Department of Neurological and Psychiatric Sciences, University of Florence, Viale Morgagni 85, 50134, Florence, Italy.
J Neurol. 2013 Jun;260(6):1452-68. doi: 10.1007/s00415-012-6678-0. Epub 2012 Nov 23.
Cognitive impairment in multiple sclerosis (MS) is common, debilitating and burdensome. Key evidence from trials was reviewed to enable recommendations to be made to guide clinical practice and research. Behavioural and pharmacological interventions on cognition reported in published studies were reviewed. Most studies evaluating behavioural treatment for impairment in learning and memory, deficits of attention and executive function have demonstrated some improvement. Controlled studies in relapsing remitting MS indicate interferon (IFN) β-1b and IFN β-1a were associated with modest cognitive improvement. The effects of symptomatic therapies such as modafinil and donepezil are inconsistent. Most studies yielding positive findings have significant methodological difficulties limiting the confidence in making any broad treatment recommendations. There are no published reports of glatiramer acetate, natalizumab and fingolimod being effective in improving cognition in controlled trials. The effects of disease modifying therapies in other forms of MS and clinically isolated syndrome have not yielded positive results. Data linking behavioural therapy, symptomatic treatment or disease modifying treatment, to either reducing cognitive decline or improving impaired cognition are limited and inconsistent. The treatment and prevention of cognitive impairment needs to remain a key research focus, identifying new interventions and improving clinical trial methodology.
多发性硬化症（MS）患者常见认知障碍，这种障碍具有致残性且给患者带来沉重负担。为指导临床实践和研究，对来自临床试验的关键证据进行了回顾，以提出建议。对已发表研究中报告的认知障碍的行为和药物干预措施进行了综述。大多数评估行为治疗对学习和记忆障碍、注意力和执行功能缺陷的研究表明，认知有一定改善。在复发缓解型多发性硬化症中进行的对照研究表明，干扰素（IFN）β-1b 和 IFN β-1a 与认知的适度改善有关。莫达非尼和多奈哌齐等对症治疗的效果并不一致。大多数得出阳性结果的研究都存在重大方法学问题，限制了对任何广泛治疗建议的信心。尚无关于那他珠单抗、加利昔单抗和芬戈莫德在对照试验中改善认知的有效性的发表报告。在其他形式的多发性硬化症和临床孤立综合征中，疾病修正疗法的效果并未产生阳性结果。将行为疗法、对症治疗或疾病修正治疗与认知衰退的减少或认知障碍的改善联系起来的数据有限且不一致。认知障碍的治疗和预防仍需成为重点研究领域，以确定新的干预措施并改进临床试验方法。
