Clinically isolated lesions of the type seen in multiple sclerosis: a cognitive, psychiatric, and MRI follow up study.

Abstract

There is a dearth of longitudinal studies on psychometric and psychiatric change in multiple sclerosis (MS) particularly on the evolution of these abnormalities early in the disease process. A 41 year follow up study documenting magnetic resonance imaging (MRI), psychometric, and psychiatric abnormalities was undertaken in a group of 48 patients with clinically isolated lesions-for example, optic neuritis-which are frequently the harbinger of MS. At follow up about half the subjects had developed clinically definite MS, with memory deficits becoming apparent. Deficits in attention documented at initial assessment were present but unchanged in those subjects who still had a clinically isolated lesion status. However, after MS was categorised into a relapsing-remitting or chronic progressive course, patients with a chronic progressive course were found to have significantly deteriorated with regard to auditory attention tasks. T1 relaxation times in apparently normal white matter correlated with certain indices of cognitive impairment. In developing a model to explain the pathogenesis of intellectual and emotional change in MS, the interaction of organic, psychological, and social factors needs to be emphasised. (7 Neurol Neurosurg Psychiatry 1992;55:869-876 tions were controlled for,'6 the preliminary evidence after a 1 to 2 year follow up period showed little cognitive deterioration. The only available longer follow up study also suggested that cognitive deterioration had occurred in less than a quarter of patients with multiple sclerosis four years after initial assessment and that there was considerable individual variation. 7An analogous position exists with respect to psychiatric disturbance in MS. The high prevalence of affective symptomatology is now well established.'8 Though there is firm evidence linking the presence of euphoria to cerebral involvement'9 it is unclear to what extent depressive features can be similarly explained.20 The developent and evolution of early psychiatric symptoms and the interplay of organic and social factors in their pathogenesis have yet to be studied.The study over time of patients with clinically isolated lesions (CIL-namely, optic neuritis and the brain stem and spinal cord syndromes-which are frequently the harbinger of MS,2' provides an unique opportunity to monitor cognitive and psychiatric changes early in the disease. Cognitive abnormalities are already discernible in some of these studies at presentation,22 23 and a follow up of such cases would allow the early natural history to be observed. In addition, the initial paucity of psychiatric symptomatology in subjects with CIL24 offers the opportunity to unravel the various aetiological factors that contribute to greater psychiatric morbidity in those who subsequently develop MS.In an earlier study, we reported that patients with CIL had significantly greater deficits in auditory and visual attention when compared with a physically disabled control group without brain involvement, matched for age, sex, and pr...

Selective Decline in Information Processing in Subgroups of Multiple Sclerosis: An 8-Year Longitudinal Study

“…It seems to be clear from our results that initial impairment in information-processing tests is an especially strong predictor of long-term cognitive decline. The striking initial impairment and continuous decline in information-processing speed is consistent with a number of studies which have found reduced cognitive speed in MS patients [8, 9, 14,38,39,40]. Jennekens-Schinkel et al [38] reported in a cross-sectional study that MS patients had significantly longer visual reaction time, but not longer auditory reaction time than healthy controls.…”

Functional magnetic resonance imaging correlates of cognitive performance in patients with a clinically isolated syndrome suggestive of multiple sclerosis at presentation: an activation and connectivity study

“…However, relatively little is known about the prevalence of cognitive impairment at the onset of the disease in CIS patients. Recent studies in this clinical population have described the presence of cognitive deficits ranging from mild to moderate, depending on the criteria used to define such an impairment [3,4,5,6].…”

Multipl Sklerozlu Hastalarda Depresyon ve Kognitif Fonksiyon Bozukluğu Sıklığının Belirlenmesi

“…Peyser et al claimed in their 1980 study that there is an association between cognitive involvement and duration of disease and cognitive impairment is one of the late stage symptoms of the disease (27). However, in later studies, cognitive involvement was shown to occur in very early stages of the disease (28,29). Amato et al showed in MS patients they had been monitoring for 10 years that cognitive impairment rate was around 56%, and the impairment was affected by factors including form of disease, late age, and physical disability (29).…”