Isolated Cognitive Decline in Neurologically Stable Patients with Multiple Sclerosis.

Jiri Motyl,Lucie Friedova,Ralph H B Benedict,Tom A Fuchs,Manuela Vaneckova,Tomas Uher,Jana Blahova Dusankova,Dana Horakova,Eva Kubala Havrdova,Jan Krasensky,Michaela Andelova,Balazs Lorincz

doi:10.3390/diagnostics11030464

Abstract

(1) Background: Cognitive deterioration is an important marker of disease activity in multiple sclerosis (MS). It is vital to detect cognitive decline as soon as possible. Cognitive deterioration can take the form of isolated cognitive decline (ICD) with no other clinical signs of disease progression present. (2) Methods: We investigated 1091 MS patients from the longitudinal GQ (Grant Quantitative) study, assessing their radiological, neurological, and neuropsychological data. Additionally, the confirmatory analysis was conducted. Clinical disease activity was defined as the presence of new relapse or disability worsening. MRI activity was defined as the presence of new or enlarged T2 lesions on brain MRI. (3) Results: Overall, 6.4% of patients experienced cognitive decline and 4.0% experienced ICD without corresponding clinical activity. The vast majority of cognitively worsening patients showed concomitant progression in other neurological and radiologic measures. There were no differences in disease severity between completely stable patients and cognitively worsening patients but with normal cognition at baseline. (4) Conclusions: Only a small proportion of MS patients experience ICD over short-term follow-up. Patients with severe MS are more prone to cognitive decline; however, patients with normal cognitive performance and mild MS might benefit from the early detection of cognitive decline the most.

Highlights

IntroductionCognitive deterioration is an important marker of disease activity in multiple sclerosis (MS) which may occur without worsening of physical disability [1,2]
Patients with severe multiple sclerosis (MS) are more prone to cognitive decline; patients with normal cognitive performance and mild MS might benefit from the early detection of cognitive decline the most
Cognitive deterioration is an important marker of disease activity in multiple sclerosis (MS) which may occur without worsening of physical disability [1,2]

Summary

Introduction

Cognitive deterioration is an important marker of disease activity in multiple sclerosis (MS) which may occur without worsening of physical disability [1,2]. It is important to focus on the benchmark of cognitive impairment but, for the purpose of the disease activity monitoring, to detect cognitive decline even before the threshold into cognitive impairment is crossed [3]. To detect such early cognitive changes, it was recommended to monitor cognitive processing speed on an annual basis using sensitive yet administered tests such as the Symbol Digit Modalities Test [2]. The underlying processes leading to cognitive decline are often difficult to appreciate with conventional MRI markers as utilized in common clinical practice [10,11,12,13]

Objectives

Methods

Results

Discussion

Conclusion