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We performed a longitudinal case-control study on patients with clinically isolated syndrome (CIS) with the aid of quantitative whole-brain myelin imaging. The aim was (1) to parse early myelin decay and to break down its distribution pattern, and (2) to identify an imaging biomarker of the conversion into clinically definite Multiple Sclerosis (MS) based on in vivo measurable changes of myelination. Imaging and clinical data were collected immediately after the onset of first neurological symptoms and follow-up explorations were performed after 3, 6, and, 12 months. The multi-component Driven Equilibrium Single Pulse Observation of T1/T2 (mcDESPOT) was applied to obtain the volume fraction of myelin water (MWF) in different white matter (WM) regions at every time-point. This measure was subjected to further voxel-based analysis with the aid of a comparison of the normal distribution of myelination measures with an age and sex matched healthy control group. Both global and focal relative myelination content measures were retrieved. We found that (1) CIS patients at the first clinical episode suggestive of MS can be discriminated from healthy control WM conditions (p, Highlights • The multicomponent relaxation method mcDESPOT allowed 3D resolved data acquisition appropriate for group comparison and voxel-wise analysis. • Myelin imaging in early clinically isolated syndrome revealed initial imaging widespread myelin loss even in normal appearing brain tissue. • In clinically isolated syndrome the myelin measures varied depending on the presence of Gadolinium enhancement. • Short-term risk of clinically isolated syndrome to convert to multiple sclerosis was determined by myelin measures within white matter lesions.

Backround: Nitrogen narcosis impairs cognitive function, a fact relevant during SCUBA-diving. Oxygen-enriched air (nitrox) became popular in recreational diving, while evidence of its advantages over air is limited. AIM: Compare effects of nitrox28 and air on two psychometric tests. METHODS: In this prospective, double-blind, open-water study, 108 advanced divers (38 females) were randomized to an air or a nitrox-group for a 60-min dive to 24 m salt water. Breathing gas effects on cognitive performance were assessed during the dive using a short- and long-term memory test and a number connection test. RESULTS: Nitrox28 divers made fewer mistakes only on the long-term memory test (p = 0.038). Female divers remembered more items than male divers (p < 0.001). There were no significant differences in the number connection test between the groups. CONCLUSION: Likely owing to the comparatively low N2 reduction and the conservative dive, beneficial nitrox28 effects to diver performance were moderate but could contribute to diving safety.

We assessed quality of life (QoL) and psychological well-being in patients with amyotrophic lateral sclerosis-induced locked-in state and their next of kin in a fully unbiased manner using eye-tracking computer systems. Eleven of 30 screened patients and 9 next of kin completed study procedures. Patients reported good QoL, which appeared to be at the cost of the QoL of their next of kin. Next of kin rated their own or patients' QoL similarly, but they identified different areas as important as compared with patients. Our results are of importance for the discussion of end-of-life decisions and the evaluation of patients' presumed wishes as well as for psychosocial interventions. Ann Neurol 2017;81:310-315.

Objectives The self-report of cognitive deficits by of patients with epilepsy is often poorly correlated with objective test performances but highly related to mood and personality. The aim of this study was to evaluate whether information obtained by close relatives of the patient shows higher correlations with the patients' objective test scores and thereby can be a complementary measure for ensuring a reliable basis for diagnostic decision-making. Methods Thirty-four patients and 29 relatives were asked to fill in a questionnaire about everyday cognitive deficits of the patient. All patients completed a neuropsychological test battery comprising measures of memory, attention, and executive functioning and questionnaires on anxiety, depression, and the personality trait neuroticism. Results Correlations between relatives' reports and patients' test performances were highly significant across all examined domains. By contrast, self-reports of the patients significantly correlated with none of the neuropsychological measures of memory and with only a subset of the objective measures of attention and executive functioning. Regression analyses additionally revealed a strong dependency of the patients' self-assessment on depression, anxiety, and neuroticism (R2 = 0.42). Conclusions These results point out the risk of self-reports distorting reality and additionally recommend consulting a close relative of the patient to ensure reliable information about the patient's everyday cognitive functioning.

Restrictions in communicative abilities are well known in patients with amyotrophic lateral sclerosis (ALS), but only few approaches in terms of evaluation of supportive technologies have been made. We aimed to assess the use and perceived usability of eye-tracking computer devices (ETCS) of severely impacted patients with ALS in an independent, direct manner and relate it to psychological well-being. ETCS enable active communication and social participation in the quadriplegic and anarthric disease state. Therefore, ETCS-based versions of widely used psychosocial questionnaires (ADI-12, SeiQoL-DW, WHO-5) as well as structured questions on communicative functioning and ETCS usage were developed to assess ALS patients, their next of kin and professional caregivers. Eleven patients (ALSFRS-R: 5.3 ± 5.9; ALS duration: 6.5 ± 3.8 years, range 1‒12; 82% invasively ventilated), nine next of kin and 10 professional caregivers could be assessed. Patients reported a mean use of their personal ETCS of 9.1 h per d (range 0.5‒16), with a high user satisfaction, preservation of communicative abilities and subjective indispensability of the ETCS. ETCS use was associated with higher psychological well-being. Next of kin and professional caregivers also nominated some critical aspect, which remains to be clarified. Our results strengthen the evidence that preserved mental autonomy influences psychological well-being in ALS and might even modify disease course and end-of-life-decisions in ALS.