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Maybe this is why my brain seems to be humming at full capacity lately. I'm right at the 30 month mark. Interesting. - Dave
Longitudinal change in PASAT performance following immunoablative therapy and haematopoietic stem cell transplant in MS
L.A.S. Walker, J. Berard, M. Bowman, H.L. Atkins, H. Lee, M.S. Freedman (Ottawa, Montreal, CA)
Background and Goals: Immediately following hematopoietic stem cell transplantation (HSCT) for refractory MS a median decrease in total brain volume of 3.2% over 2.4 months has been observed. However, beyond 2 years following HSCT, the rate of brain volume loss is similar in magnitude to that reported for normal volunteers. The potential impact of this decrease in brain volume on cognition (i.e. information processing speed [IPS] and working memory [WM]) was evaluated by examining performance on the Paced Auditory Serial Addition Test (PASAT) pre- and post-HSCT.
Methods: Twenty-three individuals with rapidly progressing MS and poor prognosis underwent high dose immunoablation and subsequent HSCT. Subjects completed the 3" PASAT at baseline and 6/12/18/24/30/36 months post-HSCT.
Results: A mean decline in performance was noted between baseline and 6-months post- HSCT. However, the change was not to a statistically significant degree as assessed by reliable change analyses. Minor declines initially noted were offset by an overall trend for improvement over time. The largest cognitive gains took place between months 30 and 36, but again not to a statistically significant degree. Level of impairment at baseline did not influence the likelihood of improvement over time. No differences in demographic variables were noted between those who improved and those who did not.
Conclusions: While an initial decline in IPS/WM was noted 6 months post-HSCT, there were no lasting negative effects of treatment given the overall trend for improvement over time. The initial cognitive decline and marked volume loss are likely secondary to acute toxic effects of the chemotherapy. While gains in cognition were made over time, their clinical significance remains unclear; however, results at 36 months suggest that long-term follow-up is essential.
Longitudinal change in PASAT performance following immunoablative therapy and haematopoietic stem cell transplant in MS
L.A.S. Walker, J. Berard, M. Bowman, H.L. Atkins, H. Lee, M.S. Freedman (Ottawa, Montreal, CA)
Background and Goals: Immediately following hematopoietic stem cell transplantation (HSCT) for refractory MS a median decrease in total brain volume of 3.2% over 2.4 months has been observed. However, beyond 2 years following HSCT, the rate of brain volume loss is similar in magnitude to that reported for normal volunteers. The potential impact of this decrease in brain volume on cognition (i.e. information processing speed [IPS] and working memory [WM]) was evaluated by examining performance on the Paced Auditory Serial Addition Test (PASAT) pre- and post-HSCT.
Methods: Twenty-three individuals with rapidly progressing MS and poor prognosis underwent high dose immunoablation and subsequent HSCT. Subjects completed the 3" PASAT at baseline and 6/12/18/24/30/36 months post-HSCT.
Results: A mean decline in performance was noted between baseline and 6-months post- HSCT. However, the change was not to a statistically significant degree as assessed by reliable change analyses. Minor declines initially noted were offset by an overall trend for improvement over time. The largest cognitive gains took place between months 30 and 36, but again not to a statistically significant degree. Level of impairment at baseline did not influence the likelihood of improvement over time. No differences in demographic variables were noted between those who improved and those who did not.
Conclusions: While an initial decline in IPS/WM was noted 6 months post-HSCT, there were no lasting negative effects of treatment given the overall trend for improvement over time. The initial cognitive decline and marked volume loss are likely secondary to acute toxic effects of the chemotherapy. While gains in cognition were made over time, their clinical significance remains unclear; however, results at 36 months suggest that long-term follow-up is essential.