Effects of acute relapses on neuropsychological status in multiple sclerosis patients

Abstract

Little is known about neuropsychological status changes in multiple sclerosis (MS) patients experiencing a relapse. The Symbol Digit Modalities Test (SDMT) and MS Neuropsychological Screening Questionnaire (MSNQ) are brief measures of cognitive performance and self-reported status, respectively. We retrospectively identified relapses in subjects participating in the 48-week open-label, safety-extension study of natalizumab (STRATA) to determine if changes in cognitive ability occurred during acute relapses. SDMT and MSNQ were administered prior to infusions. We analyzed SDMT and MSNQ scores pre- and post-relapse in 53 MS patients with relapses (cases) and 115 MS patients without relapses (controls) matched on age, gender, baseline SDMT and time from study initiation. ANOVA and GLM were used to compare cases versus controls overall, and stratified by EDSS cerebral functional status (cFS) scores. SDMT change pre- to post-relapse in cases was significantly lower than difference between similar time points in controls (p = 0.003). When comparing visit 2 (two visits pre-relapse) to visit 1 (first visit post-relapse), MSNQ change was significantly different between cases and controls (p = 0.012). For cFS ≤ 1, the change in SDMT was significantly different between cases and controls but not for cFS ≥ 2. These results confirm the involvement of cognitive function during some MS relapses suggesting the SDMT or MSNQ can be used to identify transitory neuropsychological status changes and cognitive relapses.

Isolated cognitive relapses in multiple sclerosis

“…Based on published literature,4 we defined as a meaningful change in cognition a transient reduction of SDMT score of at least four points at t 1 compared with t 0 and t 2 . This cut-off was previously used to explore transient cognitive changes in MS in a seminal study on the association of cognitive impairment during sensorimotor relapses,4 and it has been linked with an ecologically valid negative outcome 13. Patients presenting with a transient SDMT reduction of at least four points between t 0 and t 1 were thus enrolled in the ICR group, while all other patients were enrolled in the no-ICR group.…”

“…Indeed, while transient cognitive impairments have been described in association with other symptomatic neurological deficits during MS disease activity,4 the construct of isolated cognitive relapse (ICR), that is, a transient reduction in cognitive functioning not associated with other subjective or objective neurological symptomatology, albeit described in different single case reports,5 6 remains to date poorly characterised.…”

Effect on Cognition of Estroprogestins Combined with Interferon Beta in Multiple Sclerosis: Analysis of Secondary Outcomes from a Randomised Controlled Trial

“…Indeed, inflammation has a deleterious effect on cognitive function, as demonstrated by the worsening of neuropsychological performance during relapses. [24][25] As previously suggested, high doses of estrogens may enhance the anti-inflammatory effects of IFN beta and thus exert their beneficial effects on cognition. 15 Estrogens are also known as potent and efficacious mediators of synaptic transmission, promoting neural plasticity and neurogenesis and sustaining the energetic demand by increasing glucose transport, aerobic glycolysis and mitochondrial function.…”

Progress in multiple sclerosis research in the last year

“…Many articles addressed the issue of cognition in MS. Morrow et al [13] studied changes in cognitive abilities before, during and after an acute relapse, showing a worsening of performance measure of cognitive processing speed and attention during a relapse, that resolved over time. Cognitive dysfunction actually affects many patients with MS [14].…”