Lauren B Strober1, Stephen M Rao2, Jar-Chi Lee2, Elizabeth Fischer2, Richard Rudick2. 1. Kessler Foundation, 300 Executive Drive, Suite 70, West Orange, NJ 07052, USA; Rutgers, the State University of New Jersey, New Jersey Medical School, Department of Physical Medicine and Rehabilitation, USA. Electronic address: lstrober@kesslerfoundation.org. 2. Cleveland Clinic Foundation, Cleveland, OH, USA.
Abstract
BACKGROUND: Cognitive impairment occurs in 40-65% of patients with multiple sclerosis (MS). Less is known about the rate and pattern of cognitive decline over the course of the illness. OBJECTIVE: To examine long-term changes in cognition among patients enrolled in the phase III clinical trial of intramuscular interferon beta-1a (IM IFNβ-1a). METHODS: Twenty-two patients underwent a longitudinal investigation comparing neuropsychological test performance at study entry and 18-year follow-up. RESULTS: Over the 18 year interval, significant declines were observed on measures of information processing speed, simple and complex auditory attention, episodic learning and memory, and visual construction. Nine patients (41%) were found to be cognitively impaired at study entry. At follow-up 13 patients (59%) were cognitively impaired. While both the impaired and unimpaired patients at baseline experienced declines on these measures, only one measure, the Symbol Digit Modalities Test (SDMT), demonstrated a group (cognitively impaired versus intact at baseline)×time interaction. This interaction was characterized by a steeper decline in the unimpaired than the impaired group at baseline. CONCLUSIONS: Over an 18 year period, our results suggest that cognitive impairment in MS progresses, with declines being most evident on measures known to be most sensitive to MS-related cognitive difficulties both cross-sectionally and longitudinally.
BACKGROUND:Cognitive impairment occurs in 40-65% of patients with multiple sclerosis (MS). Less is known about the rate and pattern of cognitive decline over the course of the illness. OBJECTIVE: To examine long-term changes in cognition among patients enrolled in the phase III clinical trial of intramuscular interferon beta-1a (IM IFNβ-1a). METHODS: Twenty-two patients underwent a longitudinal investigation comparing neuropsychological test performance at study entry and 18-year follow-up. RESULTS: Over the 18 year interval, significant declines were observed on measures of information processing speed, simple and complex auditory attention, episodic learning and memory, and visual construction. Nine patients (41%) were found to be cognitively impaired at study entry. At follow-up 13 patients (59%) were cognitively impaired. While both the impaired and unimpaired patients at baseline experienced declines on these measures, only one measure, the Symbol Digit Modalities Test (SDMT), demonstrated a group (cognitively impaired versus intact at baseline)×time interaction. This interaction was characterized by a steeper decline in the unimpaired than the impaired group at baseline. CONCLUSIONS: Over an 18 year period, our results suggest that cognitive impairment in MS progresses, with declines being most evident on measures known to be most sensitive to MS-related cognitive difficulties both cross-sectionally and longitudinally.
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