Cognitive Decline over 30 years

C
Achiron A, Chapman J, Magalashvili D, Dolev M, Lavie M,
Bercovich E, Polliack M, Doniger GM, Stern Y, Khilkevich O, Menascu S,
Hararai G, Gurevich M, Barak Y.
Modeling of cognitive impairment by disease duration in multiple sclerosis: a cross-sectional study.PLoS One. 2013;8(8):e71058. doi: 10.1371/journal.pone.0071058.

 
BACKGROUND/AIMS:Large-scale population studies measuring rates and dynamics of cognitive decline in multiple sclerosis (MS) are lacking. In the current cross-sectional study we evaluated the patterns of cognitive impairment in MS patients with disease duration of up to 30 years.
METHODS: 1,500 patients with MS were assessed by a computerized cognitive battery measuring verbal and non-verbal memory, executive function, visual spatial perception, verbal function, attention, information processing speed and motor skills. Cognitive impairment was defined as below one standard deviation (SD) and severe cognitive impairment as below 2SD for age and education matched healthy population norms.
RESULTS: Cognitive performance in our cohort was poorer than healthy population norms. The most frequently impaired domains were information processing speed and executive function. MS patients with secondary-progressive disease course performed poorly compared with clinically isolated syndrome, relapsing-remitting and primary progressive MS patients. By the fifth year from disease onset, 20.9% of patients performed below the 1SD cutoff for impairment, p = 0.005, and 6.0% performed below the 2SD cutoff for severe cognitive impairment, p = 0.002. By 10 years from onset 29.3% and 9.0% of patients performed below the 1SD and 2SD cutoffs, respectively, p = 0.0001. Regression modeling suggested that cognitive impairment may precede MS onset by 1.2 years.
CONCLUSIONS: The rates of cognitive impairment in this large sample of MS patients were lower than previously reported and severe cognitive impairment was evident only in a relatively small group of patients. Cognitive impairment differed significantly from expected normal distribution only at five years from onset, suggesting the existence of a therapeutic window during which patients may benefit from interventions to maintain cognitive health.
 
 
.The percent of MSers with impairment in GCS at a cutoff of 85 (1SD
below the normalized mean, white bars) and at a cutoff of 70 (2SD below
the normalized mean, black bars) is presented by disease duration. The
dashed bars represent the percent of patients with GCS ≥85. N = number of patients; *p≤0.005; **p<0.001; ***p<0.05.
This study shows that cognitive decline occurs in MSers and this increases with time and becomes significant at 5 years after diagnosis, if severe in a small but significant propotion of MSers. This supports Prof G’s wish to get newly diagnosed people with MS the choice of using highly effective treatments early.

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