Ruggieri R M, Palermo R, Vitello G, Gennuso M, Settipani N, Piccoli F
Department of Neurology, University of Palermo, Italy.
Acta Neurol Scand. 2003 Nov;108(5):323-6. doi: 10.1034/j.1600-0404.2003.00157.x.
Previous papers have mainly demonstrated the presence and the frequency of cognitive impairment in patients suffering from relapsing-remitting multiple sclerosis. The purpose of this study was to investigate subjects with the relapsing-remitting form of the disease and mild clinical disability (EDSS < or = 3.5), so as to quantify this deficit when the illness does not yet interfere with daily living and the ability to work.
Fifty patients and 50 healthy controls were submitted to a wide neuropsychological battery, including Wechsler Memory Scale I- (WMS), Benton Visual Retention Test D- (BVRT), Raven Coloured Progressive Matrices (RCPM), Kohs' test (KT), Judgement of Lines Orientation H- (JLO), Facial Recognition (FR) and Aachner Aphasie Test (AAT). They also underwent Clinical Depression Scale (CDQ) and State-Trait Anxiety Inventory (STAI).
The results show the presence of significant memory impairment on both WMS (P = 0.000) and BVRT (P = 0.000) in patients compared with controls. Patients were also impaired in abstract reasoning and problem-solving deficit (KT P = 0.003; RCPM P = 0.000) and in FR (P = 0.019). Cognitive decline correlated with illness duration (r = 0.761), but was independent of EDSS (r = 0.085).
Cognitive decline was present even when physical disability was not yet severe, but it was mild and did not limit patients' ability to work. The cognitive impairment outlined was of the subcortical type and correlated with illness duration. This study emphasizes the importance of cognitive examination in clinical practice. It is suggested that a complete neurological examination include tests on memory and abstract reasoning.
既往文献主要证实了复发缓解型多发性硬化症患者认知障碍的存在及发生率。本研究旨在调查复发缓解型疾病且临床残疾程度较轻（扩展残疾状态量表评分≤3.5）的患者，以便在疾病尚未干扰日常生活和工作能力时对这种缺陷进行量化。
50例患者和50名健康对照者接受了一系列广泛的神经心理学测试，包括韦氏记忆量表I-（WMS）、本顿视觉保持测验D-（BVRT）、瑞文彩色渐进矩阵测验（RCPM）、考斯积木测验（KT）、直线方向判断测验H-（JLO）、面部识别测验（FR）和阿赫纳失语症测验（AAT）。他们还进行了临床抑郁量表（CDQ）和状态-特质焦虑量表（STAI）测试。
结果显示，与对照组相比，患者在WMS（P = 0.000）和BVRT（P = 0.000）上均存在显著的记忆障碍。患者在抽象推理和解决问题方面也存在缺陷（KT，P = 0.003；RCPM，P = 0.000）以及FR方面（P = 0.019）。认知功能下降与病程相关（r = 0.761），但与扩展残疾状态量表评分无关（r = 0.085）。
即使身体残疾尚不严重，认知功能下降也已存在，但程度较轻且未限制患者的工作能力。所概述的认知障碍为皮质下型，且与病程相关。本研究强调了认知检查在临床实践中的重要性。建议完整的神经系统检查应包括记忆和抽象推理测试。
