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J Neurol. 2018 Dec 4. doi: 10.1007/s00415-018-9142-y. [Epub ahead of print]

Can we predict cognitive decline after initial diagnosis of multiple sclerosis? Results from the German National early MS cohort (KKNMS).

Author information

1
Department of Neurology, University Hospital Münster, Westfälische-Wilhelms-University Münster, Münster, Germany. a.johnen@uni-muenster.de.
2
Department of Statistics, Faculty of Psychology, Westfälische-Wilhelms-University, Münster, Germany.
3
Department of Neurology, University Hospital Münster, Westfälische-Wilhelms-University Münster, Münster, Germany.
4
Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany.
5
Department of Neuropsychology and Behavioral Neurology, University of Basel, Basel, Switzerland.
6
Institute of Medical Biometry and Statistics, University of Lübeck, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany.
7
Central Information Office (CIO), Philipps-University Marburg, Marburg, Germany.
8
Department of Neurology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.
9
Munich Cluster for Systems Neurology (SyNergy), Munich, Germany.
10
Department of Neurology and Focus Program Translational Neuroscience (FTN), Rhine Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.
11
NeuroCure Clinical Research Center and Experimental and Clinical Research Center, Charité, University Medicine Berlin and Max Delbrueck Center for Molecular Medicine, Berlin, Germany.
12
Department of Neurology, Philipps-University Marburg, Marburg, Germany.
13
Department of Neurology, University of Leipzig, Leipzig, Germany.
14
Institute of Clinical Neuroimmunology, Ludwig Maximilian University of Munich, Munich, Germany.
15
Department of Neurology, University of Ulm, Ulm, Germany.
16
Clinic of Neurology Dietenbronn, Schwendi, Germany.
17
Department of Neurology, Hannover Medical School, Hannover, Germany.
18
Neurology, Max-Planck-Institute of Psychiatry, Munich, Germany.
19
Neurological Clinic, Sana Kliniken des Landkreises Cham, Cham, Germany.
20
Department of Neurology, Klinikum Augsburg, Augsburg, Germany.
21
Department of Neurology, University of Heidelberg, Heidelberg, Germany.
22
Institut für Neuroimmunologie und Multiple Sklerose, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany.
23
Department of Neurology, Neuroimmunological Section, University of Rostock, Rostock, Germany.
24
Department of Neurology, Inselspital Bern, Bern University Hospital and University of Bern, Bern, Switzerland.

Abstract

BACKGROUND:

Cognitive impairment (CI) affects approximately one-third of the patients with early multiple sclerosis (MS) and clinically isolated syndrome (CIS). Little is known about factors predicting CI and progression after initial diagnosis.

METHODS:

Neuropsychological screening data from baseline and 1-year follow-up of a prospective multicenter cohort study (NationMS) involving 1123 patients with newly diagnosed MS or CIS were analyzed. Employing linear multilevel models, we investigated whether demographic, clinical and conventional MRI markers at baseline were predictive for CI and longitudinal cognitive changes.

RESULTS:

At baseline, 22% of patients had CI (impairment in ≥2 cognitive domains) with highest frequencies and severity in processing speed and executive functions. Demographics (fewer years of academic education, higher age, male sex), clinical (EDSS, depressive symptoms) but no conventional MRI characteristics were linked to baseline CI. At follow-up, only 14% of patients showed CI suggesting effects of retesting. Neither baseline characteristics nor initiation of treatment between baseline and follow-up was able to predict cognitive changes within the follow-up period of 1 year.

CONCLUSIONS:

Identification of risk factors for short-term cognitive change in newly diagnosed MS or CIS is insufficient using only demographic, clinical and conventional MRI data. Change-sensitive, re-test reliable cognitive tests and more sophisticated predictors need to be employed in future clinical trials and cohort studies of early-stage MS to improve prediction.

KEYWORDS:

Cognition; Cohort study; Longitudinal; Multiple sclerosis; Neuropsychology

PMID:
30515631
DOI:
10.1007/s00415-018-9142-y

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