Department of Medical-Surgical Nursing, Faculty of Nursing, Nursing Research Center, Gonabad University of Medical Sciences, Gonabad, Iran.
School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
BMC Neurol. 2024 Nov 19;24(1):454. doi: 10.1186/s12883-024-03943-2.
Multiple sclerosis (MS) is a chronic autoimmune disorder affecting the central nervous system, leading to a range of symptoms that impact physical, psychiatric, and cognitive functions. Cognitive dysfunction is prevalent among patients with MS (pwMS), affecting at least 65% of patients, and includes deficits in processing speed, attention, learning, memory, and executive function. Despite the significant impact on daily life, cognitive impairment in MS patients is often underrecognized in clinical settings.
This systematic review and meta-analysis aimed to evaluate cognitive function using the Minimal Assessment of Cognitive Function in Multiple Sclerosis (MACFIMS) battery among pwMS patients and healthy controls (HCs). A comprehensive search of the Web of Science, PubMed, Scopus, and Cochrane Library databases was conducted on January 2024 following the PRISMA guidelines. Eligible studies included peer-reviewed research assessing the validity of the MACFIMS in adult MS patients. Data extraction and quality assessment were performed using standardized tools, and statistical analyses were conducted using R4.2.3.
Eight studies met the inclusion criteria, including a total of 1,481 pwMS and 1,072 HCs. The meta-analysis revealed significant cognitive deficits in pwMS patients compared to HCs across all the MACFIMS subtests, including language, spatial processing, new learning and memory, processing speed, and executive function. Processing speed and working memory were the most affected domains, with 36% of pwMS showing impairment on the Symbol Digit Modalities Test (SDMT). Subgroup analyses indicated that the Expanded Disability Status Scale (EDSS) score significantly influenced cognitive impairment, while disease duration had a limited impact.
The MACFIMS effectively discriminates between pwMS patients and HCs, demonstrating its validity as a comprehensive cognitive assessment tool for MS. Routine cognitive screening, particularly for processing speed and working memory, is crucial for early detection and intervention. Future research should focus on the sensitivity and specificity of the MACFIMS across diverse MS subtypes and cultural contexts to enhance its global applicability in clinical practice.
多发性硬化症（MS）是一种影响中枢神经系统的慢性自身免疫性疾病，导致一系列影响身体、心理和认知功能的症状。认知功能障碍在多发性硬化症患者（pwMS）中很常见，至少影响 65%的患者，包括处理速度、注意力、学习、记忆和执行功能方面的缺陷。尽管对日常生活有重大影响，但在临床环境中，MS 患者的认知障碍常常被低估。
本系统评价和荟萃分析旨在使用多发性硬化症认知功能最小评估量表（MACFIMS）评估 pwMS 患者和健康对照组（HCs）的认知功能。根据 PRISMA 指南，于 2024 年 1 月对 Web of Science、PubMed、Scopus 和 Cochrane Library 数据库进行了全面检索。纳入的研究包括评估成人 MS 患者 MACFIMS 有效性的同行评议研究。使用标准化工具进行数据提取和质量评估，并使用 R4.2.3 进行统计分析。
八项研究符合纳入标准，共纳入 1481 名 pwMS 和 1072 名 HCs。荟萃分析显示，与 HCs 相比，pwMS 患者在所有 MACFIMS 子测试中均存在认知缺陷，包括语言、空间处理、新学习和记忆、处理速度和执行功能。处理速度和工作记忆是受影响最严重的领域，36%的 pwMS 在符号数字模态测试（SDMT）中表现出障碍。亚组分析表明，扩展残疾状态量表（EDSS）评分显著影响认知障碍，而疾病持续时间的影响有限。
MACFIMS 有效地将 pwMS 患者与 HCs 区分开来，证明其作为 MS 全面认知评估工具的有效性。常规认知筛查，特别是针对处理速度和工作记忆，对于早期发现和干预至关重要。未来的研究应关注 MACFIMS 在不同 MS 亚型和文化背景下的敏感性和特异性，以提高其在临床实践中的全球适用性。
