Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA.
J Neurol Neurosurg Psychiatry. 2012 Jan;83(1):38-43. doi: 10.1136/jnnp.2010.237834. Epub 2011 Jul 11.
The objective was to investigate changes in cognitive functioning in subjects with early multiple sclerosis (MS) over 5 years. Methodological issues associated with longitudinal cognitive research such as practice effects and drop-outs were also examined.
Ninety subjects with a diagnosis of clinically isolated syndrome or MS and disease duration from a first symptom of ≤ 6 years participated in the study. Subjects were administered the Brief Repeatable Battery of Neuropsychological Tests in MS, which includes five measures assessing four cognitive domains. As a means of stabilising practice effects, the battery was administered 1-2 weeks apart at enrollment and then annually for up to 5 years.
Significant deterioration was found on a measure of working memory and speed of information processing. Significant deterioration was also found on measures of immediate and delayed visual spatial memory. Verbal memory was unchanged over the course of the study. Improved performance was observed on a second measure of speed of information processing and on a measure of verbal fluency. Among subjects with longitudinal follow-up, the drop-out rate was 30%, but subjects who dropped out did not differ from those who completed the study in terms of baseline cognitive performance or the change in cognitive performance from year 1 to year 2.
Subjects with early MS showed a deterioration in working memory and visual spatial memory over a period of up to 5 years. Although significant practice effects were associated with several cognitive measures, the Symbol Digit Modality Test may be useful for longitudinal evaluations of cognitive functioning in MS.
本研究旨在探究早期多发性硬化症（MS）患者在 5 年内认知功能的变化。同时还探讨了与纵向认知研究相关的方法学问题，如练习效应和失访。
90 名诊断为临床孤立综合征或 MS 的患者参与了本研究，他们的疾病起始症状持续时间不超过 6 年。患者接受了多发性硬化症简短重复认知测试（Brief Repeatable Battery of Neuropsychological Tests in MS，BRB-N），该测试包含五个评估四个认知领域的测试。为了稳定练习效应，在入组时，测试在 1-2 周内间隔进行，然后每年进行一次，最长可达 5 年。
在工作记忆和信息处理速度的测量上，发现了显著的恶化。在即时和延迟视觉空间记忆的测量上，也发现了显著的恶化。在整个研究过程中，言语记忆没有变化。在信息处理速度的第二个测量上，以及在言语流畅性的测量上，观察到了改善的表现。在有纵向随访的受试者中，失访率为 30%，但在认知表现的基线水平或从第 1 年到第 2 年的认知表现变化方面，失访者与完成研究的受试者没有差异。
早期 MS 患者在长达 5 年的时间内，工作记忆和视觉空间记忆出现恶化。尽管几个认知测量都与显著的练习效应相关，但符号数字模态测试可能对 MS 认知功能的纵向评估有用。
