University Hospital, London Health Sciences Center, Department of Clinical Neurological Sciences, Western University, London, ON, Canada.
Jacobs School of Medicine and Biomedical Sciences, Department of Neurology, State University of New York, Buffalo, NY, USA.
Mult Scler. 2023 Dec;29(14):1786-1794. doi: 10.1177/13524585231201219. Epub 2023 Sep 30.
The existence of isolated cognitive relapses (ICRs) in persons with MS (PwMS) has been debated.
To examine relapses with decline on Symbol Digit Modalities Test (SDMT) but no change on Expanded Disability Status Scale (EDSS).
This 3-year prospective cohort study identified PwMS experiencing a relapse with decrease on SDMT. Participants with SDMT decline/stable EDSS were labeled "ICR," while those with a corresponding decrease on EDSS were classified "Relapse with Cognitive Decline (RCD)." Two definitions of SDMT decline were explored: (1) ⩾ 8 points, and (2) ⩾ 4 points. Logistic regression was used to analyze the relationship between ICR and RCD.
The full cohort had 592 participants: 83 experienced relapses; 22 (26.5%) had an SDMT decrease of ⩾ 8 points; 14 (63.6%) met ICR criteria. Logistic regression (X(1) = 5.112, = 0.024) using demographics and disease characteristics explained 28.4% of the variance in ICR versus RCD. Only the MS Neuropsychological Questionnaire was associated with ICR (odds ratio (OR): 8.6; 95% confidence interval (CI): 1.1-16.4) 40 relapsing participants with SDMT decrease of ⩾ 4 points were identified: 26 (65%) had a stable EDSS (ICR). Logistic regression did not find any variable predictive of ICR.
This prospective study demonstrates evidence of ICR in PwMS.
孤立性认知复发（ICR）在多发性硬化症患者（PwMS）中的存在一直存在争议。
检查符号数字模态测试（SDMT）下降但扩展残疾状况量表（EDSS）无变化的复发。
这项为期 3 年的前瞻性队列研究确定了经历 SDMT 下降的复发的 PwMS。SDMT 下降/稳定 EDSS 的参与者被标记为“ICR”，而相应 EDSS 下降的参与者被归类为“认知下降复发（RCD）”。探讨了两种 SDMT 下降定义：（1） ⩾ 8 分，（2） ⩾ 4 分。逻辑回归用于分析 ICR 和 RCD 之间的关系。
全队列共有 592 名参与者：83 名经历了复发；22 名（26.5%）SDMT 下降 ⩾ 8 分；14 名（63.6%）符合 ICR 标准。使用人口统计学和疾病特征的逻辑回归（X(1) = 5.112， = 0.024）解释了 ICR 与 RCD 之间 28.4%的差异。只有多发性硬化症神经心理问卷与 ICR 相关（优势比（OR）：8.6；95%置信区间（CI）：1.1-16.4）。在 40 名具有 SDMT 下降 ⩾ 4 分的复发参与者中，26 名（65%）EDSS 稳定（ICR）。逻辑回归未发现任何可预测 ICR 的变量。
这项前瞻性研究证明了多发性硬化症患者中存在 ICR。
