MS Center Amsterdam, Department of Anatomy and Neurosciences, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, location VUmc, Amsterdam, The Netherlands.
Jacobs Multiple Sclerosis Center for Treatment and Research, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA.
Mult Scler. 2024 Oct;30(11-12):1468-1478. doi: 10.1177/13524585241256540. Epub 2024 Aug 28.
Substantial physical-disability worsening in relapsing-remitting multiple sclerosis (RRMS) occurs outside of clinically recorded relapse. This phenomenon, termed progression independent of relapse activity (PIRA), is yet to be established for cognitive decline.
Retrospective analysis of RRMS patients. Cognitive decline was defined using reliable-change-index cut-offs for each test (Symbol Digit Modalities Test, Brief Visuospatial Memory Test-Revised, California Verbal Learning Test-II). Decline was classified as PIRA if the following conditions were met: no relapse observed between assessments nor within 9 months of cognitive decline.
The study sample ( = 336) was 80.7% female with a mean (standard deviation (SD)) age, disease duration, and observation period of 43.1 (9.5), 10.8 (8.4), and 8.1 (3.1) years, respectively. A total of 169 (50.3%) subjects were cognitively impaired at baseline relative to age-, sex-, and education-matched HCs. Within subjects who experienced cognitive decline ( = 167), 89% experienced cognitive PIRA. A total of 141 (68.1%) cognitive decline events were observed independent of EDSS worsening. Cognitive PIRA was more likely to be observed with increased assessments ( < 0.001) and lower assessment density ( < 0.001), accounting for baseline clinical factors.
These results establish the concept of cognitive PIRA and further our understanding of progressive cognitive decline in RRMS.
在复发缓解型多发性硬化症（RRMS）中，大量的身体残疾恶化发生在临床记录的复发之外。这种现象称为与复发活动无关的进展（PIRA），但尚未在认知能力下降中得到证实。
对 RRMS 患者进行回顾性分析。认知能力下降是使用每个测试的可靠变化指数（SDMT、BVMT-R、CVLT-II）的截定点来定义的。如果满足以下条件，则将下降归类为 PIRA：在评估之间或认知下降后 9 个月内未观察到复发。
研究样本（n=336）中 80.7%为女性，平均（标准差）年龄、疾病持续时间和观察期分别为 43.1（9.5）、10.8（8.4）和 8.1（3.1）年。与年龄、性别和教育匹配的 HC 相比，基线时共有 169 名（50.3%）受试者存在认知障碍。在经历认知能力下降的受试者中（n=167），89%经历了认知 PIRA。共有 141 次（68.1%）认知下降事件与 EDSS 恶化无关。认知 PIRA 更可能随着评估次数的增加（<0.001）和评估密度的降低（<0.001）而观察到，这与基线临床因素有关。
这些结果确立了认知 PIRA 的概念，并进一步加深了我们对 RRMS 中进行性认知能力下降的理解。
