Determinants of cognitive impairment

Cognitive impairment in MS is clearly flavour of the month. #MSBlog #MSResearch

M Borghi et al. Presence and Significant Determinants of Cognitive Impairment in a Large Sample of Patients with Multiple Sclerosis. PLOS ONE, 2013

Objectives: To investigate the presence and the nature of cognitive impairment in a large sample of MSer, and to identify clinical and demographic determinants of cognitive impairment in MS. 

Methods: 303 MSers and 279 healthy controls were administered the Brief Repeatable Battery of Neuropsychological tests (BRB-N); measures of pre-morbid verbal competence and neuropsychiatric measures were also administered.

Results: MSers and healthy controls were matched for age, gender, education and pre-morbid verbal Intelligence Quotient. MSers presenting with cognitive impairment were 108/303 (35.6%). In the overall group of participants, the significant predictors of the most sensitive BRB-N scores were: presence of MS, age, education, and vocabulary. The significant predictors when considering MSers only were: course of MS, age, education, vocabulary, and depression. Using logistic regression analyses, significant determinants of the presence of cognitive impairment in relapsing-remitting MSers were: duration of illness (OR = 1.053, 95% CI = 1.010–1.097, p = 0.015), Expanded Disability Status Scale score (OR = 1.247, 95% CI = 1.024–1.517, p = 0.028), and vocabulary (OR = 0.960, 95% CI = 0.936–0.984, p = 0.001), while in the smaller group of progressive MSers these predictors did not play a significant role in determining the cognitive outcome.

Conclusions: These results corroborate the evidence about the presence and the nature of cognitive impairment in a large sample of MSers. Furthermore, these findings identify significant clinical and demographic determinants of cognitive impairment in a large sample of MSers for the first time. 

"I am not surprised that duration of illness, EDSS and vocabulary are predictors of cognitive impairment in MS. Duration of MS and EDSS are linked; the longer you have had MS the more likely you are to be physically disabled and to have cognitively impaired. Vocabulary was protective; higher vocabulary probably indicates higher cognitive reserve, which protects you from cognitive impairment. The latter is not due to some magic biological process but simply greater ability to cope with the ravages of cognitive impairment."

"Cognitive impairment in MS seems to be the flavour of the month. Dare I remind readers that MS has been on the list of the causes of dementia in neurological textbooks for decades. What has changed? With the advent of DMTs, in particular highly effective DMTs, we can now shift MS to the list of preventable dementias."
"Cognitive impairment starts early in the course of MS and can rarely be the presenting feature. Cognitive impairment is associated with mental fatigue and depression as seen in this study. I am sure that a larger driver of early unemployment in MS is due to cognitive impairment and fatigue."

"Has your neurologist, or MS nurse, discussed cognitive impairment with you? Should they?"

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