Skorve Ellen, Lundervold Astri J, Torkildsen Øivind, Myhr Kjell-Morten
Neuro-SysMed, Department of Neurology, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway.
Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway.
Mult Scler Relat Disord. 2020 Nov;46:102577. doi: 10.1016/j.msard.2020.102577. Epub 2020 Oct 12.
Cognitive impairment is common in patients with multiple sclerosis (MS) and may occur at any stage and with any subtype of the disease. Screening and monitoring of cognitive function should therefore be implemented into everyday clinical neurology practice. The Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS) was developed for this purpose. Although several cross-sectional studies have validated BICAMS, longitudinal studies evaluating its use as part of a clinical follow-up routine are still lacking.
To investigate cognitive function and trajectories of change assessed by the BICAMS test battery in a cohort of newly diagnosed relapsing-remitting MS (RRMS) patients examined at baseline and after 12 and 24 months.
BICAMS was used to assess cognitive function in 58 RRMS patients, who also filled in the Hospital Anxiety and Depression Scale (HADS) and the Fatigue Scale for Motor and Cognitive Functions (FSMC), and underwent standard neurological evaluations at baseline and at the two follow-ups.
A total of 27 patients (46.6%) were defined as cognitively impaired at baseline on at least one test, and 22 (37.9%) were defined as impaired at follow-up after 24 months. Throughout the study, 8 (13.8%) and 4 (6.9%) patients were consistently defined as impaired on two or three tests, respectively. The mean raw scores on two BICAMS subtests (SDMT and CVLT-II) improved significantly from baseline to the first follow-up, and then remained stable the next year, whereas the visual memory test (BVMT-R) were overall unchanged from baseline to the end of the study. The correlations between the scores on HADS, FSMC and the BICAMS subtests were non-significant at baseline, but weak to moderate negative correlations were found at the one- and two-year follow-ups.
The patients showed improved test results from baseline to the first follow-up examination, indicating that an effect of previous practise should be taken into account when interpreting the results. With results showing both trajectories of stability and change, our study supported the validity of including BICAMS as part of a clinical follow-up routine of RRMS patients. Anxiety, depression, fatigue and cognition should always be assessed at the same time to reveal interaction effects that are expected to affect the daily-life functioning of at least some of the RRMS patients.
认知障碍在多发性硬化症（MS）患者中很常见，可发生于疾病的任何阶段和任何亚型。因此，认知功能的筛查和监测应纳入日常临床神经学实践中。为此开发了简短国际多发性硬化症认知评估量表（BICAMS）。尽管多项横断面研究已验证了BICAMS，但仍缺乏评估其作为临床随访常规一部分使用情况的纵向研究。
调查在基线、12个月和24个月时接受检查的一组新诊断复发缓解型多发性硬化症（RRMS）患者中，通过BICAMS测试组合评估的认知功能及其变化轨迹。
使用BICAMS评估58例RRMS患者的认知功能，这些患者还填写了医院焦虑抑郁量表（HADS）和运动与认知功能疲劳量表（FSMC），并在基线和两次随访时接受了标准神经学评估。
共有27例患者（46.6%）在基线时至少一项测试中被定义为认知障碍，22例（37.9%）在24个月随访时被定义为认知障碍。在整个研究过程中，分别有8例（13.8%）和4例（6.9%）患者在两项或三项测试中一直被定义为认知障碍。BICAMS的两项子测试（符号数字模式测试和加利福尼亚语言学习测验第二版）的平均原始分数从基线到首次随访时有显著提高，然后在次年保持稳定，而视觉记忆测试（本顿视觉保持测验修订版）从基线到研究结束总体上没有变化。HADS、FSMC得分与BICAMS子测试得分在基线时无显著相关性，但在1年和2年随访时发现了弱至中度的负相关性。
患者从基线到首次随访检查的测试结果有所改善，这表明在解释结果时应考虑先前练习的影响。结果显示了稳定和变化的轨迹，我们的研究支持将BICAMS纳入RRMS患者临床随访常规的有效性。应始终同时评估焦虑、抑郁、疲劳和认知，以揭示预期会影响至少部分RRMS患者日常生活功能的相互作用效应。
