Department of Neurology, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York (SUNY), Buffalo, NY, USA.
Department of Neurology, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York (SUNY), Buffalo, NY, USA; Buffalo Neuroimaging Analysis Center, Department of Neurology, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York (SUNY), Buffalo, NY, USA.
Mult Scler Relat Disord. 2018 May;22:52-56. doi: 10.1016/j.msard.2018.03.008. Epub 2018 Mar 13.
Cognitive impairment can be seen in patients of all ages with multiple sclerosis (MS). However, there is limited research on neurocognitive disorder in older adults with MS and how to detect Alzheimer's disease (AD) or its prodromal stage, amnestic mild cognitive impairment (aMCI). Thus, the MS clinician is challenged to discriminate between signs of MS-related cognitive decline versus a secondary neurodegenerative process.
Compare cognition in older MS patients to patients with AD and aMCI.
We evaluated cognitively impaired and unimpaired MS patients, AD patients, aMCI patients, and healthy controls (HCs), all elderly (n = 20 per group). AD and aMCI diagnoses were derived by consensus conference independent of the MS research project. Neuropsychological measures assessed domains commonly affected in AD, including verbal memory and expressive language.
Cognitively impaired and unimpaired MS groups did not differ on any measures sensitive to AD. Unimpaired MS patients were comparable to HCs. Impaired MS patients showed decreased semantic fluency, similar to aMCI patients. Lastly, while both AD and aMCI groups had deficient memory retention, there was no evidence of a retention deficit in either MS group.
Our findings suggest that the cognitive profiles of MS and AD are distinct. In contrast to AD, MS is not associated with impairment of memory consolidation. However, there may be overlap between cognitive deficits related to MS and aMCI. Thus, evidence of poor memory retention, in an older MS patient may merit comprehensive dementia evaluation. The study is preliminary and includes no AD biomarkers (e.g., amyloid imaging) to confirm or rule out AD pathology.
认知障碍可发生于各年龄段的多发性硬化症（MS）患者中。然而，针对 MS 老年患者的神经认知障碍以及如何检测阿尔茨海默病（AD）或其前驱阶段——遗忘型轻度认知障碍（aMCI），相关研究有限。因此，MS 临床医生面临的挑战是区分 MS 相关认知下降的迹象与继发性神经退行性过程。
比较老年 MS 患者与 AD 和 aMCI 患者的认知情况。
我们评估了认知障碍和认知未受损的 MS 患者、AD 患者、aMCI 患者和健康对照者（HCs），每组各 20 人。AD 和 aMCI 的诊断由独立于 MS 研究项目的共识会议确定。神经心理学测量评估了常见于 AD 的认知域，包括言语记忆和表达语言。
认知障碍和未受损的 MS 组在任何对 AD 敏感的指标上均无差异。未受损的 MS 患者与 HCs 相当。认知受损的 MS 患者的语义流畅性下降，与 aMCI 患者相似。最后，虽然 AD 和 aMCI 组的记忆保留均不足，但在 MS 组中均未发现记忆保留缺陷。
我们的研究结果表明，MS 和 AD 的认知特征不同。与 AD 不同，MS 与记忆巩固受损无关。然而，MS 相关认知缺陷与 aMCI 之间可能存在重叠。因此，在老年 MS 患者中出现记忆保留不佳的证据可能需要进行全面的痴呆评估。本研究为初步研究，未包含 AD 生物标志物（例如，淀粉样蛋白成像）来确认或排除 AD 病理。
