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Mult Scler. 2019 Nov 28:1352458519891984. doi: 10.1177/1352458519891984. [Epub ahead of print]

Cognitive processing speed in pediatric-onset multiple sclerosis: Baseline characteristics of impairment and prediction of decline.

Author information

1
Pediatric Multiple Sclerosis Center, Department of Neurology, NYU Langone Medical Center, New York, NY, USA.
2
Pediatrics, The University of Utah, Salt Lake City, UT, USA.
3
Pediatric Multiple Sclerosis Center, Loma Linda University, Loma Linda, CA, USA.
4
Partners Multiple Sclerosis Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
5
Boston Children's Hospital, Boston, MA, USA.
6
Pediatric MS Center, Neurology, University of California, San Diego, San Diego, CA, USA.
7
Center for Pediatric-Onset Demyelinating Disease, Children's of Alabama, University of Alabama at Birmingham, Birmingham, AL, USA.
8
The Blue Bird Circle Clinic for Multiple Sclerosis, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA.
9
Pediatric MS and other Demyelinating Disease Center, Washington University in St Louis, St. Louis, MO, USA.
10
Mellen Center for Multiple Sclerosis, Cleveland Clinic, Cleveland, OH, USA.
11
Pediatric Multiple Sclerosis Center, Mayo Clinic, Rochester, MN, USA.
12
Department of Neurology, Children's Hospital Colorado, University of Colorado, Aurora, CO, USA.
13
Regional Pediatric MS Center, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA.
14
The Pediatric MS Center, Jacobs Neurological Institute, State University of New York at Buffalo, Buffalo, NY, USA.

Abstract

BACKGROUND:

Cognitive impairment occurs in approximately one-third of pediatric-onset multiple sclerosis (POMS) patients. The Symbol Digit Modalities Test (SDMT), a widely used cognitive screen in adults, has yet to be incorporated early into the standard care of POMS.

OBJECTIVE:

To screen for cognitive impairment early in the course of POMS and analyze predictive factors.

METHODS:

Of the 955 POMS or clinically isolated syndrome (CIS) patients prospectively assessed from March 2014 to July 2018, 500 POMS and 116 CIS patients met inclusion criteria (disease onset before the age of 18, one or more SDMTs, and 8 years or older at the time of testing). Those with relapse were analyzed separately from those who were relapse-free.

RESULTS:

At initial assessment, the mean (interquartile range (IQR)) age at symptom onset was 13.5 years (12.0, 15.9) and the mean (±SD) disease duration was 3.0 ± 2.9 years. Impaired processing speed occurred in 23.4% of POMS and in 16.4% of CIS. On serial testing (n = 383, mean follow-up: 1.8 years), 14.1% had clinically meaningful decline predicted by older age of multiple sclerosis (MS) onset and male gender. Disease relapse or steroid use led to transient worsening on the SDMT.

CONCLUSION:

Early in the disease, some POMS and CIS patients are at risk for cognitive impairment and subsequent decline.

KEYWORDS:

Pediatric-onset multiple sclerosis; cognition; cognitive processing speed; multiple sclerosis; pediatric MS; symbol digit modalities test

PMID:
31775571
DOI:
10.1177/1352458519891984

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