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Mind-MS: Can a Mindfulness-Based Intervention influence MS patients’ Cognitive Function, Patient Reported Outcomes and Brain structure?

Barbara M. Willekens1, 2*, Gaetano Perrotta3, Carl-Edward Van Mieghem4, Arash Sarwar4, Sara Vanhoorenbeeck4, Annemie Ribbens5, Wim Van Hecke5, Bjorn Prins6, Patrick Cras1, 7, 8 and Nathalie Cools9
  • 1 Antwerp University Hospital, Belgium
  • 2 University of Antwerp, Belgium
  • 3 Neurology Service, Erasmus Hospital, Free University of Brussels, Belgium
  • 4 Faculty of Medicine and Health Sciences, University of Antwerp, Belgium
  • 5 Icometrix (Belgium), Belgium
  • 6 Department of Experimental Clinical and Health Psychology, Ghent University, Belgium
  • 7 Born Bunge Institute, Belgium
  • 8 Translational Neurosciences, University of Antwerp, Belgium
  • 9 Laboratory of Experimental Hematology, University of Antwerp, Belgium

Background: Multiple sclerosis (MS) is a neuroinflammatory and neurodegenerative disease that affects both white and gray matter. Besides physical symptoms, MS can lead to various hidden symptoms, including cognitive impairment, fatigue and depression. These invisible symptoms are difficult to treat and have an important impact on quality of life and work force participation. Mindfulness based interventions (MBIs) can have a positive influence on fatigue and depressive symptoms. Research on laboratory biomarkers and neuroimaging, capable to deliver proof-of-concept of this behavioral treatment in MS, is largely lacking. Via the tripartite interaction between the brain, the immune system and neuroendocrine regulation, MBIs might affect MS symptoms, such as fatigue, depression and cognitive dysfunction and induce structural changes in the brain in regions important for memory, attention and emotional regulation. [1] Objectives: To explore effects of a MBI on cognition, structural Magnetic Resonance Imaging (MRI) measurements and patient reported outcomes (PROs). Methods: Twenty MS patients with subjective and/or objective cognitive dysfunction were included in an open-label study in 2 Belgian MS centers. The intervention consisted of a 8 week course of MBI that closely followed the MBSR program according to J. Kabat-Zinn. Two experienced mindfulness trainers were responsible for the training sessions. Study time-points include a baseline assessment, post-intervention and 6 months follow-up evaluations. The primary outcome measure is the change in cognitive function (measured by Symbol Digit Modalities Test or SDMT, different versions were used) and change in perceived cognitive deficits. As a secondary outcome measure, MRI volumetrics (gray matter volume, whole brain volume and white matter volume, via MS metrix pipeline and selected regions based on voxel-based morphometry) are analyzed. Other secondary outcome measures are patient reported outcome measures on quality of life, anxiety and depression, coping and stress (Coping Inventory for Stressful situations or CISS), and mindfulness (Five Facet Mindfulness Questionnaire or FFMQ). Results: 10 patients in the Antwerp cohort and 9 patients in the Brussels cohort were retained in the study. Mean age of the patients was 46 years (range 33-56). Seventeen patients had a relapsing and 2 a progressive disease course. Here we describe interim results of post-intervention measurements. Mean SDMT score pre-intervention was 49 ±7 and did not change significantly post-intervention (SDMT 49 ± 6). A statistically significant improvement in emotion-oriented coping measured by CISS-E and an increase in mindfulness as measured by the FFMQ was seen. Anxiety and cognitive avoidance improved after the intervention, albeit not statistically significant. 6-months evaluations are currently being collected. MRI measurements of gray matter, white matter and whole brain volume did not change significantly over the pre- and post-intervention period. Conclusions: In this exploratory study of effects of a MBI in MS patients, no significant effect on cognitive function as measured by SDMT could be demonstrated directly post-intervention as compared to pre-intervention. Furthermore, a significant improvement in emotion-oriented coping and increase in mindfulness could be demonstrated in this short time-frame.

Acknowledgements

We thank the patients who participated in this study. A special thanks goes to the study nurses of the Antwerp University Hospital and Erasme Hospital Brussels. This work and the MIND-MS study are supported by the Fund Claire Fauconnier 2013, King Baudouin Foundation, Brussels, Belgium. BW is supported by a research fellowship from the University of Antwerp.

References

[1] B. Willekens, G. Perrotta, P. Cras, and N. Cools, Into the Moment: Does Mindfulness Affect Biological Pathways in Multiple Sclerosis? Frontiers in behavioral neuroscience 12 (2018) 103.

Keywords: mindfulness, Mindfulness-based intervention (MBI), Multiple Sclerosis, coping, MRI - Magnetic resonance imaging, Cognitive Function

Conference: Belgian Brain Congress 2018 — Belgian Brain Council, LIEGE, Belgium, 19 Oct - 19 Oct, 2018.

Presentation Type: e-posters

Topic: NOVEL STRATEGIES FOR NEUROLOGICAL AND MENTAL DISORDERS: SCIENTIFIC BASIS AND VALUE FOR PATIENT-CENTERED CARE

Citation: Willekens BM, Perrotta G, Van Mieghem C, Sarwar A, Vanhoorenbeeck S, Ribbens A, Van Hecke W, Prins B, Cras P and Cools N (2019). Mind-MS: Can a Mindfulness-Based Intervention influence MS patients’ Cognitive Function, Patient Reported Outcomes and Brain structure?. Front. Neurosci. Conference Abstract: Belgian Brain Congress 2018 — Belgian Brain Council. doi: 10.3389/conf.fnins.2018.95.00083

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Received: 26 Aug 2018; Published Online: 17 Jan 2019.

* Correspondence: MD. Barbara M Willekens, Antwerp University Hospital, Antwerp, Belgium, Barbara.Willekens@uza.be