RESUMO
OBJECTIVES: The Fatigue Symptoms and Impacts Questionnaire-Relapsing Multiple Sclerosis (FSIQ-RMS) is a new content-valid, concise, and reliable 20-item patient-reported outcome measure to evaluate the symptoms and impacts of fatigue in patients with relapsing forms of multiple sclerosis. Analyses were performed to derive meaningful change thresholds (MCTs) on patient-reported outcomes as measured by FSIQ-RMS and generate receiver operating characteristic (ROC) curves to determine fatigue severity cut points at baseline and change in severity at post-baseline and supplement the anchor-based MCT results. METHODS: Analyses were based on data from the OPTIMUM trial (NCT02425644). An anchor-based approach using uncollapsed changes on the Patient Global Impression of Severity at week 108 were used to determine the MCT for only the FSIQ-RMS Symptoms domain; distribution-based MCT estimations were conducted using baseline FSIQ-RMS Impacts scores. ROC curves with calculation of area under the curve were used to identify the best cut point. RESULTS: Based on the evidence provided by the anchor-based analyses using the Patient Global Impression of Severity as an anchor for the FSIQ-RMS Symptoms domain, meaningful score changes for improvement and deterioration were -6.3 and 6.3, respectively. Meaningful score changes for the FSIQ-RMS Physical, Cognitive/Emotional, and Coping Impacts domains using distribution-based methods were 10.8, 8.4, and 9.8, respectively. These results are supported by the ROC analyses. CONCLUSIONS: Thresholds to support interpretation of the FSIQ-RMS, such as MCTs, can be used to determine and categorize patients who have experienced a meaningful change in their MS-related fatigue (eg, responder analyses) in future clinical research studies.
Assuntos
Fadiga , Esclerose Múltipla Recidivante-Remitente , Medidas de Resultados Relatados pelo Paciente , Curva ROC , Índice de Gravidade de Doença , Humanos , Fadiga/etiologia , Feminino , Esclerose Múltipla Recidivante-Remitente/fisiopatologia , Esclerose Múltipla Recidivante-Remitente/complicações , Esclerose Múltipla Recidivante-Remitente/psicologia , Masculino , Adulto , Inquéritos e Questionários , Pessoa de Meia-Idade , Qualidade de Vida , Reprodutibilidade dos TestesRESUMO
BACKGROUND: Cognitive impairment (CI) is a frequent symptom of multiple sclerosis (MS) and has a great impact on the patients' quality of life, so screening is essential. The brief international cognitive assessment for multiple sclerosis (BICAMS) was developed for this purpose. However, longitudinal data is lacking with the use of the battery. OBJECTIVE: This study is to assess the performance of patients after 5 and 7 years of the original BICAMS validation study and to identify any influencing factors. METHODS: BICAMS was used to measure cognitive function of 52 relapsing-remitting MS patients (RRMS) from the original validation study after 5 years (n = 43) and again, after 7 years (n = 42). Patients filled out the fatigue impact scale (FIS) and multiple sclerosis quality of life-54 (MSQoL-54) questionnaire, and we evaluated expanded disability status scale (EDSS). RESULTS: There was an improvement in the BVMT-R and the CVLT-II assessments at both the 5-year (p<0.001 and p=0.025) and the 7-year retest (p<0.001 and p=0.002). The prevalence of CI significantly decreased at the 5-year mark (p=0.021) but remained stable after that. There was no deterioration in MSQoL scores during the study. The basic cognitive performance is the most important influencing factor, but the duration of the disease, the EDSS score, and the escalation of the therapy also affect the cognitive scores. CONCLUSION: This is the longest longitudinal study utilizing the BICAMS battery, reinforcing its feasibility as a clinical screening tool. It seems that cognitive performance may improve in the long term and early initiation of effective therapy may influence this outcome.
Assuntos
Testes Neuropsicológicos , Humanos , Masculino , Feminino , Adulto , Seguimentos , Pessoa de Meia-Idade , Disfunção Cognitiva/etiologia , Disfunção Cognitiva/diagnóstico , Qualidade de Vida , Estudos Longitudinais , Hungria , Esclerose Múltipla Recidivante-Remitente/psicologia , Esclerose Múltipla Recidivante-Remitente/complicações , Esclerose Múltipla/psicologia , Esclerose Múltipla/complicações , Estudos de Coortes , Cognição/fisiologia , Avaliação da Deficiência , Reprodutibilidade dos TestesRESUMO
BACKGROUND: Emotions expressed on the face play a key role in social cognition and communication by providing inner emotional experiences. This study aimed to evaluate facial emotion identification and discrimination and empathy abilities in patients with MS and whether it is related to cognitive dysfunction. METHODS: One hundred twenty patients with relapsing-remitting MS and age- and sex-matched 120 healthy controls were enrolled in the study. All the subjects were evaluated with the Facial Emotion Identification Test (FEIT), Facial Emotion Discrimination Test (FEIDT), and Empathy Quotient (EQ). We used the Beck Depression Inventory (BDI) for depression and detailed cognitive tests, including the Montreal Cognitive Assessment (MoCA), the Symbol Digit Modalities Test (SDMT), and the Paced Auditory Serial Addition Test (PASAT). The quality of life was assessed with Multiple Sclerosis Quality of Life-54 (MSQL-54). RESULTS: Patients with MS were 37.6 ± 9.5 years old, had a mean disease duration of 8.8 ± 6.6 (8-28) years, and a mean EDSS score of 1.6 ± 1.3 (0-4.5). We found significant differences in the identification of facial emotions, discrimination of facial emotions, and empathy in MS patients compared to controls (p < 0.05). Especially the recognition of feelings of sadness, fear, and shame was significantly lower in MS patients. The multivariate logistic regression analysis showed low SDMT and FEIDT scores which showed an independent association with MS. CONCLUSIONS: Our findings indicate that facial emotion recognition and identification deficits are remarkable among patients with MS and emotion recognition is impaired together with and independently of cognitive dysfunction in MS patients.
Assuntos
Disfunção Cognitiva , Emoções , Empatia , Reconhecimento Facial , Humanos , Masculino , Feminino , Adulto , Disfunção Cognitiva/etiologia , Disfunção Cognitiva/fisiopatologia , Disfunção Cognitiva/psicologia , Reconhecimento Facial/fisiologia , Emoções/fisiologia , Empatia/fisiologia , Expressão Facial , Pessoa de Meia-Idade , Testes Neuropsicológicos , Esclerose Múltipla Recidivante-Remitente/psicologia , Esclerose Múltipla Recidivante-Remitente/complicações , Esclerose Múltipla Recidivante-Remitente/fisiopatologia , Qualidade de Vida/psicologia , Reconhecimento Psicológico/fisiologiaRESUMO
INTRODUCTION: Cognitive impairment occurs from the earliest stages of multiple sclerosis (MS) and progresses over time. The introduction of disease modifying therapies (DMTs) has changed the prognosis for MS patients, offering a potential opportunity for improvement in the cognitive arena as well. MATERIAL AND METHODS: 41 patients with relapsing-remitting multiple sclerosis (MS) were recruited to the study. Thirty patients were available for final follow-up and were included in the analysis. Baseline (BL) brain MRI including volumetry and neuropsychological tests were performed. Blood samples were collected at BL and follow-up (FU) and were tested for: vascular endothelial growth factor (VEGF), soluble vascular cell adhesion molecule-1 (sVCAM1), soluble platelet-endothelial CAM-1 (sPECAM1), and soluble intercellular CAM-1 (sICAM-1). Patients were invited for a final neuropsychological follow-up after a median of 6 years. Disease activity (relapses, EDSS increase, new/active brain lesions on MRI) was analysed between BL and FU. RESULTS: The study group deteriorated in the Rey-Osterrieth Complex Figure (ROCF) test (p = 0.001), but improved significantly in three other tests, i.e. semantic fluency test (p = 0.013), California Verbal Learning Test (CVLT, p = 0.016), and Word Comprehension Test (WCT, p < 0.001). EDSS increase correlated negatively with semantic fluency and WCT scores (r = -0.579, p = 0.001 and r = -0.391, p = 0.033, respectively). Improvements in semantic fluency test and WCT correlated positively with baseline deep grey matter, grey matter, and cortical volumes (p < 0.05, r > 0). Higher EDSS on FU correlated significantly negatively with baseline left and right pallidum, right caudate, right putamen, right accumbens, and cortical volume (p < 0.05, r < 0). No significant relationship was found between the number of relapses and EDSS on FU or neuropsychological deteriorations. Improvements in WCT and CVLT correlated positively with baseline sPECAM1 and sVCAM1 results, respectively (r > 0, p < 0.05). Deterioration in ROCF test correlated significantly with higher levels of baseline VEGF and sVCAM1 (p < 0.05). CONCLUSIONS: Brain volume is an important predictor of future EDSS and cognitive functions outcome. MS patients have a potential for improving in neuropsychological tests over time. It remains to be established whether this is related to successful disease modification with immunotherapy. Baseline volumetric measures are stronger predictors of cognitive performance than relapse activity, which yet again highlights the importance of atrophy in MS prognosis.
Assuntos
Disfunção Cognitiva , Progressão da Doença , Imageamento por Ressonância Magnética , Esclerose Múltipla Recidivante-Remitente , Testes Neuropsicológicos , Humanos , Esclerose Múltipla Recidivante-Remitente/diagnóstico por imagem , Esclerose Múltipla Recidivante-Remitente/complicações , Esclerose Múltipla Recidivante-Remitente/fisiopatologia , Esclerose Múltipla Recidivante-Remitente/sangue , Esclerose Múltipla Recidivante-Remitente/psicologia , Feminino , Masculino , Adulto , Seguimentos , Disfunção Cognitiva/etiologia , Pessoa de Meia-Idade , Prognóstico , Fator A de Crescimento do Endotélio Vascular/sangueRESUMO
OBJECTIVE: To explore self-efficacy as a possible mediator in the relationship between adaptive coping and psychological well-being (PWB) in persons with relapsing-remitting multiple sclerosis (RRMS). METHOD: 174 persons with RRMS (91% Female) completed an online survey consisting of psychosocial questionnaires. The COPE Inventory was used to create an adaptive coping composite that accounts for the relative contributions of both active and avoidant coping. Self-efficacy was measured using the General Self-Efficacy Scale. The Ryff Psychological Well-Being Scales captured several domains of PWB: Positive relations with others, autonomy, purpose in life, environmental mastery, self-acceptance, and personal growth. The SPSS PROCESS macro was used to test whether self-efficacy mediated the association between adaptive coping and each PWB subscale, using 5,000 bootstrap samples to estimate confidence intervals. RESULTS: In each mediational model, adaptive coping was significantly associated with each PWB subscale and self-efficacy (all p's ≤ 0.001). Self-efficacy was also significantly associated with each PWB subscale (p ≤ 0.001). After controlling for self-efficacy, the associations between adaptive coping and positive relations with others (indirect effect = 0.021, 95% CI [0.011, 0.033]) and autonomy (indirect effect = 0.019, 95% CI [0.011, 0.028]) became non-significant. The separate associations between adaptive coping and purpose in life (p = .004), self-acceptance (p = .026), and personal growth (p < .001) remained significant, despite controlling for self-efficacy. CONCLUSIONS: Self-efficacy fully mediated the relationships between adaptive coping and positive relations with others and autonomy in our sample of persons with RRMS. Interventions aimed at increasing adaptive coping skills and self-efficacy may improve relations with others and autonomy among persons with MS.
Assuntos
Esclerose Múltipla Recidivante-Remitente , Esclerose Múltipla , Humanos , Feminino , Masculino , Autoeficácia , Esclerose Múltipla Recidivante-Remitente/psicologia , Bem-Estar Psicológico , Capacidades de Enfrentamento , Inquéritos e Questionários , Adaptação PsicológicaRESUMO
Sociocognitive impairment is well known in the relapsing-remitting form of multiple sclerosis (RR-MS). The purpose of the present study was to assess explicit and implicit humor abilities in this population. Based on clinical observation and contrary to the current cognitive model, we hypothesized that implicit performances (happy facial expressions) would be better than explicit ones (humor judgment assessed by explicit humor comprehension, subjective feeling of amusement as a conscious appreciation of funniness, and verbal justifications of funniness). Twenty-five RR-MS patients and twenty-five healthy participants completed the tasks. Their face was filmed during humor ratings. Patients' results suggest that 32% of them showed an impairment in explicit humor comprehension, with normal facial expressions. Both groups found great difficulty in justifying the cause of their amusement. All these results may suggest the existence of a supplementary implicit pathway in humor processing. The preservation of this implicit pathway may be advantageous for future remediation. Contrary to the current model, we found that the subjective feeling of amusement was preserved when comprehension was impaired. Further studies will be needed to clarify this component, and adjust the theoretical modeling.
Assuntos
Expressão Facial , Esclerose Múltipla Recidivante-Remitente , Senso de Humor e Humor como Assunto , Humanos , Esclerose Múltipla Recidivante-Remitente/psicologia , Esclerose Múltipla Recidivante-Remitente/fisiopatologia , Senso de Humor e Humor como Assunto/psicologia , Feminino , Masculino , Adulto , Compreensão/fisiologia , Pessoa de Meia-Idade , Julgamento/fisiologia , Testes NeuropsicológicosRESUMO
BACKGROUND: Multiple sclerosis (MS) causes sleep disturbances in up to 70 % of individuals. These problems are linked to fatigue, mood and cognitive performance, thereby affecting the quality of life in people with MS (PwMS). The frequent and debilitating side effects of sleep medications prompt the exploration of alternative therapies. Physical activity has shown benefits in improving sleep, reducing fatigue, and enhancing quality of life. Combined with a controlled exercise program tailored for PwMS, the study aims to analyze the impact of moderate physical exercise on sleep quality, cognitive function, quality of life, mood, and fatigue. METHODS: A single-center prospective cohort study was designed to assess the impact of a 12-week physical exercise program on patients with relapsing-remitting multiple sclerosis. Changes in sleep and activity parameters are evaluated using an actigraph and cognitive, quality of life, fatigue and mood changes are assessed through specific questionnaires before, during, and after the exercise program application. RESULTS: 23 patients completed the study (women = 84.6 %) Mean age was 37.2 years (SD 7.5). The mean EDSS score was 1.9, and 80.8 % were diagnosed within the last six years. Significant improvements were noted in sleep efficiency between baseline and final measurements (χ2 = 27.5; p.adj = 0.004), sleep latency (χ2 = 275; p.adj = 0.000), sleep duration (χ2 = 251; p.adj = 0.001) and in the number of awakenings (χ2 = 269.5; p.adj = 0.000), with a decreased in total time in bed from 8.5 h to 7.35 h post-intervention. Regarding activity variables, an increase in caloric expenditure and an increase in the time participants engaged in light activity were observed. We found significant improvements in fatigue, quality of life and mood. Concerning neuropsychological exploration results, improvements were observed in all studied parameters, with statistically significant improvement in Verbal SRT (χ2 = 43; p = 0.022). CONCLUSION: Our study showed a positive impact of a 12-week physical exercise program on sleep performance, cognition and mood in PwMS. The observed improvements underscore the potential of tailored exercise interventions in promoting a more comprehensive and holistic care paradigm for PwMS.
Assuntos
Exercício Físico , Fadiga , Esclerose Múltipla Recidivante-Remitente , Qualidade de Vida , Qualidade do Sono , Humanos , Esclerose Múltipla Recidivante-Remitente/complicações , Esclerose Múltipla Recidivante-Remitente/psicologia , Esclerose Múltipla Recidivante-Remitente/fisiopatologia , Feminino , Masculino , Adulto , Estudos Prospectivos , Exercício Físico/fisiologia , Terapia por Exercício/métodos , Actigrafia , Inquéritos e Questionários , Afeto/fisiologia , Cognição/fisiologia , Pessoa de Meia-IdadeRESUMO
BACKGROUND: The heterogeneous nature of cognitive impairment in people with multiple sclerosis (PwMS) hampers understanding of the underlying mechanisms and developing patient-tailored interventions. We aim to identify and classify cognitive profiles in PwMS, comparing these to cognitive status (preserved versus impaired). METHODS: We included 1213 PwMS (72% female, age 45.4 ± 10.7 years, 83% relapsing-remitting MS). Cognitive test scores were converted to Z-scores compared to healthy controls for the functions: attention, inhibition, information processing speed (IPS), verbal fluency and verbal/visuospatial memory. Concerning cognitive status, impaired cognition (CI) was defined as performing at Z ≤ - 1.5 SD on ≥ 2 functions. Cognitive profiles were constructed using latent profile analysis on all cognitive functions. Cognitive profiles or status was classified using gradient boosting decision trees, providing the importance of each feature (demographics, clinical, cognitive and psychological functioning) for the overall classification. RESULTS: Six profiles were identified, showing variations in overall performance and specific deficits (attention, inhibition, IPS, verbal fluency, verbal memory and visuospatial memory). Across the profiles, IPS was the most impaired function (%CI most preserved profile, Profile 1 = 22.4%; %CI most impaired profile, Profile 6 = 76.6%). Cognitive impairment varied from 11.8% in Profile 1 to 95.3% in Profile 6. Of all cognitive functions, visuospatial memory was most important in classifying profiles and IPS the least (area under the curve (AUC) = 0.910). For cognitive status, IPS was the most important classifier (AUC = 0.997). CONCLUSIONS: This study demonstrated that cognitive heterogeneity in MS reflects a continuum of cognitive severity, distinguishable by distinct cognitive profiles, primarily explained by variations in visuospatial memory functioning.
Assuntos
Disfunção Cognitiva , Esclerose Múltipla , Humanos , Feminino , Masculino , Adulto , Pessoa de Meia-Idade , Disfunção Cognitiva/etiologia , Disfunção Cognitiva/fisiopatologia , Disfunção Cognitiva/diagnóstico , Esclerose Múltipla/complicações , Esclerose Múltipla/fisiopatologia , Esclerose Múltipla/psicologia , Memória Espacial/fisiologia , Testes Neuropsicológicos , Esclerose Múltipla Recidivante-Remitente/fisiopatologia , Esclerose Múltipla Recidivante-Remitente/complicações , Esclerose Múltipla Recidivante-Remitente/psicologiaRESUMO
Studying the relationship between cerebral oxygen utilization and cognitive impairment is essential to understanding neuronal functional changes in the disease progression of multiple sclerosis (MS). This study explores the potential of using venous susceptibility in internal cerebral veins (ICVs) as an imaging biomarker for cognitive impairment in relapsing-remitting MS (RRMS) patients. Quantitative susceptibility mapping derived from fully flow-compensated MRI phase data was employed to directly measure venous blood oxygen saturation levels (SvO2) in the ICVs. Results revealed a significant reduction in the susceptibility of ICVs (212.4 ± 30.8 ppb vs 239.4 ± 25.9 ppb) and a significant increase of SvO2 (74.5 ± 1.89% vs 72.4 ± 2.23%) in patients with RRMS compared with age- and sex-matched healthy controls. Both the susceptibility of ICVs (r = 0.508, p = 0.031) and the SvO2 (r = -0.498, p = 0.036) exhibited a moderate correlation with cognitive decline in these patients assessed by the Paced Auditory Serial Addition Test, while no significant correlation was observed with clinical disability measured by the Expanded Disability Status Scale. The findings suggest that venous susceptibility in ICVs has the potential to serve as a specific indicator of oxygen metabolism and cognitive function in RRMS. .
Assuntos
Veias Cerebrais , Disfunção Cognitiva , Imageamento por Ressonância Magnética , Oxigênio , Humanos , Masculino , Feminino , Adulto , Disfunção Cognitiva/etiologia , Disfunção Cognitiva/metabolismo , Veias Cerebrais/diagnóstico por imagem , Veias Cerebrais/metabolismo , Oxigênio/metabolismo , Oxigênio/sangue , Imageamento por Ressonância Magnética/métodos , Pessoa de Meia-Idade , Esclerose Múltipla Recidivante-Remitente/metabolismo , Esclerose Múltipla Recidivante-Remitente/diagnóstico por imagem , Esclerose Múltipla Recidivante-Remitente/complicações , Esclerose Múltipla Recidivante-Remitente/psicologia , Circulação Cerebrovascular/fisiologia , Consumo de Oxigênio , Saturação de OxigênioRESUMO
ABSTRACT Psychiatric disorders frequently occur in patients with multiple sclerosis (MS); however, limited reports are available on these comorbidities. We aimed to investigate the relationships among MS, anxiety, depression, and suicidal ideation. Methods: One hundred and thirty two patients with relapsing-remitting MS were evaluated using the Expanded Disability Status Scale, Beck Depression Inventory-II (BDI-II), Beck Scale for Suicide Ideation (BSI), and Hospital Anxiety and Depression Scale. Results: A hierarchical regression analysis was performed to evaluate the variables. The regression equation significantly predicted the BSI score (R2 = 0.306; adjusted R2 = 0.273; F (9, 125) = 9.18; p < 0.0005), and the BDI-II score was the only variable that contributed significantly to this model (p < 0.0005). Conclusions: A high prevalence of depression and anxiety, and a higher rate of suicidal ideation were identified in MS patients compared to the general population. The presence of depressive symptoms appeared to have a direct influence on the risk of suicide.
RESUMO Transtornos psiquiátricos frequentemente ocorrem em pacientes com esclerose múltipla (EM). No entanto, os artigos sobre estas comorbidades são limitados. Pretendemos investigar as relações entre EM, ansiedade, depressão e ideação suicida. Métodos: Cento e trinta e dois pacientes com EM remitente-recorrente foram avaliados usando a Escala de Estado de Incapacidade Expandida, Inventário de Depressão de Beck-II (IDB-II), Escala de Beck para Ideação de Suicídio (BSI) e Escala de Ansiedade e Depressão. Resultados: Uma análise de regressão hierárquica foi realizada para avaliar as variáveis. A equação de regressão previu significativamente o escore BSI (R2 = 0,306; R2 ajustado = 0,273; F (9,125) = 9,18; p < 0,0005) e o escore no IDB-II foi a única variável que contribuiu significativamente para este modelo (p < 0,0005). Conclusões: Uma alta prevalência de depressão e ansiedade e uma maior taxa de ideação suicida foram identificadas em pacientes com EM em comparação com a população em geral. A presença de sintomas depressivos pareceu ter uma influência direta no risco de suicídio.
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Adulto Jovem , Ansiedade/etiologia , Depressão/etiologia , Ideação Suicida , Ansiedade/psicologia , Escalas de Graduação Psiquiátrica , Fatores Socioeconômicos , Fatores de Risco , Esclerose Múltipla Recidivante-Remitente/complicações , Esclerose Múltipla Recidivante-Remitente/psicologia , Depressão/psicologiaRESUMO
ABSTRACT The perception of multiple sclerosis (MS) severity and risk associated with therapies might influence shared decision making in different countries. We investigated the perception of MS severity and factors associated with risk acceptance in Brazil in 96 patients with relapsing-remitting MS using a standardized questionnaire and compared this with two European cohorts. Multiple sclerosis was perceived as a very severe disease and the risk of developing progressive multifocal leukoencephalopathy due to natalizumab was seen as moderate to high. Seventy-six percent considered a risk of 1:1,000, or higher, an impediment for natalizumab use. Older age was the only variable associated with higher risk acceptance and our patients showed a more conservative profile than German and Spanish patients. Our patients perceived MS severity and progressive multifocal leukoencephalopathy risk similarly to elsewhere, but their willingness to take risks was more conservative. This should be considered when discussing therapeutic options and it might have an impact on guideline adaptations.
RESUMO A percepção de gravidade da esclerose múltipla (EM) e riscos associado a terapias podem influenciar a escolha de tratamento em diferentes países. Investigamos a percepção da gravidade da EM e fatores associados à aceitação de risco em 96 pacientes com EM remitente-recorrentecom um questionário e comparamos com duas coortes europeias. A EM foi percebida como muito grave e o risco de desenvolver leucoencefalopatia multifocal progressiva devido ao natalizumabe, como moderado a alto, sendo que76% consideraram um risco de 1: 1.000 ou maior como impeditivo deseu uso. Idade mais avançada foi a única variável associada àaceitação de risco mais elevado e nossos pacientes revelaram um perfil mais conservador do que os pacientes alemães e espanhóis. Esses dados devem ser considerados ao discutir opções terapêuticas e pode ter impacto nas adaptações de diretrizes locais.
Assuntos
Humanos , Adulto , Percepção , Assunção de Riscos , Esclerose Múltipla Recidivante-Remitente/tratamento farmacológico , Natalizumab/uso terapêutico , Fatores Imunológicos/uso terapêutico , Personalidade , Índice de Gravidade de Doença , Brasil , Conhecimentos, Atitudes e Prática em Saúde , Inquéritos e Questionários , Fatores Etários , Leucoencefalopatia Multifocal Progressiva/induzido quimicamente , Medição de Risco , Esclerose Múltipla Recidivante-Remitente/psicologia , Escolaridade , Natalizumab/efeitos adversos , Fatores Imunológicos/efeitos adversosRESUMO
ABSTRACT Multiple sclerosis (MS) may present with a cognitive impairment as disabling as the physical disabilities. Therefore, routine cognitive evaluation is pivotal. Valid and reliable neuropsychological tests are essential in follow-up and to define future therapeutic interventions. Objectives To investigate the correlation between the disabilities of MS patients and their cognitive impairment assessed by the Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS). Methods Forty patients with definitive diagnoses of MS were selected. The correlation coefficient (r) between the Expanded Disability Status Scale (EDSS) and the neuropsychological tests of BICAMS were calculated. Results The correlation was clinically substantial and significant with r = 0.55 (p < 0.01) in the Symbol Digit Modalities Test (SDMT), 0.54 (p < 0.01) in the Brief Visuospacial Memory Test (BVMT) and 0.40 (p < 0.05) in the California Verbal Learning Test (CVLT). Conclusion BICAMS has easy and satisfactory application and evaluation for routine visits and presents a significant correlation with the EDSS. Its use may be indicated for screening and monitoring of cognitive impairment in patients with MS.
RESUMO A esclerose múltipla (EM) pode apresentar um déficit cognitivo (DC) tão devastador quanto suas debilidades físicas. Uma avaliação cognitiva rotineira é essencial e testes neuropsicológicos (TNs) validados e confiáveis são fundamentais no acompanhamento e definição de futuras intervenções terapêuticas. Objetivos Investigar a correlação entre o estado de incapacidade física de pacientes com EM e o comprometimento cognitivo, avaliado pelo Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS). Métodos Foram calculados coeficientes de correlação (r) entre a Expanded Disability Status Scale (EDSS) e resultados dos testes do BICAMS em quarenta pacientes com diagnóstico definitivo de EM. Resultados A correlação foi clinicamente substancial e significativa, com r = 0.55 (p < 0.01, no Symbol Digit Modalities Test (SDMT), 0.54 (p < 0.01) no Brief Visuospacial Memory Test (BVMT) e 0.40 (p < 0.05) no California Verbal Learning Test (CVLT). Conclusão O BICAMS é de fácil e satisfatória aplicação e avaliação em visitas de rotina e apresenta uma correlação significativa com a EDSS. Seu uso pode ser indicado como rotina no acompanhamento do (DC) em portadores de EM.
Assuntos
Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Adulto Jovem , Escalas de Graduação Psiquiátrica Breve/normas , Transtornos Cognitivos/psicologia , Esclerose Múltipla Recidivante-Remitente/psicologia , Avaliação da Deficiência , Brasil , Transtornos Cognitivos/diagnóstico , Esclerose Múltipla Recidivante-Remitente/diagnóstico , Escolaridade , Idioma , Testes Neuropsicológicos/normasRESUMO
Purpose Recent papers suggest that patients with multiple sclerosis (MS) are prone to alcohol misuse. This may be due to the combination of a lifelong and disabling disease with a psychiatric profile typical of MS. The objective of the present study was to assess these findings in a culturally different population of patients with MS.Method The present case-control transversal study assessed 168 patients with MS and 168 control subjects from Brazil.Results There were no evidence that patients with MS drank more alcohol or, smoked more than did controls. In fact, control subjects had a significantly higher alcohol consumption. The only trait associated to higher alcohol consumption was anxiety, both for patients and controls.Conclusion Unlike previous reports in the literature, patients with MS in our study did not drink or smoked more than a control population.
Propósito Artigos recentes sugerem que pacientes com esclerose múltipla (EM) tem tendência ao abuso de álcool. Isto poderia se dever à combinação de uma doença crônica e incapacitante e um perfil psiquiátrico típico da EM. O objetivo do presente estudo foi avaliar estes achados em uma população de pacientes com EM culturalmente diferente.Método O presente estudo caso-controle transversal avaliou 168 pacientes com EM e 168 controles, todos brasileiros.Resultados Não houve evidência que pacientes com EM usassem mais álcool ou tabaco do que os controles. Na verdade, os controles apresentavam um consumo significativamente maior de álcool. O único aspecto associado ao maior consumo de álcool foi a ansiedade, tanto para pacientes quanto para controles.Conclusão Ao contrário de outros dados da literatura, pacientes com EM neste nosso estudo não bebem ou fumam mais do que a população controle.
Assuntos
Adulto , Feminino , Humanos , Masculino , Consumo de Bebidas Alcoólicas/psicologia , Esclerose Múltipla Crônica Progressiva/psicologia , Esclerose Múltipla Recidivante-Remitente/psicologia , Uso de Tabaco/psicologia , Consumo de Bebidas Alcoólicas/epidemiologia , Ansiedade/psicologia , Brasil/epidemiologia , Características Culturais , Avaliação da Deficiência , Depressão/psicologia , Métodos Epidemiológicos , Estilo de Vida , Fatores Socioeconômicos , Uso de Tabaco/epidemiologiaRESUMO
Background: Immunomodulatory drugs (IMD), Interferon β1a, β1 b and glatiramer acetate are available in the Chilean public health system since June 2008 for patients with relapsing-remitting multiple sclerosis (RR-MS). Diagnostic confirmation and programmed follow up of these patients is carried out at a public national reference center. Aim: To describe the epidemiological and clinical features of 314 patients evaluated in this center between 2008 and 2012. Patients and Methods: Review of clinical records, to obtain information about demographic background, medical history, expanded disability status scale of Kurtzke (EDSS), multiple sclerosis functional composite (MSfic), intensity fatigue scale of Krupp, Raos Brief Repeatable Battery of Neuropsychological Tests (BNR-R) and anxious-depressive manifestations using Hamilton and Beck questionnaires. Results: The ages of patients ranged from 12 to 63 years and 67% were women. The initial symptoms were sensory disturbances in 20%, motor alterations in 18% and optical neuritis in 16%. In 9% of patients, the disease began with several manifestations. The EDSS was 4 or less in 73% of patients and cognitive impairment was observed in 34%. Treatment failure during the first and second years, occurred in 23 and 26% of patients, respectively. Male gender, age under 40 and brainstem malfunction at the onset of disease, were predictive of treatment failure during the second year. Conclusions: The features of these patients are very similar to those reported abroad.
Assuntos
Adolescente , Adulto , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Transtornos Cognitivos/etiologia , Depressão/etiologia , Esclerose Múltipla Recidivante-Remitente/complicações , Chile , Progressão da Doença , Fatores Imunológicos/uso terapêutico , Esclerose Múltipla Recidivante-Remitente/tratamento farmacológico , Esclerose Múltipla Recidivante-Remitente/psicologia , Testes Neuropsicológicos , Estudos Retrospectivos , Índice de Gravidade de DoençaRESUMO
The aim of the present research was to investigate cognitive pattern of patients with neuromyelitis optica (NMO) and to compare it with multiple sclerosis (MS) patients' performance. Methods: Fourteen NMO, 14 relapsing remitting multiple sclerosis (RRMS), and 14 healthy control patients participated in the investigation. Neuropsychological functions were evaluated with the Brief Repeatable Neuropsychological Battery for MS; Symbol Digit Modalities Test; Digit Span; and Semantic Fluency. Results: Fifty-seven percent of NMO patients and 42.85% of the MS ones had abnormal performance in at least two cognitive tests. The NMO Group showed abnormal performance in verbal fluency, verbal and visual memories, with greater attention deficits. NMO patients outperformed healthy control in the paced auditory serial addition test (PASAT). However, no difference was found between NMO and RRMS patients. Conclusions: The NMO Group showed more dysfunction in attention and verbal fluencies than in verbal and visual memories. When compared with the MS patients, a similar dysfunction pattern was found.
O objetivo da presente pesquisa foi investigar o padrão cognitivo de pacientes com neuromielite óptica (NMO) e compará-lo com o desempenho de pacientes com esclerose múltipla (EM). Métodos: Quatorze pacientes com NMO, 14 com esclerose múltipla recorrente remitente (EMRR) e 14 participantes do Controle saudáveis participaram da presente investigação. As funções neuropsicológicas foram avaliadas com a Bateria Breve de Testes Neuropsicológicos de Rao, Teste Símbolo Digit e a Fluência Semântica. Resultados: Cinquenta e sete por cento dos pacientes com NMO e 42,85% daqueles com EM apresentaram desempenho anormal em pelo menos dois testes cognitivos. O Grupo NMO apresentarou desempenho anormal na fluência verbal e nas memórias visual e verbal, ...
Assuntos
Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Cognição , Esclerose Múltipla Recidivante-Remitente/psicologia , Neuromielite Óptica/psicologia , Análise de Variância , Atenção/fisiologia , Estudos de Casos e Controles , Depressão/fisiopatologia , Memória/fisiologia , Testes Neuropsicológicos , Distúrbios da Fala/fisiopatologia , Fala/fisiologiaRESUMO
Background: The detection of cognitive changes (CC) and psychiatric disorders in relapsing remitting multiple sclerosis (MS-RR) contributes to patient clinical monitoring. Aim: To assess the frequency and characteristics of CC and psychiatric disorders in Chilean patients with MS-RR, before starting immunomodulatory treatment. Patients and Methods: Retrospective review of data that was obtained following a standard assessment protocol. It consisted in the application of the Expanded Disability Status Scale of Kurtzke (EDSS), Multiple Sclerosis Functional Composite (MSFC), fatigue intensity scale of Krupp, brief repeatable battery of neuropsychological Rao (BRN-R) and Hamilton's depression and anxiety questionnaires. Results: We evaluated 129 patients aged between 12 and 60 years of age (69% women). Ninetyfour percent of patients had eight or more years of schooling. The average EDSS score was 2.83. CC were detected in 62% of participants, in at least one subtest of the BRN-R. The main changes were verbal memory and speed in the processing information. The frequency of cognitive impairment (CI), defined as at least two BRN-R subtests altered, was 36%. The figures decreased to 17% when significant major depression or associated fatigue were excluded. Depressive symptoms were observed in 58% and anxiety in 76.7%. Conclusions: The results are consistent with those described in the literature. The type of instruments used in the investigation of CC and the definition of CI in MS should be standardized.
Assuntos
Adolescente , Adulto , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Transtornos Cognitivos/epidemiologia , Fatores Imunológicos/uso terapêutico , Esclerose Múltipla Recidivante-Remitente/psicologia , Testes Neuropsicológicos , Ansiedade/epidemiologia , Estudos de Casos e Controles , Chile/epidemiologia , Transtornos Cognitivos/diagnóstico , Depressão/epidemiologia , Esclerose Múltipla Recidivante-Remitente/tratamento farmacológico , Estudos RetrospectivosRESUMO
Episodic memory is impaired in multiple sclerosis (MS) patients, possibly because of deficits in working memory (WM) functioning. If so, WM alterations should necessarily be found in patients with episodic memory deficits, but this has not yet been demonstrated. In this study we aimed at determining whether episodic memory deficits in relapsing-remitting MS are found in conjunction with impaired WM. We evaluated 32 MS patients and 32 matched healthy controls. Nineteen of the 32 patients had episodic memory impairment, and as a group only these individuals showed deficits in WM capacity, which may lead to difficulty in encoding, and/or retrieving information from episodic memory.
Pacientes com esclerose múltipla (EM) apresentam prejuízo de memória episódica possivelmente em decorrência de um déficit no funcionamento da memória operacional (MO). Se assim fosse, alterações de MO seriam necessariamente encontradas em pacientes com déficit de memória episódica, mas isto ainda não foi demonstrado. Neste estudo tivemos como objetivo determinar se déficits de memória episódica em pacientes com EM recorrente-remitente são encontrados em associação com prejuízo de MO. Avaliamos 32 pacientes com EM pareados com 32 voluntários saudáveis. Dezenove dos 32 pacientes apresentaram prejuízo de memória episódica, e como grupo, somente estes indivíduos apresentaram déficit na capacidade de MO, o que deve resultar na dificuldade de codificar, e /ou recuperar informações da memória episódica.
Assuntos
Adulto , Feminino , Humanos , Masculino , Transtornos da Memória/etiologia , Memória de Curto Prazo/fisiologia , Esclerose Múltipla Recidivante-Remitente/psicologia , Análise de Variância , Estudos de Casos e Controles , Esclerose Múltipla Recidivante-Remitente/fisiopatologia , Testes NeuropsicológicosRESUMO
Introducción. La ansiedad y la depresión son trastornos psiquiátricos vinculados a la Esclerosis Múltiple (EM). Sin embargo, la ansiedad no ha sido prácticamente estudiada. Objetivos. Examinar la asociación de ambos trastornos con el deterioro neuropsicológico y su contribución a la autopercepción de deterioro cognitivo. Sujetos y métodos. Se estudiaron 33 pacientes con EM Remitente-Recidivante y niveles de discapacidad mínima-leve. Instrumentos: Hospital Anxiety and Depression Scale (HADS); Multiple Sclerosis Neuropsychological Screening Questionnaire; Brief Repeatable Battery of Neuropsychological Tests. El examen neuropsicológico se aplicó a 67 controles. Resultados. La ansiedad y la depresión no están relacionadas con el deterioro neuropsicológico. La gravedad de la sintomatología ansiosa está especialmente asociada a una menor duración de la EM. Ansiedad y depresión están altamente correlacionadas y ambas predicen la percepción subjetiva de deterioro. La capacidad predictiva del HADS-total sobre la percepción subjetiva de deterioro fue similar a la obtenida por las subescalas de ansiedad y depresión por separado. Conclusiones. La autopercepción de deterioro cognitivo en la EMRR con discapacidad mínima podría estar relacionada con un factor de malestar psicológico general compartido por la ansiedad y la depresión. Nuestros resultados resaltan la importancia de detectar y tratar la sintomatología ansiosa en fases iniciales de la EM.
Introduction. Anxiety and depression are common psychiatric symptoms among multiple sclerosis (MS) patients. However, anxiety is relatively under-studied. Aims. To examine the associations of anxiety and depression with cognitive functioning and to evaluate their contribution to subjective cognitive impairment, after accounting for neuropsychological impairment. Subjects and methods. 33 patients with relapsing-remitting MS and minimal levels of disability were evaluated. Assessment measures: Hospital Anxiety and Depression Scale (HADS); Multiple Sclerosis Neuropsychological Screening Questionnaire-self report (MSNQ-S); Brief Repeatable Battery of Neuropsychological Tests (BRB). We also assessed a group of 67 controls with the BRB. Results. Neuropsychological impairment was not significantly correlated to anxiety or depression. Increased severity of anxiety symptoms was remarkably related with low disease duration. Hierarchical regression analysis showed that anxiety and depression predicted MSNQ-S. Anxiety and depression were highly correlated. HADS total score predicted a similar amount of variance to subjective cognitive impairment, compared with independent anxiety and depression measures. Conclusions. In RR MS patients with minimal levels of neurological disability, cognitive complaints could be related with a component of general psychological distress common to anxiety and depression. Despite this overlap, our study highlights the importance of assessing and treating anxiety symptoms in the first years since onset.
Assuntos
Humanos , Masculino , Feminino , Adulto , Ansiedade/psicologia , Depressão/psicologia , Esclerose Múltipla Recidivante-Remitente/fisiopatologia , Esclerose Múltipla Recidivante-Remitente/psicologia , Testes Neuropsicológicos , Escalas de Graduação Psiquiátrica , Autoimagem , Inquéritos e QuestionáriosRESUMO
Neuropsychological studies have consistently reported cognitive dysfunctions associated with multiple sclerosis. One-hundred fifteen subjects with relapsing-remitting multiple sclerosis (RRMS) were compared with forty health controls according to a neuropsychological test battery, which included digit span, trail making, cancellation and stroop test. Both groups were matched for age, sex and educational level. Subjects with RRMS had a worse performance the speed of response. Subjects with RRMS spent more time to complete the test in either sections A (p=0.001) or B (p=0.001), although there was no significant difference in terms of number of errors. The total time required to finish the Stroop test was higher for subjects with RRMS (p<0.001), being the time difference between groups significant at trial 4 (p<0.001). Attention impairment in subjects with RRMS is related to slowed central processing, which may be affected in all stages, including impairment of automatic and controlled processing of information and in the motor program.
Estudos neuropsicológicos demonstram alterações cognitivas associadas à esclerose múltipla. Foram avaliados, através de uma bateria neuropsicológica, 115 pacientes com esclerose múltipla remitente-recorrente (EMRR), comparada a um grupo controle com 40 indivíduos saudáveis. A bateria inclui os testes, span de dígitos, trilhas, teste de cancelamento e stroop. Os grupos foram pareados por sexo, idade e escolaridade.Os pacientes com EMRR tiveram um pior desempenho na rapidez de resposta (p=0,001), os pacientes gastaram um tempo maior para realizar o trilhas A (p=0,001) e o trilhas B (p=0,0001), não havendo diferenças significativas no número de erros. O tempo total no teste stroop foi maior dos sujeitos EMRR (p<0,001), apresentando diferença significativa na tentativa 4 (p<0,001). Os pacientes EMRR apresentaram lentificação do processamento central, podendo estar prejudicado em todos os estágios da doença, incluindo prejuízo do processamento de informações automático e controlado.