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.