Abstract
BackgroundIncreasingly favorable mortality prognosis in multiple sclerosis (MS) raises questions regarding MS-specific cognitive aging and the presence of comorbidities such as Alzheimer’s disease (AD).ObjectiveTo assess elderly with MS (EwMS) and age-matched healthy controls (HCs) using both MS- and AD-specific psychometrics.MethodsEwMS (n = 104) and 56 HCs were assessed on a broad spectrum of language, visual-spatial processing, memory, processing speed, and executive function tests. Using logistic regression analysis, we examined cognitive performance differences between the EwMS and HC groups. Cognitive impairment (CI) was defined using a -1.5 SD threshold relative to age and education years-matched HCs, in two cognitive domains.ResultsCI was observed in 47.1% of EwMS with differences most often seen on tests emphasizing cognitive processing speed as measured by Symbol Digit Modalities Test (SDMT) (d = 0.9, p < 0.001) and verbal fluency (both category-based d = 0.87, p < 0.001; letter-based d = 0.67, p < 0.001). After adjusting for age, sex and years of education, MS/HC diagnosis was best predicted (R2 = 0.27) by differences in category-based verbal fluency (Wald = 9.935, p = 0.002) and SDMT (Wald = 13.937, p < 0.001).ConclusionThis study confirms the common hallmark of slowed cognitive processing speed in MS among elderly patients. Defective verbal fluency, less often observed in younger cohorts, may represent emerging cognitive pathology due to other etiologies.
Highlights
Multiple sclerosis (MS) is a chronic demyelinating disease of the central nervous system (CNS) which presents with acute inflammatory episodes and co-occurring widespread neurodegeneration (Reich et al, 2018)
The elderly with MS (EwMS) were more disabled when compared to the healthy controls (HCs) in both lower and upper extremity function (T25FW, 6.7s vs. 4.7s, p < 0.001; and 9PHT, 24.7s vs. 21.5s, p < 0.001)
They showed that SPMS patients had similar performance on both letter-based and category-based verbal fluency when compared to the amnestic mild cognitive impairment (aMCI) patients and significantly lower than HCs (Muller et al, 2013)
Summary
Multiple sclerosis (MS) is a chronic demyelinating disease of the central nervous system (CNS) which presents with acute inflammatory episodes and co-occurring widespread neurodegeneration (Reich et al, 2018) These neuropathological processes are linked to physical disability progression, and to cognitive impairment (Benedict et al, 2014). AD is characterized by progressive decline in episodic memory, rapid forgetting, and impairments in semantic language These defects are associated with neurodegeneration starting within the hippocampus, and entorhinal cortex (Hyman et al, 1984; McKhann et al, 2011; Reitz et al, 2011). Favorable mortality prognosis in multiple sclerosis (MS) raises questions regarding MS-specific cognitive aging and the presence of comorbidities such as Alzheimer’s disease (AD). Less often observed in younger cohorts, may represent emerging cognitive pathology due to other etiologies
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