MULTİPL SKLEROZDA KOGNİTİF ETKİLENMENİN DEĞERLENDİRİLMESİ

Year 2022, Volume: 29 Issue: 4, 531 - 539, 27.12.2022

Melike Doğan Ünlü Serpil Demirci

https://doi.org/10.17343/sdutfd.1139204

Abstract

Amaç
Multipl skleroz (MS), santral sinir sisteminin ön planda
beyaz cevherini etkileyen kronik inflamatuar demiyelinizan
hastalığıdır. Kognitif bozukluk relapsing remitting
multipl skleroz (RRMS) hastalarında sık karşılaşılan
bir sorundur ve yaşam kalitesi üzerinde önemli
rol oynamaktadır. MS hastalarının %30-70’inde kognitif
bozukluk görülür. Bozukluklar tipik olarak bellek,
dikkat, bilgi işleme fonksiyonlarındadır. Bu çalışmada
erken evre MS hastalarındaki bilişsel bozulmanın paterninin
belirlenmesi amaçlanmıştır.
Gereç ve Yöntem
Çalışmaya 30 RRMS hastası ve 30 sağlıklı gönüllü
dahil edilmiştir. Tüm deneklere sözel ve görsel bellek,
dikkat, yürütücü işlevler, görsel-uzamsal işlevler, lisan
ve genel akıcı zekayı kapsayan geniş bir nöropsikolojik
test bataryası uygulanmıştır. Özürlülük ve işlevselliğin
etkilenen kognitif alanlarla ilişkisi değerlendirilmiştir.
Bulgular
Çalışmaya alınan MS hastaları ve sağlıklı gönüllülerin
ortalama yaş ve eğitim süreleri arasında anlamlı
bir farklılık yoktu. MS’li hastalarda ortalama hastalık
süresi 62.20 ± 52.70 ay ve ortalama tanı alma süresi
39.16 ± 39.17 ay idi. Ortalama atak sayısı 3.13 ± 1.90
idi. Ortalama EDSS puanı 1.38 ± 1.31 idi. Psikomotor
hız ve dikkat işlevlerini değerlendiren bir test olan
İz Sürme Testi A ve B alt-testlerinde MS’li hastaların
başarımı kontrol grubundakinden belirgin derecede
daha düşüktü (p=0.005).
Sonuç
MS hastaları dikkat ve yürütücü işlevleri değerlendiren
tüm testlerde daha kötü bir başarım sergilemiştir. Bu
kötü başarım Multipl Skleroz İşlevsel Bileşiği (MSFC)
ve Genişletilmiş Özürlülük Durum Ölçeği (EDSS) ile
bağıntılıdır. MS hastalarında temel olarak bellek ve
dikkat bozuklukları bildirilmiştir. Bulgularımız çalışma
belleği, dikkat ve yürütücü işlev bozukluğunun hastalığın
erken evrelerinden itibaren diğer bulgulara eşlik
edebileceğini düşündürmektedir.

Keywords

MULTİPL SKLEROZ, BELLEK, DİKKAT, YÜRÜTÜCÜ İŞLEVLER, GÖRSEL-UZAMSAL İŞLEVLER, MSFC, EDSS

Supporting Institution

yoktur

Thanks

Çalışmaya katılan tüm gönüllülere teşekkür ederiz.

EVALUATION OF THE COGNITIVE IMPAIRMENT IN MULTIPLE SCLEROSIS

Abstract

Objective
Multiple sclerosis (MS) is a chronic-imflammatory
demyelinating central nervus system disease affecting
mainly the white matter. Cognitive impairment is
a common problem in relapsing-remitting multiple
sclerosis (RRMS) patients and plays a major role
in the quality of life. Cognitive impairment occurs in
30-70% of patients with MS. Deficits typically occur
in memory, attention and information processing
functions. In this study it is aimed to determine pattern
of cognitive impairment in MS patients who are in the
early hase of disease.
Material and Method
Thirty RRMS patients and 30 healthy volunteers were
included in the study. All subjects were administered a
comprehensive neuropsychological test battery which
encompases verbal and visual memory, attention,
executive functions, visual spatial functions, language
and general fluid intelligence. The relation of disability
and functionality with affected cognitive domains were
also evaluated.
Results
There was no significant difference mean age and
duration of education between the MS patients and
healthy controls. Mean duration of disease in MS
patients is 62.20 ± 52.70 mounth and mean time to
diagnosis is 39.16 ± 39.17 mounth, Mean number of
attack is 3.13 ± 1.90 and mean EDSS score is 1.38 ±
1.31. In Trail Making Test A and B, which is a test that
evaluates psychomotor speed and attention functions,
patients with MS had significantly lower performance
than control group.
Conclusion
MS patient exhibited a worse performance in all
tests evaluating attention and executive functions.
This worse performance was correlated with
Multiple Sclerosis Functional Composite (MSFC)
and Expanded Diasability Status Scale (EDSS).
MS patients are reported to have mainly memory
and attention deficits. Our results suggest that a
working memory and attention deficits and executive
dysfunction may associate with other findings of the
disease since early phases of disease.

Keywords

MULTIPLE SCLEROSİS, ATTENTION, MEMORY, EXECUTIVE FUNCTIONS, VISUAL-SPATIAL FUNCTIONS, MSFC, EDSS

References

• 1. Beatty WM, Blanco CR, Wilbanks SL et al. Demographic, clinical and cognitive characteristics of multiple sclerosis patients who continue to work. J Neurol Rehab 1995; 9:167-73.
• 2. Benedict RH, Cookfair D, Gavett R et al. Validity of the minimal assessment of cognitive function in multiple sclerosis. J Int Neuropsychol Soc 2006;12:549-58.
• 3. Amato MP, Ponziani G, Siracusa G, Sorbi S. Cognitive dysfunction in early onset multiple sclerosis: a reappraisal after 10 years. Arch Neurol 2001; 58:1602-06.
• 4. Christodoulou C, MacAllister WS, McLinskey NA, Krupp LB. Treatment of cognitive impairment in Multiple sclerosis is the use of acetylcholinesterase inhibitors a viable option CNS drugs 2008; 22:87-97.
• 5. Drake MA, Carra A, Allegri RF, Luetic G. Differential patterns of memory performance in relapsing-remitting and secondary progressive multiple sclerosis Neurol India 2006;54:370-6.
• 6. 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.
• 7. 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;40:1651-7
• 8. Polman CH, Reingold SC, Banwell B, Clanet M, Cohen JA, Filippi M, Fujihara K, Havrdova E, Hutchinson M, Kappos L, Lublin FD, Montalban X, O'Connor P, Sandberg-Wollheim M, Thompson AJ, Waubant E, Weinshenker B, Wolinsky JS. Diagnostic criteria for multiple sclerosis: 2010 revisions to the Mc- Donald criteria. Ann Neurol. 2011;69(2):292-302. doi: 10.1002/ ana.223666-
• 9. Beck AT, Ward C, Mendelson M. Beck depression inventory (BDI). Arch Gen Psychiatry 1961;4(6):561-571
• 10. Kurtzke JF. Rating neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS). Neurology. 1983;33(11):1444-52.).
• 11. Lezak MD. Neuropsychological assessment. 3rd ed. New York: Oxford University Pres 1995
• 12. Cutter GR, Baier ML, Rudick RA et al. Development of a multiple sklerosis functional composite as a clinical trial outcome measure. Brain 1999; 122:871-82
• 13. Fischer JS, Rudick RA, Cutter GR, Reingold SC. The Multiple Sclerosis Functional Composite Measure (MSFC): an integrated approach to MS clinical outcome assessment. National MS Society Clinical Outcomes Assessment Task Force. Mult Scler. 1999;5(4):244-50. doi: 10.1177/135245859900500409.
• 14. Tuncer N. Multipl sklerozlu olgularda kognitif fonksiyon bozuklukları. Turkiye Klinikleri 2006; 26:559-64.
• 15. Rao SM. Neuropsychological aspects of multiple sclerosis. Ed: Raine CS, Mc Farland HF, Tourellotte WW, Clinical and pathogenetic Basis. pp.357-362. Chapman and Hall, London, UK, 1997.
• 16. Rao SM, Leo GJ, Bernardin L, Unverzagt F. Cognitive dysfunction in multiple sclerosis. Neurology. 1991;41(5):685-91.
• 17. Janculjak D, Mubrin A, Brinar V et al. Changes of attention and memory in a group of patients with multipl sclerosis. Clin Neurol Neurosurg 2002; 104:221-7.
• 18. Ünal A. Multipl skleroz hastalarında bilişsel işlev bozuklukları ve tedavisi (Ed: Kırbaş D) Nöropsikiyatri (Nörolojik Hastalıkların Psikiyatrik Yönü) s.221-240, İstanbul, 2006.
• 19. Roca M, Torralva T, Meli F, Fiol M, Calcagno M, Carpintiero S, De Pino G, Ventrice F, Martin M, Vita L, Manes F, Correale J Cognitive defisits in multiple sclerosis Correlate with changes in fronto-subcortical tracts . Mult Scler 2008;14:364-69.
• 20. Achiron A, M Polliack, SM Rao. Cognitive patterns and progression in multiple sclerosis: construction and validation of percentile curves. J. Neurol. Neurosurg. Psychiatry 2005;76:744-749.
• 21. Bagert B, Camplair P, Bourdette D. Cognitive dysfunction in multiple sclerosis. Natural history, Pathophysiology and Management. CNS Drugs 2002;16:445-55.
• 22. Chiaravalloti ND, Deluca J. Cognitive impairment in multiple sclerosis. Lancet Neurol 2008;7(12):1139-1151.
• 23. Winkelmann A, Engel C, Apel A. Cognitive impairment in multiple sclerosis. J Neurol 2008;255(2):309-310.
• 24. Mollahasanoğlu A. Normal deneklerde bir grup görsel ve sözel bellek testleri performansına yaş ve eğitimin etkisi. Yüksek lisans tezi, İstanbul, 2002.
• 25. Foong J, Rozewicz L, Chong WK, Thompson AJ, Miller DH, Ron MA. A comparison of neuropsychological deficits in primary and secondary progressive multiple sclerosis. J Neurol 2000; 247:97-101.
• 26. Pujol J, Vendrell P, Deus J, Junqu´e C, Bello J, Mart´ı-Vilalta JL. The effect of medial frontal and posterior parietal demyelinating lesions on stroop interference. Neuroimage 2000; 13:68-75.
• 27. Öktem Ö. Mental Durum Muayenesi. In: Nöroloji (Ed.E.Öge). Nobel Tıp Kitabevi, İstanbul, 2004; 125-26.
• 28. Özakbas S, Çagiran I, Örmeci B, İdiman E. Correlations between multiple sclerosis functional composite, expanded disability status scale and health-related quality of life during and after treatment of relapses in patients with multiple sclerosis. J Neurol Sci 2004;208:3-7.
• 29. Kujala P, Portin R, Ruutiainen J. Brain 1997;120:289-97.
• 30. Ruggiari RM, Palermo R, Vitello G, Gennuso M, Settipani N, Piccoli F. Cognitive impairment in patients suffering from relapsing- remitting multiple sclerosis with EDSS < or = 3.5. Acta Neurol Scand 2003;108:323-26.
• 31. Patti F, Amato MP, Tola MA, Trojano M, Ferrazza F, Lijoi AF, Bastianell S. Relationship between cognitive impairment and magnetic resonance imaging disease parameters in patients with early relapsing-remiting multiple sclerosis: results from teh multicenter COGIMUS study. Neurol 2008; 70:4-170.