Ralph H. B. Benedict, PhD, ABPP-CNProfessor of Neurology, Psychiatry and Psychology

University at Buffalo, SUNY

Brains & Gains

November 2013

[In] most of the patients affected by multi-locular sclerosis whom I have had occasion to observe … there is marked enfeeblement of the memory; conceptions are formed slowly; the intellectual and emotional faculties are blunted in their totality. The dominant feeling in the patients appears to be a sort of almost cheerful indifference in reference to all things.

Jean-Martin Charcot (1877)

Demyelination and axonopathy

cerebral cortex r = 0.65 [Amato 2004; Benedict 2006; Tekok-Kilic 2007]

3rd ventricle r = 0.71[Christodolou 2003; Benedict 2004]

mesial temporal r = 0.42 [Sicotte 2008; Benedict 2009]

thalamus r = 0.75 [Houtchens 2007]

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5

6

7

Job LossReduced work hours

DemotionLess Salary

Miss Promotion

WalkingUpper Extremity Function

Cognitive AbilityDepression

Negative Work EventsWork Errors

Forgetting AppointmentsSlow Work, Reduced

ProductivityUnequal Work Distribution

Social Difficulty

Accommodations/InterventionHigh Tech, Low Tech Aids

Overt, Covert AidsAdditional Time to Complete Tasks

Flexible Schedule

EmployerPatient

Coworker

Cognitive Impairment Mild

Maintain Employment

Private Disability

Social Security Disability

Early Retirement

Severe

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Hours Worked per Week

Income

Extra Time Spent Outside Work

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How to Monitor Clinical Status?

www.BICAMS.net

Published Collecting data/analysis DiscussionUSA Canada Portugal PeruIran UK Belgium OmanCzech Republic Italy Ireland Poland

Germany Hungary RomaniaAustria Australia Slovenia

Egypt SwedenEstonia TurkeyLithuania BrazilNorway MexicoColumbia

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Why do some MS Patients Fare so Well?

• Cognitive Reserve• Exercise• Personality• Cognitive Retraining

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Dimensional models of personality: the five-factor model and the DSM-5Timothy J. Trull, PhD; Thomas A. Widiger, PhD. Dialogues Clin Neurosci. 2013;15:135-146.

Conscientiousness

p = 0.023

Neuroticism

p = 0.001

Adam J. BoothJonathan D. RodgersCarolyn E. Schwartz, Sc.DBrian R. QuarantoBianca Weinstock-GuttmanRobert ZivadinovRalph H. B. Benedict

Active Cognitive Reserve Influences the Regional Atrophy to Cognition Link in Multiple SclerosisIn Press

Thank You

Bianca Weinstock-Guttman MD

Robert Zivadinov MD; Murali Ramanathan PhD

David Hojnacki MD; Channa Kolb MD

Margaret Bucello NP; Audrey Smerbeck PhD

Jonathan Rodgers PhD, Natalie Emmert BA