Gajofatto A, Turatti M, Bianchi M R, Forlivesi S, Gobbin F, Azzarà A, Monaco S, Benedetti M D
Department of Neurological and Movement Sciences, University of Verona, Verona, Italy.
UOC Neurologia dU, Azienda Ospedaliera Universitaria Integrata, Verona, Italy.
Acta Neurol Scand. 2016 Mar;133(3):183-91. doi: 10.1111/ane.12442. Epub 2015 May 26.
Benign multiple sclerosis (BMS) definitions rely on physical disability level but do not account sufficiently for cognitive impairment which, however, is not rare.
To study the evolution of physical disability and cognitive performance of a group of patients with BMS followed at an University Hospital Multiple Sclerosis Center.
A consecutive sample of 24 BMS cases (diagnosis according to 2005 McDonald's criteria, relapsing-remitting course, disease duration ≥ 10 years, and expanded disability status scale [EDSS] score ≤ 2.0) and 13 sex- and age-matched non-BMS patients differing from BMS cases for having EDSS score 2.5-5.5 were included. Main outcome measures were as follows: (i) baseline and 5-year follow-up cognitive impairment defined as failure of at least two tests of the administered neuropsychological battery; (ii) EDSS score worsening defined as confirmed increase ≥ 1 point (or 0.5 point if baseline EDSS score = 5.5).
At inclusion, BMS subjects were 41 ± 8 years old and had median EDSS score 1.5 (range 0-2), while non-BMS patients were 46 ± 8 years old and had median EDSS score 3.0 (2.5-5.5). At baseline 16% of patients in both groups were cognitively impaired. After 5 years, EDSS score worsened in 8% of BMS and 46% of non-BMS patients (P = 0.008), while the proportion of cognitively impaired subjects increased to 25% in both groups.
Patients with BMS had better physical disability outcome at 5 years compared to non-BMS cases. However, cognitive impairment frequency and decline over time appeared similar. Neuropsychological assessment is essential in patients with BMS given the distinct pathways followed by disease progression in cognitive and physical domains.
良性多发性硬化症（BMS）的定义依赖于身体残疾程度，但未充分考虑认知障碍，而认知障碍并不罕见。
研究在一所大学医院多发性硬化症中心随访的一组BMS患者的身体残疾和认知表现的演变。
纳入24例BMS病例的连续样本（根据2005年麦克唐纳标准诊断，复发缓解型病程，疾病持续时间≥10年，扩展残疾状态量表[EDSS]评分≤2.0）以及13例性别和年龄匹配的非BMS患者，这些非BMS患者与BMS病例的不同之处在于其EDSS评分为2.5 - 5.5。主要结局指标如下：（i）基线和5年随访时的认知障碍，定义为所进行的神经心理测试组合中至少两项测试未通过；（ii）EDSS评分恶化，定义为确认增加≥1分（如果基线EDSS评分为5.5，则增加0.5分）。
纳入时，BMS受试者年龄为41±8岁，EDSS评分中位数为1.5（范围0 - 2），而非BMS患者年龄为46±8岁，EDSS评分中位数为3.0（2.5 - 5.5）。基线时，两组患者中有16%存在认知障碍。5年后，8%的BMS患者和46%的非BMS患者EDSS评分恶化（P = 0.008），而两组中认知障碍受试者的比例均增加至25%。
与非BMS病例相比，BMS患者在5年时身体残疾结局更好。然而，认知障碍的频率和随时间的下降似乎相似。鉴于BMS患者在认知和身体领域的疾病进展遵循不同途径，神经心理评估对其至关重要。
