Pilloni Giuseppina, Casper T Charles, Mar Soe, Ness Jayne, Schreiner Teri, Waltz Michael, Waubant Emmanuelle, Weinstock-Guttman Bianca, Wheeler Yolanda, Krupp Lauren, Charvet Leigh
Department of Neurology, NYU Grossman School of Medicine, New York, NY, USA.
Parekh Center for Interdisciplinary Neurology, NYU Grossman School of Medicine, New York, NY, USA.
Int J Clin Health Psychol. 2024 Jul-Sep;24(3):100486. doi: 10.1016/j.ijchp.2024.100486. Epub 2024 Jul 13.
Cognitive decline in multiple sclerosis (MS) is common, but unpredictable, and increases with disease duration. As such, early detection of cognitive decline may improve the effectiveness of interventions. To that end, the Symbol Digit Modalities Test (SDMT) is effective in detecting slow processing speed as it relates to cognitive impairment, and intraindividual variability (IIV) observed in trials assessing continuous reaction time (RT) may be a useful indicator of early cognitive changes. Here, we will assess cognitive IIV changes in adults with early MS.
Adults with relapsing-remitting MS (RRMS), <11 years since diagnosis, were recruited nationally. Baseline and two-year follow-up assessments included Brief International Cognitive Assessment in MS (BICAMS) and Cogstate computerized tests. Intraindividual variability in RT was calculated from psychomotor tasks and data were age-normalized.
A total of 44 of the 66 participants completed follow-up (mean age, 34.0 ± 5.5 years; 66 % female; mean disease duration, 4.1 ± 2.9 years; median Expanded Disability Status Scale (EDSS) score, 1.5 [0 to 6.0]). Participants were grouped by SDMT z-score median split. Groups did not differ in demographics or clinical features. The higher baseline SDMT group was faster ( = 0.05) in RT and less variable (lower IIV, = 0.001). At the two-year follow-up, the higher SDMT group showed increased variability ( = 0.05) compared to the lower SDMT group, with no significant RT or BICAMS changes.
In early MS, higher SDMT performance at baseline is associated with less cognitive variability but may indicate susceptibility to increased variability over time, highlighting the importance of monitoring IIV for early cognitive changes.
多发性硬化症（MS）患者出现认知功能下降很常见，但难以预测，且会随着疾病病程的延长而加重。因此，早期发现认知功能下降可能会提高干预措施的效果。为此，符号数字模式测验（SDMT）在检测与认知障碍相关的处理速度减慢方面很有效，并且在评估连续反应时间（RT）的试验中观察到的个体内变异性（IIV）可能是早期认知变化的一个有用指标。在此，我们将评估早期MS成年患者的认知IIV变化。
在全国范围内招募诊断后病程<11年的复发缓解型MS（RRMS）成年患者。基线和两年随访评估包括MS简易国际认知评估（BICAMS）和Cogstate计算机化测试。根据心理运动任务计算RT的个体内变异性，并对数据进行年龄标准化。
66名参与者中有44名完成了随访（平均年龄34.0±5.5岁；66%为女性；平均病程4.1±2.9年；扩展残疾状态量表（EDSS）评分中位数为1.5[0至6.0]）。参与者按SDMT z评分中位数分割分组。两组在人口统计学或临床特征方面无差异。基线SDMT得分较高的组RT更快（P = 0.05）且变异性较小（IIV较低，P = 0.001）。在两年随访时，与SDMT得分较低的组相比，SDMT得分较高的组变异性增加（P = 0.05），RT或BICAMS无显著变化。
在早期MS中，基线时较高的SDMT表现与较低的认知变异性相关，但可能表明随着时间推移易出现变异性增加，这突出了监测IIV以发现早期认知变化的重要性。
