多发性硬化与认知功能障碍

多发性硬化(multiple Sclerosis, MS)是中枢神经系统最常见的脱髓鞘疾病,常分为复发-缓解型(RRMS)、原发进展型(PPMS)及继发进展型(SPMS)三种类型.MS不仅可以导致患者躯体残疾,还常常造成不同程度认知功能损害.提高临床医师对MS认知障碍的认识,并及早采取有效的干预措施,可有效改善MS患者的预后.     

多发性硬化患者认知损害的检测及其影响因素分析

目的 了解多发性硬化(multiple sclerosis,MS)患者认知功能损害的特点及其影响因素.方法 对27例MS患者及27名正常对照者采用重复性成套神经心理状态测验(repeatable battery for the assessment of neuropsychological status,RBANS)量表进行认知功能评估,采用扩展残疾状态量表(expanded disability status scale,EDSS)评估残疾状态、抑郁自评量表(self-rating depression scale,SDS)和焦虑自评量表(self-rating anxiety scale,SAS)进行抑郁、焦虑状态评估.采用双侧T检验及非参数Mann-Whitney U检验分析患者与对照之间的评分差异;采用Pearson相关分析方法,探讨MS患者认知障碍评分与EDSS评分、病灶部位、临床特点以及情绪等因素的的相关性.结果 MS组与对照组比较,RBANS评分明显降低(分别为74.7±17.6和98.0 - 15.5),差别具有统计学意义(P=0.0013);评分降低的项目包括即时记忆、视觉广度、言语功能、注意和延迟记忆五个方面(P值均＜ 0.01).对MS临床分型进行进一步分析的结果提示:继发进展型(secondary progressive multiple sclerosis,SPMS)与缓解复发型(relapsing-remitting multiple sclerosis,RRMS)比较,认知水平下降的程度更严重(P＜0.05).RBANS评分与EDSS、SDS评分及受教育程度具有相关性(Pearson相关系数分别为:-0.61、-0.42和0.54;P值分别为:0.0007,0.0275和0.0035),而与性别、年龄、病程、复发次数、SAS评分以及T2WI上病灶的部位之间无明显相关性.结论 MS患者认知损害的严重程度可能与临床类型、躯体残疾状态和情绪异常之间存在一定相关性.     

多发性硬化康复治疗

<正>多发性硬化(MS)是一种以中枢神经系统白质脱髓鞘为主要病理改变的自身免疫性疾病,常见病变部位位于脑或脊髓,临床表现为病变多发和反复复发-缓解病程,即空间和时间多发性,以髓鞘脱失、神经胶质增生、不同程度轴索病变和进行性神经功能障碍为主要特点,常累及脑室周围白质、视神经、脊髓、脑干和小脑,尤以侧脑室体部和脊髓前角多     

多发性硬化患者的认知功能损害

多发性硬化(multiple sclerosis,MS)是原发性中枢神经系统的炎症性脱髓鞘疾病.国外资料表明45% ～65%的MS患者可合并认知功能损害[1],其中约10%的患者症状可以非常严重.     

多发性硬化患者的认知功能损害

目的研究多发性硬化(multiplesclerosis,MS)患者认知功能损害的形式、特点及相关影响因素,了解认知功能损害对患者生活功能的影响。方法将66例MS患者分为脊髓型和脑/脑脊髓型两组,另外选择健康对照30名,采用神经心理学测验的方法系统评价记忆、语言、信息处理速度、执行功能及整体认知功能,并进行生活功能评定,所有MS患者同时接受头颅及脊髓磁共振成像(MRI)检查。结果神经心理学测试发现,与健康对照组相比,脑/脑脊髓型MS组瞬时记忆和长延迟记忆受损明显(P<0.05),执行功能损害显著(P<0.01),信息处理速度下降(P<0.01)。单纯脊髓型也存在认知功能损害,以执行功能损害及信息处理速度下降为主(P<0.05)。记忆、执行功能等认知功能测验成绩与头颅MRI所见病变相关(r=-0.319～-0.543,P<0.05)。认知功能测验成绩与病程长短、复发次数无明显相关。执行性画钟作业(CLOX)及Stroop测验反应错误数与扩展功能障碍状态量表(EDSS)有相关性(r=-0.325及0.372,P<0.05)。操作性日常生活能力(IADL)及MS生活影响量表(MSIS29)得分与记忆、执行功能等认知测验成绩呈负相关(r=-0.325～-0.537,P<0.05)。结论MS的认知功能损害以记忆、信息处理速度、执行功能为主,整体认知功能及语言功能相对保存。认知功能损害影响患者的生活功能,与病程长短、复发次数无明显相关。     

多发性硬化患者的认知功能障碍及其与头颅MRI病灶的相关性

目的　研究多发性硬化 (MS)患者认知功能障碍的特点及其与头颅MRI病灶的相关性。方法　对 70例MS患者进行韦氏智力量表 (WAIS)测试及头颅MRI检查 ,并用多元回归分析方法对各相关因素进行分析。结果　MS组全量表智商 (FIQ)异常 (<90分 )率为 4 0 %(2 8/70 ) ,与对照组比较差异有显著性 (P <0 0 1)。对智商成绩影响最显著的因素为病变部位 (脑部病变 )。MRI显示病灶的等级与病程呈显著正相关(r=0 348,P <0 0 5 ) ,胼胝体病灶数与FIQ呈负相关 (r=- 0 2 8,P <0 0 5 ) ,其他均无显著相关性 (均P >0 0 5 )。结论　MS患者存在认知障碍 ,MS的病变部位 (脑部病变 )对智能影响最显著 ,头颅MRI所示病灶与MS患者的认知障碍的相关性大多不显著。     

多发性硬化的颅神经损害

本文总结了28例多发性硬化患者的颅神经损害表现。其中视力障碍最为突出，占67.8％．视野缺损者占45．4％，视乳头萎缩者393％，眼外肌麻痹占28．6％，眼球震颤占39．3％，面瘫占28.6％，三叉神经损害占21．7％，少数病人有吞咽困难和舌瘫。颅神经损害表现为发作性症状者占17．8％。视觉诱发电位的异常率为61．1％。对上述表现进行了讨论。     

多发性硬化缓解期的对症及康复治疗

多发性硬化目前尚无特效疗法,许多患者遗留有神经功能障碍,适时的给予对症和康复治疗,能防止并发症,减少残疾和残障。本文从药理学、物理治疗学、心理学等方面,阐述解决ＭＳ的痉挛、疼痛、疲劳、震颤、性行为、直肠功能障碍等的手段,旨在提高ＭＳ患者的生活质量和独立生活能力。     

多发性硬化康复体操在神经内科病房中的应用价值

目的探讨多发性硬化康复体操在神经内科病房中的应用价值。方法将100例多发性硬化患者随机分为实验组50例和对照组50例。对照组采用常规的治疗和非系统锻炼,实验组在此基础上由专科护士指导,进行康复体操锻炼,随访观察2个月,采用Barthel指数评分对患者生活自理能力进行评估,并对2组患者的评分进行比较。结果实验组应用康复体操后生活自理能力评分高于对照组,差异有统计学意义(P0.05)。结论多发性硬化患者进行康复体操锻炼能有效促进其肢体功能的康复。     

多发性硬化认知功能障碍研究进展

认知功能障碍是多发性硬化（multiple sclerosis, MS）的常见非运动症状,主要表现在信息处理、记忆力、注意力、执行力和视觉空间能力等多个认知域受损;目前尚未形成统一的针对MS认知功能障碍的诊断标准和神经心理学检测方法;MS认知功能障碍的影响因素包括人口学因素、疾病相关因素、共病及生活方式等;影像学上主要表现为局灶性白质损伤、皮质和深部灰质萎缩;疾病修正治疗和认知康复治疗对认知功能的改善有积极影响。神经科医师应注重MS认知功能障碍的早期评估和干预,以改善患者生活质量。     

Aggressive course of cognitive impairment in multiple sclerosis: A new term for the management of patients

Multiple sclerosis (MS) can create different kinds of symptoms by involving different fields of the central nervous system. Cognitive impairment (CI) is one of the symptoms that can be caused by the onset of the disease and provide a change in the patient’s quality of life. Considering the course of the disease, CI usually worsens increasingly, and there is usually a severe CI in patients with end stage of MS. However, progressing CI can be so fast and severe in a few patients that it can disrupt the daily affairs of the individual. This paper plans to define the aggressive course of CIs in MS patients according to the reported cases. This definition explains that, the aggressive course of CI in MS patients happens in less than 5 years from the onset of the disease, and during this time, it causes dementia in the patient.     

Impact of cognitive impairment on coping strategies in multiple sclerosis

Objectives: To assess the impact of cognitive impairment (CI) on coping strategies in multiple sclerosis (MS). Materials and methods: Sixty-three patients (40 women, 55 relapsing-remitting and 8 secondary progressive, age 42.6 ± 10.1 years, Expanded Disability Status Scale 2.2 ± 1.7) were assessed using the Coping Orientation for Problem Experiences-New Italian version Inventory, the Beck Depression Inventory and the Rao's Brief Repeatable Battery. Results: MS patients were less likely to use positive and problem-focused strategies, whereas avoiding strategies were adopted more frequently. Twenty-three (36.5%) cases were CI. We found no differences in the type of coping between CI and cognitively preserved patients. Scores on the Stroop test (beta = −0.91, p = 0.04) and on the Word List Generation (beta = 1.15, p = 0.04) were associated with poorer coping strategies. Conclusions: Our study suggests that cognitive functioning (in particular on sustained attention and aspects of executive function) must be considered in a comprehensive account of the factors contributing to successful coping in MS patients.     

The relationship of cognitive impairment with neurological and psychiatric variables in multiple sclerosis patients

Objective. Cognitive impairment (CI) in multiple sclerosis (MS) can develop any time. CI is associated with the degree of neuronal loss, but disease duration, fatigue, comorbid affective disorder, and drug dose may also affect cognition. Our aim was to assess which cognitive domain was disturbed primarily in mild MS patients and to see whether CI was related with clinical and psychiatric features. Method. Neurological and psychiatric evaluation of 31 MS patients and 31 age, sex, and education-matched healthy controls were made with Structured Clinical Interview for Axis I Disorders (SCID-I). Depression, anxiety, functionality, fatigue, and disability scoring were determined with Hamilton Depression-Anxiety scales, Global Assessment of Functionality, Fatigue Severity and Expanded Disability Status Scales. Cognitive functions were assessed using Mini Mental, Serial Digit Learning, Verbal and Nonverbal Cancellation, Stroop and Rey Auditory Verbal Learning tests. Results. Retrieval from long-term memory and psychomotor speed were significantly worse in MS group. CI was correlated with disease duration, number of attacks, and physical disability but not with depression and anxiety severity. Disease duration predicted disturbances in recall and psychomotor speed, whereas fatigue and disability predicted depression. Conclusion. Psychomotor speed and memory were primarily impaired in MS patients, and CI was closely associated with clinical aspects of MS rather than with depression and anxiety.     

多发性硬化患者认知改变与事件相关电位研究

目的研究多发性硬化(MS)患者认知功能障碍的发生情况,及其与事件相关电位(ERPs)的相关关系。方法对70例MS患者进行韦氏智力量表测查及ERPs检查。结果韦氏智力量表测试发现MS组全量表智商(FIQ)不正常者(<90分)的比率为40%(28/70),与正常组比较差异显著(P<0.01)。MS组N2、P300潜伏期明显延长,与对照组比较差异具有显著性(P<0.05)。脑或脑脊髓型及进展型MS患者P300潜伏期明显延长,P300波幅降低。病程与P300潜伏期呈显著正相关。言语量表智商(VIQ)、FIQ与P300潜伏期呈负相关,与P300波幅呈正相关;操作量表智商(PIQ)与P300波幅呈正相关。结论MS患者存在有认知障碍。ERPs检查对MS认知障碍的判断有一定参考意义。     

A short version of Rao's Brief Repeatable Battery as a screening tool for cognitive impairment in multiple sclerosis

Rao's Brief Repeatable Battery (BRB) is the most widely used instrument for cognitive evaluation in multiple sclerosis (MS). We assessed a short version of the BRB in 116 relapsing–remitting participants. We found that the administration of three tests, the Selective Reminding Test, the Paced Auditory Serial Addition Test–3 seconds and the Symbol Digit Modalities Test, was able to detect cognitive impairment with a sensitivity of 94%, a specificity of 84%, and an accuracy of 89%. On the basis of these results we developed a screening algorithm requiring 5 to 15 minutes, which may represent a highly sensitive and rapid tool to detect MS-associated cognitive impairment.     

多发性硬化认知障碍评估及其影响因素分析

目的了解多发性硬化(MS)患者认知功能障碍的特点及其相关因素分析。方法对41例MS患者及41例健康对照组进行蒙特利尔认知评估量表(MoCA)智能测试和常规头颅磁共振(MRI)检查,对41例MS患者进行扩展功能障碍状态量表(EDSS)检查。结果 MS组MoCA得分较对照组明显降低,差异具有统计学意义(P0.01);MoCA评分降低的项目主要以视空间与执行功能、延迟记忆、命名、语言为著,而注意力、抽象能力、计算力及定向力未见明显受损;MoCA评分除与受教育程度、MS分型具有相关性(Pearson相关系数分别为0.576、0.366,P值分别为0.000、0.019)外,与性别、年龄、病程、EDSS评分及常规头颅MRI病灶等级等临床资料均无相关性(P0.05)。结论 MS患者存在认知功能障碍,以视空间与执行功能、命名、延迟记忆、语言为著,注意、计算、抽象、定向能力未见明显受损;MS患者认知功能障碍与患者性别、年龄、病程、神经功能缺损程度、常规头颅MRI所示病灶等级无相关;躯体功能障碍越严重,视空间与执行功能得分越低,即操作智商得分越低。     

Effects of transcranial direct current stimulation on cognitive dysfunction in multiple sclerosis

BackgroundAround 40%–70% of patients with multiple sclerosis (MS) may experience cognitive impairments during the course of their disease with detrimental effects on social and occupational activities. Transcranial direct current stimulation (tDCS has been investigated in pain, fatigue, and mood disorders related to MS, but to date, few studies have examined effects of tDCS on cognitive performance in MS.ObjectiveThe current study aimed to investigate the effects of a multi-session tDCS protocol on cognitive performance and resting-state brain electrical activities in patients with MS.MethodsTwenty-four eligible MS patients were randomly assigned to real (anodal) or sham tDCS groups. Before and after 8 consecutive daily tDCS sessions over the left dorsolateral prefrontal cortex (DLPFC), patients’ cognitive performance was assessed using the Cambridge Brain Sciences-Cognitive Platform (CBS-CP). Cortical electrical activity was also evaluated using quantitative electroencephalography (QEEG) analysis at baseline and after the intervention.ResultsCompared to the sham condition, significant improvement in reasoning and executive functions of the patients in the real tDCS group was observed. Attention was also improved considerably but not statistically significantly following real tDCS. However, no significant changes in resting-state brain activities were observed after stimulation in either group.ConclusionAnodal tDCS over the left DLPFC appears to be a promising therapeutic option for cognitive dysfunction in patients with MS. Larger studies are required to confirm these findings and to investigate underlying neuronal mechanisms.     

Structural MRI correlates of cognitive impairment in patients with multiple sclerosis

In a multicenter setting, we applied voxel‐based methods to different structural MR imaging modalities to define the relative contributions of focal lesions, normal‐appearing white matter (NAWM), and gray matter (GM) damage and their regional distribution to cognitive deficits as well as impairment of specific cognitive domains in multiple sclerosis (MS) patients. Approval of the institutional review boards was obtained, together with written informed consent from all participants. Standardized neuropsychological assessment and conventional, diffusion tensor and volumetric brain MRI sequences were collected from 61 relapsing‐remitting MS patients and 61 healthy controls (HC) from seven centers. Patients with ≥2 abnormal tests were considered cognitively impaired (CI). The distribution of focal lesions, GM and WM atrophy, and microstructural WM damage were assessed using voxel‐wise approaches. A random forest analysis identified the best imaging predictors of global cognitive impairment and deficits of specific cognitive domains. Twenty‐three (38%) MS patients were CI. Compared with cognitively preserved (CP), CI MS patients had GM atrophy of the left thalamus, right hippocampus and parietal regions. They also showed atrophy of several WM tracts, mainly located in posterior brain regions and widespread WM diffusivity abnormalities. WM diffusivity abnormalities in cognitive‐relevant WM tracts followed by atrophy of cognitive‐relevant GM regions explained global cognitive impairment. Variable patterns of NAWM and GM damage were associated with deficits in selected cognitive domains. Structural, multiparametric, voxel‐wise MRI approaches are feasible in a multicenter setting. The combination of different imaging modalities is needed to assess and monitor cognitive impairment in MS. Hum Brain Mapp 37:1627‐1644, 2016. © 2016 Wiley Periodicals, Inc.