Cognitive progression independent of relapse in multiple sclerosis.

IF 4.8 2区医学 Q1 CLINICAL NEUROLOGY

Multiple Sclerosis Journal Pub Date : 2024-10-01 Epub Date: 2024-08-28 DOI:10.1177/13524585241256540

Tom A Fuchs, Menno M Schoonheim, Robert Zivadinov, Michael G Dwyer, Elisa Colato, Zachary Weinstock, Bianca Weinstock-Guttman, Eva Mm Strijbis, Ralph Hb Benedict

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引用次数: 0

Abstract

Background: 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.

Methods: 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.

Results: The study sample (n = 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 (n = 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 (p < 0.001) and lower assessment density (p < 0.001), accounting for baseline clinical factors.

Conclusion: These results establish the concept of cognitive PIRA and further our understanding of progressive cognitive decline in RRMS.

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多发性硬化症患者的认知进展与复发无关。

背景：复发缓解型多发性硬化症（RRMS）患者的身体机能会在临床记录的复发之外出现严重恶化。这种现象被称为独立于复发活动的进展（PIRA），但认知能力的下降尚未得到证实：方法：对 RRMS 患者进行回顾性分析。方法：对RRMS患者进行回顾性分析。认知能力下降的定义采用每项测试（符号数字模型测试、简明视觉空间记忆测试-修订版、加州言语学习测试-II）的可靠变化指数临界值。如果符合以下条件，则将认知能力下降归类为 PIRA：在两次评估之间或认知能力下降的 9 个月内未发现复发：研究样本（n = 336）中 80.7% 为女性，平均年龄（标准差 (SD)）、病程和观察期分别为 43.1 (9.5)、10.8 (8.4) 和 8.1 (3.1)年。与年龄、性别和教育程度相匹配的 HCs 相比，共有 169 名受试者（50.3%）在基线时存在认知障碍。在出现认知能力下降的受试者中（n = 167），89% 出现了认知能力 PIRA。共观察到 141 例（68.1%）认知功能下降事件与 EDSS 恶化无关。在考虑基线临床因素的情况下，随着评估次数的增加（p < 0.001）和评估密度的降低（p < 0.001），更有可能观察到认知 PIRA：这些结果确立了认知PIRA的概念，进一步加深了我们对RRMS进行性认知功能衰退的理解。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Multiple Sclerosis Journal 医学-临床神经学

CiteScore

10.90

自引率

6.90%

发文量

186

审稿时长

3-8 weeks

期刊介绍： Multiple Sclerosis Journal is a peer-reviewed international journal that focuses on all aspects of multiple sclerosis, neuromyelitis optica and other related autoimmune diseases of the central nervous system. The journal for your research in the following areas: * __Biologic basis:__ pathology, myelin biology, pathophysiology of the blood/brain barrier, axo-glial pathobiology, remyelination, virology and microbiome, immunology, proteomics * __Epidemology and genetics:__ genetics epigenetics, epidemiology * __Clinical and Neuroimaging:__ clinical neurology, biomarkers, neuroimaging and clinical outcome measures * __Therapeutics and rehabilitation:__ therapeutics, rehabilitation, psychology, neuroplasticity, neuroprotection, and systematic management Print ISSN: 1352-4585