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Lost in Classification: Lower Cognitive Functioning in Apparently Cognitive Normal Newly Diagnosed RRMS Patients.
Marco Pitteri1, Stefano Ziccardi1, Caterina Dapor1
1Neurology section, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37134 Verona, Italy.
Brain Sciences
|November 27, 2019
Summary
Newly diagnosed multiple sclerosis (MS) patients, even those considered cognitively normal, show reduced cognitive functioning, particularly in memory and executive functions, compared to healthy individuals.
Area of Science:
- Neuroscience
- Clinical Neurology
- Cognitive Psychology
Background:
- Current classification of cognitive functioning in multiple sclerosis (MS) relies on a dichotomous impaired vs. unimpaired model.
- This traditional approach may not accurately reflect the nuanced reality of cognitive efficiency in MS patients.
- Early detection of cognitive deficits is crucial for timely intervention in MS.
Purpose of the Study:
- To investigate cognitive functioning in newly diagnosed relapsing-remitting MS (RRMS) patients classified as cognitively normal (CN).
- To determine if RRMS patients, despite being classified as CN, exhibit reduced cognitive performance compared to healthy controls (HCs).
- To explore the application of cognitive functioning as a continuous variable rather than a dichotomous classification.
Main Methods:
- A cohort of 50 newly diagnosed RRMS patients and 36 neurologically healthy controls (HCs) were recruited.
- An extensive battery of neuropsychological tests was administered to all participants.
- A Z-score index was calculated by combining data from both RRMS and HCs to measure cognitive functioning as a continuous variable.
Main Results:
- Out of 50 RRMS patients, 36 were classified as cognitively normal (CN) based on traditional criteria.
- Despite being classified as CN, RRMS patients demonstrated significantly worse global cognitive functioning compared to HCs (p = 0.004).
- Specific deficits were observed in the domains of memory (p = 0.005) and executive functioning (p = 0.006) in RRMS patients compared to HCs.
Conclusions:
- Reduced cognitive functioning can be present early in the course of MS, even in patients without clinically evident cognitive impairment (CI).
- The continuous variable approach reveals subtle cognitive deficits not captured by dichotomous classifications.
- Current criteria for classifying cognitive impairment in MS should be re-evaluated and used with caution, considering the potential for early, subclinical deficits.
