Jakimovski Dejan, Zivadinov Robert, Weinstock Zachary, Burnham Alex, Wicks Taylor R, Suchan Christopher, Sciortino Tommaso, Schweser Ferdinand, Bergsland Niels, Dwyer Michael G, Eckert Svetlana P, Young-Hong David, Weinstock-Guttman Bianca, Benedict Ralph H B
Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY 14203, USA.
Center for Biomedical Imaging at the Clinical Translational Science Institute, University at Buffalo, State University of New York, Buffalo, NY 14203, USA.
Brain Commun. 2024 Jul 2;6(4):fcae226. doi: 10.1093/braincomms/fcae226. eCollection 2024.
Cognitive impairment is common in multiple sclerosis and negatively impacts quality of life. Cognitive status has yet to be described in people with severe progressive multiple sclerosis, in whom conventional neuropsychological testing is exceptionally difficult. The objective for the study was to characterize cognitive performance in severe progressive multiple sclerosis and compare them with age-, sex- and disease duration-matched less disabled people with multiple sclerosis using a specifically developed auditory, non-motor test of attention/cognitive processing speed-Auditory Test of Processing Speed. Also, we aimed to determine the relationship between cognitive performance and MRI-based outcomes in these matched cohorts. The Comprehensive Assessment of Severely Affected Multiple Sclerosis study was carried out at the University at Buffalo and the Boston Home, a skilled nursing facility in Dorchester, MA. Inclusion criteria were age 30-80 years and expanded disability status scale 3.0-6.5 for community-dwelling and 7.0-9.5 for skilled nursing facility people with multiple sclerosis. The cognitive assessment was performed using the Brief International Cognitive Assessment for Multiple Sclerosis consisting of Symbol Digit Modalities Test, Brief Visuospatial Memory Test-Revised, California Verbal Learning Test-2nd edition along with Auditory Test of Processing Speed, Paced Auditory Serial Addition Test-3 second and Controlled Oral Word Association Test. MRI scans were retrospectively collected and analysed for lesion and volumetric brain measurements. The rate of completion and performance of the cognitive tests was compared between the groups, and the relationship with MRI measures was determined using sex, age and years of education-adjusted linear regression models. Significantly greater percentage of the severe multiple sclerosis group completed Auditory Test of Processing Speed when compared with the current gold standard of Symbol Digit Modalities Test (93.2% versus 65.9%). Severe progressive multiple sclerosis had worse cognitive performance in all cognitive domains with greatest differences for cognitive processing speed (Symbol Digit Modalities Test > Paced Auditory Serial Addition Test-3 second > Auditory Test of Processing Speed, Cohen's < 2.13, < 0.001), learning and memory (Cohen's < 1.1, < 0.001) and language (Controlled Oral Word Association Test with Cohen's = 0.97, < 0.001). Multiple cognitive domains were significantly associated with lower thalamic (standardized β < 0.419, < 0.006) and cortical (standardized β < 0.26, < 0.031) volumes. Specially designed (auditory) cognitive processing speed tests may provide more sensitive screening of cognitive function in severe progressive multiple sclerosis. The cognitive profile of severe multiple sclerosis is proportional to their physical outcomes and best explained by decreased grey matter volume.
认知障碍在多发性硬化症中很常见，并且会对生活质量产生负面影响。严重进展型多发性硬化症患者的认知状况尚未得到描述，因为对他们进行传统的神经心理学测试异常困难。本研究的目的是通过专门开发的听觉、非运动性注意力/认知处理速度测试——听觉处理速度测试，来描述严重进展型多发性硬化症患者的认知表现，并将其与年龄、性别和病程匹配的残疾程度较轻的多发性硬化症患者进行比较。此外，我们旨在确定这些匹配队列中认知表现与基于磁共振成像（MRI）的结果之间的关系。“严重受影响的多发性硬化症综合评估”研究在布法罗大学和位于马萨诸塞州多切斯特的熟练护理机构波士顿之家进行。纳入标准为年龄30 - 80岁，社区居住的多发性硬化症患者扩展残疾状态量表评分为3.0 - 6.5，熟练护理机构的患者为7.0 - 9.5。认知评估使用了简短国际多发性硬化症认知评估，包括符号数字模式测试、修订版简短视觉空间记忆测试、加利福尼亚言语学习测试第二版以及听觉处理速度测试、3秒听觉连续加法测试和受控口语单词联想测试。MRI扫描是回顾性收集的，并对病变和脑容量进行分析。比较了两组认知测试的完成率和表现，并使用性别、年龄和受教育年限调整的线性回归模型确定与MRI测量结果的关系。与当前的符号数字模式测试这一黄金标准相比，严重多发性硬化症组完成听觉处理速度测试的比例显著更高（93.2%对65.9%）。严重进展型多发性硬化症在所有认知领域的认知表现都更差，在认知处理速度方面差异最大（符号数字模式测试＞3秒听觉连续加法测试＞听觉处理速度测试，科恩效应量＜2.13，P＜0.001）、学习和记忆方面（科恩效应量＜1.1，P＜0.001）以及语言方面（受控口语单词联想测试，科恩效应量 = 0.97，P＜0.001）。多个认知领域与丘脑体积减小（标准化β＜0.419，P＜0.006）和皮质体积减小（标准化β＜0.26，P＜0.031）显著相关。专门设计的（听觉）认知处理速度测试可能会为严重进展型多发性硬化症的认知功能提供更敏感的筛查。严重多发性硬化症的认知概况与其身体状况成正比，并且灰质体积减少能最好地解释这一情况。
