Саратовский научно-медицинский журнал (Jun 2016)
Cognitive impairment in multiple sclerosis
Abstract
Aim: to identify the degree of cognitive impairment (CN) and to optimize the treatment of patients with multiple sclerosis (MS). Material and methods. A total of 695 patients (278 men and 417 women) were ranged from 18 to 63 years. The mean age was 30.2±0.7 years: women (417) 28.5±0.5 years, while for men (278) 31.8±0.7 years. Relaps-ing-remitting type (RT) of MS was established in 520 patients (74.8%), secondary progressive type (VPT MS) in 132 patients (18.9%) and primary progressive type (PPT MS) in 10 patients (1.5%). Clinically isolated syndrome (CIS) was detected in 33 patients (4.8%). The diagnosis of MS 662 patients according to the criteria McDonald etal. (2005). Score of neurologic deficit was carried out on an extended scale of disability (Expanded Disability Status Scale — EDSS). CN were evaluated by conventional tests. To estimate the orientation in time, assessment of short-term and long-term memory, attention and concentration, as well as executive functions, memory, language, evaluation of optical-spatial activities, conceptual thinking, the account used by the Montreal Cognitive Assessment Scale (MoCA). For the screening of dementia with a primary lesion of the frontal lobes and subcortical cerebral structures used battery frontal test to assess frontal dysfunction. Results. The ratio of male (265) and female (397) was 1:1.5. The severity of the condition patients EDSS scale ranged from 1.5 to 8.0 points, and the average score was 3.5±1.2. In the group of patients with RT RS average score EDSS was more than a half (2.5±1.1), than in the group of patients with MS VAC (5.5±1.2) and POS PC (6.5±1.2). In the study of history, it was found that the development of the RS (662 patients) was preceded by the following conditions: a viral infection in 277 patients (41.84%); fatigue in 147 patients (22.21%); transferred psycho-emotional load from 218 (32.93%); after pregnancy and childbirth in 20 patients (3.02%). Conclusion. Among the patients with MS often met type remitting course of the disease. CN were diagnosed in 82.93% of patients. Some patients KN come to the fore in the onset of the disease, with minimal neurologic deficit, which significantly complicates the treatment and impairs the subsequent social adaptation of this group of patients. In the patients with a VPT MS KH level was statistically significantly lower than in patients with RT RS.
