Abstract
Behavioral changes are common in patients with multiple sclerosis (MS), however not as readily recognized as cognitive impairments. The aim of this study was to analyze behavioral changes and its relation to disease characteristics, disability, and cognitive impairments in patients with MS. This is a single-center cross-sectional study. A detailed neuropsychological examination, including the Frontal Systems Behavior Scale (FrSBe), the Beck depression inventory (BDI), and the Wuerzburg Fatigue Inventory for Multiple Sclerosis (WEIMuS) test, was performed. FrSBe results were correlated with disease characteristics, disability, and cognitive assessments. 66 patients were enrolled (mean age: 43.4 years; disease duration: 9.3 years; Expanded Disability Status Scale: 3.0). Up to one third of patients showed behavioral changes in at least one domain or the total score of the FrSBe. Patients were mildly affected with regard to cognitive functioning. Consistent correlation was found between behavioral changes and fatigue (WEIMuS) and depressive symptoms (BDI), but not with disease characteristics, disability, or cognitive functions. There was an increase of behavioral changes on all FrSBe scales in the current status compared to the retrospectively rated status before disease onset. Self- and family ratings with regard to current behavioral changes were similar. Behavioral changes are common in otherwise mildly affected MS patients with up to one third being affected. In this patient cohort, behavioral changes occur largely independent of disease characteristics, physical disability, and cognitive functioning but correlate with both fatigue and depressive symptoms. Therefore, they should be tested specifically.
Highlights
Multiple sclerosis (MS) is a chronic inflammatory disease of the central nervous system characterized by inflammation, demyelination, axonal injury, and axonal loss
With regard to cognitive functions, patients were largely unimpaired in memory, executive functions, visuospatial abilities/ perception, neglect, apraxia, and language, with the exception of planning abilities
In the Beck Depression Inventory (BDI), 36% of patients did not have depressive symptoms, 59.1% showed minimal to medium depressive symptoms, and 4.9% heavily depressive symptoms (Table 2)
Summary
Multiple sclerosis (MS) is a chronic inflammatory disease of the central nervous system characterized by inflammation, demyelination, axonal injury, and axonal loss. Behavioral changes can be predictive of cognitive and functional impairment in MS patients [6, 9]. Despite their frequency and relevance, behavioral changes receive little attention in the daily care of MS patients and in clinical trials. This is at least partly due to difficulties in assessing and quantifying behavioral changes. Behavioral changes are common in patients with multiple sclerosis (MS), not as readily recognized as cognitive impairments
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