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Prevalence and incidence of cognitive impairment in multiple sclerosis: a population-based survey in Catania, Sicily

Journal of Neurology volume 262, pages 923–930 (2015)Cite this article

Abstract

Cognitive impairment (CIm) is a frequent finding in multiple sclerosis (MS) affecting up to 65 % of patients. The aim of this study was to evaluate the prevalence and incidence of CIm in a population-based cohort of MS patients identified in the city of Catania from 1995 to 2004. One-hundred and twenty-five patients experiencing the onset of MS during 1995–2004 were enrolled. Cognitive performance was assessed through the Brief Repeatable Battery (BRB) of neuropsychological tests and the Stroop word-color task (ST). CIm was defined as the failure on at least three tests involving at least two different domains. Patients without CIm at baseline were followed up after over 3 years. The most impaired tests were the Symbol Digit Modalities Test (36 %) and the Paced Auditory Serial Addition Test 3 (35 %). At baseline the prevalence of CIm was 44 % (95 % CI 35.2–53.1). An almost sixfold increased risk of developing CIm was found among MS patients aged 40 and above at the time of the NPS examination (OR 5.84; 95 % CI 2.57–13.2; p value <0.0001) and a threefold increased risk for patients with an EDSS score >3 (OR 3.51; 95 % CI 1.30–9.46, p value 0.01). At the follow-up out of the 70 MS patients without CIm at baseline evaluation, 26 (37.1 %) developed CIm. The total person-years at risk was 269 person-years giving an incidence rate of CIm of 96.6/1,000 person-year (95 % CI 57.3–128.7). The overall prevalence of CIm in MS is 44 % and the incidence after 4 years is 37.1 %. CIm affects more frequently patients older than 40 years and with a higher EDSS score.

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References

  1. DeLuca GC et al (2015) Cognitive impairment in multiple sclerosis: clinical, radiologic and pathologic insights. Brain Pathol 25(1):79–98

    Article  PubMed  Google Scholar 

  2. Patti F (2009) Cognitive impairment in multiple sclerosis. Mult Scler 15(1):2–8

    CAS  Article  PubMed  Google Scholar 

  3. Feuillet L et al (2007) Early cognitive impairment in patients with clinically isolated syndrome suggestive of multiple sclerosis. Mult Scler 13(1):124–127

    CAS  Article  PubMed  Google Scholar 

  4. Patti F et al (2009) Cognitive impairment and its relation with disease measures in mildly disabled patients with relapsing–remitting multiple sclerosis: baseline results from the Cognitive Impairment in Multiple Sclerosis (COGIMUS) study. Mult Scler 15(7):779–788

    CAS  Article  PubMed  Google Scholar 

  5. Benedict RH et al (2005) Predicting quality of life in multiple sclerosis: accounting for physical disability, fatigue, cognition, mood disorder, personality, and behavior change. J Neurol Sci 231(1–2):29–34

    Article  PubMed  Google Scholar 

  6. Amato MP, Zipoli V, Portaccio E (2006) Multiple sclerosis-related cognitive changes: a review of cross-sectional and longitudinal studies. J Neurol Sci 245(1–2):41–46

    Article  PubMed  Google Scholar 

  7. Rao SM et al (1991) Cognitive dysfunction in multiple sclerosis. I. Frequency, patterns, and prediction. Neurology 41(5):685–691

    CAS  Article  PubMed  Google Scholar 

  8. McIntosh-Michaelis SA et al (1991) The prevalence of cognitive impairment in a community survey of multiple sclerosis. Br J Clin Psychol 30(Pt 4):333–348

    Article  PubMed  Google Scholar 

  9. Smestad C et al (2010) Cognitive impairment after three decades of multiple sclerosis. Eur J Neurol 17(3):499–505

    CAS  Article  PubMed  Google Scholar 

  10. Patti F et al (2013) Subcutaneous interferon beta-1a may protect against cognitive impairment in patients with relapsing-remitting multiple sclerosis: 5-year follow-up of the COGIMUS study. PLoS One 8(8):e74111

    PubMed Central  CAS  Article  PubMed  Google Scholar 

  11. Amato MP et al (2007) Association of neocortical volume changes with cognitive deterioration in relapsing–remitting multiple sclerosis. Arch Neurol 64(8):1157–1161

    Article  PubMed  Google Scholar 

  12. Reuter F et al (2011) Frequency of cognitive impairment dramatically increases during the first 5 years of multiple sclerosis. J Neurol Neurosurg Psychiatry 82(10):1157–1159

    Article  PubMed  Google Scholar 

  13. Amato MP et al (2010) Relevance of cognitive deterioration in early relapsing–remitting MS: a 3-year follow-up study. Mult Scler 16(12):1474–1482

    Article  PubMed  Google Scholar 

  14. Duque B et al (2008) Memory decline evolves independently of disease activity in MS. Mult Scler 14(7):947–953

    CAS  Article  PubMed  Google Scholar 

  15. Zivadinov R et al (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):773–780

    PubMed Central  CAS  Article  PubMed  Google Scholar 

  16. Kujala P, Portin R, Ruutiainen J (1997) The progress of cognitive decline in multiple sclerosis. A controlled 3-year follow-up. Brain 120(Pt 2):289–297

    Article  PubMed  Google Scholar 

  17. Amato MP et al (2001) Cognitive dysfunction in early-onset multiple sclerosis: a reappraisal after 10 years. Arch Neurol 58(10):1602–1606

    CAS  Article  PubMed  Google Scholar 

  18. Nicoletti A et al (2011) Increasing frequency of multiple sclerosis in Catania, Sicily: a 30-year survey. Mult Scler 17(3):273–280

    Article  PubMed  Google Scholar 

  19. Poser CM et al (1983) New diagnostic criteria for multiple sclerosis: guidelines for research protocols. Ann Neurol 13(3):227–231

    CAS  Article  PubMed  Google Scholar 

  20. Lublin FD, Reingold SC (1996) Defining the clinical course of multiple sclerosis: results of an international survey. National Multiple Sclerosis Society (USA) Advisory Committee on Clinical Trials of New Agents in Multiple Sclerosis. Neurology 46(4):907–911

    CAS  Article  PubMed  Google Scholar 

  21. Nicoletti A et al (2001) Prevalence and incidence of multiple sclerosis in Catania, Sicily. Neurology 56(1):62–66

    CAS  Article  PubMed  Google Scholar 

  22. Nicoletti A et al (2005) Possible increasing risk of multiple sclerosis in Catania. Sicily. Neurology 65(8):1259–1263

    CAS  Article  PubMed  Google Scholar 

  23. Amato MP et al (2006) The Rao’s brief repeatable battery and Stroop test: normative values with age, education and gender corrections in an Italian population. Mult Scler 12(6):787–793

    CAS  Article  PubMed  Google Scholar 

  24. Barbarotto R et al (1998) A normative study on visual reaction times and two Stroop colour-word tests. Ital J Neurol Sci 19(3):161–170

    CAS  Article  PubMed  Google Scholar 

  25. StataCorp (2011) Stata statistical software: release 12. TSL, College Station

  26. Einarsson U et al (2006) Cognitive and motor function in people with multiple sclerosis in Stockholm County. Mult Scler 12(3):340–353

    CAS  Article  PubMed  Google Scholar 

  27. Potagas C et al (2008) Cognitive impairment in different MS subtypes and clinically isolated syndromes. J Neurol Sci 267(1–2):100–106

    Article  PubMed  Google Scholar 

  28. Benedict RH et al (2006) Validity of the minimal assessment of cognitive function in multiple sclerosis (MACFIMS). J Int Neuropsychol Soc 12(4):549–558

    Article  PubMed  Google Scholar 

  29. Deloire MS et al (2006) How to detect cognitive dysfunction at early stages of multiple sclerosis? Mult Scler 12(4):445–452

    CAS  Article  PubMed  Google Scholar 

  30. Beatty WW, Aupperle RL (2002) Sex differences in cognitive impairment in multiple sclerosis. Clin Neuropsychol 16(4):472–480

    Article  PubMed  Google Scholar 

  31. Savettieri G et al (2004) Gender-related effect of clinical and genetic variables on the cognitive impairment in multiple sclerosis. J Neurol 251(10):1208–1214

    Article  PubMed  Google Scholar 

  32. Gong G, He Y, Evans AC (2011) Brain connectivity: gender makes a difference. Neuroscientist 17(5):575–591

    Article  PubMed  Google Scholar 

  33. Miller IN, Cronin-Golomb A (2010) Gender differences in Parkinson’s disease: clinical characteristics and cognition. Mov Disord 25(16):2695–2703

    PubMed Central  Article  PubMed  Google Scholar 

  34. Bove R et al (2014) Age at surgical menopause influences cognitive decline and Alzheimer pathology in older women. Neurology 82(3):222–229

    PubMed Central  Article  PubMed  Google Scholar 

  35. Patti F et al (2010) Effects of immunomodulatory treatment with subcutaneous interferon beta-1a on cognitive decline in mildly disabled patients with relapsing–remitting multiple sclerosis. Mult Scler 16(1):68–77

    CAS  Article  PubMed  Google Scholar 

  36. Ravaglia G et al (2008) Mild cognitive impairment: epidemiology and dementia risk in an elderly Italian population. J Am Geriatr Soc 56(1):51–58

    Article  PubMed  Google Scholar 

  37. Chruzander C et al (2013) A 10-year follow-up of a population-based study of people with multiple sclerosis in Stockholm, Sweden: changes in disability and the value of different factors in predicting disability and mortality. J Neurol Sci 332(1–2):121–127

    Article  PubMed  Google Scholar 

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Conflict of interest

M. Zappia has received honoraria for speaking activities from Boehringer-Ingelheim, Lundbeck and Bayer-Schering, and scientific grants from AIFA-Agenzia Italiana del Farmaco, Novartis and Lundbeck. A. Nicoletti has received honoraria from UCB-Union Clinique Belge and Lundbeck for medical education symposia. F. Patti has received honoraria for speaking activities from Bayer Schering, Biogen Idec, Merck Serono, Novartis and Sanofi Aventis; he also served as an advisory board member in the following companies: Bayer Schering, Biogen Idec, Merck Serono and Novartis; S. Lo Fermo received honoraria for speaking activities from Biogen Idec and Merck Serono; Dr Messina has received honoraria for speaking activities from Biogen Idec; E. Bruno, G. Quattrocchi, C. G. Chisari, D. Maimone and S. Cilia report no disclosure.

Ethical standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study protocol was approved by the Ethical Committee of Policlinico-Vittorio Emanuele; each participant provided written informed consent before any study related procedure.

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    Affiliations

    1. Department G.F. Ingrassia, Section of Neurosciences, University of Catania, Catania, Italy

      Francesco Patti, Alessandra Nicoletti, Silvia Messina, Elisa Bruno, Salvatore Lo Fermo, Graziella Quattrocchi, Clara Grazia Chisari, Sabina Cilia & Mario Zappia

    2. Garibaldi Hospital, Catania, Italy

      Davide Maimone

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    1. Francesco Patti
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    2. Alessandra Nicoletti
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    3. Silvia Messina
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    4. Elisa Bruno
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    5. Salvatore Lo Fermo
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    6. Graziella Quattrocchi
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    7. Clara Grazia Chisari
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    8. Davide Maimone
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    9. Sabina Cilia
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    10. Mario Zappia
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    Correspondence to Mario Zappia.

    Additional information

    F. Patti and A. Nicoletti equally contributed to the manuscript.

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    Patti, F., Nicoletti, A., Messina, S. et al. Prevalence and incidence of cognitive impairment in multiple sclerosis: a population-based survey in Catania, Sicily. J Neurol 262, 923–930 (2015). https://doi.org/10.1007/s00415-015-7661-3

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    • DOI: https://doi.org/10.1007/s00415-015-7661-3

    Keywords

    • Multiple sclerosis
    • Neuropsychological assessment
    • Prevalence studies
    • Incidence studies