title: Cognitive impairment and "invisible symptoms" are not associated with CCSVI in MS.
abstract: BACKGROUND
  We investigated the association between chronic cerebrospinal venous insufficiency (CCSVI) and cognitive impairment (CI) in multiple sclerosis (MS). Moreover, we evaluated the association between CCSVI and other frequent self-reported MS symptoms.
  
  
  METHODS
  We looked at the presence of CI in incident MS patients with CCVSI in a population-based cohort of Catania, Italy. All subjects were group-matched by age, sex, disease duration and EDSS score with MS patients without CCSVI, serving as controls. CI was assessed with the Brief Repeatable Battery (BRB) and the Stroop Test (ST) and it was defined by the presence of at least three impaired tests. Fatigue and depressive symptoms were assessed with Fatigue Severity Scale (FSS) and Hamilton Depressive Rating Scale (HDRS), respectively. Bladder and sexual symptoms were assessed with the respective items of the Italian version of Guy's Neurological Disability Scale (GNDS). Quality of life was evaluated with Multiple Sclerosis Quality of Life-54 Instrument (MSQOL-54).
  
  
  RESULTS
  Out of 61 MS patients enrolled in the study, 27 were CCSVI positive and 34 were CCSVI negative. Of them, 43 were women (70.5%); the mean age was 43.9 ± 11.8 years; the mean disease duration was 159.7 ± 113.7 months; mean EDSS was 3.0 ± 2.6. Of them, 36 (59.0%) were classified relapsing-remitting (RR), 12 (19.7%) secondary progressive (SP), seven (11.5%) primary progressive (PP) and six (9.3%) Clinically Isolated Syndrome (CIS). Overall, CI was detected in 29/61 (47.5%) MS patients; particularly 13/27 (48.1%) in the CCSVI positive group and 16/34 (47.0%) in the CCSVI negative group. Presence of CCSVI was not significantly associated with the presence of CI (OR 1.04; 95% CI 0.37-2.87; p-value = 0.9). Not significant differences were found between the two groups regarding the other MS symptoms investigated.
  
  
  CONCLUSIONS
  Our findings suggest a lack of association between CCSVI and CI in MS patients. Fatigue, depressive, bladder/sexual symptoms and self-reported quality of life are not associated with CCSVI.
authors.forename: Carmela
authors.initials: C
authors.lastname: Leone
authors.forename: Emanuele
authors.initials: E
authors.lastname: D'Amico
authors.forename: Sabina
authors.initials: S
authors.lastname: Cilia
authors.forename: Alessandra
authors.initials: A
authors.lastname: Nicoletti
authors.forename: Luigi
authors.initials: L
authors.lastname: Di Pino
authors.forename: Francesco
authors.initials: F
authors.lastname: Patti
mesh_terms: D000328:Adult; D003072:Cognition Disorders / Q000209:etiology*; D003711:Demyelinating Diseases / Q000150:complications*; D005260:Female; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000150:complications*; D011788:Quality of Life; D014689:Venous Insufficiency / Q000209:etiology*
references.citation: Int J Neurol. 1968;7(1):44-54
references.pmid: 5730403
references.citation: Qual Life Res. 1995 Jun;4(3):187-206
references.pmid: 7613530
references.citation: Nat Rev Immunol. 2009 Jun;9(6):393-407
references.pmid: 19444307
references.citation: Clin Infect Dis. 1994 Jan;18 Suppl 1:S79-83
references.pmid: 8148458
references.citation: Eur J Neurol. 2008 Oct;15(10):1091-9
references.pmid: 18727673
references.citation: J Int Neuropsychol Soc. 2009 May;15(3):451-8
references.pmid: 19402931
references.citation: Nat Clin Pract Neurol. 2006 Oct;2(10):538-47
references.pmid: 16990827
references.citation: J Cereb Blood Flow Metab. 2009 Dec;29(12):1867-78
references.pmid: 19724286
references.citation: Mult Scler. 2001 Aug;7(4):263-7
references.pmid: 11548987
references.citation: Expert Rev Neurother. 2011 Mar;11(3):425-32
references.pmid: 21375447
references.citation: AJNR Am J Neuroradiol. 1999 Nov-Dec;20(10):1951-5
references.pmid: 10588124
references.citation: Nervenarzt. 2010 Jun;81(6):740-6
references.pmid: 20386873
references.citation: J Neuroimaging. 2004 Jul;14(3 Suppl):36S-45S
references.pmid: 15228758
references.citation: Ann Neurol. 2010 Aug;68(2):255-9
references.pmid: 20695018
references.citation: Mult Scler. 2009 Jan;15(1):2-8
references.pmid: 18805842
references.citation: Ann Neurol. 1983 Mar;13(3):227-31
references.pmid: 6847134
references.citation: Lancet Neurol. 2011 Jul;10(7):657-66
references.pmid: 21683931
references.citation: J Neurosci Nurs. 2008 Apr;40(2):85-95, 102
references.pmid: 18481738
references.citation: Lancet. 2008 Oct 25;372(9648):1502-17
references.pmid: 18970977
references.citation: Percept Mot Skills. 1977 Apr;44(2):367-73
references.pmid: 866038
references.citation: Neuro Endocrinol Lett. 2011;32(4):557-62
references.pmid: 21876515
references.citation: Neurology. 2001 Jan 9;56(1):62-6
references.pmid: 11148237
references.citation: Arch Neurol. 2009 Sep;66(9):1144-50
references.pmid: 19752305
references.citation: Expert Rev Clin Immunol. 2010 May;6(3):481-90
references.pmid: 20441432
references.citation: Br J Soc Clin Psychol. 1967 Dec;6(4):278-96
references.pmid: 6080235
references.citation: Neurology. 2005 Oct 25;65(8):1259-63
references.pmid: 16247054
references.citation: Neurology. 1983 Nov;33(11):1444-52
references.pmid: 6685237
references.citation: Ann Neurol. 2001 Jul;50(1):121-7
references.pmid: 11456302
references.citation: Neurology. 1998 Jun;50(6):1601-8
references.pmid: 9633700
references.citation: J Neurol Neurosurg Psychiatry. 2009 Apr;80(4):392-9
references.pmid: 19060024
references.citation: J Neurol Sci. 2009 Jul 15;282(1-2):21-7
references.pmid: 19144359
references.citation: Int Angiol. 2010 Apr;29(2):176-82
references.pmid: 20351673
references.citation: J Vasc Surg. 2009 Dec;50(6):1348-58.e1-3
references.pmid: 19958985
references.citation: J Neurol Sci. 2006 Jun 15;245(1-2):41-6
references.pmid: 16643953
references.citation: Mult Scler. 2006 Dec;12(6):787-93
references.pmid: 17263008
references.citation: J Neurol Neurosurg Psychiatry. 2000 Feb;68(2):157-61
references.pmid: 10644780
references.citation: Funct Neurol. 2010 Oct-Dec;25(4):223-33
references.pmid: 21388584
references.citation: Mult Scler. 2011 Mar;17(3):273-80
references.pmid: 21071466
references.citation: Int Angiol. 2010 Apr;29(2):109-14
references.pmid: 20351666
references.citation: Int Angiol. 2010 Apr;29(2):115-20
references.pmid: 20351667
references.citation: CMAJ. 2011 Nov 8;183(16):E1203-12
references.pmid: 21969411
references.citation: PLoS One. 2012;7(8):e41227
references.pmid: 22870210
references.citation: Neurology. 1974 Nov;24(11):1019-25
references.pmid: 4473151