Prevalence of cognitive impairment among Hungarian patients with relapsing-remitting multiple sclerosis and clinically isolated syndrome

Abstract

Background: Cognitive impairment (CI) is a frequent symptom of multiple sclerosis (MS); its prevalence is reported to be 43-70%. It is one of the most important determinants of MS patients' quality of life, as it is one of the main factors for MS patients becoming unemployed. Aim:We aimed to determine the prevalence of CI among the relapsing-remitting MS (RRMS) and clinically isolated syndrome (CIS) patients in Hungary, to evaluate the predicting factors of CI and to assess the differences between sexes and patients with different educational levels.Patients and methods: Five-hundred and fifty-three CIS and RRMS patients were enrolled to our study from three Hungarian MS centers. Age at screening, age at disease onset, disease duration, EDSS score, sex and educational levels were analyzed as socio-demographic factors. The BICAMS battery was used to assess their cognitive state, the BDI-II battery to assess depression. For statistical analysis, we utilized logistical regression, and used Fisher exact tests, chi-square tests and one-way ANOVA. Results:The mean age of our patients was 44.93±11.69 years, mean age at disease onset was 31.95±10.01 years, the mean disease duration was 13.05±8.05 years and the median EDSS score 2.0 (Range: 6.5, IQR:2.0) points. Three-hundred and sixteen (57.1%) patients had CI. Sex, educational level and EDSS score proved to be significant predictors of CI (OR: 2.71, p<0.001; OR: 1.94, p=0.023; OR: 0.47, p=0.003 respectively). CI was significantly (p<0.001) more frequent among men (70.1%) than women (52.0%). We found, that educational level and EDSS score were only a significant predicting factor among women. Thus, the prevalence of CI among women with college or university degree was significantly (p<0.001) less common (39.4%) than women with 12-15 years of education (57.4%) and women without a high school degree (66.7%). Also, we found that among women with higher EDSS score than 2 points, the prevalence of CI is 69.9% as compared to women with EDSS score between 0-2 points, where the prevalence is 42.8% (p<0.001). No such differences were observed among man. Discussion: Our prevalence data is similar to those reported in the literature (43-70%), and almost identical to the one assessment using the BICAMS battery. We found that men are more vulnerable to CI than women in MS, as was reported recently. We are the first to report however, that higher educational level and lower EDSS scores are only associated with better cognitive performance in women.

Contributing factors to health‐related quality of life in multiple sclerosis

“…Chiaravalloti & DeLuca, 2008). With more than 300 patients assessed, the sample size made it possible to stratify between sexes, we confirmed our previous and other results regarding the difference of CI's prevalence between men and women (Patti et al, 2015;Sandi et al, 2017).…”

“…The prevalence of depression (27.0%), fatigue (52.2%), CI (50.9%) in our cohort was in line the literature (Ben Ari Shevil et al, ; Chiaravalloti & DeLuca, ). With more than 300 patients assessed, the sample size made it possible to stratify between sexes, we confirmed our previous and other results regarding the difference of CI's prevalence between men and women (Patti et al, ; Sandi et al, ).…”

“…We hypothesize that the reason cognitive impairment solely influenced the HRQoL of men but not women is due to the fact that CI's prevalence is much higher in men, and thus its impact has reached a threshold where its burden becomes a significant factor (Sandi et al, ). The presence of CI makes an MS patient more likely to get divorced, thus self‐reportedly he feels a significant decline in his sexual life (Hakim et al, ).…”

Cognitive Impairment in Multiple Sclerosis

“…According to various authors, the frequency is in the range of 20 to 45% and is observed even in patients with a clinically isolated syndrome. 7,[11][12][13] According to the study by Achiron and Barak (2003), 95% of the studied patients with possible MS had an abnormal score in at least one neuropsychological test. 14 Cognitive dysfunctions in MS patients have been found to be correlated with a number of other factors besides the type and duration of the disease.…”

Cognitive involvement in clinically isolated syndrome and relationship with fatigue

“…Bazı araştırmacılar bilişsel bozulmanın bazen hastalığın ilk işareti olabileceğini öne sürmekle birlikte 8,38 En az bir testte bozulma saptanan (-1 SD) hasta oranı %64 iken, 2 SD altında kalan hasta oranı %48 olarak saptandı. Literatürde KİS'te bilişsel bozulma prevalansına ilişkin çalışmalarda, %27 ile %57 arasında değişen oranlar bildirilmiştir 51,52 . Achiron ve ark.…”