Fitzgerald Kathryn C, Salter Amber, Tyry Tuula, Fox Robert J, Cutter Gary, Marrie Ruth Ann
Department of Neurology (KCF), Johns Hopkins School of Medicine, Baltimore, MD; Division of Biostatistics (AS), Washington University in St. Louis School of Medicine, MO; Dignity Health (TT), St. Joseph's Hospital and Medical Center, Phoenix, AZ; Mellen Center for Multiple Sclerosis (RJF), Cleveland Clinic Foundation, OH; Department of Biostatistics (GC), University of Alabama in Birmingham School of Public Health, AL; and Departments of Internal Medicine and Community Health Sciences (RAM), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.
Neurol Clin Pract. 2018 Dec;8(6):472-481. doi: 10.1212/CPJ.0000000000000523.
We sought to determine the prevalence of pseudobulbar affect (PBA) in a large MS population and assess its association with disability and symptom severity.
North American Research Committee on MS (NARCOMS) registry participants completed the Center for Neurologic Study-Lability Scale (CNS-LS), a validated 7-question self-report measure of PBA. A composite PBA score was derived from the sum of responses to the 7 questions. We categorized individuals as PBA-positive (PBA[+]) if they had a composite score ≥17 without current depression. Participants also reported their demographic characteristics and their clinical characteristics using Patient-Determined Disease Steps and Performance Scales. We compared clinical and disease characteristics for PBA(+) responders with those without PBA using descriptive statistics and multivariable multinomial logistic regression.
Of the 8,136 responders, 574 (7%) had scores ≥17 on the CNS-LS; however, only 200 (2.5%) individuals had scores ≥17 without comorbid depression, of whom only 22 (11%) reported a diagnosis of PBA. PBA(+) individuals tended to be younger (mean [SD] 53.4 [11.0] vs 57.2 [10.3] years), non-white (13% vs 9%), and have lower socioeconomic status (≤$30,000 annual income: 28% vs 22%). In multivariable models, PBA(+) was associated with increased odds of more severe cognitive impairment (moderate vs mild disability OR: 1.37; 95% CI: 1.01, 1.84).
Our findings suggest that the prevalence of PBA in MS is low, but similar symptoms may co-occur or overlap with depression, highlighting the importance of concomitant assessment of mood when evaluating potential PBA. PBA may be associated with cognitive impairment in people with MS.
我们试图确定在大量多发性硬化症（MS）患者中假性球麻痹情感障碍（PBA）的患病率，并评估其与残疾及症状严重程度的关联。
北美多发性硬化症研究委员会（NARCOMS）登记参与者完成了神经学研究易激惹量表（CNS-LS），这是一种经过验证的、用于评估PBA的7个问题的自我报告测量工具。综合PBA得分由对这7个问题的回答总和得出。如果个体的综合得分≥17且当前无抑郁症状，我们将其归类为PBA阳性（PBA[+]）。参与者还使用患者确定的疾病阶段和表现量表报告了他们的人口统计学特征和临床特征。我们使用描述性统计和多变量多项逻辑回归比较了PBA(+)应答者与无PBA应答者的临床和疾病特征。
在8136名应答者中，574人（7%）在CNS-LS上的得分≥17；然而，只有200人（2.5%）得分≥17且无共病抑郁，其中只有22人（11%）报告诊断为PBA。PBA(+)个体往往更年轻（平均[标准差]53.4[11.0]岁对57.2[10.3]岁）、非白人（13%对9%）且社会经济地位较低（年收入≤30,000美元：28%对22%）。在多变量模型中，PBA(+)与更严重认知障碍的几率增加相关（中度残疾与轻度残疾的比值比：1.37；95%置信区间：1.01，1.84）。
我们的研究结果表明，MS患者中PBA的患病率较低，但类似症状可能与抑郁同时出现或重叠，这突出了在评估潜在PBA时同时评估情绪的重要性。PBA可能与MS患者的认知障碍有关。
