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Cognitive dysfunction in patients with relapsing-remitting multiple sclerosis

Department of Neurology, University of Rome ‘Tor Vergata’ and IRCCS ‘S. Lucia’ Foundation, Rome, 00179 Italy, u.nocentini{at}hsantalucia.it

P Pasqualetti

Centre of Medical Statistics, AfaR-Fatebenefratelli Association for Research, Fatebenefratelli Hospital-Isola Tiberina, Rome, 00186 Italy and IRCCS ‘S. Giovanni di Dio’- Fatebenefratelli, Brescia, 25100 Italy

S Bonavita

Second Division of Neurology, Second University of Naples, Naples, 80100 Italy

M Buccafusca

Department of Neurosciences, Psychiatry and Anesthesiology, University of Messina, Messina, 98100 Italy

M F De Caro

Department of Neurological and Psychiatric Sciences, University of Bari, Bari, 70100 Italy

D Farina

Neurology Unit, Department of Oncology and Neuroscience, University of Chieti ‘G. D’Annunzio’, Chieti, 66100 Italy

P Girlanda

Department of Neurosciences, Psychiatry and Anesthesiology, University of Messina, Messina, 98100 Italy

F Le Pira

Department of Neurological Sciences, University of Catania, Catania, 95100 Italy

A Lugaresi

Neurology Unit, Department of Oncology and Neuroscience, University of Chieti ‘G. D’Annunzio’, Chieti, 66100 Italy

A Quattrone

Institute of Neurology, University ‘Magna Grecia’, Catanzaro, 88100 Italy and Institute of Neurological Sciences, National Research Council, Piano di Lago Mangone, Cosenza, 87100 Italy

A Reggio

Department of Neurological Sciences, University of Catania, Catania, 95100 Italy

G Salemi

Department of Neurology, Otolaryngology, Ophthalmology and Psychiatry, University of Palermo, Palermo, 90100 Italy

G Savettieri

Department of Neurology, Otolaryngology, Ophthalmology and Psychiatry, University of Palermo, Palermo, 90100 Italy

G Tedeschi

Second Division of Neurology, Second University of Naples, Naples, 80100 Italy

M Trojano

Department of Neurological and Psychiatric Sciences, University of Bari, Bari, 70100 Italy

P Valentino

Institute of Neurology, University ‘Magna Grecia’, Catanzaro, 88100 Italy and Institute of Neurological Sciences, National Research Council, Piano di Lago Mangone, Cosenza, 87100 Italy

C Caltagirone

Department of Neurology, University of Rome ‘Tor Vergata’ and IRCCS ‘S. Lucia’ Foundation, Rome, 00179 Italy

Cognitive dysfunction is considered one of the clinical markers of multiple sclerosis (MS). However, in the literature there are inconsistent reports on the prevalence of cognitive dysfunction, and separate data for the relapsing-remitting (RR) type of the disease are not always presented. In this study, we submitted 461 RRMS patients to a battery of neuropsychological tests to investigate their impairment in various cognitive domains. As a consequence of the exclusion criteria, the sample is not fully representative of the entire population of RRMS patients. In this selected sample, when only the eight scores of a core battery (Mental Deterioration Battery) were considered (with respective cutoffs), it emerged that 31% of the patients were affected by some degree of cognitive deficit. In particular, 15% had mild, 11.2% moderate and 4.8% had severe impairment. Information processing speed was the most frequently impaired area, followed by memory. When two other tests (SDMT and MCST) were added and cognitive domains were considered, it emerged that 39.3% of the patients were impaired in two or more domains. When four subgroups were obtained by means of cluster analysis and then compared, it emerged that information processing speed and memory deficits differentiated the still cognitively unimpaired from the mildly impaired MS patients.

Significant associations were found between cognitive and clinical characteristics. However, due to the large sample size, clinically irrelevant relationships may also have emerged. Even with the limitations imposed by the sample selection and the possible underestimation of the prevalence and severity of cognitive dysfunction, these results seem to provide further evidence that information processing speed deficit may be an early and important marker of cognitive impairment in MS patients.

Key Words: cognition impairment • information processing speed • multiple sclerosis • relapsingremitting

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