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Isolated cognitive relapses in multiple sclerosis
  1. Matteo Pardini1,2,3,
  2. Antonio Uccelli1,
  3. Jordan Grafman4,
  4. Özgür Yaldizli3,5,
  5. Gianluigi Mancardi1,2,
  6. Luca Roccatagliata2,6,7
  1. 1Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
  2. 2Magnetic Resonance Research Centre on Nervous System Diseases, University of Genoa, Genoa, Italy
  3. 3MS Centre, University College London Institute of Neurology, London, UK
  4. 4Brain Injury Research, Rehabilitation Institute of Chicago, Chicago, Illinois, USA
  5. 5Department of Neurology, University Hospital Basel, Basel, Switzerland
  6. 6Department of Diagnostic and Interventional Neuroradiology, San Martino University Hospital, Genoa, Italy
  7. 7Department of Health Sciences, University of Genoa, Genoa, Italy
  1. Correspondence to Dr Matteo Pardini, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health, University of Genoa, Largo Daneo 3, Genoa 16143, Italy; matteo.pardini@gmail.com

Abstract

Objective While cognition can be affected during sensorimotor multiple sclerosis (MS) relapses, the relevance of isolated cognitive relapses (ICRs ie, those occurring in absence of new sensorimotor symptoms) remain poorly characterised. Here, we decided to explore the relationship between ICR, subjective evaluation of cognitive performance and long-term cognitive decline in a group of subjects with relapsing-remitting MS.

Methods We analysed the cognitive performance of 99 clinically stable relapsing-remitting MS for whom data from four consequent clinical and cognitive evaluations were available, that is, a baseline evaluation (t0), followed in the subsequent 6 months by a second evaluation performed not later than 2 weeks after a routine brain scan positive for at least one area of gadolinium enhancement (t1) and two gadolinium enhancement-negative follow-up evaluations after 6 months (t2) and 1 year (t3) from t1. Based on published literature, we defined as a meaningful change in cognition a transient reduction of Symbol Digit Modalities Test score of at least four points at t1 compared with t0 and t2.

Results ICRs were found in 17 patients and were not associated with subjective cognitive deficits or depression. Subjects who presented with an ICR at t1 presented with a significantly reduced cognitive performance at the follow-up evaluations compared with patients without ICR.

Conclusions and relevance We showed that ICRs were not associated with changes in mood, fatigue levels or cognitive performance self-evaluations. Our study introduces an operational definition of ICRs and suggests to their role as a factor for cognitive decline in MS.

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