School of Allied Health Science and Practice, University of Adelaide, Adelaide, Australia.
Multiple Sclerosis and Neuroimmunology Center, Clalit Health Services, Nazareth, Israel; Department of Neurology, Lady Davis Carmel Medical Center, Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
Mult Scler Relat Disord. 2023 May;73:104630. doi: 10.1016/j.msard.2023.104630. Epub 2023 Mar 21.
Multiple Sclerosis (MS) is a chronic inflammatory and degenerative disease of the central nervous system (CNS). The severity of disability in people with MS (PwMS) is generally measured with the Expanded Disability Status Scale (EDSS). A variant of MS known as 'benign MS' (BMS) has been defined as an EDSS score of 3 or lower, combined with a disease duration of 10 years or longer; however, there is disagreement in the field about whether BMS really exists. Given that the EDSS does not capture cognitive issues, communication dysfunction, fatigue, depression, or anxiety properly, its ability to accurately represent disability in all PwMS, including BMS, remains questionable.
In this study, 141 persons with BMS (PwBMS) were included, consisting of 115 females (82%) and 26 males (18%) with a mean age of 50.8 (±8.68). A computerized test battery (NeuroTrax®) was used to assess cognition, covering seven cognitive domains (memory, executive function, visual-spatial processing, verbal function, attention, information processing, and motor skills). Fatigue was measured using the Fatigue Severity Scale (FSS). The Beck Depression Inventory (BDI) was used to assess symptoms of depression. Cognitive impairment was defined for this study as when someone has a score lower than 85 in at least two subdomains of the cognitive test battery. Rates of impairment were compared to 158 persons with non-benign MS (PwNBMS; with a disease duration of 10 years and longer and an EDSS score higher than 3) and 487 PwMS with a disease duration of fewer than 10 years.
Cognitive impairment was found in 38% of PwBMS and in 66% of PwNBMS (p<0.001). In PwBMS, the lowest rate of impairment was found in the verbal function domain (18%) and the highest rate of impairment in the domain of information processing (32%). Fatigue and depression were found in 78% and 55% of all PwBMS, with no difference in these rates between PwBMS and PwNBMS (p = 0.787 and p = 0.316 resp.) CONCLUSION: Cognitive impairment, fatigue and depression are common among people with an EDSS-based definition of benign MS. These aspects should be incorporated into a new and better definition of truly benign MS.
多发性硬化症（MS）是一种中枢神经系统（CNS）的慢性炎症性和退行性疾病。多发性硬化症患者（PwMS）的残疾严重程度通常使用扩展残疾状况量表（EDSS）进行测量。一种被称为“良性多发性硬化症（BMS）”的 MS 变体被定义为 EDSS 评分为 3 或更低，同时疾病持续时间为 10 年或更长时间；然而，该领域对于 BMS 是否真正存在存在分歧。鉴于 EDSS 不能正确捕捉认知问题、沟通功能障碍、疲劳、抑郁或焦虑，它在所有 PwMS 中（包括 BMS）准确代表残疾的能力仍然存在疑问。
本研究纳入了 141 名 BMS 患者（PwBMS），其中 115 名女性（82%）和 26 名男性（18%），平均年龄为 50.8（±8.68）岁。使用计算机测试电池（NeuroTrax®）评估认知，涵盖七个认知领域（记忆、执行功能、视觉空间处理、言语功能、注意力、信息处理和运动技能）。使用疲劳严重程度量表（FSS）测量疲劳。贝克抑郁量表（BDI）用于评估抑郁症状。本研究将认知障碍定义为在认知测试电池的至少两个子域中得分低于 85 分的情况。将损伤率与 158 名非良性多发性硬化症患者（PwNBMS；疾病持续时间为 10 年或更长时间，EDSS 评分高于 3）和 487 名疾病持续时间少于 10 年的多发性硬化症患者进行比较。
在 38%的 PwBMS 和 66%的 PwNBMS 中发现了认知障碍（p<0.001）。在 PwBMS 中，言语功能领域的损伤率最低（18%），信息处理领域的损伤率最高（32%）。在所有 PwBMS 中，疲劳和抑郁的发生率分别为 78%和 55%，在 PwBMS 和 PwNBMS 之间，这些发生率没有差异（p=0.787 和 p=0.316）。
基于 EDSS 的良性 MS 定义，认知障碍、疲劳和抑郁在多发性硬化症患者中很常见。这些方面应纳入对真正良性 MS 的新的、更好的定义中。
