Afectación de las funciones cognitivas en la esclerosis múltiple secundaria progresiva / Compromise of the cognitive functions in progressive secondary multiple sclerosis

Definir el patrón de afectación cognitiva en un grupo homogéneo de pacientes afectados de esclerosis múltiplesecundaria progresiva (EMSP). Pacientes y métodos. Se incluyó a 42 pacientes mayores de edad con el diagnóstico de EMSP y un grado similar de discapacidad, un tiempo de evolución superior a 24 meses y en tratamiento con interferón beta-1b un mínimo de tres meses. Se les administró una batería de 10 test neuropsicológicos, seleccionados para este estudio y repartidos en dos sesiones de una hora. Además, se evaluó el estado emocional con el inventario de depresión de Beck y la escala de ansiedadde Hamilton. Definimos ‘deterioro cognitivo’ como la alteración de dos o más test. Resultados. El 73,8% eran mujeres; edad media: 45 años (rango: 25-62); Expanded Disability Status Scale media: 5,4 (rango: 3,0-7,5); tiempo medio de evolución: 34,5 meses (rango: 24-80), y tiempo medio de tratamiento: 13,5 meses (rango: 3-38 ). El 78,5% padecía deterioro cognitivo. Lasfunciones más alteradas fueron: capacidad atencional, percepción visuoespacial, fluidez verbal, memoria lógica a largo y corto plazo y razonamiento abstracto. La presencia de deterioro cognitivo se relacionó con el tiempo de evolución de la enfermedad (r = 0,31; p < 0,05) pero no con la edad, el grado de discapacidad o con la duración del tratamiento. Conclusión. El deterioro cognitivo es frecuente en la EMSP; la velocidad para la adquisición y procesamiento de nueva información y las funciones ejecutivas fueron las áreas afectadas con mayor frecuencia y gravedad. La alteración de la información visuoespacial fue un hallazgodiferencial de nuestra serie que podría contribuir al diagnóstico clínico de la progresión

To define the patterns of cognitive impairment in a homogeneous group of secondary progressive multiplesclerosis (SPMS) patients. Patients and methods. Forty-two SPMS patients were included with a similar degree of disability; all had been treated with interferon beta-1b for a minimum of 3 months. They voluntarily complimented a battery of 10 neuropsychological tests selected for this study, distributed in two sessions of one hour. In addition, the emotional state was evaluatedwith the Beck Depression Inventory and the Hamilton Anxiety Scale. We considered cognitive impairment as more than two tests altered, according with previously reported studies. Results. 73.8% of patients were women; mean age was 45 years (range: 25-62); mean EDSS was 5.4 (range: 3.0-7.5); mean evolution time was 34.5 months (range: 24-80); mean treatment durationwas 13.5 months (range: 3-38). Cognitive impairment was present in 78.5% of patients. The most frequently impaired functions were: attentional capacity, visuospatial perception, verbal fluency, short-term and long-term logic memory and abstractreasoning. The presence of cognitive impairment was related to the time of evolution of the disease (r = 0.31; p < 0.05) but not with the age, the degree of disability or the treatment duration. Conclusion. Cognitive impairment in the SPMS patients is afrequent finding, being the alteration in the speed for the acquisition and processing of new information, and the abstract reasoning the most frequent and severe altered functions. The also frequent impairment of visuospatial information was a differential finding in our study that could contribute to diagnosis of clinical progression

[Compromise of the cognitive functions in progressive secondary multiple sclerosis]. / Afectación de las funciones cognitivas en la esclerosis múltiple secundaria progresiva.

AIM: To define the patterns of cognitive impairment in a homogeneous group of secondary progressive multiple sclerosis (SPMS) patients. PATIENTS AND METHODS: Forty-two SPMS patients were included with a similar degree of disability; all had been treated with interferon beta-1b for a minimum of 3 months. They voluntarily complimented a battery of 10 neuropsychological tests selected for this study, distributed in two sessions of one hour. In addition, the emotional state was evaluated with the Beck Depression Inventory and the Hamilton Anxiety Scale. We considered cognitive impairment as more than two tests altered, according with previously reported studies. RESULTS: 73.8% of patients were women; mean age was 45 years (range: 25-62); mean EDSS was 5.4 (range: 3.0-7.5); mean evolution time was 34.5 months (range: 24-80); mean treatment duration was 13.5 months (range: 3-38). Cognitive impairment was present in 78.5% of patients. The most frequently impaired functions were: attentional capacity, visuospatial perception, verbal fluency, short-term and long-term logic memory and abstract reasoning. The presence of cognitive impairment was related to the time of evolution of the disease (r = 0.31; p < 0.05) but not with the age, the degree of disability or the treatment duration. CONCLUSION: Cognitive impairment in the SPMS patients is a frequent finding, being the alteration in the speed for the acquisition and processing of new information, and the abstract reasoning the most frequent and severe altered functions. The also frequent impairment of visuospatial information was a differential finding in our study that could contribute to diagnosis of clinical progression.

[Descriptive study of behavioural disorders in mild cognitive impairment]. / Estudio descriptivo de los trastornos conductuales en el deterioro cognitivo leve.

INTRODUCTION: Mild cognitive impairment (MCI) is defined as an abnormality in cognitive function not provoking a noticeable disability in activities of daily living in the affected person. In a group of patients with MCI, we propose to observe and to quantify the presence of behavioral disorders, using the neuropsychiatric inventory (NPI). PATIENTS AND METHODS: NPI is a known instrument in evaluation of this kind of disorders in patients with dementia, and it is a semi structured interview with a relevant informer or relative to the patient. NPI was applied to a series of 100 cases (61 women and 39 men) of MCI, diagnosed as usual in our settings. Mean age was 74.3 +/- 10 years, and mean MEC (Spanish modified version of MMSE) 25.57 +/- 4.2 (over a maximum of 35 points). RESULTS: Most prevalent disorder was depression, in 36 % of cases, and other frequent findings were irritability (35%), anxiety (24%) and apathy (19%). In some cases, agitation (4%), abnormal motor behavior (3%) and delusions (1%) were detected. Hallucination, disinhibition and euphoria or elation were not detected in this series. CONCLUSION: Data show a certain similarity with occidental culture environment, globally considered. The presence of behavioral and psychological disorders in patients with MCI could be a marker for later development of dementia. NPI can be a usable tool when detection and evaluation of these symptoms is required.

Estudio descriptivo de los trastornos conductuales en el deterioro cognitivo leve / Descriptive study of behavioural disorders in mild cognitive impairment

Introducción. El deterioro cognitivo leve (DCL) se define como una alteración de las funciones cognitivas que no motiva una disfunción notable en las actividades corrientes del afectado. En un grupo de pacientes con DCL nos proponemos observar y cuantificar la presencia de trastornos de la conducta, mediante el inventario neuropsiquiátrico (NPI). Pacientes y métodos. El NPI es un instrumento corriente en la evaluación de este tipo de trastornos en pacientes con demencia, consistente en una entrevista semiestructurada a un informador fiable del entorno del paciente. Se aplicó este instrumento a una serie de 100 pacientes (61 mujeres y 39 varones) diagnosticados de DCL en nuestra unidad. La edad media de la muestra fue de 74,3 ñ 10 años, y la puntuación media del MEC, 25,57 ñ 4,2. Resultados. En un 62 por ciento de los casos existía un trastorno conductual o psicológico. El trastorno más prevalente fue la depresión, en un 36 por ciento de los casos, seguido de irritabilidad (35 por ciento), ansiedad (24 por ciento) y apatía (19 por ciento). Presentes en algún caso, estuvieron la agitación (4 por ciento), la actividad motora aberrante (3 por ciento) y el delirio (sólo un caso). No se encontraron alucinaciones, desinhibición o euforia en este grupo de pacientes. Conclusión. Los datos encontrados coinciden en líneas generales con los descritos previamente para ámbitos de la cultura occidental en general. La existencia de trastornos conductuales y psicológicos en pacientes con DCL podría ser un factor predictivo del desarrollo ulterior de demencia.El NPI puede ser una herramienta útil en la detección y evaluación de estos trastornos (AU)

Introduction. Mild cognitive impairment (MCI) is defined as an abnormality in cognitive function not provoking a noticeable disability in activities of daily living in the affected person. In a group of patients with MCI, we propose to observe and to quantify the presence of behavioral disorders, using the neuropsychiatric inventory (NPI). Patients and methods. NPI is a known instrument in evaluation of this kind of disorders in patients with dementia, and it is a semi structured interview with a relevant informer or relative to the patient. NPI was applied to a series of 100 cases (61 women and 39 men) of MCI, diagnosed as usual in our settings. Mean age was 74.3 ± 10 years, and mean MEC (Spanish modified version of MMSE) 25.57 ± 4.2 (over a maximum of 35 points). Results. Most prevalent disorder was depression, in 36 % of cases, and other frequent findings were irritability (35%), anxiety (24%) and apathy (19%). In some cases, agitation (4%), abnormal motor behavior (3%) and delusions (1%) were detected. Hallucination, desinhibition and euphoria or elation were not detected in this series. Conclusion. Data show a certain similarity with occidental culture environment, globally considered. The presence of behavioral and psychological disorders in patients with MCI could be a marker for later development of dementia. NPI can be a usable tool when detection and evaluation of these symptoms is required (AU)