From the Department of Neurology (L.A.), University of Southern California, Keck School of Medicine, Los Angeles; Department of Research & Evaluation (J.B.S., E.G.G.) and Los Angeles Medical Center, Department of Neurology (A.L.-G.), Southern California Permanente Medical Group, Pasadena; and Philadelphia College of Osteopathic Medicine (S.H.), PA.
Neurology. 2020 Apr 7;94(14):e1548-e1556. doi: 10.1212/WNL.0000000000009210. Epub 2020 Mar 9.
To determine whether black or Hispanic patients with newly diagnosed multiple sclerosis (MS) are more likely to have cognitive impairment than white patients when compared to controls matched on age, sex, and race/ethnicity. Whether black or Hispanic patients have a more aggressive MS disease course than white patients remains unclear. No prior studies have examined differences in early cognitive impairment. The oral Symbol Digit Modalities Test (SDMT) is sensitive to early cognitive impairment in MS but normative data in nonwhite patients are limited.
We studied 1,174 adults who enrolled in the MS Sunshine Study. SDMT and verbal fluency were measured in 554 incident cases of MS or clinically isolated syndrome (CIS) and 620 matched controls. Multivariable regression was used to examine correlates of abnormal SDMT in the entire cohort.
The strongest independent predictors of lower oral SDMT scores in rank order were having MS/CIS, lower educational attainment, and being black or Hispanic. Black and Hispanic patients and controls had lower SDMT scores than white participants even after controlling for age, sex, and education. However, no interaction between race/ethnicity and MS case status on SDMT scores was detected. Easy-to-use reference scores stratified by age and educational attainment for black and Hispanic patients are provided.
Persons with newly diagnosed MS/CIS are more likely to have subtly impaired cognitive function than controls regardless of race/ethnicity. Lower absolute SDMT scores among black and Hispanic patients compared to white patients highlight underlying US population differences rather than differences in MS disease severity.
确定与年龄、性别和种族/民族相匹配的对照组相比，新诊断为多发性硬化症 (MS) 的黑人和西班牙裔患者是否比白人患者更容易出现认知障碍。黑人和西班牙裔患者的 MS 疾病进程是否比白人患者更具侵袭性仍不清楚。先前没有研究检查过早期认知障碍的差异。口头符号数字模态测试 (SDMT) 对 MS 中的早期认知障碍敏感，但非白人患者的规范数据有限。
我们研究了 1174 名参加 MS 阳光研究的成年人。在 554 例 MS 或临床孤立综合征 (CIS) 新发病例和 620 名匹配对照中测量了 SDMT 和言语流畅性。多变量回归用于检查整个队列中异常 SDMT 的相关性。
按降序排列，SDMT 评分较低的独立预测因素依次为患有 MS/CIS、教育程度较低以及黑人和西班牙裔。即使在控制年龄、性别和教育程度后，黑人和西班牙裔患者和对照组的 SDMT 评分也低于白人参与者。然而，在 SDMT 评分上未检测到种族/民族与 MS 病例状态之间的交互作用。为黑人和西班牙裔患者提供了按年龄和教育程度分层的易于使用的参考评分。
与对照组相比，新诊断为 MS/CIS 的患者更有可能出现认知功能轻微受损，无论其种族/民族如何。与白人患者相比，黑人和西班牙裔患者的绝对 SDMT 评分较低，突出了美国人群的潜在差异，而不是 MS 疾病严重程度的差异。
