Amato Maria P, Goretti Benedetta, Ghezzi Angelo, Hakiki Bahia, Niccolai Claudia, Lori Silvia, Moiola Lucia, Falautano Monica, Viterbo Rosa G, Patti Francesco, Cilia Sabina, Pozzilli Carlo, Bianchi Valentina, Roscio Marco, Martinelli Vittorio, Comi Giancarlo, Portaccio Emilio, Trojano Maria
From the Department of NEUROFARBA (M.P.A., B.G., B.H., C.N., S.L., E.P.), University of Florence; MS Centre (A.G., M.R.), Hospital of Gallarate; Neurological Department (L.M., M.F., V.M., G.C.), IRCCS Hospital San Raffaele, Milano; Department of Neuroscience and Sense Organs (R.G.V., M.T.), University of Bari; Multiple Sclerosis Centre (F.P., S.C.), University Polyclinic Hospital G. Rodolico, Catania; and Department of Neurological Sciences (C.P., V.B.), La Sapienza University, Rome, Italy.
Neurology. 2014 Oct 14;83(16):1432-8. doi: 10.1212/WNL.0000000000000885. Epub 2014 Sep 12.
The aim of the study was to perform a third cognitive assessment in our pediatric-onset multiple sclerosis (MS) patient cohort and determine predictors of the individual cognitive outcome.
After 4.7 ± 0.7 years from baseline evaluation, 48 of 63 patients in the original cohort were reassessed on an extensive neuropsychological battery and compared with 46 healthy controls. Two alternate versions of the tests were used at different assessment points. Cognitive impairment was defined as the failure of ≥3 tests; individual change in the cognitive impairment index was measured.
At year 5, 38% of the subjects with MS fulfilled our criterion for impairment. Between years 2 and 5, regarding individual cognitive impairment index change, 66.7% of the patients improved. However, comparing baseline and 5-year testing (when the same versions of the tests were used), cognitive impairment index deterioration was observed in 56% of the patients, improvement in 25%, and stability in 18.8%. A deteriorating performance was related to male sex, younger age and age at MS onset, and lower education. None of these variables, however, was retained in the multivariate analysis.
Cognitive outcome in pediatric-onset MS can be heterogeneous. Progression of cognitive problems in a few subjects and potential for compensation and improvement in others call for systematic cognitive screening in this population and development of effective treatment strategies.
本研究旨在对我们的儿童期起病的多发性硬化（MS）患者队列进行第三次认知评估，并确定个体认知结果的预测因素。
在基线评估后的4.7±0.7年，对原队列中的63例患者中的48例进行了广泛的神经心理测试重新评估，并与46名健康对照进行比较。在不同评估点使用了两种不同版本的测试。认知障碍定义为≥3项测试未通过；测量认知障碍指数的个体变化。
在第5年，38%的MS患者符合我们的障碍标准。在第2年至第5年之间，就个体认知障碍指数变化而言，66.7%的患者有所改善。然而，比较基线和5年测试（使用相同版本的测试时），56%的患者出现认知障碍指数恶化，25%有所改善，18.8%保持稳定。表现恶化与男性、年龄较小、MS发病年龄以及受教育程度较低有关。然而，在多变量分析中，这些变量均未被保留。
儿童期起病的MS患者的认知结果可能存在异质性。少数患者认知问题进展，而其他患者有代偿和改善的潜力，这就要求对该人群进行系统的认知筛查并制定有效的治疗策略。
