Cognitive problems can persist into adulthood in people whose multiple sclerosis (MS) began in childhood or adolescence, and are linked to neurological issues and delays in treatment initiation, a study reports.
Early use of disease-modifying therapies (DMTs) and of approaches designed to preserve cognition should be encouraged for pediatric or early onset MS patients, its researchers stated.
These findings were detailed at MSVirtual2020 by Angelo Bellinvia, with the University of Florence, in the oral presentation, “Cognition and socio-professional attainment in paediatric onset multiple sclerosis: a reappraisal after 10 years.”
Statistics indicate that nearly 30% of MS patients with disease symptoms before adulthood have some degree of cognitive impairment, evident both in their educational performance and their ability to engage in social activities.
Investigators reviewed 10 years of data from a group of Italian patients with pediatric-onset MS (POMS) to evaluate how cognitive impairments affected their ability to achieve professional and social milestones as adults.
Of the 63 POMS patients initially assessed in 2008, 48 were re-assessed five years later, and 31 — 17 females and 14 males (average age of 27.9), with minimal disability (low mean expanded disability status scale scores) — were re-evaluated after 10 years.
All POMS patients analyzed had a relapsing-remitting disease course.
Re-evaluations consisted on a battery of neuropsychological tests to assess patients’ neurological and cognitive abilities, including verbal learning, visual-spatial learning, language, attention, and information processing speed. Patients who failed two or more of these tests were considered to be cognitively impaired.
The Modified Work and Social Assessment Scale (WSAS) was used to determine their socio-professional achievements. The severity of depression and fatigue are being assessed using the Montgomery-Asberg Depression Rating Scale (MADRS) and the Fatigue Severity Scale (FSS), respectively.
Statistical analyses were also used to identify possible predictors of cognitive impairment and socio-professional performance.
The 31 patients with 10-year data were also matched with 31 healthy individuals, serving as controls for comparison.
Previously published results at 5 years of follow-up showed that 56% of the 48 patients had a deterioration in their cognitive change index compared with their initial assessment (baseline measure). Five-year data also showed “the disease had a negative functional impact on daily living activities for 53% of the patients, and on family and social relationships [37%] and school activities [33%],” Bellinvia said.
At the recent conference, researchers reported available data from a 10-year assessment.
Cognitive impairment based on test results was found in 17 of these 31 patients, and not in the other 14.
Compared to those whose cognitive abilities had remained stable over 10 years, patients with worsening cognition tended to have higher EDSS scores at baseline, indicative of great disability — a mean initial EDSS of 2.0 in this group, versus 1.0 in those with preserved cognition.
Investigators also found a lower intelligence quotient (IQ) score on first evaluation in those with cognitively impairment (average score, 86.2) compared with those showing preserved cognitive abilities (average score, 103.6). Declining patients were also less likely to have used a DMT at the study’s start (35.3%) than did those with stable cognition (78.6%).
Statistical analyses confirmed that cognitive impairments at 10 years associated with a lower IQ and DMT lack at the study’s start.
Across this study’s patient population, the average WSAS score was 3.7, indicating problems with psychosocial functioning and attainment that were not clinically relevant.
However, WSAS scores were higher among the patient sub-group with cognitive difficulties (mean of 6.1) that those with preserved cognition (mean of 1.5), suggesting poorer socio-professional attainment. Higher WSAS scores indicate greater functional impairment, and a score of six is suggestive of “marked” difficulties.
Cognitive impairments, higher EDSS scores, and being older at the time of MS onset were all seen as early predictors of poor socio-professional attainment in adulthood, the investigators found.
Of these factors, however, only the presence of cognitive difficulties was associated with poor functional outcomes at 10 years of follow-up.
“In conclusion, in our cohort of pediatric MS subjects, cognitive impairment remained significant in adulthood, affecting 55% of cases. Lower IQ and the absence of DMT treatment at baseline were associated with cognitive impairment after 10 years,” Bellinvia said, adding that diminished cognition “was associated with poorer socio-professional outcomes.”
“Therefore, early treatment and promotion of strategies aimed at enhancing intellectual enrichment and/or building cognitive reserve have to be recommended in pediatric subjects with MS,” he said.
Bellinvia also emphasized that data collection and further analyses of this POMS patient group are continuing, with particular emphasis placed on assessing the severity of depression and fatigue in these adults.
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