Ruano Luis, Portaccio Emilio, Goretti Benedetta, Niccolai Claudia, Severo Milton, Patti Francesco, Cilia Sabina, Gallo Paolo, Grossi Paola, Ghezzi Angelo, Roscio Marco, Mattioli Flavia, Stampatori Chiara, Trojano Maria, Viterbo Rosa Gemma, Amato Maria Pia
EPIUnit, Institute of Public Health, University of Porto, Porto, Portugal/Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Porto, Portugal/Entre Douro e Vouga Hospital Centre, Santa Maria da Feira, Portugal.
University of Florence, Florence, Italia.
Mult Scler. 2017 Aug;23(9):1258-1267. doi: 10.1177/1352458516674367. Epub 2016 Oct 13.
There is limited and inconsistent information on the clinical determinants of cognitive impairment (CI) in multiple sclerosis (MS).
The aim of this study was to compare the prevalence and profile of CI across MS disease subtypes and assess its clinical determinants.
Cognitive performance was assessed through the Brief Repeatable Battery and the Stroop test in consecutive patients with MS referred to six Italian centers. CI was defined as impairment in ⩾ 2 cognitive domains.
A total of 1040 patients were included, 167 with clinically isolated syndrome (CIS), 759 with relapsing remitting (RR), 74 with secondary progressive (SP), and 40 with primary progressive (PP) disease course. The overall prevalence of CI was 46.3%; 34.5% in CIS, 44.5% in RR, 79.4% in SP, and 91.3% in PP. The severity of impairment and the number of involved domains were significantly higher in SP and primary progressive multiple sclerosis (PPMS) than in CIS and RR. In multivariable logistic regression analysis, the presence of CI was significantly associated with higher Expanded Disability Status Scale (EDSS) and older age.
CI is present in all MS subtypes since the clinical onset and its frequency is increased in the progressive forms, but these differences seem to be more associated with patient age and physical disability than to disease subtype per se.
关于多发性硬化症（MS）中认知障碍（CI）的临床决定因素的信息有限且不一致。
本研究的目的是比较MS疾病各亚型中CI的患病率和特征，并评估其临床决定因素。
对转诊至六个意大利中心的连续MS患者通过简短可重复成套测验和斯特鲁普测验评估认知表现。CI被定义为在≥2个认知领域存在损害。
共纳入1040例患者，167例临床孤立综合征（CIS），759例复发缓解型（RR），74例继发进展型（SP），40例原发进展型（PP）病程。CI的总体患病率为46.3%；CIS中为34.5%，RR中为44.5%，SP中为79.4%，PP中为91.3%。SP和原发进展型多发性硬化症（PPMS）的损害严重程度和受累领域数量显著高于CIS和RR。在多变量逻辑回归分析中，CI的存在与较高的扩展残疾状态量表（EDSS）和较高年龄显著相关。
CI自临床发病起在所有MS亚型中均存在，且在进展型中其发生率增加，但这些差异似乎更多与患者年龄和身体残疾有关，而非与疾病亚型本身有关。
