不同多发性硬化症临床病程中认知能力下降的模式。

IF 2.9 3区医学 Q2 CLINICAL NEUROLOGY

Multiple sclerosis and related disorders Pub Date : 2024-11-12 DOI:10.1016/j.msard.2024.106172

André Augusto Lemos Vidal de Negreiros, Larissa Carla de Paula Gois, Mariana Moreira Soares de Sá, Gabriel de Deus Vieira, Luciana Ramalho Pimentel-Silva, Alfredo Damasceno

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引用次数: 0

摘要

背景：与年龄相仿的复发缓解型多发性硬化症（RRMS）患者相比，进展期多发性硬化症（PMS）患者是否表现出独特的认知障碍（CI）模式以及不同的认知和临床衰退轨迹，目前仍不清楚。此外，在不同形式的多发性硬化症中，脑储备（认知和脑储备）在认知功能衰退中的作用尚不完全清楚，一些研究表明，脑储备的作用在进展型多发性硬化症中有所减弱：评估年龄相仿的 RRMS 和 PMS 患者认知能力下降的轨迹，同时评估基线临床和 MRI 特征对随访认知结果的预测能力：54名患者（30名PMS患者，24名RRMS患者）分别在基线（时间1）和4年后（时间2）接受了脑磁共振成像（3T - FreeSurfer和脊髓工具箱）、临床检查（残疾状况扩展量表（EDSS）、定时25英尺步行测试（T25FW）和九孔钉测试（9HPT））和神经心理学评估（简短可重复神经心理学测试电池（BRBN）、伦敦塔（TOL）测试和波士顿命名测试）。我们还评估了认知能力和大脑储备。我们将 CI 定义为在 1 个以上的领域出现障碍：在基线（时间 1）时，37.2% 的人出现了 CI，而在时间 2 时，52.4% 的人出现了 CI。在两个研究时间段内，PMS 组在视觉记忆和信息处理速度 (IPS) 认知领域出现障碍的频率也更高。然而，随访4年后，RMS/PMS组之间在临床、认知和神经影像学变量的演变方面没有重大统计学差异，只是PMS组的言语记忆衰退（p = 0.040）和胼胝体萎缩（p = 0.014）更严重。对于 EDSS 的恶化，最佳预测因素是脊髓面积（β = -0.428），对于 T25FW，最佳预测因素是纹状体体积（β = -0.467）。对于认知退化，纹状体体积和皮质厚度是最好的预测因子。我们发现，在总体样本和 PMS 组中，认知储备对规划（β = 0.601）和 IPS（β = 0.482）领域的下降具有保护作用（分别为 β = 0.498 和 β = 0.468）：结论：我们发现，RRMS组和PMS组在随访四年后出现认知功能退化。尽管如此，这两组患者（年龄、教育程度和病程相似）在这四年期间的临床、认知和神经影像学变量的变化轨迹并无重大差异。我们在总体样本和 PMS 组中观察到认知储备的保护作用。

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Patterns of cognitive decline across different multiple sclerosis clinical courses

Background

It is still unclear whether patients with progressive MS (PMS) present a distinct pattern of cognitive impairment (CI) and different trajectories of cognitive and clinical decline compared to patients with relapsing-remitting MS (RRMS) with similar age. In addition, the role of reserve (cognitive and cerebral) in cognitive decline in the different forms of MS is not fully understood, and some studies suggest that its effects reduce in the progressive forms.

Objective

To assess the trajectories of cognitive decline in RRMS and PMS patients with similar age, also evaluating the predictive power of baseline clinical and MRI features on cognitive outcomes at follow-up.

Methods

Fifty-four patients were enrolled (30 PMS, 24 RRMS) and underwent brain MRI (3T – FreeSurfer and Spinal Cord Toolbox), clinical examination (Expanded Disability Status Scale – EDSS; Timed 25-Foot Walk Test - T25FW; and the Nine Hole Peg Test - 9HPT) and neuropsychological evaluation (Brief Repeatable Battery of Neuropsychological Tests – BRBN, Tower of London (TOL) test and Boston Naming Test at baseline (time 1) and after 4 years (time 2). We also evaluated cognitive and brain reserve. We defined CI as the presence of impairment in >1 domain.

Results

At baseline (time 1), 37.2 % of the individuals presented CI and 52.4 % at time 2, which was more frequent in the PMS group. There was also a higher frequency of impairment in the visual memory and Information Processing Speed (IPS) cognitive domains in the PMS group in both study times. However, there were no major statistical differences between RMS/PMS groups in the evolution of clinical, cognitive and neuroimaging variables after 4 years of follow-up, except for a worse verbal memory decline (p = 0.040) and corpus callosum atrophy (p = 0.014) in PMS group. For EDSS worsening, the best predictive factor was the spinal cord area (β = -0.428), and for T25FW, the striatum volume (β = -0.467). For cognitive deterioration, striatum volume and cortical thickness were the best predictors. We found a protective effect of cognitive reserve on the decline of the domains of planning (β = 0.601) and IPS (β = 0.482) for the overall sample and the PMS group (β = 0.498 and β = 0.468, respectively).

Conclusions

We found cognitive deterioration after four years of follow-up in RRMS and PMS groups. Nevertheless, there were no major differences between these groups (with similar age, education and disease duration) in the trajectories of clinical, cognitive and neuroimaging variables during this 4-year period. We observed a protective effect of cognitive reserve in the overall sample and the PMS group.

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来源期刊

Multiple sclerosis and related disorders CLINICAL NEUROLOGY-

CiteScore

5.80

自引率

20.00%

发文量

814

审稿时长

66 days

期刊介绍： Multiple Sclerosis is an area of ever expanding research and escalating publications. Multiple Sclerosis and Related Disorders is a wide ranging international journal supported by key researchers from all neuroscience domains that focus on MS and associated disease of the central nervous system. The primary aim of this new journal is the rapid publication of high quality original research in the field. Important secondary aims will be timely updates and editorials on important scientific and clinical care advances, controversies in the field, and invited opinion articles from current thought leaders on topical issues. One section of the journal will focus on teaching, written to enhance the practice of community and academic neurologists involved in the care of MS patients. Summaries of key articles written for a lay audience will be provided as an on-line resource. A team of four chief editors is supported by leading section editors who will commission and appraise original and review articles concerning: clinical neurology, neuroimaging, neuropathology, neuroepidemiology, therapeutics, genetics / transcriptomics, experimental models, neuroimmunology, biomarkers, neuropsychology, neurorehabilitation, measurement scales, teaching, neuroethics and lay communication.