Gois Larissa Carla de Paula, Pimentel-Silva Luciana Ramalho, Damasceno Benito Pereira, Damasceno Alfredo
Department of Neurology, University of Campinas (UNICAMP), Brazil.
Department of Neurology, University of Campinas (UNICAMP), Brazil.
Mult Scler Relat Disord. 2021 Feb;48:102701. doi: 10.1016/j.msard.2020.102701. Epub 2020 Dec 19.
Cognitive impairment (CI) is present in all stages and subtypes of multiple sclerosis (MS). However, the majority of studies examined relapsing-remitting (RRMS) patients, and did not address cognitive phenotyping. Is still not clear whether patients with progressive MS (PMS) have a distinct pattern of CI compared to RRMS. In addition, there is conflicting data regarding the correlation between clinical and cognitive disability.
To investigate the differences of CI between PMS and RRMS patients, evaluating cognitive phenotypes. We also aimed to analyze the association between physical and cognitive disability with MRI measures of grey-matter atrophy and lesion burden.
Thirty patients with PMS and twenty-four with RRMS underwent neurological, neuropsychological (BRB-N, Boston Naming, and Tower of London), and MRI assessments (3T). Brain volume evaluations were performed using FreeSurfer. Principal Components Analysis on neuropsychological yielded six principal cognitive domains. Cognitive deficits were classified according to three categories: no CI, impairment in isolated cognitive domain, or impairment in combined domains.
In the overall sample, the most frequently impaired cognitive domains were information processing speed (IPS) and visual memory. PMS patients had a higher prevalence of verbal memory and verbal fluency deficits, and more frequent impairment in combined cognitive domains compared to RRMS individuals. After multivariable regression analysis with clinical variables, EDSS was associated with most cognitive domains. Nevertheless, after including T1-lesion volume in the model, it was the most consistent predictor of cognitive performance. To further analyze the interaction between EDSS and T1-lesions, we performed GLM analysis with EDSS and T1-hypointense lesion volume as covariates, and T1-lesion volume adjusted better the model for verbal memory (p = 0.013), IPS (p = 0.021) and total number of impaired cognitive domains (p = 0.021).
RRMS and PMS patients tend to have a similar neuropsychological profile in general, but the extent of CI was greater in PMS patients. Worse cognitive performance was associated with increased physical disability, but this correlation was no longer significant after controlling for T1-lesion volume, suggesting that the underlying MS pathology might be involved in this relationship. Thalamic and T1-lesion volumes were the most consistent MRI predictors associated with cognitive disability.
认知障碍（CI）存在于多发性硬化症（MS）的所有阶段和亚型中。然而，大多数研究考察的是复发缓解型（RRMS）患者，并未涉及认知表型分析。与RRMS相比，进展型MS（PMS）患者是否具有独特的CI模式仍不清楚。此外，关于临床残疾与认知残疾之间的相关性，数据存在冲突。
研究PMS和RRMS患者之间CI的差异，评估认知表型。我们还旨在分析身体残疾和认知残疾与灰质萎缩及病灶负荷的MRI测量值之间的关联。
30例PMS患者和24例RRMS患者接受了神经学、神经心理学（BRB-N、波士顿命名测试和伦敦塔测试）以及MRI评估（3T）。使用FreeSurfer进行脑容量评估。对神经心理学测试结果进行主成分分析，得出六个主要认知领域。认知缺陷根据三类进行分类：无CI、孤立认知领域受损或联合领域受损。
在整个样本中，最常受损的认知领域是信息处理速度（IPS）和视觉记忆。与RRMS患者相比，PMS患者言语记忆和言语流畅性缺陷的患病率更高，联合认知领域受损更频繁。在对临床变量进行多变量回归分析后发现，扩展残疾状态量表（EDSS）与大多数认知领域相关。然而，在模型中纳入T1病灶体积后，它是认知表现最一致的预测指标。为了进一步分析EDSS与T1病灶之间的相互作用，我们以EDSS和T1低信号病灶体积作为协变量进行广义线性模型（GLM）分析，T1病灶体积对言语记忆（p = 0.013）、IPS（p = 0.021）和受损认知领域总数（p = 0.021）的模型调整效果更好。
总体而言，RRMS和PMS患者往往具有相似的神经心理学特征，但PMS患者的CI程度更大。较差的认知表现与身体残疾增加相关，但在控制T1病灶体积后，这种相关性不再显著，这表明潜在的MS病理可能参与了这种关系。丘脑和T1病灶体积是与认知残疾最一致的MRI预测指标。
