Top

Journal of Neurology

Published in:

01-08-2006 | ORIGINAL COMMUNICATION

Cognition in the early stage of multiple sclerosis

Authors: Doreen Schulz, Bruno Kopp, Annett Kunkel, Jürgen H. Faiss

Published in: Journal of Neurology | Issue 8/2006

Abstract

Objective

Cognitive dysfunctions may contribute to limitation of everyday activities of patients with multiple sclerosis (MS). Recent studies have demonstrated that 45 to 65% of MS-patients are cognitively impaired. The profile of MS-related cognitive dysfunctions varies greatly. It includes memory and learning deficits, attention deficits, executive dysfunctions and visuo-spatial deficits. Most studies of cognition in MS examined patients in later stages, often including MS-patients with marked physical disabilities. Studies of cognitive dysfunctions in the early stage of the disease are rare. This study specifically aimed at evaluating and characterizing cognitive impairments in the early stage of MS, and determining specific patterns of cognitive dysfunction.

Methods

21 MS patients, experiencing their first neurological symptoms not more than two years previously, and 22 healthy controls were compared. A comprehensive neuropsychological test-battery was used to evaluate MS-related cognition. The battery consisted of memory and learning tests, executive functioning tests and a visuo spatial functioning test. A computerized attention test-battery was also included, which assess accuracy and speed of test responses. In addition depression and intellectual capabilities were assessed.

Results

Compared with healthy controls, MS-patients in the early stage of the disease performed significantly lower on each neuropsychological assessment, except for verbal short-term memory. In particular, MS-patients showed a lengthened reaction time for simple and focused attention (19–38%), impaired non-verbal memory function (RVDLT recognition: 33%) and a planning deficit (24%). Associations between information processing speed and disease course and the employment situation were additionally found. However, patients did not have clinically relevant depression rates on the ADS-L and visuo spatial abilities remain preserved.

Conclusion

Our findings revealed discrete cognitive dysfunction in MS-patients within the early stage of the disease.

Achiron A, Barak Y (2003) Cognitive impairment in probable multiple sclerosis J Neurol Neurosurg Psychiatry 74(4):443–6 PMID: 12640060 [PubMed-index for MEDLINE]PubMedCrossRef

Amato MP, Bartolozzi ML, Zipoli V, Portaccio E, Mortilla M, Guidi L, Siracusa G, Sorbi S, Federico A, De Stefano N (2004) Neocortical volume decrease in relapsing-remittig MS patients with mild cognitive impairment Neurology 63(1):89–93 PMID: 15249616 [PubMed-index for MEDLINE]PubMed

Amato MP, Ponziani G, Pracucci G, Bracco L, Siracusa G, Amaducci L (1995) Cognitive impairment in early–onset multiple sclerosis. Pattern, predictors, and impact on everyday life in a 4–year follow–up Arch Neurol 52(2):168–72 PMID: 7848126 [PubMed-index for MEDLINE]PubMed

Amato MP, Ponziani G, Siracausa G, Sorbi S (2001) Cognitive dysfunction in early–onset multiple sclerosis: a reappraisal after 10 years Arch Neurol 58(10):1602–6 PMID: 11594918 [PubMed-index for MEDLINE]PubMedCrossRef

Arnett PA, Rao SM, Grafman J, Bernardin L, Luchetta T, Binder JR, Lobeck L (1997) Exekutive functions in multiple sclerosis: an analysis of temporal ordering, semantic encoding, and planning abilities Neuropsychology 11(4):535–44 PMID: 9345697 [PubMed-index for MEDLINE]PubMedCrossRef

Arnett PA, Rao SM, Bernardin L, Grafman J, Yetkin FZ, Lobeck L (1994) Relationship between frontal lobe lesions and Wisconsin Card Sorting Test performance in patients with multiple sclerosis Neurology 44(3 Pt 1):420–5 PMID: 8145908 [PubMed-index for MEDLINE]PubMed

Barak Y, Achiron A (2002) Effect of interferon beta–1b on cognitive functions in multiple sclerosis Eur Neurol 47(1):11–4 PMID: 11803186PubMedCrossRef

Beatty WW, Goodkin DE, Beatty PA, Monson N (1989) Frontal lobe dysfunction and memory impairment in patients with chronic progressive multiple sclerosis. Brain Cogn 11(1):73–86 PMID: 2789818 [PubMed-index for MEDLINE]PubMedCrossRef

Beatty WW, Goodkin DE, Hertsgaard D, Monson N (1990) Clinical and demographic predictors of cognitive performance in multiple sclerosis. Do diagnostic type, disease duration, and disability matter? Arch Neurol 47(3):305–8 PMID: 2138014 [PubMed-index for MEDLINE]PubMed

10.

Beatty WW, Paul RH, Blanco CR, Hames KA, Wilbanks SL (1995) Attention in multiple sclerosis: correlates of impairment on the WAIS–R Digit Span Test Appl Neuropsychol 2(3–4):139–44 PMID: 16318517 [PubMed-in process]PubMedCrossRef

11.

Behmenburg C (1993) Aufmerksamkeitsstörungen bei Patienten mit Multipler Sklerose Medizinische Fakultät, Düsseldorf

12.

Bertrando P, Maffei C, Ghezzi A (1983) A study of neuropsychological alterations in multiple sclerosis Acta Psychiatr Belg 83(1):13–21 PMID: 6613610 [PubMed-index for MEDLINE]PubMed

13.

Birnboim S, Miller A (2004) Cognitive strategies application of multiple sclerosis patients Mult Scler 10(1):67–73 PMID: 14760955 [PubMed-index for MEDLINE]PubMedCrossRef

14.

Bühl A, Zöfel P, SPSS 11 (2002) Einführung in die moderne Datenanalyse unter Windows. Pearson Studium, München

15.

Calabrese P, Haupts M, Babinsky R, Markowitsch HJ, Gehlen W (1993) Alltagsgedächtnisleistungen bei Multipler Sklerose Zeitsch Neuropsychol 4:4–16

16.

Calabrese P, Haupts M, Gehlen W (2000) Verlaufsabhängige Gedächtnisstörungen und Läsionsmuster bei Multipler Sklerose. Neurol Rehabil 6:184–188

17.

Christodoulou C, Krupp LB, Liang Z, Huang W, Melville P, Roque C, Scherl WF, Morgan T, McAllister WS, Li L, Tudorica LA, Li X, Roche P, Peyster R (2003) Cognitive performance and MR markers of cerebral injury in cognitively impaired MS patients. Neurology 60(11):1793–8 PMID: 12796533 [PubMed-index for MEDLINE]PubMed

18.

Demaree HA, DeLuca J, Gaudino EA, Diamond BJ (1999) Speed of information processing as a key deficit in multiple sclerosis: implications for rehabilitationJ Neurol Neurosurg Psychiatry 67(5):661–3 PMID: 10519876 [PubMed-index for MEDLINE]PubMed

19.

De Sonneville LM, Boringa JB, Reuling IE, Lazeron RH, Ader HJ, Polman CH (2002) Information processing characteristics in subtypes of multiple sclerosis. Neuropsychologia 40(11):1751–65 PMID: 12062887 [PubMed-index for MEDLINE]PubMedCrossRef

20.

D’Esposito M, et al. (1996) Working memory impairments in multiple sclerosis: evidence from a dual-task paradigm Neuropsychology 10:51–6CrossRef

21.

De Smedt L, Swerts M, Geutjens J, Medaer R (1984) Intellectual impairment in multiple sclerosis In: Gonsette RF, Delmotte P (eds) Immunological and clinical aspects of multiple sclerosis. MTP Press Limited, Lancaster England, pp. 342–5

22.

De Stefano N, Matthews PM, Filippi M, Agosta F, De Luca M, Bartolozzi ML, Guidi L, Ghezzi A, Montanari E, Cifelli A, Federico A, Smith SM (2003) Evidence of early cortical atrophy in MS: relevance to white matter changes and disability. Neurology 60(7):1157–62 PMID: 12682324 [PubMed-index for MEDLINE]PubMed

23.

Filippi M, Tortorella C, Rovaris M, Bozzali M, Possa F, Sormani MP, Iannucci G, Comi G (2000) Changes in the normal appearing brain tissue and cognitive impairment in multiple sclerosis J Neurol Neurosurg Psychiatry 68(2):157–61 PMID: 10644780 [PubMed-index for MEDLINE]PubMedCrossRef

24.

Fischer JS, Priore RL, Jacobs LD, Cookfair DL, Rudick RA, Herndon RM, Richert JR Salazar AM, Goodkin DE, Granger CV, Simon JH, Grafman JH, Lezak MD, O´Reilly Hovey KM, Perkins KK, Barilla–Clark D, Schacter M, Shucard DW, Davidson AL, Wende KE, Bourdette DN, Kooijmans–Coutinho MF (2000) Neuropsychological effects of interferon beta–1a in relapsing multiple sclerosis. Multiple Sclerosis Collaborative Research Group Ann Neurol 48(6):885–92 PMID: 11117545 [PubMed-index for MEDLINE]PubMedCrossRef

25.

Foong J, Rozewicz L, Thompson AJ, Miller DH, Ron MA (1997) Frontal lobe disturbance and cognitive functioning in patients with multiple sclerosis In: Ketelaer P, Prosiegel M, Battaglia M, Messmer M (eds) A problemoriented approach to multiple sclerosis. Acco, Leven, pp 88–94

26.

Foong J, Rozewicz L, Quahebeur G, Thompson AJ, Miller DH, Ron MA (2000) A comparison of neuropsychological deficits in primary and secondary progressive multiple sclerosis J Neurol 247(2):97–101 PMID: 10751110 [PubMed-index for MEDLINE]PubMedCrossRef

27.

Grigsby J, Kaye K, Robbins LJ (1995) Behavioral disturbance and impairment of executive functions among the elderly Arch of Gerontol Geriatr 21(2):167–77 PMID: 15374212 [PubMed-index for MEDLINE]CrossRef

28.

Haupts M, Calabrese P, Babinsky R, Gehlen W, Markowitsch HJ (1994) The structure of mnestic problems in multiple sclerosis: everyday memory performance and neuroradiologic findings Schweiz Arch Neurol Psychiatr 145(1):14–9 German PMID: 7526452 [PubMed-index for MEDLINE]PubMed

29.

Hautzinger M, Bailer M (1993) Allgemeine Depressions Skala (ADS) Beltz, Weinheim

30.

Heaton RK, Nelson LM, Thompson DS, Burks JS, Franklin GM (1985) Neuropsychological findings in relapsing–remitting and chronic–progressive multiple sclerosis J Consult Clin Psychol 53(1):103–10 PMID: 3980815 [PubMed-index for MEDLINE]PubMedCrossRef

31.

Helmstaedter C, Lendt M, Lux S (2001) Verbaler Lern–und Merkfähigkeitstest Beltz, Göttingen

32.

Huber SJ, Bornstein RA, Rammohan KW, Christy JA, Chakeres DW, McGhee RB (1992) Magnetic resonance imaging correlates of neuropsychological impairments in multiple sclerosis J Neuropsychiatry Clin Neurosci 4(2):152–8 PMID: 1627976 [PubMed-index for MEDLINE]PubMed

33.

Huijbregts SC, Kalkers NF, de Sonneville LM, de Groot V, Reuling IE, Polmam CH (2004) Differences in cognitive impairement of relapsing remitting, secondary, and primary progressive MS Neurology 63(2):335–9 PMID: 15277630 [PubMed-index for MEDLINE]PubMed

34.

Janculjak D, Mubrin Z, Brinar V, Spilich G (2002) Changes of attention and memory in a group of patients with multiple sclerosis Clin Neurol Neurosurg 104(3):228–30 PMID: 12127659 [PubMed-index for MEDLINE]PubMedCrossRef

35.

Kuhlmann T, Lingfeld G, Bitsch A, Schuchardt J, Bruck W (2002) Acute axonal damage in multiple sclerosis is most extensive in early disease stages and decreases over timeBrain 125(Pt 10):2202–12 PMID: 12244078 [PubMed-index for MEDLINE]PubMedCrossRef

36.

Kurtzke JF (1983) Rating neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS) Neurology 33(11):1444–52 PMID: 6685237 [PubMed-index for MEDLINE]PubMed

37.

Kurtzke JF, Beebe GW, Nagler B, Auth TL, Kurland LT, Nefzger MD (1972) Studies on the natural history of multiple sclerosis: Clinical and laboratory findings at first diagnosis Acta Neurol Scand 48(1):19–46 PMID: 5019831 [PubMed-index for MEDLINE]PubMed

38.

Lyon–Caen O, Jouvent R, Hauser S, Chaunu MP, Benoit N, Widlocher D, Lhermitte F (1986) Cognitive function in recent–onset demyelinating diseases Arch Neurol 43(11):1138–41 PMID: 3778246 [PubMed-index for MEDLINE]PubMed

39.

Mahler ME (1992) Behavioral manifestations associated with multiple sclerosis. Psychiatr Clin North Am 15(2):427–38 PMID: 1603734 [PubMed-index for MEDLINE]PubMed

40.

McDonald WI, Compston A, Edan G, Goodkin D, Hartung HP, Lublin FD, McFarland HF, Paty DW, Polman CH, Reingold SC, Sandberg-Wollheim M, Sibley W, Thompson A, van den Noort S, Weinshenker BY, Wolinsky JS (2001) Recommended diagnostic criteria for multiple sclerosis guidelines from the International Panel on the diagnosis of multiple sclerosis Ann Neurol 50(11):121–7 PMID: 11456302 [PubMed-index for MEDLINE]PubMedCrossRef

41.

McIntosh-Michaelis SA, Roberts MH, Wilkinson SM, Diamond ID, McLellan DL, Martin JP, Spackman AJ (1991) The prevalence of cognitive impairment in a community survey of multiple sclerosis Br J Clin Psychol 30(Pt 4):333–48 PMID: 1777755 [PubMed-index for MEDLINE]PubMed

42.

Metzler P (2000) Standardisierte Link´sche Probe zur Beurteilung exekutiver Funktionen (SLP) Swets Test Services, Frankfurt am Main

43.

Möller A, Wiedemann G, Rohde U, Backmund H, Sonntag A (1994) Correlates of cognitive impairment and depressive mood disorder in multiple sclerosis Acta Psychiatr Scand 89(2):117–21 PMID: 8178661 [PubMed-index for MEDLINE]PubMed

44.

Nelson HE (1976) A Modified Card Sorting Test sensitive to frontal lobe defects Cortex 12(4):313–24 PMID: 1009768 [PubMed-index for MEDLINE]PubMed

45.

Oldfield RC (1971) The assessment and analysis of handedness: the Edinburgh Inventory Neuropsychologia 9(1):97–113 PMID: 5146491 [PubMed-index for MEDLINE]PubMedCrossRef

46.

Parsons OA, Stewart KD, Arenberg D (1957) Impairment of abstracting ability in multiple sclerosis J Nerv Ment Dis 125(2):221–5 PMID: 13481718 [PubMed-index for MEDLINE]PubMedCrossRef

47.

Pelosi L, Geesken JM, Holly M, Hayward M, Blumhardt LD (1997) Working memory impairment in early multiple sclerosis. Evidence from an event-related potential study of patients with clinically isolated myelopathy Brain 120(Pt 11):2039–58 PMID: 9397020 [PubMed-index for MEDLINE]PubMedCrossRef

48.

Peyser JM, Rao SM, LaRocca NG, Kaplan E (1990) Guidelines for neuropsychological research in multiple sclerosis Arch Neurol 47(1):94–7 PMID: 2403789 [PubMed-index for MEDLINE]PubMed

49.

Poser CM, Paty DW, Scheinberg L, McDonald WI, Davis FA, Ebers GC, Johnson KP, Sibley WA, Silberberg DH, Tourtellotte WW (1983) New diagnostic criteria for multiple sclerosis: guidelines for research protocols. Ann Neurol 13(3):227–31 PMID: 6847134 [PubMed-index for MEDLINE]PubMedCrossRef

50.

Pozzilli C, Bastianello S, Padovani A, Passafimue D, Millefiorius E, Bozzao L, Fieschi C (1991) Anterior corpus callosum atrophy and verbal fluency in multiple sclerosis. Cortex 27(3):441–5 PMID: 1743039 [PubMed-index for MEDLINE]PubMed

51.

Prosiegel M, Michael C (1993) Neuropsychology and multiple sclerosis: diagnostic and rehabilitative approaches J Neurol Sci 115(Suppl.):S51–4 PMID: 8340793 [PubMed-index for MEDLINE]PubMedCrossRef

52.

Rao SM (1990) Neurobehavioral aspects of multiple sclerosis Oxford University Press, New York Oxford

53.

Rao SM (1995) Neuropsychology of multiple sclerosis Curr Opin Neurol 8(3):216–20 PMID: 7551121 [PubMed-index for MEDLINE]PubMed

54.

Rao SM (1997) Neuropsychological aspects of multiple sclerosis In: Raine CS, McFarland HF, Tourtellotte WW (eds) Multiple Sclerosis: Clinical and Pathogenetic Basis. Chapman & Hall, London, pp 357–362

55.

Rao SM, Leo GJ, Haughton VM, St. Aubin–Faubert P, Bernardin L (1989) Correlation of magnetic resonance imaging with neuropsychological testing in multiple sclerosis Neurology 39(2 Pt 1):161–6 PMID: 2915783 [PubMed-index for MEDLINE]PubMed

56.

Rao SM, Leo GJ, St. Aubin-Faubert P (1989) On the nature of memory disturbance in multiple sclerosis J Clin Exp Neuropsychol 11(5):699–712 PMID: 2808659 [PubMed-index for MEDLINE]PubMed

57.

Rao SM, Leo GJ, Bernardin L, Unverzagt F (1991) Cognitive dysfunction in multiple sclerosis. I. Frequency, pattern and prediction Neurology 41(5):685–91 PMID: 2027484 [PubMed-index for MEDLINE]PubMed

58.

Rao SM, Leo GJ, Ellington L, Nauertz T, Bernardin L, Unverzagt F (1991) Cognitive dysfunction in multiple sclerosis. II. Impact on employment and social functioning Neurology 41(5):692–6 PMID: 1823781 [PubMed-index for MEDLINE]PubMed

59.

Rey A. (1991) L´Examen Clinique en Psychologie (1941/1964) In: Spreen O, Strauss E (eds) A Compendium of neuropsychological tests: administration, norms and commentary. Oxford University Press, New York, pp 158–176

60.

Ron MA, Feinstein A (1990) Korsakoff´s psychosis in the presence of multiple sclerosis: an unusual cognitive state J Neurol Neurosurg Psychiatry 53(7):625 PMID: 2391534 [PubMed-index for MEDLINE]PubMedCrossRef

61.

Schmidt K–H, Metzler P (1992) Wortschatztest Beltz Test, Weinheim

62.

Simon JH, Jacobs LD, Campion MK, Rudick RA, Cookfair DL, Herndon RM, Richert JR, Salazar AM, Fischer JS, Goodkin DE, Simonian N, Lajaunie M, Miller DE, Wende K, Martens-Davidson A, Kinkel RP, Munschauer FE 3rd, Brownscheidle CM. (1999) A longitudinal study of brain atrophy in relapsing multiple sclerosis. The Multiple Sclerosis Collaborative Research Group (MSCRG)Neurology 53(1):139–48 PMID: 10408550 [PubMed-index for MEDLINE]PubMed

63.

Thornton AE, Raz N, Tucker KA (2002) Memory in multiple sclerosis: contextual encoding deficits J Int Neuropsychol Soc 8(3):395–409 PMID: 11939698 [PubMed-index for MEDLINE]PubMedCrossRef

64.

Trapp BD, Peterson J, Ransohoff RM, Rudick R, Mork S, Bo L (1998) Axonal transection in the lesions of multiple sclerosis N Engl J Med 338(5):278–85 PMID: 9445407 [PubMed-index for MEDLINE]PubMedCrossRef

65.

Wechsler D (1987) Wechsler Memory Scale–revised In: Härting C, Markowitsch HJ, Neufeld H, Calabrese P, Deisinger K, Kessler J (eds) (2000) Deutsche Adaptation der revidierten Fassung der Wechsler Memory Scale von D. Wechsler. Huber, Bern

66.

Zakzanis KK (2000) Distinct neurocognitive profiles in multiple sclerosis subtypes Arch Clin Neuropsychol 15(2):115–36 PMID: 14590556 [PubMed-index for MEDLINE]PubMedCrossRef

67.

Zimmermann P, Fimm B (1995) Testaufmerksamkeitsbatterie zur Aufmerksamkeitsprüfung Psychologische Testsysteme / Vera Fimm, Würselen

68.

Zivanidov R, Sepcic J, Nasuelli D, De Masi R, Bragadin LM, Tommasi MA, Zambito-Marsala S, Moretti R, Bratina A, Ukmar M, Pozzi-Mucelli RS, Grop A, Cazzato G, Zorzon M (2001) A longitudinal study of brain atrophy and cognitive disturbances in the early phase of relapsing–remitting multiple sclerosis J Neurol Neurosurg Psychiatry 70(6):773–80 PMID: 11385012 [PubMed-index for MEDLINE]CrossRef

Title: Cognition in the early stage of multiple sclerosis
Authors: Doreen Schulz
Bruno Kopp
Annett Kunkel
Jürgen H. Faiss
Publication date: 01-08-2006
Publisher: Steinkopff-Verlag
Published in: Journal of Neurology / Issue 8/2006
Print ISSN: 0340-5354
Electronic ISSN: 1432-1459
DOI: https://doi.org/10.1007/s00415-006-0145-8

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Cognition in the early stage of multiple sclerosis

Abstract

Objective

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objective

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 8/2006

Mitoxantrone versus cyclophosphamide in secondary-progressive multiple sclerosis

Andrea Verga (1811–1895)

Unusual MRI findings in primary central nervous system lymphoma presenting diffuse linear enhancements located in the perivascular space

Blink amplitude but not saccadic hypometria indicates carriers of Parkin mutations

Three patients with migraine following caloric-induced vestibular stimulation

Antithrombotic agents’ use in patients with atrial fibrillation and acute cerebral ischemia