Multiple sclerosisWednesday, June 24, 2009, 08:30 - 10:00Cognitive aspects in relapsing-remitting multiple sclerosis patients treated with immunomodulant drugs: 24-month follow-up of the ITACA studyM. Falautano (Milan, IT)
Background: Multiple sclerosis (MS) is the leading cause of disability in young adults and its progression, involving cognitive and physical aspects, may influence both the Quality of Life (QoL) and the affective status.
Aim: To evaluate long-term effects of different first-line Disease Modifying Therapies (GA or IFNs) on cognitive functions, affective status, fatigue and QoL in patients with relapsing remitting multiple sclerosis (RRMS) over a 24-month period.
Method: Observational, longitudinal, multicentre, Italian study. The study was designed to follow-up a cohort of MS patients treated with immunomodulant drugs for 2 years. The patients underwent a comprehensive neuropsychological and neurological evaluation in the designed time. MS Quality of life/54 items, Montgomery Asberg Depression Rating Scale and Fatigue Severity Scale were administered too. We defined as “mild” cognitive impairment the failure in 1 or 2 tests in the cognitive domain and as “severe” the failure in at least 3 tests. 51% (314) of the patients were treated with GA and 49% (307) with IFNs.
Results: 752 patients were enrolled by 79 Italian Centres (397 patients were treated with GA and 355 patients with IFNs). 130 patients (17%) dropped out. In the cohort of the 622 subjects who completed the 24-month follow-up, 57% showed at baseline cognitive impairment (40% “mild” and 17% “severe”). At the 24-month cognitive impairment was detected in 43% of the patients: 31% had “mild” and 12% “severe” cognitive impairment. Cognitive impairment did not progress in both IFNs and GA groups. A significant correlation between cognitive impairment and EDSS scores was observed both at baseline and at follow-up (p<0.05). Both at baseline and at 24-month follow-up patients with a “severe” cognitive impairment complained of a mean higher level of fatigue and of depressive symptoms, compared to patients with “mild” or no cognitive impairment. No difference was found between baseline and follow-up in self-perceived QoL.
Conclusions: The prevalence of cognitive impairment in our group of RRMS is remarkable. Subjects with “severe” cognitive impairment are more likely to suffer both from a more severe depressive symptomatology and physical disability compared to those with no or “mild” cognitive impairment. Subjects treated with both INFs or GA did not show progression of cognitive impairment.
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