Rao S M, Leo G J, Bernardin L, Unverzagt F
Department of Neurology, Medical College of Wisconsin, Milwaukee 53226.
Neurology. 1991 May;41(5):685-91. doi: 10.1212/wnl.41.5.685.
Previous frequency estimates of cognitive dysfunction in multiple sclerosis have ranged from 54 to 65 percent. These studies may overestimate the frequency in the general MS population, since the patients in these studies were recruited from clinic populations. In the present study, we administered a comprehensive neuropsychological test battery to 100 community-based MS patients and 100 demographically matched healthy controls. Of 31 cognitive test indices examined, 48 MS patients and five controls were impaired on four or more test indices, yielding an overall frequency rate of 43% for the MS group. The pattern of cognitive decline was not uniform: MS patients were more frequently impaired on measures of recent memory, sustained attention, verbal fluency, conceptual reasoning, and visuospatial perception, and less frequently impaired on measures of language and immediate and remote memory. We developed a brief (20-minute) screening battery empirically by selecting the four most sensitive test indices from the comprehensive battery. The brief battery yielded a sensitivity value of 71% and a specificity value of 94% in discriminating cognitively intact from impaired MS patients, as defined by the comprehensive battery. Cognitive impairment was not significantly associated with illness duration, depression, disease course, or medication usage, but was significantly (albeit weakly) correlated with physical disability.
先前对多发性硬化症认知功能障碍的频率估计在54%至65%之间。这些研究可能高估了普通多发性硬化症人群中的频率，因为这些研究中的患者是从临床人群中招募的。在本研究中，我们对100名社区多发性硬化症患者和100名人口统计学匹配的健康对照者进行了全面的神经心理测试。在所检查的31项认知测试指标中，48名多发性硬化症患者和5名对照者在四项或更多测试指标上受损，多发性硬化症组的总体频率为43%。认知衰退模式并不一致：多发性硬化症患者在近期记忆、持续注意力、言语流畅性、概念推理和视觉空间感知等测量指标上更常受损，而在语言以及即时和远程记忆测量指标上受损较少。我们通过从全面测试中选择四个最敏感的测试指标，凭经验开发了一个简短（20分钟）的筛查测试。根据全面测试的定义，简短测试在区分认知功能正常与受损的多发性硬化症患者时，灵敏度值为71%，特异度值为94%。认知障碍与病程、抑郁、疾病进程或药物使用无显著关联，但与身体残疾显著（尽管微弱）相关。
