National MS Society highlights Kessler Foundation research presented at March AAN meeting in San Diego

Studies highlighted showed memory improvement with exercise and identified factors protective against disease-related cognitive decline

West Orange, NJ. March 28, 2013. Research presented by Kessler Foundation scientists was highlighted by Andrew Bebo, PhD, associate VP of Discovery Research at the National MS Society. “Emerging evidence suggests that exercise doesn’t just help keep us physically fit,” he said, “but also helps our brains function better; presentations … on exercise, rehabilitation and quality of life issues suggest this holds true for people living with MS.” Dr. Bebo added, "...growing evidence suggests that people may be able to build cognitive reserve by engaging in enrichment activities (Words with Friends anyone?). It’s exciting to think that actions we can take, such as some mental and physical training, can actually alter brain circuits, improve brain activity and possibly help slow the progression of MS.

Dr. Bebo referred to the following presentations by Drs. Victoria Leavitt and James Sumowski, research scientists in Neuropsychology & Neuroscience Research.

Aerobic exercise increases hippocampal volume and improves memory in persons with multiple sclerosis: pilot findings from a randomized controlled trial

Victoria Leavitt 1,2, Amanda Cohen 1, Amanda Farag 2, Christopher Cirnigliaro 3 , Nancy Chiaravalloti 1,2, James F. Sumowski 1,2, John DeLuca 1,2 1 Kessler Foundation; 2 UMDNJ; 3 James Peters VA Medical Center

OBJECTIVE:Aerobic exercise improves memory and promotes hippocampal neurogenesis in non-human animals. Its efficacy has not been verified in a memory-impaired neurologic sample. Here, a randomized controlled trial of aerobic versus non-aerobic exercise was piloted in multiple sclerosis (MS) patients with memory impairment. BACKGROUND: MS leads to prominent hippocampal atrophy: as much as 10% reduction of hippocampal volume is seen in persons with relapsing-remitting MS (RRMS), even after only five years. Hippocampal atrophy is linked to memory deficits; indeed, more than 50% of MS patients suffer memory impairment, with negative consequences for quality of life. There are currently no effective memory treatments for MS, either pharmacological or behavioral. DESIGN/METHODS: Pilot data were collected from two ambulatory, memory-impaired MS participants randomized to non-aerobic (stretching) and aerobic (stationery cycling) conditions. Baseline and follow-up measurements: high-resolution MRI (neuroanatomical volumes), fMRI (functional connectivity), and memory assessment. Intervention was 30 minute sessions 3 times per week for 3 months. RESULTS: Aerobic exercise resulted in a 16.5% increase in hippocampal volume and a 53.7% increase in memory, as well as a large increase in hippocampal resting-state functional connectivity. In contrast, non-aerobic exercise resulted in relatively no change in hippocampal volume (2.8%) or memory (0.0%), and no changes in hippocampal resting-state functional connectivity. Effects of aerobic exercise were specific to the hippocampus and memory, as there were no comparable changes in overall cerebral gray matter (2.4%) or in non-hippocampal deep gray matter structures (thalamus, caudate: -4.0%), nor were there any changes in non-memory cognitive functioning (mean change: 0.0%). CONCLUSIONS: This is the first evidence for aerobic exercise to increase hippocampal volume, hippocampal connectivity, and improve memory in MS. Aerobic exercise represents a cost-effective, widely available, natural, and self-administered treatment with no adverse side effects that may be the first effective memory treatment for MS patients.

Evidence for brain reserve and cognitive reserve in multiple sclerosis: lifetime maximal brain growth and early life cognitive leisure independently but differentially protect against disease-related cognitive decline (NIH grant R00HD060765).

James Sumowski 1,2, Maria Rocca 3, Victoria Leavitt 1,2, Gianna Carla Riccitelli 3, Giancarlo Comi 3, John DeLuca 1,2, Massimo Filippi 3 1 Kessler Foundation, 2 UMDNJ, 3 Milan, Italy

OBJECTIVE: This is the first study to investigate (a) the brain reserve (BR) hypothesis in MS, (b) whether cognitive reserve (CR) protects against disease-related cognitive impairment independently of BR in any population, and (c) whether BR and CR differentially protect against cognitive inefficiency and memory decline. BACKGROUND: The BR hypothesis states that larger lifetime brain growth/size (estimated with intracranial volume [ICV]) protects against disease-related cognitive impairment. BR is supported in aging/Alzheimer's disease (AD), but is untested in multiple sclerosis (MS). The CR hypothesis states that greater lifetime enrichment (i.e., cognitive leisure) protects against disease-related cognitive impairment. Although supported in AD and MS, it is unknown whether CR (acquired through experience) protects against cognitive impairment independently of BR (determined by genetics). DESIGN/METHODS: Cognitive status was assessed in 62 MS patients (SDMT, PASAT, SRT, SPART). MRI was used to measure neuropathological burden (T2 lesion load [T2LL]) and BR (ICV). CR was estimated with survey of early life cognitive leisure (e.g., hobbies). BR hypothesis: hierarchical regression predicting cognitive status (step one: demographics; step two: T2LL; step three: ICV, step four: T2LLxICV). CR hypothesis: hierarchical regression predicting cognitive status (step one: all predictors in BR analysis; step two: education; step three: cognitive leisure; step four: T2LLxleisure interaction). Analyses repeated to predict cognitive efficiency (SDMT, PASAT) and memory (SRT, SPART) separately. RESULTS: T2LLxICV interaction (R²=.05, p=.030) showed that greater ICV reduced/moderated the negative impact of T2LL on cognitive status. BR protected against cognitive inefficiency, not memory decline. T2LLxleisure interaction (R²=.037, p=.037) revealed that higher leisure independently reduced/moderated the negative impact ofT2LL on cognitive status. CR was more protective against memory decline than cognitive inefficiency. CONCLUSIONS: BR was supported in MS, with larger lifetime brain growth/size protecting against cognitive decline. Cognitive leisure provided independent protection against cognitive impairment over-and-above BR. Voluntary lifestyle choices are protective over-and-above genetic sources of reserve. 

About MS Research at Kessler Foundation

Kessler Foundation's cognitive rehabilitation research in MS is funded by grants from the National Institutes of Health, National MS Society and Kessler Foundation. Scientists in Neuropsychology & Neuroscience Research at Kessler Foundation have made important contributions to knowledge of cognitive decline in MS. Clinical studies span new learning, memory, executive function, attention and processing speed. Research tools include innovative applications of fMRI and virtual reality. Among recent findings are the benefits of cognitive reserve; correlation between cognitive performance and outdoor temperatures; the efficacy of short-term cognitive rehabilitation using modified story technique; and the correlation between memory improvement and cerebral activation on fMRI. John DeLuca, PhD, VP of Research & TRaining, and Nancy Chiaravalloti, PhD, are leaders in cognitive rehabilitation research.

About Kessler Foundation

Kessler Foundation, a major nonprofit organization in the field of disability, is a global leader in rehabilitation research that seeks to improve cognition, mobility and long-term outcomes, including employment, for people with neurological disabilities caused by diseases and injuries of the brain and spinal cord. Kessler Foundation leads the nation in funding innovative programs that expand opportunities for employment for people with disabilities.

Contact: Carolann Murphy
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