多发性硬化症的认知障碍:临床和社会人口因素的作用-系统回顾和荟萃分析。

IF 3.9 2区 医学 Q1 CLINICAL NEUROLOGY
Katalin Lugosi, Marie A Engh, Tamás Kói, Zsolt Molnár, Gábor Csukly, Klaudia Horváth, Emma Hargitai, Péter Hegyi, Zsolt Mezei
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引用次数: 0

摘要

目的:认知障碍(CI)影响多发性硬化症(MS)患者的生活质量。识别影响因素是改善CI监测的关键。本系统综述和荟萃分析考察了影响MS亚型认知筛查符号数字模态测试(SDMT)表现的临床和社会人口学变量,确定了认知障碍风险更高的亚组。方法:注册于PROSPERO (CRD42023451696),于2023年8月6日使用PubMed、Embase和CENTRAL检索文献。根据PRISMA 2020指南,随机效应荟萃分析解决了相关和荟萃回归分析中的异质性。对多变量回归模型结果进行定性综合(系统评价)。JBI关键评估工具评估偏倚风险。根据我们的方案,主要结局是SDMT原始评分,EDSS和疾病持续时间作为主要暴露,随着年龄、性别、教育程度、抑郁、疲劳、活动能力评分和治疗作为次要暴露而延长。通过单变量研究水平相关性、单变量元回归、研究水平多变量回归模型和多变量元回归来评估关联,评估协变量相互依赖性。异质性用I2量化。仅纳入观察性横断面数据(或纵向研究的基线数据)。结果:共分析了155项研究,22,828例患者。在混合型和复发缓解型MS (RRMS)中,EDSS与SDMT呈最强负相关(混合MS: -0.44 CI:[-0.50; -0.36]; RRMS: -0.47[-0.66; -0.23])。教育程度呈中等正相关(混合MS: 0.31 [0.20; 0.42]; RRMS: 0.32[-0.02; 0.59])。由于横断面设计、异质性和潜在的聚集/生态偏差,研究结果是探索性的。解释:不良的SDMT表现主要由身体残疾和认知储备(教育)驱动,受性别、抑郁和年龄的调节,突出了在MS认知监测中整合临床和社会人口学数据的必要性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Cognitive Impairment in Multiple Sclerosis: The Role of Clinical and Sociodemographic Factors - A Systematic Review and Meta-Analysis.

Objective: Cognitive impairment (CI) affects the quality of life in multiple sclerosis (MS). Identifying influencing factors is key to improving CI monitoring. This systematic review and meta-analysis examines clinical and sociodemographic variables impacting the cognitive screening Symbol Digit Modalities Test (SDMT) performance across MS subtypes, identifying subgroups at greater risk of cognitive impairment.

Methods: Registered on PROSPERO (CRD42023451696), a literature search was conducted on August 6, 2023, using PubMed, Embase, and CENTRAL. Following the PRISMA 2020 guideline, a random-effects meta-analysis addressed heterogeneity in correlation and meta-regression analyses. Multivariable regression model results were qualitatively synthesized (systematic review). The JBI Critical Appraisal Tool assessed bias risk. Primary outcome was SDMT raw scores, with EDSS and disease duration as primary exposures, extended with age, sex, education, depression, fatigue, mobility scores, and treatment as secondary exposures, according to our protocol. Associations were evaluated via univariate study-level correlations, univariate meta-regressions, study-level multivariable regression models, and multivariate meta-regressions, assessing covariate interdependence. Heterogeneity was quantified with I2. Only observational cross-sectional data (or baseline data from longitudinal studies) were included.

Results: A total of 155 studies with 22,828 patients were analyzed. In mixed and relapsing-remitting MS (RRMS), EDSS was the strongest negative correlate of SDMT (mixed MS: -0.44 CI:[-0.50; -0.36]; RRMS: -0.47 [-0.66; -0.23]). Education showed a moderate positive correlation (mixed MS: 0.31 [0.20; 0.42]; RRMS: 0.32 [-0.02; 0.59]). Due to cross-sectional design, heterogeneity, and potential aggregation/ecological bias, findings are exploratory.

Interpretation: Poor SDMT performance is mainly driven by physical disability and cognitive reserve (education), modulated by sex, depression, and age, highlighting the need to integrate clinical and sociodemographic data in MS cognitive monitoring.

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来源期刊
Annals of Clinical and Translational Neurology
Annals of Clinical and Translational Neurology Medicine-Neurology (clinical)
CiteScore
9.10
自引率
1.90%
发文量
218
审稿时长
8 weeks
期刊介绍: Annals of Clinical and Translational Neurology is a peer-reviewed journal for rapid dissemination of high-quality research related to all areas of neurology. The journal publishes original research and scholarly reviews focused on the mechanisms and treatments of diseases of the nervous system; high-impact topics in neurologic education; and other topics of interest to the clinical neuroscience community.
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