Arch Neurol 2001 Oct;58(10):1602-6
Amato MP, Ponziani G, Siracusa G,
Sorbi S.
Department of Neurology, University
of Florence, Viale Morgagni, 85, Florence, Italy 50134. mariapia.amato@unifi.it
OBJECTIVE:
To reassess, in a cohort of patients
with early-onset multiple sclerosis, the long-term evolution of cognitive
deficits, their relationship to the disease's clinical progression, and
their effects on daily life.
DESIGN:
Ten years after our baseline assessment,
we again compared the cognitive performance of patients and control subjects
on a neuropsychological test battery. Clinical and demographic correlates
of cognitive impairment and their effects on everyday functioning were
determined by multiple linear regression analysis.
SETTING:
The research clinic of a university
department of neurology.
PARTICIPANTS:
Forty-five inpatients and outpatients
with multiple sclerosis and 65 demographically matched healthy controls
from the original sample.
MAIN OUTCOME MEASURES:
Mean scores of both groups on the
neuropsychological test battery in initial and 2 follow-up evaluations
(about 4 and 10 years, respectively); number of cognitively impaired subjects,
defined by the number of subtests failed; regression coefficients measuring
the relationship between clinical variables and cognitive outcome and between
mental decline and everyday functioning assessed by the Environmental and
the Incapacity Status Scales.
RESULTS:
Previously detected cognitive defects
in verbal memory, abstract reasoning, and linguistic processes were confirmed
on the third testing, at which time deficits in attention/short-term spatial
memory also emerged. Only 20 of 37 patients who were cognitively unimpaired
on initial testing remained so by the end of the follow-up, when the proportion
of subjects who were cognitively impaired reached 56%. Degree of physical
disability, progressive disease course, and increasing age predicted the
extent of cognitive decline. Disability level and degree of cognitive impairment
were independent predictors of a patient's handicap in the workplace and
in social settings.
CONCLUSIONS:
In the course of a sufficiently long
follow-up, cognitive dysfunction is likely to emerge and progress in a
sizable proportion of patients. As multiple sclerosis advances, neurological
and cognitive involvement tend to converge. Limitations in a patient's
work and social activities are correlated with the extent of cognitive
decline, independent of degree of physical disability.
PMID: 11594918 [PubMed - in process]