Lopez-Soley Elisabet, Martinez-Heras Eloy, Andorra Magi, Solanes Aleix, Radua Joaquim, Montejo Carmen, Alba-Arbalat Salut, Sola-Valls Nuria, Pulido-Valdeolivas Irene, Sepulveda Maria, Romero-Pinel Lucia, Munteis Elvira, Martínez-Rodríguez Jose E, Blanco Yolanda, Martinez-Lapiscina Elena H, Villoslada Pablo, Saiz Albert, Solana Elisabeth, Llufriu Sara
Center of Neuroimmunology, Laboratory of Advanced Imaging in Neuroimmunological Diseases, Hospital Clinic Barcelona, Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS) and Universitat de Barcelona, 08036 Barcelona, Spain.
Imaging of Mood- and Anxiety-Related Disorders (IMARD) Group, IDIBAPS and CIBERSAM, 08036 Barcelona, Spain.
J Pers Med. 2021 Oct 28;11(11):1107. doi: 10.3390/jpm11111107.
(1) Background: The evolution and predictors of cognitive impairment (CI) in multiple sclerosis (MS) are poorly understood. We aimed to define the temporal dynamics of cognition throughout the disease course and identify clinical and neuroimaging measures that predict CI. (2) Methods: This paper features a longitudinal study with 212 patients who underwent several cognitive examinations at different time points. Dynamics of cognition were assessed using mixed-effects linear spline models. Machine learning techniques were used to identify which baseline demographic, clinical, and neuroimaging measures best predicted CI. (3) Results: In the first 5 years of MS, we detected an increase in the z-scores of global cognition, verbal memory, and information processing speed, which was followed by a decline in global cognition and memory ( < 0.05) between years 5 and 15. From 15 to 30 years of disease onset, cognitive decline continued, affecting global cognition and verbal memory. The baseline measures that best predicted CI were education, disease severity, lesion burden, and hippocampus and anterior cingulate cortex volume. (4) Conclusions: In MS, cognition deteriorates 5 years after disease onset, declining steadily over the next 25 years and more markedly affecting verbal memory. Education, disease severity, lesion burden, and volume of limbic structures predict future CI and may be helpful when identifying at-risk patients.
（1）背景：多发性硬化症（MS）中认知障碍（CI）的演变及预测因素尚不清楚。我们旨在确定整个疾病过程中认知的时间动态变化，并识别预测CI的临床和神经影像学指标。（2）方法：本文是一项纵向研究，纳入了212例患者，这些患者在不同时间点接受了多次认知检查。使用混合效应线性样条模型评估认知动态变化。运用机器学习技术来确定哪些基线人口统计学、临床和神经影像学指标能最佳预测CI。（3）结果：在MS发病的前5年，我们检测到整体认知、言语记忆和信息处理速度的z分数增加，随后在第5年至第15年间整体认知和记忆出现下降（<0.05）。从发病15年到30年，认知功能持续下降，影响整体认知和言语记忆。最能预测CI的基线指标是教育程度、疾病严重程度、病灶负荷以及海马体和前扣带回皮质体积。（4）结论：在MS中，认知功能在疾病发作5年后开始恶化，在接下来的25年中持续稳步下降，对言语记忆的影响更为明显。教育程度、疾病严重程度、病灶负荷和边缘结构体积可预测未来的CI，在识别高危患者时可能会有所帮助。
