Multipl sklerozda spinal kord lezyonları ile kognisyon ilişkisi

Year 2022, Volume: 47 Issue: 3, 1040 - 1049, 30.09.2022

Sevda Diker , Amber Eker , Doç Dr Bahar Kaymakamzade , Aysegul Erem , Uğurcan Balyemez

https://doi.org/10.17826/cumj.1096925

Abstract

Amaç: Çalışmamızda, multipl skleroz (MS)da fiziksel özürlülük ve prognozla yakın ilişkisi olan spinal kord tutulumunun, kognitif işlevler üzerine olası etkisi incelenmiştir.
Gereç ve Yöntem: Çalışmaya 29 MS hastası (2 klinik izole sendrom, 23 relaps ve remisyonlarla seyreden MS, 2 sekonder progresif MS, 2 primer progresif MS) alındı. Demografik özellikleri, genişletilmiş özürlülük durum skalası (EDSS) skoru, Rao’nun kısa tekrarlanabilir nöropsikolojik test bataryası ile değerlendirilen kognitif durumu, beyin ve spinal kord T2 lezyon sayısı değerlendirildi. Benzer demografik özelliklere sahip 17 sağlıklı kontrol ile kognitif test sonuçları karşılaştırıldı.
Bulgular: İleri yaş, hastalık başlangıç yaşının ileri olması, kısa eğitim süresi kognitif test sonuçlarını olumsuz etkileyen özelliklerdir. Beyin ve spinal kord lezyon sayılarının kognitif testler üzerine anlamlı etkisi saptanmamıştır. Spinal kord lezyonu olan hastalar olmayanlara göre daha yüksek EDSS’ye sahiptir, ancak iki grup arasında kognitif test sonuçları açısından anlamlı farklılık saptanmamıştır.
Sonuç: Spinal kord lezyonları, EDSS ile değerlendirilen fiziksel özürlülük ile ilişkilidir. Kord plak varlığının ya da sayısının kognitif test sonuçları üzerine etkisini, servikal kord atrofisi ile birlikte değerlendirecek, daha geniş örneklemli boylamsal çalışmalara ihtiyaç vardır.

Keywords

multipl skleroz, spinal kord, kognisyon, BRB-N

Supporting Institution

-

Project Number

-

Association of spinal cord lesions with cognition in multiple sclerosis

Abstract

Purpose: The effect of spinal cord involvement, which is closely related to physical disability and prognosis, on cognitive functions in multiple sclerosis.
Materials and Methods: Twenty nine MS patients (2 clinically isolated syndrome, 23 relapsing and remitting MS, 2 secondary progressive MS, 2 primary progressive MS) were included in the study. Demographic characteristics, expanded disability status scale (EDSS) score, cognition assessed by brief repeatable battery of neuropsychological tests, brain and spinal cord T2 lesion number were evaluated.
Results: Older age, later age of disease onset, education duration are the features affecting cognitive test results. Brain and spinal cord lesion numbers did not have any effect on cognitive tests. Patients with spinal cord lesions had higher EDSS compared to patients without, however there was no difference regarding cognitive test results between groups.
Conclusion: Spinal cord lesions are associated with physical disability quantified by EDSS. Longitudinal studies with larger samples are needed to investigate the effect of presence and number of cord lesions as well as cervical cord atrophy on cognitive test results.

Keywords

Multiple sclerosis, spinal cord, cognition, BRB-N

Project Number

-

References

• 1. Filippi M, Bar-Or A, Piehl F, Preziosa P, Solari A, Vukusic S, et al. Multiple sclerosis. Nat Rev Dis Primers 2018;4:43.
• 2. Prins M, Schul E, Geurts J, van der Valk P, Drukarch B, van Dam AM. Pathological differences between white and grey matter multiple sclerosis lesions. Ann N Y Acad Sci 2015;1351:99-113.
• 3. Rocca MA, Amato MP, De Stefano N, Enzinger C, Geurts JJ, Penner IK, et al. Clinical and imaging assessment of cognitive dysfunction in multiple sclerosis. Lancet Neurol 2015;14:302-17.
• 4. Benedict RHB, DeLuca J, Enzinger C, Geurts JJG, Krupp LB, Rao SM. Neuropsychology of Multiple Sclerosis: Looking Back and Moving Forward. J Int Neuropsychol Soc 2017;23:832-42.
• 5. DeLuca GC, Yates RL, Beale H, Morrow SA. Cognitive impairment in multiple sclerosis: clinical, radiologic and pathologic insights. Brain Pathol 2015;25:79-98.
• 6. Sherman TE, Rapport LJ, Ryan KA. Awareness of deficit in multiple sclerosis. J Clin Exp Neuropsychol 2008;30:301-11.
• 7. Johnen A, Landmeyer NC, Burkner PC, Wiendl H, Meuth SG, Holling H. Distinct cognitive impairments in different disease courses of multiple sclerosis-A systematic review and meta-analysis. Neurosci Biobehav Rev 2017;83:568-78.
• 8. Benedict RHB, Amato MP, DeLuca J, Geurts JJG. Cognitive impairment in multiple sclerosis: clinical management, MRI, and therapeutic avenues. Lancet Neurol 2020;19:860-71.
• 9. Ruano L, Portaccio E, Goretti B, Niccolai C, Severo M, Patti F, et al. Age and disability drive cognitive impairment in multiple sclerosis across disease subtypes. Mult Scler 2017;23:1258-67.
• 10. Zipoli V, Goretti B, Hakiki B, Siracusa G, Sorbi S, Portaccio E, et al. Cognitive impairment predicts conversion to multiple sclerosis in clinically isolated syndromes. Mult Scler 2010;16:62-7.
• 11. Langdon DW. Cognition in multiple sclerosis. Curr Opin Neurol 2011;24:244-249.
• 12. Bot JC, Barkhof F, Polman CH, Lycklama a Nijeholt GJ, de Groot V, Bergers E, et al. Spinal cord abnormalities in recently diagnosed MS patients: added value of spinal MRI examination. Neurology 2004;62:226-33.
• 13. Kearney H, Miller DH, Ciccarelli O. Spinal cord MRI in multiple sclerosis--diagnostic, prognostic and clinical value. Nat Rev Neurol 2015;11:327-38.
• 14. Brownlee WJ, Altmann DR, Alves Da Mota P, Swanton JK, Miszkiel KA, Wheeler-Kingshott CG, et al. Association of asymptomatic spinal cord lesions and atrophy with disability 5 years after a clinically isolated syndrome. Mult Scler 2017;23:665-74.
• 15. Arrambide G, Rovira A, Sastre-Garriga J, Tur C, Castillo J, Rio J, et al. Spinal cord lesions: A modest contributor to diagnosis in clinically isolated syndromes but a relevant prognostic factor. Mult Scler 2018;24:301-12.
• 16. Brownlee WJ, Altmann DR, Prados F, Miszkiel KA, Eshaghi A, Gandini Wheeler-Kingshott CAM, et al. Early imaging predictors of long-term outcomes in relapse-onset multiple sclerosis. Brain 2019;142:2276-87.
• 17. Sombekke MH, Wattjes MP, Balk LJ, Nielsen JM, Vrenken H, Uitdehaag BM, et al. Spinal cord lesions in patients with clinically isolated syndrome: a powerful tool in diagnosis and prognosis. Neurology 2013;80:69-75.
• 18. Thompson AJ, Banwell BL, Barkhof F, Carroll WM, Coetzee T, Comi G, et al. Diagnosis of multiple sclerosis: 2017 revisions of the McDonald criteria. Lancet Neurol 2018;17:162-73.
• 19. Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J. An inventory for measuring depression. Arch Gen Psychiatry 1961;4:561-571.
• 20. Bingol, A. YS, Tütüncü M., Cognitive dysfunction in multiple sclerosis in a Turkish cohort. In: Proceedings of the 20th Meeting of the European Neurological Society. 2010, Poster presentation.
• 21. Rossi F, Giorgio A, Battaglini M, Stromillo ML, Portaccio E, Goretti B, et al. Relevance of brain lesion location to cognition in relapsing multiple sclerosis. PLoS One 2012;7:e44826.
• 22. Amato MP, Ponziani G, Siracusa G, Sorbi S. Cognitive dysfunction in early-onset multiple sclerosis: a reappraisal after 10 years. Arch Neurol 2001;58:1602-6.
• 23. Kalb R, Beier M, Benedict RH, Charvet L, Costello K, Feinstein A, et al. Recommendations for cognitive screening and management in multiple sclerosis care. Mult Scler 2018;24:1665-80.
• 24. Çınar BP, Yiğit P, Gürkan MA, Öztürk O, Özakbaş S. Cognitive involvement in clinically isolated syndrome and relationship with fatigue. Cukurova Med J 2019;44(Suppl 1):165-72.
• 25. Achiron A, Barak Y. Cognitive impairment in probable multiple sclerosis. J Neurol Neurosurg Psychiatry 2003;74:443-6.
• 26. Benedict RH, Cookfair D, Gavett R, Gunther M, Munschauer F, Garg N, et al. Validity of the minimal assessment of cognitive function in multiple sclerosis (MACFIMS). J Int Neuropsychol Soc 2006;12:549-58.
• 27. Branco M, Ruano L, Portaccio E, Goretti B, Niccolai C, Patti F, et al. Aging with multiple sclerosis: prevalence and profile of cognitive impairment. Neurol Sci 2019;40:1651-57.
• 28. Deloire MS, Salort E, Bonnet M, Arimone Y, Boudineau M, Amieva H, et al. Cognitive impairment as marker of diffuse brain abnormalities in early relapsing remitting multiple sclerosis. J Neurol Neurosurg Psychiatry 2005;76:519-26.
• 29. Ukkonen M, Vahvelainen T, Hamalainen P, Dastidar P, Elovaara I. Cognitive dysfunction in primary progressive multiple sclerosis: a neuropsychological and MRI study. Mult Scler 2009;15:1055-61.
• 30. Camp SJ, Stevenson VL, Thompson AJ, Ingle GT, Miller DH, Borras C, et al. A longitudinal study of cognition in primary progressive multiple sclerosis. Brain 2005;128:2891-98.
• 31. Sperling RA, Guttmann CR, Hohol MJ, Warfield SK, Jakab M, Parente M, et al. Regional magnetic resonance imaging lesion burden and cognitive function in multiple sclerosis: a longitudinal study. Arch Neurol 2001;58:115-21.
• 32. Calabrese M, Poretto V, Favaretto A, Alessio S, Bernardi V, Romualdi C, et al. Cortical lesion load associates with progression of disability in multiple sclerosis. Brain 2012;135:2952-61.
• 33. Bergsland N, Zivadinov R, Dwyer MG, Weinstock-Guttman B, Benedict RH. Localized atrophy of the thalamus and slowed cognitive processing speed in MS patients. Mult Scler 2016;22:1327-36.
• 34. Vollmer T, Huynh L, Kelley C, Galebach P, Signorovitch J, DiBernardo A, et al. Relationship between brain volume loss and cognitive outcomes among patients with multiple sclerosis: a systematic literature review. Neurol Sci 2016;37:165-79.
• 35. Heesen C, Schulz KH, Fiehler J, Von der Mark U, Otte C, Jung R, et al. Correlates of cognitive dysfunction in multiple sclerosis. Brain Behav Immun 2010;24:1148-55.