Cognition Evolution and MRI Markers in PPMS Patients on 2 Years

Study Overview
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Brief Summary
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Cognitive impairment is nowadays more and more recognized as an important feature of the multiple sclerosis (MS) disease. Cognitive disorders frequency in MS is estimated between 40 and 60%. Cognitive impairment affects quality of life and vocational status in MS patients. Until recently, little information was available on the cognitive dysfunction and their evolution that occur in primary progressive multiple sclerosis (PPMS) as compared with relapsing-remitting MS (RRMS). In PPMS pathological studies have shown the importance of cortical demyelination and meningeal inflammation suggesting that the GM alteration could play a major role in the cognitive impairment in this phenotype. The cognitive evolution and the brain tissue alteration at the origin of these difficulties remain poorly understood in PPMS. The use of new techniques for morphological and functional MRI can study the contribution of diffuse White Matter (WM) alteration (probably through disconnexion of relevant network) and diffuse Grey matter (GM) alterations in the cerebral cortex and other structures (the hippocampi, the cerebellum, and the thalami) in cognitive impairment in PPMS patients and on their evolution.

Official Title
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Longitudinal Study of Cognition in Primary Progressive Multiple Sclerosis: a Cohort Study

Conditions
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Multiple Sclerosis, Primary Progressive

Intervention / Treatment
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* Other: Clinical assessment
* Other: Ecological evaluation
* Other: Neuropsychological evaluation
* Other: Psychological evaluation
* Device: MRI Evaluation


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: PATIENTS Male or female; Age ≥ 18 years; PPMS diagnosis according to McDonald 2010 criteria; Disease duration ≤ 15 years; Native French speaking; Being affiliated to health insurance; Willing to participate and to sign informed consent. HEALTHY CONTROLS Male or Female; Age ≥ 18 years; Native French speaking; Being affiliated to health insurance; Willing to participate and to sign informed consent. Exclusion Criteria: PATIENTS previous history of other neurological disease; psychiatric comorbidity including severe depression according to DSM-IV; alcohol or other addiction to toxic; disabling visual or motor problems preventing participation to neuropsychological assessments; change of psychotropic drug since less than one month; contra-indication to MRI (pacemakers, aneurysm clips, artificial heart valves, ear implants, metal fragments or foreign objects in the eyes, skin or body,claustrophobia or refusing MRI); illiteracy, is unable to count or to read; pregnant or breastfeeding women; patient concerned by articles L 1121-5 to L 1121-8 (persons deprived of their liberty by a judicial or administrative decision, minors, persons of legal age who are the object of a legal protection measure or unable to express their consent). HEALTHY CONTROLS history of neurological disease; family history of MS; psychiatric comorbidity including severe depression according to DSM-IV; alcohol or other toxic addiction; psychotropic drugs; known cognitive complaint or neuropsychological affection; prior neuropsychological testing with the same tests less than 6 months contra-indication to MRI (pacemakers, aneurysm clips, artificial heart valves, ear implants, meta fragments or foreign objects in the eyes, skin or body, claustrophobia or refusing MRI); illiteracy, is unable to count or to read; pregnant or breastfeeding women; person concerned by articles L 1121-5 to L 1121-8 (persons deprived of their liberty by a judicial or administrative decision, minors, persons of legal age who are the object of a legal protection measure or unable to express their consent).

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Diagnostic
Allocation: Non-Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: patient<br>PPMS diagnosis according to McDonald 2010 criteria (Polman et al, 2011) | Other: Clinical assessment<br>* Expanded Disability Status Scale (EDSS), ambulation test and Multiple Sclerosis functional composite (MSFC). Medications will be recorded.<br>Other: Ecological evaluation<br>* Virtual reality task and Actual reality<br>Other: Neuropsychological evaluation<br>* cognitive tests exploring information processing speed, attention/concentration, working and episodic memories and executive function<br>Other: Psychological evaluation<br>* questionnaires for depression, anxiety and fatigue<br>Device: MRI Evaluation<br>* morphological MRI and resting state functional MRI (fMRI)<br>|
| Active Comparator: Control<br>40 Healthy controls | Other: Ecological evaluation<br>* Virtual reality task and Actual reality<br>Other: Neuropsychological evaluation<br>* cognitive tests exploring information processing speed, attention/concentration, working and episodic memories and executive function<br>Other: Psychological evaluation<br>* questionnaires for depression, anxiety and fatigue<br>Device: MRI Evaluation<br>* morphological MRI and resting state functional MRI (fMRI)<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change of composite z cognitive score based on individual neuropsychological scores | The composite z cognitive score is the average of z individual cognitive scores. The score from each cognitive test is transformed into z-scores. Z-scores will be calculated for each cognitive score with the following formula: (patient's score - mean value of HC group matched for age, sex, and education level)/standard deviation of the matched HC for each evaluation time (baseline and 2 years). Individual neuropsychological scores included in composite z cognitive score : the Alertness subtest, the divided attention subtest and the visual-scanning subtest from the TAP, The Symbol-digit-modalities-test, the Paced-Auditory-Serial-Addition-Test 3s, reversed span, the Stroop test, the Verbal fluency, Trail Making test, the California Verbal memory learning test and the Brief visual memory test -revised | At baseline (day 0) and at 24 months from baseline | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Correlation of composite z cognitive score and ecological score with MRI parameters reflecting grey and white matter integrity and anatomic/functional connectivity | The composite z cognitive score is the average of z individual cognitive scores. The score from each cognitive test is transformed into z-scores. Z-scores will be calculated for each cognitive score with the following formula: (patient's score - mean value of HC group matched for age, sex, and education level)/standard deviation of the matched HC for each evaluation time. The composite z ecological score is the average of z ecological scores of virtual reality task (Urban DailyCog©) and actual reality tests. | At baseline (day 0) and at 24 months from baseline | 
| Change of composite z cognitive score based on individual neuropsychological scores | The composite z cognitive score is the average of z individual cognitive scores. The score from each cognitive test is transformed into z-scores. Z-scores will be calculated for each cognitive score with the following formula: (patient's score - mean value of HC group matched for age, sex, and education level)/standard deviation of the matched HC for each evaluation time. | At baseline (day 0), at 12 months and at 24 months from baseline | 
| Changes of composite z ecological score based on individual ecological scores | The composite z cognitive score is the average of z individual cognitive scores. The score from each cognitive test is transformed into z-scores. Z-scores will be calculated for each cognitive score with the following formula: (patient's score - mean value of HC group matched for age, sex, and education level)/standard deviation of the matched HC for each evaluation time. The composite z ecological score is the average of z ecological scores of virtual reality task (Urban DailyCog©) and actual reality tests. | At baseline (day 0), at 12 months and at 24 months from baseline | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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cognitive impairment, ecological assessment, brain MRI