Short Report: Prevalence of Cognitive Impairment in Newly Diagnosed Relapsing-Remitting Multiple Sclerosis

Abstract Background: Cognitive impairment is common in multiple sclerosis (MS) and can manifest early in the disease process, sometimes as early as the first demyelinating event. However, the frequency of cognitive impairment in a newly diagnosed MS population has not been evaluated comprehensively in a clinical population. We sought to examine the prevalence of cognitive impairment in relapsing-remitting MS (RRMS) within a year of diagnosis in a clinic where cognitive testing at diagnosis is part of routine practice. Methods: A retrospective medical record review of persons with RRMS assessed in a cognitive MS clinic identified 107 patients assessed by the Minimal Assessment of Cognitive Function in Multiple Sclerosis battery within 1 year of a confirmed RRMS diagnosis. Results: The cohort was predominantly female (n = 82 [76.6%]) and white (n = 93 [86.9%]). Only 36 patients (33.6%) were diagnosed as having RRMS based on a second clinical event. Processing speed was the most frequently impaired domain (n = 38 [35.5%]). Only 37 patients (34.6%) were within normal limits on all cognitive domains. Regarding mood symptoms, 25 patients (23.4%) were positive for depressive symptoms; 59 (55.1%), for anxiety. Severe fatigue was correlated with a lower score on the Symbol Digit Modalities Test (SDMT) (r = −0.380, P < .001), and higher depressive scores were correlated with lower performance on the SDMT (r = −0.397, P < .001) and the Paced Auditory Serial Addition Test (r = −0.254, P = .009). Conclusions: Cognitive impairment, specifically processing speed, and mood symptoms are frequently present in persons with newly diagnosed RRMS.

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Cognitive impairment at diagnosis predicts 10-year multiple sclerosis progression

Multiple Sclerosis Journal ◽

10.1177/1352458515599075 ◽

2015 ◽

Vol 22 (5) ◽

pp. 659-667 ◽

Cited By ~ 53

Author(s):

Marcello Moccia ◽

Roberta Lanzillo ◽

Raffaele Palladino ◽

Kiara Chu-Mei Chang ◽

Teresa Costabile ◽

...

Keyword(s):

Multiple Sclerosis ◽

Cognitive Impairment ◽

Newly Diagnosed ◽

Delayed Recall ◽

Selective Reminding ◽

Conversion Rates ◽

Disability Status ◽

Relapsing Remitting ◽

Selective Reminding Test

Background: Cognitive impairment occurs from the early phases of multiple sclerosis (MS), and more frequently affects secondary progressive (SP) subjects than relapsing–remitting (RR). Objective: To investigate relationships between cognitive dysfunctions in newly diagnosed RRMS, and long-term MS-related outcomes. Methods: The present 10-year retrospective longitudinal study included 155 RRMS subjects, tested with the Rao Brief Repeatable Battery at MS diagnosis. The reaching of Expanded Disability Status Scale (EDSS) 4.0, and the SP conversion were recorded. Results: 67 subjects (43.2%) reached EDSS 4.0, and 34 subjects (21.9%) converted to SP during a follow-up period of 10.0±1.8 years. Subjects with cognitive impairment at diagnosis had a rate of reaching EDSS 4.0 more than three times greater ( p<0.001; HR=3.183), and a rate of SP conversion more than two times greater, as compared to cognitively preserved subjects ( p=0.008; HR=2.535). In particular, better scores in the Selective Reminding Test-Delayed Recall and in the Symbol Digit Modalities Test at baseline were associated with lower SP conversion rates during the follow-up period ( p=0.018; HR=0.835; and p=0.001; HR=0.941, respectively). Conclusion: Cognitive impairment, with particular involvement of processing speed and memory, predicts disability progression and SP conversion in newly diagnosed RRMS, highlighting the importance of cognitive assessment from the beginning of MS.

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Thalamus volume change and cognitive impairment in early relapsing–remitting multiple sclerosis patients

The Neuroradiology Journal ◽

10.1177/1971400918781977 ◽

2018 ◽

Vol 31 (4) ◽

pp. 350-355 ◽

Cited By ~ 9

Author(s):

Juan I Rojas ◽

Georgina Murphy ◽

Francisco Sanchez ◽

Liliana Patrucco ◽

Maria C Fernandez ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Multiple Sclerosis ◽

Cognitive Impairment ◽

Magnetic Resonance ◽

Processing Speed ◽

Resonance Imaging ◽

Information Processing Speed ◽

Relapsing Remitting ◽

Relapsing Remitting Multiple Sclerosis

Aims The objective of the study was to assess whether changes in the volume of the thalamus during the onset of multiple sclerosis predict cognitive impairment after accounting for the effects of brain volume loss. Methods A prospective study included patients with relapsing–remitting multiple sclerosis less than 3 years after disease onset (defined as the first demyelinating symptom), Expanded Disability Status Scale of 3 or less, no history of cognitive impairment and at least 2 years of follow-up. Patients were clinically followed up with annual brain magnetic resonance imaging and neuropsychological evaluations for 2 years. Measures of memory, information processing speed and executive function were evaluated at baseline and follow-up with a comprehensive neuropsychological test battery. After 2 years, the patients were classified into two groups, one with and the other without cognitive impairment. Brain dual-echo, high-resolution three-dimensional T1-weighted magnetic resonance imaging scans were acquired at baseline and every 12 months for 2 years. Between-group differences in thalamus volume, total and neocortical grey matter and white matter volumes were assessed using FIRST, SIENA, SIENAXr, FIRST software (logistic regression analysis P < 0.05 significant). Results Sixty-one patients, mean age 38.4 years, 35 (57%) women were included. At 2 years of follow-up, 17 (28%) had cognitive impairment. Cognitive impairment patients exhibited significantly slower information processing speed and attentional deficits compared with patients without cognitive impairment ( P < 0.001 and P = 0.02, respectively). In the cognitive impairment group a significant reduction in the percentage of thalamus volume ( P < 0.001) was observed compared with the group without cognitive impairment. Conclusion We observed a significant decrease in thalamus volume in multiple sclerosis-related cognitive impairment.

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Cognitive Impairment in Relapsing Remitting and Secondary Progressive Multiple Sclerosis Patients: Efficacy of a Computerized Cognitive Screening Battery

ISRN Neurology ◽

10.1155/2014/151379 ◽

2014 ◽

Vol 2014 ◽

pp. 1-7 ◽

Cited By ~ 31

Author(s):

Athanasios Papathanasiou ◽

Lambros Messinis ◽

Vasileios L. Georgiou ◽

Panagiotis Papathanasopoulos

Keyword(s):

Multiple Sclerosis ◽

Cognitive Impairment ◽

Processing Speed ◽

Verbal Fluency ◽

Progressive Multiple Sclerosis ◽

Effect Sizes ◽

Medium Effect ◽

Psychomotor Speed ◽

Secondary Progressive ◽

Relapsing Remitting

Objective. To investigate the pattern of cognitive impairment in relapsing remitting multiple sclerosis (RRMS) and secondary progressive multiple sclerosis (SPMS) patients using a computerized battery. Methods. RRMS patients N=50, SPMS patients N=30, and controls N=31 were assessed by Central Nervous System Vital Signs (CNS VS) computerized battery, Trail Making Tests (TMT) A and B, and semantic and phonological verbal fluency tasks. Results. The overall prevalence of cognitive dysfunction was 53.75% (RRMS 38%, SPMS 80%). RRMS patients differed from controls with large effect size on reaction time, medium effect size on TMT A and small on TMT B, phonological verbal fluency, composite memory, psychomotor speed, and cognitive flexibility. SPMS patients differed from controls in all neuropsychological measures (except complex attention) with large effect sizes on TMT A and B, phonological verbal fluency, composite memory, psychomotor speed, reaction time, and cognitive flexibility. Between patient groups, medium effect sizes were present on TMT B and psychomotor speed, while small effect sizes were present on composite memory and processing speed. Conclusion. CNS VS is sensitive in detecting cognitive impairment in RRMS and SPMS patients. Significant impairment in episodic memory, executive function, and processing speed were identified, with gradual increment of the frequency as disease progresses.

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Efficacy of Delayed-release Dimethyl Fumarate in Newly Diagnosed Patients With Relapsing-Remitting Multiple Sclerosis: Eight-Year Follow-up of an Integrated Analysis of DEFINE, CONFIRM, and ENDORSE

10.26226/morressier.59a3eda8d462b8028d895222 ◽

2017 ◽

Cited By ~ 1

Author(s):

Ralf Gold

Keyword(s):

Multiple Sclerosis ◽

Dimethyl Fumarate ◽

Integrated Analysis ◽

Newly Diagnosed ◽

Delayed Release ◽

Relapsing Remitting ◽

Remitting Multiple Sclerosis ◽

Relapsing Remitting Multiple Sclerosis

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The incidence of cognitive impairment among Hungarian relapsing-remitting multiple sclerosis patients

10.26226/morressier.59a3e8b4d462b8028d894334 ◽

2017 ◽

Author(s):

Dániel Sandi

Keyword(s):

Multiple Sclerosis ◽

Cognitive Impairment ◽

Relapsing Remitting ◽

Remitting Multiple Sclerosis ◽

Multiple Sclerosis Patients ◽

Relapsing Remitting Multiple Sclerosis

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Cognition in Early Relapsing-Remitting Multiple Sclerosis: Consequences May Be Relative to Working Memory

Journal of the International Neuropsychological Society ◽

10.1017/s1355617713000696 ◽

2013 ◽

Vol 19 (8) ◽

pp. 938-949 ◽

Cited By ~ 12

Author(s):

Lindsay I. Berrigan ◽

Jo-Anne LeFevre ◽

Laura M. Rees ◽

Jason Berard ◽

Mark S. Freedman ◽

...

Keyword(s):

Multiple Sclerosis ◽

Working Memory ◽

Processing Speed ◽

Cognitive Functions ◽

Group Membership ◽

Equation Modeling ◽

Mediating Role ◽

Relapsing Remitting ◽

Disease Stages

AbstractThe Relative Consequence Model proposes multiple sclerosis (MS) patients have a fundamental deficit in processing speed that compromises other cognitive functions. The present study examined the mediating role of processing speed, as well as working memory, in the MS-related effects on other cognitive functions for early relapsing-remitting patients. Seventy relapsing-remitting MS patients with disease duration not greater than 10 years and 72 controls completed tasks assessing processing speed, working memory, learning, and executive functioning. The possible mediating roles of speed and working memory in the MS-related effects on other cognitive functions were evaluated using structural equation modeling. Processing speed was not significantly related to group membership and could not have a mediating role. Working memory was related to group membership and functioned as a mediating/intervening factor. The results do not support the Relative Consequence Model in this sample and they challenge the notion that working memory impairment only emerges at later disease stages. The results do support a mediating/intervening role of working memory. These results were obtained for early relapsing-remitting MS patients and should not be generalized to the broader MS population. Instead, future research should examine the relations that exist at other disease stages. (JINS, 2013, 19, 1–12)

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Multiple Sclerosis and Cognitive Impairment

10.1093/med/9780197583425.003.0012 ◽

2021 ◽

pp. 39-41

Author(s):

Cristina Valencia-Sanchez ◽

Jonathan L. Carter

Keyword(s):

Magnetic Resonance Imaging ◽

Multiple Sclerosis ◽

Cognitive Impairment ◽

Information Processing ◽

Magnetic Resonance ◽

Processing Speed ◽

Rehabilitation Program ◽

Resonance Imaging ◽

The Past ◽

Demyelinating Lesions

A 60-year-old woman with a history of multiple sclerosis was evaluated for cognitive concerns. At age 30 years she had an episode of optic neuritis, followed by an episode of bilateral lower extremity numbness at age 35 years. In the following years, she had at least 6 further multiple sclerosis relapses, the last one approximately 3 years before the current presentation. She was initially treated with interferon, but she did not tolerate it. She had been taking glatiramer acetate for the past 3 years. She had noticed progressive deterioration of her gait for the past 3 years, having to use a cane on occasions. Magnetic resonance imaging of the brain showed multiple demyelinating lesions), and magnetic resonance imaging of the cervical spine showed 1 small demyelinating lesion at C6. Vitamin B12 level and thyroid function were normal. Comprehensive neuropsychological testing showed multidomain cognitive impairment, mainly impairment of speed of information processing, spatial discrimination skills, and attention/concentration. The patient’s multiple sclerosis phenotype was consistent with secondary progressive multiple sclerosis. Her cognitive impairment profile, mainly affecting information processing speed and disinhibition suggestive of frontal dysfunction, was consistent with multiple sclerosis. The patient began a cognitive rehabilitation program, and learning and memory aids were recommended. Lifestyle changes were also recommended, including weight loss and physical exercise. She was given recommendations for sleep hygiene and began taking gabapentin for neuropathic pain and restless legs. Cognitive impairment is common in patients with multiple sclerosis. Slowed cognitive processing speed and episodic memory decline are the most common cognitive deficits in MS, with additional difficulties in executive function, verbal fluency, and visuospatial analysis.

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