From the Department of Neurology (A.-K.K., T.L., C.S., N.S., C.P., S.L., R.G., R.S., I.A.); Institute of Neuroradiology (T.L., B.K., C.L., R.S.), St Josef Hospital, Ruhr University Bochum; Marianne-Strauß-Klinik (I.K.), Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke, Berg; Euroimmun Reference Laboratory (B.T.), Lübeck; Department of Neurology (M.R., O.A.), Medical Faculty; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum, Heinrich-Heine-University Düsseldorf; Center for Translational Neuro- and Behavioral Sciences (R.P.), University Medicine Essen, University of Duisburg-Essen, Germany; Department of Neurology (I.-K.P.), Inselspital, Bern University Hospital, University of Bern, Switzerland; and COGITO Center for Applied Neurocognition and Neuropsychological Research (I.-K.P.), Düsseldorf, Germany.
Neurol Neuroimmunol Neuroinflamm. 2024 Dec;11(6):e200325. doi: 10.1212/NXI.0000000000200325. Epub 2024 Oct 11.
Cognitive impairment is a common and challenging symptom in multiple sclerosis and neuromyelitis optica spectrum disease; however, data in myelin oligodendrocyte glycoprotein-IgG-associated disease (MOGAD) remain scarce. In this cross-sectional study, we investigated the frequency of cognitive impairment, associated clinical factors, and MRI volumetric measures in MOGAD.
Participants were investigated in a single center by certified psychologists and underwent a standardized 3-T-MRI protocol. MRI data were processed with FreeSurfer for gray and white matter volume estimation, presented as a fraction of total intracranial volume. Sera screening for antineural antibodies has been conducted using cell-based assays. The following clinical factors were included in the multivariate logistic regression analysis: sex, age, overall number of previous relapses, and specifically the history of acute disseminated encephalomyelitis (ADEM)/ADEM-like episodes and other brain relapses.
Thirty-two patients with MOGAD (19 female, median age 29.4 years) after a median of 2 relapses with a median EDSS of 1.0 were recruited. Seven patients (21.9%) demonstrated cognitive impairment with the most prevalent deficits in mental flexibility (16.7%), attention (11.1%-14.8%), and verbal working memory (10.3%). 72.4% suffered from fatigue and 42.9% from signs of depression, moderate to severe in 28.6%. The overall number of previous relapses (odds ratio [OR] 1.789, 95% CI 1.041-3.074) and specifically ADEM/ADEM-like episodes (OR 16.929, 95% CI 1.228-233.427) were the only clinical factors associated with cognitive impairment in a multivariate logistic regression model. Screening for antineuronal antibodies remained negative. Cerebral white matter (WM) (0.300 vs 0.317, = 0.003) and deep gray matter (DGM) (0.036 vs 0.038, = 0.002) volumes were reduced in patients with MOGAD compared with healthy controls (n = 32). Both cognitive impairment (0.031 vs 0.036, = 0.003) and history of ADEM/ADEM-like episodes (0.032 vs 0.036, = 0.006) were associated with reduced DGM volume compared with unaffected patients with MOGAD.
Despite a low overall disability, every 5th patient with MOGAD experiences cognitive impairment. Cognitive impairment is associated with a higher number of relapses and particularly ADEM/ADEM-like attacks. Although both WM and DGM atrophies are apparent in MOGAD, the latter only seems to have an association with cognitive impairment.
认知障碍是多发性硬化症和视神经脊髓炎谱系疾病中常见且具有挑战性的症状；然而，髓鞘少突胶质细胞糖蛋白-IgG 相关疾病（MOGAD）的数据仍然很少。在这项横断面研究中，我们研究了 MOGAD 中认知障碍的频率、相关临床因素和磁共振成像容积测量。
在一家中心由认证心理学家对参与者进行调查，并进行了标准化的 3-T-MRI 方案。使用基于细胞的测定法对血清进行抗神经元抗体的筛查。将以下临床因素纳入多元逻辑回归分析：性别、年龄、既往复发总数，特别是急性播散性脑脊髓炎（ADEM）/ADEM 样发作和其他脑复发的病史。
在中位 2 次复发和中位 EDSS 为 1.0 后，招募了 32 名 MOGAD 患者（19 名女性，中位年龄 29.4 岁）。7 名患者（21.9%）表现出认知障碍，最常见的缺陷是心理灵活性（16.7%）、注意力（11.1%-14.8%）和言语工作记忆（10.3%）。72.4%的患者有疲劳症状，42.9%的患者有抑郁症状，28.6%的患者有中度至重度抑郁症状。既往复发总数（比值比[OR]1.789，95%置信区间 1.041-3.074）和特别是 ADEM/ADEM 样发作（OR 16.929，95%置信区间 1.228-233.427）是多元逻辑回归模型中与认知障碍相关的唯一临床因素。抗神经元抗体筛查仍为阴性。与健康对照组（n=32）相比，MOGAD 患者的脑白质（WM）（0.300 与 0.317， = 0.003）和深部灰质（DGM）（0.036 与 0.038， = 0.002）体积减少。与未受影响的 MOGAD 患者相比，认知障碍（0.031 与 0.036， = 0.003）和 ADEM/ADEM 样发作史（0.032 与 0.036， = 0.006）与 DGM 体积减少相关。
尽管总体残疾程度较低，但每 5 名 MOGAD 患者中就有 1 名患有认知障碍。认知障碍与更多的复发有关，特别是与 ADEM/ADEM 样发作有关。尽管 MOGAD 中 WM 和 DGM 均有萎缩，但后者似乎仅与认知障碍有关。
