Multiple Sclerosis Research Center; Neuroscience institute; Tehran University of Medical Sciences; Tehran; Iran.
Department of psychology, School of humanities, Tarbiat Modares University, Tehran, Iran.
Mult Scler Relat Disord. 2021 Apr;49:102758. doi: 10.1016/j.msard.2021.102758. Epub 2021 Jan 14.
One of the most concerning features that involves 40-70% of patients with multiple sclerosis (MS) is cognitive impairment. Moreover, it affects various aspects of patients' life. In this regard, this study was conducted to find independent predictors of cognitive function.
We performed a cross-sectional analysis on 92 patients chosen from MS clinic of Sina hospital, Iran. After completing a general questionnaire of demographic and various clinical features, the included participants (patients with RRMS) underwent neuropsychological assessment using Minimal Assessment of Cognitive function in Multiple Sclerosis (MACFIMS), Expanded disability Status Scale (EDSS), Beck Depression Inventory II (BDI-II), and National American Adult Reading Test (NAART). An un-weighted average of MACFIMS subscales z-scores was reported as cognitive index. In order to find the association between CI and different factors, each variable was entered in a simple regression model first. Then, a univariate multiple regression model was invoked to evaluate the predictors of cognitive index in patients.
Simple regression for cognitive index of 92 patients (86% female) with a mean age of 33.4±7.6 years old suffering of RRMS for 6.8±4.8 years revealed patients with history of former smoking (p=0.001), sole visual symptoms as the presentation sign of the study (β=-0.341, p=0.001), lower EDSS score (β=-0.299, p=0.005), higher NAART score (β=0.416, p≤0.0001), and college education (p=0.001), had better cognitive function in our study population. Such factors including age, educational status, BDI-II score, EDSS score, and disease duration were fixed and the other significant factors entered once separately and then simultaneously in the univariate multiple linear regression model. It was revealed that former smoking (β=-0.372, p≤0.0001), NAART (β=0.304, p=0.002), and EDSS (β= -0.185, P=0.045) are associated significantly with the cognitive function of patients with multiple sclerosis.
This study demonstrated NAART, as a proxy of premorbid intelligence, history of former smoking, and EDSS score may have effects on cognitive function in MS. Future studies need to be invoked for the evaluation of the causality relation of these factors.
认知障碍是影响 40-70%多发性硬化症（MS）患者的最令人担忧的特征之一。此外，它会影响患者生活的各个方面。在这方面，本研究旨在寻找认知功能的独立预测因素。
我们对伊朗西纳医院 MS 诊所的 92 名患者进行了横断面分析。在完成一般人口统计学和各种临床特征的问卷后，纳入的参与者（RRMS 患者）使用最小认知功能评估多发性硬化症（MACFIMS）、扩展残疾状况量表（EDSS）、贝克抑郁量表 II（BDI-II）和全国美国成人阅读测试（NAART）进行神经心理学评估。MACFIMS 分量表 z 分数的未加权平均值报告为认知指数。为了发现 CI 与不同因素之间的关系，首先将每个变量输入简单回归模型。然后，调用单变量多元回归模型来评估患者认知指数的预测因素。
对 92 名（86%为女性）平均年龄为 33.4±7.6 岁、RRMS 病程为 6.8±4.8 年的患者的认知指数进行简单回归，结果显示有既往吸烟史的患者（p=0.001）、仅视觉症状作为本研究的表现征象（β=-0.341，p=0.001）、较低的 EDSS 评分（β=-0.299，p=0.005）、较高的 NAART 评分（β=0.416，p≤0.0001）和大学教育程度（p=0.001），在我们的研究人群中具有更好的认知功能。这些因素包括年龄、教育程度、BDI-II 评分、EDSS 评分和疾病持续时间，将这些因素固定后，将其他显著因素分别和同时输入单变量多元线性回归模型。结果表明，既往吸烟史（β=-0.372，p≤0.0001）、NAART（β=0.304，p=0.002）和 EDSS（β=-0.185，P=0.045）与多发性硬化症患者的认知功能显著相关。
本研究表明，NAART 作为一种先天智力的替代指标、既往吸烟史和 EDSS 评分可能对 MS 患者的认知功能有影响。未来需要进行研究以评估这些因素的因果关系。
