Cognitive dysfunction in early-onset multiple sclerosis - A reappraisal after 10 years

Objective: To reassess, in a cohort of patients with early-onset multiple sclerosis, the long-term evolution of Cognitive deficits, their relationship to the disease's clinical progression, and their effects on daily life. Design: Ten years after our baseline assessment, we again compared the cognitive performance of patients and control subjects on a neuropsychological test battery. Clinical and demographic correlates of cognitive impairment and their effects on everyday functioning were determined by multiple linear regression analysis. Setting: The research clinic of a university department of neurology. Participants: Forty-five inpatients and outpatients with multiple sclerosis and 65 demographically matched healthy controls from the original sample. Main Outcome Measures: Mean scores of both groups on the neuropsychological test battery in initial and 2 follow-up evaluations (about 4 and 10 years, respectively); number of cognitively impaired subjects, defined by the number of subtests failed; regression coefficients measuring the relationship between clinical variables and cognitive outcome and between mental decline and every- day functioning assessed by the Environmental and the Incapacity Status Scales. Results: Previously detected cognitive defects in verbal memory, abstract reasoning, and linguistic processes were confirmed on the third testing, at which time deficits in attention/short-term spatial memory also emerged. Only 20 of 37 patients who were cognitively unimpaired on initial testing remained so by the end of the follow-up, when the proportion of subjects who were cognitively impaired reached 56%. Degree of physical disability, progressive disease course, and increasing age predicted the extent of cognitive decline. Disability level and degree of cognitive impairment were independent predictors of a patient's handicap in the workplace and in social settings. Conclusions: In the course of a sufficiently long followup, cognitive dysfunction is likely to emerge and progress in a sizable proportion of patients. As multiple sclerosis advances, neurological and cognitive involvement tend to converge. Limitations in a patient's work and social activities are correlated with the extent of cognitive decline, independent of degree of physical disability.