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多发性硬化症早期的认知障碍、健康相关生活质量和职业状况:一项 7 年的纵向研究。

Cognitive impairment, health-related quality of life and vocational status at early stages of multiple sclerosis: a 7-year longitudinal study.

机构信息

INSERM U.1049 Neuroinflammation, Imagerie et Thérapie de la Sclérose en plaques, Université de Bordeaux, Case 78, 146 rue Léo Saignat, 33076, Bordeaux cedex, France.

出版信息

J Neurol. 2013 Mar;260(3):776-84. doi: 10.1007/s00415-012-6705-1. Epub 2012 Oct 19.

Abstract

The association between cognitive impairment, health-related quality of life (HRQoL) and vocational status has been studied in recent years in cross-sectional studies in multiple sclerosis (MS), but longitudinal data are still lacking. This study assesses this association in a sample of 65 newly diagnosed MS patients followed longitudinally. Each patient underwent a standardised clinical assessment, cognitive tests and the HRQoL SEP-59 questionnaire six months after the MS diagnosis (baseline) and seven years later (y7).Vocational status was also established at baseline and at y7 in MS patients. The HRQoL at baseline was severely reduced in MS patients compared with healthy subjects. The independent predictors for HRQoL composite scores at y7 were the baseline depression score and the memory Z-score. Accordingly, 81.5 % of MS patients worked at baseline and only 54.4 % worked at y7. Among the MS patients who did not work at y7, 72.7 % of them were cognitively impaired, while 27.3 % were unimpaired at baseline. The vocational status at y7 was significantly associated with the baseline IPS Z-score, EDSS and age. Vocational status at y7 and its change over 7 years was significantly associated with cognitive deterioration. IPS or memory dysfunction in the early stages of MS is correlated with a decreased level in health perception, independent of fatigue, depression and physical disability. Cognitive impairment at the diagnosis of MS increases the risk of changing vocational status in MS patients seven years later.

摘要

近年来,在多发性硬化症(MS)的横断面研究中,已经研究了认知障碍、健康相关生活质量(HRQoL)和职业状况之间的关联,但仍缺乏纵向数据。本研究评估了 65 名新诊断的 MS 患者样本中的这种关联,这些患者进行了纵向随访。每位患者在 MS 诊断后 6 个月(基线)和 7 年后(y7)接受了标准化的临床评估、认知测试和 HRQoL SEP-59 问卷。基线和 y7 还确定了 MS 患者的职业状况。与健康受试者相比,MS 患者的 HRQoL 在基线时严重降低。y7 时 HRQoL 综合评分的独立预测因素是基线抑郁评分和记忆 Z 评分。因此,81.5%的 MS 患者在基线时工作,只有 54.4%在 y7 时工作。在 y7 时不工作的 MS 患者中,72.7%的患者认知受损,而 27.3%的患者在基线时没有受损。y7 时的职业状况与基线 IPS Z 评分、EDSS 和年龄显著相关。y7 时的职业状况及其在 7 年内的变化与认知恶化显著相关。MS 早期的 IPS 或记忆功能障碍与健康感知水平下降相关,与疲劳、抑郁和身体残疾无关。MS 诊断时的认知障碍会增加 MS 患者 7 年后改变职业状况的风险。

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