1st Department of Neurology, Eginition Hospital, National and Kapodistrian University of Athens, 74 Vas. Sofias Av., 11528, Athens, Greece.
Department of Psychiatry, School of Medicine, University of Crete, Heraklion, Greece.
J Neurol. 2020 May;267(5):1464-1475. doi: 10.1007/s00415-020-09720-8. Epub 2020 Feb 1.
Numerous cross-sectional studies report cognitive impairment in multiple sclerosis (MS), but longitudinal studies with sufficiently long-term follow-up are scarce.
We aimed to investigate the cognitive 10-year course of a cohort of MS patients.
59 patients with clinically isolated syndrome (CIS) or relapsing-remitting (RR) MS were evaluated with Rao's Brief Repeatable Battery of Neuropsychological Tests at baseline and follow-up (at least 10 years later). They constituted 47.2% of 124 consecutive CIS and RRMS patients originally evaluated at baseline. Patients assessed at follow-up were well matched for baseline clinical characteristics with dropouts.
The proportion of MS patients with overall cognitive impairment was increased by 10% within the 10-year period. When grouped on the basis of impairment in specific cognitive domains at baseline, patients originally impaired showed improvement at follow-up, while the opposite trend was observed for patients non-impaired at first assessment. A detailed case-by-case investigation revealed mixed evolution patterns, several patients fail in fewer domains at follow-up compared to baseline or failing at different domains at follow-up compared to baseline.
This study suggests a more fluid picture for the evolution of cognitive function in a subgroup of MS patients and contradicts the concept of an inevitable, progressively evolving "dementia".
许多横断面研究报告多发性硬化症（MS）患者存在认知障碍，但具有足够长期随访的纵向研究却很少。
我们旨在研究一组 MS 患者的认知 10 年病程。
59 例临床孤立综合征（CIS）或复发缓解型（RR）MS 患者在基线和随访时（至少 10 年后）接受 Rao 简短重复神经心理测试电池评估。他们构成了最初在基线评估的 124 例连续 CIS 和 RRMS 患者中的 47.2%。与失访者相比，在随访时评估的患者在基线临床特征上具有很好的匹配性。
在 10 年内，MS 患者整体认知障碍的比例增加了 10%。根据基线特定认知域的损伤进行分组，最初受损的患者在随访时表现出改善，而最初无损伤的患者则出现相反的趋势。详细的逐个病例调查显示出混合的演变模式，一些患者在随访时的表现比基线时少，或者在随访时的表现比基线时不同。
这项研究表明，在 MS 患者亚组中，认知功能的演变呈现出更加不稳定的情况，这与不可避免的、逐渐发展的“痴呆”概念相矛盾。
