Bellmann-Strobl J, Wuerfel J, Aktas O, Dörr J, Wernecke K D, Zipp F, Paul F
Cecilie Vogt Klinik, Charité-University Medicine Berlin and Max Delbrueck Center for Molecular Medicine, Berlin, Germany.
Neurology. 2009 Nov 17;73(20):1624-7. doi: 10.1212/WNL.0b013e3181c1de4f.
Cognitive impairment is increasingly recognized as relevant clinical feature in multiple sclerosis (MS). We applied the Paced Auditory Serial Addition Test (PASAT), a recommended screening tool for cognitive dysfunction in MS, to investigate the relationship between cognitive performance and the presence of gadolinium (Gd)-enhancing lesions on brain MRI.
In this longitudinal correlational research study, 75 patients with relapsing-remitting MS (48 women and 27 men, mean age 36 years, mean disease duration 5 years, mean Expanded Disability Status Scale [EDSS] 1.7) without clinical signs of a relapse underwent 2 MRI measurements (number and volume of T1 contrast-enhancing lesions and of T2 lesions) and clinical examinations (EDSS and Multiple Sclerosis Functional Composite [MSFC]) with a mean interscan interval of 10 weeks. Patients were divided into 3 groups: A (n = 38), Gd on 1 scan; B (n = 12), Gd on both scans; and C (n = 25), Gd on neither scan.
In group A, PASAT was better at the Gd-negative time point (p = 0.002), whereas the other MSFC subscores remained unchanged. Subgroup analysis confirmed the finding in patients with a Gd-positive scan first, whereas this was not the case for patients with a Gd-negative scan first, presumably owing to the small sample size of this subgroup. In groups B and C, there was no difference between both time points regarding MSFC and its subscores. EDSS remained stable in all groups during the investigation.
Paced Auditory Serial Addition Test performance is affected by the appearance of Gd enhancement as surrogate marker of inflammatory activity in otherwise physically stable patients with multiple sclerosis, which may indicate that Gd enhancement causes a diffuse impairment of cerebral connectivity with a negative impact on cognitive functioning.
认知障碍日益被认为是多发性硬化症（MS）的相关临床特征。我们应用了听觉序列加法测验（PASAT），这是一种推荐用于筛查MS认知功能障碍的工具，以研究认知表现与脑部MRI上钆（Gd）增强病灶的存在之间的关系。
在这项纵向相关性研究中，75例无复发临床体征的复发缓解型MS患者（48名女性和27名男性，平均年龄36岁，平均病程5年，平均扩展残疾状态量表[EDSS]为1.7）接受了2次MRI测量（T1对比增强病灶和T2病灶的数量及体积）以及临床检查（EDSS和多发性硬化功能综合评分[MSFC]），平均扫描间隔为10周。患者被分为3组：A组（n = 38），1次扫描有Gd增强；B组（n = 12），2次扫描均有Gd增强；C组（n = 25），2次扫描均无Gd增强。
在A组中，PASAT在Gd阴性时间点表现更好（p = 0.002），而其他MSFC子评分保持不变。亚组分析在首次扫描为Gd阳性的患者中证实了这一发现，而首次扫描为Gd阴性的患者则不然，可能是由于该亚组样本量较小。在B组和C组中，两个时间点在MSFC及其子评分方面没有差异。在研究期间，所有组的EDSS均保持稳定。
在身体状况稳定的多发性硬化症患者中，听觉序列加法测验的表现受作为炎症活动替代标志物的Gd增强出现的影响，这可能表明Gd增强会导致大脑连接性的弥漫性损害，对认知功能产生负面影响。
