Hynčicová Eva, Vyhnálek Martin, Kalina Adam, Martinkovič Lukáš, Nikolai Tomáš, Lisý Jiří, Hort Jakub, Meluzínová Eva, Laczó Jan
Department of Neurology, 2nd Faculty of Medicine, Charles University and Motol University Hospital, V Úvalu 84, 150 06, Prague 5, Czech Republic.
International Clinical Research Center, St. Anne's University Hospital Brno, Pekarska 53, 656 91, Brno, Czech Republic.
J Neurol. 2017 Mar;264(3):482-493. doi: 10.1007/s00415-016-8368-9. Epub 2016 Dec 27.
Patients with clinically isolated syndrome (CIS), unlike those with multiple sclerosis (MS), have a selective cognitive impairment which is not consistently related to structural brain changes. Our objective was to characterize a profile of cognitive impairment and its association with structural brain changes in patients with CIS who are at high risk of developing MS. Patients with CIS at high risk for MS on interferon-beta (n = 51) and age-, gender-, and education-matched controls (n = 44) underwent comprehensive neuropsychological testing and MRI brain scan with voxel-based morphometry. The CIS group had lower cognitive performance in verbal and nonverbal memory, information processing speed/attention/working memory, and executive and visuo-spatial functions compared to controls (p ≤ 0.040). Lower cognitive performance was present in 18-37 and 14-26% of patients with CIS at high risk for MS depending on the criteria used. Brain volume was reduced predominantly in fronto-temporal regions and the thalamus in the CIS group (p ≤ 0.019). Cognitive performance was not associated with structural brain changes except for the association between worse visuo-spatial performance and lower white matter volume in the CIS group (β = 0.29; p = 0.042). Our results indicated that patients with CIS at high risk for MS may have a pattern of lower cognitive performance and regional brain atrophy similar to that found in patients with MS. Lower cognitive performance may be present in up to one-third of patients with CIS at high risk for MS, but, unlike patients with MS, variability in their cognitive performance may lead to a lack of consistent associations with structural brain changes.
与多发性硬化症（MS）患者不同，临床孤立综合征（CIS）患者存在选择性认知障碍，且这种障碍与脑结构变化并无始终一致的关联。我们的目标是描绘出认知障碍的特征及其与有发展为MS高风险的CIS患者脑结构变化之间的关联。对接受β-干扰素治疗的有发展为MS高风险的CIS患者（n = 51）以及年龄、性别和教育程度相匹配的对照组（n = 44）进行了全面的神经心理学测试和基于体素形态学的脑部MRI扫描。与对照组相比，CIS组在言语和非言语记忆、信息处理速度/注意力/工作记忆以及执行和视觉空间功能方面的认知表现较低（p≤0.040）。根据所使用的标准，有发展为MS高风险的CIS患者中，认知表现较低的患者比例分别为18 - 37%和14 - 26%。CIS组的脑容量主要在额颞叶区域和丘脑减少（p≤0.019）。除了CIS组中较差的视觉空间表现与较低的白质体积之间的关联（β = 0.29；p = 0.042）外，认知表现与脑结构变化并无关联。我们的结果表明，有发展为MS高风险的CIS患者可能具有与MS患者相似的较低认知表现和局部脑萎缩模式。有发展为MS高风险的CIS患者中，高达三分之一可能存在较低的认知表现，但与MS患者不同的是，他们认知表现的变异性可能导致与脑结构变化缺乏一致的关联。
