Maria P Amato1, Benedetta Goretti2, Angelo Ghezzi2, Bahia Hakiki2, Claudia Niccolai2, Silvia Lori2, Lucia Moiola2, Monica Falautano2, Rosa G Viterbo2, Francesco Patti2, Sabina Cilia2, Carlo Pozzilli2, Valentina Bianchi2, Marco Roscio2, Vittorio Martinelli2, Giancarlo Comi2, Emilio Portaccio2, Maria Trojano2. 1. From the Department of NEUROFARBA (M.P.A., B.G., B.H., C.N., S.L., E.P.), University of Florence; MS Centre (A.G., M.R.), Hospital of Gallarate; Neurological Department (L.M., M.F., V.M., G.C.), IRCCS Hospital San Raffaele, Milano; Department of Neuroscience and Sense Organs (R.G.V., M.T.), University of Bari; Multiple Sclerosis Centre (F.P., S.C.), University Polyclinic Hospital G. Rodolico, Catania; and Department of Neurological Sciences (C.P., V.B.), La Sapienza University, Rome, Italy. mariapia.amato@unifi.it. 2. From the Department of NEUROFARBA (M.P.A., B.G., B.H., C.N., S.L., E.P.), University of Florence; MS Centre (A.G., M.R.), Hospital of Gallarate; Neurological Department (L.M., M.F., V.M., G.C.), IRCCS Hospital San Raffaele, Milano; Department of Neuroscience and Sense Organs (R.G.V., M.T.), University of Bari; Multiple Sclerosis Centre (F.P., S.C.), University Polyclinic Hospital G. Rodolico, Catania; and Department of Neurological Sciences (C.P., V.B.), La Sapienza University, Rome, Italy.
Abstract
OBJECTIVE: The aim of the study was to perform a third cognitive assessment in our pediatric-onset multiple sclerosis (MS) patient cohort and determine predictors of the individual cognitive outcome. METHODS: After 4.7 ± 0.7 years from baseline evaluation, 48 of 63 patients in the original cohort were reassessed on an extensive neuropsychological battery and compared with 46 healthy controls. Two alternate versions of the tests were used at different assessment points. Cognitive impairment was defined as the failure of ≥3 tests; individual change in the cognitive impairment index was measured. RESULTS: At year 5, 38% of the subjects with MS fulfilled our criterion for impairment. Between years 2 and 5, regarding individual cognitive impairment index change, 66.7% of the patients improved. However, comparing baseline and 5-year testing (when the same versions of the tests were used), cognitive impairment index deterioration was observed in 56% of the patients, improvement in 25%, and stability in 18.8%. A deteriorating performance was related to male sex, younger age and age at MS onset, and lower education. None of these variables, however, was retained in the multivariate analysis. CONCLUSIONS: Cognitive outcome in pediatric-onset MS can be heterogeneous. Progression of cognitive problems in a few subjects and potential for compensation and improvement in others call for systematic cognitive screening in this population and development of effective treatment strategies.
OBJECTIVE: The aim of the study was to perform a third cognitive assessment in our pediatric-onset multiple sclerosis (MS) patient cohort and determine predictors of the individual cognitive outcome. METHODS: After 4.7 ± 0.7 years from baseline evaluation, 48 of 63 patients in the original cohort were reassessed on an extensive neuropsychological battery and compared with 46 healthy controls. Two alternate versions of the tests were used at different assessment points. Cognitive impairment was defined as the failure of ≥3 tests; individual change in the cognitive impairment index was measured. RESULTS: At year 5, 38% of the subjects with MS fulfilled our criterion for impairment. Between years 2 and 5, regarding individual cognitive impairment index change, 66.7% of the patients improved. However, comparing baseline and 5-year testing (when the same versions of the tests were used), cognitive impairment index deterioration was observed in 56% of the patients, improvement in 25%, and stability in 18.8%. A deteriorating performance was related to male sex, younger age and age at MS onset, and lower education. None of these variables, however, was retained in the multivariate analysis. CONCLUSIONS: Cognitive outcome in pediatric-onset MS can be heterogeneous. Progression of cognitive problems in a few subjects and potential for compensation and improvement in others call for systematic cognitive screening in this population and development of effective treatment strategies.