACP, FAAN, FANA.

Dr. Berger is Professor of Neurology and  Associate Chief of the Multiple Sclerosis Division of the Department of Neurology at the Perelman School of Medicine at the University of Pennsylvania in Philadelphia. He is a fellow of the American College of Physicians, American Academy of Neurology and the American Neurological Association. He has published more than 240 refereed papers, more than 100 chapters, and has co-edited three textbooks.  Dr. Berger co-founded and chaired the first international conference on the neurological complications of HIV, the Neuroscience of HIV meeting.  He also established the Commonwealth Neurological Society for neurologists in the state of Kentucky. Dr. Berger has a longstanding interest in international health and was one of the founding members of People-to-People, an organization for HIV/AIDS care and education in East Africa.

In the presence of mild levels of depression or significant fatigue in persons with multiple sclerosis (MS), subjective cognitive measures are unlikely to provide accurate estimates of objective cognitive functioning. This according to a recent study that aimed to examine the degree to which depressive symptoms and fatigue in individuals with MS are associated with discrepancies between subjective and objective cognitive impairment. 99 adults with MS completed the Patient Health Questionnaire–8 (PHQ-8), Fatigue Severity Scale (FSS), MS Neuropsychological Screening Questionnaire (MSNQ), and Brief International Cognitive Assessment for MS (BICAMS). Participants were classified as “Accurates,” “Underestimators,” or “Overestimators” based on discrepancies between their MSNQ (subjective) and BICAMS (objective) scores. Researchers found:

• The PHQ-8 (r=.58) and FSS (r=.48) significantly correlated with the MSNQ, but not with the
  BICAMS (rs<.07).
• Underestimators (ie, participants who underestimated their objective cognitive functioning) exhibited higher PHQ-8 and FSS scores compared to Accurates and Overestimators.
• Optimal cut-scores of ≥6 on the PHQ-8 and ≥36 on the FSS provided fair accuracy (78% and 74%) for identifying Underestimators.
• Identification of Underestimators based on PHQ-8 and FSS scores was not moderated by any demographic or MS clinical variables.

Hughes AJ. Depressive symptoms and fatigue as predictors of objective-subjective discrepancies in cognitive function in multiple sclerosis. [Published online ahead of print January 31, 2019]. Mult Scler Relat Disord. doi:10.1016/j.msard.2019.01.055.

In the presence of mild levels of depression or significant fatigue in persons with multiple sclerosis (MS), subjective cognitive measures are unlikely to provide accurate estimates of objective cognitive functioning. This according to a recent study that aimed to examine the degree to which depressive symptoms and fatigue in individuals with MS are associated with discrepancies between subjective and objective cognitive impairment. 99 adults with MS completed the Patient Health Questionnaire–8 (PHQ-8), Fatigue Severity Scale (FSS), MS Neuropsychological Screening Questionnaire (MSNQ), and Brief International Cognitive Assessment for MS (BICAMS). Participants were classified as “Accurates,” “Underestimators,” or “Overestimators” based on discrepancies between their MSNQ (subjective) and BICAMS (objective) scores. Researchers found:

• The PHQ-8 (r=.58) and FSS (r=.48) significantly correlated with the MSNQ, but not with the
  BICAMS (rs<.07).
• Underestimators (ie, participants who underestimated their objective cognitive functioning) exhibited higher PHQ-8 and FSS scores compared to Accurates and Overestimators.
• Optimal cut-scores of ≥6 on the PHQ-8 and ≥36 on the FSS provided fair accuracy (78% and 74%) for identifying Underestimators.
• Identification of Underestimators based on PHQ-8 and FSS scores was not moderated by any demographic or MS clinical variables.

Hughes AJ. Depressive symptoms and fatigue as predictors of objective-subjective discrepancies in cognitive function in multiple sclerosis. [Published online ahead of print January 31, 2019]. Mult Scler Relat Disord. doi:10.1016/j.msard.2019.01.055.

In the presence of mild levels of depression or significant fatigue in persons with multiple sclerosis (MS), subjective cognitive measures are unlikely to provide accurate estimates of objective cognitive functioning. This according to a recent study that aimed to examine the degree to which depressive symptoms and fatigue in individuals with MS are associated with discrepancies between subjective and objective cognitive impairment. 99 adults with MS completed the Patient Health Questionnaire–8 (PHQ-8), Fatigue Severity Scale (FSS), MS Neuropsychological Screening Questionnaire (MSNQ), and Brief International Cognitive Assessment for MS (BICAMS). Participants were classified as “Accurates,” “Underestimators,” or “Overestimators” based on discrepancies between their MSNQ (subjective) and BICAMS (objective) scores. Researchers found:

• The PHQ-8 (r=.58) and FSS (r=.48) significantly correlated with the MSNQ, but not with the
  BICAMS (rs<.07).
• Underestimators (ie, participants who underestimated their objective cognitive functioning) exhibited higher PHQ-8 and FSS scores compared to Accurates and Overestimators.
• Optimal cut-scores of ≥6 on the PHQ-8 and ≥36 on the FSS provided fair accuracy (78% and 74%) for identifying Underestimators.
• Identification of Underestimators based on PHQ-8 and FSS scores was not moderated by any demographic or MS clinical variables.

Hughes AJ. Depressive symptoms and fatigue as predictors of objective-subjective discrepancies in cognitive function in multiple sclerosis. [Published online ahead of print January 31, 2019]. Mult Scler Relat Disord. doi:10.1016/j.msard.2019.01.055.

Higher baseline trait conscientiousness predicts slower rates of longitudinal cognitive decline in multiple sclerosis (MS), according to a recent study. Researchers conducted a retrospective analysis of 531 patients with MS whose data were gleaned from a multi-study database, aggregated over 16 years. Linear mixed effects modeling was applied to estimate the average rate of decline on Symbol Digit Modalities Test (SDMT) performance and to predict rates of decline using baseline clinical variables. They found:

• Participants exhibited an average estimated decline of 0.22 SDMT raw-score points/year.
• There was a significant main effect of time from baseline (t = −2.78), test form (t = 2.13), disease course (t = 2.91), age (t = −2.76), sex (t = −2.71), subjective cognitive impairment (t = −2.00), premorbid verbal intelligence (t = 5.14), and trait Conscientiousness (t = 2.69).
• A significant interaction emerged for Conscientiousness and time from baseline (t = 2.57).

Fuchs TA, Wojcik C, Wilding GE, et al. Trait Conscientiousness predicts rate of longitudinal SDMT decline in multiple sclerosis. [Published online ahead of print January 7, 2019]. Mult Scler. doi:10.1177%2F1352458518820272.

Higher baseline trait conscientiousness predicts slower rates of longitudinal cognitive decline in multiple sclerosis (MS), according to a recent study. Researchers conducted a retrospective analysis of 531 patients with MS whose data were gleaned from a multi-study database, aggregated over 16 years. Linear mixed effects modeling was applied to estimate the average rate of decline on Symbol Digit Modalities Test (SDMT) performance and to predict rates of decline using baseline clinical variables. They found:

• Participants exhibited an average estimated decline of 0.22 SDMT raw-score points/year.
• There was a significant main effect of time from baseline (t = −2.78), test form (t = 2.13), disease course (t = 2.91), age (t = −2.76), sex (t = −2.71), subjective cognitive impairment (t = −2.00), premorbid verbal intelligence (t = 5.14), and trait Conscientiousness (t = 2.69).
• A significant interaction emerged for Conscientiousness and time from baseline (t = 2.57).

Fuchs TA, Wojcik C, Wilding GE, et al. Trait Conscientiousness predicts rate of longitudinal SDMT decline in multiple sclerosis. [Published online ahead of print January 7, 2019]. Mult Scler. doi:10.1177%2F1352458518820272.

Higher baseline trait conscientiousness predicts slower rates of longitudinal cognitive decline in multiple sclerosis (MS), according to a recent study. Researchers conducted a retrospective analysis of 531 patients with MS whose data were gleaned from a multi-study database, aggregated over 16 years. Linear mixed effects modeling was applied to estimate the average rate of decline on Symbol Digit Modalities Test (SDMT) performance and to predict rates of decline using baseline clinical variables. They found:

• Participants exhibited an average estimated decline of 0.22 SDMT raw-score points/year.
• There was a significant main effect of time from baseline (t = −2.78), test form (t = 2.13), disease course (t = 2.91), age (t = −2.76), sex (t = −2.71), subjective cognitive impairment (t = −2.00), premorbid verbal intelligence (t = 5.14), and trait Conscientiousness (t = 2.69).
• A significant interaction emerged for Conscientiousness and time from baseline (t = 2.57).

Fuchs TA, Wojcik C, Wilding GE, et al. Trait Conscientiousness predicts rate of longitudinal SDMT decline in multiple sclerosis. [Published online ahead of print January 7, 2019]. Mult Scler. doi:10.1177%2F1352458518820272.