Cognitive performance profile in different phenotypes of MS with cognitive complaints

doi:10.1016/j.msard.2014.01.003

Multiple Sclerosis and Related Disorders

Volume 3, Issue 4, July 2014, Pages 463-472

https://doi.org/10.1016/j.msard.2014.01.003 Get rights and content

Highlights

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MS patients with cognitive complaints in different disease course had a relatively similar cognitive impairment profile.
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When the progressive groups were evaluated separately, the PPMS group was more impaired than the SPMS and RRMS groups.
•
The relationships between cognitive impairment and severity of disability as well as duration of disease were weak.

Abstract

Background

The relationship between cognitive impairment and disease course and severity of multiple sclerosis (MS) is not well understood.

Objective

The aim of the study was to evaluate whether cognitive complaints in different clinical phenotypes and severity stages of MS are associated with differences in the profile of cognitive impairment.

Methods

196 MS patients (relapsing-remitting RRMS n=138; secondary progressive SPMS n=32; primary progressive PPMS n=26) with perceived cognitive deficits underwent neuropsychological assessment with the brief repeatable battery of neuropsychological tests (BRBNT). Mood, impact of the disease, and quality of life were evaluated with self-reports.

Results

Only minor differences were observed in the cognitive impairment profile of different disease phenotypes and different disease severity stages. RRMS patients performed better only in one cognitive test of the BRBNT, than patients with progressive disease types. When RRMS, SPMS, and PPMS groups were evaluated separately, PPMS showed more pronounced cognitive impairments than RRMS and SPMS. The relationships between cognitive impairment and severity of disability as well as duration of disease were weak.

Conclusion

MS patients with cognitive complaints tend to have a relatively similar cognitive impairment profile which is not dependent on the disease course and severity.

Introduction

Multiple sclerosis (MS), the most common disabling neurological disease in young and middle-aged adults, is characterized by a variable disease course. In most of the patients (80%) the disease emerges with relapsing remitting (RRMS) course characterized by episodes of acute exacerbation followed by almost complete recovery. Approximately 50–60% of RRMS patients progress to secondary progressive (SPMS) disease characterized by disease progression with or without relapses, remissions, and plateaus. About 15% of patients evidence a primary progressive (PPMS) disease course from onset characterized by continuous deterioration without distinct relapses (Antel et al., 2012). The conversion from RRMS to progressive course tends to occur between 35 and 50 years of age, which is the same as the typical age of disease onset in patients with PPMS. Magnetic resonance imaging (MRI) findings, cerebrospinal fluid banding, evoked potentials, genetics, or neuropathology are not objectively distinguishable between primary progressive and relapsing forms of the disease (Rice et al., 2013). Recent findings suggest that MS might be a single disease entity with several distinct clinical phenotypes (Lassmann et al., 2012, Rice et al., 2013).

Cognitive impairment is present in 50–60% of patients with MS, encompassing all disease stages and types of clinical course (Langdon, 2011). The cognitive functions most often affected are information processing speed, memory, executive functions and complex attention (Chiaravalloti and DeLuca, 2008, Langdon, 2011). Most of the evidence at present suggests that cognitive deficits are more frequent and more widespread in progressive than in relapsing form of the disease (Gaudino et al., 2001, Huijbregts et al., 2004, Lynch et al., 2005, Potagas et al., 2008, Rodrigues et al., 2011, Ruet et al., 2013, Sepulcre et al., 2006). However, the findings are not consistent. It has also been concluded that cognitive impairments may be infrequent in PPMS (Comi et al., 1995, Thompson et al., 1997). Similarly, patients with SPMS have been found to have more frequent and more severe cognitive impairment (Comi et al., 1995, Denney et al., 2005, Huijbregts et al., 2004, Potagas et al., 2008) than patients with PPMS. In contrast to these, also similar cognitive performance in the two types of progressive disease courses has been reported (Foong et al., 2000).

Cognitive impairment has mostly been found to be unrelated to physical disability and disease duration in MS (see reviews Chiaravalloti and DeLuca, 2008, Langdon, 2011). At the same time, a significant relationship between physical disability and cognition in studies representing larger samples has been reported (Lynch et al., 2005). Longitudinal studies of short timeline (1 to 4 years) have failed to show significant cognitive decline, but in longer follow-up (10 or more years) cognitive impairment seems to progress (Langdon, 2011).

The relationship between cognitive impairment and disease course and severity of MS is not well understood. Against this background, the aim of the present study was to evaluate whether patients with different clinical phenotypes (RRMS, SPMS, PPMS) or different stages of disability (EDSS 0–4.0, EDSS 4.5–6.0, EDSS>6.0) and with cognitive complaints show a different cognitive impairment profile in the brief repeatable battery of neuropsychological tests (BRBNT).

Section snippets

Participants

The study population consisted of a pooled sample of MS patients also included in two previous study samples. Both studies included patients participating in outpatient rehabilitation. In the first study (n=98), patients with moderate to severe MS (EDSS 4.0–8.0) with subjective cognitive complaints (patient report) and willingness to participate in outpatient rehabilitation were included. In the second study (n=98), patients with mild to moderate MS (EDSS 0–5.5) with subjective cognitive

Clinical phenotypes (RRMS vs. progressive)

RRMS patients were younger than patients with progressive disease course. Neither education in years nor gender distribution differed between the groups. RRMS patients had lower EDSS scores than patients with progressive disease course. Disease duration was longer in patients with progressive course, compared to RRMS patients. Mood or perceived psychological burden of the disease did not differ between the groups. Patients with progressive disease course reported more physical burden of the

Discussion

To our knowledge, this is the first study to compare the cognitive performance profile of MS patients with subjective cognitive complaints in different disease types and severity. The association between cognitive dysfunction and severity of disability or disease duration was weak. Slight differences were found among the disease phenotypes. RRMS patients performed better than the patients with progressive disease (SPMS, PPMS) course in one cognitive test, the SDMT. When RRMS, SPMS and PPMS

Conflict of interest statement

None related to this specific study. The study was funded by the Finnish MS Foundation.

Acknowledgments

We thank all our patients for their time and interest in this study. The study was funded by the Finnish MS Foundation, which is gratefully acknowledged.

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While a significant increase was observed in the HRpeak values of the participants after the exercise (p < 0.05), the VO2_max values also showed a highly significant difference compared to the pre-treatment values. (p < 0.01). While a significant difference was detected in the mental subparameter of Short Form-12 (p < 0.05), a high level of significant difference was found in the physical subparameter (p < 0.01). While no significant difference was observed in the Hospital Anxiety and Depression Scale anxiety subparameter (p > 0.05), a significant difference was found in the depression subparameter (p < 0.01). There was a significant difference in Modified Fatigue Impact Scale physical and cognitive subparameters compared to pre-treatment (p < 0.01). A significant difference was observed in the Emotional Intelligence Scale total score after the treatment (p < 0.01).
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View full text

Cognitive performance profile in different phenotypes of MS with cognitive complaints

Highlights

Abstract

Background

Objective

Methods

Results

Conclusion

Introduction

Section snippets

Participants

Clinical phenotypes (RRMS vs. progressive)

Discussion

Conflict of interest statement

Acknowledgments

Lancet Neurol

J Neurol Sci

Arch Clin Neuropsychol

J Psychiatr Res

J Neurol Sci

Arch Clin Neuropsychol

Primary progressive multiple sclerosis: part of the MS disease spectrum or separate disease entity?

Acta Neuropathol

An inventory for measuring depression

Arch Gen Psychiatry

Mild visual acuity disturbances are associated with performance on tests of complex visual attention in MS

J Int Neuropsychol Soc

A comparison of neuropsychological deficits in primary and secondary progressive multiple sclerosis

J Neurol